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O O O O O O GO O
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SURGEON GENERAL'S OFFICE


     LIBRARY.
Section;,

J\ro.
liklfiDf 
 
 
MEDICAL GUIDE,   £*~^~
                  FOR THE USE OF

   FAMILIES AND YOUNG PRACTITIONERS IN
           MEDICINE AND SURGERY.

             BEING A COMPLETE SYSTEM OF


  MODERN DOMESTIC MEDICINE;


         EXHIBITING A COMPREHENSIVE VIEW


OF THE LATEST AND MOST IMPORTANT DISCOVERIES
           IN MEDICINE, PHARMACY, &c
FIRST AMERICAN, FROM THE FOURTH LONDON EDITIOM,
      CONSIDERABLY ENLARGED AND IMPROVED.
           By RICHARD RJJECE, M. D.
Member of the Royal College of Surgeons; author of the Medical and
Chirurgical Pharmacopoeia; a Treatise on the Lichen Islandicus, &c.
Omnes homines artem medicam nosse oportet.......Sapientise cognitio-
 nem medicinx sororem ac contubernalem esse puto.  Hippocrates.
                PHILADELPHIA:

PUBLISHED BY B.B. HOPKINS, & CO. NO. 170, MARKET-STREET
           FRY AND KAMMERER, PRINTERS.
i     hlWm-KKH    I
i;'j.„eOt;c-ti!i::oA,,'«.c.;:fiCEi
''     FEB.-12.-1007 
?
V
 
                 PREFACE.


  THE views of the'Author, in the first publication
  of this work, were to render the Family Medicine
  Chest more extensively useful, by establishingaplain
  and rational system of Domestic Medicine, free from
 the fripperies of science and the jargon of profes-
 sional technicalities; and to recommend to the pub-
 lic the  Chemical and Medical Hall, the  establish-
 ment  of which he had undertaken for the express
 purpose of furnishing Medicine Chests,  and sup-
 plying the  public with drugs of the  choicest qua-
 lity.  The  necessity and utility  of such a measure
 have  been satisfactorily demonstrated, by the en-
 couragement it has experienced from some of the
 most  distinguished families, eminent physicians
 and chemical  characters in  the united  kingdom;
 and he flatters himself that its increasing patronage
 may be deemed a proof of his having conscien-
 tiously  adhered to the professions contained in the
 preface  of the first edition of this work. This mark
 of public esteem is highly gratifying to his feelings,
 and merits his warmest acknowledgments.  A grate-
ful recollection of the celebrity  which this institu- 
iv
 tion has acquired, stimulates him to use every ef-
 fort to uphold its character, and render it deserving
 of  that public confidence which it  now so  fully
 possesses.

   The very favourable reception of the two first
 editions of  this work, induced the author to make
 many additions to the third, the demand for which,
 has been much  greater than is  usual for publica-
 tions of this description.  It obtained the sanction
 of  medical  men, esteemed for liberality and erudi-
 tion, who directed copies to  be sent to their friends
 abroad: it  has been  translated  into different lan-
 guages on the continent, and reprinted in America;
 circumstances  which, in his opinion,  entitled this
fourth edition to every possible improvement, which
 he  flatters himself it has received, and  with this
 presumption it is now offered to the public. These
 improvements  principally consist, in the addition of
 the latest discoveries in medicine,  and  much im-
 portant information relative to the prevention,  cure,
 palliation, and  distinction of diseases, interspersed
 with such cautions and remarks as may prevent the
 misapplication of the means suggested,  and which
 are not to be found in any other work of this na-
 ture. The whole being the result of long experience
 and elaborate study, he flatters himself the contents
 will prove, both in Domestic Medicine, and to young-
 practitioners, of the highest  utility. 
v
   He has endeavoured  likewise  to counteract the
pernicious practices of unprincipled empirics, by ex-
posing the absurdity of professions whicjjh are perpe-
tually insulting the public understanding. The num-
bers and effrontery of these pretenders not only en-
tail a lasting disgrace on a country, celebrated for its
great improvements in  all parts of  science, both
human and divine,  but threaten  destruction to the
welfare and happiness of thousands.  Under such
alarming circumstances, he has considered it a duty
incumbent on him as a member of the community,
and of the medical profession in particular,  to  de-
tect the machinations and resist the inroads  of this
host of mercenary marauders; but, unfortunately,
the situation  of medical men is such, that,  in this
respect,  their best intentions and disinterested ex-
ertions are illiberally imputed,  by those benefited
by the sale of nostrums, to some base and sordid
motive. The  little opposition which these impostors
have  consequently met with from the regular and
legitimate profession,  has been  regarded by  the
public as a sort of negative connivance. He trusts,
therefore, that  a  just exposure of this detestable
traffic, will have its due influence  in inducing those
who have, thoughtlessly, but very  imprudently, lent
their names in its support, not only  to withdraw
such sanction, but to let their light so shine, as to be
watch-towers and not rocks, admonishing others to
shun as a pestilential contagion, those  specious and
daring impositions. 
vi
   From motives of philanthropy, the author will
endeavour to improve every subsequent edition of
this work, and render it more worthy of public favour
and approbation.  His principal object being to en-
able the benevolent to administer comfort and relief
to such objects as poverty and  disease, the two
greatest natural evils of life,  recommend to their
compassion, he assures his readers he will with plea-
sure give  every information in his power  to  assist
such persons in the discharge " of that work and
labour of  love," which is one of the most gratify-
ing and important duties of Christianity.
i 
                   CONTENTS.

                        PART I.

        FAMILY  DISPENSATORY.

 Dedication to the Right Rev. Lord Bishop aga
   ofLandaff    -               -    -    -  '  xv
 Of the advantages of the Family Medicine Chest   1 to  2
 A list of Medicines essentially necessary to fur-
   nish ditto     -    -    .    .    .     -   -   3 to  4
 Of the properties, doses, &c. &c  of ditto      -    5 to  6
 Explanation of weights and measures, and a table
   of the doses of medicines adapted to different
   ages, &c.    -   -     .    .    .    .    -   4 to  5
•A collection of the most usefuLFamily Prescrip-
tions
           Appendix to the Family Disfiensatory.
 Of the properties of prepared charcoal, and me-
  thod of using it for the purpose of cleaning the
  teeth.......
 Of the  properties, Sec and method of preparing
  the Indian arrow root     -
 Of the properties of lime water, with directions
  for making it
 Of the properties, 8cc. of barley water, with direc-
  tions for making it      ...
 Of the means of  fumigating infected chambers,
  &c. and preventing the progress of contagious
  fevers    *-
 Of the means of  counteracting the effects of the
  different poisons on the human body, viz.
Mineral poisons    -
Vegetable ditto      ....
 62 to  8!





 82 to  84


 14 to  86

       87

       87



88 to  97
97 to  99
99 to 100 
                          Vlll
                                            Page
Animal Poison.....       100 to 103
Ofsuspended animation and the means of recovery 103 to 108
Of the treatment of a fit of intoxication    -     108 to 110
Of phlebotomy or blood-letting    -    -    -   111 to 115
Of the treatment of substances lodged in the gul-
  let or taken into the stomach    -     -    -  115 to 117
Ditto  of substances and insects lodged in the ear 117 to 118
                                                    118
                                             120 to 122
                                             122 to 128
                                           -  128 to 130
                                              130 to 133
                                                    133
                                             133 to 136
                                           -  136 to 137
                                             137 to 139
                                             139 to 140
                                                    141
                                           -  141 to 142
                                              142 to 143
                                           - 143 to 145
                                             145 to 146
Of the ordinary management of children
Of the clothing of children    -
Of the feeding of ditto     -
Of the exercise of ditto
Instructions for the choice of a wet nurse
Of the diseases of children     -
Of inward fits    ------
Of convulsions......
Of difficult dentition      -
Of worms     -    -    -    -
Of swelling of the breasts of infants
Of inflamed or sore eyes      -
Of galling     -    -    -    -
Of the red gum    ------
Of the thrush......
Of the lichen islandicus, or Iceland moss, its effi-
   cacy in pulmonary consumption, and method of
   using     -------
A table of diet for invalids, viz.
Low or fever diet    -
Restorative or convalescent ditto    -
Generous or full ditto     -
Description and enumeration of different medi-
   cine chests    ..__--
      146

      152
      ibid
      ibid

153 to 15*
                      PART II.
Dedication to Her Grace the Dutchess of Leeds
Of Ague      -         .....
157
159 
                                           Page
 Of Apoplexy    -.....159 to 166
 Of Asthma     -   -----     167 to 177
 Of Bilious Affections    -    -    -    -       174 to 177
 Of Bleeding at the Nose   -    -    -    -    177 to 179
 Of Blood discharged from the urinary passages   179 to 180
 Of Biles.......180 to 181
 Of Bruises and Sprains.....181
 Of Burns and Scalds       .....182
 Of Cancer......       182 to 192
 Of Cataract......192 to 194
 Of Catarrh, Coryza, and Influenza    -    -     190 to 196
 Of Chin Cough,.....-      196
 Of Chicken-Pox    -    -    -    -    -      196 to 197
 Of Chilblains.......197
 OfCholic......       198 to 199
 Of Consumption of the Lungs    -    -    -    199 to 242
 Of Convulsive Fits......242
 Of Corns.....-      242 to 243
 Of Costiveness   ------   243 to 244
 Of Coughs     -.....244 to 247
 Of Cow Pox......247 to 256
 Of Cramp in the Stomach     -    -     -      256 to 258
 Of Croup        ......258 to 261
 Of Cuts........261'
 Of Deafness......262 to 263
 Of Diabetes     ------    263 to 268
 Of Diarrhoea, or Looseness     -               268 to 269
 Of Dropsy       ------   270 to 275
 Of Dysentery  ------     275 to 278
 Of Epilepsy      -    -     -'        -    -   279 to 285
 Of Eruptions of the Skin                 -   285 to 288
Of Excoriations.....288 to 289
Of Fainting or Syncope     -    -    -     -    289 to 290
 Of Films or Specks on the Eyes       -    -    -     291
Of Flatulency   -    -     -    -    -    -    291 to 297
Of Gout  -         -                        297 to 315
                          R 
                         X
                                           Page
Of Gutta Serena.....315 to 317
Of Head-ach......317 to 322
Of Heartburn......322 to 325
Of Hiccup......325 to 326
Of Hooping or Chin Cough      ...    326 to 330
Of Hypochondriasis,Vapours, or Lowness of Spirits 330 to 336
Of the Hysteric Passion    -                  336 to 341
Of Incontinence of Urine    -   -    -         -    341
Of Indigestion......342 to 352
Of Inflammatory Fever    -                   352 to 355
Of Inflammation of the Brain      ...  355 to 359
                   Eyes      -    -    -    359 to 362
                   Intestines    -    -    -  362 to 365
                   Throat     -    -    -    365 to 397
                   Lungs    ...     367 to 369
Of Influenza     --__...    369
Of Intermittent Fever or Ague     -    -      369 to 372
Of the Itch......372 to 373
Of Jaundice......373 to 377
Of King's Evil or Scrophula   -    -    -    -  377 to 383
Of Leprosy.......384
Of Locked Jaw.....-         384
Of Looseness......•*-     384
Of Lowness of Spirit......384
Of Lumbago    ----.._     334
Of Measles......385 to 388
Of Melancholy  ----,.    388 to 392
Of the Menses    -     -    -   -         -   392 to 393
             Retention of     -    -    -    393 to 396
             Suppression of-    -   -     396 to 399
             Excess of, or Flooding      -    399 to 402
             Cessation of                    402 to 403
Of Mumps......403 to 404
Of Nervous Diseases    -                    404 to 412
Of the Nettle-Rash......412
Of the Night-Mare    -   -    -     -    .   412 to 413 
xi
Of Palpitation of the Heart	Page 413 to 415
OfPalsey......	415 to 418
Of Piles.......	418 to 420
Of Pleurisy......	420 to 421
Of Putrid Sore Throat -	421 to 425
Of Rheumatism .....	- . 425
Acute -	425 to 427
Chronic -	427 to 432
Of Rickets......	432 to 438
Of Rupture ---...	438 to 440
Of Saint Anthony's Fire -	440 to 443
Of Saint Vitus's Dance -	443 to 446
Of Scald Head - - - -	446 to 448
Of Scarlet Fever -	448 to 449
Of Scurvy ------	449 to 454
	
Of Small-Pox......	454 to 456
Of Spitting of Blood.....	456 to 460
Of Strangury ------	460 to 461
	
Of Tenesmus --_.__	461 to 462
Of Tetany or Dock Jaw -	462 to 466
OfTooth-ach......	466 to 474
Of Typhus or Putrid Fever	474 to 479
Of Vomiting -----.	479 to 481
of Blood - - . .	481 to 482
Of Water-Brash.....	482 to 483
Of Warts......	483 to 484
Of Watery Head -	484
	484 to 486
Of Whites - - - -	486 to 489
Of White Swelling.....	489 to 491
OfWhitloe......	491 to 493
Of Worms -.....	493 to 501
Index to the First and Second Parts	503
 
 
            THE





  FAMILY DISPENSATORY;




            OR,




    COMPLETE COMPANION




           TO THE





 FAMILY MEDICINE CHEST,




          &?c. &?c. fcfc.




            BEING




       THE FIRST PART




           OF THE





DOMESTIC MEDICAL GUIDE. 
 
TO THE RIGHT REVEREND
       RICHARD WATSON, D. D.

         LORD BISHOP OF LANDAFF.

      MY LORD,
   The former editions of the Family Dispensa-
tory having been honoured with your lordship's
notice  and recommendation, I feel confident in of-
fering to the public the present improved edition,
under  the  powerful sanction  of your lordship's
name.  The numerous additions  it has received,
will, I hope, render it more worthy of your accept-
ance, and useful to  the public; as I flatter myself,
in its present form, it will direct the benevolent to
the best known means of preventing, curing, or al-
leviating the diseases of their indigent neighbours.
   I feel peculiar pleasure  in  observing, that the
Chemical and Medical Hall,  which is under my su-
perintendency, is patronized by some of the most
distinguished families and members of the medical
profession in the united kingdom, in a manner ex-
tremely flattering to me.  I therefore beg leave to
declare, that by so  signal a mark of public esteem,
I consider myself obligated  carefully to examine all
preparations and drugs preparatory to their being 
XVI
subjected to use or sale; and I pledge myself, that
for genuineness and purity they shall not be excel-
led by any chemical institution in Great Britain.  1
am sensible, to this circumstance I am indebted for
the honour  of your lordship's patronage, which I
appreciate the more highly, as it comes voluntarily
from a character so eminently distinguished for libe-
rality, science, learning, and piety.
   I have the honour to be, my lord, your lordship's
much obliged and most obedient servant,
                       RICHARD REECE.

Henrietta-street, Covent-Garden,
      December 10, 1806. 
PART I.
THE
         FAMILY DISPENSATORY.


 r OR the basis of a Family  Dispensatory, the author has
 selected those Medicines which he judges most essentially-
 necessary in a  Medicine  Chest,  and with  which, from
 their great  utility, one person at least in every village*

   * Doctor Disney Alexander, in his late popular dissertation
 on the means of preserving health, judiciously  observes, " If
 clergymen who live in the country, and gentlemen who reside
 upon their own estates, would devote a small portion of their
 time to the  study of medicine, it is incalculable how much
 good they might render  to the  poor families in their several
 neighbourhoods in this respect. The timely exhibition of a few
 doses of physic in the beginning of a  disease, with a few plain
 directions concerning  cleanliness, regimen, &c. would be no
 degradation to their character, and might frequently prevent
the spread of those infectious fevers to which the  lower classes
of people, even in country villages, are sometimes subject, and
 which, not unfrequently from neglect  and inattention, prove
 fatal to the youngest, most robust, and most useful part of the
 community." The tribute of applause  is never more justly 
2
 ought to be provided.  The advantages of such a provi-
 sion are too numerous to be detailed, and too obvious to
 be  denied.  It affords  an immediate resource  in  those
 sudden attacks of disease, and contingencies of misfortune,
 in which it is absolutely  necessary relief should be speedy
 to  be  effectual.  In  cases  of  fits, suffocation,  poisons,
 burns, scalds, &c. who will not readily acknowledge the
 good which it may do, and the evil it may prevent?
  It  enables  the  benevolent,  at  a trifling  expense, not
 only to alleviate the sufferings, but often to save the  lives
 of  their fellow-creatures. To  a heart glowing  with the
 true spirit of  Christian charity what can possibly be more
 gratifying than to  restore the  bloom of health to the wan
 and faded cheek of  poverty  and  disease? And what is
 perhaps equally important, it furnishes medicines very su-
 perior in  quality  to  those generally sold in the  country,
 and on whose purity the greatest reliance may be placed.
  A variety of plans for the family Medicine Chest has
 been  recommended  by  different  popular writers.  The
 chest termed  the Portable Family Dispensary * is  made
by the particular directions of the author, on a construc-
tion that the bottles, pots, and drawers are arranged to cor-
respond with  the numerical references of this work, and
in sizes proportioned  to  the utility and potency of the ar-
ticles they are intended to contain, viz.

due, nor more honourably  conferred, than when it is  bestowed
 on those who exert their  influence and employ their talents
 in lessening the sum of human misery; who sit by the side of
affliction, promoting the recovery of health, and mitigating the
 anguish of disease.
  * A description of this  Chest, with others, is given in the
Appendix. 
3
Five Bottles in- the Back Part fior
xo.
 1. Magnesia
 2. Rochelle Salt, or
   Epsom Salt, or
   The tasteless Purging Salt
NO.
 3. Castor Oil
 4. Tincture of Rhubarb
 5. Opodeldoc
Five Bottles in the Front Part for

             of
6. Compound  Tincture
     Bark, or
7. Tincture  of Ginger and
     Chamomile
8. Compound  Tincture  of
     Senna
 9. Compound  Spirit of La-
      vender
10. Mindererus's Spirit
11. Paregoric Elixir
Nine Boxes in the Right Wing for
12. Spirit of Hartshorn
13. Spirit of Sal Volatile
14. Vitriolic Ether
15. Sweet Spirit of Nitre
16. Antimonial Wine
17. Tincture of Myrrh
18. Diluted Vitriolic Acid
19. Tincture of Assafoetida
20. Volatile Tincture of Guai-
      acum
Nine Bottles in the Lefit Wing fior
21
22
24,
Salt of Wormwood
Crystallised Acid of Le-
   mon, or
 Concrete Acid of Tartar
Ipecacuan Powder
Essential Salt of Bark, or
25. Salt of Steel
26. Rhubarb Powder
27. Jalap Powder
28. Refined Camphor
29. Compound  Cretaceous
      Powder
30. Extract of Lead
Nine small Bottles in a Drawer fior
31. Liquid Laudanum
32. Essence of Peppermint
33. Essence of Cinnamon
34. Prepared Calomel
35. Emetic Tartar
36. Basilic Powder
37. Antimonial Powder, com-
      monly called
    James's Fever Powders
38. Acetic Acid
39. Smelling Salts
» 
4
Six Pots in the Back Part for
40. Blistering Plaster
41. Spermaceti Ointment
42. Brown Cerate
43. Yellow Basilicon
44. Savin Ointment
45. Squill Pill
46. Cathartic Extract
47. Lenitive Electuary
Six Drawers in the Front, with Partitions, fior
48. Peruvian Bark Powder
49. Jamaica Ginger Powder
50. Senna Leaves
51. Flaky Manna
52. Gum Arabic Powder
53. Purified Nitre ditto
54. Cream of Tartar
55. Flowers of Sulphur
56. Court Plaster
57. Lint
58. Diachylon
59. Ditto with Gum
60. Prepared Natron
  Pestle and  Mortar, Graduated Measure, Scales and
Weights, Spatula, Bolus  Knife,  Scissars,  Silver Spoon,
Tyle, Funnel, &c. &c.
    Explanation of Weights and Measures.

       20 Grains,      make       1 Scruple
        3 Scruples,.....1 Drachm
        8 Drachms,.....1 Ounce
       12 Ounces,.....1 Pound.

  The small round  impressions on the thin weights stand
for so many grains.

  By a tea-spoonful, is meant one drachm—a table-spoon-
ful, half an ounce—a wine-glassful, two ounces—and a
tea-cupful, three ounces, or a quarter of a pint.—A drop
is generally considered to weigh a grain, so  that  sixty
drops are reckoned equal to a drachm, or a tea-spoonful;
but in all cases the  smallest doses should be measured, as
drops  greatly differ both in size and  weight.—Spoons
likewise varylpo much in size to be used as  measures by
the exhibitor of medicine. 
5
  The graduated measure is marked from half a drachm to
an ounce, and the drop measure from one to thirty drops.

  The doses specified throughout this work are for adults,
which must be increased or diminished according to the
strength  and habit of the patient, and the age, according
to the following rule:

       Two thirds of the dose, from the age of 14 to  16.
       One-half from 7 to 10.
       One-third from 4 to  6.
       One-fourth to one of 3 years.
       One-eighth to one of 2 years.
       One-tenth to one  of a year.

  It is customary to repeat the dose of an aperient medi-
cine about everjr three hours till it operates, or to have
recourse  to a  lavement, which in cases of obstinate cos-
tiveness is often preferable.
                 No. 1. MAGNESIA,
   Taken from  15 grains to half a drachm, in a little pep-
permint water, is a very efficacious remedy in correcting
acidity in the stomach, with which it readily unites, and
forms a pleasant aperient medicine, and, by neutralizing
the acid, speedily relieves the painful sensation termed the
heartburn.
   The purgative effects of magnesia entirely depending
on its meeting with an acidity, it frequently happens that
a small dose  will operate more on the bowels than a large
one, through  there not being a sufficient quantity .of acid
present  to  dissolve it; and if there be  no acidity in the 
(3
stomach or intestines, it will not  produce any  sensible
effect.
  When acidity is the consequence of debility of the di-
gestive organs, which in adults is generally the case, the
effects  of magnesia will  be but  temporary, unless com-
bined with an aromatic bitter, as the tincture of ginger
and chamomile, No. 7, which will prevent its recurrence
by removing the cause.  When  the  complaint is  obsti-
nate,  or has been  long  standing,  the prepared  natron
will prove more effectual, and, being perfectly soluble in
water,  is  less disagreeable to the palate. (See Prepared
Natron, No. 60, and Indigestion.)
  For correcting acidity in the stomachs of children, par-
ticularly when attended with costiveness, magnesia,  either
alone or combined with rhubarb powder, is a very  excel-
lent remedy, but when attended with looseness,  or what
nurses term gripingstools,the cretaceous powder, No.29,
will prove equally efficacious in absorbing the acidity, and
at the same time will restrain the violence of the purging;
or, if the evacuations  be not immoderate, they  may  be
advantageously  combined.  (See Cretaceous   Powder,
No. 29, and Absorbent Mixture, No. 73.)
  The calcined magnesia has been  preferred  by some
practitioners  on account of no  fixed air  being  disen-
gaged in the stomach and intestines, on its union with  an
acid, which from the  common magnesia is extricated in
considerable quantity. Fixed air is however so very  grate-
ful to the stomach as often to remove nausea, and  so far
from increasing flatulency in the bowels, will  often cor-
rect and relieve it, the two airs being very different in
their nature. (See Flatulency.)
  Magnesia is  frequently adulterated  with  chalk: this
fraud may be detected  by putting  a  dessert spoonful of
the suspected magnesia into  an ounce of the diluted vi- 
7
 triolic acid, No. 18. If the magnesia be entirely dissolved,
 and the solution remain  clear, it may be pronounced pure,
 but not otherwise. If the experiment be made with the
 common magnesia, there will be a  considerable  effer-
 vescence; but, with the calcined, there should be none.


   No.  2. ROCHELLE SALT, EPSOM  SALT, and
          TASTELESS  PURGING SALT.

   The Rochelle salt has been  long esteemed by the first
 physicians  on the Continent, as less disagreeable  and
 equally  efficacious as the common  purging  salts,  and
 through the commendation  of the  late Dr.  Cullen has
 been much employed in this  country. It may be taken
 to  the  extent of an ounce, or 12 drachms,  dissolved in
 whey  or liquorice root tea, both  of which cover that
 brackish  taste from which none of the aperient salts are
 entirely free.
   The  Epsom  salt, although  more  disagreeable  to the
 palate than the  Rochelle, has  great advantage in being a
 more mild and gentle purgative; operating with sufficient
 efficacy and in general with  such ease and safety  (rarely
 occasioning any gripes, sickness, or other inconveniences),
 that have induced many practitioners to suppose  that it
 possesses the property of allaying colicky pains, even in-
 dependently of evacuations—Six drachms of this salt are
 equal in  strength to  eight of the Rochelle.  It may be
 taken, dissolved either in whey or common water—with
 the former, in the proportion of six drachms  to a quarter
 of a pint; it is by no means an unpleasant potion.
  The  phosphate  of soda,  commonly called  tasteless
purging salts, was first recommended by Doctor George
Pearson, as less  nauseous than  any of the aperient  salts. 
Its taste  is so similar to the common salt, that patients
have taken it in broth and gruel without discovering the
difference. As a purgative, it has no advantage over the
Rochelle salt, and less efficacious than the Epsom salt.—
It is taken in the same dose as the Rochelle.
  The aperient neutral salts, in the doses of one and two
drachms once or twice a day, are very excellent alterative
medicines, and dissolved in water, in the proportion of an
ounce or six drachms to a quart, form a purgative water
not inferior in medicinal properties to the native springs.
An ounce of  the Epsom salt, dissolved in a quart of dis-
tilled or pure water, is by  no means inferior, and in many
respects very superior  to  the  Cheltenham Spa; and for
those cutaneous  eruptions and leprous  affections  of the
skin, commonly termed land-scurvy,  piles, habitual cos-
tiveness,  indigestion, flatulency, and many constitutional
and local  affections,  it  will often  prove beneficial,  after
other apparently more active remedies had failed. By the
addition of two or three  grains of salt of steel to the above
solution, a chalybeate aperient water is formed,  perhaps not
less efficacious than  the Bath, or  any chalybeate spa in
these  kingdoms;  and has this very important advantage,
 that the quantity of steel and aperient salt maybe adapted
 to the nature of the  disease or constitution of the patient.
 This  artificial chalybeate water has proved  highly  ser-
 viceable  in  cases of green-sickness,  the whites, palsy,
 worms, indigestion,  flatulency, &c.;  and for those sto-
 mach complaints, affecting  the lower class of people,  it
 affords  a very cheap and efficacious remedy:  should  it
 prove too cold for the stomach, it may be taken warm, or
 with a little  ginger powder or  aromatic tincture.
    By substituting half a drachm of liver of sulphur for the
  salt of steel, a potent sulphurous  aperient water is made,
  not inferior to the Harrowgate Spa, and taken  to the extent, 
9
 wf a quarter of a pint once or  twice  a day,  has proved
 very beneficial in chronic rheumatism, cutaneous affec-
 tions and piles.
   By means of the aperient salts, the different saline, cha-
 lybeate, and sulphurous waters  may  be prepared artifi-
 cially to any degree  of strength,  and  possessing every
 virtue  of  the natural springs; and  being easily obtained
 without resorting to the  watering places, are more suited
 to those whose avocations or means do not permit them
 to go to the springs; circumstances which it is  hoped
 will bring into more general use this most beneficial spe-
 cies of remedies.
   In the former editions of this work the virtues of the
 Cheltenham salt were noticed, which is omitted, from a con-
 viction that it possesses no advantage over the Rochelle or
 Epsom salt, and that  it is rarely to be obtained genuine,
 the Glauber's salts in small crystals being generally sold
 for them, a practice  not unusual even  at  Cheltenham;
 indeed the quantity of Glauber's salt sent to Cheltenham
 is sufficient to excite a suspicion that all the mineral wa-
 ter drank there in a season is not the  natural  production
 of the Spa.

                No. 3. CASTOR OIL,

   To the extent of an ounce, or twelve drachms, affords
 a valuable purgative medicine in cases of spasmodic colic,
 habitual  costiveness, or  piles.  It may  be taken conve-
 niently  in a little peppermint-water, swallowed off as  it
 floats  on the top; to which a table-spoonful of  compound
tincture of senna will prove an useful addition, in  render-
 ing it less nauseous to the taste  and stomach, and at the
same  time  promote its purgative quality  If this mode
                          D 
10
be objected to by the patient, an emulsion may be made
with it by rubbing the castor oil with about the fourth
part of the yolk of an egg, in a mortar, and after they are
well blended, to add gradually a little peppermint-water,
and lastly some sugar.  Castor oil has of late years  been
expressed in  considerable quantity in England—greater
care being taken to free the  seeds from the decayed ones,
and from their rind, both of which are very acrid,  and
little heat being employed in the process, it is certainly
less nauseous than that prepared in the West or East In-
dies.  It is however  at  best an unpleasant medicine, and
as  a mild purgative has been much over-rated-


        No. 4. TINCTURE OF RHUBARB,

   From half an ounce to an  ounce, in the same quantity
of  water, affords an excellent warm  purgative draught,
for colicky  and  flatulent  affections  of the  bowels. In
weakness and laxity of the  stomach and intestines, and  a
sluggish state of the liver and other viscera, occasioning
bad digestion and  flatulency; it may be advantageously
taken  in conjunction  with  essential salt  of bark, as
directed  for  the   stomachic   mixture,   No.   61. It
attended with acidity in  the stomach, magnesia, No. 1,
or  prepared  natron,  No. 60, should accompany its use.
On account of the  stimulating  nature of the spirit and
cardamon  seeds,  with which this  tincture is made, it
should  not be indiscriminaiely  exhibited  in  all  cases of
pains in the bowels, in doses large enough to operate as  a
purgative, but more  employed as a warm  stomachic me-
dicine, or  in conjunction with the powder of rhubarb to
correct griping. 
11
                No. 5.  OPODELDOC

    Is a very useful external application for sprains, bruises,
 chilblains,  and for  dispersing  inflammatory  tumours;
 but, in cases of indolent tumours, deep-seated or rheuma-
 tic pains,  paralytic  numbnesses, enlargement  of joints,
 a liniment  composed of four parts of opodeldoc and one
 of spirit of hartshorn, will prove  more useful than opodel-
 doc alone. (See Volatile Liniment.)
   The liquid  opodeldoc  is  superior to the coagulated
 kind,  sold under  the name of Steers' opodeldoc, on ac-
 count of being more  penetrating, and of course requiring
 less  friction in its   application,  which  in inflammatory
 cases is of great importance.


 No. 6. HUXHAM's, or COMPOUND TINCTURE
                      OF BARK

   May be taken to the extent of a table-spoonful, diluted
 with double the quantity of pure water, three times a day,
 in cases of languor of the stomach, and debility  of the
 system; twelve drops of the diluted vitriolic acid, No. 18,
will considerably promote its efficacy, particularly if at-
tended with  profuse  perspirations. (See Tonic  Mixture,
No. 77.)
  The essential salt of bark, dissolved in Sherry or Port
wine,  as directed, No. 24, forms  a tincture that  possesses
the virtues of the bark in a much purer and higher degree
of perfection, than either the compound or simple tinc-
ture, and has at the same time the very important advan- 
                          12
                            tf ■
tage in being exempt from the pernicious effects  of  the
ardent spirit * with which they are made.


      No. 7. TINCTURE OF GINGER AND
                   CHAMOMILE.

   This tincture is strongly  impregnated with the aroma-
tic virtues of the Jamaica  ginger root, and the essential
oil and bitter properties of  the  chamomile flower, which
combined certainly afford a most valuable stomachic me-
dicine; and in cases of indigestion, flatulency, laxity of
the bowels,  dropsy, and complaints arising from debility
of  the  digestive organs, it will prove more  efficacious
than the Peruvian  bark, or  any other  strengthening me-
dicine.
   From thirty  to forty drops may  be  taken two or three
times a day, in half a wine glass of water.
   In gouty  habits  and  obstinate  cases  of indigestion,
arising from the  too free use of spirituous liquors, or old
age, the dose  may be increased to  a tea-spoonful  and
upwards.
   In affections of the stomach  an emetic  should precede
its use, and if attended with costiveness it  should be taken
in the artificial  aperient  mineral  water, recommended
under the head  of Epsom salt, No. 2; but  for nervous
irritability and hypochondriacal affections, rosemary, sage,
or valerian tea will afford the best vehicle.
  * Many persons, no doubt, have to date their first propen-
sity to dram-drinking to the too frequent use of spirituous tinc-
tures, rashly prescribed for hysterical complaints,  lowness of
spirits, flatulency, &c. 
13
  No. 8. COMPOUND TINCTURE OF SENNA.

   A  small wine-glassful  may be taken alone, or diluted
with  water, for  colicky  and flatulent complaints of the
bowels,  which it will  often succeed in relieving,  after
tincture  of rhubarb and other warm purgatives and cor-
dials have failed.
   An inferior tincture of senna, sweetened and coloured
with treacle, is sold under the name of Daffy's Elixir.

  No. 9. COMPOUND SPIRIT OF LAVENDER

   Was first  introduced  into the  practice of medicine
under the name of Palsy Drops.  It may be conveniently
taken upon sugar,  or in a glass  of wine,  from  forty to
eighty drops, in  cases of langour, weaknes of the nerves,
decay of age, lowness  of spirits, and fainting fits.  (See
Nervous Mixture, No. 72.)
   It is  chiefly employed  by  apothecaries to cover the ill
flavour of nauseous drugs, as well as to colour their me-
dicines.

        No. 10.  MINDERERUS'S SPIRIT

  Is an excellent sudorific and gentle aperient saline me-
dicine, and taken to the extent of half an ounce, two or
three times a day, in a  glass  of mint tea, produces a sa-
lutary determination to  the skin, allays fever,  and abates
thirst; it is  more safe  but less certain in exciting perspi-
ration than the antimonial preparations or Dover's sweat-
ing powder, which, however, on failing to operate in this
respect, generally aggravate the  febrile  symptoms, while
Mindererus's spirit cool the body, even when it does not
succeed in its usual sudorific effects. 
14
   In acute rheumatism, twenty drops of antimoninal wine,
No. 16, and ten of laudanum, No.  31,  as  recommended
by Dr. Blane, may be added to the night dose with advan-
tage; or if laudanum be objectionable,  three tablespoon-
fuls  of camphorated jalap may be employed in lieu of it
and the mint tea. (See Sudorific Mixture, No. 63.)
   It is not a spirituous liquor, as the title infers.

          No. 11. PAREGORIC ELIXIR.

   A tea-spoonful taken in a glass of water, three times a
day, powerfully allays the tickling sensation in  the wind-
pipe, which  provokes frequent  coughing.  In spasmodic
asthma, and chronic difficulty of  breathing, taken, (as
frequently prescribed by the late  Doctor Hugh Smith,)
with the oxymel  of squills,  (See Asthmatic   Mixture,
No.  68,) it gives very considerable relief, by facilitating
the expectoration of viscid phlegm, and allaying spasms of
the lungs.
   It should,  however, be very cautiously administered in
recent  coughs, particularly if attended  with fever, pains
in the  chest, and shortness of breath, symptoms indicat-
ing  an inflammatory  disposition, which the stimulating
ingredients of the elixir, and constipating effects of the
opium  cannot fail to aggravate.
   Half an ounce of this elixir contains a grain of opium.
   Mr.  James  Parkinson, in his  " Medical Admonitions"
observes, that tC most of the  nostrums advertised as cough
drops, &c. are  preparations  of opium, similar to the  pa-
regoric elixir of the shops,  but disguised and rendered
more deleterious by the addition of aromatic and heating
gums." Those stimulating anodynes in the hands of ig-
norance are certainly often productive of irreparable mis-
rhief in affections of  the lungs; and to their indiscrimi- 
15
 nate use may with great justice be ascribed the frequency
 of pulmonary consumptions in this island.*


        No. 12. SPIRIT  OF HARTSHORN,

   From twenty to thirty drops, taken in a glass of water,
 often affords immediate relief in cases of lowness of spi-
 rits, fainting, and hysteric  fits; it may likewise be rubbed
 on  the temples, and applied to the nostrils. The  same
 quantity of the compound spirit of lavender will render
 it more grateful to the palate, and acceptable to the sto-
 mach, and at the same  time promote its cordial powers.
  Equal parts of spirit of hartshorn and  olive oil form an
 excellent  stimulating  external application  for   paralytic
 numbness,  chronic  rheumatism,  diseased joints,  and
 inflammatory  sore  throat.  (See  Volatile  Liniment,
 No. 103.)
  The spirit of hartshorn  is frequently mixed with the
 water of ammonia, by unprincipled druggists, to increase

  * It is  a  lamentable fact, that the majority of the con-
 sumptive  patients admitted  at the  Phthisical Dispensary in
 ChAncery-lane, were, at the time of their admission, taking
 these kind of medicines, which in many instances had ag-
 gravated the disease of the lungs, so as to destroy all hopes
 of recovery. Were those people who havfc, no doubt thought-
 lessly, but very imprudently, lent the sanction of their names
 to qudck medicines, aware of the infinite mischief such sanc-
 tion produces, they would shudder at the facility with which
 they have beer. ied to afford it.  That persot* must  be pro-
 foundly ignorant indeed to suppose that one medicine can be
equally vood for diseases different in their nature, their sources,
and symptoms; even the same disease, in different stages, often
requires opposite treatment. 
16
its  pungency, and to enable it  to  bear an addition of
water.  This fraud is  detected by adding highly rectified
spirit of wine to the  suspected spirit; if no  considerable
coagulation ensue,  the adulteration  is proved.  True
spirit of  hartshorn  will likewise not  effervesce with an
acid.


           No. 13.  SP. SAL VOLATILE.

  To be taken in the same manner, and for the same pur-
poses as the spirit of hartshorn, than which it is more grate-
ful on account of being impregnated  with the flavour of
the  clove and lemon  peel.—A tea-spoonful of this  aroma-
tic volatile spirit,  with  the  same quantity of compound
spirit of lavender, taken in  a tea-cupful of  horse-radish
and  mustard-seed tea,  is an efficacious stimulating medi-
cine in gouty affections of the stomach, paralytic numbness
of the extremities, and obstinate flatulent complaints.  (See
Stimulating Mixture, No. 74.)
  It will likewise prove a valuable addition to the tincture
of the essential  salt  of bark,  made with  Sherry  or Port
wine  as directed,  No. 24, in debility of the  stomach and
nervous system.  (See Nervous Mixture, No. 72.)
  Sp. Sal Volatile, or  compound spirit  of  ammonia, as
it is now more properly  termed,  should (if  prepared  ac-
cording to the directions of the London College), be of a
bright dark reddish colour, approaching to that of tincture
of myrrh, and not pale, as generally sold:  by these de-
viations from the  formula? of the College,  the  most  se-
rious consequences  frequently  occur in the practice of
medicine.
  The  sp. sal volatile  of the Edinburgh College, being
impregnated with the properties of the rosemary, is a bet- 
17
ter cephalic and nervous medicine than that of the Lon-
don College; the dose is the same.

           No. 14. VITRIOLIC ETHER.

   A tea-spoonful in a glass of peppermint or pure water,
often affords immediate relief in spasmodic colic, cramp
of the  stomach, and asthmatic, hysteric, and fainting fits.
   A dessert spoonful in a wine-glass of camphorated julap,
Dr. Lind, and other practitioners, have found an admirable
remedy  when the  gout attacks  the stomach. It  often
gives ease in the most violent head-ach, by being  applied
externally  to the part, and relieves the tooth-ach, by be-
ing laid on the afflicted tooth and jaw by  means of lint.
In its  external  use it is capable  of producing two very
opposite  effects, according to the mode of  application;
for if its evaporation be  prevented by covering the place
to which it is  applied  with  the  hand, it  will so power-
fully stimulate, as to excite a sensation of heat and  great
redness of the skin.  On the contrary, if  a part  of the
body exposed to the air be bathed with it, its rapid eva-
poration  will produce an intense  degree of cold, and in
this manner it  has  proved more beneficial  in acute pains,
attended with increased  heat of the part.
   Ether should always be taken in a cold vehicle and swal-
lowed as quickly as possible;  and the bottle in which  it
is kept should be well corked, and inverted in water in  a
cold situation, to prevent its  escape.—(See  antispasmodic
mixture, No. 70.)
  The once celebrated anodyne liquor of Hoffman, and
Clutton's febrifuge spirit, are a weak ether.
  Good ether should not redden the  colour of litmus, or
produce a precipitation with  a solution of barytes.
                          E 
18
       No. 15. SWEET SPIRIT OF NITRE

  Allays  fever, quenches  thirst,  promotes  the natural
secretions,  moderately strengthens the  stomach, and is
said to resist putrefaction; hence  it becomes a valuable
medicine in fevers, both inflammatory and putrid. It may
be given from twenty to  thirty drops, in barley  water, or
with the Mindererus's spirit, No. 10. In cases of  strangury
or stoppage of urine, it may be given with advantage in a
decoction of marshmallow root, or linseed tea, to  which
an ounce of castor oil may be added in case of costiveness:
a tea-spoonful of a mixture of equal parts of sweet spirit
of nitre, and sal volatile, taken in a mixture  of  the essen-
tial salt of bark, will  increase the secretion of urine  in
dropsical complaints, and at the same time strengthen the
constitution.
   Sweet spirit of nitre, when properly made, should not
effervesce with an alkali, or give a blue colour to tincture
of guaiacum. By age  and exposure to  the air, it is so far
decomposed as to possess very opposite properties.


    No. 16. TARTARISED ANTIMONY  WINE

    Is  more certain  in  its  operation  than  the common
 antimonial wine, the strength  of which cannot  be de-
 pended on, however  carefully  prepared; it should there-
 fore be always preferred.  In inflammatory affections of
 the chest, and recent  coughs from obstructed perspiration,
 administered  in a mucilaginous  vehicle, as directed by
 Dr. Blount, of Hertford, in the  proportion of the cough
 mixture, No. 66, it much relieves  respiration, promotes
 expectoration, and abates fever, by producing a determi-
 nation to the skin; and in the  Doctor's practice it proved 
19
 more successful in those cases than  any other diaphoretic
 medicine.
   For the purpose of exciting full vomiting, it should be
 given to the extent of a dessert  spoonful; which, with its
 usual sudorific and aperient  effects  will often check the
 progress  of inflammatory fever, particularly in  its com-
 mencement.
   In sciatica, and inflammatory rheumatism, antimonial
 wine, in the dose of thirty drops, with fifteen of laudanum,
 No. 31, in a glass of  mint water, taken every night at bed-
 time, was a very favourite remedy with the late Dr. Fother-
 gill, and certainly deserves the high  commendation paid
 to it by that esteemed author.
   Like all other  antimonial preparations,  it  is too active
 a remedy to be indiscriminately  prescribed in all fevers;
 for although it has, under  proper management, been pro-
 ductive of much  good;  it  has, on  the other  hand, as
 frequently done irreparable mischief, from being adminis-
 tered in low  fevers,   and putrid ulcerated sore throats,
 bringing on such  great  evacuations as to  hurry the  pa-
 tients to their graves  in a short time.  In domestic medi-
 cine it should not  therefore be employed in  fevers of an
 ambiguous nature, without the sanction of an experienced
 medical practitioner.  Mindererus's spirit, with sweet spirit
 of nitre and camphorated julap, will often answer as well
 as the antimonial  preparations, in exciting perspiration,
and may be employed with safety and effect in those au-
tumnal inflammatory fevers, which frequently, and often
suddenly, exhibit doubtful symptoms.
  In obstinate eruptions of the skin, tartarised antimony
wine, in small doses  of eight or ten drops,  three times a
day, in a tea-cupful of the  decoction of the  inner bark of 
                          20
the elm tree*, is a good alterative medicine,  and  often
succeeds in obstinate leprous affections or scorbutic  erup-
tions, after other alterative  medicines have  proved inef-
fectual.
   Antimony and mercury form the basis of advertised re-
medies for diseases of the skin, although the contrary is
positively asserted by the  proprietors, not a little to  the
injury of those who  are so  imprudent as  to take them,
and neglect that attention  to diet, &c. which, during  the
use of such medicines, is  absolutely necessary.  (See  St.
Anthony's Fire and Emetic Tartar.)

         No. 17.  TINCTURE OF MYRRH
   Is chiefly employed in  domestic  medicine as a  lotion
for the teeth and  gums, and in those constitutional caries,
or decay  of  the teeth,  which  commence with  black
specks, or  superficial holes in the  enamel, it  will  fre-
quently check  their progress, but it can have little  or no
 effect in removing tartareous encrustations.  (See Carbo-
nic Powder and Tooth-ach.)
   Myrrh has been much esteemed as a warm strengthener
 of the stomach and bowels, and as such it is said to have
 proved serviceable in languid cases, and particularly those
 female disorders that proceed  from  languor  or debility of
 the system. A tea-spoonful may be taken  twice  a day,
 in a glass of strong  chamomile tea, cold; or, as  recom-
 mended by Dr.  Lind,  with half a drachm of  Peruvian
 bark powder in a glass of peppermint water: but the  best
 method of administering myrrh in cases of green sickness,
 is in the form of pills, combined with steel, gentian  and

    * This decoction is made by  boiling an ounce of the inner
 rind of the elm bark in a pint and half of water to a pint. 
21
aloes, as the ecphratic  pill of the  Edinburgh  Pharma-
copceia, ten grains of which may be  taken  twice  a day.
(See Green Sickness.)
  Both tincture  of myrrh,  and  compound  tincture of
Benzoin, commonly called Friar's Balsam,  are  improper
applications for recent cuts; the stimulating gums of which
they are made exciting so much inflammation as to prevent
the union of the sides of the wound, and consequently to
occasion ulceration.  (See Cuts and Bruises.)
  In cases  of putrid sore throat  and the  thrush, tincture
of myrrh, with the diluted vitriolic acid, and  an infusion
of roses, form a good detergent  gargle.  (See Detergent
Gargle, No. 95.)

      No.  18. DILUTED  VITRIOLIC  ACID,
  In the dose of twelve to twenty drops twice a day, in a
wine glass  of water, is a valuable  medicine in weakness
and relaxation of the stomach, and decay of constitution,
particularly when induced by irregularities, and  will often
succeed  after the  Peruvian bark, and other tonic  medi-
cines have  proved unavailing.  It is likewise an excellent
remedy for restraining the profuse nocturnal perspirations
attendant on  hectic fevers,  and relaxed habits.  (See indi-
gestion.)
  For redundancy of bile in the stomach and intestines,
this medicine will chemically prove more serviceable than
calomel, or the drastic purges commonly employed for its
evacuation,  and will, at the  same time, tend to remove
the cause, by strengthening the digestive organs, which
these strong remedies are more calculated to impair. (See
Bilious Affections.)
  The  diluted vitriolic  acid, with  an  infusion of rose
leaves, makes an excellent gargle  for inflammation  of the 
22
throat, and relaxation of the soft palate.  (See Acidulated
Gargle, No. 93.)
  This acid has the property of covering the bitter taste
of the Peruvian bark and other drugs;  and about fifteen
drops added to a pint of the solution of Epsom salt, no-
ticed No. 2, render it more agreeable to the palate, and at
the  same time promote its medicinal virtues.
  It does not differ in its  medicinal virtues to the acid
elexir of vitriol.

     No. 19. TINCTURE OF ASSAFOETIDA.
  From thirty to  fifty drops,  in a glass of pennyroyal or
peppermint water, for lowness of spirits, hysteric, (see
Antihysteric Mixture, No. 65), and fainting fits; different
kinds of nervous complaints, spasmodic colic,  (see An-
tispasmodic Mixture, No. 70), and asthma, (see Asthma-
tic Mixture, No.  68.)  The addition of ten drops of  sal
volatile to  each dose will  render it  more pleasant to the
palate, and at the  same time coincide with its virtues.
  A mixture of one third of tincture of assafcetida, and
two of paregoric elixir, taken in the dose of a tea-spoonful,
has  proved particularly serviceable in  relieving  asthma,
by expelling  wind, promoting expectoration, and  allay-
ing   irritation,  (See  Asthma.)  In  the hooping-cough
and croup it  will prove equally beneficial, in doses pro-
portioned to the age of the patient, viz. To a child of two
years old, six drops, increasing two drops for every year.
Both  Dr. Culien  and Dr. Miller speak highly  of the  ex-
pectorant  properties of  assafcetida in spasmodic asthma,
difficulty of breathing, hooping-cough,  and  croup. (See
Hooping-cough.)

No. 20. VOLATILE TINCTURE OF GUAIACUM,
  In chronic rheumatism,  gout of the stomach, and  pa- 
23
 ralytic numbness, a dessert-spoonful, taken morning and
 evening, will prove the most efficacious stimulating medi-
 cine that can  be employed.  It may be taken with the
 camphorated julap, as  recommended for the anti-rheuma-
 tic mixture; or  if attended with much debility of the
 system, the bark mixture, (See No. 24,) may be substi-
 tuted.  The part  affected with  rheumatism or  palsy
 should be well rubbed with volatile liniment, or electrified,
 and kept warm with  flannel rollers. When rheumatism
 is attended with  fever,  guaiacum, from its  stimulating
 property, will be hurtful.  (See acute Rheumatism.)

          No. 21. SALT OF WORMWOOD

   Is chiefly used for making the saline mixture with the
 lemon juice. (See No. 78.) It is often prescribed in doses
 of six or ten grains, dissolved in mint-water, for correct-
 ing acidity in the stomach, and for suppression of urine.
 The alkaline mephitic water is made by dissolving  two
 ounces and  a half of salt of wormwood, in  five quarts of
 distilled  water, and afterwards saturating it with fixed
 au\  by  Nooth's  or  Parker's  apparatus.  This  water,
 to the extent of half a pint, two or three times a  day, is
 much  recommended  by  many eminent physicians  and
 surgeons as a remedy for stone in the bladder and gravel,
 and  is no  doubt well worthy  of trial.  If  this quantity
 should prove too cold, or produce unpleasant  distention
 of the stomach  from the  disengagement of fixed air, two
tea-spoonfuls of spirit  of juniper, commonly called Hol-
lands, oV any other spirituous liquor, may be taken with
 it: or if it should  nauseate  the stomach, a tea-spoonful of
paregoric elixir may be Substituted for spirit of juniper,
or taken a quarter of an hour before it. The aerated soda
water being more  pleasant to the palate, and in calculous 
24
complaints  probably  more  efficacious, is  now  more
generally employed. (See prepared Natron, No. 60.)
  A solution of salt of wormwood in peppermint-water,
in the proportion of two drachms of the  former to two
ounces of the latter, was much recommended by Dr. Ro-
sentein as a remedy for rickets, in the dose of twenty or
twenty-five drops twice a day to a child of four years old
to eight, in a little milk or  whey. In the same manner
it has been exceedingly  beneficial in convulsive fits of in-
fants, as appears  by  several late  communications in the
monthly  medical works by practitioners of celebrity;  its
salutary  effects in such cases probably  arise  from its ob-
viating that acidifying process  in the stomach, and accu-
mulation of slime in the bowels, which certainly give rise
to many of  the  most obstinate  complaints  of children.
(See Rickets.)
  Salt of wormwood is  a powerful agent in counteracting
the fatal  effects of mineral poisons taken into the stomach.
(See treatment of mineral  poisons.)
  The aerated or super-carbonated kali, * is a very great
improvement on the salt of wormwood, for the  purpose
of making  the effervescing saline draught, (see Crystallised
Acid of  Lemon) or destroying the acidity of malt liquor.

  No. 22.  CRYSTALLISED ACID OF LEMON.
  This preparation affords  a good substitute for the juice
of the lemon when  it  cannot  be obtained fresh, which
often happens in this country.  A drachm of  this acid is
equivalent  to an ounce and a half of the recent juice.
Equal quantities of the  crystallised acid of lemon and salt
of wormwood, about  a drachm of each, dissolved in  half

  * Salt  of wormwood, salt of tartar, and prepared kali, are
synonymous terms. 
25
 a pint of water, with six drops of essence of peppermint,
 and a little sugar, readily make the  saline mixture,  so
 much extolled in inflammatory fevers. (See Saline Mix-
 ture, No. 67.) Where  the skin is parched with  great in-
 creased  heat, this mixture generally operates  as a gentle
 sudorific; cools the body, allays thirst, increases the se-
 cretion of urine, and operates  slightly on the bowels; but
 to obtain these effects, it should be given in much greater
 quantities than usually  prescribed, and instead of a medi-
 cine, should be used, as directed by Dr. Latham, more as
 the common beverage,  to the extent of a quart  in  a  day.
 The saline mixture, both in putrid and inflammatory fevers,
 succeeds better  when given in  the act of effervescence,
 which is done by dissolving a scruple of salt of wormwood
 in an ounce of mintwater, and mixing with it, at the mo-
 ment of taking, a table-spoonful of lemon juice, sweeten-
 ed  with  sugar, or a scruple  of the  crystallised acid  of
 lemon,  previously dissolved. in  an ounce of  common
 water;  the  effervescence,  with  the lemon  juice, being
 more gradual, answers in this  case much better than the
 salt, the fixed air in the latter being disengaged too  sud-
 denly for any  portion to be swallowed,  through being de-
 prived of its mucilage in the process of crystallization  of
 the acid; but when the recent juice cannot be readily pro-
 cured, this inconvenience may  be obviated, by dissolving
 with the acid five or six grains of powdered gum arabic:
 or the  effervescence may  be made to take place  in the
stomach, by first taking the solution of the salt of worm-
wood, and afterwards the  lemon juice, or solution of the.
crystallised acid,  in the above proportions;  in either  way
a much less quantity is necessary than  of the saline mix-
ture.  The effervescence  with the aerated or supercarbo-
nafed kali being considerably greater than with  common
                          F 
26
salt of wormwood, it should, in all cases of fever, be pre-
ferred.
  The saline draught, in a  state of effervescence,  is a
good  preventive medicine against the  infection  of  con-
tagious fevers,  and may be employed as  an  auxiliary to
the nitrous  fumigation.   (See  the Means of destroying
contagious Effluvia in the Appendix.)
  The crystallised acid of the tartar of wine* is, perhaps,
for medicinal purposes,  superior  to the crystallised acid
of lemon, which is scarcely to be obtained entirely free
from  a portion  of sulphuric acid.  Many physicians have,
on this account, lately preferred it even to  the recent juice
of the lemon, for making the saline  mixture.  It  is of
the same strength as the crystallised acid of lemon,  and
may  be used in the same manner. A solution of this acid
in water, in the proportion  of  an  ounce to  a pint, is
equal, in strength, to lemon juice, and  not  inferior in
flavour,  and for the  purpose of acidulating punch more
wholesome. With the addition of a little  Madeira wine,
it is  sold at  an extravagant price, under the title of a
" Vegetable Acid''' for making the saline draught, punch, &c.
   White sugar, perfumed with the essence of lemon, is
sold at a shameful high  price, under the  name of Sugar
of Lemon, as a necessary article to accompany the use of
the acid  of  lemon, in making the  saline draughts, punch,
&c.  Such a paltry  mixture would have better become a
confectioner, than one who has styled himself a  chtmist.

          No. 23. IPECACUAN POWDER

   Is  a mild and very safe emetic, having  the peculiar ad-

   *  Also named essential salt of tartar, or purified acid of
;hc grape. 
27
 vantage of passing off by  stool and perspiration when it
 fails to operate by vomiting, without distressing the pa-
 tient.  It  is, therefore,  deservedly employed in almost
 every  disease, in which  full vomiting  is required;  in
 doses of one scruple to twenty-five grains, mixed with a
 little  water,  or, as advised  by Sir John  Pringle, Stoll,
 and Zinnerman, with the emetic tartar, in the proportion
 of the emetic powder, No. 88.
   In small doses of one to three grains, it furnishes the
 most  useful,  active,  and, at  the  same  time,  innocent
 sweating medicine* we possess;  (see Sudorific  Mixture,
 No. 63) and  proves highly serviceable, combined with a
 quarter of  a grain of  opium, or five drops  of laudanum,
 every two or three hours, in dysentery, obstinate purgings,
 habitual  asthmatic  indisposition,  and   hooping-cough.
 The dose   of twenty-five  grains, with a  tea-spoonful  of
 tincture of assafcetida  in a little peppermint water, has
 proved  extremely serviceable  during the paroxysm  of
 spasmodic asthma.
   Ipecacuan  powder in the dose of five  grains  twice a
 day, has been found very efficacious in spitting  of blood
 and excessive flooding, by Dr.  Stoll,  of Vienna; which
 ample experience in this country has confirmed.  In the
 smaller doses of one or two grains every four hours, it pro-
 duces a considerable determination  to the skin, and pro-

   * The celebrated sweating powder of Dr. Dover is composed
 of one part of ipecacuan powder, one  of opium  powder, and
eight of vitriolated kali, commonly called sal polychrest. From
 ten to twenty grains may be taken in any convenient vehicle in
rheumatic affections. The patient  should lie  between the
blankets in a flannel  shirt, and take, as soon as he begins to
perspire, some  warm liquid in small portions, frequently, such
as thin gruel, bohea tea, or weak white wine whey. 
28
motes expectoration; hence it is a most valuable medicine
in pleurisy,  inflammatory affections  of the lungs, recent
coughs from obstructed perspiration, and the first stages
of pulmonary consumption. (See Cough Mixture, No. 66.)
  It has likewise the property of diminishing  the soporific
effects  of opium, or  any  of  the vegetable  poisons,  and
hence  will prove a powerful auxiliary to the emetic tartar,
(see Emetic Powder, No. 88,)  for the purpose of exciting
vomiting, in cases of too great a quantity of those poisons
being taken into the stomach.  (See Treatment of Poisons.)

      No. 24. ESSENTIAL  SALT OF BARK

   Contains, in  a concentrated state, the volatile and active
properties of the Peruvian bark, in a high degree of  per-
fection, and answers  every purpose of the powder, with-
out  producing the  ill  effects  of nausea, vomiting,  and
purging, so  much to be dreaded in cases of extreme  de-
bility  of  the system,  as  low fevers, putrid  sore throat,
mortifications  and agues, in  which  no other preparation
of this valuable medicine affords  a proper substitute for
the powder.
   Ten grains  of the essential  salt are  equal to a drachm
of the  bark in substance; much more  pleasant to  the
palate, and agreeable to the stomach, and may with equal
advantage be employed where  the use of a  tonic is indi-
cated.  In intermittent  and  remittent fevers,  ten grains
may be taken every two hours, either in the  form of pills
or dissolved in an ounce of camphorated julap;  as recom-
mended for the camphorated bark mixture, No.  67, but for
low fevers, putrid sore throat,  and mortifications, red Port
wine  is a better vehicle; with which,  in the  proportion
 of three drachms to a quart, it makes an elegant tincture,
 possessing all  the active properties of the Peruvian bark,, 
29
and at the same time free from the pernicious effects of
the ardent spirit of wine, with which the different simple
and compound tinctures are made.
  The Peruvian bark, as a strengthening medicine, has
been  more extensively  and successfully employed than
any other article in the Materia Medica. It is considered
the only safe remedy for intermittent and remittent fevers
and mortifications; nor is it  less  esteemed in diseases
arising from, or  inducing debility;  as the convalescent
state after all fevers, scurvy,  dropsy,  scrophula,  rickets,
nervous irritability, periodical  head-achs, hysteric fits, &c.
  This valuable  preparation  of the  Peruvian  bark was
first made in France, by the Count de Garraye, and pre-
scribed in this country by Dr. James Carmichael Smyth,
who, from repeated trials, now gives it a decided  pre-
ference.
  The first  public account of its advantages over the
other  preparations  of the bark, together with the process
of making it, was communicated  to  me  by Dr. James
Carmichael Smyth, with whose consent I published.them
in the Physical and Medical Journal, since which it has
been very extensively employed, with success, in cases of
extreme  debility  of the system, after  the bark in  sub-
stance had been either rejected by the stomach or had pro-
duced laxative effects on the  bowels.  Since  the publica-
tion of the last edition of this work, I have  been favoured
with very flattering accounts of the efficacy of this prepa-
ration from the most eminent physicians in this kingdom.
Dr. Cheston, of  Gloucester,  states  that he has found it
succeed in many instances, after the bark in  every  other
form had  disagreed with the  patients.  Dr.  Garthshore,
Dr. Blackburne, Dr. Wilson,  Dr. Harvey, Dr. Bradley.
Dr. Blount, of Hereford; Dr.  Ward, of Leicester;  have- 
30
also expressed their approbation of it.   Apothecaries and
druggists in the country, unacquainted with the prepara-
tion, or  some  perhaps from  sordid motives, have  sub-
stituted for it the common  extract, which is  a different
article,  and does not  contain the resinous and  volatile
parts of the bark.

             No. 25. SALT OF STEEL.

  This  preparation of iron has been long held  in  high
estimation  as a great strengthener of the stomach and
bowels, and, at the same  time, by increasing the  red
globules of  the blood,  a  most  valuable  remedy  in
dropsical complaints, green sickness,  and other diseases
of debility, attended with poverty of blood.
  From its poisonous  effects on  white blooded animals,
it proves a  very powerful and safe vermifuge, taken in
the close of five grains, (dissolved in a glass of water) when
the stomach is  most empty.
  Iron has lately been recommended by Mr. Carmichael^
a surgeon of great  respectability, as a remedy  for cancer.
The principle  on which  it  is  supposed  to act, and the
method of application,  will  be noticed  in the Second Part,
under the head of the  treatment of that disease.
  The salt of steel  readily dissolves in water,  and in the
proportion of a  grain  to a pint, affords a  good substitute
for the natural chalybeate waters.   (See Epsom salt, No.
2.) Twdnty grains  dissolved  in a  quart of sherry wine,
make a  very excellent chalybeate wine, of which a small
wineglass full may be taken two or three times  a day.
  In cases of green sickness and  irregularity of the men-
strual  evacuation, it  is  customary to combine  it  with
aperient and bitter  medicines, as  the ecphratic pill; the 
31
particulars of which are given under  the head of Treat-
ment of Chlorosis, or Green Sickness.
  In cases  of dropsy, whites, gleet, and debility of the
nervous system, it may be  advantageously combined with
the Peruvian bark in the folio wing proportion:—
  Take of salt of steel  ten grains—essential  salt of bark
     one  drachm—with  balsam  of  Peru;  make  into
     twenty pills—two to be taken twice a day.
  When the pulse  is  quick, or the  countenance  florid,
steel is not proper, even in  retention of the menses.

        No. 26. POWDER OF RHUBARB

  Is a  mild and excellent aperient medicine, operating
without violence or irritation, and may therefore  be given
with safety to pregnant women and children; besides its
purgative   quality,  it is  celebrated for an  astringency,
which strengthens the tone of the stomach  and intestines,
and hence  proves useful in disorders  arising  from  laxity
of the fibres. The purgative dose  is from one to  two
scruples in a little  peppermint water, to  which ten grains
of calcined magnesia may be added, as prescribed by Dr.
Hartmann, when an acidity prevails in the stomach.
  A powder composed of two  parts of rKubarb, one of
calomel, and a little  ginger powder, is  an  efficacious
remedy for worms, and a  good  purge for  dropsical  and
bilious complaints,  or when the bowels are obstructed
with slime; half R  drachm  may be tfl&fc#in any  thick
vehicle, to prevent the  deposition  of 4k« calomel,  or in
form of pills, as the bilious  pills, No. 83.
  A mixture of fifteen grains of rhubarb, a scruple of cal-
cined magnesia, a drachm of white syrup of poppies, and
two  ounces of dill water,  in the dose of a tea-spoonful.. 
32
 will prove highly serviceable in removing many disorders
 children are subject to, from a redundancy  of acidity in
 the stomach and  intestines, and more safe and efficacious
 than the advertised carminatives, which, from  their con-
 stipating effects,  not unfrequently occasion  fatal inflam-
 mation of the bowels of infants.
   The laxative effects of rhubarb are increased by a small
 addition of cream  of tartar or sal polychrest, which, in
 small doses, was a very favourite stomachic medicine with
 the late Dr. Hugh Smyth and Dr. Warren.
   The  purgative property  of rhubarb is destroyed  by
 roasting, nor is  its astringency increased by  it,  as is
 generally imagined.
   The Russian rhubarb is evidently very superior to that
 imported from the  East  Indies, both as a stomachic and
 aperient; it is generally sold under the title of Turkey
 Rhubarb.

           No. 27.  POWDER OF JALAP,

   In the dose of twenty to  twenty-five grains,  with two
of ginger;  or twenty grains, mixed with two drachms of
compound tincture of senna, and an ounce of mintwater,
is  a very pleasant, safe, and  effectual purgative medicine;
and  generally  performs  its  office without  occasioning
nausea or much griping. In cases of dropsy, five grains
of calomel, to fifteen or twenty grains of jalap, with two
or three drops of essence of peppermint, will prove very
beneficial both as a  purgative and diuretic.  This medicine
should  be  repeated three times  a  week,  and   the tonic
mixture, No. 77, taken in the intermediate time.
   For delicate constitutions, half the dose  of the powder
of jalap, and  as  much  powder of rhubarb, with  three
drops of essence of mint, are preferable to jalap alone. 
33
  The operation of jalap and rhubarb may be promoted by
taking after them a weak solution of the neutral purgative
salts.  (See No. 2.)
  In hypochondriacal patients jalap produces severe griping
pains, but seldom acts as a purgative;  and on the bowels
of quadrupeds, even in the dose of an ounce, it evinces no
sensible effect whatever.

                No. 28. CAMPHOR

  Is  very generally employed in  fevers, both of the in-
flammatory and malignant kind; in spasmodic affections,
morbid irritability of the nervous system, and often in
fluxes.
  The common and best method of exhibiting camphor,
is in the form of julap made by means of gum arabic and
sugar, as the following:

                  Camphorated Julap.
  Take Of camphor twenty grains, spirit  of wine twenty-
drops, white sugar and gum arabic, of each two drachms.
Rub the camphor first  with the spirit of  wine, then with
the sugar, and when reduced to a fine powder, add the
gum  arabic powder, and when  well mixed, pour on
them, by degrees, a pint of boiling water, continuing the
rubbing; then  cover  it  oyer,  and when  cold, strain it
through fine linen.
  A mixture of six ounces of this  julap,  and two ounces
of Mindererus's spirit, taken in the  dose  of three table-
spoonfuls every three or four hours, is a safe  and  good
sudorific medicine in inflammatory  and  frebrile affections.
In  fevers, strictly inflammatory, it  may  be given with
the tartarised  antimony wine, No. 16.  In putrid fever,
malignant  sore  throat,  and   mortifications,  it  affords
                          G
f 
34
a very excellent vehicle for the exhibition of Peruvian
bark. 'See Essential Salt of Bark, No. 24. and Mixture,
No. 67.)  In strangury,  three  table-spoonfuls of a mix-
ture of camphorated julap. half a drachm of purified
nitre, and two drachms of gum arabic, repeated every
three hours, will prove of great service.
  In rheumatism, gout,  and paralytic affections, a mix-
ture of six ounces of camphorated julap, one ounce of
volatile tincture of guaiacum, and two drachms of honey,
will form an excellent stimulating medicine.  The tinc-
ture should be first rubbed  with the honey, and the cam-
phorated julap afterwards added  by degrees. Three
table-spoonfuls of this mixture may be taken every three
or four hours. (See Anti-rheumatic Mixture, No. 71.)
  In cases of increased irritability of the nervous system,
six  ounces of camphorated julap, with one ounce of tinc-
ture of castor, two  drachms o' sal  volatile, and two of
spirit of lavender, may be taken with great advantage, in
the dose of two table-spoonfuls every four hours.  (See
Nervous Mixture, No. 72.)
  In cases of hooping-cough, chronic difficulty of breath-
ing; and asthma, this julap, with oxymel of squills, assa-
fcetida,  and ether in the  following  proportions,  is a
powerful remedy when unattended with any febrile symp-
toms.  Take of camphorated julap six ounces; tincture
of assafoetida one ounce, oxymel of squills, of each half an
ounce;  vitriolic ether three drachms; two table-spoon-
fuls to be taken every four  hours.  Camphor thus com-
bined with assafcetida and ether, is much recommended by
Dr. Hartmann as an excellent medicine for asthma, or
difficulty of breathing. (See Asthmatic Mixture, No. 68.)
  In acute fever, with determination of b ood to  the
head or lungs, camphor is  a very doubtful remedy, and 
35
when it fails in such cases to excite perspiration, gene-
rally increases the fever.
  In maniacal cases  and  delirium, attendant on  low
fever,  camphorated julap, in the dose of three table-
spoonfuls, will often succeed in procuring sleep after
laudanum had failed:  in  the same  manner, repeated
every four hours, it proves serviceable in eruptive fevers,
and produces a return of receded small-pox or measles.
  One  drachm of camphor, dissolved in  two  ounces of
rectified spirit of wine, and two drachms of spirit of tur-
pentine, form an excellent stimulating liniment for rheu-
matic and paralytic pains or numbness.

No. 29. COMPOUND CRETACEOUS POWDER

   Is a very useful medicine in correcting acidity, and
strengthening  the stomach and  bowels,  and hence has
been found particularly serviceable in restraining diarrhoea
or looseness arising  from acidity or laxity.   Twenty
grains may be taken in a glass of water, with three drops
of the essence of cinnamon, or in a mixture, as  the fol-
lowing:
  Take of the compound cretaceous powder two drachms,
gum arabic three drachms, pure  water half a pint, es-
sence of cinnamon  thirty  drops:  rub  the powder with
the gum arabic, and then add, by degrees, the water and
essence. Three table-spoonfuls  should be taken every
three hours, or after every loose  motion.  If the purging
should  be violent, or attended with much pain  in the
bowels,  six or  eight drops of laudanum may be added to
every or every other dose;  and two grains of ipecacuan
powder, if the  stools should be attended with much mu-
cus, or streaked with blood.  (See-,Cretaceous  Mixture,
No. 64.) 
                         36
  An emetic of ipecacuan, No. 23, or a dose of rhubarb,
No. 26, should precede the use of astringent medicines,
in cases of diarrhoea or looseness, particularly when they
arise from acrid humours in the stomach and intestines.
  The critical purgings of fevers should not be suddenly
checked,  unless the necessity of it be indicated by the
reduced state of the patient. (See Diarrhoea.)
  This cretaceous powder, for correcting acidity  in the
stomach, answers as well as  magnesia;  they, however,
differ essentially in their  operation after their union with
an  acid,  the latter acting as a purge, and the former
rendering the body   costive, or restraining  purgings;
hence when acidity is attended with costiveness, magnesia
should be preferred, and when with a contrary state of
bowels, the cretaceous mixture.  In some cases they may
be advantageously combined, (See Magnesia.)  The cre-
taceous powder is very similar to gascoign balls, the salu-
tary effects of which depend on their absorbent property.

           No. 30. EXTRACT OF LEAD,

   In the proportion of ten drops to half a pint of pure
 water with half a drachm of laudanum, makes a good
 discutient lotion for inflammatory affection of the eyes;
 but for bruises, slight  burns, scalds, excoriations, and in-
 flammations in other  parts of the body, treble the quan-
 tity of the extract may be employed, and three  drachms
 of rectified spirit of wine or three ounces of white-wine
 vinegar, substituted for  the laudanum.
   This  extract is solely used externally, and as colicky
 and paralytic affections frequently arise from a portion of
 the lead being taken up into the system, by the absorb-
 ent vessels of the skin, its application to a large surface 
37
of the  body, or continuance many days are equally im-
proper.  In such cases, white-wine vinegar, diluted with
the same quantity of water, it has been supposed,  will
answer all the good purposes of the extract of lead, with-
out producing any of its ill effects, and therefore in do-
mestic medicine should be preferred, particularly when
the inflammation is extensive. Such  lotions probably
prove serviceable as cold applications, and as lead tends
much to diminish arterial action, a slight impregnation
of it must prove a valuable auxiliary.  When there is a
tendency to gangrene, it must, on the same principle, be
very injurious.
   Dr. Aikin, Percival, and Sir G. Baker, notice the dis-
agreeable symptoms produced  by an absorption  of  lead
into the  system. The last-mentioned author relates that
twelve infants died at Dartmouth  in  convulsions, occa-
sioned by an ointment made of Goulard's extract, applied
to the nipples of their nurses, sold by a woman famous
for her skill in the treatment of sore nipples; and it  is to
be feared those accidents frequently occur from the use
of the advertised nipple ointment, the basis  of which is
lead.*  For the means  of counteracting the  effects  of

   * A  child having died rather suddenly of convulsions in
January, 1803, and understanding the  mother had applied a
favourite ointment ol the nurses to  disperse  an inflammatory
tumour in the breast, I was induced to examine the ointment,
and question the nurse respecting it.  She declared it  was per-
fectly innocent,  that it did not contain a particle of lead, but'
that it was made of lytharge of gold, vinegar and spermaceti
ointment, which  form the most poisonous preparations of lead
that can be made, and which I have no  doubt proved fatal to
the child  The dusting of children with white lead, or ceruse
powder, is also  a dangerous practice, and no doubt often the
cause of convulsive fits and cholicky pains in the bowels. 
                         38
lead taken into the stomach, see Treatment of Mineral
Poisons.

         No. 31. LIQUID LAUDANUM.

  From twelve to thirty drops may be taken in any con-
venient vehicle, and increased or diminished in propor-
tion to the degree of pain and  intervals  of repetition.
When judiciously administered, this is,  no doubt, the
most valuable  medicine in the Materia  Medica; and in
certain stages, and with certain combinations, is advan-
tageously employed  in almost every disease incident to
the human frame.  It has the wonderful properties of mi-
tigating pain, inducing sleep, allaying inordinate action,
and diminishing morbid irritability; hence it becomes an
invaluable remedy in obviating symptomatic fevers at-
tendant on fractures  and other accidents.  In spasmodic
colic, it will often prevent inflammation of the bowels;
and in all spasmodic  affections it is more or less employ-
ed. In incurable  diseases, where the sufferings of the
patient are mostexcruciating, as in cancer, diseased joints,
&c. it alleviates his miseries, and renders life tolerable.
   If the  moderate dose  of ten or twelve drops  of liquid
laudanum, which in domestic medicine should always be
begun with, do not answer,  they must  be  repeated and
increased till  the desired effect is obtained; and in this
manner  the dose of this drug may be pushed with safety
to a very great length;  but this advice should only be
followed in cases of accident and chronic diseases, where
there is considerable local irritation to overcome. When
it disagrees in the ordinary quantity,  it may often be
given with much advantage in closes of five drops every
hour till the proper  effect be produced. When the ex-
hibition  of laudanum is deemed necessarv by wav of lave- 
39
  ment, in cases of obstinate purging, pain in  the bladder
  or womb,  spasms  in  the bowels,  &c.  the proportion
  should  be more than double  the quantity given by  the
  mouth. In the violent purgings and fever, so often attend-
  ing difficult dentition of children, laudanum, in the dose of
  one or two drops about twice  a day, is  a very important
  remedy; and as children are more or less affected at such
  times with acidity  in the stomach,  it would always be
  adviseable to administer it with  a little  magnesia, as the
  Absorbent  Mixture, No.  73. In  cases  of  costiveness,
  enlarged  bowels, and ricketty disposition, it is inadmis-
  sible.
    To counteract the effects of too large a dose of lauda-
  num, coffee has  been found to answer  best as a diluter
  Kind  ipecacuan powder as  an emetic;   and  when   the
 quantity taken is so great as to render vomiting necessary,
 the ipecacuan should be administered to the extent of two
 sCrUples, with half an ounce of  tartarised  antimony wine.
 The vegetable  acids are likewise much  recommended as
 powerful  correctors  of its narcotic effect, and will prove
 an uieffrl auxiliary to the emetic. Lemon juice, and vine-
 gar, fdr this purpose, are equally  efficacious in the extent
 of a  wine-glassful.   (See  the  treatment of Vegetable
 Poisons.)
   An acetous tincture of opium, sold under the name of
 the Black Drbp, has lately  been preferred to the liquid
 laudanum by ma^y  physicians of character,  on account
 of its not producing  the affections of the head and febrile
 irritation in the system,  which  sometimes follow the ex-
 hibition  of laudanum. It is likewise said to  be more
 certain in producing sleep.*

  * The author has certainly found this  preparation in several
instances  of nervous  irritation, gout, and spasmodic cough,
succeed, after the liquid laudanum could not be persevered  in, 
40
  For slight inflammation of the eyes, two drops of lau-
danum,  dropped in the affected eye or eyes twice  a day,
will often succeed  in dispersing  the  inflammation  much
sooner  than  the  saturnine  lotions.   Some  practitioners
prefer a vinous or  watery solution of  opium for this pur-
pose ; but the small quantity of spirit in the laudanum is
more  serviceable than otherwise.

      No. 32.  ESSENCE  OF PEPPERMINT,

  By means of a little white sugar,  readily mixes with
water, and, in  the proportion of thirty drops to a pint,
makes a pleasanter and better simple water than that dis-
tilled  from the recent herb;  which, from not retaining its
flavour in  perfection long, is seldom to be procured good
in the  winter  season.  The spirituous peppermint-water
may be made, b)r employing brandy in lieu of water,
which will prove less pernicious to the organs of digestion
than  that  sold under  the name  of peppermint cordial,
made  with spirit of  wine.  Essence of peppermint is
chiefly employed to correct  the  griping quality of purga-
tives, and render nauseous medicines more palatable and
pleasant to  the stomach.   It is,  however,  often  taken
alone on sugar, or in a little brandy  or water, for flatu-
lence, colicky pains  in the  stomach  and intestines,  and
fits of  spasmodic asthma, in which it  generally  affords
speedy but temporary relief.  (See Colic.)

        No. 33. ESSENCE  OF  CINNAMON

   Is  recommended for making the spirituous and  simple

 on account of distressing head-ache, and derangement of the
 stomach and nervous system, which uniformly followed its use. 
41
cinnamon-water in  the same manner as the foregoing, to
which a little sugar  is usually added. Water  thus  im-
pregnated with the  essential oil of the cinnamon, affords
a pleasant and useful vehicle for the compound cretaceous
powder.  (See Cretaceous  Mixture,  No.  64.)  In cases
of violent  purgings, or habitual looseness, arising from
acidity, a dose of rhubarb  powder,  with magnesia, or an
emetic of ipecacuan, should always precede the exhibition
of astringent medicine in such case.  (See Diarrhoea.)

         No. 34; PREPARED CALOMEL

   Is the mildest preparation of mercury we  possebS. In
domestic practice  it is  principally employed  as a worm
medicine,  and  is  unquestionably the  most efficacious
remedy that can be made  use of  for  the  destruction of
every species of worms lodged in the alimentary canal.
Its operation as  a vermifuge is rendered more certain by
the addition of  scammony, as the basilic  powder, (see
No.  36.)  For  those  complaints of  the  stomach  and
bowels, which are  generally attributed to  a redundancy
of bile, but in fact  arise from a deficiency of that secre-
tion,  in  consequence of an indolent  state of the liver,
three or four  grains may  be taken every other  morning,
with ten grains  of  rhubarb, and three of Jamaica ginger
powder in the form of  pills, with great advantage.  (See
Bilious Affections and Indigestion.)
   In  those  cutaneous affections, generally termed scor-
butic  and chronic inflammation of the edges of the eye-
lids, half a grain of calomel, taken twice a day, with six
drops of the antimonial  wine, No. 1Q, will prove  a good
alterative  medicine: a dose of rhubarb  should  be occa-
sionally intervened,  to prevent  salivation, and  its use  dis*
continued as soon as the mouth is rendered tender by it.
                          H 
42
  In  diseases of  children, as  rickets  and convulsions,
which  frequently arise from an  accumulation of slime  in
the intestines, and obstructions  in the mesenteric glands,
this medicine, given  in doses proportioned to the age of
the child,  with  a little magnesia, will often be attended
with the most salutary effects.  Dr. Denman, Dr. Clarke,
and Dr. Heighton, often prescribe it in the dose of six
grains for  a  child of two years old; and experience has
proved that children bear the operation of a large dose as
well as an adult:  but in domestic medicine the dose for
a child of  one year old should not exceed two grains, in-
creasing one grain for every  year to  the age  of five.
Sugar so frequently  employed  for the  exhibition of this
medicine to  children is a bad  vehicle, on  account of it
turning  sour in  the  stomach,  and thus  considerably  in-
creasing its acrimony.
   Calomel, although neither  diuretic nor sudorific, never
fails  to increase  the operation of  such medicine when
given in conjunction with them; hence it  is very com-
mon to prescribe  it, with the antimonial powder, in fevers
attended with great thirst and dryness of the skin, to ex-
cite perspiration; and with turpentine and squill-powder,
to  increase the secretion of urine.
   In obstructions and chronic  inflammation of  the visce-
ra, particularly the liver, calomel, judiciously administer-
ed, has a  very salutary  effect;  for  this  purpose it should
be given in a small dose of one grain (formed  into a pill,
with conserve of  roses)  twice  a day, so  that it may enter
the system: if this dose should disturb the bowels, half a
 grain of opium,  or five grains  of  the opiate confection,
should be added to each dose.  Much vegetable food,  and
particularly  acids, should be  avoided during  the use  of
 mercurial medicines.
    Calomel is sometimes adulterated with prepared chalk, 
43
 which may be discovered by pouring on a small quantity
 of the suspected calomel a little diluted vitriolic acid; if
 an effervescence ensue, the adulteration is proved.


            No. 35.  EMETIC TARTAR.

   From one  to three  grains, dissolved  in  warm water,
 and given  alone as an  emetic; or from  half a grain to a
 grain, with fifteen or'twenty grains of  ipecacuan powder
 (see  Emetic  Powder,  No.  88,)  on the first  attack  of
 hooping-cough, small-pox, measles,  inflammatory fevers,
 foulness of the stomach, dropsical complaints,  diseases
 of the  lungs,  as asthma and dyspnoea, and  all  cases,
 where speedy and full vomiting is required.  In fevers,
 attended with  great prostration of strength or  diarrhoea,
 ipecacuan, as  operating  less on the  bowels,  should  be
 preferred.
   As patients  are differently affected  by this  medicine,
 the  safest  method of exhibiting it is by dissolving three
 grains in  two ounces  of warm water,  and giving two
 table-spoonfuls of the clear  solution every half  hour,  till
 it vomits.  For children, emetic tartar  is not so safe  an
 emetic as  ipecacuan  powder; when  great debility of the
 system is  present, even a small dose has been  known to
 prove fatal; in  domestic medicine  it should not, there-
 fore, be  given  to  children, particularly  as ipecacuan will
 answer the same purpose.
   Emetic tartar, in small  doses, combined with calomel,
 as in the following proportions, has been found a power-
 ful, yet safe alterative medicine in obstinate eruptions  or
 foulness of the  skin.  Take  of emetic tartar four grains,
 calomel sixteen grains;  mix them well together;  and with
 a little soft bread, form twenty-four pills, of which one is
to be taken every morning and evening, with a draught 
                         44
of sassafras tea, or decoction of elm bark. (See Calomel
and -Eruptions of the Skin.)
  To excite  vomiting after a large dose  of a vegetable
poison, emetic tartar, in the dose of four grains, dissolved
in a little water, will often answer better than ipecacuan,
on account of its operating more  speedily; but in cases
of mineral poisons, ipecacuan, in the doses  of two scru-
ples to a drachm is to be preferred, as the alkaline medi-
cines  administered to  decompose* the mineral   poison,
would have the same effect on the  emetic tartar, and thus
render it inert. (See Treatment of Poisons.)
  The  observations on  the  use of antimonial wine (see
No. 16.) are equally applicable to emetic tartar, of which
the tartarised  antimony wine  is only a solution in white
wine.

            No. 36. BASILIC POWDER

  Is a medicine of great ancient repute, as a remedy for
every species of worms lodged in the alimentary canal,
and is without doubt the  most powerful and safe vermi-
fuge we are acquainted with.  It may be  given to chil-
dren of all  ages, in a little  honey  or  currant jelly, every
second or third morning  for a fortnight,  in the  doses of
three grains  to  a  child  of one year old,  increasing one
grain for every year,  to  the age  of twenty.  The  tonic
mixture, No.  77,  should be taken in the intermediate
time, and  continued  some time after the evacuation of
the worms.  This  is a very favourite remedy with  Dr.
Cam, an able physician in Hereford, who frequently pre-
scribes it for children to empty the bowels of slime and
crudities, and at the same time as  a good security against
worms  and their effects, which so  frequently produce the
most alarming and even fatal disorders that assail chil- 
45
dren. It is likewise an excellent purge for children after
the measles and other eruptive fevers that require the use
of aperient medicines, and for ricketty children  with en-
larged bowels.
  The basilic powder is likewise a good purgative medi-
cine in dropsical cases, and will answer much better than
large doses  of cream of tartar, or any  other  purgative
medicine, when a considerable discharge is required from
the system.  (See Pills, No. 80, and Dropsy.)
  The  nostrums advertised as remedies  for worms are
composed of  mercury:  those made  up in the  form  of
lozenges with sugar, and  in  ginger-bread nuts, by be-
coming acescent  from being  kept long,  or  in  a  damp
place, so increase the acrimony of the mercury as to ren-
der it a powerful poison: a case of the sudden death of a
child, in consequence of taking a  medicine of this  kind,
was lately published by the coroner of Leeds, as a caution
against its use. It is  much  to be lamented, that the first
characters in this  country should  be so imprudent as  to
sanction a practice by which many of the human race are
annually destroyed* The person who suffers  his name  to
appear  in the  public prints  in the  support  of such a
traffic, one would suppose must be  either very thoughtless
or of weak intellect.

No. 37.  ANTIMONIAL FEBRIFUGE POWDER.

  This medicine has long been sold under the name  of
Dr.  James's Fever  Powders.  The  best  method of ad-
ministering it is  in form of pills, as recommended by Dr.
Blane, by making a drachm into twelve pills, with  a lit-
tle conserve  of roses  or hips, and giving one every four or
five hours, till it excites perspiration in inflammatory fe-
vers,  rheumatism, and recent coughs.  Dr.  Monro very 
46
judiciously cautions practitioners against its indiscriminate
use in every species  of fever. " I have known," says the
learned doctor, " several instances where it has been given
in putrid ulcerated sore throats and in low fevers, and it
has brought on such  a purging as to hurry the patients to
their graves in a short time." (See Tartarised  Antimony
Wine, No. 16.)

    No. 38. CAMPHORATED ACETIC ACID.

  The  acetic  acid has  a great and  rapid  action on con-
tagious effluvia ;  its  penetrating  exhalation,  changes
not only the  state of the surrounding atmosphere,  but
also rouses the vital  powers to a degree of energy capable
of resisting infection; for this purpose it will prove more
efficacious than the once celebrated thieves' vinegar;  and
for fumigating small rooms or wards, will  answer as  well
as the nitrous and muriatic vapours recommended by Dr.
Carmichael  Smyth, Mr. Cruickshanks, and, on the Conti-
nent,  by Citizen Morveau, as noticed in the Appendix.
  It is generally used by smelling a  sponge  moistened
with it in a wide-mouth bottle or  gold case; but to puri-
fy the air of infected rooms, it should be diffused through
its atmosphere by evaporating on  a saucer previously
made warm, or by holding it over the blaze of a  candle.
  For the purpose  of smelling,  in  cases of  head-ach,
and in  the  contaminated air  of jails,  hospitals,  crowded
rooms,  &c. this acid is preferable to the strong  smelling
salts,  which have  no effect in  destroying  putrid effluvia,
but by much  use considerably injure the  sense of smell,
and  may, in  head-achs arising from a determination of
blood to the brain, be productive of serious consequences;
while the acetic acid from its astringency may be of ser-
vice. (See Smelling Salts, No. 39.)
  This acid, impregnated with the essential oils of cloves 
47
 and lemon peel has been sold under the title of Aromatic
 Spirit of Vinegar, an addition  which by no means im-
 proves its antiseptic  powers; and  the  oils, by  turning
 rancid, render it unfit for keeping in warm climates, and
 in a great measure destroy its most active parts.

    No. 39. VOLATILE SMELLING SALTS,

   From their great pungency,  should not be used on
 all occasions,  and particularly  for head-achs attended
 with fever or plenitude of the  vessels of the  brain; be-
 sides, such powerful stimulants, by frequent use, so injure
 the olfactory nerves, as often to impair the sense of smell.
 They should therefore only be employed in cases of
 apparent suspension of the vital functions, as  fainting
 and hysteric fits;  and on the  appearance of returning life
 in cases of drowning,  hanging, &c.  (See Suspended
 Animation.) The camphorated  acetic acid, for the pur-
 pose of smelling in crowded rooms, or slight  head-ach,
 is far preferable.

        No. 40. BLISTERING PLASTER.

   If much  heat be employed in spreading this  plaster,
 the stimulating properties of the ingredients will be de-
 stroyed: it should be only warmed at a distance from the
 fire, till it is sufficiently soft  to  spread with the spatula,
 or end of the thumb.
   When the speedy operation of a blister is required, the
part on which it is to be  applied should be previouslv
rubbed with an onion,  or  the camphorated acetic acid.
A little camphor scraped over the surface of the blister
will often prevent strangury.
  The discharge and inflammation produced by  blisters 
48
 are extremely serviceable in internal and deep-seated in-
 flammations,  rheumatism, apoplexy, palsy, and almost
 all affections of the brain, and diseases of the joints.

       No. 41. SPERMACETI OINTMENT,

   Spread  on lint, is an useful dressing for the purpose
 of healing blisters, but when the discharge is deemed ne-
 cessary, the savin ointment, No. 44, should be used. It
 is likewise useful for softening the skin, and healing chaps.
 This ointment, coloured with alkanet root, is the  com-
 mon lip salve.

            No. 42. BROWN CERATE,

   Being first recommended by  Dr. Turner, has  been
 usually distinguished by his name.   It is a good applicp
 tion for  superficial ulcerations and excoriations, and heal-
 ing blisters; for recent cuts, diachylon plaster, spread on
 leather,  will  answer best by  keeping the edges of the
 wound  in  contact. The first object in  the healing  of
 ulcers, is to abate the surrounding inflammation by  rest,
 ancTan emollient poultice of linseed meal and water, which
 will produce a discharge of healthy matter, that will prove
 more healing than all the boasted cerates: an ulcer, in an
 healing state, is neither painful nor offensive.  Rest  and
 proper rollers are of as much consequence as ointments.

         No. 43. YELLOW BASILICON

   Is an excellent application for cleansing and digest-
ing wounds and  ulcers; it should be spread  thinly on
lint, and applied the same size as the wound, and kept
 on by an external dressing of brown  cerate  <&*&- foifofr 
49
  cerate and a calico or a flannel roller.  It is not a proper
  application  for recent  cuts,  burns, or scalds: the browa
  cerate will answer much better in such cases.

            No. 44. SAVIN OINTMENT.

    This ointment was  first recommended by Mr. Crow-
 ther, an eminent surgeon  in London, for keeping up the
 discharge of blisters in cases  of diseased joints; in the
 treatment of which it appears he has been particularly
 successful. It has since been used by Mr. Abernethy, in
 the treatment of  the  lumbar abscess.  Being  exempt
 from the unpleasant effects of the Spanish-fly  ointment,
 in not producing  strangury or much local irritation, it
 is now very generally  used  for the  purpose of keeping
 up the  discharge of blisters, in those acute  and chronic
 diseases, where it is requisite for some time; but in
 paralytic cases, where the  irritation of a blister is more
 required than the discharge,  the Spanish-fly  ointment
 should  be employed.

              No. 45.  SQUILL PILL,

   Taken from ten to fifteen grains, twice  a day, is a
 powerful medicine  in promoting expectoration,  attenuat-
 ing viscid phlegm, and increasing the secretion  of urine;
 hence it is a valuable medicine in  chronic  coughs and
 asthmatic affections, attended with difficulty of expectora-
 tion and dropsical complaints.
  The  squill pill, combined with  calomel,  as recom-
 mended by Dr. Cam of Hereford, is an efficacious and
 valuable medicine in dropsy; either of the chest, belly, or
 extremities, in the following proportions:  Take  of squill
pill two drachms, calomel a scruple,  mix well together,
                          I
                          ! 
                         50
and form into thirty pills, of which three may be taken
twice a day, with a wine-glassful of the tincture of the
essential salt of  bark,  made with port wine, as  under
No. 24.  If thes- pills should not prove sufficiently ape-
rient, a scruple of gamboge may be added with great ad-
vantage. (See Pills for the Dropsy, No. 80, and Dropsy.)

         No. 46.  CATHARTIC EXTRACT

   Is very similar to the composition sold under the name
of Pill Coccia.   In the dose of ten to fifteen grains it is a
very  useful and active  purgative medicine, and in cases
of obstinate costiveness, and when a speedy evacuation
of the intestines is required, will answer better than any
other of the kind. It  likewise affords an  excellent pur-
gative medicine for head-ach, arising from a distension
of the  blood vessels of the brain,  and especially if pro-
duced by  a suppression of the piles, which it will often
succeed in restoring; but in cases of piles being present,
the milder purgatives,  as the aperient salts, No. 2, or
aperient mixture, No. 62, will answer best. This extract,
in the medicine chest,  is divided into pills of five grains
each, of which two or  three may be  taken  for a dose.

         No. 47. LENITIVE ELECTUARY

   Has been long and very deservedly  esteemed a con-
 venient and gentle laxative medicine, in habitual costive-
 ness, piles, &c. taken to the extent of a tea-spoonful occa-
 sionally. (See Electuary for the Piles, No. 85.)

       No. 48.  PERUVIAN BARK POWDER.

   There are three species of the Peruvian bark made use 
51
of in  Britain, viz.  the pale,  the  red, and  the  yellow,
which  are promiscuously administered, from half a  drachm
to a drachm, every  hour, in fevers of the  intermittent
class,  commonly  called  agues,  with  equal  advantage.
Dr.  Saunders recommends the red, when it can be  ob-
tained  genuine; but  through the great difficulty  in pro-
curing the true sort, the pale has latterly had the pre-
ference in this country, and the yellow  in the West Indies.
If the full  dose should  disagree with the  stomach and
bowels,  so as to produce vomiting or looseness, three or
four drops of laudanum  should be given with every, or
every  other dose, and two or three  grains of Jamaica gin-
ger, or cinnamon powder, if it should oppress the stomach.
(See Tonic Powder, No. 91.)  It may be taken either in
port wine, camphorated julap, or peppermint water;  or in
order to cover its ill taste, to which some  people have an
almost invincible antipathy, in an  infusion  of liquorice
root, as  advised by  Dr.  Lewis; but  for  this purpose I
have found, with Dr. Lind, milk to answer best; it should
be swallowed immediately after it is mixed, otherwise the
flavour of the  bark will be imparted to the  milk.
  When the bark, in  powder, cannot be made to  stay on
the stomach,  the essential salt of bark, No. 24, affords a
very proper substitute, and may be employed with equal
advantage.   During  the hot fit of an intermittent, it may
be given mixed  with  two table-spoonfuls of Mindererus's
spirit.
  In urgent cases  of intermittent fever, Dr. Cullen and
Dr. Lind advise the  bark in  powder  to be  given in the
dose of a drachm and a half to  two drachms  every hour.
The stomach,  however, in this respect  is the best guide,
and as  much as it will bear, may in  general be given with
propriety; for  as Tcrti, and other celebrated writers  have 
52
inculcated, the larger the dose and the quicker the repe-
titions of it, the greater  is the power of  the medicine in
stopping the paroxysms, and the less  of it is found to be
taken in the end; whereas it has been observed, that when
given in small doses and at long intervals, the sum of the
whole quantity taken has been much more  considerable,
yet it has not produced the desired effect.
   If the paroxysms should continue  after the patient has
properly persevered in the use of the bark three days, some
visceral obstruction or unfavourable state  of the stomach
may be suspected, in such case therefore it will be advise-
able to cleanse the first passages by an emetic and a purge
of jalap and calomel, when recourse may be had to the
bark again  with success.
   The Peruvian bark, as a strengthening medicine, is now
more generally prescribed than any other of  the  class of
tonics.  In mortifications, putrid sore-throat, and malignant
fevers, it is almost the only remedy that can be employed,
taken  from twenty  to  forty grains,  every  two or three
hours, in a  glass of Port wine, or camphorated julap. In a
great variety of diseases, as  St. Vitus's dance, scrophula,
or  King's  evil, rickets, nervous  irritability, indigestion,
hysteric fits, and dropsy, it is likewise administered  with
great advantage, to which a dessert-spoonful of steel wine
will often prove a great auxiliary.  Dr. Lind observes, that
when the bark  is entirely nauseated  from a weakness of
the stomach, or from an aversion of the patient to the taste
of the medicine, it will be proper to administer it glyster-
ways, in the quantity of two drachms in half a pint of beef
tea every three hours, in which form  it has proved as effi-
cacious as when taken by the mouth.
   In coughs, asthma, consumption of the  lungs, and  diffi-
culty  of breathing, the bark should not be  employed un-
less sanctioned by an experienced physician. 
53
   The decoction of bark is made by boiling one ounce of
bruised bark in  a pint and a half of distilled water, in a
close covered vessel, for ten minutes. The liquor should
be  strained, while hot,  through a coarse strainer, and
used while turbid, for if suffered to stand till  clear,  the
most efficacious part of the bark (the resin), will subside.
An  infusion, both in boiling  and cold  water, has been
recommended in  preference to  the decoction,  under  an
idea that the volatile and most active parts escape by boil-
ing; but if a close vessel  be employed this objection is
obviated.
   The barks introduced into the practice of medicine of
late  years, under the name of Red and Yellow Bark, do
not appear to be the produce of the same tree as the true
pale bark; and  it is much  to  be doubted,  whether  the
true pale Peruvian bark  possesses any  real advantages
over the bitter  astringent  barks  of this country^  particu-
larly that of the willow, oak,  and  horse chesnut trees.*
The Rev. Mr.  Stone, some time  since, published a fa-
vourable account  of the  efficacy  of  the willow  bark;
which has been confirmed by two foreign physicians  of
repute, Gunz and Clossius, and several  recent publica-
tions by physicians of hospitals,  who have had  an oppor-
tunity of putting it to  the test of  experience.  At the
Hereford infirmary the willow bark was much employed in
conjunction with the  oak bark, in  the  proportion of one
part  of the latter to two of^the  former;  and which cer-
tainly answered as well as the Peruvian bark, and in some

  * " It is my opinion," says the ingenious St. Pierre, " that
nature  has modified her productions in every  country, con-
formable to the diseases which the climate of every particular
country generates." 
54
instances better; a fact that may be turned to a considera-
ble reduction in the  expense  of the medical departments
of hospitals.  About four years since  I  pub'shed  a con-
cise  account  of the efficacy  of  these  barks,  and gave
many  formula  for  their use, in a  work entitled  the
Medical and Chirurgical Pharmacopxia for  the  use  of
hospitals.

            No. 49. JAMAICA GINGER

  Has lately  been introduced  into domestic medicine as
a remedy  for  gout,  indigestion,  and flatulence,  in  the
dose of twenty grains to a  tea-spoonful in any common
vehicle; and where  the  use of a  warm  stomachic is re-
quired, it  is  no doubt a valuable medicine.  Ginger,  in
the state of powder,  taken in tea  or milk, warms and in-
vigorates the  stomach, without heating  the body  or in-
creasing the circulation; hence it  has  proved serviceable
in shortening  a  fit  of the  gout, and its  continued  use
has in  many instances  prevented its recurrence, probably
by keeping up an healthy digestion and counteracting  the
debilitating and other injurious effects of a too free use of
spirituous  liquors.  Ginger,  although  pungent  to  the
taste, allays  the irritation of  piles, and often speedily re-
moves them;  and in many  distressing affections  of  the
rectum or great gut, which  has been attributed to  stric-
ture  or cancerous contraction, it has  succeeded in remov-
ing,  probably  by producing  a  proper secretion  of mucus
from the internal surface of the intestines.  (See  Tincture
of Ginger and Chamomile, No. 7- and Piles.)

             No. 50. SENNA LEAVES.

  In domestic medicine senna leaves have been  long em- 
55
ployed as a purgative for children. Its flavour may be dis-
guised by infusing two draehms, with a little bohea tea, in
a quarter of a pint of boiling water,  and adding, when
poured oft* clear, a little brown sugar and milk; tht ill taste
of the senna will thus be so far covered, that children may
easily be induced to take it for tea—a few coriander or ca-
raway seeds  may be added, to correct its griping quality.
It is not so efficacious a purge as the basilic powder, which
has likewise the great advantage of removing slime and
destroying worms.
   To adults, senna is generally given in  conjunction with
the more active purges, as the Rochelle  or Epsom salt,
No. 2. (See Aperient Mixture, No. 62.)

                   No. 51.  MANNA

   Is chiefly used as an ingredient in the  aperient mixture
of senna  and  Rochelle salts.  (See  Aperient  Mixture,
No. 62.)
   Manna being very subject  to generate acidity and wind
in the bowels, is by no means so good a purgative medicine
for infants as rhubarb combined with magnesia, or the ba-
 silic powder.

               No. 52.  GUM ARABIC,

   Dissolved, from one to two ounces, in a pint of com-
mon or  barley  water,  and taken to the  extent of a tea-
 cupful,  frequently  furnishes  a very excellent  lubricating
 beverage, in cases of inflammation of  the kidneys, or
bladder,  bloody urine,  arising  from gravel  or  other
causes;  and when the natural mucus of the  intestines is
abraded, as in cases of dysentery and violent diarrhoea, or
looseness.  With the addition of  a drachm  of nitre,  it 
56
will prove very  serviceable in strangury,  and heat of
urine. (See Diuretic  Powder, No. 89.) In pleurisy  and
inflammation of the lungs, half an ounce of  gum  arabic,
the same quantity of liquorice root, and an ounce of pearl
barley, boiled in a pint and half of water to a pint, affords
a very useful pectoral drink and vehicle for the exhibition
of sudorific doses of the antimonial wine or ipecacuan
powder in such cases.

           No. 53.  PURIFIED NITRE,

   In the dose of six  or ten grains, dissolved in water,
Mindererus's spirit, or camphorated julap, possesses a
cooling quality, which quenches  thirst, abates  febrile
heat, and quiets the circulation. It is likewise serviceable
in strangury.  (See Gum Arabic, No. 52.)  In pleurisy
and  inflammation of the lungs, it is, as Dr. Cullen ob-
serves,  a very doubtful  remedy;  and  although it may
succeed in abating the constitutional fever, by provoking
cough,  it is  frequently productive  of much local mis-
chief.
  A solution of nitre in water, in the proportion  of half
a drachm to half a pint, has been much recommended as
a gargle for dispersing inflammation  in the  throat and
mouth;  but the gradual solution of a few grains  on  the
tongue, and swallowed with the saliva, generally answers
in such cases much  better.   (See Discutient Gargle,
No.  92.)

         No. 54.  CREAM OF TARTAR,

  Being a mild and cooling aperient, is deservedly much
employed as an alterative medicine for children,  in  in-
flammatory eruptions of the skin, and impurities  of  the 
57
blood and juices,  to which it is customary to add an
equal quantity of sulphur.
  The most convenient and pleasant method of giving
cream of tartar and sulphur to children, is in the form of
an electuary, made with a sufficient quantity of honey, of
which a tea-spoonful may be given everv morning with a
draught of sassafras tea; if it should not operate  suffi-
ciently on the bowels, half a drachm of jalap powder may
be added to an electuary of an ounce of  flowers  of sul-
phur, and the same quantity of cream of tartar.
  Cream of  tartar is much recommended by professor
Home as an active and efficacious purge in dropsical com-
plaints.  It rarely succeeds so well in such cases as the
basilic powder, or jalap, combined with calomel, which
produce copious discharges from the system, without in-
creasing its debility, the common effect of large doses of
cream of tartar.
  The acid beverage which has been much used in hot
climates under the name of Imperial Drink, to cool the
body and quench thirst, is made with cream of tartar in
the following manner:  Take of cream  of tartar  three
drachms, the rind of one lemon, pour on them  (in an
earthen  vessel) one quart of boiling water, and,  when
cold, add a sufficiency of white sugar, to render it agree-
able to the palate.
  Cream of tartar is likewise one of the articles used by
Dr. Hahnemann, to  make his celebrated  test for detect-
ing lead fraudulently added to Port wine, a practice soprer
valent among dealers in that article, and  attended with
such injurious  effects on the stomach  and bowels, that
the method of discovering the fraud cannot be too gene-
rally  known. This test is  prepared as follows:   Two
drachms of cream of tartar,  one  drachm of dry liver of
sulphur,  are  to  be shaken in a two-ounce phial,  filled
                         K 
58
 with distilled water, well corked; the phial is to be occa-
 sionally shaken, for about ten minutes; when the powder
 has subsided, decant  the clear liquor, and preserve it in
 a well-stoppfed bottle for  use: from sixteen  to twenty
 drops of this liquor are to be dropped into a small glass
 filled with the suspected wine; if the wine turn blackish
 or muddy, and deposit  a  dark-coloured sediment, the'
 adulteration with lead is proved, but not otherwise.
  Cream of tartar  in powder  is sometimes adulterated
 with sulphate of potash, which  may be detected by pour-
 ing on half an ounce of the suspected cream of tartar two
 or three ounces of pure water, shake the mixture frequent-
 ly,  and  let it  stand  one hour; the sulphate  of potash
 being more soluble than the cream of tartar, will be taken
 up, and may be known by the bitter taste of the solution,
 and by a precipitate, on adding  muriate of barytes, which
 will be insoluble in muriatic acid.

 No. 55. FLOWERS OR WASHED SULPHUR,

  In the dose of half a drachm to a drachm, operates as
 an aperient medicine, and by considerably increasing the
 insensible perspiration, has  proved of great  utility in
 cutaneous obstructions and foulness. It is given with ad-
vantage  in conjunction with cream of tartar.  (See No.
 54.)  From its gentle  purgative property, which it  effects
without griping or irritation, it has  proved particularly
serviceable in piles, combined with the lenitive electuary',
to which a little nitre may be added, if attended with
much heat in the part. (See Electuary for the Piles, No.
85; and  Aperient  Sulphureous Water, under the head
of Rochelle Salt, No. 2.)
  In chronic rheumatism  and  gouty affections,  a tea-
spoonful of flowers of sulphur,  with half the quantitv of 
59
 Jamaica ginger-powder, taken every morning in a glass
 of milk, has proved an excellent remedy.
   An ointment  made of one part of flowers of sulphur,
 and four of hog's lard, is a certain remedy for the itch,
 and much safer than mercury:  its internal use is,  how-
 ever, often necessary.  (See Itch Ointment, No. 107.)
   Sulphur, although a medicine of no considerable effica-
 cy, has the property of restraining the action of some of
 the most powerful kind. Mercury, by an admixture with
 it, is  almost rendered inert;  thus, iEthrop's mineral,
 which is composed of equal parts of flowers of sulphur
 and mercury, may be given to the  extent of sulphur it-
 self,  without manifesting any operation on the system
 than might be expected from the exhibition of sulphur
 alone; and, when mercury has exceeded  in operation,
 sulphur is employed to abate its violence. Even the cor-
 rosive poison,  arsenic, byT the addition of sulphur, be-
 comes almost innocent; but, for counteracting the effects
 of this poison, taken into the stomach, the liver of sul-
 phur will answer best on account of its solubility in water,
 and  its  more rapid action  on mineral poisons.  (See
 Treatment of Mineral Poisons.)
   The preparation of  sulphur,  termed from its colour,
 Milk of Sulphur, possesses no advantage over the flowers
 or washed sulphur, but  is often rendered less efficacious,
 and the peculiar properties of the sulphur much impair-
 ed by an admixture of lime to improve its colour.


           No. 56. COURT PLASTER

   Is a common application for recent superficial  cuts to
keep the edges in contact, and  defend them from the
action  of the atmospheric air,  &c. If the wound  be
deep,  or attended with  much irritation or contusion, the 
                         60
diachylon plaster, spread on leather or black silk, will
answer best. (See Tincture of Myrrh, No. 17, and Cuts.)

                   No. 57. LINT

   Is  very useful for  dressing  and  cleaning sores  or
ulcers; applied dry, it will destroy fungous flesh, and with
a little pressure stop the bleeding of superficial wounds.
and the punctures of leeches.

         No. 58. DIACHYLON PLASTER,

   Spread on leather, is a common and good application
for slight contusions, excoriations of the skin, chilblains,
corns, and fresh cuts.

              No. 59. GUM PLASTER

   Is  an useful application for promoting the suppuration
 of biles, and abscesses, spread on leather.

          No. 60. PREPARED NATRON

    Is soluble in water,  and in  the  proportion  of three
 drachms to a pint, forms a very efficacious alterative wa-
 ter;  and in  the  dose  of a wine-glassful, two or  three
 times a day, will prove highly beneficial to children af-
 fected with  scrophula,  rickets, scald-head, cutaneous
 eruptions, and acidity in the stomach.  See Rickets and
 Scrophula.) A weak  solution  of one ounce in five pints
 of water, saturated with fixed air by Nooth's machine, is
 sold under the  name  of Soda Water, and much recom-
 mended as a remedy  for stone  and gravel.  When this 
61
water disagrees with the stomach, Dr. Beddoes recom-
mends pills of dried soda and  Castile soap as a proper
substitute. (See Pills for Gravel and Stone, No. 81.)
The supercarbonate of natron is preferable to  the  dried
natron, two  drachms  of  which, dissolved in  a quart of
water, is preferable to the soda water, on account of the
fixed air  not being disengaged when exposed to the at-
mosphere.
   Prepared natron is  a medicine of great  power  in the
cure of chronic diseases; and  although slow, is a more
certain  alterative than the more active kind. Its con-
tinued use has, in many instances, succeeded in dis-
persing scirrhous  or  cancerous tumours,  and in curing
obstinate  cases of scrophula.  Mr. Parkinson, in a late
dissertation on Gout, recommends it as a certain remedy
for that disorder.  (See Gout.)   To  scrophulous and
ricketty children the solution of  it in water, as recom-
mended above, may be conveniently given in milk.  It
has, likewise, been found to increase obesity 
62
           A Collection of approved

      FAMILY PRESCRIPTIONS;

0r> Useful Compounds of the preceding Medicines.
INTERNAL  REMEDIES.
                 MIXTURES.

        No. 61. STOMACHIC MIXTURE.

 TAKE of the essential salt of bark, No. 24, one drachm,
         dissolve in half a pint of distilled water, then
         add
       Tincture  of Jamaica ginger and Chamomile,
         No. 7, two drachms.
'Two or  three table-spoonfuls to be taken three times a
 day.  If attended with an acidity in the stomach, a
 drachm  of  prepared natron, No. 60, or a drachm of
 magnesia, No. 1, may be added.

         No. 62. APERIENT MIXTURE.

   Take of senna leaves three drachms, infuse in a quar-
       ter of a pint of boiling water, for twenty minutes,
       then strain, and add
     Rochelle, or Epsom salt, No. 2, and
     Compound tincture of senna, No. 8, of each one
       ounce. 
63
 Three table-spoonfuls to be taken every two or three
 hours, till it operates.
   In cases of obstinate costiveness or colic, half an ounce
 of castor oil, No. 3, with the use of the laxative clyster,
 No. 97, should likewise be employed.

         No. 63. SUDORIFIC MIXTURE.

   Take of Mindererus's spirit, No. 10, three ounces,
       Ipecacuan powder, No. 23, ten grains,
       Pure water, five ounces,
       Essence  of  peppermint, No.  32, fifteen drops.
         Mix.
 Three table-spoonfuls to betaken every two hours, till it
produces the desired effect.
  All medicines administered to promote sensible or in-
sensible perspiration, should be assisted in theiroperation
by the plentiful use of tepid drinks, such as warm barley
water-gruel, tea, or the like.
  This is a good sudorific medicine  for inflammatory
fevers, pleurisy, and acute rheumatism; with the addi-
tion of forty drops of laudanum, it will be similar to Dr.
Dover's Sweating powder.

       No. &t.  CRETACEOUS MIXTURE.

  Take of the compound \cretaceous powder, No. 29,
        two drachms,
      Gum Arabic powder, No. 52, three drachms,
      Laudanum, No. 31,twen\y drops,
      Pure water, six ounces,
      Essence of Cinnamon, No. 33. forty drops..
      Dissolve the  gum arabic in an ounce of water,
        and nib with it the compound powder, then
        add the other ingredients. 
                        64
Two table-spoonfuls to be taken after every loose stool,
in cases of diarrhoea or dysentery.  (See Compound Cre-
taceous Powder, No. 29, and Diarrhoea.)

     No. 65. ANTI-HYSTERIC MIXTURE.

  Take of tincture of assafcetida, No. 19, four drachms,
       Sal Volatile, No. 13, two drachms,
       Camphorated julap,  No. 28, six ounces. Mix.
Two  table-spoonfuls to be taken  every  three or  four
hours, for hysteric or fainting fits, and spasmodic colic,
asthma, and St. Vitus's dance.

           No. 66. COUGH MIXTURE.

   Take of ipecacuan wine two drachms, or ipecacuan
         powder,  No.  23, ten grains,
       Gum Arabic powder, No. 52, four drachms,
       Laudanum, No. 31, twenty drops,
       Simple oxymel, two ounces,
       Pure water, six ounces.  Mix.
 Two table-spoonfuls to be taken every two hours for re-
 cent  coughs, pleurisy, and inflammation of the  lungs.
 (See Coughs.)

  No. 67. CAMPHORATED BARK MIXTURE.

   Take of essential salt of bark, No. 24, one drachm,
        Dissolve  in camphorated julap,  No. 28,  .six
         ounces,
       Sweet spirit of nitre, No. 15, two drachms.  Mix.
 Three table-spoonfuls to  be taken every  two or  three
 hours, in low infectious fevers, putrid  sore throat, raor-

                         ' vV' 
 tifications, and in all cates where the use of a strengthen-
 ing medicine is indicatec
   The  Bark  thus  associRd^acts,  as  M. Lassonne has
 observed, with more enerap anjd force,  whether it be for
 the purpose of curing fevefor■langrene;  and this obser-
 vation Dr. Cullen believes,' anq|experience has certainly
 proved  to be  well founded.  Dr; Cheston,  of Gloucester,
 speaks very highly of this combination, and asserts, that
 he has  found   it succeed after  the bark in  powder  and
 decoction has  disagreed with the patient.

        No. 68. ASTHMATIC MIXTURE.

   Take of paregoric elixir, No.  11, one ounce,
       Camphorated julap, No. 28, six ounces,
       Tincture of assafcetida, No. 19, half an ounce, or
       Vitriolic ether, No. 14, three drachms,
       Honey, half an ounce.  Mix.
Two  table-spoonfuls to be taken with ten grains (in two
pills)  of the squill pill, No. 45,  for  chronic  difficulty of
breathing and spasmodic asthma.  A tea-spoonful of
ether, No. 14, with fifteen drops of laudanum, No.  31,
taken  during  the  paroxysm  of  asthma, will afford con-
siderable relief. (See Asthma.)

           No. 69. GOUT MIXTURE.

  Take  of volatile tincture of  guaiacum,  No.  20,  six
 '■■V.      drachms,
      Camphorated  mixture, No. 28, six ounces,
      Tincture of rhubarb, No. 4, half an ounce,
      Honey, half an ounce;
  Rub  the  tincture of guaiacum with  the honey, in
                         L 
                         66.$
         the glass mortar, then^add the other articles by
         degrees.
Two table-spoonfuls to be taken every four or five hours.
(See Ether, No. 14, and  Gout.)

     No. 70. ANTI-SPASMODIC  MIXTURE.

  Take of ether, No.  14, half an ounce,
       Paregoric  elixir, No.  11, one ounce,
       Tincture of assafcetida, No. 19, half an ounce,
       Distilled water, six ounces, Mix, and keep well
         corked in a  cool place.
Two table-spoonfuls  to  be taken every three  or  four
hours, for the colic and other spasmodic affections.
  Such medicines should not be administered in cases of
colic till three  or  four evacuations have been procured
from the bowels, by means of castor oil, No. 3, or the
aperient mixture, No.  61, and clyster, No.  97, unless
attended with very acute pain in the bowels.

     No. 71. ANTI-RHEUMATIC  MIXTURE.

   Take of volatile  tincture  of guaiacum,  No.  20, one
          ounce,
        Honey, half an ounce,
        Camphorated julap, No. 28, six  ounces,
        Laudanum,  No. 31,  twenty drops,
        Rub  the tincture of guaiacum with the honey, in
          a glass mortar, and add the other articles by
          degrees.
 Two table-spoonfuls, four times a day,  for chronic  rheu-
 matism. The topical application  of  the volatile liniment,
 No. 103,  should accompany its use.  (See Rheumatism.) 
67
          No. 72. NERVOUS MIXTURE.

   Take of essential salt of bark, No.  24,  one drachm,
         dissolve in                          '
       Camphorated julap, No. 28,  six  ounces,  then
         add
       Spirit of sal volatile, No. 13, two drachms,
       Compound  spirit   of  lavender, No.  9, three
         drachms.
 Two table-spoonfuls to be taken three or four times  a
 day.  For  nervous irritability  and periodical  head-achs,
 this is a very valuable remedy.

        No. 73. ABSORBENT MIXTURE.

   Take of magnesia, No. 1, one drachm,
       Rhubarb powder,  No. 26, ten grains,
       Laudanum, No. 31, six drops,
       Pure water, two ounces,
       Essence of mint,  No. 32, four drops. Mix.
 A tea-spoonful to  be  given in case^| »"ipes, and flatu-
lency, affecting children;  if  attenfB^with  purging,  a
drachm of the compound cretaceous powder, No.  29,
may be added  in lieu of the magnesia and rhubarb. (See
Magnesia, No. 1.)

       No. 74. STIMULATING MIXTURE.

  Take of horse radish root, sliced,
       Mustard seed, bruised,
       Of  each one ounce; infuse  in a pint  of boiling*.
        water in a gentle  heat,  for twelve  hours, then
        strain and add
       Spirit of lavender, No. 9, two ounces. 
68
A wine-glassful to be taken three or four times a  day,
with thirty drops of the volatile tincture  of guaiacum,
No. 20, for paralytic complaints. The volatile  liniment,
No. 103, should be well rubbed on the parts affected by
means of flannel.
  The  mustard  poultice,  No.  Ill,  is an excellent sti-
mulating application, and  may  be applied  frequently, so
as to keep up a slight inflammation on  the skin.

  No. 75. FOR SCROPHULA, OR KING's EVIL.

  Take of essential salt of bark, No. 24,  one,,, drachm,
         Prepared natron, No. 60, two drachms,
         Dissolve in a pint of distilled water, then add
         Compound tincture of bark, No. 6, one  ounce.
Three table-spoonfuls  to  be  taken three  times a  day.
  This  mixture was often prescribed in scrophulous af-
fections, by  Dr. Symonds,  an able physician in Here-
ford, ?and Mr.  Cam, an eminent surgeon in Bath;  who
found it particularly serviceable  in correcting the scro-
phulous  diathesis. (See prepared Natron,  No.  60, and
Scrophula.)    ^Bfe

   ,,  No.  76. F(ffrHE HOOPING COUGH.

  Tkke of ipecacuan powder, No. 23, ten grains,
       Tincture of assafcetida, No. 19. one  drachm,
       Laudanum, No. 31, ten drops,
       Pure water, two ounces. Mix.
To a child of two years old, a tea-spoonful may  be given
every three hours, increasing ten drops for every addi-
tional year. (See Hooping Cough.)

             No. 77. TONIC MIXTURE.
Take of essential salt of bark, No. 24, two drachms, 
69
       Dissolve in twelve ounces of water, and add
       Compound tincture of bark,  No.  6, one  ounce,
       Sp. sal volatile, No. 13, two drachms.
Two or three  table-spoonfuls to be taken every three or
four hours, in cases of  relaxation  and weakness  of the
system.

           No. 78.  SALINE MIXTURE.

  Take of crystallised acid of lemon, or concrete acid of
         tartar, No. 22, one drachm, or
       Fresh lemon juice,  an ounce and half,
       Salt of wormwood,  No. 21, one drachm,
       White sugar, three drachms,
       Pure water,  twelve ounces,
       Essence of  peppermint,  No.  32, thirty  drops.
         Mix.
A  tea-cupful  to  be taken  frequently  in inflammatory
fevers and sore throat. (See  No. 21 and 22.)
                     PILLS.

          No. 79.  ASTHMATIC  PILLS.

  Take of squill pill, No. 45, two drachms, divide, into
         twenty-four pills.
Two to be taken twice or thrice a day, with the  asthma-
tic mixture, No. 68.  (See Asthma.) 
70
              No. 80. FOR DROPSY.

Take of squill pill, No. 45,  two drachms,
      prepared calomel, No. 34, ten grains,
      Gamboge powder, a scruple,
      Mix well together, and divide into thirty-six pills.'
Three to be taken  twice a day, with  a wine-glassful of
the tonic mixture, No. 77.  (See Dropsy.)

           No. 81. FOR THE  GRAVEL.

   Take  of  prepared  natron,  (that  has been  coarsely
        pounded, and exposed to a warm dry air, till it
        has crumbled into a white powder) two drachms,
      Spanish soap, two drachms, with
      Oil of Juniper; make into sixty pills,
Of which three are to be taken three times a day. When
the mephitic alkaline water (noticed under the  head of
Salt of wormwood, No. 21), disagrees with  the patient,
Dr.  Beddoes  recommends pills made of the prepared
natron.
No. 82. FOR FEMALE  DEBILITY AND RELAX-
                      ATION.

   Take of  essential salt of bark, No. 24, one drachm,
       Salt of steel, No. 25, a scruple,
       Gum olibanum, one  drachm, with simple syrup;
         make a mass, and divide into  thirty-six pills.
Three to be taken twice a day.  (See Whites.)

              No. 83. BILIOUS PILLS.

   Take of rhubarb, No 26, two  drachms, 
71
       Calomel, No. 34, half a drachm,
       Essence of peppermint, No. 32, ten drops;
       With a little syrup, make into thirty pills.
Three to be taken every third morning, with the solution
of the Epsom or Rochelle salt, recommended No. 2.


           No. 84. CATHARTIC PILLS.

  Take of the cathartic extract, No. 46, one drachm,
       Calomel, No. 34, fifteen grains;
       Mix, and form into fifteen pills.
Three to be taken for a dose, in obstinate constipation of
the bowels, and redundancy of bile.
               ELECTUARIES.

             No. 85. FOR THE PILES.

  Take of flowers of sulphur, No. 55, six drachms,
       Lenitive electuary,  No. 47, two ounces,
       Nitre powder, No. 53, one  drachm.
A tea-spoonful to be taken twice a day.  (See  Pile Oint-
ment, No. 105.)

        No. 86. FOR THE TAPE  WORM.
  Take of granulated tin, six ounces,
       Conserve of wormwood, three ounces. Mix. 
72
A large  tea-spoonful to be  taken every  morning, with
a draught of lime water. (See Basilic Powder, No. 36.)

           No. 87. COUGH LINCTUS.

  Take of spermaceti powder, two drachms,
       Oil of almonds, three drachms,
       Conserve of hips, half an ounce,
       Syrup  of wild poppies, six drachms,
       Ipecacuan powder, No.  23, ten grains,
       Diluted  vitriolic acid,  No. 18, ten  drops.  Mix.
A tea-spoonful to be taken every two or three hours, or
when the cough is troublesome.
POWDERS.
           No. 88. EMETIC POWDER.

  Take of ipecacuan powder, No. 23, a scruple,
      Emetic tartar, No. 35,  one grain,
      Mix. (See No. 23, and No. 35.)

          No. 89. DIURETIC POWDER.

  Take of purified nitre, No. 53, one drachm,
      Gum arabic, No. 52, three drachms. Mix.
And divide equally  into twelve papers—one to be taken
three times a day,  with a  draught of  barley water, for
strangury, heat of urine, and gravel. 
73
           No. 90. WORM POWDER.

  iSee basilic powder, No. 36.


           No. 91. TONIC POWDER.

  Take of Peruvian bark powder, No 48, one ounce,
       Jamaica ginger  powder, No. 49, one  drachm1.
        Mix.
And divide into twelve papers, one to be taken every, or
every other hour, in intermittent  fevers.  (See Nos. 24
and 48.)
                  GARGLES.


        No. 92. DISCUTIENT GARGLE.

  Take of purified nitre, No. 53, one drachm,
       Gum arabic, No. 53, three drachms,
Dissolved in half a pint of pure water.  To be used fre-
quently for inflammatory sore throat. (See No. 53.)

       No. 93.  ACIDULATED GARGLE.

  Take of red rose leaves, two drachms,
      Infuse in  a pint of boiling water till  cold, then
        strain, and add
                        M 
                       74

    Diluted vitriolic acid,  No. 18, thirty drops.  For
      inflammation of the tonsils and mouth.


       No. 94.  ASTRINGENT GARGLE.

  Take of oak bark, half an ounce*
      Boil in a  pint of water for a  quarter of an hour,
        then strain, and add
      Alum, two drachms,
      Red Port wine,  four ounces.
To be used every two or three hours, in cases of relaxa-
tion, or falling down of the soft palate.


        No. 95. DETERGENT GARGLE.

  Add to the acidulated  gargle- No. 93,
      Tincture of myrrh, No. 17, and
      Honey, of each  half an ounce.
For the malignant ulcerated sore throat, thrush and foul
ulcers in the mouth.
       LAVEMENS, or CLYSTERS.


       No. 96.  ANODYNE LAVEMENT.

  Take of starch jelly, half a pint,
      Laudanum, No. 31, forty drops.  Mix.
The whole to be injected by means of a pewter lavement 
75
 syringe* in cases of dysentery, or a violent purging, and
 pain in the bowels.


        No. 97. LAXATIVE  LAVEMENT.

   Take of Epsom salt, No. 2, two ounces.
 Dissolve in three quarters of a pint of warm gruel or
 broth, with fresh butter, or sweet oil, three ounces.

    No. 98. ANTI-SPASMODIC LAVEMENT.

   Take of tincture of assafcetida, No. 19, half an ounce,
        Laudanum, No. 31, forty drops,
        Gruel, half a pint. Mix.
 For spasmodic affections of the bowels.


        No. 99. NUTRIENT  LAVEMENT.

   Take of strong beef tea, twelve ounces,
       Thicken with hartshorn shavings, or
       Arrow root.
 In cases of extreme debility of the system, or when the
 patient cannot take food  by the mouth through an ob-
 struction in the throat, this affords considerable support
 to the system, and has preserved lives for many months.
   It should be thrown up with a flexible tube,  longer
 than the clyster pipes in common use, and  with a gentle
 pressure, insinuated high up  the rectum, so as to be ap-
 plied to as great a number of the mouths of the lacteals

  ' There are several sorts of this instrument: the one with a
curved  or flexible tube is very convenient, in enabling the pa-
tient to administer the lavement himself; for this purpose it is
 generally used in France. 
                        *6
as possible, for the purpose of being taken up to nourish
the  body.  If any irritation be produced, either from the
rude introduction of the tube, or  sudden distention of
the  intestine, the intention of the injection will be de-
feated  by  being hastily evacuated, and has often been
productive of serious  consequences, by  bringing  on a
diarrhoea, which  the reduced state of the patient could
ill bear-
EXTERNAL APPLICATIONS.
   LOTIONS AND  EMBROCATIONS.


             No. 100. EYE WATER.

  Take of Goulard's extract of lead, No. 30, ten drops,
      White wine vinegar, two drachms,
      Laudanum, No. 31, thirty drops,
      Distilled water, eight ounces. Mix.
For inflammation of the eye, or eye-lids.
  To be applied by means of folds of fine old linen, and
kept constantly moist and cold.
  If the inflammation run high, the use of the aperient
mixture, No. 62, a blister to  the nape of the neck, and
leeches to the eye-lids, are likewise necessary. (See in-
flammation of the eye.) 
77
     No. 101.  ASTRINGENT EYEWATER,

  Take of blue vitriol, one grain,
       Dissolve in four ounces of distilled water, and
         add
       Laudanum, No. 31, thirty drops.
To be  dropped within the eyelids  of the affected eye,
three or four times a day, for films or specks.

       No. 102.  DISCUTIENT LOTION.

   Take of camphor, No. 28, two drachms,
       Dissolve in rectified spirit of wine, four ounces,
         then add
       White wine vinegar, a pint.
For  strains, bruises, and inflammation, arising from ac-
cidents.
   It may be conveniently applied in the form of a poul-
tice, by adding a sufficient quantity of bran to make it of
a proper consistence, and pouring on the surface a fresh
quantity of the embrocation, when the bran gets dry, or
feels warm to the patient.

        No. 103. VOLATILE LINIMENT.

   Take spirit of hartshorn, No. 12, six drachms,
       Olive oil, an ounce; shake well together.
This is a good stimulating liniment for chronic rheuma-
tism, paralytic numbness, and diseased joints.

 No. 104. LINIMENTS FOR BURNS & SCALDS.

   Take of linseed oil and lime water, of each for ounces,
     Laudanum, No. 31, half an ounce. Mix.
 To  be applied by means of lint,  or soft old linen: or 
78
  Take of expressed juice of potatoes, half a pint,
      Spirit of wine, three ounces,
      Liquid laudanum, No. 31, half an ounce.  Mix.
To be applied as above.
  The efficacy of this liniment in recent scalds and burns,
has lately been much extolled by several able surgeons in
London.
               OINTMENTS.

          No. 105. PILE OINTMENT.

  Take of spermaceti ointment,  No. 41, one ounce,
      Goulard's extract of lead, No. 30, fifteen drops,
      Laudanum, No. 3, one  drachm. Mix well to-
        gether.
(See Electuary, No.  85.)

     No. 106. ALTERATIVE OINTMENT.

  Take of calomel, No. 34, one drachm,
      Spermaceti ointment,  No. 41, one ounce.  Mix
        well together.
For the scald head, to be rubbed over the  part affected
every morning. (See Scald Head.)

          No. 107. ITCH OINTMENT.

  Take of flowers  of sulphur, No. 55, two ounces,
      Hog's lard, four ounces,
      Oil of lavender, sixty drops. Mix. 
79
To be well rubbed on the parts affected every night, till
the eruption Qease to be troublesome.
  The internal exhibition of sulphur (See No. 55.) should
accompany the use of this ointment.
                  PLASTERS.

         No. 108.  PECTORAL PLASTER.

   Take of Burgundy pitch, two ounces,
       Blistering plaster, No. 40, three drachms,
       Camphor, No. 28, one drachm.
 Melt the Burgundy pitch over a gentle heat, and when
 cooling, add the  blistering salve, and lastly, the camphor
 in powder.  To be spread  on leather,  and applied over
 the breast bone, in case of asthma, difficulty of breathing,
 hooping cough, and consumption of the lungs.

           No.  109. CORN PLASTER.

   Take of hemlock plaster, with gum ammoniac, an
         ounce,
       Camphor, one  drachm.  Mix,  and spread  on
         thin leather.
  The  application of this plaster will not only alleviate
the pain attendant on corns, but often succeed in remo-
ving them.  (See  Corns.)

       No. 110.  DISCUTIENT PLASTER.

  Take of soap  and  hemlock  plasters, of each three
        ounces,
      Camphor, two drachms. 
8©
Melt the two plasters together, over a gentle heat, and
afterwards add the camphor in powder. To be spread on
leather, for rheumatic pains, indolent tumours, and chro-
nic enlargement of joints.
     CATAPLASMS or POULTICES.

        No. 111. MUSTARD POULTICE.

  Take of flour of mustard, one part,
       Oatmeal, three parts,
       Vinegar, a sufficient quantity to form a poultice.
Boil the oatmeal and vinegar together, and afterwards
sprinkle in the flour of mustard. To be applied warm.

       No.  112. EMOLLIENT POULTICE.

  Take of pure water, half a pint,
       Crumbs of  white  bread, a  sufficiency to form a
        poultice, then add
       Goulard's extract  of lead, No. 30, forty drops.
        Mix well together.
  Milk, so generally  employed for  making discutient
poultices, by soon turning sour, from the heat of the
body, becomes a bad external application for allaying in-
flammation.

     No. 113. STIMULATING POULTICE.
  Take of oatmeal, half a pound, 
81
       Strong beer grounds, a sufficiency to form a poul-
         tice, then add one drachm of
       Camphor,  dissolved in half an ounce of spirit of
         turpentine. Mix well together.
  To be applied warm, for the purpose of promoting the
maturation of indolent tumours, or biles.
  The  part should be frequently fomented, or rubbed
with the volatile liniment, No. 103.
N 
APPENDIX
               TO THE

FAMILY DISPENSATORY.
                  Prepared Charcoal.
THE properties of charcoal, as a dentifrice, were noticed
in the former  editions of this work,  under the title  of
Carbonic Powder; $ince which it has been very generally
employed for the purpose of cleaning the teeth.
  Well calcined  and levigated charcoal is, no doubt, the
most  innocent  and efficacious tooth-powder  we  are  ac-
quainted with,  being perfectly free from any chemical or
mechanical quality that can  possibly injure  the  enamel.
It gives the teeth a fine  healthy, white appearance, de-
stroys the offensive  effluvia arising from caries  of the
teeth, which is often so considerable  as to contaminate
the breath, and will not  only prevent that disease of the
enamel attributed to scurvy, but even arrest its progress
after  it has taken place; and it is  worthy of remark, that
people, who have suffered much from tooth-ach, have not
experienced the least relapse after  the use of this  powder.
It  is likewise  very efficacious in destroying unpleasant
taste  in the mouth, cleaning the tongue  in cases of putrid
fever,  sore throat,   and  indigestion.   Charcoal,   pre-
pared from the Areca nut, has been held in high estima-
tion  among the Indians; and  Dr. Lind,  late  physician  at 
83
 Bengal, states,  that by its use he  has preserved all his
 teeth perfectly sound, although now  arrived to the age of
 eighty: and several very respectable gentlemen, who have
 resided many years in the East Indies, have assured me that
 it is esteemed a great preserver of the teeth and a certain
 preventive against  the tooth-ach.  The charcoal of the
 Areca nut (generally  termed Betel Nut in this country)
 certainly  affords a much smoother  powder than that of
 wood; and the Editors of the Medical Observer assert it
 to be very superior as a dentifrice to common charcoal:
 and on the very respectable authority of Dr. Lind, we'can
 have no hesitation in  recommending its adoption  in pre-
 ference to that of wood, particularly as it may now be pro-
 cured with equal  facility; Messrs. Pressey and Barclay,
 foreign  merchants  in  Henrietta-street,  Covent-garden,
 having, by the request of Dr. Lind%nd several families,
 imported the Areca nut,* expressly for the  purpose of
 making the charcoal.
   The tincture  of Raiana root, mixed with a little wa-
 ter, forms a very excellent astringent lotion for the teeth
 and  should always accompany the  use of the prepared
 charcoal, or  any  other  dentifrice.  This  tincture,  from
 its peculiar astringent power, braces and strengthens the  <*
 gums, and its repeated use has often succeeded in fasten-
 ing loose  teeth.
   The tooth-powder, industriously advertised  under the
 name of  prepared charcoal,  is not  a  genuine charcoal
 powder,  but  a composition  of chalk,  or  burnt oyster-
 shells, which in no  respect resembles  charcoal as a den-

  *An interesting description of the areca nut, and the superior
 advantages of its charcoal, has lately been published, in a  pam-
phlet entitled " Dissertation on the Areca Nut," by Longman,
 Hurst, and Co. Paternoster-Row. 
                          84
tifrice, but must prove injurious  by abrading the enamel
of the  teeth.  This composition is of  a  gray colour,
whereas  true charcoal is perfectly black.  Tincture  of
myrrh is likewise daily advertised for  cleaning the  teeth,
under the ridiculous title of solution of charcoal.*

                 Of Indian Arrow Root.

   Indian arrow root has, of late years,  been cultivated in
considerable quantities in gardens  and provision-grounds
in the West  Indies.  The  following process for obtain-
ing the fine  powder, sold in  this country,  was commu-
nicated to me by a principal  planter for insertion in this
work: " The roots, when a  year old,  are dug up, well
washed in water, and beaten in a large wooden mortar to
a pulp. It is then tHrown into a large  tub of clean water,
well stirred,  and the fibrous part wrung out by the  hands
and  thrown  away.   The  milky  liquor  being  passed
through  a  lawn  sieve  or  coarse  cloth, is suffered to
settle, and the  clear water  drained off. The white  mass
left at the bottom  is again mixed with  clean water, and
strained; lastly, the  mass is  dried on sheets in the sun
for use."
   This powder  boiled in water  forms  a very  pleasant
transparent jelly, very superior to that of sago or tapeoca,

   * The  practice  of advertising  insignificant compositions, un-
der plausible fictitious names, has lately become so prevalent
as to require  the interference of the  legislature.  That man
can have no regard for his character  as a chemist, who can
descend  to advertise a solution of charcoal, which  a  person
with a very slight knowledge of chemistry  must be sensible
cannot be made, charcoal  being insoluble in any menstruum
whatever. 
85
and  is much  recommended by Dr.  Deriman and  Dr.
Clarke as a nutritious diet for children and invalids. The
jelly is made in the following manner: To a dessert-spoon-
ful of the powder, add as much cold water as will make it
into  a  paste, then pour  on half a  pint of boiling water;
stir it briskly, and boil it a few minutes, when it will be-
come a clear smooth jelly; a little  sugar and Sherry wine
may be  added for debilitated  patients, but for infants a
drop or two of essence  of caraway seeds or cinnamon is
preferable, wine being very liable  to become  acescent  in
the  stomachs  of infants,  and  thus  disagree  with the
bowels.  Fresh milk, either  alone  or diluted with  water,
may be substituted for the water. For very  debilitated
frames,  and especially  for  ricketty children, this jelly,
blended with an animal jelly, as that of the stag's horn,
affords a  more* nutritious  diet than  arrow root  alone,
which may  be done in the following  manner: Boil  half
an ounce of the true stag's  horn* shavings in a pint  of
water for fifteen minutes, then strain and add two dessert-
spoonfuls of arrow  root powder,  previously  well  mixed
with a tea-cupful of water, stir them briskly together and
boil them  for  a few minutes.  If the child  should   be
much  troubled with flatulency, two or  three drops  of
essence of caraway seeds, or a little grated nutmeg may
be added; but for adults port wine or brandy will answer
best.

   * Great care  should be taken that  the true stag's or harts-
horn shavings be employed, the calve's bone shavings, on ac-
count of being whiter and  much cheaper, being generally sold
for them; they do not impart, however,  so  strong or whole-
some a jelly as the stag's horn, being deprived of their mucilage
by the  process the hones undergo  for  the purpose of rendering
them white. 
86
   This combination  of animal  and vegetable jellies is
much recommended by Dr. Cadogan in his popular trea-
tise on the Management of Children,  who justly  attri-
butes  one-ninth of  their diseases to  being  fed  too
much  with  vegetables.  Such  an admixture is similar to
mother's milk, and very  superior to the milk of an  un-
healthy woman.
   Mr. Pressey was the first importer of this article,  and
Mr.  Godfrey,  by  frequently  advertising  it,  brought it
perhaps  first  into notice,  but through the  extravagant
high price of eight  shillings  a  pound, at which  it was
sold by  that  druggist,  its consumption has  been  con'-
fined  to opulent families. In order, however,  that no
class of invalids may be precluded  from its  use, I have
directed  it to  be retailed at four shillings a pound,  at the
Chemical and Medical  Hall, in Henrietta-street, Covent-
garden;  and as it is received  in the  original packages
from one of the most respectable planters in the  West
Indies, I can take upon  myself to  say,  that it is  per-
fectly genuine, and equal, if  not superior  in  quality, to
that sold at double the price.  It is, however, to be un-
derstood, that it is sold  at that reduced rate for charitable
purposes only.

           Directions for making Lime  Water.

   Take  of quick lime,  four ounces; pure  water,  six
pints.  Mix. Set them aside in a covered  earthen vessel
for one  hour, then  pour  oif the clear water, and keep
it  in bottles well corked for use.
   In weakness of the stomach, accompanied with aciditv
and flatulency, this water affords an excellent auxiliary
vehicle,  in the  quantity of a wine-glassful,  for  taking
the compound tincture of ginger and chamomile, No. 7,
or compound tinCure of bark, No. 6. 
87
  Lime water being capable of dissolving slime or mucus
in the stomach  and intestines, a redundancy of which
affords a nedus or lodgment for worms, will considerably
promote the  efficacy of the vermifuge medicine in the
dose  of a  tea-cupful two or  three  times  a day.  (See
Basilic  Powder.)  It has been  much celebrated as  an
alterative in scrophula and scurvy; in the latter case it has
not supported its character,  while  in the  former it has
still its  abettors.  The good effects produced by it in such
cases, are probably  to be attributed to its destroying acidity
in  the  stomach, and  promoting  digestion, for which,
however, it  is  inferior to the prepared  natron, No.  60.
The  addition of a table-spoonful of lime water  to half a
pint of milk, makes it sit easy on weak stomachs, and
prevents its curding in the stomach.

          Directions for  making Barley Water.

   Take of  pearl  barley, two ounces; water, five pints;
 first wash  the barley from the mealy matter that adheres
 to  it  with some  cold water, then boil it a little  with half
 a pint  of water to extract  the  colouring matter; throw
 this  away,  and put the barley  thus purified  into  five
 pounds of boiling  water, which is to be boiled  down to
 one half, and strained for use.
   The compound  barley  water,  an  excellent  pectoral
 drink, is made in the following manner:
   Take of barley water, prepared as above, two  pints; figs
 sliced, two ounces; liquorice root sliced and bruised,  half
 an ounce;  raisins stoned,  two ounces;  distilled water, one
 pint;  boil to  two pints,  and strain.
   These liquors afford a very excellent diluting beverage in
 cases of acute diseases, the former in inflammatory fevers,
 and  the latter  in  inflammatory attacks  of the  chest, a= 
                          88
pleurisy  and inflammation of the  lungs, recent coughs,
&c.  As  their efficacy depends  on their free use, it is of
consequence  that they should  be  prepared so as to  be
elegant and  agreeable to the palate; for this  reason  the
directions above have been inserted in the London Dis-
pensatory,  and the several circumstances  which contri-
bute to  their elegance  particularized,  as the  previous
washing of  the  barley  and extraction of its colouring
matter.
  The addition of a little lemon, or orange juice, or cur-
rant jelly, will take off the raw taste of the barley water, and
in most  instances promote its efficacy.  "  However trivial
medicines of this class may appear to be," observes that
eminent  physician Dr.  Andrew  Duncan, of Edinburgh,
" they are of greater importance  in  the cure of  acute
disease than many more elaborate preparations."

'The Means of fumigating  infected Chambers, &c.  and
     preventing the Progress of contagious Fevers.

  For the important purpose of purifying the  contami-
nated  air of the wards and rooms of patients afflicted
with contagious  fevers, various means have been employ-
ed from almost the earliest period of medicine.* The
vegetable acid vinegar  and different  mineral  acids have
of late years been  principally  employed,  and ample  ex-
perience has proved them to be the most efficacious.  Dr.
James  Johnstone,  of Worcester, in a  dissertation   on
the malignant epidemical fever which prevailed in Kid-
derminster   in  1756,  states  that he  found  vinegar,

  * Hippocrates, upwards of two thousand years ago, employ-
ed herbs and nitre boiled in vinegar in the chambers of the sickj
as appears from many parts of his works. 
                          so
 sprinkled about the room when the weather was warm,
 and boiled with myrrh or camphor, effectually to correct
 putrid effluvia. " The steams arising from the latter,"
 the Doctor asserts, " preserve the air from putrefaction,
 will insinuate themselves by the absorbent vessels of the
 lungs  into  the blood vessels, and greatly assist in im-
 peding the  progress of putrefaction in the fluids," &c.
 The camphorated acetic  acid, No. 38, evaporated  in a
 saucer over the blaze of a candle,  is not only more com-
 modious, but from the purity and pungency of the acid,
 will have a more  rapid action on  contagious or putrid
 effluvia.
   Citizen Guyton Morveau recommends the  muriatic
 acid gas for this purpose, which it appears proved parti-
 cularly efficacious in  correcting  the putrefaction of dead
 animal matter  in the church  of Dijon.  For fumigating
 uninhabited rooms, the  muriatic  acid gas will answer
 much better than the steams of vinegar or nitrous gas ;
 but as  it considerably irritates the  lungs, and is  unfit for
 respiration, it is not proper  for the apartments of the
 sick.  Dr.  Johnstone  also recommends this gas  in  a
 slight degree;  but on account of its being unpleasant for
 respiration, he preferred the employment of vinegar.*
   For disengaging the muriatic acid gas, citizen Guyton
 Morveau gives the following  directions:  " Put  into the

  * The evaporation of vinegar in the rooms of the sick was a
common practice in different parts of the kingdom long anterior
to Dr. Johnstone's publication ; but it appears  that the Doctor
was the first who employed the muriatic gas, although citizen
Guyton Morveau, in his publication, claims  the  priority of
the discovery. Citizen  Guyton,  however, did not use it till
the year 1773; whereas it is recommended by Dr. Johnstone
in his dissertation published in 1758.
                         O 
                         90
middle of the place which is to be purified, a chaffing
dish, on which a pan half filled with sand and ashes is to
be laid, on which a glass or earthen bowl, containing
common salt, is to be  placed;  the  sand being heated,
pour on the salt, at once, vitriolic acid, and retire imme-
diately—the windows and doors should be exactly shut.
The proportion for an high and  spacious ward, contain-
ing twenty beds; is,  of common  salt, nine  ounces six
drachms,  and of vitriolic  acid,  seven ounces seven
drachms (by weight), which quantity is to be augment-
ed or diminished according to the space of the room to
be purified."  Inhabited rooms  this author recommends
to be fumigated with the oxygenated muriatic acid, which
 is made bv adding black oxide of manganese in the fol-
 lowing proportion:  Take of common salt, two parts;
 black oxide of  manganese, one  part;  vitriolic acid, two
 parts:  after rubbing the salt and manganese together in
 a glass mortar, place the  mixture  in an open glass vessel
 in the infected  chamber,  and pour on it the vitriolic acid.
 The fumes are immediately exhaled and diffused through
 the atmosphere of the room, and effectually destroys pu-
 trid particles and contagion.
   The nitrous acid  gas is  preferred by Dr. James Car-
 michael Smyth, who directs it  to be used in the follow-  .
 ing manner: u Take fine  sand  and heat  it in an iron
 ladle or shovel; when made very hot, fill with  it an
 earthen quart pipkin, in  which immerse a common tea-
  cup containing about half an ounce of vitriolic acid, to
  which, when it has acquired a small degree of heat, gra-
  dually add the same quantity of purified nitre in powder;
   stir the mixture with a slip of glass until the vapour arise
   in considerable quantity.  The pipkin is then  to be car-
   ried about  the room  (the doors, windows, &c.  being 
91
closely shut), occasionally putting it under the bed and
in every corner and place where any foul air may be sup-
posed to lodge:  the fumigation to be  continued till the
room be filled with the vapour, which will appear like a
thick haze."
  In very malignant cases it should be repeated twice a
day; but otherwise, once will be sufficient, which should
be regularly continued till the contagion is destroyed. If
the  vapour irritate the lungs, so as to excite much cough,
fresh air  should be  admitted, by opening the doors or
windows of the room.  After a few repetitions, this effect
will not,  however, be produced;  but, on the  contrary,
will be found  agreeable and refreshing.  No  wood  or
metal should  be employed in  the  process,  otherwise
dangerous and offensive vapours will be disengaged with
the  nitrous. Proper attention should likewise be paid to
cleanliness in the apartments, clothes, and bedding.
  The nitrous vapours thus disengaged, not only destroy
the  subtile infectious particles arising from putrid bodies
or from persons labouring under contagious fevers as effec-
tually as the muriatic gas recommended by citizen Guyton
Morveau, but  also communicates to  the atmosphere a
vital principle,  which, by respiration,  enters the system
in  such  quantity  as  evidently to invigorate  the  vital
powers, and cheer the mind, and thus proves more bene-
ficial than medical men are generally aware  of.  The
oxygenated muriatic acid of citizen Guyton has a similar
effect, and is preferred by Mr. Cruickshank both on ac-
count of its being more efficacious and pleasant to respire.
Dr. Smyth was of opinion that his discovery  was of so
great a national importance as to  merit a  remuneration
from his country, and parliament accordingly voted him
a compensation of five thousand pounds; notwithstand- 
92
ing,  however, it does not appear  it was  employed by-
government to check the progress of the malignant fever
that  lately  prevailed  at  Gibraltar!* Citizen  Guyton
Morveau claims the priority of the  discovery, and the
experiments at Dijon were certainly  made long anterior
to Dr. Smyth's publication.
  In order more effectually to resist the effects and check
the progress of infection,  the  following rules, suggested
by Dr. Disney Alexander, should be particularly enforced.
Similar instructions are given, and  much recommended
by the late learned and ingenious  author  of " Medical
Ethics," Dr. Percival, and by Dr. Thorp, physician to
the infirmary at  Leeds.
   1st, None should be permitted to visit patients labour-
ing under infectious disorders,  but those who are impel-
led by the calls of duty, affection, or necessary business.
  2dly, None should be admitted fasting or before break-
fast. The afternoon is the fittest part of the day for visits
of this kind; or if they must be paid in the morning, a
glass or two of Port or Madeira, or a dose of compound
tincture of bark  ought previously to be drank.  A hand-
kerchief sprinkled with camphorated acetic acid, held
occasionally to the nose,  is also an useful precaution to
those who  visit infected persons. If smoking be  any
where, or on any occasion useful, it  may possibly be of
some service in such cases as these.
  3dly, The utmost attention  to  cleanliness  in every
thing relative to  the patient, should be  observed. This
is particularly requisite in camps, jails, hospitals,  &c.

  * The frequent explosion of about a tea-spoonful of gunpow-
der,  in different  parts of the chamber answering  the same
purposes. 
93
 The  frequent change  of linen, and  the  immediate re-
 moval of every thingofan offensive nature are absolutely
 necessary.
   4thly, The free admission of pure atmospheric air* is
 indispensably  requisite. The absolute necessity for this
 caution is strikingly evinced by what is, recorded to have
 happened at Philadelphia  in the yellow  fever of 1793.
 Of 2000 persons who were  removed to tents erected in
 the fields, only 17 died in 25 days; whilst out of an equal
 number in the city  178 perished.
   5thly,  Attention ought to be paid  to the temperature
 of the air.  Extreme heat might increase the tendency to
 putrefaction which  exists in a greater or  less  degree  in
 most infectious disorders.   Extreme cold on the other
 hand is not only very ungrateful to the  feelings of the
 sick, but by its debilitating property may  increase  the
 virulence and promote the spread of contagion.
   6thly, When a person dies from an infectious distem-
 per, the body  should be  removed,  where this can be,

   * The atmosphere  is not, as was formerly supposed, a  sim-
 ple elementary body, but is found to consist  of two very dif-
 ferent kinds of air, the one eminently conducive to the purposes
 of life, named oxygen; the other, which is nearly three-fourtfi6
 of the whole, destructive of life, and called azote.
   On a due admixture of these two component parts of the at-
 mosphere, depends not only respiration but  the  colour and
 circulation of the blood, and  all the phenomena of life.  And
 since in these cases the air is always more or less contaminated
 with the breath, excrements and perspiration of the patient,
 the oxigenous or pure part of it being diminished, in proportion
 as the azotic or irrespirable part is increased; in order to remedy
this deffect, the apartments of  the sick are artificially supplied
 with this vital  or oxygenous principle  by the means already
suggested. 
94
 accomplished, as soon as possible  into a room  appro-
 priated to that use: it should be then wrapped in a pitch-
 ed cloth, and the friends of the deceased should be desired
 to proceed to  interment, as early  as  is consistent  with
 propriety.  Early burial  was so  much enforced  during
 the plague at Marseilles, that Dr. Arbuthnot, in his trea-
 tise on air, asserts  that it was clearly  ascertained many
 were buried alive; a body  apparently  dead  should not,
 therefore,  be  too  hastily  consigned  to  the grave, the
 natural heat and pure  air of the earth being very powerful
 agents  in restoring the  vital functions, in case of their
 suspension.
   7thly, As  infection is liable to  be  communicated by
 clothes which have  been worn by the  sick,  such clothes
 ought never to be used, until they have been well wash-
 ed, and thoroughly fumigated.
   8thly, After the recovery or decease of a person labour-
 ing under an  infectious fever, the roof or walls  of the
 apartment  in which he  lay ought  to  be white-washed,
the windows  kept  open during the day,  and flowers or
herbs inverted in water, placed in such parts of the room,
 as are more immediately exposed  to  the action  of the
 sun's rays upon them.*

  * Whilst Dr. Priestley was engaged in a series of experiments
to enable him to purify  contaminated  air, he discovered that
vegetables answered this purpose most  effectually. The expe-
riment by which he illustrates the fact is this: Having rendered
a quantity of air very noxious by mice breathing  and dying in
 it, he divided it into  two receivers  inverted  in  water, intro-
 ducing a sprig of mint into one of them, and keeping  the other
 receiver with the contaminated air  in  it  alone. He found
 about eight or nine days after, that the  air  of the receiver into
 which he had introduced the sprig of mint, had become re- 
95
   9thly, The establishment of fever wards, or houses of
 recovery for the reception of persons attacked with infec-
 tious fevers,  is an institution which  reflects immortal
 honour on its founders; and is better adapted to check
 the ravages and prevent the recurrence of these maladies
 in large towns,  than perhaps  any other  plan which  has
 hitherto been devised.
   Many very respectable practitioners in the West Indies
 as well as on the  continent of America, &c. deny that
 the fevers which,  at times, have proved so destructive in
 those places, were contagious; and Dr. John Vaughan,
 after investigating the cause and nature of the fever which
 prevailed with such violence in the  borough of Wilming-
 ton, in North America, in the year 1802, concludes, con-
 trary to the general opinion, that the disease  was  not  im-
 ported, that  it was  not contagious,  but that  it depended
 upon some noxious state of the atmosphere, and that this
 noxious state was owing to certain  putrid effluvia, which
 formed a constituent part of heavy fogs, which used to
 collect at  that  time in the evening, and be suspended
 over the flats during the nights."  Hence we find that

 spirable; for a mouse lived very  well in this, but died imme-
 diately  upon being introduced into the  other receiver, contain-
 ing the contaminated air alone.  All strongly scented objects
 vitiate the air; and  it has been satisfactorily proved by the ex-
periments of Ingenhouz, Priestley, and  others, that most plants
emit during the night a large proportion of azotic or irrespirable
gas, we understand why it is that flowers suffered  to remain all
night in a bed-room, sometimes prove very deleterious in their
effects.  Nor is it less unhealthy  to sleep in a room  where a
quantity of green fruit is constantly kept, as from its fragrance
a portion of inflammable matter transpires which soon  impreg-
nates the air. 
96
 fevers, which are attributed to contagion, will make an
 equally rapid progress, when guards have been placed, as
 they have in Russia, on high walls built purposely to pre-
 vent communication; and some instances have happened
 of a great part of Europe, and some of Asia, Africa, and
 America, suffering from similar complaints, nearly at the
 same time, from a very widely spreading noxious  efflu-
 vium in the air.  Dr. Desgenette, physician to the French
 army in Egypt, and M. Assalini and  Larray, from many
 bold experiments, coincide in opinion that  even the
 plague is not contagious.
   The partial appearance of this  fever and  its frequent
 occurrence at the same places, have induced some practi-
 tioners  to suppose  that it was  produced by noxious va-
 pours or  putrid  miasmata  disengaged from the earth.
 The French historian  Mezeray, as quoted by the Hon.
 Mr. Boyle, states, " that a vapour broke out of the earth
 in the kingdom of Cathay, that caused fevers more fatal
 and universal than  ever before known, and that it con-
 sumed every thing before it, even to the trees and stones."
 Hoffman, Sennertus, and many of the most respectable
 ancient physicians, have  very justly  observed, that the
fiear* of contagion, under a bad  constitution ofi the air,
 has  been more productive of disease than the air itself,
 and it is to be feared has been the cause of many unfor-
 tunate sufferers being lost for want of proper  attention,
 and some even being buried alive.
   Whatever the original source or nature of the infection
 maybe, after it enters the circulation, which is probably by
 respiration, it evidently generates a quantity in the system


   *  A remarkable  instance of  the influence of  the depressing
 passions in this respect  has been lately noticed by Captain 
9-7
(the same  as other specific poisons), and passes off by
perspiration,  so as  to  contaminate the  air;  the  means,
therefore, suggested, must considerably tend not only to
prevent its spreading, but also to diminish  its malignity.
(See Typhus Fever.)

The Means  ofi counteracting  the effects of  the  different
              Poisons on the Human Body.

   Poisons may be considered  under three different heads,
viz. Mineral, Vegetable and Animal.

          OF  THE MINERAL POISONS
   Arsenic  is  the most powerful, and, therefore, for the
purpose of suicide, generally  resorted to.  The solutions
of mercury,  copper, lead, and  antimony in  different acids,
are likewise  in no great quantity active and  virulent poi-
sons.  To  counteract the effects of any  of  the  mineral
poisons taken into the stomach, the liver of sulphur is the
most efficacious medicine, which may be administered in
the  following  manner:  dissolve a large  table-spoonful of
the liver of sulphur in a pint of warm water, and give the
patient  two  table-spoonfuls  of the solution as soon as
possible, and  repeat  it every ten  or fifteen minutes for

Philip Beaver,  in a  work entitled "African Memoranda;5'
this intelligent author, speaking  of the disease which prevailed
among his men at Bulama, observes, " It  is melancholy, no
doubt, but many have absolutely died  through fear.  More
courage  and  greater exertions (he observes),  I  firmly believe,
would have saved  many of them ; but a lowness of spirits, a
general despondency, seems to  possess  every  body.  When
taken  ill, they lie  down, and say they  know they shall  die;
and what is very remarkable, I  have never yet  known one re-
cover  after having, in such a manner, given himself up."
                            P 
98
three or four doses  or as occasion may require.  If this
preparation cannot  be readily procured,  a tea-spoonful of
sulphur, with eight or ten grains of salt of wormwood
will afford the best substitute.
  The liver of sulphur, or salt of wormwood, by uniting
with  the acid of corrosive sublimate of  mercury and the
metallic  salts,  decomposes  them,  and   precipitates  the
metal, in the form of  a  calx, nearly or  wholly inactive.
It will likewise be  proper to dilute plentifully with  warm
water, and to  excite vomiting,  by giving, with the first
dose  of either of the above medicines,  or  as  soon after
as possible, two  scruples of ipecacuan  powder, and  to
hasten its operation by irritating the fauces with the fin-
ger or  a feather.  Oil and  milk may likewise  be given
with a view to blunt its acrimony.  If neither liver of sul-
phur, nor salt  of wormwood can be readily procured, ten
grains of pearl or pot-ash may be  employed,  or half a
table spoonful of soap  lees  given in a little water, or a
strong solution of soap  in water.
  In all case's of mineral poisons* this method should be
adopted. If  the  poison should be arsenic, Newman ob-
serves, the alkaline medicines, as the liver of sulphur, salt
of wormwood, or  pearl-ash, will very plentifully dissolve
it, and hence it will be the better discharged by emetics.
  The most powerful medicine we are acquainted with for
counteracting the  effects of arsenic and  corrosive subli-
mate of mercury,  is  the liver  of sulphur, given in a dose
of twenty grains, dissolved in a glass of water, and repeated

  * When  the  nature of  the poison cannot be  ascertained,
which is too often the case, it will be adviseable to treat it as
belonging to the mineral class in order to avoid  a Joss of time,
which,  with emetic of  ipecacuan, will also succeed in ex-
pelling it should it be of  the vegetable kingdoju. 
99
 in a quarter of an hour, or in the manner above-mentioned.
 The alkali of this medicine decomposes the saline prepa-
 ration of metals; and the sulphurous part restrains their
 power, and  even so  remarkably abates the virulence  of
 arsenic,  as,   when  intimately  combined,  to   render  it
 nearly inert.  (See Flowers of Sulphur, No. 55.)
   It is strange such powerful medicines, in counteracting
 the effects of mineral poisons, should not be  noticed by
 Tissot,  Buchan, and others,  who  have written on the
 subject,  professedly  for public  instruction.  Dr.  Buchan
 merely recommends oily drink to be taken, and observes
 if they  fail  to produce vomiting,   " half a  drachm  of
 powder of ipecacuan  must be given, or a few spoonfuls
 of the oxymel, or vinegar of squills  may be mixed with
 the water he drinks." The two  latter articles, no medi-
 cal man, at  least of any chemical knowledge,  would
 think of giving,  being more likely  to increase  than di-
 minish the  virulence  of the poison.  " With  respect to
 mineral poisons," says Dr. Houlston, " there is a rational
 ground for hope, as by  proper management they may be
 decomposed,  their effects counteracted, and  the danger
 resulting from their exhibition guarded against and pre-
 vented ;  but the

              VEGETABLE POISONS

  Do not admit of such  a remedy, there being no certain'
means  of counteracting  their effects.  Their speedy eva-
cuation  should, therefore,  be  attempted  by  the most
powerful  emetics; as ten or fifteen grains of white vitriol,
or four grains of emetic tartar,  No.  35, with thirty  of
ipecacuan powder, No. 23, in a little water.
  These  means should be employed  as early as possible,
before  the poison has  destroyed the  sensibility of the 
100
stomach, and  produced  such a degree  of  spasm  as to
render vomiting impracticable, the  certain  consequence
of their continued action on the  stomach; their evacua-
tion cannot then be  effected,  and  their continuance is
inevitably fatal. If an emetic medicine  cannot be readily
procured, attempts should be made to excite  vomiting by
introducing a finger  or  a feather into  the  mouth,  and
tickling the fauces  till the contents  of the  stomach are
thrown up, which  will  often  prove as  effectual.   The
vegetable acids being considered by many  practitioners
antinarcotics, may likewise be administered; vinegar be-
ing the most handy  and as efficacious as  any, may be
given  in  the quantity  of three  or  four table-spoonfuls.
The  patient  should  likewise  be  made  to  drink  plen-
tifully of  a  strong infusion of coffee, which  some ex-
perienced  practitioners assert to  be the most efficacious
remedy that can be employed for the  restoration  of the
sensibility of the stomach, and the removal of the spasms
induced by vegetable poisons.
   If the  poison be an  over-dose  of opium, the patient
should be prevented  going to  sleep  by shaking him, and
 applying  some  pungent  smelling  salts  to   the  nostrils,
 while the above means  are  employed  for its evacuation.
 The propriety of bleeding, recommended by Dr. Buchan
 in such cases, is much  to be doubted: no advantage can
 be derived from such a practice, but as tending to di-
 minish the powers of life—it would probably accelerate
 its fatal effects.

                 ANIMAL POISONS.

    The effects of poison  introduced by the sting of insects
 may  be  prevented,  by applying,  immediately, a  little
 vinegar and spirit of wine, by  means of  some folds  of
 old linen. 
101
  From the bite of a mad animal arises not only the most
formidable wound, but  also  the most  dreadful  disease
known  in  this country, termed  Hydrophobia;*  for  the
prevention and cure of which  a great variety of nostrums
have been held forth to  the public; but there is no satis-
factory  instance of any  of them proving useful;  and no
means yet suggested can be depended on, but the com-
plete  removal of the injured  part  by the knife or actual
cautery. In this all medical writers on the  subject agree,
with  this  difference, that  some  contend it can  only be
effectual when it is done soon after the accident;  while
others,  as Dr. Cullen, &c. are of opinion that the poison-
ous matter  is not immediately absorbed into the  system,
and  think  the  measures for destroying the part  may be
practised with success many days after the bite.
  Mr. Hugh Munro and Mr. Benjamin Bell recommend
the removal of the  part  as soon as  possible  after the acci-
dent; but  observe, if it have been neglected,  it  should
be attempted at any time before  symptoms of hydropho-
bia take  place,  as  there  are instances  of no alarming
symptom occuring for  several weeks  after the  bite  has
been  received.
  Sea bathing has been much recommended in  all  ages
as a preventive; and lately mercury by many practitioners;
but there are no well attested cases in which  they have
been attended with advantage, so that little  or no  depend-
ance  can  be placed in  them.  The complete cutting  out
of the part to which the teeth have been  applied is  un-

  * Dr  Berguillon, a French physician of repute, has lately
published a treatise, in which  he  maintains,  with great in-
genuity, that this  disease  is produced solely by the power of
imagination, without the  intervention of any distinct  material
poison! 
                          102
questionably the most to be  relied on: and as hydropho-
bia,  when once it has taken place,  is  absolutely an  in-
curable malady, and the period for absorption uncertain,
the sooner the excision of the  part  is accomplished the
greater will be' the chance of success.  Till the operation
can be done, the part should be constantly washed; and
even  after its removal, a  discharge should  be  kept up
from the surface of the wound by stimulating applications
of basilicon ointment,  with  red  precipitate  of mercury,
or spirit  of turpentine.
  The  preventive medicine, so  much  extolled by Dr.
Mead, is composed of ash-coloured liverwort, powdered,
half  an  ounce; black pepper, powdered, quarter  of an
ounce; to be mixed well  together, and  divided  into four
doses, one to be taken  every morning fasting  for four
mornings successively,- in  half  an  English pint  of cow's
milk, warm.
  "  After these four doses  are  taken (the Doctor  ob-
serves),  the patient must go  into the cold bath, or a cold
spring or river, every  morning fasting, for a month; he
must be  dipped all over, but not  stay in (with  his head
above water)  longer  than  half a minute, if the  water be
very  cold; after this  he  must go  in  for three times a
week, or a fortnight  longer.  The person must be  bled
before he uses the medicine."
   In the space of thirty years, it appears the Doctor had
an opportunity of giving this  plan a trial no less than one
thousand times,  with (as  he observes) uniform success!!
No  experienced practitioner, however, I am persuaded,
will  attribute to it any antidotal power whatever, or think
of employing it to the exclusion of more rational remedies,
of these the  most plausable  is mercury, which  must be
used both internally and externally, so as to excite  saliva-
tion  as  soon  as  possible.  A  drachm  of  the  strongest 
103
 mercurial ointment at least, should  be rubbed in the in-
 side of the thighs, and the part surrounding  the  wound,
 two or three times  a day, and  a pill,  composed  of three
 grains of calomel,  with a grain of opium taken  twice a
 day.  If  symptoms of hydrophobia* should occur,  musk
 should be immediately administered in large doses, if pos-
 sible by the mouth,  or otherwise by way of lavement,
 and the  body placed in a mercurial vapour-bath till the
 system be affected.

 On  suspended  Animation,  and the  means of recovering
                    drowned Persons.

   The  suspension  of the  vital powers, produced by im-
 mersion in water, called drowning, and that  by  strangu-
 lation and suffocation by noxious vapoursf and lightning,

   * It is thus named, because the  person dreads the sight or
 falling of water.
   t  The many unhappy incidents that occur on the opening
 of subterraneous  places,  such as tombs, cellars, vaults, &c.
 are produced by the quantity of fixed air contained in them,
 which, being unfit for respiration, occasions immediate  suffo-
 cation. This air  is  considerably  heavier than common air,
 hence it  occupies the lowest  situations, such as wells, caverns,
 8cc. From  the famous  lake  of Averno,  where Virgil  placed
 the entrance of hell, this  air is exhaled in so large a quantity,
 that birds cannot  fly over it with impunity.  Before a person
 enters a vault or cell that has been for some time  shut up, or
 descends  a well, the experiment should be made whether a can-
 dle will burn  in the atmosphere of the place; for  ignition and
 respiration are so very similar, that the same air that will sup-
 port the one will also the other. The best method of render-
ing the air of such places fit for  respiration, is to explode in 
104
are very similar, and require the same resuscitative means.
As in poisons, so in cases of suspended animation, what is
necessary to be done should be done quickly; therefore, on
the first alarm of any person being drowned or suffocated,
while the  body is searching for, or conveying to the near-
est house, the following articles should be  got ready, viz.
warm  blankets,  flannels, a  large furnace of warm water,
heated bricks, a pair  of small bellows, warming pan, sal
volatile, clyster pipes, and  an electrifying  machine. In
conveying the  body  to the  house the head and chest
should be placed rather in a reclining position, that in case
any water should have got into the  lungs  it may run out
at the  mouth, which  the motion in carrying the body will
accelerate. The  head, however, should not be kept much
lower than the  shoulders, or even in a reclining position
many  minutes,  otherwise the blood will gravitate in such
quantity into the vessels of the  head, as very considerably
to impede the restoration of life by compressing the brain.
   The body being placed on warm blankets, in a spacious
room  with a good fire, and only five or  six attendants,
the first attempt*  should be to restore heat and the  cir-

it some gun-powder in proportion to the size  of the place; for
this purpose  the fire-works, named Bomb and Cracker, will
answer best, as they may be thrown to  the bottom of the well
or end of the vault,  &c. To  purify the  air of the vaults  at
 Dijon,  M. Morveau threw  in bottles  of  muriatic  acid with
 such force that the bottles might be broke and the acid spilt in
 the place; but this experiment was made to  correct putrid
 effluvia, and not fixed air. If nitric acid were employed in the
 same  manner, it would not only destroy putrid effluvia, but
 render fixed air  fit for respiration by disengaging a quantity of
 vital air.
    * If the suspension be occasioned by noxious air taken into 
105
 culation  of the  blood by friction,  with warm flanneis
 or bladders, filled with warm water, to the  pit of the
 stomach, and soles of the feet.  Ether and other  spirits,
 recommended  by the Humane Society, for external ap-
 plications, are very hurtful; the degree of cold produced
 by their evaporation* must considerably tend to frustrate
 the intention of friction.
   The attempt to restore the important functions of the
 lungs,t should be made by forcing a quantity of air from
 a bellows through one nostril ;J the  other and the mouth

 the lungs, the first object must be its expulsion, by compressing
 the ribs and bowels so as to press up  the diaphragm.  The ak
 will be thus in a great measure expelled, and on removing the
 pressure, the atmospheric air will rush  in, when the heart ge-
 nerally begins to flutter, and life gradually  eturns.
   * It is a well  known fact, that an  animal may be frozen to
 death by sprinkling ether over the surface of the body, its eva-
 poration carrying off* the vital heat.
  t Dr. Cullen, in a letter to Lord Cathcart on the subject of.
 suspended animation, says, that very often  the water does not
 enter the lungs in  any material quantity, and that death ensues
 in consequence of the stoppage of respiration, and the conse-
 quent ceasing of the action of the heart, whereby the body looses
 its heat and vital principle.  Mr. Hunter, in  the Philosophical
 Transactions,  vol.  xlvi. advances the  same theory, and as-
 serts that  the  restoration  of breathing  is all that is necessary
 to restore the heart's motion.
  { During this process, it  will be proper to draw  the end of
 the tongue a little way out of the mouth, in order to elevate the^
epiglottis, which, at the same time, by opening the larynx, will
much facilitate the admission of  air  into the  lungs, which
otherwise  would more  readily pass down  the gullet into  the
stomach, the distention of which, forcing up the diaphragm, will
in some degree, elevate the chest, and  give the appearance of
                            Q 
                         106
being kept closely shut,  an assistant should gently press
down the ribs, as soon as their elevation indicates a dis-
tention of the lungs, and  this alternate inflation and com-
pression should be continued some time, so as to  imitate
natural, respiration; the  friction of the body, &c. being
still continued by the other assistants.
  The action of the  heart should be excited by passing
through its region gentle electric shocks, from the left to
the right side, and from  the front  to the back alternately.
  The  bowels  should be  fomented and  stimulated,  by
throwing up a quantity of warm water, with a handful of
common salt  dissolved  in it, which may be done with a
clyster-pipe and bladder. The injection of tobacco fumes
up the  fundament, recommended by  the  Humane So-
ciety, from the narcotic quality of the herb, is more like-
ly to prove hurtful than otherwise. It is strange an herb,
noted for its extraordinary effects in diminishing the vital
functions, should be proposed as a stimulant  in cases of
their suspension.*
  A slight agitation of the body, every  six  or ten mi-
nutes, will act as a great  auxiliary to those means.
  Bleeding, having a tendency to weaken the force of the
circulation more than stimulate it, should  be  employed
only when deemed necessary by a medical practitioner.
When, however, there is an evident congestion of blood
in the vessels  of the  head, which is generally produced

the air having entered the lungs, and thus deceive a person  un-
acquainted with anatomy. Great care, however, should  be taken
that the  air does not escape through the mouth on account of
the drawing forward of the  tongue.
  * The fumes of tobacco  thus administered in cases  of spas-
modic affections of the bowels and strangulated hernia, I have
known in many instances to destroy life in a few minutes. 
.  107
by  strangling, the opening of the temporal  artery  will
prove very beneficial, and should not be delayed.
  The brain and nervous system may be stimulated by
applying, electric sparks to the head and the surface of the
body. On the appearance of any  symptom of returning
life, a tea-spoonful of sal volatile, or a table-spoonful
of warm brandy, should be got into the stomach at once,
or by small quantities, frequently repeated.
  If, after a vigorous  employment of these  means  for
the course of two hours, there should be no symptom of
returning life, and any brewhouse, or warm bath can be
obtained, the body should be carefully conveyed to such
a place,  and remain in the bath, or surrounded with
warm grains or  ashes* for three or four hours: but if not,
the plan proposed should be persisted in for an hour or
two longer, there being instances of lives having-been re-
stored after three  hours unremitting perseverance.
  I was, some time since, successful  in restoring a poor
woman, who had  unfortunately  slipped into the Thames
off  a plank, and from every information I could obtain,
she  must have"  been under water nearly half an hour.
Being fortunately on the spot, the methods above sug-
gested were immediately had recourse to.  The case
(Mrs.  Bloxham,  of Bankside) was published by  Dr.
Haws, in the reports of the Humane Society,  and the
anniversary meeting adjudged raethe honorary medallion.

  * Tissot mentions an instance of a young girl who was re-
stored to life after she was taken  out of the water, to all ap-
pearance dead, by laying  her naked body in hot ashes; after
remaining in that situation half an hour, the pulse  returned,
and  she soon afterwards  recovered speech. This author also
relates the case of a man who was restored to life after he had
remained six hours under water, by  the heat of a dung-hill!! 
                       108    •
  If the subject be very young, it may be placed between
two healthy  persons  in a bed; the natural vital warmth
has in this manner proved, in  many cases, successful.
  The apparatus for  inflating the lungs, and the drag, re-
commended by the  Humane Society,  should be more
generally kept at public  or farm-houses, near to rivers
and canals, as  I have known many lives to be lost for
want of the latter.
  The means recommended for the recovery of drowned
people are equally applicable  to a number of cases where
the vital functions appear to be only suspended, such as
convulsive and fainting fits, suffocation from noxious va-
pours and spasmodic affections of the lungs,  strangling,
intense cold, blows or falls, &c. &c. and when they have
been neglected there is little doubt but that the principles
of life have been revived in the body by the heat and pure
air of the earth after its interment.

           Treatment of a Fit of Intoxication.

   Different acids have been recommended to correct the
inebriating power of spirituous and other liquors, but it
is much to be doubted whether they ever produced any
effect independent of the diluting liquor in which they
were given.  The recovery of the person must chiefly
depend on evacuating the  stomach, which is best done
by forcing down a quantity of lukewarm water, and pro-
voking vomiting by  irritating the fauces with a feather, or
pushing a  finger into  the  gullet.  If the  person have
so far lost the power of  sense and motion as to be unable
to help himself, he  ought to be  placed in an  arm chair
that will secure him from falling, and the neckcloth and
collar of the shirt immediately  loosened. The doors and
windows of the room should be thrown open for a free 
109
ventilation, and all visitors, except  assistants,  excluded,
and whatever may add to the heat of the body  should be
carefully avoided.
  An  horizontal position, as lying on the floor or. bed,
favouring the influx of blood into the vessels of the brain,
should be avoided if possible; in case he cannot be  kept
in a chair, the head  and chest should be elevated by pil-
lows, and inclined a little to one side to  facilitate vomit-
ing.  If the face be much  swelled and unusually flushed
or bloated, the breathing laborious, the eyes  fixed  and
theirblood-vessels distended, the danger of apoplexy may
be apprehended; to avert which it  will be necessary to
extract blood from the temporal artery, to  put the feet in
warm water, and administer an acrid clyster of common
salt and gruel, and to use every means to promote vomit-
ing.*  Throughout the whole paroxysm the application
of vinegar, spirit of wine or ether, to the temples  and
front and  back part of the head is very serviceable; the
cold produced by the evaporation, checks the deter-
mination of blood to the head, and  moderates  the  heat

   ■*  Vomiting, under an impending apoplexy,  has5 been con-
sidered a dangerous practice by some inexperienced physicians;
but I have long made the observation, that spontaneous vomit-
ing is a certain relief when there is every sign of instant  apo-
plexy ; it is, therefore, fair to imitate  that  effort  by art, and
which ample experience fully justifies.  Indeed, those practi-
tioners who have cavilled most at this practice, have produced
no fact to controvert it, their dislike resting solely on theoretic
opinions.  To  these opinions, fortunately,  the operations of
nature do  not bend, for if we are to suppose it dangerous to
evacuate the loaded stomach of the inebriate, vomiting, at any
time, must be considered an operation not only inexpedient
 but to a certainty hurtful. 
110
 and velocity of the  circulation in the brain. The com-
 mon application of  pungent smelling-salts,  or  spirit of
 hartshorn to the nostrils by stimulating the brain, is very
 improper.
   People often lose their lives in a fit of intoxication from
 an inability to conduct themselves, hence they often fall
 down  in an awkward posture, the head being generally
 bent under the body, which prevents the return of blood
 from the head,  and considerably obstructs, if not totally
 stops,  respiration, and continue in this situation till  the
 living  principle- be  extinguished.  It is to be suspected
 that most of the travellers, who  perish among snow, are
 of this description; fool-hardy under the false courage of
 dram-drinking, they sally out in the dark to explore their
 way, and quickly lose the road from the  change of  ob-
jects, which falling snow or  snow  already  fallen occa-
 sions.  The dram in  this situation of distress only helps
 to accelerate death:  it assists in bringing on drowsiness
 and  sleep,  which leave the body to be sooner weakened
 by the cold, and the unfortunate traveller sleeps " ne'er
 to wake again."
   The resuscitative means already recommended for the
 recovery of drowned people should have a fair trial before
 a body so found be pronounced dead, as it is impossible
 to say, under such circumstances, what time  had elapsed
 since he  last breathed;  for although the limbs may be
 cold and stiff, the heart may still remain  warm and  ex-
 citable, so that on restoring heat to the body by friction
 and  inflating the lungs, the vital functions may again be
put into  motion.  The body  should not, however,  be
 suddenly exposed to the heat of the fire, or put into warm
 water, till  there :tc no hopes of recovery by the other
nv.ans. 
Ill
       Directions fior Phlebotomy, or Blood-letting.

   This operation being so  frequently performed by far-
riers and barbers,  it is generally regarded by  the public
as trivial with respect to its execution. However, whether
we consider its influence on the system, or the niceness
of  the mode  employed for effecting  it, every  practi-
tioner of character must agree, that it  is nearly equal in
importance to  any operation in surgerv; and hence many
expert  surgeons have almost an  invincible dislike to it,
while the persciv gnorant of the great nicety, steadiness,
and exactness,, e  essary, as well as its effects  on  the
constitution, perform  it with  the greatest freedom,  but
not with  uniform success; as is proved by the many
melancholy cases that are constantly being admitted into
our hospitals in consequence of the ignorance of the ope-
rator,  either by wounding  a  tendon  or puncturing an
artery.*
   When the object is to lessen the general mass of blood

  * A blacksmith, in Herefordshire, who  was bleeder to his
own and the  surrounding  parishes, was  requested by  his
wife to take  a little blood from her arm on account of some
slight indisposition.   The  lancet  having  unfortunately  pene-
trated the brachial artery, and not  being able to stop the flow
of blood by his  usual means, he had recourse to pressing over
the orifice 'cob-webs  and lint, which proving ineffectual, he
was induced to  force through the wound at different times, at
least half an ounce of lint.  The blood still continuing to ooze
out, and the arm considerably to swell, he thought proper to
send her to the Hereford infirmary, but the inflammation had sg
far  extended to the chest and neck, and mortification having
commenced,  amputation  was rendered impracticable, and  the
poor woman died the following day. 
11^
 the superficial veins on the front of the arm, over the
 bend of the elbow, are not only more safe and convenient
 for opening, but experience has  proved that the blood
 flows more freely from them,  which, in many acute dis-
 eases, is of great consequence; for it is a well established
 fact,  that the speedy extraction of  blood  is more bene-
 ficial than double the quantity taken from a small  vein or
 orifice.
   The person being  properly seated in a good light, a
 bandage should be tied round the upper arm about three
 fingers'-breadth abdve the   elbow,  sufficiently  tight to
 compress  the veins so as to prevent the  return of blood,
 but not so tight as to  prevent its passing by the brachial
 artery; for after the ligature is applied,  the pulse  should
 continue to beat, otherwise the vein will not bleed after
 it is opened.  A vein of moderate size,  under which no
 beating or tendon can be  discovered, should be choosen;
 direct the patient to extend the arm, and if the vein do
 not rise well, to shut  his hand or grasp a stick: the  arm
 of the patient is then to be taken into the left hand, and
 if the vein appear loose under the skin, the thumb  should
be placed on it about an inch and a half or two inches be-
low the part the puncture is intended to be made ; then,
the lancet being firmly held between the fore finger and
thumb of the right hand, is to be steadily introduced into
the vein obliquely, and taken out  by elevating the point
so as to enlarge thepuncture:  when the  quantit  of
blood judged sufficient has flown, remove the ligature ;
take great care to bring the  edges of the orifice in close
contact; then lay a compress of folded lint or fine linen
over it, and bind  up  the arm with a riband.  The right
arm is more convenient  to the operator than the  left.
 If the Datient be subject to faint during or after the eva-
cuation of blood, an horizontal posture, either on a bed 
113
 or  couch, ought to  be preferred.   In some  diseases,
 however, as strangulated hernia, inflammation  of  the
 brain and lungs, &c. it  may be deemed advisable to in-
 duce fainting;  for it is an admitted fact, that when  bleed-
 ing produces a degree of deliquium or fainting, it proves
 much more serviceable  in those and  other  inflammatory
 complaints.   It  will, therefore, in some  cases,  be pro-
 per  that the body be  placed erect on  a  chair, as most
 favourable  for  inducing this effect.   There are  often so
 many  unpleasant  circumstances happen, not only during
 the  operation, (as the cellular membrane blocking up the
 orifice, the blood passing  under the  skin, &c.) but from
 the loss of blood, that it should only  be  performed  by, or
 at least with the consent of, a medical practitioner;  for,
 as  an old physician has justly observed,  " it is  taking
 away what  medicine  cannot give."   In internal bruises,
 occasioned by  severe  falls, it is  certainly  necessary  the
 patient should lose blood  immediately; when, therefore,
 the  aid of a surgeon cannot be readily  obtained, the  ad-
 vantage that would result from the immediate extraction
 of  blood  may,  in  general,  more than  counterbalance
 the mischief that may  ensue from the  operation not being
 judiciously  performed.  In sudden attacks  of apoplexy,
 inflammation of the  lungs,  pleurisy, and  other  internal
 inflammations and  inflammatory fevers,  attended with
 determination of blood to the head or lungs,  the speedy
 loss of  blood is often  of considerable importance, but as
the topical extraction  may prove  more beneficial than
general bleeding, even  in such  cases  it  will be advisable
 to defer it till the practitioner arrives.
  The  symptoms of plethora, and particularly the fulness
gf pulse, on which popular medical writers have laid so
much  stress  as  to the propriety  of  bleeding, are  often
very fallacious;  for inflammation  of either  the lungs,
                          R
« 
                          114
brain,  or  bowels,  is  often  attended with  a small  and
feeble  pulse, which after the loss of blood, will  become
full and strong; hence  again in  apoplexy  the pulse  is
rendered  feeble  by  pressure  of the  brain, which fre-
quently after  the  evacuation  of blood  will  often so far
rise as even  to indicate  plenitude  and strength; and it
often happens in dropsical complaints,  where the loss  of
blood would prove fatal to the patient,  the pulse will beat
with unusual strength.  The pulse,  likewise, of an old
person will feel  hard and  firm  from the rigidity of the
coats of the vessels;  hence the learned Celsus justly calls
it "res fallacissima;" and  Dr. Heberden,  in the London
Medical  Transactions,  has  published  some  ingenious
observations  to show how little it  is to be depended on
 alone.
    Periodical blood-letting  is  an  error  very  common
 amongst the lower orders of people,  and I conceive ex-
 tremely inimical to the constitution.   Bleeding is un-
 questionably a remedy of the  greatest importance in a
 number  of diseases, but like  all others has been  much
 abused, and perhaps in few  instances more so than  in
 that  which relates to this  absurd custom.  A celebrated
 author observes,  " that he who wantonly or capriciously
 squanders  this  vital  fluid, obstructs,  and  as  it were
 cuts  off the  sources  of  his  support  and  regeneration.
 The  most essential and constituent parts of  the  human
 frame are  formed  from  the blood,  and though it  be
 true  that the blood evacuated by  periodical bleeding is
  soon reproduced by  the activity of  the  vital powers,
  yet  this  restoration  is  only   brought  about  with con-
  siderable efforts, and  at the  expense  of  the  whole  ma-
  chine."   In most  inflammatory  affections,  as  I have
  already observed,  bleeding,  regulated according  to cir-
  cumstances, is  often of greater  importance  than  any 
115
 other remedy, and doubtless saves the lives of many; but
 those persons who, from a notion of preventing diseases,
 suffer themselves to  be bled regularly  once,  twice, or
 oftener in  a  year,  whether they are indisposed  or  not,
 ought to be informed, that they are  using means which,
 if persisted in, are likely prematurely to bring upon them
 those  very diseases which they profess so much to dread,
 and appear solicitous to avert.  Whether  the  habit  has
 been already established, it may be safely and easily over-
 come  by substituting in the place  of bleeding at those
 periods  a gentle purgative or two, and adhering for some
 time to a less stimulating and more sparing diet.

    Of substances lodged in the Gullet, or taken into the
                        Stomach.

   When a foreign substance is  lodged  at the top of the
 gullet, it may in general be  removed by the fingers, or  a
 pair of forceps;  but when it has descended far down, it
 will be necessary to push it into the stomach,  by intro-
 ducing a probang (made  with a piece of  soft  sponge
 fastened to the end of  a slip of whale-bone);  but if the
 article swallowed be sharp  pointed, or has acute  angles,
 this operation  must be conducted with  great care, as by
 the employment of much force it may be made to pene-
 trate  the substance of the gullet, which, in cases of pin6,
 needles,  nails,  or sharp pieces of bone, is  not an unfre-
 quent pccurrence.
  When the article has  passed into the stomach, whether
 it  be  sharp pointed, angular, or large, no  means  should
 be taken to hasten its passage  through the alimentary
 canal; for  if it be sharp pointed, it will be less  likely to
injure  the  intestines by  passing  gently with hard faeces,
 than by  being hurried through  them with liquid ones; 
                         116
and if it  be  large, as a  shilling, a halfpenny, a bullet, or
fruit-stone, it will require some time to pass through the
orifice of the stomach (termed the pylorus)  into the in-
testines,  and the more  gradually  it makes its way, the
less mischief is likely to ensue. When this  practice has
been pursued, I never  knew any serious  consequence to
acrue from  the  swallowing of such  articles; but  have
frequently known much  mischief to  follow the exhibition,
of aperient medicines, with a view to carry them off more
speedily  by stool.
   If the article be metallic, as lead,  copper, &c. it will
be advisable to avoid the \use of  acids, till it has passed
through the  intestines, and to correct and  prevent acidity,
by taking a little magnesia every morning.
   Emetics should never be  given without the sanction of
an experienced physician or surgeon.
   The late  Dr. Buchan, in his Domestic Medicine, ob-
serves, that if the various means  he has suggested to
hook  out substances lodged in the gullet, should fail, the
operation of " bronchotomy,  or opening the wind-pipe,
must  be performed."  What  advantage,  however, can
possibly  be  derived  from making an  opening into the
wind-pipe to remove a substance  retained in a different
tube, must  puzzle  an   anatomist  to  conjecture.  Should
an apothecary, not conversant with the structure of the
parts, be induced,  by  the  great  agony and apparent
danger of the life of the person, to follow  this author's
advice, and  after making the  incision  into the wind-pipe,
and  not  finding the  obstructing body there, should cut
down to it, the life of the patient  would very likely be
destroyed.
   When the substance   cannot  be removed, and the pa-
tient's life is endangered from  the want  of due nourish-
ment being  thrown into  the system,  cesoph^gotomy, 
117
or making an incision into the gullet maybe necessary; in
performing which, the  wind-pipe  is  not wounded.  On
account of the imminent hazard attending  this operation,
from  the great  blood-vessels that  lie contiguous to the
part,  it is  never practised but in cases  of the  utmost
danger, and  should be trusted only to surgeons of ap-
proved experience.  Under such circumstances, nourishing
clysters have been known  to  support life for many weeks.

       Of Substances and Insects lodged in the Ear.

   Although the formation of the external parts of the ears
and viscid  nature of the internal secretion  are admirably
calculated to prevent flies  or foreign matter getting into
them, yet it happens that much distress is  induced there-
by. Children often  push small  peas, fruit-stones, &c. and
Other such articles into their  ears, and flies and other  in-
sects  frequendy creep  into  them, and  by touching the
tympanum,  produce as  much noise to the person  as the
explosion of a cannon.  They may in general be removed
with  facility by a common forceps; when  the substance,
however, is round,  it may be more readily  turned out by
means of a curved probe,  the end of which should be pas-
sed behind it; when the article is large or much enlarged,
a little oil should first be dropt into the ear.
   When insects have got so fat into the  ear that they
cannot be taken out with  forceps, the best  method of re-
moving them is to  wash  them out by throwing  in quan-
tities of warm water or any  other mild liquid, by means
of a  syringe.  If it adhere with  firmness, which they
often do while living, the ear may be filled  with oil or
brandy, and kept in for some time (by the  person resting
his head upon the opposite side) for the purpose of killing 
118
it, after which  it may be  readily removed by forceps or a
curved probe.
  Peas and other soft bodies which  swell with moisture,
are so apt  to become large by remaining in the ear, that
they should be  removed as soon as possible. When it has
been  neglected, and  the  substance cannot  be taken out
from  its enlarged state, it must be divided with the points
of a pair of scissars, or a sharp small hook cautiously  in-
troduced along the passage, and as soon  as sufficiently
divided,  it may  either be removed by  piece-meal with
the  forceps, or washed out with a syringe. In the  same
manner peas and other extraneous bodies may be removed
from  the nostrils.

         The ordinary Management ofi Children.

  On examining the general bills of mortality, the melan-
choly fact appears, that no  less than one half of the children
born in this country absolutely die  before they become of
the  least use to the community or themselves.*
  This extraordinary  mortality of infants being peculiar
to the human race, one would have supposed,  would have
roused the attention of the ancient physicians ;f it was not,

  * The  average of the bills  of mortality for  ten successive
years, in London and its environs, demonstrate that more than
one half the children born within their limits, die  under seven
years  of age.  In Manchester and Birmingham  the proportion
is nearly the same, but throughout the country very consider-
ably less. Some have estimated the death of children in Lon-
don to be at least double that in the country.
  t It is remarkable that there was not a rational treatise on
the  management of children published in this country  prior to
that of Dr. William Cadogan, in the year 1776. 
119
however, till late years that its source has  been properly
investigated, and the  consequence is,  that many  of  the
vulgar errors in nursing, which have been handed down
from time immemorial,  and no  doubt have been  produc-
tive  of incalculable mischief, are in a great measure done
away, or at least so far  eradicated, that nature  and rea-
son begin to take place  of prejudice  and ignorance. This
great calamity  is* justly  ascribed by those physicians who
have paid  particular  attention  to the  management  and
diseases  of children, viz. Dr. Cadogan,* Dr. Alexander
Hamilton,! Dr. Clarke,J and Dr.  Keighley,§ to   wrong
management during the first and second years of their in-
fancy, viz. to  their " being both fied and  clothed impro-
perly.''''  That  the  present method of nursing  is  wrong,
certainly needs  no other proofs than  the frequent miscar-
riages attending it, the  death  of many, and the ill health
of those that survive.  This may  in  some  degree be a
natural evil, but the majority of instances  may be  justly
attributed to neglect or  officiousness; for the brute crea-
tion, guided  only by instinct,  attend to  the dictates  of
nature, and therefore  few perish until the  natural  limits
of their  existence  be complete; while  man,  the  child of
art and refinement, proud of his boasted reason, is very
liable to  err.||

  * In a Letter to a Governor of the Foundling Hospital.
  t In a late Treatise on the Management of Female Complaints,
  \ Lectures on the Diseases Of Children.
  § Complete Treatise  on the Management  and Diseases of
Children.
  || Whatever the advantage of modern refinement may be to so-
ciety, the life of man is certainly abridged by it; for the savage
is not only exempt from a number of diseases to which civilized
man  is subject, but rarely dies till he has  run his natural course. 
120
                 The Clothing ofiChildreh.

   The first  great mistake arises from the prejudice of
 nurses,  in loading and binding  children  with  flannels,
/swathes, stays, &c.  almost equal to their own weight,
 which render a healthy child so  tender and chilly, that it
 cannot bear  the  external  air;*  and  if  by accident  it
 should be exposed to a refreshing breeze, the consequence
 is frequently a serious  inflammatory affection of the lungs
 or bowels; or if  the child should survive the first month,
 it is then sent into the country, to be  reared in  a  house
 that admits  the  weather from every  quarter.   A  new-
 born., infant, being  naturally warmer than  an  adult,  re-
 quires in proportion less clothing, which should be put
 on so loose, that the bowels  may have  room,  and the
 limbs liberty to act and exert  themselves, that the  circu-
 lation of the blood, through the superficial  vessels, may
 not*J)e  impeded,  or malformation or unnatural swellings
 be produced  by  partial compression.  To the  latter is
 doubtless attributable the many distortions  and deformi-
 ties,'!"  particularly among  females,  who suffer more in
 this respect than males.  The  great  pleasure  a   child
 manifests, on being divested  of this superfluity of  dress,

   * The clothes of children should, in  all cases, be propor-
 tioned to the climate and temperature of the atmosphere.
   f The negro children in the West Indies are suffered  to lie
 and tumble about on the floor from their earliest infancy, per-
 fectly naked; and with all the hardships they undergo at every
 period of life, there is  hardly a deformed negro to be seen ; a
 convincing proof that the compressure of clothes is a means of
 producing deformity, when we see on the other hand so  mariy
 victims of it in this country.—Reighley on the Treatment of
 Children. 
121
 by all its powers of expression, would be sufficient to
 convince nurses, were they capable of making just ob-
 servations,  that the free use of its limbs, &c. are more
 agreeable to its  feelings, as well as necessary for their
 growth and strength.
   A flannel waistcoat, without  sleeves, made to fit the
 body and tie loosely behind, to which a petticoat may be
 sewed, and over this  a kind  of gown, both of the same
 thin light andflimsey materials;  the petticoat should not
 be quite so  long as the child; the gown a few  inches
 longer; with one cap only on the head, and the linen as
 usual, I think  abundantly sufficient  for the day, laying
 aside all swathes,* bandages, stays, and those  contri-
 vances that are most ridiculously used to close and keep  .
 the bones of the head in their place, which, by confining
 and compressing the brain, have no doubt been produc-
 tive of very serious mischief to that organ,  and not un-
 frequently the fatal disease commonly termed Watery
 Head.  Shoes  and stockings  are  likewise unnecessary
 encumbrances; the latter  keep the legs  wet  and nasty,
 if they are not changed two or three times a day, and the
 former too  often cramp and hurt  the  feet, so as to pre-
 vent their learning to walk.  Children  in  this  simple
 dress would be perfectly easy, and enjoy the free use of
 their limbsf and faculties. They should be  put  into it

   * It sometimes,  however, happens  that a portion of intes-
tines protrudes at the  navel, through violent or much crying of
 the child; in which case  a soft broad piece of thin flannel, in
the form of a roller, is necessary.  It should never be made too
 tight, otherwise it may not only hurt  the bowels, but perhaps
produce rupture at the lower part of the belly.
  t The unnatural custom of confining the limbs of the child
during night  cannot be too much reprobated or guarded against
                         S 
                        122
as soon as they are born, and continued in it till they are
three years old,  when  it may be  left off for any other
more genteel and fashionable. They ought to be changed
at least every day, to keep them  free from  sourness,
which is both offensive and prejudicial to the tender state
of infancy. The night-dress should be only a-loose flan-
nel shirt, and less in quantity than those which are worn
during the day, otherwise the child will be very liable to
be  affected with cold and  complaints of  the  bowels.
Tape should be used  instead of pins  in putting on their
napkins.

                The Feeding of Children

   Is of greater importance than their clothing.  Grea:
care should be taken  that their food  be wholesome and
good, and such  quantity only as the body requires for
its support and growth. In the business of nursing, as  in
physic, we should endeavour to follow the dictates  of
nature.  When a child is born, it  is full  of blood and
excrement; its  appetite and senses awake, and  require
some intermediate time  of  abstinence and rest to com-
pose and recover the pressure and struggles of the birth;
and the little fever produced from  the revolutions it un-
dergoes by the process of delivery.   If the child have
sustained no injury, it will soon fall into a sweet sleep of
six or seven hours, when it  will awake, refreshed and
hungry; it should then be put to suck;* if there be no

by parents: a simple contrivance to prevent the child from rub-
bing or scratching its eyes, is often necessary; but the confine-
ment of the legs can,, on no account, be justified.
   * If the nipples of the mother  be short, they should be first
drawn out by the  nurse, and in  case of  being tender it will be 
123
milk, the sucking of the infant will, in an hour or two,
infallibly bring it, and if nothing else be given,  the child
will grow strong, and the mother perfectly recover in a
few days.  The  general practice* of forcing down  a
child's throat, as soon as it is born, a lump of butter and
sugar, or a little oil,  with a view to cleanse the bowels,
is exceedingly pernicious.  The mother's first milk is of a
purgative nature, and cleanses a child of its long hoarded
excrements without griping or disordering the stomach
and bowels; and no child  can be  deprived  of it, with-
out very manifest  injury.f  By degrees the  milk be-
comes less purgative and  more nourishing, and is un-
questionably  the best and  only food the child likes or

proper to wash them with a little brandy, instead of the poison-
ous preparation of lead, recommended by  quacks and officious
nurses.  If the mother have small, tender, or ulcerated nipples,
the prepared nipples (from the  teats of calves) will enable her
to give suck with great comfort. These nipples are very delicate-
ly prepared by Mr. Mason, and with care will last many years.
I have, in a number of instances, found them  to  answer when
the mother, through ulceration or total  deficiency of nipple,
could not otherwise have suckled her infant.  The ease and
advantages they afford are so very considerable  and important
that it is  much to be regretted they are not  better  known to the
faculty.
   * A lady  of respectability was very near  losing her infant
lately  through the  nurse  giving it,  soon  after it was born, a
table-spoonful of water, in which the end of a red  hot poker
had been  put for a few minutes; this was done as she stated to
prevent the thrush.
  t If the infant has been deprived of the first milk, by  some
untoward  circumstance, a little oil of almond or fresh castor
oil may be given for the purpose of cleansing the bowels. 
124
ought to have, for at least three  months.  The call of
nature should be  waited  for, to feed it with any thing
more substantial; and the appetite  ever precede the food,
not only with regard to the daily meals, but those changes
of diet which increasing life requires.
   Nine in ten of the diseases of children, may justly be
imputed to the  mistakes  of nurses, both in quality  and
quantity of food. With respect to quantity, it is a most
ridiculous error to suppose, that whenever a child cries?
it wants victuals, and thus to feed it twelve or more times
in the course of a day and night,   If the child's wants
and motions be diligently and judiciously attended to, it
will be found it seldom if ever  cries but from pain. Chil-
dren no doubt suffer very acute pain from spasms in con-
sequence of the over-distention of the  stomach by food;
the nurse, notwithstanding,  in order to pacify it,  will
persist in forcing down its throat fresh quantities, or
otherwise with the same view,  it 'is put to  suck, which
will often relieve it by producing  vomiting.  If the  sto-
mach be frequently supplied with food, or be over-loaded,
it is impossible  that it can go through the process of di-
gestion ; and hence by undergoing a kind of fermenta-
tion, a quantity of air is disengaged, and a strong acidity
produced,  which  by exciting spasms  and  irritation
throughout the intestines, give rise to inward  fits, con-
vulsions, and often  inflammation  of the bowels.  The
sensation of hunger being unattended with pain, a very
young child will make other signs  of its wants before it
will cry for food.  If it be healthy and quite easy in its
dress, it will very rarely cry at  all.  Children that are fed
only three or four times in twenty-four hours,  are more
healthy, active, and cheerful than  those  who are never
suffered to be hungry.  The great fault in the qualitv of
:he food, is its  not being simple enough. The  addition 
125
  of sugar, spices, and wine to their pap, and gruels and
  panadas is unnecessary;  it was first only introduced by
  luxury, to the great destruction of the health of mankind.
  A child should not  be kept  entirely on vegetable food;
,  from its tendency to fermentation in  the heat of the sto-
  mach, and to its consequent acidity, the first and general
  cause of all their diseases is to be attributed.  As we are
  partly carnivorous animals, our offspring should not be
  deprived of that food which corrects  the acescent* qua-
  lity of vegetables.  The mother's milk, when  good, is
  certainly a mixture of vegetable and  animal properties;
  in the due proportion of which consists that salubrity of
  aliment our nature  seems  to  require.  I would advise,  '
  therefore, that  one  half of infants' diet be thin and light-
  broth, with  a little  arrow-root, bread, or rice  flour in
  it.  The admixture of  animal jelly, with that of  the
  arrow-root, recommended under the head of arrow-root,
  is likewise an excellent combination for weakly children.
  The other part of children's diet may be a little toasted
  bread, or tops and bottoms, boiled  with a  little water,
  almost dry, and then mixed with fresh milk, not boiled,
  the  properties of  the  milk and its taste  being  much
  changed by heat.   This, without sugar, spices, or any
  other pretended amendment whatever, will  be perfectly
  iight and wholesome. A sucking child  may be fed twice
  a day at first, and not oftener:  once  with the broth and

    *  When this acid corruption of food predominates, which is
  obvious from the crude, white, or  green stools,  gripes,  and
  purgings occasioned by it, a little magnesia, in mint water,  will
  prove the best remedy; or if attended with much pain in. the
  bowels, known by the child's kicking and drawing up its legs,
  the absorbent mixture, No. 73, will prove "more serviceable
  than magnesia alone. 
126
once with the  milk thus prepared, in  quantity just to
satisfy its hunger.  They should always be fed in a sitting
posture,  that  swallowing may be  more  easy  to  thi m.
If a child be not accustomed  to feeding at night,  it will
not want it, but get into a habit of  sleeping all or  most
part of the  night, very quietly, only  waking for  a few
minutes, when it  is wet and wants  changing.   It is
night-feeding that makes children so over fat and bloated.
At the end of twelve months, the child should be weaned,
by  insensible  degrees,  that it may neither feel nor fret
for the want of the breast.
   Strong liquors  of  all kinds should  be scrupulously
avoided.  The custom  of giving  children spirits  in its
food, or in the form of toddy,  with the supposed view of
preventing  gripes,  is  very pernicious.   Such liquors,
although well  diluted, applied to their tender digestive
organs,  must unavoidably  impair  their  functions, and
mav lay the foundation for a train of the most dangerous
complaints.  It has been urged in favour  of this horrid
unnatural practice, that many  children, accustomed to a
little spirits from  a few days after  birth, continue to
thrive uninterruptedly;  but such arguments only tend to
prove that the vigour of constitution in these children was
so great as to resist the usual effects of strong liquors.
  Was this plan of nursing literally pursued, the children
kept clean and  sweet, tumbled and tossed about a good
deal, played with and kept in good humour, and carried
out every day when the weather would admit of it, I am
confident in eight or nine months' time,  most children
would become healthy and strong, and able to sit on the
ground without support, to divert themselves an hour at
a time, to the great relief  of  their nurses, would very
readily find the use of their legs, and  very soon shift for
themselves. By this mrthod  of nursing likewise, here- 
127
ditai'y diseases may be avoided, and in a generation or
two, every taint  and  infirmity, the king's  evil and in-
sanity not excepted, may be  worn  out.  It  is a  duty
incumbent on every father to have his child nursed un-
der his own eye, and to make use  of his own reason and
senses in superintending and directingthe management of
it; and that of the mother to suckle  it herself; if she be
healthy it will confirm her health, if weakly  it will, in
most cases, restore  her.* It need be no confinement to
her, or abridgment  of her time;  three or four times in
twenty-four hours, will be often enough to give it  suck.
It may be fed and dressed by  some reasonable  servant,
that will  submit to be directed, with whom it might like-
wise sleep. No other woman's milk can be so good for


  * It must,  however, be  admitted that the  luxuries  whicli
modern refinement has introduced in the manner of living, al-
though they may not prevent every woman from being a mother
certainly render many very unfit for  the office of a nurse; but
when the mother is of a strong constitution, she is unquestion-
ably the most proper nurse, and ought to  be advised to under-'
take  the task on account of her own health as well as that of
her infant.  Whenever any  other milk is to be substituted, that
which approaches nearest to the human milk should be adopt-
ed.  The milk of women differs in some respects from that of
most other  animals: it  is  light,  thin,  and at the  same time
highly nutritious,  containing  a  greater proportion of sugary
principle than that of other creatures.  From its small quantity
of crud, it is also more  easily digested.  Ass's milk, in these
respects, resembles most the woman's, and next to it the mare's,
then the cow's, ar.d then the sheep and goat's.
  It is worthy observation, that mothers who have neglected to
suckle their offspring are most subject to cancerous complaints
of the breast and womb, and diseases ©f the lungs and brain. 
128
 her  child; and dry nursing is the most unnatural and
 dangerous  method of all; and, according to some late
 calculations by physicians, who have  been in the prac-
 tice of midwifery and attending children upwards of forty
 years, not one in three  do well.

                  Exercise ofi Children.

   Without a proper degree of exercise, all  our care  in
 feeding and  clothing   infants will not succeed to our
 wishes, till, by due degrees, a child is brought to bear a
 good deal of exercise without fatigue.  It should be push-
 ed forward and taught to walk as soon as  possible, so
 that  at the end of twelve months, it may  (if healthy)
 be capable of walking alone.  It is a vulgar error to sup-
 pose children are not to be put on their legs, because they
 are weak or the least bent or crooked; daily experience
 shows crooked legs will grow, in time, strong and straight
 by frequent walking,* and that disuse makes them worse.
 The walks should be gradually  increased every day, till
 they can walk two miles without weariness,  which they
 will very well be able to do in three years, if they be ac-
 customed to it properly.  From this daily exertion, they
 will, from the  impulse of their own active vigour, soon
 be found running,  leaping, and playing, all day long.

  * Every member acquires strength in proportion as it is ex
 ercised; and children by being accustomed  to support them-
 selves, will soon acquire  strength for that purpose.  When,
 however, the limbs are much curved, and evidently grow worse
 as the child is put more to bear on them,  instruments may be
necessary, not only to support the weak bones, but also to prevent
the pressure of the body falling too much on them. (See Rickets."! 
                           129

Thus a dull heavy child maybe made playful and spright*
ly, and a weakly one healthy and strong, and confirmed
in good habits and permanent health.
   There are some otherlittle niceties, which were they ob-
served in the nursing of children, would be of some ser-
vice to them, such as making them lie straight in bed; I
do not mean extended like a corpse, but that their limbs
may be free and easy. They should be taught to  use both
hands  alike; for  employing  one more  than another,*
will make the hand and side of the body bigger than the
other,  and is often  the cause of crookedness; neither

   * On this absurd custom both of parents and nurses, the in-
genious Dr. Walker Keighley observes, u Great pains are gene-
rally taken by mothers that their children should not be left handl-
ed, by which injudicious anxiety they are prevented from the full
use of that  member.  Nature has given us two hands alike  in
form, equal in strength, and equally calculated  for  exertion;
but by the present practice, this gift is  in a great measure
abandoned, and one of them comparatively rendered inefficient.
Were the same trouble taken to make children use only their
right  eye, the consequence  to the left eye would be exactly
similar.  If, therefore, I have the good  fortune to  persuade
sensible mothers to amend this universal  error,  I shall  enjoy
the satisfaction to think that I have in no small degree contri-
buted to the good of society. I would  recommend that  chil-
dren, from their earliest infancy, be habituated indiscriminately
to use both hands, to alternate  them in all their little manual
occupations,  and   when sufficiently  grown,  they  should be
encouraged to cut their meat, and employ their exertions  with
either hand.  Swinging what are  called dumb bells is a most
useful  exercise in this respect,  as strengthening the arms,
opening the chest, giving muscular action to the body, and in-
vigorating the whole system. Every one must be  sensible, how 
                        130
 should they be always laid on the same side, nor carried
 constantly on the same  arm.  It would likewise  not be
 amiss to forward their speaking plain,  by speaking plain
 distinct words to them, instead of the jargon generally
 made use of by nurses.  "
   Dr. Hamilton  condemns the use of cradles for chil-
 dren, on account of their being  improperly  used  by
 nurses.  This  author recommends a crib, to be so con-
 structed as to  be  fixed to the side of the bed during the
 night, and to be easily carried from one room to another
 during the  day: it  must not be made to rock; but, in
 cold weather, the infant ought never  to  be allowed to
 sleep by itself, as heat is absolutely necessary to keep up
the vital functions of a very young or weakly infant.

     Instructions fior the Choice of a Wet Nurse, &c.

  It is not  sufficient a wet nurse be only clean, healthy,
sober, and temperate, but likewise middle aged, because
she will have more milk than the very  young,  and more
and better than the old:  this is a very material considera-
tion  when  she has  her  own child to suckle besides.
Those between twenty and thirty are certainly of the best
age.  Great regard should  be had  to  the time of their
lying-in, and those procured who have  not been brought
to bed more than three months: for nature intending that
a child should suck only twelve months, the  milk seldom

much habitual exertion, adds  to the powers of  the members
em ployed."
      ————— k By arts like these
      " Laconia nurs'd of old her hardy sons,
      " And Rome's unconquer'd legions found their way,
      " Unhurt, through every toil, in every clime." 
131
continues good much  longer;  for  about that  time,
women, though they give  suck, are apt to  breed again,
and some that  are very sanguine much sooner; which,
and other periodical causes, disturb and affect the milk
greatly, and there fore they are not proper for nurses  so
long after their delivery.*
  The nurse's food  should consist of a  proper mixture of
flesh and vegetables: she should eat  one hearty meal  of
unsalted meat every day, with a great deal  of vegetables
and little bread, and thin broth or milk for  her breakfast
and supper, and her strongest drink good ale or porter.
  If the child have not sucked its own  mother, it should
have  a little purgative physic in a day or  two  after  its
birth, to carry off the long-hoarded excrements;  for this
purpose  a little manna may  be  given it,  dissolved  in*  v
water; or the nurse may take a little lenitive electuary,
which, through the  medium of the milk, will act on the
bowels of the child; by these means, three  or four stools
should be procured  in twenty-four houfs.
  The child should be kept awake by day, as long as it
is disposed to be so, and great care be  taken no anodyne
quack medicine be given,  or means taken to lull or rock
it to  sleep, or to continue  it asleep long, which is too
much the custom of wet nurses,  to  save  their own time
and trouble, to the great detriment of  the child's health,
spirits, and understanding.f  If  the  nurse  have  another

  * Every chemical  investigation shows, that  the milk of a
woman varies at certain stages of suckling. If this fact, there-
fore, be duly considered, how important is  it that this nourish-
ment should agree with the child both as to age  and its specific
quality. Nature and reason equally point out the propriety of
a mother's suckling her own offspring where health admits of it.
  t Mr.  Ring, an able surgeon in  London,  lately published. 
132
child to support with her own milk, the sooner the child
is fed according to the method I have recommended the
better, as it is not likely she  should have milk enough to
support two.
   A healthy child may be allowed a little mellow fruit,
either raw,  stewed, or baked,  and  the produce  of the
kitchen-garden, which, in moderation, is perfectly grate-
ful and salutary.  As soon as the  child  has any teeth, it

in a periodical medical work, the particulars of the death of a
child who died  soon after taking a quack medicine.  From
the appearance of the stomach  and brain of the infant,  he had
no hesitation in attributing its death to tne poisonous effects of
the nostrum.  The  editors of the  Medical Observer, a  work
entirely devoted  to  an impartial examination of quack medi-
cines, speaking of the practice among the lower order of peo-
ple of giving them  to their children, make the following re-
mark: " So little do this class of people regret the loss of their
children, that it ^  to  be feared  the  observations of a  late
writer on this species of mortality are but too true, that many
of the  poor think  fertility  the greatest curse that can  befal
them, and in place   of wishing their children  to  live, so far
does poverty get the better of  natural affection, that they are
dften very happy when  they die.  It has been  supposed  by
some great characters, that these Impels of medicine are employ-
ed with no other view than a mode of destroying their children,
to which no  suspicion can attach!!  A person in Manchester
is said to  sell no less  than 144 bottles  of  Godfrey's cordial
daily!"  The invaluable collection  of empirical facts and ob-
servations contained in this pamphlet, ought to find its way into
every family; for the health of man is surely of too  great a
consequence to themselves and to society to be exposed to the
attacks of the unprincipled empiric, or I should feel inclined to
let them enjoy the fruits of their own folly, and to say « Qui
vult decipi, decipiatur." 
133
may be used to a little  flesh meat, which it will be more
fond of than confectionary or pastry wares, with which it
should never debauch its taste.

              Ofi the Diseases of Children.

   Having observed that the first and general cause of al-
most all diseases that assail us  during childhood, is  the
acid corruption of the food, and it being easier to prevent
diseases than cure them, it will not be amiss to mention
in this place a certain  preventive, if given in due time.
   On the first appearance of predominating acid, which
is evinced by  crude, white, or green  stools, gripes,  and
purgings, five grains of magnesia, No. 1. combined  with
two grains of rhubarb powder, No. 26, should be given
in a little  mintwater, or the prepared natron, as directed,
No. 60, which will correct the sourness more effectually
than prepared chalk, or Gascoign balls, so generally em-
ployed by nurses ;  and instead of producing a costive state
of the bowels, the certain consequence of these cretaceous
absorbents, the magnesiaand rhubarb, or prepared natron,
will gently carry off the offending matter, and at the same
time strengthen the stomach and bowels. If the child be
supported entirely by  the. breast, the mother should live
more on animal food;  and if it be  allowred any spoon-
meat, it should be the vegetable and animal combination
mentioned under the head of arrow-root. In cases of ob-
stinate purging, two or three  tea-spoonfuls of  the creta-
ceous mixture, No. 64, should be given every thr^e/>r four
hours. By the early employment of these remedies many
complaints  may be prevented,  which, from neglect, grow
from bad to worse, and too often end fatally.

                      Inward Fits.

    The spasmodic affections, termed by nurses inwardfits, 
                        134
is the first complaint that appears in children, and which
most, if not all children, are more or less subject to. The
symptoms are, an appearance of being asleep with the
eye-lids a little open, the eyes frequently twinkling, with
the whites of them turned upwards;  the muscles  of the
face, especially of the lips, are affected with a tremulous
motion, producing something like a smile, and sometimes
almost the appearance of a laugh. The breathing becomes
interrupted, and  appears  now  and then to stop a little,
with a considerable fluttering at the heart, and intermission
of the pulse, the nose becomes  pinched, a pale circle en-
Compasses the eyes and  mouth,  often becoming livid, and
at times disappearing entirely.   The child at length be-
comes so irritable and nervous, that it starts at the Last
noise, it will then sigh and discharge wind, which affords
a temporary relief, and  presently relapses  into a  dozing.
Sometimes it struggles very much before the wind is ex-
pelled ; then vomiting, or a loud fit of crying  sets all
right again.  As the child advances, these fits generally
go off by degrees spontaneously; or by mismanagement
in their diet, grow worse, succeeded by fever or thrush;
or end in vomiting, or  sour, curdled, and green stools,
and convulsions of the whole body.
   Dr. Armstrong, who has fully treated on this disease,
and whom subsequent writers have copied, imputes it to
a quantity of mucus squeezed out of the mouth of the
glands and fauces, by the contraction of the  muscles and
pressure of the nipple in the act of sucking, which, with
the addition of the mucus of  the gullet and stomach,
mixing with the  milk, renders  it of a slimy consistence,
by which means it is not readily taken up by the vessels for
the nourishment of the body; and as there is  in most
children an acidity in the  stomach, the milk  is thereby
 curdled, which adds to  the load;  hence sickness and 
135
 spasms are produced, which, by sympathy, being com-
 municated to the gullet and fauces, occasion the convul-
 sive motions enumerated above.  Other authors, who co-
 incide with the Doctor in this opinion, think that  they
 are aggravated, if not produced by air swallowed with the
 milk in sucking,  from the relief a child experiences  on
 the expulsion of air, which, however, was more likely to
 be generated in the stomach than taken with  the milk,
 which the  Doctor, to support  his theory, thinks takes
 place: nor can they be attributed to a corrupt or vitiated
 state of the saliva, inasmuch as almost all children are
 more or less affected with them. Besides, if the Doctor
 were right in imputing the  disease to the quantity of
 mucus swallowed during suction, children that are not
 suffered to suck at  all, would be  entirely exempt from
 them,  which we find, however, so  far from being the
 case, that children  brought up by the hand are certainly
 more subject to them.
  There is no doubt but this complaint is produced by
 the over-feeding  and loading of the stomach with food,
 which, from the digestive organs not being able to convert
 into chyle, becomes acescent, and excites considerable irri-
 tation in the stomach and intestines. The mechanical dis-
 tention of the stomach at the  same time co-operates in
 producing spasms,  which, extending to the diaphragm,
 heart, and lungs, will often occasion sudden death.
  The cure will, of course, depend on avoiding the occa-
 sional cause, and emptying the  stomach and bowels  by
 gentle emetics, and the use of calomel, No. 34, or basilic
 powder, No. 36.  In case of violent  purging, or gripes,
 the testaceous mixture, No.  64, will also be necessary;
and the warm bath,  or a blister on the chest, if the breath
be affected. Spirit  of hartshorn, sal volatile, tincture of
 assafcetida, and other stimulating anti-spasmodics, so fre- 
136
quently prescribed in those cases, never fail to aggravate
the symptoms,  by increasing the irritability of the sto-
mach and intestines.
  I have known many instances in which the symptoms
have abated, and the fits gradually gone off, on changing
the food of the child from a vegetable to an animal jelly,
as that of hartshorn  shavings,  isinglass, or calves  feet.
If the milk of the mother be ever improper, it is in such
cases, w here the afflictions of the child disturb her mind,
for it is an indisputable fact, that mental perturbation has
a very unfavourable influence on the milk.

                     Convulsions.

  Children are more subject to convulsive fits than adults,
from the greater degree of excitement of the nervous sys-
tem. Convulsions originate from such a variety of causes,
and of course  require such  different treatment, that a
practitioner of  skill and judgment should always be con-
sulted on their first appearance.  When  they are occa-
sioned by dentition, they are less  dangerous.
  In all cases of the convulsions of children, great atten-
tion should be paid to the  State of the stomach and bowels;
if they appear to be in fault, the basilic  powder, No. 36,
will prove of considerable advantage, and often effectually
cure them.  If they arise from difficult dentition, small
doses of liquid laudanum, after the due operation of the
basilic powder, will be proper.  (See Dentition.)  If the
consequence of a determination of blood to the head, or
that chronic inflammation of the membranes of the brain,
which precede  the disease  termed watery head, blisters
to the head and feet, the application of leeches to the
temples, and active purgatives are necessary. 
137
  Convulsions of children, I believe, are very rarely, it
ever, a primary disease, but depend on some  local .rrita-
tion, as cutting of the teeth, worms, bad digestion, &c.

           Dentition, or the Breeding ofi Teeth.

  Whatever  fever, fits  or  other  dangerous symptoms
seem to  attend  this operation ofi nature, healthy children
generally breed their  teeth without any such bad attend-
ants, which inclines me  to  suspect the  evil  not to be
natural, but rather the effect of too great fulness, or cor-
rupt humours of the body put into  action by the irritation
the tooth produces in breaking its  way out.*  This I be-
lieve never happens wjthout some pain,  and probably  a
little fever, but  if the  blood and juices be perfectly good
and healthy,  and there be not  too great a redundancy of
them, both will be but slight, and  pass off imperceptibly
without  any  bad  consequence  whatever.  Care should
therefore be taken  to keep the humours of the body in this
state, by proper diet and  exercise.
   The  period of teething generally commences between
the  fifth  and tenth months,! and the  process  of the first
set, which consists of sixteen,  continues for  nearly two
years.

   *  Hereditary diseases, which might otherwise have lain dor-
mant, are frequently put into action by the irritation and fever
attendant  on dentition; hence the first appearance of coughs,
rickets, and various  forms  of scrophula, may be traced to this
period. Teething may therefore be considered perhaps the most
critical time of the life of a child.
  t Children are however sometimes born with teeth, but they
seldom or ever last long.
                           U 
138
  The usual bad, or what  may be  termed morbid, symp-
toms produced by this operation of nature,  are, restless-
ness, frequent and  sudden startings, especially  in  sleep,
costiveness, and  sometimes violent  looseness, fever,  or
convulsions.  In  general  those  children breed their teeth
with the greatest ease, who have a moderate laxity  of the
bowels, and  a plentiful  flow of saliva, or spittle, during
the time.  A costive state  of the bowels, as aggravating
the inflammatory symptoms, should  be  guarded  against,
by giving a little magnesia and rhubarb, or senna, (See
No. 50,) and immoderate  looseness,  which  is a frequent
attendant, as increasing the irritability of the body, should
be checked by giving two or three  tea-spoonfuls of the
cretaceous  mixture, No. 64, or two  drops  of laudanum,
No.  31, in  a little  mint  water, to which  six  or eight
grains  of the cretaceous powder,  No.  29, or  prepared
chalk may be added;  and if the skin be  dry,  and  the
child be  feverish,  one  grain  of  ipecacuana  will  prove
useful, by  producing   perspiration. The  discreet  use of
laudanum is a very important addition in this  instance;
and by allaying the irritability, not only of the gums, but
the whole body,  will often  prevent  fever and convulsions.
If its frequent exhibition produce  a  costive state of the
bowels, a  little  magnesia  should be given  with it,  and
the cretaceous powder omitted.
  At the same time, as  children about this  period' are
generally disposed to chew every  thing they can get into
their hands,  they should always have something to play
with that will yield a little to the  pressure of their  gums.
The Indian-rubber,  or  elastic gum,  secured round the
end  of a rattle,  I have found, for this  purpose to answer
best. The  repeated muscular action,  occasioned by  the
constant  biting  and gnawing  of  such a substance,  will
increase the  discharge from the salivary glands, while the 
139
gums  will be so forcibly pressed against  the  advancing
teeth, as to make them break  out much sooner, and with
less uneasiness than would otherwise happen.*  If these
means should prove ineffectual, an/1 bad symptoms begin
to appear, the inflamed gum should be lanced; and if the
tooth be so far advanced as to be distinctly felt beneath the
gum, the incision should  be made down to it, but not
otherwise,  as  the  divided gum by uniting  will form a
cicatrix that  must render its  passage more  tedious  and
painful.
   Blisters  applied to the nape of the neck, or behind the
ear, will often take off the irritation of the gums, and thus
relieve all the febrile symptoms.  If the child, on the con-
trary, he reduced,  with a feeble pulse, it should be suppor-
ted with cordials and a nutritious diet.

                      Of Worms.

   There is no complaint more frequent among children
than that of worms. It is a  common supposition that the
ova  or eggs  which produce them are conveyed into the
stomach  with fruit; but I belive there are few things  we
eat or drink  that  do not contain  them; I am, however,
persuaded  they are never  hatched, or nourished  in a
healthy stomach.  The  best preventive, therefore, for chil-
dren, is" proper food and exercise.
   The signs   of worms  in  children  are very  numerous,
such as disagreeable breath  in the  morning,  itching at
the nose, irregular appetite, swelled  and hard belly, trou-

   * The Anodyne Necklaces, as they are artfully termed, can
have no effect in cases of difficult dentition. 
                         140
blesome  sleep, grinding  of-the teeth during sleep, thirst
and  feverishness, cholicky pains, and often purgings;  but
as these  symptoms are common to other disorders,  the
only one  to be depended  on  is their being  evacuated, and
this may  be  observed with  respect to  every species. The
most effectual  and safe  remedy for  the  destruction  of
worms, lodged either in the stomach or intestines,  is  the
basilic powder, No. 36, according to the  direction there
specified. (For the description of the  different species of
worms, their causes, symptoms, Sec. see worms in the se-
cond part.)
  The spurious worm fever, as it is termed by Dr. Mus-
grave, or infantile remittent fever by Dr. Butter,  is atten-
ded with all the symptoms  noted above, without the exis-
tence of  any worms in the stomach and bowels, but arises
solely from the indulgence in too great a quantity of food.
The attack  in this  disorder is more instantaneous, and its
progress  more rapid, the patient often passing,  in the space
of a few  hours, from apparent perfect health  to a stupid
and almost dying state. In the beginning of this  disorder
an emetic of ipecacuan powder,  No. 23, should be given
without  delay, and soon after a gentle purge of  basilic
powder,  No. 36, with a view to evacuate the indigested
matter and  mucus, that remain in the stomach  and bowels;
if they operate properly, there is seldom, occasion  for re-
peating them. If the  purging continue longer than forty-
eight hours, it should be checked by a few drops of lauda-
num, No. 31, and  if the child be much reduced, two table
spoonfuls of the decoction of bark, No. 48, or  the solution
of the essential salt of bark, No. 24, in  port wine,  should
be  given two or three times a day. 
141
           Swelling of the Breasts ofi Infants.

  A slight distention of  the  breasts of new-born infants,
from a collection of whitish serous fluid resembling milk,
is a very common occurrence in both sexes, and is of little
consequence, unless attended  with  inflammation, which is
not unfrequently  excited by  the preposterous practice of
nurse* squeezing the breasts with their rough hands, for
the purpose of unloading  them.  If the pressure of the
clothes be avoided by their being put on loosely, it will go
off gradually, without any medical aid; but in  case of
much inflammation, the parts may be washed gently three
times  a  day with brandy.  Oily  applications,  with the
rubbing  employed by nurses, and  even recommended by
some practitioners, are very  improper, and never fail to
aggravate the complaint.
   If the  inflammatory symptoms run high, the most active
means should be  adopted  for its dispersion, such as the
application of a leech or two, a discutient lotion of equal
parts of brandy and vinegar,  applied cold, and an aperient
medicine,  (magnesia and  rhubarb) should be  employed
without delay, as the formation of matter might not only
leave, an unpleasant  scar, but in the female might injure
the gland, so as to render her at any future period unfit for
the office of suckling. If the complaint, notwithstanding,
advance  to maturation, the advice of a surgeon should not
be neglected.

                Infiamed, or Sore Eyes.

   Inflammations  of  the   eye-lids  and  eyes,   especially
such  as  are attended with a discharge of thick  matter. 
                         142
should, in children, be considered of too great importance
to constitute a part  of domestic  medicine, as they fre-
quently terminate in an adhesion of the coats of the eyes,
and thus  occasion  permanent  blindness: the advice of an
occulist or surgeon of  eminence  should, be taken while
there is a prospect of its being of advantage.
  A small blister behind the ear, or to the nape of the
neck, a leech to  the eye-lid, a dose of basilie powder,
No. 36, or calomel, No. 34, and the constant  applieation
of a lotion made with two grains of white vitriol dissolved
in two ounces of water, will often succeed in curing the
most obstinate attacks, and cannot produce any mischief.
The eye-lids should be opened,  and the lotion dropped on
the ball of the eye, as well as  applied externally, by means
of folds of soft old  linen.

                        Galling.

   The inflammation, and slight excoriations, that frequent-
ly occur in the groin, between the  legs, &c. termed galling,
are not only painful  to the  infant, but often perplexing to
the nurse, especially  if the child be much loaded  with fat.
It evidently arises  from a  shameful inattention to cleanli-
ness, and sometimes the use of coarse or new napkins.
   The cure  may always be effected by ablution with cold
water, and dusting the parts  with the prepared-chalk kept
by apothecaries and druggists  for the purpose.  If it be
situated  in the groin, or near the  genitals, it should (after
being washed) be  covered with a little fresh spermaceti
ointment, to defend  it from the action of  saline  particles
 of the urine, which often  produces much pain,  and in-
 creases the inflammation; it may afterwards be dusted with
 the prepared chalk recommended above. 
143
   Milk, so frequently employed  by nurses as a wash for
 these complaints, by turning sour on the parts, often ex-
 cites fresh irritation.
   A preparation of lead, termed ceruse powder, is in very
 general  use as a dusting powder  for children; it is, how-
 ever,  a  very  dangerous application,  and  has no  doubt,
 from  being absorbed  into the system, been the cause of
 the  death  of  many children,  by producing  convulsions
 and inflammation  in  the bowels, cases of which I have
 noticed under the head of Goulard's  Extract of lead,
 No. 30.
   In the Domestic  Medicine, by the late Dr.   Buchan, is
 imprudently recommended a little sugar of lead to be added
 to an absorbent powder when the parts are very  sore, or
 tend  to ulceration, without the  quantity to be  used being
 specified.  The Doctor  should have  known that lead, in
 a saline state, is a dangerous external application, even for
 adults and more particularly for. infants.
   From the inattention of  medical men to these  particu-
 lars in the management of  infants, I am persuaded their
 diseases are  often  referred to a  wrong cause, and their
 lives absolutely destroyed by the prejudices and ignorance
 of nurses.

                       Red Gum

  Is an  eruption  of small pimples  on  the skin,  evident
to the touch, generally red, but sometimes   yellowish,
appearing chiefly on the face, and  sometimes on the body
and  extremities,  in clusters  or large  patches.   It is
generally considered, by medical  practitioners, of a salu-
tary tendency, and it sometimes seems to relieve  infants
of complaints  in the bowels,  and  difficulty of  breathing:
but very frequently  it is attended with no such advantages. 
144
and may  often be traced to some  imprudent practice ot
thennrse,  in  either  washing the  infant with  brandy as
soon as it was born, from a mistaken notion of hardemng
the skin,  or ronghly washing  it with soap,  forthe  pur-
pose of removing the thick glu.inons matter w,th  whtch
all infants are more or less covered when born ad no
donbt intended  by natnre  as a protects tor the  tender
skin  dnring its fcetal state,  and to defend ,t agamst trnta-
tion on its first exposure to the atmospheric  a,r; and ,f .t
be only removed in such quantity as gentle  washmg w.th
warm  water will  take off,  it will  leave  the skm w«
and  healthy, instead of the dark, red,  and  trntable state
 occasioned by the spirit *  soap,t and  fnct.on employed
 for its removal.                                        .
   Whether the eruption  be critical or not, no  external
 application  should be  Employed  to repel it, but means
 taken  to prevent its  sudden  repulsion,  as  avoiding ex-
 posure to cold  air, and keeping  the bowels gently open
 with small doses of magnesia and rhubarb; and should it
 by any accident recede, the warm bath and a gentle erne-
 tic of ipecacuan will  generally succeed  in its  expulsion.
  If cough and difficulty of breathing, or a violent  affection

    * The evaporation of spirits  from the  surface of the body,
  whether of an infant or adult, generates such a degree of cold as
  to check insensible perspiration, and thus may occasion mflam-
  mation in the brain, lungs, bowels, or eyes: the practice, like-
  wise, instead of hardening the  skin, renders it more tender; it
   cannot, therefore, be too much reprobated.
    + The most  simple wash  for children is a water in which
   some almond powder has been rubbed between the hands, or fine
   almond powder may be used instead of soap: it will, m all cases,
   answer better than soap, the alkaline salt of which injures the
   skin, while the  almond powder will render it healthy. 
.145
of  the bowels  intervene, medical advice should be  im-
mediately resorted to.

                        Thrush.

  This  disease appears in white  specks on the corner
of the lips, the  tongue, and back part of the palate, some-
times gradually spreading all over the inside of the mouth,
and, from its appearance about  the anus, it has been sup-
posed to extend  throughout the intestinal  canal. Infants
brought up by  the hand are most subject to this disorder,
and to those it  does not unfrequentry prove fatal.
  The late Dr. Buchan was not perfectly correct in de-
scribing  this disease to consist in a number of  small ul-
cers, affecting the whole inside  of  the mouth, &c  They
certainly are not  ulcerations,  but, as Dr. Hunter states,
a kind of  inflammatory exudations, which is confirmed
by their falling off, and being  succeeded  by others.  It is
evidently the effect of too great an use of vegetable food,
especially from being  given hot, or with wine or spices.
The cure, of course, will depend on a change of diet to a
proper combination of vegetable and animal jellies,  as di-
rected under the  head of arrow root, or the employment
of  veal-broth  or  beef-tea, thickened with arrow root or
good  wheat flour. A costive  state  of the bowels should
be obviated, by occasional doses  of  magnesia, with either
calomel or rhubarb, and the parts  affected touched with
the  following  liniment  three  or four times a  day, by
means of a large  camel-hair brush:
  Take of honey of roses one ounce,
       Muriatic acid ten drops,
       Liquid laudanum forty drops. Mix.
  Borax  well mixed  with honey,  in  the proportion of
one drachm of the former to an ounce of the latter, has
                          X 
146
been  much recommended,  and on account of its  con-
sistency, will often answer better than a thin liniment.
  When the bowels are much disturbed,  and the  disease
evidently in a progressive state, the life of the child may
be considered in such danger as to  require the immediate
advice of a skilful practitioner in medicine or surgery.

  QJ33 For the treatment, &c.  of  the  other  diseases of
children, as  Croup, Rickets,  Measles, Hooping  Cough,
Watery Head, Cow Pox, &c. &c. see the second  part in
their  alphabetical order.

    Lichen Islandicus, or Iceland Liverwort, or Moss.

  It  appears, by the writings of the  Danish physicians,
who  flourished in the sixteenth century,  that the anti-
phthisical properties of this species of lichen were known
to the  Icelanders, as far  back as  the,  fourteenth.  The
celebrated  Linnseus confirmed its reputation in pulmonary
complaints, with much  additional  information, in 1737;
but  notwithstanding this  respectable  testimony, it was
not much  employed, till Scopoli published the result  of
his experiments with it in  the year 1769, which attracted
th#attention,of his cotemporary practitioners  in Germany
and Denmark, to its full employment in consumptions,,
where it still continues a prevailing remedy  in those af-
fections.
   Through  the  recommendation  of  Dr. Aikin, in his
edition of Lewis's Dispensatory, Dr.  Crichton,  and the
learned author  of the Thesaurus   Medicaminum,  many
physicians  were  induced to prescribe  it in this  country,
twelve years since, but evidently not in sufficient quanti-
ties to have given it a fair  trial. Its use has lately  been re-
Yiyed, in consequence of the account given of it in the last 
147
 edition of this work, and a few cursory observations pub-
 lished in the medical periodical works.
   This species of lichen possesses considerable medicinal
 as well  as dietetic  properties; the latter, residing  in  a
 mucilage, or jelly, which affords  a  regimen, well adapted
 to support the debilitated frame of a consumptive patient;
 and the  former in a bitter principle, which,  to a certain
 extent, is evidently of an anodyne, or composing nature,
 allaying  cough, and unlike opium, at the same  time fa-
 cilitating expectoration, abating hectic fever and quieting
 the  whole  system,  without  constipating  the  bowels.
 This  bitter quality  likewise  possesses a peculiar  tonic
 power, differing from all others of that class,  in strength-
 ening the  organs of digestion,  without  increasing  the
 action of the  heart and arteries; the union of such  pro-
 perties, unquestionably forms  a most valuable remedy in
 the  treatment  of pulmonary   consumptions.  The  bitter
 portion of this herb,  which in the relief of the phthisical
 symptoms,  is  the chief agent,  is  imparted to boiling
 water  by infusion; but by the long boiling, necessary to
 extract the whole of the mucilage, or for making the  con-
 centrated syrup, this  quality is considerably impaired.
   Quarin, a practitioner of some  celebrity on the  conti-
 nent,  being sensible of this fact, directs  the  herb  to be
 boiled in water  only  thirty minutes, which extracts  its
 bitter quality in perfection, with a considerable proportion
 of mucilage; and Hartmann,  in whose practice it proved
 very beneficial,  recommends two  drachms of the herb to
 be boiled  in a pint of milk for  fifteen or twenty minutes
 and taken for  breakfast and supper, which has been  much
 followed by the physicians in London;  but with  patients
of weak  digestive organs,  this medium  is  apt to  oppress
the stomach.
   Bergius, who  is more lavish in the commendation of 
                        148
its efficacy in diseases of the lungs, directs a kind of pot-
tage to be made with it, which he .gave to the extent of a
quart, in the course of twenty-four hours; and he asserts,
that  in this form, it  not only recovered his consumptive
patients, but  soon made  them  fat.  In  order  to obtain
much advantage from  the use  of this  remedy,  in the
various  species  of consumptions of the lungs that  occur
in this  country, ample experience  has convinced me,
that it must be exhibited  to the extent of two ounces in
the  course of a day,  which from the quantity of the de-
coction,  and  the paltry  preparations,  termed  Iceland
Lozenges, Syrup,*  &c. &c. containing a proper dose of
the medicinal and dietetic virtues of the herb,  too  often,
by   distending  the  stomach,  increase  the difficulty  of
breathing, and the quantity so disgusts  the patient, as to
induce  him  to  relinquish  the  remedy  entirely.  These
objections are effectually obviated, by following  the prac-
tice  of the Icelanders, and  many of the Dutch physicians,
in using it in a state of powder.
   The  success  that attended the adoption of this mode
in my own practice, after the other forms had been re-
jected,  induced me  to  recommend it to the attention of
the medical profession in a separate treatise on the Lichen
Islandicus, and I have  the  satisfaction  to find that this
method is preferred by the most eminent physicians in this
country.
   For  the purpose  of preparing this powder,  which, in

   * These preparations,  industriously  advertised  under the
 sanction of a  Mons.  Regnault,  do not contain  the whole of
 the  medicinal virtues  of the herb, and the quantity of sugar
 employed in making them, by becoming acescent, may disagree
 with the stomach and bowels. 
149
the former edition I introduced under the name of Farina,
the herb must be carefully freed from the little sticks and
green moss  which is always, more or less, gathered with
it;  and after being washed in cold water, re-dried in a
gentle  heated oven (so as not to  scorch  it), and ground,
it must be passed through a fine  sieve, to deprive it of its
fibrous parts, which contain no properties of the herb, and
are perfectly insoluble.
  The farina,  when carefully prepared, possesses in per-
fection  both the medicinal  and dietetic virtues of the
Lichen;  and to  form the jelly, does not require that long
boiling which proves so destructive to its bitter principle.
It may be taken in the quantity of a  quarter of an ounce,
or three drachms, boiled with half an ounce of cocoa, in
half a  pint of distilled water, or  milk,  which  coincides
with its virtues,  and so far covers its bitter  taste, as to
render it an agreeable breakfast and an evening repast,
instead of the baneful practice of tea-drinking.
   The fresh roasted cocoa nibs  I have found to answer
much better than the  ground cocoa or chocolate, generally
sold by  grocers, on  account of the oil, with  which they
abound,  being milder, and which,  in chocolate especially,
is often  very "fancid.
   The  powder of the  Lichen may  be  ground with the
cocoa  nibs, in the  proportion of one part of the former
to four of the latter (which in the last edition was  called
Iceland  Lichen Cocoa), and  used in the following man-
ner : To a large table-spoonful  of this cocoa, add as
much milk  as will make it into  a soft paste; then pour
on half a pint of whey, milk,  or distilled water,  and boil
them over a gentle heat,  for  about ten minutes,  in a pot
with a close cover; after it has stood to settle,  it may be
poured off for use, and a little sugar and  cream added, as
agreeable to the palate of the  patient.  If chocolate should 
150
be  preferred, it may be  used in lieu of the cocoa  nibs^
with the Lichen flour, in the same proportions; but  great
care should be taken, that the chocolate be fresh.
  The farina, or flour  of the herb, may likewise  very
conveniently be made  into  a kind  of pottage, according
to the practice of  the  Icelanders  and  Danes,  either in
milk, water, or broth,  as may  appear most suitable to
the case or palate of the patient, in the following manner:
  To a dessert-spoonful of the farina, add  as much cold
water as will make it into a soft paste; then pour on by
degrees half a pint  of boiling water, broth, or warm  milk,
stirring it briskly the whole time:  after boiling  for about
ten minutes it will become  a smooth thin jelly.  A  little
sugar, currant-jelly, liquorice, raisins, cinnamon, butter,
or any aromatic, may be added, to render it palatable.
  If the phthisical symptoms  should indicate the use of
the bitter quality of the Lichen in greater proportion than
contained  in the  farina, such  as  troublesome  cough,
difficulty of expectoration,  loss  of  appetite, diarrhoea^
and  profuse perspiration ;  a concentrated  infusion  may
likewise  be employed;  for  this purpose three  ounces of
the contused herb may be infused in a pint  and a half of
boiling  water for  three  hours;  evaporate  the  strained
liquor over  a gentle heat,  to the  consumption of one
half, and add one  drachm  of extract of liquorice;  three
table-spoonfuls of  which  may be taken every three  or
four hours.
  This mode of administering the bitter portion of the
herb as a  medicine, I  have  found to answer  in several
instances after the  other preparations have been rejected,
directing the patient to  use the jelly of the arrow root, or
tapioca, as an article of  diet,  over which I do not conceive
the jelly of the Lichen,  after being deprived of its bitter,
to possess  any advantage whatever. 
151
  The  decoction of this herb, which  is frequently pre-
scribed  by physicians, and  sometimes  preferred by the
patient,  is made by boiling, over a gentle heat, one ounce
of the herb (previously washed  in cold water) in a  quart
of distilled water,  for the space of fifteen minutes; two
drachms of liquorice root sliced, may be added about five
minutes before it is taken off the fire. A tea-cupful of this
decoction should be taken three  times a day; or, a quarter
of an ounce of the herb may be boiled in  half a pint of
milk for ten minutes, and taken for breakfast and supper;
or, if chocolate be preferred, it may be made with the de-
coction  of the  herb, as directed above (without the  liquo-
rice), in the usual maimer, instead of water or milk. 
152
          A  Table  of Diet for  Invalids.

              LOW  OR FEVER DIET.
   Panada;  gruel; milk, thickened with arrow root; plain
 bread pudding; arrow root, salep, tapioca jellies, rice milk;
 chicken or veal tea.

                        Drink.
   Barley water,  acidulated  with lemon juice; milk and
 water; lemon or orange whey; thin gruel;  bohea, balm, or
 mint tea.

 RESTORATIVE,  OR CONVALESCENT DIET.

   Rice or bread pudding; hart's horn, isinglass, or calves
 feet jelly; oysters and shell fish; flounder  and soles, veal,
 fowl, rabbit, and lamb.

                        Drink.

   Fresh  small beer; porter; port or claret wine with water;
 weak brandy and water.

          GENEROUS OR FULL  DIET.

   Rice or bread  pudding; strong beer; broth or gravy
 soup; oysters and  shell fish; veal, fowl,  lamb, mutton,
 beef, pork, &c. jelly of hart's horn, calves' feet, or isinglass;
 meat soups,  with vegetables, •

                        Drink.

   Brisk cyder or  perry; sheny, port, or claret wine; rum
or brandy diluted with water. 
153
      Description of Medicine Chests, &c.

  The chests are neatly made of mahogany, and the bottles
of flint  glass,  with glass stoppers, carefully ground, and
made air tight. The  bottles  and  drawers have  printed
labels affixed to them,  expressive of their contents, with a
numerical reference to the book of directions, and the me-
dicines are of the choicest quality.*

 Of the Improved Family Dispensary there are six sizes,
                         viz.

First size, containing every article specified in
  the Family Dispensary.......17    4  0
Second  size, do...........14    8  0
Third size, do...........10   16  0
Fourth  size, (with the omission of four arti-
  cles, there being only nine bottles in each
  wing)...........   .8    60
Fifth size, (eight articles omitted, there being
  only six bottles in each wing).....6   16  0
Sixth size.............5   18  0

                 The Gentleman's Case.
From 31.  6s. to..........6    6  0

                The Lady's Dispensary.
From 1/.  12*.—2/. 15*. to......   7   10  0

   * Medicine Chests,  similar to those recommended by Dr.
Reece, may be fitted up by the apothecaries in different parts
©f the United States.
                           Y 
154
                   Traveller's Case.
Made flat for the convenience of travelling      3   10  0

                    The Infirmary.
From 3/.  15*. to.........10    8  0

                The Specific Dispensary.
Complete, with alterative  medicines,  recom-
  mended in the  Supplement to the  Domestic
  Medical Guide..........3    6  0

                The Sea Medicine Chest.
From 8/.  6*. to 20/. and upwards.

              Portable  Chest ofi Chemistry.
Furnished with different tests,  for the  analysis of natural
  and artificial prqducts, with  microscope, &c. and  com-
  plete directions,"from 4/. 8*.  to 8/. 5s. and upwards.

                  Mineralogical Chest.
Containing re-agents and implements for analysing mine-
  rals, from 3l. 6s. to 10/. and upwards.

  N. B. Family Medicine Chests may be re-furnished, or
allowed for in exchange.

  QU° The chests made of deal or oak, and  furnished
with  black bottles, may be had at  a much cheaper rate.
They contain the same medicines and utensils, and are in
every respect as convenient; the only difl'erence being in
external appearance. 
      NEW AND COMPLETE SYSTEM



                 OF





     FAMILY MEDICINE,




            COMPREHENDING




       EXPLICIT INSTRUCTIONS



              FOR THE




PREVENTION AND CURE OF THE VARIOUS DISEASES



             INCIDENT TO




        THE HUMAN RACE;




               BEING




         THE SECOND PART




              OF THE




  DOMESTIC MEDICAL GUIDE.
 
& 
            TO HER GRACE

    THE DUTCHESS OF LEEDS,

         THIS SECOND PART

               OF THE

DOMESTIC MEDICAL GUIDE

      IS MOST RESPECTFULLY INSCRIBED

           BY HER GRACE'S

         MUCH OBLIGED,

           AND VERY OBEDIENT,

                HUMBLE SERVANT,

                    RICHARD REECE.
Henrietta-street, Covent Garden,
   July 27, 1806. 
 
               COMPLETE SYSTEM
                        OF

-MODERN DOMESTIC MEDICINE.
N. B. The Diseases are arranged in alphabetical order.
                     OF AGUE.

  WHEN the cold fit of an intermittent fever continues so
 long and violent as to form a principal part of the disorder,
 it is termed Ague by the  ancient writers; but in modern
 practice this distinction is not observed, all varieties being
 denominated Intermittent Fever, the different species of
 which are enumerated under that head.

         ANIMATION, SUSPENSION OF.

   See Appendix to the Family Dispensatory, page 103.

                 OF APOPLEXY.

  An apoplectic fit consists in a sudden deprivation of all
the senses and voluntary motion, in consequence of com-
pression of the brain; which when produced by an effusion
of blood, or a distention of the internal vessels of the head,
from an accumulation  of blood,  is termed Sanguineous
Apoplexy; and when occasioned by an effusion of serum,
which occurs chiefly in  dropsical habits, Serous Apoplexy.' 
160
               Ofi Sanguineous Apoplexy.
  It seldom occurs before the fifteenth year of a person's age.
The short-necked,  the  indolent, and  such as are apt to
indulge in full meals of animal food, and the free use of
spirituous and  vinous  liquors,  are  most  subject to  this
disease.  Its frequent occurrence, of late years, in  this
country, may in some  degree be attributed  to  the un-
usual vicissitude of  the climate, but  more properly to the
increased consumption  of animal  food and  spirituous li-
quors during a sedentary life.

       Ofi the Symptoms of Sanguineous Apoplexy.

  With  the loss of  sense  and voluntary motion, there is
an   appearance  of  profound and continual sleep,  with
snorting; oppression of the breath;  the  pulse generally
much slower; while the arteries of the  head,  particularly
those of the neck, beat with increased force; the  face red
and bloated; the neck swelled, with a distention of the
vessels, and dilatation of  the pupils of the  eyes. Although
the whole of the body is affected  with a loss of sense and
motion,  one  side,  on examination,  will  generally  $$
found to be more so than the other.
   These appearances, which  constitute  what  is  called
the  apoplectic fit, are often preceded by a sense pf weight
on  the  head and  giddiness;  frequent head-achs;  bleed-
ing at the nose; redness of the eyes; imperfect vision;
a noise in the ears,  like the ringing of bells at a  distance,
or  the  boiling of  a  tea-kettle;  a  transitory degree of
numbness, or loss  of motion in  the extremities; faulter-
ing of the voice; impaired memory;  drowsiness, particu-
larly after dinner; the night mare; and  disturbed sleep.
   By early attention  to these  premonitory symptoms, an
 attack of this disorder may not  only be  foreseen, but by 
161
the early recourse to the preventive means recommended,
it may be effectually obviated.

         Of the Causes of Sanguineous Apoplexy.

  The general cause of this species of apoplexy is a ple-
thoric habit of body, with a determination of blood to
the brain. It may, therefore, be brought on  by whatever
hurries on the circulation, so as to increase  the  afflux of
blood into the vessels of the head; such as violent exer-
cise; passions of the mind;* intoxication;f violent vo-
miting, or straining. It may likewise be occasioned by
whatever impedes the free return of blood from the head;
as a tight ligature or handkerchief round the neck, stoop-
ing down, or lying with the head lower than  the body;
looking behind, or  upwards for some  time.
  In order to  check the velocity of blood into the vessels
of the brain, nature has  made an admirable  provision,
by the circuitous direction in which the great artery passes
through the skull bone; in the proportion to  the acute-
ness of the angle it makes, so will be  the impetus of the
blood;  and I  am inclined to believe one cause of heredi-

  * Anger and fear, #vhose effects on the body are very oppo-
site, are  enumerated by Van Swieton, as  frequent causes of
apoplexy.
  f When sudden death takes place during drunkenness, it
must be by producing apoplexy.  Among persons in the habit
of drinking,  fatal apoplexy  is very frequent. " This disease
(observes  that  excellent physician Dr. Trotter), being so fre-
quent an attendant or a consequence of excessive drinking,
holds up a most awful warning to the inebriate:  the thought of
a human being rushing into eternity from a board of gluttony,
riot, and intemperance, ought to appal the most depraved and
obdurate of mortals."
                                  Z 
                                  162
         tary apoplexy to be the direction of this  canal, allowing
         of too free an  admission of blood. The internal  vessels
         of the head, likewise, being supported  only by the  soft
         medullary matter of the brain, instead  of the solid sup-
         port  of muscles,  skin, &c.  which they  have  in other
         parts of the body, are  more easily distended or ruptured.*
           Dr. Baillie, in his admirable work on Morbid Anatomy,
         observes, " when the  patient is not cut off at once, but
         lives for some  time after the attack, the palsy of one  side
         of  the body, which generally follows  an apoplectic fit,
         happens on the opposite side to that of the brain in which
         the  effusion of blood  has taken place;  i.  e. if the right
         side of the brain be  compressed, it will paralize  the left
         side,' and vice  versa;  hence it happens, that if a  person
         loses the use of his right side by pressure of the left  por-
         tion  of the brain, the  right  eye will not be affected,
         while that  on  the  opposite  side will be  nearly  useless.
         These effects are not  satisfactorily accounted for.
           Dr. Magennis enumerates three species  of sanguineous
         apoplexy: the  first  arising from increased vascular  tone
         throughout the system, with an undue determination of
         a rapid circulation; the second from  local  congestion;
         and the third he supposes to be derived from weakness of

           *  Some time since, I was requested to examine the head of
#        a gentleman who had suddenly died of apoplexy. In the right
         hemisphere of the bram there was a considerable extravasa-
         tion  of blood, and on the left side I discovered some coagulated
         blood, of a hardish consistence, which proved to be the  remains
         of an effusion which had produced  an apoplectic fit about
         twelve months before; a proof that a rupture of a vessel in the
         brain is not necessarily a  fatal occurrence; he was, however,
         afterwards much affected with head-ach, giddiness, and drow-
         siness. 
163
the vessels of the brain, thereby rendering them incapable
of  transmitting the  quantity of  blood  received,  which
gradually  accumulating  and distending their  coats, ulti-
mately produces compression. This last species generally
affects people  far advanced in life.
   It is very common on examining the  brain  of persons
considerably  advanced in  life,  to find  the  arteries in a
very diseased state.  Dr. Baillie has  often found a bony
or earthy matter deposited in the  coats of the  great and
sometimes the lesser arteries  of  the brain,*  by  which
they lose a part of their contractile and  distensile power,
as well as of their tenacity. The vessels of the brain, under
such circumstances of diseased  structure, are much more
liable  to  be   ruptured  than in an healthy  state. When-
ever blood is  accumulated in unusual quantity, or the cir-
culation  going on  with  unusual  vigour, they are very
liable to this  accident; and accordingly in either of these
states, ruptures frequently happen.

       Of the Treatment of Sanguineous Apoplexy.
   The first and principal object  to  accomplish towards
the recovery  of the  patient, is evidently the unloading of
the vessels of the head, by  cupping  or  scarifying the
scalp or nape of the neck, and  between  the  shoulders;
or  opening the temporal artery, which should  be done  as
soon  as  possible after  the attack.  Bleeding  from the
jugular vein,  is much recommended by medical writers;
but I conceive the  unavoidable interruption  to  the  return
of blood from the head, by the ligature, to elevate or dis-
tend  the  vessel, for the purpose  of opening,  although

   * This diseased state of the blood-vessels of the head is, no
doubt, often the cause of obstinate  head-ach, lethargy, epi-
leptic fits, and  other  nervous diseases in old people. 
                         164
temporary, will certainly increase the effusion  of blood in
the head, in case of a rupture of a vessel; or if distention
only exist, it  may produce a rupture, particularly it the
vein do not  rise readily  or  be soon  opened.  Blisters
should likewise be applied to the head and between the
shoulders.  The next object is  to lessen the  determina-
tion of blood to the head by increasing the circulation  in
the extremities, by  stimulating the feet and hands  with
mustard poultice, No.  111. The action of  the  bowels
should be  promoted by a  dose of  the  cathartic extract,
No. 46, and the laxative clyster, No.  97, with the ad-
dition  of  two  table-spoonfuls   of  common  salt.  The
body  should  be kept nearly in an  erect posture, and the
head supported in that situation, as favouring the return
of blood from, and at  the  same time  checking its afflux
into the head. The sooner these measures  are  put into
 execution, the greater will  be the probability  of success.
 It has been a question much agitated of late, whether the
 exhibition of an emetic is proper  on  the first attack  of
 apoplexy.  By producing  an  equal  circulation  through-
 out the  system, it has often relieved local  congestion;
 but the violence of straining, it has been said, may pro-
 duce  the rupture of a distended vessel in the head; and,
 if effusion have  taken place, it  will be likely to increase
.it; it  may, however,  promote  absorption. It is, at any
 rate  too ambiguous a remedy for domestic medicine.
    If  the apoplectic fit be evidently produced by  excessive
 drinking  the contents of the stomach should be diluted
 by drenching the  patient  with  warm  water. Vomiting,
 in this case, is always of great service. (See Treatment
 of a  Drunken Paroxysm, page 108.) '

         Of the Prevention of Sanguineous Apoplexy.
    People disposed to apoplexy, or who have  ever  ex- 
165
perienced an attack, should be particular in  keeping their
feet warm,  by wearing flannel socks, and the use of the
water-proof soles, which I consider an  excellent  contri-
vance to keep the feet both dry and warm; and particu-
larly to guard  against fulness of the vessels, by taking-
moderate  exercise and avoiding full  meals and spirituous
liquors. When in a bed,  the head should be always kept
much higher than  the  trunk,  but not so as  to bend  it
forward on the chest, so that the elevation may be gradual
from the feet to the head. When affected with the pre-
monitory  symptoms already noticed, a brisk purge  of
aloes,  a blister to  the nape of the   neck or  head,  and
putting the feet in  warm water, will often  obviate  an
attack.  Snuff, by increasing the secretion of the nostrils
and producing sneezing,  will likewise prove serviceable.
General blood-letting, having a tendency afterwards  to
produce plethora, should only be practised when apoplexy
is immediately threatened;  the application of leeches  to
the temples will often supersede  its necessity. Keeping
the bowels open by repeated doses of Epsom salt or the
cathartic extract, a seton or issue  near the head, will be
useful in  preventing any  turgescence of the blood, and
unquestionably the most effectual  preventive that  can be
employed.  The head should be shaved and washed with
cold water  once a day.   A reclining posture  and  much
sleep should be  avoided, for nothing is more hurtful than
too great an indulgence in bed.   By  a strict  observance
of these rules, a  fit may be kept off for a great length of
time,  however  predisposed the person may  be  to  the
disease.*

   * I  have known several aged persons that have experienced
attacks of apoplexy, procrastinate the fatal  relapse for many
years by strict attention to these means. 
166
              The Distinction ofi Apoplexy.
   Apoplexy  is distinguished from profound sleep, which
 it much resembles, by applying the smelling salts,  or sal
 volatile, to the  nostrils, which  will immediately rouse  a
sleeping, but  will have no  effect on  an apoplectic person;
and from a fit of intoxication, by the paleness of the face,
the smell of the  breath, manner of living, the stertoreous
breathing, diminution of the power of volition  and ab-
sence of convulsions, from epilepsy.  It is often  extreme-
ly difficult to discriminate between  that  insensible  state
that follows  an  epileptic fit and apoplexy, particularly as
an apoplectic paroxysm is  sometimes preceded by violent
convulsions, foaming  at the mouth, grinding of the teeth,
and other convulsive motions of  the  body; but a know-
ledge of the habit and constitution of the patients, will, in
general,  enable a practitioner to determine the comatose
state  after epilepsy  from  apoplexy.   The  state of the
pulse, laborious  respiration, and the paleness of the face
in fainting or swooning,  will distinguish it  from  such
complaints.

                  Ofi Serous Apoplexy.
   Dr. George Fordyce asserts that the  compression of
the brain, producing apoplexy, seldom  or  never arises
from  the serous part of the blood  being extravasated;
and adds, whether serum or blood be the cause, the same
methods should be  pursued for relief. When apoplexy
occurs in a  dropsical person, it  may be  referred to an
effusion  of serum, which  for  its removal, will require
the means suggested  for  the  cure of sanguineous  apo-
plexy,  with  the  omission  of  blood-letting.  Cordials,
which, in the sanguine apoplexy,  are  not allowed, would
in this case be  very proper; it is  the consequence of ex-
treme debili^ of  the system, and generally  terminates
fatally. 
167
               APHTHA.  See Thrush.

      APPETITE, LOSS OF. See Indigestion.

                   OF ASTHMA.

  Asthma  is often an hereditary disease,  and evidently
of a spasmodic  nature, occuring chiefly in sanguine habits
and straight  chests. Both youth and age are subject to
it;  in the former, if tubercles exist in the  lungs,  it will
produce  consumption; and in the latter, dropsy of the
chest. When the complaint  is attended with an expec-
toration  of phlegm, it is  termed moist or humoral; and
when with  none, dry or nervous asthma; but it is rarely,
if ever, entirely free from expectoration of a little phlegm.
  Dr. Robert  Bree,  of Birmingham, in a very excellent
treatise on disordered respiration, divides asthma into con-
tinued and  periodical.  The   continued  asthma, he ob-
serves, cannot be properly said to be free from convulsive
contractions  of the  respiratory  muscles, but these are
carried on without regular paroxysms.  They  are more
permanent, but  less violent, and depend on fixed irritation
either in the  chest or bowels.  The  periodical  asthma
consists in  regular  paroxysms  of convulsive  contractions,
and is therefore usually called convulsive asthma.
  Of the convulsive asthma the  learned  Doctor enu-
merates four  species, viz.
  1st. From  the  irritation of effused serum  in the  lungs.
  2d. From the irritation of aerial acrimony in the  lungs.
  3d. From irritation in the  stomach or some of the ab-
dominal viscera, and
  4th.  Dependent upon habit, and caused  by  sensation
after irritation has been removed from the thoracic  or ab-
dominal viscera. 
168
                 Symptoms ofi Asthma.
   An almost constant  difficulty  of breathing, with exa-
 cerbations towards evening or during the night, threaten-
 ing  suffocation,  with  a  sense  of  tightness across  the
 chest, the breathing being performed slowly, and with a
 wheezing noise:  if the patient be  lying down when the
 fit comes on, which is often suddenly,  he is obliged to
 change the posture for one more erect, and requires a free
 cool  air. These symptoms  gradually   abate  towards
 morning, and the fit seems to end  in  an expectoration of
 phlegm  from the lungs. For  several  successive nights
 the symptoms suffer an exacerbation; and after some days,
 on  the  expectoration   becoming  and  continuing more
 copious,  the paroxysms for a time  cease altogether. The
 pulse  is  for the most part quick,  weak  and small; and
 the urine, which,  on the commencement of the paroxysm,
 is  pale,  on   its remission becomes high  coloured, and
 often deposits a  sediment. The  face is,\  during the pa-
 roxysm, generally pale and shrunk, but sometimes a lit-
tle flushed and turgid.  The fit is often preceded by  las-
situde, drowsiness, a sense of weight or pain of thehead,
 and symptoms of indigestion.

                  Causes ofi Asthma.

  The principal  cause of asthma, in England,  is sup-
posed, by Dr.  Ryan, to be obstructed perspiration, pro-
ducing a congestion of blood in the vessels of the lungs.
 Dr.  Cullen  says, it depends  on  a  particular  constitution
 of the lungs, and its proximate cause is a spasmodic con-
 striction  of the muscular  fibres of the wind-pipe and  its
 subdivisions, preventing the expansion necessary for  a
full  and  free inspiration. The immediate and  exciting
 cause Dr. Dover asserts  to be a determination of blood
 to the lungs. 
169
   Dr. Darwin is of opinion,  that the humoral asthma 13
occasioned by  a torpor of the vessels of the lungs, and
particularly an  inactivity  of the lymphatics; in  conse=
quence of which, the  lymph, which  the learned Doctor
supposed to be effused in the air  cells, is not taken up by
the absorbents.  The cause of the convulsive  or spasmo-
dic asthma,  he suspects  may arise from an  affection  of
the liver or biliary ducts,  and even a pain in  a remote
part of the system.

                 Treatment ofi Asthma.

   Medicine.  If the symptoms run high, with pain in the
chest, and  great difficulty of breathing, the loss  of eight
or  ten ounces of blood, with  a  blister over  the breast-
bone, or between  the shoulders,  should always precede
the use of  medicine,  in case the  subject be plethoric and
not aged.  Two or three table-spoonfuls of the  asthmatic
mixture, No.  68,  may afterwards be taken three times
a day, with the  pills, No. 79, twice a  day.  In  obstinate
cases,  half a tea-spoonful  of ether, No. 14, with  fifteen
drops  of laudanum,  No.  31,  every night,  or during the
fit, or the inhaling of the vapours of ether,  evaporated in
a  warm saucer,  as recommended by  Dr. Temple, will
afford considerable relief, and, if it do not prevent, will
much  shorten  the  paroxysm.  The pectoral plaster,  No*
108, should be kept  over the breast  bone, so soon  as the
blister is healed.  The squill,  combined with  ipecacuan
in the form of lozenges, is  a composition well calculated
to relieve asthmatic or chronic difficulty of breathing, and,
on  account  of their  gradual  solution  in  the mouth, will
often  answer better  than pills. This medicine was much
recommended by Dr. Fordyce, and » very similar one, in
the form of pills, by Dr. Morton.
  Asthmatic people  of every description  should be Verv
                         2" A 
170
particular in attending to the state of  the  stomach and
bowels, and  guarding against indigestion and  its  conse-
quences, as costiveness and flatulency ;  for the  stomach
being connected with the diaphragm,  which is frequently,
if not always,  more  affected during the  asthmatic pa-
roxysm than even the lungs,  a slight  derangement of the
digestive organs will  bring on a paroxysm, and never fail
to increase the difficulty of breathing  during  its  absence.
On any symptom of indigestion, the patient  should clear
the first passages by an active emetic  or aperient  dose  of
the basilic powder, and keep up proper digestion by taking
a glass of  Epsom water, noticed No. 2, to which, in case
of  much flatulency,*  a little ginger  powder, or  com-
pound tincture  of ginger and chamomile, No. 7, may  be
added.
   Vinegar alone, or combined, with squills, as the oxymel
of squills, in the  dose of a  table-spoonful,  often affords
very  considerable relief in asthma, by promoting expec-
toration, and at the same time corrects, and in some de-
gree prevents the accumulation of inflammable air in the
intestinal canal.
   The  decoction of the Seneka  root  has, in many  in-
stances, proved eminently useful; but  to young  people
it has been found too  heating.  By promoting expectora-
tion,  perspiration, and  secretion of urine, it  may be con-
sidered an important remedy in  asthma of elderly people,

   * All asthmatics suffer much from a collection of inflamma-
ble gas in the intestines,  the free expulsion of which uniformly
affords considerable relief.  The prevention of this species of
flatulency is certainly of  great consequence in the treatment of
every species of asthma, by taking occasionally an active pur-
gative of jalap  und«calcn>el,  the  use  of the Epsom  water,
No. 2, and particular attention to diet. See Flatulency. 
171
particularly  when attended with a  dropsical disposition.
It may be combined with squill in  the  following propor-
tion:
   Take of decoction of seneka, eight ounces,
       Oxymel of squills,  one ounce,
       Paregoric elixir, half an ounce,
       Hoffman's anodyne liquor,  two drachms.  Mix.
Two or three table-spoonfuls  to be taken  three times  a
day.
   Dr. Ryan  judiciously recommends the  cold bath; and
Dr.  Bree observes, " that there is no single remedy of
more value in all species of asthma during  the absence of
the paroxysm."
   The extract of Hyoscyamus, combined with the nitric
acid and  squills, has lately been much extolled  as a re-
medy for  asthma, and also the red sulphate of iron.  But
there are  such varieties of the disease, which again are
attended with such opposite states of the constitution, that
a  medicine, which has proved highly beneficial in one
instance, might,  in the same species, prove as^hurtful  from
peculiarity of constitution, or from being accompanied
with plethora or inanition. To lay down directions  for the
medical treatment of every species  of this  disease, under
certain circumstances, would, therefore, occupy more room
than the limits of this work will admit of,  and which  is,
indeed, rendered unnecessary by Dr. Bree's late valuable
publication on Disordered Respiration, to  which I can
refer my readers with confidence.

                       Diet,  £s?c.

   Errors in diet  are so great a source of the inconveniences
of asthmatic  people, that,  as I have already observed, in-
digestion and its consequences often appear to be the very
causes of the disease. The  free use of strong liquors, 
172
sweet wines, and  new malt  liquor; a profuse indulgence
in the use of tea and warm watery liquids  of all kinds,
are very improper, and very frequently act as an exciting
cause of the paroxysms.  Heavy suppers, eating between
meals, and generally  all food of difficult digestion,  such
as smoked meat,  pastry, fat meat, raw vegetables, sal-
lads and unripe fruits;  also  boiled cabbage  and  carrots,
rich soups, jellies and  sauces.  These articles  do not
readily  digest in the stomach of an asthmatic, but remain
till a fermenting  process  takes place, when, if not  eva-
cuated  by  purging or  vomiting, the  paroxysm may be
excited; and even when those  evacuations  occur,  such a
consequence is not always prevented.   Every thing,  says
Dr.  Bree, which,  in dyspepsia (indigestion), ought to
be avoided, should be  abstained from by the  asthmatic,
who must rigidly believe that his paroxysm may be more
frequent, or the intermission longer,  in proportion as the
seductions of  the table are too powerful for his  prudence,
Or are resisted by his care. Intoxication and  surfeit are
among  the worst of his enemies;  but  they have so  little
allurement where  the habit is infirm, that  an asthmatic is
not likely to suffer from  such exciting  causes. (See Flatu-
lency and Indigestion.)

         Prevention of the Paroxysm ofi Asthma.

   The  use  of a thick  flannel  waistcoat next  the skin;
occasional  emetics of ipecacuan and a little  oxymel of
squills; the troches of squill and  benzoin dissolved gra-
dually in the mouth, and swallowed about twice or thrice
a day, and a seton or large issue between the  shoulders,
or  in the  side, will  often succeed  in preventing,  and
never fail to abate the violence of the paroxysm of asthma,
and relieve the breathing during its absence. If the sub-
ject be  advanced  in  years, or  affected with  swelling of 
173
the legs, an issue or seton will not  be proper, as by ex-
tracting the glutinous part of  the blood,  it may  induce
dropsy of the chest.  A  diet light and easy of digestion
should be  adopted, as broth, light  puddings,  fowl, veal,
&c. and a little ginger used in the beverage, to obviate the
flatulent  effects of vegetables: good old perry and cyder
afford the most salutary beverage.
  Asthmatic people are  differently affected by the atmo-
sphere,  some  breathing  with ease   only in pure  country
air, while  others cannot live out of London; and 1 L:-ve
known  an  asthmatic  that   could   not  continue  :n-re
than a week at a time either in the London or the country-
air,  but breathe  with tolerable freedom  in  the  city  of
Bristol.  Some require  a condensed or cold  air, while
others can only live  in  a light one.  Persons, therefore,
afflicted  with  asthma, must consult  their  own feelings as
to the  place  in  which  they should reside.  A spacious
room should always be preferred, as closeness* is parti-
cularly disagreeable  to asthmatic patients; and if the  air
be too dense, he should occupy the highest  room in the
house.  When the  breathing is very  difficult,  I have
known the nitrous gas gradually diffused in the air of the
room, as recommended for purifying the chambers of the
sick, page  90,  afford instantaneous  relief, and  often pre-
vent  the accession of a  paroxysm. Flowers and herbs,
which purify the air in  the  day-time, should not be left
in the bed-chamber  during  night  for  reasons assigned
Note,  page 94.  He  should,  likewise, select a residence
for the  different  seasons  of  the year.  Malvern air  and
water, during  the summer season, I have  known in many

  * " The asthmatic patient, (says Aretceus) loves walking in
the open air, with  his mouth open, and is dissatisfied with the
largest house, which seems too small to breathe in." 
174
instances prove so  beneficial, that patients have even ima-
gined themselves cured, and have afterwards been able to
live the winter in London without experiencing much in-
convenience.   During the winter season,  Sydmouth, and
Exmouth, in  Devonshire, afford, perhaps, the best retreat
in these kingdoms. The atmosphere  of  Lisbon or the
South of France is preferable.

                Distinction of Asthma.

  This disease is  distinguished from  inflammation of the
lungs and pleurisy in being chronic, unattended with acute
pain or stitches in  the chest, or  fever. The  returning of
the paroxysms at intervals, the sense of constriction above
the chest, occasioning the patient to get into an erect pos-
ture, and to fly for relief to the cold air,  will distinguish
asthma from other diseases.

             BILIOUS AFFECTIONS.

  It has of late years been very fashionable  to attribute
almost  every  derangement of the  stomach  and  bowels,
and even complaints of the head, to a redundancy, or an
accumulation of bile in the stomach, an idea founded in
error,   and  first  suggested by designing and  illiterate
quacks, that they  might  the better impose their trash on
the credulous  public, too often to the irreparable iniury of
the digestive  powers of  those who are  induced  to take
their antibilious medicines. No secretion in the human
body is more  regular  than that  of the bile, or less dis-
posed  to be vitiated;  and were it not disturbed by the
action of strong cathartics (generally composed  of mer-
cury)  taken for the purpose of  carrying off a supposed
redundancy, it would continue  healthy, and in due quan-
tity.  The  biliary  duct,  for conveying the bile from the 
175
liver  and gall  bladder, terminating  in the  intestine,  the
bile cannot get into the stomach, unless  forced into it by
the effort of vomiting, or by a reversion of the peristaltic
motion of the intestines,  which is a  very rare occurrence.
When, through the obstruction of biliary concretions, or
spasms, the bile cannot flow into the intestines, it is taken
up  into  the circulation by  the  absorbent vessels  of  the
liver, so  as to  tinge the  white of the eyes and skin of  a
yellow appearance, and the intestines become in an indo-
lent state, and the stools white, from  the loss of the stimu-
lating and colouring matter of the bile, which constitute
the disease named jaundice. In cases of indigestion there
is generally a deficiency of bile,  through a sluggish state
of the liver;  and in these cases we find people most com-
plain of a preternatural collection of  the bile, although the
reverse is in reality the case. Hence, medicines which ap-
proach near to the nature of the bile, uniformly give relief
in those  cases, and which may with more propriety be
termed bilious, than anti-bilious medicines.  (See Indiges-
tion.) When a redundancy of bile is evident from bilious
stools, the diluted vitriolic acid, by decomposing it,  will
afford a  safe  and  efficacious remedy, while the brisk ca-
thartics of aloes and calomel, only give temporary relief, and
aggravate the cause; but when a redundancy or deficiency
of bile exists, it should not be treated as a primary affec-
tion,  but considered as a  symptom of  some  disease, in
which the  strong cathartic medicines, or the  anti-bilious
medicines  of illiterate empirics may do irreparable  mis-
chief.*

  * The  editors of the Medical Observer, in their account of
the anli-bilious pills of a certain clerical adventurer, under the
patronage of  a Right Reverend Prelate, make the following
pertinent and just  remark: " One would have supposed  that
* 
176
    In the former impressions of this work I asserted, that
 the  complaints of  the  stomach  and  bowels,  generally
 ascribed to a redundancy of bile,  arose from a deficiency
 of that secretion; and that such was the  importance of a
 due secretion,  that good  chyle could not  be formed with-
 out it, and  that a copious secretion of course  contributed
 more to the health of the body(than otherwise, which  is
 evinced by the faeces of people  in  perfect health being
 tinged more with bile than those  of the valetudinarian,
 affected with indigestion, whose stools are generally of a
 light  clay  colour, an  evident  proof  that the bile is not
 poured into the intestines in  sufficient  quantity.* This
 opinion has  been  since  confirmed  by  a  Mr.  Aber-
 nethy, Dr.  Stone,  Dr.   Webster,  and  several medical
 practitioners of character,  who have considerably  ex-
 patiated on it.  Mr.  Abernethy  ascribes  a  number of
 chronic diseases,  such   as   cancerous  tumours,  white
 swellings,  &c.  to  unhealthy chyle, in consequence of  a

 such  characters, from their elevated  situation  in life, would
 have had a  greater  regard  for  their own reputation  than to
 have  lent their names for such purposes as the countenancing
 of quackery. One would, indeed, have thought, that a regard
 for the clerical character would have sufficiently deterred them
 from tarnishing it by the odium it incurs, when involved in the
 most pernicious  traffic  existing  in human nature. To  tamper
 with the lives of our fellow-creatures is traducing the character
 of man; but when we  sec a clergyman abandoning his sacred
 character by adverting to empiricism from the mere motives of
 lucre, well may we" exclaim, " O tempora, O  mores!!"
  * Such patients are  uniformly troubled with flatulency, aci-
 dity in the stomach, colicky pains, nausea, loss of appetite, in
the cure of which a German physician has acquired great cele-
brity by exhibiting the inspissated bile of an ox. 
177
deficiency of bile, and  proposes to cure these  obstinate
affections  by such medicines as are calculated to increase
the biliary secretion, and strengthen the  digestive organs.
  Mr. Eaglesfield Smith, in his " Observations  and Ex-
periments  on the Digestive Powers  of the Bile in Ani-
mals," recently  published,  asserts  that the bile is the
principal agent by which digestion  and  the formation of
chyle are  effected. The  bile, however, not being  pour-
ed  into the stomach, cannot, as this author supposes, be
the chief menstruum in dissolving  the food, but after the
solunon of the aliment in the stomach,  which  is effected
by the gastric juice, it is certainly necessary to assimilate
it, or  blend the whole to  form good  chyle.  The  bile,
therefore, .instead of being an " intestinal enemy," as it
is termed by empirics, may be  deemed a great promoter
of the health of the body. (See Indigestion.)

         OF BLEEDING AT THE  NOSE.

  In young people this arises from  a plethoric state of the
arteries; and in the far advanced in life, of the veins.

            Symptoms of Bleeding at the Nose.
  It is in  general confined to one nostril, occurring for
the most part in warm weather, and sometimes preceded
by  head-ach, redness of the face and  eyes, noise in the
ears,  giddiness, frightful dreams,  the  night mare, cold-
ness of the extremities, &c.

            Treatment of Bleeding at the Nose.
  In  young people it may be considered a slight disease,
and scarcely worth notice,  unless profuse, or the patient
is of a sanguine habit,  when the loss of blood from  the
arm will be proper, and the occasional use of the aperient
                        2B 
178
mixture, No.  62^ or the neutral purgative salts,  No. 2.
After due evacuations from the bowels, the cooling pow-
ders, No. 89, may be taken two or three  times a  day, in
cold water.  Vinegar,  diluted with water, should also  be
applied  cold to the nostrils, and if these fail to stop the
bleeding, dossils of lint moistened with vinegar, introduced
up the nostril  by coagulating the blood, and compressing
the ruptured vessel, will always succeed if properly mana-
ged. The body and head should be kept  in an erect pos-
ture, and the  patient exposed  to a cold  air, and every
irritation  avoided,  such as blowing  the nose, speaFing,
&c. The diet should be low and taken cold,  and  the ex-
tremities kept warm. If it arise from suppressed evacu-
ations,  which  in young  women is frequently the  case,
aloetic purges  should be employed, and the legs frequently
immersed in warm water. When attendant on putrid fever,
it happens from the weak state of the vessels, and should
be  stopped  by the  compressive means suggested above.
When it occurs in  old age, and is preceded by head-ach,
drowsiness, and redness of the face, it should be consi-
dered a premonitory  symptom of apoplexy, and the pre-
ventive  means  already  recommended  for  that  disease,
should be immediately resorted to.
   In all cases of bleeding at the nose, the chief point to
determine is,  whether it be salutary or otherwise, which,
in  cases of ambiguous fever,  is often  extremely difficult
to  decide.  I  have  known fevers,  pronounced by physi-
cians of eminence to be putrid, suddenly terminated by
a spontaneous discharge of blood from the nostrils, which,
 at  the time,  was  considered a most unfortunate circum-
 stance.
   Whatever  will  produce rigours, or slight  shivering of
 the body, as  a cold key to the back, sprinkling  the face 
179
 with cold water, Sec.  will often immediately  check the
 loss of  blood, not only  from the nose,  but a divided
 blood-vessel on the surface of the body.
   People subject to this  complaint should be  particular
 in  keeping their feet warm, and  obviating plethora by
 moderate exercise and spare diet, and the frequent use of
 the Epsom, or Rochelle salts, No. 2.

  OF BLOOD, discharged from the  Urinary Passages.

   This is a symptomatic  affection, and considered merely
 as a bleeding, is seldom dangerous, the cure of course will
 consist in the  removal of the primary cause.  The  symp-
 toms may be relieved, by  drinking  weak mucilaginous
 liquors, as linseed  tea, or a decoction of marsh-mallow
 root.  If attended with plethora, the  loss  of  blood from
 the arm,  and  frequent doses of castor oil, No. 3,  should
 not be omitted. The saline  purgatives are improper, on
account of their increasing the  irritating property  of the
urine. The diet should be  low, unless  the patient be much
reduced, or the discharge of blood arises from ulceration in
the kidneys or bladder;  stimulants,  as pepper, salt, &c.
 should be avoided.
  When  it is occasioned by the mechanical  effects of a
 stone in the bladder, or gravel in the kidneys or ureters,
 it will require the treatment recommended for these com-
plaints.  When ulceration  is  the  cause, which  is known
from its being attended with a discharge of matter, spirit
 of turpentine,  in  the dose of twelve drops in  marsh mal-
low  root  tea, has  generally  a  very  happy effect. The
bear's whortleberry in  those  affections of  the bladder and
kidneys, has proved particularly serviceable, and is the only
astringent that can with safety be employed; half an  ounce
of the leaves may be infused  in a pint of boiling water for 
180
six hours, and a  wine-glassful of  the  strained  liquor,
taken about three times a day with the spirit of turpentine
in the dose above directed.

          BLOODY FLUX. See Dysentery,

                     OF BILES.

   Biles uniformly arising from bad habit of body, sup-
puration  should  in all cases be  promoted  by the appli-
cation  of the gum-plaster, No. 59,  spread  on leather, or
the poultice,  No.  112, and if  very  painful, they  should
be often fomented  with a strong decoction of poppy heads.
After they break they require  only to be kept clean, and
defended from the action of the external air, by a little
diachylon plaster,  or spermaceti ointment, till  they are
healed. An alterative dose of  the Epsom salt,  No. 2, as
directed  page 8, should be taken every morning, or an
aperient  powder  of calomel and jalap, No. 27,  or the
basilic powder, No. 36, about twice a week, at least for
four doses; and if, after  their suppuration," the  patient
should be much reduced, the tonic mixture, No.  77, will
have a good effect in strengthening  the system, and cor-
recting the constitution. The occasional use of the  ape-
rient sulphureous water,  No. 2, will prove the best pre-
ventive.

           OF  BILES OF THE GUMS.

              Causes ofi Biles of the Gums.
   Biles of the gums  are the consequences of a fit of the
tooth-ach, cold, external  violence,  and disease  of  the
jaw-bone and decayed teeth. 
181
             Treatment of Biles of the Gums.

   When the bile arises from a carious tooth, its extrac-
 tion is  necessary.  Suppuration may be  promoted,  by
 the application of a roasted  fig: and after  the matter  is
 evacuated, the mouth  should  be frequently  rinsed out
 with the acidulated gargle, No. 93, or the tincture of the
 ratania  root, diluted with water, as directed page 83.

           OF BRUISES AND SPRAINS.

   In cases of violent sprains, the prevention of inflamma-
 tion of the  part should be attempted by the application
 of leeches, and afterwards the discutient lotion, No. 102,
 to which  may be added, in case of much pain,  half an
 ounce of laudanum, No. 31.  The aperient  mixture, No.
 62, should be taken occasionally, and  the saline mixture,
 No. 78, if fever should  intervene. If leeches cannot be
 readily  procured, and  inflammation come on, the loss of
 eight or ten ounces of blood from the arm will be proper;
 a low  diet should likewise  be strictly observed, till the
 first or  inflammatory symptoms are abated, when  a more
 generous  one may  be taken to  by degrees, provided the
 patient is not in a debilitated state.
  Superficial bruises may generally be cured by the topi-
cal  application of opodeldoc,  No. 5,  or  the discutient
lotion,  No. 102, with  the occasional use of the  aperient
salts, No.  2, or mixture, No.  62; but if the part has
sustained  much injury, a partial mortification  may  be ap-
prehended,  which  in  an elderly person may terminate
unfavourably ; such cases should therefore  be always re-
ferred to practitioners in surgerr. 
182
              BURNS AND SCALDS.

  Slight burns or scalds may  in general be cured by the
liniment, No. 104, or lotion, No.  102. In case of fever
intervening, the  aperient mixture, No.  62,  or the neutral
salts,  No. 2,  and  the saline mixture,  No.  78,  will also
be necessary. After the operation  of the aperient medi-
cine,  five or  six drops of  laudanum,  No. 31, may be
added to each dose of the saline  mixture,  particularly if
the accident be of much extent.  The  low diet is neces-
sary till the inflammatory symptoms have subsided, when
the usual mode  of living may be gradually  adopted.
  Sir  James Earl, in a late publication  on burns and
scalds, recommends  the immediate  application of cold;
as the immersion of the part in cold water, which always
affords instantaneous relief,  and if kept long in that situa-
tion,  will  soon recover the  parts.  Others recommend
the application  of  stimulants,  particularly   spirit of tur-
pentine, which, in many  instances,  I  have  known  to
prove very  beneficial.
   When the  mischief is extensive  or  deep, mortification
may  always  be  apprehended, whether the  subject  be
young or old ;  the advice, therefore,  of a skilful surgeon
 should be procured without delay.

                    OF CANCER.

   Cancer most commonly affects the glandular parts of the
 body, generally after the fortieth year of a person's age, and
 very  rarely  before.  It is distinguished  by  occult and
 open; by the former is meant its infant state, which is a
 hard scirrhous swelling, attended  with frequent shooting 
183
pain; by degrees the skin becomes discoloured,  and ul-
ceration  sooner or later takes place,  when  the  disease is
said to terminate  in open cancer, which is characterised
by callous, ragged, and unequal  edges,  great lancinating,
and a kind of burning pain, attended with a thin, dark co-
loured, foetid, i^iorous discharge,often so acrimonious as to
inflame, excoriate, and frequently destroy the surrounding
skin. From the corrosion of the vessels there is sometimes
a considerable discharge of blood.

                Of the Cause of Cancer.

   Respecting the  cause  of this disease, there  have been
a great many conjectures, without much foundation; some
contending that it arises from a general  disorder  in the
system, and others that it is in its infancy entirely local, and
that the constitution is contaminated by an absorption of
the virus from the open cancer.  It is frequently excited
by  bruises or contusions,  and therefore more frequently
occurs in the breast and lips.
  Dr.  Lambe, in his valuable " Inquiries into the Causes
of constitutional Diseases," attributes cancer to the  action
of a salt, which the doctor terms sceptic poison, introduced
into the system by the use of common water. Dr. Trotter
is of opinion that it  may be produced by the excessive use
of ardent spirits.
  Dr.  Adams, who has  paid particular attention to this
disease, asserts that scirrhus or cancer is  an independent
life,  and that  the tumour is a congeries of hydatids. Mr.
Carmichael, in a late Treatise  on  Cancer, coincides in  this
opinion of  its possessing a vitality independent of the sys-
tem  in which it grows; that it  is  in fact  a  parasitical
animal, not introduced  from without,  but produced by
what he terms (using  the language of  Dr. Darwin) the
congress of the organic  particles, in a manner  similar to 
184
 the generation of fungi on the bark of decaying trees, by
 a  kind  of spontaneous or equivocal  generation, and not
 by vital reproduction. Instead, however, of considering,
 as  Dr.  Adams has done, the  cysts that  are frequently,
 perhaps always, observed in cancer,  as the parasitic ani-
 mal, Mr. Carmichael maintains that it is*the firm white
 ligamentous  bands  interspersed among  the cysts,  and
 extending  like  roots  into the neighbouring  substance,
 (which are considered by most anatomists as merely con-
 densed cellular substances, that make the essential part of
 cancerous tumours wherever situated.

                  Treatment of Cancer.

   The grounds on which Dr.  Adams founds  his argu-
 ments in favour of the independent life of cancer, led Mr.
 Carmichael to  conclude, that  if the  vitality of those sup-
posed animals was destroyed they would be expelled from
the body by  suppuration; and as iron has  been known
to be very effectual in  destroying intestinal worms, he
thought it might be equally destructive to other animals
of  the same parasitical  nature; he, therefore,  made  a
trial of the preparation  of iron, the effects  of xvhich he
states answered his expectation. This author  first pre-
scribed the rust of iron to be taken in the  dose  of twelve
 grains  every six  hours, which was gradually increased to
half a drachm, and  as a lotion for  the part, a  saturated
 solution  of the acetite of iron. The author enumerates
 several cases of cancerous ulcerations (one of which was
 situated in the breast  of a woman)  in which this medi-
 cine proved successful; and to satisfy the  minds of prac-
 titioners  that  they  were real cancerous   affections, he
 thought  proper to request the attendance of Drs. Toole
 and Gahagan, and the surgeons of  St. George's Dispen- 
                           185
 sary, who, it  appears, did  not  entertain a doubt of the
 cancerous nature of the disease.
    Iron, however,  was much recommended as a remedy
 for cancer, by the  late Mr. Justamond,  in his lectures  on
 the Operations of  Surgery, long anterior to Mr. Carmi-
 chael's publication, who preferred the preparation termed
 Martial Flowers. From the use of this medicine and the
 hemlock bath, in cancer of the womb, he is very sanguine
 in his expectations of a cure. The best preparation of iron
 for cancerous complaints, both as an internal remedy and
 topical application, is the red sulphate of iron, which may
 be taken from three to eight drops twice a day in a  little
 water; and for a lotion, diluted  with equal parts of vine-
 gar and water, in  the proportion of a drachm to half a
 pint of the two latter.
   Mr. Samuel Young, in  a recent  work, entitled " An
 Inquiry into the Causes and  Action of Cancer," proposes
 a  radical treatment for the  cure of cancer by the means
 of natural  separation.  We  have daily  experience,  says
 Mr. Young,  that  this is  the   mode by  which nature
 throws off a part become useless to the  purposes of life;
 and we know that such  separations  can be effected  in
 parts the most healthy, by exciting., in  them  an  action
 beyond their living  principle to support.  Clear and evi-
 dent as this principle is,  and  plausible  as  the  means  of
 cure may  appear, when applied in practice innumerable
 difficulties  would arise in   effecting the  separation.  In
 many instances,  instead of  completing that purpose, our
 attempts to produce  the necessary excitement  may  fail,
 and our very  means  probably  become  new  causes of
 irritation; or,  on the other  hand, the morbid alteration,
in  many instances,  may so far extend  as  to  confound
parts, the regular existence  of which may be  necessary
even to life, and where of  course the consequences of
                         2 C 
                          186
separation would be fatal.  Arsenic is  the principal medi-
cine recommended by this  author, as a topical application,
to produce an increased excitement of the part, which is
well known to be the basis of Plunket's remedy.  It does
not appear that  the  means suggested  by this author have
been tried with success  in  his  own practice.  On the
nature of a disease so formidable, and so little determined
as cancer, any opinions are, however, more or less  im-
portant; and it  is possible, as the author justly observes,
that even error may in  some way tend to aid the progress
of inquiry.
   Dr. Lambe, in his late Inquiries into the Causes of Con-
stitutional Diseases, attributing cancerous affections to the
action of a salt, which  he  names septic poison, proposes
to cure the disease by confining  the patient to the use of
water  purified from this deleterious combination by  dis-
tillation; and  it appears, in several instances, this plan
has proved highly beneficial.  The  employment of water
thus purified as  a common beverage,  and in every  article
of diet in which water  is necessary, as broth, soups,  tea,
&c.  has certainly a very  evident  salutary  effect  on the
constitution;  it promotes digestion, and changes the black
appearance and corrects the offensive effluvia of the stools
of cancerous patients;   It has been supposed that distilled
water  cannot be more pure,  or possess  any advantage
superior to water that has passed through a filtering stone.
This idea is,  however, very erroneous;   for whatever
water may contain in a  perfect state of solution, it cannot
be deprived of by filtration, but may  be effectually so by
distillation; hence  we  find that filtered water, on being
distilled, will leave a very considerable residuum in the
still, which in a day or two becomes extremely offensive,
particularly that from the new river and the Thames. 
187
   Prepared natron has been also recommended as a remedy
 for cancer, and perhaps is as much to be depended on as
 any yet suggested. I  have given  this article a trial in
 several cases of scirrhous tumours, and where the patient
 has  persevered properly in its  use, it has never disap-
 pointed  my  expectation:  its  failure  in the practice of
 others, I am inclined to believe is owing to its not having
 been given  in  sufficient quantity, or,  to its being discon-
 tinued before it could possibly have produced a favourable
 change in the system. Instead of prescribing it in the dose
 of a few grains, two or three times a day, as is the usual
 practice, the patient should take a  glass of a strong solu-
 tion of it in water three or  four times a day; so that in
 the course of twenty-four hours, two  drachms of the salt
 be taken.  The medicine is  mild,  and if the system be
 not well saturated with  it, it cannot be expected that any
 real advantage can be derived from it in so obstinate a
 disease.   An  elderly   lady  consulted  me  about  twelve
 months  since  respecting a  tumour in  her left  breast: it
 had  been coming she stated three years, and had latterly
 become  painful; on examining it I had no doubt but that
 it was an incipient cancer: Mr. Ramsden, surgeon to St.
 Bartholomew's hospital,  also saw it, whose  opinion coin-
 cided with my  own.  She was immediately put on a course
 of the natron, and, in order to defend the part from the
 pressure of stays and  any  external irritation,  she  was
 directed  to keep constantly over it a dried skin of a hare,
 with the hairy part towards  the tumour. Fortunately for
this lady she  was  rather partial to the  taste of natron,
so that she generally exceeded the quantity of the solution
prescribed.  In the  course  of a week  her general health
began manifestly to improve,  and the pain in the tumour
to abate.  In three weeks she could suffer me to touch it
without  experiencing pain.  In two  months  a fissure was 
188
 discernible  to  the  touch,  which  gradually increased till
 the  tumour  was divided into two small  ones, which also
 continued in a  diminishing  state till they entirely disap-
 peared, and at this time  the  lady  enjoys a  much better
 state of health than she has done for many years: she also
 made use of distilled water.
   The  external and  internal use of hemlock has been
 much extolled by Dr. Stoerk,  of Vienna, as an infallible
 remedy for cancer; and it appears  by his reports,  that it
 has effected a  cure in many obstinate cases, which, from
 the description given of them by the learned doctor, there
 can be  no doubt were  cancers.  The experiments made
 with it in this country, by no means confirm  this author's
 statement of its specific power in cancer,  although  it has
 been found to  palliate the symptoms, and, in the form of
 poultice, to  cure  ill-conditioned  ulcers.  Many  writers,
 particularly Dr. Wethering,  have endeavoured to account
 for the general failure of the hemlock in the treatment of
 cancer in this  country.  The plant,  they say, chosen for
 preparing the extract or powder, might not have been the
 true conium maculatum,*  which is  distinguished by red
 spots.  It may not  be gathered when in  perfection, viz.
when beginning to  flower.  The inspissation of the juice
may not have been  in  a water-bath, but, for the sake  of
dispatch, over a common fire;  or the leaves  of the herb
 may not have been cautiously dried and preserved in a
well-stopped  bottle; or if so,  may  still  not  have  been
guarded  from the ill effects of exposure to light; or that

   * When  Dr.  Wethering resided at  3irmingham, he found
some of the medical  people there making an extract from the
 cow parsley, instead of hemlock; and it is much  to be feared
that  mistakes of this kind frequently frustrate the well-meant
endeavours of the physician.  Curtis's Lectures on Botany. 
189
 the preparation might have suffered from the mere effects
 of long  keeping.*  The  experiments by several practi-
 tioners in this country, soon after Dr. Stoerk's  publica-
 tion, were made with an extract obtained directly from
 Dr.  Stoerk,  which  was  attended with no  better effect.
 The  best preparation of this herb is the powder; for the
 purpose of making which, the  leaves  should be dried as
 soon as possible after they are gathered, as their medici-
 nal  property is much altered by fermentation: the same
 process should be observed in expressing and inspissating
 the juice. The patient should commence its use in the small
 dose of  two grains  twice a day,  and increase it half a
 grain every other day till it nauseates the stomach, or
 affects  the  head with dizziness, at which dose it should
 be continued till the effects go off, provided it does not
 distress the patient too  much, in which case it  should be
 diminished.  Before  the  exhibition of medicines of this
 class, it will always be proper to .improve the state of the
 digestive organs; for if acidity  prevail in the stomach,
 and the  food be  not properly  digested, the  medicine,
 however well prepared,  may undergo  a decomposition in

   * Dr. Clarke, in his Lectures on the  Diseases of Women,
 relates a case of a lady, for which he prescribed the extract of
 hemlock in the form of pills; the dose of which she was in-
 structed to increase gradually till it produced a slight dizziness
 of the head. The lady, in following  the  doctor's  directions,
 pushed the dose so far, that she took upwards of a drachm in
 a day without experiencing any inconvenience. When the pills
 were exhausted, the prescription was sent to another chemist|
 who,  in preparing it, made  use of fresh extract of hemlock,
 and the lady, by continuing the  increased dose,  was nearly
 poisoned, and would very probably have  lost her life, had not
vomiting soon succeeded. 
                           190
the stomach that may entirely destroy its  medicinal qua-
lity.  It is from this  circumstance that medicines often
fail in producing their desired  effects on the  constitution.
The topical application of hemlock in the form of poultice
or plaster, should, I think,  always  accompany its internal
use in cases of scirrhus or cancer. The frequent extraction
of blood from the surface of a scirrhous tumour by leeches
when it is painful,  is also  necessary.  If  by these  means
the tumour be not dispersed, its progress to ulceration may
be effectually checked.
   Mr.  Abernethy,  in  a   late  publication, entitled  the
«  Diseases of  Health," ascribes  a number of  chronic
diseased actions in the system to some error in the chylo-
poietic  organs, particularly  a  deficiency or  unhealthy  se-
cretion of bile, of which scirrhus or cancer is one.  He
proposes,  therefore, to  remedy this  evil by the  use of
small doses  of mercury,  which he directs to  be taken
everv other  night, for the purpose of  promoting  the se-
cretion of the liver  (the  bile) ; and,  with the view of
strengthening  the digestive organs, to take a quarter ot
 a pint  of  the  decoction of sarsaparella  root  three  or  four
 times a day.  Mr. Abernethy, who is by no means a  san-
 guine practitioner with respect to the efficacy of medicine,
 assures me, that he has found this practice  to succeed  in
 several very  obstinate cases. Although  the intenti6n for
 which  these  medicines are  prescribed by   this  esteemed
 author are somewhat novel, the practice is by no means
 so;  for, in the Medical Observations and Inquiries, many
 cases  of cancer, and particularly of the womb, are stated
 to have  been cured by the  use of  Plummer's  pill *nd
 the decoction of sarsaparella, the basis  of the former of
 which is mercury;  and  Dr. Clarke,  in his Lectures  on
  the Diseases  of Children, eight  years ago recommended
  a similiar practice. When we consider  the mutation the 
191
body is constantly undergoing, we  must allow its  health
must in a great  measure depend on a  proper  digestion of
our aliment, and the consequent formation  of good chyle
for its nourishment and support;  for, if the  food be  not
properly digested, an unhealthy chyle will be formed, in
which case we must expect morbid actions to  occur in the
body. By producing proper digestion, we likewise produce
an  healthy action  in the  system,  which will powerfully
counteract morbid  ones; the  salutary effects  of mercury
and sarsaparella, however, in such  cases, few medical men
will attribute solely to their operation on the digestive
organs.
   For the purpose of producing a separation of the disease
in open  cancer, a composition of arsenic has been very
successfully used under  the name of Plunket's  remedy.
Mons. Salmade  has published a case of cancer in the me-
moirs of the Medical Society of Paris, which resisted the
ordinary modes  of treatment, and  was  afterwards cured
by repeated applications of the caustic powder of Rousse-
lot,*  made into a paste with water, and laid on the surface
of the ulcer for twenty-four hours at a time; it was repeat-
ed after  the interval of a few days, till the diseased parts
sloughed off, and the sore put on a healthy appearance.
  The application of fixed  air, and poultices made of oat-
meal, charcoal powder,  and beer grounds; and also tur-
nip and carrot poultices, have been found to  destroy the
offensive effluvia of cancerous ulcers,  and in some degree
to assuage pain.

  * The composition of this powder is as follows:
  Take of cinnabar, one ounce,
      Dragon's blood, half an ounce,
      Oxyde of arsenic, half a drachm. 
192
        Ofi the Diet proper fior Cancerous Patients.
   The  diet  must, in a great  measure, depend on  the
strength of the patient; if the general health be not much
affected, the  proportion of vegetables  should  exceed that
of meat; but if the strength of the patient be  much redu-
ced, animal food and wine may be allowed. The Malvern
water is much recommended by Dr. Lambe as a remedy
for cancer, and the air being also  particularly salubrious,
that place  certainly affords an excellent retreat for cance-
rous patients. Ass's milk is also a  good alterative  beve-
rage, and mayT be taken for breakfast and supper;  spirits,
and whatever may have a tendency to inflame the  consti-
tution, should be avoided.
  These directions equally apply to cancerous  affections of
any of the external parts of the body.

                  OF CATARACT.
  This  is an opacity of the crystalline humour of the eye,
preventing the  rays of light passing to the optic nerve, and
thus producing  blindness. If the retina  (which is an ex-
pansion  of the  optic  nerve  in the inside of  the eye) be
not diseased, vision may, in  most cases, be restored,  by
either depressing the diseased lens, or  extracting it entire-
yl, which is technically termed, couching.
  With respect to the  advantage of one operation over
the  other  there is a great difference of opinion.  Mr.
Ramsden, of the College of Physicians,  a surgeon  of the
first respectability, gives the decided preference to the
depression of the lens; and the appointment held by that
gentleman, of surgeon  to St.  Bartholomew's  hospital,
must have enabled him to  determine which  method  is
generally the most  beneficial.  This operation is less
painful and hazardous than extraction, and will ultimately 
193
answer, if the lens happen to be soft (which cannot always
be  predetermined); if it be not  wholly depressed  after
breaking the cyst or tunic, it will be removed by absorp-
tion, which  may be promoted by the exhibition  of a little
mercury.  The only objection to this operation is, that the
lens will sometimes rise ag;;in; but this certainly does not
occur often.  Oculists, in general, recommend the extrac-
tion of the lens; but it must be allowed that the intention
is too often  frustrated by the inflammation and consequent
thickening of the tunics of the eye after the operation; and
it not unfrequently happens, that after the patient has gone
through the pain of incision, the lens is too  soft to be re-
moved entirely. I'he depression of the  lens,  on account of
its being simple,  less painful, attended with little or no risk,
and certainly  answering  as  often as the extraction, is enti-
tled to the preference. Mr. William Hey, senior surgeon
to the Leed's  infirmary, after thirty-three years' practice in
diseases of the eye particularly, states that experience has
led him to prefer the mode of depression, and  very ably
and  satisfactorily  confutes the arguments  adduced  by
Baron Venzet (translated into English by Mr.  Ware) in
favour of extraction.
  So  many well-authenticated instances of the  absorption
of opake  lens, by the internal use  of  mercury and  hemr
lock, have lately been published, that it would in all cases
be  advisable  to  give those medicines a  trial  before  an
operation is determined  on.
  Mr.  Ramsden has found the muriate of mercury to
answer in  this respect best. He  directs  eight grains to
be dissolved in an ounce of spirit of wine, and  ten  drops
to be  taken  in a wine-glass of thin gum-arabic tea twice a
day; after taking it a  week, the dose may be increased to
twenty, or even thirty drops, if the stomach will  bear it. 
194
If this remedy be  likely to answer,  the good effects  will
be manifested in three weeks; electric sparks to the  ball
of the eye will often  prove of great  utility.  The hemlock
may be given in the same manner as directed for cancer,
page 189.
  A British  admiral, having a cataract in each eye, ap-
plied to an eminent oculist, who advised him to have them
extracted. He agreed to submit to the extraction  of one,
and in case that answered, he promised to go through the
operation on the  other. Unfortunately, however,  he  was
not the least benefited  by it; for so much  inflammation
and thickening of the cornea  succeeded, as entirely to de-
stroy the vision. The admiral, having cured many obstinate
attacks of the  rheumatism and gout by  violent friction,
and beating  the parts with wooden hammers, &c. he re-
solved to  make the experiment on the  eye affected with
cataract. After rubbing, and at  times gently beating the
ball with a  small  wooden hammer (the eye-lids being
closed), in a  few weeks he found  that he could  discern a
luminous  body, and  by continuing  the practice, the  dis-
eased lens was really absorbed, so that the worthy  admiral
was  enabled to read small print,  after being some time
totally blind; a proof that the removal of cataract, by the
absorbent vessels  of the  eye, is  performed with more
facility than is  generally imagined. By this  pounding sys-
tem the admiral has also  cured himself of the  gout and
rheumatism.

  OF CATARRH, CORYZA, OR INFLUENZA.

   Catarrh consists in an increased excretion of mucus from
the internal  surface  of  the nostrils,  fauces,  and often the
lungs, attended with slight fever, and  a  little  cough.  It
generally begins with a sense of stoppage in the  nose, a 
195
dull pain, and a sense of weight in the forehead and stiff-
ness in the motion of the eyes, and soon after a distillation
of a thin fluid from the nose, and often the eyes, somewhat
acrid, which constitute the complaint  technically termed
coryza, and, when very prevalent, infiuenza.
  In the spring of the year 1803, catarrhal affections were,
from the  great vicissitudes in the atmosphere, very general;
and  all varieties were included under the fashionable name
of infiuenza, and even when the  symptoms run high, so as
to constitute pleurisy, inflammation of  the lungs or brain,
they were  all classed under the  same  denomination,  and
man)' practitioners endeavoured to prove, from its being
so common, that it was infectious.  It is to be feared, how-
ever, that the  employment of this general term led to a
maltreatment  of the different varieties by apothecaries,
and that many lives were in consequence lost.

                   Cause of Catarrh.
  This disease evidently arises from the effect of cold
producing an afflux of fluids to the membrane of the nose,
fauces, and lungs, by checking the natural perspiration of
the skin.

              Of the Treatment of Catarrh.
  When the febrile symptoms are  moderate, it is com-
monly sufficient to avoid cold, and abstain from animal
food for some days; but when these symptoms run high,
it will be proper to lie in bed, and  take frequently some
mild diluent  drink, a  little  warmed, as barley  water,
gruel, or weak white wine whey, to promote gentle  per-
spiration. The cough  mixture, No. 66, should be taken
every three or four hours, and  if attended  with pain in
tr»c chest, and great  difficulty  of breathing, or the patient 
196
 be of a consumptive habit, the loss of blood from the arm,
 and the application of a blister to  the side most affected,
 or over the breast-bone, should not be delayed. The diet
 should be  low, and the beverage, the compound  barley-
 water, see  page 87, with a little liquorice root boiled in it.

 CANINE MADNESS.  See Animal Poison, page 100.

         CHIN COUGH. See Hooping Cough.

                   CHICKEN POX.

                    Description, Ss?c.
   This eruption sometimes appears without  any illness
 or  previous sign, but  most commonly it is preceded  by
 slight fever. The vesicles  are always distinct and  less in
 size than those of the small-pox; on the second day there
 is on the top of most of them a very small bladder, about
 the size of a millet seed, containing a thin, colourless, and
 sometimes  a  yellowish  liquor.  This disease in general
 terminates  in three  or four days, from the first appearance
 of the eruption, and is attended with so  little danger as to
 require no  restraint of diet, or medical treatment, till after
the crusts of the  pustules  begin to peal off, when it will
be proper to administer two or  three  doses of the basilic
powder, No. 36, or jalap  powder, No.  27, in the course
of a week or ten days.

            The Distinction of Chicken Pox.
   It may be distinguished from small pox by not being
preceded by illness, or only by  a very trifling degree  of
fever; by the early appearance of  the  vesicles on the top
of the eruptions; by the serum in them never acquiring
the colour  or consistency  of pus, by the pustules  being 
197
 dry and  covered with crusts on the fifth day; and by the
 eruption being generally first visible on the back.

                  OF CHILBLAINS.

                      Description.
   These are  inflammatory swellings,  chiefly affecting the
 heels,  feet and toes, and sometimes the arms and hands,
 attended with great pain, and a degree of itching.

                   Causes of Chilblains.
   Chilblains are supposed to arise from  a weaker action
 of the  small vessels  most remote from  the heart, occa-
 sioned  by cold or dampness, and occur most frequently in
 people  of delicate constitutions.
   When  the hands or feet are benumbed by cold,  the ex-
 citability of those parts  will  be so much accumulated that
 if they be brought suddenly  near the fire, chilblains  will
 be produced,  and this imprudent practice is the principle
 cause of chilblains in this country.

             Of the Treatment of Chilblains.
   When  the  parts are  frost-bitten by long exposure  to
 the cold,  they should be plunged into the coldest water,
 and  afterwards  rubbed  with salt.  When they  are only
 benumbed, they may be rubbed with  spirit of wine and
 camphor  or opodeldoc,  to which a little laudanum may
 be      i, it the pain or  itching be very troublesome;  but
 when they crack and  discharge an acrid  matter,  poultices
 should be applied, but not for any length of time, as their
 continuance is apt to produce fungous  excrescences. Dia-
 chylon  plaster on  leather, and  avoiding the occasional
cause, will afterwards effect a cure. An ointment composed
of equal parts of nitrated quicksilver ointment and olive 
                         198
oil, is a very excellent application for chilblains.  It should
be well rubbed-into the parts with"the warm hand; but if
the skin be cracked, it may  be applied spread on lint, and ^
in case of much inflammation,  a poultice may be applied *
over it.

        COELIAC PASSION. See Diarrhcea.

                     OF COLIC.

                Symptoms  &c of Colic.
   This disorder is known by a violent pain in the bowels,
commonly about the navel.  The pain resembles various
kinds of  sensations, as of burning, twisting, boring, or
a  ligature  drawn  very tight  round the  intestines. The
belly is generally costive.  When there is a violent evacua-
tion of bilious matter, both upwards  and downwards, it
eonstitutes the disease termed cholera morbus.
   The  great difficulty in discriminating  cholic  from in-
flammation of the  bowels, renders this  disease  improper
for domestic practice;  if, therefore, it should be violent,
or be attended with rigours and fever, medical assistance
should be procured without loss of time,  as  the  intestines
will not sustain  inflammation many  hours  without  en-
dangering the life of the patient.

                Ofi the Causes ofi Colic.
   It may arise from any sudden check  given to  perspira-
tion; from austere, acid,  or  indigestible aliments  taken
into the stomach;  the application of poisons, as lead, &c.
and sometimes worms and costiveness.

               Ofi the Treatment ofi Colic.
   The first attempt should be  to evacuate the contents of 
199
the intestines,  by the  use  of castor oil,  No.  3,  with
aperient mixture,  No. 62, and the clyster; No.  97. The
spasmodic  affections  of the bowels may  be relieved  by'
fomentation,  or the  warm  bath,  and the use of ten to
twenty drops of laudanum,  No. 31,  the occasional  exhi-
bition of the anti-spasmodic mixture,  No. 70, and clyster,
No. 98. If attended with fever and full pulse,  the loss of
blood from the arm will sometimes be proper to  prevent
inflammation of the bowels.  The  dose of laudanum may
be increased or repeated according to the  severity of  the
pain, while the remedies are employed to procure a  stool.

                The Distinction ofi Colic.

   I'he young practitioner will be  able to distinguish colic
from inflammation of the intestines by the wringing,  but
not  burning,  pain about the navel.  By the spasmodic
contraction of the abdominal muscles, by the absence or
trifling degree of fever, by  the state of the pulse, and by
the diminution of pain upon pressure.

                      Prevention.

   People subject to this disease should avoid much  vege-
table food  and fermented liquors, and  wear  flannel next
the skin.

     OF CONSUMPTION OF THE LUNGS.

   So prevalent and destructive  is this disease in Great-
Britain, that it is calculated to destroy no less than sixty
thousand of its inhabitants annually, the majority  of which
is supposed  to be under twenty-five years of age.  The
great consumption of animal food and vinous or spirituous
liquors in  a climate  so mutable, may in some degree  ac- 
200
 count for its frequency, while the  melancholy fatality is
 more to be attributed to the imperfection  of the healing
 art than the absolute  incurable nature  of the disease; in-
 deed,  so generally  has this latter opinion  prevailed, that
 the  palliation  of symptoms has  been the  chief object of
 practice,  and  on this account indigent  consumptive  pa-
 tients have  been deemed improper objects of the different
 charitable  institutions established throughout the  king-
 dom for the  relief of the poor afflicted  with disease; in
 consequence of which they fall an easy and cruel sacrifice
 to the nostrums of unprincipled  quacks.  These circum-
 stances,  together with the conviction that  consumption
 of the lungs, in certain stages, is a curable disease, induced
 me  to undertake the  establishment of a Phthisical Dis-
pensary* in conjunction with Mr.  William  Roberts  (an
                 • ■
  * This charity was opened for the admission of patients  the
 25th day of March,  1805, at No. 70,  Chancery Lane. The
management of it is in the hands of the president, vice-presi-
dent, and annual subscribers  of one guinea.  His Royal High-
ness the Prince of Wales has been pleased to express his  ap-
probation of this establishment in very flattering terms, and ho-
noured it with  his patronage.  William Wilberfbrce, Esq. is
president; and Sir Robert Salusbury, Bart.  M. P; Colonel Mark
 Wood, M.  P;  Henry Willoughby, Esq.  M. P;  Robert Lad-
broke, Esq. M.  P; Sir John Palmer, Bart; Sir William Altham
Bart; the Rev. Dr. Symmons; Dr. Harvey; Dr. Mingay; Hen-
ry Upton, Esq; Thomas Hammersley, Esq;  Charles James,
Esq; Thomas Walker, Esq. vice-presidents.  Their Graces the
Duke and Dutches of Leeds; the Right  Honourable Earl Cado-
gan; Lady Albinia Cumberland; Lady Middleton; Lady Effing-
ham; Lady Caroline Wortley; Mrs. Foljambe ;  Dr. Cheston ;
Richard Palmer, Esq. are likewise  among its  principal  bene.
factors.
  Subscribers  of one  guinea annually, are entitled to recom- 
201
able surgeon  in  London),  for the  relief of consumptive
patients only,  which the liberality of his Royal Highness
the Prince of Wales, and  several  leading characters in
this kingdom, soon enabled us to  carry into execution.
The number of patients that have already been discharged
cured,  and apply every week for admission, convince me
that it will prove of greater national advantage than was
first imagined, and  it is to be hoped that its resources will
increase with  its reputation.
  In the commencement of the  year 1804, I published a
treatise on the  Anti-phthisical  Properties  of the  Li-
chen Islandicus,  or Iceland Moss; to which  I added, a
few cursory  remarks on Pulmonary Consumption, with
a view of directing the attention of the medical proft*ssion
to a proper distinction of the different species of the dis-
ease which occur in  this country,  it being too much the
practice to confound  them under one common  head, and
subject them  to the  same  mode of treatment;  although
from their different causes, as well  as the immediate seat
of the  disease, they most assuredly require very opposite
remedies.  In  that treatise  I noticed those species  only in
which  the  Lichen  Islandicus, or Iceland Moss, was like-
ly to prove beneficial, viz. the membranous  class, and
entirely omitted  the consideration  of the  species which
commence in the  substance of  the lungs ;  in  the treat-
ment of  the first stage of which the Lichen Islandicus,
from its tonic  quality, is inadmissible.

mend three patients in the course of the year, and so  in pro-
portion to the sum subscribed.
  Consumptive patients in the country may be supplied with
medicines and advice gratis, on being recommended by a sub-
scriber, the particulars of the complaint may be enclosed to
Dr. Reece, HenrietUvstreet, Covent Garden, of whom the rules,
8cc of the charity may be had.
                          2E 
202
   It requiring a knowledge of the anatomy and physiology
 of the  lungs, as well as much experience in pulmonary
 complaints,  to  distinguish  one  species  from  another,
 which is absolutely necessary for the  adoption of a judi-
 cious and successful mode of treatment, such cases should
 not be entrusted to the sole care of an unexperienced prac-
 titioner, much  less  proper  for  domestic  medicine.  I
 shall, therefore, in this work,  merely  give the outlines
 of a treatise on  pulmonary consumptions I mean to pub-
 lish  in the  course of the  present year, addressed to the
 medical profession,  in which I  shall  fully  describe the
 various species as  they  appear on dissection, with an enu-
 meration  of several confirmed cases of each species, by
 way of illustrating the mode of treatment I shall there
 more fully detail.
   Of the  pulmonary consumptions  that  occur  in  this
 country, there are  evidently two  classes, differing as to the
 seat of the  disease.  The most prevalent are those which
 commence in the cellular substance of the lungs, technical-
 ly termed parenchyma, which I shall, for the sake of a clear
 distinction,  denominate parenchymatous consumption of
 the  lungs;  and the  other class, being confined  to the
 membrane lining, the trachea and bronchial ramifications,
 I shall consider under the name of membranous con-
sumption of the lungs.
  Of the  parenchymatous class" there are  two  species;
one arising from a deposition of coagulable  lymph in the
cellular substance of the lungs, producing sooner or later
very  considerable  organic disease, which  I  shall,  there-
fore,  term organic consumption  of the lungs; and  the
other from the formation of tubercles,  which I shall term
tubercular consumption. 
203
        Ofi the Organic Consumption ofi the Lungs.
  This species dissection has proved to be the most pre-
valent in this country.  It  commences with a deposition
of coagulable lymph in the cellular substance of the lungs,
in consequence  of a chronic or habitual inflammation,
probably of  a scrophulous nature,  in  which  the vessels,
destined for  the nourishment of the lungs, appear to be
chiefly  concerned; those technically  termed  pulmonary,
being perhaps only mechanically affected  by the consoli-
dated state of the lungs.
  As this process extends through the substance of the
lungs, their  power of expansion must  be much limited,
and  respiration  of course  rendered short and difficult.
The transmission of blood through the pulmonary artery
must necessarily  be  considerably impeded, which, with
the diminished quantity of air taken into the lungs during
inspiration,  that change is not duly effected in the blood,
which is necessary for the  support  of the  body. The
frequency of respiration and  action of the heart are  no
doubt for the purpose of obviating this great inconvenience.

     Symptoms of Organic Consumption of the  Lungs.

   The  first symptoms  are difficulty of breathing, particu-
 larly on ascending a pair of stairs, or on much exercise;
 a sense of tightness across the  chest; a dry short cough;
 fluttering at the heart; an inability to take  in a long or
 deep inspiration. These symptoms, which may be termed
 Premonitory, are  generally  attended  with  costiveness,
 sometimes with slight  head-ach, frequently with obstinate
 vomiting:  in females, with  a  retention  or  suppression
 of the  menses, and often continue four or five weeks
 before  the nature of the  complaint  is suspected  by the
 patient or his friends. At length the  inflammatory pro- 
204
 cess becomes more  active, advancing  to  partial suppu-
 rations,  and forming a number of the  small  abscesses
 technically termed vomica, in the substance of the  lungs,
 which constitute the second stage of the disease,  which
 is characterised by a concurrence of the  following cir-
 cumstances:  an aggravation  of the  premonitory  symp-
 toms,  with frequent  and often  violent  rigours: pains in
■different parts of the chest, but most commonly in the
 sides or under  the breast-bone. The  cough, which was
 before dry, is at this period attended with an expectora-
 tion of a thin  mucus,  generally  of a saltish taste and
 frothyT appearance; the tongue  furred, appetite  bad, and
 for the most  part during the day and forepart  of the night
 a dry skin, and an accumulation of blood in the vessels of
 the neck. This stage, which is the  most distressing to
 the patient, seems to last  about four weeks, when the
 small  abscesses break and evacuate  their  contents  by
 degrees, either in  the cavity of the lungs or  between the
 lungs and ribs, when the third or purulent stage may be
 said to commence. The inflammation at length extends
 both to the pleura covering the lungs, and  the membrane
 lining  the  bronchial ramifications,  producing from the
 latter  a considerable  and  vitiated  secretion of mucus,
 often of a purulent appearance;  and adhesion of the  latter
 to the pleura lining the ribs; with an exudation  of coagu-
 lable lymph, occasioning those acute  pains  termed stiches
 on  coughing  or  lying  on the  side  affected.  As the
 vomica? break, so   the  patient  experiences considerable
 mitigation  of  the  most  troublesome  symptoms.  The
 breathing being relieved, and expectoration  more   easy,
 which, with the appetite and digestion improving, induce
 the patient confidently to believe that he is in a state of
 convalescence.   The   mucus  at length  becomes  more
 dense, opake, and less tenacious, and imperfectly blend- 
205
ed with an ill-conditioned pus, generally of an ash colour,
offensive to the taste and  smell, and sometimes streaked
with bloods The rigours become less frequent and violent,
while the hectic  heats  and  perspirations  increase;  the
pulse varying in the course of twenty-four hours from  80
to 130.  The  matter  formed  in the  substance  of the
lungs, is  taken up by the absorbent vessels into the  mass
of blood, and passes  off in the urine,  which is  thereby
rendered thick on cooling, and emits often a very disagree-
able  odour. It  is probably, also, discharged  from the
system by perspiration  and occasional  diarrhaea, so con-
stantly attendant on this period  of  the disease.  As the
vital powers decline, a  variety of symptoms ensue; such
as pains in the  bowels,  cramp in the muscles of the belly
or legs,  a kind of erysipelatous  inflammation attacks the
fauces, which,  on dissection, seems to be a continuation
of the  inflammation affecting  the   internal membrane
of the wind-pipe,  and  which,  by  spreading  down the
gullet and over the mouth, is  generally  attended with
the most  distressing inconvenience  and  pain  on eating
and  swallowing.  The  eyes  assume  a   pearly, white,
and  humid appearance;  the  face,  in the  absence  of
the  fever, pale and ghastly, but during  recurrence,  is
of a florid red, at  first  of a circumscribed  spot on the
cheeks,  which, as the  disease advances, becomes more
diffused  over the  face;  while the rest of the  body, not
exposed  to  the atmosphere,  is at the same time pale and
cool  to  the touch;  the hair, on being combed, readily
falls  off in great  quantity; the legs  become affected with
dropsical swellings, which often extends  to the belly;
the nails  incurved, with other  symptoms indicative  of
great emaciation  and increasing debility.  The memory
at length loses its retentive  power,  while the judgment
often remains unimpaired, and the mind  is happily sup- 
206
 ported with confidence and the hopes  of recovery,  till
 death gently terminates his sufferings.
   On the dissection of those that have fallen victims to this
 disease, it appears that one lung (generally the right)  is
 more  affected  than the other;  the cellular substance  of
 which is so completely destroyed as to leave nothing but
 the  membranes  and blood-vessels  in  a  collapsed state,
 the cavity of the chest being filled with matter and serum;
 while  the  other lung  is generally  so  consolidated as to
 support  its bulk on the chest being laid  open.  The sur-
 face is generally very  irregular and of a tubercular feel,
 from the number of vomicae formed throughout the cel-
 lular structure, which  being cut into,  discharge an ash-
 coloured matter.  There are also adhesions between the
 pleura lining the ribs and covering the lung, but no effusion,
 while the pericardium or bag containing the heart is much
 distended with serum.  The membrane  lining, the trachea
 and bronchial ramifications, exhibit appearances of inflam-
 mation, and the mucous glands much tumified. The thy-
 mus gland, in several cases, has been considerably enlarged
 and  very ponderous,  and of a true scirrhous  structure.
 Such is the extent of the disease, exhibited on  dissection
 of those who have died of this species of consumption,
 that  it strikes  the  inspector with astonishment that life
 should, under such circumstances, exist  so long,  and atten-
 ded with so little pain.

      Causes of Organic Consumption ofi the Lungs.
  From  the nature of  the inflammation  and matter de-
posited in the lungs, and the  morbid  appearances on dis-
section, there  can be  little  doubt  but this species  is
of a scrophulous  origin. Whatever,  therefore,  produces
a determination of blood to the lungs, or an  increased
action  of the heart in a scrophulous habit, may act as 
207
exciting causes of this species of the disease;  as sudden
vicissitudes in the atmosphere; exposure  of  the body,
and particularly  the chest,  to cold; fevers of all kind,
but particularly those of the eruptive class;  hence it often
follows   measels and  small-pox.   The  retrocession of
eruptions,  abuse  of spirituous liquors or vinous  liquors,
frequent catarrhal  affections,  suppression  of  customary
evacuations, &c. An hyperoxygenated state of the blood
has been adduced,  by a celebrated pneumatic  theorist, as
a  chief cause of  pulmonary consumption, which infers
that the lungs,  in  a diseased state, perform  their office
better than in a state of health.  The blood of consump-
tive  patients, however, exhibit no such  appearance.  The
florid countenance, which  is brought forward as a proof
of this doctrine, is occasioned by the partial attraction of
oxygen  by the  red  particles of  blood in  the superficial
minute  vessels of the skin, to  remedy the great deficiency
of that  principle in the  system, through the morbid  state
of the lungs, which is proved not only by the evident  defi-
ciency of oxygen  in the blood extracted from consump-
tive  patients, but  also by  the  spreading  of the redness
over the face as the  disease of the lungs advance.   This
absorption of oxygen will  also take  place in whatever
part of  the body is  exposed to the  atmosphere, particular-
ly in the last stage  of the disease, as the hands and neck,
while the  parts that are covered  remain  pale and  cool.
Retention  of the menses is attributed, by  those theorists,
to a deficiency of oxygen, and yet when this  disease ter-
minates in pulmonary consumption, a superabundance is
stated  to  exist.  Such  inconsistency, without any  other
evidence,  must prove  the fallacy  as well as absurdity  of
doctrines which have no other  foundation than a plau-
sable hypothesis. 
208
  Ofi the Treatment ofi Incipient Organic Consumption ofi
                       the Lungs.

  Such is  the delicate structure of the  lungs and their
vast importance in the  animal economy,  that  on the first
onset of the disease the most prompt and  decisive practice
should  be adopted in order to prevent the formation of
pus, which, by destroying  a portion of  the cellular sub-
stance,  must  render the recovery  of the  patient  very
doubtful. On the appearance of the premonitory spmptoms
enumerated, page 203, as denoting the incipient  stage of the
disease, especially when they occur in a  scrophulous sub-
ject, or in children  born  of scrophulous  or phthisical
parents, the loss of a few ounces of blood from the arm,
or in young subjects bleeding by leeches from the chest, is
a remedy of such  importance that it should not be omitted
without some cogent  reason.
   A blistering plaster should be applied  over  the  breast-
bone or between the  shoulders, and the irritation and
discharge kept up by dressing it twice  a day with savin
ointment  till  the  symptoms  have  entirely vanished.  If
one side be evidently  more  affected than the other, the
blister should be placed as nearly over the part affected as
possible in preference to the  back and front of the chest;
and in  case  both sides are affected  with  much pain
and stitches, or  if  the  blister  on  the  back and  front
should  not afford much  relief, it would be advisable to
apply a blister to each side; for in such cases the counter-
irritation should be proportioned to  the degree  of mischief
supposed to  be going on in the interior parts.
   As costiveness  tends to aggravate the  disease,  the use
of a gentle aperient medicine should be next  resorted to,
which, by producing a derivation from the lungs, acts a3
a very powerful  auxiliary to the above  means.  For this
purpose, one, two or three drachms of Epsom or Rochelle 
209
■;ait may be taken every or every other morning, in a glass
of whey or butter-milk, so  as  to relieve the bowels once
or twice a day, which will answer  much better than full
purging.
   For the purpose of quieting the symptoms, the cough
in particular,  two table-spoonfuls of the following  mix-
ture may be taken every two, three, or four  hours, ac-
cording to their urgency:
   Take of almond emulsion, six ounces,
       Compound tragacanth powder, two drachms,
       Ipecacuan wine,
       Tincture of fox glove, of each one  drachm,
       Simple oxymel, one ounce,
       Extract of poppies,  one scruple. Mix.
   The acetated ceruse is a very valuable medicine in this
period of the disease, in the dose of one grain twice a day,
made into a pill, with conserve of hips or  extract of pop-
pies; but this preparation, although perfectly safe  in the
hands of an experienced practitioner, is much too potent
for domestic  medicine, great attention  and judgment
being requisite  to regulate the dose according to the
symptoms and its effect  on the  constitution.  When the
disease is attended with  violent vomiting  and great irri-
tability of the  stomach, I have found this remedy to suc-
ceed after the fox glove and other medicines had been
rejected.
  When the symptoms are considerably abated, a gentle
emetic of ipecacuan maybe administered once or twice
a week, which, by exciting the  action of the absorbent
vessels of the lungs, and occasioning an  equality of cir-
culation through the system, will very considerably tend
to accelerate the recovery of the patient.

                      Diet, &?c.
   In the first stage, a diet  should be adopted that is cal-
                         2 F 
210
 ciliated to obviate the debilitating effects of the disease on
 the constitution, without aggravating the local mischief.
 For this purpose the jellies of vegetables will answer best,
 being nutritive, and free from any stimulating property.
 Cocoa boiled in whey will afford a very excellent break-
 fast, and will often agree with the patient, after milk, or
 cocoa boiled in milk, have oppressed the stomach.
   The jellies of the arrowr-root, sago,  tapioca,  and oat-
 meal, light  bread-pudding and chicken broth may be oc-
 casionally varied, as  agreeable to the inclination of the
 patient.  The animal jellies  of calves' feet, hartshorn
 shavings,  and  isinglass, a  little boiled fowl, shell-fish,
 flounders  and  soles,  without sauce, may in  some cases
 be allowed; but flesh of strong  fibres, as beef, mutton,
 lamb, pork, &c. wine and  spirits of all sorts,  must  be
 strictly  avoided.  The beverage  should be very simple,
 such as whey, distilled water, linseed-tea sweetened with
 honey, and acidulated with lemon-juice; weak lemonade,
 butter-milk,  barley-water, and  weak fresh  table  beer.
 Flannel should be worn next the skin, and sudden transi-
 tions from heat to cold, anu vice versa, should be parti-
 cularly  guarded  against; and as a light atmosphere is
 more easy of respiration than a  heavy  one, the patient
 should sleep, and live as much as possible, in the upper-
most room in the house. By a strict observance of these
instructions, the progress of incipient organic consump-
tion  may be speedily suspended, the effect of the diseased
 action  removed,  and  the  lungs rendered adequate  to
 their important functions,  and the  patient gradually re-
 stored to his usual strength and health.
  If there be a strong  predisposition to the disease, it
 will be advis hie  not to heal the blister immediately on
the disappearance of the symptoms,  but to  keep up the
irritation for some days, by applying a burgundy pitch 
211
 plaster over the part, while the  skin remains  tender, or
 by means of an issue or small seton  either between the
 shoulders, or over the  breast bone, or in the  side most
 affected.
   Animal food in substance should be resorted  to  by
 very slow degrees, and at all times full  diet and  much
 wine  scrupulously avoided. Temperance,  and the  use
 of flannel next the  skin, are  to be considered the most
 powerful  preventives of a recurrence of the symptoms,
 by  due perseverance in which, the  predisposition to the
 disease may  in course of time be entirely destroyed.
   It is but too  common a practice for patients, during
 this period of the  disease, to have recourse to the adver-
 tised  remedies of  unprincipled quacks.  The quantity of
 laudanum these nostrums contain, bv quieting the cough,
 induces the unfortunate patient to believe that their effects
 are beneficial, while at the  same time the organic disease
 is considerably increased by their stimulating properties,
 and the patient not aware of his danger till suppuration
 has taken place, and a cough thus  produced which can
 no longer be  relieved by the medicine.
  Tinctures of stimulating gums, as, balsam of tolu, gum
 benzoin, peruvian  balsam, camphor, and opium, are con-
 stantly  puffed  off under  the  spurious fictitious titles
 of" balsam of honey, balsam, of horehound, balsam  of
 lungwort, balsam of liquorice, &c." as specific remedies
 for coughs, consumptions, &c.  which the ignorant are
 induced to take  under the supposition that they contain,
 in a concentrated  state, the medicinal properties of the
 articles from  whence they are named. A practice so truly
 dishonourable, and pregnant with so much danger, should
be discouraged by  every friend to humanity; and it is to
be hoped, will soon undergo legislative investigation, and
the impostors made sensible, that to  tamper with the live« 
212
 of their fellow creatures, from motives  of lucre, is  an
 offence cognizable by the laws of their country, and little
 short of wilful murder.*

  Treatment ofi the Second Stage of Organic Consumption
                     of the Lungs.
   When suppuration has commenced, (the  symptoms Nof
 which I  have already detailed as  constituting the second
 stage) which is but too generally the case before it is con-
 sidered of sufficient importance, either by the  patient or
 his friends, for medical assistance;  the foregoing direc-
 tions require much variation. General bleeding is at this
 period very rarely necessary, while the extraction of about
 two ounces of blood from the chest, by means of leeches,
 or cupping, may in some instances be very proper, and
 repeated twice a week, with the most decided advantage,
 and  should be  continued, unless  contra-indicated by in-
 creasing debility  of  the system.  The counter-irritation
 of blisters, issues, or seton, is in this stage of the first
 importance, and should be proportioned to the supposed
 extent of the  internal mischief; for this  purpose I have
 generally recommended a seton, on  account of its being
 more manageable and less inconvenient than  either an
issue or perpetual  blister. It proves more efficacious when
applied to the side, on account  of being  more topical
than between the shoulders, or over  the breast-bone,f

  * It is worthy of notice, that nine out of ten of the consump-
tive patients admitted at the Phthisical Dispensary, were taking
Quack medicines.
  f The mass of muscles on the back and posterior mediastinum,
and the breast bone on the front and anterior mediastinum)
render the application of  blisters to these places more remote 
213
which are usually recommended.  In case both lungs are
evidently much affected,  one should  be applied to each
side,  and great  care  should be taken that a  proper  dis-
charge  be kept up, by dressing them  twice  a day,  and
occasionally besmearing the silk or  peas with yellow basi-
licon, the saven cerate, or the blistering ointment.  If an
issue  be  preferred, it should be made large enough to ad-
mit two  or  three peas, or a large  kidney bean, and the
seton should at least  be made with a full skein of silk.
   Costiveness, which is commonly attendant on this stage
of the disease, may be obviated by small doses of the tar-
tarised natron with liquorice,  or  the  Epsom or Rochelle
salts,  every morning, dissolved in a tea-cupful of whey or
butter-milk, the dose to be regulated as  directed under the
head  of Rochelle salts, No. 2, in the Family Dispensatory,
page  7,   so as to relieve the bowels at  least  once a day.
If the small doses should exceed in operation,  they should
be discontinued, and  a few grains of rhubarb,  in form of
pills,  substituted in their place.
   For the purpose of abating the constitutional fever, al-
laying the cough, promoting expectoration, and producing
a determination of blood to the  surface  of the body, a
table  spoonful of the following compound  oxymel may be
taken two or three times a day, in a tea-cupful of the de-
coction of the Iceland liver-wort.*

than is generally imagined,  while over the  ribs it may be con-
sidered a topical application,  the membrane  lining the inside
being  extended to the lungs, and  often immediately connected
by preternatural adhesions.
  * This decoction is made by boiling two  ounces of the herb
(previously washed in cold water) with a little  liquorice root,
in a quart to a pint and a half. 
211
  Take of ipecacuan wine, two drachms;
       Syrup of poppies, one ounce ;
       Simple oxymel, three ounces;
       Tincture of foxglove, one drachm. Mix.
  If this  medicine  should  produce  much nausea or  vo-
miting, or if vomiting be an attendant symptom, the ipe-
cacuan wine should be  omitted;  and if the cough be vio-
lent, four or five drops  of liquid  laudanum may be added
to each dose.  An aoetous  tincture of opium,  sold under
the  name of black drop, is a very good anodyne medicine
in these cases,  as it  produces more refreshing sleep than
common laudanum, without affecting the head and con-
stipating the bowels.  Provided these anodynes cannot be
persisted in, the  extract of hyoscyamus may be taken in
the  dose  of two or three grains two or three times a day,
which will often succeed  in quieting the system, after
opium in all forms has  failed.  But if none of the vegeta-
ble  anodynes agree with the patient, the acetite of  ceruse
merits a  trial;  it may be given  in the dose of one grain
twice a day, either in the form of pill, or dissolved in  the
decoction  of the Iceland liver-wort with the  compound
oxymel,  as above directed. This preparation is a very
valuable medicine in allaying the hectic fever; it is how-
ever an Herculean remedy, and much too potent for  do-
mestic medicine, or to  be  indiscriminately prescribed by
unexperienced practitioners.
  When the symptoms are quieted by these  means,  the
following  emetic draught may be given once or twice a
week, which, by exciting the action of the absorbent ves-
sels of the lungs, and checking the morbid determination
to them, will powerfully tend to hasten  the recovery of
the  patient.
  Take of ipecacuan powder, one scruple;
       Oxymel of squills, two drachms;
      *Pure water, one ounce.  Mix. 
215
   Emetic doses of white and blue vitriol have been much
 recommended as  a remedy  for pulmonary consumption,
 but I have never found them to  answer so well  as ipeca-
 cuan, they are less  certain  in their  operation,  in  some in-
 stances having produced no nausea,  and in others acting
 with great violence on the stomach and intestines.
   Mercury  has  been employed for the purpose of pro-
 moting an increased action of the absorbent vessels of the
 lungs  in  consumptive cases.* In the trials I have  made
 with it in the different stages of the disease, it has by no
 means answered my expectations, having in every instance
 considerably provoked  cough, and  increased  the  febrile
 symptoms.
   Th>i liver of sulphur will often succeed in allaying hectic
 heats,  and often  the cough.  In  many instances I have
 found this preparation of sulphur afford such evident relief
 to consumptive patients, that I have been inclined to at-
 tribute to it an  anodyne or  anti-spasmodic property.  It
 may be taken either with  the  dose of aperient  salts,  as
 directed under  the head of  Rochelle salts, No. 2, (See
 Harrow gate Water;) or by  dissolving one drachm in a
 quart of distilled  water, of  which  a small wine-glassful
 may be drank once or twice  a day, either alone or with milk.
 If the acetated ceruse be employed, this medicine will not
be proper, as its chemical effects will render it inert.
   The inhaling of the  vapours of resinous gums, either
 alone or impregnated with  the virtues of cicuta,  and fac-
 titious airs, have been, by different authors, much extolled
 as a remedy for pulmonary consumption. When the disease

   * A case of pulmonary consumption was some time since
 published in a periodical work, as cured by small doses of mer-
 cury,  under the direction  of Dr. Beddoesr 
216
is confined to the membranes lining  the  windpipe  and
bronchial ramifications, they may, as a  topical application,
have some beneficial effect, but in this species, by provok-
ing cough, they are generally hurtful.
  The  nocturnal perspirations  are  during the  two  first
stages of the disease to be considered of a critical nature,
and therefore should not  be  checked, either by diminish-
ing the  quantity of bed  clothes, or the common practice
of throwing  part of them  off towards morning.  When
they are in such profusion as to weaken the patient, they
may be sufficiently restrained by taking ten  drops of the
diluted  sulphuric acid  every  night, or twice in the course
of the  day, in a  little  water, without producing the mis-
chief that must follow the  exposure of the body to, the
cold air.
  The purging that occurs during this  period is,  like the
perspiration,  often critical; the object of practice is there-
fore  to moderate and not to  check it; when it is  very
frequent or immoderate in quantity, the following mixture
may be taken in lieu of the compound oxymel:
  Take  of decoction  of  calcined hartshorn,  with double
         the quantity  of gum arabic, seven ounces;
       Tincture of opium, from twenty to thirty drops;
       -----------cinnamon, half an ounce;
  Two or three table spoonfuls to be taken every three or
four hours.

                         Diet.

  The diet recommended fo.r the first stage of the disease,
page 209, is also adapted  to  this stage.  The Lichen Islan-
dicus, or Iceland Moss, may be more liberally allowed, as
well as  the animal jellies, but wine, spirits, and meat in
substance,  must be scrupulously avoided.
  Some medical practitioners  have  disapproved the  use 
217
 of milk as a diet in this disease.  The experience of many
 ages, and the arguments which may  be adduced from
 analogy, have proved to the conviction of every candid
 practitioner or inquirer, that it affords a nutriment admi-
 rably adapted to support the debilitated frame of a  con-
 sumptive patient.  Should it prove too heavy for the sto-
 mach, it may be diluted with barley water or distilled
 water, which will often reconcile  it to the stomach of
 those who could  not otherwise retain it.  Ass's m:lk
 being thinner than that of the cow often agrees better
 with  the patient;  some  patients, however, have so great
 an aversion to the milk of this  animal,  that they cannot
 be prevailed  on to take it; in this case, an imitation  of it
"may be made in the following manner, which perhaps is
 rjot inferior to the natural:
   Take of Eringo root and pearl barley, of each half an
         ounce:
       Liquorice  root, sliced, three drachms:
       Distilled water, one quart;—
 Boil them together over a slow fire  to a pint, then strain
 it, and add to the liquor an equal quantity of cow's milk.
   The milk  should be  taken from a healthy  and well*
nourished cow, not older than three or four years, and
three months after producing calf.  It should be used as
soon as possible after  it  comes from the cow, as by long
standing or exposure  to the atmosphere, it undergoes a
chemical change,  which  injures its nutritious properties.
It would therefore be advisable to collect it in  a bottle,
by means of a funnel,  and afterwards cork it, to prevent
its decomposition.
   Dr. Lambe has lately published some interesting obser-
vations on the efficacy  of distilled water in, what he terms,
constitutional diseases, among which he notices pulmo-
nary consumption of the lungs.  From a number of nice.
                          2G 
218
chemical experiments he has made with common water
in general use, he detected a deleterious matter, to which
he has given the name of septic poison, probably produced
by the putrefaction of animal and  vegetable substances.
To the  operation of this  poison,  introduced   into  the
system in the common  beverage,  he is of opinion many
of the most formidable diseases that appear in the human
frame,  may be traced.  He therefore  proposed to  cure
such diseases, by confining the patients to the  use  of
water purified  of this noxious impregnation by distilla-
tion, with which all  articles used  in diet and  medicine
should be made.
   Distilled water is no doubt a very excellent alterative,
but I am fearful its salutary effects  on the constitution are
too slow to be of service in consumptive cases;  in'mere
chronic  diseases it may prove a valuable discovery, and as
it affords a pleasant  beverage, I have  recommended its
use to consumptive patients in lieu of common  water.
   Flannel dresses next the skin should also be  adopted,
and changed at least  every morning.  A fleecy hosiery,
on account of its softness and thickness, is perhaps pre-
ferable  to  flannel.  Some authors  have recommended a
waistcoat made with  the  dried skins of hares,  which on
account of retaining the perspirable matter from the body
is more objectionable.  The feet should be kept warm by
the use of flannel socks.

                       Exercise.
   As much muscular  exertion, by quickening the circu-
lation of the blood through the lungs, will provoke cough,
and tend considerably to aggravate the organic mischief,
such exercise should be adapted  in which the muscles
of the  body  are  little  employed, as  swinging  in a
machine, or riding in a carriage,  which instead of acce- 
219
 ierating the circulation,  generally diminishes the action
 of the heart and arteries, and thus quiets the system.  It
 is probably on this account  that the motion of a ship  in
 sailing has proved, in so  many instances beneficial in pul-
 monary consumptions.  It is worthy of notice, that this
 kind of exercise  has been  found to remove cedematous
 swellings of the legs, which proves  that it increases the
 action of the absorbent vessels, while it evidently lessens
 that of the arterial system.   After taking exercise in a
 cold air, a patient  should  not  return to a warm room
 suddenly, or immediately approach the fire, the excita-
 bility of the lungs being much increased by the respiration
 of cold air, the sudden inhalation of heat  will irritate the
 internal membranes, and thus excite cough, and increase
 the difficulty of breathing and secretion of mucus, &c.

                        Ofi Air.

   It certainly is of some importance that a consumptive
patient should reside in a pure atmosphere, but I do not
conceive it of that great consequence as generally ima-
gined ; a light air always proves more easy of respiration
than a very pure dense atmosphere.  The air of London
is by no means so insalubrious as it has been represented
to be by medical  writers;  nor do I  believe that those
diseases of the lungs are, in proportion to  its inhabitants,
so frequent in town as the country. The air of Islington,
Hampstead, Highgate, and Pentonville, I am persuaded,
is good for consumptive and asthmatic patients, notwith-
standing their contiguity to London.  Exmouth and Sid-
mouth, in Devonshire, being protected from the incle-
mency of the piercing north-east winds from their peculiar
situations, afford  a  better residence during the winter
season than any part of this  island,  and  the number of 
220
 consumptive patients that  resort thither,  from the most
 remote parts of the  united kingdoms, is  very consider-
 able.  Malvern, on  account of the air and purity  of the
 water, is however preferable as a summer's  residence.
 In females, this disease is often attended with a retention
 or suppression of the menses, which, in all cases, may be
 considered the effect and not the cause of the disease, the
 patient generallv becoming regular as the disease  in the
 lungs is diminished.  It is  not therefore of that import-
 ance as  females imagine;  although it would  be advise-
 able to promote this healthy secretion, could  medicines
 be with safety emploved for that purpose. Sometimes this
 periodical evacuation is either too copious, or frequent in
 occurrence, when it rarely affords the mitigation of symp-
 toms as the circumstance would lead to expect.  It is re-
 markable,  however, that  when  a  consumptive patient
 breeds, the disease is frequently  suspended, probably in
 consequence of the great determination of blood to,  and
 healthy action in, the womb.  The  same  takes place in
 cases of insanity,  which can  be  accounted for only on
 the principle of a peculiar irritation of the brain, produ-
 cing  a derivation from  the lungs, as in insanity there is
 seldom an increased influx ol blood to the brain.
  It sometimes happens, that on relieving the disease
 of the lungs, some inflammatory affections appear in other
 parts of the body, which increase as the phthisical symp-
 toms abate.  Such morbid  appearances should be con-
 sidered of a critical nature, and therefore not checked by
 discutient  means, but encouraged  by the application of
 warm poultices or fomentations. In some instances I have
 knownthe disease terminate in white swelling of the knee-
joint, which after advancing to suppuration, and ending
 in a favourable union of the bones,  the  complaint  of the
 lungs never returned, but when this chance was not given 
221
 (he  patient by the hasty amputation  of the limb, the
 phthisical symptoms always returned with increased vio-
 lence. The occurrence of piles, or abscesses, is likewise
 of favourable import, and should not be repelled.

  Ofi Remedies recommended fior Pulmonary Consumption.

  The uva ursi has lately been much recommended by
 Dr. Bourne, of Oxford, as a remedy for consumption of
 the lungs. It appears the Doctor was induced to give this
 article a trial in this disease from its well known salutary
 effects in morbid secretions of mucus, from the internal
 surface of the bladder, termed cystirrhaea, which he sup-
 poses are similar affections.  The secretion of the mucus
 in the lungs is however of a very different nature, and in
 this species of the disease no advantage would result from
 checking it by  the  use of astringent medicines, as the
 disease in the  substance of the lungs  would thereby be
 increased.  In the few trials I have made with it, and the
 many that I have known made, at a public institution in
 London, I can say, that in this species it is a very dan-
 gerous medicine; but  in  the  pituitous  consumption of
 the lungs of elderly people, it has proved beneficial. The
 Doctor should have noticed in what species of pulmonary
 consumption this remedy might be employed with advan-
tage or impunity, as it is to be feared  its indiscriminate
exhibition in all cases of consumption, has from its astrin-
gent properties done much mischief.
  The fox-glove has been very generally prescribed by
physicians in pulmonary consumption with various effects.
 In the first stages of this  species it is  unquestionably a
very valuable medicine, in not  only quieting the disease,
but also promoting an absorption of the matter deposited
in the substance of the lungs. In the hemoptoic species, its
salutary effects are more apparent, but in the latter stager 
222
 of both, and in the pituitous kind, which occurs in the
 advanced periods of life, it certainly hurries on their fatal
 termination, seemingly by reducing the powers of the
 system. Its injudicious employment has no doubt given
 rise to the diversified opinion of its properties, maintained
 by professional men.  The saturated tincture is  the  best
 preparation of this herb.
  Dr. Peart, in a late publication on pulmonary consump-
 tion, proposes to cure this disease by a solution of volatile
 alkali and opium, with a restorative diet and wine, which
 he says produce an absorption of the matter deposited in
 the lungs, constituting tubercles; few practitioners that
 are acquainted with the nature of the disease would be so
 bold as  to give this mode of treatment  atrial.
  Mr. Davidson, a very respectahle surgeon in London, in
 a treatise  on pulmonary  consumption,  recommends his
 patient to abstain as much as  possible  from the  use of
liquids, which  he  observes, get into the  blood-vessels
and produce plethora,  as  a proof of which, he instances
the ill effects  a  full draught of water produces on the
breath of a broken winded horse.  Liquids, however,
 distress a horse  under such circumstances, not by getting
 into the vessels of the lungs, but by distending  the sto-
mach, and pressing up the diaphragm, so as to diminish
the capacity of the chest,  and thus  prevent the  full ex-
pansion of  the lungs.  The complaint of the  horse, and
that of consumption in the human frame, are as  different
as two diseases can possibly be. That the use of simple
liquids,  as water, barley water, and such like, will produce
a distension of the  vessels, is by no means probable, inas-
much as they rapidly run off by urine  and perspiration.
 Copious draughts of liquids sometimes render respiration
short, by distending the stomach, but the effect  is very
transitorv. 
223
   A French emigrant, of the name of Regnaujt, some
time since published some observations on the Lichen Is-
landicum, which he recommends as a specific for pulmo-
nary consumption.  This work, consisting principally of
extracts from German and Danish physicians, contains no
additional information to what was published about twelve
years ago, in a work entitled  Thesaurus Medicaminum,
andbyDr. Crichton Dr. Aikin, and other respectable Eng-
lish practitioners.  Monsieur Regnault recommends the
herb to be deprived of its bitter quality, by infusing it in
warm water in order to render  it more palatable. To this
bitter quality, however, all its  medicinal properties, and
salutary effects in pulmonary consumption, are attributa-
ble,  and if it be deprived of it,  it certainly possesses no
advantage over the jelly of arrow root, tonvhich, in many
respects as an article of diet, it is inferior.  From the regu-
larity and temperature of the climate, and mode of living
of the French nation, the diseases of the lungs, there
ternjed consumption, differ very little from the catarrh of
this country, and are readily cured by simple medicaments
and diet.  Before  Monsieur Regnault published his ob-
servations, he should have made himself acquainted with
the organic disease of the lungs that constitutes pulmo-
nary  consumption, and the high state  of medical  and
anatomical knowledge* to which the  profession of  this
country has  happily arrived.  He would then have known
that the disease will  not admit of a specific, and is only
to be cured by a combination of remedies.
  With respect to the exhibition of factitious airs in  dis-
eases of the lungs, from which the public  were led to ex-

  * Dr. Rowley observes, in his popular lectures on the prac-
tice of physic, « that the English physicians have the start of
one hundred years of those on the Continent,*' 
224
pect so much real  benefit by Dr.  Beddoes, they have so
generally failed of affording the least relief, as to be aban-
doned even by those who were their most  sanguine ad-
vocates, and the more recent mode of treatment of living
with cows, suggested by this philosopher, will be rescued
from oblivion more I fear for its eccentricity than utility.
  On the  various remedies that have been proposed and
resorted to in the  treatment of this  disease, Dr. Peart
justly observes, " the thousands who have fallen victims
to it under the customary modes  of treatment, at once
point out their inefficacy, and render them undeserving
of attention."
  When the disease has  arrived  to its last or incurable
state, described page 204, the only object of practice is to
render the life of the patient as comfortable as possible,
by  palliating the  most distressing symptoms; for this
purpose, laudanum, or the black drop, must be adminis-
tered in such doses as the violence of the symptoms may
indicate. It may be given in conjunction with twenty or
thirty  drops of sweet spirit of nitre, or Hoffman's anodyne
liquor, in any simple vehicle, which often acts as a charm
in abating the violence of the cough, and the affections of
the bowels, procuring for the most part refreshing sleep,
and affording to the mind a most desirable  degree of
serenity.  With respect to diet, the inclination  of the
patient may be consulted and gratified, unless from the
pain in the bowels, a violent inflammation of the intes-
tines be suspected, (which  in this stage is a very common
occurrence,) when the use  of meat,  in substance, acids,
and wine, should be prohibited, and a mucilaginous diet
adopted, as arrow root, sago, and such  like.
   But as it is often difficult to determine by symptoms to
what extent the disease  of the lungs is arrived,  unless
the means I have suggested  have  had a proper  trial, 
225
or the practitioner has had an opportunity of observing
the progress  of the  disease, the recovery of the patient
should be first  attempted, before the palliative treatment
be adopted'; as I have, in  many instances,  succeeded in
curing patients  who had been pronounced irrecoverable.
  From  the foregoing observations it will appear:  That
this species of  consumption  is so insidious in its attack, as
often to  proceed  to  the  second stage before its  nature
becomes  evident:  That  the  heating anodyne medicines
of quacks, sold under fictitious names, only relieve  the
cough, while they uniformly hasten suppuration,  and thus
render the  recovery of the patient extremely doubtful:
That from the  nature of the disease  it will  not  admit of
a specific, and  is to be cured  only by  a combination of
remedies, of which the counter-irritation of perpetual blis-
ters, seaton,  or issue, are the most important:  That  the
symptoms denoting the  last  stage are often fallacious;
and therefore,  the recovery  of the  patient  should in  all
cases be attempted, before the case is pronounced hopeless,
and consigned to a mere palliative treatment.

 OF TUBERCULAR CONSUMPTION OF THE
                      LUNGS.

  It is generally supposed  by medical practitioners, that
there is no morbid  appearance so common in the lungs as
that of tubercles. Dr.  Simmons, in his practical observa-
tions on the treatment of consumptions,  asserts, that  on
examining the lungs of a great  number of patients who
had  died  consumptive, he  never  found them " entirely
absent."
  Notwithstanding the supposed frequency of these  tu-
mours in the human lungs,  a variety of opinions is enter-
tained with respect to their  structure and situation. The
                         2H 
226
 most  esteemed  ancient writers,  as  Hippocrates* and
 Aretseus,! represent them to be " scirrhous knots, formed
 of viscous or  toughish  matter,  which  gradually become
 hard in the lungs."  The  celebrated  Morgagni,J  who
 paid particular attention  to  diseased  appearances, states,
 that he discovered a variety of them, some  of considerable
 hardness,and which, when cut into,discharged a pure sanies,
 and others, that had not suppurated, resembling the firm-
 ness of a  glandular  body; and  in the fifty-third Letter,
 article  16, he observes,  that in examining  the lungs of a
 young  man, who had died  in consequence of a stab  he
 had received with a knife, which had penetrated the lungs,
v he found " the lungs abounded with tubercles of different
 sizes, many in a state of suppuration, and, when cut into,
 discharged an ill-conditioned  matter, while  others  pre-
 served the similitude of a sound  and  uninjured  gland;"
 and this definition has  been followed by Dr. Cullen,§ and
 other authors  of celebrity, both  in England  and on  the
 Continent.  Dr. James||  says, that they  are  sometimes
 " hard like the stones of fruit, and contain a tophaceous,
 calculous, and putrid  matter."   Mr.   Davidson,^  appa-
 rently on  no other authority than mere hypothesis, asserts,
 that they are not formed  in the cellular substance of the
 lungs,  but arise  in the air  cells, and are  produced by  in-

   *-In Lib. de intern. Affect. Cap. 4.
   t In  Chron.  lib. 1. cap. 8.
   \ De Causis et  sedibus  Morborum.
   § Cullen's First Lines, and Heberden's Medical Commen-
 taries.
    || Medical Dictionary, under  the  head of Phthisis Pulmo-
 nalis.
   1 Observations, Anatomical, Physiological, and Pathological,
 on the Pulmonary System. 
227
 spissated mucus stagnating in the minute air cells,  or the
 exudation  of coagulable lymph,  from the  irritation of
 small particles of sand taken into the lungs during inspi-
 ration: this author is of opinion that they are organized
 bodies. Had  Mr. Davidson taken the trouble of minutely
 examining  the  lungs of a patient, who had died  of this
 species of  phthisis,  he would  have found, that they are
 assuredly situated in the  cellular substance of the  lungs,
 instead of the air cells.  That small  tumours  arise  from
 the membrane lining the internal cavity of the  lungs, in
 consequence  of the  irritation  of some extraneous body*
 inhaled with  the air, and lay the foundation of an obstinate
 consumption, there  can  be no doubt; but  such tumours
 are of the fungus or polypus kind, and not what is meant
 by the term u tubercle."
   Many practitioners, from this species  of consumption
 being frequently  hereditary,  suppose that  children  are
 born  with tubercles  in  their lungs, and that they remain
 in a  quiescent state for  a long time  before  they take on
 them the process of  suppuration, and that they sometimes
 remain during a person's life-time without producing any
 other  inconvenience than shortness  of  breath on  much

   * Dr. Simmons  observes, " It is not unusual  for millers,
 stone-cutters, and others, to die consumptive, from their being
constantly  so exposed to dust, which in these  cases probably
act by producing similar concretions to tubercles. I have seen
two instances of this sort in millers;" and Dr. Kirkland states,
" that scythe grinders are subject to a disease of the lungs, from
particles of steel mixing with sand, which, among themselves,
they call the  grinders'  rot."  Many such  instances may also be
met with in Rammazzini,  Morgagni, and other writers, 
                         228           y;r ■■
exertion. From the experiments made by Dr. Saunders,*
one would suppose that tubercles are very readily formed;
for this author states,  " that after injecting two drachms
of quicksilver into the crural vein of a dog, in a short time
the dog became  feverish,  attended  with  difficulty  of
breathing, cough, and  daily increasing symptoms  of dis-
eased  lungs, of which he  died;  on  examination of the
lungs, they were found full  ofi tubercles, each  of which
contained a globule of  quicksilver, forming as it were  its
nucleus." It is very  probable  that these  tubercular ap-
pearances were nothing more than  partial depositions of
coagulable  lymph  from  the irritation  excited  by the
quicksilver, and that they were not really tubercles.  The
most accurate description  of the  structure and situation
of tubercles in the lungs, perhaps the only one in which
full  dependence  may  be  placed, is  given by  that able
physician Dr.  Baillie,  in  his   very  valuable  work  on
Morbid  Anatomy.  This  esteemed  author,  in  demon-
strating  tubercles,  observes,  "• they  consist  of rounded
firm bodies, interspersed through their substance. They
are formed  in  the  cellular structure which connects the
air cells of the  lungs together,  and  are  not a  morbid
affection of glands,  as has  been  frequently  imagined.
They are  at first  very small, being not larger than the
heads of very small pins,  and in this  case are  frequently
accumulated in small  clusters. The smaller  tubercles of
a  cluster probably  grow together,  and  form one  large
tubercle.  The most  ordinary size  of tubercles  is about
that of a garden  pea,  but they are subject in this respect
to much variety. They adhere pretty closely to the sub-
stance of the lungs,  and have  no peculiar  covering or
* In his Treatise on the Liver. 
229
capsule.  When cut into, they are found to consist of a
white smooth substance, having great firmness, and often
contain, in part, a thick curdly matter."
   The dissection of tuberculous lungs, I have found for
the most part,  confirm the accuracy of this definition.
From many and minute examinations, which public ap-
pointments have afforded  the opportunity of making, I
am persuaded that tubercles are by no means of so fre-
quent occurrence as is generally imagined. That there
are a variety of them similar to those tumours which
form in the adipose  membrane, immediately under the
skin in different parts of the body, which are named from
the appearance of their contents,  meliceris,  steotoma,
&c. That they are very rarely vascular, and when blood-
vessels are discovered in them, they appear to have arisen
from deposition of coagulated lymph, which, in process
of time, becomes firm, and at length organised, a circum-
stance by no means unusual in the  human body. These
varieties I shall more  fully describe in my intended pub-
lication on pulmonary consumption. The small abscesses
which form in the substance of the lungs, in the organic
species (described page 220), which are sometimes very
numerous and not larger than a  small pea, were no doubt
taken by Dr. Simmons and Morgagni for suppurated tu-
bercles. The partial  deposition  of coagulable lymph or
scrophulous matter in the cellular structure of the lungs,
givingtheir surface a tubercular appearance, and to the feel
a collection of circumscribed tumours, have also been de-
nominated tubercles  by superficial observers. Such tu-
mours, however, when they become firm, or take on  an
inflammatory action, or suppurative process,may be con-
sidered a species of tubercle, and are perhaps a frequent
cause of pulmonary consumptions  in this country. Dr.
Baillie observes, that he has often  found a considerable 
230
portion of the cellular structure of the lungs charged with
a whitish soft matter,  similar to that of tubercles, but
only diffused uniformly over a great portion of the lungs;
while the tubercle is circumscribed, which is a convincing
proof that this renowned physician is decidedly of opinion
that tubercles are merely partial depositions of coagulable
lymph, or scrophulous  matter.
  This author notices another sort of tubercle, consisting
of a soft tumour of the size of a goose-berry, formed of a
light  smooth substance. They were placed on the sur-
face of the lungs, but some were found in the substance
of a smaller size; on cutting them through; none  were
found in a state of suppuration.
  The tubercular consumption has the same stages and is
attended with the same symptoms  as the organic species,
excepting that in the  tubercular  species a patient has
generally the power of taking in  a deeper inspiration;
when, howeVer, the tubercles are much diffused through
the  substance of  the lungs, it will  be very difficult and,
perhaps, impossible to determine whether the disease
arises from a deposition of coagulable lymph or scrophu-
lous matter  uniformly  through the cellular structure of
the  lungs, or from a number  of distinct tubercles; but as
the  treatment of one species is applicable to the other, this
want  of a discriminating symptom is  fortunately of no
importance.  I have observed that young people,  with
tubercles in  their lungs, are subject every winter, or on
any great vicissitudes in the atmosphere, more or less to
a difficulty of breathing and cough; but as this may also
be the case with people predisposed to the organic species,
uo satisfactory conclusion can be drawn from it.

  Treatment ofi Tubercular Consumption ofi the Lungs.
  The object of our art in this species of consumption is, 
231
in the first place, to  render the tubercular concretions
quiescent, so as to check any disposition in them to the
suppurative process, and afterward to promote their ab-
sorption. With these views the treatment recommended
for the cure of the organic  species is proper,  viz.  in its
incipient or first stage, the  loss of blood from the arm,
particularly if the patient be of a plethoric habit, or from
the chest by leeches or cupping.  The external irritation
and discharge of a blister, seton, or issues, the occasional
use of the aperient  medicines,  No. 2; the  demulcent
mixture, No. 66; and after the symptoms are abated, the
exhibition of emetics for the purpose of increasing the
action of the   absorbent vessels of the lungs,  for the re-
moval of the  tubercles.*
   The gradual introduction of mercury into the system,
in the dose of half a grain (prepared calomel) twice a day,
or by external friction, has been much recommended in
this species particularly, both by the ancient and modern
writers, none of whom seem to have given it even a trial.
From the well known action of this remedy  in promoting
the absorption of tumours situated in other parts of the
body, one would  suppose it might be employed with ad-
vantage. Experience  has proved it to be, in those cases,
an  Herculean remedy, and although it  may sometimes
appear  to be attended with advantage, it has  on the

  * Many practitioners  have imagined that tubercles are of too
firm a texture  to be removed by absorption; that they cannot
be thus removed till their structure is destroyed by suppuration.
The idea of their firmness and glandular structure is erroneous;
and indeed was it correct, it is no reason why they should not
be taken up by the absorbent  vessels, inasmuch as we know
that they are equal to the removal of the indurated and even
bony tumour. 
232
 contrary been productive of much and irreparable mis-
 chief. In, domestic practice,  it is  evident  this remedy
 cannot be employed  with  safety, and the young or un-
 experienced practitioner should very attentively watch its
 effects, as by its stimulating properties it has been known
 to increase the febrile symptoms, aggravate the cough,
 and considerably  reduce  the  strength of  the  patient.
 When  the tubercles  are in a quiet or indolent  state,  it
 may  be administered with less  risk and with greater
 probability of success. It has answered best when given
 in  conjunction with  common  sulphur, as iEthop's mi-
 neral, or the golden sulphur of antimony, in the follow-
 ing proportion:
   Take of prepared calomel, five grains,
        Golden sulphur of antimony, one scruple,
       Extract of hemlock, half a drachm.
 Mix well  together, and divide into twenty pills, one of
 which may be taken twice a day. When  the symptoms
 evidently  give way under the use of mercury, it should
 be continued till the mouth is rendered a little tender by
 it, when it will be prudent to discontinue till this  effect
 is gone off,  after which it.may be re-administered if ne-
 cessary.
  The treatment recommended for the second  stage of
 the organic consumption of the lungs, both with respect
 to medicine,  external applications, diet,  exercise,  air,
 clothing, he. equally apply  to the  same stage of this spe-
 cies as well as  the observations I have there made on the
 various remedies  which have  been, at different times,
 extolled as specifics for pulmonary consumption.
  This species of consumption has a favourable termina-
tion peculiar to itself, although  common to  tumours,
which occur in other parts of the body, which is after the
morbid action  of the tubercles is suspended and the sys-
tem restored to a state of health, they become vascular or 
233
 organized bodies; that is,  blood-vessels shoot through
 their substance, a regular circulation will go on in them,
 and they become as it were part of#the lungs. This ad-
 mirable  operation of nature in suspending  or 'removing
 diseased action, takes place  much  more  frequent  than is
 imagined,  and tubercles found  in  this state have given
 rise to the idea that they are of a glandular structure.

 OF THE  MEMBRANOUS CONSUMPTION OF
                   THE LUNGS.
   This disease consists in a morbid secretion of the mem-
 brane  lining  the wind-pipe  and  the bronchial   ramifi-
 cations,  of  which there  are two species, one commencing
 in young people, with the  ordinary symptoms  of catarrh,
 and the other in elderly people; the former of which, in
 my treatise on the Lichen  Islandicus, I  denominated ca-
 tarrhal, and the latter pituitous consumption  of the lungs.

 CATARRHAL CONSUMPTION of the LUNGS.
  This species on its first  attack is attended with a tick-
 ling sensation at the  top of the wind-pipe,  a short  and
 frequent cough,  and an expectoration of a thin  mucus
 often  of a slatish  taste. At length the internal membrane
 of  the  wind-pipe  and  bronchial  ramifications  become
 affected  with  chronic  inflammation; the mucus  expec-
 torated more thick and opake, which changes  from a salt
 to a sweet taste, and  as the  disease advances, assumes a
 purulent appearance,  and  on first  being spit  into water
 swims,  but, on the disengagement of the air entangled
 in  it,  will  sink;  as the  disease  extends  through  the
 course of the bronchial  ramifications the  hectic symptoms
 increase. The  mucous glands become tumid  and much
 diseased, and  I  believe in this state have been often mis-
taken   for  tubercles.  The   chronic  inflammation   in-
creasing, adhesions take place  in the cellular  substance,
so as  to prevent,  by  degrees,  the  due expansion of the 
234
lungs.  As the disease advances,  the  mucus - becomes
more vitiated, often  tinged  with  blood  and expectorated
with more facility.

  Treatment ofi the Catarrhal Consumption ofi the Lungs.
  On the first attack of this disease, or during what I
would  term its catarrhal stage, small d6ses of ipecacuan,
a blister between the shoulders, the loss of a  few ounces
of blood,  and low  diet,  will  in  general  succeed; but
when the disease has  advanced to the phthisical stage,
that is, when  the  mucous  secretion becomes vitiated,
and the internal  membranes of the trachea and bronchia
inflamed,  with the train of hectic  symptoms, the cure is
often extremely difficult.
  The balsamic or terebinthinate medicines, by correcting
the mucous secretion, will allay  the irritation of  the in-
flamed internal membrane  of the  trachea and  bronchial
ramifications,  and instead  of increasing the hectic symp-
toms, I have  uniformly found them to quiet  the system.
They may be  given in conjunction with such medicines
as the predominating symptomatic affections may indi-
cate. When the  hectic symptoms run high, the  acetated
ceruse may be added ^vith advantage  in'the  following
proportion:
  Take  of balsam  of copaiba,  or Canada balsam, two
         drachms,
       Gum arabic,  three drachms,
       Acetated ceruse, four grains,
       Rose water, six ounces,
       Syrup  of white poppies, six  drachms.
Dissolve the gum arabic in half  an ounce of  water, thej.
rub with it the balsam, and when well blended add the rose
water and syrup;  and lastly, the acetated ceruse previously
dissolved in a tea-spoonful of good vinegar. 
235
   If the expectoration be difficult,  a drachm of gum am-
 moniac, or tincture  of  squills, may likewise  be added;
 and if the  cough be very troublesome, six or eight grains
 of the styrax pill may be taken at bed-time.
   The  liver of sulphur  may be occasionally employed in
 the  dose of two or three grains  dissolved  in distilled
 water, to abate hectic heat.  This medicine, in many cases
 of consumption where the inflammatory symptoms where
 unusually  severe, I have found.a  most valuable remedy,
 in cooling the body and  quieting the circulation, in which
 it has succeeded, after the digitalis had failed.
   A perpetual  blister, or a seton between the shoulders,
 or over the breast bone,  is likewise a remedy of great im-
 portance, and should not be neglected, although the symp-
 toms may  not run high.
   In case  of profuse perspiration,  eight drops of the di-
 luted sulphuric  acid should  be  taken in  a little distilled
 water, two or  three times a day, but if they should not
 be in such  quantity as evidently to reduce  the strength of
 the patient, they should not be checked suddenly.
  Colliquative  diarrhoea  may in general  be relieved by
 native vegetable acids, as a  roasted apple, &c. but in  case
 this  symptom  should prove obstinate, a tea-spoonful  of
 preserved sloes may be taken frequently; or the following
 mixture may be substituted for the  balsamic mixture, till
 the number of  motions are  reduced to one  or two in the
 course of twenty-four hours:
  Take of the white decoction, seven ounces,
      Liquid laudanum, forty drops,
      Tincture of cinnamon, three drachms. Mix.-
  Two or three table spoonfuls to be taken every three or
four hours.
  The inhalation of anodyne and  other vapours, as to-
pical  applications,  one would suppose would prove  bene- 
236
ficial in this species particularly; but they have never an-
swered my expectations; and in some instances, by pro-
voking cough, have certainly proved prejudicial; they are,
therefore, an ambiguous remedy,  and should not be per-
sisted in, if they evidently produce irritation  in the lungs.

                         Diet.

  The Iceland liverwort should be taken in such quantities
as nearly to constitute the diet of the  patient, as directed
page 149. Animal food, especially  in substance, and wine
and spirits of all sorts, should be abandoned as poisonous.
   The instructions given for  the  diet and dress, and  the
observations made on air, exercise  and distilled water,
under the head of Treatment of the Organic  Consumption
of the Lungs, equally apply to this species.
   In females  this  disease  is  frequently attended with  a
suppression of the menstrual evacuation, which is the effect
and not the  cause of the disease, as generally imagined by
the patient.

                       Distinction.

   This  disease may be distinguished from the organic
 species  from  its  commencing  with an expectoration of
 mucus, without rigours, shortness  of breath,  or quickness
 of pulse.

    OF PITUITOUS CONSUMPTION OF THE
                          LUNGS.

    This species of pulmonary consumption occurs about
 the age of forty, and upwards; it sometimes commences
 with the symptoms of catarrh,  but more freqently is the
 sequel of chronic  affection of the lungs of  long standing,
 as  asthma, cough,  dyspucea.  It is  attended with  con- 
237
siderable secretion of mucus, from the  internal membrane
of the trachea and bronchial ramifications, often  amount-
ing to the  quantity of two pounds in  twenty-four hours;
at first clear, inodorous, and tasteless,  but gradually be-
coming opake; and after two or  three months, a kind of
chronic inflammation of the internal surface of the bronchia,
and  their  ramifications  supervene,  and the  matter ex-
pectorated  becomes  more vitiated, and of a purulent ap-
pearance (as the  discharge from other inflamed  secreting
surfaces) increased in  quantity, but rarely streaked with
blood: at this period the patient, for the first time, com-
plains of  pain  in the  chest, principally  on coughing,
which is soon followed  by the train of symptoms consti-
tuting hectic fever: the legs at length become  cedematous,
and  the powers of the constitution so reduced,  that the
patient has not  the  power of  expectorating,  without an
effort of the diaphragm, amounting nearly to vomiting;
the cavities of the lungs, in  consequence, become so filled
with mucus as  to produce  suffocation.
   The lungs, on opening the chest, do not collapse the
air cells and bronchial ramifications, being nearly filled with
a  kind of purulent secretion, which  render them very
ponderous; after squeezing out their contents, they appear
very flaccid, and the internal surface exhibit no appearance"
of ulceration.
   This species of pulmonary consumption appears to be
frequent in this  country. It is generally the consequence
of catarrh, which, by debilitating  the  lungs,  produces  a
disease similar to that we observe occur in other  secreting
surfaces from relaxation; as the whites and  gleets,  the
discharge of which often assumes a purulent appearance,
when attended  with  inflammation.  The mucus  expec-
torated in  the last stage of this disorder, being  taken by
Mr.  De Haen for  pus, that  author not being able to de- 
238
tect ulceration  in the lungs of those who died of the dis
ease, concludes, that pus  may  be formed in the  blood
vessels, and from thence poured into the bronchia.

                      Distinction.

   This disease may be distinguished from the preceding
species, in being attended with  a  more copious  expecto-
ration of mucous matter of the same appearance  through-
out, and  never tinged   with  blood;  whereas  the pus in
the organic species may be observed imperfectly blended
with a clear mucus, and often streaked with  blood.  The
heciit lever is likewise  considerably milder, and  docs not
occu till a late period of the disease. The matter expec-
torated is inodorous  and tasteless to the  patient,"but in
the purulent phthisis it is offensive  to the taste, and often to
the smell; and the patient is rarely affected with diarrhoea.

                       Treatment.

   In addition to the  use of the Farina, and concentrated
infusion  of the  Lichen, as recommended page  149,  &c.
frequent emetics of ipecacuanha, or zinc, vitriol, will prove
of considerable advantage, by compressing the lungs, and
thus forcing the mucus, secreted  in them, into the bron-
chia  and trachea,  so as to  be  expectorated  without  the
exertion  of coughing. They likewise  produce a  salutary
determination to the  skin; and instead of  debilitating the
system, the patient uniformly feels an evident acquisition
of strength, and will breathe with much  greater facility
for some  days. It should be  repeated twice a week, or as
often as  the  difficulty of respiration  indicates  a  loaded
state  of  the  lungs,  employing in the  intermediate time
tonic and expectorant   medicines combined, as  the  fol-
lowing: 
239
                        No. 1.
  fake of gum. myrrh, three drachms,
      Red sulphate of iron, thirty drops,
      The concentrated infusion  of the  Iceland  liver-
        wort, (see page 150) one  pint. Mix.
three table spoonfuls to be taken three times a day.

                      Or No. 2.
  Take of Canada balsam, three drachms,
      Mucil. G. Arabic, two ounces,
      Tinct. squills, three drachms,
      Concentrated Inf. of Lichen Island,  twelve ounces.
Mix. Three table spoonfuls to be  taken  three times  a
day.
                      Or No. 3.
  R. Gum. Ammon. two drachms,
      Tinct. of Tolu. three drachms,
      Concentrated Inf. of Lichen Island,  twelve ounces.
Mix. To be taken in the same  manner as No. 2.
  In case of profuse nocturnal perspirations, three drachms
of the diluted sulphuric'acid may be added to either of
these mixtures.
  To excite  a little counter-irritation, a stimulating plas-
ter of Burgundy pitch and euphorbium, should be applied
between the shoulders, or oyer  the breast bone.
  Opium, by weakening or paralysing the  powers  of ex-
pectoration, is in this case very improper.
  The fox glove, which is certainly an excellent remedy
in the organic and hsemoptoic species, is a very dangerous
medicine in this, and has in many instances, by lessening
the  vital principle, occasioned  premature death. The  in-
creased impetus of the circulation in this case I consider
to be for the  purpose of oxygenating the blood.
   The diet should consist principally of animal jellies: a 
240
 little meat in substance and wine may be allowed. The
 application of cold'water  to the  body, by means of the
 shower-bath, has in many instances  proved highly bene-
 ficial.
 .  There  is another  species of pulmonary consumption
 very prevalent in this country, in the advanced stage of
 which the internal membranes and substance of the lungs
 have been found on dissection to  be  equally effected, viz.
 from the  rupture of  a blood vessel in the lungs  (see spit-
 ting of blood), which is therefore  named

        1LEMOPTOIC CONSUMPTION.

   This species  often  arises  from mal-formation, occa-
 sioning a  disproportion between the capacity of the lungs
 and that of the  chest, so that when the latter exceeds the
 former, a  laceration will be produced by their sudden and
 great distention, particularly if the blood vessels happen
 to be in a loaded state  from  running,  or any  violent ex-
 ercise.  Such  an accident,  under  such circumstances,
 would very likely terminate in  ulceration, and thus occa-
 sion a lingering  but dangerous  consumption. If the rup-
 ture of the vessel be the  effect of plethora, without any
 such  mal-formation,  it  will  sometimes unite,  and no
 mischief ensue,  and  if ulceration  should take place, it is
 not of that obstinate  nature as when attended  with a dis-
proportion of parts.
   In the cure  of this species, the  fox glove  is the princi-
pal agent,  and, properly  administered,  has  always a very
 happy effect in  checking the  velocity  of the  circulation
 through the lungs, and thus quieting the local irritation,
 and  constitutional sympathy. Ten  drops of the saturated
tincture should  be  begun  with, three times a day,  in a
little barley water,  (in  which some gum arabic may be
dissolved) and the  dose gradually increased,  five  drop? 
241
each day, till it arrives to fifty, if it does not nauseate the
stomach, or produce giddiness; but if a less  dose of this
medicine should succeed in reducing the pulse to 70 or 80
pulsations in a minute, no  further  augmentation will be
necessary.
  If the pulse should be full, or especially if the patient
be of a plethoric habit, the loss of six or eight ounces of
blood from the arm will be  proper, but  this should be
practised  with caution.
  The use of flannel next the skin, a seton, or perpetual
blister over the breast bone, distilled water, the different
preparations of the Iceland moss,  and diet recommended
for the cure of  the  organic  consumption of the lungs,
should, in this case, with the same views be adopted.
  The  inhalation of the vapours of burnt pitch, or  gum
mastic, with a little gum Tolu, is  of service in this dis-
ease, but hurtful in the organic and  catarrhal species.
  In case of mal-formation of the chest, it may in some
cases be  necessary  to  prevent the  full expansion of the
ribs, by a strong laced bandage, made with flannel.
  When the violence of the symptoms is abated, and the
pulse reduced to 70 or 80 pulsations in a minute, the fol-
lowing  mixture may be taken  with considerable advan-
tage :
  Take of Canada balsam, two drachms,
       Mucil. G. Arabic, one ounce,
       Tinct. of foxglove, one drachm,
       Syrup of white poppies, six drachms,
       Distilled water, six ounces.  Mix.
of which two  large spoonfuls  may be taken three or four
times a day.
   If the expectoration should be difficult, half an  ounce
of oxymel of squills may be  added. Spirit of turpentine
is much recommended in this species of pulmonary con-
                         2 K 
242
sumption, by Dr.  Hunter, and in some  instances I have
known it to prove ver> beneficial. The ex. rcise of riding
on horseback, in a carriage, swinging, or sailing, as advised
in the organic and catarrhal consumption, should in this
case be adopted in preference to any other.
  Sauvage and other nosological writers enumerate several
species of pulmonary consumption, but the diseases from
whence they are named may be considered merely as pre-
disposing causes, and some even the effects of the disease
of the lungs.

                  CONVULSIONS.

  There are different species of convulsions, viz. epilepsy,
hysteric fits,  lock  jaw, which see  under their  respective
heads; jand for the convulsive fits of children, see Appendix
to the Family Dispensatory, p. 136.

                    OF CORNS.

   Corns consist in  a  lamellated  hard thickening of the
cuticle, generally of the feet, occasioned by the pressure
of tight shoes, &c.

                  Treatment ofi Corns.
                           m
   The callous inorganic  substance should  be  pared off
with a  sharp knife, being  previousiy soaked  in warm
water. The part should then be defended with the plaster,
No. 109, or the diachylon plaster, No. 58. The  occasional
cause should be avoided, by wearing loose  shoes. When
thev are situated at the bottom of the feet, their recurrence
may be  prevented  (after their removal as above directed),
by the use of hair  soles, the elasticity of which will obviate
the effect of pressure and pain in walking. 
243
'  Plasters of verdigris and the red precipitate of mercury
have been much recommended for the removal of  corns,
and  alleviating their pain. From  their caustic property,
they may have a good effect, but from this circumstance
they may also irritate and aggravate the pain. The benefit
of plasters is often more the  effect of the soft leather on
which they are spread, than any  chemical operation of
the plaster itself; hence  putting on two or three  plasters,
one above the other,- the lowermost having holes in their
centre to let through the top of the corn,  by taking off the
pressure entirely, is highly useful.
   The application of a diachylon plaster, spread on leather,
about the size  of half-a-crown, on the upper part  of the
foot an inch or half from the corn, is esteemed a sovereign
remedy by Admiral  Henry, who having received essen-
tial benefit  from  it, has, from motives of humanity, reques-
ted its insertion in this work.

                 OF  COSTIVENESS.
   Costiveness is generally attended with head-ach, giddi-
 ness,  disagreeable taste of the mouth, a disrelish of  food,
 and sometimes the piles.

                  Causes ofi Costiveness.
   It  arises from a sedentary  life, a deficient secretion or
 inertness of the bile, the  use of port wine, a slimy  state,
 or a spasmodic constriction  of the intestines.

             Ofi the Treatment ofi Costivetiess.
   The alterative doses  of the  aperient salts, No. 2,  taken
 every morning in  whey, will succeed in obviating  costive-
 ness  much better than rhubarb, which,  after its  opera-
 tion,  generally  leaves the  bowels  in  a  costive  state. 
244
When an accumulation of slime is suspected in the in-
testines, which is frequently the case, three or four grains
of calomel may be taken at bed-time, and repeated  every
third  night, and the  aperient salt, No. 2, the  following
morning;  three  or four doses  will generally  be sufficient
for this purpose.  Costiveness attendant on a suppression
of the menses will be best relieved by the ecphratic pill of
the Edinburgh  Pharmacopoeia, which  will at the same
time  produce the monthly evacuation.  (See Treatment
of Green Sickness.) In case of much  pain in the bowels,
the operation of these medicines should  be promoted by
the use of the laxative clyster, No. 97.
   When  costiveness  is  attended  with  acidity  in  the
stomach,  the  prepared natron  dissolved in   water,  and
taken as directed, No. 60, will prove an effectual remedy;
and the use of  the tincture  of camomile and  ginger, as
directed No. 7, a vegetable diet and  exercise, will  pre-
vent  its recurrence.  Costiveness,  produced  by  the  use
of  lead, to which painters  are particularly  subject, re-
quires much more active medicines, such as the cathartic
extract, with  calomel, in the  proportion recommended
for the cathartic pills, No. 84. A stimulating clyster of
aloes  and salt  is  also often  necessary, (see colic). When
costiveness is  accompanied with piles, the electuary for
piles,  No. 85, will answer bejSt.

                    OF  COUGHS.

   When  a  cough occurs in  a person  of  consumptive
habit, or  born  of consumptive parents,  or  at  the   con-
sumptive  period of life, it  requires more  attention  than
the patient is generally willing to  allow. A Mister to the
breast-bone, the loss of blood  from  ihe arm,  the occa-
sional use of the aperient  mixture, No. 62, the cough 
245
mixture, No. 66,  low diet,  and the use  of flannel next
the skin, are all indispensably  necessary  to prevent the
organic disease of the lungs and  chronic  inflammation of
the membrane lining the  wind-pipe and bronchial rami-
fications  and morbid  secretion  of mucus, that constitute
pulmonary   consumption,   a  very  common termination
of neglected  coughs.
   Habitual  cough, attended with  a secretion of tough
phlegm,  difficult  to expectorate, will be  relieved by die
troches of the squill and  benzion, or the following  mix-
ture :
   Take of gum ammoniac milk, six ounces,
       Paregoric elixir, and
       Oxymel of squills, of each one ounce. Mix.
Two table  spoonfuls to taken  three times a day alone,
or the squill pill, as directed No. 45.
   Cough is a symptom of pleurisy and  inflammation of
the lungs,  when  it is  attended with rigours, fever, and
pains in the chest. (See Pleurisy and inflammation of the
Lungs.)
   For coughs affecting  children' from two months and
upward, gentle emetic doses of ipecacuan  powder  every
twenty-four  hours,  afford very considerable relief, and
will often  speedily cure  it.  If attended  with great diffi-
culty of breathing, a  blister or Burgundy pitch plaster
should be  applied  between  the shoulders,  or  over the
breast bone, and a tea spoonful of a linctus of  almond
oil and syrup of white poppies, given two or three  times
a day, besides the emetic  powder.
   Cough is likewise  a symptom of an effusion of  water
in  the  chest, in  which  case it is  attended with general
debility of the system; often  swelling of  the legs, espe-
cially towards night, ind  a sense of suffocation, when in
an horizontal position. (See  Dropsy.) 
246
   Cough  being symptomatic,  of so many  and opposite
 affections of the  lungs,  the  danger  of general  cough-
 medicines  (so  industriously  advertised  by  designing
 quacks),  must  appear  obvious.  These  medicines being
 composed of paregoric elixir, tincture of Tolu, and  gum
 benzoin,  &c. sold under  plausible fictitious names, as the
 essence or balsam of herbs, once held  in estimation, for
 their supposed healing powers, are a very serious imposition
 on the public: their stimulating properties having no doubt
 often produced inflammation or tubercles,  and thus oc-
 casioned  a fatal  consumption.   In  simple  catarrh  they
 will produce  pleurisy  and  inflammation  of the  lungs,
 which  by terminating in  suppuration or  mortification,
 will destroy the life of the patient  in  a  few hours; and
 even in chronic cough  they are  often  hurtful by  check-
 ing  expectoration. If  imposition  be cognizable  by the
 laws of the  countiy, surely  that species  which  sports
 with the lives  and happiness  of his majesty's  subjects,
 should not be  suffered by the legislature  to be thus prac-
 tised with impunity.
  The lozenges, sold under the names of tolu, patarosa
and paregoric   are,  from  their  stimulating  ingredients,
improper  in cases of recent   oughs;  they  are  likewise
hurtful to the  digestive  organs, by generating acidity  in
the  stomach,  and  have  a very  injurious effect on the
enamel  of the  teeth, which in scrop  u!ous or ricketty
 habits, thev either destroy or  render black.
  Coughs, it must therefore be  remembered, are  not
 only the  effects of obstructed  perspiration,  but proceed
from various other causes, particularly in children, such
 as teething, bowel complaints, foul  stomach,  fever, &c.
 and are recurring symptoms in  delicate habits, the  re-
medies for which are recommended under their respective
heads.  However trifling coughs are generally considered, 
247
the greatest care should in all cases be taken to check their
progress, otherwise they may be  the  incipient  cause  of
almost every disorder to which the human frame is liable;
even that formidable disease pulmonary consumption may
be termed a neglected cough.


                     COW-POX.
[Instead ofi Dr. Recce's article upon this subject,  the Ame-
   rican editors have substituted the following,  as contain-
   ing  a more accurate description of the disease, and a
   more correct and satisfactory account of its  anti-vario-
   lous property.]
   This disease, if a great blessing may be so called, had
been for many years  known in several of the  counties of
England, and in some parts of Germany and  Ireland.  It
was communicated from the cows to the dairy  maids, and
it  was  well known to the common people, " That nobody
ever died of the cow-pox, and that nobody ever had the small-
pox after it.''''  But surprising as it may appear, when these
two facts were generally known, yet no person ever thought
of attempting  to transfer the virus from one human subject
to another, till the 14th day of May, 1796, when the im-
portant experiment was made by Dr. Edward Jenner, whose
name will hereafter probably be held  in as high veneration
as the name of any other man that ever lived.

   The following account of the progress and characteristic
marks  of the disease have been communicated  to the edi-
tors by one of the medical professors of the University of
Pennsylvania.
   " The symptoms of inoculated cow-pox,  in  their com- 
                          248
 mencement, somewhat resemble those or small-pox.  In
 about thirty-six or forty-eight hours  from the time of in-
 serting the matter, a small speck of inflammation makes its
 appearance, which by the end of the fourth day (counting
 the day of inoculation  the first) has the form of a small
 pimple with a   circle of  inflammation surrounding it.
 By the end of the fifth day, this generally takes on the
 distinctive  character  of  the  vaccine  pustule  which is
 entirely different  from  that of small-pox.  On the  sixth
 day it is  still more developed, and  the pock is perfectly
 regular in its margin, and has a flattened surface, the cen-
 tre of which  is of a dark colour,  and the edges  appear
 somewhat elevated. The pustule of small-pox, at this pe-
 riod has a very different form; it becomes irregular, has no
 distinct circular margin, and  the centre is  not flattened.
 The  vaccine  pustule during its whole progress is regular
 and circumscribed, while that  of small-pox becomes more
 and more irregular.
  " The vaccine pock  begins  on the fifth or sixth day, to
 change from  a red pimple to a vesicle containing a fluid,
 which is  already  capable of propagating the  disease, and
 the sooner it  is taken,  the more certainly will it produce
 this effect. From the sixth to the tenth day inclusive, is the
 most favourable period  for collecting the matter.
  " The diameter of the pustule augments considerably, but
 its elevation is always very trifling.  At the eighth or ninth
 day it has generally arrived at maturity, and  the constitu-
tional symptoms are ushered  in by a swelling and pain in
 the pustule, shooting up  into the arm-pit, the glands  of
which sometimes swell and feel  sore.  Languor succeeds,
with drowsiness, paleness, chills and flushes of heat, head-
ache, pain in the back and limbs, loss of appetite, sickness
 at stomach,  thirst  and white tongue, with a quick pulse* 
249
 These symptoms are generally very slight, and in many in-
 stances are not at all noticed; they subside in a few hours,
 without any unpleasant consequences.
   u The inflammation surrounding the pustule increases
 on the tenth or eleventh day, so as to form a beautiful areola
 around the pock, which is regarded as a decisive proof of
 the presence of the disease.  Occasionally, however, it does
 not occur, even when the disease has been communicated.
 On  the eleventh  or  twelfth  day the centre  of the pustule
 begins to grow darker, and at the end of a fortnight is of a
 brown or mahogany colour, and begins to be  detached from
 the  skin beneath, which  it leaves  in three  or four weeks
 with a slight depression."
   For a more full and complete account of the disease the
 reader is referred to  " Practical Observations on Vaccina-
 tion, by John Redman  Coxe, M. D." a gentleman whose
 exertions in extending a knowledge of vaccination, and in
 promoting  its practice, entitle him to the gratitude of every
 friend of science and humanity.

 Extracts from the Report ofi the Royal College ofi Physicians
     ofi London, on Vaccination, dated April 10,1807.
   " The royal college  of  physicians  of London, having
 received his majesty's commands, in compliance with an
 address from the house of commons,  * to inquire into the
 state of Vaccine Inoculation  in the United Kingdom, to
 report  their opinion and  observations upon that practice,
 upon the evidence which has been adduced in its support,
 and upon the causes which have hitherto retarded its ge-
 neral adoption;' have applied themselves diligently to the
 business referred to them.
   " Deeply impressed with the importance of an inquiry
which equally involves  the lives  of individuals  and  the
public  prosperity,  they have  made  every exertion  to
                         2L 
250
investigate the subject fully and impartially.  In aid of the
knowledge and experience of  the members  of their own
body,  they have applied  separately to each of the licen-
tiates of the college; they have corresponded with the col-
leges of physicians of Dublin  and Edinburgh;  with the
colleges of surgeons of London, Edinburgh, and  Dublin;
they have called upon the societies  established for vacci-
nation, for an account of their practice, to what extent it
has been carried on, and what  has been the result of their
experience ; and they have, by  public notice, invited indi-
viduals to contribute  whatever information they had se-
verally collected.  They have  in consequence been fur-
nished with a mass of evidence communicated with the
greatest readiness  and candour, which enables them  to
speak  with confidence upon all the principal points refer-
red to them.
  " I. During eight years, which have  elapsed since Dr.
Jenner made his discovery public,  the progress of vacci-
nation has been rapid, not only in all parts of  the United
Kingdom, but in every quarter of the  civilized world.  In
the British islands some hundred thousands  have  been
vaccinated: in our possessions  in the East Indies upwards
of 800,000; and among the nations of Europe the prac-
tice has become general.  Professional men have submit-
ted  it to  the  fairest trials, and the public have, for the
most part, received it without prejudice.   A  few indeed
have stood forth the adversaries of vaccination, on the same
grounds as their predecessors, who opposed the inoculation
for the small-pox,  falsely led by hypothetical reasoning in
the investigation of a subject which must be supported, or
rejected, upon facts and observation only.  With these few
exceptions, the testimony in favour of vaccination has been
most strong and satisfactory; and the practice of it, though
it has received a check in some quarters, appears still to 
251
 be upon the  increase in most parts of the United King-
 dom.
   " II.  The college of physicians, in giving their observa-
 tions and opinions on the practice of vaccination, think it
 right to premise, that they advance nothing but what is
 supported by the multiplied and  unequivocal  evidence
 which has been brought before them, and  they have not
 considered any facts  as proved, but what have been stated
 from actual observation.
   "Vaccination appears to be in general  perfectly safe;
 the instances  to the contrary  being extremely  rare. The
 disease  excited by it is slight, and seldom  prevents those
 under it from following their ordinary occupations.  It has
 been communicated with safety to pregnant women, to chil-
 dren during dentition, and  in their earliest  infancy; in all
 which respects it possesses material advantages  over in-
 oculation for the small-pox; which, though  productive of a
 disease  generally mild,  yet sometimes occasions alarming
 symptoms, and is in  a few  cases fatal.
   "The security derived from vaccination against the small-
 pox, if not absolutely perfect, is as nearly so as can perhaps
 be expected from any human discovery; for among several
 hundred thousand cases, with the  results of  which the Col-
 lege have been made acquainted, the number of alleged
 failures  have  been surprisingly small, so much so, as to
 form certainly no reasonable objection to the general adop-
 tion  of vaccination; for it appears that there is  not  nearly
 so many failures in a given  number of vaccinated  persons,
 as there  are deaths in an equal number of persons inocula-
 ted for the small-pox. Nothing can more clearly demon-
 strate the superiority of vaccination over the inoculation of
the small-pox, than this consideration;  and it  is a most
important fact, which has been confirmed in the course of
this inquiry, that in almost every case, where the small-pox 
252
 has succeeded vaccination, whether by inoculation or by-
 casual infection, the disease has varied much from its ordi-
 nary course; it has neither been the same in violence, nor
 in the duration of its symptoms, but has, with very few
 exceptions, been remarkably mild, as if the small-pox had
 been deprived, by the previous vaccine disease, of all its
 usual malignity.
   " The testimonies before the College of Physicians are
 very decided in declaring, that vaccination does less mis-
 chief to  the  constitution, and less frequently gives rise to
 other diseases, than the small-pox, either natural or inocu-
 lated.
   " The College feel themselves called upon to state this
 strongly, because it has been objected to vaccination, that
 it  produces new, unheard-of, and monstrous diseases.  Of
 such assertions no proofs have been produced, and, after
 diligent inquiry, the College  believe them to  have been
 either the inventions of designing, or the mistakes of igno-
 rant men. In these respects then, in its mildness, its safety,
 and  its consequences, the individual may look  for the pe-
 culiar advantages of vaccination.
   " III. The College of Physicians, in reporting their ob-
 servations and opinions on the  evidence adduced in support
 of vaccination, feel themselves authorised  to state that a
 body of evidence so large, so temperate, and so consistent,
 was perhaps never before collected upon any medical ques-
 tion.  A discovery so novel, and to which there was nothing
 analogous known in nature,  though resting on the experi-
 mental observations of the  inventor, was at first received
 with diffidence: it was not, however, difficult for others to
repeat his experiments, by which the truth of his observa-
tions was confirmed, and the doubts of the cautious were
 gradually dispelled by extensive experience.  At the com-
mencement of the practice, almost all that were vaccinated 
253
 were afterwards submitted to the inoculation of the small-
 pox; many underwent this operation a second, and even a
 third time, and the uniform success of these trials quickly
 bred confidence in the new discovery. But the  evidence of
 the security derived from vaccination against the small-pox
 does not rest alone upon those who afterwards underwent
 variolous inoculation, although amounting to many thou-
 sands; for it appears, from numerous observations commu-
 nicated to the College, that those who have been vaccinated
 are equally secure against the contagion of epidemic small-
 pox. Towns indeed, and districts of the  country, in which
 vaccination had been general, have afterwards had the small-
 pox prevalent on all sides  of them without suffering from
 the contagion. There are also in the evidence a few exam-
 ples of epidemic small-pox having been subdued by a ge-
 neral vaccination.  It will not, therefore, appear extraordi-
 nary, that many who have communicated their observations
 should state, that though at first they thought unfavourably
 of the practice, experience had now removed all their
 doubts.
  " From the whole of the above considerations, the College
 of Physicians feel it  their  duty strongly to recommend the
 practice  of vaccination. They have been led to this conclu-
 sion by no pre-conceived opinion, but by the most unbiassed
judgment, formed from an irresistible weight  of evidence
 which has been laid  before them. For when the number,
 the respectability,  the disinterestedness, and the extensive
 experience of its advocates, is "compared with the feeble
 and imperfect testimonies of its few opposers; and when it
 is considered that many, who were once adverse to vacci-
 nation, have been convinced by further trials, and are now
 to be ranked among its warmest supporters, the  truth seems
 to be established as firmly as the nature of such a question
 admits; so that the College of Physicians conceive that the
 public may reasonably look forward with some degree of 
254
 hope to the time when all opposition  shall cease, and the
 general concurrence of mankind shall at length be able to
 put an end to the ravages at least, if not to the existence, of
 the small-pox."

 Extract from the " Report ofi the Committee of the King
   and Queen's  College ofi Physicians,  in  Ireland" made
   November 11th, 1806,  and adopted by the College.
   " It is the opinion of your Committee, that the practice
 of Cow-pox inoculation is safe, and that it fully answers all
 the purposes that have been intended by its introduction.
 At the same time,  your Committee is willing to  allow that
 doubtful cases have been reported to  them as having oc-
 curred, of persons suffering from small-pox, who had been
 previously vaccinated. Upon minute investigation, however,
 it has been found that these supposed instances originated
 generally  in error,  misrepresentation, or the  difficulty of
 discriminating between small-pox and other eruptions, no
 casehavingcometo the knowledge of your Committee, duly
 authenticated  by respectable  and competent judges, of
 genuine small-pox succeeding the regular vaccine disease."

 Extract firom the Report ofi the Royal College  ofi Surgeons
          ofi Eainburgh, dated March 3, 1807.
   " The Members of the Royal College of Surgeons have
 much pleasure in reporting, That, as far as their experience
 goes, they have no doubt of the permanent security agvainst
jhe small-pox which is produced by the constitutional af-
 fection of the cow-pox; and that  such  has  hitherto been
 their  success in vaccination, as  also to gain for it the con-
 fidence of the public, insomuch that they have  not been re-
 quired, for some years  past, to inoculate any person with
 small-pox who has  not previously undergone the inocu-
 lation with the cow-pox." 
                         255
Extractfirom the Report ofi the Committee ofi the Royal Col-
  lege ofi Surgeons in Ireland, adopted by the  College, Fe-
   bruary 4, 1807.
  " That it appears to this Committee, That from the 25th
day of March 1800, to the 25th of November 1806, 11,504
persons  have been inoculated with vaccine infection at the
dispensary for infant poor, and 2,831 at the cow-pox insti-
tution, making a total of 14,335, exclusive of  the number
inoculated at hospitals and other places, where no registry
is made and preserved.
  " That it is the opinion of this Committee, That the cow-
pox has been found to be a mild disease, and rarely attend-
ed with danger, or any alarming symptom, and  that the few
cases of small-pox which have occurred in this country, after
supposed vaccination,  have  been  satisfactorily proved to
have arisen from  accidental  circumstances, and cannot be
attributed to the want of efficacy in the  genuine vaccine
infection as a preventive of small-pox."

         Extract from Dr. Ring on Vaccination.
  " Four hundred and twenty-nine thousand, eight hundred
and twenty-one,  had  been successfully vaccinated in the
Presidency of Madras, and its dependencies, between the
beginning of September, 1802, and the end of May, 1805,
at the expense of 55,865 star-pagodas; and two  thousand,
eight hundred and sixteen of them had been subsequently
inoculated for the small-pox, which they all resisted."

  The reader will find the foregoing reports, with sundry
documents at length, in the 4th volume of  Coxe's Medical
Museum. And  in other parts of the same work,  he will
find many satisfactory proofs of the safety and efficacy of
this disease.
                         Philadelphia, April 12, 1803.
  We the Subscribers, Physicians of Philadelphia, having 
256
carefully considered the nature and effects of the newly-
discovered means of preventing, by Vaccination, the fatal
consequences of the Small-Pox, think it a duty thus pub-
licly to declare our opinion, that inoculation for the Kine
or Cow-Pock is  a  certain  preventive of  the  Small-Pox;
that it is attended with no danger, may be practised at all
ages and seasons of the year, and we do therefore recom-
mend it to general use.
John Redman,     Jno. Porter,
W. Shippen,       Felix Pascalis,
A. Kuhn,          James Stewart,
Samuel Duffield,   James Dunlap,
                  James  Proudfit,
Benj. Rush,
Thomas Parke,
Benj. Say,
Philip S. Physick,
C. Wistar, jun.
Saml. P. Griffitts,
John R. Coxe,
J as. Woodhouse,
Saml. F. Conover,
Wm. J. Jacobs,
John C. Otto,
Isaac Cathrall,
J. Reynolds,
John Keemle,
Thos. T. Hewson, J. Church,
James Gallaher,   J. C. Rousseau,
Charles Caldwell, Arthur Blayney,
Thos. C. James,   Rene La Roche,
Wm. P. Dewees,  Monges,
Benj. S. Barton,   Elijah Griffiths,
Isaac Sermon,
George Pfeiffer,
PI. F. Glentworth,  Jos. P. Minnick,
E. Perkins,        Wm. Barnwell,
Wm. Currie,
M. Leib,

N. Chapman,
John S. Dorsey,
Wm. Shaw,
William Budd,
Geo. F. Alberti,
Joseph Pfeiffer,
Joseph Strong,
Edward Cutbush.
Adam Seybert,
James Mease,
      Philadelphia, May 26, 1806.
Peter Miller,     Isaac Cleaver,
Jos. Parrish,      S. Bleight.
      OF CRAMP IN THE STOMACH, &c.
  Cramp in the stomach is generally produced by flatu-
lency, and often precedes or  attends a fit of the gout.
When it is the effect of  indigestion, it  may  be  relieved 
                         257
by  a small tea  spoonful of sal volatile,  No.  13, in a
glass of mint water, and its recurrence prevented by the
use of the  stomachic  mixture,  No. 61;  but if the patient
be  of  a gouty  habit,  a tea  spoonful of ether,  No. 14,
in a little cold brandy and water, with the use of the gout
mixture as directed No. 69, will answer best. The Jamaica
ginger powder has  been found to succeed in  such cases,
by several  eminent practitioners, better than any other sti-
mulus.  (See Gout znd Indigestion.)  When  the spasm  is
very violent, a  full dose  of laudanum with ether, will be
necessary.  (See No. 31 and 14.)
  Cramp in  the lower extremities is a very common at-
tendant on the latter  stage  of pregnancy in consequence
of the pressure of the  enlarged womb on the great nerves
leading to  them, and  particularly the head of  the child
during labour, when it cannot be effectually removed.  It
may, however,  in  either case by relieved by  pressure,
often by change of position,  by rubbing the  part with
dry flannel or a  flesh-brush; or in obstinate cases, by the
application of ether and laudanum over the part affected.
When it occurs during  pregnancy,  the internal use  of
laudanum and ether, as directed No.  31  and  14, will also
be  proper.   Cramp, whatever  cause  it  may  arise from,
may sometimes be speedily relieved, by putting the oppo-
site muscles into action.  Thus,  when any of the muscles
of the  calf of the leg are affected, by putting  those on the
front into action by drawing up the foot,  the cramp will
often instantly go off. See Spasms.
  For the cramp in the extremities, a  variety of whimsical
remedies are in  great  repute,  which being in themselves
perfectly inefficacious, must depend on the imagination for
their success. Some of them  are calculated to  r.ffect the
mind with  surprise or horror,  as the cracking of a roll  of
                         2  M 
                         258
brimstone held in a  warm hand,  the wearing  of rings
formed  out  of the  nails or furniture of old coffins, md
suchlike fanciful  conceits;  such remedies have  certainly
a wonderful effect on all spasmodic diseases with the un-
iniormed part of  the community.

                    OF CROUP.*

   This disease, which is  principally incident to  children,
rarely  occurs till  after weaning.  It  is said to be most
prevalent in  low marshy countries, or on  the  sea coast,
and in wet and cold seasons.  It seems peculiar to some
families and  one  attack favours a  return on the slightest
exposure to cold.

               Of the Symptoms of Croup.
   It generally commences with an obtuse pain about the
upper part of the wind-pipe,  which is increased on being
pressed. The respiration is difficult, attended with  wheez-
ing and a peculiar ringing or stridulous  cough, resem-
bling much  the  crowing of a young cock,  and a trifling
 expectoration  of a mucous matter.  The  face is some-
what  livid  and  often  much  flushed,  and  the  swallow-
 ing little affected; there is also some  degree of  frequency
 and hardness of the pulse, great  thirst, restlessness, and
 feverish heat.  The urine,  on the first attack, is generally
 high  coloured,  but sometimes limpid, and  in the ad-
 vanced stage, turbid.  The  wheezing  and difficulty  of
 breathing are  increased by a kind of preternatural mem-
 brane or layer of yellowish pulpy  matter on the inside  of
 the wind-pipe, becoming separated and stopping up  the

    * This disease was, by some unaccountable mistake, omitted
 in the last edition. 
259
passage; from this circumstance it is  in its progress sub-
ject to  sudden and  considerable  aggravations, in one of
which it often proves fatal. The hands and feet are some-
times swollen.

                Of the Causes of Croup.

   It is occasioned  by the application of cojd combined
with a moist atmosphere,  particularly in the  spring and
winter seasons. The immediate  causes  of the sufferings
of the  patient  consists in an  inflammation of the inner
coat of the wind-pipe, covered with a layer of yellowish
pulpy  matter,  which  Dr. Baillie has  in  some  instances
found to extend from  the  upper part of the cavity of the
larynx to the small branches of the  wind-pipe, distributed
through the substance of the lungs.  There  is  likewise
found on dissection, a good deal of mucus in the wind-
pipe and its branches, together with a mixture of matter.

              Ofi the treatment ofi Croup.

   From the situation, shortness, and suddenness of this
disease, immediate and active remedies are requisite, the
chief of which are  bleeding and blistering.  On the first
attack of the disease,  six leeches .should be applied over
the wind-pipe,  and a blister  to the  nape of the  neck and
over the wind-pipe as soon as the bleeding from the ori-
fices, made by the leeches, will admit of it.. If  the pulse
be strong, or the feverish symptoms run high, the loss of
blood from the arm  will also be necessary; a dose of eme-
tic tartar, No.  35, or the tartarised antimony wine, No.
16, should also be exhibited  without delay;  and if  it
should  not  operate  on the bowels, a dose of the  basilic
powder, No. 36, or jalap and calomel, No. 27, should be
given an hour after  its operation. The child may likewise 
260
breathe the vapours of warm water and vinegar. If the
skin should continue dry and hot,  five drops of the  anti-
monial wine may be given every three or four hours with
the saline mixture,  No. 78; and in case these should fail
of producing perspiration, the warm bath may be employed
with advantage.  The tincture of fox-glove, in the dose of
six or  eight drops  twice or thrice  a day,  has,  in some
instances, been found very beneficial.  The discharge of
the blisters should be kept up by  dressing them with the
weak mercurial  ointment.  This application, after the re-
moval of the dead skin of the blister, has in so many instances
produced such immediate relief, that I have been disposed
to attribute the recovery of the children principally to it.
   The  child  may be"" supported with fresh  milk, mixed
with linseed-tea, of which from thirst it will drink a  suffi-
cient quantity for that  purpose, so as to require  nothing
else.  After the  termination of the disease,  the  decoction
of bark with liquorice will  be necessary to prevent a re-
lapse. Change of situation  to a more  light and  dry air
will also be advisable.
   This disease sometimes  attacks adults, when  the same
remedies to a greater extent are necessary.

                 Dictinction ofi Croup.
   The  croup may be distinguished from inflammation
of the  throat by the particular shrill ringing sound of the
voice,  and the breathing being attended with  a  wheezing
noise, at the'same time swallowing is in general perfectly
free.
   Two species of croup has been noticed by some authors,
the one  depending  on  inflammation of the inner coat of
the wind-pipe, termed inflammatory croup, which is the
one I have described; the  other  from  spasms,  unattend-
ed with inflammation, termed spasmodic croup; the lat- 
261
ter species comes on in the night-time.  It often intermits,
and in the intervals both the respiration and cough, if any
exist, arfc free from the characteristic sound of the inflam-
matory croup.  If this disease be attended to early, medi-
cines will have a very salutary effect; but if it be suffered
to continue long, it will prove very obstinate of cure,  if
not incurable. The best remedies are emetics of ipecacuan
powder,  frequently repeated, and the anti-spasmodic  me-
dicines,  recommended for asthma, which must be  perse-
vered in till the croaking noise has entirely left the patient.
See Asthma.

  CUTANEOUS FOULNESS.  See  Eruptions of the
                         Skin.

                      OF CUTS.

   The sides of an incised wound, termed a cut, should be
brought  in contact with strips of diachylon  plaster,  No.
58, spread on leather or  court plaster, No. 56, and kept in
that situation by means  of a bandage. If inflammation
come on, the use of the lotion, No.  102, and  aperient
mixture,  No. 62, will be proper.  The traumatic balsam
(commonly called Friar's balsam) is a  very common but
improper application for fresh cuts.  The hot  resinous
■gums of which it is composed being separated on mixing
with blood, prevent the union of the edges of the wound,
and thus occasion ulceration.  It  should therefore never
be  employed, however trifling the  accident, as by  its sti-
mulating quality it  may be  productive of considerable
mischief, particularly in an irritable habit.
   In all cases of deep  wounds, or when  attended with
contusion or much loss of blood, it will always be advisa-
ble to  apply to an experienced surgeon. 
262
                  OF DEAFNESS.

  When deafness is occasioned by  an accumulation or
hardness of the wax, which is frequently the case, the ears
should be  syringed  every morning with  warm soap and
water till it be removed, and a little  wool or cotton worn
in them, moistened with two or three drops of camphora-
ted oil of almonds. When   it arises from decay  of the
nerve, electric sparks, and a blister behind the ear, and the
use of sneezing-powder, are the most powerful remedies.
When ulceration is the cause, which is known by a dis-
charge of matter, the  ulcer  should be  healed  as soon as
possible, by syringing the ear every morning and evening,
with the following lotion, made a little warm:
  Take of tincture of myrrh, one drachm,
       Egyptian honey, two drachms,
       Pure water, eight ounces.  Mix.
  This diseased state of the  ear, in which the  tympanum
is often more or less  destroyed, frequently follows the
yellow fever, and is  generally very difficult to cure, the
surrounding bone of the skull being  commonly diseased.
  If it arise from obstructions in the Eustachian tube, pre-
venting the passage of air into the  internal ear, the  tube
should  be  syringed  with warm  soap and water.  When
the cavity of this tube is  obliterated by disease, which is
not an unfrequent  cause of deafness,  Mr. Astley Cooper
has ingeniously  proposed to  admit   air into the internal
cavity,  by  puncturing the membrana tympani,  which he
has practised very successfully.  This  operation is very
simple, and attended with no pain.
  A temporary deafness is often produced by slight cold,
particularly in  children, which  frequently goes  away in 
263
a day or two after the use of a little aperient and sudorific
medicine, and avoiding  the occasional cause.
  Deafness is frequently the consequence  of a  deficiency
of the secretion  of wax, when a liniment  that will  at the
same time soften and gently stimulate the  part,  will afford
considerable  relief, if not entirely remove  the cause, such
as the following:
  Take of oil of turpentine, two drachms,
       Oil of almonds,  six drachms.  Mix.
two or three  drops to be instilled into the ear,  or applied
by means of lamb wool.
  Although deafness arises from so many  different causes,
empirics are bold enough to recommend their nostrums as
a remedy for every species, which, if good for  one, must
necessarily be injurious to another. They should consider
the  ear  is a tender organ, which requires very delicate ma-
nagement; and that by  the imprudent employment of their
medicines, in a case  requiring a different  treatment, this
important sense may  be entirely destroyed.

                   OF  DIABETES.

  This disease  consists in a considerable increase of urine,
equal, and sometimes exceeding the proportion that should
arise from the quantity of aliment and fluid  taken by the
patient.*

  * The urine evacuated having in many  instances consider-
ably exceeded the quantity of food and liquids  taken by the
patient,  has induced some  practitioners to suppose that the
state of the skin  is changed  from a perspiring to an imbibing
condition. It is, I think,  much  more probable that the water
is formed in the system by the union of inflammable and vital
gas (the constituent parts of water), particularly as people 
264
              Ofi the Symptoms ofi Diabetes.
  The first symptom of this disease is, the increased dis-
charge of urine without  the  appearance of any morbid
affection of the rest of the system, which soon acquires a
sweetish taste, and when subjected  to experiment, a quan-
tity of sugary matter is found, sometimes in the proportion
of one-eighth, which is its leading characteristic, and like-
wise  emits an odour approaching to that of violets. In a
short time the stomach becomes affected, and great thirst
and voraciousness  and keenness of appetite prevail, often
so  great as scarcely to be satisfied;  with these there  is
generally present a slight  degree of fever,  and as the dis-
ease  advances, the emaciation and debility of the body
gradually increase, and all the appearances of hectic fever
are found.

                Of the Causes of Diabetes.
   The  Causes of this disease are very  obscure.  It has
 been  observed that those people  who  indulge  in fruit,
 sweetmeats, high-seasoned dishes, wine, or fermented li-
 quors*  are most subject to it. Moisture, grief, vexation

 afflicted with diabetes are also much troubled with inflammable
 gas.  This generation of water, I believe, often takes place in
 the lungs, and is the cause of dropsy  of the lungs, asthma, and
 difficulty of breathing.
    * Dr. Trotter observes, that the majority of persons he has
 known  afflicted with this disease were lovers of the bottle.  « I
 suspect (says this author), that many  drunkards have this com-
 plaint without taking  notice of it,  and that it comes and goes
 without creating alarm, just as they  happen to live regular or
 otherwise." 
                         265
or agitation of mind,  sudden variations  of temperature,
are noticed by some authors as predisposing causes. Others
have attributed it  to an increased action  of the  stomach,
and  the  consequent vitiated  state  of  its  secretion,  the
direct effects of which they suppose to be  the formation
of saccharine matter with a certain defect of assimilation,
preventing the  healthy  combinations,  and exciting  the
immediate separation of  the  imperfectly formed chyle by
the kidneys. But as the  stomach is seldom deranged till
the morbidly increased secretion of urine has existed some
time, it  is more probable that  its  affection is  more  the
effect than the cause of the disease;  besides, if an  increased
power of the digestive organs were the cause, one would
expect, as the  system became debilitated, the discharge of
urine would be diminished, but so far from this being the
case, this secretion in general increases with the debility
of the body. The disease, more probably,  depends, in a
considerable degree (as Dr. Baillie thinks)  on a  deranged
action of the secreting vessels of the kidneys, by which
the blood is disposed to new  combinations, the effect of
which  is the production of the saccharine  matter.  The
learned doctor is further of opinion, that the chyle may at
the same time be  so imperfectly formed  as to render the
blood more readily changable into a saccharine matter. The
kidneys  on dissection are generally found  preternaturally
enlarged and flaccid.

             Ofi the Treatment ofi Diabetes.
  From  the urine abounding with  vegetable matter,  Dr.
Rollo has ingeniously  proposed to  cure this disease,  by
an entire abstinence from vegetable food, and supports
his opinion by many well-attested facts. This  plan, how-
ever,  has not  so well  succeeded in the  practice oi  Dr.
Lubbock, of  Norwich,  who  found,  notwithstanding  a
                       2 N 
266
 strict adherence  to  animal  food,  that  no alteration was
 produced in the quantitv or qu.litv of the urine.
   Dr. Gilby, physician to the general hospital, near Bir-
 mingham, relates several cases in the Medical and Physical
 Journal,  of persons cured by the nitric acid, in the follow-
 ing proportion:
   Take of nitric acid, a drachm and a half,
       Barley water, half a  pint,
       Simple syrup, two ounces.  Mix.
 Four large  table spoonfuls,  to  be taken with the  same
 quantity  of  water, three times a day. Mr. Chavasse, sur-
 geon, in  Walsal, has found this medicine to answer in one
 bad state of the disease.
   Dr. Dobson, of Liverpool, who has paid much  attention
 to the  complaint, recommends  the  use of strengthening
 medicines, as the bark;  and Dr.  Schutz,  much extols
 lime water as a remedy.
   The hepatised ammonia, with  an abstinence from ve-
 getable food, has also in many instances been  successfully
 exhibited in this disease.  The  small dose, of five  drops,
 should be begun with three  or four times a day, in a little
 water, which may be gradually increased every day till it
 produces some degree  of nausea, or slight giddiness. This
 medicine  should always be dropt at the time of taking,
 as by being  mixed  up in draughts, or any other form, it
 soon undergoes a decomposition.  A  draught composed
 of fifteen drops of laudanum,  twenty-five drops of anti-
 monial wine, and a little mint water, is also recommended
 to be taken  every  night, and costiveness  prevented by
the occasional use of  flowers of sulphur, No. 55, castor
 oil, No.  3,  or  the cathartic extract,  No.  46. This plan
is  directed to be pursued  till the morbid condition of the
stomach is removed, the marks of which are, a diminished
and high-coloured turbid state of the urine, accompanied 
267
 with a loss of appetite and loathing of food.  At this time
 the tongue and gums lose their florid red  colour and be-
 come pale: when this state occurs, exercise is to be con-
joined and a gradual  return to the use  of  bread  is to be
 allowed, and  vegetables, such as brocoli, spinage, peas,
 cauliflowers, cabbage, lettuce, and parsnips,  in moderate
 quantities. The drink should consist of such  liquors as
 afford the least saccharine matter, as weak  brandy or rum
 and  water.
   Dr. Ferrear has succeeded in three cases, by giving the
 yellow Peruvian bark, with the uva ursi and opium, in the
 following proportion:
   Take of yellow bark, in powder,
       Uva ursi, in powder, of each one scruple;
       Opium, dried  and powdered, half a  grain. Mix.
 To be taken four times a day, in  a glass of lime water.
   Lime water, is  likewise recommended by this esteemed
author, for the common beverage.
   Dr.  Willan, in his  work  on the Diseases of London,
remarks, that although the  disease may be relieved, and
the saccharine quality of the urine removed, by the above
treatment, he never yet met with  a confirmed case wherein
the constitution was not  considerably disordered,  or some
organ essential to life, defective.
   Mr. Surr,  a very ingenious surgeon in London, recom-
mends a drachm of bark  to be taken every two hours for
a week.
   The ratania root  I have found  to succeed much better
than the Peruvian bark,  and I believe is the most power-
ful medicine  we are yet acquainted with. This root is the
produce of Peru, and has  been principally used by the wine
merchants of Spain for the purpose of heightening the colour
of wine, and giving it a pleasant degree  of  astringency.
From  the  many  trials I have made  with it, I am per-
suaded that  it is a very valuable  strengthening medicine, 
268
and superior in many respects to the Peruvian bark. The
extract is the best preparation, which may be given in the
following manner:
  Take of the extract of ratania root, two drachms;
       Ipecacuan powder, ten grains;
       Liquid laudanum, fifteen drops;
  Peppermint water, half a pint; Mix.
Of which a small wine glassful  is to be taken every four
or five hours.
  During the use of this medicine, the warm bath once
or twice a week for three or four  minutes, and  a flannel
waistcoat next the skin, will be proper.  The diet should
principally consist of animal  food, and  the common be-
verage of three parts of distilled water  and one of alum
whey. *
  The microscopic  salt I have also found serviceable, and
is certainly well worth  a trial.
  An increased secretion of urine is a frequent attendant on
the hysteric  affection and gout, when it  is free from sac-
charine  matter, and being a symptomatic affection, will of
course cease with the primary disease.

       OF DIARRHOEA, OR LOOSENESS.

                    Symptoms, &?c.
  This disease consists in  too frequent  and copious eva-
cuations of  liquid stools from  preternatural  irritation  of
the intestines, occasioned by acidity or perhaps putrescency
of aliment,  the  undue use of  purgative  medicines, ob-
structed perspiration, and a translation of  morbific matter

  * This whey is made by boiling a drachm of alum in a pint
of milk. 
269
to the  bowels. When the stools appear white like cream,
the ditea e  is called cceliac passion; and  when  the  food
comes  away almost  in  an unaltered  state, it is called
lientery;  but these distinctions have no reference  to prac-
tice.

       Ofi the Treatment ofi Diarrhaa, or Looseness.

   When the patient's strength is but little affected by the
discharge, it may generally be considered as salutary, and
by avoiding much vegetable food, and taking broth, thick-
ened with arrow root or rice, it will gradually cease.
   When,  from its  debilitating effects, it  is judged neces-
sary to  check the disease, the cure should be  begun by a
gentle emetic of ipecacuan powdei, No. 23; and afterwards
fifteen grains of rhubarb powder,  No. 26, in a little cin-
namon  water,  No.  33, to remove  the  irritating matter
lodged  in the stomach and  intestines. The cure  may  be
then   completed by  the use of the cretaceous  mixture,
No. 66, and the occasional  use of the  clyster,  No.  96.
 If the skin be dry, three grains of ipecacuan powder, No.
23, with five drops  of laudanum, No. 31, should be taken
at bed-time, in a little cinnamon water, No. 33. After the
 complaint is checked, the tone of the stomach and  intes-
 tines  may be  restored, by  taking the  decoction of the
 Iceland  liverwort, as directed, page  151, or a tea spoonful
 of the tincture of Augustura bark, three times a day, in a
 little water.
    The  animal  and vegetable jellies, recommended  under
 the head of Arrow  Root, page 85, will afford the best diet.
 Port  wine, so  frequently given for these affections,  by
 turning sour, is often very hurtful.  People subject to this
 complaint,  will receive  great benefit by wearing flannel
 next the skin.
    Such as indulge  in the too free use of the bottle are very-
 liable to purgings, probably  from  a diseased  state   of 
270
 the inner coat of the intestines, and consequently vitiated
 secretions; in such cases, after the operation of  an emetic
 of ipecacuan powder, and argentle dose of rhubarb powder,
 the patient  will receive benefit from the following medi-
 cines:
   Take of alkalized  mercury, half a drachm;
        Opiate confection, one drachm ;
   Mix, and divide into eighteen pills, of which three should
 be taken every  night, and  two dessert spoonfuls of the
 tincture of  the ratania root, or Columbo root, three times
 a day,  in a tea cupful of the decoction of the Lichen Is-
 landicus, (see page 151,) to which, in cases of  acidity in
 the stomach, ten grains of the compound cretaceous powder
 may be added.
   The  salutary effects of  these  medicines  will be  very
 transitory, unless the  patient avoids the occasional cause,
 and observes a regular  mode  of living.

        For the Purging of Children, see Page 125.

             Of the Distinction ofi Diarrhoea.

   This disease is distinguished from  Dvsentery by the
 absence of fever on its first attack, by the discharge of real
 faeces, which in Dysentery is rare, and only in a  particular
 hardened form, and the want of that fceior in the discharge
 which attends  Dysentery, and  marks  it as  a contagious
 malady; but in the progress of the  disease, Dysentery and
 Diarrhoea often become much allied.

                    OF  DROPSY.

                Description,  Causes, csfc.

   This disease consists in a preternatural collection of the
serous or watery portion of the blood, in different parts of
the body, through weakness, in consequence  of excessive 
271
drinking, poor diet,  loss of blood,  &c. which, by relax-
ing the exhalent vessels,  an increased quantity of serum
escapes, and, at the same time, by  diminishing the  action
of the  absorbents,  an accumulation  is rapidly produced.
It may likewise be occasioned by  whatever increases the
effusion from the exhalent vessels, or diminishes the action
of the  absorbents.  Local dropsy is frequently produced
by enlargements and  indurations  in the body, mechanically
interrupting the free  return of blood to the heart; thus an
impregnated womb,  by compressing the  large veins that
convey the blood from the lower extremities,  often occa-
sions dropsical swellings of  the  legs. Induration  and en-
largement of the liver,* in the same  manner, will  produce
dropsy of the belly; and  a polypus  in the  right ventricle,
or ossification of the  valves of  the heart,  an  effusion of
serum, or watery fluid in the chest.
  Dropsy  is  distinguished  according  to  its situation:
When  it occupies the  cellular  membrane, immediately
under the skin, it is termed  Anasarca; when in the  cavity
of the  belly,  Ascites; and  in the  chest,  Hydrothorax;
but the  whole of such collections  fall under  the general
denomination of Dropsy ; and when produced by debility
require the  same method of treatment.  The symptoms
of Anasarca are an uniformly pale,  and often shining dis-
tention of the skin, generally of the legs, at first soft, and
readily receiving the pressure of the finger. The swelling,
by an horizontal position, is much  diminished, and  the
face becomes a little swelled. It gradually extends itself up-
wards, till it occupies the thighs and trunk of the body, and

  * This diseased state of the liver  is commonly produced by
the  abuse of spirituous  and vinous liquors.  Dropsy  thus inr
duced is commonly the harbinger of death- 
272
sometimes even the head, attended with scarcity of urine,
which is always high coloured. When it occupies the belly,
the enlargement begins at the  bottom, and gradually in-
creases upwards, attended with a sense of weight, and an
evident fluctuation of a fluid, on a sudden motion of  the
body.  As it  increases,  the breathing becomes difficult,
and the legs affected  with dropsical swellings. When  the
cavity of the chest is the seat of the disease, there is always,
more or less, a sense of anxiety about the heart, or lower
part of the breast-bone, a difficulty of breathing, which is
increased  by lying down,  a dry cough, palpitation of  the
heart, paleness of the face,  and when far advanced,  the
legs  become affected  with dropsical  swellings; a fluctua-
tion of water is likewise perceived by the patient  on  any
sudden motion of the body.

              Ofi the Treatment of Dropsy.

  The evacuation of  the collected water,  and restoration
of the tone of the system, are  the only objects to accom-
plish in the cure of this disease, when the cause is  merely
weakness.  The first should  always  be attempted  by  in-
ternal  medicines,  in preference to surgical operations or
blisters. For this purpose the  bowels should be emptied
by a full dose of the  basilic powder, No. 36, and  the  fol-
lowing day the diuretic pills for dropsy, No. 80, with  a
wine glassful of the tonic mixture,  No. 77,  three  or four
times a day. The basilic powder should be  repeated oc-
casionally, or if the water be seated in the chest or belly,
the following may prove more  efficacious.
  Take of powder of foxglove, one or two grains;
       Prepared calomel, two grains;
       Aromatic spices, five grains ;
To be  taken two or three times a week, in a little of the
Batavian spirit of juniper. A table spoonful of steel wine 
273
 will likewise prove a very useful addition to each dose of
 the tonic mixture, in all cases of dropsy.
   The emetic powder, No. 88, may also be given two or
 three times a week, if the strength of the patient will allow
 of it.  The operation of  an emetic not  only increases  the
 action of the absorbent vessels, but is a powerful remedy in
 the  removal of visceral  obstructions.  A speedy absorp-
 tion of the water  of dropsical swellings is often produced
 by spontaneous vomiting.
   In case the legs are affected, they should be well rubbed
 with a flesh brush, or camphorated oil, and  supported by
 a  flannel  roller;  electric  sparks, by stimulating  the  ab-
 sorbent  vessels,  have also proved  beneficial.  The diet
 should be  chiefly  animal food,  and the  common drink the
 Batavian spirit of juniper, or  brandy (diluted) and port
 wine.
   If the collection of watery fluid be not evidently dimi-
 nished, after due perseverance in these means, if  situated
 in the cavity of the belly, it should be  drawn off by  an
 expert surgeon; and if in the  extremities, by blisters  or
 scarifications,* at the same time continuing the use of the
 tonic mixture.
   From the supposition that the condition of the  skin of
 a dropsical patient is changed from a perspiring to an im-
 bibing state,  it has been proposed to  besmear the surface
of the  body with oil.  The  quantity of water in  the
belly, accumulated in the intervals of tapping, vhich has
been found considerably to exceed in weight the quantity
of food and liquid taken  in the  time  by the patient, may,
however, be formed in the system by the  union of the in-

  * These means should not be resorted to without the sanc-
tion of an experienced practitioner.
                         2  O 
                         274
flammable and  vital airs, the former of which dropsical
patients are much  troubled  with, and  which  evidently
enters the blood vessels, by its passing off in considerable
quantity by the lungs.  See Flatulency.
  The causes of dropsy  are more numerous than those ot
any other complaint, and it is more frequently the conse-
quence  of some  other disease  than  a primary affection.
It is likewise  often influenced by such a variety of unto-
ward circumstances, that it  is  impossible to  lay  down
general rules for its treatment.
   The  diet should be nutritious, and  consist chiefly of
animal food,  either roasted, or stewed down into soup or
rich broth, and the beverage  good port wine, or the Hoi-
land spirit of juniper (commonly called gin),  diluted with
water, or with  the imperial drink noticed under the head
of cream  of  tartar, page 57, which will also promote the
operation of the medicines by increasing the secretion of
urine.  The  common practice of confining  dropsical pa-
 tients to a  limited use of  liquids has  never, I believe,
 been attended  with  any advantage.  Dr. Cullen observes,
 that he  has  seen it  carried to great length without any
 manifest benefit to the patient, while on the  contrary (ob-
 serves this esteemed author,)  the practice of giving drink
 very largely, has been found not only safe, but very often
 effectual in curing the disease.
    The ingenious  and  learned  Dr. Millman recommends
 large quantities of watery liquids for the cure of  dropsy.
 Not only from the instances  he mentions  from his own
  practice, and from that of several  eminent physicians in
  other parts  of Europe, but also in many instances in the
  records  of physic, of  the good effects of drinking  large
  quantities of mineral waters in the cure of dropsy.  I can
  have no doubt of the  nractice being very often extremely
  beneficial, by promoting  the  operation of diuretic medi-
ernes. 
275
   Exercise  is often highly  useful in dropsy; any mode
mav be employed that the patient  can most  conveniently
take, such as walking, riding  either on  a horse or in a
carriage, or swinging.  It should  always be as much as
he  can easily bear.  By exercise alone,  I am persuaded,
employed early in the disease, Anasarca, or dropsy of the
lower extremities, may often be cured.
   Dropsical  swellings of the legs,  attendant  on preg-
nancy, may be  relieved by flannel rollers,  friction,  and
keeping the  legs supported on a sofa or stool, and avoid-
ing costiveness, by taking a gentle dose of rhubarb powder
occasionally.


                 OF DYSENTERY.

   This disease generally occurs in summer and autumn,
about the time autumnal intermittent and remittent fevers
appear, with which it  is often complicated. When  at-
tended  with  discharges of blood, it  is vulgarly  called
bloody flux.  ,

             Of the Symptoms of Dysentery.

   Frequent evacuations of  slime or mucus  from  the  in-
testines, often mixed with blood, and when attended with
the natural  faeces,  they  are generally in a  compact  and
hardened form;  the motions  frequently small,  accom-
panied with  very severe griping, and followed by a bear-
ing down and irritation at the anus. With these symptoms
there are  a  loss of appetite, sickness, and vomiting,  and
the patient sooner or later is affected  with a fever,  some-
times, inflammatory, and very  often  of a  putrid kind.
This disease is more frequent in warm than  in cooler cli-
mates, and, from its infectious nature, is often  epidemic,
in camps and other places. 
276
                Ofi the Causes Dysentery.

  Putrid air and aliment; fruit,  and the too  frequent use
of fermented liquors; the action of  strong cathartic medi-
cines, and whatever increases the natural irritability of the
intestines, as  obstructed  perspiration, are the  causes of
this disease.
  From the dissection of patients, who  have died of this
disease, the coat of the colon and rectum have been found
affected with   inflammation  and its consequences,  viz.
ulceration, gangrene, contractions, and thickening.

            Of the  Treatment ofi Dysentery.
  In  the cure of dysentery, the first object is the evacua-
tion of  the irritating matter in the stomach and  intestines,
by the emetic  powder, No.  88, and  Epsom salt,  No. 2, or
the aperient mixture, No.  62,  after their operation, in
order to allay the increased irritability of the intestines, and
to produce  a  determination of perspirable matter to  the
skin,  two grains of ipecacuan powder, No. 23, with ten
drops of  laudanum,  No.  31, may  be  given  every three
hours. The starch lavement, administered twice or thrice
a day,  will  also prove serviceable,  by sheathing the inner
surface  of the large intestine, and also  as  a  fomentation.
When the pulse  is  full,  hard, and strong; or  when ap-
proaching inflammation  of the intestines is suspected;
the loss of blood from the arm  may  be  necessary;  but
otherwise it will prove  detrimental.* If the  pain in  the

  * At a certain period of this disease** which can only be de-
termined by  a skilful practitioner, blood letting is often a very
important remedy, but after the inflammatory symptoms have
subsided, the loss of blood will not only retard  the recovery,
but endanger the life of the patient. 
277
bowels be violent, the warm bath and a large blister to the
abdomen will be necessary. The  diet should  be chiefly
vegetable jellies, as that of arrow root, sago, tapioca, veal-
broth, &c. &c.
  When the first or violent symptoms are abated, and the
disease advanced to a chronic stage, the following powder,
taken three times a  day in a  teacupful of the decoction
of the  Iceland liverwort, (see page 151,) will  generally
complete of the cure.
  Take of ipecacuan powder,  one grain;
       Rhubarb       ditto, four grains;
       Cinnamon      ditto, four grains. Mix.
If, after three  days  trial of this medicine, the  symptoms
should not considerably abate, eight grains of the compound
cretaceous powder,  and five drops  of laudanum, may be
added to each dose.
  Several astringent and strengthening medicines are re-
commended  at  this period of  the disease by  medical
authors,  such as Simarouba bark, Columbo  root, Casca-
rilla  and Peruvian bark; but I have found none of them
to answer so  well as the Iceland liverwort, which has never
disappointed  my expectations in one instance.  Dr. Ches-
ton,  of Gloucester, has  noticed a  very obstinate case of
dysentery,  which resisted  all  other remedies,  that  was
effectually cured by a decoction of this herb.
  If the disease should continue  obstinate, some visceral
obstruction or  ulceration of the inner coat of the intes-
tines may be  suspected;  in either  case, five grains of the
alkalized mercury, with  five drops of laudanum, in a tea
cupful of the  Iceland liverwort  decoction, twice a day,
will prove very  beneficial.  The patient should avoid the
use of acids and vinous or spirituous liquors.
  Opium should never be employed in this disease unless
a free  evacuation of the bowels  has  been procured by 
278
aperient and emetic  medicines, and the excitement of the
system diminished, as it generally aggravates the inflam-
matory symptoms.
  The treatment of this disease  must, in a great measure,
depend on the nature of the fever accompanying it, and,- in
all cases, must  be varied according to the predominating
symptoms, &c. As the fever in general is of an ambiguous
nature, it will be advisable to call in regular assistance in
the first instance.
  This  disease is sometimes highly infectious, and is. no
doubt often propagated  by the  effluvia arising from the
motions of the patient. They should  therefore not be suf-
fered to remain in the house, but conveyed to some dis-
tance from it immediately after their evacuation if possible,
and the vessel afterwards washed with vinegar. The room
should likewise be often fumigated with nitrous vapour, as
directed page  88, which will not only prevent the disease
from spreading, but tend  considerably towards the reco-
very of the patient.
   After the disease  is cured,  the essential salt  of bark
should be  taken,  (see No. 24,  or Mixture, No. 77,) to
restore the  tone of the stomach and  bowels; and if it be
complicated with intermittent fever, the salt of bark should
be employed in the earlier  stages of  the  disease. Flannel
should likewise be worn next the skin.

            Ofi the Distinction ofi Dysentery.

   This disease may be  distinguished from diarrhoea, not
only by being attended with a greater degree of fever and
pain in the bowels, but particularly by the  motions, con-
sisting  chiefly of a  slimy  mucus,  in  which  the natural
faeces are  seldom observable, and when so, it is in hard
pieces or lumps. 
279
                   OF EPILEPSY.
   From the patient  suddenly falling to the ground on an
attack of this  disease, it is  also called Falling Sickness;
and from its affecting the mind (being the most noble part
of the rational creature),  it was termed by the ancients,
The Sacred Disease.

                  Symptoms of Epilepsy.
   An involuntary and violently convulsive contraction of the
greater part of the  muscles of voluntary motion,  particu-
larly of the extremities of the eyes, the tongue, the lower
jaw,* and the bladder, attended with foaming at the mouth
and a total loss of sensation, and  ending in a  state of in-
sensibility and apparent sleep. When the patient recovers,
he complains of topor, heaviness of the head, and general
lassitude. The fit often attacks suddenly, but for the most
part is preceded  by a pain in the head, lassitude, dimness
of the eyes, and  a kind  of tremulous sensation, beginning
in the lower extremities, often in the great toe, and ascend-
ing to the head.  The fits  frequently recur during  sleep. |

   * A person unacquainted  with the nature of these fits, would
naturally suppose, on seeing the body so convulsed and agitated,
that the person must be in great agony. They are. however, at
the time in a perfectly insensible state, and their sensations on
recovery are often pleasurable, sometimes, however, they are
the reverse, and the horror  of mind some experience has been
indescribable.
   11 was requested to see an epileptic  patient a few months
since, who was always attacked with the disease  on  going  to
bed, and  continued  more  or less convulsed all night. He^ 
280
                Of the Causes ofi Epilepsy.
   The dissection of epileptic persons has shewn a variety
of morbid appearances:  as  indurations in  the brain or
membranes; caries or  preternatural  projections of the in-
ternal  surface of the  skull bone; collections of serum, or
purulent matter, and earthy concretions  within the  skull;
while  others, who have died of epilepsy,  have exhibited
no such appearances.  An aneurism  in the head may, and
I believe is often the cause of this disease, by the pressure
and irritation produced from  distention,  which often ends
in fatal apoplexy or  palsy, from the rupture of the aneu-
rismal sack; a termination by  no means unfrequent. It
is likewise produced  by the irritation of the worms in the
stomach or intestines, particularly the tape worm; denti-
tion, and violent passions of the mind,  both of the exhi-
Iirating or depressing kind;  as, anger, joy,  terror,  and
grief.*
  In children, epileptic fits often precede the  eruption of
small-pox,  measles, and other contagions,  and sometimes
occur  in females subject to a retention  of the menstrual
evacuation; but they  more frequendy proceed  from an
hereditary  disposition  in the  system.  See Convulsions of
Children, page 136.

             Ofi the Treatment ofi Epilepsy.
  A great  variety of remedies  for  this  disease  has been
recommended,  from the time  of Galen  to the present

however, rose every morning at the usual  hour, without the
least knowledge of what had happened, and  apparently re-
freshed for his sleep; nor would he have known that he was
subject to them, had not a young  man who had happened to
sleep with him mentioned it to him.
  * Van Swieten's Commentaries, vol. iii.p. 414. 
281
period, but they have failed of either curing or modifying
the symptoms. The nitrate ofi silver* has lately been much
celebrated as a specific by Dr. Cappe, of York; Dr. Sims,
and Dr, Bostock;  which, unfortunately, has not been con-
firmed by farther experience, Dr. Magennis, and Dr. King-
lake, having published several  cases in which it proved of
no advantage.  In  case it arises from  worms, the basilic
powder, No. 36, or the electuary, No.  86, with the use of
lime water, and tonic mixture, No. 77, will prove sufficient
for the removal of the cause. See  worms.
   When the source  cannot be ascertained, if the patient be
of an apoplectic make, and plethoric habit of body, bleeding
will be proper, but not otherwise,  as the loss of blood, by
inducing debility, will render  the  recurrence of the  fits
more frequent.  Valerian tea, with spirit sal volatile, may
be tried, or the following pills:
   Take of nitrate  of silver, one scruple;
       Extract of white poppies,  two scruples.  Mix well,
         and form into twenty-four pills.
One to be taken twice a day.
   If these pills fail to afford relief in twelve days, (for I
do not conceive it  safe to continue them longer, unless
the patient derives very considerable advantage from them,

   * When this preparation was first recommended as a specific
for this disease,  Dr. Cheston was induced to give  it a trial at
the Gloucester infirmary. The first case that occurred, was a
young man that had been subject to them twice a day for many
years   After the exhibition of two or three doses, the fits sud-
denly left fiim, and  he was  shortly after discharged cured.  He
soon experienced a relapse, for which he was readmitted,  and
the same medicine  administered without evincing any effect
whatever.
                           2P 
282
without producing any derangement of the digestive organs
or bowels.) the following are worth a trial:
  Take of vitriolated zinc, half a drachm:
       Essential salt of bark, one drachm. Mix, and divide
         into twenty pills.
One to  be taken  twice a day, with a draught of valerian
tea.
  The following  bolus is much  recommended by  Dr.
Hugh Smith:
  Take of Russian castor, one scruple;
       Oil of hartshorn, six drops;
       The  confection called Paulina,  ten grains.  Mix,
         for a bolus.
To be taken every six hours.
  The flowers of cardamine, or lady's smock, has  been
prescribed with advantage by Sir George Baker; the  fresh
powder  may be taken, to  the extent of a drachm, three or
four times a day.
  Mr. Hodgson, of Bishopwearmouth,  has published a
case of  a  young  girl,  about eight years  of  age, that was
cured by electricity. A young lady was cured  by citizen
Portal, that was  every day attacked by an epileptic  fit,
which began in one of her toes; this circumstance suggested
to that able anatomist the idea of cutting the nerve, for the
purpose of interrupting the communication with the brain,
but he began by  the application  of opium  to it, and that
alone proved sufficient to effect a complete cure.
  The good effects of calcined zinc, have been attested by
Dr.  Haygarth, of Chester; Dr. White, of York; and Mr.
Bell, of Edinburgh.
  The following  prescription for the exhibition of this
medicine, is given by that able practitioner, Dr. Saunders:
  Take of calcined zinc, eight grains;
       Conserve of roses, sufficient to form a bolus.
To be taken twice a day. 
283
    Dr.  Henry Fraser has lately published a treatise on the
efficacy of the misletoe of the oak in the cure of epilepsy;
and it appears that Mr. Heynes, an ingenious surgeon,  at
Moreton, in  Gloucestershire, has experienced the efficacy
of this vegetable in three different cases of epilepsy;  all  of
which, it is stated, previously baffled the skill of several
eminent practitioners;  and Dr.  Fraser  asserts,  that its
exhibition has uniformly been attended with success under
his directions. A case of this disease in a  lady of quality,
in which it proved remarkably  successful, is mentioned by
Boyle; and, some years  afterwards, its use  was  strongly
recommended by Sir John Colbach, who has related  seve-
ral instances of its good effects. Of this remedy  I cannot
speak  from  experience,  its properties and  utility must,
therefore,  rest  upon  the  credit of the authors who relate
them, who are  very respectable. From  twenty  to  forty
grains of the fresh powder may be taken three times  a day
in a glass of rosemary tea.
  As there is incontrovertible evidence that these medi-
cines have succeeded in certain cases, they are all deserv-
ing of trial; for,  in the treatment of so distressing a disease,
no plausible remedy should be left untried.
  In case the patient should complain much of pains in the
head, a seton in  the nape of the neck should not be neglect-
ed, and the feet kept warm by the use  of flannel socks.
  The  diet  should  be  nutritious, but  not stimulating.
Distilled water should be used for the  common beverage,
and in every article of  diet that requires water, it should
be employed; this article, although simple  in itself,  may,
by producing an alteration in  the system, prove of more
real and permanent advantage than the most potent medi-
cines. Hippocrates judiciously directs a total change in 
284
the manner of life, that former habits may lose their influ-
ence.
  The power of association of ideas in the mind, is in this
disorder  very  remarkable: a gentleman, now resident in
the city of London,  is always  siezed with an epileptic fit
on  entering his carriage; and  Van Swieten relates a case
of a child, who after being frightened into an epileptic fit
by  a great dog leaping  on him, experienced a  return of
them for some  time on seeing a large dog, or even  by
hearing his barking at  a distance.  It  is a well-known
fact, that the  mentioning or  recalling  to the  mind any
particular circumstance that  attended an epileptic fit, will
often re-produce it.  Hence, the learned Galen very  judi-
ciously advises all things  to  be avoided that lead to the
recalling the disorder to the  memory.  Others of the an-
cient  physicians, observing how much this complaint is
connected with mental affections, and how it may be re-
produced by  reflecting upon  it, have endeavoured to ab-
stract the mind from such ideas, by exciting impressions
still more  powerful.  Upon this principle  it was, I appre-
hend, advised  by Pliny,* for the  patient to  drink the
warm blood of a  gladiator,  that issued from him in the
agonies of death. Scribonius Largus directs a proportion of
his liverf to be eaten for the same  purpose; and  Aretaeus
not only  mentions these, but several others of the disgust-
ing kind, as, the raw heart of a coot, the brain of a vulture,
&c. If these strange hideous remedies  could  have any
efficacy,  Dr.  Falconer observes, that it must be owing to
their  absorbing the  attention, and  of  course  leaving no

  * Pliny's Hist. Nat. lib. 28. cap. i.
  r Scribon. Larg. cap. ii. 
285
room for the apprehension and recollection of the disorder
to operate, and in this way it  is possible they may have
been of service.  The relics  of saints, and such like trum-
pery, have, on the same principle, obtained celebrity in the
prevention  of this disease,  the religious ideas connected
with them,  no doubt, in those superstitious times,  ope-
rated powerfully on the imagination.

             Ofi the Distinction ofi Epilepsy.
  This disease may be distinguished  from apoplexy, by
the increased action of the muscles, and from hysteric fits,
by not being attended with the spasmodic  contraction of
the muscles of  the gullet, giving the patient a sensation
of a ball rising in it, and by the patient  having no dread
of death.

        ERYSIPELAS.  See St. Anthony's Fire.

         OF ERUPTIONS OF THE SKIN.

   Under  this head  I  shall include the treatment of those
chronic eruptions of the skin,  generally, but improperly,
termed Scorbutic.
   When pimples, or  pustules in  the face,  are the conse-
quence of  high  living, or excessive  drinking, the  best
medicine  is the  aperient sulphureous  water,  or  neutral
salts, as directed, No.  2.
   The scaly affections of the skin, or  clusters of  small
pimples, unattended with fever, will  generally yield to the
medicines recommended under the head of tartarised anti-
mony wine, (See Nos. 2,  61, 54, and  55,) with the to-
pical application  of the ointment,  No. 106.
   Diseases of the skin  are very  numerous, and many of
them  were  very obscurely understood, till the late valuable 
1
                          286
publication by Dr. Willan, who  has devoted much time
to their investigation; it is to be feared, however, that the
introduction of cow pox, has considerably added  to their
variety, since many obstinate cutaneous diseases  have fol-
lowed, which were totally unknown before.
  When they  arise  from a  constitutional cause,  they
should be considered salutary, and treated only by internal
remedies. External applications should never be  employed
unless recommended by some medical practitioner,  as by
their  imprudent use,  particularly quack remedies (which
are chiefly composed of mercury), many lives are destroyed,
by  repelling the  morbific  matter  to the  brain, lungs, or
bowels.*
  For those chronic inflammations of the skin, appear-
ing in patches over the body, in the spring and autumn
(generally termed leprosy, and by  some  scurvy), the fol-
lowing medicines  I have never known  to fail in the most
obstinate cases:
  Take of precipitated sulphur of antimony, one drachm;
       Prepared calomel, fifteen  grains;
       Conserve of hips, sufficient to form a mass. To be
         divided into thirty pills.
One to be taken twice a day, with a draught of decoction
of the inner rind of elm bark, (see No. 16,) or of the sassa-
fras and sarsaparilla roots.  After  taking the pilis  four days,
a little of the  following ointment should be rubbed  over
the part  affected, every night:
  Take of ointment of nitrated quick silver,
       Spermaceti ointment, of each equal parts.
                                   »
  * Many instances of the fatal  effects of  this class of lotions
have  been published in the " Medical  Observations and In-
quiries, Sec." 
287
 To be  well  mixed  in  a glass  mortar,  or with an ivory
 spatula,  as metals  will  decompose  the  ointment,  and
 destroy its efficacy.
   The  eruption  termed  ringworm  is too  well known to
 require  description.  A  very  popular, and generally  suc-
 cessful application, is common ink, whose efficacy depends
 on the quantity of steel it contains. The muriated tincture
 of steel is equally efficacious, and a much  neater applica-
 tion.  When  it resists this remedy, the  nitrated ointment
 of quicksilver, rubbed over the part every night and morn-
 ing, will seldom or ever fail to cure  it. The solution of the
 Epsom salt,  with sulphur, recommended No. 2, will  also
 be very proper.
  In  all cases of eruptions of the skin, the  state of the
 digestive  organs  should be particularly attended to.  It is
 often  the source of the most obstinate cutaneous affections,
 and when impaired never fails to aggravate them. Before,
 therefore, an  alterative course of medicine  be adopted, it
 will be proper to  clear the first passages  by  an emetic, and
 a brisk aperient medicine, and to keep up a good digestion
by the decoction of sarsaparilla  root, with the tincture of
columbo,  two or three times a day, during the use of the
alterative medicines. If the disease occur in a scrophulous
habit, it will become complicated with  it,  in which case
the prepared  natron, taken as directed, No. 60, will correct
the  habit of body, and thus prove a powerful  auxiliary to
the  external application.
  The diet should consist principally of  vegetables, unless
the strength of the system be much reduced, when fresh
meat may be  allowed.  Salted and fat meat, high seasoned
dishes, and spirituous liquors,  should be avoided. Distilled
water, or whey, or butter-milk, will afford  the best beverage. 
288
   Children, from their birth till after teething, are subject
 to a variety of eruptions of the skin, such as, the red gum,
 tooth rashes, nettle rash, watery eruptions, &c. &c. which,
 although they differ in appearance, progress, and extent,
 seem all to arise from the same cause, viz. a vitiated state
of the humors from predominating acidity in the stomach,
or the milk of an unhealthy nurse.
   In  the treatment of these early  eruptions, external ap-
plications should never be  employed, unless prescribed by
a  skilful physician or surgeon, or practitioner well ac-
quainted with those diseases of infancy.  Exposure to cold
 should be carefully avoided, and the state of the  stomach
corrected by small doses  of magnesia, to which a  little
cretaceous powder may  be  added in case the bowels are
much disturbed.  If the  child be of a gross habit of body,
the basilic powder will also be proper, as directed No. 36.
As the milk is often in fault, the nurse  should take a tea
spoonful of the tincture of columbo, with a little magnesia,
in simple peppermint water, two or three times a day, and
to obviate costiveness,  by the use of the solution of Epsom
salt, as advised No. 2.
   When  the  scales of  an  eruption  become troublesome
from hardness, a  little  spermaceti ointment or cream may
be applied to them.

                EXCORIATIONS,

   Arising from friction, may be easily cured by applying
the spermaceti ointment, No. 41, or the discutient lotion,
 No. 92.  In  case of  much  inflammation,  the  emolient
poultice, No.  112,  will  be  more proper; and if attended
with fever, the aperient  mixture,  No. 62,  and  the saline
mixture, No. 78, will  also  be necessary, and small  doses 
289
of laudanum,  No. 31, after the operation of the opening-
medicine, if attended with  pain.  A low  diet should  be
observed till the inflammatory symptoms are gone off.

    For the EXCORIATIONS OF CHILDREN,
                    See Page  142.

          OF FAINTING, or SYNCOPE.

                       Symptoms.
  The fainting  fit begins with  great anxiety about the
heart, the pulse and  respiration become  suddenly weak,
and  sometimes  to such a  degree, as  to  all appearance
wholly to  cease, with  coldness of the  extremities, and
death-like paleness of the face,  &c.

               Ofi the Causes ofi Fainting.

  These fits are most commonly occasioned by excessive
evacuations, particularly of blood; they are likewise pro-
duced  by  passions  of the mind,* violent pain, impedi-
ments to the free circulation of blood,  as polypus, aneu-
rism, and  ossification of the aorta, and probably by the
communication between the auricles of  the heart remain-
ing entire.

              Ofi the Treatment of Fainting.

  When the fit is in  consequence of excessive evacuations,
the body should be  immediately placed in  an horizontal

  * The  effects of mental agitation in causing fainting are well
known;  and, when violent, sometimes prevent the reaction of
the system, and consequently occasion sudden death.
                         2Q 
290
position, in a currency of air, and the acetic acid, or sal
volatile, applied to the nostrils and temples; of the latter
of which a  tea spoonful may likewise be  given in a little
cold water; the extremities  should be rubbed with warm
flannel, and  cold water  sprinkled over the face and neck.
After the recovery from the fit, the patient should be  sup-
ported with a nourishing diet, as beef tea, or arrow root,
with a little wine.  When it arises from pain, the patient
should take laudanum, as directed No. 31, which will also
prove the best preventive. If the consequence of passions
of tht mind, and the patient be plethoric, the loss of blood
from the arm will be necessary. If from debility, the tonic
mixture, No. 77, should be  taken; and if  from obstruc-
tion of the  circulation, from polypus, or  organic  disease
of the heart, much  bodily exertion, or whatever tends to
hurry on the circulation, should be avoided.
  It is no difficult matter, says the learned Dr. Falconer,*
to induce a habit of fainting in persons endued with great
irritability  of nerves,  and  nothing  conduces more to in-
crease this, than a studious  solicitude to avoid every thing
that is likely to have that effect. It fixes the mind on the
very object we  would wish to avoid, and by augmenting
the effects  of trivial accidents, multiplies the number of
causes that may produce the disorder dreaded;  a  firm re-
solution  to resist the effects of frivolous  incidents upon
the mind, and of course on the nerves, is  far preferable.
Haller has related a story where a disposition of this  kind
was conquered by a vehement exertion of the will;  and
almost every person has seen temporary fits of a similar
kind put off by the  struggles and resolution of the person
attacked.
* Dissertation on the Passions, page 109. 
291
        FALLING SICKNESS. See Epilepsy.

FEVER INFLAMMATORY. See Inflammatory Fever.

FEVER INTERMITTENT. See  Intermittent Fever.

        FEVER PUTRID. See Typhus Fever.

     OF FILMS OR SPECKS ON THE EYE.

  To remove films,  or small specks on the eyes,  the eye
water,  No. 101, dropped into them two or three times a
day, will generally succeed ; if attended with, inflammation,
the  application of a blister to the  nape of the  neck; the
use  of  the  aperient mixture, No. 62, and an  alterative
bolus of two  grains of calomel,  No. .34,  every night for
a week, will likewise be necessary.
  If the eye water should not prove sufficiently strong, a
little levigated glass, or powdered cuttle-fish bone, should
also be  blown into the eyes through a quill,  every  night
or  morning,  or applied  mixed with  a  little honey, by
means  of a camel hair pencil.

                OF FLATULENCY.

  So prevalent are flatulent affections  of the stomach and
intestines in this country, that  very few persons, if any,
are  entirely exempt  from them.  They  have, however,
by no  means  met  with  that  attention from the medical
profession to  which their  frequency  and  effects  on the
constitution entitle  them. . Indeed, so  little  have  their
causes  and  nature  been  investigated,  that they have been 
292
merely  noticed  as symptoms  of indigestion.  The gas,
(vul'Mirlv termed wind), generated in the stomach, is of the
car'ionic acid kind, probably the effect of a decomposition
of vegrtahle  aliment in  the stomach, in  consequence of
weakness or error  in the digestive organs, the food, instead
of being properly digested, undergoing a slight degree of
fermentation, and disengaging a quantity of gas : flatulency
may so far be  considered the effect of indigestion. But
the gas  generated  in the intestines is  of a very different
kind, being  inflammable air, generally  confined to the
grer.t intestines, named  the colon and rectum, and evi-
dently not immediately the  effect of indigestion.  This
gas is I believe always discharged downwards,  and some-
times very7 offensive to the smell,  similar  to the  inflam-
mable gas arising from gutters or stagnant water.
   The  air evolved  in the stomach  being evidently the
effect of Weakness of the  digestive  organs, will be con-
sidered under the  head  of indigestion, but as the genera-
tion of  inflammable gas in  the  intestines  is difficult to ac-
count for, I shall  notice it here as a primary complaint,
and, for the sake  of distinction, term it Intestinal  Flatu-
lency.
   It is  extraordinary that this species of flatulency should
have escaped the investigation of Hippocrates, who has
been particularly  minute in delineating  the symptoms of
diseases, but at that period, the nature of the different airs
were very imperfectly known. Sauvage, in his Nosology,
notices  two species, viz.  the acid,* and fcetid,f but  he
considers them  to differ only as to smell, and as arising
from the same source. Nor do I find, that they have been

   * Flatulemia acida, Spec. 1, Sauv.
   t Flatulentia nidorosa, Spec. 2, Sauv. 
293
noticed by those pneumatic theorists of the present period,
who have endeavoured to prove, that many diseases arise
from  certain decompositions  or combination  of airs  in
the human body, and are to be cured by the exhibition of
different  gases.
  People who indulge themselves in the free use of spiri-
tuous  and vinous liquors,  are  most  troubled yvith this
species of flatulency, and it is  remarkable that  even  the
breath of those  who are in the habit of frequent  intoxi-
cation, is strongly  impregnated  with inflammable  gas.
Whether this gas be  disengaged from the wine or spirit, or
whether  those liquors, by  their chemical  action on  the
inner coat of the intestines, produce  a morbid  secretion
of  mucus, and  inflammable gas is in consequence  gene-
rated,  I  cannot take upon  me  to say. I have, however,
met with patients  much  affected with  this air, who were
not apparently addicted to the pernicious  habit of dram-
drinking, or taking  wine even in  moderate quantity;  but
from  such a  circumstance  one  can  draw  no conclusive
inference, for  those  who do not take their cheering glass
publicly, may privately. The ingenious and  learned  Dr
Trotter  is of opinion, that vinous spirit mixes  with  the
blood,  " for we know (says this  author),  that  hydro-
geneous  gas (i. e.  inflammable air),  escapes  from  the
lungs in  such quantity as to be perceived  in the breath;
we  are,  however, ignorant  what  combinations  this gas,
or other parts of  the  spirit, may form with the human
fluids.  That eminent physician,  Dr. Baillie, in  his ines-
timable  work on the morbid appearances  of the human
body, observes, " It  is not unusual to find air accumulated
in the  intestinal canal in greater  or less  quantity. This
air  is sometimes accompanied with slight inflammation of
the  jxntonseum, and other  times  not.  In such cases,  the
blood vessels  on the intestines  are frequently filled with 
294
air.  There are only two ways in which we can well  con-
ceive air to be formed in the intestines.  I'he one is some
new arrangement in the  contents of  the intestines by
which air is extricated; the other is, the formation of air
in the blood vessels of the intestines, by a process similar
to secretion, and which air is afterwards poured out by the
extremities of the exhalent arteries into the cavity of the
intestines. That the blood vessels have  this power there
can be no doubt; and I own (says the Doctor), that this is
a very frequent mode by which air is  accumulated in the
intestines. Of the nature of this gas,  this able anatomist
does not give a decided opinion, but observes, " that it
requires to be examined by some person well acquainted
with  chemical experiments,  in  order that  its ingredients
may be well ascertained."
   Nervous and  hypochondriacal patients,  appear to suffer
so  considerably  from  this  gas,  that  I  never knew  a
nervous  patient  who  did  not  always   find  himself
much  benefited by  a free expulsion  of it;  and I  have
been assured by  many, that in  proportion to its foetor, so
has been their relief.  Even violent head achs, stupor, pal*
pitations of the  heart, horror of mind,  dimness of sight,
noises in the ear, nervous twitchings, and a variety of other
symptoms, have  been speedily relieved by its evacuation.
That this inflammable gas enters  the blood  vessels, is ob-
vious,  from its  passing off by the  breath, but whether
these nervous affections be thus excited,  or whether  it
be sympathetic  of the irritation  produced by it on the
inner coat of the intestine, cannot be easily determined.
That it is the cause  of  many nervous complaints, I  think
there  can be but little  doubt.  Water being compounded.
of inflammable  gas and  oxygen or vital air^ I think  it
possible that  water  may be  formed in the system by the
 union of inflammable gas with the oxygen of the  blood. 
295
 and thus produce dropsical swelling, and at the same time,
 by depriving the blood of this  vital principle, induce  a
 dangerous degree  of weakness  in the  system.  Such an
 occurrence is, I think, more probable, than that the con-
 dition of the skin should be changed from a perspiring to
 an imbibing  state, which from the accumulation  of water
 has been supposed  to be the case  in  some diseases  of
 emaciation.

        Of the Treatment of Intestinal Flatulency.
   The first  object in the  treatment  of  this  complaint is,
 to empty the intestines by such active aperient medicines
 that will also carry off the vitiated slime adhering to the
 coats, and at the same time excite an healthy action in the
 mucous glands.  For this purpose, calomel will answer best,
 five grains of which may be  taken at bed time (made into
 a pill with a little  conserve  of hips), and purged off the
 next  clay with  the solution of  Epsom  salts, as recom-
 mended  No. 2.  These medicines  should be repeated at
 least twice a week for  a fortnight. In the intermediate
 time, three table  spoonfuls of the following mixture may
 be taken three times a day:
  Take of red rose leaves, three  drachms;
       Infuse in  twelve  ounces of boiling water till cold,
         then strain,  and add
       Sweet spirit of vitriol, three drachms;
       Compound tincture of cardamomseeds, sixdrachms;
       Tincture of ginger  and camomile, three drachms.
  If  the  constitution  have  suffered from the  free  and
 continued use of spirituous  liquors, he  should, after the
above medicine, continue the following mixture for some
time:
  Take of the infusion of roses (made as above), twelve
         ounce*; 
296
       Diluted vitriolic acid, three drachms;
       Epsom salt, three drachms;
       Tincture of cardamom seeds, half an ounce.  Mix.
Three table-spoonfuls to be taken twice a day.
  The Jamaica ginger powder is the best carminative that
can be used in this case, as it not only  effectually expels
the gas, but, I believe, also corrects  the secretion of the
intestines, and, by stimulating their inner  coat, occasions
them to throw off any accumulation  of mucus; thus, the
faxes of people in the  habit of using it  are  generally co-
vered with slime.
   It is  scarcely necessary to observe, that the  patient
should avoid spirituous or vinous liquors; if not immedi-
ately, at least by degrees.
   It is a  very common practice with physicians to desire
their patients, troubled with this complaint,  to abstain, as
much as possible, from a vegetable diet. I have known
this advice very strictly adhered to, but I have not found
 that the  patients have  been  the least benefited by it, nor
 is it to be expected, from .the nature of the  gas, that they
 would; for the fixed air disengaged from vegetables rather
 corrects  it than otherwise. Indeed,  water saturated with
 fixed air, as  the  soda water, I have  found an  excellent
 palliative,  and evidently  to diminish intestinal flatulency;
 fixed air readily  mixing  with  it, effectually destroys its
 offensive odour. A proper admixture of vegetable and ani-
 mal food I have  found best to  agree with  such  patients,
 and distilled water as a beverage.
    The cordial medicines of quacks,  as  well as  ardent
  spirits  (from which  they little differ), and  wine, often
  afford  flatulent patients  some  relief, by  expelling  the
  air contained  in the  intestines;  they,  however, after-
  wards  supply it  in greater quantity to the blood, and a
  patient, encouraged to persevere in the remedy from the 
297
 transitory relief it affords, does not discover the error till
 his stamina is so far destroyed, that an  increased dose of
 the cordial becomes  absolutely necessary to keep up  the
 vital functions.
   The mischief that flows  from  this polluted source is
 incalculable. The most  robust constitution is often ruined,
 and where it has not  been  fatal in itself, it  will lead to
 other  excesses, which  in process  of  time will  infallibly
 terminate the life of these  deluded votaries of  pleasure.
 To say the least of their deleterious effects, how completely
 do they frustrate the gn*at ends  of social intercourse, the
 promotion of harmony,  and the attainment of knowledge—
       " That Feast of Reason, and that Flow of Soul!"
   How justly, then,  may we exclaim, in the emphatic lan-
 guage of the  immortal Shakespeare,  " Every  inordinate
 cup is unblessed, and the ingredient is a devil."

                      OF GOUT.

   The gout  is  generally  allowed  to be an hereditary*
 disease,  but more often acquired  by  high  living  and a
 sedentary life. The  male sex  are  generally its victims.^

   * Dr.  Latham, in  a late epistolary dissertation addressed
 to Sir George Baker, denies that it  is an herditary disease;
 however, this  much  appears  to  be certain, that  parents do
 transmit that kind of organization  to their offspring, which dis-
poses them to take on  a gouty action.
  t Hippocrates observes, that women seldom have the gout,
and never before the age of 45. In his time  and country, per-
haps the ladies were more temperate than they were in other
countries, or in the  present state  of modern refinement.  It
appears, however, that the gout was a familiar disease among
                          * R 
298
It is divided into regular and irregular. When  the in-
flammation  appears in the joints to a due  degree, and
gradually disappears, after a certain  duration, leaving the
patient rather in an improved state of health than other-
wise, it is termed Regular.
  Of the irregular there are three species, viz.
  1st, Atonic: When the constitution is tainted with the
gout, but from some cause, the  inflammatory affection of
the joints is not produced; the organs of digestion impaired,
and the general health variously  affected.
  2d,  Retrocedent: When the  inflammation attacks the
joints slightly, and suddenly abates and affects an internal
part.  And,
  3dly, Misplaced: When the gout attacks any of the in-
ternal parts, instead of the joints of the extremities.

               OF REGULAR GOUT.

                      Description.
  A regular fit of the  gout rarely comes  on till  the  age
of thirty-five,  unless from a strong hereditary predisposi-
tion.  It attacks  sometimes suddenly, but generally pre-
ceded by  derangements in the constitution, as indigestion,
flatulency, loss of appetite,  cramp in the  stomach  and
calves of the  legs, head-ach, stupor,  numbness,  a sense
of pricking in  the thighs and legs; the day preceding the
attack, the  appetite generally returns much keener than
usual. It  comes on  sometimes in the  evening,  but ge-
nerally about two or three o'clock  in the morning, and for

the Roman  ladies; which  Seneca, in his  95th  Epistle, justly
ascribes to the luxurious living and debaucheries in which they
indulged without controul. 
299
 the most part in the Spring of the year. The ball of the foot,
 or joint of the great toe, is commonly the seat of regular
 gout, the  pain and inflammation  of which uniformly  in-
 crease, with more or less of a shivering, which abate as the
 pain becomes more violent, and is succeeded by a hot stage
 of the  same  duration  as the  pain,  and with  it gradually
 declines, when  a gentle perspiration  comes  on, and the
 patient falls into a much desired sleep.


              Of the Causes of regular Gout.

   The occasional causes of the gout are  evidently of two
 kinds,  viz. Those  which induce  a plethoric  state  of the
 body;  and, secondly, Those  which in such habits induce
 a  state  of  weakness. Of the first kind may be  inumerated,
 sedentary  indolent  manner of life,  full diets, especially
 of animal food, and the great use of  wine and other spi-
 rituous liquors;* and  of the  latter  class may  be noticed,


   * This disease, so often the  companion of wealth and indo-
 lence, has  been so frequently induced by the excess of wine,
 that in every age it has been justly styled the offspring of Bac-
 chus. This  fact is sufficiently substantiated in the records of
 medicine, for gout is  seldom or never seen in the habitations'of
 poverty and labour.  In  youth,  hard drinking is particularly
 injurious, it brings on premature decay, and, more than any
other cause, paves the way for  the diseases of age before the
meridian of life. But as  the organs of digestion are  so princi-
pally concerned in gout, the excess of drinking acts  with peculiar
force. It is  highly probable, that the mere pains and inflam-
mation of the joints are very secondary symptoms of the com-
plaint, and that the only sure way to ward it offis,by preserving
the vigour of the digestive organs, by temperate and abstemious
living, and  by beginning early  in youth  to pursue  a regular 
300
 in habits of an hereditary disposition,  whatever may, di-
 rectly or indirectly, tend to diminish the powers  of the
 system,  as excesses of all kinds.
   Dr. Cullen considers a fit of the gout, an effort of nature
 to restore tone-and vigour to the  nerves, which she accom-
 plishes by exciting inflammation in their extremities, and
 which, after subsisting some days,  gradually leaves  the
 patient in an improved state of health; and this opinion
 the  learned professor  supports with  a  long train of inge-
 nious arguments.
  Mr. JamesParkinson,whohaslatelypublished an excellent
 treatise on the nature and cure of the  gout, is of opinion,
 that in gout, a peculiar saline acrimony exists in the blood,
 in such proportion, as to  irritate  and excite to morbid ac-
 tion, the  minute termination of arteries in certain parts of
 the body.
   Dr. Wollaston,  in a paper read before the Royal Society
 in 1797, demonstrated, that the concretions formed in the
joints  of gouty persons are composed of an animal  acid
 (termed  uric or lithic acid), and soda.  Mr. Fourcroy and
 Dr.  G. Pearson also mention the existence of this acid in
 gouty  concretions.
  When  we view, says Mr. Parkinson, in a person who
 has been long subject to the gout,  the prodigious quantity
 of this matter which has  been separated from the system,
 forming  almost all the smaller  joints of  the  hand into
 white  and apparently cretaceous  nodules (vulgarly called
 chalk stones),  we  are  naturally led to the opinion, that
 the  blood must have been  preternaturally charged with


 and active mode of life. These are the best securities for a sound
 constitution, whic'i  alone can ensure a  happy and healthy old
 age.  Trotter on Drunkenness, fol. 113. 
301
this matter, or with the principles of which it is formed."
The obvious source of this alleged acrimony of the fluids
(of which the uric acid is formed) the author asserts to be
impaired digestion,  and  the introduction of acescent mat-
ter into  the stomach, circumstances evidently connected
with the gouty diathesis.

           Of the Treatment of Regular Gout.
   The treatment of the gouty paroxysm must vary ac-
cording to the age of the patient,  the  natural strength of
his  constitution, and  more particularly according to his
previous habits of living.   Indeed,  so various are the con-
stitutions of gouty people, that it is impossible to lay down
a general or invariable plan, either for the cure of the pa-
roxysm, or the prevention of its recurrence, which are the
two indications to be attended to in its treatment. On the
approach of the fit,  it  will, in all cases, be proper to clear
the stomach and bowels  by a brisk aperient medicine, as
the carthatic pills, No. 80.
   After their due operation, the following mixture may be
taken with considerable advantage:
   Take of camphorated julep, twelve ounces;
       Volatile salt of hartshorn, two scruples;
       Sweet  spirit of nitre,* two drachms. Mix.
Three table spoonfuls to be taken three, four, or five times
a day.
   If  the stomach be  much affected, or the  constitution
impaired by repeated attacks, or irregular or free  living,

  * The sweet spirit of nitre should be fresh and well prepared,
otherwise by neutralizing the salt of  hartshorn, it will destroy
the property on which its efficacy depends. 
302
half an ounce of the volatile  tincture of guaiacum may
be  added to the above  mixture, and  in case of much
acidity, two drachms of prepared natron. If the patient
be advanced in years, or in  a very debilitated state, the
gout mixture, No, 69, may be substituted.
  The liquid  laudanum may be given at bed time, to
abate the violence of the pain. It, however, by weaken-
ing the powers of the stomach,  often prolongs the fits,
and it is not an uncommon occurrence, after a full dose
of laudanum,, for the gout to attack the stomach, and even
the brain, with  such violence  as to threaten the life of the
patient, it should  not, therefore, be  employed,  unless
advised by a regular practitioner, particularly  when  at-
tended with general debility of the  system.  The acetic
laudanum is much  safer,  and certainly more efficacious
in procuring ease,  in cases of gout, than the common
laudanum.
  When the gout attacks the  stomach, warm cordials are
necessary, as the cardamom seed,  peppermint or anniseed
cordials, ether, or tincture of ginger and camomile. The
feet should likewise be immersed in warm water, or well
rubbed with flannel.
  With respect to applications to the affected part, a va-
riety of opinions has been maintained by physicians, both
ancient and modern.  If the patient  be  plethoric, or his
constitution but little impaired,  the extraction of blood
from  the part by  leeches, generally abates the  pain, and
shortens the paroxysm,  but  in people  far advanced in
years, or of weakly constitution, it is sometimes produc-
tive of very opposite effects.  Blisters near the  part have
been much recommended by Dr. Rush, and are much safer
and perhaps not less efficacious than topical bleeding. 
303
   As  spontaneous perspiration of  the limb is always at-
tended with very salutary effects, and as we generally find
the fit  thus  to  terminate,  so  I  think  the  vapour-bath
lately recommended by Dr.  Blegborough, very  likely to
prove  beneficial, by exciting perspiration; and  I under-
stand in  many  instances has  been employed with  con-
siderable advantage, in assuaging the pain  and shortening
the paroxysm.  The immersion of the limb in cold water,
as recommended by  Dr. Kinglake,  affords more speedy
relief than any other application, and I have known many
instances   in  which  it has  proved  highlv beneficial;
but the  cases  were in a great measure  local, being at-
tended  with no affection of the stomach  or  an  impaired
constitution, and complicated  with rheumatism.  It is in
those anomalous cases, I believe, that  it has proved of
such  immediate and essential benefit in  the practice of
others;  but in  the  paroxysm of regular gout, where the
constitution is  affected, it  may be  considered  an Her-
culean remedy,  and if it do not cure the  patient, it will
probably kill him by repelling it to the stomach  or brain,
instances of which  are not wanting.
   A gentleman, who has suffered very considerably from
frequent attacks of gout, has^ within these few years,  on
any  symptom  of  an  approaching  fit, had   immediately
recourse to a liniment  composed of olive  oil  and vitriolic
acid, recommended to  him  by a mechanic (who it seems
has acquired much celebrity for speedily curing the gout);
by which  he has entirely kept  off the fit,  and in  the first
instance cured himself of a  very violent attack, by rubbing
it well over the part.  In  a few  hours  after using  it,
although at the time  confined  to his bed, he has  been
able to walk with  ease. It  appears  to me that  this lini-
ment may, from its chemical action on  the gouty matter
deposited  in the part,  have a very  salutary  effect.  The 
304
1
soda, by  uniting with  the  sulphuric  acid, for which  it
has a greater attraction  than  the uric acid, would form a
salt more  soluble, and therefore more easily removed by
the absorbent vessels. Certain, however, it is, that many
people who have  been conveyed  to this man in a sedan,
have,  after the parts had been well rubbed with this lini-
ment,  been able  to walk home  with ease;  it  therefore
merits a trial,  particularly  as it is  not of  a repellant
nature.  The muriatic acid bath has  been found to afford
relief, probably on the same principle. The safest method
of applying this acid, is  in  the  state of vapour,  which
may be done  by means  of  Dr. Blegborough's vapour-
bath,  by mixing it with the  vapours  of  warm, water.
Flannel and patience are  generally recommended, and in
domestic medicine should Certainly be perferred, being free
from danger: the effects of the former probably depends
on it increasing perspiration.  During the use  of  topical
applications, the  internal  remedies recommended  above
will also be necessary.
  A variety of nostrums has been offered to  the public as
specifics for this disease, but they have all failed even to
palliate the symptoms. A remedy, principally composed of
bitters, under the name of the Portland Powder, was at one
time held  in high estimation as a specific, but further ex-
perience proved fatal to its  reputation.  It is a prevailing
opinion, that the  gout is not to be cured by medicine, but
may be effectually prevented  by  regimen; and it is a fact
noticed so far back as the time of Galen, that when a fit
of the gout has been kept off for three or four years by
the use of tonic medicines, particularly bitters, the patient
has always died suddenly, and apparently for the want of
a regular fit of the gout.
  The  prepared natron  is much recommeded by  Mr.
James  Parkinson,  with a view of destroying acidity  in 
305
the stomach, which he  considers the  principal  cause of
gout.  Alkaline  medicines have  long  been employed for
that purpose, and by some highly extolled.  By the medi-
cines  recommended above, acidity will not  only be  cor-
rected, but its formation prevented.
  Gouty subjects are likewise much affected with inflam-
mable gas in the intestines, the expulsion of which affords
relief; and it is not  unworthy of notice, that this  air  is
discharged from the system in greater quantity as  the fit
approaches to its termination; its free expulsion I have,
therefore,  always  considered a favourable  import.   Its
prevention and evacuation are  certainly of  some impor-
tance  in the treatment of gout.  The Jamaica ginger
powder,  for  these  purposes,  has answered  much  better
than any other aromatic,  as it seems to  warm and  in-
vigorate  the  stomach and  bowels without  increasing the
feverish state of the constitution, which spirituous liquors
and the  spices  abounding with an essential  oil,  are very
liable  to  do.  The Jamaica ginger has been much esteem-
ed as  a remedy for gout by a few eminent practitioners,
and instances have  been  adduced,   in which it  proved
highly beneficial, particularly that of Sir Joseph Banks, by
Mr. Stenhouse, through which  it became  a very popular
remedy.   In the  prevention of gout it is a very valuable
medicine;  but in the  cure of  the  paroxysm,  attended
with considerable fever  and plethoric state of the system,
the propriety of exhibiting in the dose recommended by
Mr. Stenhouse, is much to be questioned.

                     Ofi Regimen.

  The diet, during a  paroxysm  of gout, must also be
regulated according to the  accustomed mode  of  living,
the state of the constitution, and the violence of the symp-
toms.  If the patient has  been  in the habit of  indulging
                          .2 S 
306
his appetite with high seasoned dishes and the free use
of spirituous and vinous liquors, now is not  the time to
abandon them  entirely, particularly if  the  stomach  be
affected, or the powers of the system reduced  by repeated
attacks or age : they, however, should be allowed in mo-
deration.  In other cases a  low regimen should be strictly
adhered to,  and an abstinence  from spirits  and  wine;
fermented liquors should also be enjoined.
  The soda water affords a very  excellent beverage, as it
abates fever,  promotes digestion, and in  many  respects
will prove very beneficial.   If it should be too cold for
the stomach,  a little fine  ginger powder  may be taken
with it.  Water purified  by distillation,  is recommended
by Dr. Lambe as a common beverage  for gouty patients,
in a  very ingenious work on constitutional diseases, who
has lately published many instances in which its adoption
was attended with the most decided and^ permanent ad-
vantages.
  The most absurd  and ridiculous  doctrines  relative  to
the cause of gout are broached in the works of empirics,
to which are attached the names of individuals, who from
their elevated situations in life, one  would have sup-
posed  must  have  known  better, common  sense   alone
being necessary to detect their fallacy and the views  of
the authors.  There  is not  another  nation in the known
world who suffer themselves to be so miserably duped  by
ignorance and  fraud as the English.  Those members of
the British  Legislature, who have suffered their names
to be  posted  up  in  the public  streets in the  support
of this  practice, I  am persuaded, are not aware of the
infinite  mischief such sanction produces; nor did they
mean  to patronise   the  trade  to  that  extent  which
those advertisers wish the public to believe.  The  testi-
monies  and opinions of men  ignorant of medicine can, 
307
hov ever,  have little or  no influence on the thinking part
of the community.  It would redound much to the honour
of those  characters,  if instead of  publicly encouraging
such  practices,  they would  caution those who are  not
competent to judge for themselves against the indiscrimi-
nate use  of advertised  remedies, and  expose the impos-
tors* to the public  view in their natural deformity, which
I think cannot be  more  effectually done  than by recom-
mending, for their perusal, a pamphlet on empirical prac-
tices, entitled the " Medical Observer."
   A fit of the gout in constitutions  prediposed to the dis-
ease, is often excited by  passions  of  the mind, and in
many instances has been suddenly terminated by the same
means. Van Swieten relates, frorn  Hildanus, that a man,
disguised to represent  a ghost or  spectre, took another
labouring under a gouty paroxysm out  of his  bed,  and
carried him upon his back down the stairs,  dragging his

   * Of all the impositions practised in an enlightened country,
that of the metallic tractorism, as it is termed, appears to be the
most impudent. The strange infatuation of the wealthy to pay
five guineas for two  small pieces of compound metals, perhaps
not intrinsically worth  six-pence, to charm  away disease will
no doubt be noticed by posterity as a proof of  the ignorance and
credulity  of the age; and it is to be hoped  the names of the
President  and Vice-presidents of the  Perkinean society, and
those who sanctioned the practice, will not  be omitted in the re-
cords. A gentleman  in the neighbourhood of Covent Garden, in
a violent fit of the gout, was induced to give  tractorism a trial.
A tractor  was  accordingly applied to the inflamed foot; but in-
stead of drawing out the disease, as he expected, the cold metal
repelled it to the knee and stomach, and had  it not been for the
timely assistance of medicine, the experiment would certainly
have cost  him his life! 
308
 feet and legs, which were the seat of his pains, down the
 steps, and placed him  at last on the  ground.  The man
 thus treated, immediately recovered the use o/ his limbs,
 and ran up  stairs again with great swiftness, and under
 the  strongest impression  of terror.  After this  incident
 he lived many years free from any symptoms of the gout.
 This celebrated author also relates a case of a man being
 cured by a very opposite passion:  a person, says  he, who
 had for forty years being afflicted with the gout, was con-
 demned to capital punishment, and in  consequence there-
 of led to  execution.  Just when  he  expected death, he
. received an  unhoped-for pardon,  which affected his limbs
 in such a  manner,  as to restore to them activity and
 strength, whereas before  that event their use was nearly
 lost; this person,  as well  as the  other, lived many years
 totally free from the gout; and that celebrated physiologist,
 Haller, quotes a case still more extraordinary, of the cure
 of the gout  by a violent fit of anger.
   With respect to the management of the mind during
 a paroxysm  of gout, Dr.  Falconer judiciously observes,
 " our practice must be  directed not to excite, but to mo-
 derate such passions as are symptoms of the disorder itself,
 and to endeavour to  restore,  by  any  safe*  means, that
 calmness and tranquillity  of mind  which  those  who are
 subject to the gout find  on the going off of the fit."

        Ofi the Prevention  ofi the Gouty Paroxysm.

   The prevention of a recurrence of a fit  of the gout, I
 have  already  observed,  should  be  attempted  only  by

   * Charms were as much in use for the gout among the phy-
 sicians of  antiquity,  as for any other disease;  and  perhaps
 when we consider the periodicial nature of the complaint, we
 may not entirely discredit their efficacy. 
309
regimen, and not by the constant use of tonic medicines.
Temperance  and exercise proportioned to the strength of
the patient, will conjointly prove the best preventive; accus-
tomed habits of high-seasoned dishes, and  spirituous and
vinous liquors, should be gradually abandoned, particularly
if the patient be advanced in life, or his constitution much
debilitated.  As the quantity of cordials and rich dishes
are diminished, so should  the degree of exercise be in-
creased.  It is by total change in the manners of life that
such rooted constitutional diseases are to be conquered. If
a gouty patient have resolution to avoid the temptations of
the table, and reduce  by degrees his quantity of wine to
two glasses a day, he may still have  little cause to regret
his former indulgences.  Particular attention should be paid
to the state of the digestive organs, and  especially to the
prevention of acidity in  the stomach; on any symptom of
indigestion it would be advisable to take  a dose of the
cathartic pills, No. 80, and  the compound tincture of gin-
ger and  camomile, No. 7,  occasionally, or a small tea-
spoonful of ginger powder two  or three  times a day. It
would also  be proper  to  avoid  all  kind  of  fermented
liquors, and  to take for the common beverage distilled
water. The  instructions given for the treatment of indi-
gestion, equally apply to the prevention of gout.
   When any swelling or stiffness of a joint remains after
the fit has  ceased, it may be removed by the diligent u^e
of the flesh brush, gentle exercise of the parts, and in case
it  proves obstinate, the following liniment may be  well
rubbed over  the part for half an hour, and afterward wash-
ed off with warm water, and the part wiped dry:
   Take of olive oil, an ounce and a half,
       Vitriolic acid, two drachms,
       Spirit of turpentine,  do. 
310
 Drop the vitriolic  acid into the  oil by degrees,  and after
 they are well mixed, add the spirit of turpentine.
   As there is a disposition in gout  to return in spring and
 autumn, greater attention at those periods will be  necessary
to an abstemious  diet. The pills recommended, No.  80,
and the solutioa of prepared natron, No. 60, with the use
of ginger powder,  No. 49,  should  also be  resorted to on
any symptoms  denoting  the approach of a paroxysm, by
which means the disease may be generally prevented from
occurring. The feet should  always be kept dry and warm
by means of  flannel socks and corked-soled shoes; flannel
next the skin will likewise be proper.

               OF ATONIC  GOUT.

  The cure of this species of gout consists in strengthen-
ing the  system; for this purpose the stomachic  mixture,
Nov 61, or two tea spoonfuls of the volatile mixture of
cascarilla should be  taken,  with an infusion  of Jamaica
ginger,  or the compound tincture of Jamaica ginger and
chamomile, No. 7. In case of nausea at the stomach, an
emetic of ipecacuan powder, No. 23, and a dose of equal
parts of tincture of senna, No. 8, and tincture of rhubarb,
No. 4,  should precede  the use of these  medicines. A
generous diet  and moderate  exercise  are indispensably
requisite. The feet should be kept warm by the use of flan-
eel socks and corked-soled  shoes.

           OF RETROCEDENT GOUT.

   When gout  affects tbe  stomach and intestines,  relief
 is to lie attempted without delay, by the  free  exhibiton
 "f warm brandy and water, with  a little ginger powder, and 
311
if they do not prove sufficiently potent, ardent spirit must
be employed.  A  dessert spoonful of ether, No. 14, has,
in this case, answered very well, to which half an ounce of
paregoric elixir,  No.  11, will prove  an useful  addition.
The bowels should be fomented, and the feet put in warm
water, and afterwards rubbed  with flower  of  mustard.
When the gout flies to the head, the  same means are to
be  pursued, with the addition  of a large blister  to the
scalp. A strong mustard poultice to the feet may likewise,
in this case, be substituted for the warm water.  When it
affects the lungs, half an ounce  of paregoric elixir,  with a
tea spoonful of ether and sal volatile, should  be  given oc-
casionally, a  blister  applied over the  breast-bone, and a
mustard poultice to the feet.

               OF MISPLACED GOUT.
   When, instead of the usual determination to the joints,
 the inflammation hills on the lungs, or any internal  part,
 it often  requires to be treated as a primary inflammatory
 affection, by blood-letting, application of  blisters over the
 part and to the extremities, and aperient and sudorific me-
 dicines.  But these cases are generally involved in too much
 ambiguity for domestic medicine; they often perplex even
 practitioners of  experience, and  there is  no  doubt but by
 the injudicious exhibition of cordials in one case and bleed-
 ing in others, many lives  have been  destroyed. Nothing,
 therefore, should be  done (unless in  cases of great emer-
 gency)  without the sanction of medical men  of experience
 and judgment.

          OF THE GRAVEL AND  STONE.
    The   gravel consists  in the evacuation of small sand-
  like concretions, which  are formed in the  kidneys, and 
312
in their passage through the tubes (termed ureters) to the
bladder, often occasion a severe degree of pain, according
to the size and form of the concretion.  When a piece hap-
pens to be too large to pass off with the urine from the blad-
der,it gradually enlarges, and forms the disease called Stone,
which, when smooth  and round, is scarcely perceived  by
the patient, till from  its weight and magnitude, it becomes
troublesome, producing, independent  of local  mischief,
numbness in the  thighs,  and spasms in the calves  of the
legs, probably from its pressure on the nerves leading to
those parts. When the surface of the stone is  hagged and
of an angular form, the sufferings of the patient are often
very severe, attended  with a slimy discharge in the urine,
and not uncommonly a quantity of blood, and from cori-
sion of the inner coat of the bladder,  a  frequent inclination
to make water and go to stool.  A calculous concretion is
sometimes found  in the bladders of very young  children;
they are also formed in persons of middle and advanced
age. Men are more subject to stone than women, probably
because a small stone or  gravel will escape through the
urethra of women, which would be detained in the blad-
der of a man.

                 Ofi the Causes ofi Gravel.
   Hippocrates was the first who observed that these con-
cretions  were the consequence of hard water; and this
opinion has been very generally adopted. Dr. Lister has
recently confirmed it by an observation, that the  inhabi-
tants of Paris, who use much  hard water in their  aliment
and beverage, are peculiarly subject to this disease; and
Dr. Percival informs us, that a gentleman and lady in Man-
chester, who had  suffered much from  gravel, were great- 
313
ly benefited  by discontinuing  the  use  of their  pump-
water,  which  was unusually hard,  and  drinking  in its
stead the soft water of a  neighbouring spring.  So bene-
ficial was this change  to  the lady, that she did not  ex-
perience the least  symptom of  the disorder for  two years
afterwards.
  Many practitioners, from an analysis of the stone, have
attributed their formation  to the  use of acids: was this,
however, really the  case, we should  expect to find  the
disease most prevalent in those  counties where an  acid
beverage  is  principally employed.  The  cyder in Here-
fordshire* is generally drank in a state of acetous fermen-
tation,"and I believe no county  in England is more exempt
from calculous  complaints.  Some  have attributed it to
impaired  digestion, to which may be added a deranged
action of the secretory structure of  the kidneys, by which
the blood is there disposed to new combinations, the effect
of which is the production of calculous matter.

        Ofi the Treatment ofi a Fit ofi the Gravel.

   When the gravel or a small  stone  is  passing from the
kidneys to the  bladder,  it produces considerable  pain,
 nausea, vomiting, &c. which  constitute what  is  termed
a fit of the gravel.  During this period  the principal ob-
ject of practice should be to relax the part, and thus ob-
viate  inflammation,  by the loss of blood from the  arm,
 particularly  if the  patient be  of a plethoric  habit; the
 bowels should be rendered soluble by doses of castor oil,
 No. 3, and lavemens of gruel, the latter of which will not

   * It is worthy of remark, that a case of stone has not oc-
 curred at  the General Hospital of this county since its esta-
 blishment, being a period of thirty years.
                           2T 
314
 only  assist the operation of the castor oil,  but act as a fo-
 mentation to the parts affected; for this purpose, the  liquid
 should be injected by means of  a large syringe, that it
 may  be  thrown higher up into the bowels than by  the
 bladder  and pipe  usually  employed. The warm bath, by
 relaxing the system,  will prove a great  auxiliary to these
 means.  After the operation of the castor oil, ten or twenty
 drops of laudanum may.be given, according to the severity
 of the pain.
   The diet during the fit should be low, and the beverage
 barley water, marsh mallow root, or linseed tea.
   When the calculus has passed into the  bladder,  which
 is known by the termination of the pain, the patienf should
 take  the pills, No. 81, with  the  aerated  soda water, as
 recommended under the head of Prepared Natron, No.
 60. Dr.  Falkner, of  Bath, has published  several  cases,
 in  which this water  proved  very beneficial; and in  the
 practice  of  Dr. Blount,  an ingenious  and able physician
 in Hereford, it has been attended with similar success. The
 super-carbonated natron  is also a  very excellent remedy,
 and probably more powerful than  the  aerated soda.water
 (see Prepared  Natron,  No. 60).  An infusion of the wild
 carrot seed has been found to  afford great relief in gravel,
 and the leaves of bear's whortleberry have certainly proved
useful in many instances of stone  and gravel, particularly
when attended with  great pain,  and  coffee-coloured or
bloody urine. Dr.  Saunders directs  two or three ounces
of an infusion of these leaves to be taken two or three  times
a day, made in the following manner:
  Take  of  the leaves of the  bear's  whortleberry,  three
         drachms,
      Infuse a point  of boiling water till cold, then  strain
         for use. 
315
   Spirit of turpentine, balsam of copaiva, sweet spirit ot
nitre, and soap lees, have occasionally proved  beneficial,
and,  after the failure of the preparations of natron, are
well worth a trial.
   Distilled water*  has also  proved  in  many instances
very  serviceable in gravelly complaints; and I am  inclined
to believe if a person were to confine himself to its use as
the general beverage, in lieu of common  water in every
article of diet, he  would experience no return of the com-
plaint provided the kidneys be not diseased.

               OF GUTTA SERENA.

   Gutta  serena is  a species  of blindness,  without  any
apparent disease or fault in  the eye, except a  dilation of
the pupil. When there is a total loss of vision, the disease
is said to be perfect, and imperfect when  there is  a power
of distinguishing light from darkness.                   t

  * In order to ascertain how far it was possible to dissolve a
stone  in the bladder, by means of distilled water  and natron, I
made the following  experiment.  After curing a person of the
gravel by distilled water and the aerated soda water made with
it, with the pills of carbonate of soda, No. 81,  I desired him
to evacuate his urine every night and morning in a pot that
contained a stone extracted from a human bladder.  The urine
was poured off every day;  on weighing the stone in a fortnight,
I found it diminished upwards of two drachms, and the surface
much altered; and in the course of six weeks after, it was en-
tirely  dissolved, although of as hard a texture as  any marble I
ever saw. If the urine be rendered thus capable of decomposing
a stone out of the body, it certainly must be more so  in the
body, whose natural heat  must  assist the chemical action of
the medicated urine on the stone. 
316
              Ofi the Causes ofi Gutta Serena.
   This disease consists in a paralytic affection of the optic
 nerve, in consequence of compression, debility, or poisons.

            Ofi the Treatment ofi Gutta Serena.
   Although three causes are enumerated as producing this
 disease, the mode of treatment to be pursued for the re-
 covery of  the  optic  nerve is the  same, except blood-
 letting, which is only  advisable in plethoric  habits,  or
 when  the disease is attended with a suppression of usual
 evacuations. A seton, or a perpetual blister to the nape
 of the neck, should in  all  cases be employed,  and  the
 discharge kept up for  at least  two or three months, un-
 less contra-indicated by increasing debility of the system.
 As  an  internal remedy,  mercury, in alterative doses, is
 the  most efficacious; and as its  good effects depsnd on
 its deobstruent, more perhaps than its stimulating effects,
 its use should be persevered in  till the  constitution  is
 sufficiently  under its influence,  which is  known by  a
 slight  swelling of the gums and an increased secretion of
 saliva, as there  are many  instances on record that have
 been cured  by salivation, after  other medicines and even
 small doses of mercury had failed. The muriate of mer-
 cury is generally  recommended; but  as  calomel  will cer-
 tainly have as good an effect, and,  on  account of being
 much milder, is, in domestic  practice, entitled to  the
 preference,  it may  be  given by  making  half a drachm
 into twenty pills, one of which  should be taken every
 forenoon and at bed-time, till the gums become  swelled
 and  tender, when they  should be discontinued. It will
 likewise be proper to stimulate the nostrils,  and promote
their secretion; the compound asarabacca powder, snuffed
up the nostrils every night, has been generally employed; 
317
but Mr. Ware  recommends the following powder in pre-
ference :
  Take of turbith mineral, one grain,
       Liquorice powder, eight grains.
Of which this celebrated oculist advises one fourth to be
snuffed up by the nostrils once or twice a day.
  As a local stimulant, (to the balls of the eyes) an infusion
of Cayenne pepper, made by steeping eight grains of the
pepper pods, bruised, in  half a pint of cold  distilled water
in a close vessel for three hours, when it should be filtered
through paper for use. Two or three drops are to be con-
veyed between the  eye-lids twice a day, and persisted in
for  a considerable time. It appears this  application has
been used with success at the Liverpool  infirmary; the
pain  it excites is often so acute as to require  great  forti-
tude  to bear it for a sufficient length of time; when the
patient will not submit to it, the electric sparks  applied to
the eyes twice a day, for six or eight minutes, will often
answer as well, and perhaps in some instances better.
   If these means should not succeed in restoring vision,
the  case  may  be considered of a very obstinate nature,
and should be referred  to an experienced oculist, as Mr.
Ware, of Bridge-street, or Mr.  Charles Piatt, of Great
Surry-street, Blackfriars, whose characters as  such have
been long and deservedly established.

         H.EMOPTOE. See Spitting of Blood.

                   OF HEAD-ACH.

    No complaint perhaps is more prevalent in this  coun-
 try  than  head-ach.  It is  very seldom a  primary  affec-
 tion,  but arises from a variety  of causes, being  often 
318
a symptom of a plethoric state of the system, but more
frequently of local congestion, in consequence of an increased
determination of blood to the head, from the suppression
of customary  evacuations and obstructed  perspiration.
When such head-ach occurs  in a person disposed to  apo-
plexy, and  attended with giddiness, pulsating sensation in
the head, noise in the ears, it should be considered a pier
monitory symptom of an apoplectic fit, and the preventive
means recommended for that disease, page 164," should
be employed without loss of time.
  Head-ach  is frequently  of a rheumatic  nature, when
the  skull-bones are  principally affected, and the scalp  on
pressure appears to be tender; such head-ach is often  al-
ternate with pain in  the shoulder, or some  other parts of
the  body.
  Head-ach  is  very often the  consequence both of  an
increased and diminished excitement of the brain,  when
it is termed Nervous  Head-ach.  This species is generally
produced by  close application of the mind, particularly
on abstruse subjects.  Females are very subject to this com-
plaint from constitutional  causes. It is often  periodical,
and  sometimes  very regular  in its diurnal  attacks. This
species  is  often attendant on debility of the system, and
produced by great evacuations, as loss of blood, frequent
suckling of children, &c. Head-ach is  likewise very often
symptomatic of indigestion; and so great is the sympathy
between the brain and stomach, that it is often difficult to
determine which is really in fault. When it arises from a foul
state of the stomach, it is generally termed sick head-ach,
and is speedily relieved by vomiting. A kind of nervous head-
ach is, I am persuaded, not unfrequently occasioned by inflam-
mable gas;  hoyv this air should produce head-ach is difficult 
319
to say; but certain it is, that the most obstinate head-achs are
often relieved by the expulsion of this air from the intes-
tines. Dr.Baillie states that it is not unusual to find air extri-
cated in the  vessels of the membranes of the brain,  he
thinks, by  some new  arrangement of the particles of the
blood.  Those  who   have had  an  opportunity of  ob-
serving the morbid appearances of the brain, so frequent-
ly exhibited on dissection, will neither be surprised at the
frequency  or the obstinacy  of complaints of the head,
but  on  the contrary, surprised, from  the  disease  that
is so often found in the  membranes  and   the  tumors
in the substance  of the brain, that  the sufferings  of the
patients were not much greater.  A deposition of  earthy
matter  in the coats of arteries is often the  cause of head-
ach  ; and I believe the  blood-vessels are more  often the
seat  of the disease  than the brain itself. They are not
only subject to  a  chronic inflammation, of which  the
deposition of earthy matter is the effect, but also to ulce-
ration,  which by destroying the coats of the  vessel, blood
is effused  within  the  head, and  fatal apoplexy produced;
hence apoplexy is not always the consequence of plethora
or fulness of the  vessels, as is generally imagined.

              Ofi the Treatment of Head-ach.
    When  it arises from  distention  of  the vessels  of the
 brain,  the loss of blood  will be proper, either by leeches
 or   cupping;  or  if the  patient be of a  plethoric habit of
 body, ten or twelve  ounces of blood taken  from the arm
 will 'prove more beneficial,  which  with  the use  of the
 cathartic pills,  No. 80, and  a  spare diet, will  generally
 cure it. Should it resist  those remedies,  a blister should
 be  applied to the  nape  of  the neck,  and the feet im-
 mersed for five or ten  minutes in warm water,  and kept
 warm by flannel  socks;  ether may likewise  be applied to 
320
the temples and forehead, and cold water to  the  head.
People  subject to this  species of head-ach  will receive
great benefit from having their head shaved, and washing
it  every morning with  cold  water, and by  keeping the
feet  warm with flannel socks.  The  means  recommend-
ed for the prevention of  apoplexy, page 164, are  appli-
cable to this  species of  head-ach.  For the  rheumatic
head-ach the tincture of  guaiacum, as directed No. 20,
warm  fomentations,  the  cathartic  pill, No.  80,  small
doses of the antimonial powder, No.  37, and the  warm
bath, are  the most powerful remedies. If it be attended
with plenitude of the system, the loss of blood by leeches
or cupping, and a blister to the nape of the neck, may be
necessary.   The  aperient sulphurous water, taken  as
directed page 8,  has in  many instances  entirely  cured
the patient, after other apparently more  active medicines
had failed. See Rheumatism.
   For the cure of nervous head-ach  the exciting  cause
should  be  avoided, and whatever  is likely to irritate the
mind.  If the digestive organs be affected, an emetic should
precede the exhibition of other medicines, after the due
operation  of  which the  following mixture will  prove
highly beneficial:
   Take of camphorated julap, three ounces,
        Peruvian bark powder, two drachms,
        Valerian powder, three drachms,
        Volatile salt of hartshorn, one drachm,
        Peppermint water, three drachms. Mix.
Three  table spoonfuls to be taken two  or three times a
day.
   Ether may likewise  be applied over the part  of  the
head most affected, as directed page  17,  and a little of
the following powder snuffed up the nostrils, once in about
twenty-four  or forty-eight  hours, which,  by exciting 
321
 sneezing and producing a discharge from the inner mem-
 brane of the nostrils, often affords  instantaneous relief.
   Take of the leaves of tobacco, one ounce,
       Do. of rosemary, six drachms,
       Do. asarabacca, two drachms,
       White hellebore root, two drachms.
 Let  them be well  dried and reduced to a  fine powder.
 This powder has been sold  under  the name of cephalic
 snuff; what is, however, generally sold for it, is the  com-
 mon snuff perfumed, which has little or no  effect. If the
 patient be troubled with flatulency,  a little ginger powder
 may be taken in the common beverage.
   When head-ach arises from bad digestion, which  is a
 very common source of complaints of the head,  the  di-
 rections for the  treatment of indigestion  will succeed in
 curing it.  (See  Indigestion.)  Electricity  has been much
 recommended as a remedy for head-ach, and the appli-
 cation of the electric aura to the head has  often given
 relief.  It,  however,  frequently  recurs  with  increased
 violence; and when it has been the consequence of fulness
 of the blood-vessels of the brain, it has so increased  the
 determination of blood to the head as to produce apoplexy.
   The application of  ether to the  temples, washing  the
 head with  cold  water, the cephalic snuff noticed above,
 a blister to  the nape of the neck, keeping the feet warm
 by wearing flannel socks,  attention to the  state of  the
 digestive organs (See Indigestion), and avoiding full meals
 and  spirituous or vinous liquors,  with moderate exercise,
will, generally speaking, prove of great utility in mitigat-
 ing,  if  not effectually curing habitual or chronic head-achs
from what ever cause they may arise; but in acute head-achs
 from obstructed perspiration, or attendant on fevers, those
 remedies may not be proper, particularly the application
                        2 V 
322
of cold water, ether, or the  sneezing powder.  The cure
of such head-ach  must depend on the nature of the com-
plaint of  which it is a symptom.   In chronic or periodical
head-ach, it is likewise of consequence to attend to the
secretions of the head, particularly of the ears and nostrils;
by increasing  the secretions of the former by introducing
a little lamb  wool moistened with  camphorated oil, and
the latter by the cephalic powder above noticed, the most
obstinate head-achs have been effectually cured: and I have
known many instances  of the most violent head-achs to
terminate in  sudden secretion of a quantity of wax in the
ears. These directions may appear trifling, but in the cure
of head-achs they are often of greater efficacy  than the
most potent medicine.

                OF  HEARTBURN.

                   Description, &c.

   Heartburn consists in an acute burning sensation about
the pit of the stomach, sometimes  attended with great
anxiety, difficulty of breathing, acid eructations, flatulency,
inquietude, and retching to  vomit. It is generally sympto-
matic of bad  digestion, and a frequent attendant on preg-
nancy.

              Of the  Causes ofi Heartburn.

   The  acidity  producing  the   pain in  the  stomach,
commonly, but improperly,  termed Heartburn,  has been
supposed to be the effect of fermentation  of the vegetable
part of the aliment,  in consequence  of weakness of the
digestive organs; but it is  very  doubtful whether fermen-
tation takes  place  in the  stomach, or  if it  really  do,
whether  it be of the acetous kind, as generally imagined. 
323
Mr. Parkinson thinks it very improbable from the animal
matter present, and by the difference of time requisite to
effect the changes of the two fermentations  (the vinous
and acetous). In the gastric fermentation,  this intelligent
author observes,  " the changes  are effected with much
greater rapidity than in the acetous. Some  days are neces-
sary for the duration of the  acetous fermentation before
the acetous acid (vinegar) is produced; but very frequent-
ly within a few minutes after taking a glassful  of  weak
wine, sour belching will denote the formation of the morbid
acid. The difference of the acids proceeding from the two
fermentations, affords another objection. The acid produced
by fermentation in the stomach yields a taste very different
to that of vinegar: those who are subject to the unpleasant
occurrence of acid  eructations, often say that its taste is
very different from that of vinegar, and that it also affects
the organs of taste in other respects in a peculiar manner."
Mr. Parkinson concludes, that " the acid thus formed, is
rather of an animal than vegetable nature.  A deficiency of
the mucus, which defends the coats of the  stomach,  the
irritation of pungent or spicy aliments,  and ulceration or
organic diseases of the stomach, are causes of heartburn."

               Ofi the Cure of Heartburn.
   The treatment  of heartburn  must depend on its  ex-
citing cause.   When  it is  produced by  acidity in  the
stomach, magnesia, No.  1, or prepared natron, No.  60,
the cretaceous powder,  No.  29, or salt  of wormwood,
No. 21,  taken  as  directed under their respective heads,
will,  by  neutralizing the  acid, speedily relieve the pain,
and as  it is the effect of  indigestion, stomachic  bitter
should accompany the use of such  medicines, in order to
prevent  its recurrence; for  this purpose  the following 
                m •       324
mixture will prove very beneficial, after  the  stomach ha;.
been cleared by an emetic:
  Take of prepared natron, No. 60, a drachm and half,
       Sp. sal. volatile, one drachm,
       Tincture of ginger and camomile, No.  7,  three
         drachms,
       Pure water, seven  ounces. Mix.
Two table spoonfuls  to be taken three  times a day.  It
the patient have an aversion to medicine in a liquid form,
the following pills will prove  equally efficacious:
  Take of extract of camomile flowers, one drachm,
       Dried natron, half a drachm,
       Powdered rhubarb, one scruple,
       Oil of carraway seeds, eight drops.
Mix well together and divide into twenty-four pills, two or
three of which are to be taken twice a day.
  A wine-glass of lime  water, or  a draught  of  spring
water,  will generally  afford instantaneous  relief, the for-
mer by destroying the acidity, and the latter by diluting
it. The diluted  vitriolic  acid, taken as directed No.  18,
will often succeed in  curing heartburn after the  absorbent
and alkaline remedies  above  have failed to remove it
entirely, by preventing  the   formation  of  acidity.  The
same rules as to diet and exercise should be observed, as
recommended in cases of  indigestion.
  If the  pain should recur,  notwithstanding the  use  of
these remedies  and proper attention  to diet, a diseased
state of the stomach may be suspected, when the use of
alterative  medicines  may also  be necessary,  in  which
case the advice of an experienced practitioner should be
taken.
   When a deficiency of mucus is the cause, animal jelly
will be proper; and, when it occurs in a gouty habit, two
tea spoonfuls of the volatile tincture of cascarilla, in a 
325
wine glassful of lime water, every three or  four hours,
will generally afford relief. (See Prevention of Gout.)
   When  it  accompanies  pregnancy,  the   solution of
Epsom salt, as directed page 7, with the  use of the di-
luted vitriolic acid, No. 18, has in my practice uniformly
succeeded;  but such  cases often require a variety of
treatment according as it is attended with a  relaxed or
costive state of the boyvels.

            OF HICCUP, or HICCOUGH.

            Definition and Causes ofi Hiccup.

   Hiccup is a spasmodic affection of the  diaphragm,  com-
monly called the midriff, and generally arises from the irri-
tation of acidity in the stomach, error of diet, poison, &c.

                Ofi the Cure ofi Hiccup.
   When  acidity  is the  cause, twenty drops of  spirit
sal volatile, No.  13, with a  tea spoonful  of magnesia,
No. 1, in a glass  of mint water, will afford  relief, and
its  occurrence may be prevented by  the use  of the tonic
mixture, No.  77.   When the  consequence of improper
food,  an  emetic will be  necessary;  and when produced
by poison, the treatment recommended  for counteracting
the effects of poison, page 97.
   If the spasms continue  violent,  a tea spoonful of ether.
with eight drops of laudanum, in a glass of cold water, will
prove the best remedy.  Ether  may  likewise   be applied
to the pit of the   stomach, and the feet  immersed in
warm water.
  This affection is often cured  by whatever suddenly ar-
rests the attention,  whether the  passion  connected there-
with be of the stimulating or debilitating kind.
  In children hiccup often arises from  an acid state of 
326
 the contents of  the stomach, in consequence of overfeed-
 ing ;  when magnesia and  rhubarb,  in  a little mint-water,
 will afford the  best  remedy, but when  it occurs  in long
 bowel complaints, the compound cretaceous powder will
 prove more beneficial.  People subject to hiccup should
 particularly attend to the directions given for the preven-
 tion of  indigestion.

      OF THE HOOPING, or CHIN-COUGH.

   Thfe disorder is generally considered to  be infectious.
 It is  often epidemic, and occurs but once in a life-time;
 hence children are generally the subjects of  it.

           Ofi the Symptoms of Hooping Cough.

   It commences with the symptoms of common catarrh,
the cough  gradually  becoming more  violent  till  it  is
evidently  convulsive,  the  patient  not  being  able,  often
for a  considerable time, to respire ; and at  length respi-
ration is  affected with  a  shrill kind of  noise, like the
crowing of a cock. These  fits are attended with so  great
a  determination to  the head,  that  blood  is often dis-
charged from the nose or  mouth.   The  eyes  appear
much swelled, and the  fit often terminates in  vomiting.
It is seldom attended with fever.

            Of  the causes of Hooping Cough.

   It is  apparently produced by  a peculiar contagion of  a
specific  nature.*  With respect to the seat of the disease,

   * If this disease be produced by the introduction of a specific
contagion  into  the system, it is a curious and  unaccountable
circumstance, that its action should be  principally confined to
the muscles of  the midriff. 
327
there are a variety of  opinions.  Dr.  Butter,  who has
written expressly on the  subject, refers it to the intestines;
and observes, that neither the stomach nor lungs are con-
cerned in it. Walschmeid  says, it proceeds from a dis-
order of the stomach.  Hoffman attributes it to thin and
acrid juices in the  air vessels  of  the lungs; and others,
with more apparent probability, assert, that it arises from
a convulsive action of the midriff.  It evidently commences
in the lungs, and afterwards extends to the midriff,  the
violent spasmodic affection  of the  muscles of which occa-
sions the hooping noise.

          Of the Treatment of Hooping Cough.
   The cure should be attempted first by  an emetic of the
tartarised antimony wine,  No.  16, and afterwards  the
mixture,* No. 76.  The pectoral  plaster,  Nft^R should*
be applied to the pit of the stomach; and if tne patient be
plethoric, a blister  between the shoulders, and loss of a
few  ounces  of blood, should not be omitted.f  In the early
stage of the complaint, these remedies will generally prove
sufficient to effect a cure; but if by neglect the disease be
once established, it will often run  its course in defiance of
the most powerful medicines.
   This  disorder may be effectually cured by putting the
system  under  the temporary influence  of the vegetable

   *  The efficacy of  this  medicine principally depends on the
assafcetida it contains, which, on account of its nauseousness, is
generally rejected by children. In such case it may  be given
rlysterwise,  by dissolving ten grains of assafcetida gum in three
or four ounces of gruel.
   t  If the patient be of  a scrophulous habit or consumptive
make, this advice should  not be neglected, unless contra-indi-
cated bv general weakness of the  system. 
328
    poisons; for this  purpose the extracts  of hemlock,  the
    henbane,  and  deadly  nightshade,  have been  employed
    by different practitioners, and each have  their advocates.
    As children are differently affected by these medicices, it
    is impossible to give  a general form for  their exhibition;
   for, unless a certain  effect be produced in the  system to
   counteract the  action  of  the  contagion,  it  will prove of
   no  avail.  The  hemlock is  much  recommended  by  Dr.
   Butter, who relates twenty cases that were cured  by it:
   this author prefers  the extract,  but the powder of  the
   herb is unquestionably the best preparation, and the only
   one to be  relied on, (for reasons assigned, p. 118).  Some
   physicians prescribe it with  other medicines, as syrup of
   r.pppies, ipecacuan and  oxymel of squills; but as they may
   interrupt its peculiar operation on the constitution, it should
v#ue giv^Blply in a very simple vehicle.  I  have generally
   employerRIre following form, and when properly managed
   so as  to affect the system, which  is manifested by nausea
   and giddiness, I have never known it to fail.
     Take of powdered hemlock leaves, one scruple,
          Mint water, two ounces,
          Simple syrup, two drachms. Mix.
   A tea spoonful  to be given  three times  a day, to a child
   of any age, increasing the dose each time about ten drops,
   till it produces the effects above noticed.
     An emetic should always precede the use of this medi-
   cine;  and if acidity  prevail  in  the  stomach, the  occa-
   sional exhibition of magnesia, as  directed  No. 2, or pre-.
   pared natron, No. 60, will also be necessary,  to which a
   little rhubarb powder may be added in case of costiveness.
   The extract of  tobacco, in the dose of one or two grains,
   dissolved  in a  little simple water,  is a very  favourite
   remedy for hooping cough  with the physicians in  Ger- 
329
many.  It is certainly  more safe than hemlock, henbane,
or the deadly nightshade, and probably not less, if not
more, efficacious. The  application  of a blister over the
breast bone, or between the shoulders, should on no ac-
count be neglected, particularly, if the child be  born of
consumptive or scrophulous parents; it will prevent much
mischief, and if  it happen to produce strangury, it will,
without any auxiliary, cure the disease. The almost imme-
diate cessation of the disorder, in consequence of strangury,
has induced many practitioners to give the tincture of
cantharides in small doses of  ten drops, with a view of
exciting that affection; and when it succeeds in this effect,
it never fails to cure the disease on  the principle of a
peculiar counter-irritation.
   If the patient  be much weakened,  the use of wine may
be necessary, and the following bark mixture,*^'recom-
mended by Dr. Temple:—
   Take of decoction  of bark, three ounces and a  half,
       Paregoric elixir, half an ounce,
       Tincture of cantharides,  forty drops.
The close  from  one to two table spoonfuls every four
hours; it requires, however, much judgment to determine
when such medicines are proper;  for, although the patient
may be much reduced, there may be a preternatural dis-
tention of the vessels of the  lungs, in which  case  the
Peruvian bark would assuredly  prove very injurious.
   Dr. Hugh  Smith, after observing that  emetics, occa-
sionally repeated are of great  service, and blisters, when
the symptoms are urgent, directs the  following:—
   Take of musk julap, six ounces,
       Paregoric elixir, half an ounce,
       Volatile tincture of valerian, one drachm.
Two or three table spoonfuls to be taken every three or
four hours.
                           2X 
330
   This disease,  as  I observed before, if uninterrupted
by medicine,  will run a certain course;  but  it frequently
happens that,  after the usual period, the cough continues
from habit, in which case change of air will be of essential
service, and  generally cure  it in a few days.  The diet
should be adapted to the strength and age  of the child.  In
general, equal parts of barley water  and  fresh milk will be
sufficient both for the common  beverage  and  diet.
   When the disease resists the ordinary  means  above
suggested, the basilic powder, as directed,  No.  36, will
prove very beneficial,  especially if the patient be  affected
with worms.* When  the  cough is become  of a  chronic
nature,  it may often, if not  always, be  cured by  keeping
up an healthy  digestion, and avoiding those  things  which
are likelyto disorder the stomach. See Indigestion.
   Whe^wis disease proves fatal,  it is by  producing con-
vulsions,  inflammation of  the lungs or  brain;  and  in
scrophulous habits, consumption of the lungs; the  preven-
tion of which  should be a principal  object of practice.  It
cannot, therefore, be a proper case for domestic medicine.

   OF HYPOCHONDRIASIS; OR, THE HYPO-
           CHONDRIAC  AFFECTION.
      (Commonly called Vapours, or Low Spirits.)

   This disease, says  the immortal Cullen, is distinguish-
ed by a concurrence of the  following circumstances:  A
langour, listlessness, or want of resolution  and activity,

   * The existence of worms in the stomach is often a cause of
the obstinacy of this disease. I have known several instances of
its ceasing soon after an evacuation of worms. 
331
with respect to all undertakings;  a disposition to serious-
ness, sadness,  and timidity as to all future  events;  an
apprehension of the worst or most unhappy state of them,
and  therefore often, on  slight  grounds, a dread  of great
evil. Such  persons are particularly  attentive to the state
of their own health,  and to the smallest change of feel-
ing in their bodies; from any unusual sensation,  perhaps,
of the slightest kind, they apprehend  great danger,  and
even death itself; and, in respect to  all these feelings and
apprehensions, there  is, for the  most part unfortunately,
the most obstinate belief and persuasion.  It is generally
attended with symptoms of indigestion, but not always;
also hysterical affections, and sometimes with melancholy.
   This turn of  mind seldom appears early in life,  and
more usually  in advanced age; but  when it has once
taken place,  it generally goes  on increasing. It js  chiefly
to be attributed  to  imbecility of mind, or weakness of
imagination,  and  when far advanced, may be  considered
little less than a species  of insanity,  arising from a want of
that natural energy of mind, or proper  education, which
might have  induced the person to have engaged in the
rational pursuits and pleasures of life.

         Of the  Treatment ofi Hypochondriasis.
   No disorder admits of greater scope  for the  manage-
ment of  the  passions, perhaps, than  hypochondriasis,
which manifests  itself  in  its effects on  the  mind  and
spirits. Greater delicacy, however, is here requisite than
is generally  allowed by practitioners. It is the practice
of such patients often to change their medical  attendants,
which is certainly not altogether inconsistent; for if the
physician do not admit the reality of  the disease, it  is
not to be supposed that  he  will take much pains in curing 
332
it, or to avert a danger of which he entertains  no appre-
hension.  The sufferers are mostly of  a gloomy  disposi-
tion,  and subject to  great  despondency  of mind concern-
ing their own situation in point of relief, and want cordials
and exhilarating  remedies to the mind as well as  body.
To treat such disorders  as  merely imaginary, generally
irritates choler, and impresses  a belief that their friends
have  but little concern for their safety and welfare; and
on the other  hand to coincide in opinion concerning the
melancholy situation of such persons depresses the spirits,
and  tends  above all  things  to  aggravate the  complaint.
The itiost judicious course,  says Dr. Falconer, seems to
be to endeavour to excite the  fortitude of the sufferers,
by representing to them that it  is unworthy a  brave and
resolute  character  to  be  always complaining of misfor-
tunes which are,  in a great measure,  the common  lot of
mankind; that it is more manly to struggle with ill fortune
than to sink without resistance beneath its pressure. The
learned Sauvage observes, that the attendants  on such per-
sons should constantly endeavour to abstract their mind as
much as possible from reflecting on their own  situation and
condition of health.
   The firm  persuasion that generally prevails  in such
patients, does not therefore allow their feelings  to be
treated as  imaginary, nor their apprehensions  of danger
to be considered as groundless, though we  may be per-
suaded it  is the case  in both  respects.  Such patients
cannot be  treated  either  by raillery or  reasoning. Dr.
Alexander observes, the  best way is to keep the  mind
closely engaged in some useful or   agreeable  pursuit;
hence we learn the superior advantages of those situations
in life which more immediately call  for intellectual ex-
ertions and bodily exercises. " Industry seldom fails to
place us above want,  and  activity serves us  instead of 
333
physic." In  fact, none  are  so wretched  as  those  who
have nothing to do: they are useless to others, they are a
burden  to  themselves.*  Constantly impressed with the
apprehension of some imaginary evil, they either become
the victims of despondency, or the dupes of ignorant and
unprincipled pretenders to physic, whose sole aim seems
to be  that of  enriching  themselves  at  the expense of the
follies or conceits of mankind.f
   As it is the  nature  of man to indulge every present
emotion, so the  hypochondriac cherishes  his  fears, and *
attentive to  every  feeling,  finds,  in  trifles light as air,
a  strong confirmation  of his apprehensions;  his  cure,
therefore, depends upon the interruption of his attention,
or upon its  being diverted to other objects than his own

   * " Absence of occupation is not rest,          A-
    '< A mind quite vacant is a mind distrest."

   t If, in any  case, the pious fraud of what is termed a pla-
cebo be  allowable, it seems  to  be in treating hypochondriacs,
who,  anxious for relief,  are  fond  of medicines,  and though
often disappointed, will still  take every new drug  that can be
proposed to them.  Hence they generally become the dupes
of quacks; and it is a  well-known fact, that  many Jew ped-
lars, coblers, and carpenters, have amassed considerable wealth,
by imposing  on them their nervous cordials, Sec. and if this
practice was confined to such patients, instead of condemning
it,  I  should be  disposed  to encourage the fraud; for if  the
imagination  be diverted  by  them,  the  purchase  cannot be
considered dear at any rate; and  if the  medicines  did  not
bear a high price,  they would  not meet with a proper degree
of confidence. 
354
  feelings.  Whatever aversion to application  of any kind
  may appear,  there is  certainly nothing more  pernicious
  to  them  than absolute  idleness,  or a  vacancy from  all
  earnest  pursuits.   It  is  owing to wealth,  admitting of
 indolence, and leading to the pursuit of transitory  and
  unsatisfying amusements,  or  to that  of exhausting plea-
  sures only, that the  present  times  exhibit to us so many
  melancholy instances of this  depraved  state of imagina-
  tion. The  mind  should not only be diverted  from this
* bodily  affection,  &c.   by employments suitable  to the
  circumstances and situation in  life, and unattended with
  much emotion, anxiety, or fatigue; but *also by  various
  kinds of  sport and hunting,  which, when  pursued with
  some ardour and attended with exercise, if not too  violent,
  are  amongst  the  most  useful.  Within  doors,  company,
  which enjgages attention,  willingly yielded  to,  and is at
  the  same time of a cheerful kind, will be  always found
  of great service.  Play,  in which some skill is required,
  and where the stake is not an object of much  anxiety, if
  not too long protracted, may often be admitted.  Music,
  to  a nice ear, is a hazardous amusement, as long atten-
  tion to it is very fatiguing.
   When  amusements of every  kind are  rejected,  mecha-
  nical means  of interrupting thought are the remedies to
  be  sought for.  Walking  is seldom of  this kind,  though,
  as gratifying to the restlessness of hypochondriacs, it has
  sometimes been found useful.  The required interruption
  of thought  is best obtained by riding on  horse-back, or
  in driving a carriage  of any  kind. The exercise  of sail-
  ing, unless  in an open  boat, engaging  some  attention,
  does very little service. Exercise in an easy carriage, in
  the  direction  of which the  traveller takes no practice,
  unless it be  on rough roads, or  driven pretty quickly, 
335
and of long continuance,  is of little advantage. The exer-
cise that will prove most effectual, is that which is em-
ployed in the pursuit of a journey; first, because  it with-
draws a person from many objects of uneasiness and care
which might present themselves at home: secondly,  as it
engages  the person in more constant exercise, and  in a
greater degree than is commonly taken in airing near home:
and lastly, as it is constantly presenting new objects which
call forth a person's attention. The symptoms of indigestion
and hysteric complaints that so frequently attend this  state
of mind, although the effect rather lhan the  cause, are ob-
jects of practice, in as much as they tend to aggravate and
realize the false apprehensions of the patient. These secon-
dary affections require the same  mode of  treatment as
recommended  for indigestion and  the hysteric  disease.
Warm bathing and the drinking of tea and  coffee, which
are extremely hurtful to people with bad digestion,  gene-
rally afford relief to the hypochondriac.
   The ancient physicians (upwards of two thousand years
ago) were of opinion that the seat of this disease  is in
those parts of the body that lie under the spurious rib on
both sides, termed hypochondria;  hence it was named by
them the hypochondriac disease,  and  it must be allowed
that the unfortunate  state of mind constituting hypochon-
driasis, is often symptomatic  of some morbid or  indolent
state of the  viscera that occupy these places of the body,
and  particularly  the  liver,  which on the  dissection of
hypochondriac patients, is generally found much diseased,
and  the spleen preternaturally enlarged.  In such  cases,
which I believe to  be the most  prevalent, the following
medicines will prove very beneficial,  by removing visceral
obstructions,  promoting digestion,  and preventing  that
accumulation  of  inflammable  air in  the intestines, with 
336
 which all hypochondriacs are more or less affected, and
 to which alone many attribute their sufferings, and pro-
 bably is a principal cause of the mental distress and ner-
 vous irritability.
  Take of Rufus's pill, one  drachm,
       Prepared calomel, fifteen grains. Mix.
 Divide  into fifteen  pills, three to be taken two or three
 times a week, and  three table spoonfuls of the following
 mixture, two or three times a day:
  Take of prepared natron, two drachms,
       Tincture of ginger and camomile, half an ounce,
       Compound spirit of lavender, half an ounce,
       Pure water, twelve ounces. Mix.
  The same rules as are given for the diet of people affec-
 ted with indigestion, should likewise be observed by hypo-
 chondriacs. See Indigestion.

         OF THE  HYSTERIC PASSION.

  This disease  consists  in too great a mobility and  irrita-
bility of the nervous system, and is consequently produced
by  whatever weakens or renders the body irritable; it
most commonly appears in females; but sometimes, though
rarely, attacks males in a slighter degree.

             Ofi the Symptoms of Hysterics.

  Hysteric fits commonly begin with some pain and ful-
ness in the left side  of the abdomen; from  which a ball*
seems to move with a grumbling noise into the other parts
of the bowels, and making as it were various convolutions,

  * This sensation is usually termed the Hysteric Ball, and is
probably produced by  a spasmodic contraction of the muscles
of the gullet. 
337
seems to move into the stomach, and more distinctly still,
rises up to the top of the gullet, where it remains for some
time, and by its pressure on the windpipe, gives  a  sense
of suffocation. By the time the disease has proceeded thus
far, the patient is affected with  a stupor and  insensibility,
while at the same time the body is agitated  with" various
convulsions, the trunk  being writhed  to and fro, and the
limbs variously agitated; commonly the convulsive motion
of one arm is that of beating the breast very  violently and
repeatedly with the closed fist.  This  state continues for
some time, and has during that time some remissions and
renewals of the convulsive motions, but they at length cease,
leaving the patient in a stupid and seemingly sleeping  state.
More or less suddenly, frequently with repeated sighing
and sobbing, together with a murmuring noise in the bow-
els, the patient returns to the exercise of sense and motion,
and generally without any recollection of  the several cir-
cumstances that had taken place during the fit.
  In females, this  disease occurs from the age of puberty
to that of thirty-five years, and very rarely appears before
the former, or after the latter of these periods, and  gene-
rally attacks about the time of menstruation:  it affects the
barren more than the breeding woman, and  the  sanguine
and robust more than the phlegmatic and melancholic.
  It sometimes arises  in young women  from* a peculiar
turn of mind, when the passions are high, and the ima-
gination heated. *

  * Dr. Keighley very justly observes, " that the sentimental
novels which fill our circulating libraries, and are  read with avi-
dity both by mothers and daughters under the mask of morality,
                         2 Y 
338
          Of the  Treatment of the Hysteric Fit.
   The.fit may be relieved by the anti-hysteric mixture,*
No. 65, to each dose  of which,  in obstinate  cases,  a
tea spoonful of ether,  and ten drops  of laudanum, No.
31,  may be  added. The  feet should  be  immersed  in
warm water, and spirit  of hartshorn, No. 12,  or  smelling
salts, No. 39, applied  to  the nostrils, and  cold  water
sprinkled over or poured on the face. If the patient be
incapable of swallowing, two  drachms of the tincture of
assafcetida may be administered clysterwise, in half  a pint
of gruel; and in  case the subject be young  and plethoric,
the loss of six or eight  ounces of blood from the  arm will
be necessary; this  remedy, however,  should  not be had
recourse to, without the sanction of a regular practitioner
in medicine.
  Hysteric fits often arise from a disordered  state of the
digestive organs, or  at  any  rate  the  nervous system is
rendered irritable  by  it, and of  course  favourable  to
hysteric  affections. During the absence of  the fit,  it will
be  proper to  produce  healthy  digestion,  by strength-
ening  the  stomach,  and of  course  the nervous system
by the use of  the tonic mixture, No. 61, as there direct-

are more in^irious to female virtue than the most openly licen-
tious and immodest publications."
   * It is rema'kable that the most nauseous medicines in the
materia medica were recommended by the ancient physicians,
and are still employed in the cure of hysterical  complaints. As
these remedies manifest  no anti-hysteric  property when ad-
ministered during the hysteric  paroxysm, it is probable that
their operation on the body is through the disgust  they produce
in the  mind;  and  as the  ancients paid more attention  to the
management of the mind during disease  than the moderns,  it
was perhaps with this view that they were first  prescribed. 
339
ed, to which a drachm of prepared natron may be added in
case of acidity in the stomach. Costiveness should likewise
be obviated, by taking every morning a  dose of the solu-
tion of Epsom salts, as recommended No.  2; cold  bathing
will also  prove  very  beneficial by  quieting the nervous
system.
  A morbid sensibility appears always to accompany this
complaint, which  is very  liable to be  excited  by  the
passions  of the  mind. The learned  Sauvage  observes,
nothing contributes to aggravate  it more than indolence
and vacancy of mind. Dr.  Falconer, therefore judicious-
ly observes, that some interesting  pursuit that will occupy
the  attention,  should by all means  be sought and assi-
duously followed;  even  fear itself,  gradually introduced,
and where no imminent danger is apprehended, has been
efficacious in  preventing this  disorder. The displeasure
of a parent, supposed  likely to be incurred by the return
of  the hysteric fit,  has contributed to prevent  it; and
it is noticed by this able writer, that during the troubles
in Scotland in the years 1745 and 1746, this disease scarcely
made its appearance. Hysteric, as  well as epileptic fits, are
very apt to recur on the sight of people so affected. Dr.
Falconer  observes, that he once had  an opportunity of
seeing an instance of this kind at  a public watering place:
a lady was seized with hysteric  convulsions during the
time of divine service; in less than a minute six  persons
were affected  in a similar manner, some of whom had
never before been subject to such attacks, but were notwith-
standing  violently agitated and  convulsed both in body
and mind. But though such instances  as these show the
propriety  of prudent caution, yet too great a solicitude to
avoid  every thing likely to give  uneasiness, especially if
such solicitude be  very  apparent, is likely to do as  much
mischief as service. Nothing so much enhances  the appre* 
340
 hension of  danger,  or so  often  causes those on whose
 account the care is taken, to believe the hazard is greater
 than it really is; and  such circumstances frequently recur-
 ring, keep them perpetually  in a state of painful irrita-
 bility, which in reality constitutes the disorder.  It would
 be much better to inure such persons gradually to the com-
 mon occurrences of life, and  to the occasional mention of
 such things, which  if not  magnified  by the relators,  or
 dwelt on as meriting particular attention, will come in time
 to be disregarded and their  effects destroyed.  Instead of
 this, it is  too  usual  with  parents to  foster the sensibility
 of  their children, especially females, to an unnatural de-
 gree, by  officious attention to  remove  every thing that
 can give the least interruption to  pleasure, or even awake
 the  mind to its natural and  necessary  exertions. Affec-
 tion contributes its share to enhance these complaints: an
 unnatural and morbid sensibility is often encouraged under
 the idea of delicacy and tender feelings; and efen sickness
 itself is sometimes feigned,  as being imagined, though
 falsely, a mark of a disposition of this kind. But if we take
 the trouble of examining human nature more  accurately,
 we shall find, that the liberal and truly amiable virtues of
 humanity and benevolence are  much more frequently found
 in persons  of a steady mind and temper, who have experi-
 enced Variety of fortune, than in  those  who  have passed
 their lives  in an uniform course of luxurious indulgence,
 which  always generates selfish and mean ideas  and  sen-
 timents.*
  It is remarked by an eminent moralist,! that men who
have met  with an uniform  compliance with their  will,

  * See Falconer on the Passions, page 134.
  t Montesquieu. 
341
are inclined to cruelty and severity. A mixture of adverse
with prosperous  fortune  is,  he observes, necessary to in-
spire humanity and pity.

             Of the Distinction ofi Hysteric.
  The hypochondriac affection in women is often mistaken
for this disease:  it may, however, be distinguished from
hypochondriasis, by  its occurring  at the  early period of
puberty, while the hypochondriasis  does not occur till after
the age of thirty-five: hysterics, likewise, attack the san-
guine and plethoric; but hypochondriasis the melancholic.

        OF INCONTINENCE  OF URINE.

                    Description, &c.:
  An  involuntary evacuation of urine,  or an inability to
retain  it.

          Ofi the Causes ofi Incontinence ofi Urine.
  It arises from weakness or palsy of  the muscle  of the
bladder,  called the  Sphincter;  sometimes from calculous
concretions, irritating the neck of the bladder, or from
injury  of  parts in the operation for extracting the stone;
from pressure of the womb in a state  of pregnancy, and
sometimes in women from a communication  between the
bladder and vagina.

       Ofi the  Treatment ofi Incontinence ofi Urine.
  When it arises from the want of tone or power in the
muscular fibres of the bladder, a blister  should be applied,
low  down on  the back-bone,  and  to the part termed the
perinaum. The  tonic mixture, No.  66, should be taken, 
342
with ten drops  of tincture of cantharides in each dose,
with cold-bathing, electricity, and a generous diet. When
it is occasioned by stone or gravel,  it requires  the same
treatment as already recommended for the latter disease.
When the effect of injury, sustained in the operation for
the stone, great relief is afforded by the pressure of the
instruments called Jugum and  Pessary.  When it is pro-
duced by an impregnated womb, an horizontal position
should be observed  as  much as possible; and when, from
a communication between the bladder and vagina, it will
neither  admit of cure or relief.  This  distressing case is
generally  produced by  inflammation, and ulceration suc-
ceeding  difficult  parturition,  and is  often  attributed  to
palsy or loss of tone  in the muscular fibres of the bladder,
and as such I have known it treated by the first physicians,
to the great  injury  of the patient;  practitioners  should
therefore  satisfy  their  minds as to  the real cause of  the
disease, before they prescribe active remedies for its cure.

                OF INDIGESTION.

                Symptoms ofi Indigestion.
  A loss of appetite, transient distentions of the stomach
and bowels from flatulency, eructations, heart-burn,  gene-
rally costiveness, squeamishness, sometimes vomiting; the
body at length, for the  want of proper nourishment, be-
comes much  emaciated, and affected with symptoms  of
general debility and  a variety of morbid actions in  the
system.

              Ofi the Causes ofi Indigestion.
  It is generally supposed to arise from a loss of tone in 
343
the muscular fibres of the stomach,* induced by the too
free use of spirituous liquors,"]'  by poor diet, the over dis-
tention  of the stomach, too  great  a quantity  of  warm
relaxing  liquors, as tea and  coffee,  acid unripe fruit, an
indolent  and  sedentary life, close application or anxiety
of the mind, or whatever may tend to weaken the  diges-
tive organs.  A  vitiated or deficient  secretion  of the
gastric juice is likewise  often the cause of bad digestion.
  The prevalency of indigestion in  this country is to be
attributed to inactive  life, error of diet, and the great use
of  spirituous and vinous liquors.  With respect to our
natural food, the  formation of  the  teeth  and  intestines.
prove  that we  are destined to live  both on animal and
vegetable  aliment; and we certainly  find  the flesh of
animals, with  a proportionate  quantity  of  vegetables,  a
diet best adapted to  our frame.J  It is not,  however, in

  * There  are so  many  organs  concerned in the  process of
digestion, the  formation of chyle and  blood, that  we  cannot
be surprised (says  that excellent writer  Dr. Trotter) at the
effects of hard drinking in deranging them; want of appetite
and bad digestion are  therefore common with drunkards ; the
frequent  use of. spirits, by injuring the coats of the stomach,
procure a vitiated secretion of the gastric juice.
  t Weakness or relaxation of the stomach, is  not perhaps so
frequently the cause of indigestion as a morbid secretion of the
gastric juice, or a deficiency of bile, as the symptoms of indi-
gestion frequently  occur  in the most robust people, in  whom
weakness of the stomach cannot be suspected.
  \ What  is  the  exact  proportion of animal and vegetable
nourishment which is most conducive to health, cannot per-
haps be fully  ascertained; but we may admit  it as a  general
rule, that two-thirds or three-fourths of vegetables  to one-third
or fourth of animal food, is the most proper. 
344
 the quality, but  the quantity  of  food, in  which  man
 generally  errs.  No greater  quantity  should  be  taken
 than is required by nature to supply the waste the body
 has sustained, which will  depend on the  degree  of ex-
 ercise it  has  gone through.  The quantity  should there-
 fore be proportioned  to  the degree  of exertion the body
 undergoes, and not  to the artificial  appetites excited by
 the  use   of   bitters,  or  spirituous liquors.   Nothing
 strengthens the digestive  organs  more  than an  active
 life, which is  evinced  by the  great appetite and good
 digestion  of people  who are  compelled by necessity to
 earn their bread by  their  daily  exertions ;* indolence is
 therefore  one cause of indigestion in this country,  parti-
 cularly among  ladies of  fashion.  The principal  cause,
 perhaps, among gentlemen,  is  the  abuse  of spirituous
 liquors; I mean the practice of drinking  a  quantity of
 wine during  and after meals.  The  port and sherry wine
 consumed in  this  country are mixed with  a quantity of
 strong brandy or alcohol, which is done  (as the dealers
 in these articles say) to adapt  it to the British  palate,
 and render it fit for keeping: so that instead  of wine, it
 is really nothing less than  a weak spirit; indeed, such is
 the quantity of  spirit in  port wine, that  I have  obtained
nearly six ounces of  alcohol from a quart.   This spirit is
extremely pernicious  to  animal life, and  by repeated use,
will certainly prove (although gradual)  a certain poison.
 After the  stomach  has been accustomed to its  stimulus,
it requires a repetition to keep up its effects,  and  as  life
advances,  so an additional quantity  becomes necessary;
thus the inner coat  of the stomach is  injured,  the pylorus

  * Dissection demonstrates, that the coats of the stomach of
a labouring man are very considerably  thicker and stronger
than those  of a sedentary person. 
345
 •ften  rendered scirrhous,  and  the gastric juice will   of
 course,  be  vitiated,*  and  the  foundation  of the  most
 distressing complaint that  can possibly assail  the  human
 Frame laid before  the  meridian 'of life. The  great  num-
 bers  that  die  of scirrhosityf of the  pylorus  (which ter-

   * The effects of a morbid secretion  of the gastric juice  are
 generally,  if not always, erroneously attributed to a  vitiated
 state of the bile. See Bilious Affections.
   t Ardent spirit hardens and contracts the animal fibre, and
 coagulates  the juices; hence the sensibility of different organs
 is gradually exhausted, and the vessels for conveying fluids are
 lessened  in their diameter and ultimately obstructed. A scirr-
 hus of the pylorus and liver  especially, are frequent concomi-
 tants  of habitual  inebriety.  But  the intestines, the pancreas,
 spleen, and perhaps the kidneys,  are  also liable to the same
 affection; all of which are, after a  certain time, incurable, and
 often  speedily fatal.   The dram and purl drinkers may sooner,
 experience  these evils than  other drunkards;  but even  the
 guggler  of small beer has no security against them:  nay, so
 sure and  uniform is this effect of producing diseased bowels by
 fermented liquors, that in distilleries and  breweries, where hogs
 and poultry  are fed on the  sediments of barrels, their livers
 and other  viscera are observed to be enlarged and hardened
like  those  of the human body, and were these  animals  not
killed at a certain  period, their flesh would be  unfit to eat,
 and their  bodies become emaciated. Trotter on Drunkenness,
 page  114.  See  also  Baillie's Morbid Anatomy,  Diseases  of
the Liver,  and Morgagni de Causis et Sedibus ubicunque  de
 Sectionibus Temulentorum disserunt. Several well authenti-
 cated cases of spontaneous combustion of the human body,  in
consequence of  the long immoderate use of spirituous liquors,
 have been  published* in England and  on the continent,  by

  * By Pierre Aimie Lair, in the journal de Physique Pluvoise, year 8,
 Branching Mossei, Rolli, Le Cat. Vicq.  d'Azyr, and several men dis-
tinguished for their learning-, have given certain testimony of the fac^,
                           2 Z 
346
 minates in cancer)  and apoplexy,*  brought on  by the
 abuse of spirits, is  a melancholy  proof of this assertion.
 Independent  of superabundant alcohol  in wine,  I  have
 also detected a quantity of lead in solution;  indeed, this
 practice is become  so  prevalent, on  account  of the  plea-
 sant  astringency  it  imparts  to it,  that  I thought it  in-
 cumbent to give directions for making a  test for its de-
 tection (See page 57); and I would advise every person to
 subject it to  the experiment  before he purchases a quan-
 tity for use.f It is a  common custom  to attribute the
 effects  of indigestion  to the  insalubrity of aliment; thus
 articles are often  deemed improper for food, which,  in
 an  healthy stomach,  would  form  the most nourishing
 chyle, and on consulting the numerous treatises on diet
 and regimen, which have been lately published, we find
 the public cautioned against  the  use of one article,  on
 account of its becoming acescent, a  second flatulent, a
 third aperient,  &c.  effects  which  can be  attributed only
 to the debilitated state of the digestive organs; as is suffi-

 gentlemen of unquestionable  veracity. The transactions of the
 Royal Society  of London present a remarkable instance of this
 species  of combustion, attested  by  a great  number of eye-
 witnesses, in the parish of St. Clement, Ipswich. The extra-
ordinary occurrence became the subject of many learned dis-
 cussions, ' the  particulars, with several other similar cases, are
to be found in Dr. Trotter's late Essay, on Drunkenness.
  *. The use of spirituous liquors, by stimulating the sangui-
 ferous  system, and thus producing determination of blood to
 the brain, is, no doubt, a principal cause of the  frequency  of
apoplexy and sudden deaths in this country.
  t Lead, thus swallowed, not only injures the stomach, but
 produces the most obstinate and dangerous  species of cholic,
 which often terminates in inflammation of the intestines. 
347
ciently proved  by the labourer never suffering from in-
digestion, whatever be the food he takes.
  Three kinds of  appetites may be observed, viz. the
natural appetite,  which  is equally  stimulated and  satis-
fied with the most simple dish as with the most palatable;
the artificial appetite, or that excited by stomachic elixirs,
liquors, pickles, digestive salts, he. and which remains only
as long as the operation of these stimulants continue; and
the habitual appetite, or  that by which we accustom our-
selves to take  meals at certain hours, and frequently
without any appetite. The true and healthy appetite alone"
can ascertain the quantity of aliment proper for the indi-
vidual. If, in that state, we no longer relish a common dish,
it is a certain criterion of its disagreeing with the digestive
organs. If, after  dinner, we feel ourselves as cheerful as
before it, we may be assured we have taken a proper meal;
for, if the proper measure be exceeded, torpor and relaxa-
tion will be the necessary consequences;  the faculty  of
digestion will be impaired,  and a variety  of complaints
gradually induced.

            Ofi the Treatment  ofi Indigestion.
   The cure of indigestion depends on restoring the tone
of the  stomach,  and  avoiding the  occasional  causes.
For  this purpose it will first be proper to evacuate  the
stomach, by the  emetic powder, No. 88, afterwards  the
stomachic mixture, No. 61, or the tonic  mixture, No.
77, may be taken with advantage.  Two drachms of the
Epsom  salt, No. 2, may likewise be  taken every other
morning, to increase the peristaltic  motion  of  the   in-
testines, and remove  redundant slime.  If acidity  prevail
in the stomach, two drachms of prepared natron, No.
60, may be added to either  of the  mixtures recommend- 
348
ed above. In  debilitated, gouty, or languid constitutions,
the volatile  tincture of cascarilla, with the powder of the
Jamaica ginger, will prove an excellent remedy.
   Quassia root has lately  been much  recommended  in
cases of indigestion; but, from its  poisonous effects on
insects  and small animals, which it speedily destroys,  I
cannot consider it a safe remedy.
   The extract of camomile*  is a favourite stomachic
medicine with Dr. Cam, a  celebrated physician in Here-
ford; it may be taken in the following manner:
   Take  of extract of camomile, one drachm,
       Purified natron, one ditto,
       Tincture of ginger, two ditto,
       Mint water, six ounces. Mix.
Three table spoonfuls to be taken  three  times a day: if
pills be  preferred by the patient, it may  be  taken  with-
equal advantage in the following form:
   Take of extract of camomile, one drachm,
       Dried  natron, half ditto,
       Powdered rhubarb, one scruple,

   * The long use of bitter and astringent medicines has,  how-
ever, been found  ultimately  to  impair  the  digestive organs;
and  it is a well-established fact, that  gouty people, who have
been in the habit of taking bitter cordials, generally die sud-
denly. The quantity of quassia or other injurious bitters em-
ployed by brewers in making beer and porter has, no doubt,
been a  principal cause of the frequency of stomach and bowel
complaints in the metropolis.  The narcotics that likewise  enter
the composition of table-beer and porter,  as opium, coculus
indicus (very favourite ingredients with the public brewers of
the  present day), must not only do irreparable injury  to the
stomach and bowels, but from their continued use, prove very
hurtful to the constitution. 
349  .
       Oil of caraway seeds, ten drops,
       Syrup of  ginger, sufficient to form twenty-four
         pills.
Two to be taken two or three times a day.
   The  compound tincture of  ginger   and  camomile
flowers is  also a very excellent remedy for indigestion
and its consequences, as recommended  No. 7. If there
be a deficiency of the biliary  secretion, which may  be
known  by the  pale or blackish  appearance of  the faeces,
a grain of prepared calomel should be taken every other
night,  for-about ten days or a fortnight,  and the  stoma-
chic  medicine, two  or .three times a day.  The  decoction
of sarsaparilla  root is much recommended by IVtf. Aber-
nethy to accompany the us.e of small  doses of  calomel in
such cases, but it is  not' so ^efficacious as the  stomachic
mixture, No. 61.
  Till  the stomach  is restored to a healthy state by these*
means,  such a diet should be  adopted as will coincide
with  the  remedies,  and  not  aggravate the symptoms.
Vegetable  food, and  particularly leaven  bread,  being
disposed  to. fermentation,  and thus generate acidity and
flatulency, should  be  avoided in quantity.   The  diet
should consist principally of animal food, which, in weak-
ly stomachs, will digest  better than vegetable  alone; and
even if spirituous liquors were the chief agents in producing
the disease, they should not now  be  abandoned entirely;
for as  wine and malt liquor will soon turn acid, spirits
will prove beneficial by checking  fermentation and keep-
ing up the action  of the stomach;  a little brandy,  di-
luted with water, may therefore  be allowed. If the patient
be subject to gout, ginger may likewise be taken in the
quantity directed for  gout.  To this  treatment, exercise
will prove a very powerful auxiliary.
  In very obstinate cases  of indigestion,  attended witb 
•,350
 cramp in  the  stomach, irregularity of  the bowels and
 flatulency,  the  following mixture  will prove an admirable
 remedy, particularly in elderly people:
   Take of true winter's bark, two drachms,
        Infuse in eight ounces of  boiling water in  a close
          vessel for three hours, then strain and add,
        Prepared natron, one drachm,
        Tincture of ratania root, one ounce.
 Two or  three  table spoonfuls to be taken  two or three
 times a  day.  This medicine  will  not only  invigorate
 the  digestive organs,  but  correct the  secretions  of the
 stomach and intestines, and thus promote the health of
 the^oo%             ....    .»»••*■'    #\

             Ofi the Prevention tf 'Indigestion.
   It must appear evident from the foregoing observations
 on the causes of this disease, that the only effectual pre-
 vention  to  its  recurrence  consists in, 1st,  properly ex-
 ercising the  body; 2dly, proportioning the  quantity of
 food  to the degree of  exercise;*  and 3dly, relinquishing
the use of  spirituous or vinous  liquors;  but'if sufficient
bodily exertions cannot be taken, and an artificial appetite
must be produced, by  stimulating the digestive organs,

   * It is not easy to ascertain the exact quantity of food pro-
per for  every  age, sex,  and constitution ; the best rule is to
 avoid extremes.  Three  meals in a day are as many as nature
requires, and certainly as much as the stomach can properly
digest; dinner  ought to form the chief of these. Hearty sup-
pers,  particularly of  meat, with which  some people indulge
 themselves previous to their retiring to rest,  are highly pre-
judicial to health; hence the old adage:
  " Great suppers a very great evil we call;
   •; That your sleep may be sqund let your supper be small." 
                          3$1
such stimulants should  be employed as will not injure the
the coats of the stomach, or by  accelerating the circu-
lation, produce a  determination  to the  brain. Of  this
class, ginger, Cayenne  pepper, and well seasoned pickles
are the  most  innocent and effectual. Of  wines, genuine
claret is  probably the most salutary beverage, in the quan-
tity of a glass or two after meals; but this wine  is too often
mixed with English brandy, which entirely destroys its
salubrious property. The claret wine that comes direct from
Bourdeaux, under the name of Bloomfield's Claret, I have
found entirely free from any  addition or pernicious ad-
mixture  whatever. The wine that will blaze on being thrown
in the fire, may be pronounced unwholesome.,        »
   Such  as are in the habit of drinking a quantity of spirit,
or  spirituous  wines,  will receive great  relief by taking
distilled water at meals,* instead of wine  or malt liquors,
which will in a great measure obviate the  injurious effects
of  an over-quantity of spirit or wine. I have known cases
of indigestion  from the use of spirits, attended with symp-
toms of a diseased pylorus, that were cured by taking for
their common beverage nothing  but distilled water, and

   * While we are eating, water is certainly the best beverage.
The  custom of drinking  fermented liquors, and particularly
wine during dinner, is a very  pernicious one. The idea that it
assists digestion, is  false;  for those who  are acquainted with
chemistry, know that food is hardened and rendered less diges-
tible by these means; and the  stimulus which wine gives to the
stomach is not necessary, excepting to those  who have ex-
hausted the excitability of that organ by the excessive use of
 strong liquors.  If food want diluting, water is the best dilutent,
and will  prevent the  rising, as it is called, of strong food, much
better than \rine or spirits. 
352
gradually diminishing the quantity of wine, till they have
reduced it from eight to only one glass a day.
  On the proper digestion of our food and its consequent
conversion into healthy chyle, not only depends the health
of the body, but frequently the success of the treatment of
the  various diseases that appear in the human frame, and
those of a chronic kind especially.  It is to an impaired
digestion  and the  consequent formation of acidity in  the
Stomach, that many obstinate complaints may be traced, as
already noticed under the heads  of bilious complaints,
heart-burn, and flatulency. Indigestion is very frequently
an exciting cause of those diseases to which the constitu-
tion is pre-disposed, and without which would probably
have never been brought into action,  such as scrophula,
white  swelling, cancer, rickets, consumption,  hypochon-
driasis, insanity, calculous complaints, inveterate  ulcers,
&c.  &c.  The prevention of indigestion is therefore  not
only of the utmost importance in preserving the'health of
the  body and fortifying  it against the accession  of conta-
gious or putrid effluvia, but also in rendering constitutional
diseases dormant,  and powerfully counteracting local mor-
bid actions:  to those preventive means  I shall therefore
frequently have occasion  to refer, and which in domestic
medicine  should be particularly attended to.

            INFLAMMATORY FEVER.

                      Symptoms.
  An increased heat of the body without intermission, at-
tended with a throbbing pungent pain in the  head,  but
sometimes dull and heavy. The face appearing red  and
bloated, the pulse  strong, full, and frequent, great  diirst,
sense of  general  lassitude, the  urine high-coloured,  and 
353
 on standing, deposits a brick dust-like sediment; the tongue
 generally covered with a white fur, the judgment  much
 impaired, and rest disturbed.

           Ofi the Causes ofi Inflammatory Fever.
   Whatever tends to quicken the circulation of the blood,
 by increasing the action of the heart and arteries, will, under
 certain circumstances, produce the fever; as great pain, hard
 labour, immoderate use of spirituous liquors,  high living,
 exposure to the heat of the sun, the repulsion or absorption
 of morbific humours,  accidents, exposure to cold, and sel-
 dom by putrid or infectious vapours.

         Ofi the Treatment of Inflammatory Fever.
   The action of  the arterial system should first be dimi-
 nished by blood-letting, after which an emetic of two grains
 of emetic tartar, No. 35, will often, by emptying the sto-
 mach and bowels,* and  producing a determination to the
 skin, check its  further  progress.  If the fever,  however,
 continue, the saline  mixture may  be  taken,  as  directed
 under the head of crystallized acid of lemon,  No. 22, and
 the perspiration kept up, by  small doses of  ten or twenty
 drops  of tartarised antimony wine, No.  16,  with warm

   * In the treatment of fevers, emetics are the most powerful
 instruments, perhaps, the materia medica affords.  They not
 only  cleanse the alimentary  canal, but tend to remove visceral
 obstruction,  by exciting the action of the absorbent  vessels;
 they  emulge the  biliary duct, occasion an equality of circula-
 tion  throughout the system, and  induce perspiration; hence,
by carrying off offensive matter from the stomach and  intes-
 tines, and at  the same time producing so many healthy actions
in the system, they often  speedily  terminate inflammatory
fevers.
                          s A 
354
diluent  liquids,  as  barley  water,  common whey,  &c.
and  the body laxative,  by  means of small  doses  of
either of the neutral salts, No. 2. If there be considerable
determination of blood  to  the  head,  the  application  of
leeches  to the temples, a blister to  the nape of the neck,
and the immersion of the feet in warm water, should not
be neglected; and  if the chest  be affected with  stitches
and  difficulty  of breathing, the  loss of blood  should  be
repeated, and a blister applied  over the breast-bone.  If,
when the fever is almost entirely  gone off, the delirium,
for want of sleep,  should continue, ten or  twelve drops
of laudanum,  No.  SI, may be given in a dose of the saline
mixture. The diet  should be  principally arrow-root jelly,
barley-water, gfuel, or tapioca, 'without spices or wine, till
the inflammatory symptoms are considerably abated. See
Low Diet, page 152.
   The  application of cold water to the surface of the body,
has been much recommended by that able physician Dr.
Currie, of  Liverpool; the reaction which sometimes  fol-
lows its application,  is frequently so violent as to produce
inflammation of the  brain or lungs.  Frequent exhibition of
purgative  medicines, as  the  Epsom  salt, No. 2, lately
recommended by Dr. Hamilton, is attended with  no  such
hazard, and  in all cases not less beneficial.  When  the
fever is entirely removed, the strength of the system may
be restored by the use of the following mixture:
   Take of the essential salt of bark, No. 24, one drachm,
         dissolve in half a pint of
        Mint water, and add
        Sweet spirit of nitre, No. 15, three drachms.
 Three  table -spoonfuls to be taken four times a day. If the
salt  of bark  cannot be procured, half a pint of the decoc-
tion (See Peruvian  bark, No. 48.)  may be substituted for
it, and  the mint water. 
355
  Fevers of all kinds are involved in too much obscurity
to constitute  a part  of domestic medicine; inflammatory
fevers often suddenly changing to the low  or putrid  kind,
when a different mode of practice is required.  They  are
often symptomatic of local mischief  in the  system,  the
nature  of which can only  be ascertained by a medical
practitioner.  They likewise  often  affect one part of  the
body more than another, and frequently those parts most
necessary  for  life, as the brain and lungs, and if  those
determinations be not properly attended to, and counter-
acted,  those  parts may sustain, in the course of a  few
hours, so much injury as to endanger, if not  speedily de-
stroy, the  life of the patient; the  above   instructions  are
therefore given as a guide for young practitioners.

     OF INFLAMMATION OF THE BRAIN.

   People in the vigour of life, the passionate, the studious,
and the predisposed to  apoplexy, are most subject to  this
disorder.

        Symptoms of the Inflammation of the Brain.
   It generally commences with rigours, tremor of the ex-
tremities,  a  sense of lassitude  and stupor. The veins  in
the head  at length become distended,   and  the arteries
beat with  increased force;  the  eyes are  often steadfastly
fixed, fierce, and sometimes sparkle; the voice shrill, and
language incoherent, a proneness to anger, and at times
 a determined resolution to get  out of bed; the pulse  is
 generally  languid,  the  extremities cold;  on  dozing, the
 patient  generally talks  or  mutters a  great deal,  with a
 chattering of the  teeth,  trembling  of   the  hands,  and
 almost constant  motion of  the  fingers, which seem to  be
 picking or gathering something, and often do gather the 
356
nap of the bed-clothes. After the fourth day, the delirium
is more continual and furious, with watching, convulsions,
and hiccup, white stools, and at length the stools and urine
are discharged involuntarily; the pupils of the eyes dilated,
and other symptoms of approaching dissolution ensue; or
critical sweats and looseness come on, bleeding at the nose,
or piles, which  are of a more propitious import.

       Of the Causes of Inflammation of the Brain.
  Excessive  drinking,  violent passions of the mind, ex-
posure of the head  to  the  sun,  long watching, close ap-
plication of the  mind, suppression of natural  periodical
evacuations, concussion  of  the brain, and whatever may
increase  the afflux of blood into the head.

     Of the Treatment of Inflammation of the Brain.
  The most  powerful remedies  should  be employed on
the first  attack of the disease, to  unload  the vessels of
the head; for this purpose  as  much blood should be ex-
tracted as the system will bear, either by opening one or
both of the  temporal arteries, or cupping the scalp or
nape of  the neck; or taking from the jugular vein, or the
arm, by a large orifice, twelve or sixteen ounces of blood,
or till the patient faints, which will  prove of much greater
advantage  than double  the quantity extracted  from  a
small vessel, or by leeches. The head should be shaved,
and  the  whole of the scalp covered with a blister.  The
next object is to  produce a determination of blood from
the head, by doses of the aperient  mixture, No.  62, and
the clyster, No. 97.  With the  same  view blisters should
be  applied  to  the  feet, the thighs, and  arms; or the
mustard poultice,  No. 111. Folds of  cloth, wet  with
vinegar, may be applied to  the forehead,  or ice or snow 
357
to the  whole head.  The room should  be kept dark  and
quiet,  and the diet consist only of barley-water, acidu-
lated with lemon juice. Such is the delicate structure of
the seat of the disease, that no time should be lost in the
employment of these means, which, from the feeble  state
of the pulse,  are too  often  neglected  till the brain has
sustained irreparable mischief.
   The saline  mixture may likewise be  given every  three
or four hours, as  directed  No.  78 or  22,  with ten or
twelve drops of the tartarised antimony wine, No. 16, to
which as many drops of the tincture of fox-glove may be
added if the circulation be much hurried; but in inflam-
matory attacks of  a part  of such delicate structure and
importance as the  brain,  the advice of the  most skilful
and experienced  physician and  surgeon in the neighbour-
hood should be resorted to as early  as possible.*
   The state of mind  should, in this disease, be particu-
larly attended to.  The medical writers of antiquity  have
with regard to this, given  many very judicious directions.
Aretseus, who may be considered  the most  eminent, re-
marks several circumstances  apparently minute, but  in
reality very  important.   Thus  he  advises,  "-quiet and
calmness both to the sick person and  his attendants, and
that he should be  placed in a chamber of moderate   size,
with the walls smooth, uniform, and  regular, and  with-
out projections, and  not  ornamented with a variety  of

   * Inexperienced  apothecaries,  whose practice is  generally
 governed by the state of the pulse, and the effect more than the
 cause of disease, too often  confound  this affection with  putrid
 fever, and instead of the depleting plan  recommended  above,
 treat the phrenetic symptoms as delirium from  debility. The
 pulse, observes the learned  Celsus, res fiallaeissima est; and in
 this disease it is particularly so. 
358
colours or paintings, as these (he says) are apt to  distract
the mind and  impose  on the patient  for  realities.  He
orders even the bed-clothes to be smooth and of a regular
surface,  that the patient may not be induced  to fatigue
himself by  picking  the irregularities.  He  also  directs
that some of his most intimate friends may have access to
him,  and by  amusing discourse and  mild expressions,
endeavour  to pacify and  compose his  perturbation  of
mind.. He recommends likewise a compliance, as far as
possible, with all  the desires of the patient, especially if
he be prone to anger and violence. If light be offensive,
or seem to aggravate the disorder by suggesting objects
to the imagination, he orders the chambers  to be  kept
dark; but if darkness, from  the uncertain state  of mind
it  induces,  cause  dread and horror,  light is  directed to
be  let  in." Cselius  Aurelianus, a  physician of  great
celebrity in his time, agrees in  most  of  these points with
Aretseus, to which  he adds some useful cautions of his
own. Thus he directs the " light  to be mild  and gentle,
as of a lamp or  that of the day let in through  a  small
aperture, and  directed  principally to the face of the pa-
tient  as  an  object to  fix his  attention, and thus  prevent
the mind wandering in uncertain thoughts and ideas; a
precaution  frequently useful  in  modern practice,  and
known to be of the  greatest  efficacy  in calming delirium
when not very violent. He  also  recommends that such
persons should not be  admitted to him to whom he bore
any aversion or dislike in his  natural state of health; and
that those  people should be  introduced  whom  he" had
been  accustomed  to respect and reverence; but that the
visits of these should be only at intervals, in order that the
influence of the  mind  might  not be  destroyed by habit
and  familiarity." All  these  precautions, observes  Dr. 
359
Falconer,* are extremely proper, being founded on reason
and experience.
  These directions, however,  more apply to the delirium
attendant on fever than  active inflammation of the brain;
as in the latter instance the patient is for the most part
in a  state of stupor.

         INFLAMMATION OF THE EYE.

                       Symptoms.
   It is characterised by pain, redness, heat, and tension
of the whole  bulb of the eye, or its membranes, accom-
panied with intolerance of light, and  generally with an
effusion of hot acrid tears.

         Ofi the Causes of Inflammation ofi the Eye.

   External injury,  excessive  light, minute examinations,
repeated  intoxication,!  intense heat, and  obstructed  per-
spiration, are the most frequent causes of this disease.

       Ofi the  Treatment of Inflammation ofi the Eye.

   The repeated application of leeches to the eye-lids or

   * Falconer's Dissertation on the  Influence of the Passions,
 page 89.
   t Inflammation or redness of  the eyes is one distinguishing
 badge of a drunkard, remarked by the vulgar as if to point him
 out by the finger of scorn.  The wise king of Israel, who from
 his  admirable  proverbs, was evidently  well acquainted with
 human nature, says, " who hath woe ? who hath sorrow ? who
 hath contentions?  who hath babbling ? who  hath wounds with-
 out cause? who hath redness of eyes? they that tarry long at the
 wine, they that go to seek mixed wine."  Solomon's Proverbs,
 chap, xxiii. ver. 29, 30. 
360
 temples, blisters to the  nape of the  neck, the occasional
 use of the aperient mixture, No. 62, the constant appli-
 cation of the eye-water, No. 100, by means of folds of
 fine old linen,  the saline mixture, No. 78, a dark room,
and low diet, are all indispensably necessary, and should
be speedily employed to prevent films or specks, the effu-
sion of lymph between the layers of the cornea,* or suppu-
ration in the  ball of the  eye. If the inflammation continue
obstinate,  the blister should be kept open, by dressings of
the savin  ointment; and the aperient mixture, application
of leeches, &c. repeated;  and if the patient be of a plethoric
habit of body, the extraction of blood from the jugular vein
or arm will also be proper.  When the disease occurs peri-
odically, or in a scrophulous habit,  the mixture, No. 75,
should  be substituted for the saline  mixture, after  due
evacuations  by the  means  above suggested.  In case of
much pain, two or three drops of laudanum may be dropped
within the eye-lids at bed-time, or twice a  day, which will
not only allay the irritation, but often  succeed in speedily
dispersing the inflammation, particularly after the operation
of the aperient medicine, &c. The electric aura applied to
the eyes, is much recommended by Mr. Samuel Cam, an
ingenious  surgeon, in Hereford, in whose practice at the
general infirmary of that county,  it proved very successful
in the discussion  of local inflammation. If it arise  from
venereal taint, the internal use of mercury will be absolutely
necessary.
  The fever  diet, described page 152, should be  strictly
observed.
  When inflammation of the eye occurs in a scrophulous

  * This effusion,  terminating in adhesions  of  the layers, of
which the transparent cornea consists, produces opacity, and is
a very common cause of blindness. 
361
habit, it is generally of a very obstinate nature, and after
the excitability of the system is diminished by the means
recommended, will  generally require the use of the altera-
tive medicines, recommended for correcting scrophula, to
complete the cure, particularly the  prepared  natron,  the
alterative  pills, and compound decoction of  sarsaparilla.
See Scrophula.
  Chronic  inflammation of the edges of the eye-lids will
also require the same constitutional remedies,  which, with
the use of the following ointment will effect a cure:
  Take  of  ointment  of the  nitrated quicksilver, two
         drachms,
       Olive oil, four drachms.
Mix in a  glass mortar; to be applied to the edges of the
eye-lids, and particularly to the corners of the eyes,  every
night  and morning, by means  of a camel-hair pencil. In
such cases an issue in the neck or arm and the  scrophulous
mixture, as directed No. 75, will prevent a recurrence.
  Infants born in winter are subject to sore eyes, from  the
action of the cold air on them;  all that is requisite in such
cases, is to keep  the head warm, and wash the eyes with
fresh rose water. If the inflammation should increase, it
will be proper to add two grains of white vitriol to four
ounces of  rose or  elder-flower water, which should be
dropped within the eye-lids once or twice a day, and often
applied externally by means of some fine lint; the bowels
should likewise be emptied by  a  little magnesia and rhu-
barb in mint water. When the symptoms  run  high,  the
application of leeches  to the eye-lids,  and sometimes a
blister to the nape of the neck,  or behind the ears, will be
necessary.
  Infants  are sometimes attacked with sore  eyes a few
days after  birth, attended with a discharge  of thick mat-
                          3 B 
362
ter, which, if not skilfully treated, may terminate in blind-
ness; and as it is very rapid in its progress, the advice of
of an experienced surgeon  should be taken on its first ap-
pearance.

     Ofi the  Prevention ofi Infiammation ofi the  Eye.
  People subject to frequent inflammatory attacks of the
eyes or  eye-lids, should  pay particular attention to the
state of the digestive organs, and on any symptom of in-
digestion should take the alterative cathartic pills, as direc-
ted No.  84, or a solution of the  Epsom salt,  as advised
No. 2, especially in the beginning of spring and autumn.
The eyes should likewise be washed every morning  with
cold water, to which a little brandy may be added on the
appearance of redness or fresh irritation.  High-seasoned
dishes, and strong  wines,  and spirituous liquors, should
be avoided.

 OF INFLAMMATION OF  THE INTESTINES.

                    Symptoms, &c.

   A fixed pain in the belly, increased on pressure, attend-
ded with the usual symptoms  of fever, costiveness,  and
vomiting. The pain is felt in different parts of the bowels,
according to the seat of the inflammation, and very often
it spreads over the whole belly, and is felt more especially
about the navel. The pulse is quick, hard, and small; the
urine high coloured, the abdominal  muscles  frequently
contracted.

     Ofi the Causes  ofi Inflammation ofi the Intestines.
   It may be occasioned  by external contusion; by acrid-
of various kinds taken into the  stomach; frequently  by
very cold drink, swallowed when  the  body is warm; or
cold applied  to the lower extremities,  or belly itself; it is 
363
sometimes produced by costiveness; and often supervenes
in the progress of  colic; or produced by the strangulation
of a protruded portion of the intestine in a rupture,  or
what is commonly termed a broken belly.

   Ofi the Treatment ofi Inflammation of the Intestines.
  Copious bleeding, emollient clysters of starch, frequently
repeated, fomentations, the  warm bath, a large blister  on
the belly, small  anodyne clysters  (see No. 96), occasion-
ally injected, are the most effectual remedies  in the first
stage of this violent disease.  In the case of vomiting, great
care must be taken not to aggravate it either by the quan-
tity or quality of any thing thrown into the stomach.
  Such  is  the nature of this  complaint, that we cannot
be too cautious  either in administering medicines  or  di-
luents by the  mouth;  for the capacity of  the intestinal
canal is  often so  diminished, as to be sometimes  nearly
obliterated or shut up,  so that a quantity of any  kind of
liquid or aliment,  however simple in themselves, must,
by distending the intestines,  or being forced  against the
obstruction, necessarily increase  the  irritation, and con-
sequently aggravate  the symptoms.  Aperient medicines,
whose action depends on the irritation  they produce, are
likewise in many  cases improper.  The frequent use of
emollient clysters  will supersede their necessity,  and at
the same time act  as  a fomentation to the parts.  Fresh
olive oil in the  dose of a table-spoonful,  is, perhaps, the
only  medicine that  can  be admitted with safety.  Lauda-
num may  sometimes be employed to  great advantage,
but in others it may prove  as injurious: clysterwise it is
generally more efficacious than when given by the mouth.
When the pain  remits and  the violence of the symptoms
abates, mild diluents may  be allowed,  as chicken  broth,
linseed  tea, &c.  and if such liquors be retained without 
364
aggravating the symptoms, a little fresh castor oil may be
given every three or four hours, till it procures a passage.
  If  the  state of the intestine be suspected  to exist,
technically termed volvulus or introsusception,  that is, a
preternatural ingress of one portion of the intestine  into
the other, or a reduplication of the intestine,  quicksilver,
in the quantity of an ounce, should be  given, and as its
effects are  entirely mechanical, the patient should be put
in an erect posture, that  it may the  better press on the
inverted part, and kept in that state till it has passed the
stricture, which will require but a few minutes. He  may
then be replaced  in bed, when the quicksilver  will  more
easily pass through him.
  In  a late treatise on  inflammation of the bowels, by Dr.
E.  Peart, calomel and  opium are conjointly ordered in the
first and  every stage of this- disease. The  calomel to be
continued at short intervals, and opium when requisite, till
the disease is removed,  even  although forty,  sixty, or
more than one hundred  grains of calomel  may in the
whole be  found necessary. I have lately witnessed, in two
desperate cases,  the salutary effects of this practice, and
seriously recommend it to the attention of the medical pro-
fession, but for domestic  medicine it is much too power-
ful a  remedy.
  When  the  inflammation is  the effect  of  some  acrid
poison  swallowed, it requires the same treatment as al-
ready recommended for poisons.
   The  inner membrane of the stomach and intestines are
subject to inflammation similar to  that  of  the  cuticle,
termed St. Anthony's Fire, which  is therefore named
Erysipelatous or  Erythematic Inflammation of  the Intes-
tines. In  this species, calomel, as recommended by Dr.
Peart, is  a very excellent remedy. Stimulants,  as a  weak
infusion of ginger, has likewise proved very efficacious, 
365
by increasing the action of the mucous glands, and con-
sequentlv a secretion of mucus, in which the disease seems
to terminate. Medicines of this class should not, however,
be employed without the sanction of an experienced prac-
titioner.  Children  are particularly  subject to this species
of inflammation of the intestines, and in them it frequent-
ly proves fatal. The warm  bath, small doses of calomel,
and the cretaceous mixture, No. 64, with a diet of animal
jelly  (see hartshorn jelly,  page 85),  are, in such cases,
principally to be depended on.

   Ofi the Distinction ofi Inflammation ofi the Intestines.
   The great degree of fever,  quickness of the pulse, con-
stant pain and  great heat will  distinguish this disease from
every species of colic, in which vomiting is  likewise not
in so great a degree, and  it is at the same time attended
with coldness of the extremities.

   INFLAMMATION OF THE THROAT, OR
                      QUINSEY.

   This  disease occurs principally in spring and  autumn,
when vicissitudes of heat and cold are frequent. It affects
especially the  young and sanguine, and a disposition to it
is often  acquired by frequent  attacks.

         Symptoms of Inflammation of the Throat.
   It commences with  an  unusual  sense  of tightness  in
the   throat,  particularly on  swallowing,  which  is often
effected with  difficulty and  pain. On  inspection, some
tumefaction and redness of the fauces  may be perceived,
which spreads over  the tonsils, the uvula and soft palate,
attended with  a troublesome clamminess of the mouth
and  fever,  with  its usual attendants, as head-ach,  de- 
366
 lirium.  In desperate  cases, the tongue  and tonsils  are
 so much  swollen as  to  prevent  deglutition, and to  inter-
 rupt  respiration, that the patient  is often obliged  to  be
 supported in an  erect  posture to  prevent  suffocation.
 The inflammation generally  attacks one tonsil first, which
 in a day or two it  leaves  and extends  to  the other, and
 sometimes quits them  both suddenly, and flies to  the
 lungs.

       Of the Causes of Inflammation of the Throat.
  It is generally occasioned by the external application of
 cold air, particularly  about the neck.  Whatever violently
 stimulates the  fauces in a  plethoric habit especially,  as
 acrid food, poisons, &c.  may produce it.

     Of the Treatment of Inflammation of the Throat.
  As  the inflammation soon  advances  to  suppuration,
 active means should  be  speedily employed for its resolu-
 tion.  The patient  should  therefore  take  a full  dose  of
 either of the neutral salts, No. 2, or the aperient mixture,
 No. 62, and, after  its operation, the saline  mixture, No.
 78, with  twenty drops of  antimonial  wine  at  bed-time.
 The  gargle,  No. 92, or 93, should be used frequently,
 and  the  volatile liniment,  No.  103, applied externally,
 which for slight cases  will generally  prove  sufficient;
but if the inflammation  should so increase as to give a
 sensation  of suffocation, bleeding  by leeches,  or  from
the jugular  vein, and a blister  under the  chin, to reach
nearly from one ear to the other  will be also necessary.
  The diet should  be gruel,  arrow^root, and barley-water,
 acidulated with lemon  juice.  If,  notwithstanding  these
means,  the  inflammation  advance  to maturation, the
gargle, aperient, ancl saline  medicines  should be  discon-
 tinued, and the patient allowed a little wine and beef tea, till 
367
he is able  to swallow more substantial food, and after the
matter is evacuated, the detergent gargle, No. 95, should
be employed, and three  table spoonfuls of the following
mixture, taken three or four times a day:
   Take of red rose leaves,  dried, two drachms; infuse
         in half a  pint  of  boiling water  till cold,  then
         strain and add
       Diluted vitriolic acid, two drachms,
       Huxham's tincture of Bark, three drachms.—Mix.
   If the patient should,  at any period of  the disease,  be
incapable of taking  nourishment by the mouth, a clyster
of starch or broth should be administered three  or four
times a day, with the view of supporting life.

    OF INFLAMMATION OF THE LUNGS.

                     Symptoms, Ssfc.

   This disease commonly commences with shiverings and
 other symptoms of fever, soon succeeded by difficulty of
 breathing, cough, pain in some part of the chest, particu-
 larly on inspiration;  a sense of fulness in, and tightness
 across the chest, great anxiety about the heart, restlessness,
 loss of appetite, the pulse quick, sometimes hard, and  sel-
 dom strong or regularly full, the breath hot, the tongue
 covered with a yellowish mucus, and the urine turbid. The
 difficulty of breathing is most  considerable on inspiration
 and in an  horizontal position,  and in order to facilitate
 respiration, the shoulders and head are kept more or  less
 elevated. From the obstruction to the free passage of blood
 through the lungs, the veins of the  neck are distended,
 and  the  face swollen, with a  dark red colour about  the
 eyes and cheeks. The pain  in the  chest is generally aggra-
 vated by the lying on the side  affected, though sometimes
 the contrary happens, and  very often he  can lie easy only
 on the back. 
368
       Ofi the Causes ofi Inflammation ofi the Lungs.
  It is occasioned by the application of cold to the body,
obstructing the natural perspiration of the skin, and (bus
producing a determination to the lungs, while, at the same
time, the lungs themselves are exposed  to the action of
cold, suppressed evacuations, repulsion of eruptions, vio-
lent  exercise, external injuries, and vehement exertions of
the lungs, are often exciting causes of this disease.

     Of the Treatment of Inflammation of the Lungs.
  The  principal  object  in the cure of this disease, is to
empty  the vessels of the  lungs,  by proper  depletion,  and
such remedies as are calculated to produce a determination
of blood to the  surface of the body and extremities, which,
on account of the importance of the part affected, should
be employed as early and fully as possible.
  For  this purpose twelve  or  sixteen ounces of  blood
should be taken, by a large orifice, from the arm, and re-
peated according to the strength  of the patient and urgency
of the  symptoms ;* with the same  view, a  large  blister
should  be applied  to  the side  most affected, and  if the
patient  should  complain  of pain  in  the  head,  pulsation
or drowsiness,  one should likewise be applied to the back
of the  neck, and even to the feet. A dose of the aperient
mixture, No.  62, should be taken  every two hours, till
it operates, and  afterward the  cough mixture,  No. 66,
according to the directions there specified; ten  drops of
the  tincture of fox-glove may likewise  be given two or

  * If  the constitution of the  patient be naturally weak, the
extraction of blood from the chest, by leeches or cupping, will
often prove more serviceable than general bleeding, particularly
by the  latter method; and if  the  symptoms run high, they
may be conjoined. 
369
three times a day, if the pulse should continue quick. The
patient should be suffered to drink plentifully of an infu-
sion of linseed, acidulated with lemon juice, which will be
sufficient for his support, till the symptoms are considera-
bly abated, when he may be allowed  some  arrow-root,
tapioca  or sago jelly. After the  inflammatory symptoms
have subsided, the  decoction  of the Iceland liverwort, as
directed page 151, will prove an excellent and the  best
restorative.
  The  structure of the lungs is of that delicate nature,
that it will not sustain a violent inflammatory action many
hours  without the risk  of  endangering the life of the
patient, or laying the basis of consumption, particularly if
they happen to be affected with tubercles. The active reme-
dies recommended above should therefore be had recourse
to as speedily as possible, in order to  abate and disperse
the inflammation,  and not  employed  by degrees, as is
too frequently the  practice with timid  or  inexperienced
practitioners, through which many lives  are doubtless lost
that might have been  saved had the means been adopted
in the first instance.
  It is  scarcely  necessary  to observe,  that  in  such an
attack of a part so essential to life as the lungs, the most
able advice should be restored to as early  as  possible, as
a few hours delay may render the recovery of the patient
very doubtful.

             INFLUENZA. See Catarrh.

    OF INTERMITTENT FEVER, OR AGUE.
  When the fit of this disease returns every day, it is called
a Quotidian; when every other day, Tertian; and Quartan
when the fit occurs in the first and fourth days, the two
                         3 C 
                         370
intervening ones being free; they are likewise  called Au-
tumnal, when  they  happen in autumn,  and Vernal  when
in the spring.  Other  varieties are  observed  by authors,
but as they require the same mode of treatment, and arise
from the same cause, it will  be unnecessary to notice them
here.

         Symptoms, &?c. of Intermittent Fever.
   A paroxysm of intermittent fever is divided into three
stages, viz. The Cold,  Hot, and  Szveating. The Cold Fit
begins with  a remarkable  shivering,  nearly  amounting
to a kind of convulsive shaking of the whole body, which,
after continuing an hour or  two, is gradually succeeded
by a degree of heat, generally slow, but sometimes  other-
wise, with pain in the  head,  thirst,  and bitterness in  the
mouth, a quick and unusual pulse, which constitute  the
Hot Fit; as the heat abates, a moisture is perceptible  on
the skin, which often  increases to a profuse perspiration,
termed the Sweating Fit. The whole paroxysm generally
occupies eight, and rarely less than six hours; the fever
then entirely quits the patient, and regularly returns after
the periods noticed above. The patient is likewise affected
with heaviness, pain in the head, limbs, and  loins, pallid
complexion, chilliness of the extremities, yawning, stretch-
ing, violent shaking, small slow pulse, thirst,retching, some-
times vomiting a bilious matter,  and, during the hot fit, a
heat of the whole body, redness, distention  of skin, the
pulse quick and strong, short breath, delirium, high-colour-
ed urine, without sediment,  which abate by  degrees,  and
terminate in an universal sweat.

           Of the Cause of Intermittent Fever.
   This disease is supposed to be produced solely by the
action  of  the effluvia from marshes; some  have noticed 
371
as causes every thing likely to weaken the system,  but
these, although they may  predispose the* body for its re-
ception, are not capable  of producing the disease  without
the concurrence of marsh miasmata.

     Of the  Treatment of Intermittent Fever, or Ague.
  The Peruvian  bark has been  so  successful in  the cure
of this disease,  that it is generally  considered a specific;
but before its exhibition, it will  always be proper  to clear
the first passage  by an emetic of ipecacuan powder, No.
23.  The  bark powder*  may then be administered, for
which very  explicit directions are given, page 51.
  The  diet should be generous, and the patient  allowed
a glass or two of port wine, every day after  dinner. These
directions are applicable to every variety of the  disease,
and a continuance of the bark for at least a week, in smaller
doses and less frequent, is often necessary, after the disease
has left the patient, in order to prevent its recurrence.
  The  disease exhibits  strong marks  of the  influence of
the imagination  and passions, numerous instances having
been  published  of its being cured by  medicines  of no
medical efficacy whatever, but of that odious and  disgust-
ing  nature as is  calculated to make a strong  impression
upon the  senses, as live spiders, swallowed in that state,

  * It is remarkable that the Peruvian bark in  the cure of the
intermittent  fever, has succeeded in no other form than that of
powder, it is therefore probable that much of its efficacy is
owing to the mechanical action of the fibrous parts on the coats
of the stomach and intestines. Common sand has been  success-
fully administered in intermittents by a  foreign physician, which
can act on no principle. 
372
      snuffs of a candle, a dried toad* worn in the bosom, charms
      with ceremonious pomp and affectation of mystery.

                         OF THE ITCH.
                             Symptoms.
         This disorder usually appears about the wrists, fingers,
      arms, and thighs, but never on the  head. The itching is
      much aggravated by warmth, particularly in an evening,
      and when warm in  bed.

                        Of the Causes of Itch.
         From microscopical examination,  it is asserted, that
      this disease is produced by a kind of animalculae,f  which
      are described to be of a whitish colour, and  shaped  like a
      tortoise, each having six feet, and a  sharp head, with two
      sharp horns  on  its point,  of a hard formation, so as not
      to be destroyed by friction or pressure; others assert, with
      greater  probability, that it  arises from an ichorous serum,
      which  by irritating the small ramifications  of the nerves
      under the cuticle, occasions the itching and heat.

                         Of the Cure of Itch.
         Sulphur is a certain remedy for this disease, and  more
      safe and expeditious than  any  other application  we  are
      acquainted with. In the itch ointment, No. 107, the un-

         * A beetle or green lizard hung round the neck, are men-
      tioned as approved remedies  by Alexander Trallianus.
%        t This animal is supposed to run over the surface of the body,
      and by occasionally penetrating the skin, produces the eruption
      and itching. 
373
pleasant smell of this medicine is disguised.  The  part
affected should be well anointed with it every night, till
the  eruption  entirely disappears.  The internal  use of
sulphur will,  in  all cases, assist its external application.
The linen should be  clean and often changed,  and not
worn again before it be well washed and bleached, so as
to destroy the animalculse  or infection that may  have
lodged in them.
  The decoction  of white hellebore, is by some preferred
to sulphureous preparations,  on  account of being  free
from any unpleasant  smell.  It may be  made in the fol-
lowing manner:
  Take of white  hellebore root, bruised,  two  ounces;
       boil in a quart of water to a pint and a half, then
       strain, and add lavender water, four ounces,
with which the parts  affected should be washed two or
three times a  day.
  Mercurial applications are much used, and preferred by
many eminent practitioners, but they are neither so  safe
nor certain as  sulphur, and may,  under certain circum-
stances, prove very hurtful  to the constitution.  The ad-
vertised remedies for the  itch  are chiefly composed of
arsenic, mercury, and lead.

                  OF JAUNDICE.
                   Of the Symptoms.
  This disease comes on with listlessness, loss of appetite,
drowsiness, oppression, and costiveness, soon  succeeded
by a yellow appearance  of  the  whites of the eyes, the
nails of the fingers, and at length the whole surface of
the body; the  urine is high-coloured, with  a yellow sedi-
ment which imparts  its colour to linen;  the stools are
whitish or grey;  a violent pain frequently  extends from 
                           374
 the right  side to the pit of the  stomach, which  is con-
 siderably aggravated after meals;  some are much disposed
 to  sleep, and others to  watchfulness.  After the disease
 has existed  a few days, the whole  of the  secretions, the
 brain, and bones  become tinged with the colouring matter
 of the bile.

               Of the Causes of Jaundice.

   It  is produced by whatever may obstruct the  passage
 of  the bile  through its natural channel to the intestines,
 as  biliary  concretions  lodged  in  the duct, or from com-
 pression of scirrhous enlargements * of the  viscera, dis-
tention of the intestines by flatulency, or  an impregnated
uterus, or  from  spasmodic contraction"!"  of the  biliary
duct  itself,   without  such mechanical causes.  A redun-
 dancy of bile  in the alimentary  canal,  is sometimes, but
very rarely, a cause of this disease (see Bile); a sedentary-
life and  dejection of spirits  dispose the body to this dis-
order.

  * Scirrhous enlargements of the  viscera are  generally the
consequences of the abuse of spirituous or fermented  liquors;
drunkenness has therefore been enumerated as one cause of this
disease. " When jaundice appears,"  says a modern author, " it
may be reckoned, a proof of the patient's being a veteran wor-
shipper at the shrine of Bacchus.  The drunkard should  be
taught to look into a glass, that he might spy the  changes in his
countenance.  The first stage would present him with redness
of eyes, the second would exhibit the carbuncled  nose, and the
third a yellow and black jaundice."
  t It is remarkable that  this cause is often produced by jea-
lousy  and anger.  Hoffman and  Morgagni relate instances of
the jaundice being repeatedly produced  by mental commotions. 
375
             Of the Treatment of Jaundice.
  The cure will of course depend  on the removal of the
impediment to the free passage  of the  bile through the
biliary duct; but before  the accomplishment  of this ob-
ject is attempted, it is often necessary to palliate the dis-
tressing  or  urgent symptoms. The violent paroxysm  of
pain should  be relieved  by twenty drops  of laudanum,
No.  31, and repeated occasionally.  The  deficiency  of
bile in the  alimentary canal, may in some measure be sup-
plied, by taking three table spoonfuls  of the following
mixture, an hour before each meal:
   Take of infusion of Columbo,  six ounces,
        Salt of wormwood, one drachm;
        Aloetic wine, one ounce.  Mix.
   When it arises from spasms or  biliary concretions, the
loss of  blood from the arm will  afford considerable  relief,
and should not be omitted if the patient be of a plethoric
 habit.
   When the cause is concretions, lodged in the  biliary
 duct, the indication of cure is the dissolution of the con-
 cretion, or to facilitate   its  passage  to  the intestines,  by
 relaxing and  agitating   means.  The solution of  biliary
 concretions is extremely difficult, even out of the body,
 and  of  course must be  much more so when lodged in
 the  gall bladder, or duct.  Dr. John  Camplin, an able
 physician  in Monmouthshire, has  found ether to  answer
 this  purpose, and I  have  certainly  witnessed  its  good
 effects  in  several cases, but whether  from  any  solvent
 power, as the Doctor supposes, or as an  anti-spasmodic,
 I cannot take upon me to determine.
    For the purpose of relaxing the biliary duct, laudanum,
 the  loss of blood, the warm bath, and nauseating doses of
 the  tartarised antimony  wine,  No. 16, are  the most
 powerful remedies; and  the agitation of the parts, which 
376
will afterward accelerate its expulsion into the  intestines,
is best effected by  the  emetic powder, No.  88, active
purgatives of calomel and jalap,  and exercise.  During
the employment of  these  means, the want of the bile in
the alimentary canal should be supplied, by the  use of the
mixture of Columbo, recommended above.
  When  the disease  is produced by the pressure  of a
scirrhous  tumour,*  the  remedies to be depended on are
the hemlock combined  with mercury, in the following
proportions, and the use of distilled water as recommended
for the cure of cancer:
  Take of powdered hemlock, one  drachm;
       Prepared calomel, two scruples;
       Conserve of hips, sufficient quantity to  form a mass
         to be divided into forty pills.
  One to  be taken three  times a day, with a dose of alka-
line mixture of Columbo, already prescribed.
  The diet should  be regulated according to the consti-
tution  of the patient; in  cases  of organic disease,  the
strength should  be supported; and if it be produced by
biliary concretions, the diet should  be low, particularly if
the patient be plethoric or feverish, But as vegetables are
apt to generate a troublesome degree of flatulency and
acidity in  the stomach, the patient should be allowed broth,
and a  little animal food in substance. If it arise from  a
redundancy of bile, in  the alimentary canal, which is very
rarely the  case, gentle laxative medicines, as rhubarb, castor
oil, and lenitive  electuary will be sufficient.
  Infants, from birth,  are  very subject  to  attacks  of
jaundice,  from  viscid mucus obstructing  the gall duct,

  * Scirrhosity  of the pancreas, by compressing the biliary
duct, is not an unfrequent cause of jaundice. 
377
for the removal  of which, a gentle emetic of ipecacuan
powder (about three  or four grains), is generally  suffi-
cient; if it should yield to this remedy, a gentle  dose of
calomel and rhubarb may be given twice  a week, and the
solution of salt of wormwood,  two or three times a day,
as directed, page 24.
   People, subject to this disease  from gall stones, should
be very particular in avoiding indigestion,  and the conse-
quent formation of acidity, which, from the  analysis of
the stone, is probably  the primary cause.  (See Prevention
of Indigestion.)

       OF KING'S  EVIL, OR SCROFULA.

   The  Latins termed this  disease scrofula, from scrofa,
a hog, because it has been observed  in  the swine. It is
named the  King's Evil,  in  consequence of Edward the
Confessor, and other succeeding kings, both of England*
and  France, pretending to cure it by the touch.  This
disease is evidently hereditary, and although a generation
or two may pass without its being manifested, it generally
appears in the third.

            Of the Symptoms of King's Evil.

   This disease appears from two years of age, and gene-
rally but not always ceases at the period  of puberty. It is
often preceded  by a peculiar  look   about the eye, and
thickness of the  upper  lip; indeed, the  countenance of  a
scrofulous  habit  is generally so peculiarly marked, that

   * The last that practised  this delusion was Queen Ann.  In
the London Gazette of  the year 1707, is  inserted a proclama-
tion inviting her scrofulous subjects to the royal touch.
                          3 D 
378
a medical practitioner may in general be enabled to deter-
mine by it whether  the constitution be tainted or not.
Light hair, rosy complexion, smooth, soft, and fair, skin;
fulness  of  the upper-lip with a chap in the middle;  light,
blue-coloured  eyes, with a  dilated pupil, chiefly charac-
terise the scrofulous countenance.
  The first external signs are, hard and indolent enlarge-
ments of the glands in the neck behind the ears, and some-
times in the arm-pits and other parts of the body; in pro-
cess of time,  the ligaments  of  the joints  and  even  the
bones  become affected, so as to form the disease termed
white-swelling. The internal symptoms are, a tumefaction
of the glands of the mesentery, and formation of tubercles
in the lungs.

              Of the Causes of King's Evil.
  Both the nature and cause of this disease are but little
understood. Crude indigestible food, bad water, living in
a low damp situation,  are noticed by authors  as exciting
causes. Debility, which is more  or less attendant on this
disorder, is by some mentioned as capable of producing it,
but  this is certainly the effect instead of the cause  of the
disease, and is chiefly  produced by the tumefaction of the
mesenteric glands, preventing the chyle passing into  the
circulation for the due support of  the  body:  weakness
may, however, be the means of putting it into action.

           Of the Treatment of King^s Evil.
   A great variety of alterative medicines has been recom-
mended as specifics for this disease,  but  none has stood
the test of experience.   The prepared natron,  as directed
No. 60, has  certainly  proved most generally efficacious,
to which may be added the Peruvian bark (in the propor-
tion recommended in the  mixture for scrofula,  No. 75,) 
379
in case the  patient be much  debilitated  and  free  from
cough,  to which moderate exercise and cold bathing, par-
ticularly in sea water, will prove powerful auxiliaries.
   Madder-root is much recommended by Dr. Hugh Smith;
and  Dr. Osborne,  in  his Lectures  on Diseases  of Wo-
men, relates a case of a young woman that was wonder-
fully benefited by it.  In hardness of the glands approach-
ing to a state of scirrhosity, and  when the lungs are af-
fected,  and particularly when the patient labours under  a
suppression of the menses,  this medicine may be worth a
trial; the best preparation  is the extract, which may be
taken in the  following manner:
   Take of the extract  of madder, four drachms, dissolve
         in a pint of mint water.
Of which  a wine glassful  should be taken at least three
times a day.  If  the patient be much debilitated, the bitter
infusion may be substituted  for the mint water.
   A saturated solution of muriated barytes in the dose of
four  to  six drops twice a day,  in any convenient vehicle,
is particularly recommended in scrofulous complaints by Dr.
Crawford,  and  it appears has been productive of salutary
effects in a few instances.  It sometimes  occasions dis-
tressing symptoms in  the  system,  on which account the
learned doctor very properly cautions those who are un-
skilful  in  medicine, not  to tamper with it. From some
late accounts it appears, that this medicine has been given
with advantage  by some practitioners in  Germany, and
particularly  by  Dr. Huflelhand,   physician to the  Duke
of Saxe Weimar.  Prior to the exhibition of this medicine,
the digestive organs should be  corrected  by an emetic,
and the use of the scrofulous mixture, No. 75, for if the
food be not properly digested, it may be decomposed, and
its peculiar medicinal virtues destroyed.  From inattention
to this  circumstance, the failure  of  this medicine in scro- 
380
fulous complaints may probably be  attributed.  During its
use, the prepared natron, or any other alkaline  medicine,
is improper.
   The  decoction of coltsfoot  is much recommended by
Dr. Cullen, as a corrector of scrofula; the recent expressed
juice of the leaves I have known prove very beneficial in
the dose of two table spoonfuls two or three times a day.
   The compound decoction of sarsaparilla, which is very
similar to the Lisbon diet drink, is much extolled by many
eminent surgeons, for its anti-scorbutic  properties.  The
following are the directions for making it:
   Take of sarsaparilla root,  sliced and bruised, six ounces;
       Sassafras bark, bruised;
       Shavings of guaiac wood;
       Liquorice root sliced; of each one  ounce;
       Mezereon root,  bruised, three drachms;
       Distilled water, five quarts.
These articles are to be gently boiled over a slow fire for
five or six  hours, and the liquor to  be afterward reduced
by boiling  to five pints. The mezereon root should not be
added till  the latter part of the process.  The quantity to
be taken is, from twelve to sixteen ounces (a pint), in
twenty-four hours.
   The most eminent practitioners  generally recommend
alterative  doses of antimony and mercury to  accompany
the use of this decoction, particularly in  obstinate  cases;
which are  certainly powerful auxiliaries. The following  is
a  safe, and the best form for their exhibition:
   Take of prepared calomel, six grains;
       Golden sulphur of antimony, twelve grains;
       Conserve of  hips, sufficient to form a mass.
To be divided into six pills; one  of  which  should be
taken every, or every other night,  till the whole are con-
sumed. 
381
   I hese pills need not be persisted in more than a week
or ten days, or  longer than the above quantity lasts, as
the long  continued  use  of mercury, by debilitating the
system, will tend more to aggravate scrofula than other-
wise.  The decoction of sarsaparilla should, however, be
persevered in till the symptoms have disappeared.
  If acidity should prevail in the  stomach, notwithstand-
ing the use of these medicines, the prepared natron should
likewise be taken occasionally, as directed, No, 60.  Cos-
tiveness should in all  cases be avoided, by  the solution of
Epsom salt, (see No. 2).  During the  use of mercury cold
bathing is improper.
   Different morbid  conditions existing in different  parts
of  the body,  generally require, with the  use of internal
medicines, much topical management, according to cir-
cumstances, thus: when  a joint is affected, the formation
of matter should be  prevented, by the treatment  recom-
mended for white swellings; and when the lungs are af-
fected with tubercles, the remedies recommended for the
tubercular consumption  of the  lungs will be  necessary.
When the glands of the  neck  are much tumefied,  the
topical application of sea water, or the following lotion,
will prove very  beneficial:
   Take of crude sal ammoniac,  half an ounce;
       Muriatic acid, three drachms;
       Pure water, one quart.
To be applied by means of a folded piece  of linen, or the
parts  frequently washed  with it: and  if from their  mag-
nitude they be attended with inconvenience, the following
pills may be taken for ten days, with the bark mixture and
soda, already noticed:
   Take of extract of cicuta, one drachm;
       Prepared calomel, fifteen grains. Mix,  and divide
          into twenty pills.
One to be taken twice a day. 
382
   The topical application of leeches, a blister, or an issue,
 is necessary, if attended with pain  and  inflammation, to
 prevent suppuration, which in  all scrofulous  humours
 should be  attempted; for scrofulous ulcers  are  not  only
 difficult to heal, but always leave  an ugly  scar, and the
 discharge so far from benefiting the  system, as it is gene-
 rally  supposed  to do by old women, the strength  of the
 patient is reduced by the drain,  and the disease in  conse-
 quence frequently makes its appearance in some other part
 of the body.
   Solutions of  corrosive sublimate and arsenic have  been
 industriously  advertised as specifics for scrofula.  Such
 medicines, judiciously administered, may prove beneficial;
 but in  the  hands of ignorance, they must, from their
 potency, be often productive of serious mischief;  if the
 dose  be exceeded only a few drops,  the patient's life may
 be destroyed, instances of which have  certainly occurred.
 The proprietor's positive declaration that they are perfectly
 innocent, having induced  many to  exceed the directions
 in order to accelerate their recovery.
   People  of scrofulous  habits, should avoid all  kind of
 excesses, and particularly guard against indigestion, for
nothing is more likely to put the disease into action than
impaired digestion,  and the formation of acidity  in  the
 stomach. The   rules for the  prevention of indigestion
 should  therefore be  strictly attended to  by  scrofulous
 subjects, by  which I  am  persuaded the disease may be
kept in a dormant state  for  life, however strong the  pre-
disposition.  Diseases of every kind in scrofulous  habits
 should  also be  particularly  attended to on  their  onset;
however trifling they may appear to  be, they often  act as
 exciting causes of  scrofula. Thus, cough, or  a  slight
 catarrhal affection,  with  determination to the lungs,  may
 occasion that deposition  of matter in the substance  of the 
383
lungs, which lays the foundation of an obstinate species of
pulmonary consumption.  Rheumatic  affections of joints,
and sprains,  in such constitutions if neglected, may pro-
duce white swelling; indeed, the symptoms of all diseases
generally run higher in scrofulous subjects than any other;
acute complaints  proving more fatal, and  chronic  ones
more obstinate. In females particularly, it  is some time
before the health of the constitution  is established, and the
period of puberty with these is to be considered the most
critical  of their lives.
   It  has  been observed by many  medical authors,  that
scrofulous people should never marry.  The disease, howe-
ver, more generally appears in the third or fourth genera-
tion than in the offspring of such patients. Besides I believe
very few families  in this kingdom are to be found entirely
exempt from it; and it frequently happens that those who
have  not the least appearance  of scrofula, or been able to
trace it in their families, have the most scrofulous children,
who, from such circumstances, will not allow that the dis-
ease  is scrofulous; and  medical practitioners in general
conceal the  nature of the  disease,  sooner than incur the
displeasure of the parents.
   So far from discouraging such young women from enter-
ing the matrimonial state, I would advise them  to marry
early in life, from a conviction that nothing is more likely
to establish  the health of the body, and  counteract or de-
stroy scrofula, than the process of  breeding;  and it gene-
rally happens that all its  symptoms disappear  after the
 first pregnancy.
   A diet principally composed of  vegetables, a  beverage
 of distilled water, and avoiding costiveness (by  the occa-
 sional  use  of the  solution of  Epsom salts, as directed
 No. 2), will prove more  powerful in suspending  or de-
 stroying scrofula, than the most potent medicines. 
384
                  OF LEPROSY.

  The true Lepra, or Leprosy, very rarely occurs in this
country.  To this head, however, is referred a great variety
of cutaneous affections, which, for the most part, yield to
the remedies  recommended  for cutaneous  foulnesses.
(See Eruptions of the Skin.)

           LOCKED JAW. See Trismus.

            LOOSENESS. See Diarrhoea.

   LOWNESS OF SPIRITS. See Hypochondriasis.

                  OF LUMBAGO.

  When the rheumatism attacks the  loins,  it is thus term-
ed. In cases of pains in the loins, medical advice should
always be taken, for should inflammation be here mistaken
for rheumatism, and, as such, treated  with  stimulating
medicines, the consequence would be  a formation of matter,
constituting the disease termed Lumbar Abscess,  which
generally terminates in the death of the patient. Adver-
tised medicines for lumbago have certainly been produc-
tive of much mischief in this respect. Spirit of turpentine,
diluted with an insipid expressed oil, has  been long sold
under the fictitious name  of Essence of  Mustard, as a
remedy for this disease and  pain in  the loins.  The  exter-
nal and internal use of this medicine, as recommended by
the proprietor,  it is to be feared, has been productive of
serious mischief and much human distress.
4 
385
   When the case is doubtful, the warm bath, a blister
 over the part, and the antimonial powder, as directed No.
 37,  may be  considered safe and  efficacious. (See Rheu-
 matism.)

         MALIGNANT  SORE THROAT.
                See Putrid Sore Throat.

                   OF MEASLES.
   This disease is highly infectious, and it is a curious fact,
 that the constitution which hasbeen  once under its influence,
 is not liable to a second attack, a circumstance extremely
 difficult to  account for. It prevails  most in spring.

              Of the Symptoms ofi  Measles.
   It generally begins with  shiverings, succeeded by heat;
 a severe head-ach in adults, and heaviness in children; a
 slight inflammation and considerable heat in the eyes, attend-
 ed with swelling  of the eye-lids; a  defluxion of acrid tears,
 an inability to bear the light, frequent sneezing and dis-
 charge from the  nostrils; sooner or later a fever comes on,
with a cough, a sense of tightness across  the chest, nausea
 and vomiting. About  the fourth, and sometimes the fifth
 day, red spots, resembling  flea-bites, begin to appear  on
the forehead, and other parts of the face; and successively
on  the  lower parts of the  body, which  increase, run  to-
 gether, and form  large red spots, of different figures. The
 spots on the face  sometimes appear  a little prominent to the
touch; but, on other parts,  do not rise  higher than the
surface of the skin. On the  third day of the eruption, the
vivid redness is  changed to a brownish  red, and in a day
 or two  more, entirely disappears,  succeeded by a mealy
 scaling  of  the scarf skin,  and sometimes  a difficulty of
                          3 E 
386
 breathing, dry cough,pains in the chest,and fever; which.
 in scrofulous habits,  often terminate in consumption.

                Ofi the Cause ofi Measles.
   The measles are occasioned by a specific contagion, the
 nature of which is not understood.

             Ofi the Treatment  of Measles.
   If the  symptoms  be mild, the  occasional use  of the
 aperient mixture,  No. 62, or an infusion  of senna leaves
 with the neutral salt, No.  2, and ten or fifteen drops of
 the tartarised antimony wine, No.  16, at bed time, a low
 diet, and  a  warm  room, will be  sufficient.  If the fever
 and  affection of the  lungs  be  considerable,  the  loss of
 blood, a blister over the breast bone, and  the cough  mix-
 ture, No. 66, will likewise be absolutely  necessary,  and
 should not  be  delayed. Linseed tea, or  the compound
barley water, as directed page 87, should be  taken plenti-
 fully. If, after these means,the cough, difficulty of breathing,
 and pain in the chest continue, it will be advisable to apply
 another blister between the  shoulders, or two or three
leeches on each side of the  chest. If looseness supervene,
 it should not be checked,  unless it  be  violent,  and  even
 in that case not suddenly.  Five grains of rhubarb, with two
of ipecacuan powder, will in general for this purpose be
 sufficient.  After the spots  have disappeared, the patient
should not be too hastily exposed to the cold.
  The diet should be low, in proportion to the degree of
fever. The compound barley water, and vegetable jellies, as
 arrow root, tapioca, sago,  &c. will in general  be sufficient,
till  the  feverish symptoms  are  evidently  on  the decline-.
 (See Fever  Diet, page 152.)
  When the measles  recede, blisters  to  the chest, the 
387
warm bath, and gentle emetics of ipecacuan powder,  are
the most powerful remedies that can be employed for its
reexpulsion, but  as  such cases are always attended with
imminent danger, the  timely advice of a practitioner in
medicine should not be neglected.
  If much debility of the system should come  on towards
the end of the disease, and particularly if purple or black
spots appear, the strength of the patient  should be sup-
ported with cordials, beef-tea, and animal  jellies, in order
to  assist nature  in  effecting  a  favourable  termination.
With this view  the  Peruvian bark will  also be proper,
which may be given in the following form:
   Take of decoction of bark, six ounces;
        Extract of liquorice, one drachm;
        Diluted vitriolic acid, two drachms;
        Compound tincture of  cardamom, half an ounce.
Mix. From a dessert  to two  table spoonfuls to  be taken
three or four times a day, according to the age of the pa-
tient and urgency of symptoms. Yeast, on account of the
quantity of fixed air  it contains, has been employed  in
this case, for the purpose of counteracting a supposed ten-
dency  to  putrescence in the  system.  In some  instances
it has  been administered  with success,  in the dose  of a
dessert or table spoonful four times a day, but in the ma-
jority of cases I believe it has proved hurtful by bringing
on purging, to  obviate which,  two  or  three  drops  of
 laudanum should be given with each dose.  If the patient
 should be afflicted with violent purging, it should either
 be checked or moderated by the  cretaceous mixture, No.
 64. The propriety of restraining purging, must, in a great
 measure, depend on the appearance of the faeces, for if they
 be dark and offensive, and the strength of the patient not
 reduced by them,  they may  be considered  of a  critical
 nature, and should rather be  encouraged than diminished, 
388
but to determine a point on which the life of the patient
probably depends, the opinion of an  experienced practi-
tioner should be taken.
   After the departure of the disease, there is frequently an
inflammatory  disposition  remaining, which should  be re-
moved by gentle doses of  the basilic  powder, as directed
No. 36.  If cough should notwithstanding come on, blisters
to the chest, and the cough mixture, No. 66, will also be
necessary.
   Attempts have been made to communicate the measles
by inoculation, but I do not believe it ever succeeded, nor
could any great advantage result from the practice.

                Distinction of Measles.
  On the first attack of this disease it is often difficult to
distinguish  it  from  common catarrh. In  a day or  two
however, the violence of  the symptoms evince the nature
of the disease. It may be distinguished from other erup-
tions by the cough, watering of the eyes, sneezing, hoarse-
ness,  difficulty of breathing, and drowsiness, that precede
the eruption.

                OF MELANCHOLY.

   Melancholy is a partial insanity, so nearly allied to that
diseased  state  of imagination  termed hypochondriasis, as
to require  a similar mode of treatment.  Dr. Cullen, in
his first lines of the practice of  physic, observes, that he
is at a loss to determine how, in all cases hypochondriasis
and melancholy  may be distinguished  from one another,
whilst the  same temperament is common to both. The
distinction may  be generally ascertained in the  following
manner:  the hypochondriasis is  generally attended with
symptoms of indigestion, and though there may  be at the 
389
same time an anxious melancholic fear arising from the
feeling of these symptoms, yet while  this fear is only a
mistaken judgment,  with respect to the state of the per-
son's own health,  and to the danger to be from  thence
apprehended, I still consider the  disease as a hypochon-
driasis, and  as  distinct from the  proper melancholy; but
when an anxious fear and despondency  arise from a mis-
taken judgment, with respect to other circumstances than
those of health, and  more especially when the person is
at the same time without any symptom  of indigestion, it
constitutes the disease strictly named melancholy; but  as
a true melancholic temperament may induce a torpor and
indolence  in the  action  of the stomach, so  it generally
produces some  symptoms of  indigestion, and hence there
may be some difficulty in distinguishing such a case from
hypochondriasis. When  the  characters of the  tempera-
ment are  strongly marked,* and more  particularly when
the false imagination turns upon  other subjects  than that
of health, or when  though  relative to the person's own
body, it is of  a groundless  and  absurd kind, then, not-
withstanding the appearance  of some symptoms  of indi-
gestion, the case is  still to be  considered as that of me-
lancholy rather than hypochondriasis;  these  distinctions,
however, bear no reference to any difference of treatment.
   The  distinguishing character  of this  disorder, is  an
attachment  of  the mind  to one object,  concerning which
the reason is defective, yet in general it is perfect in what
respects other  subjects.  It is therefore obvious, like the
hypochondriac  passion, there is great scope  for the ma-
nagement  of the  mind  and  passions. The point to  be
aimed at,  observes the learned Dr. Falconer, seems to be,
to interrupt the attention of  the  mind to its accustomed
object, and to  introduce variety of matter upon which it 
390
Jnay exercise  itself.  This, however, requires the greatest
caution and delicacy in the execution.  Most melancholic
persons are jealous of being esteemed  as such, and have
generally a great opinion of their own wisdom and saga-
city, and are apt to hold very cheap the common amuse-
ments of life, especially those connected with social inter-
course and company, as they  are inclined to think them-
selves neglected and despised  by the world.
  Van Swieten supposes,  that travelling is best calculated
for the cure of such patients, as it introduces a gradual yet
interesting variety of objects and subjects of  attention,
which are the more pleasing as  they have not the appear-
ance  of being intentionally introduced. The purpose  of
travelling  also  (to  those  whose situation  and circum-
stances  admit of it), may be varied according to the  dis-
position of  the  patient.  Van Swieten  relates,  from  his
own  knowledge, that several'literary persons  who were
thus  affected, would by no means  be persuaded to go to
any mineral waters for relief,  which they thought would
confirm the opinion of the world concerning their  dis-
order, but were  easily induced to travel for the purpose of
viewing several  libraries and  resorts of learned persons,
and the varieties of  attention  thereby produced, had  the
best effects in working  a  cure.   He also recommends  to
endeavour to excite  such  passions  as are of an opposite
nature to those that  have  prevailed during the course of
the disorder. Thus the timid are to be supported  with
such arguments and discourse as may tend to rouse their
courage and resolution;  the  gloomy are to be cheered
with  merriment and  pleasure;  and the violent and pas-
sionate to  be restrained by fear.  This advice seems pro-
per,  but seldom practicable.  Even shame, observes  Dr.
Falconer, may be sometimes used successfully in prevent- 
391
ing the consequences at least of these disorders. Plutarch*
relates  that the virgins  of Miletus were seized with an
epidemic madness, that prompted  them to destroy them-
selves; which was in vain attempted to be prevented, un-
til it was ordered, that the bodies of those  who thus put
an  end  to  their lives should  be dragged naked through
the streets; shame here  proved a more  powerful motive
than the sense of duty, or any of the social affections.
  It is generally found conducive to the  cure, not to con-
tradict too peremptorily the  ideas and opinions of the pa-
tient. Opposition,  if too direct, serves  only to irritate
the temper, and to confirm erroneous opinions.  Such a
degree  of compliance as expresses only a moderate assent
often succeeds. When  the imagination  is not  inflamed
by opposition, it often corrects itself. Sometimes, indeed,
when the senses  are violently depraved, it may  be neces-
sary to  feign a more entire acquiescence with the opinion
of the  melancholy  person. The  introduction  of sports
and amusements  (see  treatment  of the Hypochondriac
passion),  and such employments  as consist of  moderate
exercise of the faculties, are likewise proper.
   Caelius Arelianus recommends for this purpose, that lite-
rary people should be amused with philosophical questions.
That the farmer should be entertained with discourses on
agriculture, and the sailor with naval affairs.  Others, he
says, may  divert themselves with games of chance. Music,
for those who have  a taste and ear for it, may perhaps be
a powerful remedy, and is mentioned by Celsus and other
writers.
* De virtutibus mulierum 
392 '
 OF MENSTRUATION; also termed MENSES, and
                   CATAMENIA*

   Menstruation is a natural  secretion of a blood-like ap-
pearance  from the womb,  so named from its  occurring
once in the course of a month.  This periodical discharge
appears to be  for the purpose of keeping up sanguification,
or the making of blood, and a  determination thereof to
the womb, for gestation, or the nourishment of the foetus
during pregnancy.
   From  its not appearing at a proper period of life, from
irregularity after it has  taken place, from too great a se-
cretion, termed flooding, and at the time of its cessation,
many derangements of  the system  are produced, all  of
which I shall  consider under this head.
   The interruption of  the menstrual  secretion may  be
considered of two kinds, the one when it does  not begin
to flow at that period of  life- in which they usually appear,
which  is  termed  chlorosis, or  green sickness,  and the

  * Young ladies are often at  a loss how to express themselves
when they have occasion to speak of the state of this secretion,
with which in  most diseases it is necessary the medical practi-
tioner should be  acquainted.  The usual term of regular I be-
lieve is often misunderstood both by the medical practitioner
and patient, as  being applicable  to the  state of the  bowels as
well  as this periodical evacuation.  The  word menstruate is
much more explicit, and could not be mistaken by either.  In-
stead, therefore, of the question, Are you regular? the physician
may say,  Do you menstruate  regularly? or the lady might ob-
serve, that she  does not menstruate regularly, or that menstru-
ation is irregular, too abundant or too frequent. 
393
other, after  it has repeatedly taken place for some time,
it does, from other causes than conception, cease to return
at the usual periods, which I shall consider under the head
of suppression of the menses.  And first,

  OF THE CHLOROSIS, or GREEN SICKNESS.
  The period of menstruation  is so different in different
constitutions, that no time can be  precisely assigned  as
proper to  the sex  in general.  In this  country it usually
appears about the age of fifteen, but in many more early,
and  in  others not till eighteen, without any disorder be-
ing  thereby occasioned.  It  is therefore only to be consi-
dered  as  a disease  when some disorders  arise in the
body, which may be  imputed to  its retention, and  which
are known from experience to be removed by the flowing
of the menses.  These  disorders  are a  sluggishness and
frequent sense of lassitude and debility, and the various
symptoms  of indigestion,  and sometimes  a preternatural
appetite, as the longing for chalk, lime, charcoal, &c. The
face loses its vivid colour, and becomes of a yellowish hue,
the  body pale  and flaccid, and  the feet, and sometimes
great part of the body, affected with an cedematous swel-
ling. The breathing is hurried by any quick or laborious
motion of the body, and the heart is liable  to palpitation
and fainting. A head-ach sometimes occurs, but more cer-
tainly pains in the back, loins, and haunches.

             Of the Causes of Green-Sickness.
   It is supposed to arise  from the want of due force in
the  action of the arteries of the womb, or some preter-
natural resistance  in their extremities.

           Of the Treatment of Green-Sickness.
   The strength of the system should be restored by ex- 
394
ercise, and in the beginning of the  disease,  by cold bath-
ing,* and  the  use  of tonics, combined with  medicines
that are known to produce  a determination to the womb,
and remove glandular obstructions,  as the following pills:
  Take of the ecphractic pill of the Edinburgh pharma-
         copoeia, two drachms,
       Oil  of caraway seeds, six drops,
       Prepared calomel, ten grains,
Mix well   together,  and divide into thirty pills, two to
be taken twice a day:  the dose should be increased, dimi-
nished, or repeated, so as to produce  not less than one or
more than two motions in twenty-four hours.  If the small-
est dose exceed this operation, they should  be only  used
as an occasional aperient medicine,  to obviate costiveness,
and three table spoonfuls of the following mixture taken
three times a day:
  Take of  gum myrrh,
       Prepared natron, of each one drachm,
       Salt of steel, one scruple,
       Mint water,  eight ounces. Mix.
  Powdered madder root has been much recommended as
a remedy for green-sickness, by that eminent  physician,
professor Home, of Edinburgh, who directs half a drachm
of the fresh powder to be taken three or four times a day;
after two days, the learned Doctor observes, two  scruples
may be given,  and  if this dose should not prove effectual
in two or three days,  it  may  be increased  to  a  drachm
four or five times a day.  It appears that out of nineteen
cases, the Doctor cured fourteen by the use  of this root.

  * If there be a preternatural determination of blood  to the
head or lungs, or the patient affected with cough, cold bathing
is improper. 
395
Dr.  Cullen, however, states, that in all the trials he made
with it, it failed, and in the practice of others  it has been
attended with no better effect.  From the bulk of the dose
necessary to be taken,  I have never met with a patient
who could persevere properly in its use. The extract, com-
prising a full dose of the virtues of the root in  small bulk,
is exempt from this objection;  it may be  taken combined
with steel,  as the following mixture:
  Take of extract of madder,  two drachms,
       Muriated tincture of steel, forty drops,
       Bitter tincture, two drachms,
       Mint water, eight ounces.  Mix.
Three table spoonfuls to be taken three times a day.
  The tincture  of  black hellebore root, in the dose of a
tea spoonful twice  a day (in a wine glassful of water), is
much extolled as a remedy for this disorder by  Dr. Mead;
it  has not,  however, succeeded  so  well  in the hands of
other practitioners: Dr. Cullen assures his  readers, that
in many trials he never found it to answer.  In fact there
is no medicine that  possesses specific powers in producing
menstruation, and therefore the disease is  only to be  cured
by  a combination of means, the success  of  which princi-
pally depends on  improving  the general health of  the
body.
  Electricity  has been employed as  a stimulus  in- those
cases, and a gentle  shock passed through the  region of the
womb, has  in a number of instances succeeded.
  Frequent and habitual exercise of  the  body is of the
highest importance. It is absolutely necessary to surmount
the antipathy which such  patients have to an  active life.
The inclination to indolence, is doubtless a symptom  of the
disease, therefore circumstances are to be proposed to them,
which will induce them willingly to take  exercise.  Inno-
cent  recreations (particularly dancing), rural occupations,
will answer  this purpose. 
396
  If the patient suffer much pain  in  the head, the feet
should be put  into  warm water every night, and a few
ounces of blood extracted from  a vein of the foot. If the
pulse  be full, or if  the  patient complain  of difficulty  of
breathing, and  a sense  of tightness across the chest,  the
timely loss of blood from  the arm, and a blister to the
chest,  may prevent consumption of the lungs.
  If the habit be tainted with scrofula, the  remedies re-
commended  for  that disease will  prove most beneficial.
(See King's Evil.)
  Marriage is  considered a  specific in those cases by Dr.
Cullen  and our first medical authors,  and I  believe it to
be infallible; it  is therefore an  indispensable duty on the
female relations of a young  woman so afflicted, to exert
their influence in promoting it.
  These remedies are adapted to the cure of the retention
of the menses termed chlorosis, or green-sickness. I shall
now proceed to the consideration

            Of the Suppression  of the  Menses,
  In entering upon which I  must  observe,  that every in-
terruption of the menses,  after  it has once taken place,  is
not to  be considered as  a  case  of suppression, for the
discharge on the first appearance  is  not always imme-
diately established in its regular course, and  therefore  if
any interruption  happen  in the  course  of the first or
second year  it may often  be considered  as  a case of the
retention  termed chlorosis, or green-sickness,  especially
if attended with the symptoms peculiar to that state. The
cases, therefore, of suppression, are such as  occur  after
the flux has  for  some time  been  established in its regu-
lar course, and in  which the  interruption cannot be re-
ferred  to the  causes  of  the retention termed  chlorosis,
but must be imputed to  some resistance in the extremities 
397
of the vessels of the womb, induced by cold, fear,  and
other causes, which may produce a constriction of these
extreme vessels. There are, however, some  cases, which
depend on general weakness  of the system, and conse-
quently of the vessels of the womb, but in such cases the
suppression always appears as symptomatic of other affec-
tions, on the  removal of which its recurrence depends.
   A suppression of this periodical discharge seldom  con-
tinues long without being attended with various symptoms
of disorders  in  different parts of the body,  arising from
the  blood being  determined  to other  parts  instead  of
the womb, and often with such force as to rupture a blood-
vessel; hence bleeding from the nose, lungs,  stomach, and
otherparts, are often produced: besides  which the patient
is commonly affected with hysteric fits, and the long  train
of symptoms of indigestion.

      Of the Treatment of Suppression of the  3Ienses.

   Warm bathing, particularly to the region of the  womb,*
by removing the constriction of  the vessels is to be consi-
dered the most powerful remedy.
   A costive state of the bowels should be removed by the
occasional use of  such medicines, which will at the  same
time produce a determination of blood towards the womb,
as the following pills:
   Take of the colocynth pill, with aloes, one drachm,
        Compound pill of galbanum, half a drachm,
        Prepared calomel, fifteen grains.
 After being well  mixed, divide  into thirty pills;  three of
 which are to be taken occasionally.

   * For the purpose of immersing the pelvis in warm water, a
 convenient bath has been constructed, named the Hip Bath, 
398
   In case of violent head-ach or much cough, the loss of
a few ounces of blood, according to the strength of the pa-
tient, or symptoms of plethora, will likewise be proper.
   The Peruvian bark, steel, and other astringents usually
employed in such cases to  strengthen  the  system, by in-
creasing the constriction  of the vessels of the uterus, often
do much harm. The feet  should be  put  every night in
warm water for ten minutes, and kept warm during the
day-time by the use of thick flannel socks.  The diet must
be regulated according to the symptoms of plethora and
debility. If the patient do  not suffer much from local ple-
nitude, as head-ach, oppression of breath, &c. it should be
of the nutritious kind, but not stimulating; wine, particu-
larly port,  and spirits, should  be avoided. Exercise,  in
this case, is of greater consequence than medicine, as it
will obviate plethora,  amuse the mind, and promote diges-
tion. If, on the contrary, it be attended with symptoms of
plenitude of the vessels, local or general, a low diet should
be strictly  observed,  and  all stimulants avoided, which
might, by  producing an afflux  of blood to the  head or
lungs, produce a rupture of a blood-vessel, which might
terminate in the death of the patient; when, therefore, the
local symptoms run high, or the general health  is much
disturbed, the  opinion of a physician of eminence should
be taken, before the case is too far  advanced to admit of
relief.
   The advertised  remedies for  obstruction of menses are
very numerous. Hooper's  pills  have long  been  employ-
ed for  this purpose,  and  I believe them  to be  a good
remedy for the retention of the menses, termed chlorosis;
but they cannot be applicable to all cases of suppression.
For chlorosis  or  green-sickness, it is  but  justice  to the
proprietors to  observe, that they are a good medicine, but 
399
certainly inferior to the  ecphractic pill of the Edinburgh
pharmacopoeia.            •
  Having considered the two kinds of interruption of the
menstrual discharge, I  shall now proceed to the consi-
deration of the increased quantity termed

                       FLOODING,

  As unconnected with a state  of pregnancy or lying-in.
The flow of the menses is considered immoderate when
it recurs more frequently,* when it continues longer, or
when, during the ordinary continuance,f it is more abun-
dant J than is usual  with the same person at other times.
It  is  not, however, every inequality  that is  to  be consi-
dered a disease,  but only those deviations that are exces-
sive in degree, which are permanent, and induce a manifest
state of debility.
  When a larger flow of the menses has been preceded
by  head-ach, giddiness, or  difficulty  of  breathing,  and
has been ushered in by  a cold shivering, and is attended
with much  pain  in  the  back and loins, with a frequent
pulse, heat, and  thirst, it may than  be considered preter-
naturally large, and  in consequence  of a repetition, the

  •* The usual period is from twenty-seven to thirty days.
  t The time of its continuance varies in different women.  It
seldom continues longer than six days, or shorter than two. In
general, women of a lax and delicate constitution have a  more
copious and a longer continued discharge than the robust.
  \ It is extremely difficult to  ascertain, precisely, wnat quan-
tity is usually discharged;  but women themselves can generally
inform the physician, with sufficient exactness for  regulating
the practice, whether the discharge be immoderate: the average
quantity is supposed to be about five ounces. 
400
face becomes pale, the pulse  weak, an unusual debility is
felt on exercise, the breathing* is hurried by much motion,
and the back becomes pained from continuance in an erect
posture, when the extremities become frequently cold, and
when,  in the evening, the feet are affected with a kind of
dropsical swellings, termed oedema, we  may, from these
symptoms, certainly conclude the flow of the menses  to
have been immoderate, and to have  induced a dangerous
degree of weakness of the  system, which is often attended
with palpitation  of  the heart, affections of the  stomach,
frequent faintings, and a weakness of mind, liable to strong
emotions  from slight causes, especially when suddenly-
presented.

               Of the Causes of Flooding.
  It is produced by a preternatural determination of blood
to the  womb,  or a plethoric  state of the body, from high
living,  strong liquors, and frequent  intoxication; violent
straining,  exercise, particularly in dancing, and violent pas-
sions* of the mind, cold applied to the feet, frequent abor-
tions, or child-bearing, and whatever will  induce general
laxity, as  living much  in warm  chambers, and  especially
drinking much of warm enervating liquors, such as tea and
coffee.

             Of the Treatment  ofi Flooding.
  When a copious menstruation has come  on, it should
be moderated as much as  possible, by abstaining from  all
exercise either at the coming on  or during the continuance
of  the menstruation,  by  avoiding  an  erect posture  as
much  as  possible, by shunning external  heat,  as warm
chambers and soft beds, by using as light and as cool a
diet as former  habits will  allow, by obviating costiveness,
by  the use  of laxatives  that will give little  stimulus,  as 
401
castor oil, and lenitive electuary; the  external and inter-
nal use of astringents to constringe the vessels of the womb,
as the application of cloths sprinkled with vinegar to the
region of the womb, and three^table spoonfuls of the fol-
lowing mixture taken every four hours:
   Take of red rose leaves, dried, half an ounce, infuse
         in a pint and a half of boiling water, till cold, then
         strain and add
       Acid elixir of vitriol, thirty drops,
       Tincture of ratania root, one ounce.
If the discharge, notwithstanding, continue immoderate,
the following should be  thrown up the vagina by means
of the female syringe:
   Take of pomegranate rind, bruised, three drachms, boil
         in  a pint and a quarter of water to a pint, then
         strain and add,
       Alum, a drachm and a half.
To be used  cold.
   Ipecacuan powder, in  small doses of two or  three
grains, so as to excite nausea and  not vomiting, according
to the experiments  of Dahlberg, as related by Dr.  Murray,
has  been found to  answer best;  but in bpth instances
they should be  administered with caution, since  it  some-
'times  happens that they do more harm than good.  Dr.
 Cullen  once met with an accident of this kind,  in which
the  vomiting increased the discharge to a great and dan-
gerous degree. Spontaneous vomiting is, however, always
attended, in such a case, with the most decided benefit in
 checking the discharge; and I have known the exhibition
 of an emetic dose of ipecacuan powder snatch, as it were,
 the  patient from the jaws of death.

              Ofi the Prevention ofi Flooding.
   When flooding arises from laxity of the system or the
                          3G 
402
 vessels of the womb, or if the discharge have  induced
 much debility in the system, it will be proper, during the
-intervals  of menstruation,  to  employ cold bathing and
■strengthening medicines, as the  infusion of roses,  with
 elixir of vitriol  and tincture of ratania root, as above di-
 rected. The occasional cause, in all cases, should be par-
ticularly avoided, by which  means  only the disease may
 be prevented. From inattention to such causes, and to the
 moderating of the discharge in the first beginning of the
 disease, it at length becomes violent, and of difficult cure.
  In cases of flooding, attendant on  miscarriages, or  lying-
 in women, the patient should be kept as quiet as possible,
 till medical assistance can be procured. If it be very con-
 siderable, a cloth wetted with vinegar may be applied to
 the loins and bowels till  his arrival.
  When  flooding  occurs during  labour,   the life of the
 woman may lie  considered in such imminent danger, that
 a mOment should not be lost in obtaining the assistance of
 an able man-midwife.
  The  most critical period of a woman's  life is, perhaps,
 when the menstrual discharge is about to  cease, which is
 generally denominated the turn ofi life. It  occurs between
 the 40th and  50th year  of  her  age, frequently about the
 50th; and if this period  be passed over without producing
 disease, her health may be considered established, and her
 life very good;  but for the  most part the  entire  cessation
 is succeeded  by a determination of  blood  to  the  head,
 producing* violent head-ach, and  ultimately apoplexy;  or
 to the  lungs or  bowels.  At  this period a  woman should
 be very particular in avoiding  a  plethoric state, by mo-
 derate exercise  and abstemious diet and the frequent use
 of aperient medicines, of which  aloes will answer  best.
 If she  be attacked with violent head-ach and  giddiness, 
403
she should lose blood  from the arm; and if disposed to
apoplexy, an  issue in the neck, the use  of thick flannel to
the soles of the feet, aloetic purges,  spare diet, and exer-
cise, are the most powerful preventives.
  The discharge from the womb  or vagina, termed fluor
albus, or whites, is considered in its  alphabetical order.

                 OF  THE MUMPS.
  This disease has  been little  taken notice of by medical
writers.  It is often epidemic, and supposed to be infectious.

             Ofi the. Symptoms ofi the Mumps.

   It generally comes on with  the common symptoms of
fever, such as cold shiverings, sickness, vomiting, pain  in
the head, &c. which is soon succeeded by the  appearance
of a considerable tumour in the neck, at the corner of the
lower jaw; often only on one side, but more frequently on
both, and finishing its course  on one side and  afterwards
attacking the other, it increases till  the fourth day, and from
that period it declines, and in a few  days  goes off entirely.

             Ofi the  Treatment ofi the Mumps.

   This disease commonly runs its course, without either
dangerous or troublesome symptoms;  so that a low diet,
and the  occasional  use of the neutral  salts,  No. 2, or
aperient  mixture, No. 62,  are  all that are requisite.  If,
however, the swelling be considerable, and the fever run
high, with pain in the head, the application of leeches to
the part (and sometimes the loss of blood from the arm,
if the patient be of a full habit), a blister to the nape of
the neck, and the saline mixture, No. 69,  will be necessary. 
404
             OF NERVOUS DISEASES.
   In domestic medicine, the appellation of nervous has
 been much too vaguely applied.  In one  sense, every dis-
 ease that assails the human frame may be termed nervous,
 inasmuch as the nervous system is,  either  primarily  or
 sympathetically, affected, but in  the professional accepta-
 tion of the word is signified, a class ofi  diseases in which
 the  nervous  system is primarily or  principally  affected.
 Thus Dr. Cullen, and- other physicians,  who are celebra-
 ted  for their classification of diseases, comprehend under
 this title all those morbid affections which consist either
 in the interruption and debility of the powers of sense or
 motion, or in the  irregularity with which these powers are
 exercised, and which are arranged under four orders, viz.
 First, Such  as consist in the loss of voluntary motion,  as
 apoplexy and palsy.  Secondly, In a weakness or loss  of
 motion in either the vital or natural functions, as fainting,
 hypochondriasis,  Sec.  Thirdly, Spasmodic affections with-
out fever, as epileptic fits, St. Vitus's dance, locked jaw,
 asthma,  hooping cough, &c.  And fourthly, Disorder  of
 the intellectual functions,  as insanity.   Hence  the term
 nervous embraces a great variety of diseases, remote in
their causes and  nature; some arising from an  increased
 action, and others from a diminished one; and again, even
such increased excitement may depend on debility and a
 diminished excitability, in consequence of compression  of
the brain from plenitude of the vessels and increased ac-
tion of the heart.
  Medical practitioners  often make use of the term ner-
vous in accounting for sensations the patient may notice
 in detailing the various symptoms of his  complaint, which
 I believe has given rise  to  the present general loose  and
 inaccurate application of the word. 
405
  Quack doctors, however, artfully refer all  the diseases
of the body to a morbid  state of the nervous system, in
order to impose their nervous  cordials on the credulous
public. Thus, in their  advertisements, a  long train  of
symptoms are classed as primary diseases, and although
diametrically opposite in their  nature, the  unfortunate
sufferers  are assured, that by  the use of their cordials,
they may be most certainly restored to health; hence the
hypochondriac  (who, through weakness of intellects, can-
not discover the fraud)  falls an easy prey to the allure-
ment;  and unfortunately this class of people are but too
numerous in this country to support this disgraceful prac-
tice; and if empiricism  is at all  to be justified, it is  cer-
tainly in such lamentable cases  of diseased imaginations;
but their nostrums are  too  often  taken in cases in which
they are a slow but certain poison,  and therefore should
not be allowed, especially in a  country in which medicine
has been more successfully cultivated  than in any part of
the known world. There is not another nation who suffer
themselves  to  be so miserably duped by ignorance and
fraud as the English.  If the impositions were limited to
the purses of  the public, or the amusement of the  mind
of  restless hypochondriacs, or what are more commonly
called nervous patients, the  injury would  be but trifling;
but unhappily  many of these illegitimate objects of specu-
lation are dreadfully pernicious in their effects upon the
health of those who are so weak as to purchase them.
 Common sense, one would  imagine,  was alone sufficient
 tO  detect  the  impudent falsehood  of a quack,  who pro-
 claims to the world that his medicine is equally good for
 diseases different in their nature, their sources, suid their
 symptoms, and which every apothecary's boy can tell him
 requires a different and even an opposite treatment.
   That eminent and philanthropic  physician* Dr. Hamil- 
406
 ton, of Edinburgh, observes in his popular treatise on the
 Management of  Female  Complaints, ." many  shocking
 cases  have occurred within the observations of the author
 of this work, where women have neglected pursuing, with
 steadiness, the suggestions of regular practitioners, in con-
 sequence of the  false  confidence  they  were induced to
 place in the  dishonest promises of the discoverers of- nos-
 trums. A simple recital of  the agony  of  such women,
 previous to death, might appear incredible!  and the inter-
 ference of the legislature, in checking this species of rob-
 bery, is certainly required, since not only is money stolen,
 but also life  is destroyed, and that in a way of torture too,
 which the  severity of the law has never  yet exercised on
 the most flagitious criminal!!"
   The publications  of  these  impostors,  addressed  to
 youth  of both sexes, it is to be feared, have  proved  as
 injurious to the  morals of those who have perused them,
 as their  medicines have to the health of their patients;
 and  it is a  lamentable fact that these  works have, by
 some  unaccountable means,  got into the possession  of
 young ladies, particularly at boarding-schools! to  whom
 the obscenity*  of the* works is probably  the  only induce-
 ment to read. " It is really lamentable (says Mr. Cony,
 in his Detector of Quackery)  that his Majesty's Attorney-
 General  has not been  informed of these indecent publi-
 cations; perhaps  the time is  approaching when  he may
 take cognizance  of  these moral essays,  and there  can
 be little  doubt but the sage and beneficent authors  will

  * Since the observations published in the  last edition of this
 work on»Empirical  Practices, 1 am happy to observe that the
proprietors of the most respectable public prints in the metro-
polis have excluded the advertisements of quacks that have an
immoral tendency. 
407
be amply rewarded.  Whoever  publishes an obscene pam-
phlet is liable to fine, imprisonment, and the pillory." How
much greater then should the  punishment be for such as
endeavour to poison the health and morals of a  people, by
the propagation of falsehood and imposture."
  Valetudinarians often voluntarily suffer more pain than
ever was inflicted  by the Inquisition.  By swallowing every
medicine which  ignorant friends or artful quacks  recom-
mend, these wretched dupes^ instead  of disarming disease,
only render it more formidable.  One  fourth of the  dis-
eases of mankind, I firmly believe to be imaginary; and that
many persons contribute to the support of  the  physician,
and  pay him  liberally for  regular  attendance,  while they
labour,  not under bodily  indisposition, but a a mind dis-
eased."   Many an athletic hypochondriac, whose sanity
would be restored in a few days by exercise, now imagines
himself at the point of death, though he  will probably
outlive his physician.*
  The  revelling  and excess  of  these unhappy  beings,
have produced in them  such  a  relaxation  of nerves and
imbecility of mind, that they tremble at the momentary

  * About ten years since, I was requested to see a lady who
was supposed to  be in a dying state. On my arrival, I found
her so far revived by  (as she stated) a thimbleful of Hollands, as
to give me an history of her complaint. The relation of her
nervous symptoms occupied upwards of an hour. She had been
ailing about fifteen years, during which time she had been given
over no less than twenty times. By the use of a cordial me-
dicine she was restored, and at this time drags on a miserable
existence from the  dread that every approaching night is to be
her last, although her appetite is good  and her sleep  sound!.!
Her husband in  one  year spent one-fourth of his income in
quack medicines, from which she derived no benefit. 
408
gloom occasioned by every passing  cloud, the sight of a
hearse fills  them with  horror, and the  mournful knell
thrills through every fibre.
  A variety of nervous  sensations, tremors, and paralytic
affections, are common  followers of intoxication. u The
head  and hands  of some inebriates,"  says Dr.  Trotter,
u particularly  in the  morning, shake and  tremble, but re-
gain their usual strength, and become steady as the cordial
dose is repeated.  Men of this description are  so nervous
as  to be  a  kind of living thermometers;  as the blood
warms their spirits rise,  and when it cools again by with-
holding their dram, they sink into languor and dejection.
When affections of this kind make  their appearance, the
wretched inebriate has almost finished his career of dissi-
pation, the silver cord of life is nearly loosed, and the
wheel broken at the cistern!!"
  The term nervous, as  it is now generally applied, may
be considered  as  synonymous with hypochondriacal. We
however frequently meet with patients with  a deranged
state of the nervous system, unaccompanied with that turn
of mind which I  have  noticed, page 331, as  constituting
hypochondriasis;  but such derangement may generally be
traced lo either some error in the digestive  organs, visce-
ral obstruction, or an accumulated or diminished excita-
bility  in consequence Of the imprudent use of exhilarating
cordials. When this  unfortunate state of the nerves arise
from  indigestion, which  is certainly the most frequent
source, the patient will derive considerable advantage  by
taking three table-spoonfuls of the following mixture two
or three times a day:
  Take of extract of ratania root, two drachms,
       Compound tincture of ditto, one  ounce,
       Sp. sal volatile, two drachms,
       Pure water, twelve ounces. 
409
  If the stomach  be much affected with acidity, nausea,
or flatulency, an emetic  of ipecacuan  should precede  the
use of this medicine; and in case of costiveness, the  so-
lution of Epsom salt, as  directed page 7, should be taken
every morning  as there directed.  The ratania root will
not only promote digestion, but in allaying nervous irrita-
bility, is the most powerful  remedy  we are  acquainted
with.  This invaluable medicine has hitherto  been princi-
pally employed by wine-merchants  on the continent, for
the purpose of giving a colour and  pleasant astringency to
the red  wines, the  medicinal virtues  of which are  to  be
chiefly attributed to it. It evidently invigorates the diges-
tive organs, strengthens the nervous system,  and corrects
acidity  in  the  stomach  and  bowels,  and  prevents that
species  of flatulency which I have  termed  intestinal (see
Flatulency), and which . is  probably a principal cause of
the mental sufferings of  nervous patients.
  When any of the  viscera  are affected,  or if  there be
evidently a  deficiency of bile, which  may  be known  by
the pale or black appearance of the faeces, a grain of calo-
mel made into a pill, with conserve of hips or soft bread,
should be taken every other night for  a week or ten days.
During the use  of these medicines,  the patient should
attend  to the directions given for  the prevention of indi-
gestion.
  The  abuse of spirituous  liquors not  only  disturbs the
digestive  organs,  but so  deranges the nervous system,
that it receives false impressions, and  communicates them
to  the  sensorium; hence external  objects which would
otherwise give pleasurable ideas, often excite  disgust,  and
the mind of such patient is  truly  wretched as long as he
is not under the influence of  the exhilarating  cordial;  by
the frequent use of which the soul itself receives impres-
sions  that  are incompatible  with its reasoning power.
                           3  H 
                          410
Spirituous liquors raise the animal spirits,  exhilarate the
mind, which are only immediate  effects; for it seems a
law of the human body, that  the  spirits are never artifi-
cially raised without being afterwards, perhaps,  more than
proportionably depressed; and thus after the effects of the
spirit or  wine are gone off, if the person finds himself lan-
guid and enervated to a terrible degree, the  ideas in the
absence of the stimulus have all a gloomy cast,  and every
sensation is  unpleasant;  there is  an  aching void  which
nothing can fill up but a repetition of the cordial draught,
which is  no sooner swallowed  than  another is desired;
thus by degrees the structure of the brain itself, the very
origin or root of the nerves,  is injured, and every species
of delirium, often amounting to insanity, are the  certain
consequences.*
      «----an anxious stomach  well
      May be endured : so may the  throbbing head:
      But such a dim delirium, such a dream,
      Involves you; such a dastardly despair
      Unmans your soul,  as madd'ning Pentheus felt
      When baited round Cithaeron's cruel sides,
      He saw two suns and double Thebes ascend."
   Wine  and ardent  spirits of every  kind ought  only  to

   * The  nervous cordials of many of the quacks are an ardent
spirit, so  powerful  that a  table spoonful is equal to a glass of
the strongest brandy, to which  their  efficacy is solely to be as-
cribed. These stimulants, by exhausting the excitability, soon
blast the  vigour and sap the foundation of the  strongest consti-
tution.  It is only those whose  nervous system has been im-
paired by the abuse of spirituous liquors, that would, however,
receive even a temporary relief from such medicines ; and we
may conclude that those who have attested their efficacy were
drunkards. 
411
be resorted to on extraordinary occasions, and in a medi-
cinal point of view.  Persons in good health have no need
of them, they are better  and stronger without them ; for
in proportion as they exhilarate, so do  they afterward  de-
press,  and the habitual use  of  them,  even in what is
generally considered moderation,  by too rapidly exhaust-
ing the excitability of the system, seldom fails to shorten
the natural duration of life. In these  observations it must
be understood, that

     " We curse not wine,  the vile excess we  blame."
For after  we  have  passed the meridian of life, a little
wine may be more serviceable than otherwise ; but the ex-
act period it should be employed in must depend on the na-
tural strength of the  constitution and  occupation  of the
person. Dr. Trotter is of opinion, that no person in health
can  require  wine till he has arrived to forty.  " He  may
then (says this esteemed  author) begin with two glasses in
the day,  at fifty he may add two more, and at sixty he may
go to the length of six glasses in  a day, but not to exceed
that quantity even though  he  should live to a hundred.
Good wine in old age stimulates the withered limb to mo-
tion, softens the rigid fibre, and produces an healthy deter-
mination of perspirable matter to the skin,  on which ac-
count wine has been  aptly called the " milk ofi old age."
       " Oh! seldom may the stated hours return
       Of drinking deep ;  I would not daily taste,
       Except when  life declines, even sober cups ;
       Weak withering age no rigid law forbids,
       With frugal nectar, smooth and slow with balm,
       The sapless habit daily to bedew,
       And give the hesitating wheels of life
       Gliblier to play, But youth has better joys:
       And is it wise, when use with pleasure flows,
       To squander the relief of age and pain:" 
412
  Such as have impaired their general health and nervous
system, particularly by  frequent  intoxication, or  the too
liberal use of spirituous  or vinous liquors, will  receive
every benefit medicine  can afford by attending  to the di-
rections  given  for the  prevention  of  indigestion. (See
Causes, &c. of Indigestion.)

             OF  THE NETTLE RASH.

  This eruption  is so named  from its  resemblance  to
that produced by the stinging of nettles.  It is a very mild
disease, and seldom requires the use of medicines. When
it is attended  with fever, small doses T>f  either of the
neutral salts, No.  2, or  the aperient mixture, No.  62, with
twenty drops of  antimonial  wine,  No.  16, at bedtime,
and a low diet, will be  sufficient;  and if it be of a chronic
nature, twelve  drops of the diluted vitriolic  acid,  No. 18,
mav be taken three times a day (in a wine  glassful of
cold camomile tea), or the aperient  sulphurous water re-
commended under the  head Rochelle Salts, No.  2.

                   NIGHT MARE.

   This complaint always  happens during sleep.  It comes
 on  with a sense of great weight on  the  chest, with great
 horrors and  agitation of  mind;  sometimes the patient
 imagines he  sees spectres of  various shapes, which op-
 press and threaten him with suffocation, and attempts  to
 cry out,  but often• without effect;  sometimes the un-
 easiness continues after he awakes, so  as  to prevent his
 turning or moving in bed. Nervous and studious people,
  and the predisposed to apoplexy, are most subject  to this
  disease. 
413
             Ofi the Causes ofi Night Mare.
  It is probably produced by slight pressure  on the brain,
from  distention of  the  vessels, occasioned by whatever
may obstruct the free return of blood from, or  increase
its afflux into, the head; as lying on the back, with the head
low, a tight bandage round the neck.  Many practitioners
suppose, that the sensation originates in air or indigestible
matter  in the  stomach of supper eaters, which  pressing
the stomach against the  diaphragm,  impede respiration,
and render it  short  or convulsed.  People  are  certainly
most subject to it after  a  hearty supper, and when  they
lie on the back, which seem to favour this supposition.

            Ofi the Treatment ofi Night Mare.
  If  the patient be of a sanguine habit, the loss of blood
will be  proper, with the use of  the aperient mixture, No.
62, and a spare diet, due exercise during the day, a light
supper, keeping the feet  warm  by wearing  flannel socks,
and obviating  costiveness, by  the  occasional use of the
cathartic extract, No. 46, will prevent its recurrence.
   If the patient be what is generally termed nervous, a
tea  spoonful of the  volatile  tincture of  valerian,  taken
twice a day in a wine glassful of cold camomile tea, afford
the most efficacious remedy.
   When it arises  from  indigestion, the ground Jamaica
ginger, No. 49, taken at night in a little water, will in
general prevent its occurrence.

      OF  PALPITATION OF THE HEART.

    This affection is frequently so violent as to be  heard at
 a considerable distance, and  sometimes  the action of the
 heart may be perceived on the  outside of the clothes. 
414
   When it  arises from a plethoric state of the  system,
 the loss  of blood, and the use  of the aperient mixture,
 No.  62, are necessary;  when from  irritability of  the
 nervous  system,  ether, No. 14, with tincture of castor
 and  valerian tea,  will prove serviceable;  when it proceeds
 from mal-formation  or disease  in  the heart itself,  or of
 some of the large  vessels,  relief may  be  obtained  by
 avoiding plethora, much  bodily exertion, full meals, and
 excesses of every kind, with the use of medicines calcu-
 lated  to  allay nervous  irritability,  as  camphor, valerian,
 laudanum and ether;  when the action of the heart is very
 violent, from ten  to  twenty drops  of  the tincture of fox-
 glove may be taken  two  or three times  a day,  in three
 table  spoonfuls  of the saline mixture, and  a blister  ap-
plied to the left side;  if its violence should not abate after
the use  of these  remedies  for  two or  three days, two
grains of the extract  of tobacco  or  hemlock powder may
likewise  be taken  every six or eight hours.
  This  affection is sometimes  symptomatic  of water  in
the pericardium,  which chiefly occurs  in aged  people,
 when small doses of calomel,  about   one or two grains
 every night for  a fortnight, or till the  mouth is rendered
 render by it, and twenty  drops of muriated tincture  of
 steel, in  a glass  of water three times a day, with the jolt-
 ing* of a carriage once a day, will be the most beneficial.
  This disease is often the consequence of the communi-
 cation between  the auricles of  the heart (which exists

  * The  exercise on the box of a carriage without springs is
 preferable to that of the  inside of the carriage; but the nature
 of the disease should be well ascertained before such a remedy
 be employed, for if the disease arise from  aneurism of the
 aorta, or some organic disease of the heart,  the agitation will
 prove very hurtful. 
415
during the foetal state) remaining unclosed;  such a case
will  only admit of the palliative means  of avoiding  ple-
thora,  full  diet, violent exercise,  and agitation of mind,
with the occasional loss of blood.


                     OF PALSY.

                  Symptoms ofi Palsy.
   Palsy consists in a loss of tone and vital powers, some-
times  of  the  whole  body;  more  frequently  of one side,
rarely  the lower extremities from the  loins, and some-
times  confined  to a muscle or nerve,  as of the bladder
and anus, suffering the  urine and stools to pass off invo-
luntarily,  sometimes the muscles of the  tongue,  occasion-
ing stammering and loss of speech, sometimes of the optic
nerve,  producing the disease called  gutta serena,  or  im-
perfect vision, and sometimes the nerve of  the ear, pro-
ducing deafness.  In violent cases, where one half of the
body is paralysed, the speech is much impeded, or totally-
lost; convulsions often take place  on the sound side. The
muscles  of the  affected side of the face being relaxed,
give those of the  opposite side  an appearance of being
drawn up or contracted, and the patient having  the power
 only of putting those in action  on the  well side,  appears
 on  speaking to  elevate the corner of the mouth so as to
 amount to a kind of grin or laughter, which is only owing
 to the muscles  of the opposite side being  in  a  relaxed
 state.  The paralytic part  gradually decays, shrivels  up,
 feels  much colder than any other part of the  body, and
 with a weaker action of the arteries.

                 Ofi the Causes of Palsy.
    Palsy  is produced by compression, interrupting the flow
 <>f the nervous  power from the brain  into  the organs of 
416
motion, or the  effect of poisons.   The  compression may
be  from distention of blood-vessels, effusion of blood or
serum, or from tumors. Of the poisonous causes, lead is
the chief.  It is often produced by the division of a princi-
pal nerve; and sometimes, but very rarely, it is the con-
sequence of extreme debility.

              Of the Treatment ofi Palsy.
  When it is produced by compression of the brain, from
distention or effusion, the  paralytic numbness  is  only-
symptomatic  of  apoplexy, and as such should be treated.
(See  Apoplexy.)  If, however, the  palsy continue  after
the compression of the brain is evidently removed by the
means there  recommended,  it should be treated as local
palsy, by external stimulants, as  friction with flannels, or
mustard-flour and  blisters.  Electricity,  so much recom-.
mended for paralytic affections, by stimulating the brain
and sanguiferous system, is a dangerous remedy, and may,
by producing a determination of blood to the head, occasion
a fatal relapse of the apopletic fit.* The organs of digestion
should be invigorated by  such stimulating medicines that
will not, at the same time, increase the action of the heart
and arteries;  for this purpose a tea spoonful of powdered
Jamaica ginger, No. 49, may  be taken  twice or  thrice a
day, or a pill of two grains of  capsicum.  The  peristaltic
motion of the bowels should be kept up by taking five or
ten grains of the aromatic  pill twice a  day, or  in  such
quantity  as  to produce one stool  in twenty-four hours.

  * This effect of electricity  is  by no  means unfrequent.  I
have known several instances of apoplexy immediately follow-
ing the application of electricity, and  when  palsy is the sequel
of an apoplectic fit, this stimulus should never be employed. 
417
A seton in the nape of the neck, particularly if the patient
be affected with giddiness, will afford considerable relief,
and should not be neglected. The diet should be nutritious,
but in moderate quantities, and flannel worn next the skin.
If it arise from the compression of a tumor, its removal, if
practicable, is  first necessary; the part  afterward will be
easily recovered  by  local stimulants.  If  curvature or
disease in the  back bone, compressing the spinal  marrow,
be the cause, a perpetual blister, an issue, or seton, over
the part affected, or on each side of the diseased portion of
the bone, are the only remedies to be relied on. If confined
to a muscle or a limb, the topical application of electricity
and  a blister, will  prove serviceable.  When  the effect of
poison,  the part should be stimulated by electric sparks,
mustard poultices, and the  mixture,  No.  74, or  71,
taken as there specified.
   The rhus  toxicodendron or sumach, has  been lately
much recommended by Dr. John Alderson, as  a remedy
Tor palsy.  The Doctor, in a  treatise on  its virtues, re-
lates several desperate cases of palsy, in which it proved
successful.  A grain of the powder is  directed to be taken
in any  convenient  vehicle twice a day, and to be  gradu-
ally  increased to three  grains twice  a day.   From the
account given of it by  Dr.  Alderson, it appears to have
effected more in  the  cure of palsies than has  ever been
ascribed to any other remedy, and such as justly entitles
it to  the attention of the  medical world. It is  worthy of
notice, that on the continent it  has been considered  a
virulent poison, and therefore should be given with great
caution.  In one of the  cases, the dose was increased to
ninety grains night and morning, and  in some it  is said
that  even two grains  produced pain in the  stomach and
bowels.
                           3 I 
418
      PHRENSY.  See Inflammation of the  brain.

                     OF PILES.

                  Symptoms  ofi Piles.
   A discharge of blood from one or more tumours, some-
 times external and  sometimes within the verge  of the
 anus. When attended with no discharge, they are term-
 ed  blind piles, and when the discharge is only the serous
 part of the blood, white piles. This disease, at first, is
 generally local; but from frequent occurrence,  the  con-
 stitution becomes so habituated to the discharge, as  at
 length to be established a disease of the system, in which
 case it  is  preceded  by head-ach, stupor, giddiness, and
other symptoms of  fever, with a  sense  of tightness or
fulness,  heat  and itching,  and a sense of  dragging down
about the  anus, or  otherwise  symptoms of  indigestion,
as fl itulency, acidity in  the stomach,  often attended with
spasms.  When inflammation of the tumors  run high, it
often ends in the formation of matter,  and thus produces
the sinous ulcer, termed fistula,  a common  termination
of mismanaged piles.

                Ofi the Causes of Piles.
  This  disease  may be  occasioned  by any thing  that
interrupts  the  free  return of  blood from  the  rectum,
most  commonly the  pressure  of hard faeces,  an impreg-
nated or enlarged  womb;  thus it frequently  happens to
those who are habitually  costive.  It is  often  produced
by  irritation; hence  aloes or the Scotch pills, as they are
termed, are calculated to produce this disease, from their
peculiar stimulating  effects on the rectum. By repeated
use of such medicines,  the constitution is not only habi- 
419
 tuated to this unpleasant affection, but from the irritation
 they keep up in the neighbourhood of  the anus, excre-
 scences frequently arise, which I have known to prove so
 troublesome  to ladies, as to render them unable to sit half
 an hour at a time without experiencing considerable pain,
 until they were relieved by a surgical operation. The piles
 are sometimes the effect of relaxation  and debility, and I
 believe not unfrequently arise from an inflammatory action
 in the rectum, and a diminished  secretion of mucus from
 its inner membrane.

               Of the  Treatment of Piles.
  When  costiveness is the  cause, the electuary for  the
 piles, No. 85, or the  aperient sulphurous  water, noticed
 under the head of Rochelle salts, No. 2, should be taken
 as there directed; after the due operation of either of these
 medicines, the parts should be anointed with the ointment,
 No. 105.  In case of much inflammation, general bleeding
 and the  application of leeches to the part, will be necessary
 to prevent the formation of fistulous ulcers; and the patient
 should keep  in an horizontal position,  and  strictly observe
 a low diet. If irritation be the  cause, the  same mode of
 treatment should be pursued, with the occasional use of lau-
 danum, No. 31.  And if the consequence of relaxation, the
tonic  mixture, No. 77, and the application of a decoction
of oak bark (made by  boiling half an ounce of the bark in
a pint of  water, for  about ten minutes) should be applied
to the part frequently. Astringent  and cold topical appli-
cations should, however, be employed  with great  caution,
and  not  without the  advice of a surgeon,  as  apoplexy
has followed sudden repulsion of piles. -
  If the discharge of blood in either case be considerable,
the patient should be  kept quiet, in a reclining position, 
420
 and use a  cold diet,  and avoid stimulants and external
 heat.
   When  the constitution  has become  habituated  to the
 disease, and the parts  suffered much from its frequent
 occurrence, stimulants, as pepper,  and  ginger, taken with
 the aliment, often afford considerable relief. A stimulating
 electuary, known by the name of  Dr.  Ward's paste, has
 been much puffed off, and even recommended by regular
 practitioners. The following is an exact copy of the Doctor's
 receipt for  making the paste, as published by John Page,
 Esq. to whom he bequeathed his book  of receipts:
   Take of  elecampane powder, two ounces,
        Sweet fennel seed powder, three ditto,
        Black pepper powder, one ditto,
        Purified honey, and
        Brown sugar, of each two ounces.
   The size of a nutmeg to be taken two  or three times a
 day.
   Ginger powder, or black pepper, generally have a  very
 salutary effect in  piles, although attended with great irri-
 tation  and  even  a  degree  of inflammation,  which  one
 would suppose, from their stimulating qualities, they would
 increase. Such medicines probably  afford relief, by produ-
 cing an increased  secretion of mucus from the inner mem-
 brane of the great  gut,* and invigorating the haemorrhoidal
 vessels, which in cases of piles appear much relaxed.

  * The application of stimulants to inflamed secreting surfaces
 have often a very happy effect,  by producing  the natural secre-
tion of the parts, and excitmg them to  an healthy action. In the
 same manner it is probable, aromatics prove serviceable in colic
 and other pains in the bowels. 
421
  A scorbutic inflammation round the anus is very often
mistaken for piles, by people who are unacquainted with
the disease.  This  complaint  is  attended  with a  most
troublesome degree of itching, and often an ichorous dis-
charge. It soon yields to the following ointment:
  Take of citrine ointment,
      Spermaceti ditto, of each equal parts.
To be well mixed together in a glass mortar, and rubbed
over the affected parts two or three times a day.
  The solution of the Epsom salt, taken as  directed, page
7, will  prevent its  recurrence. The parts are likewise
subject to excrescences or warts, which are often mistaken
for piles;  they may  be removed by ligature, caustic, or
the knife: the ligature should be preferred,  if the  basis of
the excrescence will  admit of its application. The daily-
ablution of • the parts with cold water will afterward de-
stroy  the  disposition to their formation. The recurrence
of this disease will be best prevented by obviating  costive-
ness, by proper management of diet,  cold bathing, and
general bleeding in sanguine habits.

                     PLEURISY.

  This  disease is  an inflammation  of the membrane of
the lungs, and lining of the internal surface of the thorax,
termed  the pleura. It is attended with the  same  symp-
toms as characterise inflammation of the lungs, but gene-
rally in a slighter degree; and requires the same mode of
treatment  with respect to medicine, diet, &c. to be  pursued
for the recovery of the patient as already recommended
for inflammation of the Lungs, page  368.
PUTRID FEVER.  See Typhus Fever. 
422
      OF THE  PUTRID, OR MALIGNANT
                  SORE THROAT.
                       Symptoms.
   It commonly  begins with alternate  chills  and heats,
pain and  heaviness  of  the  head, a strong expression of
anxiety  in the countenance,  and other symptoms of fever,
soon  succeeded by slight swelling of the throat, the ton-
sils becoming inflamed  and tumid, which  spread to the
neighbouring glands, with a high florid, or bright  crim-
son  appearance  of the  fauces, &c.  somewhat shining or
glossy,  soon attended with whitish or ash-coloured spots,
which increase rapidly,  and terminate in ulcers,  more or
less  superficial;  the  tongue  becoming  foul at the  root,
and the breath exceedingly offensive. The  feverish symp-
toms are much aggravated towards night, and accompanied*
with delirium.  The  disease gradually grows  worse; and
about the third day, nauseau, griping, and  dysentery are
produced, probably by the discharge  from the ulcers being
swallowed. There is commonly (especially  with children)
a partial or  general  crimson efflorescence of the skin, or
an eruption of small pustules, which relieves the  affection
of the stomach and bowels, the early and kind appearance
of which is considered  a favourable omen: it is highly
infectious.

          Ofi the Cause  ofi Putrid Sore Throat.
  This  disease seems to be produced by a peculiar specific
contagion, affecting all ageg, occurring at all seasons, and
prevailing in all situations. The nature of the contagion is
unknown.

           Of the Treatment of Sore Throat.
  This  disease, like other febrile contagions, is generally
terminated by a natural course; the chief object, there- 
423
fore, of its medical treatment, is,  in the first instance, to
moderate  the fever, and  afterward combat  unfavourable
occurrences.  With the first view, a full dose  of ipeca-
cuan powder, as directed No. 23, should be  administered
on its first attack,  and  after its  due operation,  the saline
draught, in a state of effervescence, as  directed page 25.
If the emetic should not operate on the bowels, and  they
be in  a confined state, a dose of the Epsom salt, as directed
No. 2, will  be proper; but both  emetics  and purgatives
should be employed with caution, for should  they produce
violent diarrhoea, to which there is generally a  great dis-
position, by reducing the  strength of the  system,  they
would tend  to accelerate its fatal termination.  On  the
contrary,  if  the faeces be black and offensive, and the pa-
tient's countenance  and spirits  improved by the evacua-
tions,  purgatives will be  very proper.  The  antimonial
preparation,  sold  under the  name of Dr James's fever
powders,  which,  in domestic medicine, is  generally re-
sorted to on the attack of all fevers, is a very  dangerous
medicine in  this disease, and by reducing the vital  pow-
ers has  been  productive  of the most serious mischief,
many instances of which have been noticed by Dr. Monro,
who states that it has hurried  many to their graves  in a
few  hours.  The  early application  of a blister  to the
throat and  the use of the  acidulated gargle, No 93, will
tend  much to abate  the  local inflammation and conse-
quent ulceration.  When the  diseased  parts begin to
separate,  the  saline  draught should be discontinued for
the tonic mixture, No. 77, with two drachms  of the di-
luted vitriolic acid in lieu of  the spirit  sal volatile and the
detergent gargle,  No. 95, used instead of the  astringent
one.  The  patient should be supported with strong  beef
tea and arrow root jelly, and if incapable of taking a suffi-
ciency by the mouth, the nutrient lavement, No. 99,
should be  injected three  times  a day, by means  of  a 
424
syringe with a long flexible tube,  that it may be thrown
higher up into  the  bowels, than by the bladder and pipe,
generally  used. In case of violent purging, the  clyster,
No. 85, will be proper, or  forty drops of laudanum may-
be  added  to the  nutrient clyster; and if the patient be
not able  to swallow the bark  mixture, two drachms of
Peruvian bark powder may likewise be added. The room
should be fumigated twice a day with  the nitrous vapours,
as directed page  90,  which  will  not only prevent the
spreading of the contagion, but being inspired  by  the pa-
tient, will  prove  perhaps more beneficial than medicine
taken by the mouth. The evaporation of the acetic acid,
as advised No. 38, will, in a small room,  answer as well
in destroying contagious effluvia; but for  the purpose of
inhaling, is  by  no  means so efficacious as the nitrous va-
pours when diffused in the atmosphere. As this  disease
is highly contagious, the faeces  of the patient should.be
received into a  pot with some vinegar in it, and conveyed
from the house as soon after their evacuation as possible?
  The spirits of the patient should be supported by, in-
spiring a confidence of recovery and  avoiding all objects
that are likely  to depress them, as funerals, passing-bell,
or any notice of the fatality of the disease  in the neigh-
bourhood, particularly  of a  friend.  Even  charms, says
Dr. Falconer,  might be used with  good effect,  could we
promote  a strong prepossession  of their efficacy, either
by the confidence they inspire,  or by  their engrossing the
attention of the  mind.  Aretasus,  fully sensible  of the
necessity  of supporting  the strength of  the  system in
general, and how  much this depends on the spirits,  ex-
pressly  counsels the patient " to be  of good heart, and
advises the physician to entertain him with such  discourse
as might tend to encourage his  hopes  of recovery." Hope
and  confidence are as necessary for the prevention,  as 
425
cure of contagious fevers.  It is scarcely necessary to ob-
serve, that the advice of the  most experienced and able
practitioner should be solicited  on the  first attack of the
disease, when medicines may be administered with effect.

      QUINSY. See Inflammation of the Throat.

                OF RHEUMATISM.

   This disease  commonly occurs in autumn and spring,
and seldom in winter or summer, unless the vicissitudes
of heat  and  cold be  sudden  and frequent. When it is
attended with fever, it  is called acute  or  inflammatory
rheumatism, and when there is no fever, chronic rheumatism.


    OF THE ACUTE OR INFLAMMATORY
                  RHEUMATISM.

            Symptoms ofi Acute Rheumatism.
   This species  commences with the usual symppms of
fever,  accompanied  with pain, swellings, and r-'dness of
the joints, generally  of the knees,  hips, ankle** shoulders,
elbows, and wrists, while the smaller joints of the toes and
fingers are seldom  affrcced. The fever rarely continues
violent more than fourteen days, although sometimes the
pain keeps  shifting  from one  joint to another for  some
weeks. The pain and sometimes the  fever is much in-
creased in the evening, and the  former during night is often
acute. As the pains become fixed the fever generally abates.

              Ofi the Causes of Rheumatism.
   It is produced by exposure  to cold, when the body is
                         3 K 
                         426
unusually warm, or by its partial  application or from a
continuance of cold, as from wet  clothes; the immediate
cause of the pain is difficult to account for.

         Of the  Treatment of Acute Rheumatism.
  The first object in the  cure  of  this disease, is to abate
the constitutional  fever; for  as long  as the febrile symp-
toms run high, all topical applications will prove unavail-
ing. For this purpose,  particularly  if the patient be of
a  plethoric habit, general blood-letting will be proper,
and afterward the  occasional exhibition of the aperient
mixture, No.  62,  or either of the  neutral salts, as directed
No. 2, after the due  operation of which, the antimonial
febrifuge powder  may be exhibited  as directed page 45;
or  if the pain  be very  severe, the  following draught at bed
time:
   Take  of tartarised antimony wine,  No. 16,  thirty  drops;
       Liquid laudanum, No. 31, fifteen drops;
       Camphorated julap, No. 28, one ounce.  Mix.
 Hall a pint of weak white wine  whey should be taken in
 about *n hour after this draught, to promote its sudorific
 operation,and the mixture, No. 63, taken every four or five
 hours during the  day time, in order to keep up perspiration.
 The draught may be repeated *very night till the symptoms
 have considerably abated. If the inflammation run high,
 the application  of six or eight leeches will be necessary.
 When the fever  is abated,  and  the  pains become  fixed,
 the parts should be well rubbed with the volatile liniment,
 No. 103, or opodeldoc, No. 5. In case  the  pain  and in-
 flammation continue obstinate, the use of the warm bath
 once in twenty-four hours, and blisters to the parts affect-
 ed, will prove powerful auxiliaries to the above remedies.
    Opium, in the dose of one grain, three times a day, is
 much  extolled by Dr. Pearson, as a  remedy for acute 
427
rheumatism, and in general it  proves very successful; but
the loss of blood, and the use of aperient medicines, should
be premised.  Exposure to cold should  be avoided, and a
low diet observed.  Common whey, taken  warm, affords
an excellent medicinal beverage.
  Electricity is a very popular remedy for rheumatic com-
plaints ; but for this species, by increasing the fever, it is
uniformly hurtful.  It  should,  therefore, never be  em-
ployed till the complaint becomes of a chronic nature.

          OF CHRONIC RHEUMATISM.

         Of the Symptoms of Chronic Rheumatism.
   When the febrile symptoms, together  with the swelling
and redness of the joints attendant on the acute species,
have  entirely abated,* and the pain still continues to affect
certain joints with  stiffness, and uneasiness of motion,
and   change of weather,  the  disease is  termed Chronic
Rheumatism,  which often  continues  a  length of  time,
The joints most surrounded by muscles, and  the parts that
suffer much by bodily exertion,  as the hip and the  loins,
are commonly the seats of this complaint.  When it affects
the hip joint, it is named Sciatica; and when situated in
the loins, Lumbago.
          Of the Causes of Chronic Rheumatism.
   It  is supposed to arise from a loss of tone in the mus-
 cular fibres and  blood-vessels of the part affected, which
 is attended with rigidity and contraction of the  former,
 and  when far advanced, with a considerable diminution

   * The period of  acute rheumatism seldom if ever exceeds
 forty days, after which, if  the pain  continue, it may be said to
 have become chronic. 
428
of nervous  energy, approaching  to a  state of palsy. Vio-
lent exertions and strains  are often the exciting causes of
lumbago.

        OJ the Treatment of Chronic Rheumatism.
  The  indications of cure  are exacdy opposite to  that of
the acute or inflammatory species; the latter being attended
with an increased action of the system, and the* chronic
with a  diminished one. The energy  of the part  affected
should be roused by topical stimulants, as  electric  sparks,
the volatile liniment, No. 103, with friction,* and appli-
cation of flannel. If these means prove ineffectual, a blister
may be applied over the  part affected; or the following
stimulating  plaster,  recommended  by  the  late Dr. Hugh
Smith:
  Take of gum plaster, one ounce;
       Blistering plaster, a quarter of an ounce;
       Gum euphorbium, one drachm.
To be mixed with as little heat as possible, and spread on
leather.

  * Friction  is, perhaps, more efficacious in the recovery of
joints affected with chronic rheumatism, than electricity or the
most stimulating applications. By friction alone I  have known
many very obstinate cases of diseased joints from rheumatism,
perfectly cured. Even gently beating  the parts with a stick, or
pounding them with a wooden hammer, not only proves a pow-
erful remedy in removing the disease, but in preventing its re-
currence. A gentleman of great respectability, who had suffered
much from rheumatic pains, complicated in some degree with
gout, had recourse to these latter methods, since which he  has
not suffered a relapse, although  now upwards of fifteen years
since he employed them; the same  gentleman, as I have no-
ticed under the head  of  Cataract,  cured himself by the same
method of that disease. 
429
   The warm or hot bath may likewise be employed with
advantage.
   These external applications should be assisted by the in-
ternal use of the anti-rheumatic mixture, No. 71, as there
directed, to which a drachm of the essential salt of bark
may be added, in  case of much debility of the system; a
tea spoonful of the farina of the Jamaica ginger may like-
wise be taken twice a day in a glass of camomile tea. The
diet should be generous, and the  common beverage the
Batavian  spirit  of juniper,  commonly called gin, diluted
with water.
   If the disease be attended with emaciation of  the body,
and particularly with an exacerbation of  pain in the even-
ing or during night,  two of the following pills may be
taken twice a day, with a quarter of a pint of the compound
decoction of sarsaparilla, and will prove very beneficial:
   Take of prepared calomel, twelve grains;
       Gum guaiacum, one drachm;
       Extract of  tobacco, half a drachm;
       Golden sulphur of antimony, one scruple.  Mix, and
         divide into thirty pills.
   The compound decoction of sarsaparilla*  should be
taken to the extent of a pint a day.  A  decoction of the
leaves  of the  oleander or rosebay, in the dose of a wine
glassful three  or four times a day, has  been strongly re-
commended as  a remedy for chronic rheumatism in par-
ticular; the  decoction is made by boiling half an ounce of
the leaves in a pint of water  till  one fourth is consumed.
It will be advisable to begin with a smaller dose at first,
and gradually increase to  a  wine glassful.
   The use of the  distilled water in every article of diet,
and as the  principal  beverage,  is much recommended by

  * The directions for making  this decoction, are  given page
380. 
430
Dr. Lambe, an experienced physician in London;  and I
am well persuaded, will prove of the greatest advantage in
the cure of  both  acute and chronic  rheumatism;  in  the
latter case, a little of  the  spirit of juniper, noticed  above,
may be added to the  common drink.
  A clergyman of great  respectability in  Bath, with an
obstinate  rheumatic  affection  of the  extremities,  nearly
approaching to a  state of  palsy, derived more advantage
from the use of this water, than either the Bath waters,   <
warm  bathing, and stimulating medicines;  and by  due
perseverance in its use, is now able  to walk five  or six
miles with ease, after being confined  to  his house two or
three years.

            Of the Prevention  of Rheumatism.
  Cold bathing, and the use of flannel next the skin, are
the most effectual means of preventing the recurrence of
both chronic, and  acute rheumatism.

            Of the Distinction  of Rheumatism.
  Rheumatism may  be distinguished from  gout,  in  not
being preceded by pain in the  stomach,  symptoms  of in-
digestion,  and cramp  of the extremities; by  being  seated
in the  larger joints, while the  gout affects principally the
smaller joints;  occurring at an earlier period of life; not
being  hereditary, and in  general  can be traced to some
exciting cause, particularly  the action of cold. It is  ex-
ceedingly  difficult to  distinguish  rheumatic pains from
those  produced  by deep-seated inflammation, and from
such mistakes the most serious consequences often arise,
particularly  when seated  in  the loins or  hip-joint;   the
stimulating  applications, as electricity, &c.  employed for
the cure  of rheumatism, increasing the  inflammation,
and occasioning  extensive suppuration, which  generally 
431
terminates in the death of the  patient. Such mistakes
have happened even in regular practice; and through the
imprudent  use of  quack  medicines, such  terminations
are very frequent. That  obstinate, and generally  fatal
disease, the lumbar abscess, begins with pains in the loins,
similar  to lumbago, and the only chance the patient has
of recoverv, is to prevent the formation of matter; there-
fore, in all doubtful cases, the application  of  a  blister,
cupping, and  the  use  of the following diaphoretic medi-
cine should be employed, instead of the stimulating  plan
recommended for chronic rheumatism:
   Take of camphorated julap, No. 33, five ounces;
       Mindererus's spirit,  No. 10,  three ounces;
       Sweet  spirit of nitre, No. 15, three drachms. Mix.
Three table spoonfuls to be  taken every four or five hours.
   Spirit of turpentine  diluted with the oil of mustard has
been much puffed off in the daily prints under the name
of Essence ofi Mustard, as a remedy for rheumatism, &c.
Spirit of turpentine has been long  employed both inter-
nally and  externally in  cases of chronic rheumatism, but
in the acute  kind,  it must, on the same principle, prove
highly injurious.  From the admixture with oil of mus-
tard,  it derives no advantage whatever, as  that oil  does
not contain the medicinal properties of the seed, but is per-
fectly insipid, and may be obtained at the mustard manu-
factories at a much cheaper rate than any  other simple
expressed oil,  and probably  on this  account it has  been
adopted.  The stimulus of  the mustard is  of a  peculiar
nature,  and very  different  to turpentine;   if,  therefore,
a  person that  was desired to take the mustard seed by a
physician,  and he preferred the essence ofi mustard from
the supposition that  it contained,   in  a pure  and  con-
centrated state, all the virtues of the seed, which is stated 
432
to be the case,  the  most serious  consequences might en-
sue, and in a court of justice a person  so injured might
recover heavv damages,  notwithstanding the  interest of
the stamp  office might be exerted in behalf of the pro-
prietor.*

                    OF RICKETS.

  This disease  is peculiar to infancy, seldom appearing
after the third year, or before the ninth month of a child's
age, but generally in the intermediate space.  It first shows
itself by an enlargement of the head, face, and belly, while
the other parts  of the body diminish  in bulk, except the
joints of the hands, arms, knees,  and  feet, which become
irregularly  tumefied, the bones lose their solidity, so as to
be incapable of supporting the body;  hence  those which
are employed for that purpose, as  the  legs, thighs, and
back bone, become crooked  and distorted,  and the child
walks with more and  more difficulty,  till it entirely loses
the use of  its feet; the veins of the neck, and those that
surround the enlarged joints are generally much distended,
while those on other parts of the body appear in a dimi-
nished or contracted state; the countenance  is  lively, the
cheeks full, and often florid,  and the faculties of the mind
sometimes  impaired, but more  frequently possess a pre-
mature  acuteness of the  understanding; the  sides of the
chest flattened,  and the  breast bone elevated,  often in a
point;  the  ends  of the ribs, like the joints above noticed,
are often knotty; the teeth generally come forward  at a

  * The editors of the  " Medical Observer" have very pro-
perly exposed this dangerous and disgraceful practice of adver-
tising nostrums under fictitious  names, in order to deceive the
ignorant and  unwary,  and have made many judicious stric-
tures on the Essence of  Mustard. 
                          433
late  period, and soon  turn black  and decay, or become
loose and fall out; the pulse  is quick and feeble; the ap-
petite  sometimes good, but the digestion evidently bad,
with flatulency and vomiting of acidity.
  This disease seldom proves  fatal, unless fever and con-
sumption of  the lungs  supervene; but after the fourth or
sixth year,  the child generally gains strength, and the bones
of the legs, although very  crooked, often become straight
as the child  grOws, while  the distortion or  curvature of
the back bone frequently increases.

                Of the  Causes of Rickets.
   From the  frequency of this  disease in marshy countries,
a moist atmosphere has been  noticed, by medical writers,
as a predisposing cause. Some have  attributed it to bad
nursing,  the use of acescent food,  and whatever may tend
to debilitate the body; others, with less probability, have
imputed it  to a scrofulous  or venereal taint in the parents.
From the examination of those who have  died of the dis-
ease, the mesenteric glands, the liver and lungs, have been
found enlarged, and the bones nearly destitute  of  the
earthy matter which gives  them firmness and shape.
    Dr. Bobba, of Italy, sometime since presented to the
Medical Society at Paris,  some ingenious remarks on the
cause  of rickets.  It is well known,  that the bones owe
their solidity to phosphat  of lime,  he therefore ascribes
the  cause  of rickets  to a  want  of  this  substance ;  but
whether the  phosphat of lime is  entirely wanting in the
system,  or the vessels destined for  its deposition in the
bones be too weak to perform their office, the  learned
Doctor does not  take upon  himself to determine. The
source of  rickets  may be  traced to some  wrong action
in  the digestive  organs,  probably  from  unwholesome
                           3 L 
434
food, or want of the due exercise of the body;  in conse-
quence of which, the bile* is  not  secreted in  sufficient
quantity, a strong acid is  generated, and the food not pro-
perly converted into chyle.  The  acidity which is formed
both from animal and vegetable food (the nature  of which
has not yet been ascertained by any  chemical experiment),
no doubt enters the mass of blood, and there forms the uric
acid. The existence of this  acid in  the circulating fluids,
may  prevent  the  due formation and  deposition  of  the
phosphat of lime, or, as is much more probable, may de-
compose it after it is deposited, so as afterward to become
an extraneous body, and removed by the absorbent vessels
and  evacuated by the  urine* thus  we find the  urine  of
rickety children charged with  calcareous  matter.  It is
observed, by  Morgagni,  Portal, and Pinel, that softness
of the bones  in adults  generally occurs  in  gouty  habits.
Now it  appears, by the  experiments of Dr.  Wollaston,
Mr. Fourcroy, and Dr. Pearson, that the concretions de-
posited about the joints  of gouty persons, are a calcareous
earth combined with  the  uric acid. It is, therefore, pre-
sumable, that the uric  acid has a  greater  affinity to  the
calcareous  earth than the phosphoric  acid,  and that in
consequence  of which, the phosphat of  lime  deposited
in the bones, is decomposed, taken  up into  the circulation
by  the  absorbent  vessels, and  either deposited in some
other part of the body, in  which  there may be a morbid ac-

  * The pale appearance of the fxces of rickety children suf-
ficiently prove that the bile is  not secreted in proper quantity,
and the enlarged state of the  bowels,  flatulency, irregular ap-
petite, and acidity, indicate the disordered state of the digestive
organs and  wrong action that is going on throughout the in-
testinal canals. 
435
tion  or preternatural determination,  or separated from
the blood by the kidneys,  and conveyed  from the body
by the urine, which the urine of people affected with gout
confirms.  Gravel and stone  may likewise be thus formed,
for their analysis has proved that they are composed of  the
uric  acid and calcareous matter.


              Of the Treatment of Rickets.

   The  first  object to  attain  towards the  cure of this
disease is, an healthy action in the digestive organs, for
which purpose it will be  necessary to clear the first pas-
sages by an emetic of ipecacuan powder, as directed No.
23, and to empty the intestinal canal by  an active dose of
calomel, No  34, or basilic powder, No. 36, after which
a dessert or table spoonful  of  the following mixture may
be given three times a  day:
   Take of extract of ratania root,* one drachm;
       Dissolve in  lime water, six ounces; then add,
       Tincture of cardamom  seeds, half an ounce.
If the faeces  should continue pale after  this medicine  has
been taken a week, a  grain of calomel should be given
every, or every other, night,  in a little currant jelly or
sugar, and if the bowels  should not be  relieved twice or
at least once  a  day, the basilic  powder should be repeated.
The alterative  dose of calomel should be continued every
other night for a week, or till the  stools become of a pro-
per yellow appearance.

   * This extract is a very admirable strengthening medicine
for children.  If it cannot be obtained (for at present it is little
known in this country,) half an ounce of the tincture of Columbo
may be substituted for it. 
                          436
    After this state of the  digestive organs is  corrected,
 cold bathing may be employed with the most decided ad-
 vantage.
   If notwithstanding these remedies, the acidity continue
 to prevail in the  stomach, which  is frequently the case,
 the emetic of  ipecacuan  powder should be repeated, and
 the patient should, besides the mixture, take the prepared
 natron,  as directed  No.  60, and when the symptoms  of
 indigestion  have subsided, the  mixture need not be taken
 more than once a day (about an hour before dinner). The
 limbs, and even bowels, should be well rubbed every night
 and morning, with the flesh brush, flannel, or the warm
 hand.
   If the bones of the lower extremities be much curved,
 they should  be supported by instruments,  so made as  to
 take off the whole weight of the body, by sustaining the
 pelvis, and at the same time to produce a  slight pressure
 on the  distorted parts of  the bones. Several plans of in-
 struments have  been  recommended for  this purpose,  bu^
 those invented  by Mr.  Whiteford, surgical instrument
 maker  at Bartholomew's hospital, are certainly the most
 serviceable, and least inconvenient to wear.
   The  phosphat of lime  is much  recommended by Dr.
 Bobba,  of Italy, and it appears has in a  few instances been
 successfully  employed in  this  country.  Before  its  exhi-
 bition, it will be necessary to correct the state of the sto-
 mach and bowels by an emetic of ipecacuan and  the mix-
 ture of  extract of ratania root; from inattention to this
preparatory  treatment, it  is probable that  this  medicine
 has failed in  the practice  of some  practitioners, for the
 acidity  which forms  in the stomach of rickety  children,
 will  assuredly decompose  it, and  render it  inert.  The
phosphat of  soda, noticed  page 7,  under  the  head of 
437
Epsom salt, may likewise be taken every morning, as di-
rected for the Epsom water, page 7. The muriate of lime
has also been recommended as  a remedy for rickets,  but
I believe it has little or no  advantage  over the muriate of
soda, which is the common culinary salt.*
  The Peruvian bark has been much recommended as a
strengthening medicine, but instead of producing such an
effect, I have uniformly found it disagree with the bowels,
and increase the difficulty of breathing. The use of issues
in cases of rickets, recommended by some authors, is much
to be doubted. The discharge cannot be beneficial, but by
increasing the debility of the frame, would very likely prove
injurious; they are at any rate too ambiguous a remedy
for domestic medicine in this complaint.
   Exercise is  of the greatest importance in  the treatment
of rickets, the child should therefore be well tossed in the
arms of an  athletic nurse, and when she is tired, it should
be  put to roll and kick on the  carpet, and not into a cradle
to* be rocked to sleep, or  to sit and amuse itself with toys.
A  lively  nurse, that  will do her duty out of the sight of
the mother as well as in it, will be of much greater  ser-
vice  in establishing the health of the child, than all  the
medicine that can be recommended  by the most skilful
physician. Nothing strengthens the  digestive  organs of
children more than exercise, and  if they have not  then-
due share of it, indigestion and other diseases in the sys-
tem will be the consequences.j

   * I have found common  salt so very serviceable  in cases of
rickets, that I recommend it to be taken  in extra quantities in
almost every article of diet.
   t In manufacturing towns,  where mothers have not time to
exercise their children, rickety complaints are  very prevalent. 
438
   The diet of rickety children should consist of a pro-
 portionate combination of animal and vegetable food, such
 as broth, chicken, veal, bread and rice puddings,  and the
 animal  and vegetable jellies, as those of arrow root, sago,
 and  hartshorn shavings, as directed,  page 85, and the
 beverage chiefly pure water.
   Malt liquor, wines of all sort; vinegar, tea, and fruit,
 should be particularly avoided.
   If the child have any difficulty of breathing, or be very
 weakly, flannel should be  worn next the skin.

                   OF RUPTURE.
   A  soft compressible  tumor,  formed by the protrusion
 of some part of the  bowels, generally occurring in the
 groin and scrotum, and  sometimes  at the navel and dif-
ferent parts  of the belly, constitutes rupture. They are
differently named, from their situation and contents.

               Of the Causes of Rupture.
   Whatever diminishes the cavity of the belly, by forcing
the bowels out of their natural situation, will produce this
disorder; such as excessive laughing, sneezing, an im-
pregnated womb, and sudden and violent exertions. The
fashion  of wearing the waistband of the breeches high up,
and tight round the waist, by pressing down  the  bowels,
is  perhaps the cause  of the unusual frequency of ruptures,
in England, of late years.

              Of the Treatment of Rupture.
   All that can be done towards the cure  of ruptures, is,
to replace the prolapsed parts into the cavity of  the  belly,

 A late medical author observes, that rickets did not appear in
 this country till manufactures began to  flourish. 
439
and to prevent them from slipping out again; the surgeon
has then done his part, and the rest  is nature's.  For the
purpose of retaining them in their proper situation, dif-
ferent bandages  are  employed, according to their seat.
When situated in the groin, or scrotum, an instrument,
termed a truss, has generally been applied; which,  if not
properly constructed,  by producing  an unequal  pressure
over the aperture, through which the  bowels protrude, has
been  productive  of  much mischief, by suffering a  small
portion of the bowels  to  get between the  pad  and the
bone, so as to become pinched or contused. To obviate
such  a serious  occurrence,  several  improvements have
lately been made on the common truss, which from the
length and peculiar formation  of the pads,  by means of
regulating springs, an equal pressure is produced, and the
descent of the bowels  thus effectually prevented.  From
the elasticity of the  circular spring, it is attended with no
kind of inconvenience in walking, or any kind of exercise;
but, from the additional spring, the  pad is not disturbed
by  any position  of the body.  These  improvements have
been  made according to the directions of the first practi-
tioners in  surgery in London, viz.  Messrs.  Cline, Rams-
den, Cooper, Roberts, &c. When the body  is in an ho-
rizontal position, as  during bed-time, the use of a truss
is not necessary. The bowels should likewise be supported,
by means of drawers, with a wide wasteband, which should
button as low down as possible.
* Costiveness and flatulency should be carefully  guarded
against, by taking  occasionally  a table  spoonful of the
bitter tincture of rhubarb, and avoiding much vegetable
food and fermented liquors.
  When the  contents  of the tumor  cannot be returned,
and is attended  with much  pain in  the part, or in the 
440
bowels, with nausea, vomiting, restlessness, fever, and no
discharge by stool, a strangulation of the protruded parts
may be suspected, in  which  case  surgical aid should be
resorted to without delay, as the life of the patient is en-«-
dangered by approaching inflammation, and  if the  con.*-*
fined parts be not soon liberated, mortification and death
must inevitably ensue.

  OF ST. ANTHONY'S FIRE, OR ERYSIPELAS.

  The  plethoric, young people,  and pregnant  women,
are generally the subjects of this disease; and  after being
once affected, are very liable to future attacks.

         Of the Symptoms of St. Anthony's Fire.
  It comes on with more or less of  cold shiverings, and
other symptoms of fever, the hot fit being sometimes at-
tended with  greater affection of the head, as drowsiness,
confusion, and often delirium.  The  redness of the  skin
appears after the first  or second, and sometimes the third
day of the fever, generally on the face, gradually spreading
over the neck and scalp of the head, which become turgid,
and the eye-lids often so swelled as to close the eyes en-  -
tirely.  The redness is attended  with considerable heat,
and  disappears on slight pressure of the finger, quickly
returning on its removal. After  some  time there com-
monly  arise, sooner or later, blisters  of larger or smaller
sizes, containing a clear watery fluid, of so ichorous a na-
ture as to inflame the skin it  is discharged over. Some-
times the inflammation first appears on the legs, which
soon become  considerably  tumefied. The disorder in-
creases for two or three days,  and continues at its height
for two more, when it abates, and afterward terminates in 
441
     a falling off of the diseased scarf skin, in large scales; but
     sometimes the delirium  increases, and  inflammation  of
     the brain  intervenes, which, about the seventh, ninth, or
     eleventh day, often terminates fatally.

  1            Of the Causes of St. Anthony's Fire.
  L    It is produced by sudden exposure to  cold, particularly
  ■ when the body is hot, or in a state of perspiration. TissOt
  '-  observes, that the superficial inflammation of the skin is
     occasioned by the irritation of an acrid sharp humour, not
     duly discharged by perspiration.
       Dr. Darwin is of opinion that it is not a  primary dis-
     ease, but  that it arises from  torpor  or  inflammation of
     some internal and distant membrane, as of the stomach,
     liver, kidneys, or more commonly  of the  brain, which the
i     learned author thinks is countenanced by the  inflamma-
     tion changing its situation, and liable to  return at certain
     annual or  monthly periods. Dr. Cullen supposes it tO de-
     pend on a matter generated within the body, and in con-
     sequence of fever thrown out on its surface.

             Of the Treatment of St. Anthony's Fire.
       When  the  brain  is not, or but slightly,  affected, this
     disease is not attended with danger, and requires  only the
     occasional use of the  aperient mixture,  No. 62,  with
     twenty drops  of antimonial wine, No. 16, at bed-time, in
     a little weak white wine  whey. The diet should  be low,
     and the drink  chiefly barley-water, acidulated with tama-
     rinds.  But when the head is  much disordered,  the feet
     should be put  in warm water, and a blister applied to the
     nape of the neck.  If these fail to afford relief, and the per-
     son be of a plethoric habit, the loss of eight or ten ounces
     of blood  from the  arm  will likewise  be necessary.  If,
     notwithstanding these  remedies, the affection of the brain
                              3 M 
442
should increase, and the patient become delirious, the head
should be shaved, and a large blister applied to the scalp,
and mustard poultices to the feet. The fever attendant on
this disease, especially when it occurs in autumn, is often
of an  ambiguous nature, and, instead of the depleting plan,
may require an opposite treatment; when, therefore, it is
attended with  an affection of the head, medical advice
should always be taken, the life of the  patient being cer-
tainly in a critical situation.
   The volatile  alkali in the dose of five or  six grains two
or three  times  a day, dissolved in water, has lately been
much recommended by Dr. Peart, and it appears in many
instances has proved beneficial.  The  decoction  of  Peru-
vian bark, with the  diluted vitriolic  acid, is  directed  by
some eminent  practitioners  from the commencement of
the disease; but the propriety of administering such  medi-
cines  must depend on the attendant  symptoms. If there
be considerable determination of blood  to the head, and
symptoms of inflammation of the brain appear, no cautious
practitioner would venture on their exhibition. When this
disease proves fatal, it is generally by attacking the brain;
the object of the practice is, therefore, to check the velocity
of the blood to the  head, and to  diminish the excitability
of the system and calm the mind; the symptoms of putrid
fever which so often  attend the latter stage of the disease,
or appear a few days before the dissolution  of the patient,
are merely symptomatic of the affection of the brain.
   The diet  should be low, and  consist  principally of ve-
getable jellies,  and wine  and stimulants strictly avoided,
unless the debility or sinking state of the patient indicates
their use.
   Great caution is  necessary in  the application of external
remedies; as, by the imprudent  use of repellents, inflam-
mation of the brain has been produced. Fine oatmeal may 
443
be sprinkled over the parts, to absorb the discharge, and
cabbage leaves stripped of the stems, softened  before the
fire, or by being immer ed in boiling water, applied in case
of much  heat  and dryness of the parts  affected.  Notwith-
standing  the great  danger that always  attends the use of
external  applications in this disease, empirics  are  bold
enough to assert, that, by the use of their lotions, it may
be infallibly cured.  I was sometime since requested to see
a patient, afflicted with this disorder, who, from the use of
one of these advertised remedies, was attacked with  slight
inflammation  of the brain; and had she continued its ap-
plication one  day longer, it  would most  assuredly  have
cost her  her life. I embraced the opportunity of analysing
this innocent composition, as it is stated to be in the direc-
tions, which proved to be no less than a solution of corro-
sive sublimate of mercury!!

           OF SAINT VITUS's DANCE.

           Description ofi Saint Vitus'1]s Dance.
   This disease is a kind of convulsion, principally at-
tacking children of both sexes, from ten to fourteen  years
of  age.*  It  first  shews  itself by a lameness, or rather
unsteadiness of one of the legs,  which  the patient draws
after him like an idiot; and afterwards affects the  hand,
on  the same side, that if a glass of liquor  be put into it to
drink, before  the patient can get it to  his mouth, he uses
a great number of odd gestures; through the hand  being

  * Dr. Rotheram observes, that he has seen this disease, in  a
robust man of forty-two:  this patient, after various ineffectual
remedies had been used, was cured by strong electrical shocks,
directed through the whole body. 
444
drawn different ways by the convulsive action of the mus-
cles, he is not able to carry it  in a  straight line thereto;
and  as soon as it hath reached his lips, he throws it  sud-
denly into his mouth, and drinks it  very hastily, as if he
only meant to divert the spectator. The will of the patient
seems often to yield to these convulsive motions, as  to a
propensity, and thereby they are often increased, while the
person affected seems to  be pleased with  increasing the
surprise and  amusement which his motions occasion to the
bystanders.   It is sometimes accompanied by confusion of
mind, and the patient often labours  under an impediment
of speech.   Females  are   generally the subjects of this
disease.

          Ofi the Causes ofi Saint Vitus's Dance.
  From its generally attacking weakly people, it has been
attributed to debility of the System. It arises from an in-
creased excitement of the  nervous  system, which is often
produced by  irritation  in the stomach and intestines, such
as worms, and sometimes by violent passions and pertur-
bation of mind.  In females, at the  period  of puberty,  it
probably arises from the same  causes as hysterics.

        Ofi the Treatment ofi Saint Vitus's Dance.
  As the stomach  and intestines are always more or less
disordered in this disease, the cure must  be commenced
by an emetic of  ipecacuan powder, No. 23, and the fol-
lowing day a dose of the basilic powder, No. 36, after the
due operation of which, strengthening medicines, combined
with those that are known to allay the nervous irritability,
should be persevered in, such as the following mixture:
  Take of essential salt of bark, No. 24, one drachm; dis-
         solve in half a pint of water, then  add 
445
          Tincture of Russian castor, three drachms,
          Tincture of valerian, six drachms. Mix.
   Two table spoonfuls to be taken three times a day.
     If the complaint be attended with pain in the  head,  a
   blister should be applied to the nape of the neck, and the
   feet kept warm by the use of flannel socks.
     When  the symptoms are  abated, cold bathing  every
\   morning will prove of great advantage ;  and with the use
   of the  muriated tincture of  steel,  in the dose  of ten or
   fifteen  drops, in  a glass  of cold valerian and camomile
   tea, will probably complete the cure. The basilic powder
   should be repeated two or three times a week till nine or
   twelve doses have been taken, for if it  arise from worms
   it will  effectually  dislodge them;  and if the stomach and
   intestines are in fault, which in ninety-nine cases in a hun-
   dred is the case,  the  frequent exhibitions of such a pur-
   gative  will probably remove  it.  Irregular action of mus-
   cles is certainly connected with the state of the  stomach
   and intestines, and Dr.  Hamilton  asserts may be cured
   by frequent doses of cathartic medicines, many instances
   of which  that very  able  and  experienced  physician has
   lately published.  If this treatment  fail of affording relief,
   the cure  should be attempted in  the manner directed for
   epilepsy.
      In many cases electricity  has  proved of great advan-
   tage ;  but, in the majority,  it has  aggravated the  symp-
   toms,  and when attended with the  head-ach  or plethora,
   should never be employed.
      The electuary  of tin, recommended for the tape worm,
   No. 85,  has been successfully prescribed by Dr. Blount,
   of Hereford, and in  all  the cases  1  have  known  it ad-
   ministered,  it certainly has proved  beneficial in improving
   the general  health of the  patient and quieting the nervous
    ystem,  which I  attribute  to its mechanical operation  on 
446
 the inner coats of the stomach and intestines, occasioning
 them to throw off  redundant slime,  and  producing an
 healthy action in the mucous glands,  and thus tend  con-
 siderably to the promotion of  the health  of the body.
 With this  view I have  lately given the granulated tin, in
 many  diseases of  children, in which the  stomach  and
 bowels were disordered, with the most decided advantage.
 The diet, should be regulated according to the strength of
 the patient: if plethoric,  a low diet should  be observed,
 and wine and  stimulants avoided.  On  the contrary, if the
 body be much debilitated,  a nutritious diet should be em-
 ployed; but even in this case, wine and stimulants should
 be allowed with great caution.  Cold bathing, if it do not
 alarm the mind, will prove highly beneficial, and in two
 instances I have known it succeed after  all other means
 proved of no  avail.

              OF THE SCALD  HEAD.

   This disease may be  considered of a contagious nature.
 It is often communicated by  a change  of hats at schools,
 and in families by the use of the same comb. The whole
 of the hairy scalp is subject  to  it, but on  inspection  it
1 will  appear more virulent  at  the roots of the hair.   The
 discharge is often so acrimonious as to cause swellings of
 the lymphatic glands of the  neck.  It  is  sometimes  dry,
 and at others  moist.

             Ofi the  Treatment ofi Scald Head.
   On  the early appearance of this disease, it will only be
 necessary to  cut the hair  short in  the places affected, to
 remove the scabs, and  rub a little  of  the  following oint-
 ment well over the  parts:
   Take of the citrine ointment, three  drachms, 
447
       Olive oil, one drachm. Mix ifl^t glass mortar.
  When the disease has been neglected, and  the scalp
much affected, the shaving of the  head will be  requisite,
afttr which  it should be well washed with a strong solu-
tion of soap in water, till the scabs and matter be entirely
removed,  when the following should be well rubbed over
the parts every night and morning, by means of a piece of
soft leather:
  Take of the citrine ointment,
       Pitch ointment,  of each half an ounce.
To be mixed*in a glass  mortar.
   This ointment  should be removed  every  morning by
first rubbing over the scalp some  olive  oil, and afterward
washing it off by means of a piece of flannel. If any part
appear more diseased than another, the hair of  such parts
should be pulled out by degrees as their roots are affected.
During the use of this   ointment, a  cap  made  of bladder
should be  worn.  After the virulence of the  disease is
abated, the cure may be completed with the citrine oint-
ment  and olive oil, as  above directed;  and even after it
has  entirely disappeared, it will be necessary to wash the
scalp once or twice a day with a strong  solution of .soap,
or a decoction of tobacco, till the hairs  begin to grow on
the parts, which may be considered a proof of the disease
being destroyed.
   If this disorder occur in a scrofulous habit,  it is gene-
rally extremely difficult to cure.  In  such case  it will be
necessary to correct the scrofulous diathesis of  the system
 by the remedies recommended for scrofula, of which the
 prepared natron  and compound decoction of sarsaparilla
 will prove the most efficacious. The internal use of mer-
 cury there  recommended will not, however, be necessary,
 as long as the citrine  ointment is  well rubbed' into  the
 scalp. 
448
   Although the ge|feral opinion is,  that this disease ic
confined to the scalp, I conceive  it will in all cases  be
proper to attend to the general health, and particularly to
the digestive organs of the patient; and to guard against
acidity in the stomach, by the use of the prepared natron,
as directed No. 60. If the stomach be disordered, an emetic
of ipecacuan powder, No. 23, and  a full  dose  of  the
basilic powder, No. 36, will be necessary, and  afterward
thirty or forty  drops of the tincture of columbo  may be
taken in the solution of prepared natron, as directed, No.
60; but if the patient be of full habit of body, the solution
of Epsom salt,  or the sulphurous saline water, as directed,
No. 2, will answer best.
   The diet should consist of a proper proportion of vege-
table  and animal food, and the beverage pure or distilled
water.

               OF SCARLET FEVER.

                   Ofi the Symptoms.

   It begins with chilliness and shiverings; after which the
whole skin becomes covered with red spots, more nume-
rous,  larger, and redder, than those of the measles.  In two
or three days they disappear, succeeded by scalings of the
skin,  like bran dispersed over the body,  which fall off and
come again, two or three  times successively.

           Ofi  the Treatment ofi Scarlet Fever.
   This disease is generally so  mild as to require  nothing
more than a low diet, and to avoid a cold  air and cold
drink.  If the  body  be costive, a  dose of the aperient
mixture,  No. 62, or powdered rhubarb, No. 25,  may be
taken  and  repeated occasionally;  and  if  the feverish 
449
symptoms run high, the saline mixture, No. 78, may like-
wise be taken every two or three hours,  in the dose of a
tea cupful.  The drink should be barley water, acidulated
with tamarinds.  If attended with much pain  in the head,
or stupor, a  blister  should be applied to the  nape of  the
neck, and the feet immersed in warm water.  When it is
accompanied with more malignant symptoms,  its tendency
is  always to the putrid kind  of fever,  with  ulcers in  the
throat;  which will require  the same  treatment  as recom-
mended for putrid sore throat.


                    OF SCURVY.
   The  diseases of the skin, generally termed scorbutic in
this country, are considered  under the  head  of " Erup-
tions of the  skin."  The  true scurvy is of a  very putrid,
but  not contagious, nature; and more frequently  occurs
in cold  climates than in warm ones. It chiefly affects sailors,
and such as are shut up in besieged places. It  is character-
ised by extreme debility of the system, a pale and bloated
complexion,  spongy gums, livid spots on the skin, offensive
breath, cedematous swelling of the legs, foul  ulcers, foetid
urine,   and  extremely offensive  stools; the  pulse  small,
frequent, and towards the last, intermits. This disease, in
its last stage,  exhibits a  most  lamentable  and wretched
appearance:  with considerable  aggravation of the  above
symptoms, the  joints  become swelled and stiff, the ten-
dons of the legs rigid and contracted, general emaciation
ensues, bleeding at different parts of the body, the  stools
extremely foetid; at length  violent purging or  dysentery
comes on and soon terminates the tragic scene.

                Ofi the Causes ofi Scurvy.
   This disease evidently arises from  the want of fresh
                          3 N 
450
provisions  and a due quantity of  vegetables, probably
assisted by the prevalence of cold and moisture, and such
other causes as depress the nervous  energy; as indolence,
confinement,  neglect  of  cleanliness,  much  labour  and
fatigue, sadness, despondency,  &c. A preternatural saline
state of the fluids is assigned by  Dr. Cullen  as its proxi-
mate cause.  It seems to depend more  on  a  defect  of
nourishment  than on a vitiated  state of the fluids; and
the reason  that salted meat  is so  productive of scurvy, is
most probably because it is drained of its nutritious juices,
which are extracted and  run off in brine, and at the same
time its fibres are hardened and  rendered  more  difficult
of digestion.

               Ofi the  Treatment  ofi Scurvy.
   A diet  of fresh vegetables  and  beverage  strongly im-
pregnated  with the juice of lemons, oranges, and the sub-
acid fruits, are more efficacious in the cure of this disease
than the most powerful antiscorbutic medicines the  materia
medica affords. The essence of malt and spruce have like-
wise been  found of great service, probably from the quan-
tity of fixed air they contain. When lemon or orange juice
cannot be obtained, nitre dissolved in vinegar in  the pro-
portion of two  ounces of the former to a  quart of the
latter, has been  found  to afford  the  best substitute.
Water, acidulated with  the nitric acid, is perhaps not less
efficacious; from one to two  ounces or more of the former,
may be given three or four  times in the course of the day;
and of the latter a quantity containing about fifteen  or
twenty drops of the nitric  acid may be taken every five
or six hours. The vitriolic acid,  the Peruvian bark, and
the red sulphate of iron, are likewise very valuable remedies
in the far  advanced  stages of this disease. 
451
   I'he room or cabin of the patient should be fumigated
two or three times with the nitrous vapours, as directed
page  90, which  with cleanliness will contribute  much
towards the recovery of the patient.
   The  faeces and urine  should  be thrown away  as soon
after they are evacuated  as possible, and the vessel  rinsed
out with vinegar.
   The  bleeding  should  be  suppressed by  the application
of styptics, such  as  a solution  of alum with dossels of
lint.
   In case of ulceration, the lemon juice, with tincture
of myrrh,  or  vinegar and  myrrh,  will  prove the most
efficacious application.
   The  true  sea scurvy  exhibits,  in  a  remarkable  de-
gree, the  great  influence of the  passions of the mind.*
 Depression of spirits,  bordering on  despondency, is its
constant attendant,  the counteracting  of which, expe-
rience has proved to be of  the utmost consequence to the
recovery of the  patient. In Lord Anson's voyage, it was
 noticed in reiterated experience of this  malady,  "that
 whatever discouraged the seamen, or at any time damped
 their hopes, never failed to add new vigour to the dis-
 temper; for it usually  killed those who were in  the last
 stages of it, and confined  those  to their hammocks who
 were  before  capable of some  kind of duty; so that (as
 the writer judiciously observes) it seemed as though alacri-
 ty of mind and  sanguine thoughts were  no  contemptible
 preservatives from its fatal-malignity." And in Mr. Ive's
 journal, a remarkable  instance of  the good effects  of an
 opposite state of mind is given: "Upon  the  British fleet
 coming into the  bay  of  Hieres (Feb.  1744), the men
* Hoffman de Scorb. et ejus vera indole. 
452
understood they were soon  to  engage the enemy's  fleet.
There appeared  not  only in the healthy,  but  also in the
sick, the highest marks of satisfaction and pleasure, and
the last mended surprisingly  daily, insomuch  that  on
the 11th of February, the day they engaged the combined
fleets  of France and Spain, there were  not above four or
five men but what were  at their fighting  quarters." The
siege  of Breda, observes Dr. Falconer, in the year 1625,
affords an example  of the influence  of  the mind, in this
disease, still more striking: " That city, from a long siege,
suffered all the miseries that fatigue, bad provisions, and
distress of  mind could  bring on its inhabitants. Among
other  misfortunes, the scurvy  made its appearance, and
carried off great numbers. This,  added to  the  other
calamities,  induced the garrison to incline towards a sur-
render of the  place; when the  Prince of Orange, anxious
to prevent its loss, and unable to  relieve the  garrison,
contrived however to introduce letters, addressed to the
men,  promising  them the  most speedy  assistance. These
were  accompanied  with  medicines   against  the scurvy,
said  to be of great  price,  but of  still greater efficacy;
many more were to  be sent them. The effects of this
deceit were truly astonishing: three small  phials of medi-
cine were given to each physician. It was publickly given
out that three or four drops were  sufficient to impart an
healing virtue to a gallon of  liquor. We now displayed
our  wonder-working balsam,  nor  even  were  the  com-
manders let into the secret of  the cheat  on  the soldiers.
They flocked in crowds about us,  every one soliciting
that  part might be  reserved  for his use. Cheerfulness
again appeared in every countenance, and an universal con-
fidence prevailed in the sovereign virtues of the remedy.
The  effect of this  delusion was  really  astonishing, for
many were quickly and perfectly  recovered; such as had 
453
not moved  their limbs for a  month  before, were  seen
walking in the streets, with their limbs sound, straight,
and  whole.  They boasted of the cure  by the Prince's
remedy,  the motion  of their  joints being  restored  by
simple friction with oil.  Many  who had  declared  they
had been rendered worse by all former remedies, recover-
ed in a few days, to their inexpressible joy and the no less
general surprise, by their taking what we affirmed  to be
their gracious  Prince's cure."  " This curious relation
(adds Dr. Lind*) would perhaps hardly  gain credit, were
it not in every  respect consonant  to the most  accurate
observations and the best attested description of that
disease. It is given us by an eye-witness, an  author of great
candour and veracity, who,  as he informs us, wrote  down
every day the state of his patients, and seems to  be  more
surprised with their unexpected recovery than he  probably
would have been had he been  better acquainted  with the
nature of this surprising malady. An important  lesson in
physic (adds the excellent writer last mentioned) is  hence
to be learned, the wonderful and powerful  influence of the
passions of the mind on the state and  disorders of the  body.
This is too often overlooked in the cure of disorders, many
of which are sometimes attempted  by the sole  mechanical
operation of drugs, without calling into  our assistance the
strong powers of the  imagination or the concurring influ-
ence of the soul.  Hence it is, that the same remedy will not
 always produce the same effect, even in the same person;
 and that common remedies often prove wonderfully success-
 ful in the  hands of bold  quacks, but do  not  answer the
 purpose in a timorous and distrustful patient."
' Lind on the Scurvy, page 349. 
454
   Scurvy, like all other diseases, has its specific remedy
 most arrogantly  puffed off in  the  daily papers;  and
 although  composed  of corrosive  sublimate of mercury,
 the  public are in  the most positive  terms assured  it is
 perfectly  free from  any poisonous ingredient whatever.
 This preparation  of mercury,  cautiously administered, is
 no doubt a good medicine  in  those diseases of the skin,
 generally termed scorbutic  or  land scurvy;  but  certain
 restraint of diet  and  great care are  required  during its
 exhibition, which  the   patient  does not  think necessary
 to observe, from a  supposition that the medicine is as
 innocent as the proprietors  represent it to be;  besides
 there are many circumstances and states of constitution
 that may render the use of mercury highly injurious;  and
there can be  little doubt, but that even in land scurvy
 they have indirectly  destroyed  many lives;  and in the
true sea scurvy, I consider  them as certain and deadly a
poison as a large dose  of arsenic.

                   OF SCIATICA.

   When rheumatism  attacks the hip joint, or the great
 nerve of .the  thigh, it is thus termed. When attended
with fever, it will require the treatment recommended for
the acute rheumatism; and  when fever is entirely absent,
 it is to be considered of the  nature of chronic rheumatism,
 and as such treated.

              SCIRRHUS. See Cancer.

           SORE THROAT. See Quinsey.

                 OF  SMALL-POX.
   This  disease is highly infectious, and  the constitution 
455
that has been once under its influence, is thereby rendered
secure against its future attack. When the pustules are sepa-
rate from each other, it is termed distinct,  and when they
run together it is denominated confluent.

             Ofi the Symptoms of Small-Pox.
   It comes on with shiverings, pain in the head, nausea.
and other symptoms of fever, and sometimes, a few hours
before the eruption, children are afflicted with convulsions.
The  eruption appears about the fourth day of the fever,
first on the face and afterward  on the neck,  breast,  and
body. The  pustules gradually enlarge and proceed to
maturation, which is completed about the eleventh day
after their first appearance, when the attendant inflammation
and  swelling manifestly abate, the  eruption  afterwards
begins to dry  and scale off; and  about the fifteenth day
entirely disappear. The confluent sort is generally attended
with more violent symptoms than the distinct, but observes
 the same period of termination, &c.

               Of the Causes of Small-Pox.
    It is produced  by a specific contagion.

             Of the Treatment of Small-Pox.
    The small-pox, like  the  measles, always runs its deter-
 mined course: all therefore that art can do, is to moderate
 the attendant fever and  to combat unfavourable symptoms.
 The  great advantage of inoculation  is,  that  precautions
 may  be  used, from the certain knowledge of the fever,
 which cannot be  employed in  due  time, when received
 naturally; besides the mode of introducing  it into the consti-
 tution,  evidently makes a difference  in  the  subsequent
 symptoms. To avoid a full  crop of the  eruption, and  to 
456
keep down the feverish symptoms, a dose of basilic powder,
No. 36,  should be  taken soon  after inoculation, and re-
peated every third day till  the  eruption appears, provided
the subject be not very weakly; or,  if the infection has been
received  naturally,  fifteen  drops of antimonial  wine in  a
dose of the saline mixture, No. 78, may be taken  every
six or eight hours, till the  feverish symptoms are  abated:
a low and cool diet will be proper. Barley water, acidated
with tamarinds, may be taken  frequently. If the feverish
symptoms  run high after the eruption  has  appeared, the
basilic powder and antimonial  wine should be repeated,
and the saline mixture taken oftener.  When the pustules
begin  to maturate, these debilitating  means should be
discontinued, and the patient allowed gradually to take to
his usual living;  and if the crop be considerable, and the
strength  of the patient much reduced, a little  port wine
may likewise be allowed after dinner. If symptoms of putrid
fever  intervene,  denoted by low pulse, delirium, extreme
debility,  the purple eruptions, it will require a liberal allow-
ance of cordials,  a nourishing  diet, as beef tea, animal
jellies, and the Peruvian bark,  in  case the bowels are not
disturbed. On the first appearance, however,  of such symp-
toms, the most able advice should be called in, the life of
the patient being in great danger.
   The matter for inoculation should be  taken  about the
ninth day  of the eruption, on a lancet  or  needle,  with
which the  skin of the patient to be infected need be  only
slightly scratched. See Cow-Pox.

         SPECKS ON THE  EYE. See Films.

             OF  SPITTING OF BLOOD.
   It is often difficult to determine in  cases of spitting of 
457
 blood, whether it proceeds from the internal  surface of
 the mouth, from the fauces, from the adjoining cavities of
 the  nose, from the  stomach, or  from the lungs; it  is,
 however, of importance to ascertain  its source, which in
 most cases  may be  done, by attending to the  following
 observations made by the able  Dr. Cullen: " When  the
 blood proceeds from some part of the internal  surface of
 the mouth itself, it  comes out without any hawking  or
 coughing: and generally, upon  inspection  of the  mouth,
 the particular source of it becomes evident. When it pro-
 ceeds from the fauces or the adjoining cavities of the
 nose, it  may be brought  out by hawking, and sometimes
 by  coughing,  as from the  lungs,  so that in  this way a
 doubt may  arise concerning its  real source. A bleeding
 from the fauces is, however, more rare than from  the
 lungs, and seldom happens but to persons who  have been
 before liable, either to bleeding at the nose, or to some
 evident  cause of erosion; and in most cases  by looking
 into the fauces, the blood may be perceived coming from
 thence."
  When the blood is of a  florid and frothy appearance,
 and brought up with more or  less coughing, preceded by
 rigours and other feverish symptoms, with anxiety and a
sense of tightness across the chest, there can be no doubt
 but  that  its source  is  in the  lungs.  When vomiting
 accompanies  the throwing out of blood  from the mouth,
 as vomiting  and  coughing often mutually excite each
 other, so  they  may  be frequently joined, and  render it
 doubtful  whether  the  blood thrown  out  proceeds from
 the lungs  or the stomach;  we may, however, generally
decide by considering that blood does not  so  frequently
 proceed from the lungs: that  the  blood proceeding from
the lungs  is usually of a  florid colour, and mixed with a
little frothy mucus only, while the blood  from the stomach
                         3 O 
W&     458
  is commonly of a darker colour, more grumous, and mixed
  with the other contents of the  stomach: that the coughing
  or vomiting, according as the  one or the other first arises
  in the cases in which they are afterward joined, may
  sometimes point out the  source  of the blood; and  lastly,
  that much may be  learned  from  the circumstances  and
  symptoms which have preceded the discharge.
    When  the source is from  the stomach,  it  is termed
  vomiting  of  blood, which is considered  in its alphabetical
  order. When the  origin  is the mouth or fauces, it is of
  little consequence, and  may be checked by the  use  of the
  astringent gargle, No.  94, and the loss of blood from the
  arm,  if it arise from plethoric state of the system.  If the
  cause  be  erosion or  ulceration, or if it occur during fever;,
  the treatment must depend on  the  nature of such fever
  or ulceration.
    What  is  strictly meant by  spitting  of blood, is when
  the blood is discharged  from a ruptured vessel  in  the
  lungs, technically termed,

                     H/EMOPTOE:

    Which occurs  generally from  the  age of sixteen to
  thirty-five,  chiefly  arising from  a faulty proportion be-
  tween the capacity of the vessels of the lungs,  and those
  of the rest  of the body; accordingly it is often an here-
  ditary disease, which implies a peculiar and faulty confor-
^mation.  It  likewise happens  especially to  persons who
  discover  the smallest capacity of the lungs, by the narrow-
  ness of the chest, and by the prominency of their shoulders,
  which last is a mark of  their  having been long liable  to a
  difficult  respiration. It  happens likewise to persons of a
  slender delicate make,  of which a long neck is a sign; to 
459
 persons of much sensibility and irritability, and therefore
 of quick  parts, whose bodies are generally of a delicate
 structure.  It likewise frequently arises from  suppression
 of the menstrual discharge; from plethora and violent ex-
 ercise of the lungs.

             Of the  Treatment ofi Hatmoptoe.
  The discharge of blood may be moderated  by avoiding
such  things  as have  a tendency to  irritate  the body and
increase the action of the heart; a low diet must therefore
be strictly observed, and  external heat  and bodily exer-
 cise avoided; the. air of the room should likewise be kept
 cool, and  the  drink (which should consist chiefly of bar-
ley-water,  acidulated with lemon juice)  taken cold, and
the patient not suffered to  exert  his voice.  After the ope-
ration of  a  little  gentle aperient medicine,  as lenitive
electuary, or  an infusion of senna, with a little cream of
tartar dissolved in it, two table spoonfuls of the  following
may be given  to  diminish the excitability of the system
 and  quiet the circulation in particular.
  Take of almond emulsion,  six ounces,
       Powdered ipecacuan, four grains,
       Tincture of fox-glove,  forty drops,
       Syrup of white poppies, half an ounce. Mix.
  In  case of much cough, five drops of laudanum may
be added to each dose of the mixture; but it must  not be
resorted to unless it be violent.
  If  the pulse  be  not much redifced by the discharge, a
few ounces of blood should be taken from  the arm, and
a blister applied over the breast-bone, especially if pain be
experienced in the  chest either on'coughing or breathing.
  If  the discharge of blood  should not be suppressed or
considerably  checked after  two or three days trial of these
remedies, or if the quantity of blood be  excessive,  it will 
460
be advisable to give the patient one  or  two grains of the
acetated ceruse twice  a day, dissolved in an ounce ol rose
or barley-water.  This is a very powerful remedy in re-
straining the discharge  of blood from  the lungs, and in
many very desperate  cases I have  known it  to succeed
beyond expectation, and in no instance have I known it
to fail entirely.   Emetics have been given in  those cases
with  advantage by Dr.  Robinson,  and still  more lately
by Dr. Stoll, of Vienna, who observes, that in discharges
of blood  from  the  lungs, ipecacuan powder sometimes
acts like a charm, seeming to close the open vessel sooner
and more  effectually than any other  remedy.
  When  the discharge  has  ceased, its recurrence should
be prevented by the following means:  the use of cooling
astringent medicines, as  a wine glassful of the  infusion
of red rose  leaves, with six drops of the  diluted vitriolic
acid three or four times a day; the loss of blood from the
arm on experiencing any pain in the chest or difficulty of
breathing; a seton in the side, or perpetual blister between
the shoulders, or over the  breast-bone; flannel next the
skin; avoiding  much exercise, particularly of the lungs;
the occasional use of aperient medicines, to  obviate cos-
tiveness, and a spare  diet, consisting principally of animal
jellies; but  diseases  of this class are  all so formidable,
that it is  advisable to call  in an experienced practitioner
without delay.
  If  symptoms  of ulceration succeed the discharge  of
blood, as  cough, with Ian expectoration of matter, &c. it
constitutes that species of pulmonary consumption, termed
phthisis haemoptoica,  which see.

     STONE  IN  THE BLADDER. See Gravel.

                 OF STRANGURY.
  When this  complaint  succeeds the  application of blis- 
461
ters, by an extra use of  diluting liquids, as linseed tea or
barley water, with a few  grains of nitre powder, and a
little gum-arabic, it will be relieved in the course of a
few hours. When it is occasioned  by the pressure of an
impregnated womb, costiveness should be avoided by small
doses of castor oil,  and an  horizontal position observed as
much as possible. When attendant  on the stone or gravel,
it  may be relieved  by the means  already recommended
for those complaints.

              SWEATING, PROFUSE.

   Excessive  perspiration attendant  on inflammatory fevers
or internal inflammation, as pleurisy,  &c. should always be
considered salutary. If it be evidently the consequence of
debility or relaxation of the system, the  diluted vitriolic
acid, as directed No. 18, will prove the best remedy.
   In all cases of perspiration, it is of great importance to
determine whether  it  be really a disease or an  effort of
nature to  expel  any morbific matter  from the system, or
to relieve  it of plethora, which often requires an experien-
ced practitioner to decide;  even the colliquative sweats
attendant  on  hectic  fever,  are  to be  suppressed  with the
greatest  caution.   Colliquative  perspirations are noticed
page 216.

             TAPE-WORM. See Worms,

                  OF TENESMUS.

             Ofi the Symptoms ofi Tenesmus.
   A constant irritation at the fundament, with  an incli-r
nation to  go  to  stool,  when little or  nothing can be dfe- 
462
 charged,  except slime  or  mucus,  which  is  sometimes
 streaked with blood.

               Ofi the Causes ofi Tenesmus.
   It is Often attendant on stone in the bladder, and fre-
quently occasioned by  inflammation of the neck of the
bladder,  from gravel,  clap,  or  the use of astringent and
stimulating  injections. It is likewise  frequently produced
by small worms in the rectum, acrid humours, the pressure
of an impregnated womb, piles, &c.

             Ofi the Treatment ofi Tenesmus.
   When it is produced by the  irritation of  a stone in the
bladder,  the  patient should change  his usual  position  of
body till it is removed. (See Stone and Gravel.)
   When it is occasioned by inflammation of  the neck  of
the bladder  (from whatever  cause the  inflammation may
arise), the application of leeches, the  use  of  castor oil,
as directed  No. 2, and the  warm bath will be necessary,
and general bleeding, if the  subject be of a plethoric habit.
   If worms be the cause, the treatment recommended for
their  expulsion  will be  necessary;  and if attendant  on
rYregnancy, occasional doses of rhubarb, No. 25, or leni-
tive electuary, No. 47, and lying on  the right  or left side
when in bed, instead of the back, will certainly afford relief.
   In all cases, aloetic medicines are  highly  improper; the
frequent use of this purgative medicine having, from  its
stimulating effects on the rectum, often produced the dis-
ease.  (See Piles.)

                    OF TETANY.
   This disease is a spasmodic affection, and occurs chiefly
in warm climates. 
463
              Ofi the Symptoms of Tetany.
  It is characterised by an involuntary and continued con-
traction of all or several of the muscles of  the body, re-
ceiving various appellations according to  the situation of
the parts attacked. When the muscles of the jaw are prin-
cipally affected,  it is named Trismus or Locked Jaw. It
commences with a stiffness in the back of the neck, which
gradually increases to  a pain,  and renders the affected
part entirely  immovable.  It  extends to  the root of the
tongue, affects the parts concerned in swallowing, .then at-
tacks  the  front of the chest, and lastly seizes  the back.
Spasms then arise in the stiffened parts, occasioning such
excruciating pain, that' death is often wished for, even by
the spectators.  A  remission of these spasms often takes
place  every ten or fifteen  minutes,  but  is renewed with
 aggravated torture on the slightest  causes, even  by the
 least motion  of the person, or  the touch of an attendant.
 The teeth become entirely closed, so that nothing can be
 introduced into the mouth; and  in  the  end  every volun-
 tary  muscle  of the body is affected, producing the most
 hideous deformity of appearance.
    No permanent fever attends this  disease, though some
 temporary symptoms of it appear during the  violence of
 the spasms;  nor is any habit of body exempt from it; but
 the robust and strong are most frequently its victims.

                 Of the Causes ofi Tetany.
     Cold  and moisture, particularly sudden vicissitudes; or
  irritation of the nerves in consequence of local injury, as
  punctures, cuts, &c. are noticed as causes of this disease.

                Ofi the Treatment ofi Tetany.
     When the disease is known to arise from  a wounded
   nerve, the  most important step towards the cure is, to 
464
 cut off the communication of the  part  with the brain,
 either by dividing the nerve in its course, or by destroy-
 ing, to a certain extent, the affected part.  If the wound
 be on a finger or a toe, it should be  amputated.
   Opium is the only anti-spasmodic that can be depend-
 ed on  in the cure or palliation of this disease: sixty drops
 of laudanum should be given in a little wine every three
 or four hours, and the dose increased ten  drops each time,
 till the spasms are  evidently abated  in violence; it should
 then be continued at that dose for  some  time longer, the
 disease being very liable to recur. This medicine, even in
 largfe doses, does not  operate in these cases as  in  other
 diseases; for although it produce some remission of the
 spasm  and pain, it hardly induces any sleep, or occasions
 that stupor, intoxication, or delirium, which  it generally
 does in other complaints. Opium has been given, and in a
 few instances with success, to the extent of half a drachm,
 which  is  equal to  about three  quarters  of an  ounce of
 laudanum.
   If the  muscles of the jaw, and those  concerned in
 swallowing, be so much  affected  that this remedy cannot
 be got into the stomach, it  must be administered clyster-
 wise, by dissolving about two scruples,  or a drachm of
 opium  in half a pint of gruel, which  should be  injected
 every three or four hours. If the jaws  be so closed by
 the spasm of the muscles,  that  they cannot be  opened
 during any period of  the day, it will be advisable to re-
 move a portion  of the  front teeth by  a  small  saw or
 trephine, for it is certainly of great consequence to get the
 remedy as well  as  nourishment  into the  stomach, which
 may in general be afterward done by means of a flexible
tube; if,  however, the muscles  of  deglutition  and the
 gullet should be  affected, the  body  should be immersed
 in warm  milk> two or three times a day, from which a 
465
sufficient quantity will be  absorbed to support  life,  and I
think if the milk were strongly impregnated with opium,
it might also tend to abate the spasms.
  Mercury has been much recommended as a remedy for
this disease;  and as it does not interfere with  the exhibi-
tion  of opium, a drachm of the strong mercurial oint-
ment, may be rubbed on the inside of the thigh, till  the
whole be  taken  up  into the system, and repeated twice a
day; and in order to accelerate its specific powers on the
constitution,  the body may be placed in mercurial fumes,
as directed by Lalonette,  and  lately recommended by Mr.
Abernethy, in order to saturate the  system with mercury,
without loss of time, which in so formidable a disease is
certainly of the  utmost importance.   For this purpose the
patient should be inclosed, naked,  in  a kind of box re-
sembling a sedan,  having above  an opening which  encir-
cles the neck, and at the  bottom another for the reception
of a  grate and heated  iron;  the mercurial powder* is to
be thrown on the iron, and  after the fumes  are entirely
dispersed over  the body, a  flannel dress, which has also
been fumigated,  should be put on.f
   Cold bathing  is much extolled, and it  seems in many
instances has succeeded  in  curing  this disease: and as
the use of the warm bath is  very doubtful, and in many
cases has proved hurtful, the cold bath should have the
preference.

   * The gray precipitate of mercury and cinnabar are generally
employed for this purpose, but  calomel will answer as well.
   f Sir Charles Blicke, surgeon to St. Bartholomew's hospital,
recommends stockings and a flannel waistcoat, fumigated with
mercury,  to be worn next the  skin, with the view to produce
mercurial effects both locally and on the constitution, without the
fatigue and other unpleasantness of rubbing in the ointment.
                          3 P 
466
   I'he application of blisters and  loss of blood, have ap-
parently, in some instances, proved serviceable; but in the
majority of cases they have  had no salutary effect, and in
many have appeared to aggravate the symptoms.
   As irregular  actions of the muscular system are often
produced  by irritation in  the  stomach  or intestines,  it
would also be advisable to clear them out with a strong
dose  of the  cathartic  extract  and calomel, both by the
mouth  and  clysterwise, which  should be  frequently re-
peated. As the exhibition of opium will retard the action
of purgative medicines, instead of administering it by the
mouth it might  answer as well, and probably better, if the
body  were  immersed  in  a  strong solution of opium in
warm but not hot water;  and  as it is in the  commence-
ment  of this disease that remedies  are  to  be employed
with a probability of success,  medical aid should be pro-
cured while it is likely  to prove beneficial.

              OF  THE TOOTH-ACH.

   This well-known  disease in general arises from the ex-
posure of the nerve of  the tooth to the action of cold air
or acrid matter, in consequence of caries.*  It is, how-

   * The nature  or causes  of  this ulcerative process are little
understood, even by those who term themselves dentists. It is
remarkable, that of all animals, man is most subject to it.  It
is generally supposed that it  arises  from injury  done to the
enamel, and the consequent exposure of the interior to the ac-
tion of the  atmospheric  air;  but  it has been observed, that
when a tooth has been broke by accident, this disease never fol-
lows.  It is more probable it arises from the use of improper
food, particularly sweets  and acids, or from its being taken too
hot. It is certainly often of a scrofulous nature. 
467
ever, frequently occasioned by inflammation of the mem-
brane lining the socket,  in which case the tooth  is a little
elevated, seldom  carious, very painful to the touch, and
attended with a throbbing pain which often  extends to the
neighbouring teeth. This latter kind generally terminates
in the formation of matter commonly termed a gum bile.
   When the tooth is carious, its  extraction  may in some
instances be  advisable, which, when properly  managed, is
attended  with  considerably  less pain than a severe pa-
roxysm of the tooth-ach.*
   When the  decay of the tooth  appears to be a constitu-
tional  disease,  its removal   is  not  in all cases to be ad-
vised, as the  same diseased action  will, in that case, very
probably,  go on  in  another  tooth.   Although it be a pre-
vailing opinion  with  the medical men and  dentists, that
one  bad tooth will contaminate another in this  instance;
I  am well persuaded that its continuance in  the jaw will
be the means of preserving the others sound.
   When it  is  of an inflammatory nature  and the tooth
sound,  the cure  should be  attempted by  the extracting
blood  from  the gum by leeches  or  scarification,  which

   *  The principal  pain attending this operation  is occasioned
by the great pressure of the heel of the instrument, in common
use,  on the inflamed gum; to obviate which, I some time since
had  an instrument  made, with the  fulcrum  and claw so con-
structed, that  this  great inconvenience is not  only prevented,
but the extraction of the tooth effected  in nearly  a perpendicular
direction, by which means any  injury  of the jaw bone is like-
wise avoided.  An account of this improvement I communicated
to the medical profession, with a drawing, through the medium
of the medical periodical  works, and  I have the satisfaction to
"understand, it is adopted by the first dentists in London. 
468
       with the use of an aperient medicine  and the antimonia
       febrifuge  powder, as  directed  No.  37, will generally
       succeed; if, however,  it should prove obstinate, a blister
       may be applied  behind the  ear, and  the scarification or
       application of leeches  repeated,  of which the  former is
       the most  efficacious.  The augustura bark powder, in  the
       dose of fifteen  grains, taken every four hours in  a little
       water, is  much  recommended as a remedy  for tooth-ach.
       When  it  is entirely nervous, or  arises from a disordered
       state of the stomach, I have  known this medicine to  suc-
       ceed in curing it in a few hours.
         The  poignancy of the pain may in all cases be mitigated
       by the application of ether and laudanum, by means of a
       little lint, with  which  the tooth should be covered, and
       the mouth afterwards  kept  closely shut for some time.
       The part should be  previously rinsed out  with warm
       water,  to remove any acrid matter that may  irritate the
       nerve  of  the tooth. Pills of camphor and  opium have
       been very successfully applied  to allay the  pain, as have
       likewise  oil  of cloves, thyme,  and pellitory of  Spain.
       The exclusion of the atmospheric air, by filling the cavity
       with gum mastic and white wax (melted together) or  any
       other composition that will stick  in, will not only prevent
       its recurrence, but often suspend the caries.
         Dr. Handel, of Mentz, recommends  the following  as a
       very powerful sedative in tooth-ach when occasioned by
> r:h  corrupted or rotten  teeth, upon the application of which
 ,v#.  it is said the  excruciating pain almost instantly ceases:
      ^ Take of opium, half a drachm,
             Extract  of deadly nightshade and  camphor, of
                each six grains,
             Oil of henbane, one drachm,
       .  " "  Cajeput oil and tincture of cantharides, of each
               eight drops. 
469
To be formed into a  mass, and  a little to be introduced
into the decayed tooth either in  form of pill or on lint.
  The effects of fear on an acute attack of  the tooth-ach,
is remarkable.  The sight of the instrument for extract-
ing the tooth,  often giving perfect relief, even  when  the
pain has arisen from a carious tooth.*
  The best preventive to this disease is to clean the teeth
every morning with proper tooth-powder  and cold  water:
the former with the  use of a hard brush, will remove  the
tartarous adhesions, and check the progress of the decay
of the tooth, while the latter will remove any acrid mat-
ter  that may lay on the  exposed nerve; and at  the same
time,  being applied cold, will in some  degree destroy its
sensibility;  by the observance  of these means,  I have
known many people  that have suffered very considerably
from the tooth-ach, never  after  experience  a return. The
prepared charcoal, for this purpose, is indisputably  the
best, being perfectly  exempt  from  the pernicious ingre-
dient of which tooth-powders in general are made, whose
mechanical  and chemical  effects on  the enamel  of  the
teeth, often produce  the mischief they  were employed to
prevent. Charcoal powder was  first  recommended by the
celebrated French chemist, Fourcroy, oh account of its
possessing the properties  of  rendering the teeth white,
destroying fetor  (which contaminates the   breath)  pre-
serving the  gums in  an  healthy  state, and  capable of
suspending the further decay of a tooth, when  it  has

  * Dr. Falconer observes, that he  recollects  this complaint,
when not very violent, to have been cured by the application of
the artificial magnet;  which, whatever the  supporters of the
imposture of animal magnetism may allege (says this esteemed
author), could be only  owing to the confidence  the patient had
in the efficacy of the remedy. 
470
once taken place,  and at the same time  incapable of in-
juring either the  teeth or gums:  a particular account of
the different charcoal preparations is given, page 83.
   For the management of the  teeth,  the following  very
judicious directions are given by the ingenious author of
the Clinical Guide:
   " As the  teeth are  so liable, from their  office, to be
affected by matters taken into  the  mouth, the  first and
most  natural precaution is, to remove these before  they
can act against their surface, or any  effects  of  heat and
stagnation take place. The practice, therefore, of washing
after meals, cannot be too strongly inculcated.
   " Where tartar  also forms, it is most observable in the
morning,  adhering to  the teeth  and gums.  This points
out the  propriety of the teeth being regularly cleaned
every  morning; and  from the gums inclining to softness
and spunginess, as well as this adhesion  of tartar  to the
enamel, a  proper  tooth-brush, such as recommended by
Dr. Lind, should  be  employed for the purpose.  If a soft
tartar  is already formed on the teeth, before adopting this
plan, the addition  of some finely levigated charcoal should
be used along with the brush  (the powder of  the charcoal
of the betel nut is unquestionably superior to any other);
but if the tartar has formed  a  firm solid body  adhering
inseparably to the  teeth, and forming, as  it were, part of
their substance, the best practice will  be  to separate this
by proper instruments, and then the method proposed will
be effectual for preserving them  in a healthy state.
   " But instead of this safe practice recommended,  per-
sons  anxious  only to have their teeth cleaned, without
regard to the means  employed,  have had  recourse to cer-
tain modes of effecting it, which,  though answering the
purpose in the  mean time, have,  in the end,  been attend-
ed  with  the  most  pernicious  consequences.  These 
471
methods,  however  various, may be  all reduced  to two
heads, being the effect of strong  mechanical friction, or
chemical solution.
  " The former depends on the use  of certain  powders,
variously coloured  according to the views of their inven-
tors, in the composition of which pumice  stone, or some
other gritty substance forms  a principal part:  this pre-
paration  rubbed daily with  the  assistance  of a  brush
against the enamel, produces no doubt a polish and white-
ness on its surface; but from the strong friction, this effect
can only be produced at the expense of the enamel, or by
occasioning a pa. tial detrition of it.
  " That this is really the case, has been established  by
actual experiment;  for if  a sound human tooth be placed
in a  vice with the convex side  upwards,  and rubbed with
a brush charged with  any tooth-powder,  in  less than an
hour, by continuing the rubbing, the  enamel of that part
exposed to the friction will be  entirely destroyed. In  re-
peating this experiment,  with  the  different compositions
sold  under the title of tooth-powders, the same effect has
been  known to  follow, only  varying a little in the time
required, according to the fineness of the  powder.
  " From this fact  a calculation may be formed, supposing
such  powders,  used twice or thrice  a week, and rubbed
for each time  one fourth  of a  minute,  in what length of
time the enamel may be entirely destroyed; by such calcu-
lation, it will be found to require only a very few years.
  " To render the above experiment still more conclusive,
it need only be  observed,  that the teeth never receive any
renewal of the enamel,  when worn away. That it  in-
creases only in growth and fineness till the age of  twenty;
but that after that period  it receives  no addition, but on
the  contrary gradually decays, so that by the age of thirty 
472
 it  will  frequently be  entirely  gone.  Nay,  its original
 thickness, even  in  full  growth, is not  more  than  the
 twenty-fourth part of an  inch, how soon then must con-
 tinued friction itself against such a thin structure produce
 an abrasion.
   " The mischief of this practice many have attributed less
 to the powder than to the brush that applies it, and they have
 therefore substituted a cloth in place of the latter.  To show,
 however, that this idea is ill founded, the same experiment
 may be repeated as already related, employing a cloth in-
 stead of the brush. The  same effect will be found to follow
 it, with this difference, that the cloth, by not entering like
 the brush into the interstices of  the  teeth, does not render
 the polish so complete.
   " When the teeth possess a thin scale of tartar, the use
 of prepared charcoal will in time remove it.
   " After a thick tartar has been removed by instruments,
it will prevent its reaccumulating.
   " The teeth that are not regularly clean, should be more
 rubbed with it than the others.
   " Lotions are sold under the name of tinctures, and the
chief part of their composition consists always  in a certain
proportion of mineral acid. Hence they turn out, when ex-
amined,  very powerful in softening and  destroying the
enamel.
  " They are much more easily applied than the pow-
ders,  are very quick  in  producing their  effect,  and are
therefore too  often preferred.  But  in  proportion to this
quickness of their operation are their  bad effects produ-
ced; and the slower any effect is produced on  the enamel,
the safer is the action of the remedy.
  " All tinctures, then,  for the teeth, are composed of
mineral acids, diluted  and  concealed  under various arti-
fices : and that this is the case is clear, 
473
  " 1st, From their sour astringent taste, conveying to the
teeth a peculiar rough sensation.
  " 2d, From their effervescence on  the  addition of an
alkali; and,
  " 3d, From the known effects of mineral acids on the
teeth, when submitted to their operation by way of experi-
ment.
  " From  experiments made  on this subject it  appears,
that  a mineral acid is the only menstruum by which the
enamel of the teeth can be speedily cleaned; and  that,
though all acids are powerful  solvents of the teeth, yet
that  the vitriolic is the only one  which has also  the sin-
gular effect of whitening them.  Hence  it becomes neces-
sarily a principal ingredient in all such compositions. Nay
it may be observed, that even in its most diluted state, the
effects of this acid on the enamel are the same; and though
several attempts have been  made to meliorate its hurtful
principle, and yet preserve its property on the enamel,  it
appears that those properties cannot be disjoined, and that
such attempts are merely a deception of their authors on
the public.
   " Thus, all acids seem to have a  particular tendency to
destroy the structure of the teeth, and that in proportion
to the strength of the acid principle they possess. •
   *' By the nitrous or muriatic acid the substance of the
teeth can be  entirely destroyed  in one or two  days.  In
the  vitriolic,  again,  this* operation  is  slower, and it seems
to take place  more by  acting on the  cementing  principle
that on  the  other parts. In the  vegetable acids, though
this effect is  proportionally weak,  yet  it does take place
 in a considerable degree, which is evident from the effects
 of tartar, and also from the similar known effects of sugar,
 sweetmeats, &c.
   " In all  the   countries  where much vegetable acid  is
                           3Q 
474
uped, particularly in the West Indies and other southern
climates, the  teeth of the inhabitants are seldom good;
Sugared meats and liquors again produce, while they are
in the very  mouth, symptoms  of roughness,  tooth-edge,
and pain; and the teeth of such  people  as use them are
susceptible of pain on the slightest impressions of  cold or
chewing.
  " To these bad  effects  of mineral  substances  on the
teeth  themselves, may be subjoined that of others which
act upon the gums, and thus, in an indirect manner, have
the same hurtful  tendency. The chief  of these is the use
of tooth-picks. The gum is  spread  closely, between the
teeth, and it is intended by this  closeness, that the teeth
should support each other in their place. Whatever then
widens  the  interstices between the teeth, must tend to
destroy  the  intention of nature; and independent  of this
also, the frequent use  of the tooth-pick affords a more
convenient lodgment for the  food. Instead of the tooth-
pick,  therefore, a small hair brush, like a pencil, should
be used, which will answer the purpose, and obviate all
the inconveniences that have been mentioned."
  Astringent tinctures, free from acids, are however of
considerable utility in constringing  the gums and  render-
ing the teeth  more firm, for which purpose the tincture
of the  ratania root will  answer best, as  recommended
page 83.
                              •
               TRISMUS. See Tetany.

        OF TYPHUS OR PUTRID FEVER.
  This disease is likewise named malignant,  camp, gaol,
pestilential,  and when  attended with livid eruption, pete-
chial  or  spotted fever.  It  occurs  most frequently in 
475
autumn, and the end of summer, when the days  are hot,
and the nights cold and chiUy. The debilitated are gene-
rally the subjects of its attack.

              Symptoms of Typhus Fever.
   It commences with pain in the  head, vomiting, slight
shiverings,  intense and permanent heat, great thirst,  the
pulse irregular  in  the wrist, sometimes tense and hard,
and sometimes quick and small,  while the arteries of the
temples and neck  often appear to  beat  with  increased
force, with flushing of the face, redness of  the  eyes, de-
noting  a considerable determination  of the blood to the
head. An increase of the fever is observable every even-
 ing; so that in a few days  the patient becomes  delirious,
 with great prostration of strength, the tongue dry, and  of
 a blackish or livid appearance. The breath is  offensive,
 the delirium becomes more  constant, and at length changes
 to a stupor; an eruption of livid  or purple spots sometimes
 appears;  the stools  become  blackish, which, as well  as
 the, urine, emit a disagreeable odour, and  are sometimes,
 at this stage, discharged involuntarily; great anxiety about
 the heart and sighing take place; and often  a discharge ol
 blood from the nose, gums, intestines, and other parts; a
  copious and obstinate purging, cold  clammy perspirations,
  and hiccup precede  its fatal termination.

               Ofi the causes ofi Typhus Fever.
     Putrid air,  lowness of spirits,  poor diet, and whatever
   weakens  the nervous  power, are enumerated  by authors
   as  causes of  this  disease. It  is evidently produced by
   putrid effluvia, but in what manner it acts on the system,
   or the nature  and real seat of the disease,  I believe to be
   little understood. 
                          476
   The first symptoms, as the acute pain in the head, the
 turgid state of the vessels of the eyes, and the increased
 action of those  in the  neck and temples, the disordered
 state of the mind, the  deprivation of sleep, and affection
 of the whole nervous system,  indicate an  increased or
 inflammatory  action in the brain, which is confirmed  by
 the appearances that organ exhibits  on dissection;  as the
 formation  of  several small abscesses  in its substance, an
 increased effusion of serum in the ventricles, and adhesions
 of the membranes. From the examination of those who
 have died of this disease, it appears to  me, that it is
 primarily an inflammation of  the membranes of the brain,
 produced by the peculiar stimulus of putrid effluvia; which,
 in a short  time, by impairing that important organ, and
 impeding its functions, produces the  various symptoms of
 debility in the system, which we observe  sooner or later
 to take place,  and which have been attributed to a putre-
 scency of the  fluids of the body: whether the process of
 putrefaction ever takes place during life is extremely doubt-
 ful, such  a disposition being so powerfully counteracted
 by the living principle: that it  does not take place, I think,
 is sufficiently obvious, from the bodies of those, who have
 fell a sacrifice to this disease,  keeping a much longer time
 than any other,  before  signs  of  putrefaction  appear; and
 on this account such bodies are  preferred  by anatomists,
 at hospitals, for demonstrating its structure, &c. to pupils.

           Ofi the Treatment ofi Typhus Fever.
 „ As this disease,  when once established,  generally runs
a certain course, in defiance of medicine, the chief object
of practice is to check,the progress in its  onset: for this
purpose a dose of emetic tartar, No.  35,  should be  given, 
477
on  its first attack; which,  by  evacuating the stomach
and  bowels,  producing,an  equal distribution of  blood
over the body,  and  promoting the different secretions,
often succeeds in this  respect.  If the  symptoms, how-
ever, continue, the head should be shaved, and a blister
applied to the scalp, leeches  to the temples, and the  feet
kept warm by frequent immersion  in  warm water.  The
saline mixture should be given, in a state of effervescence,
as recommended  under the  head of crystallized acid of
lemon, No. 22, or a table-spoonful of  yeast, twice a day.
Fixed air, administered in  this manner,  affords more
relief than any medicine we  are acquainted with; and in
several  instances, has alone proved an effectual  remedy,
not by counteracting putrescency, as has been imagined,
but  by  cooling  the body, abating thirst, and  diminishing
the  excitability of  the system. The room  should be
spacious, frequently ventilated and fumigated, as directed
page 86. The  washing of the  body  with cold  vinegar
when it  is hot and dry, and  the application of  it to the
scalp and forehead, by means  of folds  of linen, have
proved very beneficial, probably by extracting the  super-
abundant heat.  The  application of  cold water or  ice
to  the  head, has  been much  extolled in this  disease;
but  cold vinegar is certainly preferable. The patient  may
likewise be permitted to smell  a sponge, moistened  with
the  acetic acid, No.  38, at a  short  distance from  the
nostrils,  a  little  of which may  likewise be sprinkled  over
the  quilt of the bed,  or  evaporated   in  a saucer,  over
the  blaze of a candle, which, in small  rooms, will super-
sede the necessity of the more elaborate process of fumi-
gation.  The smelling of pungent salt  in this  case is  very-
improper, as  it increases the delirium,  and has no effect
in  destroying  the  infectious  effluvia  of the body.  The
food should be,  principally  weak  veal broth thickened 
478
with a little arrow root or oatmeal, and the drink mint tea,
or barley water, acidulated with lemon juice.
  If, on the fifth or sixth day of the disease, symptoms oF
debility come on, and the patient be evidently in a sinking
state, a  more  nutritious  diet may be  allowed, and the
strength of the patient  supported with  port  wine,  and
the camphorated bark mixture, No. 67,  which require
great caution in  their employment, and  should be  in-
creased  and diminished  according to the urgency of the
symptoms.  If  the brain  be  not  affected,  and  the fever
arise evidently  from debility, the camphorated mixture,
No. 67, with  wine  and  the  restorative diet,  page 152,
should be employed.  This fever often  attends the con-
fluent small-pox.  Inflammation ©f  the  brain,  produced
by the action of putrid effluvia, is less vigorous than that
occasioned by the application  of  cold, noticed  under the
head of inflammation of the brain or phrenzy,  and seems
to be  confined  to  the  membranes of the brain; while, in
the  latter case, the whole of the brain and membranes are
affected: it  does not therefore require the active  means
there suggested for its resolution,  or to be pursued  any
longer than indicated by the state of the patient, and the
relief afforded by the depleting plan, &c.
  When  treating on  inflammation of the brain,  I ob-
served, that disease  was often mistaken  for putrid fever,
and there noticed a well-marked  case of the kind,  which
was so  treated  by a  country apothecary,  within  my
knowledge;  the  disease  of  course  terminated fatally,
which afforded  me the opportunity of examining the state
of the brain.
  The  following case  will prove' how little the nature of
this fever  is understood.  An  experienced  practitioner, in
Herefordshire,  was  requested to, see a  patient affected
with  fever; on  his arrival he found the patient delirious, 
479
and labouring apparently under symptoms of debility, and
from its being epidemical in  the neighbourhood, he had
no hesitation in pronouncing it typhus fever,  and as such
treated  it  with cordials.  The   symptoms  of  delirium
afterward increased, and the patient, in a fit of phrenzy,
divided  his  wind-pipe with  a  razor, by  which he  lost
nearly two  quarts  of blood, before  surgical assistance
could be obtained. The surgeon approximated the edges
of the wound with  a  ligature and proper bandages,  and.
supposed the loss of blood, under such circumstances, must
prove fatal; but to his great surprise, the patient speedily
recovered from the  fever, and  the  wound healed on the
 first  intention, so that  the  patient in this instance really
 cured himself by cutting his throat.
   If medical men of judgment be deceived in the nature
 of this disease, it Cannot be a proper case for domestic me-
 dicine; and I seriously advise the calling in of a practitioner
 of approved judgment and skill, before the disease has
 made much progress. For the means of destroying putrid
 or contagious effluvia, see page 86.
                    OF VOMITING.
    When vomiting is  the effect  of poisons taken into the
 stomach, it requires the treatment  already  recommended
 for poisons, page 97.
    Vomiting is a very common attendant on pregnancy, and
 the most healthy women, as well as the  weak and delicate,
 are equally subject to it; the symptoms require, however,
 different treatment in those opposite states.  When it is at-
 tended with fulness of the  vessels and determination  of
  blood to the brain  (evinced  by pains and giddiness in the
  head, flushing in the  face, and bleeding at the nose,) blood-
  letting, with gentle purgatives  (as the Epsom water, No.
  2, taken every morning,) and  a spare  diet,  will afford the 
t80
 greatest relief; but when it occurs in a delicate woman, and
 it be attended with symptoms of debility, such as languor,
 profuse perspirations, an opposite plan of treatment will be
 necessary, as a nutritious but light diet, with a moderate
 use of port wine, will prove most beneficial.  Two table
 spoonfuls of the  following mixture may be taken two or
 three times a day:
   Take  of infusion of roses, seven ounces,
       Epsom salts, two drachms,
       Comp. tincture of cardamom seeds, six drachms,
          Mix.
   Moderate exercise will in both cases be necessary. Eme-
 tics should never be taken in such cases, unless prescribed
 by a skilful practitioner, as their injudicious exhibition may
 produce  abortion.  When vomiting arises from weakness
 and irritability of the  stomach,  or the*acid corruption of
 the food, it should  be  considered as a symptom of indi-
 gestion, and as such  treated. When the matter thrown up
 is bilious, the neutral salts, No. 2,  and the diluted vitriolic
acid, No. 18, will be proper, with small doses of laudanum,
 in case the symptoms be violent.  When vomiting is the
consequence of hard drinking, diluents, as tea and coffee,
 with a dose of magnesia, No. 1,  or salt of wormwood, No.
 21, will  prove the most efficacious. When the  cause is not
 evident,  the saline draughts, in a state of effervescence, sec
 No. 22, with the occasional use of small doses of rhubarb
 and laudanum may be employed, and an anodyne plaster
 applied to the  pit of the stomach.
  Vomiting is often attendant on  organic  disease of the
 stomach,  scirrhosity of the pylorus, or ulceration of the
 inner coat of the stomach; in  such cases,  two or three
 grains of extract of hemlock, or one  of purified opium,
taken twice a day, with the prepared  natron, as directed
 No, 60, or lime water, will afford relief. 
481
  Vomiting is  generally a symptomatic affection, when
the cure will of course depend on the nature of the pri-
mary disease.
  Vomiting of children frequently arises from their being
over-fed, when the matter brought up is  always  sour: a
little magnesia or prepared natron, in mint water, will, in
such cases, remove the cause.  If the stools be green or of
a clay colour, a gentle emetic dose of ipecacuan  powder
will be necessary.

           OF VOMITING OF BLOOD.
  When blood is  discharged into the stomach, and brought
up by vomiting, it is thus termed; and when it proceeds
from the lungs, although its expulsion be assisted by vo-
miting, it is  termed  haemoptoe, or spitting of blood. In
describing the latter  affection,  I noticed in what manner
the source of the  blood thrown out from the mouth might
be ascertained.  When the blood  is brought up  without
coughing, if of a black and grumous appearance, and mix-
ed with the contents of the stomach, there can be no doubt
but that it proceeds from the stomach.

           Ofi the Causes of Vomiting  of Blood.
   It  may arise from the suppression  of accustomed eva-
cuations, as the menses or piles.

             Of the  Treatment ofi Vomiting.
   If the patient be of a plethoric habit of body, the loss of
eight or ten ounces of blood from the arm will be neces-
sary, after which  three  table  spoonfuls of the following
mixture should be taken every four hours:
   Take of red rose  leaves,  dried, two drachms; infuse
                          3 R 
482
         in half a pint of boiling water for three hours,
         then strain, and add,
       Diluted vitriolic acid, two drachms,
       Tincture of ratania root, half an ounce. Mix.
   It will likewise be proper to produce a determination of
blood to the skin, by small doses of ipecacuan powder,
combined with opium, as two grains of the former, with
about eight drops of laudanum, or half a  grain of opium.
With the same view the feet  should be put into warm
water for ten minutes. If  these  means fail to check the
bleeding, six or eight grains of  alum in  powder may be
added to each dose of the  mixture,  and a blister applied
to the pit of the stomach.
   Thin gruel will be sufficient both for food and beverage,
which should be taken cold. If it arise from  suppression
or retention of the menses,  after  the discharge has ceased
for some days, the  remedies  already recommended for
these complaints should be  employed to produce a proper
determination to the womb.  (See  Green Sickness  and
Suppression of the Menses).
   When the  cause is a suppression  of the  piles, the oc-
casional  use of aloetic  purges, as the cathartic extract,
No. 46, will prevent its recurrence.

            OF THE  WATER BRASH.
   This disease chiefly appears  among the lower order of
people,  and  more  commonly at  middle  age, though
sometimes old people  are subject  to it.  It affects females
oftener than males, and of married women (unless during
pregnane^) the barren  are  most  subject to it.  It is very
prevalent in Scotland and  Ireland, but rarely occurs in
England.  It  consists in a discharge of clear water by
vomiting or eructations, attended with a burning  heat 
483
about the pit of the stomach. It generally comes on by fits,
which are most frequent when the stomach is empty, as in
the morning and forenoon. The pain is considerably abated
by eructations and discharge, but it does not entirely ter-
minate for some time.

             Ofi the Causes ofi Water Brash. .
   This disease is generally produced by the intemperate
use  of ardent  spirits, particularly  whiskey, with a poor
diet.  Passions of the mind  and cold  applied to the lower
extremities, are often exciting causes.

            Ofi the Treatment ofi Water Brash.
   The spasms of the stomach may be relieved by lauda-
num  and ether, the  dose of which must  be proportioned,
and repeated according to the  violence  of the fit;  after-
ward the use of the  compound tincture of camomile and
ginger, as directed No.  7.  The avoiding of costiveness,
by the occasional use of the  cathartic extract, No. 46, with
a generous  diet  and abstinence from spirituous or  fer-
mented liquors will effect a cure.

                     OF WARTS.

   When warts have narrow roots they may  be easily re-
moved by ligatures, but when the bases are broad, they
may  be as effectually, but not  so expeditiously destroyed,
by rubbing  their surface every second  morning, with a
little  lunar caustic, till they entirely disappear.
   Warts are organised  bodies,  and  evidently a kind of
parasitical or  independent life, like the fungus of a tree.
Whatever,  therefore, proves  destructive  to  the life of
parasitical animals, will, by frequent applications, destroy
warts; such as  strong solutions of steel or  arsenic, as
noticed under the treatment of cancers. 
484
   The  influence of the imagination, in destroying warts,
is very  extraordinary, many instances having occurred of
their gradually disappearin'g after  the use of  a charm,
which could operate only on the mind. It has been  ob-
served, when the person  has  not had confidence  in  the
mystic remedy, it has uniformly failed.

               OF WATERY HEAD.

   This  disease is  almost peculiar to infants, chiefly of a
scrofulous  habit, rarely occurring beyond the fourteenth
year.
   The symptoms are not  at first clear. It commences with
slight pain in the head, generally across the brow; as the
effusion of water  increases, the child becomes affected
with nausea, sickness, starting in the sleep, screaming, and
other disorders  of the animal  functions,  as convulsions,
&c.  without  any apparent cause ; at length the  brain  be-
comes so compressed as to produce dilatation of the pupils
of the eyes,  a variable pulse,  with evident stupor. It is
commonly  fatal.

         Ofi the Treatment of the Watery Head.
   Unfortunately the nature of this disease is rarely ascer-
tained, till  the  effusion of serum is so considerable as to
render  all  efforts  to  produce  its  absorption ineffectual.
The disease  is, in the first instance, an inflammation or
increased  action in the membranes of the ventricles,  &c.
and  if it were at first  detected, an effusion  might be pre-
vented by  the  application of a large blister to  the head,
leeches to the temples,  and the use of brisk purges, as
calomel, or the  basilic powder, No. 36.  When, however,
this  stage is passed over,  the most active means must be
employed to  stimulate the absorbent vessels for  the remo- 
485
val of the accumulated serum; for this purpose a perpetual
blister over the scalp, gentle  electric shocks  through the
head, and the exhibition of mercury, are the most powerful
remedies.
   One grain of calomel may be given in a little jelly three
times a day, or a scruple of the strong mercurial ointment
may be rubbed on the back twice a day, till it disappears,
by means of a hand covered  with bladder. Some practi-
tioners  recommend the ointment to be rubbed over the
blister  for the  purpose of being more  speedily taken up
into  the system, and if the patient can bear it, it is certainly
to be preferred. Five drops of muriated tincture of steel
may likewise be given in a little water two or three times
a daj, and the strength of the system supported by beef
tea and wine.
   As this disease, when far  advanced, is  generally con-
sidered incurable, medical aid should be speedily employ-
ed to prevent its arriving to that hopeless pitch.

                      OF WEN.

   The tumor termed wen, is situated on the front of the
neck,  between the wind-pipe and skin. Several remedies
have been suggested for the cure of this disease,  of which
the  burnt sponge  has  answered best. Lozenges of this
medicine have been much recommended by  Dr.  Cheston,
an eminent physician in Gloucester, and Mr. Ring, sur-
 geon, in London, who found this form to answer best; the
 advantages of which is attributed to its gradual solution in
 the mouth. Rubbing the surface of the tumor every night
 with salt, has, in  some instances, succeeded in removing
 wenny substances of considerable sizes, and also the applica-
 tion of the hand of an executed criminal, which can operate
 only through the medium of the imagination. A dead toad 
486
 hung round the neck has on the same principle effected a
 cure.
   If the burnt sponge lozenges do not succeed, the sources
 of its nourishment may be cut off, by applying  ligatures
 to the arteries that supply  it with blood, which, when the
 vessels are  superficial (as  is often  the case) is neither a
 painful nor difficult operation.
   There are  several  species of tumors  that form in dif-
 ferent parts of the human body, which derive their names
 from the nature  of  their  substance. I sometime  since
 removed one from the back of a carpenter (Mr. Thomas),
 at Abbey Tintern, in Monmouthshire, that weighed, after
 it was freed from the blood, sixteen pounds twelve ounces,
 which was the largest I ever saw.  It had been gradually
 growing nearly twenty years,  and had  latterly,  from its
 magnitude and weight,  become so troublesome as to pre-
 vent his following his occupation, which he has  since pur-
 sued with greater ease than he had done for many years.
 The  removal of a wen (which  is always situated on the
 anterior part of the neck)  by the knife,  is on account of
 the number of blood-vessels  that pass through it, and in
 the neighbourhood, a  dangerous operation.

            OF WHITES, or Fluor Albus.

                     Description.
   This disease consists  in  a slimy or puriform discharge
from  the  passage leading  to  the  womb termed vagina,
varying in appearance,  consistence, and  quantity, in  dif-
ferent persons.  It generally  proceeds from  the  vagina,
and sometimes from the womb itself.

                Ofi the Causes ofi Whites.
   Frequent miscarriages,  difficult  labours, and  debility, 
487
are enumerated as causes of this  disease.  As  it often
occurs in women  of  robust  constitutions,  and,  in  every
other respect, perfectly healthy, it is not always to be con-
sidered a disease of weakness, but  as arising from a mor-
bid action of the mucous glands of the vagina, or some
organic disease of the womb.

              Ofi the  Treatment ofi Whites.
  It is often readily  cured by those  balsamic medicines
which are commonly determined to the urinary  passages,
as the balsam copaiva, and the other turpentine balsams,
which may be taken in the following manner:
  Take of  balsam copaiva, three  drachms, to be well
       rubbed  in a mortar,  with  the yolk of  an egg,
       then add, by degrees,
     Mint  water, eight ounces, and sugar three  drachms.
Two table spoonfuls to be taken three times a day. If the
strength of the system be much reduced,  eight ounces of
the decoction of  bark may  be  substituted for  the mint
water, or three of the following pills may be taken twice
or thrice a day:
  Take of gum olibanum,
     Essential salt of  bark, of each one drachm,
     Syrup  of  ginger, sufficient to form  a mass, to be
       divided into thirty pills.
  If attended with costiveness, a drachm of the ecphractic
pill of the Edinburgh  Pharmacopoeia may be employed in
lieu of the  essential  salt of bark.  Cold bathing, or the
local  application of cold water, by  means of a bidet, is a
very  important remedy  for  this disease, and should  be
used every morning.
   If the discharge continue  after the due employment of
these means, an astringent lotion may be made use of with
effect, as the following: 
488
   Take of the Pomegranate rind, bruised, three drachms,
       boil in a quart of water to a pint and a half, then
       strain and add alum, a drachm and a half.
To be  injected up the  vagina, by means of the female
syringe. The  due employment of these  remedies, with
proper exercise and nutritious diet, will generally succeed
in curing the disease. But when it is attended with irrita-
bility of  the nervous  system, or  connected  with  any
constitutional  disease, or arises from impaired digestion,
the balsamic medicines  recommended above  will often
have little or no effect. In such cases the  following mix-
ture in the dose of three table spoonfuls, two  or three
times a day, will generally succeed in curing it:
   Take of red rose leaves, dried,
       Bears whortle-berry, ditto, of each  three drachms,
         boil  in a pint of water till one fourth be con-
         sumed,  then strain, and add,
       Epsom salts,  three drachms,
       Compound tincture  of  cardamom seeds,  six
         drachms.
   If the faeces should be  of a pale clay, or very dark co-
lour, one grain of calomel should be taken every other
night for about a fortnight.
   These medicines,  with the use of  the astringent injec-
tion (twice a day,) I have never known to fail in most ob-
stinate cases.
   If the medicine should occasion more than  one or two
motions  in the course of  twenty-four hours,  the dose
should be diminished, or  taken  less frequently.
   When the  discharge is of  an ichorous nature, and of a
dark and yellowish colour, and attended with pain in the
region of  the womb, or with inflammation, burning heat,
difficulty or heat of urine, troublesome itching, a sense of
bearing down, and a frequent inclination  to go  to  stool;
pains on the approach, or during the time of menstrua- 
489
 tion, and particularly if pieces of coagulated blood (gene-
 rally termed clots),  are discharged, some organic disease
 of the  womb may be suspected; especially if they occur
 about the time  of the cessation of the menstrual discharge,
 in which case the patient should lose no  time in availing
 herself of the advice of the most skilful and  experienced
 practitioner in the neighbourhood.
   The diet must depend on the  general health of the pa-
 tient.  If she  be weakly and of a delicate constitution, it
 should be nourishing and easy of digestion, such  as blanc-
 mange, and the vegetable and animal jellies, recommend-
 ed page 83,  with a small portion of meat; a little good
 port, or white wine, may be also allowed, but water should
 be adopted in  lieu of malt liquor,  and if the complaint
 be attended with much irritation or pain on making water,
 it will be advisable to avoid pepper and  much salt, but not
 otherwise.  Warm diluent liquids, as tea  and coffee, and
 the use of spirituous  liquors, are very improper,  and will
 certainly counteract the salutary effects of medicine.

              OF WHITE SWELLING.
   This  disease is generally of a scrofulous  nature, but
 sometimes the consequence of frequent and violent attacks
 of rheumatism. The former begins in  the extremities of
 the bones  or cartilages of  the  joints, while the latter is
 seated principally in the ligaments,  and may  be  relieved
 as already  directed for rheumatism.  The knee, ancle, and
 elbow joints are generally  the  seats of  this disease. The
 scrofulous  white  swelling begins with  acute  pain in the
 interior  part  of the joint, which is  sooner or later suc-
 ceeded by a gradual enlargement of the  ends of the bones
-forming the joint, with a distention of the veins of  #ie skin
 surrounding it. 
490
     Ofi the Treatment of Scrofulous White Swelling.
   The object of  topical management is to prevent the
formation of matter, by the  application of  leeches  or
cupping,  which  should  be  repeated every other day, or
according to the urgency of the case; the whole joint should
then be kept continually wet and cold, with  the following
lotion, by means of folds of  old linen:  .
  Take of crude  sal ammoniac, half an ounce, dissolve
         in
       Spring water, one pint and a half,  then  add
       Vinegar, half a pint.
Two drachms of either of the neutral salts, No. 2, should
be taken every morning, and the medicines recommended
for the king's evil, to correct the scrofulous diathesis of
the system.
   In all diseases of the joints, particularly white swelling,
the use of distilled water is a most important remedy. It
should not only constitute  the patient's beverage, but be
employed in every article of diet, viz. in the  making of
tea, coffee, broth, &c.  The diet  should be low,  and
consist principally of vegetables, animal broth, and  milk,
till the diseased part be in a quiet state. Such is the opinion
of  Dr. Lambe,  of the 'alterative powers of this  water in
those cases, that he is persuaded, that by its general use,
even without any local  application or medicines,  diseased
joints may generally be recovered.  As it does not  inter-
fere with the means suggested, it is certainly advisable to
adopt its use.*

   * Since the last edition  appeared, in which the distilled water
was particularly  recommended by Dr. Lambe, an able phy-
sician has published a very ingenious treaties on its peculiar
properties in the cure of constitutional diseases, which'he has
illustrated by many important cases. An  apparatus for dis- 
491
    After the  local affection is evidently abated, the cure
  may be completed by the application of small  blisters on
  each side of the joint, the discharge of which should be
  kept up by dressing them every morning with the savin
  ointment, No. 44; for which purpose the thin skin of
  the blister should be entirely removed. The limb should
  be kept perfecdy quiet, and when the disease  is  quieted,
  the joint may be moved a little once a  day,  to prevent
  adhesions and  consequent stiffness.  By the external  irri-
  tation and discharge of  blisters,  properly  managed and
  continued  for a length  of time, with medicines  calcu-
  lated to correct the constitutional  affection,  and  at the
  same time to  support  the  strength of the  patient, as
  recommended for  the treatment  of  king's  evil,  many
  limbs have been saved, which by a hasty surgeon would
  have been condemned to the knife. The profession is much
  indebted to Mr. Crowther, of London, and Mr. Russell,
  of  Edinburgh, for  many valuable observations  on this
  disease. When the blisters are healed up, the plaster of
  gum ammoniac and cicuta may be applied with advantage.
  The  same local treatment is  proper  for the enlargement of
  a joint  from rheumatism, which if attended with fever re-
  quires  the constitutional remedies  as recommended for
  acute rheumatism.

              OF WHITLOE, OR  FELON.

    This disease  consists  in an inflammatory  swelling of
i  the end of a  finger, the pain and  obstinacy of which
  depend on the part attacked:  if the skin  be only affected,
  the pain is  inconsiderable, and after the effused fluid is

  tilling water in any common fire place, has lately been invented
  by Messrs. R. and G. Knight, Ironmongers, Foster-Lane, 
492
 discharged, it  soon heals without endangering the nail;
 but if situated in the membrane beneath the skin, which is
 often the case,  the symptoms are  more violent; and if the
 membrane covering the bone be affected, the inflammation
 often extends to the hand, and the  pain up the  arm. The
 lymphatic vessels, and the gland in the arm pit, are also
 inflamed and much swollen; in this latter case, if the disc ase
 advance to suppuration, the bone  is  generally rendered
 carious.

                   Causes of Whitloe.
   It  may be produced by various causes.  It frequently
 occurs from external violence, particularly from punctures
 and bruises,  but it happens more frequently without any
 evident exciting cause, and probably arises from bad habit
 of body.

          Of the Treatment of Whitloe, or Felon.
  As the matter that forms in this disease, is generally
 of that acrid  nature as to corrode the soft parts, and even
 the bone, it will, in all cases, be advisable to prevent its
 suppuration by  applying four or  five leeches, and encou-
 raging the bleeding by immersing it in warm water after
 the removal of  the leeches; when the bleeding has ceased
the finger should be wrapped up in soft linen, frequently
 moistened with spirit of  wine.  The  aperient mixture,
 No. 62, taken  as  there directed,  will also be necessary;
and if the patient  be of a plethoric habit of body, or the
arm much inflamed, six or eight ounces of blood should
be taken from the arm. If these means should fail of dis-
persing  it, an  incision should be made into the part nearly
to the bone, which will effectually prevent suppuration, and
thus preserve the nail and the bone.
  When an effusion of serum has taken place,  it should 
493
be let out as soon as possible, to prevent the mischief that
it  will otherwise produce  by lying  on the parts, particu-
larly if near the bone. A poultice may then be applied,
which, with an occasional use of a little brandy, will effect
a  cure.  But  so many untoward circumstances happen
in those  cases, such as caries of the bone, the formation
of fungus under the nail, &c. that it will always  be ad-
visable to apply to an experienced surgeon, whose timely
assistance  will  prevent  much  mischief, by  saving  the
finger, &c.

         WOMB, CANCER OF. See  Cancer.

                    OF  WORMS.

   The worms that  infest the human body may  be re-
duced to three  general classes, viz.  ascarides, or small
round and short worms,  which chiefly occupy the lower
intestine; the teres,  or round and long worm, which are
generally seated in the small  intestines and stomach; and
the taenia or tape worm, which for the most part possesses
the whole tract of the intestinal canal, and from the tes-
timony of some medical authors, are from two to forty
feet long.
   The teres  or round  and  long  worm  is  much  more
commonly found in the intestines of  children than adults.
This  worm, from its general resemblance  to  the earth
worm, has been often confounded with it; they, however,    ^
differ materially in  their structure; as this circumstance
is not generally known, I shall briefly notice in what  their
difference  consists.  On  examining their  outward ap-
pearance with attention,  the teres or human worm will
be found more pointed  on  both extremities than the
 common earth-worm.  The mouth of  the teres  consists 
494
 of three rounded projections, with an intermediate cavity;
 whereas the mouth of the earth-worm consists of a longi-
 tudinal fissure, situated on  the  under, surface of a  small
 round head.  Upon the under  surface  too  of  the  teres
 there is a large  semilunar  fold of  skin, into which  the
 head retreats, or out of which it is elongated, which is
 entirely wanted in the earth-worm. The anus of the teres is
 situated on the  under surface of the  worm, a little  way
 from its posterior extremity, and appears like a transverse
 curved  fissure.  The anus  of the earth-worm is an oval
 aperture at the  very extremity  of  the  worm.  The out-
 ward covering or skin of the teres is less fleshy and  not
 so  strongly marked by transverse rugae as the earth-
 worm.  In the latter there  is often to  be  seen a broad
 white band surrounding the body of the  worm; but in
the teres this is entirely wanting.   On  each side of  the
teres there is a longitudinal line very well nrarked; in  the
other worm there are three such  lines upon the, upper half
of its surface, but very faintly marked, so as to be hardly
discernable.  The  teres has nothing   resembling  feet,
whereas the earth-worm has on its under surface and to-
wards its posterior extremity a double row of processes on
each  side, very  sensible to  the  eye  and finger, which
manifestly  serve the purpose of feet on the locomotion of
the  animal. The  internal  structure of  both animals is
 also extremely different: in  the teres there is an intestinal
 canal,  nearly  uniform and smooth in its   appearance,
which passes  from  one  extremity of the worm  to  the
other. Jn  the earth-worm there  is  a large and complex
stomach, consisting  of three  cavities,  and the  intestinal
 canal is likewise larger and more formed into sacculi than
the former. The parts subservient to generation are very-
different in both,  there being in  the  teres a distinction of
sex, the parts being different in the  male  and female; 
495
whereas  the common earth-worm is  an hermaphrodite.
Many other differences would no doubt be found by a per-
son who might choose to prosecute their anatomy minutely.
  The symptoms denoting the existence of worms are
common  to the different species,  viz.  indigestion with a
variable appetite, foul tongue,  offensive breath,  hard, full
and tense belly, with  occasional gripings and pains about
the navel, heat and  itching sensation in the rectum, and
about the anus, the eyes heavy and dull, itching of the nose,
short dry cough, grinding of the teeth,* and starting dur-
ing sleep, attended often with a slow fever.

                 Of the Causes of Worms.
   As worms are generally found only in persons of  weak
digestive organs, indigestion may be noticed, as, if not the
principal cause, at least favouring their generation. There
is nothing, however, in the economy of  animals, more in-
volved in mystery  than the origin of  intestinal  worms.
Were they  found to live in situations out of the bodies of
living animals, one  might readily suppose that their eggs
were taken  into the body with the food or drink, and there
gradually evolved into animals. This, however, is not the
case, they are evidently incapable of existing for any length
of time in any situation, except within a living animal body,
which appears to be  the proper place for their growth and
 residence.  We might, therefore, be led to  another suppo-
sition, viz.  that they  are really formed from the matter con-
 tained in the intestines, which previously  had no regular

   * This strong and involuntary action of  the muscles  of the
 lower jaw is a proof how much the muscular system is affected
 by irritation in  the stomach and bowels. 
496
 organization; but this idea is widely different to all analogy
 in the production  of animals.  The origin,  therefore, of
 such animals is a subject of much obscurity. That they are
 not produced by ovula of animals taken with the food, is
 not only obvious from their being  found in the liver  and
 brain,  but  from the frequency  of  another kind of animal
 which is generated in the kidneys, brain, and liver, named
 hydatids.*

               Of the Treatment of Worms.
   The indications of cure  are, first, to  evacuate the re-
 dundant slime,  and afterwards to strengthen  the stomach
 and bowels, so as to destroy the disposition to their gene-
 ration.
   The first object is best accomplished  by brisk cathartic
 medicines,  as the  basilic  powder,  No. 36,  a dose  of
 which  should be taken every  second or third morning,
 for at least a fortnight, and the tonic  mixture, No.  77,
 in the intermediate  time.  Lime water  being capable of
 dissolving the mucus in which the worms  are involved,
 may be taken in the quantity  of  a  tea cupful,  two or
 three  times a day,  during the operation of  the  basilic

   * There is not the least doubt but hydatids are animals; they
 have been seen to move when taken out of the liver, and they
 retain their power of motion for some time when put into warm
 water. The origin of such animals is extremely mysterious, and
 when the whole evidence of one and the other opinion is com-
 pared together, the grounds for believing, that in  some orders
of animals equivocal generation takes place, appears stronger
 than those for a contrary opinion.  Those who wish to consider
 those animals more minutely, will find an excellent account of
 them, published by Dr. John Hunter, in the Medical and Chi
 rorgical Transactions, p. 34.
t 
497
powder, and with the tonic mixture; the electuary of tin,
No.^  86,  may likewise be taken  every  morning  and
evening.
  In  domestic medicine,  an infusion of Indian  pink  is
generally employed for the destruction of worms  in chil-
dren, and often with. success. Giddiness, stupor, dimness
of sight, redness and pain in the eyes sometimes come on
during the use of  this medicine, but these  symptoms are
speedily removed by a purgative medicine, as rhubarb or
julap. These  effects, however, prove  that  it should be
administered  with caution, and not till after safer vermi-
fuges have been tried in vain. The docoction of quicksilver
is also a  popular remedy, but I conceive equally unsafe.
  Powdered  rust  of iron  is a very excellent vermifuge
medicine, and where the complexion of the patient is pale,
or the system weakly, is preferable to any other; but when
the countenance is  florid and the habit evidently plethoric,
it is not so proper as the basilic powder, No.  36.  The
powdered rust of  iron  is  recommended by Dr.  Rush to
be given from five to thirty grains,  in a little currant jelly
or brown sugar, for children  between one  and ten years
old. Of all the worm medicines that I have administered,
observes this eminent physician, I know none more safe
and  certain than this simple preparation of iron. If ever
it fail of success,  it is because it  is given in too small a
dose. Taught by an old sea captain, who was cured of tape
worm by this medicine, Dr. Rush has given to adults from
two drachms  to half an ounce of  it every morning  for
three or four  days, not only with safety, but with success;
 the addition  of ten grains of  granulated tin will prove  a
 powerful auxiliary to this medicine.
   The hairy down which covers  the  pods of  cowhaga
                          3 T 
498
 niade into an electuary with treacle, has been much recom-
 mended by Bancroft and Mr. Chamberlayne, surgeon in
 London.  The electuary, in  the dose of a tea spoonful is
 said to be perfectly safe, and that two or three doses gene-
 rally suffice. As, however, its effects are attributed to its
 mechanical action on the worms, it-  may also act on the
 intestinesof infants, particularly if the  natural mucus should
 happen to be abraded.
   The common male fern root has been much extolled as
 a certain remedy for the tape-worm; the following directions
 are given for its use: " Two or three  drachms of the pow-
 dered root to be  taken in the morning, no supper having
 been taken the night before. It generally sickens a little.
 A  brisk  purgative with a little calomel, (as  the basilic
 powder, No. 36)  is  to be given a few hours after, which
 sometimes brings off the worm entire;  if not, the  same
 course must be followed at due intervals." For the-success
 of this remedy, it is necessary the root should be recently
 gathered; for after being  kept long in the  shops, its activity
 is diminished or destroyed. It should be used recently dug,
 being brought to a  state  fit for powdering, by drying it in
 a gentle heated oven  or before the fire.
  The ascarides  or round  short worms are  principally
lodged in the lower intestines, and through being enveloped
in mucus, are often very difficult to dislodge; with the use
of the basilic powder it will be proper to inject the follow-
ing by means of a clyster-pipe and bladder:
  Take of martial flowers, twenty grains,
       Lime water, eight ounces. Dissolve the flowers in
       the lime water. To be injected warm.
  A strong  decoction of  Indian  pinks, with  common
salt, has been recommended by  Dr. Clarke; and  a solu- 
499
tion of assafcetida in water and tobacco  fumes, by other
eminent  physicians to be  thrown into the rectum,  and
have been used with success. The muriated tincture of steel
would probably  prove more powerful, if the worms were
not so defended from its action by the mucus in which
they are so completely invested. Soap lees has been re-
commended for dissolving the  mucus, but  it often proves
too irritating. The repeated use of the  basilic powder,
with the injection  of lime water and steel, as  above di-
rected, generally succeeds in destroying them.
   For the prevention of worms, it  will only be necessary
to attend to the  state of the digestive organs, and to avoid
such  diet as is likely to derange them, as acid or unripe
fruit, fermented liquors, &c. If the pale or dark appearance
of the faeces should indicate a deficiency of the secretion
of bile, the  patient should take half a grain  of prepared
calomel at bed-time, for  five or six nights, for nothing  is
more destructive to the life of worms than a proper secre-
tion of bile; and I believe the success of mercury  is more
owing to its  increasing  the  biliary secretion  than  any
immediate effect on the  worms.
   Children  are  very subject to  an irritative  fever, from
having been indulged with too great quantities of fruit  or
acescent food, which is generally attended  with  the symp-
toms I have noticed  as denoting the existence of worms.
This fever  has  therefore been termed by Dr.  Musgrave
the Spurious Worm Fever; and latterly by  Dr. Butter, the
Infantile Remittent Fever. Dr. Hunter states that he dis-
sected " a great number of children, who have been sup-
posed to die of fever arising from worms,  in whom he did
not discover the least appearance of worms." This fever
is evidently symptomatic of a disordered  state of the di-
gestive organs,  and may be cured by a gentle emetic of
ipecacuan powder, the occasional use of the basilic powder, 
500
 No. 36, and a little stomachic medicine, as camomile tea,
 with the prepared natron, as directed No. 60, which will
 also prove  of service should the fever arise from worms.
   No  disease offers such a field for the imposition  of
quacks as  worms.  Mercury  is the basis of all vermifuge
nostrums that have fell under  my examination; although
in the directions  the proprietors solemnly declare,  that
not " a particle  of mercury enters their compositions, but
that, from  their mildness, they may with safety be given
to infants at the breast, and that  no extra attention is re-
quired during their operation." The articles  with  which
mercury is mixed to form it into lozenges or  gingerbread
nuts, becoming acid by keeping; the mildest preparation
of mercury, may be thus converted into a-powerful poison,
nearly equal  in  violence  to arsenic; besides the mercury
not being well blended with the other ingredients, from
the quantity that is  made at a time, it may, and I know it
has happened, that  one nut has contained  an over-dose  of
mercury, while another in the same box has scarcely con-
tained any. To these circumstances the many fatal  effects
that have followed  the exhibition  of advertised remedies
for worms may be attributed.
   The  artifice practised  by worm doctors to deceive the
ignorant, is  worthy of notice. Dr. Keighly  states, that
"  appearances  of  tremendous vermin, many  yards  in
length, suspended in a fluid, are ostentatiously displayed
at the window, with interesting  accounts of their being
expelled  by the never-failing nostrum,  to the admiration
of the  gaping passenger, and in order  to gain his com-
plete  faith  in the  amazing  ability  of the  self-dubbed
doctor. Little does he think that these monsters,  at the
sight of which he shudders, never entered the body  of any 
501
human being whatever,  but  are  a species  ofi deception,
being the small tripe of poultry, prepared so as to imitate
the tape-worm to an ignorant or superficial observer!!"
   It has been observed that it is  unworthy a professional
character to notice the practice of empirics. In this work,
which is professedly  published for domestic reference, I
have considered it my duty to  point out the dangers that
must inevitably follow the indiscriminate use of nostrums;
and I shall therefore conclude, by recommending to the
perusal of my readers, a pamphlet lately published on the
subject of quackery, by Mr. Samuel Highly, entitled the
Medical Observer, which, independent of its animadver-
sions on empiricism, contains many valuable observations
on domestic medicine. Such  a work has been long wanted,
and I hope the clergy and other friends to  humanity and
the promotion of science, will give it every degree of pub-
licity in their power. The editors have done a real public
 service, and deserve the thanks of their country.
FINIS. 
\
>
♦ 
INDEX.
                           A.     j

ABERNETHY,  Mr. his opinion of the causes of chronic
  diseases, 174; his treatise on Indigestion, noticed, 190.
Absorbent Mixture, for children, prescription for, 67.
Acetic Acid, camphorated, its properties, &c. 46; its advan-
  tages over aromatic vinegar, 46.
Acetous Laudanum, why preferable to the common lauda-
  num, 39; its efficacy in gout, 302.
Acid Elixir of Vitriol, see diluted vitriolic acid, 21.
Acid of Lemons, crystallized, its properties, &c. &c. 24.
Acid of Tartar, concrete, 25.
Acid Vitriolic, its use in fumigating  chambers, &c. 90.
Acute Rheumatism, see rheumatism.
Adams, Dr. his opinion of the structure of cancer, 183.
jEthiop's Mineral, its property, &c. 59.
./Ether,  see ether.
Ague, description of, 159.
Aiken,  Dr. his notice of the baneful effects of the external ap-
  plication of  lead,  37;  his recommendation of the Lichen
  Islandicus, 146.
Air, observations  on the purity of, in consumption of the
  lungs, 219.
Alderson, Dr. his recommendation of sumach in palsy, 417.
Alexander, Dr. Disney,  his advice  in cases of Hypochon-
  driasis, 333; recommends the study of medicine to  the
  clergy (Note), his instructions for  checking the progress of
  infectious fevers, 92. 
                          504

Alkaline Mephitic Water, how made, see prepared natron;
  substitute for, see super-carbonated natron; its efficacy in
  cases of gravel and stone, 314.
Almond Powder, recommended in lieu of soap for washing
  children, (Note) 144.
Amaurosis, see gutta serena.
Anasarca, see dropsy.
Animal Poisons, to counteract the effects of, 100.
Animation, suspension of, the means of recovery, 103.
Anodyne Balsam or Liniment, see opodeldoc.
         Necklaces, observations on, (Note) 139.
Antibilious Pills of Quacks, observations on, (Note)  175.
Antihysteric Mixture, prescription for, 64.
Antimonial Febrifuge Powder, (commonly called Dr. James's
  Fever Powder) the properties and doses of, 45.
Antimonial Wine, see tartarised antimony wine,  18.
Antirheumatic Mixture, prescription for, 66.
Antiscorbutic Medicines of Quacks, the composition, &c. of,
  see treatment of scurvy.
Antispasmodic Clyster, directions for making, 75.
              Mixture, ditto, 66.
Aperient Chalybeate Water, how made, 8.
         Sulphureous, ditto, 8.
         Mixture, prescription for, 62.
Appetite, different species of, 342.
         loss off, see Indigestion.
Apoplexy, the different species of, 159; the sanguineous, 160;
  causes of, 161; treatment of, 163; prevention of, 164;  how
  distinguished, 166; serious apoplexy described, 166.
Appendix to the Family Dispensatory, 82 to 154.
Aphtha, see thrush.
Arabic Gum, uses, &c. of, 55,
ArekaNut, Charcoal of, recommended as a dentifrice, 84.470.
Aretaeus, his observations on asthmatic people, (Note)  173;
  his opinion of the structure of tubercles, 226. 
505
Armstrong, Dr. his opinion of inward fits of children, 134;
  quoted, 410.
Aromatic Vinegar, an account of, 48.
Arrow Root, its properties, method of using, &c. 84.
Arsenic, the means of counteracting its effects, 97.
Ascarides, causes, Sec. of, 493; cure of, 498.
Assafcetida, Tincture of, the properties, dose, &c. of, 22.
Ascites, see dropsy.
Assalina, Mons. his opinion of the infectious nature of plague,
  96.
Asthma, the different species  of, 167;  symptoms and causes
  of, 168; treatment of,  169; prevention of a paroxysm  of,
  172; how distinguished, 174.
Asthmatic Mixture, prescription for, 65.
Atmosphere, the composition of, (Note) 93; contaminated,
  how purified, 88.
Atonic Gout, 310.

                           B.
Haillie, Dr. his account of the state of the brain in palsy, 162,
  163; ditto, of the structure of tubercles in the lungs, 228;
  ditto, of the  cause of croup, 259.
Baker, Sir George, his cautions respecting the external use of
  lead, 37; his recommendation of cardamine flowers, as a
  remedy for epileptic fits, 282.
Bancroft, his  recommendation of cowhage  as a remedy  for
  worms, 498.
Banks,  Sir Joseph, bart. his  use and recommendation of Ja-
  maica ginger, 305.
Barytes Muriated, its effects in scrophula, 379.
Bark, Peruvian, Essential Salt of,  why superior to other pre-
  parations, 28; its properties, doses, 8cc. 29.
Bark, Huxham's Tincture of, its properties, &c. 11.
      Powder  of, its properties, 8cc. 50.
Barley Water, directions  for making, 87.
Barry, Dr. his account of cow-pox in Ireland, 247
Basilic Powder, properties, doses, &x. 44.
Basilicon Ointment, Yellow, its use, &c. 48
                           3 U 
506
Beddoes, his prescription of soda, &c. for the gravel and stone,
   61; his case of consumption of the lungs cured by calomel,
   (Note) 215.
Beaver, Capt. Philip, his remarkable cases of the influence of
   fear, in inducing disease, (Note)  101.
Bell, Mr. Benjamin, his recommendation of calcined  zinc in
   epilepsy, 282; his advice in cases of a bite of a mad dog, 101.
Belly, Dropsy of, see dropsy.
Bergius, Dr. his account of the antiphthisical properties of
   the Lichen Islandicus, 147.
Berquillon, Dr.  his singular opinion of hydrophobia,  (Note)
   101.
Bilious Affections, considered,  174; prescriptio s for, 73.
Birch, his treatise  on the cow-pox, quoted, 250, 252.
Black Drop, see acetic laudanum.
Blackburne, Dr. his recommendation  of the salt of bark, 29.
Blair, Mr. his vaccine contest;  observations on, 253.
Blane, Dr.  his  prescription for  acute rheumatism, 14;  his
   mode of giving antimonial powder,  45.
Bleeding, directions for, 111.
Bleeding at the  Nose, causes and treatment of, 177; cautions
   respecting the checking of, 178.
Blegborough, Dr. his vapour bath recommended,  304.
Blindness, see gutta serena, and cataract..
Blind Piles, see  piles.
Blistering Plaster, use,  &c.of, 47.
Blood, discharge of,  from the urinary passages, 179; causes
   and treatment of, ibid.
Bloody Flux, see dysentery.
Blood-letting, periodical, observations  on, 114.
Bloomfield, Mr.  his claret wine, why superior  to others, see
   causes of indigestion.
Blount, Dr. (Hereford) his prescription for recent coughs, 18;
   ditto for St. Vitus's  dance,  see treatment of St. Vitus's
   dance; his approval of the essential salt of bark, 29; his tes-
   timony of the  mephitic alkaline water, 314.
Bobba, Dr. his opinion of the cause of rickets, 433; his reme-
   dy for, 436.
Biles, causes and treatment of, 180;  of the gums, 181. 
507
Bostock, Dr. his sanction of nitrated silver in epilepsy, 281.
Bourne, Dr. his recommendation of the uva ursi in consump-
  tion of the lungs, 221.
Boyle, the hon. Mr. his quotation from Mezerary on a pesti-
  lential fever, 96; his  recommendation of misletoe as a re-
  medy for epilepsy, 283.
Bradley, Dr. his recommendation of the essential salt of bark,
  29.
Breast, swelling  of, in infants; proper treatment of, Sec. 140.
Bree, Dr  Birmingham, his account of the different kinds of
  Asthma, 167.
Biown Cerate, the property, &c. of, 48.
Bruises and sprains*, proper treatment of, 181.
Buchan, Dr. his treatment of mineral poisons swallowed; ob-
  servations on,  99; the propriety of his advice, of bleeding
  in cases of over-dose of vegetable poisons, questioned, 99;
  his imprudent recommendation of sugar of lead, as an ex-
  ternal application for infants, 143; his error in the defi-
  nition of thrush,  145;  his extraordinary recommendation
  of opening the wind pipe  in cases of substances  lodged in
  the gullet, 116.
Burns and Scalds, proper treatment of, &c. 182; liniment for,
  77.
Butter, Dr. his opinion of the causes of hooping cough, 327;
  his remedy for, 328; on the infantile remittent fever, 140.

                           C.
Cadogan,  Dr. his treatment on the management of children
  quoted, 119; his recommendation of a combination of ani-
  mal and vegetable jellies for children, 86.
Calcined Magnesia, its properties, doses, &c. 4; how to detect
  its adulteration, 5.
Calomel, its  properties, doses, &c. 40;  how to detect adulte-
  ration of, 42.
Cam, Dr. (Hereford) his recommendation of basilic powder
  as a vermifuge, Sec. for children, 44; his prescription for
  dropsy, 49; his opinion of the stomachic property of camo-
  mile, 348.
Cam, Mr. Surgeon, (Bath) his prescription for scrophula, 68. 
508
Cam, Mr. Samuel, Surgeon, (Hereford) his use of electricity
  in dispersing inflammation, 360.
Camomile and Ginger, tincture of, recommended,  12;  its
  properties, doses of, 8cc. 12.
Camp fever, see typhus fever.
Camphor, its properties, doses, &c. 33;  julap of, how made,
  33; mixtures,  33, 34.  -
Camplin, Dr. his recommendation of ether, in obstruction of
  the biliary duct from concretions, 375.
Cancer, description and causes of, 183; treatment of,  184.
Canine madness, see animal poison.
Cappe, Dr. (York) his  recommendation of nitrated silver, as
  a remedy for epilepsy, 281.
Carbonic Powder, see prepared charcoal, 82.
Cardamine Flowers, their efficacy in epilepsy, 282.
Carmichael, Mr. his recommendation of steel in cancer, 30.
   184; his opinion of cancer, 184.
Carminative, mixture  for children, prescription for, see ab-
  sorbent mixture, 67.
Castor Oil, its  properties, doses, &c. 9; cold expressed, obser-
  vations on, 10.
Catamenia, see menstruation.
Cataplasm of Mustard,  prescription for, 80.
          Emollient, 80.
          Stimulating, 80.
Catarrh, symptoms of,  194; cause and treatment, 195.
Cataract, description, treatment of, 192;  operation for, by de-
  pression recommended, 193.
Cathartic Extract,  properties,  doses, &c. of, 50; pills,  pre-
  scription for, 71.
Cathcart, Lord, Dr. CuIIen's letter to, on the subject of sus-
  pended animation, quoted, 105.
Cayenne Pepper, infusion  of, recommended for gutta serena,
  317.
Celsus, Dr. his opinion  of the pulse, (Note) 357.
Cephalic Snuff, composition and effects of, 321.
Cerate, Brown, use, &c. of, 48.
Ceruse  Powder, the danger of its use as a dusting powder
  for children, 143. 
509
Chalybeate Water Artificial, how made, see salt o£ steel.
           Wine, how made, 30.
Chamberlayne, his recommendation of cowhage, as a remedy
  for worms, 498.
Chambers Infected, how purified,  88.
Charcoal, Prepared, its properties  as a dentifrice, 82, 469.
Charms,"their effects in gout, 308.
Chavasse, Mr. Surgeon, (Walsal), his recommendation  of
  nitric acid in diabetes, 266.
Cheltenham Salts, observations on, 9.
Chest, Dropsy of, see dropsy.
Cheston, Dr. his recommendation of lozenges of burnt sponge
  for wen, see treatment of wen; his approval of the essential
  salt of bark, 29; of the Lichen Islandicus in dysentery, 877;
  his experiment with nitrated silver, in a case of epilepsy,
  281.
Chicken Pox, description and treatment of, 196.
Chilblains, cause and treatment of, 197.
Children, the ordinary management of, 118; nursing of, 118;
  proper clothing for, 120;  feeding of, 122;  exercise, 128;
  diseases of, 133; inward  fits, 133; medical treatment, &c.of,
   133;  dentition of, 137;  worms,  139, 493; swelling of the
   breasts of, 141; inflamed eyes of, 141,  361; galling, 142;
   dusting powder for, 143;  red gum, 143; the danger of washing
   with spirit, 144; a proper wash for, 144; thrush, 145; cases
   of sudden deaths  of, from the use of nipple ointment made
   with lead, 37; ditto, by the quack worm medicines, 45; in-
   flammation of the bowels of, 365.
 Chincough, see hooping cough.
 Chlorosis, see menses.
 Chocolate Iceland,  objections to, see Lichen Islandicus.
 Chronic Inflammation of the Eye Lids, see  inflammation of
   the  eye.
 Chronic Rheumatism, description, cause, and  treatment of,
   427.
 Cicuta, best preparation of, see hemlock.
 Cinnamon, Essence of,  its properties, doses, &c. 40;  water,
   how made, 40. 
                           510

 Claret Wine, Tartar of, purified; its advantages over the acid
   of lemon, 8cc. 25.
 Clarke, Dr. his dose of calomel for children, 42; his caution
   respecting the extract of hemlock, 189.
 Closseus, Dr. his testimony of the tonic powers of the willow
   bark, 53.
 Clothing of Children, directions for, 180.
 Clyster, anodyne, prescription for, 74.
        for Ascarides, ditto, 498.
        Antispasmodic, ditto, 75.
        La  ative, ditto, 75.
        Nutrient, ditto, 75; method of exhibiting, ibid.
 Coccia Pill, see carthartic extract, 50.
 Ccelic Passion, see  diarrhoea.
 Colbatch, Sir J. his recommendation of misletoe in  epilepsy,
   283.
Colic, described, causes and treatment of, 198; distinction and
   prevention of, 199; often produced by lead in wine, see wine.
Compound Cretaceous Powder, its properties, doses, &c. 35.
Combustion of the Human Body, remarkable instances of, 346.
Consumption of the lungs,  its fatality in England,  199; the
   division of, in two classes, 202; the parenchymatous class,
   202; the organic  species of, 203; symptoms of ditto, 203;
   causes of ditto, 206; treatment of ditto,  208; diet, proper
   for, 209; the danger of the use of advertised remedies in,
   211; treatment of the second stage of, 212; tubercular con-
   sumption, 225; treatment of ditto, 230; membraneous class
   of consumption, division  of,  233;  catarrhal consumption of
   the lungs, symptoms of, 233; treatment of, 234; distinction
   of, 236; pituitous consumption of the lungs, 236; distinction
  of, 238; treatment of, 238; hsemoptoic consumption, symp-
   toms of, 240; treatment of, 241.
Contagion, to destroy, 88.
Contusion, see bruises.
Convulsions, in children, 136.
Cooper, Mr. Surgeon, his operation for a species of deafness,
   263. '
Coot, the raw  heart of, recommended by Aretxus as a remedy
   for epilepsy, 284. 
511
Corns, description, cause, and cure of, 242.
Curry, Mr. his'Detector of Quackery, quotation from, 406.
Coryza, see catarrh.
Costiveness, cause and treatment of, 243.
Cough, different kinds of, 244; danger of advertised nostrums
  for, 246.
Cough Drops, the advertised, the baneful effects of, 211, 240.
Count de Garray, first preparer of the essential salt of bark, 29.
Court Plaster, directions for  its use, 59.
Cow-pox, its first discovery,' 247 ; its progress and characte-
  ristic marks, 248; testimonies  of its  anti-variolous power,
  by the royal college of physicians of London, 249; by the
  king and queen's college of physicians in Ireland, 254;  by
  the royal college of surgeons  of Edinburgh, 254; by the
  royal college  of surgeons in Ireland, 255; its success in
  Madras, 225;  recommended by the physicians of Philadel-
  phia, 256.
Cowhage, its efficacy as a vermifuge, 497.
Cramp in the Stomach,  causes and treatment of, 256.
       in the Extremities, causes and treatment of, 257.
Crawford, Dr. his recommendation of muriated barytes as a
  remedy for scrophula, 379.
Cream of Tartar, properties and dose  of,  56; how to detect
  its adulteration, 56.
Cretaceous Powder, compound, its properties, doses, &c. 35';
  mixture with, 63.
Crichton, Dr. his recommendation of the  Lichen Islandicus,
   146.
Croup, symptoms of, 258; causes and treatment of, 259 ; dis-
   tinction of, 260.
Crowther, Mr.  Surgeon,  first recommended the savin oint-
   ment, 49 ;  his treatment  of the white swelling, see whire
   swelling.                                         #  #
Cullen, Dr. his recommendation of Rochelle salts, 7; opinion
   of the expectorant properties of assafcetida in asthma,  Sec.
   22; cautions  against the use of nitre in coughs and inflam-
   mation of the lungs, 56; his directions for giving the Peru-
   vian bark in ague,  51;  quoted on the treatment of animal
   poisons,  101; his letter to LordCathcart on suspended ani-
   mation, quoted, (Note) 105;  his opinion on the  cause of 
512
   asthma, 168; ditto of tubercles in the lungs, 226; his opi-
   nion of the cause of gout, 300; ditto, hypochondriasis, 330;
   his distinction of melancholy  from hypochondriasis, 389;
   his recommendation of matrimony in cases of chlorosis, see
   treatment of green sickness; his definition of nervous dis-
   eases,  404; his opinion of the cause of scurvy, 450.
Curtis, Dr. his lectures on botany, quoted, (Note) 188.
Cutaneous Eruptions, Sec. see eruptions of the stan.
Cuts, proper treatment of, 261; Friar's balsam, a bad appli-
   cation  for, ibid.
                            D
Daffy's Elixir, its composition, &c. 13.
Dahlberg, Dr. his recommendation of ipecacuan in flooding,
   401.
Darwin,  Dr. his opinion of the cause of humoral asthma, 169.
Davison, his treatise on  consumption of the lungs, quoted,
   222; his opinion of tubercles, 226.
Decoction of Bark, how made, 53.
Denman, Dr.  his recommendation of calomel  in  diseases of
   children, 42.
Deafness, different species of, 262;  treatment of, 263; the
   danger of the use of nostrums for,  263.
Dentition of Children,  137.
Desgenette, Dr. his opinion of the nature of plague, 96.
Diabetes, described, 263; causes  and treatment of, 265.
Diachylon Plaster, its use, Sec. 60.
Diarrhoea, symptoms and causes  of,  268; treatment of, 269;
   distinction of, 270.
Diet, the fever, convalescent, and generous, directions for, 152.
Digestion, bad, see indigestion.
Diluted Vitriolic Acid,  its properties, doses,  Sec. 21.
Dimsdale, Baron, the success of his practice in small-pox, 256.
Directions for the  Management of the Teeth, 470.
Dispensary for Consumption of the Luhgs, an account of,
   (Note) 200.
Discutient Lotion, prescription for, 77.
Diseases of Children, see children.
Distilled Water, its effects in cancer,  186; ditto, consumption
   of the lungs", 218; ditto, gravel and stone, 315.
Dixon, Dr. his opinion of small-pox,  256. 
513
Dobson, Dr. (Liverpool), his treatment of diabetes, 265.
Doses of Medicines, a regulating table of, 5.
Dover, Dr. his sweating powder, how made, (Note)  27; his
  opinion of the cause of asthma,  168.
Drink, imperial, how made, 57.
Dropsy, description and causes of, 270; distinctions of, 271;
  treatment of, 272.
Drowned Persons, recovery of, see suspended animation.
Duncan,  Dr.  Andrew, his observations on barley water in
  acute diseases, 88.
Dusting Powder for Children, what proper, see children.
Dysentery, symptoms of, 275; causes of, 276; treatment of,
  ibid, distinction of,  278.

                           E.
Ear, Substances lodged in, treatment of,  117.
Earle, Sir James, his treatment of burns and scalds, 182.
Effluvia,  contagious, how to destroy; see contagion.
Electricity, a case of epilepsy cured by, 282; ditto of St. Vi-
  tus's  dance; cautions against its use in cases of head-ach,
  321; ditto palsy,  416;,  recommended for chronic rheuma-
  tism, 429; ditto inflammation of the eyes, 359.
Electuary, Lenitive, properties and doses of, 47.
Electuary for Cough, prescription for, 72.
          for the Piles, ditto, 71.
          for Tape Worm, ditto, 71.
Elixir of Vitriol, acid, see diluted vitriolic acid, i 1.
Elm Bark, decoction of, how made, (Note) 70; its properties
  and dose, ibid.
Emetic Powder, prescription for,  75.
                Tartar, properties, doses, Sec. of, 43.
Empirics, the ignoble practices of, see quacks.
Epilepsy, symptoms  of,  277; causes of, 280; treatment of,
  ibid; distinction of, 285.
Epsom Salt, properties and doses of, 7.
Erysipelas, see St. Anthony's fire.
Eruptions of the Skin, described, 285; treatment of, 281; the
  danger of external applications, ibid,
                          3X 
514
Essence of Cinnamon, 40.
         of Ginger, 105.
         of Mustard, the dangerous effects of, 384. 431.
         of Peppermint, 40.
Essential Salt of Bark, properties and doses of, 28; its advan-
  tages over the bark in substance, and its different prepara-
  tions,  29; mixture with,  64.
Ether, Vitriolic, its properties, doses, See. 17; method of as-
  certaining its purity, ibid; cautions respecting its external
  application in cases ofsuspended animation, 105.
Excoriations, management, Sec. of, 288; ditto of children,  142.
External Applications, various prescriptions for, 76 to 8].
Exmouth, in Devonshire, recommended as a winter residence
  for asthmatics, 174.
Eye, inflammation of, 359; causes and treatment of, ibid.
     affecting children, 141; chronic, 360; cure of, ibid; specks,
      .291.
     Water, prescription for, 76;  astringent ditto, 77.

                            F.
Fainting, symptoms, causes,  and treatment of, 289.
Falconer, Dr. William, his recommendation  of alkaline me-
  phitic  water as a remedy for the stone and gravel, 314; his
  dissertation on the influence of the mind, quoted on scurvy*
  452; ditto on melancholy, 389.
Falling Sickness, see epilepsy, 244.
Family Dispensatory, 1 to  154.
Family Dispensary, description and advantages of, 2;  medi-
  cines proper for,  9; the different sizes particularised,  153.
Family Prescriptions, 62 to 81.
Farina, of Lichen Islandicus,  or Iceland Moss, recommended,
  150.
Female Debility, pills for, 70; see  whites.
Fever, inflammatory, see inflammatory fever; intermittent, see
  intermittent fever;  camp, see typhus;  pestilential,  see ty-
  phus; petechial, see typhus; putrid, see typhus; scarlet,.see
  scarlet fever;  spotted, see typhus; diet, directions for, 152.
Films or Specks on the Eyes, treatment of, 291.
Flatulency, the causes, different species, and treatment of, 291. 
515
Flooding, when a disease, 399; causes and treatment of, 340;
  prevention of, 401.
Flowers of Plants, the nature of the air emitted from, during
  night, &c. 95.
Flowers of Sulphur, properties, doses, Sec. of, 58.
Fluor Albus, see whites.
Food, proper for children, 112; see also arrow root, and causes
  of indigestion.
Fordyce, Dr. George,  his opinion of serous apoplexy,  166;
  his prescription for asthma, 169.
Fourcroy, Mons. his examination of gouty concretions, 300.
Fothergil, Dr. his prescription for sciatica and acute rheuma-
  tism, 19.
Fox-glove, its effects in consumption of the lungs, 222; cau-
  tions against, 239; prescription with, for dropsy, 272.
Fraser, Dr. Henry, his recommendation of misletoe in epi-
  lepsy, 283.
Friar's Balsam, bad application for recent cuts and wounds,
  21.261.

                            G.

Galen, Dr. his remedies for epilepsy, 280;  ditto gout, 307.
G .lling of Infants,  causes and treatment of, 142.
Gaol Fever, see typhus.
Gargle, acidulated, prescription for, 73.
        discutient ditto, 73.
        astringent ditto, 74.
        detergent ditto, 74.
Garraye, Compt de, first prepared the essential salt of bark, 28.
Garthshore, Dr. his recommendation of the salt of bark, 29.
Generous or full Diet,  directions,* 152.
Gilby, Dr. (Birmingham) his treatment of diabetes, 265.
Ginger, Jamaica, its properties, Sec. 54; its efficacy, in gout,
           305; ditto,  palsy,  416.
        tincture of, and camomile, its properties, doses, Sec. 12. 
516
Gladiator, the warm blood of, recommended by Pliny as a re-
   medy for epilepsy, 284; the liver of ditto, by Scrib. Largus,
   ibid.
Glauber's Salt, why inferior to Epsom salt, 7.
Glyster, see clyster.
Godson, Mr. (Portsea) his cases of small-pox succeeding cow-
   pox infection, 251.
Gout, its distinctions into regular, atonic, retrocedent and mis-
   placed, 297; regular, described, 298; causes of, 299; treat-
   ment, Sec. of, 301; prevention of, 308; atonic,described, 310;
   treatment, Sec. of, ibid; retrocedent, described, 310; treat-
   ment of, 311; misplaced, described, 311; treatment of, ibid.
Gravel, description of causes, 312; treatment of, 313.
Green Sickness, described, 393; causes and treatment of, ibidv
Guaiacum  Volatile Tincture, its properties, doses, Sec. 22.
Gullet, substances lodged in, treatment, Sec. of, 115.
Gum Arabic, its properties,  doses, Sec. 56.   ,
Gum Plaster, its use, See.  60.
Gunz, Dr. his account of the willow bark, 53.
Gutta Serena, described,  315; causes and treatment of, 316;
   powders for, 317.

                           H.
Haemoptoe, see spitting of blood, 458.
Haen, his opinion of the formation of pus in the lungs, 287.
Hahnemann, his test for detecting lead in wine, Sec. how made,
   57.
Hamilton, Dr. his substitute for cradles for children, 130; his
   observations on Quackery, vquoted, 405;  his recommenda-
   tion of purgative medicines in spasmodic affections, 445.
Handell, Dr. his remedy for tooth-ach, 468.
Harrowgate Water, artificial, how made,  see  aperient  sul-
   phurous water, 8.
Hartmann, Dr. his  prescription for asthma, 34.
Hartshorn, shavings of, how distinguished from those of calves
   bones, Sec. 85.
Hartshorn, spirit of, its properties  and  doses,  15; how to
   ascertain its purity, 16;  liniment with, 77, 
517
 Harvey, Dr. his recommendation of the essential salt of bark,
   92.
 Hay garth, Dr. (Chester) his recommendation of calcined zinc
   as a remedy in epilepsy, 282.  t
 Hawes, Dr. his reports of the Humane Society, 107.
 Head-ach, causes of, 317; treatment of, 319;  Dr. Lambe's
   case of, cured by the use of distilled water, 320.
 Heartburn, description and causes of, 322; cure of, 323.
 Heighten, Dr. his dose of calomel for children, 42.
 Hemlock, the method of  administering, .188;  its  efficacy in
   cancer, ibid; ditto in hooping cough, 328.
 Henry, Admiral, his cure of a cataract by friction,  194;  his
   remedy for corns,  243.
 Herefordshire,  the  inhabitants  particularly free from stone
   and gravel, 313.
 Hey, Mr. his opinion of coughing, 193.
 Heynes, Mr. his recommendation of misletoe in epilepsy, 283.
 Hiccup, description,  causes and treatment of, 325.
 Hippocrates, his opinion of the cause of stone, 312; ditto of
   the structure of tubercles, 226; his advice in epilepsy, 283;
   his  recommendation  of the vapours  of  vinegar to purify
   contaminated air, note 83.
 Hill, Rowland,  the  Rev. his pamphlet on cow-pox,  observa-
   tions  on, 253.
 Hodgson, Mr. his testimony of the  efficacy of electricity in
   epilepsy, 282.
 Hoffman,  Dr. his anodyne liquor, 17; his opinion of the cause
   of hooping cough,  320;  ditto of fear in favouring infection,.
   96;  ditto, of the cause of scurvy, 451.
Holt, the Rev. Mr. his laudable example  to his brethren, in
  the inoculation for the cow-pox, 255.
 Home,  Dr. (Edinburgh) his recommendation of cream of tar-
   tar in dropsy, 57; his testimony of the efficacy of madder
   in green sickness,  394.
 Hooping Cough, symptoms and causes of, 326; treatment of,
   327.
Horse Chesnut  Tree, the Bark of, its properties, Sec. 53. 
518
 Houlston, his observations on the treatment of mineral and
   vegetable poisons swallowed, 99.
 Humane Society, their  rules  for the recovery of  cases of
   suspended life, objections to, 115.
 Hunter, Dr. his opinion of thrush, 145; his recommendation
   of spirit of turpentine in the spitting of blood, 241; his opi-
   nion of the worm fever, 499.
 Hunter, Mr. his theory on the  recovery of drowned persons,
   (Note) 105.
 Huslehand, Dr. his remedy for scrophula, 379.
 Huxham, Dr. his tincture of the Peruvian bark, properties
   and doses of, 11;  objections to, (Note) 12.
 Hydrothorax, see dropsy of the chest.
 Hyoscyamus, extract of, remedy for asthma, 171.
 Hypochondriasis, described, 330; treatment of, 331; frequent
   cause of, 335; distinction from melancholy, 388.
 Hysteric Fits, symptoms and causes  of,  336; treatment of,
   338; distinction of, 341.

                           I.
 Iceland Liverwort, or Moss, its properties, Sec. 146; the farina
   of, recommended, 150; different preparations, and the best
   method of using  it, from  146 to 151; chocolate, objections
   to, 148; lozenges, paltry preparation, 148.
Imperial Drink, how made,  57; properties, Sec. of, ibid.
Incipient Consumption, see consumption  of the lungs.
Incontinence of  Urine, description, causes, and treatment of,
   341.
Indian Arrow Root, its properties, 84.
       Pink, its properties as a vermifuge, Sec. 479.
Indigestion, symptoms and causes of,  302 ; treatment, 347;
  prevention of,  350; its effects in exciting constitutional dis-
   eases,  352.
Infectious Vapours, means of destroying,  see contagion.
Inflamed Eyes (of Children), 141.
 Inflammation of the Eye, symptoms, causes, and treatment of
             359.
           of  the  Brain,  description and causes of, 355:
             treatment of, 356. 
519
Inflammation of the Intestines, description and causes of, 362;
  treatment of, 363; erysipelatous, treatment of, 364.
Inflammation of the Lungs, description of,  367; causes and
  treatment of, 368.
Inflammation of the Throat, desci'iption, causes, and treatment
  of, 365; malignant, see putrid sore throat.
Inflammatory Fever, symptoms of, 352; causes and treatment
  of, 353; cautions respecting, 355.
Influenza, see catarrh.
Infusion of Iceland Liverwort, concentrated, how made, 150.
Ingenhouz, his opinion of air emitted by flowers during night,
  95.
Insects in the Ear, how removed, 117.
Intermittent Fever, symptoms and different species of, 370;
  causes and treatment of, 371.
Intoxication, the proper treatment of a fit  of, 109; frequent
  cause of apoplexy, 114.
Introsusception of  the  Intestines, described, Sec. see inflam-
  mation of the intestines.
Invaiids, a table of diet for, 162.
Inward Fits of Children, 134.
Ipecacuan Powder, properties, doses, Sec.  of, 26.
Iron, the Rust of, its properties as a vermifuge, 497.
Itch, description, cause, cure, Sec. of, 372.

                            J.
Jalap Powder, properties, doses, Sec. of, 32; its effects on qua-
  drupeds and hypochondriacs, 33.
Jamaica Ginger, properties, Sec. of, 54,
James, Dr. his opinion of the structure of tubercles, 226.
James's Fever Powders, see antimonial febrifuge powder, 45;
  Dr.  Monro's caution respecting, 45.
Jivundice, description and causes of, 373; treatment of, 375.
Jenner, Dr. his account of the cow-pox, as a preventive of the
  small-pox, 247.
Johnstone, Dr. James (late of Worcester) his method of puri-
  fying the air of infected rooms, 88.
Jugum, an instrument for  retaining urine in case cf incon-
  tinence, recommended, 341.
Justamond, his recommendation of steel in  cancer, 185. 
520
                           K.
 Kali, supercarbonated,  its advantages over common Salt of
   Wormwood, 24.
 Keighley, Dr. his observations on sentimental novels, (Note)
   337; ditto, on the clothing of infants, 121;  on the cause of
   children being left-handed,  (Note) 129; his account of the
   practices of worm doctors, 500.
 Kinglake, Dr. his opinion of nitrated silver in epilepsy, quoted,
   281; his treatment of gout, 303.
 King's Evil, why so called, 377; symptoms, causes, and treat-
   ment of, 378.
 Kirkland, Dr. his opinion of the cause of consumption among
   grinders, (Note) 227.

                           L.
 Lady Smock Flowers, efficacy ofin epilepsy, 282.
Lalonette, Mons. his method of speedily affecting the system
  with mercury, 465.
Lambe, Dr. his opinion of the cause of cancer,  183; his re-
  commendation of the distilled water as a remedy for cancer,
   186.430.
Largus Scribonius, his remedy for epilepsy, 284.
Larray, Mr. his opinion  of the nature of plague, 96.
Latham,  Dr. his recommendation of  saline  mixture,  2.5; his
  opinion of gout, 297.
Laudanum,  its properties, doses, Sec. 38; to counteract the
  effects of an overdose  of, 39; acetous, its properties and su-
  perior  advantages, 39; its efficacy in gout, 302.
Lavemens, see clysters.,  74.
Lead, how detected in port wine, 57.
      Extract of, properties, Sec. of,  36; cautions respecting,
         Sec. 37; a substitute for, 37.
Lead, White, cautions respecting its use as a dusting powder
  for children,  143.
Leeds, Her Grace the Dutchess of, Dedication to,  158.
Leeds, the Sheriff of, his report of the death  of a child by a
  quack  medicine, 45.
 Legs, Dropsy of, see  dropsy.
 Lemon,  Crystallized  Acid of, its properties, doses,  &c. 24;
  sugar of, how made, 26. 
521
Lenitive Electuary, its properties, doses, &c. So.
Leprosy, described, Sec. 384.
Lewis, Dr. his method of giving Peruvian bark powder, 51.
Lichen Islandicus, its properties and best method of adminis-
  tering, 148.
Life, the turn of, 402.
Lime Water, how made, 86; properties, doses, Sec. of, ibid.
Lind, Dr. his prescription of ether for gout in the stomach,
  17; ditto, of myrrh and bark,  20; his recommendation of
  milk as a vehicle for the Peruvian bark powder, 51; ditto, in
  clyster, ibid;  his recommendation of the areka charcoal as
  a dentifrice, 83; his opinion of the cause of scurvy, 437.
Liniment, for burns arifi scalds, 77.
          Volatile,  77.
Linnaeus, Dr. his testimony of the properties  of th.e Lichen
  Islandicus, in consumption of the lungs, 140.
Lint, its use, Sec. 60.
Lip, Cancer  of,  192.
Lipscom.be, Mr. his opinion of cow-pox, 250.
Liquid Laudanum, see laudanum.
Lisbon Diet Drink, how made, 38Q.
Lister, Dr. his opinion of the cause of gravel and stone, 312.
Liver of Sulphur, its chemical properties in counteracting the
  effects of mineral poisons in the stomach, 98.
Liverwort, Iceland, see Lichen Islandicus.
Lock Jaw, see tetany.
Looseness, see diarrhoea.
Lotions and  Embrocations, prescriptions for, 76.
Lotion for Inflammation of the Eye, prescription'for, 67.
        Astringent,  ditto for ditto, 77.
        Discutient ditto, 77.
        for Burns and Scalds, ditto, 77.
Lowness of Spirits, see hypochondriasis.
Lozenges of Lichen Islandicus, or Iceland Moss, cautions re.
   specting,  148.
Lubbock, Dr.  his observations on Dr. RoUo's treatment of
   diabetes,  265.
Lumbago, description, causes, and treatment of, 384. 427. 
522
Lumber Abscess, how often produced, 348.
Lungs, consumption of, see consumption.
       inflammation of, see inflammation of the lune-s,
          •                                      <-»


                          M.

Mad Dog, The Bite of, treatment, Sec. of, see animal poisons.
Madder, its efficacy in green sickness, 394.
Madness, the efficacy of camphor in, 35.
Management of the Teeth, directions for,  470.
Magennis, Dr. his experiment with nitrated silver in epileptic
  fits, 281; his notice of three kinds oi apoplexy, 162.
Magnesia, its  properties,  doses, Sec. 5;  how to ascertain its
  purity, 5; calcined, 6.
Male Fern, its efficacy in destroying the tape worm, 498.
Malignant Fev§r, see typhus  fever.
Malignant Sore Throat, see putrid sore throat, 42].
Malvern in Worcestershire, the salubrity of its air and water
  in cases of asthma, 173.
Manna, properties and doses of, 55.
Mason, Mr. his artificial nipples recommended, (Note) 123.
Matrimony, recommended by Dr. Cullen in cases of obstinate
  chlorosis, 396.
Mead, Dr. his remedy for the bite of a mad dog,  composition
  of, Sec.  102.
Measles,  description, 385,; causes and treatment of, 386; di-
  stinction of, 388.
Medical Observations and Inquiries, quotations from, 190.
Medical  Observer, quotations from,  on advertised'charcbal,
  83; on quack medicines for children, (Note)* 131. 5.01.
Medicine Chest, advantages of, 2; different sizes, Sec. of, de-
  scribed, 15 3.
Medicines, a list of such necessary to be kept by families re-
  mote from medical aid, 3, 4.
Melancholy, definition, treatment, Sec. of, 388.
Menses, see menstruation.
Menstruation, irregularity of, 392. 
523
Menstruation, Retention of, 393; causes and treatment, ibid.
             Suppression of,  described,  396;  causes and
               treatment of, ibid.
             Cessation of, ibid. .
             Excessive, see flooding, 399.
Mephitic Alkaline  Water,  directions for  making,  23; pro-
  perties, doses, Sec. of, ibid.
Metallic Tractorism, an account of, 301; the dangerous effects
  of, in a case of gout, (Note) 301.
Mezerary, his account of a pestilential fever, 96.
Miller, Dr. his recommendation of assafcetida, in spasmodic
  asthma,  22.
Microscopic  Salt, its efficacy in diabetes, 268.
Mind, its influence in  curing hiccup, 325;  ditto in hysterics,
  339; the management of in hypochondriasis, 331.
Mineral Poisons, to counteract the effects of, 97..
Millman,   Dr.  his recommendation of watery  liquids  in
  dropsy, 274.
Mindererus's Spirit, its properties, doses, Sec. 13.
Misletoe, its efficacy in epilepsy, 283.
Mixtures, prescription for, 62 to 71.
Mixture Absorbent, prescription for, 67.
         Antihysteric, ditto, 64.
         Antirheumatic, ditto, 66.
         Antispasmodic, ditto, 66.
         Aperient, ditto, 62.
         Asthmas, ditto, 65.
         Camphorated Bark,  ditto, 64.
         Cretaceous, ditto, 63.
         for Cough, ditto, 64.
         for Gout, ditto, 65.
         for Hooping Cough,  ditto, 63.
          Nervous, ditto, 67. 408.
          Saline, ditto, 69.
          for Scrophula, ditto,  68.
          Stimulating, ditto, 67.
          Stomachic, ditto, 62.
           Sudorific, ditto, 63:
           Tonic, ditto, 68. 
524
Monro, Dr. his cautions against the use of James's  Powders
  in ambiguous fever, 45.
Monro, Mr. Hugh, his treatment of the bite of a mad dog, 101.
Montesquieu, his opinion of the effects of an uniform indul-
  gence of the will, 340.
Morgagni, his description of the structure of tubercles, 226.
Morveau, Citizen Guyton, his method of destroying contagious
  effluvia, 89; ditto, of purifying the vaults at Dijon, (Note)
   105.   .
Morton, Dr. his prescription for asthma, 169.
Mosely, Dr. his opinion of cow pox, 250.
Mother's Milk, a  substitute for, see arrow root.
Mumps, description, causes, and treatment of, 403.
Murray, Dr. his recommendation of ipecacuan in flooding,40L
Musgrave, Dr. his spurious worm fever, noticed, 140.
Mustard, Essence of, its composition, Sec. see essences.
Myrrh, Tincture  of, its properties, doses, Sec. 20.

                           N.
Natron, Prepared, its properties, doses, Sec. of,  60; its efficacy
  in cancer, 187.
Necklaces', Anodyne, an account of, (Note) 139.
Needles swallowed, treatment of, 115.
Nervous Diseases, definition of, 404.
Nettle Rash, description, causes, and treatment of, 412.
Nipples, sore, treatment of, 123.
        Artificial, recommended, 123.
Nipple Ointment, cautions respecting,  37.
Nisbet, Dr. his opinion of the effects of tooth powders, Sec.470.
Nitrated silver, its efficacy in epilepsy, 281; pills with, 281.
Nitre, Purified, its properties, doses,  Sec. 56.
Nitre, Sweet, Spirit of, its properties, doses, Sec. 18.
Nitric Acid, its efficacy in scurvy, 450.
Night-Mare, description, causes, and treatment of, 412.
Nose, Bleeding of, see bleeding of the  nose.
Nostrums, The advertised, see quack medicines.
Nurse, Wet, instructions for the  choice of, 130.
Nursing of Children, directions for,  see children. 
525
                           O.
Oak Bark, its tonic powers, 53.
Ointment, of Savin, its properties, Sec. 49.
          of Spermaceti, its use,.Sec. 48.
Ointments, prescriptions for, 78.
           for the Piles, ditto, 78.
           Alterative, ditto, for the scald head, 78.
           for the Itch, ditto, 78.  '
Opium, its effects in acute rheumatism, 426; means of coun-
  teracting the effects of an over dose of, 100.
Opodeldoc, its properties, Sec. 11.
           Steel's, objections to, 11.
Osborne, Dr. his testimony of the effect of madder in scrophula,
  see treatise of scrophula.
                            P.
Palpitation of the Heart, causes and treatmenjt of, 413.
Palsy, description, 415; causes and treatment of, 416.
Palsy Drops, see compound spirit of lavender.
Paregoric Elixir, properties, doses, Sec. of, 14; cautions  re-
  specting, ibid.
Parkinson, Mr. his cautions respecting advertised cough drops,
  14; his opinion of the cause of acidity in the stomach, 322;
  his recommendation of prepared natron in gout, 61;  his
  opinion of the cause of gout, 300.
Pearson, Dr. his recommendation of the  tasteless salts, 8;
  ditto, opium, in acute rheumatism, 426.   '
Peart, Dr. his recommendation of volatile alkali in consump-
  tion of the lungs, 222 ; ditto, calomel in inflammation of the
  intestines, 364; ditto, Saint Anthony's fire, 442.
Pectoral Drink, how made, see barley water.
Pellitory of Spain, recommended for the tooth-ach, 468.
Peppermint, Essence of, its properties, doses, Sec. 40.
Percival, Dr. his cautionsrespectingthe external application of
  lead,  37;  his opinion of the cause of gravel and stone, 312.
Peruvian Bark Powder, its properties, doses, Sec. 50.
              Essential Salt of, 28.
               Huxham's Tincture of, 11. 
                           526

 Pestilential Fever, see typhus.
 Petechial Fever, see typhus.
 Phlebotomy, directions for, 111.
 Phosphate of Soda, its properties, doses, Sec. 7.
 Phrenzy, see inflammation of the brain.
 Phthisical Dispensary, an account of, (Note) 200.
 Phthisis Pulmonalis, see consumption of the lungs.
 Pierre, St. his opinion of indigenous remedies, (Note) 53.
 Piles, description, causes, and treatment of, 418.
 Pill Coccia, see cathartic'extract, 30.
 Pills, prescription for,  69 to 71.
      for asthma, ditto, 69.
      Bilious, 70.
      Cathartic, ditto, 71.
      for Dropsy, ditto, 70.
      for Female debility, ditto, 70.
      for Gravel, ditto, 70.
Pins, Sec. swallowed, treatment of, 115.
Pituitous Consumption, see consumption.
Plaster, Blistering, 47.
        Diachylon, its use, Sec. 60.
        Gum, its use, Sec. 60.
Plasters, prescriptions for,  79 to 80.
         for Corns, ditto, 79.
         Discutient, ditto, 79..
         Pectoral, ditto, 79.
Piatt, Mr. his advice as an oculist recommended,^ 17.
Pleurisy, description, causes and treatment, Sec. of, 420.
 Pliny, his remedy for epilepsy, 284.
Poisons, the means of counteracting the effects of, mineral
  sorts, 97 ;  vegetable, 99 ; animal, 100.
 Portal, Citizen, his cure of epilepsy, 282.
Portland Powders, observations on, as a remedy for gout, 304.
 Poultices, see cataplasms.
 Powders, prescriptions for, 72 to 73.
          Emetic, prescription for, 72.
          Tonic, ditto, 73.
          for Worms, ditto, 73. 
                          527
Prescriptions for the use of Families, 62 to 81.
Pressey and Barclay, their  Charcoal Powder from the Areka
  Nut noticed, 83.
Pringle, Sir John, his prescription for chronic  rheumatism,
  12;  ditto of ipecacuana, Sec. 27.
Priestley, Dr. his experiments on air, Sec. 94.
Purging, Excessive, see diarrhoea.
Putrid Fever, see typhus fever.             .
       Sore Throat described, 421; causes and treatment of,
           422.


                            Q

Quack Medicines, baneful effects of anodyne to children, 118;
  their danger in coughs,  246;  ditto, cases of deafness, 263;
  ditto,. St. Anthony's fire, 280; ditto, gout, 304; when justi-
  fiable, (Note) 333; the danger in lumbago, 384; Dr. Hamil-
  ton's observations on, 404; the serious effects of,  in scurvy,
  453; ditto, in diseases  of the lungs, 15. 211.;  the basis of,
  for scurvy, Sec. 20.
Quarin, Dr. his testimony of the Lichen Islandicus, 146.
Quartan, see intermittent fever.
Quassia, its fatal effects on insects, Sec. 348.
Quinsy, see inflammation of the throat, 425.
Quotidian, see intermittent fever.

                             •
                            R.

 Ramsden, Mr. his recommendation of depression of the ca-
   taract, 192; his prescription for, 193.
 Ratania Root, the Tincture of, recommended  as a lotion for
   the teeth and gums, 83; its efficacy in diabetes, 267.
 Red gum, description, causes and treatment of,  143.
 Regnault,  Monsieur, his  pamphlet on the Lichen, observa-
   tions on, 188; his syrup of the lichen, objections to, 148; his
   treatment of pulmonary consumption, 223.
 Regular Gout, see gout.
 Restorative Diet, directions for, 152. 
528
Retention of the Menses, see menstruation.
Rheumatism, Acute,  description of,  425; causes and treat-
               ment of, 426.
             Chronic, described, 426; cause and treatment
               of, 428.
             Prevention and distinction of, 430.
             Treatment of doubtful cases of, see lumbago.
Rhubarb, Tingture of, its properties, doses, Sec. 10.
         Powder of, its properties, doses, Sec. 31.
Rickets, description of, 432; causes, 433; treatment, 435; the
           effects of distilled water in, 436,
        Dr. Rosenstein's prescription for, 24.
Ring, Mr. (Surgeon) his recommendation of burnt sponge as a
  remedy for wens, 412; his case of a child poisoned by quack
  medicines, (Note) 431; his opinion of cow-pox, 254.
Ringworm, Treatment of, 287.
Roberts, Mr. (Surgeon) Chancery Lane, his appointment to
  the Phthisical Dispensary, 200.
Robinson, Dr.. his recommendation of ipecacuan in spitting of
  blood, 460.
Rochelle Salt, properties and doses of, 7.
Rollo, Dr. his treatment of diabetes, 265.
Rosenstein, Dr. his prescription for rickets, 24.
Rotheram,Dr.his cases of St. Vitus's dance cured by electri-
  city, 443.
Rousselot, his caustic powder for cancer, composition of, 191.
Rowley,  Dr. his observations on the state of the practice  of
  physic on the Continent, 223; his opinion of cow-pox,  250.
Rupture, description, causes, and treatment of, 438.
Rush, Dr. his prescription for worms, 497.
Ryan, Dr. his opinion of the cause of asthma, 168; his recom-
  mendation of the  cold bath for asthma, 171.

                           S.
Sacred Disease, see epilepsy.
Sal Polychrest, and Rhubarb Powder, recommended by  Drs.
  Warren and Hugh  Smith, 22. 
529
Sal Volatile, Spirit  of, its properties, doses, Sec. 16; the pro-
  per colour of,  ibid.
Saline Mixture,  prescription for, 69.
Salt of Steel, its properties, closes, Sec. 30.
       Tartar, see  salt of wormwood.
       Wormwood, its properties, doses, Sec. 23.
                    Super-carbonated, its advantages over
                     the common, 24.
Saint Anthony's Fire, described, 440; causes and treatment of,
  441. cautions respecting external applications, and adver-
  tised nostrums in, 442.
Saint Pierre, his opinion of remedies, (Note) 53.
Saint Vitus's Dance, description, causes, and treatment of, 444.
Salmade, M. his case of cancer cured by external application,
   191.
Saunders, Dr. his preference  of red Peruvian bark, 51;  his
  prescription of uva ursi for stone and gravel,  314; ditto, of
  calcined zinc for epilepsy, 282;  his opinion of the formation
  of tubercles, in the lungs, 228.
Sauvage, his advice respecting  the treatment  of hypochon-
  driacs, 332.^
Savin Ointment, its use, Sec.  49.
Scalds, see burns.
Scald Heads, causes and treatment of, 446.
Scarlet Fever, description, causes, and treatment of, 448.-
Schutz, Dr. his recommendation of lime water, as a remedy
   for diabetes, 266.
Sciatica, see rheumatism, 454.
 Scirrhus, see  cancer.
 Scopoli, Dr. his opinion  of  the  antiphthisical properties  of
   the Lichen Islandicus,  146.
 Scotch Pills,  the effects of in producing piles, 419.
 Scrophula, see  king's evil.
 Scrophulous Consumption, see consumption.
          Inflammation of the Eye, cure of, Sec. 361;
 Scurvy, description, causes, and  treatment, Sec.  of, 449.
 Seneka Root, recommended in cases of asthma, 170.
                            3Z 
530
 Senna, Tincture of, its properties, doses, Sec. 13; why superior
   to Daffy's elixir, ibid.
 Senna Leaves, properties, doses, Sec. of, 54.
 Sennertus,  Dr. his opinion of fear in favouring the action of
   contagion on the system, 96.
 Simmons, Dr. his opinion of the frequency of tubercles in the
   lungs, 225.
 Sims, Dr. his recommendation of nitrated silver as a remedy
   for epilepsy, 281.
 Skin, Eruptions of, causes, and treatment of, 285.
 Small Pox,  description, causes, and treatment of, Sec. 454.
 Smelling Salts, Godfrey's, objections to, 47; the advantage
   of the acetic acid, 46.
 Smith,  Dr.  Hugh,  his prescription for asthma,  14;  ditto,
   hooping cough, 329; his testimony of madder in scrophula,
   380;  his recommendation of powdered rhubarb and sal po-
   lychrest, 82; his prescription for epilepsy, 282.
 Smith, Mr. his experiments with bile, 177.
 Smith, Dr. James Carmichael, his testimony of  the superior
   efficacy of the essential salt of bark, 29; his method of  de-
   stroying infectious vapours by fumigation, 91.
 Solomon, King, his Proverbs quoted on drunkenness, (Note)
   359.
 Solution of Charcoal, observations on, 84.
 Sore Eyes of Children,  141; treatment of, 142. 361. see in-
      flammation of the eye s
     Throat, see quinsey.
 Specks  on the Eye, see Films.
 Spermaceti, its properties, doses, Sec. 55.
            Ointment of, use, Sec. of, 48.
 Spirits,  cautions respecting, as a wash for children, 146.
 Spirits of Hartshorn, its properties, doses, Sec. 15; its purity,
   how ascertained, 16.
 Spirit of Lavender, Compound, its properties, doses, Sec. 13.
        Nitre, Sweet, its properties, doses, Sec.  18; its good-
           ness, how proved, 18.
        Sal  Volatile, ditto, ditto, 16.
Spirituous Liquors, the baneful effects of, 408. 
531
Spitting of Blood, how to ascertain its  source, 457; causes
  and treatment of, 459.
Spotted Fever, see typhus.
Sprains, see bruises.
Squill Pill, its properties, doses, Sec. 49.
       Troches of, recommended in cases of asthma, 171.
Stag's Horn Shavings, properties, Sec. 85.
Steel, Salt of, its properties, doses, Sec. 30.
Steer's Opodeldoc, see opodeldoc.
Ste nbeck, Mr. his account of the preventive powers of cow-
  pox against small-pox infection, 247.
Stimulating Mixture, prescription for, 67.
Stoerk, Dr. his recommendation of hemlock in cancer,  189.
Stoll, Dr. his method of prescribing ipecacuan, 27. 460.
Stomach, cramp of, 256.
Stomachic Mixture, prescription for, 62.
Stone, Dr. his treatise on indigestion, noticed, 176.
       The Rev. Dr. his account of the  willow bark, 53.
Stone, see  gravel.
Strangury, description, causes, and treatment of, 400.
Sugar of Lead, Dr. Buchan's recommendation of, cautions re-
            specting, 143.
         Lemons, observations on, 26.
Sulphur, Flowers of, its properties, doses, Sec. 58.
         Liver of, its effects on mineral poisons, 106.
          Milk of, observations on, 59.
          Washed, its properties, doses, Sec. 58.
 Sulphurous Water, how made, 8.
 Super-carbonate of  Soda, its properties and doses in cases of
   stone and gravel, see prepared natron.
 Surr, Mr. his treatment of diabetes, 267.
 Suspended Animation, the means of recovery of, 103.
 Swelling of the Breasts of Infants, 140.
 Sweating, Profuse,  461.
 Swieten, Van, his notice  of the effects of fear and anger in
    producing apoplexy, (Note) 16.
 Symonds, Dr. (Hereford), his prescription for scrophula, 68.
 Syrup of Lichen Islandicus, objections to, 148. 
532
                           T.

 Tape Worm, see worms; how imitated by quacks, 501.
 Tartar, Cream of, its properties, doses, Sec. 56.
        Emetic, properties and doses, Sec. 42.
        Salt of, see salt of wormwood.
 Tartarised Antimony Wine, properties, doses, Sec. of, 18.
 Tasteless Purging Salts, see phosphate of soda.
 Teeth, Cutting of, see dentition, 137.
       Tincture for, recommended, 83.
       Directions for the Management of, 470.
 Thieves' Vinegar, an improvement of, see acetic acid.
 Temple, Dr. his prescription for asthma, 169; ditto, hooping
  cough, 329.
 Tenesmus, description, causes, and treatment of, 461.
 Tertian Ague, see intermittent fever.
 Tetany, description, 462; causes  and treatment,  463.
 Test for detecting Lead in Wine, how made, 57.
 Thesaurus Medicaminum, quotation from, on the properties
  of the Lichen Islandicus, 146.
 Thomas, Mr. (of Abbeytintern, Monmouthshire), his extraor-
  dinary large tumour, noticed, 484/
Thornton, Dr. his Vaccina Vindicia, observations on, 253.
 Thorp, Dr. (Leeds), his  instructions for checking the pro-
  gress of contagion, 92.
 Thrush, in children, description, causes, and treatment of, 145.
 Tin, an  Electuary of, prescription for,  71;  the  effects of in
  St. Vitus's dance, 444.
Tincture of Assafcetida, its properties, Sec. 22.
         of Ginger and Chamomile Flowers, properties and
           doses of,  12 ;  recommended as a remedy for indi-
           gestion, 349.
         of Guaiacum, properties, doses, Sec. of,  22.
         of Myrrh, properties, doses,  Sec. of,.20.
        of Rhubarb, properties,  doses, Sec. of, 10. 
                          533

Tissot, his treatment of poisons, observations on, 99; his
  case ofsuspended animation restored, (Note) 107.
Tobacco, vapours of, its efficacy in cases of suspended anima*
  tion, 106; extract of, its efficacy in hooping cough, 328.
Tongue, cancer of,  192.
Tonic Mixture, prescription for, 68.
       Powder, ditto, 73.
Tooth Ach, causes and treatment of, 466; prevention of, 83.
        468.
       Powder, proper, see prepared charcoal, 83.
               The advertised, Dr. Nisbet's observations on,
                 471.
Trismus, see Tetany.
Troches of Squill and Benzion, recommended in cases  of
  asthma, 172.
Trotter, Dr. his opinion of the effects of spirituous and vinous
  liquors in producing indigestion, (Note)  343; ditto, apo-
  plexy, 161; ditto, of the cause of diabetes,  (Note) 264.
Tubercles in the lungs, description of, 228.
Typhus Fever, description of, 474; causes, 475; treatment of,
  476.

                           U.

Urine, Bloody, causes and treatment of, 179.
       Incontinence of, 341.
       Increased secretion of, see diabetes.
Uva ursi, its efficacy in consumption of the lungs, questioned,
  221.

                            V.

Van Swieten,  his opinion  of the cause of epilepsy, 280;  his
   case of epilepsy produced by fear, 284.
 Vaughan,  Dr. his opinion of a fever that raged in  North-
   America, 95.
 Vegetable Poisons, the means of counteracting the effects of
   an over dose of, 99.
 Vinegar Aromatic, see acetic acid. 
534
 Vinegar, Radical, see acetic acid.
          Theives', an improvement of, see camphorated acetic
            acid, 46.
 Vitriolic Acid, how used to destroy infectious vapours, 90.
               diluted, its properties, doses, Sec. 21;
 Volatile Liniment, how made, 77.
         Smelling Salts, the use of, 47.
        Tincture of Guaiacum, its properties, doses, Sec. 22.
 Vomiting, causes, treatment, Sec. 479; of children, 481.
          of Blood,  description, 481; causes and treatment
            of, ibid.

                          W.

 Walshmeid, his opinion of the cause of hooping cough, 327.
 Ward, Dr. (Leicester), his recommendation of the essential
  salt of bark, 29.
 Ward's Paste, receipt  for, 420.
 Ware, Mr. his prescription for  gutta serena,  317; his cha-
  racter as an oculist,  317.
 Warren, The late Dr.  his recommendation of powdered rhu-
  barb and sal polychrest, 32.
 Warts, destruction of,  Sec. 483.
Wash, proper for Infants, 144.
 Water Brash, 482; causes and treatment of, 483.
 Water, Cinnamon, how made, see essence of cinnamon, 40.
        Peppermint, how made, see essence of peppermint,
          40.
Watery Head, description,  cause, and treatment of, 484.
 Webster,  Dr. his opinion of the bile, 176.
Weights and Measures, explanation of, 4.
Wen, description and cure of, 484.
Wet Nurse, instructions for, 130.
Wethering, Dr. his reasons why hemlock has not succeeded
  in the cure of cancer, in this country, 188.
White, Dr. (York) his recommendation of calcined zinc,  as
  a remedy for epilepsy, 282.
White Swelling, description, causes, and treatment of, 489. 
535
Whites, description, causes, and treatment of, 486.
Whiteloe, causes and treatment of, 491.
Willan, Dr. his observations on diabetes, 267; his treatise on
  diseases of the skin, noticed, 286.
Willow Bark, its tonic  power, Sec.  53.
Wilson, Dr. his recommendation of the salt of bark, 29.
Wine, a test to detect the presence of lead in; how made, 57.
       the ill effects of, (Note) 345.
Wollaston, Dr. his opinion of the cause of gout, 300.
Womb, Cancer of,  192.
Wroodville, Dr. his  account of small pox, 256.
Worm Fever, the spurious, 140. 499.
Worms in Children, 139; different species of,  493;  causes,
  treatment, Sec. of, 495; advertised remedies for, why dan-
  gerous, 4. 501.
Wormwood, Salt of, its properties, doses, Sec. 23; its effects
  in decomposing mineral poisons, 98.

                           Y.

Young, Mr. his treatise on the treatment, of cancer, observa-
  tions on,  184.


                            Z.

 Zinc Calcined, its  effects in epilepsy,  282;  Dr. Saunders's
   prescription with, 282.
 Zimmerman, Dr. his method of giving ipecacuan, 27. 
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