w^ t. ' ' 1 'X -■■C Q uQOQC1- '-OQO.iO'QXjQG'^0'QjC'QOG-^;aQ->! !i i! r, Surgeon General's Office PRESENTED BY No 2,4"7 ^ > '=, L'L OQ CO C Z''j-£j C DC ■ r> »' *. # ' .»-•. % J "7^ / J?\4**'r- AMERICAN MODERN PRACTICE; OB, A SIMITLE METHOD OF PREVENTION AND CURE OF DISEASES, ACCORDING TO THE LATEST IMPROVEMENTS AND DISCOVERIES, COMPRISING A PRACTICAL SYSTEM ADAPTED TO THE USE OF MEDICAL PRACTITIONERS OF THE UNITED STATES. TO WHICH IS ADDED &n ftppenttijt, CONTAINING AN ACCOUNT OF MANY DOMESTIC REMEDffiS RECENTLY INTRODUCED INTO PRACTICE, AND SOME APPROVED FORMULAE APPLICABLE ' TO THE DISEASES OF OUR CLIMATE. A/ BY JAMES THACHER, M. D. A.A.S. Author of " The American NewTKspensatory," and * Observations on Hydrophobia.'' " The young disease, which must subdue at length, Grows with our growth and strengthens with our strength.".,..?^. t BOSTON : PUBLISHED BY EZRA READ 1817. C. Norris and Co. Printers. District of Massachusetts, to wit: DISTRICT CLERK'S OFFICE. BE 11 REMEMBERED, that on the thirtieth day of December, A. D. 1816, and in the for- ty-first year of the Independence of the Unitttl States of America, EZRA READ, of the said District, has deposited in this office the title of a book, the right whereof he claims as proprietor, in the words following, to wit: " American Modern Practice ; or, a simple method of Prevention and Cure of Diseases, accord- ing to th« latest improvements and discoveries, comprising a practical system adapted to the use or medical practitioners of the United States. To which is added an Appendix, containing an account of many domestic remedies recently introduced into practice, and some approved formu- la applicable to the dist ases of our climate. By James Thacher, M. D. A. A. S. Author of" The American New Dispensatory," and u Observations on Hydrophobia." " The young disease, which must subdue at length, Grows with nur growth and strengthens with our strength."....P<>j£»*. In conformity to the Act of the Congress of the United States, entitled, " An Act for the En- noun. p-meM of Learning, by securing the Copies of Maps, Charts and Books, to the Authors and Propri'-tors of such Copies, during the times then iu mentioned :" and also to an Act, entitled, " An Act supplementary to an Act, entitled, An Act for the encouragement of Learning, by se- curing the Copies of Maps, Charts and Books, to thu Authors and Proprii tors of such Copies dur- ing the timet therein mention, d; and extending the benefits the reef to the Arts of Designing, Engraving and Etching Historical, and other Prints." WILLIAM S. SHAW, Clerk of the District of Massachusetts. PREFACE. w IT is confessedly a matter of regret, that a country, in which literature and science have been so honorably and suc- cessfully cultivated, should so long remain destitute of a sys- tematic work on practical medicine. It may, however, be admitted in extenuation, that those most distinguished in the walks of science ; and who, by talent and experience, may be supposed best qualified for the important undertaking, are constantly subjected to urgent demands of profession- al duties, controling the disposition of their time and inclina- tions. The position will undoubtedly be conceded, that the diseases peculiar to a country, are most judiciously treated by native physicians, who are particularly conversant with their true characteristics. However ample the attainments of the practising physician, or prompt his sagacity in recog- nizing diseases and their curative indications, every one must be aware of the aid to be derived from a practical sys- tem, when the energies of bis mind are oppressed by a mul- tiplicity of professional applications. To what source can such resort with more confidence than to the productions of those, who have long labored in the same field ; whose whole lives have been devoted to similar pursuits ; who have suc- cessfully encountered the same embarrassments,' and sus- tained an equal weight of responsibility ? " PREFACE. Such has been the rapid progress of medical science, and such the essential improvements, effected by the zeal and talents of the professors and medical practitioners of the U- nited States, within the last thirty years, that many periodical publications have been issued to record and promulgate im- portant discoveries. These augment our materials for con- stituting a practical work embracing, in a methodical view and condensed form, the principles of modern practice eve- ry way adapted to the use of American physicians, and cal- culated for the meridian of the present day. Such is the object which the author has for years had in contemplation; and the fruits of persevering labor and research, have now resulted in a compendium of the most modern and approved modes of treating the diseases of our country, and of the most judicious application of the medicinal productions of our own soil. The high responsibility, which devolves on an author, who undertakes to dispense instruction and rules of practice pertaining to health and life, cannot fail of promp- ting,his solicitude to a conscientious discharge of duty : nor will his sense of the high obligations of honor and moral rec- titude, permit aught to pass from his pen without the strong- est conviction of its correctness and utility. Throughout the whole course of this compilation the most substantial au- thorities have been consulted, such as no one, it is presum- ed, will be disposed to impeach, and under whose influence, even the wise and learned of the medical faculty will not disdain to prescribe. Dr. Thomas' Modem Practice has unquestionably acquired in this country its merited popular- ity and repute, but in this compilation there is an evident redundancy on the one hand and a deficiency on the other, as respects American practice. Should it therefore be found that the present volume contains bis appropriate practical precepts incorporated with our own improvements, it may PREFACE. ».U with just propriety be recommended as a substitute for that English production. Disclaiming all pretensions to theoret- ical explanations, and rejecting hypothetical disquisition as fallacious, I have directed my views simply to rules of prac- tice. To the scientific reader who may object to the plan of this work as not being conformable to any classical ar- rangement, it may be replied that we possess no systematic arrangement deemed free from imperfections at the pres- ent day, inasmuch as the character of that which exalted the name of the venerable Cullen is now on the decline. The method here adopted although imperfect may subserve the useful purposes ,in practice. Should the public as we an- ticipate, be favored by some of our learned professors with a new classification, calculated to annihilate the doc- trine of the unity of disease, it may be adopted in the event of this work being so fortunate as to reach another edition. The very formidable and fatal epidemics, which have with- in a few years ravaged our country and justly excited great public interest and alarm, are portrayed in their true char- acter, with their medical treatment, according to the views of the most experienced physicians. To inculcate the high importance of a complete medical education, agreeably to the established rules of our universi- ties and medical institutions, and to discountenance the at- tempts of the illiterate and the impostor, who thrust themselves into medical practice, are among the primary objects of this production. In treating on the various subjects, I have been solicitous to adopt a concise and perspicuous style of lan- guage, diverted as much as possible of technical terms, where others equally clear and expressive can be applied. How- ever obnoxious this mode may be to the censure of the classic and scientific, it will not, it is presumed, appear ob- jectionable to a majority of my readers, especially those who IV PKLFACE. reflect, that whatever relates to the health and life of man cannot be exhibited in too plain a garb, or explained in too clear a light. Thus every class of readers may obtain a knowledge of those causes, which produce, and those rerae dies which mitigate and relieve the various diseases, to which they are liable. Could the author be permitted to indulge his own complacency, without the hazard of incurring the imputation of arrogance or egotism, he might assert, that this production combines greater advantages than any prac- tical book now extant. It may be applied to useful purpos- es in families, and as a profitable companion in every gentle* man's library. It is replete with lessons of instruction for practitioners whose residence in the country precludes them from access to other sources of information. It is cal- culated to facilitate the practice of those who are but little conversant with medical records, and of the junior class who are about commencing their professional career as the pledge and hope of the rising generation. In the Appendix, I have inserted a few articles which are contained in the American New Dispensatory, principally with the view of communicating the improvements of later experience. These with additions will probably appear in the next edition of that work, which is now susceptible of further improvment. In collating scattered materials from preceding writers and loose notes, it was scarcely practicable, in every instance, to designate with the usual marks of quotation, and it is hoped that no censure will be incurred by the omission. If by in- defatigable industry and laborious research, the author ha* merited any share of praise or patronage, it only remains to solicit indulgence in regard to imperfections and errors. Plymouth, Mass. January 1st, 1817. INTRODUCTORY. HISTORICAL SKETCH OF MEDICAL SCIENCE, AND THE SOURCES AND MEANS OF MEDICAL INSTRUCTION IN THE UNITED STATES. AMONG the various sciences and literary pursuits of life, there is no one more pre-eminently important than that which is emphatically styled the healing art; that which brings health and joy to mankind. It is an inestimable blessing, bestowed in mercy, to counterpoise the frail condition of our nature, and to meliorate or remedy the miseries which result from the indulgence of our vicious propensities, Jt assuages the anguish of corporeal disease, and sooths that keen men- tal distress, which overwhelms the faculties of the soul. " Two thousand years ago, no fewer than three hundred dangerous diseases, besides their various species and degrees, were discovered by physicians; and, even now, new diseases are every day making their appearance.' It would be a pleasant and useful speculation to trace our art from its crude and embryo state, to its present condition of improvement and maturity; but a cursory retrospect only will comport with our present plan. I When we contemplate the condition of the inhabitants of the earth in the primitive ages of the world, we are struck with the formidable embarrassments which they were doom- ed to encounter. Unacquainted with the means of fortify- ing themselves against the numerous evils of life, they were continually exposed to casualties and disease, and, at the ( same time destitute of such assistance as would afford the 4 HISTORICAL SKETCH OK desired relief. Ignorant of the structure of the human frame, and of the laws of the animal economy, no rational method of cure could be devised, and their medical knowledge could consist only of an incongruous mixture of superstition and absurdities. The primitive inhabitants, however, were blessed with firm original stamina, robust and vigorous constitutions, and were provided with plain and simple food for their subsis- tence ; either the spontaneous productions of the soil, or the easy acquisitions of agriculture. The climates, which they enjoyed, were probably of a mild and genial temperature, the aic pure and serene, and the natural means of health and comfort, their peculiar patrimony. While, therefore, they observed the rules of sobriety and temperance in their living, according to the dictates of nature and right reason, and ad- hered to the principles of morality and virtue, their diseases could be neither so numerous, nor so complicate and diffi- cult, as to require profound skill for their removal. It is, nevertheless, presumable, that this happy condition of the human race was not of long continuance ; but that a corruption of manners was gradually introduced, and the seeds of diseases sown either by irregularity or unavoidable incidents, and fostered by the baneful influence of effeminate and luxurious gratification. If, while in the salutary pur- suits of pastoral life, men generally enjoyed an uninterrupted state of health ; by a departure from the virtuous habits of such a life, and by yielding to temptations, and the corrupt propensities of nature, their constitutions became impaired, and the first principles of disease were engendered and nour- ished. In consequence of these powerful causes, and the influ- ence of others of a physical nature, operating in conjunc- tion, the system of individuals acquired a disposition to MEDICAL SCIENCE, he. 5 diseases, which could not fail of being disseminated among the people, and entailed, through their offspring, to succeed- ing generations. Although accustomed to the event of death by fatal accidents, or old age, the novel and affecting scenes exhibited, when diseases terminated in the extinction of life, must have excited among the early inhabitants of the earth an uncommon degree of consternation and alarm ; and being altogether ignorant of the true causes, which generated them, they would probably ascribe such extraordinary phenomena to some supernatural power. Prompted by a spark of that reason implanted in the breast of man for his preservation, as the first principle in nature, they endeavoured to obtain from the most probable sources a remedy for their diseases ; nor are we to be surprised that the human mind, influenced by superstition, and untaught by experience, should associate the idea of religion with medicine, and resort to charms and incantations, in full confidence of accomplishing their desir- ed purpose of preventing and curing every malady. Such, in fact, was the melancholy predicament of our species during the early part of their history. Ignorant priests, magicians and astrologers were their only physicians, and the superstition of the times animated their hopes, while it gave a sanction to the grossest impositions. If, under in- fatuation and despair, consolation could have been derived from these sources of folly, fatal experience must soon have taught the sufferers that a cure of their maladies was to be effected by more potent remedies than those of sorcery and enchantment. In process of time, therefore, an expedient suited to their circumstances was put in practice for the at- tainment of medical knowledge. The sick were directed to be exposed in public places to the view of travellers and strangers, who were required to examine and compare their cases with such as might antecedently have fallen under B HISTORICAL SKETCH OF iheir observation, and to recommend such remedies as had been known to produce beneficial effects in similar complaints. And when discoveries were thus made, the precious reme- dies were held in veneration, and the knowledge of them was conveyed by oral tradition, or recorded upon pillars in the most public places, or on the walls of the temples dedicated to the God of health : and afterwards registers of cures were kept in those consecrated places for the general good of mankind. Thus was the practice of physic commenced under no other advantages, than the simple principle of analogy; and many ages elapsed before this abstruse and important science was placed upon a more solid foundation. The Egyptian medicine appears to have been little else than a collection of absurd superstitions. Among the Greeks, iEscuIapius was the most celebrated of those to whom they attributed the in- vention of physic. He was accounted the most eminent practitioner of his time, and his name continued to be rever- ed after his death. He was even ranked among the Gods, and the principal knowledge of the medical art remained with his family till the days of Hippocrates, who reckoned himself the seventeenth in a lineal descent from iEsculapius. We are not furnished with a correct series of information relative to medical history until about four hundred and fifty years prior to the Christian era, when, amidst a' cloud of darkness and ignorance, the superior wisdom and brilliant talents of the great Hippocrates were displayed to the world. Under the auspices of this Prince of Physicians, the healing art first assumed the form of science, and was known and practised as a regular profession. In the treatment of diseases, he studied and copied nature, with the greatest care and assiduity, as the only sure basis of medical science, and so extensive was his knowledge, and so accurate his ob- MEDICAL SCIENCE, Sec. 7 tervations, that he has been constantly held in veneration, through succeeding generations. His numerous writings on medical subjects remain a monument of his penetration and judgment, and are considered, by the learned, as replete with lessons of instruction, even at the present day. By his un- paralleled industry and perseverance, this father of medicine acquired a character and fame, which united the applause of nations around him, and divine honours were consecrated to his memory. A medical school was instituted at Alexandria in Egypt, which was conducted by the most learned professors of that early period. Dissections and the study of anatomy and surgery were practised and patronized, and the institu- tion, which flourished near a thousand years, has been re- nowned in history as the earliest and most important seat of medical literature and science. It was here that Herophi- lus and Erasistratus were distinguished for the vast number of human subjects, which they dissected, and for their im- portant contributions to anatomical knowledge. But they were accused of procuring access to the springs of life by the reproachful practice of employing the knife upon the living bodies of criminals. Galen, a man of signal talents and a disciple of the Alexandrian school, whose life was devoted to the study and pursuit of medical science, was another celebrated name among the physicians of antiquity. He collected and arranged the rich treasures of medical knowledge, which the labours of preceding ages had acquired, and made con- siderable improvement on the original stock. He is said to have been the author of three hundred volumes on medical subjects, and with the exception of Hippocrates, was esteem- ed the greatest physician of antiquity. So surprising were some of the cures which he performed, that his skill was ascrib- 8 HISTORICAL SKETCH OF ed to magic. Although he introduced a false and chimeri- cal theory, and indulged in the most extravagant disputa- tions respecting medical subjects, so high was the authority of his name, that, for about fourteen centuries, his systems and doctrines were most sacredly adhered to and rever- enced by all descriptions of men. In the early part of the 16th century, the noted Paracelsus flourished, as a physician and chemist. He laid the foundation of a chemical system, directly opposed to that of Galen, which he resolved to subvert. The prin- cipal remedies which he employed, were mercury and opi- um, and the success of his practice extended his fame and celebrity, and inspired confidence in his system. He was an enthusiastic labourer in the cause of the alchymists, and boasted of being in possession of the philosophers stone. He travelled through almost every country of Europe, con- sulting indifferently physicians, barbers, old women, con- jurors, and chemists. In the height of his prosperity he was appointed to deliver lectures in the town of Basle, in Switzerland, and was the first public professor of chemistry irr Europe ; but he soon quarrelled with the magistrates about a medical fee, and left the city. He was extremely dissolute and eccentric in his manners and character. While seated in his chair as professor, he burned with great solemnity the writings of Galen and Avicenna, and declared to his audience, that, if God would not impart the secrets of physic, it was perfectly justifiable to consult the Devil. He invented an elixir proprietatis, which he termed the elixir of life, for the professed purpose of procuring longev- ity, and pretended that, by the use of it, his life would be protracted to the age of Methuselah. Continuing to ramble about the country, he sunk into the deepest dissipation, being scarcely ever sober, and never changing his clothes, nor MEDICAL SCIENCE, &c. 9 sleeping in a bed, neither the counsel of the Devil, nor his universal elixir conferred on him his boasted gift of immor- tality, and he died in a hospital in the 48th year of his age. The quacks and empirics of the present day may probably trace the origin of their craft, and vaunted nostrums to the vagaries of their great master Paracelsus. Notwithstanding the whole life of Paracelsus was a tissue of blunders and vice, it is acknowledged that his talents were great, and that his labours were not entirely useless. Having carried his speculations concerning the philosophers stone and the universal remedy to the greatest height of ab- surdity, and having, in his own person, exemplified the ideal pursuit, he contributed more than any man to their disgrace and subsequent banishment from the science, and, at the game time, gave a favourable impulse to the true principles of chemistry. Vesalius, professor of anatomy in the University of Padua, and Michael Servetus, a Spanish physician, were, about this era, distinguished for their medical abilities and erudition, especially for their attainments in anatomical knowledge. Boldly controverting the principles on which Galen had founded his system, and which were then deem- ed inviolable, these ingenious men soon developed and ex- posed the errors of their great predecessor, and during this investigation, Servetus actually discovered, in the year 1553, the course of the blood through the lungs, which is termed the lesser circulation. But, unfortunately for Serve- tus and the medical world, his love of controversy and ar- dour of temper involved him in a dispute with John Cal- vin, the celebrated religious reformer, which eventuated in a cruel sentence of death against him for heresy; and this valuable man, together with his writings, was, at the age of about 45 years, consigned to the flames. 2 10 HISTORICAL SKETCH OK It is matter of wonder and astonishment that, after the com- mencement of human dissections by Democritus, the cotempo- rary and friend of Hippocrates, two thousand years should elapse before the very important discovery was made of the true circulation of the blood. But this luminous event was greatly retarded by a scrupulous adherence to the errors of Galen and his followers, who attributed to the liver the of- fice of preparing the blood and transmitting it through the veins to all parts of the body, conceiving that air was con- tained in the arteries, and that the veins were the only true channels of the blood. It was also the opinion of some, that the blood moved forward and backward like the ebbing and flowing of the tide. In the early part of the 17th century, Aquapendente, a learned Italian physician, announced his discovery, that the veins were furnished with valves, the mechanism of which precluded the possibility of their performing the of- fice which the ancient doctrine had assigned them; the valves admitting the progress, but obstructing the regress, or return of the blood. This perplexing dilemma did not escape the observation of the sagacious Dr. William Har- vey, an English physician, who had been a pupil of Aqua- pendente. Unbiassed by the doctrines of the ancients, and inattentive to the errors of his immediate predecessors, this ingenious anatomist availed himself of established prin- ciples, and commenced his investigation of the structure and functions of the heart and arteries. Apprized of the fact that two ounces of blood is received into the heart and projected into the aorta, at every pulsation, his natural in- quiry was, whence is this blood received, and how is it dis- posed of, unless by a regular course of circulation ? Having, therefore, tied an artery, the corresponding vein received no blood ; but, making a vein the subject of the same ex- MEDICAL SCIENCE, &c. 11 periment, all its branches and the corresponding artery in- stantly became distended with that fluid. Animated by this successful experiment, he was induced to prosecute his inquiries with unremitting industry, for several years. His efforts were at last crowned with the attainment of their noble object, and it has been received as an invaluable ac- quisition to the science of medicine. In the year 1628, his new theory of the circulation of the blood became the sub- ject of his lectures, and, by numerous experiments, he de- monstrated the phenomena in a manner the most convincing and satisfactory. Such is the ignoble spirit of jealousy and envy, that it is not usually the fate of novel doctrines, how- ever important, to be received without opposition; accord- ingly we find that there were some, who, biassed by passion and interest, had the boldness to deny the facts so fairly proved, and to calumniate the name of the illustrious Har- vey. Every argument against him was, however, complete- ly refuted and silenced, and his new principles of circula- tion universally established before the termination of his honourable life. It is observed by a judicious writer, that " the books of Harvey present us with many indications of " a great mind, acute discernment, unwearied application, " original remark, bold inquiry, and a clear, forcible and J' manly reasoning." He was not less distinguished for his piety, than for his erudition, and, at the close of his useful life, he was consoled with the reflection, that the spirit of malevolence, so hostile to his merit and fame, became attem- pered to the grateful duty of enhancing and perpetuating the honour justly due to his character. Great and manifold are the advantages derived to mankind from the ingenious labours of the immortal Harvey. His splendid discovery, which had eluded the research of ages, subverted the falla- cious doctrines of the ancients, and, at once, effected a to- 12 HISTORIC AL SKETCH OF tal revolution in the theory and practice of medicine. Of ail (he transactions recorded in medical history, this is in- comparably the most essential in its effects and consequen- ces. Medical, like all other knowledge, is progressive, and the melancholy triumph of disease over its victims, and the numerous reproachful examples of medical impotency, clear- ly evince that the combined stock of both ancient and modern learning is greatly insufficient to perfect our sci- ence. From the commencement of medical history, revolutions in the theories of physic have been extremely numerous and fleeting. Many of them were no other than visionary hypothesis, emanating from perverted imaginations, uncon- nected with facts, and utterly repugnant to the plainest dic- tates of observation and experience. An appropriate dis- quisition on the various systems and rotation of systems, which have prevailed, will not comport with the plan of this sketch. The reader may consult the writings of Boer- haave, Cullen, Rush, and the several Encyclopaedias, where the versatility of human systems is abundantly displayed. Every age has teemed with the controversies of the learn- ed ; and while ambitious projectors imagined they had at- \ tained to perfection, their cotemporaries or immediate suc- cessors contested their principles, and triumphed over their errors; hence we see theories which scarce survive their authors, give place to others as transient and unsubstantial as themselves. In consequence, however, of diligent and learned research, and of emulation among medical philoso- phers, new and important facts have been developed, and the restoring art has reached its present honourable and dig- nified rank among the sciences. Far indeed beneath the standard of perfection, it is still fraught with deficiencies, and altogether inadequate to our desires. To what extent MEDICAL SCIENCE, 8tc. 13 the frail condition of human nature is capable of being mel- iorated, and existence protracted by the application of the principles of medicine, must be reserved to the wisdom and industry of future generations to determine. It is never- theless incumbent upon us to consecrate our talents to this noble science, duly to appreciate and exalt its merits to cher- ish its dignity, to study and improve its principles, and to cultivate a religious sense of the inestimable blessings which mankind derive from its influence.* While medical philosophers laboured with unceasing as- siduity and zeal for the promotion of the science, its pro- gress was impeded by the preposterous edicts of sovereigns and legislatures. In the 16th century the emperor Charles 5th, although addicted to crimes of the blackest stain, or- dered an assembly of divines to deliberate whether it were lawful, in point of conscience, to dissect a dead body. During the same reign a violent controversy subsisted res- pecting the question whether, in a pleurisy, blood should be drawn from the arm of the affected side, according to Hip- pocrates, or from the opposite side. The University of Salamanca, in Spain, decided by a decree, that no one should dare to let blood but from the contrary arm, alleging, that the other method was of no less pernicious consequence to medicine, than Luther's heresy had been to religion. That eminent and indefatigable physiologist, Baron Haller, was obliged to flee the city of Paris, to avoid prosecution for dissecting dead bodies ; yet his ardour was not diminished, and he found means to dissect three hundred and fifty hu- man subjects and a vast number of the brute creation, some * So great, says the pious Dr. Rush, are the blessings which mankind derive from the healing art, that if every other argument failed to prove the administration of a Providence in human affairs, the profession of medicine would be fully sufficient for that purpose. 14 HISTORICAL SKETCH OK of them while alive. The science of medicine is greatly in debted to the zeal and ability of this illustrious man. In some countries laws have been enacted, obliging physi- cians to adopt, ii all cases, the prescriptions which had been collected and approved by the physicians of former ages. During the prevalence of a malignant fever in Barcelona, a few years since, the Court of Madrid, as is related, wrote the prescription and, by the command of his Catholic Majes- ty, the physicians were ordered to adhere to it, and forbid- den to prescribe any thing else. Such bigoted and illiberal procedure could not fail of suppressing the spirit of investi- gation, and of presenting insuperable obstacles to that pro- gressive improvement so ardently desired by every friend of medical science. The cultivation and improvement of medicine in the Unit- ed States have not, perhaps, until within a few years, been commensurate with our national progress in wealth and pop- ulation. Prior to the revolution many of the more respecta- ble physicians, especially those of the Southern sections, were either Europeans, or gentlemen sent from hence to com- plete their medical education in foreign Universities. The practice of medicine in New-England was frequently united with the ordinary parochial duties of ministers of par- ishes, who were thus enabled, in a double capacity, to admin- ister spiritual consolation and sooth the bed of death. Publications on medical subjects were seldom known in America prior to the beginning of the 18th century. The first in Massachusetts was a paper in 1677, entitled " A brief guide in the small-pox and measles" by Thomas Thacher, a clergyman and physician, who is spoken of as the best scholar of his time. The communication of the small-pox by inoculation was introduced in Boston in 1720, under the influence and pat- MEDICAL SCIENCE, &c. 15 ronage of Dr. Cotton Mather, a celebrated divine. The nov- elty of the subject and the strong prejudices then subsisting, occasioned much public agitation, and soon involved both clergymen and physicians in a spirited but illiberal contro- versy, relative to the propriety of thus experimenting with the lives and health of their fellow men. The clergy of Massachusetts were, for the most part, zealous supporters, while some of the medical faculty were violent opposers of inoculation* Among the latter are mentioned Lawrence Dalhound, a Frenchman, William Douglas and Joseph Mar- rion. Dr. Zabdiel Boylston, a man of liberal views, and great literary acquirements, having obtained information by the transactions of the Royal Society of London, of the suc- cessful practice of inoculation by Timonius of Constantinople in 1713, and being warmly supported by Dr. Cotton Mather, resolved to surmount every obstacle, even at the risk of his popularity, and his life. He selected his son, as the subject of his first experiment, and inoculated in one year two hund- red and forty-seven persons, of which six only died; where- as of five thousand eight hundred and eighty nine, who took the disease the natural way in Boston, at the same time, eight hundred and forty-four died. Dr. Boylston visited London in 1725, where he was high- ly respected, and was honoured by being elected a fellow of the Royal Society. He published in ]726 an historical ac- count of inoculated small-pox in New-England, and lived to witness the extensive and very important effects of his in- trepidity and perseverance in his professional duty. The practice extended, by degrees, through New-England to New-York and Philadelphia, and finally to Charleston, South- Carolina, where it was partially adopted iu 1738. Dr. William Douglas, a native of Scotland and a reputable prac- titioner of physic in Boston, wrote essays respecting the 16 HISTORICAL SKETCH OP small-pox in 1722 & 1730. Another publication on the same subject, by Dr. Nathaniel Williams, a learned physician, a celebrated chemist, and an useful preacher, appeared in 1742.* Among the earliest American publications, was an essay on the Iliac Passion by Dr. Cadwallader of Philadelphia, printed about the year 1740. Dr. Tennent of Virginia produced about the same time a work on pleurisy, in which he brought into view the virtues of the Polygala Senega or Senaka snake root, which was before unknown. This was followed by an ingenious essay on the causes of the different colours of people, in different climates, by Dr. John Mitchill of Virginia, who also wrote on the yellow fever as it appeared in Virginia in 1742. This last was not published, but his valuable manuscripts were communicated to Dr. Rush through the hands of Dr. Franklin. Dr. Tho- mas Bond, an eminent physician of Philadelphia, was, about this time, author of some useful medical memoirs, which were published in a periodical work in London. In 1743, Cadwallader Colden, Esq. Lieut. Governor of the Province of New-York, and a distinguished physician, communicated his thoughts on the most probable method of curing amalignant fever which occasioned great mortality in that city in 1741. He also published a treatise on the cure of cancer, and an essay on the virtues of the great water dock, which intro- duced the learned author to the celebrated Linnaeus. The same author published in 1753 some observations on an ep- idemical sore throat, which appeared in Massachusetts, and had spread over a great part of North America. Dr. John Bard, eminently distinguished as a practitioner in New-York for more than fifty years, was the author of an interesting * Much of this information has been obtained from Dr. J. Bartlett's Dissertatiou oi the progress of Medical Science. See Med. Communications. Mass. Med. Soc MEDICAL SCIENCE, &c. 17 account of the malignant pleurisy, which prevailed at Long- Island in the year 1749, besides some other medical papers. About the year 1750, Dr. Benjamin Gale of Connecticut considerably distinguished for his skill and acquirements, published several of his productions ; among which was a dissertation on the inoculation for the small-pox in America, in which he advocated the utility of a course of mercury, as a preparative ; affirming that, before this practice was adopted in the year 1745, one in a hundred of the inoculat- ed died; but of those who afterwards were the subjects of this new method of treatment, one only in eight hundred died. Another production on the same subject, and incul- cating a similar mode of practice, appeared in 1760 by Dr. Thompson of Pennsylvania. It appears that, in 1752, of five thousand five hundred and forty-four persons, who were the subjects of the small-pox in the town of Boston, the natural way, five hundred and fourteen died, and the whole number of inoculated persons was two thousand one hundred and thirteen, of whom thirty died. The first public hospitals for small-pox inoculation, of which we have any account, in New-England, were opened in the vicinity of Boston in 1764; one at Point Shirley by Dr. William Barnet from New-Jersey, and another at Cas- tle William by Dr. Samuel Geltson of Nantucket. Mercu- ry was, at this period, in the highest repute for its supposed specific powers, as an antidote to the variolous poison, and it constituted a part of the preparatory course of every ex- perienced inoculator. About the year 1748, Dr. John Lining of South-Carolina published an accurate history of the American yellow fe- ver, which was the first on this subject that issued from an American press. Dr. Lionel Chalmers of the same place, in 1754 communicated to the Medical Society ofLon- 3 18 HISTORICAL SKETCH OK don some useful remarks on Opisthotonus and Tetanus, and the same gentleman published also an essay on fevers in 1767. Dr. Garden, a respectable physician of Souih-Car- olina presented to the public in 1764, an account of the medical properties of the Spigelia Marilandica, or Caroli- na Pinkroot, with a botanical description of the plant. About the same time Dr. Ogden of Long-Island favoured the pub- lic with some valuable observations on the malignant sore throat. Dr. Peter M iddleton, a man of great professional talents, and Dr. John Jones, a distinguished surgeon, both of the city of New-York, were authors, the former of a med- ical discourse or historical inquiry into the ancient and pres- ent state of medicine, published in 1769, and the latter of an excellent work on wounds and fractures, designed chiefly for the use of the surgeons of the revolutionary army. In 1769, some observations were published by Dr. JohnKears- ley, jr. of Philadelphia, relative to Angina maligna, or rhe putrid and ulcerated sore throat, which prevailed in 1746 & 1760. It extended, says the author, through the neighbouring Provinces, with mortal rage, in opposition to the united endeavours of the faculty. It swept away all before it, baffling every attempt to stop its progress, and seemed, by its dire effects, to be more like the drawn sword of vengeance, to stop the growth of the colonies, than .the natural progress of disease. Villages were almost depopu- lated, and numerous parents were left to bewail the loss of their tender offspring. In the years 1775 & 1T76 the small-pox made its appear- ance in the form of an epidemic, and hospitals for the pur- pose of inoculation, were again established in various parts of Massachusetts, particularly at Cambridge and Brooklyne, by Drs. Isaac Rand, William Aspinwall, and Lemuel Hay- ward, by whom more than two thousand persons were inocu- MEDICAL SCIENCE, &c. 19 lated in one year, and, by whose successful mode of treat- ment, the practice of inoculation was greatly encouraged and its benefits extensively diffused. The high confidence, which had long been reposed in the efficacy of a mercurial course was now considerably diminished, and practitioners were daily strengthened in the opinion, that success depend- ed principally on the cooling regimen, air, and antiphlogistic diet, with which it was accompanied. The small-pox again visited the town of Boston, it is hoped, for the last time, as an epidemic in 1792. The whole town was inoculated in three days, to appease the infatuated temper prevalent among the inhabitants, with respect to the danger of infec- tion ; as the preposterous opinion had long been generally entertained that the small-pox infection is capable of spread- ing far and wide, through the medium of the air, as a most deadly pestilence. The hurry and confusion in which inoc- ulation was resorted to, on this occasion, precluded the pos- sibility of affording, in every instanoe, the requisite atten- tion, and of prescribing the most judicious and eligible mode of procedure. Nine thousand one hundred and fifty-two persons were the indiscriminate subjects of inoculation, and one hundred and sixty-five deaths were the consequence. These, however, were chiefly the children of poor families, many of whom were destitute of the comforts of life. Lit- tle reliance was now placed on the specific action of mer- cury in this disease. In many instances it was entirely dis- pensed with, and shortly after altogether exploded. The hospitals and camps of our army afforded a new field and more ample scope for improvement in the knowl- edge of medicine and surgery than had ever before been exhibited in our country. Through the wisdom and pru- dence of the Commander in Chief, the immortal Washing- ton, candidates for the offices of surgeon and mate were 20 HISTORICAL SKETCH OK required to undergo an examination by a medical board, ap- pointed for that purpose, at the commencement of the war in 1775. During the subsequent periods of that arduous struggle, the higher stations in the important department of medicine were occupied by men no less distinguished for public, virtue and genuine patriotism, than for medical dignity and eminence.* Their united wisdom was happily directed to the melioration of the condition of our military medical es- tablishments, and ultimately, to the promotion of professional knowledge and the faithful discharge of duty among the surgeons of the army. Since the termination of our glori- ous struggle in the cause of liberty, the dark clouds, which, in our infant state enveloped the science of medicine, have been gradually dissipated, our imprisoned mental powers and faculties liberated, and progressively improved, and our medical character, like our national independence, has been honourably and advantageously established. It is ascertained by historical records, that the yellow fever made its appearance in the cities of Charleston and Philadelphia in 1699 & 1740, and that the same malady again visited Philadelphia, New-York, and some other parts of North America, in the years 1744, 1747, 1760, & 1762. * The first Director Genei'al of the hospitals was Dr. Benjamin Church of Bos- ton, but being, soon after his appointment, charged with a treasonable correspond- ence with the British, was superseded by Dr. John Morgan of Philadelphia. Af- ter his retirement, Dr. William Shippen succeeded to the same office, and Dr. Benjamin Rush was appointed Physician General, which office he sustained only fbr a short period. The following gentlemen are personally recollected as holding the stations of Physician or Surgeon General, or Deputy Director of the different departments of the army, viz. Malaehi Treat and John Cochran of New-York, Jonathan Potts of Pennsylvania, James Craig of Virginia, and Isaac Foster of Massachusetts. Andrew Craiggie, Esq. Apothecary General. Those who served as hospital or regimental surgeons, belonging to Massachu- setts during the war, were Isaac Foster, Samuel Adams, John Warren, William Eustis, David Townsend, John Hart, Joseph Fiske, Josiah Bartlett, John Thomas, Daniel Shute, and James Thacher. MEDICAL SCIENCE, &c. 21 \t the last mentioned period it was attended with such symptoms of malignancy, as baffled the skill of the most experienced physicians. The medical characters of those times, as well as the public, generally considered the disease to be contagious, and imported from the West-Indies. The same fever was recognized in our hospitals and camps, during some seasons of the revolutionary war. The dreadful visitation of the yellow fever in the city of Philadelphia in 1793, must be regarded as a memorable event in the history of the United States. Such was the magnitude of this awful calamity, as to excite in the breasts of all classes of people the keenest emotions of sympathy, and the mdst terrible sensations of consternation and dis- may. No less than four thousand and forty-four persons fell victims to this destructive epidemic in that city, be- tween the 1st August and 9th November. The same epi- demical fever has, at several subsequent periods, been per- mitted to ravage that city, New-York, and almost all the sea-port towns in the United States. It first made its ap- pearance, as an epidemic, in the town of Boston in 1798, where it exhibited every mark of great malignity. Although limited to a small section of the town, the deaths were about one hundred and forty-five. There were no evidences of its having been imported, nor any instance to justify the supposition of its being contagious. Boston was again visit- ed by this fatal malady in 1802, with all the circumstances of its former malignant and destructive nature, and about fif- ty persons died. The nature, causes, origin, and propagation of this for- midable disease immediately became the topics of interest- ing inquiry, and universal concern. The investigation was pursued by many of our most distinguished medical philos- ophers with the utmost zeal and perseverance; but from the 22 HISTORICAL SKETCH OK conflict of opinions on this abstruse subject, a spirit ot illib- erally was, in too many instances, allowed to mingle with discussion and to impede the progress and attainment of truth. Whether the yellow fever, as then prevalent, was of an inflammatory or typhoid character, was a question agitat- ed with considerable warmth. The facts were also impor- tant to be decided, whether the disease was imported from a foreign country, and was of a contagious nature, or origin- ated in some domestic and local cause, and was epidemic. The learned labourers in this ample field of controversy were designated by the names of contagionists and non-con- tagionists, or advocates for the importation, and such as favoured the idea of the domestic origin of this awful source of mortality. Although the discordant opinions of the fac- ulty were little calculated to satisfy and sooth the distract- ed state of the public mind, they nevertheless effected a more rigid observance and assiduous application of the means of prevention than could have resulted, had either of those doctrines alone prevailed. A more complete system of quarantine laws were adopted, and more efficient regula- tions were introduced in the management of our police. The long and interesting controversy respecting the real nature of the disease in question, seems to have resulted in favour of those who supported the doctrine of its non-con- (a^ion and its domestic origin. It should be noticed in this sketch that, for more than half a century, it has been the practice of some physicians of eminence, particularly in New-England, to administer mercury as an efficacious remedy in febrile diseases of every description. It was employed, not so much for its evacu- ating power, as with the intention of introducing it gradually into the system, as an alterative. The writer has a distinct recolieotion that, when a medical student in 1774, his res- MEDICAL SCIENCE, &c." 2U pected instructor* reposed the fullest confidence in a mod- erate course of mercury, in pleurisies and peripneurnonies, esteeming it the most efficacious attenuant and expectorant, which the Materia Medica afforded. Several other physi- cians of the same standing in Massachusetts we e in the habit of pursuing a similar mode of practice.f But it was reserved to a more recent period to call into requisition this Sampson of the Materia Medica to combat those formidable destroyers of mankind, which have, of late spread such havoc and terror in our country, the contagious and epi- demical diseases. Dr. Rush after having experienced the palpable inefficiency of all the known curative remedies in the yellow fever of 1793, was induced to adopt the deplet- ing plan, and boldly resorted to the lancet and to mercurial purges, as his last hope ; and at subsequent periods of its prevalence, the lancet was more cautiously employed, and mercury used as the sovereign remedy. It was given with the view of evacuating the alimentary canal, or in such form as would speedily induce a moderate salivation, in which event it proved eminently efficacious. Influenced probably by the opinion and example of Dr. Rush, most of the learned physicians of the United States have declared themselves advocates for the mercurial mode of treatment. Being thus sanctioned by the highest medi- cal authority and by general assent, the mercurial practice is now received and adopted by most of our practitioners as the safest and most successful method of cure, not only in the yellow fever, but also in typhus and other forms of malignant febrile affections. This plan of treatment was found to be coincident with the opinions and practice of * Dr. Abner Hersey of Barnstable. j- See Dr. Holyoke's Letters. Med. Repos. Vol. I. p. 500. See also Dr. J. War- den's excellent Treatise on Mercurial Practice. 24 HISTORICAL SKETCH OF some respectable medical men of the most extensive ex- perience in the yellow fever of the West-Indies. Dr. Chisbolm, indeed, is reputed to have been one of the earli- est of those who resorted to mercury as an agent in control- ing the violence of that fatal disease, in that climate, in the years 1789 & 1790; and he is worthy of being styled the champion and father of the mercurial practice; having, in one instance, exhibited by the mouth, by inunction and by clyster no less than five thousand seven hundred and four grains of mercury in five days, and the result was the rapid recovery of his patient. It would seem scarcely credible, a priori that the human constitution is capable of sustaining such an enormous quantity of this active metal, and it is to be presumed that the learned gentleman will long re- main without a rival, in this respect, in the United States. The reader may obtain farther information relative to the yellow fever of the United States, by consulting the works of Professor Rush, Medical Repository, Caldwell's Medi- cal and Physical Memoirs, Ree's Cyclopaedia, Webster's History of Epidemics, Appendix to Thomas' Modern Prac- tice, by E. Miller, Warren's Treatise on Mercurial Prac- tice, Med. and Philo. Register of New-York. See also the chapter on contagious diseases in this volume. Among the epidemics which have visited our country, the Influenza or Tusis Epidemica of Sydenham deserves to be noticed in this sketch. It has prevailed in America at nine or ten different periods, since the year 1733 ; but in the autumns of 1789 & 1807 it was more universally ex- tensive and severe in its effects than at any preceding peri- od of its visitation. It first appeared at New-York and Philadelphia, from which it was, in a short time, diffused through every part of the continent. It was estimated, at the time, that three fourths of the inhabitants were, in a few MEDICAL SCIENCE, &c. 25 days, affected with this singular epidemic, in a greater or less degree. The amazing rapidity with which it spread through the country resembled more a storm, agitating the atmosphere, than the natural progress of a disease, from any contagious source. Almost a whole city, town, or neigh- bourhood became affected with its influence, in a few days, and, as it did not incapacitate people, in general, from pur- suing their ordinary occupations, it was common to observe in every street and place of resort, such coughing, hawking, and wheezing, as to interrupt conversation, and, in public assemblies, little else was to be heard or attended to. Al- though all classes of people experienced the operation of the influenza, it is remarkable that a small proportion, com- paratively speaking, were so ill as to require medical attend- ance, and instances of its fatal termination were of rare oc- currence. The very brilliant and important discovery of the vaccine disease by Dr. Edward Jenner, a celebrated English physician, and the fact, that it will render the human system unsusceptible of the small-pox, was announced in our news- papers, and in the Medical Repository of New-York in 1799. The first information relative to this novel and sin- gular discovery, although from undoubted authority, did not receive universal credence. By some it was treated as chimerical, while others resolved to suspend their opinion for the issue of future experiments. Dr. Benjamin Water- house, however, then Professor of Medicine in the Univer- sity at Cambridge, did not hesitate to proclaim his full con- fidence in the statements and facts, which he had received directly from England. In July 1800, he procured matter from thence, by which he was enabled to test Ihe experi- ment in the person of his own son, who thus became the first subject of vaccination in the United States. From 4 26 HISTORICAL SKETCH OK this source matter was furnished for the inoculation of sev- eral others, some of whom were tested by variolous infec- tion, with the desired success, which afforded additional evidence of the prophylactic efficacy of the vaccine dis- ease. In the year 1800, and at subsequent periods, Dr. Waterhouse presented to the public historical and practical treatises on the cow-pox, and communicated, through the medium of news-papers, useful and discriminating directions and precautions relative to the genuine disease. He was, for a season, exclusively in possession of vaccine matter, which he occasionally distributed to practitioners for the ex- tension of its benefits to different sections of our country. In the following September Dr. James Jackson of Boston returned from London, and having acquired experimental knowledge, by attending the practice of vaccination with Dr. Woodville, generously contributed to its propagation in Boston and the vicinity. In the same year Dr. Miller of New-York received matter from Dr. Pearson of London, which failed, however, to produce the genuine disease, nor was another supply, sent on from Boston attended with bet- ter success. In fact, spurious matter, in some instances, and want of skill and experience in the operator, in others, occasioned numerous failures, during the first attempts, which had the effect of damping the public confidence and restricting the exertions of the friends of vaccina- tion. The Massachusetts Medical Society early in 1801 ad- dressed an application to the vaccine institution in England requesting a supply of matter. Publications on this new subject were now continually multiplying, and the most grat- ifying evidences in favour of vaccination issued from vari- ous quarters. In the year 1802 the Boston Board of Health, actuated by the most laudable views, directed nineteen per- MEDICAL SCIENCE, &c. 27 sons to be vaccinated under their inspection, all of whom were afterwards tested by the small-pox infection in the most satisfactory manner and with the happiest result. In the following year the junior physicians of Boston formed an association for the express purpose of bestow- ing gratuitously the benefits of vaccination upon the indi- gent, and of disseminating the matter among medical practi- tioners. In 1808 a committee was appointed by the counsellors of the Massachusetts Medical Society, for the purpose of collecting all the evidence which had transpired respecting the efficacy of the cow-pox, as preventive of small-pox, and to report the most eligible method of conducting the practice. A copious and interesting report was made and published in the communications of the society, accompani- ed with evidence sufficiently strong to remove every vestige of prejudice and uncertainty relative to the prophylactic powers of vaccination. The fellows of the society, being also enjoined to inquire whether the native cow-pox had been discovered among the cows in this country, the re- sult was a confirmation of the fact in several instances. The town of Milton, having in 1809 made arrangements to extend the benefits of vaccination to its inhabitants, Dr. Amos Holbrook inoculated three hundred and thirty-seven persons, being more than a fourth part of their population ; twelve of whom were afterwards tested with small-pox, with- out receiving it. In imitation of this laudable example, the town of New-Bedford in the same year adopted a similar plan, and about fifteen hundred of its inhabitants were inoc- ulated under the direction of Dr. Benjamin Waterhouse. The next attempt to disseminate the advantages of vaccina- tion will be found in the transactions of the legislature of Massachusetts, who, in 1810, authorized the several towns 28 HISTORICAL SKETCH OK to appoint committees, and raise monies annually for this important purpose. The glorious triumph of vaccination over that most dread- ed scourge of the human race, the small-pox, is now estab- lished by incontestible proofs, and has received the sanction and applause of the community, and of the wise and learn- ed in the remotest regions of the earth. We can now con- gratulate the citizens of the United States, who, in common with the whole civilized world, are in possession of this heavenly blessing, a blessing which eradicates from the cat- alogue of human miseries the most odious and fatal disease, and which happily closes one of the most crowded avenues to the tomb. The horrors occasioned by the ravages of the yellow fe- ver, in our cities, had not ceased when another epidemic equally formidable and malignant in its nature, and fatal in its consequences, commenced its distressing career, and spread terror and desolation through the interior of the country. This malady, which has obtained the name of spotted of petechial fever, first appeared in the town of Medfield in Massachusetts in 1806. Its ravages were afterwards expe- rienced in Connecticut, and in 1810 it prevailed in the coun- ty of Worcester, with unexampled mortality, baffling the powers of medicine, and setting at defiance the best skill of physicians. On this alarming occasion, the counsellors of the Massachusetts Medical Society appointed a commit- tee with instructions to make all possible inquiry and inves- tigation relative to the disease in question. Their report, as to its causes, history and mode of treatment, was elabor- ate, honourable to themselves and reputable to the individu- als who furnished its materials. This valuable document occupies a place in the Society's communications, lately published. The fact is well ascertained that the disease is not contagious, as was by some, at first apprehended. MEDICAL SCIENCE, &c. 29 It is remarkable of this epidemic, that it is most rife in the cold seasons of winter and spring, and that it is more prevalent and genuine, in its character, in the interior, than in the vicinity of the sea board. But, wherever it waves its standard, the arrows of death cross its paths, and all classes and sexes become its indiscriminate victims. In some situations and seasons, the proportion of deaths, in severe cases, is supposed to be greater than one half of the number seized. One instance occurred, at a considera- ble distance from the place where the disease was known to exist, of the death of seven adult persons out of eight, belonging to four or five contiguous families, before the fifth day, and the eighth survived but a few days longer. In other more favourable instances, and under a more improved and judicious mode of treatment, the num- ber of deaths, it is said, has not exceeded one in sixty or eighty. In the autumn of 1812, a formidable epidemic made its appearance among the soldiers of the LTnited States' army at Greenbush and other military stations, where its desolat- ing effects were marked with great severity. During the winter and spring of 1813 it was prevalent and extremely fatal among the inhabitants of Vermoni, in the upper parts of the State of New-York, in several towns in the interior of Massachusetts and the District of Maine, assuming a multitude of treacherous shapes, and triumphing over its victims with inexorable sway. The town of Boston and its vicinity were not altogether exempted from its attack, though its subjects were principally the newly enlisted soldiers quartered in that metropolis. According to its various symptoms and forms, this pestil- ence has been termed Bilious Peripneumonia, or Typhoid Peripneumonia. In some of its appearances and forms it 30 HISTORICAL SKI.TCH OF may be identified with the petechial fever above mentioned. but if it be a distinct disease, there ii an obvious and close analogy in their nature and character. It has been remark- ed, that the petechial fever produces a peculiar derange- ment of the functions of the brain, while the last epidemic directs its morbid powers to the pleura, lungs, heart and its membranes. The reader may consult Dr. N. Strong's Inaug. Diss., Dr. E. North on Spotted Fever, Communic. Mass. Med. Soc. Vol. II., New-Eng. Med. Jour., Amer. Med. and Phil. Register, and Med. Repos. of New-York. To which may be added Gallup on Epidemics, and Med. Sketches by James Mann, M. D. MEDICAL, INSTITUTIONS OF PENNSYLVANIA. No attempts were made to establish a regularly organized school for the purpose of medical instruction in this coun- try until about the year 1762. Dr. William Shippen and Dr. John Morgan, both of Philadelphia, having completed their medical education at the Universities of London and Edinburgh, concerted a plan for establishing a medical school in their native city. Accordingly, Dr. Shippen commenced in 1764 the first public course of lectures upon anatomy, ever delivered in America; his first class consisting of ten pupils. He was soon recognized as Professor of x\natomy, and Dr. Morgan of the Institutes of Medicine. In the year 1768, Dr. Adam Jruhn, who had studied under the cele- brated Linnaeus was" appointed Professor of Botany and Materia Medica, and in the following year, Dr. Benjamin Rush, who had just completed his studies, and obtained medical honours in Europe, was chosen Professor of Chem- istry. These learned characters, assisted by the venerable Dr. Thomas Bond, as lecturer on clinical medicine, zealous- MEDICAL SCIENCE, Stc 31 ly devoted their talents to the duties of the several depart- ments of medical instruction ; thus laying the foundation for the first medical institution in the American colonies. This was soon after confirmed and established by the authority of the trustees of the college of Philadelphia, while the venerable Dr. Franklin officiated as their president. The science of medicine was unfortunately deprived of the benefits and improvements expected from this very hon- ourable association by various circumstances connected with the American revolutionary war. Since its close, however, the medical school of Philadelphia has been revived and re- organized under circumstances propitious to medical im- provement. An unfortunate competition and discord be- tween the Medical College and an Opposition school, for a time marred their prospects, and impeded that progress which the friends of the institution and the public had con- fidently expected. But in 1791 some important changes took place, an harmonious union of the contending parties was effected, and Dr. Rush was appointed Professor of the Institutes and Practice of Physic and of Clinical Medicine. From this period the progress and improvement of the school has been honourable to the venerable founders, and benefi- cial to the community. The commanding talents and pro- found erudition of Professors Rush, Physick, Barton, Wistar, Chapman, and others, have given to the medical school of Philadelphia a celebrity which will probably long remain unrivalled in the United States, and will enable it to vie with the most improved seminaries of the European world. It has become the resort of students from every section of the Union. About four hundred in one season attended the va- rious courses of lectures, and the inaugural dissertations of those who from time to time have received its honours, have extended the fame of the school from which they emanated. 32 HISTORICAL SKETCH OK It is calculated that £125,000 are annually expended in the city of Philadelphia, by the students who visit its medi- cal school from the different parts of the United States. Medical Professors of the University of Pennsylvania for the year 1815, after the demise of the venerable Profes- sor Rush. Casper Wistar, M. D. Professor of Anatomy. Benjamin S. Barton, M. D. Theory <£• Practice of Phy- sic, and Clinical Medicine. Nathaniel Chapman, M. D. Materia Medica. John R. Cox, M. D. Chemistry. Philip S. Physick, M. D. Surgery. John S. Dorsey, M. D. Adjunct Professor of Surgery. Thomas C. James, M. D. Midwifery, & Diseases of Women & Children. The public lectures commence the first Monday in No- vember, and continue four months, and the commencement is about the first of April. To obtain a degree of Dr. of Medicine, the candidate must have attained the age of twenty-one years, and must have applied himself to the study of medicine three yearsr two of which, shall have been in this University ; and have attended the Pennsylvania hospital during one session, and have been the private pupil of some respectable practition- er. He shall have attended two complete courses of lec- tures, delivered in this University, on Anatomy, Institutes and Practice of Physic, and Clinical Medicine, Materia Medica, Chemistry, Surgery, and Midwifery. Excepting only such gentlemen, as have attended two courses of lec- tures on the same subjects in some other respectable Uni- versity or school, and for such it shall be only necessary to attend one entire course in this University. MEDICAL SCIENCE, &c. 33 The student must take a ticket on or before the third Monday of the session. Each candidate shall write a the- sis, and undergo an examination upon it in presence of the faculty. The candidate shall be placed behind a skreen, and the examination shall be so conducted that no Professor except the Dean of the faculty, shall know the candidate. The voting on this subject, shall be by private ballot. Two negative votes shall reject the candidate. The fees of graduation shall be paid to the Dean of the faculty, at the time of his examination. Each Professor re- ceives $20 for a course of lectures, but after two courses, admission is gratuitous. Each Professor also, receives $5 for signing a diploma. Note. Benjamin Rush, M. D. Professor of the Theory and Practice of Physic in the college of Philadelphia, died in April 1813. Dr. Rush stood highest among tlioije who have in our country attempted to benefit their profession and country, by a free communication of the results of their ob- servations and reflections. Benjamin Smith Barton, M. D. Professor of the Theory and Practice of Physic, &c. died in December 1815. " Dr. Barton has long been known as an able teacher and zealous, promoter of science in the Philadelphia school." " The successive loss of two of its most distinguished Professors must be heavily felt by the Philadelphia school; and the death of men who had contributed largely to the sci- entific reputation of the country, may be looked on by the public in the light of a national calamity." JV. Eng. Journal of Med. & Surg. Vol. V\. i MEDICAL INSTITUTIONS OF NEW-YORK. The first human dissection in America of which we have any record, was the body of Hermanus Carroll who was ex- 5> 34 HISTORICAL SKETCH OF ecuted for murder in the city of New-York in 1750. This dissection was conducted by two eminent physicians of that city, Drs. John Bard and Peter Viddleton, by whom some arrangements were made about that time for the purpose of imparting medical knowledge to students. These attempts were, at length, followed by an establishment for medical education in 1768, in which were united the learning and abilities of Drs. Clossey, Jones, Middieton, Smith, Tennant and Bard, by whom lectures on the several branches were delivered. The medical doctorate was conferred on Samu- el Kissam, by Kings College as early as 1771, probably, the only instance prior to the American Revolution.* The events of the revolutionary war deranged and wholly frustra- ted in its infancy the immediate design of this establishment. After the peace of 1783 some exertions were made for the renovation of the medical school and professorships erected for that purpose ; but for the want of cordiality and agree- ment among the professors and others, the plan was soon abandoned. Attempts were more successful in 1792, when the board of trustees formed a new medical establishment in connexion with Columbia College, formerly called Kings College, and professors of distinguished talents and profes- sional merit, were appointed to deliver lectures on the dif- ferent branches of medicine, and the science was essentially promoted by their assiduous labours. Though from various causes the benefits arising from it were very limited,—only thirty-four students since its creation to the year 1811, had completed their courses of study and received the medical honours of the institution. " Considerations of expediency, howevur, affecting the interest of science, as well as other in- terests arising from causes not implicating the distinguished * Inaugural dissertation on the anthelmintic qualities of Cow-itch, by S:unuel Kis- sam was published in May 1771. JTosack's Sketch. MEDICAL SCIENCE, &c. 35 gentlemen filling the different professorships in this medical school, determined the Regents on the 12th of March 1807, to grant a charter, establishing the present college of physicians and surgeons of the city of New-York. The incorporation of this institution, under the patronage of the Regents, and its sanction by the legislature gave very general satisfaction, and the benefits which have resulted from it during the pe- riod of its existence are to be seen in the annual reports to the Regents of the University. Its successful progress was, however, for a short time, retarded by feuds and dis- contents among the professional members of the institution and of others, arising principally from competition and rival- ry between medical'schools in the same city, whose objects were the same. It was, therefore, deemed advisable by the Regents, to whom representations of these disorders had been made, to remodel the college of physicians, and this was ac- cordingly done on the first of April 1811, ingrafting altera- tions upon their charter, principally with a view to their un- ion with the medical faculty of Columbia College. This un- ion was finally and happily effected at the last session of the Regents in 1814, and to the satisfaction of all concerned; and the united school now combines the most eminent med- ical talents in the state in one splendid seminary, under the general superintendence of the honourable the Regents,aided by the patronage and liberal endowments of the legisla- ture."* In April 1816 the Regents made the following re- port to the legislature. " The college of physicians and surgeons, in the city of New-York, is advancing to that celebrity, which must soon place it at the head of similar institutions in the United States. Perhaps no other place can afford greater oppor- * The honourable legislati re in 1808 made the liberal grant of §20,000 for the benefit of the college. 36 HISTORICAL SKETCH.OP Umities for giving medical instruction to the best advantage, on all the variety of cases in which the human frame is lia- ble to disease, and where more opportunities are daily offer- ed to exhibit them to the inspection, and for the instruction of students. If is, therefore, the decided opinion of the Re- gents, that this institution should receive the undivided sup- port of the state : and that no other should be countenanced, which, by a spirit at rivalship or hostility, might, in any de- gree, succeed in repressing its justly deserved and increas- ing reputation as a medical school. Convinced, by obser- vation and reflection, that, in order to effect the means of giv- ing that ample instruction which is all important to a profes- sion, on the proper exercise of which depend our lives, as well as the comforts of health, selections of the most emi- nent talents, as well as the patronage of government, should be concentrated, the Regents have stipulated for the aboli- tion of the college of physicians and surgeons of the west- ern district. And unless convinced, by better reasons than at present occur to them, they will not sanction the estab- lishment of a second in the state." The most sanguine expectations were entertained respect- ing the utility of the institution thus re-organized, and the re- sult of a few years experience clearly evinced that the learn- ed professors filled the important stations assigned them, with ability and success. The inaugural dissertations of the graduates, are indicative of great industry, and of acquire- ments which reflect honour on their authors, and which pro- claim the medical advantages they have enjoyed at the in- stitution. In 1811, medical degrees were conferred by the college of physicians and surgeons on eight persons; and in 1812ihe number was increased to twenty. In 1813 the number was reduced to five ; and in 1814 there were eleven graduates. The number of medical pupils in 1815, was one hund- MEDICAL SCIENCE, &c. 37 red and seventy-one, and the number of graduates was twenty-seven, greatly exceeding the number attending at any prior session. The author of an historical sketch of the present institution, concludes his observations in the following words. " When the advantages which New-York possesses for a great medical establishment are considered, advantages arising from its natural situation, its extensive population, now nearly equal to most of the capi- tals of Europe, its large and well endowed hospital and other public charities, its botanical garden, its well organized med- ical college and the extensive system of education which it embraces ; and when it is further considered, that these advantages are increased by the munificent patronage of the state, it is not too much to say that, in the means of instruc- tion, the college of physicians and surgeons is second to no similar institution in the United States." Of this respectable institution Samuel Bard, M. D. is President. Benjamin De Witt, M. D. Vice-President. 1. The College opens, annually, on the first Monday in November, and the several courses begin, successively, that week, after the Introductory Lectures of the respective Professors. The session closes the last day of February. LECTURES IN THE FORENOON. 2. Theory and Practice of Physic, by Dr. Hosack, from nine to ten o'clock, daily. Principles and Practice of Surgery, by Dr. Mott, from ten to eleven, daily. Anatomy, Physiology, and Surgery, by Dr. Post, from eleven to twelve, daily. The Clinical Practice of Medicine, by Dr. Hamersley, and attendance at the New-York Hospital, from twelve to one, daily. 38 HISTORICAL SKETCH OF LECTURF.S IX THE AFTERNOON. Natural History, including Mineralogy, Botany, and Zoo» logy, by Dr. Mitchill, from one to two, daily. Chemistry and Materia Medica, by Dr. M'Nevcn, from five to six, daily. Obstetrics, and the Diseases of Women and Children, by Dr. Hosack, from four to five on Mondays and Thurs- days. Clinical Lectures, by Dr. Hamersley, from four to five on Wednesdays and Saturdays. Institutes of Medicine, by Dr. Francis, from four to five on Tuesdays and Fridays. Forensic Medicine or Medical Jurisprudence, by Dr. Stringhem. GRADUATION. 3. It is expected that a candidate for Graduation shall have attained the age of twenty-one years, and have attend- ed the Lectures of the several Professors of the College, and the practice of the New-York Hospital, during one ses- sion at least. . 4. On or before the first of February, the candidate shall make known his name and intention to one of the Professors, by whom he will be informed of the time and place of ex- amination. This first examination is by the board of Profes- sors only : it is private and confidential. 5. A second examination is held before the board of Trustees, to whom, on this occasion, an appeal lies, and before whom there is offered an opportunity of redress, if a candidate think himself in any wise aggrieved. 6. The names of those who have been approved by the Trustees are forwarded to the Regents of the University, who return an equal number of Diplomas, under the signa- MEDICAL SCIENCE, &c. 39 lure of the Chancellor. They are afterwards signed by the Professors. 7. By the 20th of April, the candidate shall deliver to one of the Professors a dissertation on some medical subject. He is publicly examined on the same, in the College Hall, the first Monday in May, and may publish, or not, at his discretion. The Degrees are conferred the next day at a public Commencement. EXPENSES. Hospital Ticket,........... #10 00 To the Professor of the Theory and Practice of Physic, and of Obstetrics and the Diseases of Women and Children, for both courses, ... 25 00 To the Professor of Anatomy, Physiology, and Surgery, and to the Professor of Chemistry, and Materia Medica, each,........20 00 The Fees for the other Professors do not exceed, for each,.............15 00 Good board, and comfortable accommodation, may be had, for Students, from four to five dollars per week. N. B. The Student of Medicine has abundant opportu- nities of prosecuting private dissections, under the immedi- ate direction of the Professors of Anatomy and Surgery, as the College enjoys the peculiar advantage of being able to procure subjects from the State Prison, under the sanction of an act of the Legislature. By order, Samuel Bard, M. D. President. John W. Francis, M. D. Register. New-York, May 1st, 1816. 40 HISTORIC M. SKETCH OF There existed in the city of New-York prior to, and for several years contemporary with the college of physicians and surgeons, a faculty of physic connected with Columbia Col- lege ; where lectures on the different branches of medicine have been annually delivered, and medical degrees confer- red; but in order to annihilate a source of mutual jealousy, personal animosity, and perpetual collision and dissention, this as already mentioned has been amalgamated with the college of physicians, the officers of which being selected from both institutions. We find also a third respectable medical institution in that populous city, but not recog- nized, or sanctioned by authority. Being viewed as arrang- ing themselves in opposition to the established institution, and aware of the evil consequences arising from competi- tion and rivalship, the honourable legislature rejected their memorial and petition for an act of incorporation and pecu- niary assistance. Students of this institution who are found duly qualified, are invested with academic honours under the authority of the president and trustees of Queen's College in the state of New-Jersey. In June 1812, a new medical school was incorporated by the Regents of the University of New-York, into a college of physicians and surgeons. It was located in the town of Fairfield, Herkimer county, and encouraged by a liberal grant of #15,000 by the legislature of that state. This institution, of which Dr. Lyman Spald- ing was president, has recently stipulated with the Regents for the surrender of their charter, and there now remains but one medical establishment under the sanction and pat- ronage of the legislature. A respectable medical socie- ty has also been for several years incorporated and estab- lished in the state of New-York. MEDICAL SCIENCE, &c. 41 MEDICAL INSTITUTIONS OF MASSACHUSETTS. The University at Cambridge, Mass. has also contribut- ed to the interest and advancement of medical science, by an institution founded on the generous benefactions of sever- al enlightened and liberal individuals. Dr. Ezekiel Hersey of Ilingham, who died in 1770, bequeathed one thousand pounds, and his widow, at her decease, a like sum, to be appli- ed to the support of a Professor of Anatomy and Surgery. His brother Dr. Abner Hersey of Barnstable, who died in 1786, and Dr. John Cummings of Concord were also donors to the amount of five hundred pounds each, for the same purpose, and William Erving, Esq. of Boston left one thou- sand pounds towards the support of an additional professor. In conformity with the views of the patrons and donors, professors of talents and character were in 1782 appointed, by whom lectures on the several branches have been regu- larly delivered, and students have received the honours of the institution. Dr. John Warren, while surgeon of a military hospital in Boston in 1780, commenced the first course of anatomical lectures ever delivered in New-England, and in the follow- ing year they were attended by the students of the Uni- versity. This gentleman, at the instance of the late Presi- dent Willard, who was well apprized of his superior qualifi- cations, furnished a plan for a medical school, which was adopted by the Corporation, and Dr. W. was appointed the first Professor of Anatomy and Surgery. Dr. Benjamin Waterhouse Professor of the Theory and Practice of Physic, and Dr. Aaron Dexter Professor of Chemistry and Materia Medica. This first medical school in New-England was thus or- ganized, and its important objects have since been faithfully 6 42 HISTORICAL SKETCH OK and ably prosecuted. In consequence however, of many inconveniences, both to professors r.nd students, in the town of Cambridge, and of the superior advantages which might result from lectures delivered in a more populous situation, the Corporation and board of Overseers of Harvard College deemed it expedient to establish a medical school in the town of Boston. The several courses of lectures were ac- cordingly transferred and commenced in that metropolis in December 1810. A commodious building has been pro- vided for the teachers and students, and lectures on clinical medicine have also been delivered at the hospital depart- ment of the Boston Alms-house, by James Jackson, M. D. AH important operations in surgery, which may occur in the private practice of the professors, will be open to such stu- dents as attend the lectures, and they will also be allowed the privilege of the College library. That the high expectations entertained of the superior advantages, which would be realized by the removal from Cambridge, were not imaginary, the immediate accession to the number of students presents the most abundant and con- clusive evidence. The number, who attended the lectures while confined to Cambridge, rarely exceeded twenty, be- sides those of the first class of the University. The num- ber of medical students who resorted to the Boston school in 1813 was nearly fifty, and the number of medical gradu- ates, twelve. At the Commencement in August 1814 pro- fessional degrees were conferred on nine, and more than sixty medical students attended the lectures in Boston in December of the same year. This flattering impulse to- wards the improvement of the Boston school, and the hon- ourable attestations that their indefatigable services are justly appreciated must afford the learned teachers the highest gratification. The legislature of Massachusetts have granted the sum MEDICAL SCIENCE, Lc. 43 of #20,000 to Harvard University for the liberal purpose of improvement in the medical department. When the medical abilities and zealous efforts of the pro- fessors are considered, in connexion with the numerous privileges annexed to this institution, it will be conceded, that the means and opportunities of acquiring medical knowl- edge, in our metropolis, arc such as to justify the respect and full confidence of the community, The professors are in possession of a very valuable col- lection of anatomical preparations, presented by John Nich- ols, Esq., a counsellor at law, in Englandr with a number of natural preparations by his father. The University is also indebted to the liberality of Elias H. Derby, Esq. of Salem, for several valuable and curious imitations, in wax, of va- rious parts of the human frame, from a nunnery in Italy, They are also furnished with an extensive chemical appara- tus, which, by recent improvements and additions, is suppo- sed to be the most complete of any to be found in the Unit- ed States. In addition to the foregoing advantages, a very important one has been conferred by Ward Nicholas Boylston, Esq., a distinguished and liberal citizen of this commonwealth. In 1800 he presented to Harvard University a valuable collec- tion of more Jhan 400 volumes of medical and anatomical works and engravings, with permanent arrangements for fu- ture additions. The use of this collection is extended to the fellows of the medical society, residing within ten miles of Cambridge. In the year 1803, "with the beneficent and " laudable view of improving the art of medicine, and to " excite practitioners to bring those talents to light, which " might otherwise be lost to the community," Ihe same gen- tleman provided a fund, the proceeds of which are to be annually appropriated to the purpose of a complimentary pre- mium to the authors of the best performances on such medi- 44 HISTORICAL SKETCH OK cal, anatomical, physiological or chemical subjects, as are proposed by a committee of the medical faculty, appointed by the corporation of Harvard University. Premiums have been annually adjudged, agreeably to the design of the founder, for ingenious and approved dissertations, which sufficiently evince that this generous establishment is well calculated to inspire the desired laudable emulation among professional men of the rising generation, and to promote the interest of medical science in general. Candidates for the degree of Doctor in medicine must attend two courses of the lectures of each of the medical professors in this University, and also their clinical practice in medicine and surgery> during the lectures. They must study two years under the direction of a regular practitioner of medicine, and allow a third to elapse before they can be examined. Provided, however, that, in extraordinary cases, the medical professors, with the consent of the president, may dispense with one course of lectures on such conditions as may be thought reasonable. Those, who have not re- ceived a University education, shall satisfy the president and medical professors, of their knowledge in the Latin lan- guage, and in experimental philosophy. The examination of candidates will commence on the second Wednesday after the termination of the winter course of lectures, and the subjects of their examination will be An- atomy, Surgery and Midwifery, the Theory and Practice of Medicine, Chemistry, Materia Medica and Clinical Medi- cine. Each of the candidates approved shall prepare an inaugural dissertation on some medical subject, which dis- sertation having been submitted to the faculty of medicine, at least fourteen days before, shall be read and defended at a public examination, in the Philosophy chamber at Cam- bridge on the Friday preceding the last Wednesday in Au- gust, in presence of the Governors and Instructors of MEDICAL SCIENCE, &c. 45 the University, and such members of the Massachusetts Medical Society, and other individuals as may choose to at- tend. Each successful candidate will be admitted to re- ceive the degree of Doctor in medicine, at the ensuing Com- mencement. All those who have heretofore obtained the degree of Bachelor in medicine at this University, will re- ceive the degree of Doctor in medicine. In the year 1809 John C. Warren, M. D. was associated with his father as adjunct Professor of Anatomy and Surgery, and John Gorham, M. D. adjunct Professor of Chemistry ; and in 1812 James Jackson, M. D. superseded Dr. B. Wa- terhouse, as Professor of the Theory and Practice of Physic. November 1st, 1815, John C. Warren, M. D. was inau- gurated at the University Hall Professor of Anatomy and Surgery in Harvard College as successor to the late lament- ed Professor Warren, who held that station for many years, with great honour to himself and advantage to the institution, and who was no less distinguished for his talents and virtues, than zeal and success in performing the arduous duties of his profession. On the same occasion was announced the appointment of Jacob Bigelow, M. D. as lecturer in Materia Medica, and Walter Channing, M. D. as lecturer in the Theory and Practice of Midwifery in the University. The legislature of Massachusetts by a recent grant, have endowed the University with funds for the erection of a College of Medicine in Boston.* This large and handsome * "The Massachusetts Medical College is situated in Mason-street, near the Bos- ton Common and Mall. The building is of brick, 88 feet in length, and 43 in its greatest breadth. Its figure is oblong, with a pediment in front, and an octagonal centre rising above the roof, and also forming a three-sided projection in the rear of the building. This is surmounted by a dome, with a skylight and ballustrade, giving an appearance of elegance to the neatness and fit proportions of the build- ing. The apartments on the first floor are a spacious Medical Lecture room of a Square form, with ascending semi-circular seats; a large Chemical Lecture room in 46 ::KSTORICAL SKETCH OF building is now nearly completed, and will be in readiness for the lectures of the ensuing season. The faculty of medicine in Harvard University have founded by their private donations, a library for the use of students in medicine. The Boston medical library consist- ing of nearly 2000 volumes, is now united with it, and de- posited in the Medical College. The students of the medi- cal class will be admitted to both of these, as well as the val- uable medical library pre*.*nted by Ward N. Boylston, Esq. These highly valuable collections of medical books, will afford a supply amply sufficient for all the purposes of students in each of the principal departments of medical science. A hail in the new building is appropriated and furnished with every necessary aid and convenience for the the centre, of an octagonal form, with ascending scats; a Chemical Laboratory, fitted up with furnaces and accommodations for the costly apparatus used in the lectures; and a room to be occupied by the Massachusetts Medical Society, which is filled by a Medical Library, already consisting of 3 or 4000 volumes. In the second story is the anatomical theatre, the most extensive room, occupying the whole celitral part of the building, covered with the dome and skylight; with semi- circular seats which are entered from above, and descend regularly toward the cen- tre. In this theatre are placed a beautiful statue of the Venus of Medici, and a noble cast of the Apollo of Belvidera, designed to illustrate the external forms of the human body. A large and a small room for practical anatomy, together with another for the museum, occupy the extremities of the same story. The whole building is warmed by a single stove situated in the cellar, calculated by the inventor* for burning the Rhode-Island coal. Owing to the smallness of its draught, it burns this coal in great perfection, keeping up a permanent and intense heat. The stove is surrounded by a brick chamber from which a brick flue is car- ried up to the second story, communicating by large pipes or apertures with all the principal rooms of the house. The air is admitted from the outside of the building through a brick passage way, down to the stove; a portion of it goes to maintain the combustion; the rest being rarified by the heat of the stove, ascends rapidly through the flue, and may be delivered at pleasure into any, or all the apartments, by opening the pipes or communications. The strong current of heated air thus obtained is sufficient to warm the largest rooms in a very short space of time. A cistern of water is placed near the roof, which is supplied by pumps from a well in the cellar, and may be drawn out for use by pipes communicating below." * Mr. Jacob Perk-in*. MEDICAL SCKENCE, &c. 47 *tudy of anatomy. Students will have the aid of private demonstrations on any part they may prepare for the pur- pose, and every convenience will be furnished to assist them in making preparations for their own use. The number of subjects for demonstration is as great as could be wished. In future the surgical lectures will be made to occupy near- ly a third part of the course. Students will occasionally have access to the valuable and expensive collection of wax preparations lately purchased by the University, and when proper opportunities occur they will be invited to attend surgical operations by the professor. The physician of the Marine Hospital, has also very liberally invited such as de- sire it to attend the practice of that place; and the practice at the Boston Alms-house is usually accessible for a small fee. The fees for attendance on the lectures are, For the course on Anatomy and Surgery, $20. Chemistry and the Theory and Practice of Physic, each $15. Materia Medica and Midwifery, each $10. The fee for the degree of Doctor in medicine $20. The lectures will commence on the third Wednesday of November, and continue for three months. Anatomy and Surgery, by Dr. Warren. Chemistry, by Dr. Dexter and Dr. Gorham. Materia Medica; by Dr. Bigelow. Midwifery, by Dr. Channing. Theory and Practice of Physic, by Dr. Jackson. The number of students attending the lectures in the win- ter of 1816, was seventy-five, and the number of medical grad- uates at the commencement in August of the same year was eighteen. The lectures designed for the senior class of the Univer- sity will be given in the spring, annually at Cambridge. It is recommended, but not required, that medical students 48 HISTORICAL SKETCH OK who have not received a college education should attend the lectures on natural and experimental philosophy, which are given at Cambridge three or four times a week, from April to August. Candidates for a medical degree are also advis- ed to attend the course on Botany, which is given at Cam- bridge by Professor Peck and Dr. Bigelow during the spring and summer. Separate lectures are given in Boston on Botany, by Dr. Bigelow. The practice of the obstetric art was confined almost exclusively to females, till within the last sixty years. The late Dr. James Lloyd, who finished his education in London, in the year 1753, was for many years an eminent physician in Boston, and he is said to have been the earliest systemat- ic practitioner in midwifery in New-England. That branch is now taught in all our Universities, and the practice has, in general, devolved on physicians. The establishment of a botanical garden at Cambridge, will doubtless prove at a future period, an excellent auxilia- ry to the sludy of botany and pharmacy, and facilitate a knowledge of the indigenous plants of the country, and their introduction into the Materia Medica. Two townships of eastern land have been granted by our legislature, and a sub- scription of $30,000 has been obtained for the purchase of land, and other expenses of this valuable establishment. It is under the inspection of William D. Peck, as professor of natural history, and a board of trustees, of whom the presi- dent of the Medical Society is ex officio a member. The Massachusetts Medical Society was incorporated by an act of the legislature in 1781, and in the following June was organized, and Edward A. Holyoke, M. D. appointed the first president. By several subsequent acts the constitution and by-laws have been so altered and reformed, as more effectu- ally to promote the views and designs of the founders of this excellent institution. The number of fellows, originally MEDICAL SCIENCE, &c. 49 limited to seventy, may now embrace all the respectable prac- titioners of physic and surgery in the.state, who, in the elec- tion of counsellors, may vote by proxy. In the act of incorporation, the honourable legislature have disclosed their views of the high importance of medical reg- ulations and establishments, formed on liberal principles and fostered by the patronage of the government. They pre- mise that " it is clearly of importance that a just discrimina- " tion should be made between such as are duly educated " and properly qualified for the duties of their profession " and those who may ignorantly and wickedly administer " medicine, whereby the health and lives of many valuable " individuals maybe endangered or perhaps lost to the com- " munity." The society is therefore " authorized and re- quired to appoint censors or examiners of candidates, and li- cense such as may be found qualified for practice. To de- vise and direct such systematic mode of medical instruction as might be deemed requisite for candidates previous to ex- amination, and to increase and diffuse medical knowledge." In order to subserve the views of the legislature, and to render the society extensively beneficial, it was desirable to unite and associate as far as practicable into one harmoni- ous body of brothers all the meritorious part of the medical practitioners in the commonwealth. For this purpose great exertions have been made by the counsellors and fellows, since their organization, to select those gentlemen whose ed- ucation and respectability as physicians or surgeons justly entitle them to the honours and privileges of the society. It is conceived that the object in view is in a great degree ac- complished, but if there remain some exception, the door is still open to persons of the proper description, and they will, when known, meet with a cordial reception. The so- ciety now consists of more than two hundred and sixty fellows, exclusive of honourary members. Their stated meeting is on 7 50 HISTORICAL SKETCH OF the first Wednesday of June annually, when a discourse on a subject connected with medical science is delivered by one of the fellows. Among other transactions at the annual meeting a proper number of the fellows in the several counties of the slate are elected by ballot to officiate as counsellors. This branch is authorized to elect fellows and honourary members, to appoint the officers of the corporation, to establish district societies, and, in general, to watch over and promote the in- terests of the institution. The stated meetings of the coun- cil are on the day following the annual meeting of the socie- ty, and the first Wednesdays in October and February. The censors meet for the examination of candidates for practice, on the Thursday next preceding the annual meet- ing of the society, on the days following the meetings of the council in October and February, and on special occasions when the president by his written order may direct. The modes provided for the purpose of admission into this society afford a facility, which cannot fail of being sat- isfactory. Licentiates of the society and medical graduates at Harvard University, who have been reputably engaged in the practice of medicine three years from the reception of the license or diploma, and have supported an honourable private character, may claim a right of admission. A can- didate for admission by election must be nominated at a meeting of the counsellors by some one or more of the fel- lows of the society ; and the person who has made the nom- ination, having satisfied the counsellors that the candidate is a respectable and honourable practitioner of medicine, he may be balloted for at any stated meeting of the counsel- lors after the expiration of three months. All Bachelors or licentiates in medicine, although not fellows, may claim the use of the society's library. It is the duty of the counsel- lors, once in three years, to publish a list of the most ap- proved books, which should be read by medical students. The act of the legislature in 1813, authorizes the organiza- MEDICAL SCIENCE, &c. 51 lion of district societies. Upon the application of any two members of the society, the counsellors may establish, with- in such districts and portions of the commonwealth as they shall judge expedient, subordinate societies and meetings to consist of the fellows of the said corporation residing in such districts respectively, wherein the communication of cases and experiments may be made, and the diffusion of knowl- edge in medicine and surgery encouraged and promoted. The honourable legislature continue to extend their lib- eral patronage and encouragement to this society. In 1810 they granted a township of land for its use and support, and they have exempted the fellows from serving in the militia, as a remuneration, in some degree, for their expense and ex- ertions in promoting an institution of public interest and concern. The most salutary and beneficial effects have already re- sulted to the community from the association thus patroniz- ed by the government. By far the greater portion of re- spectable practitioners of medicine and surgery established in business in the commonwealth are associated and ce- mented into one learned body, whose efforts are constantly directed to the extension and increase of medical knowledge. Their united and individual influence are exerted in favour of a regular system of medical education, and in discounte- nancing those who undertake the important employment of the profession, without being qualified for the great and seri- ous duties it imposes. They are, moreover, in some re- spects, alert and vigilant guardians of the public health and welfare, regarding with peculiar interest, as a public calam- ity, the occurrence of every new epidemic or other disease, which assails the inhabitants of our country. The judicious measures adopted by the counsellors, relative to the cow-pox in 1808, and the spotted fever in 1810, have already been men- tioned, and reference may be had to the society's communi- cations for the detailed particulars of their valuable reports. ■>'2 HISTORICAL SKETCH OF . « At an early period of the institution (1790) the society published their first number of medical papers, containing a selection of important communications. A deficiency of funds for a time retarded the subsequent numbers, but two volumes are now completed and distributed among the fel- lows of the society. In the last number will be found j a brilliant and masterly dissertation on the mercurial practice in febrile diseases, by the president of the society, which is a valuable acquisition to the medical character of our me- tropolis, and of great utility to the physicians of the United States. In 1808 a Pharmacopoeia conformable to the mod- ern chemical'nomenclature, and designed to establish uni- formity in the prescriptions of physicians, was published by the society as a standard work. This valuable production was adopted as the basis of a compilation by the author of this work, entitled " The American New Dispensatory," which was approved by a committee of the society. A sec- ond edition has since been published, and, as co-operating with the society's Pharmacopoeia, and as an attempt to intro- duce many indigenous vegetables, as articles of our Materia Medica, it is hoped this Dispensatory may be found of some utility among the practitioners of our country. The counsellors and fellows, having laboured with unweari- ed assiduity to establish this institution on a respectable foundation, and having imbibed a tenacious concern for its interest and dignity, it was not to be expected that persons of deficient education, or undeserving character would be admitted to a participation of its honours and privileges. Accordingly proper means were adopted to exclude all such from a fellowship, as will appear by the following extracts from the by-laws of the society. " Candidates and their qualifications. No person edu- cated within the commonwealth shall be admitted to an ex- amination by the censors of the society or by those of any district society, unless he have the following qualifications. MEDICAL SCIENCE, &c. 53 1st. He shall have such an acquaintance with the Greek and Latin languages as is necessary for a medical or surgical edncation, and with the principles of geometry and experi- mental philosophy. 2nd. He shall have attended two full courses of lectures, and studied three full years under the direction, and attended the practice of some one or more of the fellows or honourary members of the society ; during which time he shall have studied the most approved authors in Anatomy, Chemistry, Materia Medica, Surgery, Midwifery and the Theory and Practice of Medicine; or, at least, all those which the counsellors shall from time to time specify as constituting a proper course of medical or surgical educa- tion. No person educated out of this commonwealth shall be admitted to an examination, either by the censors of the society, or those of any district society, unless he have the qualifications specified in the first of the articles above men- tioned, and instead of those required in the second, shall have studied three full years under the direction, and at- tended the practice of some reputable physician or physi- cians, surgeon or surgeons, as the case may be. The cen- sors of the society, and those of the several districts, before examining any candidate, shall demand and receive from him a satisfactory certificate of his being qualified in one or the other of the modes above mentioned. " Consultation. To promote the laudable design of the legislature in forming and incorporating this society, to pre- vent, as far as may be, all unqualified persons from practising medicine or surgery, and in order to discourage empiricism and quackery, it shall be deemed disreputable, and shall be unlawful for any fellow of this society, in the capacity of physician or surgeon, to advise or consult with any person, who having been a fellow of the society, shall be expelled therefrom, or with any person whatever who shall hereafter commence the practice of medicine or surgery within this commonwealth, until ha shall have been duly examined, and 54 HISTORICAL SKETCH OK approbated by the censors of the society, or by those of some district society; or shall have received a degree of Bachelor or Doctor of medicine at Harvard University ; or, (in case he shall have been educated in, or come from some other state or foreign country) shall have produced to the censors of the society, or those of the district wherein he re- sides such evidence or testimonials of his qualifications for the practice of medicine or surgery, as they deem and cer- tify to be sufficient to entitle him to the privileges of a phy- sician or surgeon regularly introduced. And every fellow of the society who shall abet or assist any person not so quali- fied, by affording him assistance in the capacity of physician or surgeon, shall, for such offence, be disqualified from giving his vote, at any meeting of the society, or of the district so- ciety whereof he is a member, for one year; shall be liable to the censure and reprimand of the counsellors, and in ag- gravated cases, to expulsion. " If any fellow of the society shall publicly advertise for sale a.jy medicine, the composition of which he keeps a se- cret ; or shall, in like manner, offer to cure any disease by any such secret medicine, he shall be liable to expulsion, or such other penalty as the society, at their annwil meeting, may think proper to inflict." Officers of the Massachusetts Medical Society for 1816. Joshua Fisher, M. D. President. Thomas Welsh, M. D. Vice-President. David Townsend, M. D."J Aaron Dexter, M. D. f Josiah Bartlett, M. D. > Censors. William Spooner, M. D. I James Jackson, M. D. J John C. Warren, M. D. Corresponding Secretary. John Dixwell, M. D. Recording Secretary. John G. Coffin, M. D. Treasurer. John Gorham, M. D. Librarian, * MEDICAL SCIENCE, &c. 55 MEDICAL INSTITUTION OF NEW-HAMP9HIRE. In the year 1798, a medical school was founded at Dart- mouth College, in the state of New-Hampshire, which, by the ability and assiduity of Dr. Nathan Smith, who was chiefly instrumental in its establishment, and was at first appointed professor of the several branches, has progressed to a res- pectable state of importance and usefulness. A considera- ble number of students have attended the annual courses of lectures, many of whom have been honoured with professional degrees, by conforming to the University statutes, which are similar to those of Harvard University. Dr. Smith has lately withdrawn from the professorship and connected him- self with the new institution at New-Haven. Cyrus Perkins, M. D. remains as Professor of Anatomy and Surgery, and Reuben D. Mussey, M. D. has been appointed Pro- fessor of Physic. By these gentlemen the lectures will be continued and the objects of the institution will be pros- ecuted.* MEDICAL INSTITUTION OP RHODE-ISLAND. An institution for medical instruction has recently been formed in connexion with Brown University at Providence, of which William Ingalls, M. D. is Professor of Anatomy and Surgery, and Soloman Drown, M. D. Professor of Materia Medica and Botany, by whom lectures are annually deliver- ed, and medical degrees conferred. At the commencement in September 1816, we perceive the names of nine graduates mentioned as having received the degree of Doctor of med- icine, after the usual examinations and having publicly read and defended medical dissertations. • It is now announced, August 1816, that Dr. Nathan Smith ia appointed Profes- •or of Surgery and of the Theory and Practice of Physic, and that nine candidates were admitted to medical degrees at this commencement. 56 HISTORICAL SKETCH OF MEDICAL INSTITUTION OK CONNECTICUT. The legislature of Connecticut in October 1810, devised a system of medical education, honourable to the state, and admirably calculated to accomplish the important objects in view. Its excellencies will be seen in the following ab- stract from the act of the legislature. The establishment is to be known by the name of " The Medical Institution of Yale College" It is to include a complete circle of medi- cal science, and to consist of four professorships, as follow ; Chemistry and Pharmacy, Theory and Practice of Medicine, Anatomy, Surgery and Midwifery, Materia Medica and Bo- tany. A cabinet of anatomical preparations and specimens in the Materia Medica are to be provided as speedily as the college funds will allow. A botanical garden is contemplated, and will be established as soon as the progress of the insti- tution will admit. Medical students are required to study physic or surgery with some professor or practitioner of re- putable standing for two years, if graduated at some college, otherwise three years and to have arrived at the age of twen- ty-one years. They shall attend one course of each of the above systems of lectures at Yale College, or of some other medical institution previous to being admitted to an examin- ation for a license ; the said course of lectures being includ- ed within the term he is required to study. One meritori- ous and necessitous person from each county in the state shall annually be allowed the privilege of attending one course of each of the systems of lectures gratis. The committee of examination for licentiates consist of the professors of the medical institution, and an equal number of the members of the medical society. Candidates for the degree of Doctor of medicine are re- quired to attend two courses of the above system of lectures at Yale College, or at some other public medical institution, MEDICAL SCIENCE, &c. 57 where a similar course of public instruction is pursued ; which degree, upon the recommendation of the committee of examination, shall be conferred by the president of the col- lege, and the diploma signed by him and countersigned by the committee, or a majority of the same. For the accommodation both of the students and com- mittee, there will be but one examination in a year, which shall be immediately at the close of the course of lec- tures. When a candidate is prevented by sickness, he may be examined by the medical professors at college. All med- ical students, who shall have attended two courses of the lec- tures in the medical institution, shall have the privilege of at- tending all future courses gratis ; and those, licensed to prac- tice physic or surgery, agreeably to the foregoing provisions, shall be, of course, members of the medical society in the respective counties where they reside. The by-laws for the particular government of the medical institution, are of the most salutary nature and extremely conducive to that sobriety and morality which is so charac- teristic of this venerable seat of literature. Every candidate for admission into the medical institution shall produce sat- isfactory evidence of a blameless life and conversation, and at the time of his matriculation, shall subscribe a promise on his faith and honour, to observe all the laws and regulations of the institution; particularly, that he will faithfully avoid using profane language, gaming, and all indecent, disorderly behaviour, and disrespectful conduct to the fac- ulty of the medical college. It is enjoined upon all the stu- dents to observe the Lord's day, as holy, and sacred to the duties of religion, and to attend at some place of public wor- ship. They are also required to attend prayers morning and evening. The medical students are located in the room9 of the Medical College, and^board in commons, where ample provision is made for their subsistence and comfort. Every 8 58 HISTORICAL SKETCH OK medical student shall be subject to the laws ami government of the medical institution, and liable to collegiat< pi.i.«sliment suited to the nature and demerit of '-he crime or misdemean- or. The members of the medical institution may borrow books from the college library, in the same manner, and un- der the same restrictions, as the junior and senior classes of undergraduates in the college. For the benefit of the students, surgical operations, and attendance during confinement are given gratis, by the pro- fessors, to al! such poor palients as apply and submit to op- erations, in the presence of the class of medical students. The following respectable characters are appointed to oc- cupy the several professorships in this promising institution. iEneas Munson, M. D. Professor of Materia Medica and Botany. Nathan Smith,* M. D. C. S. M. S. Lond. Prof, of the Theory and Practice of Physic, Surgery and Obstetrics. Eli Ives, M. D. Adjunct Prof, of Materia Medica and Botany. Benjamin Silliman, A. M. Prof, of Chemistry and Phar- macy. Jonathan Knight, A. M. Prof, of Anatomy and Physi- ology. They commenced their operations and lectures in 1813, and thirty-seven students attended, three of whom, having previously attended lectures at other institutions, were ad- mitted to the degree of Doctor in medicine. In the year 1814, the number of medical students was increased to fifty- seven. The price of a ticket for the whole courses of lectures as specified by law is $50, to be paid in advance. Each stu- dent, on being matriculated, pays the sum of five dollars, and for room rent, twelve dollars per year. The price of board in commons aud other contingent expenses are dete,r- ' See note, p. 55. MEDICAL SCIENCE, to. 59 mined by the President and fellows. Candidates examined for the degree of Doctor in medicine must pay four dollars to the President of the college, thjee dollars to each of the examiners present, and ten to the treasurer of the medical society. At the commencement September 1816, the de- gree of Doctor in medicine was conferred on fourteen per- sons. The legislature of Maryland, in the year 1809, incorporat- ed an institution under the name of the College of Medicine, and the several professorships were honourably filled, and lectures in the various branches immediately commenced in the city of Baltimore, but we are unacquainted with the pro- ' gress or present condition of this institution. In the state of Connecticut, a medical society has existed several years, and one number of communications has ema- nated from that respectable body. Similar societies have been incorporated in the states of New-Hampshire and Rhode-Island, and it is presumed in most of the states of the Union. Medical schools, and associations, have been es- tablished in Charleston, South-Carolina, and in Savannah, in the state of Georgia, of the last of which the honourable George Jones is President, and Dr. LemuelKollock is Vice- President. We possess no documents relative to their suc- cess and prosperity, 'out from a knowledge of the merit and talents of many of the founders and conductors ii ma}r be presumed that they deserve praise and gratitude for their ex- ertions in advancing the interest of medical science. The annual number of medical graduates educated in the United States, is estimated by Dr. Hosack at about one hund- red and twenty. The licensed, and partially educated practi- tioners, like the locusts of Egypt, are scarcely to be numbered. By the establishment of medical schools and societies throughout our country within the last forty years most im- portant improvements have been made in almost every branch 60 HISTORICAL SKETCH OF of medicine, and it must gratify every patriot to know that our own countrymen have acted a very conspicuous part in effecting an object, in which the interests of mankind are so deeply concerned. These circumstances will be hailed as propitious omens of the prosperity and literary fame which await our aspiring citizens. Important and auspicious effects are already visible in the character of our physicians. A thirst for the acquisition of knowledge, a laudable emulation, a taste for observation, inquiry and research have been ex- cited, and the talents and efforts of medical men in various sections of the Union have been combined. Within the last thirty years medical publications have great- ly multiplied in the United States, and many of them reflect honour both on their authors and on the national character, The numerous and valuable works of our late medical phi- losopher, Professor Rush, hold the first rank in the Ameri- can catalogue. These with the learned productions of Pro- fessors Barton, Mitchill and Hosack have been translated into various foreign languages, and received the meed of ap- plause from some of the most celebrated characters of the European continent. There are numerous other writers in the United States, who, by their labours have honourably contributed to our domestic literature and science. Many handsome specimens of ability, industry and learning will be found among the various inaugural dissertations published by the students of our medical schools ; and the most consider- able portion of our journals and other periodical publications, in point of merit and utility, may vie with the long establish- ed vehicles and repositories of medical intelligence beyond the Atlantic. The first periodical publication consecrated to medical science in the United States was the Medical Repository, a valuable production commenced in the year 1797, by the in- genious editors Drs. Mitchill and Miller of New-York. The MEDICAL SCIENCE, &c. 61 fame of this work has extended not only through our own, but to different foreign countries, and its high character is universally acknowledged. Although Dr. Miller, one of the learned editors, has ceased from his labours, his active spirit still lives, to inspire his surviving associates in the work which he commenced, and wliich has contributed so essen- tially to the growing fame of his country. The Medical Repository is not now our only medium of medical intelligence. Many others of real merit have since been introduced ; among which are Dr. Barton's " Philadel- phia Medical and Philosophical Journal" and " the Medical and Philosophical Register," a respectable work, by Dr. Hosack of New-York; Dr. Coxe's valuable "Medical Muse- um" is discontinued. The " New-England Journal of Med- icine and Surgery" commenced in Boston with the year 1812. It is edited by gentlemen of professional eminence, and evinces the talents and ardour for medical improvement which distinguish the faculty of Massachusetts. In addi- tion to many valuable original essays, it exhibits to the American student and physician the earliest information of whatever is new, ingenious or useful in foreign publications, connected with the science of medicine." The plans and means of instruction in our establishments and seminaries are-continually meliorating and improving. The road to medical knowledge is laid open, and is fraught with allurements. Emulation and fashion are directing their votaries into its various avenues, and conducting them to the fountain of professional honours, distinctions and emoluments. Instead, therefore, of humbly reaping the fruits of European fields, let us assiduously cultivate and diffuse the ample ad- vantages to be found in our own. The opportunities of prac- tical instruction, which our epidemic and endemic diseases of the hot season afford, are peculiarly interesting and im- portant. They impart to young students a knowledge, which 62 HISTORICAL SKETCH OK they cannot acquire in Europe, of the causes, symptoms, prevention and cure of the diseases of the country in winch they are to practice. In duly appreciating our own institu- tions and advantages, we advance the interests and reputa- tion of our country, and prevent the necessity of students resorting to Europe and subjecting themselves 1o heavy ex- penses to qualify them for the practice of medicine. With respect to theoretical systems, those of Ihe celebrat- ed Cullen and Rush, improved and modified according to the judgment of the respective professors, are in gen- eral adopted and taught in the various American Univer- sities. The Brunonian theory, though respected for its ingenuity and for the intrinsic merit of some of its doctrines, is deemed too vague and inexplicit to be generally adopted, unless strip- ped of many of its errors and inconsistencies. It has not perhaps obtained so many admirers in the United States as in the country in which it originated. The theory of Dr. Darwin is very difficult if not impossi- ble to comprehend, and his peculiar doctrines are not so well established, perhaps, as to justify the labour and trouble of studying his system. In the art of surgery the leading authorities are Pott, the Bells, Desaujt, the Coopers, Aberneihy, Cline, Home, Lat- ta, and JjKey, to which we add our own countryman, Physick, fwith many of our surgical professors who rank with some of the most eminent in Europe. In the depart- ments of chemistry and botany the most modern Euro- pean authors are consulted, together with the labours and improvements of our own enlightened professors. American botany is now cultivated with that ardour and solicitude, which the importance of the subject demands, and many in- digenous medicinal plants have been introduced as new arti- cles of our Materia Medica. MEDICAL SCIENCE, &c. 63 I cannot conclude this interesting subject in a manner iriore gratifying to myself or acceptable to my readers, than by the following extracts from a very eloquent discourse on the importance of medical education, by Samuel Bard, M. D. a rnaii of pre-eminent talents and learning, and President of the College of Physicians and Surgeons at New-York.* "In a profession so various, so intricate and so extensive, it is easy to see that the scholar can make but little progress by private study. Lost and bewildered in the multiplicity of objects and in the contrariety of opinions he absolutely requires the hand of a master to lead him into the plainest and most direct path, to remove as he goes along the obsta- cles which may obstruct his progress, and to point out such objects as are most worthy his observation. Nor are there many individuals capable of teaching all the preliminary branches, each of which is sufficiently extensive to employ the time and to occupy the attention of a man of no common talents and industry. Besides, Chemistry requires a labora- tory, Botany a garden,and Anatomy a theatre and subjects ; and, above all, the study of diseases and the practice of medicine cannot be taught but in a public hospital. As much therefore as oral instruction, and the voice of the professor is to be preferred to the silent investigations of the closet; still more is required the co-operation of several teachers, and the facilities of a public institution ; among which a large and commodious building, furnished with proper apartments for a library, an apparatus, a museum, an anatomical theatre, a chemical laboratory, proper lecturing room and a public hall is essentially necessary to a good medical school, and that too in a large city, where only in this country at least, anatomy and the practice of medicine can be properly taught. In both these the student must not only receive the instruc- • See American Med. 8c Philos. Register, Vol. II. p. 369 64 HISTORICAL SKETCH OF tions of his teachers, he must not only reflect on and digest what he hears and reads, but he must see, examine and han- dle for himself. In anatomy the subject, properly prepared, must be placed before him. Without this, the most accu- rate description, even when aided by the finest plates, and drawings, will be found perfectly inadequate to convey cor- rect ideas, or to make durable impressions on the mind. The parts must be unfolded by the knife, they must be distended by injections, and whatever is uninteresting and obscures their intimate structure must be removed, or the student will look with a vacant eye upon what, to him, at least, will ap- pear a confused and unformed mass." " In the study of diseases, and in the practiceof medicine, no histories, however accurate, no reasoning, however just, can convey the knowledge necessary for their treatment and cure. The student must see and hear and feel for himself; the hue of the complexion, the feel of the skin, the lustre or the languor of the eye, the throbbing of the pulse, and the palpitations of the heart, the quickness and ease of respira- tion, the tone and tremor of the voice, the confidence of hope or the despondence of fear, expressed in the countenance, baffle all description; yet all and each of these convey im- portant and necessary information. Where can these be learned, but at the bed side of the sick, and where shall a num- ber of young men, who cannot be admitted into the privacies of families or the chambers of women, acquire this neces- sary and important information, but in public hospitals, which are not only intended to relieve the complicated misery of poverty and sickness, but, as schools, should always be made conducive to the public good, and, as such, even more than as charitable institutions, merit and receive the patronage of government." " But besides the impossibility of teaching medicine in private, there are many advantages which attend public in- MEDICAL SCIENCE, &c. 65 stitutions, in this as well as in most other arts and sciences ; and one is, that, in general, from the division of the subject into many hands, a more enlarged, comprehensive and sys- tematic view of the whole will be taken ; its connection with, and dependence on other branches of learning will be more cer- tainly pointed out, and general laws and first principles bet- ter taught ; by which the student learns what are the proper objects of his inquiry at each stage, and, as he goes along, is taught to make a proper use of his previous acquirements and experience. Young men, too, engaged in the same stud- ies mutually assist each other. Emulation which warms and engages the passions on the side of whatever is excellent, cannot be excited without rivals, and without emulation in the scholar, instruction will proceed but at a languid rate, improvement will creep but slowly on, and excellence is nev- er attained. Nor is emulation confined to the scholar. The emoluments of the teacher depend on his fame, and both on his talents and industry. Stimulated therefore by his inter- ests and spurred on by his ambition, he will make every ex- ertion to recommend his lectures, which, he knows, are to be brought to the ordeal of a nice and critical examination. Among his hearers there will always be a number of elder students very capable of judging of his merits, and very will- ing to discover and expose his errors. Such a system of education cannot long be conducted in a slovenly or incom- petent manner. Negligence will sit very uneasy, and incom- petence cannot long keep her seat in a professor's chair. In no profession are sound learning, clear and definite opinions, and correct conduct of more consequence than in that of medicine, in the exercise of which our dearest interests, our own lives and health, and the lives and health of our wives and children and friends are deeply and essentially concerned. For let it be remembered that there is no mid- dle course in medicine. It is a mistake to suppose that the 9 66 HISTORICAL SKETCH OF MEDICAL SCIENCE, 8cc. conduct of a physician unless intentionally, is ever of that neutral and inconsequential nature, that although it may do no good, it will do but little harm. If, through ignorance a physician does not do good, he will most probably do much injury; for our occasions of acting are so fleeting that they must be seized at the moment, and to omit the opportunity of affording relief, is frequently to do all that is necessary to render the case under our care fatal or desperate. If a dysentery, a pleurisy, an apoplexy, or indeed almost any acute disease be neglected in the beginning, protracted ill- ness generally, and frequent death is the consequence. Nor, on the contrary, is there any profession in which that cau- tious difSdence, which is the result of deep knowledge, is of greater consequence. In our profession, to knowr when to act with vigour, when to look on with patience, and from what circumstances to deduce the arguments for either, is the re- sult only of a thorough knowledge of our subject." BOOK I. CHAPTER I. OF THE NONNATURALS.* PREVIOUS to entering on the principal subjects of this work it will be proper to take a brief view of the several agents or causes which influence the human constitution, and according to their nature, or operation conduce to health or disease. By the singular term nonnaturals, the ancients under- stood those things which are natural in themselves, and ne- cessary to our existence ; such as affect mankind without entering into his composition, or constituting his nature. The term comprehends air, meat and drink, sUjsep and watch- /■ ing, motion and rest, retention and -esaulisland the affec- * tions of the mind. The whole of which may be included in Hie term Dietetils. Of Air or Atmosphere. Air, is that invisible transparent compressible and elastic fluid, which every where surrounds our globe; and which generally receives the name of atmosphere. It is the medi- um in which we breathe, and without which we cannot exist. It is now very generally understood that the atmos- pheric air, or that by which we are usually surrounded, is not a simple, but a compound body, consisting of at least four distinct substances, namely, oxygen, azote, carbonic acid, and aqueous vapour. The two former substances however, constitute almost the whole of the atmospheric air near the surface of the earth; the other two are variable in their proportion, and exist only in minute quantities which * In treating of the Nonnaturals, I am assisted by Thompson's Family Physician, Dr. Willich, and outer late writers. 68 OF THE NONNATURAl.v it is difficult to appreciate. There are various met hods known to chemists, bv which these two airs may be sepa- rated from each other." Vital air, or oxygen, which consti- tutes about one fourth of the atmosphere, is necessary to respiration and combustion, and an animal immersed in it will live much longer than in the same quantity of common air. The remaining three fourths, called azote, or mepnit- ic air, is totally incapable of supporting respiration, or com- bustion for an instant. If a caudle be included in a given quantity of atmospheric air, it will burn only for a certain time and then be extinguished, as the oxygen is all absorbed, and the azote which remains is incapable of supporting flame. If an animal be immersed in a given quantity of common air, it will live only a certain time, at the end of which, the air will be found diminished about one fourth, and the re- mainder will neither support flame nor life. It appears that three parts of azote, and one of oxygen, will form a com- pound similar to atmospheric air, and is that which is best suited to support the health of the body. Were the at- mosphere to contain a much larger proportion of oxygen, by its powerful influence on the system, inflammatory dis- eases would be induced, and the excitability be sooner exhausted. If on the other hand, a much less proportion of oxygen should prevail in the atmosphere, there would be a deficiency of stimulus, and the excitability of our systems would morbidly accumulate, and diseases of debility would be the consequence. The oxygen which is received into the lungs of animals, is supposed to communicate the red colour to their blood, and to impart heat and activity to the system. When ani- mals die for want of vital air, their blood is always found black. There is a constant consumption of the oxygenous portion of atmospheric air, by the burning of combustible bodies; by the fermentation and putrefaction of vegetable and animal substances ; and by the calcination of metals. A greater or less proportion therefore, of the noxious ingre- dent azote, in our atmosphere undoubtedly arises from the innumerable processes of combustion, putrefaction, and res- piration of men and animals, particularly in populous cities, the atmosphere of which is almost constantly prejudicial to he9 Or 1 ME DISF.ASF.S OF CHILDREN. children. But much of the absorbent quality of magnesia. is often lost, by being too thoroughly wet, or standing too long after being mixed ; it is only necessary to break all i • lumps, and give it in as dry state as it can conveniently be swallowed. In those cases where (here prevails a superabundant acid- ity, accompanied with sour belchings, green stools, with curdled milk, i( will be necessary (o evacuate (he contents of the stemach and bowels, by a gentle emetic of ipecacu- anha, and a dose of castor oil; after Ihe operation of which. the following laxative absorbenl mixture will prove exceed- ingly beneficial. Take of magnesia, and prepared chalk, of each two drachms, rhubarb in fine powder, half a drachm, oil of anise seed, twenty drops, sugar, one drachm, simple cin- namon, or peppermint water, two ounces, common water, four ounces. First mix the powders in a marble mortar, and then add the oil and sugar, and lastly add gradually Ihe wa- ter. One or two tea spoonfuls of this mixture should be giv- en every three or four hours, shaking the phial each time it is used. On some occasions it may be useful to add two or three grains of salt of wormwood, or tartar, or a few drops of spir- it of sal ammoniac to each dose. This mixture will be fovnd in most complaints of children proceeding from acidi- ty, a very eligible absorbent, laxative and carminative prep- aration. Acidities in the first passages, are frequently attended with a severe purging, for which absorbent powders have been recommended as highly useful; but the mixture just mentioned, is also a medicine well adapted to the indications of cure, and will prevent the accumulation of acescency of the stomach if properly employed. Infanls are frequently attacked suddenly with colic pains, when acidities and flatu- lency prevail in a high degree, without any previous warn- ing. The accompanying symptoms are, violent crying and screaming, kicking, and drawing up of the legs, and hardness and tension of the belly. In such cases it will be necessary to prescribe some mild laxative, or a clyster, and if the com- plaints are severe, recourse may be had lo the warm bath, fomentations, and frictions, with warm brandy or camphorated oil on the belly. Although strong prejudices exist against (he use of opiates, or anodyne medicines for infants, they are of indispensable necessity in many instances. When these tender little creatures, are suffering the severest pain OF THE DISEASES OF CHILDREN. 223 from colic, gripes, or even from colds and coughs, it is real- ly cruel to let them remain in lhat condition for hours, when immediate relief can be produced by a tew drops of elixir paragoric, which is perfectly innocent and harmless. From ten to twenty drops of elixir paragoric, or four or five of laudanum, will on most occasions afford relief from pain, dis- tress, and peevishness, so common with children at the breast; and if not too frequently resorted to, no sort of ill consequences need be apprehended from the practice. Acid- ities, gripes, and flatulency sometimes originate in costive- ness, this is to be obviated by occasional doses of castor oil, or magnesia, in an infusion of the seeds of anise. It is a well founded remark, that the passions of the mind greatly affect the stale of the nurse's milk, occasioning gripes, and colic pains. The infant therefore, should never be ad- mitted to the breast, while the mind of the nurse is disturb- ed or agitated. Of the Thrush or Aphihod. However harmless the thrush, or sore mouth, as it is vul- garly called, may be considered, it is undoubtedly a disease of debility, arising from acidities in the first passages, or some olher acrimonious humour lodged in the stomach and bowels, or from indigestion, whether occasioned by bad milk, or other unwholesome food. This disorder generally appears first in the angles of the lips, and then on the tongue and cheeks, in the form of little white specks. These increasing in number and size, run together more or less according lo the degree of malignity, composing a thin while crust, which at length, lines the whole inside of the mouth, and extends into the stomach and through the whole intestinal canal; producing also a redness about the anus. If the specks are of a pale colour, superfi- cial, and easily fall off, they are not considered dangerous; but, when the crust falls off, and is succeeded by another of a darker colour, or livid hue, it is reckoned the worst kind. In forming our prognostic of the termination of the disease, it is necessary to attend to the sensibility of the stomach and bowels, and the appearance of the egestion. Frequent vomiting, repeated thin stools, with griping, and a tender stale of (he abdomen, are very unfavourable; drowsiness, oppressed breathing, moaning, spasms, and great languor. with frequent pulse are symptoms indicating; danger 224 OF THE DISEASES OF CHILDREN. A remarkable propensity to sleep, fretfulness when awakt, and an unusual heat in the mouth, are among the premonitory symptoms of fatal termination of the disease. In its mild form, or when it is an original disorder, it is never attended with any fever; but when it has arisen in consequence of severe bowel complaints, or olher infantile diseases, it is not unusual, in such cases, for the thrush to be accompanied wilh fever of the low kind. In mild and recenl cases of this disease, when the aphtha: is confined to the mouth, and appears in a few scatlered spots resembling little pieces of curd sticking lo (he surface of (he tongue, or within (he lips it may in general be easily removed by keeping the bowels duly open with a little mag- nesia given daily. Many regard aphtha? as a salutary complaint, and in con- sequence of this erroneous belief, the disease has been neg- lected until it has extended down (o (he stomach and intes- tines producing cough, and great difficulty of breatiiing, with other symptoms of a disordered state of (he stomach and bowels. Under (hese circumstances (he most active appli- cations must be employed or we shall be unable to arrest its fatal termination. In the treatment of the thrush, it will be proper on its first appearance to give a gentle emetic of the wine of ipecacu- anha, in order to evacuate the stomach of acidities or other acrimonious humours. After the operation of the emetic we may recommend manna, magnesia, or a course of the testa- ceous powders, if the child is of a costive habit. If the in- fant is robust, and the disease is violent, and has extended rapidly, suitable doses of calomel may be taken with advan- tage. But on the contrary, if its bowels are rather loose, and the constitution feeble and delicate, we may substitute the compound powder of contrayerva, or the mixture of chalk (see Appendix) endeavouririg at the same time to sup- port the strength by cordials, and injections of a decoction of the bark, with the addition of a few drops of the tincture of opium. A variety of local detergent applications in the form of gargles and lotions have been recommended, the most com- mon of which is a saturated solution of borax in water, and mixed with honey, or a syrup of Ihe wild turnips. Besides this preparation, a strong decoction of Peruvian bark acidu- lated with the elixir vitriol, a solution of white vitriol, and OF THE DISEASES OF CHILDREN. 225 diluted muriatic acid have severally been employed with an expectation of their disposing the sloughs to fall off, and of constricting and healing the parts beneath. Among the vegetable productions of New-England, the arum maculatum, belter known by the name of wake-robbin, dragon root, or wild turnip, is a remedy of approved effica- cy. The common method of employing it, is to mix about one drachm of the finely pulverized root into a paste with com- mon honey, a small quantity of which being put upon the infant's tongue will be licked to all parta of the mouth. This by being frequently repeated during Ihe day, will keep the infant's mouth moist, clean, and comfortable, and promote a separation of (he aphthae. A few grains of calomel mixed wilh honey, and applied to the mouth and tongue, will also be found very serviceable in this complaint. See sophora tincto- ria, Appendix. Of Tumours of the Scalp. It sometimes happens, lhat after a laborious birth, the scalp of the child is considerably tumefied ; (his is seldom attended with serious consequences, and byr Ihe application of cloths wet with brandy, or camphorated spirits, the effused fluid is soon absorbed, and the swelling disappears. On some occa- sions however, such tumours do not readily subside, but rather increase, and continue for several weeks, and the moth- er becomes alarmed. Under such circumstances, it may be necessary (o make an opening through the in(egumen(s, for the discharge of the contained fluid ; there can be no danger from this simple operation, and by Ihe application of spirits, or vinegar, in which some crude sal ammoniac has been dis^ solved, wilh proper compression, (he incision soon closes and a cure is effected. Of Cutting the Tongue. We are frequently importuned by mothers and nurses, to liberate tjje tongue, when on examination, it is found to be inexpedient, there not being one in many hundreds of infants, whose tongue is so confined by the fraenum, as to incapaci- tate it from sucking, and afterwards articulating distinctly. Whenever the tongue is so confined, that the infant cannot move it over the gum, or take proper hold of one's finger* or 29 226 OF THE DISEASES OF CHILDREN. a good nipple, the 'membranous siring, which in (his case binds it down, ought lo be so divided as lo enable it to suck with freedom. The operation may be performed wi(h (hi coru non scissors, while lifting up (he (ongue with (he fingers of the left hand. Some attention however, is requisite, to avoid cutting any of (he blood vessels beneath the tongue, from which infants have sometimes bled to dealh. Another danger to which careless operators are liable, is that of cut- ting the string to too great an extent, in consequence of which, the point of the tongue being entirely unconfined, may fall back inlo the throat and occasion suffocation. When- ever this accident does lake place, the infant appears great- ly agitated, the face turns black, and unless it be soon reliev- ed by bringing the tongue into the proper place, convulsions and death will be the consequence. Of Vomiting. It is not uncommon for healthy thriving infants at the breast to puke up Ihe milk, especially after a free indulgence, and when the child is shaken or dandled. When vomiting is evidently occasioned by overfeeding, and ihe milk comes up unchanged, it is lo be regarded as a kindly exertion of nature to free herself from any superfluous quantity receiv- ed inlo the stomach. This is not lo be accounted a disease, and requires no other remedy but abstinence after the stom- ach is disburdened of its load, and care not to overfeed it for the fdlure. If the vomiting proceeds from acidity in the stomach, an emetic of ipecacuanha will be proper, after which,repeated doses of magnesia will probably effect a cure. If from an increased degree of sensibility, or too great an ir- ritability of the nerves of the stomach, (he saline mixture, with a few drops of laudanum, will be beneficial, and in or- der lo brace and strengthen the stomach and abate its sensibili- ty, a cold infusion of Peruvian bark, with a little rhubarb and orange peel will be essentially necessary. In cases of se- vere and obstinate vomiting, Ihe operation of internal remedies may be assisted by the application of aromatic and spiritu- ous fomentations, or an anodyne plaster to the pit of the stomach. In all cases of vomiting, mild cathartics and laxa- tive clysters, should be administered, as occasion may re- quire. When vomiting is symptomatic of other diseases, as teething, worms, &c. its treatment will be influenced by a re UF THE DISEASED Ul CIHLDKF.N 227 gard to those particular causes. If there is reason (o sup- pose (hat the cause be a sudden disappearance of some eruption of (he skin, the child must be put inlo the warm or tepid balh, and if (he vomiting continues, an emetic ought (o be given and a blister applied (o (he pit of (he stomach. Fever from taking Cold. The infantile fever now lo be noticed, may very easily be distinguished from any other, by its being attended with symptoms of cold, as a cough, hoarseness, difficulty of breathing, inquietude, flushing of the cheeks, a disposition lo sleep, and often with a running at the nose, and watery eyes. The fever is not often of long continuance, and al- though it may be violent, it is not frequently productive of much danger if properly Irealed. The danger to be appre- hended however, is, that it may lead to inflammation of the lungs, one of the most afflicting diseases incident to infants. It is therefore, of more consequence to attend lo colds and feverish complaints in children in good season. When fe- verish symptoms are perceived with a cold and cough, the feet and legs should be bathed in warm water, and a mild laxative ought to be given, and half a tea spoonful of the syrup of squills may be directed in some hyssop, liquorice, or mullein tea, sweetened with honey, and if the bowels be relaxed, ten or fifteen drops of elixir paragoric may be add- ed at night; when honey is directed for children, it is al- ways proper to boil it and skim off the impurities. Should (he fever continue, a tea spoonful of the saline mixture, or fifteen or twenty drops of the spirit of nitre dulcis, with six or eight* drops of antimonial wine, ought to be adminis- tered every two or three hours, and if the infant is not at the breast, it should drink freely of barley-water sweetened wilh honey. In this disorder, and in most complaints of infants, where the inflammation is not great, it will be useful besides bathing the feet and legs in warm water, to apply garlics to the soles of the feet; which, according te Dr. Sydenham, operates more powerfully than any other article in occasioning a derivation or revulsion from the head. The garlic is prepared either by beating in a mortar equal parfs of it and hog's lard, or by simmering them together ; this should be applied to the soles of the feet and renewed every day. If garlic cannot be procured, the root of coakum, or the leaves of burdock may be substituted. 228 OF THE DISEASES OF CHILDREN Inflammation of the Lungs. By exposure to a damp cold air, children from one to tw© years are frequently affected wilh this very distressing and dangerous complaint. It comes on by a slight feverish heat, which in (he course of a few hours increases, wilh evident signs of pain, distress, and quickness of breathing. A short, dry, hard cough ensues, and the respiration becomes more quickened and laborious, and is performed with a rough whizzing sound. The presence of these symptoms should be regarded as indicating considerable danger, and demand- ing immediate attention and assistance. If the inflammation is considerable, with laborious breatiiing, i( will often become necessary lo (ake a little blood from the jugular vein or the arm, or leeches should be applied to the breast, and imme- diately afterwards, a blister to the same part, and a mild purgative given. The child should next be immersed in a warm bath up to the arm-pits, from ten to fifteen minutes, and after being wiped dry, wrapped in a blanket and placed In bed, with tfie leaves of burdock applied to Ihe feet. The syrup of squills ought to be administered, to which some jpecapuanha may be added, so, as to excite occasional vom- iting, as the little patient has not discretion, nor ability, lo expectorate in the usual manner, and unless relieved, the lungs become exceedingly oppressed wilh phlegm. A mix- ture of syrup of squills, oil of almonds, and elixir paragoric, in equal parts, in doses of a tea spoonful, should be given every (wo or three hours, and a few drops of spirit nitre dulcis, occasionally durjng (he continuance of the fever. If much pain appear to distress the infant, the skin about the breast or side should be vesicated by the application of the tincture of flies, or of the plaster. Of Dentition, or Teething. Dentition is often a painful and critical period wifh in- fants, in which the first appearance of indisposition should be watched with peculiar care and attention. For various and complicated are the complaints during this important crisis, which, though harmless in their commencement, be- come, through neglect, formidable in their progress, and fre- quently fatal in their termination. OF THE DISEASES OF CHILDREN. 229 Many children appear to suffer greatly from the tension, irritation, or inflammation of the gums, before there is any appearance of teeth. They suddenly become fretful and uneasy; disgusted rather than amused with their toys; sink upon the bosom, or incline to lay in the arms ; and sleep with their eye-lids half closed, and frequently start, or groan. The teeth are formed within the jaw, previous to the birth of (he infant; and evident signs of pain and irritation in the gums, and an increased discharge of saliva, are apparent about the third or fourth month, (hough (hey seldom cut all (heir teeth until nearly two years, and sometimes even later. There are only ten teeth in each jaw evolved during in- fancy, and these are not permanent. The two fore teelh of the lower jaw first appear, and in about a month those of the upper jaw come through. Then the two lateral ones of Ihe lower jaw, and next those of the upper one appear. These are succeeded by four grinders, and then the eye- teeth as they are called. These are the primary or milk- teeth, which are shed, agreeably to the order in which they came, and are replaced by olher teeth, more permanent, larger and better formed, and their roots longer and more ex- tended. A variety of circumstances may occur, which will interrupt the regularity of this process; but every de- viation does not constitute disease, nor afford a sure indica- tion of more difficult, or more easy dentition. It has been observed as one of the phenomena of teething, that, in the greatest number of instances, the first dentition commences at seven months, the second at seven years, and its progress is completed at the end of the third septenary, that is at twenty-one years. Many children pass through this important period with so great ease and regularity, as not to have any observable al- teration in their usual health produced by it. But when dentition is difficult, there is no occurrence to which they are liable, attended wilh such grievous and distressing effects. The symptoms which usually precede or accompany if, are a considerable irritation of the mouth; the gums are hot, itchy, swelled, and spread; the secretion of saliva is increas- ed, the child constantly drivels; the actions of the stomach and bowels are performed imperfectly, or are occasionally suspended ; there is often a circumscribed redness in the 230 Ol THE DISEASES OF I HILDREN cheeks, eruptions appear on different parts ; a looseness en- sues, wi(h gripings, and (he stools are of a green, pale, or leaden blue colour, sometimes containing mucous, anil o' n (hick ; and (he child is watchful and peevish, starts during sleep, and sometimes general convulsions of (he voluntary muscles take place. These symptoms, in very irritable habits, when the tooth advances fast, or several leeth push forward at the same time, are followed by fever, difficulty of brea(hing, spasmodic cough, scrofula, marasmus, and con- vulsions. Among (he symptoms of less importance which sometimes attend dentition, may be mentioned a swelling of (he tops of the feet and hands, and also a transient palsy of the arms or legs, but these are seldom of long continuance. The influence of the seasons, and constitutional differences of the human system, are not more apparent in any disease, than in dentition. It has been observed that infants cut their teeth more readily in the spring and winter, than in summer and autumn ;—The lean more easily, than the fat;—Strong and healthy earlier than the weak and tender; and those children whose bowels are regularly open suffer the least. The most troublesome and alarming disorders, which at- tend dentition, and require the most prompt and efficacious remedies, are diarrhaea, cholera infantum, fever, convulsions, and affections of the lungs. Each of these shall be separ- ately but briefly considered; reserving a more full and par- ticular discussion of these subjects for another part of this work. Acidifies, flatulency, gripes, cosliveness, and sore ears are to be obviated by those means which have been rec- ommended when treating of these complaints. When a spontaneous purging arises during dentition, unat- tended with fever, not profuse, and the child preserves a good appetite, it ought not to be hastily stopped. It is to be considered rather as a beneficial, than a prejudicial dis- charge, and may prevent the occurrence of more serious symptoms. But if it should continue long and violent, so as greatly to weaken and debilitate (he child, attended with a gradual emaciation, (he countenance pale and dejected, the eyes dull and heavy, a peculiar sinking of the features, and slight febrile paroxysms, it becomes, an alarming disease, and is termed the diarrhaa of dentition. Under these circum- stances, the proper practice is to cut the gum over that tooth OF THE DISEASES OF CHILDREN. 231 which is farthest advanced, if inflamed and distended. The incision should be made on the anterior part of the gum, in the course which the tooth takes in the gum, and carried so deep as to reach the tooth. It is also necessary that the in- cision should be made in this manner, to prevent the con- necting membrane between the first and second set of teeth from being divided. Attention to the quality and quantity of food is necessary, and the frequency of administering it. If the mother's milk is abundant, it will be all the food that the child will require ; and is to be preferred to all other food, as it is the most grateful to Ihe palate, the most easily retained, and the most perfectly digested by the stomach. For a child which does not nurse, milk new from the cow is the best substitute for the breast. But if this cannot be pro- cured, (he next in order of preference is arrow root, or some aqueous nutriment as nearly resembling milk as can possibly be prepared. An excellent beverage of this description can be obtained by boiling several hours, a handful of dry flour closely confined in a cloth, until it becomes perfectly hard ; when cold, a table spoonful of it finely grated, is to be mixed with half a pint of boiling milk, sweetened, and a lea cupful taken as often as necessary. Active purges, such as castor oil, senna, and calomel, must be employed in the commence- ment of the disease, in such quantities as will evacuate the contents of the stomach and bowels, or destroy the irritating effects of these substances on those organs. The operation of the cathartic may be followed by a gentle anodyne, given at bed time, to allay the irritation, and to procure a respite from pain and suffering. The remainder of the cure is to be conducted on general principles. This disease is frequently succeeded by the cholera in- fantum, which is peculiar to teething children, and in its mild form resembles a severe attack of the diarrhsea. There are certain symptoms common to both diseases, but the chol- era infantum may be easily distinguished by the following characteristic appearances. It generally commences with flatulency in the stomach, and sharp griping pains in the bow- els, succeeded by a severe and frequent vomiting and purg- ing of great quantities of bilious matter, and a constant and urgent thirst. The child is distressed and restless for some time after taking food, which is thrown up again, almost as soon as swallowed, and from the very irritable state of the stomach, it is very difficult for any kind of medicine to be 232 OF THE DISEASES OF CHILDREN retained on it. The appetite is much impaired, and in con- sequence of (he weakened powers of Ihe digestive organs, the stools contain small curds of milk, or portions of undi- gested food, but rarely much faeculent matter. The colour and consistence of these discharges are various ; they are sometimes yellow, but more commonly either green, or white, or brown, and are thin, watery, or mucous; and they smell sour or putrid. In frequency they vary from three or four to twenty during twenty-four hours. In the treatment of cholera infantum, our attention should be directed to the removal of all noxious matters from the stomach and bowels, which may be accomplished by exhib- iting small doses of ipecacuanha, combined with calomel. This compound will be found to produce beneficial effects given independently, and in such quantities as are insufficient to operate as an emetic. In cases where it is necessary to evacuate the bowels more completely, jalap may be joined with the calomel, and the evacuation assisted by an emolli- ent injection. The patient should be made to drink some diluent or mucilaginous liquors, such as barley water, lin- seed tea, rice gruel, or animal broths. The restoration to health is further to be attempted by employing tonics and cordials, and when indicated, the warm bath, friction to the abdomen, rubefacients, and blisters. This dangerous disease will be more particularly treated of in some of the following pages. It sometimes happens, that robust children are attacked with a considerable degree of fever during dentition, in which case the loss of a little blood, either by the lancet, or leeches behind the ears, has been recommended as necessary. But it must be recollected that they suffer more from bleeding than from other evacuations. It will be advantageous to ad- minister small doses of antimonial wine, from six to ten drops according to the age and other circumstances of the child, together with diluting liquors, if it does not nurse, in order to promote perspiration. As there is generally a constipa- tion of bowels, ii will be necessary to give a smart purge, and keep the bowels open afterwards by magnesia. The spirit nitre dulcis, in doses of eight or ten drops added to the antimonial wine, and small blisters applied behind the ears, are often employed with advantage. Opiates are not to be administered unless the bowels have been previously opened, the pain severe, and the respiration free and easy- OF THE DISEASES OF CHILDREN. 233 Children are sometimes attacked with convulsions, the most alarming and dangerous complaints that accompanies difficult dentition. As these are produced by an irritable, or excitable state of the nervous system, we should without delay scarify the gum, through which the (ooth is forcing a passage, and this operation may be repeated for several suc- cessive days, until either the tooth appears or the convul- sions cease. If slight scarifications do not procure relief, the incision should be carried boldly down to the tooth al- though no swelling be discovered. We are at the same time not lo neglect the bowels, which should be kept per- fectly open. We may further attempt to lessen the irrita- bility of the system by antispasmodics, as asafcetida, castor, and valerian; or what is still more efficacious the pothos fcetida, or skunk cabbage. A strong infusion of the root of this domestic plant may be given in doses of a large spoon- ful every few hours until relief be obtained. Blisters and the warm bath, will prove useful auxiliaries. Should there be any objection to tepid bathing; the pediluvium may be at any time proper. As a general direction, light nourishing diet, preserving the bowels in an open state, restraining immoderate evacua- tions, proper exercise, pure air, and all those means which have a tendency to promote general health, will contribute to the safety of dentition, and facilitate its process. Many of the ancient physicians recommended certain charms and amulets, but these futile inventions scarcely sur- vived their superstitious patrons. And modern custom has adopted a practice equally ridiculous, if not worse than useless, of giving children during teething, gum-sticks, coral, and other hard substances to put into their mouth. But every parent and nurse ought to know, that (he natural ten- dency of (hese means is to harden the gum, by which the process of absorption is rendered more difficult. If any ap- plication is made to appease the anguish of the gums, let it be the finger, which is soft, yielding, and easy, and will serve every necessary purpose. The Cholera Infantum, or vomiting and purging of Children. This is a prevailing malady in most of our cities during the months of summer and autumn, and a multitude of child- 30 234 OF THE DISEASES OF CHILDREN ren are the victims of its annual visitation. It has been the subject of investigation by many ingenious authors, and the accurate description which follows, is nearly in the language of the late celebrated Dr. Rush. It sometimes begins with a diarrhaea, which continues for several days without any olher symptom of indisposition, but it more frequently comes on with a violent vomiting and purging, and a high fever. The matter discharged from the stomach and bowels, is generally yellow or green, but the stools are sometimes slimy and bloody wilhout any tincture of bile. In some instances (bey are nearly as limpid as wa- ter. Worms are frequently discharged in each kind of the stools (ha( has been described. Tlie children in this stage of the disease appear to suffer much pain. They draw up their feet and are never easy in one posture. The pulse is quick and weak. The head is unusually warm while the ex- tremities retain their natural heat or incline to be cold. The fever is of the remitting kind and discovers evident exacer bations, especially in the evenings. The disease affects the bead, and in some instances violent delirium ensues ; the child throws its head backwards and forwards and attempts to scratch and to bite the atiendants. Swelling frequently oc- curs in the abdomen and in the face and limbs. An intense thirst attends every stage of the disease. The eyes appear languid and hollow, and the children generally sleep with them half closed. Such is (he insensibility of (he system in some instances in (his disease, that flies have been seen lo alight upon the eyes when open, without exciting a motion in the eye-lids to remove them. Sometimes the vomiting continues without the purging, but more generally (he purg- ing continues without the vomiting, through the whole course of the disease. The stools are frequently large and extreme ly fetid, but in some instances, they are not, and are small, resembling the drinks and aliment which have been taken into the stomach. The disease is sometimes fatal in a few days. Its duration is varied by (he season of the year, and by the changes in the temperature of the weather. A cool day frequently abates its violence and disposes it (o a fa- vourable termination. It often continues with occasional va- riations in its appearance for six weeks or two months. Where the disease has been of long continuance, the ap- proach of death is gradual and attended by a number of dis- tressing symptoms. An emaciation of the body to such a OF THE DISEASES OF CHILDREN 236 degree, as (hat the bones come through the skin, livid spots, singultus, convulsions, a strongly marked hippocratic coun- tenance and a sore mouth generally precede the fatal termin- ation of this disease. We have also a striking delineation of this disease from the pen of Dr. James Jackson, medical professor in Harvard University, in an elaborate and practical essay on the morbid effects of dentition.* According to the observations of this sensible writer, cholera infantum is peculiar to teething child- ren. It rarely occurs before Ihe 8th or 9th month, and sel- dom commences in children who are past eighteen months of age. We seldom find this disease in any of its severe forms among infants at the breast; and those children who are accustomed to the free enjoyment of the open air, are comparatively very little subject to the cholera of infants. In his animated sketch, the professor presents the child " asleep in its crib, cold amidst the load of woollen in which it is wrapt, unless during a febrile paroxysm, when an arid warmth is spread over it; so peculiarly dead are the limbs in their appearance, lhat it would seem that life was preserv- ed only in its sacred temple in the centre of this " little world ;" its countenance more than deathly, and with which the visage of pulmonary consumption will scarcely compare ; its pulse quick and wiry, and its respiration scarcely to be heard. So strongly, under these circumstahces, are the characters of death impressed on the Utile subject, lhat the inexperienced observer cannot doubt that a few hours will decide the case forever. That the appearances have been the same for days, and even sometimes for weeks, seems to him impossible. But in this situation the patient may con- tinue for weeks, with some fluctuations and at length recov- er. In all the forms of cholera infantum the breast milk is un- questionably the most suitable food ; where the patient does not nurse, cow's milk fresh from the animal should be em- ployed. Cow's milk may often be rendered more particular- ly suited to certain cases, by mixing with i( half i(s quantity of lime water, and sometimes they should be boiled together. Next to milk, unless when the stomach is in the most irrita- ble state, animal food is to be preferred, and this in a solid form moderately broiled or roasted, provided the appetite * Vide New-England Journal of Med. and Surgery, Vol. I. This excellent sketch is recommended to the attentive peril0*! of every medical practitioner. 236 OF THE DISEASES OF CHILDREN. and digestion are favourable to it. The pure juice of meat obtained by broiling, or extracted by boiling in a bolll i* directed in the Appendix, will sometimes answer a valuable purpose, when neither solid meat nor milk can be easily borne. On some occasions the farinaceous and mucilaginous substances, as arrow root, sago, &x. will be found more agreeable to the patient's stomach than any other food. The quantity both of food and drink, should always be small, and in a state of great irritability of the stomach not more than a tea spoonful should be given at a time, and not too frequent- ly repeated. In the medical treatment of cholera infantum, the first in- dication is to discharge the acrid and offensive contents of the stomach and bowels. About fifteen or twenty grains of Ipecacuanha may be given at (he onset, and repeated occa- sionally in every stage of the disease, unless we except those cases where from a long continued spontaneous vomiting, (he strength is greatly reduced, the pulse feeble, and the heat has receded from the extremities. If an emetic is deemed improper, a dose of calomel adapted to the age and strength of the patient will produce the happiest effects ; and in many instances calomel and Ipecacuanha conjoined, about three or four grains of each will be found of singular efficacy in ex- pelling the offensive contents of the stomach and bowels. After the first passages are sufficiently cleansed, opium should be added to the calomel, and this forms one of Ihe most efficacious and powerful remedies that can be prescrib- ed. Experience has evinced, that these two active medi- cines correct, regulate, and soften the powers of each other. The proper proportion of this compound is three parts calo- mel to one of opium ; the dose of which, and frequency of repetition must be varied according to existing circumstan- ces. About half a grain of the compound intimately mixed, may be given to a child eighteen months old, and repeated every three, four, or six hours according to the urgency of the symptoms and the effect produced. It may be formed into pills wilh mucilage of gum arabic, or mixed wilh a few grains of prepared chalk. If the patient should be inclined to be costive, magnesia may be freely administered ; or a few grains of jalap may be added to the calomel, or a full dose of Ihis last given and followed by a dose of castor oil. When constant looseness prevails, absorbents are indicated, as lime water, and prepared chalk, or a few drops of laudanum may OF THE DISEASES OF CHILDREN. 237 be combined in a chalk julep with peppermint. A solution of the alkaline salts of tartar, or soda, will in most cases be extremely useful in correcting acidity in the stomach, and mild carminatives, as infusions of aniseed, caraway, and calamus aromaticus, will tend lo relieve symptoms of flatu- lency. Demulcent and diluting drinks, as infusions of marsh- mallows, the shavings of hartshorn, and gum arabic, wilh cinnamon, together with clysters of mu((on brofh or of starch, wi(h a few drops of laudanum, are among (he remedies often employed, and they may have their use. Great advantages may be derived from external remedies applied to the abdo- men, (hese are warm or tepid bathing, flannels dipped in in- fusions of bitter and aromatic herbs, or in warm spirits or wine. To these should be added friction, rubefacients and blisters. The tincture of flies of greater or less strength, is admirably calculated to answer the double purpose of rube- facient and vesication, and should in no case of severity be omitted. In the advanced stage of cholera infantum, when all acrid and offensive substances have been entirely evacuated from the bowels, astringent medicines become necessary, one grain of alum given two or three times in a day has been ad- ministered with great success, and sugar of lead in doses of half a grain for a child a year old, and repeated according to the exigency of the case, has also effected cures, but these are to be cautiously employed. Catechu is a mild but ex- cellent vegetable astringent, and may be administered in this disease, either in tincture or infusion with a prospect of su- perior advantage. In many instances of cholera infantum, a considerable ine- quality as (o (he heat of the different parts of the body is observable. Those parts of the body which are heated be- yond the natural standard, should be exposed to a stream of cold air several times in a day, and should be washed with vinegar and water moderately cool by means of a spunge. When the head is unusually hot, attended with redness of the face and eyes, and delirium, that part should be fre- quently washed in the coldest water. If the extremities are too cold, they should be covered with flannel, and sinapisms applied to the feet. Another remedy to be mentioned, is the injection of cold water into (he intestines after their offen- sive contents have been thoroughly evacuated ; this is said to be of superior efficacy as an anodyne, sedative, and an- 238 OF THE DISEASES OF CHILDREN tispasmodic When the force of the disease has been sub dued and a slate of convalescence commenced, the vegeta- ble tonics, as decoctions of Ihe bark of cinchona, angustura, columbo, with cinnamon, and wine and brandy, will have the effect of restoring the healthy state of the system. But in every instance where the measure is practicable, the" ex- hausted patient ought (o be removed inlo (he country for the benefit of fresh air, which is of the utmost importance. It is mentioned in Med. Repos. Vol. I. New Series, that a strong decoction of a plant called Erigeron Canadense, or Fleabane hn« proved an effectual remedy in this disease.* Canker of the Mouth. Many physicians have doubled the existence of this complaint, as a distinct disease from aphthae, and have ridiculed the term, as the peculiar invention of the nursery, where the disorders of infants often receive the most pre- posterous appellations. Practical authors have given it the significant name of Ulcuscula Oris, by which it is more gen- erally known. It makes its appearance about the time of teething, and more especially in severe cases of diarrhaea and cholera infantum. It commences wilh little white cir- cular vesicles, with a red line surrounding their basis, and oc- cupies the tongue, gums, and the inside of the cheeks. These vesicles are easily rup(ured, and by running together, the part beneath becomes ulcerated, and discharge a quantity of thin foetid matter. It is frequently attended with an unu- sual discharge of saliva; and a very foetid breath. Occa- sionally from the very commencement, there is some degree of inflammation of the gum, attended with pain, and a remarka- ble soreness. Such is the tenderness of the mouth, in many cases, that the infant cannot be induced lo take the breast, or the mildest liquids, even when the calls of hunger are ur- gent. It has been known to extend to the oesophagus, and throughout the whole alimentary canal, and even the anus becomes affected in the same manner, and we frequently hear nurses and women express their apprehension of ser'r- ous consequences from the " inward canker." This affec- tion is not difficult to cure excepting in its worst form. The * Dr. James Mann has published a valuable treatise on this disease which obtain- ed the Boylstonian prize, and which is well deserving the perusal of practitioners OF THE DISEASES OF CHILDREN. 239 bowels are to be kept open by gentle laxatives, Ihe strength supported by a good diet, and attention paid to cleanliness. To slop the progress of the ulcers, local applications are in- dispensably necessary. The mouth may be frequently washed with an infusion of gold thread ; and the wake-robbin paste recommended for aphtha may also be used. In all ulcerations of the mouth much benefit will be derived from (he application of borax, if used in sufficient quantity. It ought (o be applied in (he form of satorated solution, or re- duced to a fine powder and mixed wi(h honey, so as to form a (hick substance and freely applied. The detergent gar- gle described below will be found more effectual than any other with which we are acquainted. But it remains to be mentioned (hat calomel surpasses in efficacy all olher reme- dies which I have ever employed. A few grains of this, either in dry powder by itself, or mixed with honey, if ap- plied to the tongue, will be carried to the ulcerated surfaces and its good effects will soon be manifested. The applica- tion may be repeated several times in a day, and if swallowed no injury will ensue from that circumstance. As a complete remedy for canker of the mouth I have the fullest confidence in (he efficacy of (he sophora (inctoria, mentioned in the Appendix. Let a decoction of the root be used as a gargle, and freely taken internally and it will answer every purpose. Of the Croup. There has prevailed a great diversity of opinions, among practical writers, respecting the seat, the peculiar nature, and treatment of this disease. Nosologists have described it under the various appellations of Cynanche Trachealis, Cynunrhe Stridula, &c. ; and in every country it has also obtained a vulgar name by which it is generally known. In Scotland it is called croup ; in Ireland choak, or stuffing; in England the rising of the lights; in the southern section of the United States hives; and in many parts of New- England it has received the name of quinsy. But quinsy is considered by nosologists, as a generic term, and appli- ed to e\ery inflammation of the internal fauces, of which the complaint under consideration is only a species. There is no just foundation for dividing the croup into two species, which some writers have denominated inflam- matory and spasmodic : neither is there any practical utility 240 OF THE DISEASES OF CHILDREN. in such a division. It is probable lhat in the greatest num- ber of cases, these two states are combined in a certain de- gree, and happily IhoBe means which are acknowledged the most effectual in counteracting inflammation, are such rem- edies as possess powerful antispasmodic virtues. The only distinction of species, which we shall admit as proper, is the idiopathic and the symptomatic. The disease is known by the latter appellation when it succeeds to the malignant sore throat, scarlatina, measles, small-pox, putrid thrush, a common catarrhal affection, pneumonic inflammation, or the acute rheumatism. But it is only in its idiopathic form that we are to consider in this place, when the disease is prima- •rily and exclusively local, and confined to the mucous mem- brane of the trachea, bronchia?, and surface of (he lungs. It often commences suddenly without any premonitory symptoms ; or the previous indisposition is so short and in- considerable as scarcely fo attract observation. Under whatever circumstances it may occur, it is an inflammatory affection of the mucous membrane of the trachea and la- rynx, often extending throughout the whole of the windpipe, and a considerable part of the surface of the lungs, produc- ing a lymphatic incrustation,* which is sometimes vomited or coughed up in detached portions. Whether the attack be sudden or more gradual, it is ac- companied with the common febrile symptoms, which, in infants incapable of communicating their feelings, may be discovered by the heat of the skin, thirst, restlessness, and nausea. In many cases for several days previous to its in- vasion, the child will appear drowsy and inactive, the eyes watery, inflamed, and heavy, the pulse frequent, the breath- ing shorter and quicker than natural, and attended with a hissing noise. This peculiarity in the sound of the respira- tion is more observable when the child first awakes, at which time it will be seized with an unusual hoarse, shrill, dry cough. The disease is frequently epidemic, but never, as has been supposed by many physicians, contagious. It most com- monly occurs during the variable weather of autumn and spring, but more rarely in the severe cold of winter, or the * Dr. J. Jackson, of Boston, has communicated several cases of dissection, in which "the peculiar sound of Croup was exceedingly evident," where tliis preter- natural membrane of coagulable lymph was not present in the larynx. See New- England Journal of Med., &c. Vol. I. p. 3S3. OF THE DISEASES OF CHILDREN. 241 mild and genial warmth of summer. But solitary cases have been witnessed \h every season, if at the lime, there pre- vailed much dampness, with an atmosphere alternately warm and cold. From these facts it may be inferred, that the application of cold is the general cause which produces the disease. It has likewise been observed to be peculiar to certain families ;—that children under six months are not so liable to this complaint, as they are after that period to the age of eight or ten years;—that it most frequently seizes the ruddy and robust;—and that those who have once su'i*- ered an attack are peculiarly liable to repeated returns of the disease. The duration of a fit of croup is various ; in a few in- stances it proves fatal within twenty-four or thirty hours af- ter the attack ; in other cases its fatal termination has been prolonged to a week. The unfavourable symptoms are, vio- lent fever, a permanent dyspncea, great anxiety, frequent cough without expectoration, and the voice becoming more shrill and sonorous. When if proves fatal it is generally by suffocation, induced either by a spasm of the muscles of the glottis, interrupting the passage of the air, or a preternatural membrane obstructing the windpipe. Notwithstanding it is an inflammatory affection, it very seldom ends in suppura- tion or gangrene. Practical authors have differed widely in their opinions with regard to the mdde of treatment which is to be pursu- ed in the cure of the croup. Some physicians have relied entirely upon antispasmodic medicines; while others have rejected them as useless, and have given calomel in doses almost incredible to be believed.* A few practitioners have had recourse to blood-letting, which they advise to be carried to that degree of profuseness which will produce deliquium. This practice has been opposed by those who dread the debilitating effects which succeed to bleeding children freely. Venesection, emetics, and the warm bath have been employed by English physicians in the first attack of this disease, with a view to obviate the inflammation, and * Dr. Stearns, of Albany, prescribed to a child of a year old 20 grs. of calomel with 8 grs. of the cerated glass of antimony ; and to a child of two years of age, he gave 25 or 30 grs. of calomel for a dose, with a proportionate increase of antimo- ny. See Coxe*s Med. Museum, Vol. V. p. 195. Dr. Bums assures us that 50 or 60 grs. of calomel are often given, and occa- sion all v above 100, to children in this disease without producing salivation. Vid. Prin Mud. 31 242 OF IHE DISEASES OF CHILDREN they recommend the use of antispasmodics during the re- mainder of the cure. Without attemptinc to refute, or to reconcile these discordant opinions, we shall divide the dis- order into three stages, agreeably to the plan of Dr. D. Ho- sack, of New-York,* and propose such remedies as are bcsl adapted to each of them. The first may be denominated the forming stage, in which is manifest the premonitory symptoms above described, when the affection is merely lo- cal. Perhaps the only marks of indisposition at this time will be a difficulty of breathing, which is generally attended with a wheezing noise; a peculiar hoarse, hollow shrill couc;.'es for the practice will not deny ; nor that the indiscriminate employment of it, especially in the last stage of typhus fever is to be considered as an abuse of the medicine and altogeth- er inadmissible. This subject will now be dismissed by quoting the con- cluding paragraph of Dr. Warren's excellent treatise. " No instance, I believe has ever been afforded within the whole compass of medical experience, of a medicine of equal activity, having been so thoroughly tested in different coun- tries, and in all forms and degrees, as mercury. If so des- tructive lo the constitution as some have represented, it would long since have been condemned by the experience of hysicians in those countries in which it has been most ex- ibited. That salivation increases the irritability of the system, and may sometimes have laid the foundation of chronic disease may be admitted ; though a suspicion of it ought not to prohibit the use of it as an excellent remedy in some of the above diseases in the hands of the skjlful. But this circumstance should be improved to enforce caution it: practice." Consistently with his views of discarding stimulants in fe- vers, Dr. Gallup has condemned in strong terms the employ- ment of opium in any form. Although the stimulant pow- ers of opium are well known to every practitioner, the ad- ministration of it has been sanctioned by the highest author- ities ; and Dr. Rush, that very accurate observer, emphati- cally said, " that those physicians enjoy but little pleasure in practising physic, who know not how much of (he pain and anguish of fevers of a certain kind may be lessened by the judicious use of opium." However improper the stimulant 288 OF FEVERS IN GENERAL effects of this drug may appear, under circumstances of high inflammatory action, it will not readily be dispensed with in fevers of a low type, by those who have experienced its ma- ny advantages in mitigating pain and anguish, inducing repose. allaying irritation, and restraining evacuations. As there are distinct kinds of fever, each requiring a diff- erent mode of treatment, and as much depends on the abili- ty of the physician to discriminate between (hem, without which such errors may be committed at an early period, as to render all subsequent attention and skill unsuccessful, we shall proceed to discourse in the ensuing chapters, on the different species, and to point out the appropriate method of treatment. CHAPTER II. INTERMITTENT FEVERS, OR AGUES. THIS fever in its most regular form consists of repeated paroxysms, the patient during the intermediate period en- joying apparently a state of good health. From the shiver- ing which commences the fit, the disease has been called ague, and when it recurs every day, it is termed a quotidi- an, when every alternate day, or once in three days, forty- eight hours intervening, a tertian, and when on the fourth day with an interval of seventy-two hours, it is called a quartan. The common people denominate the quartan a third day ague, and the tertian, a second day ague, but as physicians reckon the day on which a disease commences the first; and the third day after, the fourth of the disease, the above terms are correctly applied. When these fevers* arise in the spring of the year, they are known by the name of vernal, and when in autumn they are called autumnal. They often prove obstinate and are of long duration in warm climates; frequently resisting every mode of cure, they degenerate into other chronical diseases, particularly dropsical swellings and enlargements of the liver or spleen. From a peculiar susceptibility induced in the system by this fever, the patient is liable to repeated renew- als of it during a long period when exposed to the influence of the original exciting causes. Vernal agues most readily yield to medicines, and the tertian is the most common and easily cured. The miasmata or effluvia arising from putrid stagnant wa- ter, or marshy ground, when acted upon by heat, occasion- ing putrefactive decomposition, is generally acknowledged to be the mosfc frequent cause of this fever. This is evi- dent from its prevalence in rainy seasons, and in those coun- tries which abound in stagnant ponds, and in low swampy and marshy situations. Intermitting fevers may also be oc- 37 290 1NTERMHTEN 1 FEVERS, OR AGI ES. casioned by whatever relaxes the solids, diminishes the pers piration, or obstructs the circulation in the capillary vessels; such as a watery poor diet, great fatigue, long watching, grief and anxiety, exposure to a moist or cold damp atmos- phere, lying upon damp ground, especially during evening dews, the suppression of accustomed evacuations, and the repulsion of eruptions. Each paroxysm consists of three parts, denominated the cold, the hot, and the sweating stages. The cold stage commences with languor, a sense of debility and sluggishness in motion, frequent yawning and stretching, and an aversion to food; sometimes a vomiting, with pain in the head, back and limbs. The face and extremities become pale, the feat- ures shrink, the bulk of every external part is diminished, and the skin over the whole body appears constricted, as if cold had been applied to it. At length the patient feels very cold, and universal rigours come on, together with increased pains in the head, back, loins, and joints, nausea and vomit- ing of bilious matter; the respiration is small, frequent, and anxious ; the urine is pale; sensibility is greatly impaired; the thoughts are somewhat confused ; and the pulse is snail, frequent, and often irregular. These symptoms abating after a short time, the second stage commences with an increase of heat over the whole body, redness of the face, dryness of f he skin, thirst, pain in the head, throbbing in the temples, anxiety and restlessness; the respiration is fuller and more free, but still frequent; the tongue is furred, and the pulse has become regular, hard, and full. If the attack has been very severe, delirium will often ensue. When these symptoms have continued for some time, a jaoisture breaks out on the forehead, and by degrees be- comes a sweat, and this, at length, extends over the whole body. As this sweat continues to flow, the heat of the body abates, the thirst ceases, the urine deposits a sediment, res- piration is free and full, and most of the functions are res- tored to their ordinary state : the patient is, however, left in a weak and wearied condition. After a specific interval ac- cording to the species of intermitting fever, the paroxysm again returns, commencing as above described. When the paroxysms are of short duration, regular in their recurrence, and leave the intervals quite free, we ex- pect a speedy recovery; but when they are long, violent, INTERMITTENT FEVERS, OR AGl'ES. 291 and attended with much anxiety and delirium, the event may be doubtful. The employment of medicine is seldom requisite during the cold fit of an ague, but warm drinks should be freely used for the purpose of promoting sweat, which is the nat- ural crisis of the disease. These may consist of water-gru- el, camomile or thoroughwort tea, and wine whey acidulated with the juice of lemons or oranges. During the intervals of the fits, the patient's food ought to be nourishing, but light and easy of digestion ; such as broths made of the ten- der meats, especially beef-tea, sago, arrow root, and light pud- dings. He may likewise drink frequently of infusions of bitter herbs, as wormwood and thoroughwort. If we can increase the strength, and support the natural heat during the intermission, we prevent the return of the cold fit and all the subsequent train of symptoms. In this view exercise is of indispensable necessity ; however strong the disposition to indolence, it should on no pretence be in- dulged. If riding in the open air cannot be accomplished, walking through the house as much as the strength will per- mit ought to be constantly encouraged. It is an opinion among some persons, that an ague proves salutary to the constitution, and in expectation of such event, the disease is allowed to take its course for a considerable time without the application of medicine. It must be confessed that persons of a bad habit of body, and whose natural strength has been impaired by a long con- tinuance of some chronic complaint, have experienced a fa- vourable change in the constitution by repeated shocks of an intermittent fever. But such complaints are probably sus- ceptible of cure by means far less severe, and not injurious to the constitution. When the ague is properly formed, and the patiept has undergone several fits of shaking and sweating, the curative remedies should be immediately adopted. Dr. Trotter, of the British navy, has found by his experi- ence, that a proper dose of opium taken at the approach of an attack will effectually prevent the cold fit. His method is to give thirty drpps of tincture of opium (liquid laudanum,) to an adult, and if it do not bring on some warmth in the space of ten or fifteen minutes, from twelve to twenty drops more are given. He never had occasion to go beyond sixty drops, for in no case did the remedy fail to give relief in the 2iJ2 INTERMITTENT FEVERS, OR AGUES space of an hour. As soon as any symptoms indicated another paroxysm, the tincture of opium was repeated in the same manner as in the former fit, and always with equal suc- cess ; so that the patient seldom experienced much shaking or trembling. Another novel remedy is that of compression of the cir- culation in the extremities by means of a tourniquet or liga- ture. Mr. G. £##*> surgeon in the British navy, relates the curious farttjk that in several instances he applied a tour- niquet on one thigh and one arm of opposite sides, at Ihe same time, and in two minutes after the application of the tourniquets, the shaking and other symptoms of the cold stage entirely ceased, and a mild hot stage was immediately induced, and the patient found himself quite relieved. Af- ter suffering the ligatures to remain on for about fifteen min- utes, (hey were removed and the cold symptoms did not return. When the tincture of opium, or the tourniquet have been omitted, or in the event of their failure when employed, the patient must resort to the usual course of remedies. Bleeding is improper in intermitting fevers, unless excessive heat, de- lirium, and other symptoms of inflammation appear at the beginning, and it is rarely necessary to repeat the operation. Essential advantages however, are to be derived from the early employment of e/netics in the cure of this disease ; na- ture herself points out the propriety of evacuations from the stomach and bowels, large quantities of bile and viscid phlegm being usually thrown off by vomiting. A dose of about thirty grains of Ipecacuanha will answer the purpose for an adult, and the operation should be promoted by drinking freely of warm camomile tea or water-gruel. The vomit ought to be taken two or three hours before a return of the fit is expect- ed, and it may be repeated in two or three days if necessary. Emetics not only cleanse the stomach, but increase the pers- piration, and all the secretions, and sometimes cure inter- mitting fevers without the assistance of any other medicine. After the operation of an emetic, some suitable cathartic medicine should be administered during the intermission, that its operation may be finished before the next return of the fit. Either rhubarb, jalap, extract of butternut, or Glaub- er's salt, will be found to answer the desired purpose, and it may be useful to give a grain of opium, or thirty drops of laudanum after the operation of both the emetic and ca- thartic. INTERMITTENT FEVERS, OR AGUES. 293 The stomach and bowels having been properly cleansed, and the perspiration aird other secretions rendered free, the patient should commence taking the cinchona, or Peruvian bark, as the most efficacious remedy with which we are ac- quainted. It is to be observed that the benefits arising from this medicine, depends chiefly upon a large quantity being ad- ministered in a short time. Several ounces of bark given in a few days, will do more than as many pounds taken in the course of some weeks. Let it be a rule to throw in the medicine in such doses, and as often as the stomach will receive it. This valuable medicine is to be given in the simple form of pow- der, in preference to any of its preparations. It may be taken in a glass of Port wine, or mixed in a cup of milk, as may be most agreeable to the palate and stomach. About one ounce of good powdered bark will, in general, be found sufficient to prevent the return of the ague and fever, when taken in (he interval. From forty to sixty grains may be taken at a time, and in a quotidian, or every day ague, a dose ought to be taken every two hours ; in a tertian, every three hours ; and in a quartan, every four hours during the intermission. If the patient find it difficult to take the medi- cine in such quantify, he may diminish the dose and take it more frequently. For younger persons and children, the dose must be proportioned to their age. Although by the use of the bark another fit of the ague has been prevent- ed, the employment of the medicine is by no means to be immediately discontinued, but it must be taken in smaller quantities for several d.iys, or weeks after the disease ap- pears to be cured, in order to secure against a relapse which so frequently occurs. Those who have once been troubled with ague, are peculiarly liable to a return of it during cold moist weather, and easterly winds, when the air is most fa- vourable to its production ; such persons ought at those seasons, lo fake the bark, or a preparation of it combined with aromatic bitters, as follow : one ounce of bark, one drachm of Virginia snake-root, two drachms of the outer rind of Seville oranges, and half an ounce of calamus aromaficus, or sweet flag roof. Or, take one ounce of the leaves and flowers of thoroughwort, half an ounce of calamus aromaficus, and of quass;a and orange peel, two drachms each. Let these ingredients be infused in a quart of brandy, or pure old cider, for three or four days, and afterwards filter the tincture, through paper ; about half a wine glass full of this 294 INTERMITTENT FEVERS, OH AGUES tincture may be taken twice in a day. The use of this medi- cine will also render the bark more efficacious in the cure of agues if taken at the same time. The bark may be ad- ministered in decoction or infusion, when it cannot be swal- lowed in substance. , When the stomach cannot bear the bark in any form, it may be given by way of clyster, which often proves success- ful; about a drachm of the extract of bark dissolved in a sufficient quantity of water, with the addition of a few drops of laudanum, should be injected every four hours. Child- ren have been cured of a:;ues by means of a waistcoat with powdered bark quilted between its folds, as they likewise have by being bathed frequently in a decoction of the bark. Bathing and rubbing along the spine of children with strong spirits, or anodyne balsam has often proved beneficial. When the hot fit of an intermittent is accompanied with symptoms which indicate considerable inflammation, whether in adults, or children, much benefit has been received from the use of the saline julep prepared as follows : take of salt of tartar, or carbonate of potassa, one drachm ; fresh juice of lemons, or sharp vinegar, three table spoonfuls: in less than a minute after they are mixed, or as soon as the effervescence ceases, add of mint water and common water, each two table spoonfuls with a bit of loaf sugar, or a little common syrup. To a child four or five years old three tea spoonfuls of this julep may be given every two hours. When the bark has a tendency to pass off through the bowels, a few drops of laudanum may be added to each dose, and if costiveness be produced, a few grains of rhubarb may be conjoined to the bark occasionally. In case of much in- flammatory diathesis, and especially if cough and pain in the side attend, nitre, or carbonate of potassa, should be conjoin- ed, and the application of blisters will be proper. Dr. Rush affirms that in all cases of autumnal intermittents in which bark did not succeed after three or four trials, the applica- tion of blisters to the wrists seldom failed of rendering that remedy efficacious; but if blisters had been neglected, or applied without effect, and the disease had been protracted into the winter months, he generally cured it by means of one or two moderate bleedings. It was the praotice of Dr. Lind to give opiates in the hot fit of intermittents. It generally gives sensible relief to the head, abates the burning heat of the fever, and occasions a INTERMITTENT FEVERS, OR AGUES. 295 profuse sweat. And he has found that opium is the best preparative for the bark, occasioning such a salutary and co- pious evacuation by sweat, as generally to render a much less quantity of bark requisite. Adult persons may take fifteen or twenty drops of laudanum, half an hour after the hot fit has begun, and for a young child, two or three tea spoonfuls of the syrup of white poppies will answer the pur pose. Of the various species of bark now to be met with, a de cided preference is given to the yellow, as possessing vii tues far superior to the red, or any other species yet intro- duced into practice. The numerous other barks which have been introduced as substitutes for the Peruvian, areangustu ra, quassia wood, swietenia febrifuga, St. Lucia bark, and the bark of the willows, particularly the broad leafed willow. These are recommended with much confidence by those Europeans who have experienced their efficacy, but in the United States they are not much employed. The cold bath between the fits has sometimes been successful in the cure of obstinate agues. The sulphate of zinc, (white vitriol) is said to have been administered in agues with success, and the sulphate of copper, (blue vitriol) in doses of a quarter or half a grain every four or six hours, has proved very effi cacious in some cases of intermittents of the most obstinate nature. But of all the medicines introduced of late years, no one is more highly extolled than Dr. Fowler's solution of white arsenic. It is undoubtedly a very powerful medicine, and intermittents of the most obstinate character have in nu- merous instances yielded to it. The peculiar activity of the arsenical solution however, is such as to require much cau- tion and very precise rules in its administration, in order to obtain its beneficial effects with safety. The most proper manner is to begin with four drops for an adult, and add one or two to every morning and evening dose, until the patient experience a peculiar sensation about the eyes or skin of the face, somewhat similar to that excited by a cobweb adher- ing to the skin. This sensation being the criterion, should be continued by doses either diminished or increased, ac- cording to its effects on the system. The number of drops will seldom exceed twelve or fifteen, and eight days admin- istration of the medicine, will, it is said, generally be found sufficient for the radical cure of an intermittent. We have among our own productions numerous articles possessing in a greater or less degree, the tonic and astring- 296 INTERMITTENT FEVERS, OR AGl'ES. ent properties of Peruvian bark, and several of these hare been successfully employed in the cure of intermittents. The one which first demands our attention, as being in the highest repute, is the Eupatorium perfolialum, or common thoroughwort. It appears by an inaugural dissertation, by Dr. Andrew Anderson, of New-York, (hat the leaves and flowers of this plant, possess properties exactly similar to the Peruvian bark, and in addition to his own, he adduc- es the authority of many very respectable practitioners, par- ticularly Drs. Barton and Hosack, in proof of its superior efficacy as a remedy in intermitting and remitting fevers. The author relates six cases of intermittent fever in which after a single evacuant, the thoroughwort effected radical cures, and adds, that the same remedy was administered in almost all the instances of intermittents that occurred in the New-York alms-house in the year 1812, to the exclusion of the Peruvian bark, and with uniform success. It was given either in decoction or in powder, from twenty to thirty grains every second hour during the intermission. See American New Dispensatory, 2d edition. It happens not unfrequently when intermittents have con- tinued a long time, whether much bark has been taken or not, that tumours are formed in some of the abdominal vis- cera, as the liver or spleen, vulgarly denominated ague cakes; these in general prove difficult of cure, but will finally yield to a course of mercuryr if judiciously conducted. Dropsi- cal complaints are also sometimes occasioned by the long continuance of intermittents, but may be removed by the use of the bark, combined with stomachic bitters, diuretics, and chalybeates. It is deemed altogether unnecessary to mention the numer- ous empirical and whimsical remedies which have been band- ed down by popular tradition, or proclaimed by persons of the pm ent day, for the cure of intermitting fevers; since, amidst the great abundance of remedies of unquestionable efficacy, no rational person can be so regardless of health and life, as ever to trust for a cure, to nostrums, or to any thing of a doubtful or insignificant nature. The inhabitants of our southern states, and of the low swampy situations on the Delaware river, &c. are peculiarly liable to the attacks of intermitting fevers, but those affected with it who resort to the salubrious air of New-England, ex- perience a speedy cure, and that frequently without the aid INTERMITTENT FEVERS, OR AGUES. 297 of medicine. To prevent the attacks of agues, or their re- currence when once cured, care should be taken to avoid the influence of the hot sun, and the damp air of morning and evening; a flannel shirt should be constantly worn next the skin and regularly changed once a week. The tincture prepared as directed in this chapter, will prove a valuable preventive if taken twice or thrice in a day. If fires are kept burning in the sitting rooms, mornings and evenings, during the damp seasons, they will be found use- ful by depriving the air of its unhealthy moisture, and keep- ing the walls dry. "By this practice" says Dr. Mease, " I have known the health of a family in Ihe swamps of Delaware, preserved during a whole summer while the neigh- bours were all afflicted by agues." Dr. Rush recommend- ed that fires should not only be kept in the house during the sickly months, but that large fires be made every evening of brush near the house between it and the spots from whence the exhalations are derived. This practice he observed, should be continued till Ihe appearance of two or three frosts; for frosts, as well as heavy rains in Ihe autumnal months, never fail to put a stop to the progress of intermittents. Since this chapter was completed, it has been announced in the New-England Journal of Med. and Surgery, Vol. IV- page 105, by Dr. Makesy of the British forces stationed at Castine, that common charcoal powder properly prepared, has been found by European physicians to be an efficacious remedy in intermittent and remittent fevers. The author mentions that in a village in Sicily one hundred and five cases were speedily cured by this new remedy, two or three doses of which being often found sufficient to interrupt the expected paroxysm and cut short the disease. From half a drachm or two drachms given three or four times during the intermission, or immediately before the expected paroxysm will in most cases prove sufficient. 3S CHAPTKIi III. THE REMITTENT FEVER. THIS fever receives its name from the appearances which it preserves through its progress, having affinity with both intermittent and continued fever, but seems more nearly al- lied to the former, and differs from the latter, by being at- tended with a remission or abatement of the febrile symp- toms at irregular periods, and of uncertain duration. The more closely however, the fever resembles a regular inter- mittent, the less is the danger of a fatal termination. This fever may in general be ascribed to similar causes with those of intermittents. It prevails most in low marshy situations abounding with wood and stagnant waters. Where great heat and moisture are combined, remittents often have a malignant and putrid tendency and prove very fatal. They are most frequent when close and sultry weather quickly succeeds heavy rains, or great inundations. No age, sex, or constitution is exempted from the attack; but it chiefly seizes those of a relaxed habit, who live in low dirty habita- tions, breathe an impure stagnating air, and use a poor un- wholesome diet. Remitting fevers, in general, commence suddenly with weakness, lowness of spirits, yawning and stretching, pain and giddiness in the .head, with alternate fits of heat and cold. Sometimes the patient is affected with a delirium al the first attack. There is a pain, and sometimes a swelling, about the region of the stomach, the tongue is white, the eyes and skin frequently appear yellow, and the patient is often afflicted with bilious vomitings. The pulse is small and quick, but seldom full, and the blood when let rarely shews any signs of inflammation. In some patients there is a troublesome looseness, in others the opposite extreme. At length about the sixth or eighth day, a moisture appears over the surface of the body, when a remission of the febrile action ensues. It is impossible to describe all the symptoms THE REMITTENT FEVER 299 ok this disease as they vary according to the situation, the season of the year, and the constitution of the patient. They may likewise be greatly changed by the method of treatment, and by many other circumstances too tedious to mention. Sometimes the bilious symptoms predominate, sometimes the nervous, and at other times the putrid. Nor is it at all uncommon to find a succession of each of these, or even a complication of them at the same time, in the same person. In remitting fevers the patient is always to be considered in considerable danger, particularly in warm climates, where it usually goes through its course in the space of five or six days ; but in colder ones, it is frequently protracted to twelve or fourteen days. The principal object in the cure is to bring it to a regular remission, which greatly facilitates a favourable termination. In cold climates, and in a very early stage of the disease, when the patient is of a full plethoric habit, the pulse full and hard, the heat intense, the* breathing difficult, or the head much affected with stupor or delirium, it will be necessary to have recourse to bleeding ; but in warm climates, when few or none of these symptoms are present, this evacuation may be dispensed with, as it may prove injurious by weakening the patient and prolong- ing the disease. It will however in all cases be requisite to cleanse the stomach by giving an emetic of about twenty grains of Ipecacuanha and two of tartar emetic, which may be repeated at proper intervals if the sickness or nausea continue. After the operation of this, the body must be kept open by mild laxative medicines, as an infusion of sen- na and manna, with tamarinds, prunes, cream of tartar, or Glauber's salts, which may be taken in small doses every hour till a stool is procured. If the following mixture be taken every few hours, it will be found a valuable laxative in this fever. Take good powdered rhubarb, twenty grains, salt of tartar, or of wormwood, ten grains, lemon juice, or sharp vinegar, two table spoonfuls. Let this be given in the act of effervescence, or the powder may be taken in wafer- gruel and the acid swallowed immediately after. In order to reduce the feverish heat, or to bring on regular intermis- sions, the saline julep mentioned in the cure of the intermit- tent fever should be given with the addition of one eighth, or one quarter of a grain of tartar emetic in each dose. As soon as a distinct remission is perceived, Ihe Peruvian bark 300 THE REMITTENT FEVER must be immediately given, in the quantity of half a drachm or upwards, and repeated every two hours ; by which the usual increase of the fever may be prevented, and the dis- ckp entirely subdued. In domestic practice ihe powder ol thoroughwort may be substituted for the Peruvian bark, as directed in the last chapter with a fair prospect of success. Fowler's arsenical solution in doses regulated as in inlermit- teuts, is by many practitioners considered as a valuable rem- edy in this fever. In warm climates, calomel is considered a valuable remedy in this species of fever to deterge and evacuate feculent matter from the bowels; where there is much nausea or vom- iting, it may be retained on the stomach when all other purg- atives might be rejected. Where frequent vomiting prevails, antimonials must be omitted, but the saline mixture mention- ed in the last chapter should be frequently administered in a state of effervescence, adding to each dose ten drops of laudanum ; flannel cloths wrung out from a decoction of chamomile flowers, or mullein, and bruised poppy heads, with some spirits, should be constantly applied over the re- gion of the stomach, and if the vomiting still continue, a large blister ought to be applied to the same part. The pa- tient during the continuance of the vomiting should swallow as little drink as possible, and only moisten the mouth and throat ; for whatever is received into the stomach will be re- jected with considerable violence, by which the disease is strengthened and the patient exhausted. The cold affusion when applied agreeably to the rules pre- scribed in page 273, has been found productive of the most decided good effects in remittent fevers. This should be employed at the height of the paroxysm when the sensations of heat are violent, the head-ach severe, and the skin dry. The effects to be observed from the cold affusion, are an al- leviation of the violent symptoms, a tendency to quiet sleep is soon induced, the skin becomes moist, and a distinct re- mission follows. Where from great debility of the patient or other cause, it may not be deemed prudent to resort to the cold affusion, tepid wafer may be employed in a similar manner, or the sponging the body over with cold water and vinegar, will be found to induce grateful sensations, and afford essential re- lief. The diet of the patient must be suited to the degree and symptoms of the disease. If considerable inflammatory ac- 1 HE REMITTENT FEVER. 301 tion appear, every thing of a heating quality both in food and drink must be avoided ; but when nervous or putrid symptoms occur, the patient must be supported with such diet and cordial liquors as are usually directed in those fe- vers. Wine given with the bark has often excellent effects after distinct remissions have become manifest. It is of great importance that the patient be kept clean, cool, and perfectly quiet. Fresh air ought to be frequently admitted into the apartments by the windows and doors, and the floors should be sprinkled with vinegar. Both linen and bed clothes, should be frequently changed, and the excre- ments immediately removed ; for too much attention cannot be given towards keeping the air of the chamber pure and untainted. Bilious Remitting Fever. When a continual remitting, or intermitting fever is ac- companied with a frequent and copious evacuation of bile either by vomit or stool, the fever is denominated bilious. .A fever of this character frequently exists in the United States, and from the season in which it is most prevalent it hag been termed autumnal fever. According to Dr. Rush, it prevailed in Philadelphia in the autumn of 1780. It came on with rigour, giddiness in the head and faintness. The fever was accompanied with acute pains in the head, eye-balls, back, and limbs, sometimes affecting the neck and arms with unusual soreness of the flesh resembling rheumatism. So exquisitely severe were the pains and soreness in every part of the body, that the patient could not lie in bed, and from these circumstances the disorder obtained the name of the Break-bone fever. A nausea and sometimes a vomiting attended ; the pulse was quick and full, but seldom hard. The tongue and skin were generally moist, and the former was tinctured of a yellowish colour. Remissions, or at least, exacerbations were observed morning and evening. A rash often appeared on the third and fourth day, which proved favourable. When the fever did not terminate before the fourteenth or twentieth day, it assumed in its progress the usual symptoms of the typhus gravior, or mitior of Dr. Cul- len. Dr. Rush treated this fever by giving a gentle vomit of tartar emetic, and if given while the fever was in its form- ing state, it frequently effected an immediate cure. If a nau- ;jo2 THE REMITTENT FEVER se i, or ineffectual attempt to vomit continued after the exhi- bition of the tartar emetic, he gave a second dose of it with the happiest effects. He next gave gentle doses of Glaub- er's salts and cream of tartar,* or of the butternut pill, so as to procure two or three plentiful stools. In every in- stance the patients found relief by these evacuations, espe- cially from the pains in the head and limbs. Small doses of salts and tartar emetic were afterwards administered, to promote perspiration, and to evacuate the bile as fast as accumulated. He recommended the use of pediluvia every night, and for drinks, sage and balm teas, apple and tamarind water, weak punch, lemonade, and wine whey. On the third or fourth day, the severity of the symptoms abated, with a sweat, which was diffused over the whole body, and distinct remis- sions occurred. Though the pulse remained quick, a few doses of the bark taken in the interval, seldom failed to pre- vent a return of the fever. After the necessary evacuations had been made, opium was found to produce the best effects < in relieving pain, procuring sweat, and remission of the fe- ver. If the fever continued beyond the third or fourth day without an intermission, Dr. R. had recourse to blisters, which produced the most immediate good effects. Where the fever did not yield to blisters, and assumed the form of typhus, the medicines usually employed in that species of fever were given. The convalescence from this disease, was marked, says Dr. R. by a number of extraordinary symptoms which ren- dered patients the subjects of medical attention for many days after the pulse became perfectly regular, and after the crisis of the disease. A bitter taste in the mouth, accompanied by a yellow col- our on the tongue, continued for near a week. Most of those who recovered, complained of nausea, and a total want of appetite. A faintness, especially upon setting up in bed, or in a chair, followed this fever, and a weakness in the knees was universal. These complaints were removed by the tinc- ture of bark, and elixir of vitriol, with nourishing diet, and gentle exercise in the open air. * Dr. R. observes, cream of tartar renders the purging salts less disagreeable to the taste and stomach ; but that lemon juice and loaf sugar, added to a solution of salts, form a mixture that is nearly as pleasant as strong beverage. CHAPTER IV. OF CONTINUED FEVERS. Of the Inflammatory Fever, or Synocha. THE ardent or inflammatory fever, is attended w;.*h symp- toms denoting general inflammation in the system, oy which it may be distinguished from either the nervous or putrid fever. It makes its attack at all seasons of the year, but is most frequent in the spring and beginning of summer, and it seizes persons of all ages and habits, but more particularly those in the prime of life, with strong elastic fibres, and of a plethoric constitution. This acute fever may be occasioned by sudden transition from heal to cold, swallowing cold liquors when the body is heated by exercise, too free use of spirituous liquors, violent passions, exposure to the heat of the sun, the suppression of habitual evacuations, and the sudden repulsion of erup- tions. It commences with chilliness, and a sense of lassitude and inactivity, succeeded by vertigo, and pains over the whole body, particularly in the head and back, redness of the face, great restlessness, intense heat and unquenchable thirst, difficult breathing, nausea and sickness, a foul tongue, and loss of appetite. The skin is dry and parched, the eyes appear inflamed, and are incapable of bearing the light, the urine is high coloured, and the pulse is full, hard, and quick, beating from ninety to one hundred and thirty in a minute. In some instances after the symptoms have con- tinued for some days they assume those of typhus, so that the disease obtains the form of Synochus. The blood when drawn exhibits a yellowish or buffy crust on its surface. If the fever runs very high, or continues many days, with delirium, subsultus tendinum, picking at the bed-clothes, la- borious respiration, hiccups, cold clammy sweats, and invol- untary discharges by stool and urine, the event will certain ly be fatal. 304 OF CONTINUED FEVERS. From the danger with which this fever is attended, it will appear advisable to procure the best medical assistance as soon as possible, that the proper evacuations, and other reme- dies may be applied before the strength of the patient be too much exhausted. If the physician find the pulse frequent, full and hard, and the patient young and plethoric, he will not hesitate to draw about eighteen ounces of blood from a large orifice, remembering that one large bleeding at the be- ginning, will be more beneficial than repeated small ones af- terwards. He will judge of the propriety of another bleed- in"- in a small quantity, from the appearance of the blood, and the abatement of the inflammatory symptoms. Should the patient be too much reduced to bear a considerable loss of blood, and the head is much affected with severe pain, or delirium, topical bleeding by the application of three or four leeches to the temples, will be found beneficial. A powder or pill consisting of calomel, four parts, opium, one part, given in doses of about three grains every six hours, will tend greatly to open the secretions and to induce a so- lution of the fever. If nausea or sickness prevail, the stomach should be re- lieved by exciting a gentle vomiting, by the use of a solution of emetic tartar, in small doses every quarter of an hour, as- sisted by chamomile, or thoroughwort tea. In this fever cathartics will be found peculiarly useful. A few grains of calomel, made into pills with the extract of butternut, or a solution of Glauber's salts and manna, will effect the desired purpose without increasing the heat and irritation. Costive- ness may afterwards be obviated by a repetition of mild lax- atives, or by laxative clysters. The antiphlogistic regimen, should be strictly observed through the whole course of this fever. The patient's food should be light and easy of digestion, as preparations of bar- ley, oatmeal, sago, and arrow root, roasted apples, &c. His drink should be barley water, linseed tea, toast and water, apple tea, whey, thin gruel, and lemonade. If from the dic- tates of nature, the patient should manifest a longing, or strong desire for some particular kind of food, or drink, he may be indulged in moderation, though it may seem in a de- gree improper. Bathing the legs and feet in warm water, is among the means to be frequently employed, and cleanliness, and a free circulation of air, ought never to be neglected. Acids of OF CONTINUED FEVERS. 305 all kinds, when sufficiently diluted, are refrigerant remedies of particular utility in all continued fevers. Besides the mineral acids, those from the vegetable class, as tamarinds, oranges, lemons, currants, apples, &c. may be mixed with various fluids, and will form a grateful and refreshing bever- age. Cream of tartar dissolved in hot water, will be of use as a cooling laxative, and fifteen grains of sal nitre, or sixty or eighty drops of sweet spirits of nitre, added occasionally to some of the drinks, will be found well adapted for the purpose of moderating the heat, and quenching thirst in this fever. It is a point of considerable importance, to determine the circulation to the surface of the body, and to excite a general perspiration. This is generally effected by Ihe use of the neutral salts, and the preparations of antimony, either separately, or combined as follows : take of salt of tartar or wormwood, two drachms, juice of lemons or strong vine- gar, four table spoonfuls, mint water, a gill, loaf sugar, half an ounce, mix them, and give three table spoonfuls with twenty-five drops of (he wine of antimony every four or five hours. Ten grains of sal nitre, may be added to each dose, when the heat and thirst are great, and the diaphoretic effect of these medicines, should be increased, by taking frequent small draughts of warm liquids, and by warm fomentations to the lower extremities. All attempts to excite sweating in fevers, by the common method of stimulant, heating and inflammatory medicines, will prove decidedly more injurious than beneficial. A partial sweating, confined to the upper parts of the body, instead of relieving, is almost sure to ag- gravate and prove hurtful. The patient should be keptqui&t in bed, and not covered with more bed clothes than is usual while in health. Should great oppression in breathing, or violent pains in the head, stupor, or delirium ensue, the application of a blis- ter near the part affected, will in general afford essential re- lief. Where there is any unusual coldness of the extremi- ties, with a sinking pulse, trembling of the nerves, &c. blis- ters must be applied to the ankles, inside of the legs, or thighs, and stimulating poultices, of mustard and vinegar, or of roasts ed coakum root, to the soles of the feet. The strength of the patient must now be supported, by a free use of cordials, as strong wine whey, sago, or arrow root gruel with wine, and the efforts of nature should be further assisted, by cam* phor, the volatile salts of ammonia, ether, compound spirits 39 30G OF CONTINUED FEVERS. of lavender, &c. Should the patient be troubled with vom iting, the saline draught ought to be taken in the act of effervescence, with the addition of eight or ten drops of the tincture of opium, and a few drops of the essence of pepper- mint to each dose. In case of great restlessness and want of sleep, where opium is deemed improper on account of much pain of the head or stupor, a pillow filled with hops, and laid under the patient's head, or a strong infusion or tinc- ture, drawn from the flowers and leaves of that herb, will probably have the desired effect, of procuring refreshing sleep. If about the tenth or twelfth day, the pulse becomes more soft, tongue more moist, and the urine begins to let fall a redish sediment, there is reason to expect a favourable is sue to the disease. Under these encouraging circumstances, or when the febrile symptoms are continued and kept up solely by debility, it will be requisite to administer some of the vegetable tonics, as the Peruvian bark, cascarilla, quas- sia, thoroughwort, &c. But these should be given at first in the form of decoction or infusion, and acidulated with the elixir vitriol. In the state of convalescence, the recovery of the patient is to be completed, by a perseverance in a res- torative and generous diet, with a moderate use of wine, a change of air, and the employment of daily exercise, care- fully avoiding all fatigue of body or mind. It has already been observed, that modern physicians, are much in the practice of employing the affusion of cold wa- ter over the body of the patient, for the purpose of moder- ating or abstracting the morbid heat in fevers. It is not to be expected that this powerful agent will be resorted to in all cases indiscriminately, nor is it to be recommended with- out first consulting a judicious physician. In almost every fever however, where no catarrhal symptoms, or inflamma- tory affection of the lungs are present, it will be perfectly safe and proper during the hot season of summer to wash and sponge the surface of the body with cold water, in the height of the paroxysms of heat. See directions for the application of this remedy, in the chapter on fevers in gen- eral, the remittent fever, and the two following chapters. CHAPTER V OF THE NERVOUS FEVER, OR TYPHUS MITIOR. THE slow nervous fever is distinguished by its effects on the nervous system; but it does not affect the habit so universally as the one last described. It principally attacks those of weak lax fibres ; who lead a sedentary life ; study much; and who indulge freely in enervating liquors. This fever may be occasioned by whatever depresses the spirits, or impoverishes the blood ; as grief, fear, anxiety, want of sleep, intense thought, living on poor watery diet, and unripe fruits ; and likewise by damp confined or un- wholesome air. It is often generated, and it proves most fatal in jails, hospitals, transport and prison ships, crowded barracks, work-houses, and the ill ventilated apartments of the poor. (See page 270.) Whatever debilitates the system, obstructs perspiration, or induces spasmodic stricture of the solids, contributes to the causes which produce nervous fevers. The autumn is the season in which this fever is usually the most preva- lent. " The nervous fever makes its first appearance with slight chills and shudderings, uncertain flushes of heat, and a sen- sation of weariness over the whole body, resembling that which is felt after great fatigue. It is commonly attended with a dejection of mind, and more or less of a sense of weight, pain, or giddiness of the head. A great numbness, or dull pain and coldness, affects the hinder part of the head frequently ; and likewise along the middle from the forehead to the back part. A sickness at the stomach and a loathing of food soon follow, without any considerable thirst, but oft- en with an inclination to vomit, which if it happens, brings up little else than insipid phlegm. These symptoms are commonly succeeded by some degree of delirium. " Tn this condition the patient often continues for five or six days, wilh a heavy, pale, sunk countenance ; seeminglv 308 OF THE NERVOUS FEVER, OR TYPHUS MITIOR hot very sick, and yet far from being well; restless, anxious, and commonly deprived of sleep, though sometimes very drowsy and heavy ; appearing to those about him actually to sleep, but is himself so insensible of it, that he does not acknowledge he has slept at all. " The pulse during all this time is quick, weak, and un- equal ; sometimes fluttering, and sometimes for a few mo- ments slow, perhaps even intermitting; and then, with a sudden flush in the face, immediately very quick ; soon af- ter which, it may again be surprisingly calm and equal. " The heats and chills are equally variable with the pulse : sometimes a sudden glow arises in the cheeks, while the tip of the nose and ears are cold, and the forehead at the same time in a cold dewy sweat. It is even common for high col- our and heat to appear in the face when the extremities are quite cold. The urine in this fever is commonly pale; fre- quently of a sherry or natural colour, containing either no sediment, or a kind of loose matter like bran, scattered up and down in it. The tongue at the beginning is seldom or never dry or discoloured, but sometimes covered with a thin whitish slime, but towards the crisis of the disease it often becomes dry, red, and chapped, or is with the teeth incrust- ed with a dark brown fur, though the patient scarcely ever complains of thirst. About the seventh or eighth day, the giddiness, pain, or heaviness of the head increases, with a constant noise in it, which is very disturbing to the sick, and frequently precedes a delirium." It frequently happens, that after the fourth or fifth day, the fever diminishes in its violence, and presents flattering appearances, but soon in- creases again, and assumes a more formidable aspect. " There is an irregularity in the exacerbations, which instead of the evening, sometimes appear in the morning. Profuse sweats frequently break forth all at once about the tenth or twelfth day, commonly coldish, and clammy on the extrem- ities ; often also very thin stools are discharged, and the pa- tient's strength is depressed, even to faintness whenever he attempts to sit up. " The whole nervous system is much affected with tre- mours and twitchings ; involuntary motions of the muscles and tendons arise, the patient picks at the bed-clothes almost incessantly, and either mutters to himself, or talks incoher- ently, and there is a dilatation of the pupils of the eyes. In most instances the patient grows deaf and stupid towards the OF THE NERVOUS FEVER, OR TYPHUS MITIOR. 309 end of fhis disease. It is not uncommon for them to languish eighteen or twenty days in this fever, but often it exceeds a month in duration, and there is no other evident crisis, than the urine becoming turbid, and depositing a sediment. " When about the fourteenth day the pulse becomes fuller and more slow, the tongue more moist, and respiration free, a gentle moisture appears on the skin, or a suppuration hap- pens in one or both ears, and large pustules break out about the lips and nose, a favourable termination of the disease may be expected. But if profuse evacuations by sweating or purging ensue, if the tongue when put out trembles ex- cessively, and there is a sinking of' the pulse, great incoher- ency of ideas, muttering, picking at the bed clothes, invol- untary discharges by urine and stool, starting of the tendons and hiccup, with almost a total loss of sight and hearing, death will soon close the scene." In some instances the access of this fever is so mild and slowly progressive, that medical attention is dispensed with for many days, and the patient is scarcely apprehensive of approaching serious indisposition. But when the fever is completely formed, it will in general pursue its course in des- pite of all our endeavours. The degree of violence, the du- ration, and the final issue, are greatly influenced by the diff- erent modes of medical treatment. It has been the practice almost invariably among former writers, to condemn the use of the lancet, as altogether inadmissible in this modification of typhus fever, but practitioners are daily becoming less te- nacious of the vital fluid ; and it has been asserted that ty- phus fever has often been marked with symptoms of inflam- matory excitement to a degree justifying depleting reme- dies, and that experience has evinced their utility. In the early stage therefore, if inflammation and excitability greatly prevail, such quantity of blood may be cautiously drawn as will be fairly proportionate to the strength of the patient and urgency of the symptoms. After this evacuation, it is in- dispensably necessary to clear the first passages of their crude and acrid contents, by the early exhibition of an eme- tic, which by the concussion it gives to the whole system, dissolves the morbid catenation and frequently terminates (he disease ; and in every stage of this fever, mild emetics may be exhibited as often as indicated with beneficial effects. Cathartics of calomel and jalap, or neutral salts and manna are next to be directed, and throughout the whole course of ■>iO OF lilF, NERVOUS FEVER, OR TYPHUS M1TIOR the disease, costiveness mu^t be obviated cither by mild lav atives or emollient injections. At bed time it will be prop- er lo direct an opiate,and its effects will be promoted if com- bined with camphor or with Ipecacuanha as in (he form of Dover's powder. These evacuating remedies having been applied it is a general and very efficacious mode of practice next to administer tartar emetic in solution, and calomel and opium in small doses. Let about one and half grain of the former, and one quarter of a grain of the latter be given eve- ry sixth hour, and if a very moderate degree of plyalism be induced it will tend greatly to open the secretions, hasten a restoration of the balance«of excitement, and shorten the du- ration of the fever. If the head should be considerably af- fected, it will be proper to apply a blister to the back of the neck or temples, and blisters should be applied to different parts, as circumstances may require. On some occasions when stupor, coma or delirium prevail, bathing the feet in warm water, with frequent washings .of the temples and whole head, when properly shaved, wilh cold water and vi:; °ar, or applying ether to these parts may be advantag- eously substituted for blisters. Shaving the head, and wash- ing it frequently with vinegar and wafer, and keeping it thin- ly covered, are refreshing and often afford considerable re- lief. As a diaphoretic medicine the neutral mixture, or spir- it of mindererus lo each dose of which, one quarter of a grain of tartarized antimony may be added, will be found beneficial if given a table spoonful for a dose, once in two or three hours. If nausea prove troublesome, omit the tar- tarized antimony, and add a few drops of laudanum and of the essence of peppermint to each dose. Should great irrita- bility of the stomach, and frequent vomiting attend, there is not perhaps a more effectual remedy than a large blister ap- plied over the region of the stomach, and sometimes it be- comes requisite to apply one on the inside of each thigh from which essential benefit will be derived. When there is a torpid state of the vessels of the skin, and the external heat is below the natural standard, it becomes a point of con- siderable importance to have recourse to artificial heat so applied as to effect an equable degree of excitement, and lo relieve the internal viscera from oppression. For this pur- pose the warm bath is frequently employed, but it is now supposed that dry heat possesses many advantages over (hat of moisture. The most eligible mode of applying heat OF THE JfER VOL'S FEVER, OR TYPHUS MITIOR. &l f to the surface of Ihe body is by means of the spirituous va pour bath, invented by Dr. Jennings. Another process for the purpose of imparting dry heat described in note page 281 of this volume, may be employed with much advan- tage. But there are frequent occasions for adopting a practice (he reverse of that just described. In those cases where there is a morbid increase of external heat, (he affusion of cold water over the naked body is the most powerful remedy. The human body like all other bodies, when preternaturally heated, may be reduced to its natural temperature by the application of cold water over its surface, and when judi- ciously conducted this remedy has proved one of the most powerful and efficacious means which can be employed in typhus fevers. If adopted in the forming stage of the dis- ease, this remedy will frequently arrest and cut short its progress, or if delayed till after the fourth day, when the fe- ver is completely formed, the pa(ien( will experience (he most essential relief from the heat and other distressing feb- rile symptoms. But there are particular circumstances, and precise rules to be regarded by the physician in the applf- cation of this remedy. The safest and most advantageous time for using cold water, is when the exacerbation is at its height, which is marked by increased flushing, thirst, and restlessness ; when there is no sensible chilliness present; when the heat is steadily above what is natural, and when there is no general or profuse perspiration. In the advanc- ed stage of typhus fever, or in fact at any period of the dis- ease when the heat is already reduced, and the debility great, some cordial, such as wine warmed with the addition of spice, or even brandy, should be given immediately after the employment of the cold affusion. The mode of apply- ing the cold water, is by dashing it from a pail or allowing it to fall from a height in considerable quantity from a watering pot, or when the patient is extremely weak it may be appli- ed by wrapping him in a blanket well wet with cold water. If in the advanced stage of fever the cold affusion should ap- pear objectionable, the aspersion, or ablution of the body, by means of a sponge may be substituted, or the tepid bath may perhaps be more eligible. See page 274. When a slow feeble pulse with diminished external heat indicates a torpid state of the extreme vessels, the following cordial powder will produce the happiest effects, by invigo- 312 OF THE NERVOUS FEVER, OR TYPHUS MITIOR rating Ihe vital energy, inducing the desirable perspiration, and diffusing a more uniform warmth over the surface. Take powdered camphor and carbonate of ammonia, of each six grains : Ipecacuanha two grains, mix for a dose and repeat it every three hours. The spirit of hartshorn, or of sal ammoniac, in doses of thirty or forty drops in a cup of mus- tard whey, or infusion of Virginia snake-root, often repeated, is a useful auxiliary for the same purpose. If a diarrhea at- tend and threaten to debilitate the patient a mild cathartic should be administered, after which it may be restrained by a free use of the chalk mixture or the compound powder of chalk with opium. When restlessness or other symptoms arise for the want of sleep opiates combined with diaphoret- ics, either in the form of Dover's powder, or laudanum in prop- er doses should be directed ; it has been observed that opi- ates are almost constantly found beneficial in typhus fevers. When the patient is much affected with subsultus tendinum, it has been usual to administer musk, castor, camphor, and by some sal succini, each of these may in some instances prove useful, and when given to the extent of twenty grains musk often has a powerful effect as an antispasmodic. But I should repose equal confidence in the virtues of the root of a domestic plant, pothos fcetida, or skunk cabbage, as an an- tispasmodic, destitute of heating properties and well calcu- lated to diminish nervous irritations and subsultus tendinum. If in the progress of typhus mitior symptoms of putridity should arise, two table spoonfuls of y»?st, if given every three hours, will be found of great utility. It frequently happens that miliary eruptions appear about the ninth or tenth day of the disease ; they must by no means be checked by any kind of evacuation, as they may prove to be an effort of nature to throw off the fever ; nor should the patient be kept too warm, as sometimes happens, in order to force out such eruptions. When the mouth becomes affected with apthous ulcers a gargle composed of borax and honey, should be fre- quently applied to those parts. The sophora tinctoria, or Indigo weed, has of late been found to produce the. most speedy good effects of any application yet employed, the in- fusion of the root being used as a gargle. See American New Dispensatory, 2d edition, and Appendix to this volume. Cold water, if taken internally in the cold stage of the paroxysm of fever, increases the chilliness and torpor of the OF THE NERVOUS FEVER, OR TYPHUS MITIOR. 313 surface and extremities, and produces a sense of coldness in the stomach, augments the oppression on the praecordia, and renders the pulse more frequent and more feeble accord- ing to Dr. Currie. When the hot stage is fairly formed and the surface is dry and burning, cold water may be drunk with the utmost freedom, as at this period it is highly grate- ful, and tends to diminish the heat of the surface and lessen the frequency of the pulse, and often brings the paroxysm to a speedier issue. During the whole course of this fever, the patient must be supported by light nutriment, such as oat gruel, sago, panado, arrow root, jellies, chicken broth and beef tea. For ordinary drink wine whey, or negus pre- pared by mixing one part of Port wine with two parts of water and sweetened, and also mustard whey acidulated with the juice of oranges or lemons, will be useful in this fe- ver. The chamber of the patient should be well ventilated and the floor frequently sprinkled with vinegar, the bed and body linen must be kept constantly clean, and the excrements im- mediately removed from the room. The impressions made by noise, light, external heat, and thirst should be avoided as prejudicial in this and all other fevers. Every experienced physician must be sensible, that the treatment in typhus fever, requires to be varied after the in- flammatory symptoms of the first stage have been vanquish- ed by the evacuation of blood and other depleting means. It would be exceedingly improper to continue the exhibition of mercury and antimony in the last stage of typhus. As soon, therefore, as distinct intermissions or remissions of the fever become manifest, the Peruvian bark or some oMts sub- stitutes, should be prescribed in the absence of the parox- ysms. Half a drachm of the cinchona in powder may be given in a glass of wine every two hours. The bark of cas- carilla and the Virginia snake-root will sometimes be found useful when the cinchona is inadmissible, or when combined with it. The eupatorium perfoliatum, or thoroughwort, has of late been substituted for the cinchona, with decided ad- vantage, and I have known it to succeed more effectually than cinchona and without producing any unpleasant effect. The cordial qualities of wine are well calculated to exhila- rate and to invigorate the vital powers, when much exhaust- ed in the latter stage of typhus fever. The wines to be preferred are Madeira, Port or Claret, and if pure and sound, 40 314 OF THE NERVOUS FEVER, OR TYPHIS MITIOR one bottle or more may be used in twenty-four hours, pro- vided no ill effects result from it. If the least degree of in- toxication arise, wine should be discontinued. The mineral acids, especially the muriatic, if liberall^ employed, will prove useful auxiliaries in the cure of this disease, as also pure old bottled cider. When in the last stage of typhus, the usual stimulant remedies fail in rousing the powers of life, the most singular advantages have been derived from the use of the arsenical solution. From trials in the hands of Drs. Ff rriar and Thomas, successful results may be con- fidently expected, from its use in similar circumstances. When the patient has been happily brought to a state of con- valescence, it is important that he enjoy a pure air, take moderate exercise daily, and use a nourishing diet, recollect- ing however, that over-eating is a more frequent cause of re- lapse than any other. Peruvian bark, and wine with stom- achic bitters, should be employed to complete the restora- tion to health. As typhus fevers are supposed to be of an infectious nature, every endeavour should be exerted for suppressing its further propagation as recommended under the head of contagious diseases. CHAPTER VL OF THE PUTRID AND MALIGNANT FEVER, OR TYPHUS GRAVIOR, IT is alleged by some authors that the nervous fever des* cribed in the last chapter, and this, which is known by the various names of jail fever, hospital fever, ship fever, pe- techial fever, the pufrid, and the malignant fever, are essen- tially the same disease, and that the apparent difference de- pends upon the degree or upon the different constitutions of the patient. But there is a radical distinction, and they can- not be confounded in practice without the most serious con* sequences. It frequently happens however, that the in- flammatory, nervous, and putrid symptoms are so blended together, that it is difficult to determine, especially at the beginning, to which of the three classes the fever belongs. The putrid fever may be distinguished from the inflam- matory, by the sniallness of the pulse, the uncommon dejec- tion of mind, the great prostration of strength which ensues on the first attack, the brown or black tongue, the dark and foetid sorties about the teeth, the livid flush of the counte- nance, and the acrid and more intense heat of the skin; and in its more advanced stage, by the petechia?, or purple spots which appear on various parts of the body, and the foetid stools which are discharged. In addition to these symptoms, the peculiar biting heat of the skin, the perpet- ual writhing of the body, which has been termed a mortal inquietude, the more florid colour, and the violence of the symptoms at the commencement, will afford a sufficient diag- nosis between this and typhus mitior. The general source from which putrid fevers originate, is contagion, (see page 270) communicated either immediately from the body of a person affected with it, or by clothes or other articles having been in contact with the sick. It is 316 OF THE PUTRID AND MALIGNANT sometimes generated by a hot and moist constitution of the air : and in low marshy countries, by the affluvia arising from animal and vegetable substances, in a state of putrefaction, especially when intense sultry heat quickly succeeds a wet and rainy season. But typhus fever is supposed to origin- ate in general, from exhalations arising from human excre- tions, when closely confined, and acted upon by animal heat. Hence no situations are more liable to this fever, than close and confined rooms, such as crowded hospitals, jails, camps, and on board of ships, when the strictest attention is not paid to a free ventilation, and other proper means of cleanliness. It is also occasioned by eating flesh or fish, that have been too long kept, and by living too much upon salted animal food, without a suitable quantity of vegetables; whence seamen on long voyages are much exposed to its influence. Damaged corn, and water that has become putrid by slag- nation, may likewise produce putrid fever. The poor in habitants of large towns, who breathe a confined unwhole- some air, and such mechanics and manufacturers as are em- ployed about dirty substances, and are constantly confined within close and crpwded rooms, are peculiarly liable to pu- trid fevers. Persons of lax fibres, and who have been weakened by any previous debilitating cause, such as poor diet, long fast- ing, hard labour, continued want of sleep, &c are most com- monly the subjects of this disease. The symptoms of this fever in the beginning are not un- like those of the nervous fever, but the attack in general is more sudden and violent, and the progress more rapid and alarming. There is usually considerable chilliness attended with, and gradually ending in acrid and often burning heat with little remission ; great prostration of strength ; general anguish of body, and depression of spirits. The breathing is short and anxious ; and a nausea and vomiting of bilious matter sometimes ensue; the pulse is quick, small, and often hard, with distressing head-ach, noise in the ears, and a vio- lent throbbing of the temporal arteries. The eyes are suwk, dull, listless, with a dusky, sallow, dejected countenance, or red, full, and rolling with restlessness and fierce delirium; the tongue is generally foul, often brown or black, with blackness of the lips and foetid sordes about the teeth; and there is sometimes considerable thirst. The urine is scanty, and at first but little changed, but progressively becomes FEVER, OR TYPHUS ORAVIOR. 3f7 high coloured, sometimes greenish or sooty, and generally of a strong smell. The fever continuing to increase, the speech becomes inarticulate and scarcely intelligible ; the patient mutters to himself, and delirium attends. At length, symptoms of putrefaction appear, the stools are dark col- oured, offensive, and pass off insensibly, haemorrhages issue from the gums, nostrils, and intestines; or more frequently, extravasations of blood from the cutaneous vessels produce red, livid, or purple spots, or petechia;, or larger marks like bruises on the neck, breast, arms, and other parts of the body, shewing the great malignity and danger of the dis- ease. The pulse now intermits and sinks, the extremities grow cold ; hiccups ensue, and death soon closes the tragic scene. The duration of the putrid fever is extremely uncertain; sometimes finishing its course between the seventh and four- teenth day, and at other times continuing for several weeks. When after the fourth or fifth day, a gentle universal warm perspiration, with diminished frequency, and increased ful- ness of the pulse, a moist and cleaner tongue, scabby erup- tions about the mouth, and moderately loose stools occur, a favourable termination may be expected ; while partial clam- my sweats, weaker and irregular, or tremulous pulse, dry, black, and chopped tongue, swelling and tension of the ab- domen, involuntary discharges by urine and stool, subsultus tendinum, picking the bed-clothes, high delirium, constant vomitings, coldness of the feet and hands, and trembling mo- tion of the tongue, laboured respiration, and difficulty of swallowing, denote a fatal event; and if the patient can lie on his back only, and draws up his knees, and makes fre- quent attempts to get out of bed without assigning any rea- son, and passes frequent stools of a very offensive smell involuntarily, the hour of dissolution is near at hand. In the treatment of this fever one of the principal objects is to counteract as far as possible the putrid tendency of the fluids ; to support the patient's strength and spirits, and to assist nature in resisting the cause of the disease. No part of the treatment is more important than a rigid attention to the means of personal cleanliness, a free circulation of pure air, and the exclusion of noise and light from the patient's chamber. As the breath and perspiration of a person whose whole mass of fluids is in a state of putrefaction, will soon contam- ;il8 OF IHE PI I RIO AND MALIGNANT inafe the air of an apartment, and as the least noise or fa- tigue of body or mind in such debilitated state, will occa- sion faintness, and aggravate the other symptoms, it is ob- vious, that the avoidance of all these causes ought to be strictly enforced during the whole course of the fever. Not only should the chamber be constantly ventilated, but the floor should be sprinkled with vinegar, and its fumes diffus- ed through the house by burning or boiling it. The juice of oranges or lemons, or other vegetable acids, should be freely used by the patient, and the skins of those fruits, to- gether with strong scented herbs, as rue, tansy, and worm- wood, may be distributed about the bed and apartment, as means of rendering the air more agreeable, and of prevent- ing the spread of the disease. The vegetable acids are pe- culiarly useful in this fever, and they should be mixed with all the patient's food and drinks, which may consist of bar- ley water, orange, mustard, lemon, or vinegar whey, camo- mile or thoroughwort tea, and occasionally with a proper ad- dition of Port or Madeira wine. The food must be light and easy, as panado, oat gruel sharpened with acids, or the jelly of currants, Sec. and the patient may eat freely of ripe fruits, jellies, and preserves, of almost every description. Thoroughwort tea, will be found very serviceable in this dis ease, and it may be acidulated by adding to every cup ten or fifteen drops of the elixir of vitriol. When the body is bound, a tea spoonful of cream of tartar may be dissolved in a cup of the patient's drink occasionally, or a decoction of tamarinds, will tend to quench thirst and promote a dis- charge by stool. The patient ought to swallow a little food or drink very frequently, as it will tend to support his strength and spirits. If delirium prevails, the hands and feet should be frequently fomented in a strong decoction of thor- oughwort, which both relieves the head and assists in coun- teracting the putrid tendency. In regard to the curative treatment, blood-letting was formerly deemed inadmissible in typhus and putrid fevers; nothing but the clearest evidence of high inflammatory affec- tion could, it was imagined, justify the practice even at the first onset of the disease; but recent improvements have changed the sentiments of physicians in this respect, and venesection is now resorted to by some with the same free- dom and confidence as in other acute diseases, limiting the extent by the effects produced on the pulse and system, FEVEK, OK TYPHUS GRAYIOK 319 but this requires much caution. Emetics given at the be- ginning, and repeated occasionally during the course of the fever, never fail of rendering very essential service, and when administered before the forming state it often arrests its progress. After the stomach has been sufficiently cleans- ed, an adequate dose of calomel and jalap should be exhib- ited, to evacuate from the intestines that accumulation of putrid matter which tends to increase the fever and aggra- vate all the symptoms. The bowels during the progress of fever, should be kept constantly at command by means of calomel, or some mild laxative medicine, and occasional in- jections. When delirium, local pains, or symptoms of con- gestion are present, or when diminished excitement on the surface or extremities, demand the use of blisters, these should be extensively employed. Applied to the head and inside of the legs and thighs, they are productive of the most important good effects. Stimulating sinapisms of must- ard seed, rye meal, and vinegar, or the coakum root, should be applied to the soles of the feet, and warm frictions and rubefacients to different parts of the body, where torpor and coldness prevail. These may sometimes supersede the use of blisters and are less apt to occasion gangrene. Calomel and opium, as advised in typhus mitior, have usually been exhibited in the early stage of typhus gravior with ihucli confidence, and generally with great success ; a fatal termi- nation rarely occurring where a mild affection of the saliva- ry glands has been induced. The celebrated Dr. G. For- dyce, relies chiefly upon a weak solution of tartarized anti- mony, administered in such manner as to induce a slight nausea, and repeating it every third hour, until either vomit- ing, purging, or free perspiration be excited, taking care not to push it so far as to weaken the patient by profuse sweats or other evacuations. By the use of this medicine in the early stage of typhus, he asserts that in one third or one half of the cases, he has seen symptoms of a crisis arise in less than five hours after the exhibition of it, and in less than twelve hours the fever has often ceased altogether. Every practitioner however, must be aware that a constant nausea is a very unpleasant and distressing sensation, and also that both mercury and antimony have so powerful a tendency to exhaust the vital energy, as to render their use exceedingly objectionable after the first stage of typhus fevers. But tonic and antiseptic medicines and nourishment are mostly 320 OF THE PUTRID AND MALIGNANT to be depended on for the cure, after the necessary evacua- tions have been made. In the advanced stage all debilitat- ing causes must be avoided, and the patient should be sup* ported by cordials and stimulants adapted to the peculiar circumstances of the case. Such are volatile alkali, ether, porter, yest, Virginia snake-root, and cascarilla ; but good sound wine, as Port, Claret, or Madeira, is incomparably the most efficacious. Numerous extraordinary cures have been effected when patients were reduced to the last extremity of danger by the administration of wine to the extent of a quart or more in twenty-four hours. Another useful article in this species of fever is pure bottled cider, which may be given with much freedom. In the mtost dangerous form of this fever, when purple or black spots appear, two table spoonfuls of yest should be administered every two or three hours, and no time should be lost in resorting to the cinchona joined wilh the mineral acids. The most efficacious form of administering the bark is certainly in substance. One ounce of the powder may be mixed in half a pint of water, and the same quantity of red wine, and sharpened with the elix- ir vitriol, which will make it sit easier on the stomach, and render it more beneficial. A little loaf sugar may be added, and the patient should take two table spoonfuls every two hours. If in this form the bark should offend the stomach, it may be tried in decoction or infusion conjoined with Vir- ginia snake-root, to which some of the compound spirit of lavender may be added. The muriatic acid has obtained considerable repute for its efficacy in typhus and malignant fevers. In his Modern Practice, Dr, Thomas vouches in strong terms for its great utility as experienced in his own practice for several years. Having premised the usual evacuations, and subjected the patient to the cold affusion where that is deemed proper, he prescribes for adults, ten or twelve drops of the muriatic acid guarded with five drops of laudanum, and mixed in about an ounce and half of an infusion of cascarilla or columbo. This he directs to be re- peated every four hours, gradually increasing the quantity of the acid to eighteen or twenty drops or more.' The ef- fects of the muriatic acid in all febrile diseases of a malig- nant nature, says Dr. Thomas, are truly great; and from using it in all such cases his practice has been attended with the most decided success. In the hands of other practition- ers likewise the muriatic acid has been productive of favour- FEVER, OR TYPHUS GRAVIOR. 321 able effects in both typhus mitior and gravior. In one case of the latter species, attended with extreme danger, I ad- ministered this medicine in a strong infusion of thorough- wor(, wi(h a few drops of laudanum ; when it had been tak- en freely for about twelve hours, a profuse sweat ensued of a yellowish colour, and nauseous smell; a favourable change immediately appeared, and the recovery was rapid. The patient's linen was corroded and entirely destroyed, by what exuded through the pores. As a mild tonic and antiseptic, the thoroughwort in the form of infusion, acidulated with the mineral acids, will prove beneficial in all the stages of this fever. Opiates are indispensably necessary, and afford great relief in this disease, a suitable dose of which may be given every night with some diaphoretic medicine or drink, more especially if a troublesome looseness attend. And to obviate this threatening symptom recourse must be had to internal astringents, such as the compound powder of chalk, catechu, the root of tormentilla, and in obstinate cases, the acetite of lead, one grain, opium, half a grain, every two hours till the desired effect be produced. For the healing of those foul ulcers so troublesome about the mouth and tongue, antiseptic gargles should be freely employed, among which, no one is to be preferred to an infusion of sophora tinctoria, (see Appendix.) When from extreme irritability of the stomach, a troublesome and obstinate vomiting at- tends, the neutral mixture ought to be so administered that the effervescence may take place in the stomach, and a few drops of laudanum occasionally added ; or eight or ten grains of salt of tartar, or sal aeratus dissolved in a wine glass full of lime water, with a few drops of essence of pep- permint, should be given every three or four hours. A large blister should be applied over the region of the stomach, and blisters to the thighs and legs will also be very beneficial. Spirituous fomentations with laudanum to the stomach, and the latter injected into the intestines will often afford great relief. The internal exhibition of carbonic acid gas is sup- posed to be highly useful in taking off that peculiar debility of the stomach which is often so distressing in putrid dis- eases. This gas may be conveniently administered by means of aerated water prepared as in the Appendix, or by the neutral mixture as above mentioned. In the act of ef- fervescence the gas is extricated and exerts its effects di- rectly on the stomach. It is on the principle of its afford- 41 322 OF THE PUTRID AND MALIGNANT ing fixed air, that yest has obtained such high repute in pu trid diseases. The discovery originated with the Kev. Mr. E. Cartwright, an English clergyman, and the remedy has been found by experience to merit the highest attention. Whilst visiting a boy ill with putrid fever to such degree as to preclude all hope of recovery, he recollected an experi- ment of a piece of meat being made sweet, by being sus- pended over a tub of wort in the act of fermentation. The idea occurred that j^est might correct the putrid nature of . this disease, and he immediately gave Ihe boy two large spoonfuls, and directed it to be repeated every three hours. The good effect was immediately visible, and the recovery was remarkably rapid. This benevolent clergyman, repeat- ed his trials with astonishing success, and he affirms that he has since administered the yest to above fifty persons, la bouring under putrid fevers; and what is singular, all of them recovered. In some instances the relief was so speedy, that from a state of drowsy insensibility, with a black tongue, and pulse scarcely perceptible, (he patients were in a few hours able to leave their beds and walk. It is given in doses of two table spoonfuls in a cup of water, or an infusion of malt, or mild porter, every two or three hours, and bark and wine are given-at proper intervals at the same time. A decoction of the root of sOphora tinctoria, from ils anti- septic properties has been administered in a few cases of pu- trid fever with effects so decidedly beneficial, as to excite sanguine expectations of its efficacy ; and as it may be given without interfering with other remedies, it is recommended for further trial. Since the introduction of the practice of affusing the body with cold water, that remedy has been resorted (o in cases of putrid malignant fever, and the proofs are now irresistible that when judiciously employed it is productive of the most important advantages. The circumstances and restrictions under which alone this powerful agent may be used have been fully described in the chapter on fevers in general, and on typhus mitior, to which the reader is referred. In all in- stances of contagious fever, the utmost care should be taken to prevent its being communicated to other persons. The sick should be as much separated from the rest of the fam- ily as possible ; the bed linen and every thing about the pa- tient ought to be changed every day; all discharges and filth ot every kind immediately removed, and cleanliness in HEVER, OR TYPHUS GRAVIOR. 323 the strictest sense of the word most rigidly and constantly enjoined. The chamber or apartment must be properly ven- tilated by allowing a free admission of fresh air into it during both day and night, securing the patient however from a cur- rent of cold or damp air. The fumes of warm vinegar in which some aromatic herbs have been infused should be dif- fused through the room. No person, but the necessary at- tendants should have any communication with the sick, and these should avoid sitting down on the patient's bed ; or in- haling the breath or vapour arising immediately from his body. It may be proper for those who are necessarily exposed, to keep a sponge, or handkerchief, moistened with camphor- ated spirits or vinegar to the nose and mouth,* and the va- rious means recommended in the chapter on contagious dis- -eases ought to be adopted and a steady perseverance enjoined* * " When the contagion of a putrid fever id taken hy the saliva into the stomach and bowels, which is its constant road, if the patient, the moment he finds himself attacked with a sense of chilliness, loss of appetite, and an unpleasant taste in his mouth, has recourse to two emetics at proper intervals, and after the operation of" the first emetic takes a cathartic, he has certainly got rid of the infection." Towwend's Ghiidt to Health, Vol. 11. /»• 53 CHAPTER VII OF THE YELLOW FEVER, OR TYPHUS ICTERODES. THE yellow fever was known to exist in Charleston, (S. Carolina) and in Philadelphia, so early as the year 1699, and fn 1748 Dr. Lining, of Charleston, published an accu- rate history of it, and pronounced it an imported disease, and contagious. During our revolutionary war, it was re- cognized in our camps and hospitals. In 17i»3, it visited the city of Philadelphia, where it spread universal terror and desolation ; and at divers subsequent periods and sea- sons, it has prevailed in most of our seaport towns, and in its fatality, equalled, if not exceeded the plague itself, to which malady it bears a strong similarity in many of its symptoms. The prevalence of this dreadful epidemic could not fail to occasion the greatest consternation and alarm, while at the same time it afforded opportunity for Ihe dis- play of talent and industry, in the investigation of its nature and origin. On a subject so recondite in its nature, a differ- ence of opinion among the learned faculty, is naturally to be expected. There were some who supposed that the yellow fever being of a contagious nature, was imported by ships from the West-Indies, while in opposition to this doctrine, Drs. Rush, Miller, and other learned investigators, firmly supported the opinion, that this malady originated from local causes, and is not in its nature contagious. They allege that the primary and essential cause of yellow fever, is a miasma or pernicious exhalation floating in the atmosphere. This miasma is emitted from accumulated masses of dead animal and vegetable substances, undergoing decomposition by means of solar heat combined with moisture. Besides the high authorities above introduced, we have that of the learned and experienced Dr. Ramsay, and Dr. Tucker Harris, both of the city of Charleston, where the disease has often been prevalent, in favour of its local ori- OF THE YELLOW FEVER, OR TYPHUS ICTERODES. 325 gin and non-contagious nature. Dr. Ramsay, in a letter to the late Dr. Miller of New-York, says, " There is but one opinion among the physicians and inhabitants, and that is, the disease was neither imported nor contagious. This was the unanimous sentiment of the medical society, who, in pur- suance of it, gave their opinion to the government, that the rigid enforcement of the quarantine laws was by no means necessary on account of the yellow fever." The fact is corroborated by their undoubted testimonies, that in no one instance has the yellow fever been communicated from one individual to another, even when a constant exposure had been unavoidable.* This fever is commonly ushered in wilh alternate slight chills and heats. Dr. Rush says (he disease appeared with different symptoms in different people, and that the premon- itory signs of it were costivencss, a dull pain in the right side, defect of appetite, flatulency, perverted taste, heat in the stomach, giddiness or pain in the head, a dull, watery, brilliant yellow or red eye, dim and imperfect vision, a hoarseness or slight sore throat, low spirits, a disposition to sweat at nights or after moderate exercise, or a sudden sup- pression of night sweats. More or less of these symptoms frequently continued for two or three days before the pa- tients were confined, and in some they continued during the whole time of the prevalence of the fever in the city with- out producing the disease. Many went to bed in good health, and awoke in the night with a chilly fit; many rose in the morning after natural and regular sleep, and were seized at their work, or after a walk, with a sudden and unexpected attack. He observes, that it frequently came on with a weak pulse, and often without any preternatural frequency or quickness ; and that, in some instances, it was so low as not to be perceived without pressing hard on the artery ; in some' cases, the pulse intermitted, and these intermissions occurred in several persons who were infected, but who were not confined by fever; in others there was a more than or- dinary slowness of the pulse, which was now and then ac- companied with a dilated pupil of the eye. Haemorrhages happened at the commencement of (he disorder, chiefly of the nose and uterus ; and as it advanced, (he discharge of blood became more universal, and (hen issued from the gums, ears, stomach, bowels, and urinary passage. * See Dr. Hosack's opinion in chapter on Contagiou. 326 OF THE YELLOW FEVER, OR TYPHUS ICTERODES. Many complained of a dull pain in (he region of (he liver, but few felt any soreness (o the touch, or pain at (he pit of the stomach ; in scrme, a determination of blood took place to the lungs, but the brain was chiefly affected with morbid congestion which was indicated by the suffusion of blood in the face, redness of the eyes, dilatation of the pupils, pain in the head, haemorrhages from the nose and ears, by sick- ness or vomiting, and by an almost universal costive state of the bowels. With respect to the secretions and excretions, there ap- peared to be a preternatural secretion of bile, which wag discharged from the stomach and bowels in large quantities, and of different qualities and colours, being in some cases yellow and in others black. The urine was often plentiful and of a high colour; sometimes pale and at others small in quantity and turbid ; accompanied with sweats of a yel- low colour, and highly offensive. On the first and second day, the tongue was invariably moist and white ; but as the disease advanced, it became red, and put on a smooth shin- ing appearance ; towards the close, a dry black streak ap- peared in its middle which gradually extended to every pari of it. The effects produced on the nervous system were differ- ent, according as the fever affected the brain, the muscles, the nerves, or the mind. In a few instances, apoplexy was induced, which usually proved fatal; tremours of the limbs and twitchings of the tendons were common ; delirium was a frequent symptom, but many passed through the disease without the least derangement of ideas : in some cases the pain in the head was acute and distressing, and the stom- ach, towards the close, was affected with a burning or spas modic pain of the most severe nature. Deafness and dim- ness of sight sometimes took place. Thirst and want of ap- petite were present, as in most other fevers. In some cases the skin was preternaturally warm ; in others it was cooler than in health. The yellow colour was by no means univer- sal ; when it did take place it was seldom to be observed be- fore the third day, but more frequently about the fifth or seventh from the first attack. The eyes seldom escaped a yellow tinge. There were eruptions of various kinds on the skin, and in the latter stage petechia? were common ; car- buncles also took place in some- OF THE YELLOW FEVER, OR TYPHUS ICTERODE9. 32? The disease ended in death in various ways. In some, it was sudden; in others, it came on gradually. The last hours of some were marked with great pain and strong con- vulsions; but in many, death seemed to insinuate itself into the system with all the gentleness of natural sleep. It is to be remarked the symptoms in this fever are ex- tremely variable in different subjects. Dr. Rush observed the disease in some instances continued for fifteen, twenty, or thirty days. Persons in the prime of life were most liable to it, and men more subject to its attack than women. The symptoms lhat may be regarded as favourable are, a settled state of the stomach, lessened head-ach, eyes live- ly, appearance of an eruption on the skin, free perspiration, copious and high coloured urine, bilious flux, and sound sleep. No disease, however, exhibits a greater variety of symptoms, and often less to be depended upon, than this; for sometimes it goes on with favourable appearances, then suddenly changes lo the worst, and sometimes patients apparently almost in a state of convalescence, expire in a few hours. Youth and a plethoric state, are invariably circumstances of danger. A sudden oppression of all the functions at once ; great debility ; weak irregular pulse ; sighing; severe vomiting of dark coloured matter; tremours of the body when moved, with a tendency to faint on the slightest exer- tion ; pensive sadness in the countenance ; and a dilatation of the pupils of the eyes, with coma; are signs of great dan- ger. Black and foetid discharges by urine and stool, the breath being highly offensive ; and the appearance of pe-> techiae, portend almost certain death. With regard to the most approved and successful mode of treatment in yellow fever, this has been a subject of no inconsiderable degree of contention among our most distin- guished practitioners. It seems, however, to be generally agreed, that in our climate, this most fatal disease in its ear- ly stage, is marked by symptoms of inflammatory diathesis, and that it tends rapidly to a state of universal putrefac- tion. The antiphlogistic course as pursued by Dr. Rush, has been almost universally adopted in the first stage, and the earlier this was commenced, the more successful has been the result. In this as in all fevers, the patient should abstain from •qinial food, and confine himself to gruel, panado, sago,, ar- 328 OF THE YELLOW FEVER, OK 1MT1LS 1UTERODES row root, chicken broth, and olher spoon meats ; he should use cool diluting drinks, such as barley water, toast and wa- ter, lemonade, apple tea, tamarind water, hop tea, thorough- wort tea, and also ripe fruits which tend lo keep the bowels soluble. The chamber of the sick should be spacious and airy, and frequently ventilated, vinegar impregnated with aromatic herbs, should be frequently sprinkled, and diffused over the rooms, bed clothes, &c The passions of the mind ought to be calmed and composed. The excrements, and every offensive thing, ought to be immediately removed. These directions should be considered of great importance both to the sick, and to those whose duty it is to frequent their apar(men(s. The firs( indication in (his fever is (o subdue the inflam- matory dialhesis by the most speedy means in our power. The second is to arrest, or obviate as much as possible, its progress to a putrid state, and at the same time to support the strength of the patient. Bleeding and purgatives are the means most suited to accomplish the first intention. Bleeding ought, however, (o be performed as soon as pos- sible after the attack, within the first twenty-four hours, or at most within thirty-six. The operation may be repeated with a view of alleviating the violent pains of the head, eyes, &c. provided it be performed within the time pre- scribed. In order to moderate the violent determination lo the head, (he feet should be bathed in warm water, and an opening clyster occasionally administered. As obstinate costiveness generally prevails, and the stomach is seldom capable of re-' taining those purgatives which are in common use, no one can be better adapted to circumstances than calomel and ja- lap combined ; four grains of the former, with eight or ten of the latter, may be given either in powder or pills every four hours until a proper effect is produced. Mercury when given so as to excite a degree of salivation has been found a more successful remedy in yellow fever than any other which has been employed. To insure its success, it should however, be exhibited at the very commencement of the disease, and be so conducted as to affect the mouth be- fore the dangerous symptoms of the second stage of the fe- ver make their appearance ; after the second stage has come on, but more especially when signs of putrescency are pre- sent, mercury aggravates and increases Ihe danger, if not OF THE YELLOW FEVER, OR TYPHUS ICTERODES. 329 accelerates the fatal event. When incessant vomiting pre- vents the use of calomel in sufficient doses to effect a spee- dy salivation, mercurial frictions have been successfully sub* stituted. In this form mercury may be employed at any period of the disease, so long as the extremities continue warm, and the absorbents preserve their power. From half a drachm to one drachm of the strongest mercurial oint* ment should be rubbed into the thighs, hams, legs, and arms, every four hours, and calomel either by itself or combined with opium may be exhibited internally at the same time. When a gentle ptyalism takes place these remedies ought to be immediately discontinued, and only nourishment and wine be given, as all danger is then supposed to be over, and the recovery of the patient to be almost certain. In cases of great irritability of the stomach, Where ex- cessive vomiting prevails, the early application of a blister immediately over the part will often be attended with the happiest effects. The vomiting has sometimes been known to cease upon the application of a large poultice of mustard flour to the stomach and feet, which occasioned a very ex- tensive and painful inflammation of "the skin. The saline mixture administered so that the effervescence may take place in the stomach, with an addition of ten or twelve drops of tincture of opium to each dose will frequently have the effect of checking obstinate vomiting. When symptoms of putrefaction have occurred, the Pe- ruvian bark must be given in as large doses as the stom- ach will bear, either in substance, decoction, or infusion, and also by way of clyster. The mineral acids, especially the muriatic, would undoubtedly be very serviceable in this fever, and they ought on no account to be omitted. The affusion of cold water over the body, or aspersion, or sponging the body with vinegar and water on the first onset of yellow fever, agreeable to the rules advised by Dr. Currie, have proved eminently serviceable, and affected cures in a variety of instances. The proper directions for the use of this remedy will be found in the foregoing chap- ters. In a state of convalescence the patient should avoid ev- ery thing which may tend to bring on a relapse ; such as a too early exposure to improper exercise, food, and drink. He should eat but little at a time, and that little should be easy of digestion. Morning and evening air should be 42 330 OF THE YELLOW FEVER, OR TYPHUS ICTERODF.S. avoided at all events. Bark should be continued in mod- erate doses, until the debilitated system is invigorated, the digestive faculty repaired and strengthened, and the patient returns to his usual mode of living. The proper means of prevention of yellow fever are inserted, and particularly recommended in the chapter on contagious diseases. / CHAPTER VIII. OF THE SPOTTED, OR PETECHIAL FEVER. THIS very formidable disease made its first appearance in our country in the town of Medfield, Massachusetts, in the year 1806. Subsequent to that period, it has occasion- ally been recognized as an epidemic in various parts of the New-England states, in the state of New-York, and on the borders of Canada. In 1810 it prevailed with mortal rage in the county of Worcester, and other parts of this state, and in the autumn of 1812, and winter 1813, the same or a distinct epidemic visited the army of the United States, at Greenbush, and at various other situations, where its des- troying power has scarcely been exceeded by military slaugh- ter. It was prevalent also in Connecticut and Vermont, and a considerable number of fatal cases occurred likewise in Bos- ton, both among the inhabitants, and the soldiers quartered in that metropolis. It has usually occurred during the cold weather of winter and spring, and its continuance has been protracted in some seasons to May and June, chiefly in the interior of the country. In some instances, death has ensued within a few hours in a manner similar to the plague, but in others, the disease has been very mild in its attack and short in its duration. This epidemic exhibits a remarkable varie- ty of character, often counterfeiting other disorders, and is so insiduous in its approach, that the physician is not unfre- quently surprised by the event of death, even before dan- ger was suspected. The name " spotted fever," as designating the present disease, has been deemed exceptionable by most medical men, as a very small proportion of cases were marked with petechia?, spots, or eruptions ; nay, some have asserted that spots are wanting in five cases out of six. A judicious wri- ter in the New-England Journal of Med. and Surgery, Vol. I. p. 240, prefers the name malignant nervous fever, 332 OF THE SPpTTED, OR PETECHIAL FEVER as being more appropriate. The predisposing cause of this terrific malady, seems to have eluded investigation. That it is not contagious is universally agreed. The suggestions that ergot (spurred rye) or any other foul grain, has been influential in its production, is not corroborated by a single shade of evidence. The true cause of its prevalence un- doubtedly, is like that of all other epidemics, dependant on a peculiar state of the atmosphere, and the predisposition of our bodies being favourable to its operation. The exciting causes are precisely those which are known to operate in all cases during Ihe prevalence of epidemics which are not con- tagious. These are errors in diet, intemperance, exposure to cold or damp air, fatigue, anxiety of mind, and assiduous attention to the sick. All ages and classes are liable to its attack, and to become its victims. Persons have often been attacked a second time, and relapses have frequently occur- red with the same symptoms as in the original attacks, and these cases often terminate fatally. The most fatal consequences have been known to result from the influence of fear and horror. The terrific name of spotted fever or cold plague, its well known fatality, the tolling of bells, the frightful visage, the weeds of mourning, and the tears of sorrow, wonderfully conspire to induce a morbid state of the system, favourable to the reception of the disease and tend more immediately perhaps than any other causes, to multiply the instances of mortality. The humane and prudent physician therefore, will, to the utmost of his power divest the disease of its terrific name, and obviate all the circumstances and causes which occasion alarm. In March 1810, the counsellors of the Massachusetts Med- ical Society, solicitous for the public welfare, appointed a committee to investigate the nature, history, and mode of treatment of this alarming epidemic ; and of their very able and judicious report, I avail myself on the present occasion.* The invasion of the disease is generally sudden and vio- lent. The patient is seized in the midst of his usual labours, and oftentimes is struck down suddenly almost as by a stroke of lightning. The first symptoms are exceeding various, scarcely two cases resembling each other, and the diversity of symptoms are not to be comprised in any enumeration. * The committee consisted of Thomas Welsh, M. D.; James Jackson, M. D ; and John C. Warren, M. D. OF THE SPOTTED, OR PETECHIAL FEVER. 333 The disease often commences with shifting pains, sometimes beginning in one joint, or one limb, in the side, back, neck, or head, either a sensation like a stinging of a bee, or most excruciating pain moving from place to place, with great vio- lence, and is often confined to one side of the body. The pain in the head is often so intolerably severe, that it is com- pared to the beating of hammers upon the part. Partial lotfs of sensibility, numbness and paralysis of the limbs, deafness, dimness of sight, or total blindness ; delirium either mild or furious, stupor, and coma, convulsions and spasms occasion- ally attend the access, or occur in its later stages. Some have been affected with that species of spasm termed opis- thotomos, when the head and heels have been violently drawn almost in contact. There is a remarkable prostration of strength, and sometimes accompanied or followed by severe chills ; the skin dry and pale, eyes dull and glassy, pupils contracted, and again suddenly dilated ; the tongue white at first, and assumes a redish colour ; the face sublivid, with paleness around the mouth, and the countenance expressive of the utmost anxiety and distress. The whole body be- comes cold, respiration very laborious, pulse small, feeble, and irregular, slow at the beginning, but afterwards greatly accelerated. There is great oppression and faintness, with undescribable distress about the praecordia ; eructations, nausea, and vomiting ensue, occasionally becoming inces- sant, embarrassing, and obstinate. With more or fewer of these symptoms of the first stage, some have died in twenty- four hours. In the second stage, about the third day the pulse becomes more full and regular, the skin warmer, coun- tenance flushed, respiration short and very difficult ; eye-lids swollen, and eyes staring, with a throbbing pain in the head, great restlessness, anxiety and delirium ensue. In a large proportion of cases, these symptoms have all subsided, and the disease has terminated within three days, often in one, the patient suffering only a slight debility. The following singular appearances have been observed among the various forms of this disease, especially with female patients. " U- niversal deadly coldness; skin white as polished marble and smooth ; countenance perfectly placid ; not one distorted muscle ; pulse in the wrist imperceptible; motion of the heart scarcely to be felt; respiration visible only by gasping, and that not frequent; and as it were only a step between this imperfect state of life and death." Even from this for- 331 OF THE SPOTTED, OR PETECHIAL FEVER. kirn and hopeless condition, recoveries have been known to result. The intestines appeared in general to be exempted from the effects of the disease, as constipation or diarrhaea rarely occurred, though in a few instances bilious matter was evac- uated from the stomach and bowels. The urine is scanty and high coloured, and the patient is often afflicted with strangury. When sweating took place, the matter discharg- ed imparted a peculiar mawkish smell. A small proportion of the sick, greater in some districts than others, die in ten ortwelvehours, others in twenty-four, lhirty-six,or forty-eight hours from the first symptoms of the disorder. On some occasions the threatening symptoms seem to subside, when in a few hours another paroxysm dissevers the slender thread of life. When the fatal termination happens within two days, besides many of the symptoms already enumerat- ed, the countenance is fallen, the solids flacid, petechial spots of dark colour, violet, or livid, suddenly appear on the supe- rior extremities, and immediately owr the whole body. At length confusion of mind with constant drowsiness, inability to swallow, respiration more frequent and more laborious, with fluttering pulse, bespeak the speedy dissolution of the sufferer. The spots on (he skin occur in all stages of the disease. The blotches are florid, or red and fiery. Vesicles and pus- tules resembling measles, vaccine and variolous eruptions, attended with itching and followed by scabs of a brown col- our, have in a few cases been observed. After death, the skin assumes a formidable livid colour, either generally dif- fused over the body, or in spots on the face, rack, and shoulders, and gradually extending fo the back part of the trunk. The parts (hat had been blistered become quite dark coloured and bloody. On dissection it almost constantly appeared (hat the brain with its meninges and blood vessels were in a diseased state, and in most instances (here was an effusion of serous fluid, and of coagulated lymph within the ventricles. In the tho- rax, the heart and pericardium have in general exhibited some appearance of diseased affection, and (he lungs and pleura have often been found in a morbid condition. It has been remarked that this, like all other epidemics, is subject to great mutability' of character, seldom retaining the same form, and degree of malignancy in different OF THE SPOTTED, OR PETECHIAL FEVER. 33ii seasons, and in remote parts of the country. In that form which it assumed in 1812—13, though manifestly the identical disease, the peculiar symptoms were, extreme pain in the side or breast, with great oppression and difficulty of respiration, short distressing cough, chills, and great pros- tration of strength, the pulse a little accelerated, rather full. not very hard, but easily compressible. The tongue at first yellow, then brown and dark coloured, the countenance pe- culiarly livid, and the patient slightly delirious. Afterwards the cough increases, and expectoration sometimes occurs. The heat of the body is not proportional to the violence of the pain, and never approaches that of common inflamma- tions. In the worst cases, the pain in the side or head is inexpressibly severe, and the general sensation about the Sraecordia is indescribably distressing ; the patient becomes elirious, and dies in Iwo or three days. In some instances the disorder resembled a common pleurisy, except that the pulse was not so hard, the cough nor the heat so great, noi the progress so regular. Dissections in these cases demon strated a morbid state of the heart and lungs with their con tiguous membranes. With respect to the mode of medical treatment in this awful disease, it is obvious that it must be varied with the vascilating symptoms which are present. In a large majori* ty of instances, no pressing danger will occasion solicitude, or embarrassment on the part of the physician, and little atten- tion will be requisite to discriminate between those of the mildest grade, and violent cases, which demand the most prompt and decisive applications to obviate the speedy des? truction of the patient's life. Because experience has sanctioned the practice of evacu- ating from the system at the beginning of acute diseases in general, it would be absurd indiscriminately to adhere to this rule in diseases of a malignant and debilitating tendency. The most important of all evacuations is that which abstracts the vital fluid from the general system ; this may in the pres- ent case prove highly beneficial or irreparably injurious.. Such is the infinite diversity of forms and symptoms, thai no measure can be adopted with a prospect of success, with- out a cautious discrimination of existing circumstances. The constitution, former habits, season and particular char- acter of the epidemic, must be critically reviewed. Instan- ces have most undoubtedly occurred in practice, in which 336 OF THE SPOTTED, OR PETECHIAL FE^ ER. blood-letting to considerable extent, has been the mean of " turning death into life and despair into confidence;" whilst on the olher hand, there have been some who, while their condition was not apparently very dissimilar,became (he vic- tims of the same operation. It should probably be established as an invariable rule m this disease, never lo open a vein when the blood has reced- ed from the surface and extremities and left those parts in a state of coldness and torpor. But first moderately stimulate the heart and arteries by mild cordials, as warm wine, ether and laudanum., accompanied by the application of externa] heat; and when by these means external action and warmth are restored, and the pulse perceived to rise and become hard, blood may be drawn, but if the pulse again sink during the operation, the evacuation must be stopt and cordials ad- ministered. It has been remarked that in the epidemic of 1810, evacua- tions were scarcely admissible, whilst in that of 1813, evac- uations of some kind, were almost constantly necessary, and blood-letting in particular was in most severe cases indispen- sable. When there is phlegmonous inflammation affecting the brain and its membranes, or when that organ is suffering pressure from the fulness of its vessels, manifested by coma or convulsions, respiration extremely distressing, and if the pressure is so violent that the face swells and becomes al- most black, like a person who is strangulated, no prudent physician can hesitate to draw blood from the jugular vein, or the arm by a Large orifice, that the relief may be as imme- diate as possible. If the head be unusually hot, the application of cold water to the head and face during the operation will be proper, and some mild cordial stimulant, as aqua ammo- nia? with spirit of lavender, and essence of peppermint, should be given to prevent a dangerous faintness. In cases of inflammation, or local congestion on the heart, lungs, or their membranes, venesection will become equally indispen- sable ; and if in either case much relief be obtained, if the pulse become more full, soft, and slow, and especially if con- siderable inflammatory buff appear on the blood, the opera- tion may probably be advantageously repeated. But in cir- cumstances the reverse of those just detailed, the use of the lancet must be prohibited. Emetics are exhibited at the be- ginning of febrile affections, for the double purpose of evacr uating any offensive substances in the stomach, and by the OF THE SPOTTED, OR PETECHIAL FEVER. 337 concussion which it gives the system, it may dissolve the morbid catenation, or effect such change as to interrupt the diseased action. In violent affections of the brain however, emetics are contra indicated, and blood-letting should in such cases precede their use. If there be much oppression at the stomach, with a dry skin, an emetic should be administered, and perhaps twenty grains of Ipecacuanha, and two or three grains of turpeth mineral, will be preferable to any other. Cathartics of jalap and calomel, or small and repeated doses of calomel are to be employed, and the intestinal canal must be kept soluble by mild laxatives and injections during the continuance of the disease. The next remedies to be men- tioned as among the most important, are epispastics, these should be applied early in the disease, and as near the part most affected as possible ; and in order to obtain their speedy good effects, the skin should first be excited by friction with strong tincture of cantharides. When the blisters are ap- plied, care should be taken that they adhere properly to the skin until it be thoroughly vesicated. So highly beneficial are their effects, that blisters ought to be applied in succes- sion to the head and chest, until the most effectual relief be obtained. In every case of considerable violence, the head should be immediately shaved, and cold water and vinegar applied, while the back of the neck and temples are vesicat- ed. Sinapisms to the feet, and sometimes to the wrists may be useful. In most instances of this disorder, sudorifics will be found essentially beneficial, for this purpose Ipecacuanha and opium in the form of Dover's powder with camphor is one of" the most eligible preparations, in doses of fifteen or twenty grains often repeated, until the desired diaphoresis be effected. The sweating should in no case be carried to ex- cess, but a moderate diaphoresis ought to be continued a considerable length of time to derive from it all the benefit it is capable of affording. The most generally approved remedy, and the utility of which has been the most extensively tested by experiment in the present disease is mercury. This valuable metal ap- pears to possess a property admirably suited to the indica- tions, and capable of interrupting (he diseased action which has been excited in the system. After its cathartic effect has been attained, calomel should be administered as an al- terative, in doses of one or two grains every two, four, or six hours, according to its effect, if combined with small doses 43 338 OF THE SPOTTED, OR PETECHIAL 1 EVER of Ipecacuanha and opium, greater advantages may be ex pected, and the medicine may be continued until all symp- toms of the disease have subsided, unless a considerable de- gree of salivation should be induced, in which case it must be sooner discontinued. In cases of great violence, where life is immediately threatened, this medicine cannot operate so speedily as to arrest the dangerous progress. But in cag- es of less severity, or where the most urgent symptoms are removed by other remedies, this will be found eminently effi cacious and successful. When the patient is tormented with intolerable pain, recourse must be had to opium as the only solace, and in fact, instances have been reported in which this medicine has rendered permanent advan- tage. Where besides excruciating pain, the patient suf- fer? from faintness, depressed state of circulation, and torpor of the extreme vessels, the following cordial prepara- tion may be expected to produce the happiest effects, though I have not ascertained that it has been employed in this dis- ease. Take of volatile tincture of gum guaiacum and anodyne balsam equal parts, about two drachms every two hours, un til relief be obtained. This will produce warmth, in the stom- ach, and over the whole body, excife increased action of the heart and arteries, relieve pain and promote a diaphore- sis. The oppression on the lungs attended with cough without expectoration, is to be relieved by blisters and pectoral medicines, of this class none is to be preferred lo turpeth mineral; if the patient is not too much debilitated, about two or three grains given every fourth or sixth hour soon ex- erts its effect by exciting a free expectoration. This may be assisted if necessary by squills, and seneka root, the lat- ter of which in doses of a table spoonful of the decoction, or about six grains in powder, three or four times in a day, has been found highly useful as an expectorant and diaphoretic. Antimonials are not in any form, it is supposed advisable in this complaint. We must however except some reported cas- es, where antimonial wine and laudanum combined, was advan- tageously employed. A whey prepared from mustard seed as in the Appendix, has been employed with good effects, and is recommended as a useful warm stimulant, and expectorant. As assisting the operation of diaphoretic medicines, a warm decoction of thoroughwort is by some held in much estima- tion. OF THE SPOTTED, OR PETECHIAL FEVER. 339 II ore it is proper to advert to the hazardous practice, so absurdly adopted in many places of administering without the advice of a physician large quantities of brandy and other internal stimulants tending to increase the excitement in the large internal vessels, without being capable of inducing re- action and' equalizing the circulation in the extreme vessels of the skin. The fullest attestations derived from ample ex- perience, prove the dangerous tendency of these measures when indiscriminately or incautiously employed, as they ag- gravate all the symptoms, and occasion a rapid progress of the fever into its most malignant slate, which suddenly and unexpectedly terminates in death. These means however, are not in every instance to be prohibited, for oftentimes a cautious use of stimulants may be indispensably necessary. The excitement of the system should on all occasions be supported nearly as possible to the natural standard, but nev- er raised by artificial means above that of health. With this object in view, the stomach must be invigorated by the lighter kind of stimuli, as warm aromatic tea drinks, and such medicines as will communicate congenial warmth without ir- ritating by their stimulus the heart and arteries. Among these are, saffron, sage, pennyroyal, orange peel, seneka root, Virginian snake-root, cinnamon, camphor, spirit of lav- ender with essence of peppermint, ether and wine, to which may be added pure cider, coffee, mustard whey, and animal broths. Whilst some of these are given in moderation, the application of artificial heat to the surface is by no means to be neglected, provided there is a deficiency of natural warmth, and excitement in the extreme parts of the body. When a torpid state of the cutaneous vessels, and consequent coldness of the skin prevails, and perhaps the internal organs are at the same time labouring under a dangerous congestion, the application of external warmth becomes a point of primary importance in the early stage of the disease, in order to ex- cite action on the surface, and divert from the internal visce- ra. The warm bath is well suited to answer the desired purpose, but on many accounts it may be more convenient, and not less useful, to enclose the body of the patient in blankets dipt in warm water, renewing them often as they become cool, after which the skin should be wiped dry, and the patient's body kept moderately warm between blank- ets, that the renewed action on the surface may be properly supported. Billets of wood having be/en well heated in boil- 840 OF THE SPOTTED, OR PETECHIAL FEVER. ing water, may also be applied to different parts of the body where required. The small limbs, or twigs of hemlock, or pine, after being a little moistened and then thoroughly heat- ed by enclosing them in a cloth with a hot stone, will impart to the body, a dry heat well calculated to fulfil the indica- tions. But the method invented by Dr. Jennings, of com- municating heat by means of a spirituous vapour bath, is supposed to be preferable to all other means hitherto em- ployed for restoring warmth and heat to the surface and ex- tremities of the body. Whatever method be adopted, should be so regulated that the heat of the surface be not in- creased beyond the natural healthy standard. One circum- stance not generally adverted lo is lo be regarded as pecu- liarly important; the patient should never be permitted to sleep longer than one hour without being roused and desired to swallow some drink or medicine, otherwise a fatal torpor or coma may ensue and close in death. In regard to the use of tonic remedies in the last stage of this disease, Hux- ham's tincture of Peruvian bark, decoction of cascarilla, stom- achic bitters, and the mineral acids, with thoroughwort, are those which may be most advantageously employed. Two cases have been reported to me by a correspondent, in which a decoction of the root of sophora tinctoria (see Appendix) was highly beneficial as an antiseptic. Fowler's solution of arsenic has acquired considerable repute, and practitioners in general of most experience in this disease, have agreed in their expressions of confidence in its superi- or efficacy. This remedy however, is not often to be ad- vised at the onset, but reserved to an after period, when proper evacuations have been made, and a subsidence of violent symptoms has taken place. The proper dose is from three to six drops, every four or six hours, until its effects on the system become evident by a peculiar sen- sation about the eyes and face. The diet during this disorder may be more liberal than that allowed in acute diseases in general, as the appetite and powers of digestion are not much impaired. It may consist of the usual farinaceous substances, and animal broths and soups, with some vegetables. Another recent epidemic, apparently in close alliance with spotted fever, and sometimes confounded with it, will be treated of in the following chapter. CHAPTER IX. OF THE PERIPNEUMONIA NOTHA, OR TYPHOID PNEUMONIA. THE epidemic now to be considered has a strong affinity to that described in the preceding chapter. Both are prob- ably dependant on the same predisponent and exciting caus- es, and equally destitute of the contagious character. Con- federate accomplices in the great work of mortality, they are no less humbling to the pride of medical science, than fatal scourges to the human race. In 1812—13, this formidable epidemic prevailed among the soldiers of our army on the frontiers of Canada, and extended to the inhabitants in those vicinities with the most alarming mortality. It has since continued to display the arrows of death, and to spread con- sternation and dismay through various sections of the United States. Its greatest prevalence has been during the cold weather of winter and spring, and generally remote from the seaboard. According to its supposed existent forms, it has received the different appellations of peripneumonia notha, pneumonia typhoides, bilious pneumonia, and malignant pleurisy. * The analogy between this epidemic and spotted fever, seems to be evinced by the violence and suddenness of at- tack, variety of forms, sudden prostration of the vital prin- ciple, and rapid progress to a fatal termination ; and on some occasions by the appearance of both at the same epidemical season. The analogy of the two diseases is also manifest by nearly the same appearances on dissection, and that on general principles they require a similar mode of curative treatment. The two diseases however, are not to be con- founded either in theory or practice. In the petechial fe * The vulgar term " cold plague" or " cold skin fever," given it in the southen. states is not inaptly applied, considering the remarkable coldness of the surface and extremities, and also its dreadful fatality in some particular places and seasons. 342 OF THE PERIPNEUMONIA ver, the principal morbid affection discovered on dissection was on the parts within the cranium ; in the present disease it is generally found in some of the thoracic viscera, as the heart and lungs with their membranes ; yet in some instan- ces, all those different parts participated in a greater or less degree in the diseased affection. The peripneumonia notha is far from being a new disease, we find it mentioned by the great Sydenham about the year 1680, under the denomina- tion of bastard peripneumony, which he says " arises every year towards the beginning, but more frequently at the close of winter. It chiefly attacks such as are of a gross habit of body and middle aged persons, but oftener t-hose who are more advanced in years and too much addicted to spirituous liquors, especially brandy." The very accurate description given of peripneumonia notha, by that excellent practical author, Dr. John Hux- ham, in Ihe year 1759, so exactly corresponds wilh the epi- demic which has recently visited our country, (hat no one can doubt of their real identity. I shall give a concise ab- stract of his description. " Though the load at the breast is very great, breathing difficult, and the cough very impor- tunate and sometimes violent, yet the fever and heat are small, many times scarce perceptible, the pulse either quick, weak, and small, or sluggish and oppressed, never hard and tense.—So that as this distemper hath very different, and almost quite contrary symptoms to those of a frue peripneu- mony in several respects, it is reasonable to suppose.it arisv es from very different causes, and requires a very different method of cure.—And in fact we see, that bastard peripneu- monies commonly seize the old and phlegmatic, the weak and lax, the fat and unwieldy, and are most rife in wet, fog- gy weather and winter seasons ; whereas the true inflamma- tory peripneumony generally attacks the robust, vigorous, and active, and is most frequent in cold, dry weather, during northeast winds and high stations of the barometer___These two diseases then seem to differ almost as much as ardent and slow nervous fevers; or as much as an inflammatory quinsy doth from one that is purely humoral, or arising mere- ly from a serous defluxion. The frequent chills and flushes of heat however, the quickness and irregularity of the pulse, anxiety and weight at breast, pain and giddiness of the head, foulness of the tongue, &c sufficiently indicate a feverish habit." " A perpetual laborious wheezing, great anxiety \0T1IA, OR TYPHOID PNEUMONIA 343 und constant oppression on the prsecordia, comatose symp- toms, cold extremities, and dark lead coloured nails and visage, are marks of great and immediate danger." The following observations to be found in Mr. J. Bell's Anatomy will further confirm the close resemblance of this epidemic with the European disease. " In peripneumonia notha, there is not merely an inflammation of the pleura, as the name expresses, but of the lungs themselves ; and it is not from inflammation, pain, fever, or acute suffering, that they die, but because the lungs are entirely crammed ; the heart can no longer move ; they are not sensible of their dan- gerous state, but are suffocated in a moment and die without a groan." " When this disease comes upon a place, it comes with all the frequency and destruction of an epidemic disease; and the sudden and unexpected deaths are terrible." " The pulse is weak ; the cough slight; the difficulty of breathing more anxious than painful; the face sunk in the features and flushed, or rather of a livid colour, except when it is cadaverous, pale, and sallow. The suffocation is sudden ; the lungs have, as Morgagni expresses it, a liver- like, solid consistence ; they have no longer the cellular ap- pearance of lungs, for their bronchia*, are crammed with blood ; their common cellular texture is also full of exuded blood; they are dense, solid, and very heavy and black, and they sink in water like the lungs of a foetus. The heart is so curbed in its actions, that it gives but a small, feeble, and trembling pulse," &c. It may be deemed somewhat singular, that having the characteristics so accurately portrayed by the first Europe- an authorities, we should not be prepared to recognize the disease immediately on its appearance in our country. The shades of dissimilarity, may, it is presumed, be explained by referring to the difference in climate, and the constitu- tions and habits of the people. The disease has in general commenced with acute pain in the side or breast, stricture across the thorax, and difficulty of breathing, short distress- ing cough, sometimes attended with a mucous expectoration tinged with blood; numbness in the muscles, excruciating pains in the limbs and about the region of the heart, chills and great prostration of strength, together with palpitation, irregularity, depression, and annihilation of the pulse, syn- cope and cold sweats ; but in a few cases, the pulse was ve- ry rapid and not depressed. 344 OF THE PERIPNEUMONIA In some instances the patient was seized with a violent pain in the head, soon became delirious and died in a few hours, (see the last chapter.) This most violent and fatal malady is to be combattcd with promptitude and decision, little time is afforded for de liberation. Remedies should be applied within the first few hours of attack. As Dr. Huxham observes, " the timid, low, insipid practice of some is almost as dangerous, as the bold unwarranted empiricism of others ; time and oppor- tunity, never to be regained, are often lost by the former; whilst the latter, by a bold push, sends you off the stage in a moment." The remarkable mutability of the disease, and the dis- cordance of opinion among practitioners, bring the fullest conviction that no precise or uniform rules can be adopted, all must be regulated by the particular state and condition of the patient. Relative fo a few points however, there ex- ists no contention among judicious practitioners. Blood-let- ting is not to be resorted to indiscriminately, and the stimu- lant plan by the use of ardent spirits has in general been de- nounced as highly injurious, while some individuals having experienced their salutary effects, extol the remedy as be- ing singularly efficacious, even when exhibited to such ex- tent as in a state of health would appear a dangerous exper- iment, and it is sometimes found difficult to control the pop- i::ar bias in favour of their administration. But let it be ob- served as a general position, that the intended effects of ar- dent spirits and other cordials, are to warm the stomach, and to increase the force and frequency of the heart and large vessels, when these are almost arrested in consequence of pressure on the brain ; but by the liberal and indiscrim- inate exhibition of such stimulants while those organs are in a gorged state, there is much hazard of so increasing the local congestion of blood, as to lessen the power of the ves- sels to contract, and to produce sudden death. Ardent spirits seldom fail also of interrupting the natural evacuation from the lungs' by expectoration. That excellent physi- cian, Dr. Huxham, was an advocate for bleeding at the com- mencement of peripneumonia notha, provided great load and oppression at the breast with difficult breathing, full, or tense and hard pulse, and other urgent symptoms indicated the ne- cessity of it; but in contrary circumsfances he advises to proceed with great caution; and when the blood drawn ap^ NOTHA, OR TYPHOID PNEUMONIA. 345 pears loose, thin, and florid, or more commonly of a darkish livid hue, and without that thick viscid buff as in common inflammations of the lungs, a repetition of the operation is inadmissible, as the patient soon sinks, and the powers of life fail in consequence of the evacuation. But the fact is to be remarked, that in this as in all other epidemics, no in- variable rules can apply to particular seasons, constitutions and other individual circumstances ; very much must depend on the vigilant attention and happy discernment of the at- tending physician. During the epidemic, the present year, (1816,) in this state, blood-letting had in general a remarkable tendency to a fatal termination, inasmuch that it became an established opinion among the most judicious, that in not more than one in ten instances could the lancet be employed with safety. Local blood-letting by leeches or cupping, may often prove beneficial when the general evacuation is to be avoided. Cases may, and have undoubtedly occurred however, where (he lungs are so gorged wi(h blood, (hat the heart and arteries are dangerously impeded in the per- formance of their action, while at the extremities and surface of the body, torpidity and coldness prevail. This condition of the patient is often accompanied also with most laborious and suffocating respiration arising from the bronchia? being loaded with bloody mucus. Here the stimulus of ardent spirits internally must be carefully avoided, but the most effectual means of external warmth should be immediately and assiduously employed. It is in these circumstances that fhe use of the lancet is not to be guided by the state of ihe pulse ; although a full evacuation may be improper, small bleedings of four or six ounces, and repeated every six or eight hours, attentively watching the effect, will afford oppor- tunity for the gorged vessels to relieve themselves from the oppressive load, and may be the means of permanent advan- tage. And when a general warmth and uniformity of action, and excitement are restored to the surface and extremities, a more copious evacuation may in some instances be requi- site ; or the appropriate auxiliary remedies may now be dil- igently applied with the fairest prospect of success. A very extensive application of epispastics to the parts most affected, as advised in spotted fever, should be regarded as among the principal remedies to be relied on; these when applied to the legs and thighs, says Dr. Huxham, are often found to relieve the head and breast when other methods faH. 44 34 ti OF THE PERIPNEUMONIA But the limbs, when cold and torpid, should be well rubbed before the blisters are applied, and then wrapp< - - ^ :ood : the drink should be barley water, toast and water, infusions of sage and elder flowers, common whey, &c.; a little wine may be added in case the pulse become low and the spirit* are sunk. With regard lo external applications they must be resorted to with much caution i', and most simple kind. The patient oughl (o be (;:'pt qui;'*, and avoid speaking as much as possible; his head should be raised while in bed, and a moderate pcispi- ral ion should be encouraged. His feet and legs must be often bathed in warm wafer, and his bowels gently deterged with Glauber's salts when required. It is important that the neck be kept warm, and a douMe flannel well moistened with the volatile liniment, prepaid as in the Appendix, if often repeated, in conjunction with the means above men- tioned, will frequently remove slight affections of the throaf, and r uder furtiicr expedients unnecessary; or a blister may be applied lo the part with advantage. The use of gargles in this disease is attended with the most beneficial effects, by attenuating the viscid mucus which clogs the mouth and ihroat, and in rendering it more easily removed. An infusion of red rose leaves sweetened with honey, and acidulated with the sulphuric acid, of such strength as the patient can easily bear, will be found fo answer the desired purpose. Another preparation of this kind may be made of sage tea, with a little vinegar and honey, and it may be improved by the addition of the jelly of black or red cur- rants. With some such preparation, the mouth and fauces should be frequently cleansed, and if necessary, it may be injected by means of a syringe. When the mouth is very dry and parched, and the tonsils much inflamed, considera- ble relief may be obtained by dissolving in the mouth a few grains of pure nitre, and allowing it to lodge on the parts affected, or leisurely swallowing it. An emetic will often afford essential relief. In some instances the inflammation and fever will run to such height at the beginning, as to require bleeding from the arm or jugular vein, the quantity and repetition of which must be determined by the urgency of symptoms, and strength of the patient. After this evacuation leeches ought to be applied to the throat. The volatile linimeut ought also to be employed as mentioned above, and should it not prove effectual, a blister must be applied round the throat SORE THROAT, (CYNANCHE TONSILLARIS.) 399 in its stead. By a diligent employment of the means above recommended, (he inflammation will in most cases be dissi- pated and a suppuration prevented. If however, (he inflam- mation cannot be resolved, and (he formation of an abscess is indicated, we ought to hasten the suppuration by the fre- quent application of warm fomentations, and emollient poulti- ces to the throat, and directing the patient to inhale the vapour from warm milk and water through an inverted funnel several times in a day. When the abscess has progressed to a ripened state, if it break not spontaneously, nor by the efforts of the patient, it must be opened with a lancet. If in any instance the tumour becomes so large as to obstruct the passage of food into the stomach, it only remains to af- ford fhe patient sustenance by nourishing clysters, made of broth, thin jellies, gruel, and milk, by which means he may be supported until by the breaking of the abscess the pas- sage for food is restored. The size and pressure of the tumour, may be so increased as to obstruct the passage of the lungs, and endanger the life of the patient by suffocation, in which case bronchotomy, or making an incision into the wind pipe must be performed, if an experienced surgeon can be procured, but fortunately, there occur very few instan- ces in practice where recourse to this operation is necessary. There is sometimes an obstruction and enlargement of the glands of the throat, which occasions a difficulty of swallow- ing, unattended wilh inflammation, which may be soon re- moved by the application of the soap liniment or opodeldoc and keeping the neck warm. Persons who are subject to inflammation in the throat, should carefully observe regularity and temperance in liv- ing, and should occasionally carry off the superabundance of humours, by purging and other evacuations. They ought likewise to guard well against cold, and avoid whatever is of a stimulating nature in diet. Drinking cold liquor imme- diately after violent exercise, is very prejudicial: as is like- wise a sudden exposure to cold air, after any great exertion of the throat by speaking or singing. The glands of the throat sometimes continue swelled after an inflammation, and acquire a degree of hardness which is f difficult to be removed. No attempt should ever be made to resolve these tumours by any stimulating application. The throat should be kept warm, and the fauces gargled twice in a day with a decoction of figs or bailey, sharpened with vinegar, leaving the swellings to dissipate by time. CHAPTER VI. OF THE CYNAXUIF. MALIGNA. SCARLATINA ANGINOSV SCARLATINA MALIGNA, OR PUTRID SORE THROAT. THE generic term scarlatina comprises the three varie- ties of scarlatina simplex, already described, page 364. Scar- latina anginosa, when attended wilh an ulceration of (he (hroat; and scarlatina maligna, when with the same affection the symptoms of malignancy and putrescency prevail. It is no longer doubted that scarlatina in all its alarming forms is produced by the same specific contagion, and frequently (he symptoms are so blended together that it is difficult to determine to which species they more particularly belong. This disease has long been considered by European au- thors as being highly contagious, spreading epidemically through villages and districts with an alarming degree of mortality. In our own country it has been known at differ- ent periods to spread its ravages Ihrough many towns and some seaports with singular malignity. In the year 1735, it prevailed extensively throughout this country, and it was estimated that in Massachusetts about one thousand persons fell victims to it. The physicians of that day were of opinion that it was not contagious. In 1784, it again appeared, and spread through most parts of the New- England states ; since which, sporadic cases have frequently occurred in different families and neighbourhoods, disap- pearing and' again returning, without a general infection, and leaving it even doubtful whether Ihe disease is com- municatifl by infection. But in its more virulent and malig- nant forms, it may unquestionably be communicated by Ihe breath, if not from the simple contact, or contaminated at- mosphere of fhe patient. The sources from which this malady is supposed to de- rive its origin, are a peculiar state of the atmosphere, dam- aged provisions, obstructed perspiration, and other causes that produce putrid fevers which it greatly resembles. OF THE CYNANCHE MALIGNA, OR PUTRID SOBE THROAT. 401 It attacks chiefly children, and persons of weak lax hab- its, as being more predisposed lo receive the infection, and it is supposed by some that it affects the same person more than once during life. It commences suddenly wilh cold shiverings, anxiety, nausea, and vomiting, succeeded by heat, restlessness, thirst, and oppression at the breast; great de- jection of spirits, with faintness when attempting to sit up. The pulse is greatly accelerated though low and unequal. The tongue is moist, the eyes heavy and watery ; the coun- tenance frequently full, flushed, and bloated ; though occa- sionally pale and sunk ; the breathing is quick and laborious, the skin extremely hot, and in many cases there is an erup- tion, or efflorescence about the second or third day, in large patches of a dark red colour, about the face and neck, which by degrees extend over every part of the body, even to the extremities of the fingers. The urine is commonly pale, thin, and crude; but in some adults in small quantity, high coloured or turbid like whey. The patient complains of a stiffness in the neck, with acute pain in the back of the head. The throat is sore, and inflamed, exhibiting a shining redness of a deeper colour than in common inflammatory sore throat, and interspersed with pale or ash coloured spots. The breath is highly offensive ; the tongue is covered with a yel- low mucus or thick brown fur ; and the inside of the lips is beset with vesicles containing an acrid matter which excori- ates the corners of the mouth and other parts. The inside of the nose is red and inflamed, and a thin acrid matter is- sues from the nostrils, which corrodes the skin wherever applied. There is sometimes a delirium, though the symp- toms appear slight; the swallowing is difficult, and more so on swallowing the saliva only, than of any liquid or soft diet. A vomiting and purging is most common wilh children, and when the efflorescence, or eruption appears, about the sec- ond or third day, these evacuations generally cease. But children have sometimes died on the second day of the at- tack. The malignant or putrid sore throat, may be distin- guished from the inflammatory, by fLe looseness and vomit- ing ; the puffy and dark coloured redness attending the swelling, and by the foetid ulcers of the throat, covered with white or ash coloured sloughs. It may also be distin- guished by the slight delirium appearing early in the dis- ease ; and by the sudden weakness with which the patient is seized. Where the pulse about the fifth or sixth day of 51 40'1 OF THE CYNANCHE MALIGNA, this disease becomes more moderate and stronger, the respiration freer, the skin soft and moist, the florid colour begins to return to the fauces, and a better matter to be dis- charged from the ulcers, and when the eyes are bright, and there is no great degree of weakness or faintness, a fa- vourable termination may be expected. But if the weakness be great, if the pulse should be weak and small, accompa- nied with a looseness or shivering; if the eruptions disap- pear, or become livid ; if the eyes look very dull, and the nose bleeds, and there be much fetor of the breath with a ca- daverous appearance of the body, the event will be fatal. And if on the third or fourth day, respiration grow more laborious, with a peculiar kind of catching the breath, or double breathing; and an anxiety of five or six minutes con- tinuance come on, three or four times in an hour, such as induces the patient to bite his hands and arms, death may be expected on the fifth day. In detailing the medical treatment of scarlatina it is first to be observed, that this must vary according to its appear- ances and forms in different seasons and circumstances. Scarlatina anginosa has been known to assume inflammatory symptoms to such degree as to indicate the use of the lancet at its commencement, and it appeared in that character in Philadelphia in 1783 and 84, when in some instances Dr. Rush was induced to have recourse to blood-letting; but this evacuation is rather out of course in practice in this complaint, and a hard full pulse should perhaps be the in- variable criterion. In that form termed scarlatina maligna, when putrid symptoms are present, it has been universally agreed that the evacuation of blood is utterly inadmissible, experience having evinced that it never fails to debilitate and promote the fatal tendency. But the administration of an emetic is of the first importance, and the earlier it is exhib- ited the greater will be the probability of diminishing the violence, and shortening the duration of the disease. By thus evacuating the stomach and bowels of their putrescent contents, the disorder has sometimes been entirely arrested at the beginning. The powder of Ipecacuanha will in gen- eral prove sufficiently powerful, and less debilitating than antimonials ; but on some occasions, it may be advisable to add a few grains of turr/eth mineral, and the prescriber must not rest satisfied until he is assured of its having bad its due effect in cleansing the stomach. It was formerly con- OR PUTRID SORE THROAT. 403 sidered as the most successful practice in this disease to administer a moderate course of mercury as an alterative, and Dr. Rush adopted fhe practice of adding calomel to his emetics, after which he gave the calomel in small doses in every stage of the disorder, and combined it also with his gargles. If the calomel did not sufficiently deterge the intestines, he directed it to be followed by some mild laxa- tive. This method however, must not be adopted incau- tiously by inexperienced practitioners, for when the putrid tendency is great, and considerable debility has ensued, mercury and every other debilitating medicine should be employed with the greatest circumspection, as it too fre- quently happens that even the mildest cathartic depresses and sinks the patient. But emetics of Ipecacuanha, may be frequently repeated if required, and costiveness must be obviated by gentle aperients or laxative injections ; active purgatives are sometimes followed by alarming effects. With the view of determining to fhe surface, the spirit of mindererus, or the neutral mixture, with a due proportion of tartarized antimony, should be directed in doses of a ta- ble spoonful every two or three hours, and on some occa- sions Dover's powder may be preferred. A powder con- sisting of about four grains of camphor, and fen of cream of tartar, or when much febrile heat attends, the same quantity of sal nitre, will be productive of beneficial effects. In scarlatina anginosa, it will be proper to employ some detergent gargle as recommended in the preceding chapter, which in young children may be injected with a syringe. A blister has sometimes been advised, but it will be preferable to apply a poultice of mustard with meal and vinegar to the throat, and continue it as long as it can be borne. Cold water applied to the throat, and by way of gargle, has been known to answer an admirable purpose. Should the eyes appear much inflamed, and delirium pre- vail, drawing blood from the temples by leeches might be likely to afford relief. When great inquietude and restless- ness demand the use of opiates, these should be combined with diaphoretics, as the neutral mixture or spiritus nitri dulcis. Scarlatina in its mild form is not often attended with great danger, but we ought to be constantly on our guard in this insidious disease, as the severest cases of cynanche maligna often make their attack in so mild a manner, that for some- 404 OF THE CYNANCIIE MALIGNA, time the disease assumes the mos( favourable form, when in an unexpected hour the symptoms denoting its most malig- nant type are ushered in, and the patient is sometimes cut off before danger is suspected. The affusion of cold water, or sponging the surface of the body, has been practised in scarlatina of late years with remarkable success. Accord* ing to Dr. Currie, the cold affusion in several instances has extinguished scarlatina in its incipient state, so as to prevent either efflorescence, or any affection of the throat from tak- ing place. The great utility of this remedy is fully corrob- orated by the experience of Dr. Thomas, and other respec- table authorities. This very efficacious agent however, is to be employed only on the first onset of the disease, when there is intense heat and dryness of the skin. When Ihe least chilliness prevails, or where Ihere is any tendency to perspiration the application of cold water might be produc- tive of much danger. In cases where from several days continuance of fever, extreme debility, with small irregular pulse have ensued, the cold ablution is deemed improper, it will be advisable to sponge the body with tepid water or with the addition of vinegar. On the other hand, should a coldness and torpor of the surface and extremities occur, the warm bath, or other means of restoring warmth and equable excitement must be employed. But so soon as a putrid tendency and a great prostration of strength has become manifest, the objects which should excite our chief attention are, to support the patient's strength, to obviate the putrid tendency of the humours, and to cleanse the ulcers of the mouth and throat. Should therefore, the inflammatory symptoms not run high, or these having sub- sided, the tonic and antiseptic remedies, are to be applied with the utmost assiduity. The cinchona and wine must be administered to the fullest extent of the condition of the stomach to receive them. If the bark in substance cannot be retained on the stomach, the decoction or infusion should be substituted, and the elixir of vitriol, or muriatic acid ought at the same time to be freely employed as directed in typhus gravior. When children cannot be prevailed on to take the bark in any form, it should be injected into the in- testines with a syringe. Information has reached me from a source deserving of confidence, that a decoction of the root of sophora tinctoria, has been exhibited in this disease with the most satisfactory success, and is even esteemed by OR PUTRID SORE THROAT. 40.5 some, as a more efficacious antiseptic than the cinchona. It is given in doses of a (able spoonful every few hours, but in diminished doses, if it prove cathartic. Used as a gar- gle, it certainly deterges and heals the aphthous ulcers in a wonderful manner. As auxiliary remedies, nothing can be more essential than the application of proper gargles to the mouth and fauces ; and particular attention should be paid to this point in cases of children, who are incapable of garg- ling, that the remedy be properly and thoroughly applied by injecting with a syringe, to clean the throat before swal- lowing any food or drink, as otherwise, the sloughs and pu- trid discharge from the ulcers, may be carried down and greatly aggravate the complaint. Much benefit will be re- ceived by a few grains of calomel, either by itself or mixed with honey, and often applied to the tongue and ulcerated parts of the mouths of children. The following may be regarded as among the best preparations for the purpose of gargling. Take a handful of red rose leaves, a piece of myrrh fhe size of a nutmeg, and three or four figs ; simmer the whole in a pint of pure old cider, the older the better, then strain and sweeten it with pure honey. An excellent gargle may be prepared by diluting the muriatic acid, and sweetening with honey so as to be in some degree palatable; in cases of troublesome aphtha?, or erosions of the mouth and tonsils, it allays the intolerable heat and dryness of those parts, and induces an agreeable cooling sensation. It ap- pears by Thomas' Modern Practice, that the throat distem- per prevailed among the children in the West-Indies a few years since, with the greatest mortality, in despite of the utmost endeavours of the physicians, till at length fhe superior efficacy of the following remedy was discovered. Take two table spoonfuls of capsicum, or Cayenne pepper, and two tea spoonfuls of common salt, infuse these in half a pint of boiling water, and then add the same quantity of warm vinegar; after standing for about an hour the liquor is to be strained through a fine cloth, and two table spoonfuls given for an adult every half hour, using it also as a gargle. " The speedy and good effects" says the author, " produced by the use of this medicine in every case in which it was tried, evidently points out the utility of giving warm aromatics, which will bring on a timely separation of the sloughs, as well as other antiseptics to correct the tendency in the parls togangrene." The root of marsh rosemary (statice limonium) is another article which has be'en employed as a gargle in this complaint tot; OF THE CYNANCHE MALIGNA, with very essential benefit. It is undoubtedly an astringent of considerable efficacy, and well deserving of further trial. The carbonic acid gas, has of late been employed as an antiseptic in angina maligna with some advantage ; the most eligible way of introducing it into* ffle sfomach, is to direct the patient to swallow ten grains of salt of tartar, or other fixed alkaline salt, dissolved in a cup of water, immediately after which two table spoonfuls of lemon juice, or sharp vin- egar, must be swallowed. During the act of effervescence, fhe gas will be extricated, and exert its immediate effect on the stomach. It is on the principle of its containing a por- tion of fixed air, that yeast has been recommended in both malignant sore throat and putrid fever. When given in dos- es of two table spoonfuls every three hours, yeast has prov- ed manifestly beneficial. If the patient should be troubled with a diarrhaea, every attempt should be made to restrain it, as in every stage of the disease, this is a dangerous symp- tom. A decoction of catechu, or the root of tormentilla, being excellent astringents, may be employed for this pur- pose with decided good effects. A little wine or brandy mulled up with cinnamon or nutmeg, may also be advised, and small doses of laudanum will sometimes be requisite. Violent vomiting is to be appeased by the saline draught in the effervescing state, by small doses of laudanum and pep- permint, and by the application of tincture of opium and camphorated spirits to the region of the stomach. There is some diversity of opinion respecting the employ- ment of blisters in any form of this complaint, their utility it is said has not been experienced in practice, and as they are attended with inconvenience, and interfere with more useful applications, they may perhaps in most cases be omit- ted. When angina visited Boston in 1802, Dr. John Wa»- ren observed that " for swellings of the parotid glands, noth- ing was so efficacious as the application of cold water, or vinegar and water, by cloths kept constantly wet with these fluids. The drinking of cold water was in some instances attended with the happiest effects." In some instances a suppuration of the parotid glands will take place, when this is indicated emollient poultices should be applied till matura- tion is complete, when the tumour must be opened, and the ulcer is then to be dressed with digestive ointment. In some cases there happens a discharge of blood from the nose, mouth, or ears, which not being critical, but on the contrary threatens the greatest danger, ought to be res- OR PUTRID SORE THROAT 407 trained if possible by administering freely the mineral acids internally, and by the external application of tents dipped in some powerful styptic, as a solution of blue vitriol or al- um. A singular occurrence sometimes follows a crisis in this disease, the patient is seized with a swelling of the wrists and ankles, accompanied with redness and great pain in ev- ery respect similar to acute rheumatism. Others were af- fected with an universal tumefaction from head to foot, the cellular membrane being puffed up like a bladder, and the patient in this case discharges but little urine. Both of these complaints are soon removed by the use of diaphoretic, and diuretic medicines, joined with tonics and a nourishing diet. But Dr. Rush succeeded in removing these dropsical swel- lings in every instance by fhe use of cathartics of calomel and jalap. It has already been mentioned that it was the New-England practice on former occasions, to administer a moderate course of mercury so as to act upon the system at large for the cure of scarlatina, and that mode of treatment was eminently successful. Dr. Rush also employed calo- mel in small doses in all stages of scarlatina anginosa which appeared in Philadelphia in 1783 and 1784. In subsequent visitations however, the disease has appeared fo be some- what different, and the predominant symptoms of putrid dia- thesis, and of debility, have deterred many physicians from resorting to the same mode of treatment. This shews the high importance of a judicious discrimination at different seasons of its prevalence, as well as peculiarities of personal circumstances. Through the whole course of this disease the patient should be supported with nourishing food, light and easy of digestion, consisting chiefly of vegetable substances, as oat gruel, rice, sago, arrow root, and panado. The ordinary drink may be wine whey, and barley water, acidulated with any of the vegetable acids. When (he patient is happily brought to a state of conval- escence, some gentle laxative medicine should be given oc- casionally, to carry off the putrid dregs that may remain in the intestines ; and if he continues weak, he ought (o perse- vere for sometime in the use of the Feruvian bark, and elix- ir vitriol, with daily exercise and a clear air. Or the thor- oughwort may be substituted for the Peruvian bark. When scarlatina anginosa is viewed in the light of a contagious dis- ease, it will be conceived that the means of prevention are considerations of no small importance (o the community. 408 OFTHBCYNANCIIE MALIGNA, OK PUTRID SORE THRO AI As respects the management of the patient, the greatest attention to cleanliness must be observed. Whatever is voided by stool ought to be speedily removed, the linen and every infected article should be frequently changed and cleansed. The chamber should be sufficiently ventilated, but not so as to give any check to the perspiration, or efflor- escence, and the floor should be often sprinkled with vine- gar. The patient must not be surrounded by more attend- ants than are necessary, and those should carefully avoid in- haling the breath of the sick. The Cayenne pepper as men- tioned above is affirmed to be an excellent preventative med- icine. According to Dr. Thomas, " by giving the attend- ants of the sick and others who may unavoidably be expos- ed to infection, a tea spoonful every two or three hours, us- ing it at the same time as a gargle, (he preventative effect of the remedy is said lo have proved certain. It seems to act by producing and keeping up a regular excitement in the tonsils, uvula, and fauces, and thereby enabling them to re- sist the sedative effects of the poison which is inhaled." But an expedient still more important consists in a speedy separation of the sick from the well, and of such as have been exposed to infection, as much as possible from all others. The period which elapses from the reception of the con- tagion, to the appearance of the symptoms, is said to be from three to six days. Whenever the disease is recogniz- ed, whether in a private family or boarding school, or other assemblage of children, every person affected should be sep- arated without delay from all the rest, until a sufficient time has elapsed to secure from danger of infection. These are (he most probable means of checking the progress, and ef- fecting the total extinction of this fatal disease. According to Dr. Willan, persons under the influence of contagion do not communicate it until they are actually af- fected with the fever and efflorescence, but it may be con- veyed from one to another, by means of cloths, or a hand- kerchief, which has received the vapour from the lungs, or any of the discharges from the mouth or nose of the patient. Convalescents, he observes, from the disease, notwithstand- ing the minutest attention to cleanliness and change of appa- rel, remain for two or three weeks capable of affecting others. Even the slightest case of simple sc arlet fever, he thinks, may produce in some scarlatina anginosa, and in others scar- latina maligna. CHAPTER VII. OF THE MUMPS, OR (CYNANCHE PAROTIDE*,.) THIS is a contagious disease, affecting chiefly children and young persons, and is often epidemic. If is known by an external moveable swelling that arises on one side of the neck, but more commonly on both, and frequently attains to so considerable size as greatly to impede the powers of res- piration and deglutition, giving rise thereby to symptoms of fever. These tumours occupy fhe parotid glands ; are large and hard, and somewhat painful, continuing to increase till the fourlh day, when they with the attending fever decline and soon disappear. After these symptoms have subsided, it is remarkable (hat the contents of the scrotum in males, and the breasts in females, become affected with a large, hard, and often painful swelling, which generally subsides in a few days. Sometimes however, the tumour in the fauces is sud- denly suppressed, and not attended with the last mentioned symptom; in which case the fever increases rapidly, and is often succeeded by delirium, and has sometimes proved fatal. The mumps commonly terminates without danger, and seldom require the assistance of medicine. The principal requisite is, to keep the head and feet warm, to avoid taking cold, and to regulate the bowels by the mildest cooling lax- atives. But should the tumour in the neck suddenly van- ish, and the inflammatory fever increase so as to induce an apprehension that the brain will be affected, it will be ad- visable to promote and reproduce the swelling, by warm fomentations, and to obviate the fatal consequence that may result from its sudden repression, by emetics, bleeding, or blisters, according to the nature of the case. When the testicles, or the female breast, become affected, and are much swelled, every endeavour should be exerted to prevent suppuration from ensuing, by having recourse to bleeding, cathartics, cooling and discutient applications, such as solutions of saccharum saturni, and crude sal ammo- niac, and directing a suspensory bag for the swelled testicle 52 CHAPTER VIII. OF A CATARRH, OR (OLD AND COUGH. HOAVEVER trivial in the view of many persons com- plaints of this description may appear, they are in reality to be regarded as of a serious nature, and as frequently leading to the most fatal consequences. A cold when aggravated, or rendered extremely frequent in its return, by neglect or imprudence, eventually becomes a malady sufficiently for- midable lo combat and defeat the skill of the most experi- enced physician; and this is the rock upon which the health and lives of thousands have been wrecked. Some interesting observations respecting (he manner in which colds are contracted, will be found in the chapter on air and atmosphere, in the first part of this volume, to which the reader's particular attention is requested. A catarrh or cold is always occasioned by a suppression of perspiration, by exposure to cold and damp air, or lo al- ternate changes from heat to cold, and vice versa; and the degree of severity depends on the violence of the cause, or the constitution of the patient. If we could always enjoy a uniform degree of temperature, we should never be affected with a catarrh, but. such is the variableness of our climate, that our constitutions are perpetually subjected fo diseases in consequence of obstructed perspiration. The symptoms of a catarrh or cold are so generally known, as scarcely to need description. They are most commonly lassitude or weariness ; a sense of chilliness al- ternating with glows of heat upon the skin ; stuffing of the nose ; more or less obtuse pain of the head ; frequent sneez- ing ; a disagreeable dryness and huskiness of the nostrils; the eyes are watery, red and sore ; a cough with hoarseness and sore throat, difficulty of breathing, and a slight degree of fever. At length a copious excretion of mucous fluid from the nostrils and throat, proves a solution of the com- plaint. Sometimes however, fhe cough and other symptoms OF A CATARRH, OR COLD AND COUGH. 41 i are more severe, and the affection being extended to the bronchial system, the breathing becomes laborious and wheezing, the fever is often considerable, and the disorder assumes its most severe forms. V cold in general is not difficult of cure, if early attention be given to the application of proper remedies, but if long neglected, or frequently re- newedpt may prove both obstinate and dangerous. For the removal of catarrh, we should endeavour to re- store obstructed perspiration and obviate the occurrence of inflammatory symptoms. The patient must be kept in a moderate temperature, avoiding the extremes of heat or cold. Those who adopt the old adage, of " feeding a cold," with the view of a cure, will be convinced of their error, when too late to retrieve their dangerous condition ; and he who will practice upon the opinion, that colds arc soonest cured by a debauch in wine, or drinking hot punch, or other heating liquors, hazards an experiment which will often dis- appoint his expectations, and may convert a slight complaint into some dangerous inflammatory affection. Immediately on the approach of symptoms of cafarrh, the patient ought to diminish the usual quantity of solid food, and abstain from all kinds of spirituous liquors, and other stimulating drinks. The food should consist of broths, light puddings, rice, sago, arrow root, fruits and vegetables. A free use of cooling mucilaginous drinks should be directed, such as barley water, infusions of licorice, flax-seed, quince seeds, slippery elm bark, mullein, or water gruel sweetened with honey. The drinks should be taken cold, and pure cold water is by some late writers held in preference to all other liquids, repeated draughts of which they recommend as the best mean of promoting perspiration. By the use of these means, and bathing the feet and legs in warm wafer at bed time, perspiration will be induced in the course of the night, and by a due perseverance in this method, a common cold may often be speedily cured, which if neglected might be attended with Ihe most pernicious consequences. In severe cases of catarrh, when the symptoms are ur- gent, the most soothing ami immediate relief may be obtain- ed by inhaling into the throat and lungs, the warm vapours from the infusions of emollient herbs, such as the flowers of marsh-mallows, mullein, or of elder. The receiving these vapours into the lungs by inhalation, is esteemed as a sover- eign remedy which ought never to be neglected in cases of 412 OF A CATARRH, OR COLD AND COUIiH. catarrh, or olher pulmonic affections. The inhaler invented by Dr. Mudge, is admirably calculated for rendering the process convenient for children, as well as others,. When however, this apparatus cannot be obtained, a coffee-pot, or an inverted funnel may be substituted. The operation should be continued about twenty minutes each time, and repeated morning and evening, especial care being taken to exclude the external cold air from having access to the throat and lungs. If inflammatory symptoms prevail, with a hard quick pulse, and pain of the head and breast, and a hot dry skin, it will be necessary to take blood from the arm in proportion to the urgency of the symptoms and other cir- cumstances of the patient, but not to such extent as to re- duce the pulse and heat below the natural standard. An emetic of Ipecacuanha will next be highly useful, and the bowels must also be moved by a proper dose of jalap and calomel, or by the following saline mixture. Take of Glau- ber's salts, one ounce, fresh lemon juice, one ounce, boiling water, half a pint,.loaf sugar, two ounces. Two table spoon- fuls every hour, for an adult, until it prove laxative. If the skin be hot and dry, the warm bath should be used, after which the patient should go into a warm bed, and during the continuance of the febrile symptoms, it will be advisable to administer either the neutral mixture with a small quanti- ty of tartarized antimony and laudanum, or the following mixture in doses of one table spoonful every hour, with the view of diminishing the heat and promoting perspiration. Take sal nitre, half an ounce, water,half a pint, lemon juice, half an ounce, spii if us nitridulcis, half an ounce. Should the fever still prevail, small doses of calomel and opium may be given morning and evening. For appeasing the cough, a simple domestic medicine may be prepared by mixing lemon juice, honey, and sugar candy in equal parts, of which a table spoonful may be ta- ken at pleasure. In the absence of fever two tea spoonfuls of elixir paragoric, or a suitable dose of syrup of white pop- pies should be taken at night. Common Cough. It must be obvious to every observer, that a long pro- tracted obstinate cough, especially if improperly treated, too often lays the foundation for a fatal consumption of the OF A CATARRH, OR COLD AND COUGH. 413 lungs. When therefore, a cough produced by a cold, has not yielded to the method of treatment above recommended or if that has not been adopted, the condition of the patient ought to excile alarm and receive (he most prompt atten- tion. If the cough appears lo proceed from a defluxion of thin acrimonious humours irritating the membranes of the lungs and other parts, the most proper remedies are those which tend to thicken, and sheath the sharp humours, such as mu- cilages, oils, and gentle opiates, as the following prepara- tion. Take of barley water, six ounces, while sugar and gum arabic of each,three drachms, incorporate the two last articles in a mortar, with a small quantity of the water, and gradually mix one ounce of the oil of almonds, or of olives, and* then by little at a time, add the rest of (he barley water, and it will form a soft white emulsion, well adapted to the com- plaint ; or if preferred, spermaceti may be used instead of the oil. Two table spoonfuls of this excellent sheathing emulsion, may be taken every two or ihree hours. Anoth- er emulsion equally useful, may be prepared as follows. Take blanched almonds, or white poppy seeds, two ounces, beat them in a marble mortar with the same quantity of su- gar, adding a small quantity of water to facilitate their mix* ture, and then add a quart of barley water to the ingredients and strain the liquor through a fine cloth for use. If it is required to be more mucilaginous, one ounce of gum arabic may be dissolved in it while warm. Half a pint of this mix- ture, taken frequently, serves an excellent purpose in ob- tunding and sheathing the sharp mucus, and in diluting the ac- rimonious juices in the lungs, or in the first passagesT These remedies must be assisted by the use of opiates, which are often requisite to appease urgent coughs, and to procure a respite from the violent action on the chest and lungs which they occasion; with this view, two or three tea spoonfuls of the paragoric elixir, thirty drops of antimonial wine may be given in a cup of the mucilaginous drinks, or emulsions above mentioned at bed time, and repeated as occasion may require. Purgatives are commonly necessary to keep the bowels solu- ble during the continuance of the cough, Glauber's salts, man- na, castor oil, or cream of tartar, afford a choice for the pur- pose. Emetics may also be given in every stage of the complaint. In cases where considerable febrile heat prevails, the sa- line mixture should be administered. If the stomach and 414 OF A CATARRH, OR CVOLD AND COUGH lungs be oppressed with phlegm, an emetic of Ipecacuanha will be fo-md to afford relief. When the lungs appear fo be loaded with tough viscid mucus, not easily expectorated, and if no fever be present, the medicines fo be relied on are those of a pectoral and attenuating kind, as gum ammoniac and squills. Half a drachm of gum ammoniac, made into pills with twenty drops of laudanum and taken at bed time, is said (o have an excellent effec( in almost uniformly pro- ducing an expectoration, and abating the distressing fatigue of the cough. If a liquid form be preferred, dissolve two drachms of the gum in half a pint of mint wafer, and let the patient take two table spoonfuls three times in a day! The oxymel, or syrup of squills, may be mixed with an equal quautily of simple cinnamon water, and taken in the quantity of a table spoonful two or three times in a day if they do not disagree with the stomach, or some of the preparations in (he Appendix. In obstinate coughs occasioned by a flux of humours on the lungs, blisters are highly expedient and useful; they should be applied between the shoulders, or about the chest, and kept open a considerable time by the savin ointment; or when one has healed, a new one should be applied. If blisters are not employed, a plaster of Burgundy pitch should on no account be neglected, this ought to be worn between the shoulders, and renewed once every week so long as fhe cough continues, which by its stimulating effect, will afford considerable relief to the lungs. Issues and se- lons, near the chest, will also be beneficial by diverting from the lungs that flux of humours, which irritates lhat tender organ, and excites the action of coughing. Those persons who are of a consumptive disposition, should be particularly careful to avoid taking cold, as it may bring on a spitting of blood, or if tubercles are about forming in the lungs, fhey may .thence be excited to a speedy and fatal suppuration. Persons advanced in life, often experience the most seri- ous consequences from taking cold, such as inflammation of the lungs, or chronic catarrh, from which they seldom recover. Aged persons when affected with a tedious cough unat- tended with inflammation, often receive essential relief by the use of balsam of Peru, balsam of Copaiva, or the balsam of sulphur, with half the quantity of the oil of aniseed mix- ed, a common tea spoonful of (his last taken two or three times in a day, sometimes prove more efficacious than any other remedy. OF A CATARRH, OR COLD AND COUGH. 415 It is not to be recommended that persons for every slight cold, confine themselves to close warm rooms, and drink too freely of warm liquors, as these tend to relax the system, and protract the complaint, but if no fever attend, the pa- tient should take some exercise in the open air whenever the weather will permit. Coughs sometimes have their origin in the stomach, affect- ing the lungs by sympathy, in which case the cure depends chiefly on cleansing and strengthening the organ primarily affected. After giving an emetic or two, a cure may be ef- fected by a stomachic tincture composed of Peruvian bark and bitters, eifher in wine or brandy, assisted by proper ex- ercise, particularly riding on horseback. When a cough proceeds entirely from an affection of the nerves, the proper indications are to strengthen the body by means of tonics, as the Peruvian bark, thoroughwort, and preparations of iron, with a light nourishing diet, tranquility of mind and daily exercise on horseback. In this complaint however, much relief may be obtained by (he occasional use of asafcelu'a, one drachm of which, may be dissolved in two ounces of cinnamon water, and a (able spoonful taken three times in a day. Bui the root of poihos fcetida, or skunk cabbage; will in most instances of (his description prove a more pleasant, as well as a more effi- cacious remedy. This root may he taken either in powder to the extent of half a drachm three times a day, or in the form of infusion as most agreeable to the patient. In children, we frequently meet with a cough occasioned by teething, and often by worms ; in both which cases, it is to be cured by such remedies as are adapted to those complaints. When women in the last months of pregnancy, are affect- ed with a troublesome cough, the complaint is greatly miti- gated by small bleedings, and keeping the bowe!s soluble by gentle laxatives, avoiding at the same time all food of a flatulent nature. When the intimate connection between the lungs and the surface of the body is considered, and that by preserving the perspiration uninterrupted, the lungs are in a manner se- cured from injuries which otherwise they are so apt to sutler, the utility and necessity of wearing a flannel shirt next the skin, cannot-but be duly appreciated. The caution (oo, of guarding against wet feet, cannot be too often, repeated to 416 OF A CATARRH, OR COLD AND COUGH those who are habitually disposed to complaints of the breast. With regard to both of these particulars, 1 speak experimentally from the fullest conviction of their great im- portance. From the particular interest which I take in (he welfare of our meritorious clergymen, I am induced to observe here, that instances too frequently occur, in which ihey hazard their future health, and even their lives, by the great fatigue and exertion in speaking in public assemblies, while labour- ing under complaints of the lungs and breast. Influenza, or Epidemical Catarrh. This species of catarrh has been known from the days of Hippocrates, and it has been mentioned as prevailing fre- quently in England during the last century. In America, it has appeared at nine or ten different periods since the year 1733, but at no period so universally extensive, and with such severity, as in the autumns of 1789 and 1807. It commenced first at New-York and Philadelphia, from which it soon pervaded every part of the continent. Ac- cording lo estimation, three fourths of the inhabitants were in a few weeks affected with the disease, in a greater or less degree. It spread with such amazing rapidity, as to resem- ble more a storm agitating the atmosphere, than the natural progress of a disease from any contagious source ; almost a whole city, town, or neighbourhood, becoming affected in a few days. Although all classes of people experienced the operation of this singular epidemic, it is remarkable that a small proportion, comparatively speaking, were so ill as to require medical attendance, and instances of its fatal termi- nation were of rare occurrence. The few cases of mortality were confined chiefly to the aged and those who were previously affected with pulmonic complaints. But it was not uncommon for persons from in- temperance, or exposure to cold and wet, to suffer relapses, which proved severe and lingering, and in a few instances led to fatal consequences. The symptoms which characterized the disease, were ve- ry similar to those that attend a common catarrh or cold in its severest forms. It was in general ushered in wifh chilli- ness and shiverings, succeeded by some degree of heat, a hoarseness, soreness, and rawness of the throat, lungs, and OF A CATARRH, OR COIL AND COUGH. 417 stomach, accompanied with an incessant tickling cough or hawking, with expectoration of thin sharp mucus. Pains in the head, chest, back, or limbs, with a lassitude, restless- ness, and great prostration of strength, almost universally attended. The pain in the head was often severe, accom- panied in a few instances with vertigo and slight delirium. The pain and oppression in the breast, resembled that of peripneumonia notha, and those in the back and limbs were often similar to the pains accompanying the accession of ty- phus fever. The respiration and cough, in some instances, exhibited that peculiar croaking noise which takes place in croup. Sometimes a diarrhaea, at others a nausea, but more frequently a constipation of the bowels, with thirst, a furred tongue, quick pulse, but not very full, high coloured urine, and more or less fever accompanied the complaint. Some have the full symptoms of pulmonic inflammation, as stiches in some part of the chest, tinged expectoration, and a per- tinacious cough. When perspiration was free, and the bow- els lax in the early stage, fhe fever usually declined about the fifth or sixth day, but the cough continued for sometime longer, with a free expectoration of mucus, and some old and infirm people died, apparently from an accumulation of phlegm which they were unable to expectorate. Such in general was the form of the influenza, but its modifications were extremely numerous. With respect fo the medical treatment of this disease, the plan varied in the hands of different practitioners. A large proportion of those affected were subjects only of simple domestic remedies usual in ca- ses of common colds. Blood-letting was practised in a few instances, but in general this evacuation was considered as inadmissible. Emetics, when nausea indicated their use, blisters, to relieve the pain about the chest, diaphoretics and mild laxatives were more universally employed. The inhalation of warm vapours, the liberal use of emollient drinks, and the mucilaginous emulsions already directed in (his chapter, are to be considered as the most appropriate remedies in the influenza, and as all those means, with di- rections for their use, have been mentioned in fhe preceding pages, a more particular recital here would be superfluous. I must not omit to mention that an unpleasant, and not un- frequent sequel of both catarrh and influenza, is a partial or complete loss of voice, depending upon a state of (he mus- cles subservient to speech approaching to palsy. This is 53 418 OF A CATARRH, OR COLD AND COUGH. sometimes only of a very temporary nature ; at others, it has been known to continue for several montliB after the dis- appearance of the other symptoms. It is in general easily to be restored by the use of stimulating gargles composed of mustard seed and horse radish, but still more effectually by a decoction of seneka snake-root, with the addition of a little honey, a table spoonful of which for an adult every two hours, and gargle with the same. The lobelia inflata is another efficacious medicine in this affection, which may be used as a gargle in the form of tincture or infusion. Elec- tricity has also been known speedily to remove this com- plaint. CHAPTER IX. OF THE PLEURISY, (PLEURITIS.) A PLEURISY is an inflammation of the pleura, or mem- brane which lines the thorax and envelops the lungs. It may be occasioned by exposure to cold, and by all the caus- es to which other inflammatory diseases are usually ascrib- ed. It prevails chiefly in the spring, and attacks most fre- quently those of robust constitutions, and of a plethoric habit. This disease generally begins like most acute fevers with a sense of cold and shivering, followed by heat, thirst, flush- ing of the face, and other febrile symptoms. The pulse is quick, hard, and strong; and an acute pain is felt in one of the sides, most commonly the right, which increases upon every inspiration, and attended with a difficulty of lying on the side affected. A difficulty of breathing succeeds, ac- companied with a short cough, at first dry, but afterwards moist, with some expectoration of phlegm, either streaked with blood or of a yellowish colour. The efforts of nature in this disease indicate relief by expectoration from the lungs, with which the pleura is inti- mately connected, and our utmost endeavours should be di- rected to the promotion of that salutary discharge. The patient should be kept quiet, cool, and easy ; his diet must be of the most slender kind, and his drinks should be mucilaginous and cooling, as barley water, gruel, infu- sions of figs and raisins, marsh-mallows, licorice, flax-seed, and mullein. These should be taken moderately warm, and often sipped, in order to moisten and relax the throat and adjacent parts, and they have an excellent effect in sheath- ing the acrimony of the humours, which irritate and excite fits of coughing. His feet and hands ought to be bathed in warm water several times in a day, and the steams of the decoction of emollient herbs, or of warm water and vinegar, should be frequently. inhaled into the lungs by means of 420 OF THE PLEURISY, (PLEURITIS.) Mudge's inhaler, or an inverted funnel. Drastic cath?rlics are improper in this disease, but (be bowels must be kept moderately loose by small doses of Glauber's salts or aperi- ent clysters. Pleurisy is one of those diseases in which every physi- cian knows the importance of copious bleeding from the sys- tem, as early as possible, after the complaint is formed. It is immaterial from which side blood is drawn, but very es- sential that it be from a large orifh e. Dr. George Fordyce is particularly solicitous fo inculcate t his practice, and it accords wilh the sentiments of our most experienced practitioners. The quantity drawn, ought lo be to the full extent of the strength, and the violence of the symptoms of the patient. If after the first bleeding, the pulse remains full, hard, and ob- structed, the pain in the side acute, the breathing difficult, and the blood exhibit a sizy crust on its surface, it will be neces- sary to repeat the operation at the distance of some hours, and even a third or a fourth time, should fhere be no mitigation of (he symptoms; recollecting however, lha( after a free expecto- ration has commenced, bleeding will be injurious. Topical bleeding either by leeches, or by cupping glasses, and scari- fication, applied immediately over the pained part, is of con- siderable advantage. Emollient fomentations made of camo- mile flowers, elder flowers, or marsh-mallows, should be ap- plied to Ihe sides as warm as the patient can bear, and soon as the cloths cool they ought to be changed, and care taken to prevent catching cold. Blisters are of great utility in pleurisy, but in every case of acute inflammation their use should be preceded by copious bleeding, as they seldom pro- duce so good an effect until the inflammatory action of (he system has been in a considerable degree subdued. After proper bleeding has been premised, a blister of eight or ten inches square should be applied immediately over the part affected, and when one is healed another ought to succeed it, and be continued open for several days, or till the pain is removed. With the view of assisting nature as much as possible in throwing off the offending matter from the lungs by expecto- ration, various means have been employed and recommend- ed; among the first, and certainly the most efficacious, are mercurials. Very beneficial effeefs may be derived from the use of turpeth mineral in doses of one or two grains eve- ry four or six hours ; or a powder composed of about two OF THE PLEURISY, (.PLLURITIS.) 421 grains of calomel and half a grain of opium, or this propor- tion varied as fhe case may require, should be repeated eve- ry six or seven hours, and a liberal quantity of barley wa- ter ought to be directed during its use. This remedy has received encomiums from various respectable sources as an excellent expectorant, and the course should be commenced immediately after blood-letting has been premised. The pleurisy root as directed in the American New Dispensatory will be found a valuable remedy. Anlimonials in nauseating doses are also considered as highly useful in promoting both expectoration and cutane- ous perspiration. A solution of tartarized antimony, is the preparation most generally prescribed for this purpose, and the dos; s should be such as to excite a slight nausea with- out vomiting. If four grains of emetic tartar be dissolved in six ounces of water, with one ounce of spirits of laven- der, and a little sugar, a table spoonful of the mixture may be taken every four hours. As a powerful refrigerent, sal nitre is much commended in this disease, in doses of ten or fifteen grains every three or four hours; it may be added to the mixture just mentioned, or to the mercurial powrder, to avoid multiplying the medicines. When the chest is much oppressed with tenacious phlegm not easily expecto- rated, the following mixture will be found well adapted to afford relief. Take of the milk of gum ammoniacum, four ounces, of oxymel or syrup of squills, one ounce, a table spoonful every four or five hours. Where the action of the lungs requires to be excited by a moderate stimulus, a de- coction of the seneka root has been used with satisfactory success. It may be directed in the quantity of two or three table spoonfuls, as the patient's strength will permit, three or four times in a day. The class of mucilaginous and oily medicines should in no case of this disease be omitted, as they serve to sheath the acrimonious humours, to abate irritation, and appease fits of coughing. For this purpose the emulsions advised in common cough page 413, are admirably adapted. As opiates evidently tend to give a check to expectora- tion, they should be prohibited in the first stage, but when they become absolutely necessary to procure sleep, and to appease the distressing cough, at a more advanced period, two tea spoonfuls of camphorated tincture of opium, (para- goric elixir,) with the same quantity of spiritus nitri dul- 422 OF THE PLEURISY, (PLEURITIS.) Cis, may be directed at night with much safety and advan- tage. After the fever and pain have subsided, and the patient is in a.state of convalescence, a few doses of gentle physic should be advised, and his body ought to be replenished with healthy juices, by means of a light diet of easy diges- tion. As persons who have once been affected with pleuri- sy, are particularly liable to its attacks, they ought prudent- ly to avoid every cause which can have a tendency to repro- duce fhe disease. CHAPTER X. PERIPNEUMONY, OR PNEUMONIA. INFLAMMATION OF THE LUNGS. THIS disease is sometimes complicated with pleurisy and there is such analogy in their nature and character, that instances occur in which physicians are unable to define the line of distinction. In pneumonia, there is a variation in the symptoms accordingly as the inflammation affects more es- pecially the substance of the lungs, and their proper cover- ing, or Ihe contiguous membranes, and combined with each other in various degrees. The peripneumony is commonly divided into the spurious, which is occasioned by a viscid pituitous matter obstructing the vessels of (he lungs, and the true, or catarrhal, when it arises from a thin acrid deflux- ion on those organs. Pulmonary inflammation, by some cal- led lung fever, may proceed from the same causes as the pleurisy, especially the application of cold and wet to the body which gives a check to perspiration, and determines an unusual flow of blood to the lungs; severe exercise, a free indulgence in the use of ardent spirits, repelled eruptions, and external injuries. It attacks principally those of a ro- bust constitution, and plethoric habit, and occurs most fre- quently in the winter and spring. The symptoms which characterize pneumonia, are great oppression at the breast, with difficulty of breathing, an ob- tuse dull pain in some part of the chest, with inability to lie on the side when that is affected, together with a cough, dryness of the skin, heal, anxiety, flushing of the face, some- times it is swelled, and appears of a purplish hue. The pulse is usually full, strong, hard, and frequent; but in the advanced stage, it is commonly weak, soft, and often irregu- lar. In the beginning, the cough is frequently dry, but in some cases it is moist even from the first, and the matter 424 PERIPNEUMONY, OR PNEUMONIA, spit up is various both in colour and consistence, being of- ten streaked with blood. When pulmonic fevers terminate favourably, fhe change commonly takes place from the fourth to the seventh day, though in some cases it is extended to the fourteenth. The curative treatment of pneumonia, both in diet and medicine, is in general (he same as in pleurisy. The cool- ing antiphlogistic plan of regimen, should be strictly enjoin- ed through the whole course of fhe disease ; the patient must be supported with food of alight nutritive nature. Blood-letting is of essential importance, and it ought fo be drawn from a large orifice, and (he quantity proportioned to the strength and vigour of the patient, and the urgency of the symptoms. One copious bleeding is always more bene- ficial than repeated smaller ones ; though in cases of high inflammation, and iminent danger, a repetition of fhe opera- tion will be indispensable, until an abatement of the inflamma- tory diathesis takes place. In many instances of slight pneu- monia, the pectoral remedies usually directed in catarrh, will effect a cure without bleeding, and in aged persons the loss of blood is often inadmissible, so that much depends on the judgment of the attending physician in this dangerous complaint. The next mean, best adapted to afford relief from the distressing symptoms, is the repeated application of strong blisters eight or ten inches square to the parts af- fected ; practitioners of experience need not to be reminded that vesicating the parts about the thorax, is of the greatest utility in cases of pulmonic inflammation, not only from the discharge which they occasion, but from their effect in removing spasm, and promoting the discharge from the lungs. The safety of fhe patient, however, greatly depends on a free and easy expectoration within the first three or four days, of this disorder. Those most powerful expectorants, the mercurial powder, and the solution of tartarized antimony, in small nauseating doses, as directed in pleurisy, may in this disease be administered with full confidence, as experience has amply confirmed their superior efficacy. The two pre- parations may be given alternately, and when the mouth be- comes slightly affected by the calomel, the febrile symptoms will soon subside, and should the antimony induce evacua- tions from fhe stomach or bowels, it must be discontinued, or the doses diminished, lest it produce too great debility of the system. The turpeth mineral will be found of signal ad- INFLAMMATION OF THE LUNGS. 425 vantage as an emetic and expectorant. Moderate purgative medicines will occasionally be proper, but these must neith- er be heating or drastic ; eight or ten grains of calomel, fol- lowed by an ounce of Glauber's salts, will be a suitable ca- thartic for an adult. Instances will occur in this disease, in which emetics will be strongly indicated ; when the stomach appears to be ovorloaded, and the lungs greatly oppressed with phlegm, moderate doses of Ipecacuanha, combined with tartarized antimony, or squills, will afford more effectual relief than any pectoral medicine. In cases of young child- ren, who are frequently affected with this disease, there is not a more effectual mode of procuring relief, than by re- peated vomiting by means of Ipecacuanha or antimonial wine. It not unfrequently happens, that emetics in their ordinary doses, or even when increased, fail to produce the desired operation. I have in such cases of late years, administered the lobelia i7iflata, or Indian tobacco, with much success. It will often induce vomiting in a very speedy and effectual manner, and frequently relieves the laborious breathing, without its emetic effect. A table spoonful of the tincture, for an adult, and a tea spoonful for a young child of three or four years may be a proper dose, and repeated if necessary According to its effect. Mucilaginous and demulcent medicines are among the most useful means of affording relief from the fatiguing cough, these have been often detailed in the chapter on catarrh, and on pleurisy. But the inhalation of the steams of warm water, impregnated with vinegar, or demulcent herbs, is a remedy so peculiarly useful in all pulmonic complaints, and at the same time so seldom put in practice, that the employ- ment of it in the most copious manner may be again recom- mended. The gum ammoniacum, squills, and the extract of licor- ice, possess pectoral qualities, which may be advantageous- ly applied in some varieties of pneumonia, and in aged per- sons, much benefit may be derived from the use of a decoc- tion of seneka snake-root. When the inflammatory symp- toms have subsided, and the patient is much exhausted by a distressing cough, two or three tea spoonfuls of paragoric elixir, in some pectoral drink, will effect the desired respite and relief. It may be proper to observe, that a large proportion of cases of inflammation of the lungs, have an unfavourable ter 54 -I2t> PERIPNEUMONY, OR PNEUMONIA. mination, and in the asthmatic, especially those advanced in life, if generally proves fatal. When on recovery, the patient should carefully guard against exposure to wet and cold, or any irregularity which might occasion a relapse, as it may lay the foundation for a fatal consumption. When tonic medicines become necessa- ry, the cascarilla, quassia, thoroughwort, and the wild cher- ry free bark, should be advised, as the cinchona bark will seldom be proper. When the inflammation of the lungs does not yield to bleeding, and the other remedies prescribed, it usually ter- minates in suppuration, and a vomica or empyema is the consequence, the former is an abscess or collection of mat- ter formed in the substance of the lungs, and the matter in this case may be discharged by expectoration ; the latter, being a fluid floating in the cavity of the breast, between the pleura and the lungs, can only be discharged by an incision made between the ribs, and without this operation the event will be fatal. There are other species of pulmonic inflammation, as Carditis, inflammation of the heart. Pericarditis, inflam- mation of the pericardium, and Diaphragmitis, inflammation of the diaphragm. The former is to be known by the great labour in breathing, the patient being unable to lie in bed, and by the severe palpitation of the heart. The inflamma- tion of the diaphragm is not always to be distinguished from pneumonia and pleurisy, and it is probably often combined with those complaints. The medical treatment, therefore, of these several affections, is precisely the same with that above recommended in pleurisy and pneumonia. I ought not to omit the observation of Dr. J. Fisher, presi- dent of the Massachusetts Medical Society, that he has not in his practice had recourse to blood-letting in pleurisy, or peripneumony, but in every instance has been successful, chiefly by the use of turpeth mineral, sometimes as an eme- tic, but always in small doses, as one of the most efficacious expectorants. The disease termed typhoid peripneumony, which has of late ravaged our army, and pervaded several parts of our country, has already been treated of under the1 head of peri pneumonia notha to which the reader is referred. CHAFFER XI OF A SPITTING OF BLOOD, OR HAEMOPTYSIS*. THE term haemoptysis, (haemoptoe,) comprehends all morbid effusions of blood through the mouth, except that which is vomited up, whether it be discharged by the ac- tions of coughing, hawking, or spitting; but fhe term ap- pears more properly applied, when blood is coughed up from the lungs. When it proceeds from the internal sur- face of the mouth, upper part of the throat, or adjoining cav- ities of the nose, it may be discharged by hawking or spit- ting, and this is seldom attended or followed by any seri- ous consequences. Persons most subject to this complaint, are those of slen- der delicate frames, who have long necks, prominent should- ers, and a narrow chest; and those whose blood is acrid and copious, especially if formerly subject to a bleeding at the nose. It most frequently occurs in the beginning of sum- mer, when th« external heat rarifies the blood more than it relaxes the solids, and generally attacks people between the 16th and 35th year of their age. This disease may be pro- duced at all seasons, by violent exercise, great exertion of the lungs in »peaking or singing, by wounds, plethora, hectic fever, coughs, excess in eating or drinking, and vio- lent fits of anger. Haemoptoe may also arise in conse- quence of omitting lo bleed, or purge, at the usual seasons, when the system has been habituated to those evacuations, and it frequently attacks females who labour under obstruct- ed menstruation, and males who suffer a suppression of the bleeding piles. This complaint in most instances, begins with a sense of weight and anxiety in the breast; difficulty in breathing; a pain in different parts of the chest, and some sense of heat under the breast bone ; being often preceded by a saltish taste in the mouth. Immediately before the discharge ap- pears, a degree of irritation is felt at the top of ther throat: 428 OF A SPITTING OF BLOOD, OR HEMOPTYSIS. and on attempting lo relieve this by hawking, a little florid and somewhat frothy blood is brought up. The irritation returning, more blood is spit off with a noise in the wind-pipe resembling that of air passing through a fluid. Sometimes, liowever, at (he very first, the blood is discharged with coughing, or at least a very slight coughing accompanies the hawking above mentioned. In most instances, at first the blood is in very Bmall quan- tity, and soon disappears ; but sometimes when it frequently occurs, it is in greater quantity, and often continues to ap- pear at times for several days successively. It is sometimes profuse, but seldom in such quantity as, either by its ex- cess, or by a sudden suffocation, to prove immediately mor- tal. When blood is discharged by vomiting, it commonly pro- ceeds from the stomach, and appears in larger quantities than when from the lungs, and is of a darker colpur, often consisting of lumps, and mixed with the other contents of the stomach; while that coughed up from the lungs is usually of a florid colour, and mixed with a little frothy mucus only. A spitting of blood in a strong healthy person, of a sound constitution, or in females from obstructed menstruation, or arising from external violence may often be considered as not more dangerous than a similar discharge from the nose. But when it attacks the slender and delicate, it is most fre- quently to be regarded as a presage of consumption; and when it proceeds from ulcerated lungs it always proves fa- tal. In the treatment of this complaint, our attention must be directed to the antiphlogistic plan, carefully avoiding every heating or stimulating substance, either of food, drink, or medicine. The diet should be soft, cooling, and slender, con- sisting chiefly of milk, rice, small broths, barley water, ar- row root, gruel, jellies, and fruit. It is of much importance that the patient be kept quiet, calm, and easy, both in body and mind, no exertion of the lungs by talking, or reading aloud, should on any account be permitted. Warm rooms, or beds, or too much clothing, as they tend to quick- en the circulation of the blood, are equally intproper; in- stead of a feather bed, a mattress or straw bed should be preferred. His feet must be bathed frequently in warm wa- ter, and his bowels ought to be kept in a soluble state by the OF A SPITTING OF BLOOD, OR HAEMOPTYSIS. 429 occasional use of Glauber's salts and manna, or other mild laxatives. When the patient is hot and feverish, and the pulse is full, bard, and quick, denoting a plethoric state of the vesseU, blood should be taken from the arm, or as some prefer, the vein in the ankle ; and this may be repeated in small quantities a9 fhe urgency of the symptoms may require. But on the contrary, when the pulse has been lowered by the effusion, and debility induced, and the blood is of a dark colour, the lancet is not to be employed. The late Dr. Rush advises in this complaint, a table spoon- ful of common salt in fine powder, to be swallowed dry, and repeated often if necessary; he says it is often successful when other means fail in restraining the discharge of blood. Sal nitre is often employed in this complaint with consid- erable advantage ; eight or ten grains of this, with double the quantity of loaf sugar, may be taken every second or third hour until the bleeding abates. In cases of profuse haemorrhage from the lungs proceed- ing from a relaxed state of the vessels, recourse must be had to astringent medicines, a strong infusion of red rose leaves sweetened with loaf sugar, and well acidulated with elixir vitriol, should be given by spoonfuls every hour or two; and should this fail, and the danger appear iminent, a trial may be made of the sugar of lead in doses of one or two grains every four or six hours, with perfect safety, and often with complete success. Another remedy has of late been adopted with decided good effect in haemoptysis, which is the digitalis purpurea, or fox-glove. Among olher authorities, we have that of Dr. I. Rand of Boston, who in very urgent cases, has given twenty-five drops of the tincture every hour till the dis- charge was suppressed. In one instance he says, of haemop- tysis, in a very athletic young man, where the discharge eluded the force of every olher medicine ; it reduced the pulse in eight hours from one hundred in a minute, to fifty pulsations, and stopped the haemorrhage. But this powerful medicine as well as the acetite of lead, must be entrusted to (he discretion of experienced practitioners only. The application of a large blister to the breast will be found in most cases of haemoptoe, essentially beneficial. Opiates often have a good effect in fhis disease, when it is deemed necessary, two tea spoonfuls of elixir paragoric, or thirty drops of laudanum, may be given as a quieting dose 430 OF A SPITTING OF BLOOD, OR HjEMOFTYSlfc. in the evening. After the bleeding has subsided, in order to prevent a stagnation of blood in the cavities of the lungs, which might tend to ulcerate* the following preparation should be given to promote expecforation. Take spermaceti and honey,of each one ounce, melt them together, and when about milk warm, add one drachm of balsam Copaiva, stir- ring the mixture constantly until it becomes cold. The size of a small nutmeg may be taken every three or four hours. Much relief it is said has been experienced in this disease, by taking two or three times in a day, a tea spoonful of a medicine known by the name of Riga balsam, which comes from Riga in Russia. With the view of preventing a return of this complaint, a strict adherence to the antiphlogistic regimen for a considera- ble time, should be observed, carefully avoiding all vigorous exertions of the body, agitations of the mind, and other oc- casional causes. It has just been announced, that Dr. G. Rees, a respect- able English physician, has published his sentiments res- pecting the cure of haemoptysis, in which he differs essen- tially from the established practice. Dr. Rees asserts, that he has seen great and irreparable mischief produced by the use of the lancet in cases of haemoptysis, and knows the practice to be prejudicial; and he informs, that the reme- dies of all others he has found the best are emetics. He has never found the haemorrhage increased by these reme- dies, on the contrary, he has found them to be checked, and the periods of their recurrence either entirely put a stop to, or the intervals sensibly increased between them. When the bleeding was very alarming, half a drachm of sulphas zinci was given ; in cases of less urgency, he employed the common emetic of Ipecacuanha and tartarized antimony. The author has adduced a number of successful instances in confirmation, and corroborative testimony from respectable authorities in favour of his opinion and practice. CHAPTER XII. OF PULMONARY CONSUMPTION, OR PHTHISIS. IT is a melancholy truth verified in almost every family that pulmonary consumption constitutes a large proportion of our bills of mortality, and forms one of the most crowded avenues to the tomb. It is supposed that about one seventh of all the deaths in this state, are to be attributed to this fatal disease. A regular treatise on consumption will not comport with the plan of this work, some cursory observa- tions respecting its most obvious causes, and the most eligi- ble means of prevention and cure must suffice. The causes which contribute lo the production of phthisis pulmonalis are extremely numerous, many of these have al- ready been recited in fhe chapters on clothing, longevity, catarrh, and on pulmonary inflammations which the reader is invited attentively to peruse. This disease has been observed to make the most deplor- able ravages among our youth of both sexes, between the ages of 17 and 27. Instances frequently occur in which whole families one after another become victims to it in the early periods of life. It is probably from this circumstance lhat some have alleged that the disease may be propagated by contagion ; there is indeed much reason to suppose, that by sleeping in the same bed, with a consumptive patient in the ulcerative stage, with foetid expectoration, night sweats, and offensive breath, or by being much confined in a close room, and imbibing the effluvia from the lungs, that the disease may be by these means communicated. The generality of consumptions are the consequence .of colds and coughs, which have been neglected, or injudi- ciously treated in their early stage. Persons who are most subject to become consumptive, are those of a delicate make, fair complexion, and florid countenance, soft skin, long necks, narrow cnest, prominent shoulders, with hollow temples, thick npper lips, a week voice, great sensibility, and clear white 432 OF PULMONARY CONSUMPTION, OR PHTHISIS. teeth. This description of persons have constitutionally weak and tender lungs, and need nothing but colds and coughs to excite inflammation, which ends in suppuration, hectic fever, ulcers, and consumption. This disease is also often hereditary, and those most subject to spitting of blood, are likewise most liable to its attacks. There are some oc- cupations in life which dispose persons to consumptions, such as require artificers to sit in one position, or constantly to lean forward and press upon the stomach and breast, as cutlers, taylors, and shoe-makers ; it has been also observed that the small particles of stone, wood, metals, and other hard substances inspired into (he lungs by the workmen, have produced this disease in the artists who work in (hose substances. Ph(hisis pulmonalis often takes place in con- sequence of certain diseases, such as catarrh, pneumonia inflammation, ulcerated tonsils, haemoptoe, syphilis, scrofu- la, influenza, small-pox, and measles ; and also from violent passions of the mind, as grief, disappointment, anxiety, and close application to study, without proper exercise ; playing on wind instruments, dissipation, and intemperance. Ex- cessive evacuations of various kinds, and a sudden suppres- sion of those evacuations to which the system has been long accustomed, are also to be reckoned among the causes which give rise lo this disease. The sudden changes of temperature to which our climate is subject, is undoubtedly a principal cause of the frequency and prevalence of con- sumptions, and many other diseases in our country. Con- fined air in hot close rooms, is well known to be extremely prejudicial to health. What can be more pernicious and destructive to the human constitution, especially to tender lungs, than the sudden changes from heat to cold, and from cold to heat, as practised by many young gentlemen who spend the day in an office, or counting room, heated to a great degree by a sfove, and in the evening exposed to the dews, damp air, and cold easterly winds unprovided with covering sufficient to protect the body from their noxious influence ? nor is this remark inapplicable to the olher sex; our fashionable young females, accustomed, to a warui apart- ment during fhe day, often brave the elements in the even- ing, and resort to the theatre, or ball-room, with uncovered breast and neck, naked arms to the shoulders, and thin shoes ; by such imprudent exposure, who is surprised that colds are contracted, and that so many young persons are consigned to the grave in the bloom of life ? OF PULMONARY CONSUMPTION, OR PHTHISIS. 433 Another source of great injury to the constitutions of young persons, is a habit of indolence, or a want of bodily exercise, which nature requires to expand the chest and strengthen the lungs, to preserve vigour and energy in the system, and that due order and regularity in the animal functions, on which a healthy state so essentially depends. The immediate cause in the largest proportion of instances of consumption, is tubercles, or small tumours, which finally suppurate and form ulcers in the substance of the lungs, and this is considered as the most dangerous kind. The first symptoms of phthisis pulmonalis, usually vary with the cause of the disease; when tubercles are the immediate cause, it begins with a short dry cough, without much ex- pectoration for sometime, except a frothy mucus, that seems (o proceed from (he throat, and mostly in the morning, sometimes exciting vomiting. The patient feels an uneasi- ness about the chest, or a sense of pain on lying down on one or both sides, or under the breast bone ; the breathing is also oppressed by the least quickened motion, and partic- ularly so in hot rooms, or in moist weather ; his spirits are very irregular, being either very lively, or much dejected, without any known reason, and (he body gradually emaciates. A particular quickness and cautious manner of speaking is observable, as well as an unnatural peevishness, though be- fore of the most amiable disposition. These symptoms may be observed perhaps many months before the patient thinks of complaining, or will acknowledge that he is so ill as to require attention; when indeed this is a most critical moment, and perhaps the only one, when by proper care and judicious management, he may be rescued from his im- pending fate. The patient under these circumstances, is more easily affected than usual by slight colds; the cough grows more troublesome and severe, particularly at night, and the expectoration is more free and copious, of a greenish colour, and on some occasions streaked with blood. The laborious breathing, the emaciation and weakness, go on in- creasing, the pain becomes severe, and the patient is unable to lie on the side affected, or to make a full inspiration with- oul exciting a fit of coughing. The pulse at the beginning is often natural, or perhaps is soft, small, and a little accel- erated ; but at length becomes full, hard, small, and fre- quent, even to one hundred and twenty or upwards in a minute: a red flush now appears on one or both cheeks, F,fy 434 OF PULMONARY CONSUMPTION, OR PHTHISIS particularly after meals, with a dryness and heat in fhe palms of the hands and soles of the feet, the evening exa- cerbations of fever become obvious, anil the patient is now affected with the whole train of symptoms which usually accompany a confirmed hectic fever. " This species of fe- ver is evidently of the remittent kind, and has two exacer- bations every twenty-four hours. The first occurs usually about noon, and a slight remission ensues about five in the afternoon. This last is however, soon succeeded by anoth- er exacerbation, which increases gradually until after mid- night ; but about two o'clock in the morning, a remission takes place, and this becomes more apparent as the morning advances. The patient is very sensible to any coolness of the air, and often complains of a sense of cold, when his skin is at the same time preternaturally warm." The even- ing exacerbation in hectic fever is by far the most consider- able, and on some occasions, particularly in cases of haemop- toe, the hectic symptoms advance wilh more rapid strides. In general the urine is high coloured, and deposits a copious branny red sediment. The appetite is not greatly impaired, the tongue appears clean, the mouth is usually moist, and the thirst is inconsiderable ; at length, aphthous ulcers ap- pear in the mouth, and the red vessels of the coats of the eye assume a pearly whiteness, a florid circumscribed red- ness appears on each cheek during the exacerbations, but at other times the face is pale and the countenance sunk and dejected. The tongue appears clean and with the fauces is of a bright red colour, and generally sore and tender. The pulse is frequent, full, and tense, or small and quick ; the palms of his hands and his feet are hot and dry ; his nails are of a livid colour and are bent over the ends of his fin- gers ; his breath offensive, quick, and laborious. A colliqua- tive diarrhaea and night sweats ensue, and induce great debil- ity and emaciation, the eyes lose their lustre and brilliancy, the cheeks appear prominent, the nose sharp, the temples depressed, and the strength rapidly declines. The misera- ble patient now exhibits fhe appearance of a walking skele- ton bewailing the loss of its corporeal substance. His voice becomes hoarse and feeble, his hair falls off, and his feet and legs are affected with edematous swellings, and a glossy appearance of the skin. At this period the substance of the lungs is almost consumed, and fheir feeble remains are loaded with purulent matter, large quantities of which are OF PULMONARY CONSUMPTION, OR PHTHISIS. 435 coustantly expectorated ; the laboured breathing now like the expiring taper, grows more and more feeble, faintness often occurs, fhe heart ceases to perform its office, the voice faul- ters, and the melancholy, long protracted scene is brought to a close. Thus thousands are consigned to a premature tomb. It is a characteristic trait in this disease, that the patient is seldom alarmed with his approaching fate, but retains his hope to the last and still flatters himself with a speedy recovery.* In female cases the menstrual evacua- tion is sometimes profuse, at others altogether suppressed. When women are affected with consumptive complaints pre- vious lo a state of pregnancy, the symptoms are generally suspended, or so disguised during that period, that both the patient and friends are unconscious of any impending danger; but shortly after parturition, the disease resumes a more rapid progress and soon terminates in death. When it is desired to ascertain whether the matter expectorated be pus or mucus the following experiment discovered by the lafe Mr. Charles Darwin will afford a decisive discrimination. Let the expectorated matter be dissolved in sulphuric acid and in caustic alkaline lixivium, and then add pure water to both solutions; and if there is a fair precipitation in each, it is a certain sign that some pus is present: if in neither a precipitate occurs, it is a certain test that the material is entirely mucus. Another method has been invented by Dr. T. Young, physician to St. George's Hospital, more convenient and not less satisfactory. He found by experi- ment that a luminous body, when viewed through a trans- parent liquid holding in suspension minute particles of nearly equal dimensions, " is surrounded by rings of colours some- what resembling the rainbow, but differently arranged and often beautifully brilliant. Blood, a little diluted, always exhibits them in great perfection, and they afford a very accurate criterion for the distinction between pus and mu- cus. Mucus, containing no globules, affords no colours, while those, which are exhibited by pus exactly resemble * Even physicians themselves have been known while just expiring with this complaint, to be unconscious that they were consumptive. " A late eminent teach- er of Anatomy, in his very last lecture, (at a time when the symptoms of confirmed decline were "too obvious to be mistaken by the youngest of his pupils,) speaking of this circumstance whilst describing the structure of the lungs, observed : «This deceitful persuasion is not to be wondered at in those who have not studied physic ; but that any man to whom frequent observations must have made every fatal symp- tom so familiar, can be blind to his own situation is truly wonderful.' He himself died of phthisis within the fortnight." 436 OF PULMONARY. CONSUMPTION, OR PHTHISIS the appearance produced by the blood, the rings being us- ually of the same dimensions. A minute quantity of the fluid to be examined in this manner, may be put between two small pieces of plate-glass, and if we hold the glass close to the eye, and look through it at a distant candle, with a dark object behind it, the appearance, if the globules are present will be so conspicuous as lo leave no doubj inspect- ing their existence." Pus is of the consistence of cream, of a whitish colour, and has a mawkish taste ; it is inodo- rous when cold, and when warm it has a peculiar smell. It should here be remarked, that instances sometimes occur in which there is neither much cough nor expectoration till within a short period before the patient expires; nay fur- ther, a hectic fever has been known to prove fatal after a long continuance, without any purulent expectoration, or any very considerable discharge of mucus; and it often has the appearance of a slight cold. There are likewise many instances on record, of the lungs on dissection being found perfectly sound, no traces of tubercles or ulcers being dis- covered ; all the terrible symptoms of confirmed consump- tion in these cases, arising from extensive inflammation of the membrane lining the bronchia. Pus it has been ascer- tained, may be formed from the vessels of a membrane where there is no ulceration, and the debility and emaciation con- sequent to a copious discharge of purulent matter, will readi- ly account for all the symptoms which supervene. The plans of treatment in phthisis pulmonalis, vary with the supposed cause, and according to the views of the dif- ferent practitioners by whom they are prescribed. There is however, little or no diversity of opinion relative to the great utility of a rigid adherence to a well adapted regimen, and a careful avoidance of all the exciting causes by which the disease has been produced. From the fullest convic- tion, derive^phom experience, as well as the observations of others, I can assert, that more confidence is to be reposed in this plan, than in all the drugs and medicine lhat can be prescribed by the most skilful physician. Of all the arti- cles of diet, I consider milk as incomparably the best adapt- ed to the circumstances of consumptive patients. It consti- tutes a sort of medium between animal and vegetable food ; it is of a mild bland balsamic nature, easy to be digested, and admirably calculated to furnish the blood with sweet, wholesome, nutritious chyle, and to sheath the acrimony of OF PULMONARY CONSUMPTION, OR PHTHISIS 437 the humours. But in order to derive all the advantages of a milk diet, it is not to be (aken sparingly once or twice in a day, it must constitute the principal sustenance of the pa- tient, combined with a little toasted bread, or some light agreeable vegetables. Asses milk has been held in the greatest estimation in this disease, but in this country it cannot be procured in sufficient quantity for (be purpose of diet. That milk should be preferred which comes from young, sound, and healthy cows; and it should be taken while warm from the animal if convenient, at least four times in twenty-four hours. Dr. Buchan says, lhat milk alone is of more value than all the medicines in the Materia Medi- ca. But 1 am aware of Ihe objection that milk does not a- gree with all constitutions ; it may be admitted that in some stomachs, when first introduced, it is apt ,to produce unfa- vourable effects, but by proper management, it may in al- most every instance be rendered agreeable and salutary. If the milk be too rich, or there be an acid in the stomach, by which the milk is coagulated into cheese curds, let one (bird the quantity of lime water be added; if it produce a diarrh- aea, a spoonful of good conserve of roses, or a drachm of prepared chalk will correct it; if costiveness be induced, a little rhubarb and manna, or cream of tartar, may be taken occasionally. There are several articles possessing mild nutritious properties, which ought to be combined with milk; apples baked or roasted are admirably adapted to this pur- pose; consumptive patients have been cured, it is said, by this simple diet alone. The lichen islandicus, or Iceland moss, is another substance of considerable use, as possess- ing mucilaginous and nutritive |5?operties, which has been much extolled in consumptive cases. This is to be first boiled in water, then, by adding a proper quantity of sugar, , it is formed into a thick syrup or jelly, and eaten very free- ly wilh milk. There is a valuable domestic article but little known, produced plentifully in our low meadows, which may be esteemed as not inferior to any thing of the kind with which we are acquainted. It is fhe root of the Osmond Royal, by some called meadow Buck's horn. There is not perhaps a vegetable which produces a soft bland mucilage in so great abundance. The roots fresh from the ground, should be cleaned, and then boiled in milk, or with the ad- dition of a little water, until it thicken to the consistence of common starch for use; it imparts no unpleasant taste to 438 OF PULMONARY CONSUMPTION, OR PHTHISIS. the milk, and the patient may eat of it to any quantity he pleases, and with a certainty of beneficial effects, it having in some instances contributed, it is said, very greatly to the cure of consumption in its early stages. Besides milk, the preparations made from it, as whey and butler-milk, may be used by consumptive patients with great advantage. The whey may be made from new milk, by adding to it a lit lie rennet, cider, orange juice, or cream of lartar, and the pa- tient should habituate himself to the drinking a tumbler full of it several times in a day. Butter-milk, while new and sweet, may be taken in the same manner, and with salutary effects, beginning with small quantities, and increasing as the stomach can bear. Other articles possessing nutritive quali- ties, proper in consumptive cases, are beef tea, meat broths, calf's feet jellies, eggs, and shell-fish; oysters taken with their juices in a raw state, are perhaps, preferable to every kind of animal food, on account of the nulrilive and salu- tary properties which (hey afford. In (he vegetable class may be enumerated rice, sago, arrow root, asparagus, bar- ley, light puddings, turnips, and potatoes. To these may be added conserve of roses, jellies, and preserves made from ripe fruits, and also subacid fruits of every description, in their proper season. The acid juices of oranges, lemons, grapes, currants, strawberries, gooseberries, plums, and cher- ries, all tend to quench thirst, and cool the blood, and should be taken in a liberal manner, even though the thirst should not be very urgent. If notwithstanding (his plentiful re- source, the strength and spirits of the patient should de- cline, and something more sjdid should be required, he may be allowed strong broths, and once a day a little animal food. Such is my conviction of the salutary effects deriva- ble from this course of diet, that I am irresistably impelled to recommend a regular persistance in it for many months, or even years, if circumstances should render it necessary. It is proper however to observe, lhat patients are not to de- part from a full animal diet all at once ; the change should be gradually introduced; and be the kind of food what it may, it ought to be taken in small quantities at a time, and the stomach must not on any account be overloaded. All fermented liquors, particularly spirituous ones, must be care- fully avoided. The next points of importance in the cure of consump- tions, are a pure uncontaminated air, and a proper degree •F PULMONARY CONSUMPTION, OR PHTHISIS. 438 of exercise on horseback, or in an open carriage. At an early period of consumptive complaints, arrangements should be made, if circumstances permit, for journeying through the country at a proper season of fhe year, avoiding the un- wholesome air of large towns, and if practicable (be patient should spend the winter season in a warm climate. In a long journey, the advantage of a continual change of air, is joined to that of the mind being constantly entertained with new objects, and agreeable scenes. During his exercise he should most carefully guard against any exposure to cold, which never fails to determine an undue quantity of blood to the lungs. He should not omit to wear flannel, or Qeevy hosiery next his skin, and stockings of cotton, or worsted, in preference to linen or silk. In some instances of con- sumption, a sea voyage has been productive of considerable advantage by the constant exercise, the change of air, and (he vomiting which it sometimes occasions. "Wholesome air, proper exercise, and a diet consisting chiefly of milk and vegetables, is the only course," says Dr. Buchan, "that can be depended on in a beginning con- sumption. If the patient has strength and sufficient reso- lution to persist in this course, he will seldom be disappoint- ed of a cure. I have frequently seen consumptive patients, who had been sent to the country with orders fo ride and live upon milk and vegetables, return in a few months,, quite plump, and free from any complaint. This indeed was not always the case, especially when the disease was heredita- ry, or far advanced : but it was the only method in which success could be expected : where it failed I never knew medicine succeed." Sydenham affirms that be has fre- quently cured both tabes and phthisis by horse exer- cise and long journies when all medicines had been given in vain, and this not merely in the incipient stages, but when night sweats and diarrhaea usually the concluding symptoms had appeared. But when great arterial excitement is pres- ent it may seem doubtful whether exercise should be deem- ed a well adapted remedy. Those who cannot have the benefit of travelling at a dis- tance, ought to make use of as much exercise by short rides, or otherwise, as their strength will permit without much fatigue. Swinging is a kind of exercise which may be useful, and severe friction with a coarse cloth, may tend to increase the action of the vessels in the extremities, and 440 OF PULMONARY CONSl MPTION, OK PHT1I1S1> to preserve a uniformity in the circulation*. In (he ad vanced stage of consumption, exercise can be of litlle ser- vice, and much fatigue may prove detrinu nfal by increasing debility. Dr. Rush, has recommended in fhe early stage, severe exercise by bodily labour, and even exposure to the hardships of a sea voyage as having in some instances prov- ed successful. The diet and regimen, being thus properly accommo- dated to the disease, the next object should be to apply the most salutary food to the patient's mind ; this should consist of amusements, cheerful company, and the most soothing reflections, which exhilarate and keep the mind in the same active state that exercise does the body. The consolations of religion are excellently adapted to compose the mind, when prudently suggested. But all melancholy and gloomy ideas, ought if possible to be dissipated. We come now to notice the various medical remedies which are held in the highest repute for the cure of phthisis pulmonalis. The first point which demands attention, is the very important one relative to the propriety of abstracting blood from the general system. The former practice of re- peated small bleedings having been carried probably to an unwarrantable extent, and without a successful result, has fallen very much into disrepute, and physicians are now supposed in consequence, to have vibrated to the opposite extreme. It is rational to suppose, that in all cases of tu- bercles, or of inflammatory affection of the lungs, bronchial vessels, or their investing membranes, it ought to be the pri- mary object to diminish fhe inflammatory diathesis, and to produce a resolution of inflammation and thereby obviate a tendency to the process of suppuration. So long therefore, as the circumstances of the case will justify a hope of affec- tuating this important object, we may use the lancet with a degree of confidence as being the best adapted agent to ful- fil the indication. The evacuation must in all cases be in proportion to the arterial action, and the system may be subjected to a repetition of bleeding until it be reduced below the point of morbid irritability ; if this can be done without increasing the debility. Instances have been reported in which resort was had to the lancet every few days for sev- eral weeks or months with fhe happiest result. This pro- cedure however, is to be decided in each case by the phy- sician of discernment, precise observation and experience. OF PULMONARY CONSUMPTION, OR PHTHISIS. 441 He will be guided by the more or less fulness and tension of the pulse, pain about the chest, and irritability of the sys- tem, and the quantify'of blood should be judiciously propor- tioned (o the streng(h and other circumstances of the pa- tient. Local blood-letting, by the application of cupping glasses, or a number of leeches to the chest may in many instances be employed as an advantageous substitute for drawing blood from the system al large. But in the last stage of ulcerated lungs, with purulent expectoration, night sweats and debility, no beneficial effects can possibly be ex- pected from the loss of blood. In every instance of this complaint attended with a fixed pain and straitness about the thorax, blisters are of indispensable necessity, and they should be applied to the parts affected in constant succes- sion, so as to keep up a perpetual discharge. Vesicating plasters are seldom made sufficiently large, they should be eight by ten, or ten by twelve inches. A plaster of Bur- gundy pitch of six or eight inches in length, ought to be worn between the shoulder blades and renewed once a week. A seton, or issues between the shoulders, or ribs, are ad- visable, and in many cases of incipient phthisis, they ha^e undoubtedly produced very beneficial effects. When ex- pectoration requires to be promoted, strong decoctions of pectoral medicines may be directed, such as liquorice root, with figs and raisins, marsh-mallows, colts-foot, and mullien sweefened with honey. Where there is much feverish heaf, particularly in the evening, the patient should take a tea spoonful of spiritus nitri dulcis every third hour in a cup of warm tea of mullein flowers sweetened with honey, and if the cough is very severe and troublesome, two tea spoonfuls of elixir paragoric may be taken in the same drink at bed time. During the absence of the febrile symptoms, the cascarilla bark, and the bitter pectoral herbs, will be found useful and less apt to bind the chest than the cinchona bark, among these are thoroughwort, elecampane, horehound, ground ivy, and Roman-wormwood. Both the mineral and vegetable acids of every description should be freely used in the patient's drinks, as they serve to cool and abate fe- ver, quench thirst, and check night sweats. For this last purpose the elixir vitriol should be freely employed in every stage of the disease. The lac ammoniacum, or milk of gum ammoniac, is a medicine of considerable effi 56 1-12 OF PULMONARY CONSUMPTION, OR PHTHISIS cacy ill promoting expectoration ; (hough (he following mix- Hire is equally well adapted to answer Ihe same indication : lake of muoilage of gum arabic, or of quince seeds, six ounces, oxyrael of squills, two ounces, powder of Ipecacu- anha, thirty grains, liquid laudanum, thirty drops. A table spoonful of this mixture may be taken every few hours, if if excite vomiting, lessen the dose, or if vomiting be desired to relieve the lungs from tough phlegm, it may be increas- ed accordingly. It often happens that a little exertion by puking will unload the lungs more expeditiously, and in deed it is more safe and pleasant than continual coughing. The digitalis purpurea or fox-glove, has been introduced of late years as a valuable remedy in pulmonary consump- tion. European physicians of the first eminence, have re- sorted to the use of it wilh high expectations, and many of (hem have made the most flattering reports respecting its superior efficacy. It is administered with the view of its peculiar properties in exciting the action of the absorbent vessels, and its singular power in retarding the circulation of the blood, and diminishing the frequency of the pulse. A- mong our own physicians of high reputation, we are indebted to Dr. Isaac Rand of Boston, for his valuable observations on digitalis, read before the Massachusetts Medical Society, in June, 1804. In this production he details two cases treated successfully by the use of fox-glove, and closes his address in these words. " I must acknowledge and with pleasure assert, that I have cured more by this, than by all and every other medicine conjoined." Notwithstanding however, the high encomiums bestowed on fox-glove, it has not in general answered the valuable pur- poses which its sanguine advocates have encouraged us to expect. How far this failure is ascribable to the bad quali- ty or the careless manner in which the medicine has been prepared, or to the want of proper attention during the ad- ministration of it, I am not disposed to decide. As the em- ployment of this very powerful medicine must not be en- trusted to inexperienced hands, the reader is referred to Dr. Rand's production, to Thomas' Modern Practice, and to the American New Dispensatory, 2d edition, which contain all the information and directions that can be desired re specfing the preparation and use of this article. The san- guinaria canadensis, or blood root, is recommended by some OF PULMONARY CONSUMPTION, OR PHTHISIS. 443 respectable practitioners in whose hands it has been tried, as a good substitute for the fox-glove. Professor Smith of New- Haven, and Dr. I. Allen of Sterling, assure me, that blood root diminishes the frequency of the pulse, and produces its effects on the system more immediately than fox-glove; inducing in large doses great sickness at the stomach, and prostration of strength, yet it is not liable like digitalis to Eroduce fatal effects. This medicine being represented as aving proved useful in coughs, consumption, and other pul- monic complaints, is probably deserving of trial, in the form of a saturated tincture, from thirty to sixty or eighty drops twice in a day, increasing or diminishing the dose according to the effects produced. The fixed alkaline salts, from their well known property of retarding the circulation, and diminishing fhe irritability of the heart, by their action on the stomach, have been employ- ed in this disease, and obtained considerable repute in the opinion of some experienced practitioners, and as no ill ef- fects can arise from their use they should be recommended. The late celebrated Dr. Beddoes, and other medical men of high standing, have introduced a plan for supplying the lungs with factitious airs and gases, as remedies in the early stage of consumption, and they were reported to have con- tributed essentially to the relief and benefit of the patients, but the day of their reputation seems in a manner to have passed by, without a prospect of a revival. From several trials however, of the carbonic acid gas, within the com- pass of my knowledge, I am disposed to advocate its use from the opinion that it may in some cases of incipient con- ' sumption, be the means of mitigating the distressing symp- toms, and protracting the fatal period. Dr. Jonathan Leon- * ard of Sandwich, affirms that in five cases of ulcerated lungs, he persevered in the use of the carbonic acid gas, until cures were in some of them accomplished, and that the gas reduces the frequency of the pulse with as much certainty as digitalis, and that it speedily produces a copious expectoration. This gas is applied by the following pro- cess : about three or four ounces of chalk coarsely pow- dered, is put into a common bottle. Sulphuric acid diluted to the strength of about five or six parts of water to one of the acid, being poured upon the chalk, the gas is instantly extri- cated, and the patient inhales it through a small tube or quill passing through the cork. A sensation of pain anct 444 OF PULMONARY CONSUMPTION, OR PHTHISIS. heat about the glottis is induced by (he gas, but it is in gen- eral found practicable to continue fhe inspiration from fifteen to twenty minutes each time, and the operation should be repeated three or four times in twenty-four hours. The next remedy to be noticed for the cure of phthisis pulmonalis, is the one adopted by several English physi- cians, and by the late Dr. Senler of Newport; it consists in the exhibition of an emetic composed of from seven to ten grains of vitriolunv cupri or blue vitriol, and the same quantify of Ipecacuanha made into pills, to be taken in fhe morning fasting, without drinking any thing for sometime af- terwards. This, which is termed the dry vomit, is to be exhibited every second or third day; it excites vomiting without relaxing the stomach, irritating the intestines, or greatly fatiguing the patient. Dr. Senter assures us that he has restored more persons labouring under hectic fever from glandular suppuration by vomiting in this manner, and giving in the intervals as much as the stomach would bear, of Dr. Griffith's myrrh and steel mixture, than by all olher medicines he has ever read of or tried. "To the good ef- fects of the mode of treatmenf pursued by Dr. Senter, I can bear" says Dr. Thomas, " ample testimony, having adopted it in many cases of incipient phthisis with infinite advantage." The warm or tepid bath is a remedy from which consid- erable advantage has frequently been experienced in the different stages of this disorder. In those cases of hectic fever which are unattended with any great degree of heat or thirst, and which do not shew manifest signs of inflamma- tion, myrrh combined with steel, as recommended by Dr. Moses Griffith, has been found a valuable remedy. When administered in the early stage, and duly persisted in, it has demonstrated its superior efficacy and evinced its tonic and invigorating powers in the most safisfactory manner. To allay the local irritation and appease the cough, mu- cilaginous substances will have their use ; of these, gum ara- bic, liquorice, slippery elm, flax-seed, quince-seed, osmund royal, and spermaceti, are chiefly to be employed. When in the last stage, the lungs and bronchiae are greatly oppres- sed with pus or mucus, much benefit has been derived from the tincture of lobelia inflata; if given in small doses, as a tea spoonful occasionally, it excites the throat and bronchial OF PULMONARY CONSUMPTION, OR PHTHISIS 445 • essels into immediate action, by which expectoration is produced and relief is speedily obtained. It remains fo be mentioned that meicury has of late years been broii.iht into notice by fhe late Dr. Rush, as a remedy in some forms of this disease, and under particular circum- stance*, it has in a few cases proved decidedly successful; but the exhibition of this active medicine requires the cau- tion of an accurate observer, and whenever a mercurial course is contemplated, the writings of Dr. Rush, and Warren's treatise on Mercurial Practice may be consulted. Having thus glanced at the various remedies which from time to time have been recommended for the cure of pulmo- nary consumption, I close with the remark, that it is in the incipient stage only that a cure of this most cruel disease can ever be expected; in the last stage, the healing art is incompetent fo any further assistance than to palliate the dis- tressing symptoms, to sooth the patient's mind, and to smooth fhe path of death. It is a painful consideration that numerous instances oc- cur of young females labouring for months under a severe cough and other complaints, in consequence perhaps of a cold contracted at a critical period, unconscious of any im- pending danger, while (he insidious disease is making im- perceptible approaches, and fastening its hold on the con- stitution. Either from timidity, or possibly from parsimony, no medical advice is requested, or it may be that the unfor- tunate patient is flattered and deluded with the vain hope, that a few trivial medicines without any regard to a proper regimen of diet, may be the means of restoring the desired state of health ; until at length a severe pain and oppression about the chest, with a more distressing cough, and a copi- ous expectoration of purulent matter, attended by hectic fe- ver and night sweats excite alarm, and arouse the unhappy patient or friends to a sense of danger. A physician is now consulted, but the disease has advanced to that stage, when alas! it is deemed irremediable. Thousands have in this manner trifled away their lives, which, by early care and attention, might have been preserved as ornaments to so- ciety and blessings to their friends. The admonition of the poet, therefore, cannot be too fre- quently repeated, (hat .......................... " For v ant of timely care Millions have died of medicable wounds." 446 OF PULMONARY CONSUMPTION, OR PHTHISIS Atrophy, or Nervous Consumption. This disease consists in a gradual wasting of the body, unaccompanied with any remarkable fever, cough, or diffi- culty of breathing; but usually attended with a loss of ap- petite and impaired digestion. It may be occasioned by too copious evacuations, deficiency of nourishment, un- wholesome air, abuse of spirituous liquors, severe mental affections, and scrofulous obstructions of internal glands. This complaint is apt to seize young persons of a delicate make and of rapid growth, before they arrive at mature age. In the beginning of this disease, the countenance is pale and squalid, the appetite loaths every kind of food, the patient is constantly languid, and inclines to keep very much in bed, the urine is often small in quantity and high colour- ed, sometimes pale and copious. This disorder is for the most part very difficult to cure, and often terminates in a fa- tal dropsy. We should attempt in the early stage to re- move this complaint, by first administering a gentle emetic, and then occasional doses of rhubarb ; and afterwards by restoring the tone of the solids, and improving the state of the digestive organs, by the use of tonic and stomachic medi- cines combined as follows: lake of Gentian root, two drachms, orange peel, half an ounce, Peruvian bark, one ounce: infuse them in a quart of white wine or pure cider for two or three days, and filter through paper. Three ta- ble spoonfuls twice in a day is the proper dose, to which ten drops of the tincture of muriated iron may be added, or the patient may take from five to ten grains of the carbo- nate of iron twice in a day; or the myrrh and steel mixture as directed in the Appendix. If the disease depends on a weakness of the nervous system, as in the hysterical and hypochondriacal affection, the same plan must be pursued, to which may be added pills of asafoetida and castor. The diet ought to be of the most nutritive kind, and proper ex- ercise and free air should not be neglected. CHAPTER XIII. OF GASTRITIS, OR INFLAMMATION OF THE STOMACH. AN inflammation of the stomach, is an acute disease, which is attended with the utmost danger. It may be pro- duced by drinking too freely of cold liquors when the body is very hot; from acrid substances taken into the stomach; one instance has occurred lo me which was occasioned by swallowing a large quantity of unripe damsons and apples. It may proceed from drinking too much ardent spirits, from a surfeit, a stoppage of perspiration, repulsion of the gout, and violent passions. Among the most powerful causes of this disorder, is a sudden transition from cold to heat, as passing from a cold atmosphere into a warm room. This disease is known by a violent burning pain in the region of the stomach, with extreme anxiety, restlessness, and tossing about of the body ; excessive heat and a contin- ued painful vomiting of every thing swallowed, a great sore- ness, tension, and fulness of the stomach, with flatulency and most distressing thirst. The pulse is quick, hard and contracted. Great loss of strength, faintness, short and in- terrupted respiration, cold clammy sweats, hiccups, coldness of the extremities, and an intermitting pulse, are the sure harbingers of death. A disease so fraught with danger, requires the most speedy exertion in our power, as a very few days will decide the point between life and death. When consulted in this disease therefore, whatever may be the state of the pulse or fhe absence of febrile heat, and how- ever great the prostration at the commencemen', no time is to be lost, no timidity or prejudice should prevent the im- mediate employment of -the lancet, and this in fhe most co- pious manner. If in the earliest hours of attack, not less than fifteen or twenty ounces of blood ought to he ta!. in at the first operation, and smaller bleedings may afterwards 448 OF GASTRITIS, OR INFLAMMATION OF THE STOMACH. be employed if required. A low pulse will generally rise upon bleeding in (his complainL A large blister should next be applied to the region of the stomach, and warm fomentations applied over the whole abdomen, and continued without intermission for a length of time. The feet and lejs should likewise be frequently bathed in luke- warm water, and (he whole body immersed in the balh. Clysters of infusion of chamomile flowers and linseed, or mallows, with tlie addition of two drachms of sal nitre lo each ought also to be often administered ; they ought (o be large in quantity, that they may act not only as laxatives, but as fomentations to the bowels and stomach. In regard to purgatives, we conceive that calomel, in the form of pills and followed by a solution of Epsom's salts, either alone or with manna, are to be considered as by far the most eligible and the best adapted to the state of the stomach. Cas- tor oil is probably the next article best calculated to an swer (he desired purpose. From the great propensity of the stomach to reject every thing taken down, very lit- tle can be expected from internal remedies, and ev- ery heating and irritating substance must be most carefully avoided. Demulcent, and diluting drinks, moderately warm, may however be tried ; as may likewise small doses of nifre with spermaceti, or some mucilage of gum arabic, or of the slippery elm bark, to which may occasionally be added a few drops of laudanum. But opiates may be given in clys- ters when the vomiting has a little abated, with great advan- tage ; a drachm or more of the tincture of opium, in half a pint of barley water, should be often injected; and with the view of affording the patient some nourishment, a gill of warm milk added to the clyster will be highly useful. If the disease cannot be resolved by the means above mention- ed, mortification and death must ensue, and this fatal ten- dency may be known by the sudden cessation of the pain; by the pulse continuing its frequency, but becoming weak- er ; and by delirium, hiccups, and other marks of increasing debility. CHAPTER XIV. OF ENTERITIS, OR INFLAMMATION OF THE INTESTINES. THIS acute and very hazardous disease may be occa- sioned by the same causes which were recited when treating of inflammation of the stomach. It may arise also, from obstinate costiveness, cold, fever, worms, hard indigestible aliments; drinking stale and windy malt liquors, sour wine, cider, &c. Very high seasoned, and stimulating food some- times give rise to it, and it is often produced by wet feet, wet clothes, and whatever obstructs perspiration. Another cause of this complaint, is what is termed an introsusception, or running in of one part of a bowel into the other, and there confined by some stricture, or adhesion. It may likewise be occasioned by a rupture, and by scirrhous tumours of the intestines. An inflammation of the intestines is accompa- nied with nearly the same symptoms as inflammation of the stomach. It commences with slight wandering pains in va- rious parts of the abdomen; which soon becomes fixed about the region of the navel, and is excessively violent, with a burning sensation of heat; the belly being swelled, tense, and extremely tender to the touch ; the fever is acute, the tongue is parched, and of a dark brown colour, and the thirst is unquenchable. There is frequent evacuations, and urg- ings to vomit, and the efforts are sometimes so violent, that the motion of the bowels is inverted, and even the excre- ments are discharged by the mouth. When this last symp- tom occurs, it is called iliac passion. The urine is dis- charged in small quantity, and with pain and difficulty, and the costiveness is often so obstinate, as not to yield even to the greatest efforts. The pulse is small, hard, and quick, frequently becoming at fast irregular and intermittent, and the prostration of strength, as in gastritis, is in 57 4J0 OF ENTERITIS, OR INFLAMMATION proportion to the violence of the symptoms. If effica- cious remedies are not early employed, or do not succeed, the disease sometimes ends fatally in ten or twelve hours; and almost always before the third day; so lhat there is seldom any suppuration. If the pain soon changes its sit- uation, and becomes less violent ; if the vomitings lessen, and stools are produced, and the heat abates, it may be ex- pected (ha( a resolution is about taking place. But if fhe pain increases-, and keeps constantly in one point, and (he belly becomes more tense and tender; if no stools are ob- tained, and the vomiting continues, and fcecal matter with the clysters is thrown up, it is too evident, that little ground for hope remains ; and when a sudden cessation of pain, hic- cups, clammy sweats, fallen countenance, convulsions, and coldness of the extremities occur, the fatal termination is near at hand. In the cure of this dangerous complaint nothing is more important than copious bleeding, and this should be repeated according to the urgency of the symptoms, until the pulse becomes soft. Topical bleeding, either by cupping glasses, or leeches, may also prove advantageous, provided the pa- tient can bear their application ; and blisters over the abdo- men are of essential importance, and ought on no account to be omitted. The patient should be placed up to his breast in lukewarm water, or emollient fomentations must be most thoroughly applied. His feet and legs should be often bathed, and mild softening clysters consisting of milk and water, barley water or gruel, as they serve the purpose of internal fomentation, ought to be frequently injected. Having thus far attempted to reduce the inflammation, the next point is, to endeavour to procure an evacuation of the contents of the bowels by the use of purgatives of the gent- lest kind; among which, no one perhaps is to be preferred to castor oil, provided it can be retained on the stomach; it may be rendered less unpleasant, by combining it with mucilage, or yolk of egg. Another mild, but very useful laxative, may be formed by dissolving one ounce of Glau- ber's or Epsom's salts with an ounce of manna in a pint of water, a tea cup full of which, may be taken every half hour, till the desired effect is produced. It may be proper to give small doses of laudanum occasionally, to appease the vomiting during the employment of the solution. If liquid purgatives cannot be retained, or should fail of pro- OF THE INTESTINES. 451 ducing the desired evacuation, we must resort to those of (he solid kind, of which calomel unquestionably is the most eligible. This valuable medicine may be given in doses of ten grains, made into pills, and repeated at proper intervals, as occasion may require, or it may be combined with jalap. If spasmodic contractions of the intestines should be pres- ent, one grain of opium will be a necessary and a valuable addition, and the employment of the warm bath should be directed. Should the vomiting continue fo distress the pa- tient, yeast or the saline draught, with a few drops of lauda- num and the essence of peppermint, will be likely to miti- gate the complaint. The skins of animals, applied while warm to the belly, have it is said, been found of much ser- vice, and the fumes of tobacco, thrown up the rectum, have also produced good effects. A very erroneous supposition sometimes prevails, that the constipation in this disease, should be the first and chief symptom to be attended to, giving it the vulgar name of stoppage; they immediately have recourse to active purga- tives, and persevere in their use, to the great hazard of the patient. Another error is sometimes committed, by mis- taking this disorder for colicy pains, when spirituous and other heating liquors are administered, which greatly tend to increase the inflammation and the real danger. The fe- ver, with quick and hard pulse, and great tenderness of the abdomen, will sufficiently distinguish this disorder from col- ic. In regard to food in this disease, it is obvious that very little can be taken, and nothing but the most bland and mildest liquids should be swallowed. After the acute stage of this disease is over, we not unfrequently meet with a swelling or induration between the crest of the right ilium and the umbilicus, which seems fo be the seat of the pain, is tender to fhe touch and produces great uneasiness when the contents of the alimentary canal pass through this part. The difficulty undoubtedly proceeds from coagulable lymph effused among the intestines, andfrora inflammation in a suba- cute degree. The cure is effected by cupping or applying leeches to the part, or by frequently bathing it with some cold liquid as diluted alkohol, camphorated spirit, &c. Per- haps (he following may be preferable to any thing else. Take of the water of acetite of ammonia and of pure water, each four ounces, brandy,one ounce, mix and place them in a cool situation. Keep flannels wet in this preparation con- 452 OF ENTERITIS, kc stantly applied to the part, and renew as often as they get warm. Experience has proved both the efficacy and safety of this course. The danger of attempting to produce sup- puration will appear obvious to every one who reflects on the nature of the parts concerned. If however, suppuration should take place contrary to all our wishes, as soon as the circumstances will admit, we must proceed to make an open- ing for the passage of the matter. From the consideration of the obstinacy of this dreadful disease, and its frequently fatal termination, it must be ob- vious, that people cannot guard with too much caution a- gainst the various causes by which it is produced; among these are, long continued costiveness, sour unripe fruit, and sour or very stale liquors. The danger of wet clothes should be particularly avoided, and especially wet feet, which of all the various ways of catching cold is the most pernicious to the bowels. CHAPTER XV. HEPATITIS, OR INFLAMMATION OF THE LIVER. INFLAMMATION of the liver is more frequently met with in warm climates, than in cold or temperate ones. It commences in general with a rigour, or shivering, which is Succeeded by febrile heat with pain, either acute or dull, under the short ribs of the right side, increased by pressure upon the part, and frequently extending to the collar bone and shoulder. There is a difficulty of laying on the left side, shortness of breath, a dry cough, and sometimes vomiting of bilious matter attended with hiccups. The symptoms vary in this disease according to the degree of inflammation and the particular part of the liver which happens to be af- fected. Sometimes the pain is so inconsiderable, that the disease progresses to a dangerous state before it is even suspected. There is a loss of appetite, great thirst, and costiveness; the urine is of a deep saffron colour, and small in quantity ; the pulse strong, hard, and frequent; the skin is hot and dry ; the tongue covered wilh a white or yel- lowish fur, and in some, it is attended with yellowness of the eyes. This disease may be distinguished from pneumonia, or pleurisy, by the pain being less violent, and extending up to the shoulder, the pulse not so hard, by the sallowness of the countenance, by the cough being unaccompanied by expectoration, and commencing at a later stage of the dis- ease, and a less degree of labour in breathing. The causes which may produce this disease, besides those which give rise to other inflammations, are certain passions of (he mind, violent exercise, any thing that sud- denly cools the liver after it has been much heated. Too free use of hot spicy aliment, and strong wines ; but more es- pecially spirituous liquors. Gall stones obstructing the pas- sage of the bile may sometimes produce this disease. Inflammation of the liver, like that of other parfs, may terminate by resolution, suppuration, gangrene, or scirrhus ; 154 HEPATITIS, OR INFLV.MMAT10N OF Tllh L1VEK but in this climate, a suppuration or gangrene, is not a fre- quent occurrence. A resolution is often effected by some spontaneous evacuation, as a bleeding at the nose, or the bleeding piles. Sometimes it is accomplished by a bilious looseness, a profuse swealing,ora discharge of urine deposit- ing a copious sediment. When the disease ends in suppu- ration, the matter of the abscess may be discharged by (he biliary ducts, or if that pari of the liver most contiguous to the abscess, has formed adhesions with some neighbouring part, the matter may be discharged by the different outlets with which this part is connected, thus, it may be coughed or vomited up, or Ihe matter may work its way outwardly by bursting through the integuments, or a passage be made for it by incision. But if the abscess should burst info fhe cavity of the abdomen at large, death will be the conse- quence. It frequently happens, that fhe inflammatory symptoms at the beginning of this disease, are not sufficiently alarming to arrest the attention ; but as soon as the existence of (he disorder is ascertained, no time should be lost in drawing from the arm a proper quantity of blood, and (hough (he pulse should not be remarkably hard, a repetition of the op- eration must be determined by the degree of pain and fever, with which fhe patient is attended. After bleeding, fomentations, softening clysters, and bathing the feet, should be put in practice as directed in the two preceding chap- ters. A large blister should next be applied over the region of the liver, and mild laxatives of Glauber's salts and manna, preceded by a few grains of calomel, administered. As diuretic medicines have been found useful in this com- plaint, about twenty grains of sal nitre, or a tea spoonful of the spiritus nitri dulcis, may be given in a cup of tea drink every three or four hours. A tendency to sweat may be encouraged, by drinking plentifully of warm diluting liquors, and repeated doses of the saline mixture, with tartarized antimony. Should a looseness occur, it ought not to be checked, unless (he evacuations be so considerable as to weaken the patient, as loose stools often prove critical, and carry off the disease. When all our endeavours to subdue the inflammation fail, and an abscess is about forming in fhe liver, which is marked by the pulse becoming softer, fre- quent shiverings, abatement of pain, and a sensation of weight about the part affected, we must endeavour as much as pos- HEPATITIS, OR INFLAMMATION OF THE LIVER. 455 sible to promote the suppuration. For (his purpose the usual application of poultices, and emollient fomentations must be immediately made, and duly persisted in, until the contents of the abscess can be discharged by an incision through the external teguments by some skilful operator. The opening should be made in the most depending part of the tumour, where a fluctuation is perceived. Having with a scalpel, cut through the external teguments, and reached the abscess, it may be pierced with a trocar and the matter gradually evacuated. If the liver has formed such adhesion to the peritonaeum, as (o prevent the pus from falling info the cavity of fhe abdomen, fhe life of the patient may be preserved. The Peruvian bark, in doses of half a drachm in powder, should be given four or five times a day, during the formation of the abscess, and after it is opened, in order to support the strength, and to guard against the effects of absorption of the purulent matter. The patient is to be supported with light nourishing food and cooling diluting drinks, carefully avoiding all heating substances as in other inflammations. If the pain and swelling do not yield to the antiphlogistic plan, which has been advised, and the inflammation should terminate in induration, and scirrhus, the patient may sur- vive for many years, provided he pay proper attention to his diet and mode of living. He ought in this case, to use less of animal than vegetable food ; avoiding high seasoned meat and strong liquors. There is likewise a chronic inflammation of the liver, in which the symptoms are more moderate, and the disease is slow in its progress, often continuing for many months, and at last terminating in a very considerable suppuration. The patient complains rather of a sense of weight than of pain, and the fever occurs in paroxysms or fits, somewhat resem- bling the attacks of an intermittent, and the liver on exam- ination externally, will often be found to be considerably enlarged. In both chronic inflammation and scirrhus affections of the liver, a moderate course of mercury will be found of singular efficacy. Mercury may be introduced into the system, by rubbing in about one drachm of the ointment in the neighbourhood of the part affected, or in the groins eve- ry night, until some tery obvious effect is p-oduced on the constitution; or till the swelling and hardness are dispersed. 456 HEPATITIS, OR INFLAMMATION OF THE LIVER. If an internal course should be preferred, about two grains of calomel, and half a grain of opium, every night, will prob- ably effect the desired purpose, without -«9mwfHg* it to such extent as to excite complete salivation. During the course, it will be advisable to intersperse a mild laxative of Glauber's, or other neutral salts, every third or fourth morn- ing. It will in some instances perhaps be found necessary to continue this course for five or six weeks, observing at the same lime a proper regulation of diet, consisting chiefly of light puddings, of rice or arrow root, with milk and vege- tables, meat broth, &c. Salted meat, greasy substances, and all spirituous liquors, must be particularly avoided. As an auxiliary remedy during the employment of mercury, the nitric acid, largely diluted with water, and mucilage, or syrup, has been found useful. A course of stomachic bit- ters, with cinchona bark, ought to be adopted during the ■convalescent state. CHAPTER XVI. INFLAMMATION OF THE SPLEEN, KIDNEYS, BLADDER, AND OTHER PARTS. IN consequence of long continued remittent or inter- mittent fevers, the spleen is sometimes affected with a degree of inflammation, and remains a long time in a hardened in- dolent state, and the tumour, as well as indurations of the liver, has obtained the vulgar name of ague-cake. This disease comes on with a remarkable shivering, succeeded by great heat, thirst, and other febrile symptoms. A dull pain is felt under the short rib3 of the left side, accompani- ed for the most part with a protuberance externally. The fever generally increases every fourth day; the feet and knees grow red, the nose and ears sometimes pale, and there is a difficulty of breathing. The inflammation of the'spleen is accompanied with less danger than that of the liver, and a vomiting of black matter, which in other acute diseases is reckoned a fatal symptom, is said to prove sometimes crit- ical and salutary in this disease. The inflammation is like- wise sometimes carried off by the haemorrhoids ; but it fre- quently terminates in a scirrhus. An abscess of the spleen will sometimes be formed without much previous distress or disorder, which bursting suddenly, pours its contents amongst the viscera of the abdomen, and in a few days destroys the unhappy patient. The method of cure in this disease, is in most respects the same as in inflammation of the liver. Inflammation of the Kidneys, (Nephritis.) The patient in this complaint is seized with the usual symptoms of inflammation, and is attended with heat and a sharp pain about the region of the kidneys, and a stupor, or dull pain in the thigh of the affected side. The urine is at first clear, and afterwards of a reddish colour, voided 58 158 INFLAMMATION OF THE SPLEEN, KIDNEY.s, frequently and in small quantities at a time. There is a vom- iting and often a costiveness and difficulty in breathing, with cold extremities. There is a painful uneasiness when sifting upright or standing, the most easy position being that of lying down on the side affected. This disease maybe dis- tinguished from the colic, by the pain being seated further back than in. colic ; and from lumbago, by the patient be- ing able to move the trunk of his body without occasioning that severe pain s-hoofing along the course of the ureters, and by the difficulty of passing his urine. This disorder may proceed from any thing of an acrid nature stimulating the kidneys, as strong diuretic medicines, spirits of tur- pentine, tincture of cantharides, &c. It may also be occa- sioned by suppressed evacuations, external contusions, cal- culous concretions, strains of the muscles of the back; violent or long continued riding on horseback, or shaking in a carriage. At the first onset of this complaint, bleeding must be em- ployed, and if the quantity of blood taken should prove insufficient to afford considerable relief, the operation ought to be repealed, according to the urgency of the symptoms, within twenty-four hours, especially if the patient be of a full habit. Fomentations and the warm bath are among the most important means to be employed ; but blisters, on ac- count of fhe irritation which might be excited by the can- tharides, are not to be advised in this complaint. A mild laxative, consisting of an infusion of senna, Glauber's salts, and manna, will be highly proper, and soft emollient clysters of milk and water, or mallows and milk wilh some linseed oil, must be frequently injected. The mucilage of gum arabic, with barley water, or an infusion of linseed or marsh-mallow root, sweetened with honey, may be drank occasionally with much advantage. In case of violent pain, twenty drops of laudanum every six or eight hours, will afford essential relief, but if combin- ed with a tea spoonful of spiritus nitri dulcis, the effects will be still more beneficial. Considerable relief may some- times be obtained by mixing a tea spoonful of laudanum with the clyster. Besides bleeding from the system at large, topical bleeding, by the application of leeches to (he he- morrhoidal veins, has in some inslances afforded relief. A decoction of (he dried leaves of (he peach tree, says Dr. Thomas, drank in the quantity of a pint a day, has been found a very useful remedy in many cases of nephritis. BLADDER, AND OTHER PARTS. 459 Should this affection of the kidneys terminate in suppura- tion, which may be known by the abatement of the pain, a remaining sense of weight in the loins, with frequent shiver- ings succeeded by heat and the appearance of purulent mat- ter in fhe urine, balsamic and delergent medicines, with chalybeates and the Peruvian bark, must be directed. But the uva ursi, or the wild cranberry of our woods, when giv- en in doses of half a drachm or more three times a day, has been productive of the happiest effects. Where an inflammation of the kidneys has proceeded from the stimulus of a stone or gravel, (he same course is (o be followed, with (he additional means recommended under (hose particular heads. In all (hese complain(s, (he patient should abstain from every thing which by its acrid or heating qualities, may prove a stimulus to the kidneys. His diet ought to consist chiefly of milk and vegetables with animal broth and rice, or barley. His drink should be whey and butter-milk; the latter used while fresh is said to be a valuable remedy in ul- cere of the kidneys. Inflammation of the Bladder, (Cystitis.) In this complaint, the patient experiences a violent pain in the region of the bladder, sometimes attended with an external redness in that part. There is a frequent desire and a great difficulty in discharging urine, often a total sup- pression, with frequent efforts to expel the faeces, occasion- ed by the perpetual irritation affecting those parts. These symptoms are accompanied with febrile heat, sickness, and vomiting, great anxiety and restlessness, and sometimes de- lirium and coldness of the extremities ensue. The cure of this disease is to be effected consistently with the plan which has been prescribed in the preceding local inflammations ; but the case will require the most prompt at- tention and application of remedies. Bleeding, fomenta- tions, and the warm bath, followed with gentle laxative medicines, are chiefly to be relied on. Ten or fifteen grains of sal nitre, or a tea spoonful of the spiritus nitri dulcis, may be given in the patient's drink occasionally, which should consist of barley water or linseed tea. If the urine be retained from a stricture in the neck of the bladder, and all other means fail to relieve, the catheter must be employ- 460 INFLAMMATION OF THE SPLEEN, KIDNEYS, &c ed to evacuate the urine, but this must be done with the caution of an experienced hand. But no disease requires or bears more copious bleeding than an inflammation of the bladder, and it should be repeated so long as the symptoms continue to be violent. Inflammation: of the Mesentery and of the Omentum. When the mesentery is affected with inflammation, there is a tumour and deep seated pain about the region of fhe navel; the body is costive, there is a bitter taste in fhe mouth, and loss of appetite; the fever is slight, sometimes remittent, and at others violent. In the most advanced stage of the disease, a thin red foetid or white matter passes off by stool. Inflammation of the omentum is distinguished by an acute darting pain through the superior and middle part of the lower belly, below the skin, muscles, and membranes of the abdomen; increased upon pressure, with swelling and ten- sion, accompanied by an inflammatory fever. As these two affections require the same mode of treat- ment with other local complaints, which have repeatedly been described, it was deemed necessary here only to speci- fy those symptoms by which they are said to be distinguish- able. The muscles of the abdomen sometimes become affected with inflammation, which in some instances has been mis- taken for an inflammation of the liver. It may however, be distinguished by examining the skin and muscles, by the pulsation of the tumour, and circumscribed figure, extend- ing itself beyond the limits of the liver, and above the lower ribs; from the absence of cough, difficulty of breathing, vomiting and hiccup. Inflammation of the peritonaeum and of the uterus, as oc- curring chiefly to women after delivery, will be noticed in the place assigned for the treatment of female and puerperal dis- eases. CHAPTER XVII. OF PAINFUL DISEASES NOT ATTENDED BY FEVER. Head-ach. THE head-ach is so general a complaint that there are few persons who have not at some period of life been made experimentally acquainted with it. It is differently distin- guished according to the degree of the complaint and the part which the pain occupies; as cephalalgia, when the pain is not very considerable; cephalea, when it exists in a high degree, and extends over the whole head; and hemi- trania, when one side only is affected. When the pain oc- cupies so small a part on one side of the forehead, that it may be covered with the end of the finger, it has been call- ed clavis histericus. Head-ach may be either internal or external, and is often- er a symptomatic affection than a primary one, and frequent- ly ensues in consequence of a fever, or accompanies hys- teria or some other nervous affection. It may however, be occasioned by indigestion, foulness of the stomach, and by whatever distends the vessels of the head, or obstructs the circulation through them. It often proceeds from the suppression of customary evacuations; as the piles, bleeding at the nose, sweating of the feet, &c. A long exposure to the heat of the sun, a stoppage of perspiration, costiveness, or other causes which by impeding the motion of the blood in the lower extremities produce a greater fulness in the head ; and also an acrid state of the fluids and translations of gouty and rheumatic matter from other parts of fhe body, may be enumerated as among the causes of this disease. When the head-ach is owing to a fulness of blood, and the patient is of a sanguine habit of body, bleeding in the jugular vein, will generally afford relief, and if necessary, cupping at the nape of the neck, or between the shoulders, and gentle purgatives may be resorted to. In most kinds •W'2 OF PAINFUL DISEASES NOT ATTENDED BY FEVER. of head-ach, especially if long continued and very violenf, blisters should be applied to (he neck, behind (he ears, or any part of (he head (hat is most affected. In some cases it will be proper to blister the whole head ; sometimes they are more serviceable when applied to the back and legs. In persons of a gross habit, issues or a selon may prove beneficial. The feet and legs should be frequently bathed in warm water, aloetic wine or pills must be occasionally administered, and on some occasions it will be advisable to shave the head and wash with cold water and vinegar. In phlegmatic constitutions, a head-ach may be relieved by the use of aloetic purgatives, and by blisters, and if much debility attend, the Peruvian bark in powder with about Pour grains of salt of wormwood in each dose, will prove an efficacious remedy. Considerable benefit will also be de- rived from taking twenty or thirty drops of antimonial wine twice a day in a cup of valerian tea as it tends lo promote perspiration. From (he great sympathy between the head and stomach, it frequently happens that a foul state of fhe stomach produces a severe head-ach. When this is sup- posed to be the cause an emetic must by all means be ad- vised, and if costiveness attend, this should be removed by some proper stomachic purgative. After which, the Peru- vian bark with bitters and chalybeates will be necessary to strengthen the stomach. When this complaint arises in consequence of some nervous affection, called nervous head- ach ; after cleansing fhe stomach by a gentle vomit, and the bowels by some mild laxative, Ihe most proper medicines will be, valerian, castor, asafoetida, and the root of skunk cabbage ; and these must be accompanied wilh the usual tonic remedies, as Peruvian bark with steel, and stomachic bitter infusions of quassia, calamus aromaficus, and thor- oughwort. In such constilutions, exercise on horseback, and a nutritive diet, and probably the shower bath, will prove advantageous and salutary, as tending to render the habit more robust and healthy. The application of a tea spoonful of ether to the temples, or the part affected, and covering it closely with the hand to prevent its evaporation too soon, will afford essential relief in the severest parox- ysms of head-ach. The sick head-ach, according to the late Dr. John War- ren, is to be ascribed fo an acid generated in the stomach, and may be almost invariably relieved by a few grains of OF PAINFUL DISEASES NOT ATTENDED BY FEVER. 4G3 calomel. "Drinking a draught of Warm water at bed time, dilutes the acid, and gives temporary ease." In periodical head-aches, after premising an emetic, and cathartic, the cin- chona or thoroughwort, will generally effect a cure. Though I have met with a few instances of periodical head-aches, in which such a degree of inflammation prevailed as to require bleeding, and a moderate course of calomel and opium. In other similar cases, the arsenical solution of Dr. Fowler will often succeed ; beginning with about three or four drops, repeated twice a day, and increasing the number gradually to eight or ten. If the head-ach proceed from a vitiated state of the hu- mours, as in scorbutic constitutions, or from a venereal taint, the decoction of sarsaparilla with raisins, or an infusion of the root or leaves of phytolacca decandra, will prove advantag- eous, if freely used, but mercurials must be added to com- plete the cure. Instances will frequently occur in which it will become indispensably necessary to resort to opium, iu order to procure relief from the extreme violence of pain, continual watching, and even delirium, with which the pa- tient is afflicted. About twenty drops of laudanum may be taken in a cup of valerian tea several times in a day, and bits of linen, well moistened with anodyne balsam, should often be applied to the part affected ; care being at the same time taken, to obviate costiveness, which aggravates the complaint. That sickness of stomach and vomiting, which women often experience, after taking a dose of opium, may be greatly mitigated, or prevented, by a cup of strong coffee without milk, if taken when the narcotic effects of the ano- dyne are over. Persons who are constitutionally subject to head-ach, ought to guard against wet feet ; they should on no account. go to bed with their feet cold, and they ought always to lie with their head high, to avoid any thing tight about their necks, and to refrain from the use of spirituous liquors. Of the Tooth-ach, (Odontalgia.) The term tooth-ach applies only to a particular symptom of some disease with which the tooth is affected. It is in general a symptom of a caries of the tooth, or of such dis eased state of it, as will, if not cured terminate in caries. When the tooth is in this condition, it is liable to be acted 464 OF PAINFUL DISEASES NOT ATTENDED BY FEVER. upon by various irritating causes, such as the application of cold about the head, or by cold and wet feet which repel the blood towards the head. The tooth-ach may proceed frem any of the causes of inflammation, and is often owing chiefly to an acrimony in the fluids, either of a rheumatic or scor- butic kind, when the whole side of (he face will be affected. When a tooth becomes carious, or rotten, it is not only troublesome from the severe pain which it occasions, but it frequently affecls the neighbouring teeth, and unless timely checked, or removed, it may extend its influence even to the jaw-bone, producing tedious caries and ulcerations. In most instances, the caries appears first upon the external surface, or enamel of the tooth, but in some, it commences in the internal surface or bony part, and the caries spreading and corroding deeper, at length penetrates the substance of the tooth, and giving access to the external air, and other matters, these, by irritating the nerve, excite the painful sen- sation of tooth-ach. Extraction of the diseased tooth is undoubtedly the only effectual method of curing the disorder, but there will be cases in which this operation will appear inadmissible, and it will often be strongly objected to by the patient. It would indeed be absurd to attempt this operation, when the gums and contiguous parts are greatly inflamed and tumefied; but when this is not the case, and when the tooth-ach is evident- ly owing to an external cause, or open caries, there is reason to believe that the affected tooth will prove a martyr to the disease, and it ought to be extracted before it becomes so carious as to render the operation ineffectual. In attempting to cure the tooth-ach, our first object is to divert the flux of humours from the part affected, by the usual means of mild purgatives, and bathing the feet in warm water. The perspiration should also be promoted, by drink- ing freely of wine whey, or other diluting liquors, and if much heat prevail, ten grains of sal nitre may be given two or three times a day. If the gums and cheeks are much inflamed and tumefied, a roasted fig should be applied to the tumour in the mouth, while poultices of linseed, or elm bark, with a little meal added, are applied externally, and these ought to be renewed until the complaint entirely ceases, or a suppu- ration takes place. There is however, no application of su- perior efficacy to blisters, they should be large enough to extend from behind the ear over the greater part of the low- er jaw of the side affected. OF PAINFUL DISEASES NOT ATTENDED BY FEVER. 465 When the carious tooth is hollow, the pain may be remov- ed, by introducing into the cavity some caustic substance, to destroy the sensibility of the nerve. For this purpose a little lint or cotton, impregnated with some of the essential oils, are usually employed, as the oil of cloves, nutmeg, and savine ; but the cajeput oil, when it can be procured genuine, is pre- ferred to any other. The mineral acids, properly diluted, are also recommended. A small pill of opium and camphor, with two drops of some essential oil, or equal parts of laud- anum, and tincture of myrrh, or a few drops of ether, put into the hollow of the tooth, will seldom fail of procuring temporary relief, and to prevent a return of pain the hole ought to be stopped up with wax, or lead, so as to exclude the external air. It is asserted by Dr. Conyer, that a tea spoonful of ether applied to the affected jaw, and covered closely with the hand, that it may not too soon evaporate, and repeated till the pain cease, is a never failing remedy for the tooth-ach. Dr. Buchan says, that a piece of sticking plaster, with a bit of opium in the middle of it, laid on the temporal artery will relieve the pain. Promoting an increased flow of saliva, by means of chew- ing some pungent vegetables, as horse-radish, ginger, must* aid, and tobacco, frequently alleviates the severity of tooth- ach. When this complaint proceeds from a foulness of the stomach, as it often does, an emetic is the only proper rem- edy. And in women during the earliest months of pregnan- cy the tooth-ach is generally cured by small bleedings. 59 CHAPTER XVIII. TIC DOULOUREUX, OR PAINFUL AFFECTION OF THE NERVES OF THE FACE, OR NEURALGIA. THE character and description of this most singular dis- ease were not to be found till of late years in medical re- cords, and it is fortunate for the professors of the healing art, that they are not more frequently called to deplore the suff- erings of individuals under a complaint so unyielding fo the power of medicine. The late Dr. Fothergill, is said to have been the first who published an account of this disease, since which, the subject has arrested the attention of several other authors. We are indebted to Dr. J. Jackson of Boston, for a valuable communication with cases of neuralgia, published in the New-England Medical Journal, Vol. II. From this gentleman's accurate observations, aided by a case peculiar- ly interesting, which has receutly occupied my attention, I shall endeavour briefly to describe the disease, and the mode recommended for relief. Neuralgia of the face, the name given by Professor Chaus- sier, and adopted by Professor Jackson as the most eligible, is an exquisitely painful affection of the nerves of the face; most commonly the seat of the disease is the nerves over the cheek bone, just below the orbit, following fhe course of the nerves to the nose, upper lip, teeth, and gums. Other parts of the head and face, as fhe ear, eye, lower jaw, and occiput, have likewise been known to suffer from this affection. The pain occurs most frequently by sudden paroxysms, and in quick succession, more rapidly repeated however, in some instances than in others, and the pain is excruciating beyond expression. The continuance of the pain seldom exceeds a minute, and the intervals of ease are from two, to eight or ten ; this however, seems to depend on the greater or less degree of irritability of the nerves, or the occurrence of some exciting cause even of the most trivial nature. Thus, the action of the muscles of the face, in coughing, chewing, TIC DOULOUREUX, OR PAINFUL AFFECTION, &c. 467 speaking, laughing, and swallowing, as also a sudden emotion of the mind, or the slightest stroke, or motion of the bed- clothes, will produce a return of the paroxysm. The pain often remits as suddenly as it comes on, leaving no other sensation than a dread and horror of its return, or a slight tenderness and soreness of the part affected. The accession of the paroxysm sometimes resembles a spasmodic affection, with an evident vibration of the nerves, and in other instan- ces, they are like the sudden, but severest dartings and twinges of tooth-ach, though incomparably more violent. Ascribing Ihe whole affection to carious teeth, some persons have been induced to have several of them extracted, with fhe hope of obtaining relief, but good effects have rarely been experienced from the operation. Some patients, after being afflicted with this tormenting complaint, by night and by day, for several weeks, or months, are at length happily favoured with a respite during a period of several months, or years, when they are again visited with all the distressing circumstances as before. The tic douloureux, may be distinguished from rheuma- tism, hemicrania, and tooth-ach, by a paroxysm being excited by the slightest touch, by fhe shortness of its duration, and extreme violence of the pain, seldom attended with redness, or swelling of the affected part, and by the pain accurately following the ramifications of the affected nerves, and some- times with convulsive twitchings, and an entire freedom from pain during the intervals. , With respect to the mode of treatment best adapted for the cure of neuralgia, that of Dr. Jackson, detailed in the production above referred to, is undoubtedly well worthy of adoption. His experience and judicious observations, may with much propriety be made the rule of our practice. The first remedy to be noticed is hemlock, (conium maculatum,) which was often successfully employed by Dr. Fothergill, but in other hands it has since failed to afford relief. This is probably to be attributed to the inferior quality of the pre- paration employed, or the want of precise rules in its admin- istration. The fact seems to be confirmed by experience, that unless cicuta be given so as to produce a sensible effect on the system, it seldom exerts its influence over the local affection, but in being attained, a subsidence of the pain is the immediate consequence. From the active properties of cicuta, and the incertitude of its operation, it will in no case 468 TIC DOULOUREUX, OR PAINFUL AFFECTION Of • be prudent to give a full dose on the first trial. The gen- eral practice is, to begin with a small dose, and increase gradually to the extent which the particular constitution can bear, or circumstances require. If therefore, in neuralgia, we prudently begin with a single grain of the inspissated juice, or extract, we may with safety increase it to five grains for the second or third dose, and add five grains lo every future dose progressively, till its effects on the system are evinced by the occurrence of slight dizziness, nausea, or some other sensation. And as it has been ascertained by Dr. J. that the effect of the medicine becomes evident within two hours, and often within fifteen or twenty minutes after being received into the stomach, the doses may be repeated every second hour, or at longer or shorter intervals, according to the urgency of the case, carefully attending to its effects. In one of Dr. J.'s patients, three hundred grains were taken in six hours, by which dizziness and faintings, with an inabil- ity to set up, were induced, but a very essential respite from pain was the happy result. Encouraged by this bold ex- ample, even the quantity above mentioned, has been exceed- ed in another instance which will presently be related. When the extract of hemlock appears of doubtful quality, the tinc- ture of the same plant prepared with proof spirit, in the same proportions as the tincture of digitalis, may be substi- tuted. This proved successful in one of the cases detailed, beginning with thirty drops, and increasing in the same man- ner as the extract. The aqua ammonia having been suc- cessfully employed by Dr. F. was also in the hands of Dr. J. the mean of effecting a cure in one instance, when given from one to three tea spoonfuls three times in a day. Preparations of zinc, silver, mercury, and arsenic, have been mentioned as remedies in this disease, but they are not supposed to be entitled to confidence; though a salivation is said to have succeeded. From the well known narcotic, and sedative powers of stramonium, it may be recommended as among those con- sidered worthy of trial. Stimulating embrocations, blisters, electricity, and fric- tions with mercurial ointment, and opium in liberal doses, are the remedies to be resorted to with the view of obtaining palliative relief in this most distressing complaint. " In certain cases the sensibility of the diseased nerves has been destroyed by dividing the trunk of the particular THE NERVES OF THE FACE, OR NEURALGIA. 469 nerve, from which the diseased branches proceed." This mode of treatment is certainly to be advised in cases, where the disease resists internal remedies. " It is not infallible, for in some instances the nerve uniting, the pain has return- ed in a short time, or in others, after a number of years." This operation, and the expediency of resorting to it, must be entrusted to the judgment of a skilful anatomist and surgeon. The truly afflicting instance of tic douloureux, which I have recently witnessed, was in a respectable lady in the ninth month of pregnancy ; the anguish of whose sufferings I attempt not to describe. She had experienced occasion- al attacks for several years in a moderate degree, and one or two teeth had been extracted without any benefit result- ing. During the few first days of this last attack, the inter- nal and external use of the tincture of opium, and anodyne balsam, seldom failed fo afford relief from pain, and render her condition tolerable ; but when these could no longer con- trol the violence, and diminish the frequency of the parox- ysms, recourse was had to the extract of hemlock. This during the first three days, was exhibited in moderate doses, but on the fourth day it was increased from ten to eighty grains an hour, amounting in seven hours, to four hundred grains ; two hundred of which were taken during the last two hours and a half. The effect produced on the system, was only a slight dizziness for a short time, but the violence and frequency of the paroxysms, were in a considerable de- gree suspended during twenty-four hours, when they return- ed with their usual severity. A further perseverance in the use of this medicine, under existing circumstances could scarcely be deemed warrantable. The aqua ammonia was afterwards tried in a few doses without effect, but some relief was obtained by the application of a blister and the tincture of cantharides, to the parts affected, assisted by large doses of laudanum. The sufferings of this patient were greatly aggravated by a severe catarrhal affection, and a distressing cough, with symptoms indicating a vitiated state of the stomach; for the removal of which, an emetic was administered, and from this, she derived more permanent benefit than from all the medicines previously exhibited. She experienced an im- mediate abatement of all her distressing complaints, and the paroxysms were almost entirely suspended, recurring only •irO 1IC DOULOUREUX, OR PA1VFC1 AFFECTION 01 in-i slight degree when excited by coughing. The circum- stances attending parturition were encountered without dif- ficulty, but during the period of nursing, she became debili- tated, and was occasionally affected with neuralgia; by the use of cinchona and chalybeates the tone of her system was restored, and with it her general health. The following case is sufficiently inleresting and important (o be inserted in (his place. A particular detail is found in a lelter from the patient himselP, Samuel Chipman, Esq. to Dr. Low of Albany, and published in the Albany Gazette. A brief abstract only must suffice. The patient describes the paroxysms of pain as being so extremely acute as to resemble that produced by thrusting into the part fhe point of a sharp knife, and at length increased to such severity that he could conceive of nothing except the inquisitorial rack more completely horrid. He continued for many weeks in this dreadful situation employing external applica- tions only, as the physicians were unacquainted with the real nature of his complaint. Finding at length his health and strength failing fast, and the disease constantly gaining ground, he resorted to other physicians who fortunately had met with the publication of Dr. James Jackson of Boston, on the subject of tic douloureux, and recommending cicuta as a remedy. Resolving to make a full trial of the cicuta he took the first night twenty-six grains of the extract, which produced but little effect, increasing however to one hun- dred and seventy-five the next night, and to one hundred and eighty the following night. He was so intoxicated that he could with difficulty walk without assistance, and the par- oxysms were considerably diminished. The cicuta being ex- hausted and fhe pain becoming again intolerable, he took five grains of opium, and in two hours after, seventeen grains more, which eased the pain, but neilher intoxicated nor oc- casioned sleepiness. Having procured a new supply of ci- cuta, he commenced with a dose of four pills of five grains each, and in two hours and ten minutes took one hundred and twenty grains, by which a perfect cure was effected. This gentleman describes as follows fhe effects which he experienced from the cicuta. " It fixed me to my chair and rendered me almost entirely motionless, unable even to raise my hand to my head. It was only with considerable exer- tion that I could open my eyes, and could but indistinctly distinguish objects across the room. Its effect on my sight THE NERVES OF THE FACE, OR NEURALGIA. 471 was to multiply every object at which I looked. The dif- ficulty I experienced in opening my eyes was not occasion- ed by drowsiness. I had my reason perfectly and could converse. In another instance it might affect the organs of speech, as well as the other parts of the system. In about two hours I could bear my weight, and with the assistance of a person to enable me lo keep my balance could walk, but wilh great difficulty. This was about five weeks, and the debility which for near a fortnight was so great as to produce the "fever and ague inarch" fo perfection, still continues though very slight. My health is now good and I am able to attend to business. I have no doubt a perma- nent cure is effected.'' He further observes, that the intox- ication produced by cicuta, is very different from lhat by spirituous liquors or opium ; having neither that depression nor exhilaration caused by them. " It affects the limbs but not the head. Indeed, there is no unpleasant feeling while under the operation of it, if you sit perfectly still; but if you attempt to move there is a disagreeable pricking sen- sation like that in a limb after it has been what is called asleep." The fact is here to be remarked, that similar affections of the nerves, may also take place in other situations besides the face. Examples are recorded in books on surgery, of painful affections of the fingers, extending up the arm, which in all particulars correctly resembled (he tic douloureux of the nerves of (he face. Since writing the foregoing, a case of tic douloureux has been promulgated in the New-England Medical Journal, Vol. IV. page 91, in which the nerve had been divided with- out success and where large doses of opium had failed. Recourse was then had to the extract of atropa belladonna; one grain of which was first tried in a pill, this occasioned vertigo and great lassitude with a peculiar and distressing dryness of the tongue and fauces ; but the pain was remov- ed. It returned the next day, and was again kept in check by smaller doses of the same medicine. A quarter of a grain of the extract was given three times a day, and in- creased to a third of a grain ; then a quarter of a grain morn- ing and noon, and half a grain at night, sometimes omitting the medicine altogether for a day. The pain, whenever it returned, was as certainly removed by fhe medicine. In the course of three weeks, the disposition to the disease 472 nc DOULOUREUX, OR PAINFUL AFFECTION, &c gradually subsided, and the remedy was consequently dis- continued. In Ihe same volume, page 235, another case is related in which cicuta had failed, and which was cured by the use of alcohol ammoniafum; commencing with thirty-five drops three times a day and increasing one drop a dose. The remedy was continued till nearly a drachm was taken three times daily, when (he disease gradually disappeared. The lady whose case I have related, was in the fourth month of another pregnancy again most exquisitely tor- mented with neuralgia ; every remedy failed of affording relief until recourse was had to ammoniated alcohol; be- ginning with thirty-five drops, and increasing four or five, two or three times in a day till augmented to sixty, when an opiate plaster being at (he same time applied the pain im- mediately yielded and a complete cure appeared to be ef- fected, but she has since experienced a recurrence of the pain which is often relieved by a plaster of opium. % CHAPTER XIX. OF DYSPEPSIA, OR INDIGESTION, AND OTHER COMPLAINTS OF THE STOMACH. AMONG the numerous diseases to which the stomach is liable, dyspepsia is one of the most obstinate and distressing. Though it seldom of itself proves fatal, it is frequently pro- tracted to a length of time, in despite of everyr remedy that can be devised. The causes which give rise to this dis- ease are various, such as indolence, intense study, grief and anxiety of mind, profuse evacuations, abuse of ardent spir- its, and a too liberal use of strong tea, coffee, or other re- laxing liquors ; immoderate use of tobacco or opium, wast- ing of the saliva, and exposure to cold and moist air. The more immediate causes are a deficiency in the quantity or quality of (he gastric fluid; and atony, or debility of the muscular coat of the stomach. This disease consists in loss of appetite, and is generally attended with nausea, flatulent distension of the stomach, vomiting of viscid mucus, heart-burn, eructations either sour or rancid, and great costiveness. A sense of constriction and uneasiness in the throat, with pain in the side, paleness of countenance, languor, lowness of spirits, palpitation, and disturbed sleep. When with many of the above symptoms, there is an acute and constant pain in the region of the sto- mach, unattended with faintness or fever, often with a swell- ing of the stomach, it is termed gastrodynia. If a degree of faintness attend, cardialgia, or heart-burn. When the principal symptom is a sense of burning and distressing heat in the stomach, rising into the throat, and extending to dif- ferent parts of the body, with a frequent and copious dis- charge of a watery or glairy insipid fluid from the mouth, it has the name of pyrosis, or water-brash. To assist in the cure of dyspepsia, the patient ought in the first place to avoid every species of luxury and intern- 60 474 . OF DYSPEPSIA, OR INDIGESTION, perance, indolence, and late hours ; and should practise mod erate exercise in a pure air, early rising, simple diet, cheer- ful company, and pleasing occupations. Very much of fhe cure depends on a proper regulation of diet. The patient should be restricted to a few simple articles that will require the least possible exercise of fhe digestive organs while in a deranged and debilitated condition. At the same time se- lecting such as abound in nutritive qualities and are calcula- ted to counteract a tendency to acidity. Of all the substan- ces within our knowledge cow's milk is unquestionably the one to be most relied on lo answer these views. This as- sertion is not from the experience of an individual only, but is supported by authority which will not be contested.* To obtain all the advantages of its valuable properties however, milk is not only to be taken in small quantities several times in a day, but it must be considered as the principal article of the patient's diet. When it can be procured directly from the cow it should be preferred in that state, and (he patient ought not to observe regular meal hours, but take a cup of milk as often as the stomach prompts a desire for food. In every form of dyspepsia or gastric affection a milk diet may be adopted with incomparable advantage. However strong therefore the prejudice against it, a fair trial of its effects should always be made. Although it may disagree at first, a few days perseverance will in most instances convince both the practitioner and patient that a milk diet is decidedly ben- eficial. I am aware of the objection that with some stom- achs milk will not agree, and that it is frequently rejected in the form of curds or coagulum ; this is merely the effect of digestion and need excite no serious apprehensions. When much acidity prevails in the stomach a wine glass full of lime water added to half a pint of milk will prove a valuable cor- rective, and in case of pain and vomiting, this composition will also be found one of the best remedies. Other articles of food to be selected are chocolate after being deprived en- tirely of the oily matter which covers its surface, and to which cream and sugar should be added. Boiled rice, roast- ed potatoes^ and well toasted bread without bulter may be allowed (o the exclusion of all other vegetables, as well as tea and coffee, which must be especially forbidden. It is not intended to prohibit the use of every description of ani- * The learned Professor Chapman of Philadelphia, in hi3 practical lecture*, as I am well informed, enjoins a strict cooformity to a milk diet in all gastric affection; AND OTHER COMPLAINTS OF THE STOMACH.. 47i mal food. Beef, mutton, fowls, and salted fish may consti- tute a part of the course, and on some unavoidable occasions may be substituted for it. But all salted or smoked meat, to- gether with veal, soup, and broths ought to be rejected by every dyspeptic patient. The drinks may be simple water, or weak brandy and wafer, and pure old bottled cider. An infusion of hops has been found an excellent stomachic bit- ter, and is highly recommended in gastric affections. It has been remarked that cold or wet feet are frequently the cause of complaints of the stomach and bowels, these therefore should be guarded against with the greatest care. It will be of great utility about half an hour before eat- ing, and again soon after, to have recourse to brisk fric- tion with a coarse cloth over the region of the stomach and abdomen, and the same operation should be practised every night and morning over the whole body and extrem- ities while in bed. The operation of friction remarkably contributes to the health of sedentary persons, for it in- vigorates and excites the natural warmth, promotes insen- sible perspiration and cutaneous absorption, it increases the action of the stomach, and consequently its power of di- gestion. In short, friction is so highly conducive to the re- covery of the patient, that it cannot be too strongly incul- cated. As a carminative in cases of flatulency, a strong in- fusion of the root of the common cow parsnip will be found exceedingly beneficial; and for the same complaint,the pleu- risy root or butterfly weed has been used with some advan- tage. The powder of Ipecacuanha, from cr.e quarter to one or two grains, with two grains of rhubarb, every day for a length of time, will have the effect of a mild and very efficacious laxative, well adapted to this complaint, provided the dose is not increased so much as to excite an unpleasant sensation of nausea. The next indication in the enre of this disease, is to evac- uate the offending matter from the alimentary canal. A gen- tle emetic of Ipecacuanha, either by itself, or combined with .in equal quantify of blue vitriol, should be exhibited, and may be occasionally repeated. Whenever a laxative is re- quisite, ten grains of powdered rhubarb, and twenty of mag- nesia, will probably effect the desired purpose preferably to any other. If however, more powerful purgatives should 'be required, the pills of aloes and myrrh with a few grains <©f calomel, or the tincture of aloes with rhubarb, may be 4f6 OF DYSPEPSIA, OR INDIGESTION, employed. To accomplish the intention of correcting the morbid acidity in the stomach, alkalies and absorbents are chiefly to be relied on. Of the former we may employ either sal soda, sal tartar, sal aeratus, dissolved in a mucilage of gum arabic or tragacanlh, and taken in such quantities as the sto- mach can bear, and the symptoms of acidity may demand. The volatile alkali may, however, be preferred ; and this in the form of aqua ammonia may be given in a dose of half a table spoonful two or three times a day. The absorbents and antacids, most useful in this disease, are calcined magnesia, chalk, and Hme water, which may be alternated with the alkaline solution, with the best effects. The calcined magnesia should be preferred, and the lime water may be given to the extent of a pint in a day. When the patient is distressed with pain and flatulence in the stomach and intestines, with vomiting, the application of a large blister to the stomach, becomes highly necessary, and the es- sence of peppermint, with the spirit? of lavender, and a good proportion of laudanum, must be prescribed ; the sa- line mixture in the act of effervescence will also be useful. But in these circumstances, opiates must be administered to the full extent required for the alleviation of the pain and other urgent symptoms. Or the hyoscyamus may be sub- stituted as being less apt to occasion costiveness. When by the employment of the foregoing remedies, the violence of the disorder is in some degree mitigated, it becomes ne- cessary to resort to medicines best calculated to restore the lost tone of the stomach in particular, and the system in general. Here the tonic powers of cinchona, with chaly- beates and stomachic bitters, and the mineral acids, are in- dispensable, and these will effect all that can be expected from medicine. The compound tincture of cinchona pre- pared with brandy, and combined with a due proportion of some chalybeate wine or tincture, is one of the most eligible preparations, and this may be accompanied with decoctions of columbo, cascarilla, quassia, thoroughwort, calamus aro- maficus, and hops. Or the same indication may be fulfilled by the myrrh and steel mixture of Dr. Griffith. In many instances of complaints of the stomach, as car- dialgia, gastrodynia, and pyrosis, the oxide of bismuth has been employed with satisfactory success after other reme- dies had failed. This medicine is to be exhibited in doses of from three to ten grains three times a day. Five grains AND OTHER COMPLAINTS OF THE STOMACH. 477 may be considered as a medium dose, but it will be prudent to begin with three and increase gradually. It should be combined with about twenty or thirty grains of gum arabic, or tragacanth, to guard against its irritating the stomach. I have combined it with a tea spoonful of arrow root, and have experienced the utility of the medicine. The use of the tepid bath, of about ninety-eight degrees of heal, for half an hour every other day, for two or three months, has in many Instances, as asserted by Dr. Thomas, (Modern Practice,) proved of great service to dyspeptic persons. And on some occasions the cold shower bath will tend to invigorate the system, and admirably coincide with the tonic remedies in the restoration to health. There is a class of remedies yet to be mentioned, which in England have been found very efficacious in dyspeptic complaints ; fhese are the various mineral waters with which that country so much abounds. These waters, being strong- ly impregnated with the properties of iron, impart their ex- cellent Ionic powers without exciting permanent heat, and thereby improve the general health and spirits, which are so intimately connected with the functions of (he digestive or- gans. In our own country we have springs at Ballston and Stafford, which possess similar chalybeate properties ; their medicinal powers have been demonstrated in a variety of instances, and are well deserving of further trial. The ex- ercise and change of air, with the amusements and social company always to be found at such resorts, are admirably calculated to inspire hope and confidence, and to banish all gloom and despondency. The artificial soda water is likewise capable of rendering the dyspeplic patient very essential benefit if copiously em- ployed. A sea voyage may with propriety be recommended to persons who are afflicted with dyspeptic or other similar complaints of the stomach. CHAPTER XX. OF THE COLIC. THERE are several kinds of disorders of the bowels de- nominated colic, and authors distinguish them according fo the different causes from which they derive their origin. The characteristics of this disease are a painful distension of the whole lower belly with a twisting round the navel, vomiting, arid costiveness. The colic is to be distinguished from inflammation of the bowels, by the spasmodic contraction of the abdominal mus- cles, by the absence or trifling degree of fever, by the state of the pulse which is scarcely affected, and by fhe dim- inution of pain upon pressure. I shall here but briefly treat of those species termed fhe flat- ulentor windy, the bilious,the hysteric, and the nervous colic. The flatulent or windy colic is known by a wandering pain in the bowels, with costiveness and rumblings, which abate when air is expelled either upwards or downwards. There is no great thirst, and Ihe pulse varies but little from the natural standard. Persons of a delicate habit are most liable to this complaint, and it often is produced by unripe fruits, meats of hard digestion, flatulent vegetables, and fer- menting liquors. The most speedy relief in this case will be obtained by some stomachic cordial combined with opiates, as spirit lavender compound, essence of peppermint, ether and laudanum, repeated in proper doses and intervals until the pain abates. This should be accompanied by infusions of cow parsnip, garden angelica, anise or caraway seed, and a little gin or brandy may be added. Emollient and carmina- tive clysters may be at the same time injected, and fomen- tations to the whole abdomen applied ; should clysters fail to produce evacuation from the bowels, fhe castor oil with half its quantify of elixir salutis,'will form an excellent cath- artic for that necessary purpose. If the symptoms increase, and threaten an inflammation of the bowels, immediate re- course must be had to bleeding, the warm bath and blister- ing over the abdomen. OF THE COI.IC. 479 The bilious colic prevails most in summer. It is attend- ed with acute pain diffused over, or in different parls of the abdomen, often fixed about (he region of the navel, and the abdomen is sometimes much tumefied. The patient is troub- led wilh a bitter taste in fhe mouth, with great heat, thirst, and fever, and a vomiting of yellowish or greenish bile. He discharges little or no urine, and there is an obstinate costive- ness. Instances of such violence have occurred that fhe peristaltic motion of the intestines become inverted and the fasces, and even the clysters have been thrown up by vom- iting, which constitutes the true iliac passion. The bilious colic is considered as a highly inflammatory disease, for fhe removal of which recourse must be had to the lancet with a very liberal hand. A copious evacuation of blood amounting to eighteen, twenty, or even thirty oun- ces if the subject be a robust adult, will answer the fir3t in- dication at fhe commencement. This, or a repetition of it by abating inflammatory and spasmodic action, will in general arrest the progress of the complaint, and pave the way for the operation of such cathartic remedies as the case imperi- ously demands. It will be altogether useless however to administer purgatives until spasm and irritation are in a mea- sure appeased. The means most proper to be adopted are moderate doses of opium, and if this cannot be retained on the stomach, the same medicine should be injected into the rectum, and recourse must be had to the warm bath, or im- mersing the patient up to his breast in luke warm water, and at the same time applying friction to the abdomen. These or emollient fomentations occasionally repeated will have a happy tendency in allaying spasm, mitigating pain, and pro- moting the desired evacuation. Emetics are often necessary unless spontaneous vomiting has emptied the stomach or ex- hausted the patient. Our next attempts should be directed to the removal of constipation by means of suitable purga- tive enemata. A strong .infusion of senna, in one pint of which one ounce ef Glauber's salts have been dissolved, of- ten proves exceedingly efficacious. By some the following terebinthinate clyster is held in preference. Take common turpentine, half an ounce, or spirits of turpentine one ounce, rub it with the yolk of one egg until they are well incorpo- rated, then add a pint of linseed tea or warm water. In ob- stinate constipation attending bilious colic, recourse is often had to the sedative powers of the fumes or infusion of to 480 OF THE COLIC bacco wilh the happiest effects. We are however caution- ed against the use of a strong infusion, as it has been kuown to induce fatal consequences ; half a drachm of Ihe leaves infused in a pint of water is the quantity not to be exceeded al one time. The smoke is milder in its operation, and is employed by blowing it from the bowl of a common pipe in- to a light bladder furnished with a tube, and then injected by the way of clyster. I have more than once witnessed its exhibition to such extent that it has passed the whole length of the alimentary canal and escaped by (he moulh. I( has often been advantageous but never productive of un pleasant effects. During the employment cf these remedies or immediateljr after the irritation is by their means allayed, active purgatives must be diligently employed until a thor- ough evacuation of the canal is effected. The eupatorium perfoliatiim or thoroughwort, is in great repute among many country practitioners for the removal of this obstinate dis- ease ; if given in the form of infusion it certainly produces excellent effects as a cathartic, and is often employed with much success. The purgative articles generally preferred are castor oil, to each dose of which ten or fifteen drops of laudanum may be added. A solution of Glauber's or Ep- som salts, or an infusion of senna, or bofh combined may be given occasionally, and should these means prove una- vailing the following pills may be the next resort. Extract of butternut, three grains, calomel, three grains, opium, a grain. Three or four of these for a dose every two or three hours. The opium allays the irritation and spasm and af- fords opportunity for the other articles to produce a cath- artic effect. Another remedy to be mentioned as efficacious in obsti- nate constipation is tartar emetic in the form of enema, from ten to fifteen or twenty grains of this dissolved in about four ounces of water, and injected into the rectum, have been known to rescue fhe patient from the most iminent danger. The application of blisters and cold water dashed over the abdomen and the lower extremities, or injected by the way of clyster according to the favourite practice of Dr. Rush, have been highly commended and are well deserving at- tention. In cases which assume a desperate aspect and re- sist the ordinary course of remedies judiciously persisted in, we are by some advised to adopt the old practice of giv- ing quicksilver to the extent of twelve or more ounces, but I OF THE COLIC. 481 although in one instance I can vouch for the successful re- sult of this, it must be deemed a precarious remedy and not altogether free from danger. When the vomiting continues to be urgent, it must be appeased by the use of the saline draught with liquid laudanum, drinking mint tea or water in which toasted bread has been boiled, and by the application of the leaves of mint wet with spirits to the pit of the sto- mach. A (ea spoonful of elher wi(h thirty drops of lauda- num in a cup of cold water will sometimes check the vomit- ing and alleviate distress, but laudanum must often be inject- ed into the intestines. From its bitter and stomachic quali- ty, the powder of columbo root, in doses of twenty or thir- ty grains, has been found particularly serviceable in appeas- ing the vomiting and correcting the bile in these cases. In those persons who are subject to frequent returns of bilious colic, it is recommended as a valuable preventive to use a decoction of the root of the common mulberry tree. Dr. Mease, in his edition of Willich's Dom. Ency. speaks of it with considerable confidence, having received ac- counts of some well attested instances of its successful em- ployment. The hysteric colic is peculiar to women of an irritable disposition. It resembles in respect bbth of pain and vom- iting the preceding species, but it is more particularly char- acterized by lowness of spirits, difficult breathing, and se- vere spasm and costiveness. In the cure of this kind of colic, neither bleeding nor severe purging is in general deemed admissible. A mild emetic may be advised, and the costiveness should be re- moved by clysters and the mildest laxatives; after which, proper doses of laudanum ought to be directed occasionally, and antispasmodics, as valerian, castor, asafoetida, and the skunk cabbage, to complete the cure and obviate its return. A plaster composed of aromatic and anodyne ingredients, ap- plied to the pit of the stomach will be serviceable. Of the nervous, or painters1 colic. This species of colic, is attributed to the deleterious prop- erties of lead, when it has been received into the system, either by swallowing into the stomach, or by its fumes ab- sorbed by the pores of the skin, or received into the lungs. It has been denominated the Devonshire colic, from its 61 482 OF THE COLIC. great prevalence in that country, occasioned as is aupposedy by the drinking of cider, kept in vessels of lead, or where this poisonous metal is used for fastening the nails in the vats. The colic of Poictou, and the dry belly-ach of the West-Indies, are of the same origin, and occasioned by rum distilled through leaden worms. Painters, plumbers, min- ers, and all who are employed in the manufacture or fhe use of lead, are more or less liable to be affected with this species of colic. But this disease is not to be ascribed to the effects of lead exclusively, for long confinued costive- ness, acrid bile, cold applied either to the extremities, or to the belly itself, a free use of unripe fruits, acrid food, or drink, such as sour wine or cider, are enumerated among its causes. The patient is seized with an acute spasmodic pain in the pit of the stomach, which extends gradually to Ihe whole intestinal canal; particularly round the navel; the bowels are frequently drawn towards the spine, so as lo render the injection of clysters impracticable. At the same time, there is a loss of appetite, yellowness in the counten- ance, slight nausea, and obstinate costiveness. Soon after, the stomach is distended as with wind, and there are fre- quent retchings to vomit. The whole region of the belly be- comes highly painful to the touch, the muscles of the ab- domen are contracted into hard irregular knots, or lumps. The pulse is generally low, but a little accelerated by the pain. The patient discovers a lowness of spirits; the ex- tremities are often cold, and by the violence of pain, cold clammy sweats and faintings ensue. In this miserable con- dition, the patient sometimes continues for three or four weeks, or even for six months ; in which case the pains be- come intolerable, and the pafient's breath acquires a strong foetid smell. At length, when the pain in the bowels begins to abate, it is succeeded by a pain in the shoulder joint and adjoining muscles, with an unusual sensation, and ting- ling along the spine of the back. This soon extends itself to the arms and legs, which become paralytic, with a total loss of motion. Sometimes fatal convulsions occur, at others, the true iliac passion is produced which also soon proves fatal. The medical treatment in this dreadful disease, is in some respects similar to that of an inflammation of the intestines, to which it is nearly allied. With the view of obviating inflammation, we are advised in the first instance, to draw blood in a quantity proportioned to the age and habit of the patient, unless from debility, advanced life, and mildness of OF THE COLIC 483 the attack, (he evacuation may be deemed improper. A gentle emetic of Ipecacuanha, and repeated doses of castor oil, with laudanum, should be directed, and this last continu- ed until, with the aid of emollient clysters, the obstruc- tions in the bowels give way. For the purpose of removing spasm, we are directed to the employment of emollient fo- mentations, frequent immersion hi warm wafer, but above all, throwing cold water over the legs and feet while the pa- tient is walking barefooted on the cold floor: or if fhissprove ineffectual, the patient is next to be placed in a large tub, and a pail of cold water thrown over the abdomen and thighs, which it is said will seldom fail to remove both spasm and costiveness. Another remedy adapted to the removal of constriction of the intestines, is the infusion or smoke of to- bacco, used in the form of clyster, as directed in bilious col- ic. At the same time lhat the foregoing means are diligently employed, the back, spine, and limbs, should be strongly rubbed with the volatile liniment, or camphorated spirits. In the colica pictonum, occasioned by lead, alum in doses of fifteen grains every four, five, or six hours, has been ad- ministered by Dr. Percival; but others affirm that a more powerful remedy is to be found in blue vitriol. Eight grains of it being dissolved in half a pint of water, two or three table spoonfuls are to be taken fasting, for nine successive mornings. For the first four or five days, this medicine dis- charges much vitiated bile both ways ; but the evacuation of it lessens by degrees, and great relief is obtained. The most efficacious medicine in this disease is calomel, either by itself as. a cathartic, or combined with opium. About eight or ten grains of the former, with one of the latter, giv- en every twelve hours, will in general produce the happiest effects. Dr. Joshua Fisher, an eminent physician of Bev- erly, administers opium in doses of from fifteen lo forty grains, and has not, as he affirms, for many years past seen a single case of this distressing disease, which has not yield- ed to its efficacy in about an hour ; but this bold practice is not to be resorted to by inexperienced physicians. During the use of these remedies, the patient's diet ought to be mild and simple, consisting of broth made of Jean meat, oat meal gruel, rice, panado, and arrow root. When the violence of the disease has subsided, recourse must be had to the Peruvian bark and bitters, with a res* torative diet and proper exercise. CHAPTER XXI. OF POISONS. IT is extremely proper that every person should be made acquainted with the nature of poisons, and the means of counteracting their deleterious effects. Poisons are di- vided into mineral, vegetable, and animal, to which may be added the aerial poisons, which are reserved for another chapter. Among (he mineral poisons, arsenic is the most corrosive, and fatal in its effects. The symptoms which arise in con- sequence of swallowing this poison, are, a burning heat and violent pricking pain in the stomach and bowels, accompa- nied with extreme thirst and an inclination to vomit. The tongue, mouth, and throat, are rough and parched, and an unquenchable thirst prevails, with great anxiety and restless- ness. If relief be not soon obtained, and if the quantity of the poison swallowed be considerable, these symptoms are followed by faintings, hiccups, with coldness of the extremi- ties, and the discharge of black foetid matter from fhe stom- ach and bowels, indicating a mortification of the intestines and approaching death. In this dreadful situation, the utmost exertion should be made to relieve the stomach of the corrosive poison. A strong solution of white vitriol, or proper doses of Ipecacuanha, should be administered in such quantities, and at such in- tervals, as will be found necessary fo excite a very copi- ous vomiting. The patient must drink very large quanti- ties of milk and honey mixed, of warm water, lean broths and barley water with gum arabic. It has been dis- covered that oils and all unctuous substances add activity to arsenic, and greatly increase the danger; they should therefore be avoided. Clysters of the same materials ought likewise to be injected in so copious a manner, as to fill the whole tract of the alimentary canal with soft emollient OF POISONS. 485 liquids, both to dilute and to sheath the poison. A dose of castor oil, or Glauber's salts, should be occasionally inter- spersed, but a rigid persistance in the use of some of the above mentioned emollient liquids, will be requisite for sev- eral days, as no other remedies can be equally useful. In- stances may however occur, in which a full habit of body, strong and full pulse, and severe pain will justify bleeding to a certain extent, as the judgment of the experienced physician may direct. According to Dr. Hannemann, noth- ing is more efficacious in this deplorable case, than half a pound of white soap dissolved by boiling in a quart of wa- ter, and sweetened with honey. Haifa tea-cup full of this solution should be taken every five minutes, lhat the patient may swallow several pounds in the course of twTo hours. It has recently been ascertained that when corrosive sub- limate has been swallowed, it may be readily decomposed and resolved into an inert mass by albumen or fhe whites of eggs. These should be swallowed in very large quantities until the powers of the poison are entirely destroyed. Su- gar or syrup, if swallowed in very large quantities, is a com- plete antidote to the poison of copper or verdigrise, by chemically changing its properties, and active purgatives should afterwards be administered. A strong solution of muriate of soda or common salt freely swallowed, proves an effectual antidote to the poisonous effects of nitrate of silver. Sulphate of soda or sulphate of magnesia destroys in a great measure the deleterious effects of the acetite of lead or oth- er preparations of that metal. When tartar emetic or other antimonials have been taken in excessive doses, some pow- erful vegetable astringeut,as a decoction of bark or galls will do much in preventing their fatal effects. As an antidote or corrector to the mineral acids, calcined magnesia in large quantities is the most efficacious. The vegetable poisons, which most frequently exert fheir deleterious effects when taken by mistake, are the stramoni- um or thorn apple, and the atropa belladonna or deadly night- shade, the seeds and berries of which, are sometimes eaten by children. Some species of mushrooms, hemlock or ci- cuta ; aconite or monkshood ; henbane or ^yoscyamus; water hemlock or cicuta maculata; fox-glove%ar digitalis purpurea, and opium. All the poisons of the' vegetable class, seem to produce their fatal effects by their narcotic or stupifying properties. The chief symptoms which they 486 OF POISONS. produce are, a staring wildness in the eyes, confusion of sight, palpitation, giddiness, loss of memory and voice, stu- por, or fury, vomiting and convulsions. " An instance oc- curred of eight persons in one family, suffering the noxious effects of stramonium, the leaves of which had been eaten at table, mixed with other vegetables. They exhibited a scene scarcely to be described, and formed a group, in which were displayed the various grades from idiotism, to mania; such as torpor, or abolition of sense, slow pulse, vertigo, tremour, wild delirium and raving, with glaring eyes,and di- lated pupils. They all recovered in about twenty-four hours by the use of strong emetics." American New Dispensato- ry, 2d edition. The most effectual antidotes against these poisons, con- sist in a speedy evacuation of the offending substance from the stomach. Immediately on its being ascertain- ed that any of these poisons has been swallowed, about twenty or thirty grains of white vitriol, if an adult person, may be dissolved in warm vinegar and water, and the dose repeated every quarter of an hour, until a thorough evacuation be produced. The vomiting must be accom- panied with large draughts of warm water, and olive oil, fat broths and gruel. In the mean time, emollient clysters must be injected, until the offending cause be entirely removed. The vegetable acids, as vinegar and the juice of lemons, or limes, have likewise been found serviceable in correcting what remains of these substances in the stomach, and they should be freely given. In order to rouse the patient from a state of torpor, blisters between the shoulders, sinapisms to fhe feet, and keeping the body as much as possible in motion should be directed. There is a species of rhus, or swamp sumach, commonly known by fhe name of poison dogwood, which is capable of communicating its poisonous effects (o the skin, by means of contact, or by smelling of it, or even by the smoke, or the steam from a decoction of the shrub. In about forty-eight hours an inflammatory eruption appears on the surface of the skin, attended by pain, swelling, blindness, itching,and fever. A man having incautiously expressed a quantity of the juice of a species of this shrub, was soon after seized with violent inflammation, and eruption over the whole surface of the body, with swelling of the head, and blindness, resembling the most malignant kind of small-pox, which occasioned the OF POISONS. 487 Iosb of his hair and nails, and it was several weeks before a cure was effected. There are some constitutions which are incapable of be- ing affected with this species of poison. The remedies to be applied in these cases are bleeding, when the symp- toms are violent, and cathartics of neutral salts. The ap- plication of cold water, or a solution of crude sal ammoniac, or the spirits of sal ammoniac diluted with water, a weak solu- tion of corrosive sublimate, or of the sugar of lead, as a wash to the parts, will soon effect a cure. When opium has been taken in too large quantities, eith- er by mistake, or for the horrid purpose of self destruction, the alarming symptoms induced are, vomiting, delirium, stu- por, deep and difficult breathing, convulsions, and death. The remedies are in the first instance, powerful emetics of white vitriol, twenty grains of which should be immediately given in a glass of warm water, and repeated every ten min- utes, until copious vomiting is excited. Warm water is then to be freely given, and a smart purgative of jalap with a few grains of salt of tartar administered. Frictions with salt should be thoroughly applied over the whole body, and the nostrils should be stimulated with the spirits of harts- horn, or of sal ammoniac, and blisters between the shoul- ders, and on the extremities applied. In short, every pos- sible effort should be made to rouse and irritate the patient, so as to counteract the effects of the poison. Both the min- eral and vegetable acids will be useful, as also the saline draught, and they should be liberally employed. But no internal medicine is to be preferred to a solution of volatile sal ammoniac, a table spoonful of a strong solution of ammo- nia, often repeated, it is affirmed, has a wonderful effect in obviating the torpor of the stomach, and stimulating the whole system. When symptoms of apoplexy are present, and great morbid action from the excess of stimuli is mani- fested, Dr. Rush advises copious blood-letting, having him- self cured four patients by this remedy. As soon as the stimulus of the opium appears to be subsiding, and the sys- tem discovers marks of sinking, a new stimulus becomes highly necessary, and the frictions with salt, and the solu- tion of ammonia must be persevered in, and brandy or oth- er ardent spirits should be freely given, and at length grad- ually discontinued. 488 OF POISONS Of the Bites of Poisonotis Animals. The animals most liable to communicate their poison to the human species, are dogs and cats, when in a state of madness. The specific nature of this subtile poison, has hitherto eluded all investigation ; nor has experience prov- ed more successful with respect to the remedy for this most formidable species of infection^ It is nevertheless a point of high importance to ascertain with precision the symp- toms which characterize madness in those animals, to enable us to guard against their fatal attacks. For several days previous to the invasion of the disorder, the dog is observed to manifest a change in his natural man- ners ; he grows dull and heavy, and shews an equal indiffer- ence to his master, and his usual meat and drink. He be- comes solitary, and endeavours to hide himself, does not bark as usual, but makes a murmuring noise, is peevish and easily offended. His ears and head hang down, and he walks as if overpowered with sleep, but in this stage he re- members and respects his master. A disposition to quarrel with all other dogs, is manifested early in fhe disease. He breathes thick and heavy, keeps his mouth constantly open, and hangs out his tongue ; sometimes he walks slowly as if half asleep, and then suddenly runs, but not always direct- ly forward. At length he forgets his master, and will bite him if opportunity offers ; his eyes look dispirited, dull and full of tears and red ; his bark is hollow and hoarse, and his tongue of a lead colour. He now strays from home, and follows any path or road he happens to meet, but seemingly without purport or design. If he be confined in this ad- vanced stage of the disease, he bites and gnaws every thing near him, is furious for a moment when approached; and his chops are covered with tough frothy saliva. He now grows faint, thin and weak, often falls down, again rises, at- tempts to fly at every thing, and soon grows furious. This second stage seldom continues thirty hours, death by that time putting an end to the disease. He can swallow both solids and liquids during the whole disease, and having no aversion to water, he never endeavours to avoid it. In most instances there is a very treacherous disposition manifested in rabid dogs ; if called, they.will come, wag their tails, and shew every mark of fondness, and seem pleased with atten- tion ; but on a sudden they will turn and give a bite. It is OF POISONS. 489 also important to know, that many instances have occurred of dogs having given a fatal bite, while they were in appar- ent health, even many days before they discovered a single symptom of indisposition. Innumerable are the remedies which have for ages past been administered with the view of eliminating, or counter- acting the poison, or obviating the constitutional affection after a bite has been given. But on close investigation, they have been found totally inadequate to the purpose, and the most of them, calculated rather to excite contempt than con- fidence. In fact, when once this dreadful poison has been communicated by a bite, it is hardly to be expected that its fatal effects can be prevented by internal medicines alone. The most effectual preventive remedy yet discovered, con- sists in cutting out all the muscular parts with which the dog's teeth have come in contact, or to which the virus may have penetrated. The earlier the operation is performed, and the more completely it is effected, the greater will be the chance of security. But when insuperable obstacles pre- vent the employment of the knife, recourse must be had either to the application of the hot iron, or to some liquid caustics. A strong solution of the lunar caustic, or the caustic vegetable alkali of fhe Dispensatory, or the aqua for- tis, should be applied to every part of the wound, and the application must be repeated at various times during several weeks. When neither of the above caustics can be season- ably procured, some powdered quick lime, may be advan- tageously substituted. In some instances, it may be neces- sary to dilate the wound in such manner, as to admit the remedies to every part into which the poison may have in- sinuated. In every instance, it will be advisable to convert the wound into a running ulcer, and to keep up a discharge from it during six or eight weeks. Either the caustics, the quick lime, or blistering flies, may be employed for this pur- pose. Another remedy of reputed efficacy, is the affusion of cold water to the wounded parts. The water must be poured forcibly over the surface of the ulcer, and continued daily, from the moment of the bite, fo at least thirty or for- ty days. The internal remedy most deserving of confidence as pre- ventative of hydrophobia, is probably the Scutellaria lateri- flora, or scullcap, a description of which will be found in the Appendix. This plant was for many years employed 62 190 OF POISON b. as a secret by a Mr. Lewis in the state of New-York, and has obtained greater reputation, and its character as an anti- dote, seems supported by more substantial evidence than perhaps any other remedy with which we are acquainted. It should therefore be resorted to immediately after receiv- ing a bite, and its use persisted in during a period of thirty or forty days, when the danger is in general supposed to have passed. The metiiod of using (his remedy, is lo make a s(rong infusion by pouring boiling water on (be dry herb, prepared as in the Appendix, and the patient to take a gill four times every other day ; the day it is omitted he must take a spoonful of flowers sulphur in (he morning fasfing, and at bed time in new milk, and apply the pounded green herb to the wound every two hours. If our utmost efforts to destroy the poison in the first instance, should unfortu- nately fail, it is not improbable that within a period from ten days to six or eight weeks, or it may be extended to a year or more, after the bite, the miserable patient will be seized with that deplorable malady called hydrophobia. But a- midst the horrors experienced during a period of painful suspense after having received a bite, there is a source from which the sufferer may derive considerations of a soothing and consolatory nature. Numerous writers of (he mos( es- tablished credit have recorded, and experience fully verifies the fact, that a large proportion of persons bitten by dogs actually mad, are never affected by the disease even though they dispense with preventive remedies. These exemp- tions however, ought not to induce a security which may prevent every precaution being taken to avert the awful ca- lamity. From the consideration that one even in twenty may be the victim, it would be the height of indiscretion and folly, not to resort to the most judicious and reputable source for early advice and assistance. The approach of the disease is known by the part bitten becoming painful, hard, and elevated, attended by a peculiar sense of pricking and itching at the part, and pain resemb- ling rheumatic pain extends into the neighbouring parts, and towards the throat. There are more general pains of a fly- ing convulsive kind, which affect the patient in the neck, joints, and other parts, and a dull pain seizes the head, breast, belly, and along the back-bone. A lassitude and a vertigo soon come on ; the patient is melancholy, mut- ters, is forgetful and drowsy ; his mind seems disordered, OF POISONS. 491 his temper irritable and irregular; his slumbers disturbed, and convulsive agitations immediately follow his waking. His eyes are watery, his aspect sorrowful, the face pale and contracted; sweat breaks out upon fhe temples, an unusual discharge of saliva flows from the mouth, though the fauces are dry; the tongue becomes foul, and the breath occasion- ally foetid. There is a straitness and sensation of choking, and a horror and dread at the sight of water and olher liquids, together with tremours and a loss of appetite. The person is, however, capable of swallowing any solid substance with tolerable ease; but the moment that any thing in a fluid form is brought in contact with his lips, or even pre- sented to his view, it occasions him to start back with much dread and horror, although he labours, perhaps, un- der great thirst at the time. From the beginning, there is a peculiar stricture and heaviness on the breast, a struggling, as it were, for breath, a sighing, a nausea, and often a bilious vomiting. This op- pression of the praecordia is one of fhe constant symp- toms of the disorder; it begins, increases, and ends with it. The second stage advances and a fever ensues, which at first is mild, but attended with momentary horrors, though there is sometimes little or no fever; sleep is lost, the mind is more and more disturbed, a delirium approaches, and an aversion to liquids, to polished bodies, and even to light, ra- pidly increases. In some instances the peculiar symptom of (he disease, the dread of water, comes on all at once, and augments so visibly that on the sight of any liquid, of a looking-glass, or any thing clear or pellucid, a horror seiz- es the patient, and if he strive to drink, spasms, anxiety, and loss of strength follow. The air, although really warm, is very distressing to the patient, and the slightest touch or motion, and (he least sound is offensive and painful, The patient mourns bitterly, and at times, loses all knowledge of his intimate acquaintance. But reason returns at intervals, and he laments his own calamity; thirst excites in him a desire to drink, but he strives in agony, and in vain io swal- low, and soon sinks into the most affecting despondency. He desires his friends to keep at a distance, and it is sup- posed that he feels an inclination lo bite, and by some the greatest efforts are made for that purpose. There is constantly a great flow of viscid saliva into the mouth, which is exceedingly troublesome to (he patient, as it has the 492 OF POISONS same effect upon the fauces that other liquids have. At length the fever and thirst increase; the eyes are bright and furious; the urine is high coloured, acrid, and in small quantities ; the tongue hangs out, the mouth foams, he gnashes his teeth, his pulse throbs and strength fails, cold sweats come on, the tightness of the breast increases, and the miserable patient expires in spasms, often losing fhe difficulty of swallowing x liquids for many hours; so that the dread of water is by no means a pathognomonic symptom. I have now described the symptoms of this disease as (hey occur in general, but they are so various that they cannot be enumerated, for we seldom read of two cases of hydro- phobia which do not differ very remarkably in this respect. Although medicine has hitherto proved ineffectual in al- most all cases where the disease had fully established itself, yet humanity demands every possible aid and exertion in favour of the unfortunate sufferer. Death in its most awful forms closes the scene most commonly on the third or fourth day after the appearance of the symptoms. The remedies heretofore employed for the cure of canine madness, are blood-letting and the antiphlogistic course ; opi- um and antispasmodics of every grade and description ; the cold and warm bath, blisters, alkaline salts, the different preparations of mercury, antimony, arsenic, zinc,and copper. By none of these, either singly or combined, has this formid- able disease in its genuine character, been vanquished in a single well attested instance. No remedy has ever been more amply or more universally experimented at various periods than that of blood-letting, and its failure has been no less notorious, than its trials have been numerous. It is not to be dissembled however that two or three authenticated instances of cures by means of copious blood-letting and mercurial frictions at the same time, have recently been an- nounced. In two successful cases by Dr. Shoolbred of Calcutta, venesection was resorted to immediately on the disorder becoming apparent, until faintness was induced, and the operation was repeated at intervals as long as firmness of arterial action or the symptoms of hydrophobia remained. In another case the patient was bled by a Mr. Tyraon, sur- geon in the British service, and the bleeding continued until scarcely a pulsation in either arm was to be felt; and to this, the cure is chiefly attributed, although his head was blister- ed, and mercury both internally and externally was very OF POISONS. 493 liberally applied. The curative plan in hydrophobia there- fore, shuuld be prompt and decisive ; if bleeding is relied on, let it be from a large orifice, at the earliest stage of the at- tack, and carried (o (he ulmost limits of safefy; and the boldest administration of mercury should follow the operation. Twenty or thirty grains of calomel, repeated at short inter- vals, and half an ounce of the strong ointment, rubbed in the Ihroat and chest three times a day, until symptoms of salivation commence, will probably be a justifiable practice. But the mode of inducing a speedy salivation recommended by fhe late Dr. Darwin, may be preferred. He directs three grains of corrosive sublimate to be dissolved in one ounce of rectified spirit of wine ; half of which is to be taken undilut-, ed ; it produces a copious salivation for an hour and half, or longer, during which, the patient spits a quart. This is to be repeated according to its effect, and a dose of Glauber's salts should be taken the day after the operation. The atropa belladonna, is supposed by some German authors (o possess properties eminentiy adapted (o (he cure of hydro- phobia. Besides a remarkable narcotic power, it is said to be particularly useful in promoting the secretions by sweat, urine, and also by saliva. It is highly probable therefore, that belladonna may prove of real efficacy in the present disease. The dose is from two or three to six grains twice or thrice in a day. Opium has been administered in cases of hydrophobia to the utmost possible extent, but it has uni- formly failed to afford relief and respite. In fhe opinion of Dr. Thomas however, when the patient loses the power of swallowing, introducing opium freely inlo the system by- means of friction, appears to be a very eligible plan. In- deed, as the throat appears in this disease always fo be af- fected with spasmodic contractions, it would seem that no remedy we can employ, promises betfer effects than the rubbing in, and particularly about the throat and chest, opium in the form of liniment or ointment. If the tincture of opi- um be conjoined with camphorated spirit and aqua ammonia, these will probably assist its operation. When a diaphoretic is required, the compound powderof Ipecacuanha, with the addition of the volatile alkaline salt, will be the preferable preparation. The sponging the body freely with warm olive oil, and pouring repeated doses of it forcibly down the throat, has been recommended as a successful remedy in hydrophobia. 4(J4 OP POISONS As fhe canine virus probably lie3 dormant in the bitten part for a considerable length of time, it is a point of fhe greatest importance to pay proper attention to the state of the original wound in Ibis stage of the disease. If it hai been suffered to heal, the cicatrix must be immediately open- ed afresh, and spirit of turpentine, aqua fortis, or some other stimulating or caustic medicine should be applied to excite inflammation and suppuration. This may be of great utility even after the symptoms of hydrophobia have commenced. Newspaper intelligence has lately been received from Eu- rope, and it appears to be well authenticated, that in two instances, hydrophobia has been successfully treated by the .use of vinegar, a pint of which was given morning, noon, and night. This may prove a discovery (although not new) of the greatest importance, and as the experiment will be a laudable and a harmless one, it ought to be tested on every occasion that may be presented. I must not omit to mention, that one case of hydrophobia has been promulgated from the most respectable authority, in which a cure was effected by the severest operation of galvanism.* It now remains to suggest the requisite precautions relative to (he management of the hydrophobous patient, so as to avoid any ill consequences from a bite or contact of saliva. Should danger become apparent during the furious stage of the disease, the patient ought to be so confined, either by a strait waistcoat, or other means, as to prevent injury to himself or attendants. It would also be particularly proper to avoid the saliva coming in contact wifh any part of the body ; and with a view of annihilating every source of ap- prehension, it would be advisable to bury in the earth, all such clothes as have been in use, and are contaminated with the saliva, as a small quantity of it applied to a part where the skin is broken, might be productive of disastrous consequenc- es, as exemplified in the following case. Dr. Henry H. Childs of Pittsfield, while attending a young woman labouring under hydrophobia, received ac- cidentally by her nails, a scratch on his hand which was then covered with Saliva from her mouth. In about ten days, be began to feel some indisposition, and the alarm- ing symptoms of hydrophobia rapidly progressed till his * Medical and Chirurgical Reriew, Vol. X. OF POISONS 49J situation became extremely hazardous. After a confine- ment of thirty days, and pursuing a very severe course of mercury both internally and externally, the disorder was subdued and he gradually recovered. The reader is re- ferred for a particular detail of this case, and for a mass of information relative to the subject, to " Observations on Hydrophobia," by the author of this work, published in 1812. Dr. Nathaniel Miller has lately experienced fhe efficacy of Dr. Fowler's arsenical solution in several cases of teta- nus and other spasmodic affections, and it should be strong- ly recommended for trial in every case of hydrophobia, and that the result rWay be promulgated. The proper dose is ten* drops repeated every half hour until relief is obtained. Another species of animal poison to which we are some- times exposed, is that of the rattlesnake and viper. The most efficacious remedies in these cases, are a solution of some alkaline salt, as the volatile sal ammoniac, salt of tar- tar, or of wormwood; these are to be given as freely as the patient's stomach will admit, repeating the dose every few minutes, as the danger increases with the greatest rapidity. The wounded part must also be constantly moistened with the same liquid. Instances of this kind have been report- ed as cured by the use of olive oil, when taken freely inter- nally, and thoroughly applied to the wound. The applica- tion of poultices will on some occasions be useful to abate in- flammation, and promote a discharge from the wound. Vinegar has often been found highly beneficial in cases of poison, and it ought to be plentifully taken. The stings of bees and hornets may be cured by anoint- ing the parts with warm olive oil or vinegar. Should the stings however, be so numerous as to excite very considera- ble inflammation, poultices of bread and milk or of flax- seed, with sweet oil, must be applied fo fhe part; and the patient will perhaps require bleeding, and a dose or two of Glauber's salts. CHAPTER XXII. OF THE VENEREAL DISEASE. THIS disease is the well known offspring of a free in- dulgence in Ihe sexual intercourse, by whfrh, when one of the parties is infected, the disease is commonly contracted, and again propagated from one individual to another. It is generally distinguished into the local, and the constitutional affection. When it is confined to the organs of generation, and shews itself by a running, or discharge of matter from the urinary passage in either sex, it is a local affection, and termed vir- ulent gonorrhoea, or clap. When in consequence of the absorption of the poison, there is a general taint of the whole system and mass of fluids, it is denominated syphilis, lues venerea, or confirmed pox. The virulent gonorrhaea, sometimes commences in two or three days after the infection has been received, and at oth- ers, not before several weeks; but it commonly makes its appearance in eight or ten days. The first complaint is an itching at the orifice of the urethra, and a soreness extending along its whole course, which is succeeded by a discharge of a thin glairy matter from the urinary passage, at first whitishjbut afterwards changing to a yellow, or green colour. A slight degree of**redness and inflammation begin to appear about the lips of the urethra, and a heat, a smart- ing pain in most cases, are felt in every attempt to make water. There is commonly a sense of fulness about the glans of the penis, and frequently a soreness along the course of the urethra, accompanied with more or less pain in erection. When the inflammation or irritability of the urethra is very considerable, the erections become more frequent and lasting than when natural, particularly when warm in bed, and the penis is curved downward, with considerable pain, which is called chordee ; and this is sometimes attended with a slight OF THE VENEREAL DISEASE. 497 haemorrhage at the time of passing the urine. As the dis- ease advances, the symptoms become more severe and dis- tressing ; the heat and scalding of the urine, as well as the chordee, are extremely troublesome, and there is a constant inclination to discharge urine, which is altended with much difficulty, and often is rendered only by drops. There is also a painful sensation of heat and fulness about the scro- tum and perinaeum, and the running is very copious, of a brown, greenish, or a bloody colour. These symptoms are sometimes accompanied with a painful swelling of one or both testicles,or sympathetic tumefaction of the neighbouring glands, especially those of the groin, and when great local inflammation p^ails, the prepuce becomes so swelled at Ihe end, that it cannot be drawn back; which symptom is call- ed a phimosis : or it may be sd contracted behind the glans, that it cannot be brought forward, when it is named a paraphimosis. When women are affected with gonorrhaea, theyr experi- ence a train of symptoms similar to those just described, but in a much more slight degree; but it must be carefully distinguished from the fluor albus, to which females are liable, as the matter discharged in both, is often of the same colour and consistence. (See Fluor Albus.) If the patient in gonorrhaea, receive early attention and assistance, and adopts a judicious mode of medical treatment, the violence of the symptoms gradually abates, and in about a fortnight or three weeks, the discharge will become thick, white, and of a ropy consistence, and diminish in quantity, until it entirely disappears; but if a contrary course is pur- sued, and the patient indulge in sensuality and intemperance, and partakes of stimulating, high seasoned food, and spiritu- ous liquors, the cure will not only be protracted for several months, but a great risk will be incurred of giving rise to a constitutional affection, from the absorption of the matter. When any suspicion arises of having caught the venereal infection, the person should immediately resort to a mild easy diet, consisting of milk and vegetables, light broths, puddings, rice, &c. He must abstain from all animal food, spiceries, and stimulating liquors, and drink freely of barley water, milk and water, linseed tea, whey, or decoctions of marsh-mallow and liquorice. All severe exercise, particu- larly walking, or riding on horseback, as well as venereal intercourse, ought to be carefully avoided, as also exposure to cold and damp air during a state of inflammation. 6a 49* OF THE VENEREAL DISEASE The time necessary for the cure of a gonorrha-a, depends not only upon the virulence of the infection, but the partic- ular constitution of fhe patient. It will often under the imnt judicious treatment, continue two or three weeks, and some times it may be protracted to six or eighf. A\ hen however, the infection is slight, it may often be removed in ei^il or ten days, by a strict attention to cleanliness, and by foment- ing the parts with warm milk and water, and injecting fre- quently into the urethra, a little sweet oil, or linseed tea, about the warmth of new milk. In almost every instance of gonorrhaea a cure may be effected by the diligent employ- ment of injections. These are varied according to particular circumstances, or as suggested by the discAtion of fhe pre- scriber. When an astringent injection is preferred, it is composed of about half ft drachm of sulphate of zinc, dissolved in a pint of pure water, or the proportion is increased if a stronger astringent be requisite. If a mercurial injection he desired, one drachm of calomel is suspended in two or three ounces of mucilage of gum arabic, or one grain of muriae hydrargyri is dissolved in eight ounces of wafer. When much inflammation prevails, a weak saturnine preparation mixed with a large proportion of oleum amygdali, forms an excellent injection ; and when from excessive irritation a more sedative preparation is indicated, a few drops of the vinous tincture of opium added to this will be found exceedingly efficacious. Whichever of the injections are employed, if should be used six or eight times in the course of the day, be of sufficient strength to excite some degree of irritation in the urethra, but not so strong as to occasion much pain, and it should be thrown up in such manner as to reach the seat of the disease. It too frequently happens, that by attempting to make a hasty cure of gonorrhaea by means of astringent injections, on its first appearance, the discharge is speedily suppressed, and the pafient is soon afterwards attacked with an inflammation and swelling in one or both testicles. During the inflamma- tory stage therefore, it will be most prudent to use such as are of a mild and sedative nature, and begin with those of a mod- erate degree of astringency afterwards. If at the commence- ment, or indeed in any period of the disease the patient should appear in a plethoric state, and the inflammation be considerable, blood-letting and the antiphlogistic regimen will be proper and necessary. Cooling purges are advisable in the first stage of the complaint, for this purpose one ounce of OF THE VENEREAL DISEASE. 49*9 Glauber's salts and half an ounce of manna, or of cream of tartar may be laken every second or (hird day during (he continuance of inflammatory symptoms. As a cooling di- uretic medicine calculated lo abate the irritations and pain in the urethra, which is often very troublesome in the early stage, an ounce of cream of (artar and the same quantity of gum arabic powdered and mixed should be taken in a dose of a tea spoonful four or five limes in a day; and-at fhe same time drinking copiously of mucilaginous diluting liquors, such as barley water, linseed lea, or solutions of gum arabic in milk. By this mode of treatment, both the inflammatory symptoms and the running will be diminished, and the latter will change bofft its colour and consistence, becoming gradu- ally more white and ropy as the virulence abates ; under these circumstances, astringent injections may be employed with safely and advantage. The genital parts ought lo be frequently fomented with warm milk and water, and emolli- ent poultices, where they can be conveniently used, are also of considerable service in removing violent pains which often accompany Ihe inflammatory stage of the disease. The chordee will be relieved by the employment of opi- ates internally and externally, and by rubbing along the course of the urethra an ointment composed of one part camphor, and two parts of the mercurial ointment. When phimosis occurs, the penis should be frequently immersed in warm milk or linseed tea, or the mucilage of slippery elm, and these should be injected under fhe prepuce and the penis should be suspended. If we do not succeed by these means, and by taking blood from the part by leeches, the prepuce must be slit upwards in the manner directed in books on surgery. If paraphimosis takes place, warm em- ollients must be applied, the parts should be rubbed with some mild ointment, and attempts should be made by gentle force fo draw (he prepuce over (he glans ; if it arise from an enlarged state of the glans, cold astringent applications must be used, and a poultice should be applied, in which it will be useful to put a small quantity of acelite of lead and vinegar, and if these means fail the stricture must be remov- ed by (he knife. If phimosis or paraphimosis are attend- ed with symptoms of mortification, the parts must be foment- ed frequently with a strong decoction of cinchona and cham- omile flowers, and cinchona and the mineral acids should be freely given internally. Where the inflammation has ex. 500 OF THE VENEREAL DISEASE. tended farther than the membrane of the urethra, and has reached Cowper's glands, the prostrate gland, or fhe blad- der, we should endeavour by (he injection of warm oil and other emollients to increase rather than diminish the dis- charge, and we should obviate the effects of inflammation by the usual means. ' Should the discharge stop suddenly, and the inflammatory symptoms continue, it will be improper to employ astringent injections, but emollient ones should be persevered in till the discharge relurn. A very common symptom attending a gonorrhoea is a swelling of-one or both testicles, termed hernia humoralis, this is often in consequence of cold, a sympathy of the parts affected by (he imprudent use of severe exercise, or of strong astringent injections. This complaint is fo be treat- ed as inflammation in general, by bleeding and purging, and applying fomentations .and poultices. Leeches have often proved serviceable, as also the warm bath. The patient will be most at ease in a horizontal posture, and fhe return of the discharge should be solicited by the frequent injec- tion of warm oil, or warm milk into the urethra. Much re- lief may be obtained by suspending the testicle by means of a well adapted bag and bandage. When these are judi- ciously applied and adjusted, the patient need not be con- fined to a horizontal position. If the testicle remains in an enlarged state after the inflammation is subdued, emetics have been known to cure the complaint in the most speedy and effectual manner. If after the inflammatory symptoms of a clap have ceased, a running or discharge from the urethra continue, it is term- ed a gleet; it is unattended with pain or scalding in making water, and is the consequence of relaxation. This variety of the complaint may be removed by astringent injections and the use of bougies. The injections may consist of sul- phate of zinc, to which a few grains of alum may be added, or a weak solution of corrosive sublimate may be tried ; the injections should stimulate the part gently but not excite much inflammation. If we do not succeed with injections there will be much reason to suspect a stricture in the ure- thra, and the introduction of bougies become necessary. The perinaeum must be frequently bathed with cold water, sea water is preferable, blisters to the same part should be applied, and balsams, turpentines, and small doses of can- tharides should be administered. The tonic course of bark OF THE VENEREAL DISEASE. 501 and steel should be adopted, and these with the local astrin- gents must be continued for a considerable time after the symptoms have disappeared, as the discharge is liable to return with increased violence. Of Chancres. Chancres are small callous ulcers seated chiefly about the glans, and which mayr appear without any previous gonorr- haea. A small pimple is first discovered, most commonly near fhe fraenum, which contains a whitish matter inclining to yellow, this soon bursts and leaves a circumscribed pain- ful sore, having a foul appearance and is sloughy at the bot- tom with hard edges; it discharges a matter of a dirty green colour, often tinged with blood, and which is large in quan- tity in proportion to the size of (he sore. The period of (he appearance of chancre after receiving (he infection va- ries from five or six days fo as many weeks, and as there always is a risk of an absorption of mailer from this source, we ought as speedily as possible to heal the ulcers, and at the same time endeavour to secure the constitution by a free administration of mercury. When a chancre appears soon after impure coition, and is accompanied with gonorrhaea, the same cooling treatment already recommended, moderate bleeding, mild laxatives, fomentations and poultices common- ly abate the inflammatory symptoms, and in cases of a re- cent nature, chancres will readily yield to these means and the application of a weak solution of the muriated mercury. In the most inveterate cases no topical applications answer so effectually as touching the ulcerated parts with the nitrate of silver, or (he oxidum hydrargyri rubrum sprinkled over (he surface, and (he parls kept very clean by means of a lotion composed of one grain of corrosive sublimate fo eight ounces of water. After the chancres become clean, some mild oint- ment with the addition of calomel will be found exceedingly useful as the daily dressings. If the parts are very irrita- ble, or much inflamed, the usual means of reducing inflam- mation should be diligently employed and fhe irritation must be allayed by opiates. There are different opinions among practitioners respect- ing the expediency of administering mercury as a remedy in gonorrhaea. Those who maintain the doctrine that it is merely a local complaint, not having a venereal origin, con- SO- OF THE VENEREAL DISEASE. sequentiy incapable of affecting the system by absorption of the matter, deny the necessi(y of giving any medicine wilh the view of counteracting or destroying (he venereal virus. Although experience has clearly evinced that a simple clap in its recent state may be cured by the means above advised, yet every experienced practitioner mujl have met with instances in which prudence and a sense of duty requir- ed a more efficient and secure mode of treatment. When therefore, the inflammatory symptoms have subsided in those severe cases, especially where the virulence of the poison appears to have extended its effects beyond the urethra, if is advisable in point of security to have recourse to the cel- ebrated specific antidote mercury, in its most preferable forni. Pills composed of calomel and opium, if not to be preferred, are undoubtedly adequate to effect every purpose. Of this preparation in fhe proportion of three parts calomel to one of opium, about two or three grains may be given ev- ery night and morning until fhe salivary glands become slight- ly affected ; increasing or diminishing according to the sen- sible effects produced, carefully guarding against a full sali- vation. Should the medicine occasion a diarrhaea and grip- ing, it must be discontinued for a time and a mild cathartic ad- ministered ; and if in any instance, it cannot be persisted in long enough to effect a cure, the mercurial inunction must be substituted. About half a drachm of the strongest ointment should be rubbed in upon the inner part of the thighs and groins, every night till fhe mouth becomes slightly affected, and continued a short time after the disappearance of every symptom. During the mercurial course the patient should wear a flannel shirt, avoid all exposure to cold and in- temperance of every kind; totally abstaining from spirituous liquors and every thing of a heating quality. Of Buboes. A bubo is generally the consequence of chancre, though sometimes it is the first symptom of the disease. It is a hard painful tumour seated generally in the glands of the groin, distinguished into such as proceed from a recent in- fection, and such as accompany a confirmed lues venerea. A bubo commonly begins with a sense of pain accompanied with some degree of hardness and swelling, which increase like every olher inflammation that has a tendency to suppur- OF THE VENEREAL DISEASE. ,0£3 afion, and unless checked, pus forms and ulceration follows. Venereal tumours do not however, advance so rapidly to ma- turation as common abscesses, but more quickly than those arisim;; from scrofula. In eery instance of bubo, it is a desirable object fo pro- cure its discussion in its early sjage before matter is formed to apy considerable extent, as the distress and trouble lheyr often occasion by proceeding to suppuration are extremely severe. To effect this purpose, the mercurial ointment should be quickly introduced into Ihe system by rubbing fhe inside of the thigh and leg with it in considerable quan- tities ; in this way the mercury cannot enter the system without passing through the diseased gland. The quantity at first may be about the size of a hazelnut every night, and gradually increased to double that quantity, and continued till the tumour and induration have entirely subsided. The mercurial friction should be accompanied with all the usual means of abating inflammation, as bleeding by leeches, fre- quent saline cathartics, perfect rest, and low diet. When the tendency to suppuration cannot be arrested, we must en- deavour to promote the process by fhe application of warm emollient poultices and fomentations ; and when the end is accomplished, the abscess must be opened either by the lancet or caustic, and the*ulcer be brought to a proper di- gestion by suitable dressings and the internal use of mercu- ry. If instead of healing readily the edges of the sore be- come hard, livid, and retorted, discharging a thin sharp and foetid matter, and the ulcers spread or heal in some parts and break out in others, exhibiting a honey-comb appear- ance attended with pain, the most efficacious remedies are carrot or hemlock poultices, and the application of caus- tic round the edges ; the cicuta should also be administered internally as in schirrus. The cinchona joined with the nitric acid, the cempound decoction of sarsaparilla and opi- ates in such quantities as will allay irritation and procure relief, are essentially necessary; and these should be assist- ed by a generous diet with wine, and if possible a pure coun- try air. A gonorrhaea, when attended with much inflammation, is sometimes.accompanied with a tumour in the perinaeum ; if this cannot be dispersed by fhe usual remedies, a suppura- tion should be promoted, and the matter evacuated exter- nally to prevent its making an opening inlo the urethra. which has been known to take place. *04 OF THE VENEREAL DISEASE. Inflammation on some occasions extends to the neck of the bladder, inducing a distressing strangury, attended with heat, a cons(an( desire (o void urine, and a troublesome ten- esmus. If this complaint yield not to blood-letting arid olh- er measures direcled in the chapter on strangury, the cathe- ter must be employed to empty the bladder, and should this mode of relief prove abortive, and the case become des- perate, the operation of puncturing the bladder must be re- sorted to by the hand of a skilful surgeon. When strangury proceeds from spasm, as soon as the urine touches the in- flamed and tender part of fhe urethra a sudden constriction ensues, and the urine is evacuated by spirts or by drops only. The profession, says Dr. Thomas, is indebted to Mr. Cline for fhe discovery of a very efficacious remedy in (his complaint. It is the muriated tincture of iron, given in doses of ten drops every ten minutes until some sensible ef- fect is produced. After six doses, the urine usually flows freely, the patient previously becoming a little sick and faint. Mucilages and emollients would be useful at the same time, to lubricate, sheath, and dilute the acrimony of the urine. When in consequence of inflammation of gonorrhaea ex- tending beyond the urethra, the mucous membrane of the bladder becomes thickened, indurated, or ulcerated, the purulent matter gives to fhe urine the appearance of whey, and sometimes it is mixed with blood. This is commonly a tedious and obstinate complaint, but may be cured by inject- ing emollient decoctions into the bladder, and by giving a drachm of uva ursi three times a day, and proper doses of balsam of copaiva, or balsam canadensis at the same time. If the prostrate gland should become affected with inflam- mation from gonorrhaea, known by a pain and heat in the perinaeum, extending into the rectum, or by detecting a tu- mour by the finger in ano, we should resort to topical bleedings by leeches to the perinaeum, and apply emollient fomentations and poultices. Warty excrescences which appear about fhe penis and the female genitals, as a consequence of gonorrhaea or chan- cre, should be extirpated by a ligature applied round, or by the scissors, and the caustic, or powder of savine which is preferable, should be afterwards repeatedly applied to destroy the remainder. There are few complaints connected with the venereal disease more truly deplorable than strictures and callosities OF THE VENEREAL DISEASE. 505 m the urethra; these cause the urine in its passage to spread abroad, or split into fwo or more streams instead of flowing uninterruptedly in one direct stream ; and on some occa- sions a total suppression of urine takes place, especially when bougies have not been seasonably employed. This difficult affection can be successfully treated only by the careful introduction of bougies, and by continuing their use for a considerable length of time. On the failure of these, it not unfrequently becomes necessary to introduce bougies armed with lunar caustic, but as the appropriate treatment of this form of disease is a point of much delicacy and impor- tance, and as a detail of the rules to be observed would swell this chapter to an undue length, the reader must be referred for information to the most approved authors on the subject, as Hunter, Bell, Home, Abernethy, Whately, and Cooper. It may be observed that in all the varieties of the disease, mercury is to be considered as the only remedy to be reli- ed on for a radical cure, and in whatever form it is employ- ed, it must not be discontinued while any particles of viru- lence is suspected to lurk in the system. If the local symp- toms which have been described do not yield to the usual method of cure, or when cured, if they break out again with- out any fresh infection, there are strong reasons to suspect that the poison is universally diffused. It has long been a controverted question whether lues venerea and virulent gonorrhaea, are one and the same dis- ease, arising from the same matter of contagion ? The late Mr. Hunter ably and zealously supported the affirmative, and Sawrey, Swediaur, Whately, and Adams, have advo- cated the same doctrine. Mr. Benjamin Bell is the princi- pal author who has written in opposition to the opinions maintained by the above recited authorities, and many of her modern practitioners of eminence have acceded to the same sentiments, and suggested strong reasons for dissenting from the inferences which Mr. Hunter has drawn. Although on each side of the question are found advocates of profound research and investigation, the subject seems still to be in- volved in a degree of obscurity. The syphilitic virus is communicated by contact only, and the poison must be applied to some part which is soft, or covered with a mucous membrane, or where some excoria- tion ulcer or wound has taken place. The infection gener 64 rfUb OF THE VENEREAL DISEASE ally appears first in the part to which the matter is applied, as about the organs of generation, the nipples and breasts of women who receive it from (he moutii of a child, and on the contrary, (he lips and moutii of the infant when it receives the infection from Ihe nurse. In like manner the infection may be conveyed to the fingers, or any other part on which there exist a slight scratch or wound, as experienced by accoucheurs who officiate under such circumstances. A person labouring under the venereal irritation in any form, if not attended with a discharge, cannot according to Mr. Hunter communicate the disease to another. Of the Secondary or Constitutional Disease. The venereal virus is generally conveyed into the system from a chancre or bubo, and according to Mr. Hunter's doc- trine it may be absorbed from a gonorrhaea. It is asserted that the syphilitic poison may be introduced into the circulation without producing any evident local effect on the part to which it was first applied; and on some occasions it will remain dormant in the circulating mass for several months before any visible effects are produced. When either by neglect or improper treatment, the vene- real poison has contaminated the whole habit, (he disease receives the name of syphilis, or a confirmed lues, and is attended by a tram of distressing symptoms. Among the numerous characteristics are reddish and brownish blotches and eruptions, dispersed over different parts of the body; appearing first on the breast and arms, next on the shoulders, thighs, legs, soles of the feet, palms of the hands, round the nails, and at the margin of the hair. These eruptions have a branny appearance, and are superficial, unattended with itching, and the scales being cast off, an uleer of a copper colour is formed which discharges an acrid foetid matter. In the throat, tonsils, and inside of the mouth, the disease generally makes its appearance at once in the form of foul ulcers, which are covered with a yellow coloured slough, and often accompanied with an erysipelatous redness. There is great heat and irritation of the fauces, which are covered with an acrid viscid mucus, and the ulcer ofteu spreads very rapidly, exhibiting the deep copper coloured complex- ion which is characteristic of lues, and which at length destroys the palate and injures the subjacennjones, making OF THE VENEREAL DISEASE: 507 an opening from the mouth to the nose. When by its rapid spread, the disease attacks the cartilaginous parts of the nose, the ulcers are foul wilh callous edges, discharging a thin offensive matter, and being suffered to spread still more exten- sively, the bones become carious, and so completely corroded that (he nose is prostrated level with the face. Characteris- tic (oo of syphilis, arc deep seated pains, particularly of the arms, head and shins, always fixed in the same place, raging chiefly, and with great violence in the fore part of the night. Hard indolent tumours, or nodes, at length make their appear- ance upon the tendons, ligaments, periosteum or bones, es- pecially on the forehead, tibia, arms, sternum, and ribs, with distressing pain when the patient is warm in bed. Being thus severely afflicted, the patient becomes debilitated, his countenance is sallow, his appetite diminished, his hair falls off, his strength and flesh fail, and a small fever of (he hec- tic kind ensues. Besides the formidable train of symptoms just enumerated,there is an ophthalmia arising in consequence of lues, and when the venereal sore throat extends its effects to the eustachian tubes, or the membranes or bones of the ear, a deafness is the consequence. Frequent abortions, or premature births of dead fcetuses, whose bodies are scabby, ulcerated, and half corrupted with- out any manifest cause, may be regarded as almost an infal- lible sign of one of the parents being tainted with syphilis. Having detailed the symptoms characteristic of confirm ed lues, it is proper to remark that they are liable to ambi- guity, and to be counterfeited by some other affections, as rheumatism, scrofula,.&c. f The local forms of lues venerea, are so extremely equivo- cal, and deceptive in their visible appearances, as on some occasions to baffle the discriminating powers of the most ex- perienced physician. Such discrimination however is of the utmost importance, as it too frequently happens that some excoriation, or trivial diseased action to which the gen- ital parts are susceptible in common with other parts of the body, have been greatly aggravated, and rendered inveter- ate by a mercurial course, when they might have been speedily cured by the most simple applications. Venereal ulcers in the mouth, are distinguished from those arising from a too free use of mercury, by their affecting in general only one plac£ at a time, are circumscribed, of a dirty brown colour, and a|f>ear on all parts of the mouth indiscriminately; 508 OF THE VENEREAL DISEASE. whereas, those which are the effect of mercury, are diffused, appear in different parts of the mouth at the same time, and most frequently on the sides of the tongue, near the angles of the jaws, and on the inside of (he cheeks. The mercurial ulcer as described by Mathias, or the mercurial disease, is commonly attended wilh more pain than the venereal. K will often heal and after a time break out afresh in the neigh- bouring parts; and this it will continue to do for many months, particularly in throat cases. One of its striking characteristics is to heal in one part and grow bad in anoth- er; and we find this disposition to heal even in almost the incurable stale of this disease, whether in the bubo, in the chancre, in the throat, or on the face. The mercurial ulcer is more irritable than the venereal ulcer. In regard to the medical treatment of syphilis in its con- firmed state, mercury is unquestionably the only specific remedy, and no other is deserving of confidence as being adequate to effect a radical cure. The only important point is to decide as to the particular preparation, and the most eligible form of administering this antidote. The mode of administering mercury for (he cupe of lues under all i(s forms, is now ascertained with sufficient preci sion. It is by no means necessary to induce a profuse sali- vation ; this is rather to be avoided as hurtful; at the same time, it is proper to carry it to such extent as to produce its full action on fhe system. This action is to be continued for a certain time, longer or shorter, according to the state of the symptoms and the previous existence of the disease. In mild cases it will in general require from four to six weeks perseverance to effect a cure ; but in cases of long standing eight or ten weeks or longer. It will be indispensably necessa- ry to administer mercury in a quantity sufficient to render the constitution safe against future attacks. Withthis view the remedy must be continued in such quantity as will keep the system in an equal degree under its influence not only till all the symptoms are removed but for sometime afterwards. In primary affections only, a course continued for a fortnight after the symptoms have disappeared will most generally prove sufficient to eradicate the disease; but in obstinate and inveterate cases, it will be advisable to persevere in the course at least a month after the cure is to all appearance complete. A The patient who commences a course of Tnercury, be- sides beginning with small doses and proceeding gradually, OF THE VENEREAL DISE \SE. 509 should be careful not to stimulate the salivary glands, either by rubbing or keeping the parts too warm with flannel. He should likewise avoid as much as possible any exposure to cold, which will endanger inflammation and tumefaction of these glands, and thereby give rise to a salivation. His diet should consist of plain animal food, thin broths, pud- dings, milk, vegetables, ripe fruit, &c. carefully avoiding all salted and high seasoned meats, spirituous liquors, and acids; and in fact abstaining from every substance of a heating or stimulating nature. There are two methods by which mer- cury may be introduced into the system for the purpose of eliminating or deslroying the venereal virus; either by mer- curial friction or by exhibiting some of its preparations in- ternally ; and in either form it may be used to such extent as to excite full salivation, or so cautiously as only to induce a moderate degree of ptyalism. Some practitioners indeed limit their views to an alterative course only, but though this may succeed in some primary affections, it is by no means calculated to eradicate a confirmed lues venerea. By 1 a majority of physicians and writers of fhe present day, the external application of mercury is deemed (he mos( eli- gible mode. It is however agreed that instances will not unfrequently occur in which either the external or internal absorbents will not receive a sufficient quantity to produce the desired effect either on the disease or the constitution"; and when administered internally, mercury will very materi- ally affect the functions of the stomach in despite of all our precautions. If therefore, on trial, the external appli- cation should not succeed, we are to resort to the internal administration, and on the other hand, should this fail, the inunction must be substituted. During the process of inunction, the patient should be confined within doors in a well aired apartment, which should be kept in an equal and moderate temperature, and he should wear flannel next his skin. The remedy will be more efficacious when introduced into the system in a grad- ual manner, unless the disease is spreading with rapidity, or the ulcers are deep seated. One drachm of the strong oint- ment containing equal parts of hydrargyrus and lard should be rubbed in every night, and frequently in the morning, on the inside of the thighs, legs, or arms, by the patient him- self, and to do 4t properly it will require from twenty to thirty minutes of gentle friction before a moderate fire; the Alfl of the Venereal disease quantity should be increased or diminished according to the effects it produces ; and continued regularly till a slight soreness is perceived in the gums, a coppery taste in the mouth, or a fetor in the breath; this is. the desirable point which if possible should be supported without much increase of saliva for a proper length of time. The strength of the patient should be assisted by a nourishing diet and a proper use of wine. If a profuse salivation occurs, the remedies employed to check it are mild cathartics, small doses of opi- um, the application of a blister to the throat, and the ad- ministration of the sulphuret of potash, or the sublimed sul- phur, and fhe air of the apartment should be rendered cool- er. Free exposure to a cool air, is, according to Mr. Pear- son, more effectual than any other method. Peruvian bark, mineral acids, and the assiduous application of astringent gargles will be useful, while the employment of mercury must be discontinued for a time. A valuable gargle may be composed by dissolving an ounce of borax in a pint of wa- ter, adding an ounce or two of honey. Opiates should be occasionally administered to allay the irritation. It is pro- per however to remind the incautious practitioner, that the sudden suppression of a profuse salivation by cold liquids taken into the stomach, or exposure to cold and moisture is not without danger. On some occasions a morbid condition of the system occurs during a mercurial course, and which tends lo a fatal issue. This Mr. Pearson has termed ere- thismus. It is characterized by a great depression of strength; a sense of anxiety about the praecordia; frequent sighing; trembling, partial or universal; a small quick pulse, sometimes vomiting; a pale contracted countenance; a sense of coldness, while the tongue is seldom furred, or the vital or natural functions much disordered. In this state a vio- lent or sudden exertion of muscular power will sometimes prove fatal. To prevent the dangerous consequences the administration of mercury must be immediately suspended, and fhe patient exposed to a dry cool air, in such manner as shall be attended with the least fatigue, and large doses of the volatile alkali administered. When mercury is exhibited internally for the cure of sy- philis, it must be so gradually introduced as to steal as it were imperceptibly upon the constitution, that it may as- simulate itself by solution with the juices ofythe body. The most successful practice consists in promoting the action of i OF THE-VENEREAL DISEASE 511 all (he secretory vessels of (he system, and especially those of the surface. Among (he various preparations of mercury which at dif- ferent limes have been employed, the common quicksilver pills of the Dispensatory are mild in their operation, and supposed capable of answering every purpose which the remedy in any form can serve. The usual dose given with the view of inducing the mercurial action, is two pills con- taining one grain each, al bed lime, and one in the morning which may be occasionally increased. The mild muriate of mercury or calomel, possesses anti- venereal powers capable of curing the disease in every form, as by proper management it may be made to increase in a remarkable manner, almost any of (he secretions or excre- tions. It is given in the dose of a grain, night and morning; or in larger doses, combined with a proper proportion of opium to prevent its usual determination to fhe intestines. The corrosive sublimate of mercury, is the most powerful of the mercurial preparations. As an antisyphilitic remedy it acts speedily, and ils action is more general on fhe sys- tem, or less determined lo particular organs, but from the occasional violence of ifs operation ils use requires some caution. The celebrated Van Swiefen, entertained an ex- alted opinion of its antivenereal virtues, but since his day it has grown into disrepute. According to Mr. Pearson, it will sometimes cure the primary symptoms of syphilis, es- pecially if it produce considerable soreness of the gums, and the common specific effecis of mercury in the system ; but it will often fail, and will not secure (he patient from a con- stitutional affection, though it is peculiarly efficacious in re- lieving venereal pains, in healing ulcers' of the throat, and in promoting the desquamation of eruptions. Dr. John W. Frances of New-York, in his ingenious in- augural dissertation on mercury, strenuously advocates the employment of corrosive sublimate, and has made the most favourable report of ils antivenereal powers, corroborated by the respectable testimony of Professor Hosack, who for the last seventeen years has employed it for the removal of sy- philis with uniform success. Dr. Frances observes, that in the course of the extensive private and public practice of the Professor, no disappointment was experienced, not a case occurred in which fhe cure has not been permanent; and farther, lhat the medicine has been fairly tested in the 512 OF THE VENEREAL DISEASE New-York hospital with such success as to confirm its cfli cacy in the fullest manner. For delicate children labouring under some hereditary taint, two grains of the sublimate are dissolved in one ounce of brandy, of which four drops fo a child of one year, and six or eight to one of three years, are given three times a day in a little sweetened water. After its usje two or three days, the dose may be a little increased. This preparation of mercury has frequently been adminis- tered in the form of spirituous solution, but on account of its inducing nausea and other affections of the stomach and bow els, the form of pills are in general lo be preferred. To fifteen grains of corrosive sublimate, Dr. Frances adds fhe same quantity of the muriate of ammonia; having well rub- bed them together, pour on one drachm of pure water, com- bine with the mixture a sufficient quantity of Ihe crumb of stale wheat bread to absorb all the fluid, and divide the mass info one hundred and twenty pills. One of these is to be taken every night and morning, though in some aggravated cases another pill may be taken in the middle of the day. Thus a quarter of a grain of this preparation will be taken in twenty-four hours without any inconvenience though the same quantity in the form of solution might induce some se- rious derangement of the stomach and bowels. The employ- ment of the medicine ought in general to be continued two or three weeks after the disappearance of the disease, in order to effect with more certainty a radical cure. As aux- iliary to the above course, the decoction of guaiacum and sarsaparilla was employed, and attended with advantage. On some occasions mucilaginous diluents and the use of opium may appear requisite to obviate any irritation excited by an over dose of the medicine.* When topical applications are requisite as in venereal sore Ihroat, none is more serviceable than a solution of corrosive sublimate in the proportion of two grains to sjx or eight ounces of the decoction of cinchona, to which may be added three drachms of tincture of myrrh. The occasional appli- cation of lunar caustic, and the mercurial fumigation will tend much to induce healthy granulations. The nitrous acid has been given with considerable advan- tage in restraining the progress of the disease, and will at the same time improve the health and strength of the pa- * See farther particulars on this subject in Dr. Fiances' Dissertation, aud Amer- ican New Dispensatory, c2d edition. OF THE VENEREAL DISEASE. 513 tient, when the introduction of mercury inlo the system is inconvenient or improper, or when there is a considerable degree of debility. But this remedy is not of itself to be reli- ed on, as it is said to be doubtful whether it has ever effected a permanent cure, after the secondary symptoms appeared. There is yet to be mentioned a domestic remedy which may be well deserving of trial as an auxiliary at least in the cure of syphilis. It is the phytolacca decandra, described in the American New Dispensatory, and in the Appendix (o (his work. Some of the most respectable physicians in the southern states, repose great confidence in its efficacy, eith- er with or without the use of mercury, and esteem it as far more valuable than opium and guaiacum in answering the same intentions. The extract of phytolacca decandra, is undoubtedly one of the mildest, and best vegetable caustics with which we are acquainted, and in various vitiated ulcers it has proved an admirable remedy. It appears surprising that this article has never been recommended as an applica- tion to chancres, venereal ulcers, and eruptions, as it is much less irritating than lunar caustic, and may prove a valuable substitute. I will venture still further to suggest, whether seme mild preparation, as the infusion of the leaves, or a weak solution of the extract, may not be employed as an injection in cases of stricture, callosities, or other morbid affection of the urethra, which sometimes requires the intro- duction of bougies and caustic ? These observations are not intended to have influence as if from practical experiment, but only to excite attention among those who have the most frequent opportunities of ascertaining the antivenereal prop- erties of this vegetable. The sophora tinctoria is another domestic plant whose efficacy as an external application has recently been satisfactorily ascertained. An infusion of the root of this plant produces excellent effects when used as a wash to venereal ulcers and mercurial sore mouth. See Appendix. The treatment of infants affected with syphilis is detailed under the head of diseases of children. After this work was prepared for the press, the author was grati- fied by the perusal of " Medical Sketches" by James Mann, M. D. In this valuable production it is stated that several most obstinate cases of syphilis occurred in the military hospitals in 1814, in which a course of mercury had failed, and which speedily yielded to the use of nitro-muriate of gold, one eighth of a grain in form of pills every night and morning. 65 CHAPTER XXIII. OF SCIRRHUS AND CANCER. A SCIRRHUS is commonly defined a hard unequal tu- mour, occupying some glandular part, as fhe breasts, armpits, groins, and neck. At first there is neither pain, nor discoloura- tion of the skin ; it seldom acquires the magnitude to which all other tumours are liable to grow ; it is generally more fixed, and less moveable than other kinds of tumours, and is gener- ally harder and heavier. A scirrhous tumour may remain in an indolent harmless state for years, when not irritated by improper treatment. At length it gradually increases in hardness and size, and is attended with a peculiar kind of burning shooting pains, the surface becomes unequal, the skin puckers, and changes to fhe colour of brownish purple, or livid appearance, with a swelling of the veins, and a pain- ful sensation in the neighbouring parts. The puckering and dull leaden colour of the skin, the knotted and uneven feel of the swelling, the occasional dart- ing pain in the part, its fixed attachment to (he skin above and muscles beneath, form an assemblage of symptoms, which distinguish in the clearest manner, a malignant scirrhus, or confirmed occult cancer. In process of time, this tumour progresses to a state of ulceration, when it is called an open or ulcerated cancer. The disease is most incident to elder- ly persons, but no age is exempted from its effects. It has been known to attack, and destroy the eyes of young child- ren. The parts most commonly affected wilh cancer, are the testes, breast, and face, but the lips and female breasts, more frequently than all the other parts of the body, especially about the period of the cessation of the menstrual discharge. The causes which produce this disease are said lo be long continued grief and despondency of mind ; blows, bruises, or other external violence, and sometimes the suppression of some accustomed evacuation. In the course of its pro- gress, a cancerous tumour extends its limits fowards the neighbouring parts, by white ligamentous bands in the form OF SCIRRHUS AND CANCEN 515 of roots, or limbs, resembling in some measure the claws of a crab, from whence the name of cancer is derived. While Ihe tumour increases in size, the skin assumes the various colours of red, purple, and livid, and finally with the sur- rounding veins distended with blood, change fheir colour to a black. The patient is cruelly tormented with a burning heat, and lancinating pain. The skin covering the tumour at length gives way, and a large hideous ulcer is formed, whose edges are ragged and unequal, reversed in different ways, being sometimes turned upwards and backwards, and often inwards in the form of a full blown rose. The whole surface of the sore is commonly unequal, considerable risings in some parls, in others there are deep excavations. The discharge is a thin dark coloured ichor, which often exco- riates the neighbouring parts, and the fetor which issues from the ulcer, is intolerable even to the patient. The adjacent glands become affected with the disease, and new tumours are generated which communicate with each olher. A vio- lent burning heat and pain are universally felt over the whole ulcerated surface, and by the corrosion of blood ves- sels, which occur, considerable quantities of blood are sorae- tines also discharged. The strongest constitution is at length exhausted with pain and irritation, and made to yield itself a victim to this merciless disease. It may be remark- ed, that scirrhus, is not invariably situated in a glandular part, nor does every hard glandular swelling partake of the nature of scirrhus, and terminate in cancer. The doctrine which regards cancer as a disease of the general system, seems to be abandoned, and the best prac- titioners of the present day, view the disease merely as a local affection. This is a point of great importance as res- pects the mode of cure. The first measure to be enjoined in the curative plan, is for the patient fo resign himself en- tirely to a milk and vegetable diet. As early as possible after a genuine scirrhus or cancer is discovered, the patient must abstain from every article of food or drink that can tend to heat or stimulate the system. Nothing but the bland nutriment which milk and whey, with a few vegetables afford, should on any pretence be allowed. It may be con- fidently asserted, that if this method be early adopted, and rigidly persisted in, even to the extreme of taking no more of this simple nutriment than is absolutely necessary for the support of life, it will afford a greater chance of a cure, than any medicine ever yet discovered. The mind ought in the mean 516 OF SCIRRHUS AND CANCER time to be kept constantly as easy and cheerful as pdssible. Our utmost endeavours should be used to disperse scirr- hous tumours on their first appearance ; for this purpose topical bleeding, frequently repeated, by the application of a number of leeches to the part should be tried, and mild lax- atives must be given. The mercurial ointment, to one ounce of which about a drachm of camphor is added, should be well rubbed inlo the tumour daily, which will sometimes have an excellent effect in dispersingsuch tumours ; but too frequently we are baffled in every attempt, and the healing art knows no remedy but complete extirpation. In every instance therefore, of genuine scirrhus or can- cer, unless some insuperable obstacles prevent, let the pa- tient be conjured to assume a resolution superior to the terrors of the knife, and without delay submit to the dictates of some skilful operator. If this advice be complied with in due season, before ul- ceration takes place, and the judicious operator is attentive to remove a considerable portion of the surrounding parls so as lo include every vestige of ligamentous bands or roofs which may be attached to the muscles, or fat, a large proportion of persons may confidently expect to receive a radical cure. The general remedies which have been employed for the cure of cancer are of the narcotic tribe, as cicuta, belladonna, hyoscyamus, aconite and opium,, all which together with mercury and arsenic, may be rejected as utterly undeserving of confidence. Many of them have proved worse than use- less, by occasioning delay, deceiving the patient, and result- ing in fatal disappointment. The carbonate, or common rust, and other preparations of iron have of late been employed, and are highly extolled by Mr. Carmichael of Dublin, for their efficacy in the cure of cancer. There is however, much reason to suspect that the successful cases which he has adduced, were not all genuine cancerous affections. It appears by the New-England Journal of Medicine, Vol. I. and II. lhat Dr. W. Gamage of Boston, has on ma- ny trials experienced the most decided advantages from the carbonate and muriated tincture of iron in obstinate ulcers of the uterus and other parls, which by some would be de- nominated genuine cancers. It is therefore desirable that in every case of th s description, the preparations of iron have a fair trial, and if successful, let the fact be recorded OF SCIRRHUS AND CANCER. 51T in letters of gold. The carbonate may be given in doses of from half a drachm fo one drachm thrice in a day, and the phosphate in the same quantities. The muriated tincture has also been increased from twenty drops to the extent of one drachm, wilh safety and advantage. It yet remains to mention the remedies best adapted to obviate pain, and the intolerable fetor which is produced by the cancerous ulcer. Considerable benefit may probably be derived from the powdered rust, or a saturated tincture of iron in vinegar or old cider, if applied to the surface of the ulcerated parts. Poultices of raw carrots, grated and mois- tened, have superseded those formerly made of hemlock,and (hey are said to produce as much ease and diminish fetor more powerfully. The poultices should be frequently renewed, and the ul- cer kept perfectly clean by washing with soap suds or lime water. The carbonic acid gas applied to the nore, has been said to correct the fetor, and to produce other advantages. A poultice composed of bread and milk, with the addition of two ounces of finely powdered charcoal, is preferred by some for the purpose of correcting the fetor and acrimony of the discharge. A poultice made by stirring into an infusion of malt as much oat meal as will give it a proper consistence, and fhen add a spoonful of yeast, has also been found useful. The hemlock poultice is made by boiling two ounces of the leaves in a quart of water till only a pint remains, when as much linseed meal as is necessary is to be added, or the hemlock may be used by way of fomentation. The ulcer may also be covered with some mild cerate, composed of lapis calaminaris or saccharum saturni; and the necessary doses of opiates should be occasionally administered. The root of the indigo weed (sophora tincforia,) is reported to have rendered great service in various vitiated ulcers, and is probably deserving of trial in the form of lotion or wash. The various forms of caustic preparations, consisting of ar- senic and muriated mercury, as they never perfornr a cure, and often have a dangerous tendency, may be altogether dispensed with. The extract of phytolacca decandra is one of the best caustic applications lo cancerous ulcers, cleansing and heal- ing better than any other vegetable or mineral caustic. But for the purpose of correcting the fetor and acrimony of the discharge, and soothing the pain which attends, I have expe- j!8 OF SCIRRHI'S ANT) CANCE15 rienced the best effects from the application of an infusion of the rools of sophora tincforia. See Appendix. I feel fhe incumbent duty in this place, to caution those who may be afflicted with this deplorable disorder, against the shocking imposition of ignorant quacks, who pretend to cure cancers by the use of caustic plasters. Their process is infinitely more painful than the operation of cutting with the knife, and instead of realizing the promised cure, the patient will assuredly meet a woful disappointment. The following is among the numerous melancholy instan- ces which can be adduced as a solemn warning lo others A healthy woman applied to me for advice respecting a small scirrhous tumour in her breast of several months stand- ing. I viewed the case as a very favourable one for extir- pation, and assured her that in my opinion, there was the fairest prospect of a radical cure if she would submit to the operation. Observing at the same time that as the circum- stances of her case were not immediately alarming, it might be deferred for consideration or further advice. On a sec- ond interview, she suggested the idea of applying lo a man in Boston, who had advertised to cure cancers by drawing them out wifh plasters, as she dreaded the operation of cut- ting. Notwithstanding my earnest entreaties to the contra- ry, she finally resolved to try the hazardous experiment. After persevering in the use of poisonous applications for eight or ten days, a painful ulcer was produced, which soon extended over the whole surface of her breast. She con- tinued under the distressing operation of plasters for six or eight weeks, wThen she became discouraged, and at length despairing of a cure, she returned to her family in a most deplorable condition. The original tumour had so increas- ed, as fo occupy the whole breast, and was converted into a genuine ulcerated cancer, one or two tumours had formed under the armpit, and one in the opposite breast. She was exercised with the most tormenting pains, not only in the ul- cerated parts, but in her limbs, and over her whole body, which I could attribute to nothing but the poison of arsenic absorbed into the system by fhe use of the plasters. I need scarcely add, that a few weeks terminated her miserable ex- istence. I have strong reasons to believe, that if no improp- er applications had been made, in this instance, the patient might have continued in comfortable health for many years ; or if the tumour had been extirpated a perfect cure would have been effected. CHAPTER XXIV. DISEASES OF THE BRAIN AND NERVOUS SYSTEM. Of the Apoplexy. AN apoplexy is a sudden deprivation of the internal and external senses, and of voluntary motion, while the heart, lungs, and arteries, continue to perform fheir actions. It is most incident to persons in the decline of life, and those of a corpulent habit, with a short neck and large head, and who lead an inactive life, use a rich and plentiful diet, or drink fo excess, are the most liable to its attacks. It is in some in- stances preceded by a vertigo, and pain in Ihe head, drowsi- ness, noise in the ears, loss of memory, and a difficulty of breathing. It may be occasioned by any cause which in- creases the motion of the blood towards the brain, or pre- vents its relurn from lhat part, violent passions, rich and luxurious diet, and a free use of ardent spirits, excess of venery when advanced in life, the suppression of any cus- tomary evacuation, suffering the body to cool too suddenly after being much heated, wearing any thing too tight about the neck, and the sudden disappearance of eruptions. As also blows, wounds, and other external injuries. Modern practitioners have advanced fhe opinion fhal apoplexy has its origin in the stomach, and the brain is secondarily affect- ed by sympathy. This opinion is reported to be confirmed by numerous dissections both in France and England, in which the cause was demonstrated to be a diseased state of the stomach while in the brain little or no morbid affection was detected. It is however scarcely to be doubted that the brain is in general either primarily or secondarily affect- ed. This new pathology annihilates the usual distinction of sanguineous and serous apoplexy. The patient when seiz- ed with this disease most commonly falls down suddenly, the face is red and appears puffed up, the veins of the head. 520 DISEASES OF THE BRAIN AND NERVOUS SYSTEM. particularly the eyes, temples, and neck are turgid, the head feels hot, the eye-lids are half open and rigid, the patient appears to be in a deep sleep, and breathes with great labour and difficulty, and with a loud snoring ; one side of (he body is commonly more affected than the other, which condition is termed hemiplegia, fhe pulse in most instances is full and strong, but slower than natural. In the cure of apoplexy our indications are to relieve the oppression both of the brain and stomach. Let the patient be placed as much as convenient in an erect posture, and immediately subtract from the jugular vein or from the arm such quantity of blood as the case may appear to demand, and the condition of the system will admit. If evident signs of relief are not perceived and there be no reasons to fear an exhaustion of the vital powers, the operation may be repeat- ed within two or three hours, or a number of leeches may be applied (o (he temples. Every thing tight about fhe neck should be loosened, and the garters tightened, to retard the motion of the blood from the lower extremities, and a free air should be admitted into the apartment. Immediately after a very copious depletion by the lancet, and arterial ac- tion is reduced, the most prompt evacuations of the alimen- tary canal is of indispensable importance as is strongly re- commended by Dr. Hamilton. This exigence demands very active evacuants, as the following : turpeth mineral, four grains, or tartar emetic, six grains, Ipecacuanha, ten grains, jalap, twenty grains. Should this fail of evacuating both upwards and downwards, it may be repeated, or prop- er doses of calomel and jalap, or gamboge should be given at proper intervals until the object be fully accomplished. A solution of Glauber's salts with infusion of senna together with stimulating clysters should be diligently administered. Blisters are next to be applied, not only over the head and back of the neck, but on the thighs and legs, accompa- nied with frictions of the extremities and strong sinapisms to the soles of the feet. When apoplexy proceeds from the use of opium, the di- rections already given in the chapter on vegetable poisons must be pursued. Persons who have once suffered an apoplectic fit, or those who are predisposed to the complaint, should avoid the ex- tremes of heat and cold, and guard against all violent com- motions of the mind. They ought to keep their feet warm DISEASES OF THE BRAIN AND NERVOUS SYSTEM. 521 and dry, to abstain from heavy suppers; to wear their clothes loose about the neck, and to lie with their head high, and to obviate a costive habit. Perpetual issues, or setons, have likewise salutary effects, in preventing a return of this dis- order. A light cooling diet and moderate exercise should be recommended. Lethargy is a species of apoplexy which is manifested by an invincible drowsiness, or inclination to sleep, from which the patient is with difficulty awakened, and if roused he remains destitute both of sense and memory, and slumbers instantly again. The remedies applicable to this affection are the same as those advised in serous apoplexy. 6,6 CHAPTER XXV. EPILEPSY, OR FALLING SICKNESS. THIS is a sudden privation of sense, accompanied with unusual motions, generally with violent convulsions of all the voluntary muscles, and a frothing at the mouth, followed by great drowsiness. The fit recurs at various uncertain inter- vals, and often attacks during sleep. This disease is more frequent among children than adfhlts, and males seem more subject to its attack, than females. It is very uncertain in its termination, if it commences during infancy or childhood, it may take a favourable turn at the age of puberty, but when it seizes adult persons, and is hereditary, there are but little hopes of a cure. This disease may proceed from wounds, blows, and oth- er external injuries, strong passions, or affections of the mind, sudden and severe frights, intense application to study, frequent intoxication, venereal excesses, suppression of cus- tomary evacuations, too great emptiness or repletion, tumours or concretions within the skull, worms, teething, and it is sometimes hereditary. The attack of epilepsy, is in some instances preceded by a pain in the head, dimness of sight, noise in the ears, dis- turbed sleep, palpitations, flatulency, weariness, and in some instances there is a singular sensation like a cold vapour, ascending from the lower extremities towards the head, which is called aura epileptica. More frequently however, the patient is seized suddenly, and falls to the ground without much previous notice, quite destitute of sense and reason, and general convulsions immediately follow ; the muscles of the face and limbs are violently agitated and convulsed, the fingers are closely clinched, and the thumbs drawn fo the palms of the hands, the eyes are distorted, he foams at the mouth, and grinds his teeth with violence, and sometimes bites his tongue, and the urine and faeces are discharged in- voluntarily. The pulse at the commencement of the par EPILEPSY, OR FALLING SICKNESS 523 ■oxysm is quick, small, and scarcely perceptible, towards the termination of it, it becomes more full and slow, at length the convulsions cease, and the pulse and respiration return to their natural state, the patient falls into an apparent pro- found sleep, from which he gradually recovers his senses and power of voluntary motion, unconscious of any thing that passed during the paroxysm. Immediately on the patient being seized with a fit, great care should be taken to prevent his injurii.«g himself, by the strong convulsions, which often require four or five men to resist; a piece of wood should be placed between his teeth, to guard against their being closed upon the tongue. The patient should be put into a bed, wilh his head raised; and to have any pressure occasioned by clothing, or ligatures about his neck, instantly removed ; volatile spirits should be applied to stimulate the nostrils, and clysters, composed of antispasmodics, as opium, or skunk cabbage, should be administered, and the anodyne balsam should be well rubbed along the spine. If it should appear that the patient has been indulging too freely in spirituous liquors, or has loaded his stomach with some indigestible and offensive substance, a strong emetic must as soon as possible be forced down, and the operation promoted until the stomach is cleared of its injurious contents, when the convulsions will entirely sub- side. Cathartics may be given and persisted in. The method to be pursued in the intervals of paroxysms, with the view of a radical cure in epilepsy, must be varied according to the cause by which it is produced. If the disease is sympalhetic, and arises from worms, or from teeth- ing, it should be treated as already advised in those com- plaints respectively. In every instance, the particular cause, if it can be ascertained, should be remedied or obviated, as far as practicable. When the patient is of a plethoric hab- it, venesection will be proper in the paroxysm, to such ex- tent, as circumstances may require and justify, repeating the operation pro re nata. Blisters between the shoulders, and on the extremities, and mustard, and other stimulating poul- tices to the feet, will produce beneficial effects. When the approach of a paroxysm is indicated by the epileptic aura, it may sometimes be prevented, by a tight ligature applied to the limb above where the sensation of coldness begins. In many instances of epilepsy, which recur periodically, and which appear to depend on a debility, or irritability of the nervous system, the Peruvian bark, combined with chaly- 524 EPILEPSY, OR FALLING SICKNESS. beates, will be found particularly efficacious, and when aid- ed !>y the well known strengthening powers of a cold ba(h, a radical cure may often be expected. Among the various an;i>p; s i.odic medicines which have been celebrated by differeni authors for the cure of this disease, are musk, opi- um, and valerian ; the metallic tonics most extolled, are the flowers of zinc, from half a grain to eight grains, ammoniacal copper, quarter of a grain to five grains ; and the nitrated Bilver, one eighth of a grain to half a grain, twice in a day. With respect to their peculiar efficacy, it may be observ- ed that each one has been known to afford flattering prospects, and again to disappoint expectation, and fheir success in any particular case can be known only by a fair and patient trial. The nitrated silver, from its successful employment, has I am warranted to say, the strongest claim to preference. Arsenic and fox glove, hav6 some repute as remedies in the present disease; and Dr. Rush has cured a boy by giving him two grains of sugar of lead, three times a day. Opium is said (o be the most effectual antispas- modic, it should be administered in such doses as the pa- tipnt can bear, a short time before the expected paroxysm; and repeated at proper intervals, increasing the dose in a gradual manner, in proportion to the violence or frequent re- currence of the fits. In those cases where the fifs recur during sleep, a full dose of opium should be given at bed time. But the skunk cabbage root, is probably equally effi- cacious as an antispasmodic, and is not apt like opium to in- duce costiveness; let this have a fair trial, in doses of half a drachm, twice or thrice in a day, and if it fail, it will pro- duce no injurious effect. The application of a tobacco poultice to the pit of the stomach, if repeated for several days, just before the return of the paroxysm, has destroyed the diseased catenation and effected a permanent cure. There are two of our domestic productions which have been found to possess considerable efficacy in the cure of epilepsy. The common cow parsnip was brought into no- tice by the late Dr. Joseph Orne of Salem, who adduced five cases of its trial, in three of which complete cures were effected. In the three successful cases, the patients were remarkably affected with flatulency, and a morbid sensibili- ty of the stomach, which complaints were remedied by the carminative effects of the cow parsnip. It was given in dos- es of two or three drachms of the powdered root every day for a length of time, and a strong infusion of the leaves and EPILEPSY, OR FALLING SICKNESS. 52j tops, to be drunk at bed time. This medicine undoubtedly possesses considerable efficacy, and merits further trials in similar cases, for if it does not cure, it often mitigates the symp- toms of epilepsy. See Dr. Orne's communication to the Massachusetts Medical Society, and American New Dispen- satory, 2d edition. The stramonium, or thorn apple, is another remedy much to be relied on in the cure of this disorder ; though its fail- ure is not unfrequently to be expected, it will often justify the most sanguine expectations. The utility of this medi- cine, like many others, is frequently lost for the want of proper management and due perseverance. " Dr. Fisher of Beverly, from extensive experience, assures us that great confidence may be reposed in the virtues of this medicine, in those cases of young persons, where the fits occur daily or monthly, at regular periods, especially if assisted by chal- ybeates, or such other medicines as particular symptoms ap- pear to require. The patient must be kept constantly un- der the influence of the medicine, and will require every day one or two doses, according to the severity of the symptoms. The saturated tincture is the most convenient form for children, and the requisite dose may be known by the pupil being more or less dilated during its use." In one instance, a lady about fifty years of age was cured of alarm- ing attacks of epilepsy, by taking one grain of the extract of stramonium, once or twice in twenty-four hours ; although she did not suffer another attack after commencing the use of it, she found it necessary to continue taking it, during several months, to remove all apprehensions of a recurrence, with which she was occasionally menaced. A single grain seldom failed to excite unpleasant vertiginous sensations, ac- companied with an efflorescence about her face, and some degree of stupor. In another instance, as I have been in- formed, a man took fifty grains daily, divided into two doses, which constantly obviated a recurrence of the fits, though it produced dilated pupils, blindness, and sleepiness. See stramonium in American New Dispensatory, 2d edition. Per- sons liable to fits of epilepsy, should live abstemiously, care- fully refraining from all gross animal food, and the poison of spirituous liquors. They ought to cultivate composure of mind, and guard against all violent passions. Moderate ex- ercise ought to be practised, avoiding extremes of heat or cold, and also such situations as may expose the patient to danger of accidents when suddenly seized with a fit. •326 EPILEPSY, OR FALLING SICKNESS. Epileptic fits are sometimes occasioned by imitation and sympathy; the presence of a young woman during a parox- ysm, has produced the disease in a number of young female spectators. The disease has also been known to arise from violent and outrageous fits of passion in children. Dr. Parkinson relates the following remarkable instance. A girl about seven years of age, having been habitually indulged by fond parents, was whenever restraint was attempted, thrown into a violent gust of passion, which terminated in an epileptic fit. After employing without the least appearance of success, every remedy which physicians could devise, her parents in despair, declined any further attempts at a cure. At length, a friend recommended a remedy, which he asserted would, if employed with a strict attention to every circumstance enjoined, infallibly, effect a cure. He directed two ounces of blood fo be taken from the arm of the patient, about the full of the moon, and having stirred inlo it a tea spoonful of salt, she was to swallow fhe mixture whilst still warm. If any return of the fit should occur, fhe same oper- ation, and fhe same portion, was lobe repeated on the ninth morning. Such was the confidence reposed in this singular prescription, that it was rigidly complied with, not however, without exciting in the unfortunate subject of the experi- ment, the strongest signs of repugnance and horror. Com- plete success was the reward of their resolution, for not only was the return of the fit prevented, but a most unexpected event took place, the child was no longer prone to those vio- lent gusts of passion, to which she had hitherto been sub- ject, wisely preferring submission to the alternative of drink- ing her own blood. Convulsions generally partake of the nafure of epilepsy, ihey are frequently occasioned by overloading the stomach with unripe fruit, or indigestible food. Their cure is to be effected by the administration of emetics and cafhartics, with opiates occasionally, and in some instances venesection will be required. St. Vitus's Dance, or Chorea. This is a species of convulsions most generally confined to one side, and affecting principally the arm and leg. It is chiefly incident to young persons of both sexes, but partic- ularly those of a weak constitution, making its attacks be- tween the age of ten and fifteen, occurring but seldom after EPILEPSY, OR FALUNL SICKNESS. 527 that of puberty. This complaint may arise from a relaxation of particular muscles, or from various irritations, as teelhing, worms, acrid matter in the bowels, or from violent affections of the mind, as horror, fear, and anger; and it has been known lo proceed from sympathy at seeing the disease in others. The convulsive motions which attend chorea are sometimes preceded with yawning, stretching, anxiety about the heart, palpitations, nausea, difficulty of swallowing, gid- diness and pains in the head, &c. To these succeed a kind Of lameness or instability of one of the legs and arms, com- monly of fhe same side of the body, which are agitated by convulsive motions, and in walking the leg is dragged along in an awkward and ridiculous manner, and the arm is so affect- ed that it cannot be held still for a moment, and in every at- tempt to drink, the patient uses various singular gesticulations, and at length pours the liquor down his throat wilh great haste, as if he meant to afford amusement to fhe by-slanders. In some instances (he head and trunk are likewise affected in a singular manner, and there are frequent fits of leaping anil runniug, often accompanied with confusion of mind, weeping and laughing, as in hysteria. The countenance is pale, the eyes become dull and lose their lustre ; deglutition is perform- ed with difficulty, and there is sometimes an impediment of speech, with impaired appetite and digestion. This disease however, is seldom atlended with fatal consequences. When chorea is merely the effect of debility unconnected with any irritating cause in the first passages, evacuants are not to be employed, but the cure is to be attempted by ton- ic and strengthening remedies, Ihe principal of which are cinchona in large doses with chalybeates and cold bathing together with the usual antispasmodics as advised in epilep- sy. It has in a few instances been successfully treated by administering one or two grains of the acefife of lead thrice in a day. Electricity, the warm bath, and a perpetual blis- ter to the os sacrum have also been recommended as useful. Chorea undoubtedly sometimes arises from local irritation, and is not dependent on debility, and very complete cures have in such cases been effected by expelling worms, or by the frequent exhibition of drastic purgatives consisting of jalap and calomel. In obstinate cases having resisted the common method of cure, the effects of purgative medicines in regular and moderate doses should certainly be tried, af- ter which the cure may be completed by fhe employment of the tonics and antispasmodics as above directed. CHAPTER XXVI. OF THE HYSTERIC DISEASE, (lIYSTERIA.) THOSE women who possess great sensibility of consti- tution, and who are frequently liable fo obstructions of Ihe natural sexual evacuation, are in general the subjects of hys- teric complaints. It generally commences between the age of puberty and thirty-five, and is of all disorders one of the most various in its appearances. The disease generally begins with a sense of fulness, and rumbling noise in the bowels, attended with a sensation of a ball rolling round in fhe abdo- men, ascending lo the stomach and throat, and inducing a sense of weight and anxiety, nausea and vomiting; when this peculiar sensation arises to the throat, occasioning a sense of suffocation and difficulty of breathing, or swallow- ing, it is called globus hystericus. The extremities are cold but sometimes attended with a sense of heat indifferent parts of fhe body ; the colour of the face is variable, being sometimes flushed and sometimes pale, there is a pungent pain in Ihe head called clavus hystericus, swelling of the an- kles, flatulence, spasms, lassitude, and palpitations ; the eyes are dim and suffused with tears. The fit sometimes ceases after these symptoms have continued for a certain time, but more frequently the patient falls into a fainting fit. Sometimes she beats her breasts violently wilh her hands, at others, she lies quite motionless as if in a profound sleep\ The whole body is frequently agitated with convulsions, and the disease assumes the appearance of epilepsy ; sharp pains likewise at- tack the head, the loins, back, and bladder, and a very copi- ous discharge of limpid urine takes place, which is one of the most characteristic signs of the disease. The mind, as well as the body, is greatly affected, and the patient is liable to sudden transitions from laughing to crying. The patient usually continues in this condition for sometime, when at length, the heat returns to the extreme parts; a gurgling noise arises in the bowels, and as if awaking from a profound sleep she regains her voice, sense, and motion; but complains OF THR HYSTERIC DISEASE, (HYSTERIA.) 529 of a heavy pain of the head, and a general weakness. The paroxysms are considerably varied in different persons, in having more or fewer of the above symptoms, and in the violence and duration of the fit. The hysteric affection, will be distinguished from the epi- lepsy, by the globus hystericus, by Ihe great flow of limpid urine, by the sudden transition from laughing to crying, and by the anxiety and fear of death preceding and succeeding the paroxysm. During a hysteric paroxysm, if the patient be in a pletho- ric sfate, blood-lettipg will be serviceable, but if the disease has been of long continuance, especially in delicate habits, this operation generally proves injurious. The nostrils should be stimulated by the application of volatile spirits, singed feathers, vinegar, &c. and cold water, with volatiles and ether, administered infernally, as soon as the patient can swallow. Cold wafer and vinegar may be sprinkled on the face and breast, and free cool air should be admitted to the patient, and her feet and legs, placed in warm water. An antispasmodic clyster of the infusion of skunk cabbage root, or of opium, will be beneficial; but a clyster of cold water, it is said relieves the hysteric symptoms instantaneously. With the view of a radical cure, particular attention must be paid to the state of the menstrual evacuation ; if deficient, it ought to be promoted, if too copious, it should be restrained. It is the opinion of Dr. Hamilton, and he is supported by other authorities, that this disease does not proceed from the uterus as formerly supposed, but from some morbid af- fections of the stomach and alimentary canal. The leading indications therefore are to evacuate by the frequent exhi- bition of cathartics, but these are fo be preceded by the employment of the lancet where a fulness of the vessels re- quires the depleting operation. Our great object should be to strengthen the nervous sys- tem by the employment of Peruvian bark, mvrrh, and chaly- beates, together with the cold bath duly persisted in. It will be advisable, occasionally to administer medicines adapted to allay irritation. Take the tincture of asafoetida, and of castor, each two drachms, spirits of lavender compound, four drachms ; a tea spoonful or more of this mixture may be taken in a cup of valerian or motherwort tea on (he approach of any languor; and at bed lime a moderate dose of lauda- num may be added for the purpose of composing any ner- vous agitation and procuring sleep. The volatile tincture of 67 530 01' THE HYSTERIC DISEASE, (IIYSTERI \ ) valerian is also a valuable medicine. It frequently happens that hysteric women are afflicted with cramps in various parts of the body, which are most apt to seize them in bed, and when asleep. In these cases the patient's feet should be immersed in warm water, but when the spasms are violent, and of some duration, we must have recourse lo opiales, skunk cab- bage, ether, and camphor,internally, and to the warm bath,and frictions with anodyne liniments externally. Cramps in the legs may be prevented and sometimes removed by the appli- cation of tight ligatures, or by the exercise of walking. Hysteric women will experience great advantage by a pro- per attention to the mode of living, and to their conduct in life. The diet best adapted to this complaint, consists of milk and vegetables, but those who have been accustomed fo a more generous diet, may sometimes indulge in light animal food ; the most proper drink is water with a little red wine or bran- dy ; strong lea should be particularly avoided. Cold bath- ing, with proper exercise, and early rising, as they (end to brace the nerves, and invigorate the system, should be en- joined as of great importance. The mind must be constant- ly preserved in a calm serene state, and every thing lending to irritate the spirits, or ruffle the passions, ought to be most scrupulously guarded against. It is with much satisfaction lhat I introduce on this occa- sion a domestic medicine, the valuable properties of which are not generally understood ; the skunk cabbage, (poihos foetida.) I can assert from my own recent experience, and from trials in the hands of others, that it has displayed antispas- modic powers, surpassing most other medicines of that class. In several cases of obstinate hysteria and convulsions, this medicine alone, has effected permanent cures, or afforded essential relief. It is free from the heating and constipating qualities of opium, and the vast expense of musk, and may be given to any extent without producing unpleasant effects. The proper dose of the dried root in powder, is half a drachm thrice in a day, or of a strong infusion, a table spoonful eve- ry two or three hours. During every stage of nervous and hysteric complaints, and in cramps and spasms, this medi- cine is strongly recommended as a valuable substilute for the various antispasmodic remedies commonly employed. See American New Dispensatory, 2d edition. A young woman about eighteen years of age, was harass- ed by severe convulsive and hysteric paroxysms, almost incessantly, insomuch that her friends estimated the number OF THE HYSTERIC DISEASE, (HYSTERIA.) 531 at seven hundred in the course of a few weeks, her abdomen was remarkably tumefied and tense ; and there was a singu- lar bleatedness of the whole surface of her body, and the slightest touch would occasion intolerable pain. At length her extremities became rigid and immoveable, and her jaw was so completely locked, that she was unable to articulate, and liquids could only be introduced through the vacuity of a lost tooth. She had been treated wilh a variety of an- tispasmodic and other medicines, by an experienced physi- cian, without relief. Having prepared a strong infusion of the dried root of skunk cabbage, I directed half a tea-cup full to be given every few hours, without any other medicine; the favourable effects of which, were soon observable, andt>y persisting in the use of it about ten days, the muscular con- tractions were removed, the jaw was relaxed, and her faculty of speech and swallowing, with the use of all her limbs were completely restored. Another young woman had been ex- ercised with the most distressing paroxysms of hysteria for several days, without obtaining relief by t\e medicines pre- scribed ; when the skunk cabbage infusion was so success- fully directed, that her fits were immediately arrested, and in a few days a cure was completely effected. The brother of this patient, was seized with violent convulsions of the whole body, in consequence of a cut on his foot; the skunk cabbage was administered, and he Was speedily restored to perfect health. Since writing the above, a woman was affected with violent spasmodic pains, twenty-four hours after parturition, six doses of skunk cabbage entirely removed her complaints. Ergot has of late succeeded in the cure of this disease. The following important case may be implicitly relied on. " A lady about forty years of age, of a gross habit, was af- flicted with hysteric paroxysms which returned as often as once in twenty minutes. " She took laudanum, asafcetida, ether, &c. till I despaired of success. I then gave her twelve grains of ergot in decoction without her knowing it to be any- thing different from what she had taken before. She imme- diately replied, " that goes to the right place, that reaches the difficulty." In about half an hour she had a slight re- turn of (he fits, upon which I repeated the dose; after this there was no further appearance of them. After her recov- ery I learned that she had been subject to this disease, and although she had applied to a number of the most respecta- ble physicians, she had never found a medicine before which stopped the fits." See Appendix, Ergot. CHAPTER XXVII. OF THE HYPOCHONDRIAC DISUSE. THIS disease is nearly allied to dyspepsia, and is chiefly incident to persons of a melancholic temperament, of a stu- dious and sedentary' life, especially such as have indulged in grief and anxiety, and are advanced above the middle age. It is sometimes known by the name of spleen, or low spirits, or the vapours, as there is commonly a peculiar de- pression of spirits, accompanied with absurd and ridiculous fancies. The mind of the patient is constantly disturbed with imaginary evils and suspicions, and a strong apprehen- sion of death from the slightest cause, may be regarded as characteristic of the disease. The patient is frequently troubled with a spasmodic constriction of the (hroa(, sour belchings and vomiting of viscid phlegm, or acrid corrosive matier. He complains of languor, listlessness, or want of resolution and activity, coldness of the skin, and disposition to seriousness, sadness, timidity, and gloominess. These symptoms are accompanied with spasmodic pains under fhe short ribs of the left side, and somelimes with a swelling of those parts, attended with flatulency, indigestion, watchful- ness, palpitations of the heart, and generally a costive habit. But it would occupy many pages to enumerate the long train of nervous symptoms which sometimes harass (he misera ble hypochondriac. The hypochondriac disease may be occasioned by long and serious attention fo study, indoldhce, and protracted grief, long continued evacuations, obstructions of some of the viscera; high and full diet, or crude flatulent unwhole- some food, wifh irregularity and intemperance, by which (he stomach becomes loaded with indigestible crudities and viscid mucus. This disease, however distressing lo (he pa- tient, and embarrassing to (he physician, is seldom atiended with dangerous consequences. The cure depends less upon medicine, than on (he judicious management of the mind, which requires the utmost address, as those patients are ca- I OF THE HYPOCHONDRIAC DISEASE 533 pricious and irritable in the extreme ; the mind must be di- verted from desponding and ill grounded apprehensions, by inviting to such agreeable amusements, and cheerful compa- ny, as will engage the altention to other objects than his complicated, and often, imaginary feelings. In order to gain his confidence, and fo flatter his hope we ought to attend to his complaints a.-> of real existence, and to change his medi- cines from time to time, as often as he expresses much dis- appointment in his expectations of relief. Every cause of anxiety and fatigue must be studiously avoided, or remedied, moderate exercise on horseback, when convenient, should be uniformly persisted in, that new and varied scenes may be presented to his view. The reading of entertaining books will also be useful in assisting to divert the mind to different objects. A proper diet, constitutes an essential part in the treatment of the hypochondriac, as well as the dyspeptic pa- tient. In general, light animal food is what alone agrees with Ihe stomach in these cases; vegetables, and every thing of an acescent tendency are apt to generate crudities and flatulency. The drink should be old claret or Madeira wine, or occasionally a little brandy with water; but neither of these should be indulged in so freely as to acquire an ir- regular habit. Strong tea and coffee, are to be avoided as pernicious. Instead of these, cocoa, or chocolate, or infu- sion of camomile, with some juniper berries, ginger, or mustard, should be preferred for breakfast. The cold bath is to be regarded as a powerful assistant in the strengthening and tonic plan of treatment, in all nervous and hypochondriac cases. Sea bathing, when it can be ob- tained, should be preferred. It ought to be practised three or four times in a week, from March to November, and fhe most suitable time is either an hour or two before, or two hours after breakfast. In some instances where a rigidity of the solids prevails, the tepid bath will prove more benefi- cial than the cold bath; and the warm pediluvium will fre- quently prove serviceable. Another auxiliary highly con- ducive to recovery in nervous affections is friction, which ought fo be applied over the whole body wilh a coarse cloth, every night and morning, for a quarter of an hour at a lime ; this kind of exercise stimulates and excites the action of (he extreme vessels, and has a peculiar tendency to invigo- rate the whole system. Much benefit may often be derived from a sea voyage and change of climate. In regard fo the medical treatment in the present disease, the first step is to f 534 OF I HV, HYPOCHONDRIAC DISEASE clear the stomach and intestines of their acrid, or viscid contents, by means of genfle emetics and purgatives, which may be occasionally repeated if found necessary. With the view of counteracting the effects of the prevailing acid, or acrimonious humours in fhe stomach, we are next to pre scribe alkalies and antacids, as in dyspepsia. The salt of tartar, sal soda, or sal aeiatus, mixed wi(h some mucilage, should be exhibited in their proper doses several times in a day, and the absorbent powders, as chalk and magnesia, are well adapted to correct the prevailing acidity ; about ten grains of rhubarb with a drachm of calcined magnesia, will answer the desired purpose of a gentle laxative to be taken occasionally ; but in a torpid state of the bowels, three or four grains of calomel may be added to advantage. The elixir proprietatis, will be found useful as a warming invigo- rating stomachic laxative. After the stomach and bowels have been properly evacuated of their impurities, recourse must be had to those medicines which are best adapted to (he purpose of strengthening the alimentary canal, and pro- moting the secretions. A plaster of Burgundy pitch to the stomach and abdomen, will be beneficial, but our chief de- pendance must be in the employment of chalybeate medi- cines, and the form of Griffith's myrrh and steel mixture, is excellently adapted to the purpose of corroborating and strengthening the stomach and digestive organs, and is pref- erable to Peruvian bark in torpid habits. If antispas- modics should at any time be required, the skunk cabbage root, as directed in the last chapter, may be employed. Such is the capricious and fickle temper of hypochondriac patients, that they become dissatisfied and impatient, unless they are liberally supplied with medicine; and we are often obliged in compliance with their whims, to vary our pre- scriptions, and to direct palliative remedies ; among those most commonly employed, are ether, musk, asafoetida, castor, camphor, valerian, volatile salts, salt and oil of amber, and opium. From among these, the prescriber may make a se- lection, but in regard to opium, it should be resorted to on urgent occasions only, lest the patient become addicted to a practice which can never be relinquished. Indeed those who accustom themselves to a regular use of this drug, ought to be apprized, that by taking about two ounces of lemon juice, or strong vinegar with each grain of opium, the uneasy sensation which the medicine often occasions, and its ten- dency to induce constipation, will be in a great measure ob- OF THE HYPOCHONDRIAC DISEASE. 53y viated. An infusion, or the tincture of hops, will in some constitutions answer fhe same purpose as opium. The phosphate of iron on account of its absorbent quality, will frequently be found of more utility than any other prepara- tion of that metal. Flahdency, or Wind in the Stomach and Bowels. This symptom, which proceeds from a want of tone or vigour in the stomach and bowels, is peculiarly incident to all nervous patients, and greally contributes fo aggravate (heir distress. This complaint is to be relieved by carmin- ative medicines, and by such as have a tendency fo reslore the tone and vigour of fhe alimentary canal. When fhe stomach is empty, fhe eating a dry biscuit will often afford relief. The carminative medicines most in repute, are asa- fmtida, elixir vitriol, ether, and opium, to which may be ad- ded acorus calamus, the cow parsnip, and the seeds of anise, caraway, coriander, and juniper berries. Ether may be giv- en in the quantity of two tea spoonfuls, or more, in a cup of cold water, and about fifteen drops of laudanum may be added, or given separately when required. The tincture of castor and spiritus nilri dulcis, fo either of which laudanum may be combined, will generally afford much relief, and in fact, ether and laudanum are superior to any other medi- cines in these cases, whether the flatulence be contained in the stomach or bowels. Some advantage may be derived from the application of the antihysteric, or the stomach plas- ter, or from rubbing the anodyne balsam on the parfs at bed time. When costiveness attends fhe complaint, four or five of the following pills will produce excellent effects. Take asafoetida, two drachms; socoforine aloes, salt of steel and powdered ginger, of each one drachm; as much elixir pro- prietatis, as will be sufficient to form them inlo pills. The tonic and chalybeate medicines mentioned in the preceding pages, are to be advised, and active amusements, and severe exercise, with temperance in eating and drinking, should be constantly practised. The Hiccup. This complaint is a spasmodic affection of the stomach and diaphragm. It is sometimes a primary disease, but in general is only symptomatic. It may proceed from excess in eating or drinking; from irritation or acrimony, poisons. 636 OF THE HYPOCHONDRIAC DISEASE. inflammation, or scirrhous (umours of (he stomach, or neigh bouring par(s. In malignant fevers and gangrene, it is often the harbinger of death. A common hiccup is often removed by swallowing in quick succession, small draughts of cold water, or by a sud- den fright or surprise. In obstinate cases of this complaint, recourse must be had to antispasmodics, the most useful of which are ether, musk, and opium, and they are found more effectual, when combined together in due proportions. The skunk cabbage root is perhaps deserving of trial. The com- pound spirits of lavender, will be found useful in this com- plaint. If it arise from impurities of the stomach, emetics and cathartics will be the proper remedies ; and if from flatulence, some powdered ginger will be of service. The oil of amber, says Dr. Rush, in doses of from five to ten drops every two hours, often cures a hiccup which attends aged people in malignant fevers. Blisters to the stomach are sometimes necessary. Incubus, or Night-mare. The night-mare attacks a person during sleep, and when he lies on his back, particularly after eating a heavy supper. There is a sensation of a great weight, or oppression about the breast and stomach, and is generally accompanied with frightful apprehensions. The person groans, and sometimes cries out and makes ineffectual efforts to speak. In some instances he imagines himself engaged with an enemy, and in danger of being killed, and attempts in vain to make his escape. In others, the patient fancies himself falling over a precipice, and fhe horrors of being dashed to pieces suddenly awakes him. This is a nervous affection, and arises chiefly from indigestion and oppression of the stomach, in consequence of eating a heavy supper just before going to bed. Wind in the stomach is also a very frequent cause of this com- plaint. Deep thought, anxiety, and a sedentary life may produce the night-mare. When indigestion, or any weak- ness of the stomach prevails, a course of tonics, as advised in other nervous affections will be highly necessary. In every instance the cause which gives rise to the complaint, must be carefully avoided, especially flatulent or indigestible food, and heavy suppers late at night; let him preserve cheerfulness of mind, and sufficient exercise through the day, and at night take a glass of brandy or peppermint water, which is better, to promote digestion and obviate flatulency. CHAPTER XXVIII. TETANUS, (TRISMUS,) OR LOCKED-JAW. THIS is a most formidable and frequently a mortal dis- ease. It has been distinguished by practical writers into opisthotonos, when all the muscles of the neck and spine are affected with rigidity, and the body is drawn violently back- wards, and emprosthotonos, when by similar spasms and rigidity, the head and body is drawn forwards. When the muscles of the lower jaw become rigidly contracted, so that the teeth are firmly closed together, it is termed trismus, or locked-jaw. This horrid disease is more frequent in warm climates than in cold ones, and is often occasioned by ex- posure to cold and moisture, when under profuse perspira- tion persons imprudently sleep in the open air, especially in a damp situation and after intoxication. But the most com- mon cause of tetanus in colder climates, is the partial lacera- tion, or even puncture of a nerve or tendon. Gun-shot wounds and various surgical operations, particularly ampu- tation, are sometimes succeeded by this disease. It is truly remarkable that a very trifling injury or puncture by a nail, splinter of wood, or bits of glass, about the feet, hands, or fingers, will on some occasions produce tetanus when it is least expected, while at other times wounds of a more formi- dable nature will have no such effect. Some cases have been recorded where trismus was supposed to be owing to the presence of worms, or viscid mucus in the intestinal canal. When this disease takes place in consequence of expos- ure to cold, the symptoms make their appearance suddenly. But when produced by a wound, puncture, or any other external injury, they gradually approach from the eighth, tenth, or fourteenth day ; and it not unfrequently happens, that the original wound or puncture, has entirely healed be- fore the attack, and the patient scarcely recollects its having occurred. A slight stiffness is at first perceived about the back part of the neck, with general lassitude, and the mo- tion of the head becomes difficult and painful; as the rigid- 538 TETANUS, (TRISMUS,) OR LOCKED-JAM ity of the neck becomes more considerable, a sense of unea- siness is felt about the root of the tongue, which by degrees produces a difficulty or inability of swallowing ; there is a violent pain at the end of the sternum shooting into the back; when this pain arises, the muscles particularly of the back part of the neck are immediately affected with spasm, pul- ling the head strongly backwards; at the same time the muscles of the lower jaw become rigidly contracted, so that the teeth are firmly closed together; as the disease advanc- es the muscles of the whole spine are affected, and the body is drawn backwards in such manner, that it is supported by the head and heels, the spine forming an arch. When flic antagonist muscles of the whole body are so contracted that the patient can bend himself in no direction, but remains stiff in one position, fhe disease is called tetanus, which is however not so common a form as those above described. The abdominal muscles become violently affected with spasm, so that the belly is strongly retracted ; Ihe tongue is often partially attacked with spasm, and it is often thrust out violently between the teeth ; at the height of the disease, every organ of voluntary motion suffers in a greater or less decree, the eyes are hollow, rigid, and immoveable, the countenance is hideously distorted, and expresses the great- est distress, the strength is exhausted, the pulse becomes irregular, respiration difficult, and universal convulsions su pervene to terminate a most miserable state of existence. The spasms are attended wilh violent pain, and generally continue for a minute or two, and return at intervals of ten or fifteen minutes ; there is seldom any fever, but when the spasms are violent, the pulse is contracted, hurried and ir- regular ; in the remissions, the pulse and respiration are na- tural ; the heat of the body is commonly not increased, the face is generally pale, and covered with a cold sweat. It is remarkable, that neither the mental nor natural functions are considerably affected, there is seldom delirium, the appe- tite remains good, the urine is sometimes suppressed, or is void- ed with difficulty, and there is a costive state of the bowels. When tetanic affections arise in consequence of lacerated wounds or punctures, or from amputation, or gun-shot wounds, they are almost sure to prove fatal; frequently dealh lakes place in forty-eight hours, or four days, sometimes the pa- tient lingers for ten days or a fortnight. In other instances, proceeding from exposure to cold, by a timely use of the proper remedies permanent cures are frequently effected. TETANUS, (TRISMUS,) OR LOCKED-JAW. 539 In those instances of tetanus arising in consequence of slight injuries, or punctures, by nails reaching a tendon, or nerve, we arc advised to dilate the wound, and to apply (o (he inner surface lint moistened wifh the oil of turpentine with the view of inducing inflammation and suppuration. A splinter under the finger nail, says Dr. Rush, produces no convulsions, if pain, inflammation, or suppuration follow the accident. This measure should be adopted on all such oc- casions, either before, or immediately on the appearance of any tetanic symptoms. When tetanus is evidently depend- ant on the particular state of a wound, or partial division of a nerve, practitioners in general agree, that the wounded part should be completely removed, whenever such an ope- ration is practicable, the nerves of the part at least, ought fo be divided, or destroyed with fhe application of caustics. In fact, some have gone the length of amputating a limb, particularly a finger, or toe, for fhe purpose of cutting off" all communication of the injured nerve with the brain, but experience has now fully evinced, that such an operation after tetanus has commenced, is seldom successful. With the view of producing a speedy suppuration, it has been recommended to apply the lunar caustic freely to the wounded part, and afterwards cover it wifh the common bread and milk poultice. With respect to internal remedies for the cure of (his dread- ful disease, opium has long been considered as the most prominent of all others, and it has been administered to fhe astonishing quantity of an ounce in twenty-four hours before the violence of the spasms could be subdued. This power- ful remedy should be given at first in moderate doses, as two or three grains, repeated every two hours, or oftener, and boldly increased as the violence of the spasms, and other symptoms may seem lo demand, paying less regard to (he real quantity given than the salutary effects produced. From the great difficulty of swallowing sufficient doses of opium, it often becomes necessary to administer it by way of clys- ter, and in this form it should be carried to very great extent. Opium may likewise be employed externally by rubbing it thoroughly into the parts more particularly affected by spasm, either in the form of ointment or liquid, with the prospect of relief. By some we are advised to combine other antispasmodics, as ether, musk, and camphor, with opium, but experience does not prove that much advantage is to be expected from them. With the hope of producing * relaxation of the contracted muscles, the warm bath has 640 TETANUS, (TRISMUS,) OR LOCKED-JAXV been employed and recommended as promising essential benefit, but on numerous trials it has disappointed expecta- tion, and sometimes it has even been supposed (o produce mischievous effects. Instances are adduced of patients dy- ing the instant they were taken out of the warm bath. It is now asserted by the best authorities, that of all the remedies which have been employed in cases of tetanus, the cold bath has been attended with the greatest success. This is prac- tised by plunging the patient into a bath of the coldest wa- ter, or placing him in a large tub and pouring from a consid- erable height, several pailfuls of cold water over bis head and body ; after which, he is to be carefully dried, and rub- bed with a cloth, and put to bed, and a dose of laudanum given him. This process must be repealed every three or four hours, until the intervals of freedom from the attacks of the spasms increase in length, which soon follows, and often ends in a perfect cure. Another remedy recommended for the cure of tetanus, is mercury, which if resorted to early in the disorder, and pushed to the extent of speedily affect- ing the mouth, has undoubtedly been attended with some success. The mercurial frictions have in general been pre- ferred, and opium is directed to be given in moderate doses at the same time. Dr. Rush, strongly recommends the em- ployment of the bark and wine, as the most efficacious rem- edies which he has employed; and Dr. Latta, advises to the extent of two or three ounces of bark, with a bottle and half of Port wine in twenty-four hours. There is one case reported by Dr. Hosack of New-York, arising from a punc- ture of a pin in the wrist, which he cured with Madeira wine alone, the patient having taken three gallons in a few days, in doses of a wine-glass full every hour. We find on record a few cases of tetanus, or locked-jaw, cured by electricity, and the remedy merits further trials. Throughout the whole course of this affection, costiveness should be obviated by laxatives and clysters, and the pa- tient's strength is to be as much as possible supported by wine and light food, and when he is unable to swallow, nutritive clysters must be substituted. Where viscid mucus abounds in the alimentary canal, emetics and cathartics are indispensably necessary, and with the view of answering the indication in the speediest manner, it will be advisable to administer ten or fifteen grains of calomel, and six or eight of tartarized an- timony combined, and this repeated in smaller doses until a thorou^ii evacuation be effected. One instance has recent- TETANUS, (TRISMUS,) OR LOCKED-JAVV. 541 ly been reported of a cure having been performed, or the symptoms surprisingly mitigated, by half an ounce of the spirit of turpentine exhibited in the form of enema, combin- ed with eight ounces of the infusion of senna. This medi- cine is now known to be a powerful antispasmodic. New- England Journal of Medicine and Surgery, Vol. V. page 280. A decoction of tobacco is said in another instance to have produced very beneficial effects when administered by way of injection into the rectum. After a diligent research and examination, of perhaps all the respectable authorities of modern times, it is difficult to determine which of the curative plans has the greatest claim (o preference ; and such is the rapid progress of the dis- ease, that little time is allowed for changing our prescrip- tions. It has recently* been announced to me by my friend Dr. Nathaniel Miller, that he has lately succeeded in the treatment of three or four cases of tetanus arising in conse- quence of wounds, by the use of the arsenical solution of Dr. Fowler. His first trial was merely accidental, but the favourable result induced him to repeat his trials, and the efficacy of the remedy has far surpassed his expectations. He administers ten drops, combined with an equal quantity of laudanum, and a large spoonful of common spirits, every half hour. When relief is obtained he diminishes the dose, and gradually discontinues the medicine. It is doubtful whether the laudanum and spirits are of any particular use, the solution may be tried alone, and if it succeed the dis- coverer will assuredly be entitled to the praise and gratitude of the public. Cramp of the Stomach. The cramp is a painful and distressing complaint, and when it attacks the stomach and bowels, it is always attend- ed with danger. The patient is affected with a kind of numbness, or involuntary contraction of the muscles, attend- ed with a convulsive effort of the neck, arms, legs, &c. When it seizes the stomach, that organ is suddenly affected with violent, but transitory pain, abating and returning at in- tervals, with nausea and vomiting. This complaint is chief- ly incidental to people advanced in years, especially those who are subject to the gout, or any nervous affection. The remedies best adapted for the removal of this disorder, are laudanum injected into the intestines, as this when given by the mouth, has often the effect at first, of increasing the 542 TETANUS, (TRISMUS,) 0*R l.OCKED-.TAW complaint of the stomach, and as often as (he pain returns, the anodyne clyster should be repeated : and the anodyne balsam may be applied to the region of the stomach with good effect. The warm bath and diligent friction will prove particularly serviceable, as also fomentations, and bladders of warm water to the stomach. After the abatement of the fit, tonic and antispasmodic medicines should be employed (o prevent a return, and all irregularities in eating or drink- ing, ought (o be particularly avoided. If the disorder is known to proceed from the gou', a glass of brandy, or a dose of the essence of peppermint, with a tea spoonful of the com- pound spirit of lavender or of ether, should be taken, and at the same time, blisters are fo be applied to the ankles, and the feet and legs bathed in warm water. See chapter on Dyspepsia. Palpitation of the Heart. This is a violent and irregular motion of that muscle; the palpitation is sometimes so great as to be perceived and heard at a distance, and is attended by numerous anxious and painful sensations, as great uneasiness and oppression of the breast, and frequently a troublesome dyspnoea wifh a purplish hue about fhe lips and cheeks. This complaint may originate from various causes, as organic affection, a morbid enlargement of the heart itself, or of the large ves- sels, plethora, and nervous debility. In many instances it is merely symptomatic of histeria and other nervous disor- ders. If the patient be of a full habit venesection will pro- duce immediate relief; after which, mild laxatives, bathing the feet in warm water, and moderate exercise in the open air should be recommended. If it arise from debility, bit- ters wifh chalybeates and cold bathing will be the proper remedies. If symptomatic of any nervous disorder, anti- spasmodics conjoined wifh tonics will be most advisable. When this complaint proceeds from an organic affection of the heart or large vessels, we have only to caution the pa- tient against exposure to such circumstances as may increase the action of the arterial system, particularly fits of passion, sudden surprises, violent exercise or great exertions of the body. See Professor Corvisart on Diseases of the Heart, and also Cases and Observations on Organic Diseases of the Heart, by John C. Waren, M. D. Massachusetts Medical Communications, Vol. II.,and New-England Medical Jour- nal, Vol. I. where ample satisfaction relative to those com- plaints will be obtained. CHAPTER XXIX. OF THE PALSY. THIS disease is frequently the consequence of apoplexy, and consists in the loss of the power of voluntary motion in certain parts of (he body only ; sometimes i( is accompanied with a loss of sense or feeling, and there is often stupor in a greater or less degree. It most frequently affects the whole of the muscles of one side of the body, and then the disease is called hemiplegia , when fhe muscles of the lower half of the bodyr, divided transversely, are affected, it is named paraplegia ; and when a single limb only, if is termed par- alysis. This disease, if it is not the effect of apopiexy, is often preceded by universal torpor, giddiness, and sense of weight, or uneasiness in fhe head, dulncss of comprehension, loss of memory, and a sense of coldness in the parts about (o be affected ; there is also sometimes tremour and pain in (he par(. But in general, palsy comes on with a sudden and immediate loss of (he motion and sensibility of the parts; when the head is much affected, the eye and mouth are drawn to one side, the memory and judgment are much im- paired, and the speech is indistinct and incoherent. When palsy attacks any vital part, such as the brain, heart, or lungs, it soon terminates fatally. In some instances, there is a total loss of sense, while motion remaii.s entire, in oth- ers, a total loss of motion, with very slight, or even no affec- tion of sense ; and in some cases, while a total loss of motion takes place in one side, a total loss of the sense of feeling has been observed in the other. But most commonly, there is a loss of voluntary motion while feeling remains. Palsy is induced by whatever prevents the nervous power from acting on any particular part or the body. The more remote causes, are intemperance, certain poisons received into the body, particularly lead, suppressed evacuations, wounds of the brain or spinal marrow ; spasmodic colic ; old age, and debility of Jhe nervous system, worms, &c. When the part affected feels cold, is insensible or wasted away, or when the faculties of the mind begin to fail, there is little hope of recovery, though the patient may continue for 544 OF THE PALSY. many years in a feeble helpless condition. A feeling of w arm(h, a slight pricking pain, or a sensation as if slung by ants in (he par( affected, are favourable symptoms, and if a fever ensue, there is a chance of its curing the palsy. When convulsion succeed to a palsy, (he termination is almost inevitably fatal. The curative plan in this disease is in the first instance aimilar to that in sanguineous apoplexy. If the patient be young and of a full habit, bleeding, blistering, and strong purgatives, and sharp clysters must be immediately employ- ed. But when fhe disease proceeds from relaxation or de- bility, and the palient is advanced in life, an opposite meth- od of cure must be adopted. The diet should be of a warm and strengthening quality, seasoned with spices or aromatic ingredients ; and the drink ought to be generous wine, mus- tard whey, or brandy and water. A stimulating clyster should be immediately injected, and an emetic must follow the operation of it, and repeated occasionally. Volatile and stimulating medicines are next to be administered, such as the volatile alkaline salts and spirits. The seeds of mus- tard unbruised, a table spoonful, and the same quantity of the root of horse-radish scraped and swallowed without chewing, if given night and morning, will prove extremely beneficial ; or two ounces of each of the above may be in- fused in a quart of boiling water for four hours, and add to fhe strained liquor two ounces of the tincture of pimento, and a tea-cup full may be given three or four times in a day. Frictions on (he pajls affected, and along the spine, with warm cloths impregnated with the flower of mustard or tine ture of cantharides, should be assiduously employed, as well as blisters and the volatile liniment to different parts of the body. The warm bath has been frequently used as an external stimulant in cases of palsy; the utility of this rem- edy however, will depend entirely on the particular circum- stances of the case. When there is evidently a diminished degree of vital heat or action, and the constitution is enfee- bled, the warm bath will undoubtedly be productive of real beneficial effects. Electricity and galvanism are powerful remedies as external stimulants; they are often successful when moderately applied, and should perhaps in every in- stance be employed, and long persisted in. The swamp sumach, (rhus toxicodendron,) has been extolled as a stimu- lant in cases of palsy and extremje^debility, and even in the palsy of the lower extremities, from distortion of the spine. The powder of the dried leaves h.as been given from a third OF THE PALSY. 545 of a grain three times a day, fo one drachm ; but from its deleterious qualities, much caution is necessary in its ad- ministration. In a palsy of the tongue, the patient should frequently gargle his mouth with brandy and mustard, and hold in it a bit of sugar wet with fhe compound spirits of lavender, and the valerian root and mustard seed taken in- ternally will also be useful. In that palsy of the lower extremities arising from a de- formity of the spine, when the ligaments which connect the vertebrae together are thickened, without any particular af- fection of the bones, the most successful mode of treatment is to insert issues as near as possible to fhe tumour; for this purpose, a large caustic should be applied on each side of the protuberant vertebra?, and the discharge promoted and kept up for a length of time, by sprinkling the sore with powdered cantharides ; or instead of this, a seton may be preferred. In those paralytic affections proceeding from the poison of lead, a moderate course of mercury has proved of the greatest utility. (See nervous colic.) Those paralytic shakings or tremblings of the hands or other parts, which are frequently owing to intemperance, may in general be treated as a partial palsy, but chiefly by the external appli- cations already mentioned. When the patient from a long continuance of the disease, sinks into a state of debility, with loss of appetite, he should have recourse to Peruvian bark and stomach bitters. In every instance of palsy, the patient should fake daily exercise if possible, either by walking or on horseback, as his strength will permit. Frictions with strong stimulants should on no account be neglected. Flannel must be worn next the skin, and all exposure to cold and damp air ought to be carefully avoided. In Townsend's Guide to Health several cases are recorded of palsy occasioned by worms, and which were cured by anthelmintic medicines. The use of splints in cases of paralysis of the muscles of the extremities has been found of great utility. They should be applied in a manner similar to that practised in fractured limbs, being long enough to reach from one joint to another, and sufficiently firm to support the limb, and the apparatus to be removed every four or five days and again replaced. In many cases of paralytic limbs, this method is said to have been attended with obvious advantages, and had a considerable influence in accelerating the cure. See New- England Medical Journal, ¥o* IV. p. 333. 69 CHAPTER XXX. ASTHMA. THIS spasmodic affection of the lungs is distinguished by a peculiar difficulty of respiration, and is most frequent in the decline of life, and more incident to men than women. It is frequently an hereditary disease, though it does not commonly appear before the age of puberty. When fhe disease is attended with a discharge of humours from the lungs, it is called the humid asthma; but when no expecto- ration takes place it is named the dry or spasmodic asthma; though in fact both species appear to partake of a spasmod- ic nature. The paroxysms, which generally commence in the night, are often preceded by lassitude, torpor, drowsi- ness, a sense of weight or pain of the head; and symptoms of dyspepsia or indigestion seem to be connected with the disease. During the first sleep or soon after, the patient is seized with a sense of tightness and stricture across the chest, and a feeling of uneasy oppression in the lungs, im- peding respiration. There is either no cough present, or it is not attended with any expectoration ; the patient, if in a horizontal position, is obliged immediately to become erect, and to fly for relief to the open window. The difficulty of breathing increases, and is attended with a wheezing noise, the voice is weak, and the exertion of talking is more or less painful: after these symptoms have continued for some hours, an expectoration of mucus or phlegm takes place, and the symptoms abate, but there is a greater or less degree of tightness across the chest, and of difficulty of breathing throughout the course of the following day ; towards even- ing or about ntidr:&ht, for several successive nights, (he symptoms suffer an exacerbation, and a remission takes place toward morning, and after some days, on the expectoration becoming more copious, the paroxysm ceases altogether. The pulse is for the most part quick, weak, and small, and ASTHMA 547 the urine, which at the commencement of the paroxysm was pale, on its remission becomes high coloured and often de- posits a sediment. Asthma may proceed from any cause that obstructs the circulation of the blood through the lungs ; such as a stop- page of customary evacuations, violent exercise, noxious vapours arising from metals or minerals received into the lungs; impure or smoky air, cold and foggy atmosphere, scrofulous, rheumatic, or gouty and scorbutic acrimony ; and from a weak digestion, attended with great flatulency and general debility. In the treatment of asthma, if the patient is young and of a plethoric habit, moderate blood-letting in the paroxysm may afford some relief, but in general this operation is inad- missible, and elderly persons have too often been injured by the practice. Cupping between the shoulders frequent- ly proves beneficial; gentle laxatives and clysters should be employed at proper intervals to keep the bowels regular, and the feet and legs bathed in warm water. But gentle emetics of Ipecacuanha should on no account be dispensed with, and when a paroxysm is about to occur in the course of the night, an emetic exhibited in the evening will gen- erally prevent it. The medicine, however, best adapt- ed to excite vomiting in (his distressing disease, is probably the lobelia inflata, or Indian tobacco. About a table spoon- ful of the saturated tincture, will in general induce a moder- ate vomiting, and if repeated, a copious discharge of viscid mucus, by which great relief is obtained ; the medicine may be repeated as often as the operation is desired, and even independent of its emetic effect when taken in small doses, this medicine procures a freedom of breathing superior to any other known remedy ; and experience has often? induced asthmatic patients to take small doses of it every quarter or half hour during the severity of the paroxysm. With the view to assist and promote expectoration in the moist asth- ma, the lac ammoniacum and syrup of squills should be pre- scribed, either separately or conjoined, and it is believed that squills may be considered as the most valuable expectorant of any in the Materia Medica. The volatile alkali has been known to relieve the dyspnoea during the fit, and if given in the form of spiritus mindereri, a table spoonful every half hour, with about one eighth of a grain of tartar emetic, con- siderable relief may be expected. Strong coffee, without 548 AS MIMA. sugar or milk, has been recommended as being well adapted to abate (he violence of an asthmatic fit; it ough( to be of the best Mocca, newly roasted, and made immediately after grinding, in the proportion of an ounce for one dish, which is to be repealed fresh after the interval of a quarter or half an hour ; by this remedy fits of spasmodic asthma have been cniireiv removed. Blisters and issues have been commonly employed, but they seem to relieve in those cases only which are occasioned by the stoppage of some habitual discharge, or repelled eruption, or in the complicated complaints of old people. When antispasmodics are supposed to be indicat- ed, opium and ether are deemed the most efficacious when combined, and on some occasions they have been taken in large and repeated doses with the happiest effects. Among our valuable antispasmodics, are skunk cabbage and stram- onium, the former of which is capable of alleviating the most distressing symptoms in spasmodic asthma, and being a simple and harmless medicine, may be used in the freest manner, either in powder or infusion, the trial of it ought in no case to be omitted. The stramonium has of late years acquired great repute as a remedy in asthma. If no evi- dence can be adduced of its having effected permanent cures, ample experience affords sufficient attestations of its efficacy as a soothing palliative. It is in general adminis- tered in the form of extract, beginning wilh one grain and increasing gradually until it induces some sensible effect on the system, or until permanent relief is obtained. Other preparations of this plant may be employed as a tincture, syrup, or the dried leaves, but the adequate dose must be properly adjusted. The smoking the prepared herb or dried root, has in numerous instances been remarkably beneficial in relieving the dyspnoea and wheezing, so troublesome to asth- matic patienfs. It has been observed that asthmatic patients are frequent Iy troubled with flatulency of the stomach, acidities, and other symptoms of dyspepsia; for the removal of these complaints, absorbents and bitter infusions, as recommended in dyspepsia, will answer a valuable purpose : opium com- bined with chalk, according to Dr. Bree, will produce excel- lent effects in allaying irritation proceeding from dyspepsia of the first passages. Two table spoonfuls of vinegar and an equal quantity of cold water, has likewise been found very useful in counteracting the flatulence of the stomach and relieving the asthmatic fit. ASTHMA. 549 The digitalis is another medicine recently introduced as a remedy in asthma ; the tincture in doses of fifteen drops, repeated twice a day, has in several instances, as appears by Dr. Thomas' Modern Practice, produced astonishing ef- fects ; the most violent symptoms were greatly mitigated, and the general state of health visibly improved, but its efficacy is said to be increased by the addition of opium. When these two medicines have been given in the dose of half a grain of each, every four or five hours, it has suspended the dis- tressing symptoms, and been highly serviceable in cases of spasmodic asthma. Opium may be combined with other antispasmodics to advantage in some cases of nervous asth- ma, as follows : take of the tincture of wood soot, one ounce, tincture of castor and elixir paragoric, each half an ounce, a tea spoonful for a dose two or three times a day. For the attainment of permanent relief in the dry asthma, nothing it is said, is found fo answer a more valuable pur- pose than eight or ten grains of Ipecacuanha, according to the strength and constitution of the patient, (aken every other morning; this produces the happiest effects, acting some times as a mild emetic, at others as an antispasmodic, or se- dative, allaying the irritation of the nerves ahd preventing a return of the paroxysm. In the intermission of asthmatic paroxysms, it is important that we have recourse to tonics, as the Peruvian bark, stom- ach bitters, and the preparations of iron, to strengthen the habit and obviate the recurrence of the fits; and to assist the effects of these remedies, cold bathing or the shower bath ought not fo be neglected. Issues and setons are ben- eficial in both kinds of asthma, and the use of them should never be discontinued. In every species of asthma, the pa- tient's diet should consist of such things as are light and easy of digestion, carefully avoiding whatever may tend to generate flatulency. Animal food of the lightest kind, taken in a moderate quantity, will be fhe most proper ; garlic and onions are salutary, but other vegetables, and all spirituous and fermented liquors, cider excepted, will prove detriment- al ; proper exercise, as riding and sailing, with a change of air ought to be pursued,. CHAPTER XXXI. JAUNDICE. THIS disease, proceeding from an absorption of fhe bile into fhe blood, begins with a sense of lassitude, languor, and a sensation of pain and tension about the region of the liver; (here is frequently anxiety and some trifling difficulty of breathing ; the white of the eyes and roots of the nails first become yellow, afterwards the whole body, and there gen- erally is an intolerable itching of the skin, and a bitter taste in the mouth,often accompanied with nausea and vomiting, and dyspeptic symptoms; the stools are of a white colour, some- what resembling pipe clay; the urine of an obscure red colour, and tinges linen with a yellow hue; the pulse is generally more quick than natural, except during the passage of a gall stone, when it is slower than in health; the bowels are cos- tive, and there is some degree of fever present. The im- mediate cause of jaundice is an obstruction to the passage of the bile into the intestines, by various means, as gall stones formed in the gall bladder, and forced from thence into the common duct, or viscid bile or mucus, or spasmodic con- striction ; the stoppage of customary evacuations, the bil- ious, or hysteric colic, or strong purges, may produce the disease, as may likewise tumours in*the neighbouring parts, compressing the biliary ducts, as in fhe case of pregnant wo- men, violent passions, and the biles of some poisonous ani- mals. That species of jaundice which originates from bil- iary concretions, or obstructions of the biliary ducts, by vis- cid bile or spasmodic stricture, frequently admits of a cure by a seasonable resort to the proper remedies. The gall stones, although of considerable size, frequently effectuate their passage through the biliary ducts, though with much pain. They have been evacuated of various sizes, from a pea to that of a common walnut; some rough and angular, others round and smooth,. During their passage into the JAUNDICE, 551 duodenum, the patient is exercised wifh acute lancinating pains in the region of the liver and abdomen, but with in- tervals of ease. Sometimes the pain extends up to the shoulders, the intestines are obstinately constipated, and fre- quently a vomiting attends, accompanied with considerable inflammation and fever. When the inflammatory symptoms are severe, in full ple- thoric habits, it will be advisable to evacuate a quantity of blood, according to the urgency of the case, having regard to the age and strength of the patient. He is next to be placed in a warm bath up to his breast, or warm fomenta- tions may be diligently applied to the parts most affected with pain ; and proper doses of opium given every four or six hours, until ease is procured. Emollient clysters, to serve as internal fomentations, should be frequently injected, and diluting drinks may be freely taken. When there is no reason to suspect the concretion to be of any great magni- tude, and when the pain is not violent, nor the inflammation very considerable, the operation of an emetic may have a happy tendency to facilitate the discharge of the calculus, it would seem most eligible to exhibit small doses of Ipecacu- anha, so as to occasion for a time a degree of nausea, but ul- timately, to produce its full effects, and as no remedy is bet- ter adapted for the purpose of dislodging biliary concretions, or viscid bile, obstructing the gall duct, it may be occasion- ally repeated during the cure of the disease. The costive- ness is next to be removed by the use of mild laxatives, as pills formed of rhubarb, castile soap and calomel, or a dose of castor oil if preferred. Gentle exercise on horseback is particularly serviceable in promoting the passage of calculi, and preventing the bile becoming stagnant and viscid in the gall bladder, and liable to obstruct the free passage of it into the duodenum. Electrical shocks passed through the liver and duct at proper intervals, is likewise a good auxiliary in promoting the passage of the calculus. Cicuta has in some instances been employed as a remedy in jaundice, occasion- ed by spasmodic constriction of the biliary ducts. Dr. Fisher of Beverly, reports a variety of cases, in which he has experienced its efficacious and successful result. This medicine must be increased from small doses, to the full ex- tent which the system can sustain, and continued with proper care until the desired object is attained. Jj-J JAUNDICE. If it be discovered that jaundice is owing to scirrhosity, or fixed obstruction in the liver, which may generally be known from a weight in that part, and a darkness of the complexion, the symptoms must be palliated by small doses of calomel and opium, and diuretic medicines. It has been the prac- tice to exhibit neutral salts, with soap and alkalies, as deob- struents in cases of jaundice. They are sometimes useful, and the prescriber may direct them in such form and dose as shall be judged best adapted to the particular case. Many cures have been effected by living almost entirely on raw eggs for several days. On all occasions, when the pain is violent, and other symptoms urgent, recourse must he had to opiates, the warm bath, fomentation*, and emollient clysters; should they fail and should nausea and vomiting continue to be severe, a large blister applied to the pit of the stomach, and the saline draught in the act of efferves- cence, will probably be productive of favourable effects'. During the continuance of the disease, the diet should be light and chiefly of fhe vegetable kind. If in any case a putrid tendency is discovered, recourse should be had to the Peruvian bark and other antiseptic medicines, and after the cessation of the disease, the best preventive of its re- turn, is a course of stomach bitters, with alkaline salts, to- gether with regular and sufficient exercise daily on horse- back, as nothing will tend more to dislodge those concre- tions before they have acquired such size as to render their passage through the ducts an object of difficulty. It has been suggested to me by Professor Smith of New- Haven, and by Dr. I. Allen of Sterling, that the blood root has been successfully employed in jaundice, and other af- fections of the liver. It is used in the same manner as digi- talis, increasing and diminishing the dose from thirty to eighty drops of the tincture, according to the effects produc- ed ; or it may be taken in the form of infusion, or powder, in doses of two or three grains twice in a day, and on some occasions it may be advisable to combine it with opiates. Although it produces its effects on the system more immedi- ately than digitalis, and if given in large doses it occasions great prostration of strength, yet it is not liable like fox-glove, to produce fatal effects. The wild cellendine is said to be another valuable medicine in jaundice and biliary obstruc- tions in general; it may at least be commended as a useful auxiliary, to be employed on all occasions with freedom, in JAUNDICE. 553 strong infusion, during the use of other remedies. In cases of jaundice depending on spasmodic constriction,the extract of stramonium is calculated to afford relief, and a trial of it should be recommended. In the Medical Repository Vol. L 3d series, the following remedy is recommended by Dr. 1. Mace. Salt of tartar, one ounce, castile soap and gum arabic, of each half an ounce, to be dissolved in a pint of common spirits or brandy. Dose two thirds of a wineglass full mixed wifh one third of a glass full of water every morning:. ra CHAPTER XXXIL DROPSY. THIS disease consists in a preternatural collection of wa- tery humours, either under the skin, or contained in some of the cavities of the body. When it occupies the cellular membrane, whether diffused over fhe whole, or a part of the body, it receives the name of anasarca, or leucophlegmatia; when contained in the cavity of the breast, hydrops pecto- ris, or hydrothorax ; when in the brain, hydrocephalus in- ternus ; if in the cavity of the abdomen, ascites, in fhe ute- rus, hydrometra; within the scrotum, hydrocele. The causes which give rise to dropsies are numerous, as excessive and long continued evacuations, especially copi- ous bleedings and strong purgatives ; frequent salivations ; abuse of spirituous liquors ; suppression of customary evac- uations, as the menses and haemorrhoids, scirrhosities of the liver, spleen, mesentery, or other abdominal viscerap; pre- ceding diseases, as jaundice, diarrhaea, dysentery, asthma, intermittents of long duration, and scarlatina, the striking in of eruptive diseases, and whatever disposes the system'to a state of relaxation. The anasarca commonly begins with a swelling of the feet and ankles, only in the evening, disappearing again in the morning ; the swelling is soft and inelastic, and when pressed with the finger, will pit like dough, and the impres- sion remains for some time. The swelling gradually ascends, and occupies the legs, thighs, trunk of the body, and some- times also the head ; the skin is pale and dry, there is great thirst, the urine diminished in quantify and high coloured; the body is costive, and in the advanced stages of the dis- ease, a considerable degree of dyspnoea, cough, and a slow fever ensue. The ascites is not necessarily connected with a collection of water in any other part of the body, but is not unfrequent- DROPSY. 55* ly combined with anasarca or hydrothorax. It commences with a tumefaction of the abdomen, which gradually increas- es until it is uniformly distended, and there is a distinct fluctuation perceivable by applying one hand to the belly and striking it with the other ; the urine is in small quantity, and of a deep colour ; there is considerable thirst, and more or less fever; the face is generally pale and bloated, and the breathing is difficult when the water is accumulated in a large quantity, pressing against the diaphragm. When the disease arises iu consequence of morbid affections of the liv- er or any other viscera, the general system is frequently not much affected, but the event is always dubious. In the ascites, the water; is on some occasions confined, in different cysts, or in one of the ovaria, in which case the fluctuation is more-obscure, and in the early stage of ovarial dropsy the tumour is situated towards one side of the abdomen, and is less smooth and uniform than in ascites. When too the water is very viscid, or whe*h hydatids are present, the fluc- tuation will be less distinctly perceived. In the hydrothorax the water may be contained in one or bolh sacs of (he pleura, or in the pericardium alone, and they are often blended together. It commences with a sense of oppression and tightness at the end#)f the sternum, with anxiety and difficulty of breathing, the patient being unable (o res.t in bed in a horizontal position, and is afflicted with sudden startings during ^sleep, from a sense*of immediate suffocation. The pulse is small and in the last stage ex- tremeb/ irregular, with palpitations of the heart; the skin is dry, the urine diminished in quantity, the lower extremities become aedematous, the countenance is pale, with a purple hue of the lips and cheeks, there is a cough, at first dry, afterwards attended with expectoration of thin mucus- A fluctuation is sometimes to be perceived, the face svells, and -will pit upon pressure, and great debility and emacia- tion ensue. As the disease advances, these symptoms are greatly aggravated, or others still more distressing supervene. In the first stage of dropsy in a majority of cases in this climatejhigharterialaction and inflammatory diathesis unques- tionably prevail This is clearly evinced by the hard,. tense, chorded pulse, hot and dry skin, parched tongue, and excessive thirst. To these may be added srcy blood, and (he grea( relief obtained by venesection and other de- pleting remedies. Who then will question the propriety. 556 DROPSY. or even (he absolute necessity of blood-letting in (he early stage of dropsical affections ? This was the practice of (he able Professor Rush,, and (he experience of his successors affords ample attestation to its utility. Although this rem- edy is applicable to the different species of dropsy, it is not to be adopted indiscriminately under all circumstances (hat may occur. High arterial action and 1he ordinary'signs of inflammatory diathesis must be regarded as the correct crite- rion and the discerning practitioner's only guide of safety. , When anasarcous aMlematoys swellings .arise from any tumour compressing some lymphatic, or from a lymphatic vessel of a limb being cut, or in case of a-weakness-of a limb, in consequence of a "sprain or bruise, the best method of cure will be to remove the tumour if practicable, to sup- port the weakened v essels by a circular* bandage, or roller applied from the lower extremity upwaeds; and at the same time to employ frictions daily with a solution of crude sal ammoniac and a decoction of* white oak bark, with forge water which is strongly impfegnated wifh iron, and fhe cold bath may also be useful. In some instances of swellings of the legs, proceeding from a deficient action of the absorbents of the lower extremities, cures have baen performed by an universal bath of wat>m sea water, or a substitute may be pre- pared by dissolving a proper quantity ofsalj ln.commop wa- ter, the degree of heat should be moderate* and the immer- sion may be continued about half an hour every night for sometime; the action of the vessels upon the surface must be excited by frictionj«diligently employed* from below up- wards, but never in a contrary direction. The water col- lected in the cellular membrane may often be drawn off by scarifying or puncturing the skin ; the punctures must not however, be made deep,nor near to eaqh other, as gangrene is v^ry apt to ensue in consequence of wounds made in drop- sical cases, especially if in a very dependant part, the best preventive of which is embrocations with camphorated spirits, &,c. to the scarified parts. Blisters and issues are of little use, and not altogether free from a dangerous ten- dency to gangrene, but the application of colewort and burdock leaves serve to moisten the skin and afford some relief. In those cases of dropsy where there is an evident in- creased action of the arterial system, the diet of fhe patient should be mild, soft, and easy, but where debility chiefly pre- DROPSY. 55? vails, a more generous warming cordial diet will be requi- site, such as roasted meat, garlic, mustard, raw onions, &c. Daily exercise is of much utility in all dropsical cases, as it promotes absorption and increases the excretions both by perspiration and urine; it ought to be practised to the full extent of the patierit's strength, while the air which he breathes should be pure, warm, and dry, and flannel should be worn next to the skin. , That emetics are adapted to excite the action of the lymphatic vessels, and promotte absorption of the effused wa- ter is universally agreed. These should be occasionally ad- ministered in both anasarca and ascites. But still greater advantages will be>derived from the judjcious employment of cathartics ", among which it may with confidence be as- serted that cream of tartar and jalap combined is of superior efficacy-in the recent* or inflammatory stage of dropsical complaints. The singular success 'of this remedy in the hffnds of many experienced apd respectable physicians en- title it to the highest praise, and'a steady perseverance in its use cannot be too strongly recommended. In one instance even where venesection had been dispensed wilh, all the symptoms yielded lo a few doses of cream tartar and jalap, acting powerfully .both as cathartic and*diuretic From im- prudent exposure, the disease recurred a few weeks after- wards, and was .completely subdued by the same remedy alone. The proper dose of this medicine is one drachm of the tartar and fifteen or twenty grains of jalap,to be exhibit- ed at proper intervals until a very copious evacuation is ef- fected. Cream of tartar is also well established as one of the most efficacious diuretics in dropsical complaints. With this view, one ounce is directed to be dissolved in a pint of water, and this to be taken in divided doses during the day. Among the mild diuretics well calculated to subdue febrile action in this disease, is nitre in doses of twelve or fifteen grains three times in a day. Equally well suited to these views however, is the dulcified spirits of nitre, if given in large doses,as a table spoonful or half an ounce three or four times in twenty-four hours. This proves less offensive to the stomach than the nitre in powder, and produces favour- able effects as a diuretic and in reducing arterial action. It is not in every case of dropsy that the antiphlogistic and depleting plan is to be long persisted in, nor will it on all occasions be deemed applicable at the commencement. 558 DROPSY. When the system is reduced to a state of debility, and all symptoms oflnflammatory action have subsided, recourse must be had to a more appropriate course of treatment. It is here that the more stimulating and drastic purgatives,as cal- omel, scammonv, colocynth, gamboge, and even elaterium, evince their peculiar efficacy, and that digitalis and squills display their diuretic powers. In every species of dropsy, but more particularly hydrothorax, digitalis remains in high repute, and is (he favourite diuretic in modern practice. The rules first directed by Dr. Withering respecting the administration of digitalis in dropsy, have from long experi- ence and observation become established principles in prac- tice. It is in cases of debility with feeble pulse, pale coun- tenance, and coldness of the surface, and in these circum- stancesonly, that digitalis is successfully administered. The dose in powder is from half a grain to two or three grains morning and evening, or one*drachm of.the dried leaves may be infused in eight ounces of w*ater, and half an ounce of this given twice in a day and gradually increased until the effects of the remedy appear. (See American New Dispensatory, article fox-glove.) Squills combined with nitre in Ihe proportion of from five to ten grains of the dried root, and double, the quantity of ni- tre, has been extolled for ils efficacy in dropsical cases. The tincture of tobacco, in the opinion of some, is entitled to much confidence as a powerful diuretic in dropsical swell- ings. One article more deserving of notice is the oil of tur- pentine ; this stimulating diuretic has, produced favourable effects in doses of six or eight drops, but when exhibited in half ounce doses, undiluted, in cases of tape worm, it oper- ates as a powerful cathartic, and it may probably in this manner prove also a valuable remedy in dropsies. But it is to be remarked, that diuretic medicines very frequently fail when given alone, but act with increased powers when ad- ministered in conjunction4 ^hus, digitalis may be combined with cream of tartar, nitre with squills, and on some occa- sions, calomel may be added to each of fhese with the hap- piest effects. During the employment of diuretics, the pa- tient should be enjoined lo make a liberal use of diluting drinks, as barley water wilh cream of tartar dissolved in it, and a little brandy or Geneva, and sugar added; mustard whey, pure bof'Ied cider and water, &c. The eupatorium purpureum, or trumpet weed is a domestic plant well deserv- BROPSY. 559 lhg of attention as possessing diuretic powers. A strong infusion of the roots of this plant is much used by country physicians as a diuretic, and it should, be recommended in every species of dropsy. Among the articles of domestic and popular use are garlic, water-cresses, and parslej'. This last article was recommended by Dr. Rush, and is said to be a valuable diuretic. A singular expedient for procuring a discharge by urine in ascites, is by long continued friction over the abdomen with fhe fingers dipped in sweet oil, which has succeed- ed when the operation has been repeated daily and perse- vered in. The atonic, or dropsy of debility, known by a weak and quick pulse, and by little or no preternatural heat or thirst, requires a method of treatment somewhat variant from that just described. It consists in fhe use of stimulating sub- stances fo increase arterial action, or to excite the urinary secretions. " Here both the. vegetable and metallic tonics claim our chief regard ; they are stomach bitters, angustura, and Peruvian bark, wilh chalybeates and mercury ; this last, when given so as to excite salivation, has often cured dropsical affections, and calomel combined wifh squills forms an excellent diuretic. Mercurial friction has sometimes been employed till fhe mouth begins fo be affected, when a course of diuretics and tonics has completed the cure. Strength- ening and tonic medicines must be administered during the employment of purgatives, and after the water is evacuated, that class of remedies is indispensably necessary in order to effect a permanent cure. Among the expedients which Dr. Rush enumerates, as of salutary tendency in this dis- ease, are hard labour, fasting, or abstinence from food, and the passion of fear, each of which has been found to induce a sudden increase of the quantity of urine, by which cures were obtained. The operation of tapping for the purpose of drawing off the water in cases of ascites, frequently be- comes of indispensable importance, and it is erroneous to suppose that it ought to be deferred as fhe last resort. If the bowels are suffered fo remain long immersed in the wa- ter, their texfure becomes impaired, and (he case is render- ed incurable. Whenever, (herefore, the abdomen is fully distended with waler, and a proper trial of Ihe usual inter- nal remedies has been made "will-out a prospect of success, it would appear most advisable to have recourse to the op- 560 OROPS\ eration in the manner described in books on surgery, after which, by (he use of (he warmer diuretics, chalybeates, and bitters, together with squills, the re-accumulation of water is sometimes prevented, and a radical cure effected. The cure of hydrothorax is to be attempted upon the same general plan with lhat of anasarca; the digitalis or squills, combined with calomel and opium, are chiefly to be relied on : antimonial diaphoretics and blisters applied in succession to different parts of the thorax, will probably af- ford some relief. On the failure of these remedies, and if a fluctuation is clearly perceptible, it will be advisable to have recourse lo the operation of paracentesis of the tho- rax. - For the treatment of hydrocele, the proper books on sur- gery must be consulted. CHAPTER XXXIII. TYMPANY. THIS disease is a flatulent distention of the belly,, and the wind is eitiier pent up in the intestinal canal, or confined between the intestines and the membranes which line the muscles of the abdomen. In the former instance, the tu- mour of the belly is often unequal, and there is a frequent explosion of wind, alleviating both the tension and pain; but in the latter species the tumefaction is more equal, and the emission of wind, which is less frequent, affords not such evi- dent relief. This complaint is generally preceded by an unusual flat- ulency in the stomach and intestines ; as the disease advan- ces, there is a constant desire to discharge wind, which is attended with much difficulty, and affords but transient re- lief; there is at the same time costiveness and occasional colic pains. The abdomen soon becomes extremely swell- ed, which does not yield much to pressure, but is very elas- tic and sounds like a drum, and no fluctuation can be per- ceived. It may be distinguished from ascites by the tense feeling of the abdomen, by the quick reaction of the parts after removing the pressure of the finger, by the absence of fluctuation, by the frequent desire to belch, and by the urine being at first not altered, either in quantity or quality. In almost every instance, this proves an obstinate and dangerous disease, and the patient after long suffering, is frequently destroyed in consequence of a gangrene of the intestines. With the view of a cure, the patient should abstain from all flatulent vegetables and fermented liquors. If much fe- ver and a full pulse attend, it may be proper to bleed; the air in the intestines must be evacuated by mild laxatives joined with aromatics and the essential oils of anise and ju- niper ; opiates and other antispasmodics must be administer- ed ; injections of the infusion or smoke of tobacco are par- 71 562 TYMPANY. ticularly recommended. The abdomen should b« frequent- ly rubbed wi(h stimulating linimente, and swathed with a flannel bandage ; a blister, or bags of warm bran, sand, or salt, may also be applied; but to excite the action of the intestines, nothing is better adapted than snow or very cold water applied to the abdomen. The Peruvian bark and chalybeates should be given, combined with carminatives and aromatics, such as the essential oils, elixir vitriol, ginger, and a little Geneva, or other spirits diluted with water. A clyster pipe should be frequently introduced into the rec- tum, and allowed to remain there for some time. When the air is known to be diffused in the cavity of the abdomen, relief, in desperate cases, is sometimes obtained by the op- eration of paracentesis or tapping ; after which the system must be invigorated by gentle exercise, and the stomachic and tonic medicines already recommended. CHAPTER XXXIV. SCURVY. THE genuine sea scurvy prevails most in cold climates, and chiefly affects sailors and such as are confined in close places, and whose diet consists principally of salted or pu- trescent substances ; but more especially if to these causes are added indolence, neglect of cleanliness, much fatigue, despondency, cold and damp air, and whatever depresses (he nervous energy. The first symptom in general is a soreness of the gums, which are affected with a spongy swelling, and bleed upon the least touch; there is great lassitude, heaviness, and dif- ficulty of breathing, particularly after motion ; the face be- comes sallow and bloated, and the breath offensive: as the disease advances, purple or livid spots, resembling bruise marks and flea-bites, appear on the skin, and on the fleshy parts of the legs hard substances are felt; blood frequently issues from the nose, mouth, anus, urinary passages, and sometimes even from the pores of the skin ; the legs near the ankles become sedematous, and the hands become con- tracted and rigid. The catching of the breath on motion, with the loss of strength, dejection of spirits, and putrid gums, are regarded as the distinguishing and characteristic symptoms of the disease- Persons on shore, who have not been exposed to the usual causes of scurvy, are sometimes affected with slight blotches and scaly eruptions on different parts of the body, and a sponginess of the gums, unattend- ed by any more violent symptoms. When the scurvy has been contracted by the long use of salted or putrid provisions, it will be most certainly remov- ed by fresh vegetables, and the expressed juice of lemons, limes, oranges, apples, and other subacid fruils of every description; and it is worthy of remark, that the less the patient is confined to animal food for some time, the more 664 SCURVY speedy will be the recovery, unless, however, the strength of the patient is greatly reduced, and vegetables disagree wi'.h the stomach, when he may indulge in some animal food of the lighter kind, joined with vegetables, either fresh, or if rot to be procured, then in a pickled or preserved state, such as celery, water-cresses, scurvy-grass, cabbages, mus- tard, horse-radish, &c. The essence of malt or of spruce will often be found of considerable service as a medicinal drink ; bue use of unwholesome and putrid food, and by noxious exhalations and vapours, hence it is frequent in camps and ships, and other places where a number of people are assembled under circumstances favourable for its production. It is most prevalent in autumn, and is frequently of a contagious na- ture, and in some particular conditions of the atmosphere it prevails epidemically. This disease is most commonly preceded by costiveness, unusual flatulence, acid eructations, and wandering pains in the bowels ; in most cases however, from the commence- ment, griping pains are felt in the lower part of the abdo- men, which often arise to a considerable degree of severity; the bowels are irritated to frequent evacuation, in indulging which, but little is voided, and the rectum often becomes exquisitely painful and tender; the matter evacuated is often very foetid, and the stools are frequently composed of mu- cus, pus, blood, membranous films, and white lumps of a sebaceous nature, the mucus is generally mixed with a wa- tery fluid, and is often frothy: tenesmus in/a greater or less degree generally accompanies the evacuation of the bowels, and it very rarely happens that natural foeces appear during the whole course of the disease, and when they do, they are in the form of scybala, that is, small separate balls, which * appear to have lain long in the cells of the colon ; when 588 DYSENTERY. these are voided, either by Ihe efforts of nature, or as solic- ited by medicine, they procure a remission of all the symp- toms, more especially of the frequeut stools, griping and tenesmus; with these symptoms there is loss of appetite, great anxiety about the praecordia, frequent sickness, nausea, vomiting, and fhe matter ejected is frequently bilious, watch- fulness, and prostration of strength: there is always some degree of symptomatic fever, which is sometimes of the re- mittent or intermittent type ; sometimes it assumes the syn- ochous, and very frequently the typhous type: the tongue is white and covered with tough mucus, or rough, dry, and sometimes black ; the patient complains of a bitter taste in the mouth, and in the advanced stage of the disease there is hiccup and aphthae. When the fever attending the dysentery is of a violent in- flammatory kind, and especially when it is of a highly putrid nature, the disease often terminates fatally in a few days by a gangrene, or mortification of some part of the bowels; but when the attendant fever is moderate, or entirely disappears, the disease is often protracted for weeks, and even months. If vomiting, hiccup, greenish or black stools, with an ex- treme putrid smell occur in this disease, the danger is great; ajid when the pulse becomes weak, and the extremities cold, wjth difficulty of swallowing, and convulsions, death will soon close the scene. In the curative treatment, particular regard should be paid -to the prominent symptoms, carefully discriminating between those which attend the early stage, and those which succeed at a later period, that the remedies may be properly appro- priated to the different stages and circumstances. If the disease is attended with acute pains, and a tenderness of the abdomen, indicating inflammation of the coats of the intes- tines, venesection is obviously indispensable, and the neces- sity of a repetition must be determined by the continuance of inflammatory symptoms, whether the pulse be full m:d tense, or small, frequent, and more or less hard. In warm climates however, this practice must be pursued with a de- gree of caution, as the employment of powerful antiphlogis- tic measures is often succeeded by a sudden and dangeroun debility, and the fever which attends is v e: y apt to assume a typhoid type. We may however, always begin wifh emet- ics, which are not only useful in emptying the stomach and bowels, but they also determine to the surface. The most DYSENTERY. .'>89 efficacious emetic is Ipecacuanha and tartarized antimony combined, and after the operation of the first full dose, small- er doses of the same may be advantageously employed. The morbid and noxious contents of the intestines, the pernicious source of the irritation, must be expelled by cathartics, and calomel is one of fhe most efficacious, but it should always be combined with some antimonial preparation, as fhe tar- trife or cerated glass of antimony ; from six to ten grains of this last, with an equal quantity of calomel is greatly extoll- ed by many practitioners as an excellent cathartic in fhe early stage of dysentery ; but in general it will be more ad- visable to begin wifh smaller doses, increasing according to the effect produced. Among the other cathartics fo be rec- ommended, the Epsom or Glauber's salts, castor oil, extract of butternut, crystals of tartar and manna, form an ample variety for the choice of the prescriber. During the inter- vals of the operation of the cathartics, small doses of calomel and opium, as directed in fevers, will be productive of ex- cellent effects, by opening the secretions, deterging the in- testines, and abating distressing pain. Nauseating doses of Ipecacuanha, as two or three grains three times a day, will prove useful by impelling the fluids towards the surface of the body ; and this is in fact, one of the most important curative indications. There is almost constantly a diminish- ed action in the extreme vessels, and a coldness and dryness of the skin ; nothing can be more important than to restore and equalize the circulation, and thereby induce a salutary diaphoresis. With this view the most efficacious diapho- retics accompanied by friction, and the means of external heat, must be diligently and perseveringly applied. Per- haps no diaphoretic is to be preferred to Dover's powder with the addition of a few grains of camphor to each dose, this should be administered in such manner as fo excite some nausea, and repeated every few hours until free sweat- ing be induced, and this continued for several hours, the patient being properly secured from fhe access of cold air. For the purpose of imparting external warmth, no method is to be preferred to Dr. Jennings' steam bath; when this can- not be obtained, heated billets of wood, bladders or jugs of water, or heated bricks frequently renewed, may be substi- tuted. It has recently been announced by Dr. T. Clark, an English physician, that a decoction of the root of Ipecac- uanha has been administered as injections in dysentery 590 HYSENTERY. with surprising success, and the practice has been success- fully adopted by others. He directs for an adult, three drachms of the bruised root to be boiled in a quart of water down fo a pint, strained and given all at once by way of enema, and repeated if necessary. The following preparn- tion has by common report, gained some reputation as a remedy in this disease. Add fo lemon juice, or strong vin- egar, as much common salt as the acid will dissolve. Givs a large spoonful of (his in a cup of mint tea, or hot water, sweetened, every two or three hours. After the proper evacuations have been made, opiates become indispensable to allay irritation; the extract of hyoscyamus, by its ano- dyne and gently laxative qualities, is also well adapted to this disease. Where languor and coldness of the surface and extremities have supervened, the repeated application of blisters and warm frictions to the extremities are auxilia- ries of peculiar importance. The warm bath, or semicupi- um, or the partial fomentation of fhe abdomen, is often used with much advantage, and should in general be advised, especially where the abdomen is hard, fense, and painful to the touch, and fhe gripings are frequent and severe ; cam- phorated spirits should be added to the fomentation, and if these fail to afford relief, a large blister must be applied to the region of the abdomen. Should an obstinate vomiting attend, it will be highly important to bathe the region of the stomach wifh tincture of opium and camphorated spirits, and to inject into the intestines, proper quantities of opium until relief is obtained. With the view of abating the tenes- mus, or continual straining, and desire of going fo stool, which is one of the most distressing symptoms of this disease, clys- ters made of half an ounce of powdered starch, dissolved in half a pint of barley water, or fhe same quantity of fat mut- ton broth, without the starch, with forty drops of laudanum, should be given twice every day. The pain attending the tenesmus may also be allayed by fomenting the anus wilh a decoction of chamomile flowers with some tincture of opi- um sprinkled on the cloths which are applied. If strangu- ry should occur, it will be effectually relieved by fomenting the pubes and perinaeum. During the whole course of this distressing disorder, mucilaginous demulcent liquids must be given in the most liberal manner, for the purpose of de- fending the intestines against fhe jacriraony of their contents, and alleviating the violent gripings which often prevail. DYSENTERY. 591 For this intention one ounce of gum arabic dissolved in a pint of barley water, or half a drachm of spermaceti mixed with the mucilage of gum arabic, may be advantageously employed, as also mucilage of slippery elm bark or linseed tea. In the advanced and chronic sfage of the disease, as acid- ity of the stomach chiefly prevails at that period, absorbents will be useful, as the chalk mixture, lime water, or the com- pound powder of chalk combined with opiates ; astringents will also at this period of the disease be proper, as the kino, logwood, alum and catechu ; when there exists a remarkaLle degree of debility, with a frequent discharge of stools without pain, small doses of white vitriol with opium, is well adapted to remove the complaint. Dr. Mosely of Jamaica, asserts that in chronic dysentery, unattended with fever, there is not a more efficacious remedy than the following solution taken every morning, and an opiate at bed time. Take sul- })hate of zinc, three drachms, alum, two drachms, spirits of avender, half an ounce, boiling water, one pint. Dose for an adult from four to six drachms on an empty stomach without diluting it; in severe cases fo be repeated every six hours. When evacuations are required, the quantity of alum may be diminished, or entirely omitted; and when astringency is required, the alum increased, and the sulphate of zinc diminished. I have been informed from a source deserving of credit, that in some parts of the state of New-York, the root of the'com- mon blue flag is employed as a successful domestic remedy in dysentery; and one case has been reported to me by Dr. E. Sergeant of Lee, in which the discharges were bloody, acrid,4 and attended with severe gripes ; the patient without advice took a table spoonful of the powdered root of blue flag, the effect of which was immediately favourable, the pain was relieved, the stools were changed in appearance, and the next day he was in a state of convalescence, and he soon recovered. In the last stage of dysentery the tone of the bowels must be restored by administering the simarouba, quassia, cinchona, angustura, logwood, white oak bark, or columbo, some of these in Port wine and a little cinnamon added will answer a valua- ble purpose, and a dose of calomel and rhubarb should be occasionally administered in this chronic form of the disease. Opium combined with the nitric acid, according to Dr. Thomas, has on various trials been found to have been at- 592 DYSENTERY tended with the best effects in the advanced stage of dys- entery, when all other remedies have proved ineffectual, and even in cases where death seemed almost inevitable. It is administered in the following form: take nitric acid, two drachms, opium, two grains, pure water, three ounces, mix and give a table spoonful three times in a day. If this disease should be complicated wilh an intermittent fever, and protracted chiefly from that circumstance, the cure must be performed by the Peruvian bark. The diet in the first stage should consist of milk, sago, pa- nado, arrow root, jellies, veal or chicken broth, rice, gruel, &c. During the whole course of this disease the patient should wear a flannel roller round the body, as recommended by Mr. Dewar. In the application of this excellent contrivance four or five folds of flannel is first to be laid over the abdomen and then a flannel bandage moderately tight should extend from the groin to the arm-pit. The advantages of this application are supposed by some to supersede fhe use of the warm bath, fomentations, and all other external remedies. In fhe chronic form of dysentery particularly, no application has ever been found o*f equal utility. It effectually obviates the impression of cold, imparts new vigour and energy to the torpid and languid vessels, and affords a mechanical support to the intestinal canal. In the putrid dysentery, or when there is much bile in the stomach and bowels, the patient may be allowed to eat freely of any of the common fruits when ripe, such as apples, cherries, grapes, strawberries, currants, &c. The drink at the commencement should be either barley or rice water, boiling water poured upon toasted bread, whey, or the decoction of hartshorn ; in the advanced stage of the disease Port wine, or Madeira, or a moderate quantity of spirits di- luted with water will be proper ; chamomile or thoroughwort tea if not offensive to the stomach, will often be useful. It yet remains fo be observed, that as dysentery is often of a very contagious nature, every precaution should be taken to prevent its spreading; both the patient and his apartment should be kept as clean as possible. Every thing about him should be frequently changed; his excre- ments as soon as voided, ought to be carried off and buried under ground ; a free ventilation should be kept up in his chamber by means of the door and windows : and the floor ought frequently to be sprinkled with vinegar, and its vapour diffused through the room. CHAPTER XL. COSTIVENESS AND THE HJEMORRHOIDES, OR PILES. A COSTIVENESS, or retention of the excrements, ac- companied with an unusual hardness and dryness, so as to render the evacuation difficult and somewhat painful, is either constitutional or accidental, and may prove the cause of dif- ferent complaints. Sedentary persons are peculiarly liable to this disorder, especially those of sanguineous and choleric temperaments, or who are subject to hypochondriac affec- tions, the gout, acute fevers, and bilious disorders. Cos- tiveness often becomes habitual by neglecting the usual time of going to stool, and checking the natural tendency to those salutary exertions; by an extraordinary heat of the body, and copious sweats, by taking into the stomach a large pro- portion of solid food, or such as is dry, heating and difficult of digestion; by drinking hard water, rough red wines or other astringent liquors, and by too much riding on horseback. When costiveness is not constitutional, it is apt to occa- sion pains of the head, vomiting, flatulence, colics, and dif- ferent disorders of the bowels. There is a species of cos- tiveness incident to persons much relaxed, and which is at- tended with great pain in the lower part of the rectum ; the faeces being so extremely hardened that the person is unable to protrude them. In this case the best remedy is clysters of oil, which by lubricating the passage will facili-, tate the discharge. Those who are afflicted with this com- plaint should visit the customary house of retreat every morning at a stated hour, and thus endeavour to promote the natural evacuation by moderate efforts, even though they may not perhaps be much inclined, and should not at first succeed ; for experience has proved that nature will in this respect by perseverance acquire a habit of regularity. The most proper time for that purpose is either early in the morning or late in the evening, and never neglect the solici- tations of nature. It should be considered that as purgatives 75 594 COSTIVENESS AND Till tend to weaken the bowels, and that a constant use of them rather confirms the complaint, it is bef ter to obviate costive- ness by means of diet than medicine. Let fhose therefore who are subject to it, avoid all astringent food and drink, and chiefly confine themselves to aliments of a moistening and laxative kind, such as veal broth, boiled meats, apples roasted or boiled* stewed prunes, raisins, and ripe fruits in general with a large proportion of vegetables and soft pot herbs, such as spinage and leeks with the roots of turnips and parsnips. Butter, honey, and sugar, are likewise suita- ble articles of dieti Bread composed of Indian corn meal and rye, and eaten not till the day after being baked, ought to be preferred. The most suitable drinks are molasses and water, whey, butter-milk, and malt liquors of a moderate strength. When laxative medicines become necessary to obviate costiveness, those should be chosen which occasion the least heat or irritation : nothing has been more popular for this purpose than Anderson's pills, and in phlegmatic constitutions they are both convenient and useful, but in pregnant women and in bilious habits, a long continued use of these or other aloetic pills are apt to induce piles; and besides every purgative medicine creates a necessity for ifs repetition, and by this repetition the bowels lose fheir energy and their delicate nerves become torpid. A very suitable laxative in costive habits is the extract of butternut or flow- ers of sulphur and cream of tartar, equal parts, a heaped tea spoonful with molasses every night and morning ; or the person may chew a little rhubarb at his leisure. In bilious habits, and such as are troubled wifh indigestion, no laxative is to be preferred to a pill composed of one or two grains of Ipecacuanha, and the same quantity of rhubarb taken once or twice in a day; if it excite nausea reduce the quantity of Ipecacuanha. When obstinate costiveness has once taken place, the powdered charcoal has been administered with remarkable success. Three drachms of it finely powdered may be mix- ed with three winces of the lenitive electuary, adding about two drachms of the carbonate of soda, of which from half an ounce to one ounce may be taken as circumstances require. Of the Hemorrhoides, or Piles. This distressing complaint is known by painful small tu- mours, distinguished into the external and internal, according to their situation, either without or within the anus. HiEMORRHOIDES, OR PILES. /1 696 When blood is discharged from thetumours, it is called th« bleeding piles, and when there is no discharge of blood it has the name of blind piles. This complaint may proceed from habitual costiveness, plethora, hard riding on horseback, strong aloetic purges, and^a stoppage of customary evacuation*, sitting on damp ground, repeated and long continued pressure on the lower part of the rectum by the uterus during pregnancy, impeding the return of venous blood from thai part. - ■<• This affection is generally accompanied with a sensation of weight, pain, or giddiness in the head, difficulty of breath* ing, nausea, and sickness, pains in the back, loins, and anus, and sometimes attended with febrile symptoms. A pungent pain is felt about the anus on going to stool, and if the tu- mours about the verge of the anus burst, a quantity of blood is voided, and much relief from pain is immediately obtained. Sometimes considerable blood is discharged without the faeces. When the piles exist in the state of tumour and the pain is severe, the principal objects are to counteract the inflam- mation and promote a discharge of blood from the part, in which case blood-letting from the arm has occasionally been of essential service, and the application of leeches as near as possible to the tumours will often be found no less advantage- ous ; but should these fail to draw blood, the piles may be opened with a lancet with ease and safety;.after which, emollient"cataplasms and fomentations should be applied- As costiveness is the moat frequent cause of piles, this must be obviated by mild laxatives, and none appears to be more efficacious than the internal use of the flower9 of sul- pur combined with an equal quantity of cream of tartar, and double the quantity of the lenitive electuary, a> tea spoonful of which two or three times in a day ; or the extract of but- ternut may be substituted. The balsam copaiva in doses of forty to sixty drops morning and evening frequently produc- es a laxative effect, and relieves the pain arising from ihe piles, and on some occasions performs a permanent cure. Digitalis is said by Dr. Thomas to have afforded.immediate relief in a most violent cr.se of external and (internal piles; when given in tincture to the extent *f forty drops. But the method of curing the piles by the phytolacca decandra, or garget, by some called coakum, I conceive to be more eli- gible and successful than any other which I have experienc- ed. It was first communicated to me by Dr. J* Leonard of Sandwich, who directs a strong infusion of the lfeayes .or COSTIVENESS AND THE HJEMORRHOIDES, OR PILES. roots of this plant to be given in doses of about two table Bpoonfuls three or four limes in a day, and if it fails to cure in about forty-eight hours, a quantity of the same infusion is to be injected into the rectum by way of clyster, and a few repetitions of this will in general answer the desired purpose. In some instances however, where considerable inflammation i, prevails, the cure has been facilitated by the previous admin- istration of calomel and opium, in small doses for a few days. In some instances a prolapsus ani will be a troublesome attendant on the piles, in which case the intestine must be immediately replaced after every evacuation by pressing gently upon the anus with the fingers until the reduction of the gut is completed, and ils return must be prevented by astringent applications, as. a strong decoction of oak bark or nut-galls in forge water applied cold; vinegar in which a little alum has been dissolved may also be used for the same purpose, and the parts may be washed with cold water; as a general tonic,#he cold bath will be beneficial. When the bleeding piles return periodically, once in three or four weeks as sometimes happens, it is to be considered as a salutary discharge, by freeing fhe constitution of a re- dundancy of blood, and ought therefore not to be stopped un- less it becomes so excessive as to weaken the patient, in which case the Peruvian bark and elixir vitriol must be prescribed, and the astringent applications above mentioned assiduously employed; besides which, a weak solution of alum in the oak bark decoction may be injected into the rectum, or three or four grains of the acetite of lead dissolved in water may be substituted. When in the external piles the tumours are painful and swelled, without discharging blood, some relief may be ob- tained by making a firm and gentle pressure of the piles be- tween the finger and thumb, and the patient may be further relieved by sitting over the steams of hot water, and after- wards applying a little of the simple ointment, with the addi- tion of a tea spoonful of laudanum, or a mixture of lead water and laudanum, or the stramonium ointment may be advan- tageously employed. AH the remote causes, particularly plethora and costive- ness, both doring the disease and afterwards, must be studi- ously avoided; riding on horseback or a sedentary life, a full diet, and intemperance in the use of spiritous liquors, all have a pernicious tendency in those who are afflicted with haemorr- hoides. CHAPTER XLI. OP THE DIABETES AND OTHER AFFECTIONS OF THE URINARY ORGANS. A DIABETES is a distressing and in general a very obstinate disease. The chief symptom is a very copious discharge of limpid sweet urine, often exceeding in quantity all the liquids which the patient takes into his stomach. It is clear, pale, commonly sweet to the taste, and has generally an agreeable smell, when it is called diabekis raellitus ; and when the urine is limpid and not sweetish, it is termed diabetus insipidus, but this distinction is of no utility in prac- tice. The patient complains of intense thirst with a keen appe- tite at first, a parched mouth with constant spitting of a thick viscid phlegm of a mawkish, sweetish, or bitterish taste, a whitish tongue with red bright edges ; there is a head-ach and a dry hot skin, with flushing of the face, and the pulse is small and quick, there is likewise an uneasiness of the stomach and kidneys, with a fulness of the loins, testicles, and feet, a weariness and disinclination to motion or exertion, costiveness, mental debility, weakness and emaciation. A diabetes may proceed either from too dissolved a state of the blood, or some fault of the stomach or kidneys, wheth- er a relaxation of those organs or a morbid stimulus applied to them. It is sometimes the consequence of acute diseases in which the patient's strength has been reduced by exces- sive evacuations,it may be occasioned by hard drinking, and by strong diuretic medicines. But it has occurred in many instances without any obvious cause. This disease is sometimes attended with febrile symp- toms indicating inflammatory diathesis, in which case small bleedings and low diet will be proper; but in general it pro- ceeds from a diseased state of fhe stomach and of fhe natur- al powers of digestion and assimulation. The cure is there- 598 OF THE D1XBETES AND OTHER AFFECTION'S fore to be attempted by a regimen and medicines calculated to prevent the formation of saccharine matter, and to dimin- ish the increased action of Ihe stomach. The patient must in the first place submit fo an entire abstinence from every species of vegetable matter, and adopt a diet solely of ani- mal food, and that in as small quantifies as the stomach will be satisfied wilh; jellies, sago, and shell fish may be allowed, and the drink should be lime wafer in which some oak bark has been infused, or the white decoction mentioned in fhe Appendix. It will in most instances be advisable to admin isfer an emetic of Ipecacuanha, and as a mild laxative ten grains or more of the powder of rhubarb may be taken daily, supporting at (he same time the perspiration by wearing flannel next the skin, and taking every other night a moder- ate dose of the compound powder of Ipecacuanha. The next class of remedies commonly employed in this disease, consists of astringent^ and tonics. Of equal parts of gum kino, catechu, alum, and gum arabic, all powdered and mixed together, the patient may fake forty grains three or four times in a day, drinking after it a cup of lime water in which some oak bark has been infused. Alum whey which is made by boiling over a slow fire two quarts of milk with three drachms of alum fill the curd separates is likewise highly beneficial; and Ihe infusion of nut-galls with lime water has been found useful. In some cases depending on general debility, the acetite of lead in doses of two grains twice in a day has proved successful. The pills of acetite of lead and Ipecacuanha mentioned in the American New Dispensatory would probably be found a valuable prepara- tion in this disease. Opiates will be requisite to allay the irritation of fhe kidneys, on which account fhe patient may take ten drops of laudanum in a cup of drink three or four times a day. The tonic medicines most commonly employ- ed are cinchona, myrrh, and chalybeates, as directed under the head of dyspepsia, together with the cold bathing. Dr. Ferriar has succeeded in three cases by giving twenty grains of cinchona with the same quantity of uva ursi, and half a grain of opium four times a day, and lime water for the com- mon drink. Dr. Rollo, a late and very excellent writer on this disease, recommends besides a diet consisting wholly of animal food, the hepatized ammonia which is prepared by making a stream of pure hepatic gas pass through the aqua ammonia unfil the alkali is saturated. The dose to an adult OF THE URINARY ORGANS. 599 should not at first exceed three or four drops three or four times in a day, and this dose is lo be increased gradually so as to produce a slight giddiness; it should be taken immedi- ately after being dropped from the phial in a little pure wa- ter. The nitric acid is another remedy reputed to have cured diabetes when a total abstinence from all vegetable food has been strictly observed. But upon the whole ac- cording to the observations of Dr. Thomas, a total absti- nence from vegetables and the employment of animal food together with the nitric acid, opiates, blisters to fhe loins, and the warm or tepid bath comprehend the general and most successful method of cure, and that a steady perse- verance in the proper regimen alone, will often arrest the progress of the diabetic symptoms and bring the patient in- to a state of convalescence; but that the bark, astringents, and alkalies, either alone or combined with sulphur, (such as the hepatized ammonia,) afford little assisfance in subduing diab- etes, or even arresting the progress of its characteristic symptoms. In order to restore the patient fo general health and strength, an admixture of vegelableand animal food is to be gradually and cautiously entered upon as soon as ever the saccharine impregnation of the urine and the voracious appetite have disappeared. " The variety of means by which nature is capable of attaining the same end has been seldom more remarkably exemplified than in the successful treat- ment of diabetes. By the most opposite means, such for instance as blood-letting and the internal exhibition of opium, the same end has been effected. In support of the efficacy of the former method several very satisfactory cases have been published by the late Dr. Satferley, in one of which one hundred and six ounces of blood were abstracted ; and the relief was so evident even to the patient, that he request- ed a more frequent renewal of the remedy than the doctor deemed it prudent to grant." New-England Journal of Medicine and Surgery, Vol. V. p. 281. Incontinency of Urine. In this disorder the urine passes off involuntarily by drops, but does not exceed the usual quantify, nor is it attended with pain. It may originate from the irritation of the neck of the bladder by stones, or from a paralysis of the sphinc- ter muscle, or from the injury which the parts suffer from 600 OF THE DIABETES AND OTHER AFFECTIONS pressure in difficult labours. It frequently affects children otherwise healthy when asleep ; originating from indolence, so (hat proper correction will prove the most certain reme- dy ; and it is often a real infirmity with people in fhe de- cline of life. Sometimes this complaint is produced by a continued use of strong diuretics, or by injuries received about the neck of fhe bladder in consequence of bruises, hard labour, &c. The most proper remedies for this com- plaint are tonics in general, such as cinchona, preparations of iron, elixir of vitriol, uva ursi, and balsam of copaiva; the cold bath is a valuable remedy ; cold water dashed upon the genital parts, and a cold solution of acetite of lead in vin- egar and water applied to the perinaeum, will often have a powerful effect. But of all the remedies yet employed (here is none so immediately effectual as a blister applied to the os sacrum, or lowermost part of the back-bone. Some sur- prising instances of complete cures in twenty-four hours in obstinate and long continued cases by the application of large blisters are found on record, and this efficacious reme- dy should in no case be neglected. Ischuria, or a Suppression of Urine. A total suppression of urine is called ischuria, when there is a frequent inclination to void urine, and it is discharged in drops, with difficulty and pain, it is termed dysuria, or strangury. A suppression of urine refers more particularly to a defect of the secretion of urine by the kidneys, while a retention implies an inability to expel by the natural efforts the urine contained in the bladder. Persons advanced in life are particularly subject to this last complaint, which of- ten arises from neglecting or resisting the calls of nature, and holding the urine too long, or from a paralysis of the blad- der. This complaint to which all are liable, may proceed from a variety of causes, and the particular symptoms com- monly designate the original seat of the disease. It may arise from an inflammation of the kidneys or bladder; gravel, or small stones obstructing the urinary passages ; a spasm, or contraction of the neck of the bladder; acrid injections, can- tharides,either internally or externally applied ; fumour, or ul- cer of the prostrate gland; hard faeces lying at fhe bottom of the rectum ; a large extension of the haemorrhoidal veins; pressure of the pregnant uterus, &c. When the cause of is- OF THE URINARY ORGANS. 601 churia exists in the kidneys, the patient complains of pain or an uneasy sensation of weight in the region of the kidneys without any tumour, or fulness about the bladder, or inclin- ation to make water, and is often accompanied with numb- ness of the thigh, nausea, and vomiting. W hen the ureters are the part affected, there is a sense of pain or uneasiness in the course of those ducts. When the complaint proceeds from the bladder, there is a circumscribed tumour, or dis- tension of the lower part of the belly, and an acute or ob- tuse pain is felt about the neck of the bladder, attended with a frequent inclination to make water. When tlie cause of the suppression is in the urethra, there is a pain in some part of that passage, accompanied with the symptoms last mentioned. If a scirrhus of the prostrate gland has occa- sioned the suppression or difficulty of urine, a hard indo- lent tumour, unattended with any acute pain, may readily be felt in the perineum, or by introducing the finger into the anus. It sometimes happens that a dysuria lakes place in consequence of the application of a blister, this may be re- moved by drinking plentifully of warm diluting liquors, such as barley water, linseed tea, or a solution of gum arabic. In all cases of suppression of urine it will be advisable in the early stage of the disease, to have recourse fo blood-let- ting from the arm in a quantity proportioned to the strength of the patient and urgency of the symptoms ; and this should be followed by gentle purgatives of senna and manna, or Glauber's salts ; emollient clysters, which tend not only to obviate costiveness, but have the effect of an infernal fomen- tation, and allay the spasm of the bladder and contiguous parts, ought to be diligently employed. The warm bath, by sitting up to the middle of the body in warm water, or the application of emollient fomentations to the abdomen, will in general be found of much utility. We are advised in every instance of this complamt, whether arising from in- flammation, stricture, gravel, or spasm, to administer repeat- ed doses of opium, but it will be more efficacious if combin- ed with mild diuretics. The following preparation will sel- dom fail of aftbrding more permanent advantage and relief in all the various complaints of the bladder and urinary passages than any other remedy. Take spiritus nitri dul- cis, half an ounce, liquid laudanum, one drachm, two thirds or the w hole for one dose, and repeat every half hour if necessarv. The application of ice or snow to the pubis, 76 602 OF THE DIABETES, &c. or cold water to the feet and legs, while the patient stands on a cold stone, is said to have succeeded in removing a suppression of urine after other remedies had failed. To- bacco clysters and the tincture of tobacco in doses of thir- ty drops twice or Ihrice a day, have been known to have a happy effect in cases of dysuria. ' Dr. Thomas speaks wifh much confidence of the efficacy of the muriated tincture of iron in suppression arising from spasm: he directs ten drops to be taken every ten minutes until some sensible effect is produced. After six doses the urine usually flows freely. If a suppression of urine does not yield to the means above directed, the case becomes extremely urgent and dangerous, and the next resource consists in the introduction of the catheter, or a hollow bougie, for drawing off the wafer, fhe latter of which is on some occasions more easily introduced. Should it so happen that this mode of relief is found to be impracticable, it only remains for the patient to submit to the surgical operation of puncturing the bladder, either above the pubis or with a trocar through the rectum. The diet during the continuance of these complaints should be of the light kind and taken in small quantities. CHAPTER XLII. GRAVEL AND STONE. THESE very painful diseases consist in a lodgement of calculous concretions, either in the kidneys, bladder, or urin- ary passages. If small stones or sand is discharged with the urine, the person is said to have the gravel; but when calculous matter has accumulated in the bladder and ac- quired such size as to be incapable of passing through the common passage, the complaint receives the name of stone. Those persons who are in the decline of life and who are engaged in sedentary employments, especially those who are much afflicted with the gout, are in general subject lo ne- phritic complaints, men are more liable to them than women; and children from infancy to about fifteen years are very frequently subject to the formation of calculi. The reputed causes of both gravel and slone, are high living and a sedentary life, with the free use of strong as- tringent wines, and water impregnated with earthy or stony particles; on some occasions an accidental introduction of some substance into the bladder, has appeared to form a nucleus for a stone. The symptoms which attend the existence of small stones or gravel in the kidneys, are an obtuse pain about the loins, nausea and vomiting, and sometimes bloody urine. W hen the stone descends into the ureter, and is too large to pass with ease through that canal, all these symptoms are increas- ed ; the pain extends along the course of the duct towards fhe bladder ; the thigh and leg of the affected side are be- numbed ; there is a retraction of one of the testicles, and the urine is obstructed in its passage. These symptoms constitute what is called a fit of gravel, and the pain is on some occasions so exquisite as to produce faintings and convulsions. When one or more stones are contained in the bladder, it is known by a weight in that part, and a pain at the time, as well as before, and after making water; from 604 GRAVEL AND STONE the urine being discharged by drops, or stopping suddenly in the midst of the evacuation ; or it can be passed only when ) ing on the back. There is also a pain in the neck of the bladder upon motion, especially on horseback, or in a carriage on a rough road ; in consequence of which the urine is often bloody. There is likewise frequently a white, thick, and copious sediment in the urine, an itching at the end of the urethra, and an inclination to go fo stool during the discharge of the urine. There is also a kind of convul- sive motion occasioned by a sharp pain in discharging the last drops of urine. The existence of a stone in the bladder may be further ascertained by discharge of small pieces of such stony matter, but more certainly by 3ounding or searching, either by the introduction of the finger into the anus, or of the catheter into the bladder. Since all attempts to dissolve a sfone in the kidneys or bladder have proved ineffectual, our remedies must be adapted fo palliate fhe distressing symptoms. In a fit of gravel as it is called, the patient must be bled once or more if necessary, emollient clysters administered, and warm fomentations or bladders filled with hot water applied to the part affected, with the use of diluting and mucilaginous liquors. And a similar mode of treatment with that detailed under the heads of inflammation of the kidneys and bladder, must be pursued. The preparation of spirit of nitre and laudanum, mentioned above, for the suppression of urine, will here also prove peculiarly advantageous. A common plant called Philadelphia flea-bane, is said to have been given wifh evident relief in gravelly affections. Half a pint of a strong infusion of the plant twice a day is the dose prescribed. A jelly made of blackberries has like- wise obtained considerable credit in different parts of the United Stales, for the essential relief which it affords in all gravelly complaints. Among the endless variety of lithontriptics the fixed al- kali has been held in (he highest estimation, and the form of caustic ley or soap leys, is that in which it has been gener- ally employed ; but a long exhibition of this active medi- cine commonly produces injurious effects on the stomach. This medicine, with the alicant soap and cockle-shell lime water of the late Dr. Whyte, appear now to be wholly su- perseded by the alkaline aerated water, lately introduced by Mr. Colbourne, Drs. Falconer, Percival and others. It GRAVEL AND STONE. C05 possesses the alkaline properties, but rendered extremely mild by being impregnated with the carbonic acid gas, or fixed air ; and although it is not considered as an absolute solvent of the stone, it is affirmed to be the most efficient and certain of all medicines as yet recommended to the public confidence, in alleviating fhe distressful symptoms of this most painful disease. Experience has evinced that it will prevent the farther accumulation of calculous matter and wonderfully tend to render the urinary passages less sensible lo the irritation of the calculus which exists, and thereby render the days of the unhappy patient tolerable and comparatively comfortable. The quantity of fhe aerat- ed alkaline water usually taken is a gill thrice a day, before breakfast, dinner, and supper. When the stomach will bear a larger quantity it may be increased to a pint in a day. When it proves cold to the stomach or occasions flatulency, a tea spoonful or two of brandy or gin may be added to each dose. The manner of preparing this liquid will be described in the Appendix. The artificial soda water sold in our cities, will probably answer the same purpose, and when neither can be procured, a medicine nearly similar may be prepared in the following manner : dissolve twenty grains of salt of tarfar or sal aeratus in two or three table spoonfuls of water: add to fhe solution a table spoonful of the juice of lemon or pure vinegar. This mixture should be swallowed immediately, and is the proper quantity for a dose, and may be repeated three or four times in a day as circumstances require. When the irritation of the urinary passages is great, it may be of use to take a few drops of laudanum with each dose of the above ; but this ought to be discontinued whenever there is an abatement of the pain- ful symptoms. In many cases where these medicines are not employed, the mixture of spiritus nitri dulcis and lauda- num, taken as recommended in suppression of urine, will afford considerable relief. No particular diet or regimen is necessary to be observed while using the above mentioned medicines farther than abstaining from acids, fat meat, and butter. The method of prevention and cure of gravel in the kid- neys and stone in the bladder, recommended by (he late Dr. Whyte of Edinburgh, consisted chiefly in the use of alicanl soap and oyster or cockle-shell lime water, to the quantity of one ounce of the former and three or four pints of the 60b' GRAVKL AND STONE latter during the twenty-four hours, and to be persevered in for several months or even years if necessary. Preference however, has latterly been .tiven to the caustic alkali or soap leys, in doses at first of thirty or forty drops, increased by degrees as far as the stomach can bear it, which on account of its acrid nature must always be given in some mucilagin- ous liquor, such as linseed tea, a decoction of marsh-mallow roofs, or a solution of gum arabic. But it has been found that no stomach can endure the application of either of these medicines for a length of lime sufficient to act as a solvent of the stone without material injury. An infusion of fhe seeds of daucus sylveslris or wild carrot sweetened with honey, is a simple and much esteemed remedy in painful complaints of the kidneys and bladder; considerable bene- fit has also been experienced by the use of the garden-leek in strong infusion, to the quantity of a pint a day. The uva ursi, or bear's whortleberry, has beet, recommended as a most efficacious remedy for fhe stone, but it possesses no Iithontriptic powers, and can be useful only in cases of re- laxation or ulceration of the kidneys or bladder, when it should be freely employed as a tonic, in doses of from half a drachm to one or two drachms in powder, or two ounces of a strong infusion twice or thrice in a day. From Dr. Seamon's Dissertation on the Mineral Waters of Saratoga and Ballston, we learn that those waters are a valuable rem- edy in all gravelly complaints, having afforded great relief in almost every instance in which they have been tried. Another simple remedy may be mentioned as having been prescribed with great success by Dr. Macbride ; boil thirty berries of raw coffee in a quart of water until it acquire a deep greenish colour; of this liquor about half a pint is to be taken morning and evening, with ten or fifteen drops of dulcified spirits of nitre ; the use of this is said to have oc- casioned the discharge by urine of large quantities of earthy matter in flakes. The common hop is said to have been administered in ne- phritic calculous affections with such manifest advantage as to obtain high encomiums as a valuable antilithic. It has been ascertained by experiment, that the infusion is a certain solvent of the stone out of the body, and it is asserted by high authority, that it seldom fails to alleviate the pain and increase the secretion of urine when taken internally. Dr. Barton, however, found by experience in his own case, that GRAVEL AND STONE. 607 the use of the highly hopped malt liquors subjected him more frequently to nephritic attacks. Although physicians entertain different and opposite opin- ions respecting the antilithic powers of 1 his vegetable, there is sufficient evidence of its efficacy to warrant and induce a thorough trial of it in every instance of these distressing complaints. The infusion is directed in doses of about a wine glass full every few hours, to the extent of a pint in a day. A respectable clergyman a few years since assured me that he was in possession of a secret remedy for gravel and stone, which had been very successfully employed, and obtained great celebrity. Having furnished him with some calculi of considerable size, taken from the urethra, I wit- nessed his experiments with them. The calculous substan- ces being moistened with his liquid remedy, actually adher- ed together by chemical attraction, and being immersed in the liquid, they were in a few days completely dissolved. I have since ascertained this liquid to be no other lhan a de- coction or infusion of fhe hop. The muriatic acid is reported to have produced benefi- cial effects in many calculous cases, and to have proved a powerful lithontriptic when given in doses of twenty or thir- ty drops three or four times a day, properly diluted with water or some mucilaginous drinks. In most of the painful cases of gravel or stone which may occur, some of the above enumerated remedies will undoubt- edly be the means of affording all the ease and comfort (hat the afflicting disease will admit of, but the remedies must be varied according to the particular circumstances of each case. The reader is referred to the chapter on inflammation of the kidneys and bladder. Those who are afflicted with the gravel or stone ought to avoid all aliments that are hard of digestion, flatulent, or of a heating nature, as well as fermented liquors, wines, and acids in particular of every kind are prejudicial. The al- kaline aerated water, or the common soda water, and some- times a little gin and water, will be the most proper drinks. " When a person is conscious of having passed a small stone through the ureters inlo the bladder, it is recommended to drink freely of diluting liquors and to retain the urine till the bladder is so distended as to occasion a greaf desire to evac- uate. He should (hen place himself on his knees, bend his bodv forward, and make water in that situation. The small 608 GRAVEL AND STONE. stone by its weight will fall into the neck of the bladder, and very probably be carried away with the urine which is rush- ing out. Sir James Earle is persuaded that if persons sub- ject to calculous concretions were attentive fo such direc- tions, we should see fewer cases of stone in the bladder." Dorsev's Cooper. Dr. Ferriar speaks very favourably of the uva ursi in ne- phritic complaints, and in doses much smaller than fhe usual quantity. Hav ing premised bleeding and gentle purgatives, he gives five grains of uva ursi and half a grain of opium three or four times a day, according to the urgency of the symp- toms. This method, he observes, always relieves and gen- erally effects a cure. Many patients have used the remedy for several months together before a permanent relief from pain was attained ; the fits became lighter, and at length ceased altogether. In cases of bloody urine, Dr. F. has found the uva ursi equally efficacious. He conceives that this remedy acts specifically as a tonic and astringent on the kidneys. In doses of a scruple or half a drachm, this medi- cine produces nausea, even when joined with opium. He further asserts, that he has met with no remedy which has answered so well in that distressing strangury which some- times is produced by blisters. An infusion of the uva ursi, given during the use of the blisters, will effectually prevent the strangury. See New-England Journal of Medicine and Surgerjr, Vol. II. page 180. " Mr. Brande, in a paper printed in the London Philo- sophical Transactions, recommends magnesia in calculous complaints as a substance well adapted to prevent the forma- tion of uric acid, and thus arrest the progress of these dis- orders. Mr. Brande states that the best method of giving (he magnesia is in plain water or milk, to be taken in the morning early or at mid-day. If the stomach is weak and this produces uneasy sensations or flatulency, some common bitter, such as gentian, may be added ; and if it purges, a little opium should be combined. The dose of magnesia may be five grains fwice or thrice a day to children below ten years of age.; fifteen and twenty grains to adults. Com- mon magnesia has been usually employed, but calcined magnesia may be used occasionally.—When a stone is al- ready formed in the bladder, this medicine cannot be expec- ted to diminish it, but merely to prevent its increase.' New-England Journal of Medicine and Surgery, Vol. II. page 307. CHAPTER XLIII. BLEEDING AT THE NOSE, VOMITING OF BLOOD, AND BLOODY URINE. A SPONTANEOUS discharge of blood from the nose sometimes comes on without any previous symptoms, most commonly however it is preceded by head-ach, or a sense of heaviness in the head, redness of the eyes, flushing and swelling of the face, an unusual pulsation in the carotid and temporal arteries, a sense of fulness, heat and itching in the nostril, and is often accompanied by costiveness, coldness of the feet and some degree of chilliness. A haemorrhage from the nose is not always to be consid- ered as dangerous, nor is it in every instance prudent to stop the discharge immediately. To those who have a redun- dancy of blood, (his evacuation may be serviceable, fre- quently curing vertigo and other affections of the head, and sometimes epilepsy. It is often particularly beneficial in fevers where there is a great determination of blood towards the head ; in inflammation of the liver, in gout and rheuma- tism, and in inflammatory diseases in general it may prove salutary. It is therefore only when the discharge is immod- erate, or continues so long as to weaken the patient, that it ought to be suppressed and its return prevented. It is a remarkable fact, evincive of the superiority of na- ture in curing diseases, that a spontaneous bleeding from the nose is of more service lhan an equal quantity of blood drawn from a vein when bleeding is necessary. If a bleeding at the nose should happen to a person in perfect health, and who abounds with blood, it ought not fo be suddenly checked, lest the rupture of some internal blood vessel, or an extravasation in the brain be the consequence. But when the discharge continues till the pulse becomes weak, the lips pale, and the patient complains of being sick 77 610 BLEEDING AT THE NOSE. or faint, it ought to be speedily restrained. With this view, the person should be exposed to cool air, and be placed nearly in an erect position, with his head a little inclined backwards,and his legs and hands put into lukewarm water. His garters ought to be tied a little tighter lhan usual, and ligatures applied to the arms, of such tightness as to impede the return of the blood from (he extremities. He should drink freely of cold liquors, and cold wafer impregnated with crude sal ammoniac ought to be constantly applied fo the back of the neck, and over the whole head; and cold vine- gar and water snuffed up the nostrils. Sometimes dry lint, crowded up the nostril from which the blood flows, will pro- duce the desired effect. If these means should not succeed, dossils of lint dipped in spirits of wine, or a solution of white or blue vitriol in brandy, or a tent dipped in the white of an egg well beat up and rolled in a powder of burnt alum, while vitriol or rosin, and put up the nostril, will commonly check the discharge ; and these means may be assisted by immers- ing the genital parls in cold water. In addition to these remedies, the bowels should be opened by a cooling purge of Glauber's sails, and ten grains of sal nitre should be taken in cold water and vinegar every half hour if fhe stomach can bear it. From ten to twenty drops of the oil of turpen- tine in a little water, given frequent ly, has a powerful effect in restraining a haemorrhage from the nose ; but the roost effectual astringent for this purpose is the acetite of lead, in doses of one or two grains repeated every three or four hours till the discharge is restrained. The following prepa- ration is an efficacious styptic, and well adapted to this com- plaint. Take sulphate of copper, three grains, sulphuric acid, twenty drops, common water, two ounces ; from twen- ty to forty drops may be taken in water, and repeated eve- ry hour during the continuance of the discharge. In full robust habits, or where there is a quickened circulation, bleeding from the system may be proper; or the tincture of digitalis in doses of about thirty drops every six hours, for four of five doses, will probably prove an efficacious remedy. When the haemorrhage proceeds from a thin dissolved state of the blood, the Peruvian bark with the elixir vitriol in pretty large doses will be the most proper remedies. It sometimes happens lhat when the discharge of blood is stopped outwardly, it forces its way through the nostril VOMITING OF BLOOD. 611 into the throat, and endangers suffocation, especially when the person falls asleep. To prevent this accident, the pas^ sage may be slopped by introducing a pliable probe up the nostril, through the eye of which some strong threads have been passed, and bringing them out at fhe mouth, then fast- ening pieces of sponge to their extremities, afterwards draw- ing them back, and tying them on the outside sufficiently tight. When the bleeding is stopped, fhe patient ought to be kept easy, and as free from disturbance as possible, lying with his head a little raised; and he should not pick his nose, nor remove the tents or clotted blood, till they fall off of their own accord. Those who are subject to frequent bleeding at the nose ought particularly to avoid getting cold or wetting their feet; the collar of fheir shirt and their cravat should be easy about their neck ; if of a sanguinary constitution and liable to a redundancy of blood, they should live abstemiously, and occasionally take some cooling purgative. Vomiting of Blood. This complaint is generally preceded by pain of the stom- ach and sickness, with great anxiety and frequent fainting fits; but is unaccompanied by any cough. It often origin- ates from obstructed calamenia in women, and sometimes from a stoppage of the haemorrhoidal flux in men. Strong vomits or purges, acrid poisons, sharp or hard substances, or any thing that greatly stimulates or wounds the stomach, may occasion this disease. It is often the effect of obstruc- tions in the liver, spleen, or some of the other viscera, and it may be occasioned by external violence. In moderate attacks of this disorder it may be sufficient to direct the patient to drink freely of cold water acidulated with elixir vitriol, together with small doses of laudanum, as five or six drops two or three times a day, or the acetite of lead may be combined with opium in suitable doses. If these fail to check the discharge, recourse may be had to some of the astringents advised for bleeding at the nose. The muriated tincture of iron in doses of twenty or thirty drops every hour, is suggested by Dr. Thomas as a valua- ble styptic in this complaint. When the discharge has ceased, a few gentle purges of castor oil will be proper to alleviate the gripes which com- 612 BLOODY URINE. monly succeed, and may be supported by the acrimony of the putrid blood remaining in the intestines. The patient's food should be weak broths taken cold in small quantities. Bloody Urine. This complaint may proceed from falls, blows, bruises, hard riding, and venereal excesses ; but it often arises from gravel, or a stone in the kidneys, or ureter. If pure blood is voided suddenly, without either pain or interruption, it may be supposed to proceed from the vessels of the kid- neys. But if the discharge be in small quantity, attended with an acule pain about the bladder, and a previous stop- page of urine, wilh heat and pain about the bottom of the belly, there is ground for concluding lhat it issues from (he bladder. If the pain is in the back and loins, extending to- wards the bladder, we may presume that it is occasioned by a rough stone descending through the ureter. This com- plaint is never entirely void of danger, but it is the more alarming when fhe urine is mixed with purulent matter, as this evinces the existence of an ulcer in the urinary passag- es. When it arises in the course of any malignant disease it shews a highly putrid state of the blood, and always indi- cates a fatal termination. If the disorder be accompanied with a plethora, or if it arise in consequence of some exter- nal injury, bleeding from the system will be proper, and the body must at the same time be kept open by softening clys- ters or some mild laxative, as castor oil or Glauber's salt. An infusion of red rose leaves with a few grains of nitre dissolved in it, should also be directed. When the cause of bloody urine is a dissolved state of the blood, the cure depends on the free use of cinchona and acids. If it be ascertained lhat there is an ulcer in fhe urin- ary passages, a cool diet of the vegetable kind should be ad- vised, and the drink may be a decoction of marsh-mallow roots, with liquorice, linseed tea, and solutions of gum arabic, to which some nitre should be added, and the uva ursi may be advantageously employed. When the disorder is in consequence of a stone in the bladder, the removal of it by the operation of lithotomy is the only remedy. In this case we are to moderate the distressing symptoms by the mucilaginous drinks above mentioned, and by repeated small doses of opium, and by injecting emollient clysters frequent- ly into the intestines. BLOODY URINE. 613 A case of bloody urine is recorded, says Dr. Thomas, which had resisted all the usual remedies, and was quickly and effectually removed by giving the patient a pint a day of a decoction of an ounce of the dried leaves of the common peach tree, in a quart of water, boiled till it was reduced to a pint and a half. An early use of astringents is not advis- able in cases of bloody urine, as the discharge being stopped before the vessels are relieved, the grumous blood thence arising may produce inflammations, abscesses, and ulcers. But in those cases which depend on a relaxed state of the vessels of the kidneys or a putrid state of the blood, tonic and astringent medicines must be employed, as the cinchona bark and lime water, tincture of roses, elixir of vitriol, and the uva ursi. This last medicine is much to be relied on for a cure. / CHAPTER XLIV. OF MENSTRUATION AND ITS IRREGULARITIES. THAT periodical discharge of sanguineous fluid which takes place every month from fhe uterus, is termed menses or catamenia ; and upon Ihe regular recurrence of which the health of females essentially depends. This evacuation commences at a much earlier period of life in warm climates than in cold ones, and ceases sooner in proportion to ifs ear- lier or later commencement. In our climate the age of about thirteen or fifteen is the usual period in which this important change in fhe female constitution takes place, and the age of about forty-five or fifty is that in which it termin- ates, and with it fhe capability of bearing children. At the age of puberty, when the uterine evacuation first appears, the constitution undergoes a considerable change in many respects ; it is to be regarded as an important and critical season in the life of females, and with their conduct, not only during the first mensfruation, but in all its subse- quent returns, their fufure health and enjoyments are inti- mately connected. The interruption of the menstrual discharge is of two kinds; when it does not begin lo flow at the lime in which it is usually expected, it is termed a retention ; but when after having taken place, it cease to return at the usual pe- riods from other causes than conception, it is called a sup- pression of the menses ; and both of these incidents are implied in the technical term amenorrhea. The quantity of the discharge varies according to the climate and con- stitution of the woman. About four or five ounces is the usual quantity discharged gradually, during the space of from three to six days, at each menstrual period. The menses are naturally suspended during pregnancy and while nursing; but if suckling be loo long continued, the menses return, and fhe milk disappears or becomes impaired and OF MENSTRUATION AND ITS IRREGULARITIES. 615 unfit for the nourishment of the child. The revolution which the periodical discharge induces in the female constitution, is not effected all at once, a number of preceding complaints in some instances announce its approach. A general lan- guor and weakness, depraved appetite, impaired digestion, frequent head-ach, a sense of heat, weight and dull pain in the loins, distension and hardness of the breasts ; lassitude and paleness of the countenance often distress the young female several weeks or months before fhe discharge ap- pears ; but soon cease after the evacuation takes place. On the appearance of the above symptoms about fhe age at which the sexual discharge usually begins, every thing which may tend to obstruct that salutary evacuation should be studiously avoided, and every endeavour to promote it ought to be enjoined. If at this critical time of life, young females indulge themselves in indolence or unwholesome food, instead of practising active exercise and enjoying the invigorating quality of fresh air, amusements, and a mild but nutritious diet, (hey become relaxed, the nafural functions are impaired, menstruation is obstructed, and a train of evils, both general and local never fail to ensue, and often lay the foundation for consumptions or other fatal diseases. During the process of menstruation, all food of hard digestion, acid and unripe fruits, and whatever is liable to sour upon the stomach or chill by its coldness, must be particularly guard- ed against; but nothing is of more importance than to avoid catching cold, as the most dangerous consequences might result from such accident. Instances have been recorded of obstructed catamenia being induced by drinking cold wa- ter during the period, and which have terminated fatally. All great affections of the mind, such as sudden surprises, frights, violent passions, particularly grief and anger, are also extremely prejudicial; while wholesome diet, exercise and cheerfulness, are all conducive to the promotion of this salu- tary evacuation. The retention of fhe menses is frequently attended with chlorosis, called also green sickness, known by a feeling of weariness and debility, with dislike to aclive employments; a pale or sallow complexion, cachectic appearance, edemat- ous swelling of the legs and feet, flatulency and acidity in the stomach, loathing of food, but an inclination for indigesti- ble substances, as chalk, lime, and sand ; pains of the head and different parts of the body, swelling of the abdomen with 616 OF MENSTRUATION AND ITS IRREGULARITIES hysteric symptoms, such as palpitation of the heart or dys- pnoea ; and if this state be not soon removed it is apt to end either in consumption or dropsy. The chlorotic condition just described, is in almost every instance to be ascribed to a general debility of the system ; and accordingly the . most successful mode of treatment consists in improving the health and increasing the strength of the patient in general and exciting the action of the uterine vessels in particular. Dr. Hamilton considers chlorosis as depending on costive- ness ; this inducing the feculent odour of the breath, disor- dered stomach, depraved appetite, and impaired digestion which attend this disease. His first intention is to thoroughly evacuate the intestinal canal, after that if necessary to pro- mote the recovery by tonic medicines. The defective energy of the system will be restored by constant moderate exercise, particularly walking; a nourishing and digestible diet with a proper proportion of wine ; the administration of tonic medicines, as aromatic bitters and.the Peruvian bark; but by far the most efficacious remedies are the different preparations of iron, such as the chalybeate waters, the mu- riated tincture of iron, the phosphate or the carbonate of iron. Dr. Griffith's myrrh and steel mixture, or the same ingredients formed into pills will be found eminently service- able. The following composition is also well adapted to the various circumstances of the chlorotic patient. Take of fil- ings of iron, two ounces, Peruvian bark roughly powdered and orange peel each one ounce, infuse them for a week or ten days in a quart of Lisbon wine or pure cider, and then filter the tincture and give half a wine glass full of it twice a day. A large spoonful of a saturated tincture of pennyroyal has been known to produce very favourable effects, composing and inducing sleep when taken at bed time. Strict atten- tion should be paid to the state of the bowels, which in this disease are generally torpid, and have great power of com- municating to the rest of the system a similar state. Some stimulating cathartic therefore should be administered once or twice a week, or small doses every night; for this pur- pose there is none to be preferred to the pills of aloes and myrrh, to each dose of which about two grains of the pow- dered root of our swamp hellebore should be added. In some instances where admissible the sexual intercourse may be re- commended as the most natural and effectual remedy. With the view of exciting still farther the action of the uterine OF MENSTRUATION AND ITS IRREGULARITIES. 617 vessels, the patient should be enjoined to use active exercise and frequent friction of the body and limbs, warm pediluvi- um and fomentations to the lower part of the abdomen, and on some occasions (he warm bath, or silting up fo the hips in warm water. Electricity when directed in the form of eith- er sparks or small shocks about the region of the uterus, has frequently been attended with the most speedy and salutary effects. When the menstrual discharge after having been once es- tablished, is interrupted in its regular recurrence, it is first to be ascertained whether the suppression is occasioned by a state of pregnancy, as both the welfare of the woman, and the credit of the physician may sometimes be affected by deceptive appearances. If however pregnancy be the cause, it will soon be decided by its peculiar progress and effects. A suppression of fhe menses generally arises from the operation of those causes which induce debility of the sys- tem at large, and a defective action of the uterine vessels, such as cold at the lime of menstruation, passions of the mind, fear, inactivity of body, the frequent use of acids and other sedatives. The symptoms are head-ach, pains in the back, loins, and knees, accompanied wilh hysteric and dyspeptic complaints; colic pains, nausea, edematous swellings of the legs, and costiveness ; haemorrhages from the nose, lungs, stomach, and other parts are often the consequence of sup- pression, and they sometimes observe a monthly period, but oftener appear at irregular intervals. In some instances, nau- sea, tumour of the abdomen, and other indications of preg- nancy are produced by uterine obstruction. When sup- pression of the menses takes place in consequence of some obstinate chronic disease, as consumption or dropsy, it would be both useless and hurtful, to attempt by stimulating em- menagogues to restore the evacuation, But in suppression arising from cold, fear, or some removable cause inducing debility of the system, or constriction of the vessels of the uterus, the curative remedies ought immediately to be em- ployed. When obstructions are occasioned by a relaxed habit of body, the proper remedies are those which brace the solids, promote digestion and give force to all the pow- ers by which the natural functions are conducted. The means which have been advised for (he removal of a reten- tion of the menses, are those best adapted to our present views ; arid the prescriber may select such forms as accord 78 618 OF MENSTRUATION AND ITS IRREGULARITIES with his judgment, and is most agreeable to the patient With the tonic plan of treatment it will often be requisite to employ some emmenagogue medicines, such as savin, from twenty to thirty grains of the powdered leaves, or fhree or four drops of the essential oil twice in a day, or the tincture of black hellebore in doses of one drachm thrice in twenty-four hours ; and if this should not produce a purgative effect, fhe aloetic pills before mentioned ought to be given occasionally. In obstinate cases of suppression it is recommended as high- ly beneficial about the time.when the menses are expected to appear, to administer an emetic and direct the patient to ait during the operation in a warm bath up to the middle of the body. It should be observed, that in general our en- deavours to restore or promote the menstrual flux are most likely to prove successful when directed at the time of its expected return, or when some natural efforts for that pur- pose are observable. Another medicine of approved effica- cy in many cases of obstructed menses is calomel, either alone, or combined with opium in small doses; when judi- ciously administered, it has proved peculiarly beneficial. When the complaint depends on spasmodic constriction of the uterine vessels, and is attended with hysterical symp- toms, the root of skunk cabbage in doses of one drachm of the powder twice or thrice daily will probably afford the most essential relief; and the extract of stramonium has been reported to have proved successful in similar circumstances. it must be recollected that irregularities in menstruation are sometimes symptomatic, and that the original disease should be removed previous to any efforts for promoting the natural sexual discharge by means of stimulating emmeua- gogues. When a woman upon the sudden suppression of the men- strual discharge is affected with febrile symptoms, as a hot skin, accelerated pulse, flushing of the face, pains in the chest, back, and uterine region, or in the bowels, stimulating medicines will prove injurious; and should there be dys- pnoea with pain about the side or breast, increased by in- sp ration, it will be necessary to take some blood from the am, and to administer a saline purgative dissolved in a large quantity of warm water, to which one or two grains of the taririte of antimony may be added. After the febrile symp- toms are removed, the myrrh and steel mixture or olher chal- ybeate preparation will be advisable ; and as an efficacious OF MENSTRUATION AND ITS IRREGl LARITIES 619 cmmenagogue, the black hellebore will often be found useful. It seems to be satisfactorily ascertained that ergot deserves to be classed among our most powerful emmenagogue medi- cines. This has certainly succeeded in the removal of ob- structed catamenia in several instances. We find recorded in the New-England Journal, Vol. V. p. 162, seven cases of amenorrhaea in which ergot was administered, in six of which permanent cures were effected. In one case six ounces of the medicine was taken in about ten days, prepared by boil- ing one ounce in a quart of water down to a pint. But the us- ual quantity was half an ounce per day, and in no instance was any ill effects produced by the medicine. , Amenorrhaea succeeding to abortion, laborious parturition or fever, on some occasions assumes the form of pulmonic consumption, from which it is difficult to discriminate, and if great attention be not paid to improve the health and restore the tone and energy of the system, it may lead to a fatal ter- mination. In this instance, the pulse although frequent, is not liable to the same regular exacerbation as in hectic ; a full inspiration gives no pain and little excitement to cough; the person can lie with equal ease on either side; the cough is not increased by motion, nor by going to bed, but it is often more severe in the morning, and is accompanied with a trifling expectoration of phlegm. It is not short like that excited by tubercles, but comes in fits and is sometimes convulsive, whilst palpitation and many hysterical affections with a tim- id and desponding mind accompany these symptoms. Un- der these circumstances it will be of much utility to admin- ister occasionally an emetic of Ipecacuanha and sulphate of copper, as in phthisis pulmonalis, and to keep the bowels soluble by saline laxatives ; mild pectoral medicines will be serviceable, and an opiate should be given at night. Exer- cise, a free country air, and a mild diet chiefly of milk, will be indispensably necessary. When obstructions proceed from violent affections of the mind, every endeavour calculated to sooth and tranquilize ought to be exerted ; for this purpose a change of place, amusements, and cheerful company are of much importance. There is another irregularity or deviation from the natural process of menstruation which is called dysmenorrhea, in which there is a deficiency in the quantity, and the evacua- tion is accompanied with severe pains in the head, back, and loins, owing probably to an imperfect menstrual action. This 620 OF MENSTRUATION AND ITS IRREGULARITIES. complaint may be obviated by chalybeates, the warm bath, or semicupiiim, which should be employed for a day or tw'o previous to menstruation, and repeated every night during its continuance; opiates combined with Ipecacuanha should be given to relieve the pain, and the bowels are to be kept open by mild saline laxatives. Immoderate flow of the Menses. When the menses are abundant in quantity at the regular period, or return too copiously once in three weeks, or even more frequently, it is to be regarded as a morbid condition of the system at large, or the uterine organ in particular, and is called menorrhagia. But as menstruation is in many fe- males irregular, both in the quantity and time if flows, every little deviation or excess is not to be considered as coming under this description ; it is only when it flows in such quan- tity as to induce an alarming state of debility, and in that case it is preceded by head-ach, giddiness, dyspnoea, and more or less fever ; there is af the same time much pain in the back, loins, and lower part of the abdomen ; the pulse becomes quick and weak, the face pale, and the breathing hurried ; fhe above symptoms are also attended with dyspep- tic and hysteric affections, coldness of the extremities, and an edematous swelling of Ihe feet towards evening. Copious menstruation often proceeds from indulgence in high seasoned food, plethora, intemperate use of spirituous liquor?, violent exercise, particularly dancing, contusions, sprains, or shocks of the whole body, or abdomen, violent passions of the mind, costiveness, cold applied to the feet, excess of venery, particularly during menstruation. It may also be occasioned by a general relaxation of the system, in- duced by frequent *abortions, difficult and tedious labours, heated rooms, and the immoderate use of tea and coffee. In the treatment of this disease the patient must in the first place be enjoined to avoid the causes by which it has been produced. She ought to lie upon a hard mattress in a horizontal posture, with her head low and lightly cover- ed with bed clothes, and kept perfectly at rest both in body and mind; cool air should be constantly admitted to the room, and cool drinks liberally allowed; the diet must be of the least stimulating nature, and costiveness must be obviated by the employment of mild laxatives or injections; refriger- OF MENSTRUATION AND ITS IRREGULARITIES. 621 ants must be administered, particularly sal nitre, and the sulphuric acid. If there is a considerable degree of excite- ment with severe pains, and if the patient is of a full and ro- bust habif, it will be proper to draw from the arm a few ounces of blood ; and if the haemorrhage takes place about the time of the cessation of the menses, gentle emetics of Ipecacuanha and sulphate of copper may be employed with safety and advantage. In cases where increased action of the uterine vessels is evident, the tincture of digitalis in dos- es of from twenty to forty drops, two or 1 hree times in a day will sometimes prove eminently beneficial. When Ihe hae- morrhage is very copious, recourse must be had to astrin- gents both infernal and external, of the former class the most powerful are kino, catechu, alum, sulphuric acid, and the acetite of lead, the last of which is by far the most effica- cious. Dr. James Mann has reported several cases of me- norrhagia and leucorrhaea in which permanent cures were effected chiefly by fhe use of acetite of lead conjoined with calomel and accompanied with blisters applied to the os sa- crum. Two grains of the acetite and half a grain of cal- omel were given night and morning. See Massachusetts Medical Society's Communications, Vol. II. The form of pills of acetite of lead, opium, and Ipecacuanha, to be found in the Appendix is a valuable preparation ; one of which should be given every third or fourth hour until the de- sired effect be produced. The following preparation has often demonstrated its superior restringent powers in uterine haemorrhage and will seldom fail of success. Take sulphate of copper, three grains, sulphuric acid, twenty drops, common water, two ounces, mix and give from fif- teen to thirty or forty drops in water and repeat it every hour, or according to the urgency of the case. It may be presumed that these two last preparations will supersede the necessity of all other internal astringents in any instance that may occur; after the employment of which, the Peruvian bark with elixir of vitriol should be freely administered to restore the tone of the system. The external astringents of greatest effect, are cold water or vinegar, or a strong decoc- tion of oak bark with alum dissolved in it, constantly applied by means of wet cloths to the back, abdomen, and pudenda. Blisters applied to the lower part of the loins have been sur- prisingly successful and should never be omitted. As there generally is a considerable degree of irritation of the system I >''22 OF MENSTRUATION AND ITS IRREGULARITIES and uterus, it must be allayed by opiates in conjunction wifh astringents. In the intervals of menstruation, the remote causes must be studiously avoided ; and the system in general must be invigorated and strengthened by the cin- chona, the different preparations of iron, the sulphuric acid, moderate daily exercise, and the cold bath ; cold water may with much benefit be poured daily upon the back, or inject- ed frequently into the vagina, in obstinate cases. The period of life at which the menses cease as well as that of their first commencement, is undoubtedly lo be con- sidered as critical and important ; for the constitution must nndergo a very considerable change by a tolal suppression of a long accustomed discharge ; hence it is not unfrequent for various chronic complaints to afflict the patient and lead fo a fatal termination. VVhen, however, women survive this period, without being affected with any serious disorder, tiiey acquire a degree of constitutional strength that sub- sists to a very advanced age. The cessation of the dis- charge seldom takes place all at once, but becomes irregular and sometimes it is obstructed for two or three months, and then returns at uncertain intervals, often accompanied with symptoms which are mistaken for pregnancy. When a ces- sation of the discharge is sudden in women of a full habit of body, they ought to retrench a little their usual quantity of food; they should also take daily exercise, and keep the bowels open by a few grains of aloes or rhubarb. If the person is troubled with giddiness and pain in the head, small bleedings will be advisable. If the cessation is followed by swellings in the legs which become ulcerous, they should be allowed to continue open, or a discharge by an issue substi- tuted in their place. It is to be observed that when blood is discharged from the uterus in large clots or concretions, attended with a con- siderable degree of pain or bearing down, the case is alarm- ing and dangerous, for it indicates a diseased state of the womb, as the menstrual blood is well known to be purely fluid, and never in its natural state to coagulate. That morbid condition of the uterine system where the menses are either obstructed or much deficient in quantity, as well as where they are too frequent or profuse, is consid- ered as among the causes of barrenness. CHAPTER XLV. OF FLUOR ALBUS OR WHITES, (lEUCORRILEA.) THIS disease consists in a discharge of a serous fluid from the uterus and vagina, and is most incident to women of relaxed constitutions, who have borne many children. At the commencement of the disease the discharge is gen- erally whitish, but in ils progress it becomes very much va- ried, both in colour and consistence ; it is at first generally of a mild nature, but afterwards becomes more acrimonious; there is frequently a heat and smarting pain in making wa- ter ; in ils violent degree or advanced stage it is accompani- ed with severe pain in the back and loins, great debility, dyspepsia, difficulty of breathing, palpitation of the heart, frequent faintings, paleness of countenance, loss of appetite, pain in the stomach, dejection of spirits, and there is often some degree of hectic fever, and the eye-lids are sometimes very much swollen. The patient is seldom refreshed with undisturbed sleep; her body becomes greatly emaciated, her mind dejected, and a state of melancholy supervenes, often attended with hysteria and an irregularity in the men- strual evacuation. Fluor albus may proceed from various causes which induce debility of the system in general, or a laxity of the parts concerned; such are an inactive and se- dentary life, poor diet, frequent abortions, difficult and te- dious labours, immoderate flowing of the menses, and other profuse evacuations. It is a circumstance of great importance to distinguish fluor albus from venereal gonorrhaea, for if one be mistak- en for the other the most- pernicious consequences may ensue.* In the gonorrhaea, an itching, inflammation, and heat of urine precede and accompany the discharge, which pro- * See chapter on Venereal Disease. 624 OF FLUOR ALBUS OR WHITES, (LEUCORRILEA ) ceeds from fhe parts contiguous to the urinary passage, (he orifice of which is prominent and painful, and there is a frequent inclination to make water, and the discharge con- tinues whilst the menses flow ; there is often also an enlarge- ment of fhe glands of the groin ; whereas in fluor albus (he discharge issues from the vagina, comes on more gradually, is more offensive and redundant in quantity ; and the men- ses are seldom regular. The cure of this disease will frequently be attended wilh much difficully. The principal object is to strengthen the system and excite the action of the uterine and vaginal vessels by restoring their tone, which will be best accom- plished by the administration of cinchona, bitters, chaly- beates, and the sulphuric acid, with cold bathing in the sea when convenient. The patient who is afflicted wifh this disease should make use of solid and nourishing food, but of easy diges- tion. A milk diet alone has been found of great advantage; but if mixed with a fourth part lime water, it is still more efficacious. Red port wine is a useful and proper article of drink, to which some lime water may be added. The patient should abstain from tea and coffee, and avoid indul- gence in a soft bed, and she ought to take daily exercise on horseback or in a carriage. Emetics of sulphate of copper and Ipecacuanha will in general be of much utility in the cure of this disease, and costiveness must be obviated by proper laxatives. Internal astringents should always accompany the tonic medicines, and of this class there is none to be preferred to those ad- vised in the preceding chapter, particularly the acetite of lead with calomel; opium may be combined or given sepa- rately when urgent symptoms demand the employment of it. The application of blisters to the lower part of the back is of essential importance, and should on no account be neglected. Alum whey, made by boiling one drachm of alum with a pint of milk, will be of use both in this dis- ease and uterine haemorrhage, which sometimes alternate with each other. We are likewise advised to employ some of the stimulating balsams, as the balsam of Peru, balsam of copaiva, and the Canada balsam. The tincture of canthar- ides, in doses of twenty or thirty drops three or four tinier in a day, is of considerable repute in this disease. The partial cold bath should be employed by sprinkling cold OF FLUOR ALBUS OR WHITES, (LEUCORRHiEA.) 625 water over the loins and thighs; a plaster of Burgundy pitch should be worn on the loins and lower part of the ab- domen. The parts must be kept extremely clean, and in- jections should be daily thrown into fhe vagina with a syr- inge, such as a strong decoction of oak bark in which some alum or sugar of lead has been dissolved. But the most efficacious injection is said to be about two or three grains of corrosive sublimate dissolved in a pint of water; a small quantity of crude sal ammoniac should be added, fo enable the sublimate lo be more completely suspended than it oth- erwise would be. The patient should wear flannel next the skin and make use of friction very frequently. 79 CHAPTER XLVI. OF DISEASES OF FREGNANCY AND THE PUERPERAL STATE. PREGNANCY is frequently the source of numerous dis- agreeable sensations, and sometimes the cause of diseases which require the utmost care and the most judicious man- agement. It is, however, universally acknowledged that those women who bear children, enjoy usually more certain health and are much less liable to dangerous diseases than those who do not. The first sign of pregnancy is usually a suppression of the menses, to which soon succeed nausea and vomiting in the morning, heart-burn, indigestion, peculiar longings, head- ach, giddiness, tooth-ach, and sometimes a slight cough; the breasts become enlarged, and shooting pains extend through them. A feverish disposition, with debility, ema- ciation, irritability, and peevishness of temper often occur, whilst in other instances no inconvenience whatever is expe- rienced. About the sixteenth week after conception, in some in- stances later, what is called quickening usually takes place, when the mother becomes sensible of a slight motion of the child, and she is then liable to sudden faintings and slight * hysteric affections. The sickness and vomiting in the morning may generally be prevenfed by taking some light food before rising from bed, and keeping the bowels constantly soluble by cooling easy laxatives. Should this complaint, however, continue during the course of pregnancy, small bleedings will be high- ly necessary, and the saline mixture in the act of efferves- cence, with essence of peppermint, will in most cases afford "essential relief. The elixir vitriol will also be found useful. The application of .laudanum to the pit of the stomach OF DISEASES OF PREGNANCY, &c. 627 will often abate excessive vomiting, but if it still continues to be obstinate, a gentle emetic of Ipecacuanha will become necessary, and experience has proved that it may be given and repeated during fhe pregnant state with perfect safety. After this operation an infusion of columbo or other stom- achic bitters will be of considerable benefit. The feverish disposition which almost always attends pregnancy must be relieved by bleeding and low diet. The head-ach, when attended with plethora and drowsiness in ro- bust women, will in general require a small evacuation of blood from the arm, and gentle laxatives. In weak irritable habits the application of leeches to the temples will be more proper, and camphorated spirits, ether, and laudanum should be freely applied. In cases of severe tooth-ach we have often extracted the one most affected with perfect safety, alfhongh some authors assert that abortion has usually been the immediate consequence of the operation. The applica- tion of a few drops of the essential oil of cloves, savin, caje- put, or juniper, will often prove an effectual remedy. The heart-burn, which so often incommodes pregnant women, generally proceeds from an acidity in fhe stomach, and is best obviated by a free use of calcined magnesia, chalk, and the alkaline salts, or the aqua ammonia. When pregnant women manifest some peculiar longings for particular articles of food, they should always be gratifi- ed if possible, as miscarriage is sometimes the consequence of anxiety attending disappointment on such occasions. Cos- tiveness is commonly a troublesome complaint during preg- nancy in consequence of pressure of the uterus on the rec- tum ; this should be prevented by a daily use of some laxa- tive, as the extract of butternut, manna, tincture electuary, cream tartar, &c. Pills of aloes and soap, or Anderson's pills, are commonly employed, and they are not found so in- jurious as some have represented. The various complaints which attend the more advanced stage of pregnancy, as suppression of urine, diarrhaea, retro- verted uterus, edematous swellings, convulsions, cramps, va- ricose veins, jaundice, incontinency of urine, &c. are to be treated in the manner recommended by the different authors on midwifery, with which every practitioner ought to be ac- quainted. It not unfrequently happens that women at an advanced itage of pregnancy are attacked with spurious pains, some- 628 OF DISEASES OI PRE'.NANCY what resembling those of labour, which occasion an unne- cessary alarm. In such instances, if plethora prevail, bleed- ing will be requisite ; laxatives and clysters to remove cos- tiveness ; and a quiet easy position, with opiates to alla\ irritation, will commonly prove eft'ectual; but if spasm or hysteric symptoms attend, nothing is to bv preferred to fhe root of skunk cabbage in doses of half a drachm, repeated frequently till the desired effect be produced. In every period of pregnancy, when there are evident marks of ful- ness, especially in the latter months, it should be removed by blood-letting, and all violent exercise or ex< rtion of bo- dy or mind must be guarded against with the utmost care. Of Abortions. Every pregnant woman is more or less liable to disappoint- ment iu her fond expectations by the accident of abortion. It may happen at any period of gestation, but is most fre- quent in the second or third month. If it happens within the first month it usually receives the name of a false con- ception ; if before the seventh month it is termed an abortion or miscarriage, and at this period the infant although feeble and weakly, may often be reared by proper care aud atten- tion. Abortions are seldom dangerous in the first five months, but a repetition of them by weakening the system frequent- ly lays the foundation for chronic diseases of the most obsti- nate and dangerous nature. Some women have a certain tendency to miscarry, which renders the most trivial acci- dent productive of that misfortune, while others suffer the most astonishing agitations of the mind and body with perfect impunity. This peculiar tendency to abortion sometimes occasions such repetition of the same accident as to render the woman incapable of being the mother of a living child, and is the cause of irreparable injury to her general health. It is therefore a subject of extreme regret that we some- times meet with instances of unfortunate females who, (ocou- ceal their criminal indulgences, resort to various artificial means to procure abortion in order to prevent a discovery of their situation ; such attempts are frequently attended with fatal consequences.*. * Applications are sometimes made to practitioners for this unwarrantable: pur- pose, but every conscientious man will repel the solicitations with disdain, howevei desirous he may l>etosave the reputation and the feelings ol individuals, as the inten- AND THE PUERPERAL STATE r;29 The usual causes of abortion are violent exercise or great exertions of strength, as dancing, jumping, and severe cough- ing, sudden surprises and frighls, violent fits of passion, anxiety and grief, uncommon longings, overfulness of blood, drastic purges, profuse evacuations, excessive venery, gen- eral debility of the system, external injuries, as blows and bruises. It is of importance to remark that instances have occurred, where in cases of twins one child has been expel- led and the other retained lo Ihe full time. Those women in whom abortion has become in a manner habitual should observe the greatest precautions in order to prevent a repetition of fhe accident ; if of a full plethoric habit, she ought to be bled just before the usual time of her miscarrying; her diet should be mild atid simple, consisting principally of milk and vegetables ; costiveness must be par- ticularly avoided, as also all agitations of the mind, severe exercise, violent efforts, and such objects as may be likely to make a disagreeable impression on her mind. She ought to exchange her feather bed for a mattress, sleep less than usual, and keep her body cool, and take daily exercise with- out much fatigue. Habitual abortion, however, is more frequent in women of a weak lax habit, where bleeding would be altogether inad- missible. Here a nutritive and generous diet, moderate ex- ercise in a carriage, the cold shower bath, and a course of chalybeates with other tonics will be indispensably necessa- ry; the patient at the same time carefully avoiding all the exciting causes. The muriated tincture of iron, has in cases of this description, been employed with satisfactory success in doses of fifteen drops two or three times in a day. The symptoms attending the progress of a threatened abortion are a pain in the loins or about the bottom of the abdomen, with a dull heavy pain along the inside of the thighs, a slight shivering, sickness, and palpitation of the heart. The breasts subside and become flaccid or soft, the belly sinks, and there ensues a discharge of blood or watery tion can seldom bt accomplished without exposing the life of the mother to the ut- most danger, and himself to the penalties of the law. By an act of the British Par- liament the crime of procuring abortion after the child has quickened, is punished with death. In France the crime was formerly capital, but since the revolution the punishment is twenty years imprisonment. In every civilized country it is decreed that if a woman die in consequence ef tak- ing medicine to cause abortion, the person who administered it shall be held guilty *f murder. >.;nt OF DISEASES OF PREGNANCY humours from the uterus, sometimes coming away in cioi* and at others flowing profusely for a short time, and at inter> vals again reluming violently. When the pregnancy is ad- vanced beyond (he third month, these symptoms are gener- ally increased with sickness, faintness, and slight febrile heat, troublesome bearing down of the uterus, and a most rapid discharge of blood, owing to the increased size of the uterine vessels. In some instances abortion ensues in a few hoars, buf in a majority of cases in about three days from (he commence- ment of the symptoms, though the process has on some oc- casions been prolonged to several weeks. On the first appear- ance of flooding or other signs threatening abortion, fhe woman ought to be laid on * mattress with her head low and hips a little raised, where she should be kept as quiet and comfort- able as possible, perfectly cool, and debarring her of all food of a heating nature, and directing cold liquors acidulated with elixir vitriol or lemon juice. If the strength of the patient is not much reduced, and where the pulse is in any meas- ure full and frequent, it may be proper to fake a little blood from her arm, after which some genlle laxative or aperient clyster should be administered. Should a copious haemorr- hage occur, it will be advisable lo prescribe ten or fifteen drops of laudanum, to be repeated so a3 to keep up a con- stant effect, and this may be combined with astringents. In extreme cases, anodyne clysters may be injected from time to time, and linen cloths wet with cold vinegar and water, be kept constantly applied to the back and lower part of the abdomen. Astringent injections composed of a saturated solution of alum, white vitriol, or acetite of lead, or of a de- coction of oak bark are often employed in violent floodings with good effect, and the various internal astringents as rten- tioned under the head of menorrhagia will on many occa- sions of threatened abortion prove the most efficacious rem- edies. In obstinate or protracted cases where great debility is induced, instead of bleeding we ought to trust to the effi- cacy of the digitalis in suitable doses, which has in some in- stances succeeded. But in fact uterine haemorrhage, when it occurs in the three last months of pregnancy, is one of the most formidable and dangerous accidents to which women are subject. It sometimes happens that all the means pre- scribed fail of producing the desired effect, and the woman becomes exposed to imminent danger, and the most profound AND THE PUERPERAL STATE. 631 judgment and experience may be baffled in every attempt to preserve the life of the patient. It would be inconsistent wifh the plan of this work to de- tail all the particular circumstances which may attend the process of abortion in every instance, reference must there- fore be had to proper books on midwifery, and to the as- sistance of an experienced practitioner. See Ergot in the Appendix. Of Child-Birth and the after treatment. It is by no means intended here to enter into the particu- lar circumstances pertaining to the various cases of parturi- tion, much less to detail the peculiar duties of (he obstetric art; suffice it to offer some general observations relative to the management of women in the parturient state, and the proper treatment after child-birth. It is generally estimated that nine calendar months, that is, forty weeks, or two hundred and eighty days, constitute the term of gestation, but the period is liable to some varia- tion or inaccuracy in the calculations of particular individu- als. It is from many observations, rendered highly proba- ble, that in some instances the term of pregnancy is consid- erably shortened, and in others somewhat protracted. In by far the greatest number of instances the labour is accomplished by the powers of nature, unattended with dif- ficulty or danger, unless rendered so by the officious inter- ference of rash and unskilful practitioners. It is, however, indispensably necessary to have the assistance of some per- son well versed in the art, in order to guard against acci- dents, which might otherwise happen, and which might be attended with very serious consequences. The condition of every woman during parturition must be regarded as extremely distressing ; she is often dispirit- ed and impressed with the most fearful apprehensions, which if indulged, may be productive of the most injurious effects. It is therefore incumbent on the practitioner to exercise the duties of a humane and cheerful friend, endeavouring all in his power to sooth the distressing passions and acute sensibilities which unavoidably occur at the beginning of labour. When any alarming circumstances are present, these should be concealed from the patient, or otherwise explained in such satisfactory manner as to gain her confi- 632 OF DISEASES OF PREGNANCY dence and inspire her with resolution and courage, and ani- mate her hopes of speedy relief. Every proceeding which may tend to increase her anxiety, bul more especially every appearance of indelicacy must be scrupulously guarded against. During actual labour the woman ought to take nothing of a heating nature ; confining herself to beef fea, panado, jel- lies, and broth, with barley wafer and tea or coffee. If she is disturbed wilh spurious pains of the spasmodic kind, (hey may be effectually removed by a few doses of the powdered root of skunk cabbage, or the infusion, or by proper doses of laudanum. If the labour prove tedious and diffi- cult, it will be proper to bleed for the purpose of preventing inflammation, and emollient clysters should be frequently injected. On some occasions, sitting over the steams of warm water, or fomentations to the lower part of the abdo- men, will be both useful and proper. When the patient appears fo be exhausted with fatigue, so that nature seems to sink, some cordial medicine will be requisite, as the spirits of hartshorn, with the compound spirits of lavender, or a glass of generous wine. There is a pernicious custom still prevalent among females in the middle and lower stations of life which ought to be aban- doned. It is that of taking during labour a variety of heat- ing drinks, and rendered more stimulating by the addition of spices, wine, or spirits. Nothing can be more opposed to the true indications in these circumstances, nor more det- rimental in its effects. All internal stimulants have a direct tendency to increase the action of the heart and arterial system, which will not readily subside when the woman is delivered, and if there be any previous disposition to fever existing in her body, nothing is so likely to bring it into ac- tivity, and fevers of the most dangerous kind may be the consequence. The most proper drinks for women in labour, are barley water, toast and water, lemonade, apple tea, with other weak and diluting liquids. See the use of Ergot in the Appendix. Immediately after delivery a broad bandage should be applied round the abdomen moderately tight, the woman must be kept as quiet and easy as possible, carefully avoiding the heat of bed clofhes, confined air, and every stimulating sub- stance, whether internally or externally applied. It will in general be necessary to direct a dose of tincture of opium AND THE PUERPERAL STATE. 633 to allay irritation and procure sleep, and to those who have been habituated to high living, a little light animal food and a glass of wine may be allowed, recollecting, however, that loo much indulgence is more to be feared than loo rigid ab- stinence ; all extremes ought to be avoided. Instances sometimes occur of dangerous floodings imme- diately after delivery, in which case the patient ought to be laid with her head low, kept cool, and to be treated in the same manner as for an excessive flow of the menses; should the haemorrhage be violent linen cloths wrung out of a mix- ture of vinegar and water should be applied cold to the abdo- men, the loins, and thighs, and repeated doses of opium must be given. Although the patient should be particularly careful to avoid too much heat, it is no less necessary to guard wilh the greatest attention against the danger of taking cold. As soon after delivery as the mother's strength will per- mit, and she and the child have taken some sleep, her breasts should be washed with warm milk and water in order to re- move the bitter viscid substance which surrounds the nip- ple, and the infant should be applied and invited lo make its natural attempts to draw nourishment from the breast. If this operation be attended with difficulty, on account of the nipples not being sufficiently prominent to afford a proper hold for the child, the breasts should be drawn by an adult person, or an older child, or the glasses made for the pur- pose may be employed ; but cautiously avoiding every de- gree of violence, as it may be productive of considerable injury. It must be remarked as of some importance, that in every instance a mild laxative should be given within forty-eight hours after delivery. A table spoonful or more of castor oil, or a dose of salts and manna, will generally be sufficient, and should always be preferred to irritating aloetic pills. After Pains. For some time after delivery, the contractions of the ute- rus are apt to continue, and occasion pains, which in some cases are so violent as lo resemble the throws of labour. This complaint, termed after pains, is seldom to be regard- ed as dangerous, though productive of considerable distress; it is usually temporary in its duration. After pains occur more rarely in the first than in future labours, owing proba- 80 634 OF DISEASES OF PREGNANCY bly to the womb not contracting so readily after several de liveries as at first. These pains may be distinguished from other affections by their alternating with intervals of ease, by the breathing not being impeded, and by the pains being followed by the expulsion of coagulated blood. This com- plaint is to be removed by the application of warm fomenta- tions to the abdomen, and repeated doses of tincture of opi- um, accommodated to the severity of the case. If spasmodic affection be evident, the skunk cabbage root will afford fhe most effectual relief. The Lochial Discharge. There is in all women a certain degree of haemorrhage from the uterus after delivery, but the appearance and du- ration of the discharge is very various in different women. For the first four or five days, the discharge consists of florid blood, after which it assumes a mucous appearance, and at last the evacuation ceases entirely. When a suppression of the lochia ensues before the accustomed period, great pain is felt in the lower part of the abdomen, which is some- what tumid and tender to the touch, and febrile symptoms appear. In these cases a return of the evacuation must be attempted by the application of warm fomentations to the abdomen, by the use of warm diluent drinks, as gruel with a little white wine or cream of tartar dissolved in water. The saline mixture, with the addition of antimonial wine, should be freely taken, together with laxatives and opiates, to allay the pain and irritation. Milk Fever. The secretion of the milk about the second or third day is commonly attended with a slight degree of fever, and the breasts become turgid and painful. These symptoms, how- ever, are of short duration if properly managed, seldom con- tinuing longer than twenty-four or thirty-six hours, when they terminate by a profuse sour smelling sweat, a gentle looseness, or a copious discharge of milk from the breasts. The milk fever may often be prevented by applying the child to the breast soon after delivery, and by giving a purgative medi- cine about the second or third day. During the hot stage, mild diaphoretics, as the saline mixture with antimonial wine will be proper, and when the breasts are much distended AND THE PUERPERAL STATE. 635 they should be softened by rubbing in some warm olive oil wilh a little camphor twice in a day, and covering them with flannel. Our sentiments relative to the expediency of every woman nursing her own child, have been amply detailed when treating of the management of infants in the first part of this work ; but if from ill health or any sufficient cause, the mother should determine not to suckle, a proper method must be adopted with the view of diminishing a too copious flow of milk. This, however, is not to be effected by the use of repellent applications to dry up or put a stop to the secretion, as it may be attended with dangerous consequenc- es. Her breasts must be drawn three or four times a day ; she should use a very spare diet, regulate her bowels by laxative medicines, and abstain as much as possible from all liquids. A curious fact relative to this subject is asserted by a late sensible writer, the aulhor of the Maternal Physi- cian,* which is" this ; when the mother is unable to suckle on account of sore nipples, if the milk can be drawn out with sucking glasses, and the child fed with it, the milk may be preserved in the breasts for a length of time ; for, while the babe is nourished by it, it will continue to flow let it be ob- tained from the breast how it may ; whereas if it is drawn out and thrown away, the quantity will gradually diminish, until it dries away entirely. This fact, however inexplicable, is analogous to that which experience has long since taught every observing dairy woman, that by milking their kine on the ground, the quantity may be daily diminished until it cease altogether. It may be deserving of notice here that Dr. Erastus Ser- geant, of the county of Berkshire, has found by experience that fhe small winter grape-vine, taken by way of infusion, or mixed with milk in the manner of milk punch, has a strong tendency of increasing the secretion of milk in nurs- ing women. diseases of ihe Breasts. Women who suckle are particularly liable to inflammation of fhe breasts which often is the source of infinite pain and distress. It may be excited by the direct application of * The Maternal Physician is a production replete with interesting matter, wor- thy the attention of every nursing family 636 OF DISCASES Or PKEGNANCl cold, retention of the milk in consequence of sore nipple^, o by bruises and other external injuries. A sudden fright ha* been known lo produce it. When any hardness or painful swelling is perceived in the breasts of lying-in women, immediate attempts ought lo be made to arrest (he progress of inflammation and the conse- quent suppuration. A slight hardness may often be remov- ed by rubbing (he volatile liniment or sweet oil diligently in- to the part wi(h a warm hand for a quarter of an hour twice in a day, and then covering it with a cabbage leaf, which pro- motes perspiration and contributes to the dispersion of in- flammation ; or spirit of mindereri applied cold, or the oint- ment of stramonium may be applied to the tumour as an ex- cellent remedy for the same purpose. The breasts should be frequently but tenderly drawn through fhe whole course of the complaint, either by fhe child or a grown person who has been accustomed to the operation ; saline purgatives must be occasionally administered, as also anodynes when- ever pain and irritation require their use. If the local in- flammation continue to increase and the febrile symptoms become violent, blood must be taken from fhe arm er by leeches to the part, and the patient restricted to a low diet and cooling drinks; and recourse must be had to the saline mixture with tartarized antimony. Should these means fail to disperse the inflammation, a large blister must be applied to the part, taking care to place it smoothly that it may ad- here closely to the skin, a hole being cut in the centre for the nipple to protrude, and if necessary the tincture of can- that ides may be used to increase the vesicating effect. After the blistering the sore should be dressed with the sperma- ceti ointment. The above is reputed as the grand remedy which will in general speedily disperse the most alarming swellings of the breast and prevent the formation of painful abscesses. Another method recommended by Dr. John Clark who has been much conversant with the treatment of lying-in women, with the view of dispersing inflamed tumours of the breasts, is first to apply several leeches to the part, and afterwards cloths wet wilh a strong cold solution of the ace- tite of lead, and to be renewed as often as ihey become dry. The peculiar advantages to be derived from Ihe diligen' em- ployment of the saturnine solution, so greatly preferred by Dr. Clark, to the common practice of employing emollient fomentations and poultices, are by their coldness and astrin- gent quality; the blood is repelled from the put and the in- AND THE PUERPERAL STATE. 637 flammation diminished ; (he woman will suffer less pain and the constitution will be less affected : the breast will not be weakened, and if an abscess should form, the extent of the suppuration will be very much lessened and the duration of the disease considerably shortened. But when a resolution of the inflammation cannot be effected, and an abscess is about forming, any further attempts to discuss the tumour will be improper and fhe suppuration must be promoted by the usual means of poultices and fomentations. The poultices to be preferred are composed either of the meal of linseed or the mucilage of slippery elm bark, rendered of a proper con- sistence by the addition of Indian meal or the common one of bread crumbs and milk. Should any thing more stimulat- ing be required, an onion cut fine may be added, or a little basilicon ointment spread over the poultice. Wrhen the ab- scess has advanced to a state fit to be opened, if it should not burst, a slight opening with the point of a lancet in (hp most distended and dependent part must be made. The poultices should still be continued, and fhe wound kept open for the discharge of the matter. It is, however, to be ob- served that as a long continued use of poultices has a direct tendency fo relax and debilitate the parts, as soon as thej'- can he dispensed with, compresses wet with a solution of crude sal ammoniac in vinegar, with the addition of a third part brandy, should be substituted, the sore at the same time being dressed with basilicon or the spermaceti oint- ment. Abscesses of the breasts sometimes heal and others form, or sinuses are insinuated into different parts, attended with a hardness of the whole glandular substance of the breast; in some instances these cannot be healed till freely opened from one sinus to the other. The remaining induration of the breast may be reduced by the employment of leeches to the part, and by the application of a poultice composed of hard soap dissolved in vinegar with a little crude sal am- moniac, and made of a proper consistence by the addition of rye meal. The camphorated mercurial ointment and the discutient plaster, to be found in the Appendix, are reme- dies well adapted to the purpose intended, experience hav- ing confirmed their beneficial effects. When the patient is much exhausted and debilitated by a long continuance of pain and discharge, her strength must be supported by the use of the cinchona and a nutritive diet. t;3a OF DISEASES OF PREtiNANCY Excoriations and soreness of the Nipples. This is another tedious complaint with which nursing wo- men are frequently afflicted. The action of the child's mouth when sucking, and the irritation which the stagnant milk occasions, are very apt to injure the delicate structure of the nipples unless kept very dry. On some occasions the pain, when the child sucks, is so exceedingly severe lhat the mother is actually unable to continue to suckle, and the sores can scarcely be healed until another nurse be substi- tuted. In some instances an aphthous state of the child's mouth excites this affection, in others the child receives it from the nipple, and it is difficult to cure the one without the other at the same time. The great object to be attended to in this complaint is to obviate as much as possible every cause which can tend to irritate these lender parls. it will be very useful to wear a sort of cup made of wax or lead over the nipple to prevent its being wet with the milk or fretted by the clothes. When excoriations have made their appearance, a solution of alum, sulphate of zinc, acetite of lead, or sulphate of copper, arc fhe astringent applications most commonly recommended; but there is not, in my opinion, a more truly valuable bal- samic application to sore nipples lhan a solution of borax in warm water, with the addition of a little honey; or it may be reduced to powder and mixed with sugar, and applied for the same purpose as well as to the aphthous mouths of children, wifh the happiest effects if freely used. There are various forms of ointments and liniments which may be esteemed as among the most efficacious remedies in this complnint, of which description is the elegant white oint- ment called cold cream, see Appendix, and also a popular one prepared from the solanum dulcamara, called also woo- dy night-shade or bitter sweet. Take a small handful of the bark of the root of bitter sweet, and add to it as much fresh butter or cream as will cover it in a proper vessel, and let them be simmered together over a very moderate heat dur- ing six or eight hours, and then strain it through a clolb, when it will form a beautiful yellowish coloured ointment, well adapted to the purpose. A valuable liniment may be prepared as follows : take of litharge and of vinegar, two drachms each, olive oil, six drachms; rub them well together in a mortar till the mix- ture be of a pale flesh colour, and of the consistence of AND THE PUERPERAL STATE. 63U cream. Either of the above preparations will be found of great utility in the cure of ibis troublesome complaint. It must, however, be recollected that whatever may be the remedy employed, the child should never be permitted to suck until the nipple be thoroughly washed with warm water or covered with oil, lest it receiv e injury from the sub- stances which have been applied. With the view of diminishing the sensibility of the nip- ples, and thereby preventing excoriation and soreness, it has been recommended to wash them frequently with some stimulating liquor for some time previous to delivery ; bran- dy and water or alum water may be advantageously em- ployed. But fhe pickle of salted meat, after being boiled, has been recommended as an infallible specific for the pur- pose. Recent experimental trials have confirmed most sat- isfactorily that a simple infusion of the root of sophora tinc- toria, applied as a wash, is one of the most efficacious reme- dies for sore nipples with which we are acquainted. See Appendix. Inflammation of the Uterus. Child-bed women are sometimes attacked with an inflam- mation of the womb, which is a dangerous affection and calls for the earliest attention. It generally occurs about the second or third day after delivery, though in some in- stances later. The existence of it may be ascertained by pains in the lower part of the belly, which are greatly in- creased by pressure, and also pains in the head and back extending into the groins ; a constant fever with a weak and quick pulse, great prostration of strength, sometimes inces- sant vomiting, an inclination to go frequently to stool, a heaf, and sometimes a tofal suppression of urine. There is no remarkable tension nor general swelling of the abdomen, un- less the peritonaeum have become affected, but we can feel distinctly the uterus to be hard and enlarged, and it is very sensible and affected with a considerable degree of burning heat. The lochial discharge is very early suppressed, and the secretion of milk diminished or destroyed. The pain in this complaint is constant, not like after pains, alternating with intervals of ease. The causes which tend to induce an inflammation of the womb are difficult, or tedious labours, artificial efforts to de- 6-iU OF DISEASES OF PREGNANCY liver the child by hurrying the labour, a hasty extraction of the placeHfa, ami the use of heating and stimulating drinks. To these may be added exposure to cold after delivery. The progress of this disease is always rapid, and sometimes proves fatal in a very few days, it may terminate favoura- bly by a free perspiration, a diarrhaea, or a uterine haemorr- hage, which last is the most frequent and complete crisis. But if the pain becomes more acute, with increased throb- bing, frequent rigours, sickness, and delirium, the inflamma- tion may then be expected to terminate in mortification or suppuration. If the pains abate, the pulse become more moderate, and the lochia and secretion of milk return, we may consider the patient as having the prospect of a speedy recovery. The successful treatment of this disease depends very much upon (he early use of the lancet, and the quantity of blood to be abstracted, and the repetition of fhe evacuation must be regulated by the constitution of the patient, the ef- fect produced, and the period of the disease; in plethoric habits a second or third repetition may be necessary. Fo mentations of emollient decoctions to the abdominal region should be diligently employed, and the volatile liniment with camphor ought to be frequently rubbed into the part. Gen tie laxative medicines and aperient clysters, in preference to strong purgatives, should be frequently administered, and diluting drinks are to be directed. Diaphoretic medicines seldom fail to produce beneficial effects in this inflammation; the compound powder of Ipecacuanha, Dover's powder in doses of eight or ten grains every four hours, followed by suitable doses of the saline mixture, are capable of effect- ing all the advantages to be derived from this class of medi- cine. Afler the inflammation has been subdued by vene- section and laxatives, opiates must be prescribed to such extent as to alleviate pain, procure rest, and obviate irrita- tion of the system. Should a diarrhaea occur, and become so severe as to exhaust the woman's strength, the chalk mixture with tincture of opium will have the effect of mod erately restraining the evacuation, while fhe patient is sup ported by food of a light nutritive nature. Of Peritoneal Inflammation. An inflammation of the peritonaeum during the puerperal state is not an unfrequent incident, ami in «3«me instances it AND THE PUERPERAL STATE. 641 is combined with an inflammation of the uterus. If may be produced by violence during delivery, or the application of cold, or the injudicious use of stimulants. The disease has by some authors been called puerperal fever, as the distin- guishing characteristics of the two affections are often not very obvious. The period of its attack is in some cases within a few days, in others not until three weeks after de- livery. The symptoms are rigors and shiverings, with thirst, fever, accelerated pulse, sickness, and vomiting. These are soon succeeded by pain, tension, and soreness, either over the whole abdomen or confined to one spot; which in- creasing rapidly, the belly in a short time becomes swelled to a size nearly to what it was before delivery, and is so ex- quisitely tender, that the weight of the bed clolhes can scarcely be endured, and the patient is incapable of bearing the least motion. The skin is hot, the tongue white and dry, and fhe milk and lochia are usually obstructed ; the bowels are either costive or there is a purging of dark coloured faeces, and sometimes a constant inclination to discharge urine. As the disease advances a difficulty of breathing ensues, and the symptoms of general inflammation and irritation prevail; the pulse is frequent, small, and contracted,beating from one hundred and twenty to one hundred and thirty in a minute, the swelling and tension of the belly increase, the vomiting continues, the pulse becomes still smaller and even more fre- quent and irregular, the moutii is affected wifh aphthae, the extremities are cold, the evacuations by urine and stool be- come involuntary, the pain ceases suddenly, and the patient sinks about the sixth or eighth day of the disease. If on the contrary the termination is to be favourable, the pain and tension of the abdomen gradually subside, the vomiting ceas- es, the pulse becomes fuller and slower,the breathing less la- borious, the milk returns in the breast, and the lochial dis- charge re-appears ; and in some cases a gentle diarrhaea en- sues at the close of the disease. Instances sometimes occur where the inflammation ends in suppuration, and the abscess bursts externally. The mode of cure in this disease is similar to that of other inflammatory affections ; the most vigorous means and close attention must be pursued, and the young practitioner must not suffer himself to be misled by the condition of (he pulse or any accidental symptom so as to deter him from the use of the lancet. But if the case be a (rue peritonaeal inflaru 81 64*2 OF DISEASES OF PREONANCA mation unconnected wilh typhoid fever, and the pain on pressure be very acute, no time should be lost in drawing blood from the system, and the evacuation may be repeated or not, according to its effects and the constitution of Ihe pa- tient. If after one bleeding the pulse becomes slower and fuller and the pain subside, we may venture to repeat fhe opera- tion if necessary. If, however, local blood-letting should be preferred, a number of leeches or the scarificator may be employed. The next object will be to open fhe bowels free- ly, and then to administer diaphoretic medicines. The cas- tor oil or the common cathartic salts with manna are the most suitable laxatives, and the saline mixture with tartarized antimony or the compound powder of Ipecacuanha are those to be recommended as the best diaphoretics. Emollient fo- mentations to the abdomen and softening injections into the intestines will be useful, and must not be neglected. After general and local bleeding have been adopted, considerable benefit may be expected by blistering the abdomen. Ano- dyne medicines should be administered as often as pain, rest- lessness, and irritation indicate their use, increasing the quan- tity as the urgency of symptoms may require. The Peru- vian bark with wine and sulphuric acid will be proper at the close of the disease. Of Phlegmasia Dolens* or Lymphatic swelling of the lower extremities of puerperal women. This singular complaint to which lying-in women are sub ject, is not of very frequent occurrence, and is more formid- able and distressing in its circumstances than dangerous in its nature and consequences. Numerous conjectural theo- ries have been advanced wifh the view of explaining the na- ture and causes, and accounting for the phenomena of this perplexing disease ; but the result so far from being satisfac- tory, seems to evince that the subject has hitherto eluded investigation and remains involved in obscurity. It is, how- ever, the opinion of most modern writers that phlegmasia do- lens is a lymphatic disease of a local nature, confined fo the lymphatics of the pelvis, and the limb actually affected, and dependant on causes peculiarly connected with the puerperal state. The usual period of its attack is from fifteen to twen- ty days after parturition, and frequently when the woman is in Ihe most favourable circumstances of recovery, and not ATCD THE PUERPERAL STATE. 643 having been exposed to any error or untoward accident eith- er at the time or subsequent to delivery. It commences suddenly with a sense of weight, stiffness, and pain about the back, upper part of the-thigh, groin, and labia pudendi of one side ; sometimes preceded by rigors and accompa- nied with a degree of febrile heat. "In some instances the pain is first felt in the calf of the leg or knee, darting down to the heel; the limb soon begins to swell, and becomes ve- ry tense with heat but without redness, the skin being pale and of a peculiar shining aspect. The swelling sometimes proceeds from the groin downwards, and in other cases be- gins at the calf of the leg and proceeds upwards, but in eve- ry instance the pain and swelling continue to increase and. extend until the whole limb from the hip to the toes, arrive in about twenty-four or thirty-six hours to twice or fhrice ils natural size. The skin is now of a pale glossy vvhife colour, rather warmer than natural, excessively tense and elastic, leaving no impression of the finger; exquisitely painful and tender, the patient being utterly incapable of moving her body or leg from the spot it occupies ; some abatement of pain takes place when the swelling has arrived at its greatest extent. The pulse is seldom below one hundred and twenty, often one hundred and forty in a minute ; the tongue is white and moist, and there is thirst and loss of appetite. The countenance exhibits a pale chlorotic appearance, the bow- els are sometimes bound butoftener loose with foetid stools, and sometimes attended wilh a vomiting of dark coloured bile. The lochial discharge and lacteal secretion are in some instances suppressed, in others these continue free during the progress of the disease. The inside of the pelvis and the inguinal glands are tumefied, painful, and tender. With- in six or eight days or sooner, after the attack, the inflam- matory or febrile symptoms generally subside, and the swel- ling, tension, and pain of the limb begin gradually to dimin- ish from the groin downwards, and in this state of the com- plaint, some indentation may be made with the finger, but tlie patient is debilitated and the limb remains stiff, weak, and often motionless for some weeks or even months. Ii sometimes happens that before the complaint has complet- ed its course in the leg and thigh of one side, the other be- comes in the same manner affected, and this has no influence on the progress of the first; and in fact the extremities may he a second time attacked with the same affection. If in 641 OF DISEASES OF PREGNANCY any stage of the disease the skin be punctured, very little serum is discharged as in anasarca, nor is the swelling in- creased by placing the limb in a depending position. In the curative treatment of phlegmasia dolens, regard must be paid to the state of the limb and to that of the gen- eral system. Cases may present of robust plethoric habits in which such degree of inflammation may prevail as to in- dicate the use of the lancet and the antiphlogistic regimen for its removal. The bowels should be moderately excited by a solution of the neutral salts and cream of tartar or oth- er laxatives, and the saline mixture with tartarized antimony should be administered to promote a regular determination to the surface: but if much nausea or vomiting attend, a gen- tle emetic will undoubtedly be proper. Where considerable irritability of the system and restlessness prevail, the com- pound powder of Ipecacuanha may be given in a proper dose at bed time. We are not, however, to promise ourselves much permanent advantage from the feeble means above mentioned in this obstinate complaint. A remedy of superior efficacy and in which we may confide for a cure, is to be found in the sub muriate of mercury; a moderate course of calomel either by itself or combined with opium will in most cases of this description rectify the diseased action of the lymphatic system, and speedily reduce the swelling of the affected limb. About two grains of calomel given every six or eight hours for a short time,»has in several instances af- fected permanent cures; the pain, tumefaction, and other symptoms yielding very readily to a slight affection of the salivary glands. Opium is a medicine of much importance in these cases, and must be administered to such extent as pain, irritation, and restlessness may require. In those in- stances, where the patient is of a lax habit, or is much debil- itated by previous evacuations or other cause, the antiphlo- gistic regimen must be rejected, and means resorted to for the purpose of restoring the proper tone and energy of the constitution. The medicines best adapted for this intention, are cinchona bark, bitters, chalybeates with wine, a nutri- tious diet, exercise, and cold bathing. The tonic medicines may on some occasions be combined with diuretics, as crys- tals of tartar and squills, with advantage. With respect to topical applications, these have not in general produced the beneficial effects which were desired and expected. All at- tempts to induce a discharge? of lymph from the diseased AND THE PUERPERAL STATE. 645 limb by punctures or blisters have proved useless, or of mis- chievous tendency. More beneficial effects have been de- rived from the application of a strong solution of sal ammoni- ac and acetite of lead in vinegar. In one instance I have found a soft poultice of boiled turnips to afford more relief than any other application which was tried. From the known efficacy of mercury internally administered, it may be prop- er to suggest the trial of the inunction of the mercurial un- guent, and attentively observing its effects. Flannel cloths wrung out in hot vinegar and renewed as often as they be- come cold, have, according to Dr. Thomas, been practised with invariable success in the lying-in hospitals in London; and much relief he observes has been received by surround- ing the limb with a soft poultice composed of bran and olive oil, with the addition of half an ounce of tincture of opium, and a sufficient quantity of warm water to give it a proper consistence, renewing it morning and night. A flannel roller should be constantly worn round the limb, being applied uni- formly smooth and moderately tight from the foot upwards. CHAPTER XLVI1. DISEASES OF TUB EYES. Amaurosis, or Gutta Serena. THIS is a disease of the eye attended with a dimness, or total loss of sight, and arising generally from a paralytic affection of the retina and optic nerve. The eyes appear natural and the pupil is dilated, and does not contract upon being exposed to the strongest light; it is sometimes attend- ed with head-ach. This kind of blindness is generally pre- ceded by an imaginary appearance of numerous insects or substances like pieces of cob-webs floating before the eyes. Gutta serena has always been considered as not very susceptible of cure, especially when it arises from a defect of the optic nerve. In some instances an imperfect amau- rosis depends on some irritation existing in the stomach and bowels, and sometimes connected with a general nervous debility in which the eyes participate. In these cases the cure must be attempted first by emetics and cathartics, to free the primae viae from all irritating matter, and afterwards by administering tonic medicines to strengthen the gastric organs, to promote digestion, and re-animate the nervous sys- tem in general and the nerves of the eye in particular. Blis- ters to the temples and to the crown of the head, and elec- tricity are said to be of singular service; sparks should be tak- en from the eyes, and moderate shocks sent through the head and often repeated. Errhines are of considerable use, one grain of turpeth mineral and eight of powdered liquorice root well mixed form a very proper sternutatory, one fourth of which should be snuffed up the nostrils once or twice in a day. A strong infusion of valerian root is to be freely employed, and a mercurial course is said to have succeeded; and galvanism is also recommended, as are likewise issues and setons. DISEASES OF THE EYES. 647 In a cataract, especially when it arises without any as- signable external cause, a cloudiness of vision, or a settled mist is almost always perceptible by the patient before any opacity has become visible in the pupil. The cataract shews itself as a speck or spot in the pupil of the eye, occupying sometimes the whole and sometimes only a part of this aper- ture. It is most commonly of a grey or whitish colour; but sometimes of a deep white, and it may in all cases be easily distinguished from the naturally dark appearance of the pu- pil. In the commencement of the disorder it occasions a weakness or imperfection of sight, and it terminates sooner or later in total blindness. For a description of the different species of cataract and fhe proper method of cure, the reader is referred to books on surgery. Specks or spots on the eyes are frequently the conse- quence of inflammation. These may sometimes be removed by the application of a powder formed by mixing a small proportion of white vitriol with refined sugar; this may be blown into the eye through a quill, or a simple solution of white vitriol, or a very mild one of corrosive sublimate may be tried. When such means fail, the only remaining expe- dient is a surgical operation, which if judiciously performed, will sometimes succeed. A blood-shot eye in consequence of external violence, or straining by vomiting or coughing, seldom requires any thing more than to be fomented with warm milk and water or a solution of the acetite of lead. The watery or weeping eye, proceeding from a relaxation of the glandular parts of that organ, requires some astringent application, as a small proportion of brandy with water used cold, or the preparation of white vitriol with the whites of eggs, to be found in the Appendix; besides which, blisters and purgatives will be proper. Fistula lachrymalis is a disease arising from an obstruc- tion in the nasal duct, preventing the tears and mucus from descending into the nose. A tumour is thus produced in the inner corner of the eye, and the tears and mucus run oft' down the cheek. A cure of this troublesome complaint may be attempted by the frequent application of the extract of Phytolacca decandra, and if unsuccessful, the only remed) is a surgical operation. Strabismus or squinting may proceed either from a ner- vous affection or a vicious habit acquired in children by 648 DISEASES OF THE EYES having their eyfes unequally exposed to the light, or by iui itafion from a squinting nurse or other example. When this defect has not been confirmed by long habit, it may be obviated by darkening the more perfect eye for some hours daily, by which means it will be gradually weakened, and the defective eye will be gradually corrected by using it, or the child may wear a mask which will only permit him to see in a straight direction. That condition of the eyes called myopia or short-sight- edness, may be in some measure remedied by the help of concave glasses, and in a contrary condition of the eyes, convex glasses will be requisite and useful. When the sight is considerably impaired and weakened by too constant application, especially night-watching and candle-light lucubrations, these causes should be immediate- ly abandoned, and the use of green glasses will greatly assist in mitigating the complaint. When the great importance of the organs of vision and their very complicated and delicate structure are duly considered, it will appear obvious that too much care cannot be taken for their preservation. On the least appearance of diseased eyes, excess of every kind should be carefully avoided, as the use of strong liquors or long abstinence from,food, sudden transitions from darkness, or obscure light into that of the bright light of sunshine, or the glare of candles. All irritating causes, as smoke, the vapours of stimulating or volatile substances, vivid lights and glaring colours, are to be considered as highly prejudi- cial to the organs of vision. Among the preventive means to be employed by those who are subject to disorders of the eyes, issues or setons on the arms, food of easy diges- tion, and occasional laxatives are to be regarded as of no inconsiderable importance. CHAPTER XLVI1I OF DEAFNESS. DEAFNESS may proceed from various causes, as a radi- cal defect in the organ of hearing which admits of no remedy. It may arise from too great dryness of the ear, from a de- ficiency in the secretion of wax, from hardened wax ob- structing the passage of sound, inflammation of the mein- brana tympani, inflammation or obstruction of the Eustachi- an tubes, fevers, violent colds affecting the head, syphilis, and atony, or paralysis of the auditory nerves. According to Mr. Saunders all the diseases of the internal ear may be denominated nervous deafness ; the term in this sense em- bracing every disease the seat of which is in the nerves, or parts containing the nerves. The different species of deaf- ness may in general be distinguished by their peculiar symp- toms, and the mode of treatment should be varied according- ly. A deafness depending on hardened wax obstructing the auditory passage, may be effectually removed by syring- ing the ear with warm water and soap, or water saturated with common salt, which is found to be an excellent solvent of the wax ; the ear may afterwards be cleansed by syring- ing it wifh warm water. This kind of deafness is attended with noises in the ear, particularly a clash or confused sound in mastication, and of heavy sounds like the ponderous strokes of a hammer, but the existence of wax may be as- certained by examination with a probe. If a thin acrid or foetid discharge attends the deafness, blisters should be ap- plied behind the ears, or a constant discharge kept up by issues, and an infusion of the root of Indigo weed should be in- jected into the ear. When deafness proceeds from cold affecting the head, this part should be kept warm, especially by night. The feet likewise ought to be kept warm and frequently bathed in warm water, and purgatives occasion- ally taken. In that species of deafness occasioned by an \ 6jO 01 DEAFNESS. obstruction of the Eustachian tube, the patient cannot feel the inembrana tympani crackle as it were in his ear, or the membrane forced outward on blowing forcibly with his nose and mouth stopped, and there is no noise in the head like that which is known to accompany nervous deafness. To remedy fhis species of deafness, Mr. A. Cooper has resorted to the mode of puncturing the membrana tympani, by which the air is conveyed into the cavity of the tympanum, an- swering the same purpose as the Eustachian tube. This operation in the hands of Mr. Cooper has proved successful, and others have adopted it with the same result. A nervous deafness generally approaches in a gradual manner; the person hears better at one time than at another; a cloudy day, a warm room, and agitation of the mind increase for a time the difficulty of hearing ; the patient experiences dif- ferent noises in the head, as the murmuring of water, the hissing of a boiling kettle, roaring of the sea, rustling of leaves, the sound of bells, and blowing of wind. Sulphuric ether dropped info the ear in such cases, answers a valuable pur- pose in stimulating the torpid nerves; electricity, galvan- ism, and cold bathing are also appropriate remedies; and Mr. Wilson asserts that galvanism is capable of effecting a cure when deafness depends on a defective energy of the auditory nerve. Errhines will often be found useful auxilia- ries. When deafness is induced by atony or paralysis, the sulphuric eiher, the juice of garlic and other stimulants should be applied and retained in the ear by dossils of wool or cotton. When deafness is the effect of fever, the hearing is commonly restored with the strength of the patient. In all cases of this complaint it is of importance to keep Ihe head warm and the feet dry. CHAPTER XLIX. OF CUTANEOUS AFFECTIONS. Itch. THIS loathsome and unpleasant disorder consists of litth? watery pimples of a contagious nature, which first appear between the fingers and on the wrists, afterwards affecting the arms, legs, and thighs, and in process of time spreading over the whole body except the face, and attended with a great degree of itchiness, especially when warm in bed or exposed to the heat of a fire. The hot vesicles contain an acrid serum, to which by scratching, dry rough scabs succeed. A want of cleanliness is frequently the original source of this disease by producing animalcula, or small in- sects in the skin, which occasion the violent itching, and by which the infection is supposed to be communicated by contact with the body, or by wearing the same clothes, or lying in the same bed-linen that has been used by a person already infected. The itch is seldom attended with dan- gerous consequences unless neglected or improperly treated; if suddenly repelled or driven in without proper evacuations, it may give rise to fevers or some internal inflammation. Persons affected with this disease if to any considerable degree, should never neglect to take as much flowers of sul- phur and cream of tartar internally as will have a laxative effect before or during the employment of the proper exter- nal remedies. Among the numerous forms of ointment re- commended and employed for the removal of this disorder, experience confirms that no one is to be preferred to those which have sulphur as a principal ingredient; the unpleas- ant sulphureous smell may be corrected by fhe addition of the essence of lemons or burgamot. The particular forms will be found in the Appendix. The unguentum citrinum, or yellow ointment of the Dispensatories, is a safe and in 652 OF CUTANEOUS AFFECTIONS. general a very effectual remedy. A neat and efficacious ointment may be formed by mixing half a drachm of sulphu- ric acid with two ounces of hog's lard, but this is apt to cor- rode the person's linen when applied. Various mercurial preparations have been employed successfully, but they should not be resorted to incautiously. There are various vegetable productions possessing properties adapted to fhe cure of (his filthy disease, as digitalis, the two species of lau- rel, tobacco, and the root of white hellebore, found in our meadows and swamps. A strong decoction of either of these applied as a wash will seldom fail to effect a cure. In some instances where the patient is of a full habit it will be proper to bleed, or to administer one or two purges before the ap- plication of the ointments, which are to be rubbed upon the arms, legs, and thighs, or other parts at bed time every night, it being seldom necessary to apply the ointment over the whole body. When the cure is completed, which generally requires two or three nights, the patient's body should be thoroughly washed with soap and water, and all the infected clothes ought to be well fumigated with sulphur or other- wise effectually cleansed. Some attention should be paid to the diet while labouring under this disorder ; high season- ed or salted meats and heating liquors should be avoided, and milk and vegetables with a small proportipn of animal food preferred. The patient should shift his linen frequent- ly and attend carefully to the means of cleanliness. It frequently happens that children are afflicted with eruptive disorders having a similar appearance with the itch, but it is not always safe to treat them in the same manner, for those eruptions are often salutary and ought not to be suddenly repelled. Herpes and Tetters. These consist of an assemblage of small red or whitish pimples, pustules or broad spots, appearing indiscriminately in different parts of the body, but most commonly on the face, neck, arms, and wrists, attended with a troublesome itching. They are sometimes separate and distinct, but afterwards run together in clusters, discharging a thin watery serum exuding over the whole surface of the part affected ; at length drying into a thick crust or scab, and forming ex- tensive excoriations or ulcers. When the scurfy scales peel off in the form of a white powder, they leave the under OF CUTANEOUS AFFECTIONS. U33 surface red, and the same appearances are soon renewed in a successive series till the disease is cured. In the opinion of Mr. B. Bell, every species of herpes is in a greater or less degree contagious, and easily communicated by contact. In the removal of these as well as other cutaneous affections, much depends on the employment of the means of cleanli- ness, (he warm bath with frictions with a coarse cloth will always contribute to the cure. The local applications best adapted as remedies, are solutions of sulphate of zinc, or of acetite of lead, should these fail a solution of corrosive sub- limate or the unguentum citrinunr may prove more effica- cious. A strong decoction of the fresh leaves of digitalis has been successfully employed, as also the leaves or ex- tract of phytolacca decandra, when used as a lotion and taken internally at the same time. The bark of slippery elm in decoction may be employed as a wash and taken in- ternally with much advantage, and in many slight cases these vegetable productions alone will effect a cure. Where the disease proves inveterate, a course of Piummer's pills wilh issues, and a milk and vegetable diet will be the most effica- cious mode of procedure. Of the Pimpled face, or Gutta rosea. This complaint is frequently the consequence of intemper- ance, though it does not in all cases proceed from that cause. From its disagreeable appearance the patient is often solicit- ous to obtain a remedy, but when these cutaneous inflamma- tions have become habitual, repellent applications for their removal may be attended with dangerous or even fatal con- sequences. The safest and probably the most effectual applications are decoctions of the root of sophora tincforia, the barks of slippery elm, and of the dulcamara or bitter sweet. If more powerful remedies should be desired, solu- tions of acetite of lead or of corrosive sublimate may be tried, but prudence will require that these should be accom- panied with mercurial purges, or an alterative course of mer- cury joined with antimony as in the form of Piummer's pills, and issues should be introduced and their discharge contin- ued. Fowler's arsenical solution, it is said, has succeeded in this complaint when taken in doses of eight drops twice in a day. The ring-worm is a disease of a similar nature with herpes and tetters, and may be cured with some of the rem- edies above recommended. CHAPTER L. BURNS AND SCALDS. THE degree of danger with which these accidents are attended, depends more on their extensiveness over the sur- flce than on the violence of the injury suffered. A burn, for instance, that is so violent as to destroy the life of mug-* cular parts down to the bone, if not large, is far less danger- ous than a scald which is entirely superficial, if it be very extensive. Much of the curative process also depends on the speedy application of the proper remedies, so as to allay the violent anguish, and to prevent, if possible, that exten- sive vesication and inflammation consequent to injuries by fire. The part scalded or burned should, without a moment's delay, be plunged into the coldest water that can be procur- ed, or the water should be constantly applied by means of linen cloths, and continued till the violent pain has entirely subsided, and as often as the pain returns the same applica- tion should be assiduously repeated. Another excellent ap- plication to recent burns and scalds is vinegar ; this may be used in the same manner as cold water, and in slight inju- ries, either of these if assiduously applied will soon effect a cure. If large blisters arise on the part, they should be opened that the vinegar may act immediately upon the burnt flesh. In the cold weather of winter the vinegar may be made about blood warm, and although some pain will be excited, it is strongly recommended to persist in its use. After a few hours continuance of cold water or vinegar, we are advised by some to employ a liniment composed of equal parts of lime water and linseed or olive oil, but as I conceive, the volatile liniment is a remedy greatly to be preferred, in- deed this last will be found a very eligible application as a common dressing from the beginning, being Spread over the surface of the sore with a feather, and covered with lint or BURNS AND SCALDS. 655 a linen cloth ; the smarting pain which it will at first occa- sion, will be of temporary continuance, and an agreeable soothing sensation soon follows. A decoction of the root of sophora tincforia, applied as a lotion, is excellently adapted to abate inflammation and dispose the sores to heal. But in most cases of burns and scalds attended with severe pain, permanent relief is only to be obtained by such means as tend to promote suppuration, and with this view emollient poultices composed of the mucilage of slippery elm bark, thickened with bread or meal, and covered with sweet oil, are of indispensable utility. When matter is formed on the surface, fhe sores may be covered with chalk finely powdered, till it has absorbed fhe matter and appears quite dry. A poultice, or the stramo- nium ointment, should be laid over the chalk, and the same dressings repeated morning and evening till the sores begin to heal, when the cicatrization may be completed by the employment of the cerate of lapis calaminaris, or the satur- nine ointment. When the injury is of a very extensive nature and much febrile heat ensues, fhe antiphlogistic plan must be pursued, gentle laxatives and refrigerants should be employed, and opiates to allay pain and irritation. If the parts become livid and black, and there is reason to be apprehensive of a mortification, the cinchona and wine must be immediately administered internally, and the sore should be kept con- stantly moistened with a decoction of sophora tincforia, and recourse must be had to all the usual means of obviating mortification. If the burn is occasioned by the explosion of gunpowder, and some of the grains are forced into the skin, they should be picked out as soon as possible after the accident, as they excite irritation and leave marks during life. Cotton wool, when applied to recent burns and scalds, is said to have proved beneficial, and I have witnessed one instance of its good effects. It is to be spread over the whole surface of the injured parts, and suffered to remain for several days, when it may be removed with perfect ease, and the sores will often be found nearly healed. A plan of cure precisely the reverse of lhat just describ- ed, has been introduced and strenuously advocated by Dr. Kentish. His principles are, " that any part of the system, having its action increased to a very high degree, must con- 656 BURNS AND SCALDS tinue fo be excited, though in a less degree, either by the stimulus which caused the increased action, or some other having the nearest similarity to it, until by degrees the ex- traordinary action subsides into the healthy action of the part." It might seem not inconsistent with his doctrine to have recourse to actual fire or the hot poker, as the best mode of relief, but Dr. K. relies on alcohol, made more stimulating by the addition of essential oils, to be applied healed to as great a degree as the sound parts can bear with- out injury. He directs the injured parts to be bathed two or three times over with spirits of wine, either with or with- out camphor, or spirits of turpentine heated by standing in hot water. After this, a liniment composed of the common yellow basilicon, softened with spirit of turpentine, is to be spread on a soft cloth and applied. This liniment is to be re- newed only once in twenty-four hours, and at the second dress- ing the parts are to be washed with proof spirit, or lauda- num made warm. When a secretion of pus takes place, milder applications must be made till the cure is effected. Dr. K. thinks it of importance that the injured surface should be left uncovered as little as possible, as the air has an inju- rious effect. He advises powdered chalk to be used to re- press the growth of exuberant granulations and to absorb the pus. Our author is also of opinion that internal stimu- lants should be administered in proportion to the degree of injury during the few first days or till suppuration takes place, when it will be no longer necessary to excite the sys- tem. Dr. K. observes, that by his mode of treatment the inflammation will in general be found to disappear at the end of forty-eight hours, when the dressings may consist of cam- phorated oil, Goulard's cerate, or the cerate of lapis cala- minaris. The theory of Dr. K. is viewed as visionary, it must not, however, be dissembled that his practice has been success- fully adopted and warmly approbated by some practitioners of great eminence. The success of the cooling method of cure is also corroborated by the highest medical authorities, and it may be asserted that this last still holds almost uni- versal preference. All extremes should in these cases be avoided, and a medium course, varied according to partic- ular circumstances, may perhaps be deemed the most eli- gible. CHAPTER LI. RUPTURES, OR HERNIA, THE various kinds of ruptures are distinguished by dif ferent appellations according to the contents of the tumour and the situation of the parts in which they make their ap- pearance. The parts in which hernia most commonly ap- pear, are the groin or labium pudendi, called bubonocele, or inguinal hernia ; when it protrudes into the scrotum it is termed scrotal hernia. If in the upper and fore part of fhe thigh it receives the name of crural, or femoral hernia. When the bowels protrude at the navel the case is named an exomphalos, or umbilical hernia. The contents of the tu- mour are a part of the intestinal canal or a portion of the omentum or caul, or bofh together. The most frequent causes of this disorder, are in children crying, coughing, or vomiting; in adult persons, blows, violent exertions of strength, as lifting or carrying heavy weights, straining at stool, par- turition, jumping, running, &c. When a rupture is produc- ed by bodily exertion, the tumour is formed suddenly, and is generally attended with a sensation of something giving way at the part and with considerable pain. If it come on in consequence of a laxity of the constitution, the tumour is small at first, and the protruded parts return into the ab- domen when the patient is in a recumbent posture, or may easily be reduced with the hand. A rupture that is reducible and free from strangulation, ap- pears in the form of an elastic indolent colourless tumour, subject to change its size, being smaller when the patient lies down on his back and larger when he stands erect. The tumour frequently diminishes when pressed, and grows large again when the pressure is removed. When persons labour under this description of hernia, although they may remain for some time free from severe pain or distress, their condi- tion is nevertheless such as to require much attention as 83 6;)*i RUT IT RES, OR HER.MA neglect or mal-treatment may be attended with falal conse- quences. When the profruded parts are found to be irre- ducible, and considerable pain and inflammation ensue, the case becomes an incarcerated or strangulated hernia, the peculiar symptoms of which are, the tumour is very tense, painful to the touch and resisting the impression of the fin gers, sickness and vomiting soon follow, and a suppression of all discharge by stool, attended with a frequent hard pulse and febrile heat. Under these alarming circumstances eve- ry possible effort should immediately be made to effect a removal of fhe stricture, and a restoration of the relapsed bowels or a mortification must inevitably ensue. The first attempt is always to be by the taxis, or the operation of re- ducing a hernia by the hand. For this purpose the patient should be placed on his back, and the foot of the bed be el- evated about twenty inches higher than the head, the thighs should be bent towards the body, and that on the same side with fhe rupture inclined inwards, by which position the muscles of the abdomen will be relaxed. By some we are desired to place the patient on fhe side opposite to that of fhe rupture, which may be tried. The pressure which is made on (he tumour by fhe hand of the operator for its re- duction, should always be directed upwards and outwards in inguinal hernia, and first backwards and then upwards in femoral hernia. The efforts may be continued about half an hour, but no v iolence ought on any account to be used, as it will tend greatly lo aggravate the inflammation, and when the pressure becomes painful it should be discontinued. Should the taxis fail of success, the patient should be immediately bled from a large orifice if nothing forbid, and then another trial be made, and on failure of this also, resort be had to the warm bath, and the taxis repeated while the patient lies in the water. It has been my practice to pour gradually over fhe tumour from one to two ounces of ether, and allow it to evaporate. When the smarting which it produces becomes insupportable, I pour on cold water for a minute or two and then repeat the ether. The three last cases which have fall- en to my lot were cured within half an hour by the applica- tion of this remedy alone. The next remedies to be employ- ed are the coldest applications to the tumour, as pounded ice included in a bladder, or when this cannot be procured a mix- ture of equal parts of nitre and sal ammoniac, in the propor- tion often ounces to a pint of water, should be tried by a con RUPTURES, OR HERNIA. '85£ tftant application of it to the tumour. In conjunction with these means, opiates may be useful, but the sedative effects of to- bacco clysters will probably be more effectual. The smoke of tobacco has commonly been employed, but the decoction on account of its more convenient administration should be preferred ; one drachm of tobacco boiled for ten minutes in a pint of wafer is the proper proportion. One half of this quantity only should be injected at a time, and fhe remain- der after it shall be found lhat the first does neither succeed nor operate with such extraordinary violence as to produce a dangerous depression of the system, as Mr. A. Cooper has seen two drachms, or even one when infroduced at once prove fatal. Some or all of the above mentioned remedies should be employed with the utmost assiduity, as no time should be lost in this very hazardous disease. If the strangulated parts are not relieved and the return of the intestine effected in a short time, often in a few hours, all the symptoms become greatly aggravated, still more alarming circumstances super- vene, and unless relief be obtained by the only remaining resort, a surgical operation, a mortification and death will in- evitably close the scene. " There are some cases," says the experienced Mr. Hey, " so urgent that it is not advisa- ble to lose any time in the trial of means to produce a reduc- tion. The delay of a few hours may cut off all hope of suc- cess, when a speedy operation might have saved the life of the patient." Resort therefore, to a surgeon competent to this important operation, should in no instance be delayed be- yond the first twenty-four hours. With the view of guarding against the dreadful consequenc- es of a strangulated rupture, every person subject to hernial complaints should immediately procure a well adapted elastic spring truss, which should be worn night and day wilhout intermission. Very much of the utility and safety of a truss depends not only on ifs being properly constructed, but also on its being fitly adjusted to that part of the body where the hernia is situated. The pad of the truss being covered with leather and lined with soft materials, should be accurately applied over the aperture through which the ruptured parts descend. The neck of the truss should be made short so as to occupy the hollow of the groin only, for if it rest on the thigh the pad will be apt to move with the motion of the body, and the gut or caul may slip down behind the pad and occasion much pain and injury. 660 RUPTURES, OR HERNIA. - The hoop, or if made without one, a thick well stuffed strap must pass in a circular line pretty low down round the body with convenient tightness,and its end secured by a knob on the spring or pad part. But no truss can be a sufficient security without a thigh strap; this should be made of wash leather, and being properly lined or stuffed, musl be looped over Ihe hoop or circular strap, and sewed just below the lower hip bone, the proper place can be more exactly ascertained after the truss has been fried on the patient. This strap is to pass under the thigh of the srme side and fastened to a knob or buckle on the lower end of the pad. Another requisite is an object of attention ; it is absolutely necessary to wear un- der the pad a cushion or compress made of coarse calico or cotton cloth, folded into a square of about three fourths of an inch in thickness, so as to fill up the hollow in the groin, and to project a quarter of an inch beyond the edges of the pad, except the side next the thigh. The calico cushion will materially assist the truss in fulfilling its object, it pro- tects the spermatic cord from being injured by the pressure of the pad, and enables the patient to wear the truss with a proper degree of tightness, and adds considerably to the pressure above and around the aperture, by which a descent is more effectually prevented. When a person is ruptured on both sides he must wear a double truss applied in the manner above directed. In cases of umbilical rupture, a similar mode of treatment will apply, and a truss of an appro- priate form will be requisite. For a description of the ope- ration for an incarcerated hernia and information respecting other species of ruptures, the reader is referred to the prop- er books on surgery. It is an erroneous idea that infants and young children are incapable of wearing a steel spring truss ; if well adapted and judiciously applied, they will be found not only practicable, but to subserve the desired pur- pose of security until by growth and strength nature per- forms a cure. Whoever expects a rupture, either in child- ren or adults, may be radically cured by plasters or nostrums, will be wofully disappointed in the trial, and he who encour- ages such expectation, is too ignorant to deserve confidence or too knavish to escape censure and punishment. But by a due observance of the foregoing directions, the condition of ruptured persons may be rendered comfortable, and they may be enabled to endure fatigue and labour ; but by neglect and inattention, their situation must be miserable and their lives constantly exposed to danger- RUPTURES, OR HERNIA. 661 The trusses manufactured by Mr. Samuel D. Howe of Salem, having a spiral steel spring operating on the pad, are ingeniously constructed, and from examination and personal trial, I am of opinion they ought to be recommended. Mr. John Beath of Boston, has lately improved upon Read's patent spiral spring truss. It consists of a pad fur- nished with a spiral spring, and a semicircular spring extend- ing half round the body ; the pad being applied over the part where the rupture descends, the opposite end is made to rest on the vertebrae of the loins, thus combining the ad- vantages of a double spring truss with a uniformity of press- ure. This I can from experience approve as being adequate to all the purposes required. Dr. Jonathan Leonard has invented a spring truss, the pad of which moves on a kind of pivot, allowing a rotatory mo- tion capable of favouring the different movements and posi- tions of the body in the most easy and secure manner possi- ble. From my experimental knowledge I am confident that those who may experience the use of this truss will not re- linquish it for any other.—They are for sale at the druggist store of Mr. William B. White, No. 49, Marlborough street, Boston. CHAPTER L1I. OF PERSONS APPARENTLY DROWNED. IT is now a well established fact that the principle of life may lie dormant in the body after it is apparently dead, and that it may be resuscitated and rescued from a prema- ture grave by the means recommended by the various hu- mane societies instituted in our country. As soon as the body of a person recently drowned is taken out of the water, it must be carefully conveyed with the head raised to a house or other place where it can be laid dry and warm, avoiding the destructive methods of hanging it by the heels, rolling it on a barrel, or playing it across a log on the belly. The clothes must be imme- diately stripped off, and the body wrapped up in blankets well warmed. It should be laid on its back, with the head a little raised. If the weather be cold, it should be placed near a fire, and an heated warming-pan should be passed over the body ; but in warm weather it will be sufficient to place it between two blankets well heated, or in the sun- shine, taking care to prevent the room from being crowded with any persons who are not necessarily employed about the body. At the same time the whole body should be rubbed with the hand or with hot woollen cloths. The rub- bing should be moderate, but continued with induslry, and particularly about the breast. Apply also heated bricks to the feet, belly, and breast. The immediate application of frictions is of the utmost importance, as many have been re- covered by frictions only when early used. As soon as it can possibly be done, a bellows should be applied to one nostril, while the other nostril and the mouth are kept closed, and the lower end of the prominent part of the wind-pipe (or that part which is called by anatomists pomum adami) is pressed backward. The bellows is to be worked in this situation ; and when the breast is swelled by it, tiie bellows should stop, and an assistant should press the belly upwards to force the air out. The bellows should then be applied as before, and the belly again be pressed ; this NOXIOUS VAPOURS. 663 process should be repeated from twenty fo thirty times in a minute, so as to imitate natural breathing as nearly as possi- ble. Some volatile spirits heated may be held under the valve of the bellows whilst it works. If a bellows cannot be procured, some person should blow inlo one of the nos- trils through a pipe or quill, whilst the other nostril and mouth are closed as before; or if a pipe or quill be not at hand, he should blow into the mouth whilst both nostrils are closed ; but whenever a bellows can be procured it is to be preferred, as air forced in by these means will be much more serviceable than air which has already been breathed. During this lime a large quantity of ashes, water, salt, or sand, should be healed, and as soon as it is milk warm the body must be placed in it; the blowing and rubbing are then to be contin- ued as before; and when the water, ashes, or salt, are cool- ed, some warmer must be added, so that the whole may be kept milk warm. Loud noises have sometimes proved suc- cessful in recovering such persons and restoring to life. When signs of returning life are apparent, the frictions must be continued, but more gently. These methods must be continued three or four hours, as in several instances they have proved successful, although no signs of life appeared until that time. When the patient is able to swallow, he must take some wine, brandy, or rum and water. Bleeding or purging ought not to be used without consult- ing a physician, who should be called in as soon as possible: but clysters of salt and water may be injected. Where either convulsions or stupor and head-ach remain after the person has come to himself, the physician will doubtless see the propriety of drawing off a small quantity of blood, cith- er by die lancet or the application of leeches to the temples, but where these symptoms do not prevail, the loss of blood will be injurious. The meuns above recommended are likewise applicable in the case of suspension by the cord. But in the circum- stance of strangulation, a few ounces of blood must be tak- en from the jugular vein or arm ; or cupping-glasses be ap- plied to fhe head and neck, and leeches to the temples. Noxious Vapours. Suffocation and immediate death may be occasioned by entering wells, cellars, caverns, or mines, that have long been kept closely confined from the atmospheric air. The dele- terious fumes arising from burning charcoal, or those from 664 TO PREVENT THE FATAL EFFECTS OF I.IGHTNINO. fermenting liquors, &c. may likewise produce the same fatal effects, if imprudently received by any person into the lungs. The external appearances of persons thus suffocated are as follow : the head, face, and neck are swollen; the eyes are propelled from their sockets; the tongue is protruded at one side of the mouth; the jaws are firmly closed; the face is of a livid, and the lips are of a deep blue colour ; the abdo- men is inflated; the body is insensible to pain, and the per- son appears to be in a profound sleep. No person therefore ought to venture info any such place where a long stagnation of air have produced mephitic vapours, until these have beeu sufficiently corrected by the explosion of gunpowder or some combustible substance burnt, and a free ventilation of the infected place. The safety of such suspected plac- es may be ascertained by first letting down a lighted candle or burning fuel; if these continue to burn, it is a proof that the air is pure; but if the flame be suddenly extinguished, no person can enter without immediate suffocation and death. Immediately on discovering a person apparently dead from such cause, the windows and doors ought to be thrown open, and the body be undressed and exposed freely to cool air, the face be sprinkled with vinegar, and cold water be thrown from buckets over the whole body for some time. If this method fail, frictions and the other means recommended for the recovery of drowned persons should be put in practice. To prevent the fatal effects of Lightning. The circumstance is worthy to be regarded in every fam- ily that lightning is conducted with more facility by some substances than by others, and indeed that some substances are non-conductors. The substances which are the greatest conductors are all metallic bodies, as gold, silver, platina, brass, iron, tin, and lead; also, water, ice, snow, green wood, and most earthy substances. Non-conductors are glass, sulphur, resin, silk, cotton, feathers, wool, hair, paper, ashes, and most hard stones and bricks. During the time of danger from lightning, we should carefully avoid standing or sitting near any of the conductors within doors, and when in the open field no safety will be found by resorting to trees for shelter, especially such as have dead or dry branches about them. Whilst within doors it will be safest to avoid being near the furniture of the fire place, the wires and cords of bells, picture frames, and other gilt furniture. The doors CLOTHES CATCHING FIRE. 665 and windows should be opened for a free passage of the flashes of lightning, and the middle of the room should be chosen as the most secure situation for the family, and if sitting on mattresses or couches filled with hair, wool, or feathers, it would be an additional security. " When light- ning exhibits a deep red colour it is seldom accompanied with dangerous consequences; but if the flashes be bright, pale, and in a zig-zag direction, destruction generally marks their course." Persons injured by a flash of lightning, though apparently dead, may in many instances be restored by proper and timely applications. In general there are no external marks discoverable, though sometimes red streaks appear on differ- ent parts. The treatment to be pursued for the restoration of persons suffering injury from lightning, is precisely the same as that for persons suffocated by noxious vapours. The sprinkling with vinegar and the affusion of cold water are the principle means to be employed. In some instances of suspended animation, electricity may be successfully directed. Clothes catching fire. Instances are not unfrequent since muslin dresses have become fashionable, of females and children being destroyed by this most painful and shocking form of death. When casualties of this kind do occur, a little resolution or presence of mind may be crowned with the happy effect of saving some valuable lives. It should be considered that fire spreads most rapidly when cloths are suspended over it, and the blaze is allowed to progress upwards. The first step therefore, to be taken when a female finds her clothes have caught fire, is to throw herself down and roll herself up in the carpet, or some woollen cloth, directing the doors and windows to be shut, in order as much as possible to prevent the air being admitted. In this situation time will be afford- ed to procure buckets of water, and this, while arresting the progress of the flame, will be the most effectual application lo obviate the fatal consequences to the sufferer. (See chapter on Scalds and Burns.) Of Frost bitten, or the effects of intense cold- When persons are exposed to an intense degree of cold greater than the body is capable of sustaining, the vessels 84 666 EFFECTS OF COLD AND FROSI upon (he surface, particularly the extremities, are constrict ed, by which the circulation is obstructed, an unusual quan- tity of blood is forced towards the brain, and a fatal apo- plexy is generally the consequence. The first alarming symptom is a drowsiness or almost irresistible propensity to sleep, and if this propensity be indulged it will assuredly prove the sleep of death. Whenever therefore, a person is long exposed to extreme cold it should be recollected lhat his safety greatly depends on the constant motion and activ- ity of the body and firm resolution to resist the propensity to drowsiness. If unfortunately a person has suffered by exposure to extreme cold so that every symptom of life has disappeared, the only proper method of treatment consists in placing the naked body in a cold room or in a situation distant from a fire, and immediately cover it, except the face, with a bed of snow, or plunge it into a bath of the coldest water for some time, and when taken out the whole body should be thoroughly rubbed with cloths wet with cold water. The immersion and the friction should be repeated and alternately applied for a length of time ; for instances have occurred of persons being restored by a steady perse- verance in the process when no signs of life had been dis- covered for several hours. When symptoms of animation appear, external warmth must be very gradually applied, and when the patient is able to swallow, a cup of tea or a little wine or brandy may be allowed. When the hands or feet have been exposed to severe cold and have become benumbed or frozen, the excitability of those parts will be so much stimulated that if they are brought near a fire a violent inflammation and probably a mortifica- tion will ensue. External heat should on no account be ap- plied, but the frozen parts ought to be immediately covered with snow, or immersed in cold water until they recover their natural warmth and sensibility, and if necessary the applications and the friction should be repeated and contin ued for several days, and afterwards the external warmth must be applied in a gradual manner. The application of goose grease, or the fat of common fowls have been very successfully employed as a remedy to frozen limbs, even when the parts were perfectly black. The parts should be kept constantly covered with the grease. APPENDIX. OF LEECHES, (iHRUDO MEDICINALIS.) THE employment of leeches as medicinal agents has be- come so universal in practice, that every physician will find it incumbent to make himself acquainted with their character and properties. Of this animal there are various species, some of which are more valuable than others for their use in drawing blood. The medicinal leech is commonly about two or three inches long, and its head is turbinated. Its back is of a dull olive green colour, divided into three nearly equal parts by four yellow longitudinal lines, the two lateral entire, the two cen- tral broken with black. Besides these between the lateral and central lines on each side, there are two others resemb- ling a chain of black and yellow. The belly is turkey blue, irregularly marked with yellow spots. It sucks with either end ; but the bite of those found in stagnant waters, or the horse leech as it is termed, being entirely brown, or only marked with a marginal yellow line, is said to cause pain and inflammation, and should be rejected. Leeches should be collected in the summer in ponds having a clear sandy bot- tom, and preserved for use in a bottle half filled with pure spring or river water, and covered with gauze or muslin. The water should always be kept in a moderate temperature and ought to be changed frequently, although there are in- stances of their living many months and even years in the same water, and it is remarkable that water in which they are kept continues much longer sweet than by itself. Leeches are very useful and convenient remedies in every case requiring local blood-letting. They cause less irritation than cupping, and can often be applied nearer to the part. They are employed in all local inflammations where general blood-letting will be improper ; the particular circumstances which require their use have been mentioned in the course 668 APPENDIX of this work. The applicafion of leeches is sometimes at- tended with considerable difficulty. In cloudy weather and in the evening they do not readily bite. If kept out of the water some minutes and allowed to crawl on dry linen and then moistened with warm water before they are applied, they are said to bite more eagerly. The part to which fhey are to be applied should be well washed, and if covered with strong hairs should be shaved and the skin may be moisten- ed with a little blood or warm milk. The leeches should be confined by an inverted glass or cup over the part from which the blood is to be drawn, and when a sufficient number have fastened the glass may be removed. A large leech will draw about an ounce of blood; but the quantity may be much increased by bathing the wounds with warm water, or applying over them cupping-glasses. It is on some occa- sions found necessary to employ from ten to twenty or even thirty leeches in order to draw a sufficient quantity of blood. When they have gorged themselves with blood, they drop off and not unfrequently die of indigestion, and cause a great mortality even among those that have not been employed. To avoid this danger, leeches which have re- cently sucked should be kept by themselves until they have recovered their usual vigour ; and a little salt applied to the head of the animal will occasion it to vomit up the blood which it has received. These insects change their skin fre- quently, at that time they are subject to indisposition and will not bite. Cupping. The apparatus for local blood-letting by cupping consists of a scarificator and a glass, shaped somewhat like a bell. The scarificator is an instrument containing from sixteen to twenty lancets which are so contrived, that when the instru- ment is applied to any part of the surface of the body, the whole number of lancets are by means of a spring pushed suddenly into the skin to the depth at which the instrument has been previously regulated. As only small vessels can be thus punctured, very little blood would be discharged from them were not some method taken to promote the evac- uation. This is commonly done with a cupping-glass ; the air within the cavity of which being so rarified by heat as fo produce a very considerable degree of suction. The meth APPENDIX. 669 od of applying the heat, is to dip a piece of tow or paper in spirit of wine, and having set it on fire, put into the bot- tom of the glass ; and on its being nearly extinguished, to apply the mouth of the glass directly upon the scarified part, forcing it down on the skin, and a considerable suction takes place. If the scarifications have been properly made they instantly begin to discharge freely; and so soon as the glass is nearly full of blood, it should be taken away by raising one side of it so as to admit the external air. When more blood is desired to be taken, the parts should be bathed with warm water ; and being made perfectly dry, another glass exactly the size of the former, should be instantly applied in the same manner. Should it happen, however, that the full quantity of blood cannot be obtained in one place, fhe scari- ficator must be again applied on a part as near to the former as possible, and the application of the glasses be renewed as before. On some occasions the quantity of blood is more quickly obtained by the cupping-glasses being applied for a few se- conds to'the dry skin before scarifying, as by means of the suction the more deep seated vessels may be brought into nearer contact with the skin and more of them be cut by the scarificator. When the sufficient quantity of blood is procured, the wounded surface should be perfectly cleared of blood and covered with soft lint dipped in a little milk or cream, and no other dressing will be required. In a variety of local complaints where a local evacuation of blood is desired, and where the scarificator and glasses can be applied, this method is greatly preferable to any oth- er ; buf in cases where the operation cannot be performed contiguous to the part affected, recourse must be had to leeches which can be placed upon almost any spot whence we would wish to discharge blood. When a cupping-glass cannot be procured, a common wine glass will answer the purpose. In the New-England Journal of Medicine and Surgery, Vol. V. p. 127, a correspondent proposes the following as a substitute for leeches, which forms a species of cupping. A small machine may be made of tin composed of two cham- bers, one above the other, joined by a short tube ; both cham- bers being as far as is convenient cylindrical. The lower chamber may have a wide mouth with a smooth blunt edge 6?0 APPENDIX to apply closely to the flesh ; two or three long and narrow apertures being placed perpendicularly in its sides, closed with glass, (but so as to be air-tight) in order to give a view into the interior. Lastly, the upper chamber terminates in a small mouth on its upper side, having a cork stopper. The flesh of the patient being first properly scarified, and (hen covered with the mouth of the lower chamber of the machine ; a hot iron is next to be held within the air of the upper chamber in order to rarify it; the cork stopper being re- moved for this purpose. When this air has been to a cer- tain degree rarified, the cork stopper is to be restored; and the sides of the upper chamber are then to be cooled, that the air which remains may again become condensed. This being accomplished, the blood may be expected to flow ; and whenever the flowing ceases, the operation just mentioned is to be repeated, toties quoties ; till the due quantity of blood shall have been taken away. Of Cold and Warm Bathing. Baths receive various denominations, not only according to their different degrees of temperature, but also as to the manner and form in which they are employed. They are distinguished into the cold, tepid or temperate, warm, and hot baths. To these may be added the steam or vapour bath, the air bath, and earth bath. Baths may be either generally or partially applied. When water, either cold or tepid, is thrown over the body from a bucket, or by means of a constructed apparatus, in a shower, it is termed affusion, or shower bath. The immersion of the feet in warm or tepid water is professionally termed pediluvhim; and when the lower half of the body is immersed in a similar bath, it is denominated semicupium. When the naked body is ex- posed for a considerable time to the cold air, this is termed the air bath, a practice recommended by Franklin as a substitute for bathing; and when the naked body is sur- rounded with sand, or buried up to the shoulders or neck in the earth, it is said to be placed in a sand bath; from which, however, very little utility can be expected. The "cold bath is that which possesses the ordinary temperature of the atmosphere in the temperate climates, varying from 32° to about 65° of Fahrenheit's thermometer." Whether bathing in sea water, or in ponds or rivers, the ef- APPENDIX 671 fects cannot be essentially different. On some occasion-.. however, the salt with which sea water is impregnated may act as a gentle stimulus on the surface; and this effect will be increased by heat, friction, or a long immersion ; but in cases where the immersion is only momentary, or where affusion is employed, and where the body is immedialely dried, salt water can have no advantage over that which is fresh. The immediate effect produced in a person in ordi- nary health, on being immersed in the cold bath, is a sensa- tion of cold and a sudden shock to the whole system, which is almost immediately succeeded by as general a sensation of warmth ; the latter rapidly increasing, so as to cause (he surrounding water to feel of an agreeable temperature. Af- ter a sudden immersion, if the body be immediately wiped dry and clothed, the agreeable sensation of warmth contin- ues, the system is invigorated, and generally the natural pers- piration is promoted. If, however, the body continues long immersed, and the wafer be extremely cold, fhe sensation of warmth ceases, and is followed by violent shivering and numbness of the extremities, a series of alarming symptoms supervene, and at length delirium and torpor ensue, and the person is destroyed by a fatal apoplexy. The increase of animal heat which takes place immediately after the cold, occasioned by the first immersion, constitutes that re-action •f the system, which enables it to resist an external impres- sion by which it might be injured. This re-action is in pro- portion to the intensity of the cause by which it is excited, and to the vigour of the vital powers. It is this re-action of the system by which all the advantage from the application of the cold bath is derived ; and when the re-action does not occur, or takes place only in a small degree, it is evident that the cold bath has been injudiciously or excessively em- ployed. When, therefore, the system has been debilitated by long continued exertion or disease, where the temperature of the body is below the natural standard, or where a pro- fuse perspiration has come on, cold bathing should be avoid- ed as injurious. The employment of the cold bath, it appears, is attended with three principal effects : a sudden and powerful shock given to the body, a sudden abstraction of heat from the surface, and the re-action of the system to counteract the shock, and to restore the diminished temperature. In its general and primary effect therefore, the cold bath acts as a 672 APPENDIX. powerful stimulus to the whole system, and to this effect its advantages as a remedy are chiefly to be ascribed. Cold bathing has been found by experience to prove highly ad- vantageous in all those cases where the temperature of the body continues steadily above the natural standard, as in acute or ardent fevers, the hot stage of intermittents, yellow fever, &c. by reducing excessive heat and producing a sal- utary re-action of the system. It has been employed with beneficial effects in tetanus or locked-jaw, in those convul- sions which so commonly affect young children, in insanity, and in several chronic diseases, particularly chronic rheu- matism. When used by persons in health, it increases the tone of the muscular fibre, strengthens the digestive organs, and by diminishing the sensibility of the whole system, and particularly of the skin, renders the body less susceptible of atmospheric impressions from cold, wet,and sudden changes of temperature; thus contributing to the production of what is termed a robust or athletic constitution; and thus fortify- ing the system against contagious and febrile diseases. It is peculiarly adapted to those constitutions which are often liable to hysteric, hypochondriacal and paralytic affections, as well as to frequent attacks of flatulency and consequent in- digestion, as it stimulates the nerves and excites to those powerful exertions on which the vigour of the system so much depends. Cold bathing is eminently beneficial in cas- es of rickets in children, and is useful to preserve them from the bowel complaints which prevail in the summer months throughout the United States. This powerful remedy is to be regarded as inadmissible in all those cases where the heat of the body is below the natural standard, or where a profuse perspiration has come on ; where there is any con- siderable degree of plethora, or unusual fulness of the blood vessels ; where the person is subject to inflammatory affec- tions of the lungs, or any considerable determination of blood to the head; it should also be prohibited in haemorrhages, in constipations, difficult breathing, short and dry coughs, &c.; in scurvy, in fits of the gout; in cutaneous diseases, and where from constitutional weakness, or unconquerable dread, the use of this remedy may be productive of un- pleasant feelings. With respect to the condition of the body when recourse may be had to this powerful agent, and the most proper mode of employing it, it must be remarked, that the morning or forenoon is the most suitable time, either APPENDIX 673 when the stomach is empty, or two hours after a light break- fast. It is an erroneous and unfounded opinion, that im- mersion in cold water when the body is considerably heated by exercise or other exertion, is a dangerous practice'; on the contrary no person should ever enter into it while the body is in a stafe below the natural standard, but should first employ such a degree of exercise as will produce some increased action of the vascular system with some increase of animal heat. It is in this condition of the body only that the application is productive of a shock, without which not the smallest benefit arises from cold bathing. The next point to be observed is, that a quick immersion with the head foremost is the only safe and sure method, unless the head be first wet, either by diving or pouring water upon it, or by the application of a wet cloth, that the first impression may be uniform all over the body, there may be considera- ble danger of propelling the blood from the lower to the up- per parts of the body, and thus occasion a fit of apoplexy. As soon as the first shock is received, fhe person has deriv- ed all the advantage which the immersion is capable of af- fording, and a longer continuance in the water wiil be unne- cessary. Immediately after immersion the body ought to be rubbed with a dry and coarse cloth, and moderate exer- cise out of doors if convenient, should be employed. If a glowing warmth pervade the whole body after retiring from the bath, beneficial effects will certainly follow; but if the person feels heavy, inactive,or chilly, or finds himself affect- ed with head-ach or tightness across the chest, it is evident that it disagrees, or that it has been too long continued, and may prove hurtful. The shower bath may often prove an eligible substitute for immersion, and on some accounts this possesses superior advantages, as considerable benefit is derived from the grav- ity as well as the tonic power of the water. The head and breast are secured from danger by receiving the first shock, and the water is quickly transmitted over the whole body. The temperature of the water too may be more easily mod- ified and adapted to the circumstances of the patient. From the foregoing observations it must appear obvious that the cold bath is capable of producing extraordinary effects; and is not equally adapted to all constitutions and circumstances, nor can it be employed indiscriminately with perfect impu- nity. There is much reason to suppose that many invalids, 85 6? 4 APPENDIX delicate females, and young puny children have been mate- rially injured in their health by an injudicious and unadvised resort to (his very powerful application. The tepid bath may be at the temperature of about 80° to 86°, and the warm bath from 90° to 98° of Fahrenheit's thermometer, or about the same temperature with the blood It has been supposed till very lately that one constant ef- fect of the warm bath is to relax and debilitate the body ; but numerous experiments seem to prove that this opinion was founded in error, and that on the contrary, persons de- bilitated by disease, have felt stronger on the days when they used the warm bath, and were soon restored to their former strength. If in any cases relaxation and debility followed the use of the warm bath, it is to be attributed to the heat of the bath having been too great for the constitu- tion of the patient, or the immersion having been continued too Song. The stimulant effects of the warm balh are very inconsiderable, and it is found useful in allaying irritation, diminishing morbid frequency of the pulse, relaxing and purifying the skin, and in inducing sleep and repose. The warm bath will be attended with advantage in those cases of fever where the heat is preternaturally great, but where from some affection of the lungs, or other unfavourable symp- tom, cold bathing is inadmissible; in the paroxysms of hectic fever ; in several eruptive diseases attended with in- creased heat and dryness of the skin; in atonic gout and rheumatism accompanied with stiffness and swelling of the joints; in chlorosis; in slight cases of palsy ; in scrofulous swellings; in some spasmodic and convulsive affections where the cold bath might prove too violent; in all those affections of the bowels that seem t© depend on an irregular or dimin- ished action of any part of the alimentary canal; and in cases of debility attended with nervous irritation. In cases of predisposition to phthisis, it abates the frequency of the pulse, and tends to retard at least, if it does not wholly pre- vent fhe pulmonary affection. The time of continuing in the warm bath should be varied according to the tempera- ture of the water and the feelings of the patient. In a bath of ninety-six, a person may remain fifteen, twenty, or thirty minutes ; but in one of ninety-eight or one hundred, which is the temperature of the hot bath, ten minutes is the extent to which most persons can bear. When the warm bath is intended to produce increased perspiration, it is best em- APPENDIX. B7j ployed in the evening, and the patient should be removed from fhe bath to a warm bed. Where, however, it is not intended to excite sweating, the most proper time is about two hours after breakfast; and after bathing, gentle exercise in the open air should be employed. Friction with a coarse cloth while in the water will often prove extremely benefi- cial. The vapour or steam bath is a modification of the hot bath. " It consists in the application of steam, brought by pipes from a vessel of boiling water, and either admitted to the whole body placed in a chamber for that purpose, or to any particular limb enclosed in a proper apparatus. The room is heated to a temperature considerably above that of the atmosphere, and the naked body is for some time suffered to remain in this heated air ; the common effect of which is to increase its temperature, and accelerate the circulation of the blood. After some time the steam is ad- mitted, and a profuse perspiration is soon produced. This is generally promoted by friction, and a removal to a warm bed. The general effect of this process is to relax the body, remove obstructions of the skin, alleviate pain and spasmodic contractions and promote sleep." For the substance of the foregoing observations the pub- lic are indebted to the late ingenious Dr. Currie of Liver- pool, tand to Dr. Sanders on mineral waters, an account of which may be found in the original works, in Rees' Cyclo- paedia, Edinburgh Encyclopaedia, and American New Dis- pensatory, 2d edition. Of the Mineral waters of Ballslon and of Saratoga. The diseases in which they may be employed as remedies- Among the numerous medicinal springs of which the United States can boast, those of Ballston and Saratoga have obtained the greatest celebrity and become a fashionable annual resort of a train of invalids from various parts of the union. It is therefore essentially important that their medical properties and virtues be clearly ascertained, and the diseas- es in which they may be successfully employed accurately discriminated. "" For it is an unquestioned law in medicine, that that which possesses active curative powers in one sel of diseases is equally detrimental in others." Both Profess- or Hosack and Dr. Valentine Seaman, one of the surgeons of the New-York hospital, have devoted considerable atten 676 APPENDIX tion to the analysis and experimental investigation of thr mineral waters of Ballston and Saratoga. The sentiments of the former gentleman have been promulgated in the Ameri- can Medical and Philosophical Register, and those of the lat- ter, in an ingenious dissertation on the mineral waters of SaN raog.i, &c. It appears from their experiments, that " fhe caioonic acid, salt and iron, are the principles upon which we should chiefly ground our calculations of fhe use of fhese waiers ;" and that diseases of debility are those in which (hey are prescribed wifh fhe greatest advantage and success. In dyspepsia these wafers have been found eminently bene- ficial, and in dropsy, hypochondriasis,hysteria,paralysis, chro- nic rheumatism, gout in its chronic state, and in chlorosis, and fluor albus, tbey have been employed with much advantage. But in calculus or gravelly complaints, these waters have been found singularly efficacious. " Here then" says Dr. Seaman, "we have in Ihese waters all the remedies that have proved the most efficacious in such affections, viz. a superabundant carbonic acid, (he carbonate of soda and lime. Indeed, the benefit experienced by those who have drank of them fully answers our expectations. A number of cases have come within my own particular knowledge, and Dr. Powell, whose long residence at fhe springs has given him a full opportunity of ascertaining the fact, assures me they are a valuable remedy in gravel, and that he has rarely seen a case of it where relief was not obtained." Other diseases in which these waters have afforded relief, are phagedenic and gangrenous ulcers, and various cutaneous eruptions, fevers and agues and scrofulous affections. In a plethoric state of the system, in consumption of the lungs, inflammation of the liver, acute rheumatism, and other inflammatory affections, these waters are invariably injurious. Dr. Jennings' patent portable warm and hot Bath. By the polite attention of Dr. Samuel K. Jennings, a res- pectable physician in the state of Virginia, I am authorized to occupy a few pages with an account of his new method of restoring warmth and heat to the surface and extremities of the body, by his patent warm and hot bath. The narrow limits allotted, however, and the urgent call of the printers for the manuscript, preclude the possibility of giving an ade- quate and just illustration of the theoretical principles of the APPENDIX. 677 learned author, a complete knowledge of which can only be obtained by the perusal of his scientific and very excellent treatise. A concise detail of his practical instructions must suffice on this occasion. It may not be improper to premise, that the spirituous vapour bath has been tested by repeated practical experiments in various hands, and received the sanction of the government of the United States; the sur- geon general of our late army, several hospital surgeons, and numerous individual medical and other respectable characters. Since the visitation of the ravaging epidemic called spot- ted fever or cold plague, which is always attended with a torpid state of the vessels of the surface and extremities, physicians have been induced more than formerly to appre- ciate the means of applying artificial heat to restore the bal- ance of excitement. Among the various applications em- ployed for this purpose are the warm balh, steams of hot water, billets of wood heated, twigs of pine or hemlock heat- ed by hot stones, bladders or jugs filled with hot wafer, &c The most of these have their inconveniences and defects, and it has long been a desideratum in practice to devise a more eligible mode of fulfilling the indication. In fhe dis- covery of Dr. Jennings we have the means of administering dry heat with fhe greatest facility and success, free from many of the evils and inconveniences of the usual methods of applying heat to the body. His method consists in con- veying and diffusing the gas of burning alcohol or ardent spirits over the body of the patient. The tin cup contain- ing burning spirits is placed on the floor, and a tin tube of proper length shutting over it, conveys the gas to the pa- tient in bed. "By this invention," says the author, "every physician, and indeed every family may be furnished with a convenient, elegant, and delightful method of applying heat. It may be put into operation in five minutes. The appara- tus may be carried in a large pocket; it would scarcely in- commode a pair of saddle-bags in travelling. It does not weigh three pounds. It may be applied to a patient seated in a chair or lying on a couch, sofa, cot, or bed. It is used without water. And it can be safely applied to patients in the most helpless condition. So far as I have been able to ex- tend my inquiries, my system is original."* The following * I have been apprized of the curious fact that the "apparatus of Dr. Jennings is exactly described in a German publication two centuries ago." It is by no means to be supposed however, that the Doctor ever had access to that source of informa- tion. 678 APPENDIX. is an abstract from one of the author's pamphlets. "A mor- bid determination of excitement or a local disease is correct- ed by general remedies, as blood-letting or puking, purging, &c. &c. where fhe general sfafe of the system seems to re- quire such general course. Or it may be treated by local remedies, as by bathing the part affected, or by blisters, lin- iments, &c. Sec. In consequence of the unity of disease, skilful physicians have imperceptibly run into an uniformity of practice. Hence we find that blood-letting, puking, purg- ing, blisters, &c. for many years have been the general remedies which they have employed for the cure of recent disease, although they have called it by a very great variety of names." " In offering the patent portable hot bath as a general remedy, it is obvious, therefore, that no more is assumed in its favour than has been assumed by physicians generally in favour of the almost universal practice of bleeding, purging, blistering, and salivating in almost any and every recent in- flammatory case. "But not to insist on the absurdities of those who claim for themselves what they disallow to others, I contend for the unity of disease and calculate upon the establishment of this great and philosophic truth. And if disease is indeed a unit as was so ably and conclusively taught by the great Dr. Rush, it is perfectly philosophic to admit the existence of remedies of general application ; and of great general prin- ciples and agents which may be so modified as to be gener- ally appropriate. " Heat is an agent which admits of such general application. Applied to the surface in an intense degree it extinguishes vital power, and thus safely in a direct way lessens the force of feverish excitement. " In the same mode of application it necessarily must be a powerfully diffusive agent, and furnishes the most natural and certain method of correcting any local affection. And when gradually applied in an agreeable temperature, it will never fail to produce cordial effects. And in fact in every delicate case, where a stimulant dose as wine or laudanum is absolutely necessary, these remedies would be infinitely more safe and effectual if a pleasant application of heat were first administered. With suitable variation in the degree and continuance of the treatment, according to the degree of violence of the disease, the patent steam bath will be useful in all the following forms of disease, viz. APPENDIX 'ti'y " In colds, catarrhs, coughs, pleurisies, and in fever in its various forms, including that form of it now raging in differ- ent sections of the country and called by different names; none of which perhaps is more appropriate than that of the western country, where it is called the " cold plague or cold skin fever." In local inflammations and other local affections, as sore breasts in female cases, in swelled glands, anthrax or carbuncle, sore throat, quinsy, ear-ach, tooth-ach, head- ach, especially that of the nervous kind, and in inflamed wounds, &c. In scrofulous, glandular, ulcerous, and erup- tive affections including St. Anthony's fire, nettle-rash, scald head, &c. In suppression of urine and other painful affec- tions of the bladder, &c. In piles whether blind or protrud- ed. In haemorrhage whether from the lungs, as in hemoptoe, from the nose or urethra, &c. In excessive fatness, in old age, &c. And in gout, rheumatism, and other similar pain- ful affections." Directions for using the Steam Bath. " In any case of sudden emergence, the bath may be admin- istered by supporting the bed-clothes with a staff or board of suitable length, or with any sort of a temporary frame, tak- ing care to use a sheet or two of paper to defend the bed from being scorched, and to adjust the whole affair so as to secure a free diffusion of the heat over the body of the patient. " There should be provided in every family where the bath is used, a suitable frame* for the purpose. It might be something like the following description :—Half a circle or a half-hoop of good strength and twenty-two inches in diame- ter, will form the end which is to stride cross the body of the patient a little below the breast. A half circular plank, eighteen inches in diameter, will make the foot end of the frame. A thin board four feet long should cover the top, and a lath or two of similar length should secure each of its sides. A hole of suitable size should be made in the middle of the foot end for the introduction of the tube. " The patient should be stripped of all his clothing ex- cept his linen, which after the bath goes into operation, he may draw up to his chin. The frame is to be laid over him in bed, and a sufficient weight of bed-clothes should be used * This frame is highly important, and in many cases indispensable. In pleurisies and other violent cases, the heat ought to act at once with considerable violence upon the whole surface. 680 APPENDIX. so as to confine the heat properly. A sheet and four or more blankets, or other covering to that amount for the win- ter season; a blanket less will serve for the summer. The bath is applied at the feet, which is most proper in all ordi- nary cases, and the gas has a free opportunity to diffuse it- self all round the body of the patient, which is always im- portant. The weight of the bed-clothes being properly sus- tained by the frame, he can turn himself over at pleasure, which will give him the advantage of warming first one side and then the other, as it may be most agreeable to his feelings. " Complaints should always be met at their first appear- ances, before the patient is exhausted by disease. In cases of very robust patients it is often safest to take some blood before the bath is applied, especially in the winter and spring seasons of the year. And it sometimes happens in recent painful cases in which the propriety of blood-letting may be doubtful, that the bath produces partial sweating and tempo- rary ease, but presently the perspiration suddenly dries up, and the pain increases. This circumstance will at once de- termine the necessity of blood-letting, which in such an in- stance will be found more effectual after the bath than it would have been if performed prior to its application. "In some instances also, when the bath is administered to patients inclined to be feverish when blood-letting has not been premised, and especially when too small a cup has been used, an uncomfortable restlessness is felt. This cir- cumstance as well as a head-ach, if they continue any length of time after the bath should be relieved by some agreeable cathartic dose, and blood-letting when necessary. "In cases where it may be used with great decision, it commonly produces some throbbing of the head. When this appearance is considerable, the process may be discon- tinued, and if blood-letting is not necessary, the throbbing will quickly subside, leaving no inconvenience to the patient. In delicate cases, however, it ought not to be pushed up lo this pitch ; the fire should be lighted up and extinguished alternately, as it may be found agreeable to the patient. "In cases of feeble and very old persons, the smaller cups ought to be used. And in most instances it ought to be re peated once every sixth hour, sometimes once every fhird hour. Meanwhile the patient should be supported by nour ishment and cordials.* * In such a case the intention should be to warm the patient effectually, but no* to produce a sweat. APPENDIX. 681 " Sometimes it may be beneficial to remove the apparatus from the feet to the side of the patient, and so on alternately as the judgment of the practitioner will quickly discover. " In cases of long standing debility, it sometimes happens that (he bath is scarcely put into operation before fhe pa- tient feels distressing sickness and faintness. When this happens let the fire be extinguished, and give a glass ot wine and wafer, and when sufficiently refreshed re-kindle the bath. In such delicate cases it is frequently necessary to use lau- danum as well as the wine and water. Say ten, fifteen, twenty, or thirty drops, to be given at the close of the process. " In almost every enfeebled case of any standing, it is ne- cessary after the bath, to use jugs or bottles filled with bail- ing water, or hot bricks to aid the weak excitement of the surface, that it may retain fhe advantages gained by the bath; and in some cases blisters should be added.. "There is no danger of taking cold. The gas which is used is as free from moisture as atmospheric air. It will dry a damp sheet. Besides, in all the instances in which it has been used, I have not known one by which ve patient found any ill effects in that way. Indeed, if such a thing should happen, another application and a little care would perfectly correct every inconvenience. " When the patient is not much reduced, and seems to be too long coming into a state of perspiration,, I always add more heat. If two or more cups cannot stand within the base of the bath, I place it upon them in any way I can, proping it up wilh bricks, or any other convenient support. The heat of two or three cups will be drawn up by tiie tube. If the patient complain too much I remove one of the cups for a few seconds, and replace it so soon as the heat a li.lle subsides. By this method my object is more speedily, certainly, and safely accomplished.'' We find in our author's pamphlets a concise description of several acute and chronic diseases or forms of disease, with his method of cure, in which he does not depend exclu- sively on the steam bath. His prescriptions are simple, neat, and efficacious, and his medical treatment precisely conformable to our best modern practice. As a specimen the following valuable article is introduced. 86 682 APPENDIX. Typhoid Pneumonia, or Cold Plague. " The prevailing epidemic, known in different sections of the country by different names, in the western states by the appellation of the cold plague, is properly a grade of lyphus fever.. In regions where it rages there must be present some poisonous agent which debilitates the organic move- ments of the system ; or else there is a want of something in the atmosphere, upon a full supply of which, the vital functions are dependant for a perfect state of the powers of life. Through this abridgment of the vital power, the system is placed in a condition which renders it unable to diffuse the circulation with compleite and equable impetus throughout the whole mass. Those vessels most remote from the centre of motion, must languish most. Hence'the surface is first enfeebled; and external cold must act first and chiefly upon the surface : of course it follows, that persons having previ- ously been in feeble health; those who are badly clad; those who live in cold houses, or are badly supplied with fuel for fires, and especially such as are exposed to fatigue and the weather, will furnish the greater number of instances of this form of disease. The enfeebled surface, under the influence of cold which it is not prepared to resist, is imperceptibly brought into a condition approximating to a state of death ; whilst the powers of life, repelled from the surface and con- centrated upon the vital organs, produce a storm of excite- ment, which threatens speedy destruction. The excite- ment thus pent up,determines upon the head, upon the chest, and upon the glands of the throat. Upon this theory of (he disease, blood-lettirig must necessarily, in most instances, be pernicious. By the sudden loss of blood, the surface, almost deprived of life, is instantly left destitute of excitement; that is, is reduced to a state of death. No measures within the reach of human power can afterwards prevent the destruc- tion of the patient. For the cure, the first intention should be by the application of heat, in some way, to restore a due portion of excitement to the surface : and this can be done more speedily and effectually by the agency of the patent steam bath, where it can be had, than by any other means. " After the use of the bath, the bowels should be cleared by a gentle but brisk cathartic: say salts and manna. After the operation of the cathartic, fhe bath should be repeated. And in any very alarming case it would be highly useful t« APPENDIX. MS wrap the patient in a blanket wrung out of heated spirit of very high proof, in which a portion of spirit of turpentine has been previously dissolved. Possibly in some instances this treatment might supersede the necessity of blisters. If, however, the throat be considerably affected, a blister ought to be applied to the neck, to extend down the back or breast, so as to secure a blistered surface equal in area to an hundred or an hundred and twenty square inches. A second or third cathartic may frequently be found necessary : but no blood-letting should be tried until the excitement of the surface is by some means first properly secured. The gen- eral treatment in other respects should be regulated accor- ding to existing circumstances and appearances. The ex- planation here given of this alarming complaint, will account for its appearance without referring to any thing like conta- gion. And regular living, moderate exercise, and a con- stant use of good fires, will be found generally effectual to prevent its assault." Note. Dr. Jennings'apparatus, together with the author's valuable pamphlet on the subject of his patent warm and hot bath, are kept for sale by Mr. William B. White, at his druggist store, No. 49, Marlborough street, Boston, price ten dollars. Weights and Measures employed in Medicine. The weights usually employed are those commonly called Troy weight. The pound is thus divided. A pound, 1|0 g An ounce, 3| v "3 A drachm, 3j C § A scruple, 9i j « The wine gallon measure is divided as follows • A gallon, congj) g C 8 pints, Oviij. A pint, Ojf '3 7 16 fluid ounces, fjxvi. A fluid ounce, f§»( g J 8 fluid drachma,! Jviij. A fluid drachm, fji) v (60 minims, rnjx. 12 ounces, _§x"" 8 drachms, ^viij- 3 scruples, 9iij. 20 grains, gr. xx. 684 APPE.ND1X. When medicines are directed in the quantities of a table spoonful and of a tea spoonful, it is to be understood that the spoons are of the medium size, the former equaling about half a fluid ounce, and the latter a fluid drachm. When a dose is measured by drops, the size of the drops is liable to vary according to the form of the mouth of the bottle, and specific gravity of the liquid, &c. But it is in general to be estimated that sixty drops of water, one hun- dred drops of spirits and tinctures, and one hundred and twenty of alcohol, are equal to a drachm by measure. Of Medical Prescriptions. Much accuracy and attention ought to be observed in fhe forming a medical prescription. This point, however, in practice is too often inexcusably disregarded, and not un- frequently the intention of the prescriber is entirely frus- trated by an unchemical mixture of substances of opposite virtues. Simplicity, neatness, and elegance, should always be regarded, so far as will comport with the object of the prescription. No unnecessary article should ever enter the composition, and the taste of the patient ought as much as possible to be consulted. The doses of medicines are to be adjusted according to the age, sex, temperament, idio- syncracy, habit, and disease. Women in general require smaller doses of medicine than men ; and the sanguine less powerful doses than the phlegmatic and melanchol- ic. There is in some constitutions a peculiar disposi- tion to be affected with certain causes, in a manner different from the generality of mankind. This, which is termed idiosyncracy, requires to be attended to by the prescriber. Habit too has an important influence on the operation of medicines. In general all strong stimulants and narcotics lose some of their power by being long continued. Thus the inebriate, habituated to large quantities of ardent spirits, can bear ten times the quantity of opium, to that of ofher persons. In a state of disease, the doses of medicine must be regulated according to the greater or less degree of sus- ceptibility to external impressions. The following table will shew the proportions from infan- cy to adult age. APPENDIX. 685 Let the dose for a person of middle age be......1 or one drachm. For one from 14 to 21 years, it will be | or two scruples. 7 to 14.....a or half a drachm. 4 to 7.....| or one scruple. of 4 years of age - - - -• or fifteen grains. 3.....-- i or half a scruple. 2.......-£ or eight grains. 1.....- - ,aa or five grains. , Directions for collecting and preserving Medicinal Vegetables. Those medicinal vegetables which grow wild in dry soils and high situations, fully exposed to the air and sun, are in general to be preferred to those which grow in moist, low, shady, or confined places. Roots of annual plants should be gathered before they shoot out their stalks or flowers; biennial roots in the harvest of the first, or spring of the second year, perennial, either in the spring or autumn, when the sap is most in the root. All roots, immediately after being gathered, should be quickly washed in cold water; rejecting such as are worm eaten, as well as the defective, and the fibres or little roots that are not essential. Such roots as are thick, should be cut into slices, if covered with rough bark, it should be peeled off. The sound clean roots are to be carefully dried, either by a current of cool air, or by the heat of a moderate fire. Herbs and leaves in general should be gathered after the flower buds have formed, or about the time of the plant's flowering. The flowers are to be collected when fresh blown, or about opening, and in the forenoon after the dew is off. The greatest care is requi- site in diying leaves and flowers, that both their colours and virtues may be preserved in the greatest perfection. They should be dried hastily by a heat of common fire, as great or greater than that of the sun. After drying, they should be carefully preserved in drawers or boxes for that pur- pose. They ought always to be so preserved as to retain their natural colour and smell; when they lose these, they are not fit for use. Those herbs and leaves, preserved in the careless manner of most families, and allowed to become black and mouldy, lose all their medicinal virtues, and are altogether unfit for any purpose. Seeds should be collected 686 APPENDIX. when ripe, and beginning to grow dry, before they fall off spontaneously; they are best preserved in their natural husks or coverings. The most proper seasons for cutting woods and barks for medicinal use, are the spring and au- tumn. The young trees afford the best bark, but the woods should be taken from those more advanced. Arbutus Uva Ursi. Bear's Whortleberry. This is a small hardy evergreen. Stems long and woody, trailing over the ground and forming extensive beds. Flow- ers io small bunches, drooping, rose coloured in June. Ber- ries red, remaining long on their stalks; they are insipid, pulpy, and mealy. This shrub grows very abundantly in our woods, and on mountains in sandy soils. It is known among the inhabitants by the name of wild cranberry. The leaves impart an astringent quality to the taste, followed by a bitterness. So great is Iheir astringency that they are in Russia used for the purpose of fanning. The uva ursi has long been known in medicine for ifs astringent and tonic powers ; and it has obtained considerable reputation for the cure of various affections of the urinary organs depending on debility. In diabetes, and in ulcerations of the kidneys and bladder, it has often been employed with decided good effects. Dr. Barton was of opinion that it is peculiarly adapted to cases of nephritis depending upon gout, and he has known it to be useful even when it was ascertained that a calculus was present: and it greatly alleviates the dyspep- tic symptoms accompanying nephritic complaints. It is in general administered in the form of powder, in doses of from twenty to thirty grains three or four times a day. Dr. Ferriar has experienced very beneficial effects from uva ursi in nephritic cases, and even in smaller doses than usual. He exhibited five grains of the leaves and half a grain of opium three or four times in a day, according to the urgency of the symptoms, which he found always to relieve, and generally to effect a cure. In some instances it was employed for several months together before this was attain- ed. In several cases of hematuria in delicate females, where the haemorrhage evidently proceeded from the kid- neys, uva ursi always succeeded in removing the complaint. Dr. F. is of opinion that this remedy acts specifically as a tonic and astringent on the kidneys. He always prefers APPENDIX 087 small doses, as a scruple or half a drachm often produces nausea, even when joined with opium. This gentleman has also discovered in uva ursi the property of preventing or curing that distressing strangury which is sometimes produced by the application of blisters. It has in his hands and others proved an effectual remedy if given during the application of the blister. Datura Stramonium. Thorn Apple, or Apple Peru. The thorn apple is an annual plant, a native of America, and in the southern states has long been known by the name of James-town weed. It is commonly found among rubbish and on waste land, flowering in August and September. There are two varieties of this plant frequently found grow- ing near each other. Of one variety the stem is of a pale green, often solid, and the flowers clear white. The other is considerably larger in size, has a uniformly hollow stem, of a purple colour, covered with light dots; the flowers light purple or blue, striped on the inside. In both varieties the stem is erect, repeatedly forked, with spreading branches, and from three to four feet in height. The fruit is of the size of a small hen's egg, covered with thorns. The leaves are large, egg shaped, pointed, angular, and deeply indent- ed, of a disagreeable smell and nauseous taste. It is fhe purple sort that is chiefly employed in medicine. Every part of this plant is a strong narcotic poison, and instances frequently occur of children and others having suffered the most alarming consequences, and sometimes even death from swallowing the seeds or leaves. The symp- toms, immediately after being received into the stomach, are dilatation of the pupils, vertigo, delirium, tremour, itching, eruption, insupportable thirst, and palsy, which soon termin- ate in death. See page 486 of this volume. The medical properties of this plant have recently arrested very consid- erable attention, and in the American New Dispensatory more ample details will perhaps be found relative to it than in any other production. In common with narcotic plants in general, it possesses antispasmodic powers; hence its successful employment in maniacal cases, and in convulsive and epileptic affections, by Baron Stork, and other German physicians. The reputation of this plant has been considerably in- creased of late by a very extensive knowledge of its valua- 688 APPENDIX. ble properties in the United States. The late Professor Barton esteemed it as possessing great and invaluable pow- ers. Dr. J. Fisher, president of the Massachusetts Medi- cal Society, extols it as a valuable remedy in epilepsy in young persons, where the fits occur daily or monthly, at regular periods. The medical properties of stramonium have been tested by numerous other practitioners, corrobo- rative of my own opinion of its great utility in a variety of diseases of the spasmodic class. In some cases of spasmod- ic asthma, stramonium has greatly relieved the distressing symptoms, and we find recorded in the New-England Jour- nal of Medicine and Surgery, Vol. IV. p. 226, a singular case of spasmodic cough, accompanied with convulsions, subsultus tendinum, and a train of nervous symptoms, which, after the failure of the usual remedies, yielded in a few days to the extract of stramonium, beginning with two, and in- creasing to six grains. The forms in which this medicine is generally admiuistered, are the watery extract, or the in- spissated juice of the leaves, beginning with one or two grains, and gradually increasing to fifteen or twenty. In one case of mania Dr. Barton gave to the extent of sixty grains at a dose. In another case, in which it was exhibit- ed to fifty grains daily, divided into two doses, it obviated a recurrence of epileptic fits, but produced dilated pupils, blindness, and sleepiness. I have witnessed an instance in a lady, who could not bear more than one grain, and even this seldom failed to induce unpleasant vertiginous sensations and drowsiness. The saturated tincture is preferred by Dr. Fisher for children, regulating the dose by drops, and the effect produced of dilating the pupils, &c. An ointment prepared by simmering the leaves in hog's lard is much em- ployed to procure ease in external inflammation, haemorr- hoids, and burns. The practice of smoking the dried roots or, leaves of stramonium for the relief of asthmatic complaints has become very general from the beneficial effects which it is known to produce. I have received information from a creditable source that a pamphlet has recently been published by an English phy- sician stating a number of instances of convulsions and ob- stinate constipation in children, in which stramonium proved remarkably successful when applied externally by way of immersion in a decoction of the medicine. From its narcot- ic and antispasmodic powers I should repose much confi- dence in this mode of application. APPENDIX. 689 Eupatorium Perfoliatum. Thoroughwort. Bone-set. There are numerous species of eupatorium which are natives of our soil. This species, which is by some called cross wort, grows in standing water and in low marshy situ- ations. The stem is erect and rises from two to four or five feet, perforating the leaves at each joint, and is hairy or wooly, and branches,only at the top. The leaves are serrated and rough, broad at their base and gradually les- sening to a very acute point, of a dark green, and covered with short hairs. Flowers white in a large corymb—Au- gust and September. The medicinal properties of this very valuable plant have been detailed in the American New Dispensatory, 2d edition, but later experience will warrant some additional observations relative to its virtues and ef- fects. According to the form in which it is administered it produces the effect of an emetic and cathartic, sudorific, and tonic. If given in decoction or infusion of the leaves and flowers, to the quantity of eight or ten ounces, while warm, it operates as an emetic and cathartic, and in this form it may be confidently directed as a remedy in bilious colic, accompanied by obstinate constipation. If in the form of cold infusion or decoction, or in substance, it proves a powerful bitter and tonic, and is admirably adapted to the cure of intermittent and remittent fevers.* In doses of twenty or thirty grains of the powdered leaves, given every two hours during the intermission of fever, it answers all the valuable purposes of cinchona without producing heat or stricture, and may often be exhibited under circumstances which might render cinchona inadmissible. In typhus and in spotted fever, in its varied forms, an infusion of thorough- wort has been employed with satisfactory success as a cor- dial diaphoretic and tonic. In cases of debility, a tincture of this plant, with the addition of a little orange peel, has been found one of the best forms of stomachic bitters, and is an excellent substitute for the Peruvian bark. About two quarts of a strong infusion of thoroughwort, with the ad- dition of one ounce of aloes, form an excellent cathartic for a horse or cattle. ■ See Dr. A. Anderson's Inaugural Dissertation, and Barton's Collections 87 690 APPENDIX. Eupatorium Purpureum. Trumpet Weed. Mvhawk Tassel. " A tall plant growing about the borders of thickets in wet land. Stem five or six feet in height, straight, round, purplish, hollow throughout its whole length, its tube not being interrupted byr joints. Leaves in whorles of four, five, or six ; ovate, rugged with veins, acute. Flowers purple, in a large branching terminal corymb—August, Septem- ber. Perennial." This plant is an excellent diuretic, affording great relief in dysuria and other affections of the urinary passages, in- creasing the secretion of urine in dropsy, &c. The root is the part employed, and is given in the form of infusion or decoction, in a liberal manner, until the desired effect is produced. Lobelia Inflata. Indian Tobacco. A biennial plant found common in dry fields among barley and rye stubble. It has a very subtle acrimonious taste, not unlike that of green tobacco. The stem is angular, hairy, branching at top from one to two feet in height; tin. stem and its branches terminate in spikes of small blue flow- ers on short foot stalks. It flowers in July and August, its capsules are oval, inflated and filled with numerous small seeds. This plant was first discovered and brought into notice by fhe Rev. Dr. M. Cutler, as may be seen in his account of indigenous vegetables, published in the Memoirs of the Academy of Arts and Sciences. It was next found in the hands of an adventurous empiric, where, from its deleterious properties it proved a weapon of destruction in various in- stances. The character and medicinal properties of lobelia had not excited the attentibn of physicians until, by infor- mation received from Dr. Cutler, it was in 1810 introduced into the American New Dispensatory as a new article of the Materia Medica. Subsequent practice affords ample attes- tations of its utility in various diseases. As an active emet- ic, the dried leaves may be administered to an adult in dos- es of from fifteen to twenty grains, or perhaps to thirty, though its active powers require considerable caution in its use, and ought to preclude it from inexperienced hands. It APPENDIX. 6M imparts to the mouth and fauces a peculiarly acrid and stim- ulant effect, and will often excite vomiting by its impression on the oesophagus before it can enter the stomach. The efficacy of this medicine appears to be particularly display- ed in those pulmonic cases where the lungs and bronchial vessels are oppressed with mucus or tenacious phlegm. Hence in certain species of asthma the most-signal benefit and relief have been obtained by its use; the laborious breathing and other distressing symptoms being frequently alleviated even before vomiting is produced ; or when given in small doses as an expectorant. It must, however, be ob- served that its salutary effects are not uniformly the same in every instance. From its very speedy operation as an emetic and its expectorant powers, it may be supposed to be a well adapted remedy in croup and hooping cough, and some respectable practitioners are in the habit of prescrib- ing it in the form of tincture in cases of common cough at- tended with difficult respiration. But in febrile cases it is not to be recommended on account of its too stimulating ef- fects. The saturated tincture is the form in which it is most conveniently exhibited; about half a table spoonful being the usual dose, though in some cases a tea spoonful will be. found sufficient. The tincture may be much improved by the addition of a small proportion of some aromatic. 1 have generally employed the bark of the bayberry root, (myrica cerifera.) This medicine is endowed also with di- uretic properties, and it is by some practitioners successful- ly employed in small doses in pills to promote the discharge of urine. The leaves should be collected in August, while the plant is in blossom ; the seeds are supposed to possess the same properties as the leaves, and both in too large doses may be productive of dangerous effects. Osmunda Regalis. Osmond Royal. "FloweringFern. An indigenous handsome fern growing in watery places and boggy marshes. The leaves are doubly winged, and bear bunches of flowers at the ends. The root of osmond royal abounds in a rich mucilaginous substance ; when fresh from the earth, water or milk may be thickened to the con- sistence of syrup by the mucilage found in the interstices of the roots. This mucilage is of a quality well calculated to defend the internal parts against the irritating effects of ac- 692 APPENDIX. rimonious humours. Thus in some consumptive cases (he greatest advantages have been derived from its use, and it is even reputed to have performed cures in some instances. The roots are to be boiled in milk, and this should be re- commended as the principal food and nutriment of the pa- tient. On account of their soft mucilage Ihe roots will be found highly useful as an external application to parts con- tused or bruised, being a powerful discutient. This do- mestic article merits attention, and a place in the Materia Medica. Pothos Fgltida. Mich. Dracontium FffiTIDUM. L. Skunk Cabbage. t This singular plant abounds in swamps and low meadows. The vulgar name by which it is known is derived from ils very rank and disagreeable smell, resembling that of a skunk, and from its leaves resembling the cabbage. The roofs and seeds impart to the mouth a sensation of pungency and ac- rimony similar to arum. This plant has no stem, and the flower is the first part that appears in April and May. The leaves next appear at a small distance from the flower stalk in a conic form, very closely rolled together, expanding near- ly ovate, as they rise, supported on foot stalks. The medi- cinal properties of this domestic plant was first announced by Rev. Dr. Cutler, by whose authority, corroborated by the experience of medical correspondents, it has been intro- duced into the American New Dispensatory as a new arti- cle of the Materia Medica. Since that publication a more extensive,acquaintance with its virtues justifies the fullest confidence in its antispasmodic powers. My own experi- ence warrants the assertion that it is not inferior in efficacy to the most esteemed remedies of that class, and which have received universal sanction. In cases of asthmatic affec- tions it alleviates the most distressing symptoms and short- ens the duration of the paroxysm. In chronic rheumatism and erratic pains of a spasmodic nature it often performs a cure or affords more benefit than any other remedy. It has in some instances of epilepsy suspended the fits and greatly alleviated the symptoms. In obstinate hysteric affections this medicine has surpass- ed in efficacy all those antispasmodics which have been gen- erally employed, and in several instances it has displayed APPENDIX. 693 its powers like a charm. Having in a few instances tested its virtues in subsultus tendinum attending typhus fever, its pleasing effects will encourage the future employment of it in similar cases. In those spasmodic affections of the abdo- minal muscles during parturition or after delivery, this root has proved an effectual remedy. It is possible that the dreadful spasms attending tetanus and locked-jaw may be considerably alleviated by this powerful antispasmodic. This can be ascertained only by a thorough trial, exhibiting it to the greatest extent, not only by the mouth and inject- ing into the intestines, but by immersing the whole body in a strong infusion of the root. The root should be taken up in the autumn or spring before the leaves appear, and being dried and pulverized, may be given to the quantity of twenty or thirty grains three or four times in a day, or an in- fusion of it lo any extent, as it never occasions unpleasant effects. « Phytolacca Decandra. Garget. Coakum. Poke-weed. This is one of the most common American plants, and is known in every part of the United States by some of the names above mentioned. It grows in waste ground and by the side of roads, having branching purple stems five or six feet high. The leaves are large, flowers in long simple ra- cemes of a dull white, succeeded by large flat berries, af- fording a juice which gives a purple dye. All the parts of this plant are endowed with medicinal virtues, and its emet- ic powers have recently been satisfactorily ascertained by practical experiments in the hands of respectable physicians. The root dried and pulverized is the part to be employed for that purpose. If to an adult a small dose of ten or twelve grains be given, it is tardy in ifs operation, several hours sometimes elapse before it induces an evacuation ; but in a dose of twenty grains or more it rarely fails to produce all the desirable effects as an efficacious emetic in the usual time. In one instance twenty-four, and in another thirty grains, operated with considerable severity both as an emetic and cathartic. It probably possesses a degree of narcotic power, as it has not been known to occasion gripes or spasms. One ounce of the dried root, says Dr. Cutler, in- fused in a pint of wine, and given to the quantity of two spoonfuls, operates kindly as an emetic and cathartic. 694 API'ENDIX. u Dr. Shultz, in his ingenious Inaugural Dissertation on Ihis subject, observes, that scabies and herpes have been often removed by it. In these cases, a solution of the ex- tract in water is generally substituted where the expressed juice cannot be had. In rheumatisms the whole substance of this plant has at different times been of essential service, although the berries have generally been preferred. In those rheumatic affections which sometimes occur fo syphi- litic patients, ifs virtue far exceeds that of opium ; and it seems more valuable than guaiacum, especially when combin- ed with mercury. For medicinal purposes the leaves should be gathered about July, when the foot stalks begin to as- sume a reddish colour, dried in the shade and powdered for nse. An extract may easily be obtained from the leaves, when gathered at this period, by gently evaporating their expressed juice to a proper consistence. A tincture may be made by dissolving either the extract or the leaves, in their green or dry state, in common brandy or other spirit. An extract may be made from the root by boiling down in the same manner as other extracts. " It is affirmed by a physician of reputation and experi- ence that the leaves of phytolacca decandra have been found an admirable remedy in haemorrhois. A strong infusion is given internally, and if it does not speedily relieve, the same infusion is to be injected into the rectum. This method will in general effect a cure." (American New Dispensa- tory.) " The extract made from this plant is found to operate as a mild vegetable caustic, cleansing and healing foul ulcers better than most other remedies of that class." It is strong- ly recommended for trial in syphilitic cases as a substitute for the nitrate of silver. Scutellaria Lateriflora. Side Flowering Scull-cap. " The Scutellaria is perennial, of which there are numer- ous species indigenous to fhe United States. The plant is found in great abundance on the banks of rivers and the borders of ponds ; flowering in July or August. The stem is square, branched, and attains the height of from one to three feet. The leaves are opposite, narrow pointed, on long foot stalks. The racemes are axillary and lateral, bearing small violet coloured blossoms, intermixed with small APPENDIX. 69S leaves. The calyx is hooded, or helmet formed, from whence originated the generic name of scull-cap, or Scutellaria." (American New Dispensatory.) Another species, Scutellaria galericulata, is often found associating with that above described, and is liable to be confounded with it, but is to be distinguished by its axillary flowers in pairs on pedicles from the alae of the leaves and pendulous. The medical properties ascribed to scull-cap are those of an antidote against the effects of canine madness, as will be seen particularly detailed in the work just quoted. In a publication entitled Observations on Hydrophobia, by the author of this work, a mass of evidence in favour of the an- tidotal powers of this plant has been recorded. Our knowl- edge of this remedy has been derived from a certain Mr. Lewis, of the state of New-York, in whose hands as a secret it was for many years so successfully employed as to ob- tain the credit of an infallible preventive of hydrophobia, either in man or beast, if properly administered immediate- ly after the bite has been inflicted. Since it has been pro- mulgated, numerous gazettes and journals have teemed with encomiums on its antidotal powers, and from sources so res- pectable as to claim attention and confidence, and where it has been most known and employed, it has been the most highly extolled. Dr. Vandeveer, late of New-Jersey, be- ing in possession of the secret, acquired extensive populari- ty by his success, and he is said to have declared lhat dur- ing his practice he has prevented upwards of three hundred persons from going mad, and that he never lost but one pa- tient to whom his medicine had been administered. From the high reputation, therefore, of scull-cap, perhaps surpass- ing that of any other remedy, practitioners ought to resort to the use of it on any occasion which may offer, either in relieving mankind from this awful malady, or in arresting the devastation among the brule creation. The following is the manner in which Mr. Lewis and Dr. Vandeveer prepared and administered the remedy. The leaves should be gath- ered when in flower, carefully dried and reduced to a fine powder, and put into bottles well corked for use. When a person has received a bite by a mad dog, he must take of a strong infusion of the leaves or powder a gill four times a day every other day. The day it is omitted he must take a spoonful of the flowers of sulphur in the morning, fasting. 696 APPENDIX. and at bed time in new milk, and apply the pounded green herb fo the wound every two hours, continuing the prescrip- tion for three weeks. To cattle or horses he directs four times the quantity prescribed for a man. Sfcale Cornutcm. Ergot, or Spurred Rye. The history and properties of this very singular produc- tion have attracted the attention of naturalists and physi- cians for more than two centuries, and has recently excited an extraordinary degree of interest and speculation among fhe medical faculty of the United Slates. This substance is found projecting from the ears of rye in its mature slate, and from its resemblance to a cock's spur it has received the French name of ergot. It is of different lengths and size, some growing to an inch or more in length, while others are smaller than the genuine grains of rye, of a dark brown col- our externally, and whitish within. Its form is in general crooked, angular, and the extremities either blunt or point- ed. Some ears produce a few grains of ergot with small shrunk grains of rye intermixed, whilst others contain from ten to twenty ergots of different sizes. This diseased state of rye is said to be more frequent in newly cultivated ground, and in wet seasons and moist situations than in those more dry* and both winter and spring grain are supposed to be equally liable to this spurious production. Wheat is also often ergotted, bul barley is rarely if ever affected with the disease. With regard to the alleged deleterious character of ergot, we must first revert to the different European authorities who have made it a subject of particular investigation. In numerous publications of former times; it is reported that in certain districts in France, and other parts of Europe, such large proportion of rye has been infested with ergot as to render the bread made from it destructive to health and life. That at six or more different periods subsequent to the year 1596, the inhabitants of those districts where ergot was most prevalent, were visited with epidemical diseases of a malignant and fatal nature, particularly violent spasmodic af- fections and dry gangrene or mortification of the extremities, destroying the flesh and ligaments and leaving the bones bare. In the year 1709, no less than five hundred patients were in the hospital of Orleans in France, afflicted with dis- eases supposed to be in consequence of eating bread impreg- APPENDIX. 697 nated with spurred rye. By Ihe same authorities we are apprized that various animals, such as sheep, dogs, swine, and poultry being fed with ergot by way of experiment, died in great agonies, some convulsed, others mortified and ulcer- ated. These alleged circumstances naturally excited the greatest interest at the time and occasioned the most assidu- ous investigation, which unfortunately, however, has not re- sulted in harmony of opinion relative to the real character of this morbid production. Opposed to the foregoing reported circumstances are numerous experiments instituted by other respectable individuals, Shewing in a satisfactory manner that ergot has been taken as well by men as animals and birds, to a very considerable amount without fhe least inconvenience. In this confused and equivocal state the subject was permit- ted to rest: but the late Dr. Beddoes and others have since represented ergot as an empirical agent or inert substance, nor do we learn that its medical properties have ever been noticed or investigated by any European author. The mer- it therefore of designating ergot as an agent capable of sub- serving valuable purposes in medicine seems to have been reserved for American physicians, and Dr. John Stearns of the state of New-York is undoubtedly entitled to the hon- our of being the first promulgator. This gentleman in a let- ter to Dr. Akerly, published in the Medical Repository in the year 1807, announced that ergot is capable of exciting a specific action upon the uterus, that it greatly augments the power of that organ during the efforts of parturition, and in lingering and protracted cases it speedily induces forcible pains and greatly expedites delivery. Curiosity being thus excited, a few physicians were induced to test ifs virtues by practical experiment. In the year 1810, it was introduced into the American New Dispensatory as a new article deserv- ing a place in the Materia Medica. In June 1813, the natural history and the merit of this article as a medicinal agent, was ably investigated and discussed in a dissertation read before the Massachusetts Medical Society by Dr. Oliver Prescott, which has been published. The character of spurred rye as a medicine, may now be considered as fully established, and a majority of the physicians of our metropolis and many others have adopted the employment of it in promoting reg- ular and efficient labour. By experience and observation it Is ascertained beyond controversy, that this medicine pos- sesses a peculiar power of stimulating the gravid uterus, ancl 88 ^98 APPENDIX. increasing the feeble throes of parturition. Particular cir- cumstances, however, are to be cautiously regarded in its administration. For if given in the early stage of labour be- fore the orifice of the uterus is sufficiently relaxed and di- lated, much mischief to both mother and child is to be ap- prehended. The powerful and continued efforts of the ute- rus from the effects of a full dose of ergot, prevents the re- treat of the child's head after being advanced, and the un- ceasing pressure has too often been the means of destroy- ing the child. Either preternatural presentation, deformity of the pelvis, or rigidity of the muscular parts, are obstacles to delivery, which ergot has no power to remove ; and if ad- ministered, its effects must inevitably prove injurious to fhe mother, and greatly endanger the life of the child. It is ob- vious therefore that the aid of ergot is indicated, and may be given with safety in those cases only where no rigidity ex- ists, and where the labour has been lingering and long pro- tracted, merely from the feeble and unfrequent uterine ef- forts. In the first birth it is seldom requisite or proper; nor should this powerful agent be administered by inexperi- enced or imprudent accouchers. Besides its beneficial ef- fects as a parturient, ergot is endowed with a peculiar prop- erty of constringing the uterine vessels and restraining an undue haemorrhage after delivery; and even the lochial dis- charge is often diminished by its use, but without any ill effects resulting. " This singular property of the ergot," says Dr. Prescott, "to diminish the enlarged cavity of the uterus, is never more strikingly exemplified than when its agency is employed to restrain those floodings which sometimes appear in the early months of pregnancy, when the action of gestation has ceased, and abortion must follow. In such cases it speedily excites in the uterus such ener- getic action, that its contents are soon expelled, and the haemorrhage ceases." Among the extraordinary qualities of ergot, none is more surprising than its almost instantaneous operation. The experienced gentleman just quoted, asserts that he noticed the precise time in twenty cases ; " in two of them the increased strength of the pains and Ihe continued action commenced in seven minutes from the time the de- coction was taken ; in one case it was eight minutes, in seven it was ten, in three eleven, and in three others fifteen min- utes. In the four remaining cases there was no apparent operation until twenty minutes had expired." ATPENDIX. 699 The form in which Dr. Stearns administered ergot, is that to which he applied the appellation of pulvis parturiens, in doses of from five to ten or fifteen grains, but later experience evinces that the decoction or infusion is to be preferred. Half a drachm fo four ounces of water, one third of which is given and the dose repeated in twenty minutes if necessary. An over dose of ergot in any form will sometimes excite vomiting, and Dr. Prescott has judiciously suggested a more eligible mode, that of giving " a table spoonful of the decoc- tion only once in ten minutes, as inducing a more temperate though efficient action;" and in his opinion a cautious di- rection of its powers cannot be too strongly recommended. In a few instances if has failed to exert any effect as a parturi- ent, and in male subjects it has on trial proved inert. I must not omit adverting to another valuable property in ergot which has recently been developed by practical experiment. It has in several instances proved an efficacious emmenagogue when employed in amenorrhaea. This information is deriv- ed from the New-England Medical Journal, Vol. V. p. 162, communicated by Professor Bigelow, in the words of Dr. J. Randall, who exhibited it successfully in six out of seven cases of amenorrhaea. One of his patients took six ounces, each ounce being boiled in a quart of water down to a pint. In another instance one ounce relieved his pa- tient the first, and the same quantity the second time, and two ounces at the third period. Four others were com- pletely cured by taking one ounce each, in the quantity of half an ounce per day. In his unsuccessful case half an ounce was taken for four successive days without relief and without injury. The only symptoms produced in the seven patients above mentioned, were "head-ach, increased heat of body, and occasional pain in the hypogastric region." In the same volume, page 247, a solitary instance is related by Dr. Henry S. Waterhouse, of menstrual retention in a pa- tient aged sixteen years. She had been under a course of the usual remedies, and was labouring under haemoptysis, and various chlorotic complaints of an alarming nature. Af- ter venesection and the use of a cathartic she was directed to take the saturated tincture of ergot in doses of twenty- drops three times a day, and this without any other medi- cine effected a cure in about three weeks. The same intelli- gent writer, page 248, details a very lingular and interesting case of puerperal convulsions with dreadful spasmodic con- 700 APPENDIX. tractions, in which ergot operated like a charm, and almost instantaneously rescued the suffering patient from the jaws of death. "The ergot of wheat," says Dr. Bigelow, Medi- cal Journal, page 163, "has been the subject of a few trials which serve in some degree to establish its affinity to that of rye. Its taste is equally nauseous and somewhat more un- like that of the original grain. I have seen it occasion nau- sea in a dose of a scruple, and vomiting when a drachm had been given. In some cases of labour it has evidently increased the uterine efforts; in one it produced no effect." I have now delineated the character of ergot as a medicin- al agent so far as its properties have been developed. Fu- ture experience may improve our knowledge of its utility. I shall not trust myself with the task of discussing the just- ness of the accusation recently brought against it as having an agency in producing the fatal epidemic called spotted fe- ver. Attempts to vindicate or to invalidate the imputation might be construed to imply a " zeal without knowledge," since the subject is confessedly involved in deep obscurity, and we are favoured only with the feeble light derived from speculative knowledge and doubtful assumption. Suffice it to observe as a pertinent fact, that ergot to the amount of from four to six ounces has been taken with impunity or with temporary inconvenience only, and it is not presumable that this article is often so abundant that individuals are liable to receive a greater quantity in one season by way of food. It must also be conceded that spotted fever has been prevalent in situations where spurred grain has seldom or perhaps in no instance been produced. The position is nevertheless to be regarded, that morbid or damaged grain may predispose to, if not actually prove the generating cause of diseases, and no one will hesitate to recommend to farmers and others the greatest vigilance in separating ergot from the pure grain in- tended for use.—"In the winter of 1813—14,a gentleman in New-Jersey lost twenty-seven horses which had been grain- ed with mouldy corn." New-England Journal,VoI.V. p. 244- Sophora Tinctoria. Wild Indigo. Indigo Weed. "This in Dr. Cutler's catalogue is called indigo fera. and is sometimes known by the name of broom, but more commonly indigo weed. It is perennial, growing in great abundance in almost every barren pasture and in woods APPENDIX. 701 The stem rises to two feet or more, is smooth, sending off numerous branches. The leaves are in threes, on short pe- tiols, inversely heart shaped and sessile. In July and Au- gust all its branches display butterfly shaped, golden col- oured blossoms, which render the plant very conspicuous. The seed vessels are inflated, containing numerous seeds. The root is ligneous, rough, and irregular in shape, of a dark brown colour externally, and sending off many long sdender branches. Its taste is unpleasant, sub-acrid, and nauseous. very similar to that of Ipecacuanha. The particular medi- cal properties of indigo weed are yet to be ascertained ; that it possesses great activity is unquestionably true ; those who in the spring season have made the young shoots a substitute for asparagus, experienced its drastic evacuating powers. In the hands of some physicians it is found fo operate in a large dose with much severity as an emetic and cathartic. But a weak decoction of the root has frequently been given with fhe effect only of a mild laxative. A decoction of the root has it is said, been made known by an empiric experi- enced in its use, as a remedy in scarlatina anginosa, and its employment has been extended in a few instances to typhus or putrid fever with such good effect as to encourage farther trials. An experienced physician considers it as an excel- lent antiseptic and febrifuge, preferring it in some fevers to Peruvian bark. As an external application its antiseptic qualities ought to be more extensively known. In the form of fomentation or cataplasm, it has proved eminently benefi- cial when applied to phagedenic and gangrenous ulcers, es- pecially if the decoction be administered internally at the same time." American New Dispensatory. The above quotation contains the whole lhat has ever been published respecting this indigenous vegetable, but its valuable properties, verified by later experience, merits a more particular consideration. Some experiments have been made with the pulverized root in doses of twenty to thirty grains, for the purpose of ascertaining its emetic and cathartic powers, but without a very favourable result. My own experience of the medicine has hitherto been directed to its antiseptic qualities, as an external application to vi- tiated ulcers of almost every description, and it is incumbent upon me to observe, that it has in many instances surpassed in efficacy any other remedy which I have ever employed. In aphthous and other ulcers of the mouth, sore nipples, and 702 APPENDIX. in various painful ulcers, discharging acrid matter, the as- suaging and healing qualities of an infusion of this root by way of lotion has been most strikingly exemplified in prac- tice. Impressed with the assurance of its great utility, and solicitous to diffuse an experimental knowledge of it more extensively, I was induced to furnish several medical friends in Boston with the root, to be used in the marine hospital and in Ihe alms-house. My object in this instance was chiefly directed to the ascertainment of its effects in cases of syphilitic ulcers, nor has the result disappointed my most sanguine expectations. Reports have been made to me of its peculiarly pleasing effects when applied to obstinate sy- philitic ulcers, mercurial sore mouth, and other ulcerous af- fections. It now remains to recommend to practitioners the trial of the root of wild indigo in cancerous and various vi- tiated ulcers, in those occasioned by burns and scalds, sore nipples, canker, and in aphthous sore mouth. In malignant ulcerous sore throat no opportunity has presented for trial, but the happiest effects are anticipated in lhat disease as well as all others of a putrid nature. In mortification and in cases of a putrid tendency, besides its external use, the in- fusion should be freely employed internally, and it is pre- sumable that it will not often disappoint expectations. From its known qualities it is not improbable that it maybe advan- tageously employed as an injection in virulent gonorrhaea. An ointment may be made by simmering the fresh root in hog's lard, to be applied to burns and ulcers. The virtues of this root appear to be considerably diminished by long keeping. Arachne. Cob-web. This extraordinary article has not long since been taken from empirical hands and sanctioned by the first medical au- thority as a remedy in diseases. In the 21st and 22d Vol. of the Medical and Physical Journal is recorded a commu- nication from Dr. Robert Jackson, a distinguished English physician, announcing that the late Dr. Gillispie of Edin- burgh, a man of sound professional judgment and of great candour and sincerity of character, having been baffled by the obstinacy of an intermittent fever, had recourse to the spider's web with the most perfect success. Dr. Jackson then proceeds to recite the complete success which has at- APPENDIX. 703 tended his experiments with the cob-web in the cure of in- termittents. He next relates the very great relief procur- ed by this substance in the advanced stage of phthisis pul- monalis, shewing fhe extraordinary powers of cob-web in al- laying irritation and procuring ease in a case past the reach of common remedies. The writer further observes, that he might multiply instances of the efficacy of this substance if necessary, and the value of its tranquilizing effects, and re- commends the trial of it in hydrophobia, as being a disease of excessive irritability. He adds that he can attest by living evidence that cob- web diminishes morbid irritability and calms irritations both of body and mind in a degree far exceeding any drug or remedy within the circle of our knowledge. The follow- ing remarkable case is adduced in the same publication to evince the singular efficacy of the spider's web. Walter Sands, Esq. has been afflicted for many years with a dis- tressing asthma, which has proved fatal to his father and two sisters. The complaint being hereditary and aggravated by mal-formation of the thorax, no remedy gave any permanent relief, nor did change of climate procure any alleviation of symptoms. He has often been under the direction of emi- nent physicians, and frequently in a kind of despair has re- sorted to numerous empirical compositions, but in vain. For a considerable time back he has never been able to lie down in bed on account of a sense of suffocation, but is obliged to be supported half sitting by pillows, and is seldom able to sleep. Having collected nearly a scruple of the spider's web he swallowed it at bed time, and to his utter astonish- ment enjoyed sound and uninterrupted sleep all night; a blessing to which he had been an entire stranger above six years. Since he began with the cob-web he thinks his health is improved ; the cough has certainly abated, but whenever the remedy is omitted the complaint returns. A medical correspondent says he has been induced from the evidence afforded of the virfues of cob-web to try it in one or two cases, and feels satisfied of its palliative and ano- dyne properties, and having tried a dose himself, he found it produce the most delicious tranquillity, resembling fhe effects of opium, and followed with no bad effect. It has been long known that the spider and spider's web have been held in esteem among the vulgar as a certain remedy in ague, and about thirty years ago Dr. M'Bride 704 APPENDIX quoted Dr. Lind to shew that both of these were empirical remedies for that disease ; although few will be willing to swallow the disgusting animal itself, the delicate fabric which it forms may be received by the most squeamish stomach when enveloped in a mucilage of gum arabic. About two or three grains of the web is given every few hours until fhe ague fits are subdued. In other cases it is said to be eminently applicable to nervous irritations and mental inqui- etude, even superior to opium as an agreeable anodyne; wilh this view it may be taken until relief is obtained. A more extensive experience, will, we hope, develop the pe culiar properties of this singular remedy. The foregoing article, together with cornus florida, prinos verticillatus, primus virginiana, and liriodendron lulipifera, were inadvertently omitted when treating of intermittent fe- ver, page 296. See these several articles in American New Dispensatory. Rub us Villosus. High Blackberry. Rubus Procumbens. Low or Running Blackberry, or Dewberry. These require no description, but their valuable properties merit the attention of every medical practitioner. In domes- tic practice the roots of blackberry have acquired great con- fidence where they have been used, for their astringent vir- tues in the various forms of bowel affections. I conceive this article deserving of the highest praise as one of the most active and effectual vegetable astringents which our country produces. The low blaekberry or dewberry is the one commonly preferred, and the root is more astringent than the leaves or fruit. It is exhibited in decoction in the quan- tity of a tea-cup full for an adult, or a table spoonful for child- ren, several times in a day. Ignorant people have been too indiscriminate in its use, but the diseases in which it displays its efficacy are dysentery in its closing stage, chronic diarr- haea, and cholera infantum, to check inordinate evacuations. I have recently been informed that Professor Chapman of Philadelphia, in his practical lectures, has extolled the root of this vegetable as an astringent of superior powers, and thinks it well adapted to a depraved state of the stomach t and digestive organs. Dr. Mease, in his edition of the Do APPENDIX. 705 mestic Encyclopaedia, says, " a jelly made of blackberries, when ©n the turn from red to black, is much used in the United States for the gravel. A friend of the editor, sub- ject to this disease, spoke highly in praise of the remedy." It is not improbable that a decoction of the root would be still more efficacious in the same complaint, and that it may be extended to other diseases also. We may anticipate the time when this vegetable will be received as an acquisition to our Materia Medica, and as it is a cheap and pleasant medicine, easy to be procured in every situation, it cannot be too strongly recommended to general attention. Artificial Mineral Waters. The immense improvements in the science of chemistry have enabled chemists to analyze with great accuracy the natural mineral waters, and to ascertain their nature and even the proportions of the several ingredients which they contain. " In the manufacture, therefore, of artificial mineral waters the original water is perfectly imitated by the addition of all the ingredients in the proper proportions; and the gas by a peculiar and very powerful apparatus is afterwards forced in till the waters acquire a degree of briskness and activity far surpassing any thing which they ever exhibited in na- ture." " Every species of mineral water whatever, can be prepared by art, but the principal ones that have been at- tempted in this country, are the Ballston, Soda, and the Seltzer waters." Ballston Water. " The Ballston water is well known in the United States as a gentle cathartic, an active diuretic, a remedy against gravelly complaints, a tonic to the stomach, and generally to the system ; not to mention its efficacy against rheumatic and cutaneous complaints, when applied externally as well as internally. It remains only to be added, that the artifi- cial Ballston water is found by experience to produce the effects of the natural water ; it is, however, more powerful, and therefore, an equal quantity produces more marked ef- fects." See Mineral Waters of Ballston and Saratoga, page 675. 89 706 APPENDIX. Soda Water. " The soda water is not an exact imitation of any natural water, but has been directed by medical men as a remedy in a number of common and troublesome complaints. It is ordered in the Pharmacopoeias and Dispeusatories, and their prescriptions should be followed in this manufacture. It is a complete remedy against sourness of the stomach, com- monly called heart-burn, and in most cases of indigestion and weakness of the stomach it is very useful; gradually restor- ing the appetite, and with it the tone of the organ; it is a preventative of many of the diseases of the stomach and bowels which proceed from acidity, and, for the same rea- son, it often removes or prevents the sick head-ach. " As a palliative, and even a remedy,in some cases of urin- ary calculi and gravelly complaints, it is preferable to the Ballston water. It may prevent, arrest, retard,, or remove the complaint according to circumstances. " The soda water is also a very refreshing, and to most per- sons a very grateful drink, especially after heat and fatigue, and may be made a complete substitute for the beverages of which ardent spirits form a part. With wine and sugar it is very grateful." The soda water is made by dissolving two ounces of the carbonate of soda in ten pounds of pure water, and after- wards combining with it the carbonic acid gas to the fullest extent. This operation is performed by a powerful appara- tus, affording so great a pressure as to be capable of impreg: naling the liquid with no less than five, or even six times its bulk of carbonic acid gas. The water should be afterwards preserved in glass vessels well closed, and kept as cool as- possible. Seltzer Water. " The seltzer water has long been known, aud is one of the most famous of the natural mineral waters of Europe. On account of its agreeable taste and exhilarating effects, it is largely used at table, and as a beverage, at all hours. It is a diuretic, and possesses considerable efficacy in nephritic and urinary complaints ; it is very useful against bilious and dyspeptic affections, and in many cases of cutaneous erup- tions. APPENDIX. 707 "** It possesses a peculiar power of allaying feverish irrita- tion, and has done much service in slow hectic fevers; it mixes well wi(h milk, and is (bus used wilh advanlagc by hectic patients. It is also used with sugar and wine." For the preceding quotations I am indebted (o "Conver- sations on Chemistry." Appendix—New-Haven edition. The following is from Ihe Emporium of Arts, &c. by Thorn as Cooper. "The best method of combining the sellzer water with a » laxative proportion of the purgative salts is the following ; which will enable every body lo make, at will, a mineral water, impregnated with cathartic qualifies in any proportion that the palate will bear, or the bowels will require, combin- ed with the lively, sparkling qualities of the seltzer water. Take of supercarbonate of soda, or even the common car- bonate, twenly grains, of the common carbonate of magnesia as much, put them in a strong black quart bottle; fill it nearly, but not quite full of water ; having previously ready a cork that will fit it. Pour in the quantity of strong vitri- olic acid, that you know from previous experiment will bare- ly neutralize that quantity of saline matter. Cork the bot- tle, and tie down the cork instantly. The carbonic acid gas will thus be combined with a solution of Glauber's and Epsom salts, which must be kept in a cool place. In the same manner the dose may be altered or diminished, or sul- phate of iron in the proportion of three or four grains may be added if the symptoms of the patient require it, and a mineral water produced more efficacious than any that na- ture presents to us. "As to the aerated waters generally, I am of opinion that every family should have an apparatus of the kind, in order to make them at any time, for the purpose of medicine and salutary beverage. I found them in a recent complaint of more service than any other preparation. Owing to extreme debility, no medicine or food would stay on my stomach until I drank the seltzer and soda waters ; and I am of opin- ion, that by their use, sickness may be avoided, and of course, health preserved." James Cutbush. Phosphate of Iron. If equal parts of phosphate of soda and sulphate of iron be mixed together in solution, a blue precipitate will be 708 APPENDIX formed, called the phosphate of iron. The sulphuric acid combines with the soda, and the phosphoric acid with the iron, and precipitates the iron, which is insoluble' in water, and when well washed, is nearly insipid. This is the pro- cess by which Dr. John Williams of Cambridge prepares the phosphate of iron ; the powder is of a sky coloured blue. By a similar process Dr. Caleb Miller of Bristol, prepares his phosphate of iron, but which is afterwards oxygenated, (as he terms it) by subjecting the powder to a fall of water in broken showers, by which it is converted to a yellowish colour. It is not probable that these preparations produce effects essentially different. The phosphate and the oxy-phosphate of iron were the favourite preparations with Mr. Carmichaelof Dublin, in can- cerous affections, but his account of their successful appli- cation is suspected to have been exaggerated. This prepa- ration has of late been administered with a good degree of success in diseases of debility and various chronic affections, in which chalybeates in general have long been employed. In the New-England Medical Journal, Vol. III. and IV. fa- vourable reports respecting it will be found as a remedy in scrofula, dyspepsia, amenorrhaea, chronic rheumatism, diarr- haea, and obstinate cutaneous eruptions. Having adminis- tered this medicine in a few instances of amenorrhaea, and impaired state of the digestive powers, I can add my own attestations of its being equal, if not superior, in efficacy to most other preparations of iron. It is given in doses of from thirty to sixty grains three times a day ; if it induce nausea or looseness diminish the quantity; if costiveness, a little aloes should be added. Eau Medicinale d'Hus&on. This much celebrated composition was discovered about f ty-five years ago by M. Husson, a French officer, and has been so highly famed for its almost infallible powers in the cure of gout, as to command the enormous price of from one to two crowns a dose, and it still retains its high reputa- tion in England, and in various parts of the European conti- nent. This remedy is considered as producing a specific effect in removing the paroxysms of gout, as often, and al- most as soon as they occur; scarcely an instance of its fail- ure having yet been known in practice. For more particu- APPENDIX. rog lar information respecting this subject, reference may be had to American New Dispensatory, 2d edition, p. 361. Numerous attempts have been made to discover the compo- sition, or to devise a substitute for eau medicinale. " Mr. James Moor, surgeon, London, has succeeded in compound- ing a medicine, closely resembling the original medicine in smell, taste, and dose, in its evacuant powers, and finally in its property of relieving the gout so far as it has been tried. This medicine, whose identity with the specific is thus presumed on, is composed of three parts of the wine of white hellebore, and one of wine of opium. The above wine of white hellebore is prepared by infusing for ten days eight ounces of the sliced root of that plant in two pints and a half of white wine. The dose of the compound is from one to two drachms." The root of our own species of swamp hellebore has been found equally efficacious as the imported root. This composition, since its promulgation, has been consid- erable employed in practice, and with the success anticipat- ed by its sanguine advocates. In gout and rheumatism it has obtained a reputation in some degree proportioned to the original preparation of M. Husson. The dose above specified, however, is too large, as it is apt lo irritate and induce nausea and vomiting. It is found more convenient to limit the dose to sixty or eighty drops, or increase as the stomach of the patient can bear ; smaller doses twice in a day have on some occasions proved advantageous. The fact has lately been announced in the New-England Medical Journal, Vol. IV., that Mr. Want has discovered the composition of a medicine which possesses the power of removing the paroxysms of gout in a degree fully equal to the eau medicinale; and has had abundant experience to satisfy himself of the identity of the two medicines. He directs a tincture to be made by infusing for two or three days, four ounces of the root of colchicum autumnale, vul- garly called meadow saffron, in eight ounces of alcohol, or Sherry or Lisbon wine. For medicinal purposes, an infu- sion of the fresh or dried root in water is equally efficacious. Mr. Want has made extensive trials with this watery infu- sion, and never been disappointed in its effects. The dose of this tincture or infusion, whether it be made with water, wine, or spirit, should be the same, and should vary accor- ding to the constitution of the patient. Upon an average no APPENDIX we may fix two drachms, or two ordinary tea spoonfuls as the proper quantity for an adult. Mr. Want's experiments have extended to at least forty cases, followed by results of the most satisfactory nature, the paroxysms being always removed, and in several in- stances, no return of the disease having taken place after an interval of several months. He is authorized by Sir Joseph Banks, and other highly respectable characters, to publish their decided conviction that his medicine and the eau me- dicinale are the same, as far as they are enabled to judge from fhe appearance, taste, and smell.* Preparations of Sal Aeratits by Edward A. Holvoke, M. D. of Salem. " Take a cylindrical box of wood about nine or ten inches in diameter, bore eight or ten holes half an inch in diameter in the side of it just below the lower edge of the cover, at nearly equal distances all round; bore also as many holes in the circular bottom of fhe box, close to the edge of it: then take another box of the same kind, but of a smaller di- ameter by half or three quarters of an inch; place this in the larger, and to keep it steady, thrust three or four wooden wedges between the two boxes. The two boxes being thus prepared, fill (he inner one with the purest salt of tartar, or clean well calcined pearl ashes, or any clean, pure fixed vegetable alkali : put its cover on the outer box, leaving the inner one uncovered; sling this double box, thus filled, with a cord, and suspend it in a distiller's vat or cistern, while the wash is fermenting, a little above the liquor, or in an empty cistern, if it has been much used, and still retains the fixed air (carbonic acid); let it remain in this situation for six weeks or two months, or longer if it is not wanted ; let * ColchicumJlutumnale. Meadow Saffron is of ihe. sixth class, third order of Linnxus—Hex andria trigynia,—and is thus described by Rousseau. " It is clearly of the liliaceous tribe; its resemblance to crocus or saffron is obvi- ous. It has flat lance shaped erect leaves, and flowers of a light purple; the first coming out in the spring, the latter in autumn ; a spathe for a calyx, a corolla di- vided into six parts, with the tube extending down to the bulb; and a tribolate cap- sale, of three valves and three cells." The root of this plant was formerly employed in medicine, and preparations of it are to be found in the old Dispensatories. It was considered as an efficacious di- uretic, but very acrimonious, and in large doses poisonous. I have not ascertained whether it has been found in Uie United States, but it is cultivated iu the Elgin Bo- tanic garden at New-York. APPENDIX. 71T it then be taken out, and the salt now fully saturated with the acid be exposed to the sun and air to dry. The salt thus prepared, does neither effloresce nor deliquesce in (he open air, and for all common purposes is, I believe, equal to that prepared by crystalization. "Note. The pearlashes had better be put into the box in moderate sized lumps than in powder, that the fixed air may have free access to it. " The salt is much more tolerable to the palate, and may be taken in larger doses than the naked alkali; and as it is decomposed by vegetable acids, as well as the mineral, it may be exhibited instead of the alkali, in perhaps every case where the latter is proper, unless the fixed air is judg ed improper." (Medical Repository, Vol. II.) Dr. Fisher's Amalgam of Tin. R Melted tin, five parts, quicksilver, two parts, mix them and add one part of testacious powder ; keep the amalgam melted, and rub in a mortar until the smallest parts of it dis- appear : when the mixture is cold, a little additional levigat- ing will reduce it to an impalpable powder. This preparation is admirably adapted to the purpose of destroying worms in children. For the removal of the long round worm (teretesx) there is not perhaps a more sure and effectual medicine. Dr. Fisher directs for a child about fifteen or twenty grains of the powder twice in a day, and to be continued until from twelve to twenty-four doses are taken, unless sooner relieved. A few grains of calomel may occasionally be added to keep the bowels open. Should the symptoms be very severe a large dose of calomel should be given, otherwise the patient may be lost before the amal- gam has time to operate. See Communications of Massa- chusetts Medical Society, Vol. I. Dr. Fowler's Arsenical Solution. ft White arsenic in powder and salt of tartar, or other vegetable alkali, each sixty-four grains ; boil them gently in a Florentine flask with half a pound of distilled water, until the arsenic is dissolved. To this solution, when cold, add half an ounce of the compound spirit of lavender, and as much water as will make the whole equal to a pint, or fifteen 712 APPENDIX. ounces and a half in weight. The dose of this solution i* as follows : from two years old to four, two drops, or three to five; from five to seven, five to seven drops ; from eight to twelve, seven lo ten drops; from thirteen fo eighteen, ten to twelve drops; from eighteen and upwards twelve drops. These doses may be repeated once in eight or twelve hours, diluted with thick gruel or barley water. A peculiar sensation about the eyes and face is a criterion of the med- icine having produced its effect on the system, and it is not proper to augment the dose or much longer to persist in its use. The diseases in which the arsenical solution has been most successfully employed, are intermitting and remitting fevers, periodical head-ach, dropsy, hydrophobia, and ob- stinate cutaneous eruptions. Recently it has been success- fully administered in typhus fever and in locked-jaw, occa- sioned by wounds. In this last disease the dose must be larger than usual, and repeated every half hour until its ef- fects be ascertained. Dr. Ferriar strongly recommends this medicine in hooping cough after blisters and emetics have been employed. He begins with one drop daily for an in- fant, and for children under seven,two drops, repeated accor- ding to the symptoms, intermitting the use of it for a day or two. Vegetable Caustic. ft Root of phytolacca decandra, two pounds, Expressed juice of may-weed (anthemis cotula,)four ounces, Potash, two ounces. Boil the root in water for some time and strain it off, add the other articles to the liquor, and simmer, and evaporate to the consistence of an extract. This is a useful caustic, and was much employed by an individual out of the profession for the cure of cancer. It should be kept from the air. Tincture of Blood-root, {Sanguinaria Canadensis.) ft Blood-root coarsely powdered, two ounces ; infuse in a pint of proof spirit for seven days, and filter through paper. This medicine has recently been found to be a valuable substitute for digitalis, in the cure of coughs and pneumonic APPENDIX. 713 complaints. It appears to possess the same power of dimin- ishing the frequency of the pulse as the digitalis, when exhib- ited with the same precautions ; and is equally efficacious in pulmonic affections, and is much less apt to induce debility and dangerous consequences. The proper dose of the tinc- ture is from thirty to eighty drops twice in the day, increas- ing or decreasing the number as particular circumstances may seem to require. Essence for Head-ach. ft Alcohol, four ounces, Gum camphor, two ounces, Spirit sal ammoniac, or ether, two ounces. Mix thoroughly and apply with the hand. The following preparations will be found well adapted for the cure of colds, pulmonic aud febrile complaints. Emulsion for Catarrh and Cough. ft Oil of sweet almonds, one ounce, Barley water, six ounces, Best white sugar and gum arabic powdered, of each half an ounce, Liquid laudanum, forty drops. Incorporate the sugar and gum arabic together in a mortar with a small quantity of the barley water, then gradually mix the oil and afterwards add by little at a time, the remain- der of the water with the laudanum. A cup full of this emul- sion may be taken frequently. Pectoral decoction for Colds. ft Linseed, four ounces, Liquorice root, one ounce, Raisins or figs, four ounces. Simmer them moderately in two quarts of water till reduc- ed to one, then add a quarter of a pound of sugar-candy powdered, a table spoonful of old spirits, and the same quan- tity of vinegar or lemon juice. Drink half a pint at going to bed, and a cup full whenever the cough is troublesome. 90 714 APPENDIX. Spermaceti Mixture. ft Spermaceti, two drachms, Refined sugar, three drachms, Elixir paragoric, half an ounce, Water, eight ounces. Rub the spermaceti and sugar together with the yelk of one egg, then gradually mix the water.—Dose, a table spoon- ful three times in a day for cough. Candy for Cough. ft Vervain, coltsfoot and horehound, of each two ounces, Root of elecampane, three ounces, and a small quantity of rue. Put them into five pints of pure water, boil them till the liquor is reduced to a quart, then add two pounds of clean sugar and boil down till it becomes of a consistence for can- d^ The patient may dissolve in his mouth and gradually swallow as much and as often as convenient. Nitric lac Ammoniac. " Infuse two drachms of pure nitric acid in pure water, eight ounces (half a pint,) gradually pour fhe compound on of best gum ammoniac, two scruples and a half. Triturate them in a glass or composition mortar, until the whole of the gum is dissolved, and a homogeneous milky fluid is formed. The dose is one table spoonful in six table spoonfuls of sweetened water, or of any other convenient vehicle to di- lute it, every three or four hours." For the above preparation we are indebted to J. Stuart, M. D. editor of a valuable production, entitled, "A popular Essay on the disorder familiarly termed a Cold." He as- serts that he has for several years past used the nitric lac ammoniac with the greatest success in the cure of catarrh and protracted coughs, and even in many cases of phthisis pulmonalis, deeming it far preferable to digitalis. The following is from the same source. APPENDIX ri.-. Cough Mixture. ft Paragoric elixir, one ounce, Powdered gum arabic, one ounce, Simple water, two ounces, Sweet spirit of nitre, two drachms, Antimonial wine, one drachm. Mix and dissolve. One table spoonful to be taken whenever the cough is troublesome. But in the first stage of catarrh, when inflam- matory symptoms are present, this and ail opiates are im- proper. Receipt for a Cough. & Gum ammoniac, two drachms, Syrup of squills, half an ounce, Liquid laudanum, fifty drops, Pure water, six ounces. Reduce the gum to powder in a marble mortar and gradu- ally add the water, and triturate till the gum is dissolved, then strain from the impurities and add the other articles. Dose, a table spoonful three or four times a day. Another. ft Elixir paragoric, one ounce and a half, Wine of antimony, one ounce, Syrup of squills, one ounce, Lac ammoniac, four ounces, Syrup bal. tolu, one ounce. Dose, half a table spoonful every two or three hours. The following is highly esteemed by those who have ex- perienced the use of it. ft Tincture of opium, one drachm, Wine of Ipecacuanha, half a drachm, Oxymel of squills, half an ounce. M. Dose, seventy drops every two hours while the cough is severe. 716 APPENDIX. Pills for Cough. ft Calomel, twenty-four grains, Squills powdered, half a drachm, Tartarized antimony, six grains, Gum opium, eighteen grains. M. f. pills No. 24. Dose, one every night. Domestic remedies for Hooping Cough. Dissolve thirty grains of salt of tartar or sal aeratus in a gill of water, add to it ten grains of cochineal finely pow- dered, sweeten this with fine sugar, and give an infant a tea spoonful four times a day. To a child of two pr three years old two tea spoonfuls, from four years and upwards a table spoonful or more may be taken. The relief is said to be immediate, and the cure in general within five or six days. Another. Take equal portions of new milk and the ley strained from hickory ashes, of which one table spoonful may be given every hour through the day to a child of seven or eight years old. This remedy is strongly recommended in the National Register, a very respectable newspaper, in which it is stat- ed that the good effects of this remedy have been witnessed in upwards of fifty cases. Febrifuge Mixture. ft Glauber's salts, one ounce and a half, Lemon juice, one ounce, Boiling water, half a pint, Loaf sugar, two ounces. Mix and dissolve. When cold, add sweet spirit of nitre, two drachms. Dose for an adult, two table spoonfuls every hour until it produce a cathartic effect, afterwards in small doses as an alterative. Or, ft Sal nitre, half an ounce, Simple water, half a pint, Lemon juice, half an ounce. Mix and dissolve. APPENDIX. 717 Let it be kept in a corked bottle, and give a table spoon- ful every hour during the continuance of fever. Febrifuge Powder. ft Sal nitre, one drachm, Tartarized antimony, three grains, Gum opium, six grains, Calomel, ten grains. Mix, and divide into ten doses.—To be administered one every third hour. Solution of Tartarized Antimony. Let six grains of emetic tartar be dissolved in eight ounc- es of water ; distilled water is preferable. If to promote vomiting, give two table spoonfuls every fifteen or twenty minutes. If to excite a diaphoresis in fevers, one table spoonful is to be given every six hours. Dr. G. Fordyce asserts that he has seen in less than five hours after the ex- hibition of this medicine the symptoms of a crisis, and the fever has ceased in less than twelve hours; in a large pro- portion of cases it will succeed if exhibited within the first three or four days of continued fever. The same author observes, that if tartarized antimony be dissolved in a large quantity of water it will be decomposed in case the solution be suffered to stand with a surface exposed to the atmos- pheric air, as in an open vessel. It is therefore much bet- ter dissolved in wine in the proportion of a quarter of a grain to half a drachm of wine. But in every instance care should be taken that the antimonial powder be fairly dissolved, and not permitted to subside to the bottom, and be unequally distributed. This preparation is much employed by re- spectable physicians for the purpose of increasing the gas- tric secretions, and maintaining for a length of time a solu- ble state of the bowels. Yeast for Medicinal Use. Thicken two quarts of water with about three or four spoonfuls of rye meal or fine flour; boil for half an hour, sweeten with half a pound of brown sugar; when near cojd put into it four bpoonfuls of fresh yeast, shake it well togelh- 718 APPENDIX. er in a jug, and let it stand one day io ferment near the fire without being covered. Pour off the thin liquor on the top, and cork up the remainder for use. Or, Boil one pound of clean washed potatoes to a mash, when half cold add a cup full of veast and mix it well. It will be ready for use in two or three hours. Anotlier Method. Take one pint of yeast and add half a pint of molasses and one quart of luke warm water. Stir these well together and let it stand in a moderately warm place till active fer- mentation becomes ev ident; then it may be kept in a cool place for the patient's use. In warm weather it should be prepared fresh every day. Yeast has acquired considerable celebrity for its virtues in the cure of putrid fever and malignant ulcerous sore throat. It is fo be exhibited in doses of two spoonfuls every two or three hours; should it purge or gripe, the dose must be di- minished. Cathartic Pills. ft Calomel, three drachms, Jalap in powder, three drachms, G. gamboge, one drachm and a half, Squills, forty grains. M. Mucilage of gum arabic q. s. f. pil. No. 160.—Two or three pills for a dose. * ft Gum aloes, G. gamboge, sal nitre, equal parts. M. Mucilage of gum arabic, q. s. f. pil.—To contain five grains each.—Two or three for a dose. Pills Foztida with Opium. ft Gum asafoetida, three ounces, Aloes sue, one ounce, Opium, one drachm, Soap, half an ounce. M. Common syrup, q. s. f. pil. No. 480. In nervous cases attended with flatulency, three or four pills taken at night will produce excellent effects. APPENDIX. 7\9 Lockyer's Pills. ft Panacea antimony, twenty grains, Sugar-candy, one ounce, Mucilage of gum tragacanth or of gum arabic, suffi- cient to form amass, which divide into eighty pills. Under certain circumstances of the patient, these pills moderately evacuate the stomach and bowels; in many chronic complaints in both children and adults, and especial- ly in cutaneous affections, the use of these pills when duly persisted in has been attended with fhe happiest effects. Lockyer's pills were formerly in the highest repute and considered by some as a sort of intelligent agent as respects the state of the alimentary canal, proving emetic when the stomach required evacuating, and cathartic when the intes- tines were in a condition to require that operation. Two or three pills are found to operate gently by stool and vomit, but they should be increased gradually until the proper ef- fect be produced, and afterwards taken in small doses as an alterative. Chalybeated Myrrh Pills. ft Myrrh powdered, two drachms, Carbonate of soda, sulphate of iron and sugar, each one drachm. Rub the myrrh with the carbonate of soda, add the sul- phate of iron and rub them again, then beat the whole to- gether until they are thoroughly incorporated. These pills are intended as a substitute for Griffith's myrrh and steel mixture, as it may occasionally be conven- ient to prescribe it under the form of pill, or to form the mix- ture from it extemporaneously by diffusion in water. Two pjlls of about five grains each may be given morning and evening. Saturnine Anodyne Pills. ft Acetite of lead, Ipecacuanha in powder, of each one drachm, Opium, ten grains. Beat them with simple syrup iuto a mass to be divided in- to forty equal pills. 720 APPENDIX. In cases of uterine haemorrhage, fluor albus, ^.c. attended by debility and pain, these pills taken one every three or four hours, seldom fail to produce the desired astringent effect; and if Iheir use be duly persisted in, will often induce that salutary change in the system upon which a radical cure depends. Piummer's Pills. ft Calomel, sulph. aurat. antimony, of each two drachms, Gum guaiacum powdered, four drachms, Hard soap, two drachms. Let the calomel and sulphur be thoroughly triturated to- gether, then add the powder and beat the whole into a mass with jelly of soap. This formula differs from the original # one of Dr. Plummer, in omitting the extract of gentian, and adding the guaiacum. These pills for many years sustained a high reputation, and may still be considered as a very effi- cacious remedy in venereal and in various cutaneous affec- tions. The proper dose is from four to eight or ten grains morning and night, observing the same rules as when under a course of any mercurial preparation. Compound Aloetic Pills. ft Castile soap, aloes, powdered rhubarb, equal parts, Mucilage of gum arabic, or simple syrup, q. s. f. pills. Two or three of these pills of five grains each, prove mildly laxative, and are a good substitute for Dr. Anderson's pills. Calomel Pills. ft Sub muriate of mercury, (calomel,) half an ounce, Starch powdered, one ounce. Mucilage of gum arabic, q. s. f. mass, divide into two hundred and forty pills. The compound calomel pills are formed by adding eighty grains of opium to the foregoing mass. These pills are well adapted to most cases where a mercurial course is prop- er. The dose and frequency of administration is to be regu- lated according to circumstances. » APPENDIX. 721 Absorbent Laxative Mixture. ft Magnesia alba, two drachms, Rhubarb in powder, half a drachm, Oil of aniseed, twenty drops, Loaf sugar, one drachm, Simple cinnamon water, one ounce, Pure water, four ounces. M. First mix the magnesia and rhubarb in a mortar, then add the oil and sugar, and lastly add gradually the water. Cne or two tea spoonfuls of this mixture is given with much ad- vantage to children whose stomach and bowels abound in acidity, which occasions griping and colicy pain. On some occasions it may be useful to add a few grains of alkaline salt, or a few drops of aqua ammonia. Gargle for Canker. ft Red rose leaves, a small handful, a piece of myrrh the size of a large hazle nut, three or four figs. Simmer the whole in a pint of old cider, the older the better, then strain and sweeten it with pure honey ; gargle the throat and wash the mouth with a little mop wet with the liquor. Remedy for Angina Maligna, or Putrid Sore Throat. ft Cayenne pepper, two table spoonfuls, Common salt, two tea spoonfuls. Infuse in half a pint of boiling water, and add thereto the same quantity of warm vinegar. After standing for an hour, the liquor must be strained through a fine cloth, and two table spoonfuls given internally every half hour. The most speedy and good effects were produced by this medicine in almost all the numerous cases of pulrid sore throat in which it was tried in the West-Indies, where it was first introduced. (Thomas' Modern Practice.) Styptic Tincture. ft Sacchar. saturni, one ounce, Sal martis, half an ounce, Alcohol, eight ounces. M. Infuse for two days and strain through paper. 91 r-22 APPENDIX. Dose for adults, twenty drops three or four times in a day as a remedy in profuse haemorrhages. Or, ft Sulphate of copper (blue vitriol,) three grains, Sulphuric acid, twenty drops, Pure water, two ounces. M. This efficacious remedy for uterine haemorrhage is to be given in doses of from fifteen fo forty drops in wafer, repeat- ed every hour, or once in six hours, according to the ur- gency of the case. Anti-Dysenteric Mixture. R Lemon juice or best vinegar, two ounces, Common salt, as much as the acid will dissolve, Strong mint tea, half a pint, White sugar, sufficient to sweeten it. Dose, a fable spoonful in two spoonfuls of hoi water eve- ry two or three hours in cases of malignant dysentery, in which it has been found very efficacious. Collyria, or Eye-waters. ft Acetite of lead, five grains, Sulphate of zinc, three grains, Liquid laudanum, one drachm, Pure soft water, four ounces. M. This will be found extremely useful in ophthalmia after the active symptoms of inflammation have subsided. A rag wet with the fluid should be applied over the eye-lids, and oc- casionally they should be opened so as to admit it into contact with the ball of the eye. ft Water of acetite of ammonia (spirit of mindererus,) Pure water, of each four ounces. Mix and strain. To the above may occasionally be added tincture of opi- um, one drachm. ft Acetite of lead, one scruple, Water, eight ounces, Tincture of opium, one drachm. M. ft Sulphate of zinc (white vitriol,) twelve grains, Acetite of lead, sixteen grains, Water, eight ounces. M. > APPENDIX 723 Tar Water. ft Tar, half a pint, Water, one quart. Stir them together with a wooden stick for a quarter of an hour, and after the tar has subsided strain the liquor and keep it in well corked phials. In obstinate ophthalmia Dr. Physic employed tar water with complete success after the usual remedies had proved ineffectual. This may be made weaker by the addition of water, if too strong. Tar water is also an excellent remedy in dyspepsia, it is found to strengthen fhe tone of the stom- ach, to excite appetite, promote digestion, and the excre- tions of urine. Alum Curd. ft Alum, half a drachm. Agitate it well together wilh the white of an egg until a coagulum be formed. This has been found greatly beneficial when applied to in- flamed eyes, to allay heat and restrain the flux of humours^ It should be spread upon linen, and not be kept on above three or four hours at a time. The following astringent eye water is said to prove pecu liarly useful in obstinate inflammation of the eye-lids from debility of the parts. Take the whites of six eggs after be- ing boiled quite hard, cut them into small pieces, and while warm sprinkle over them half an ounce of white vitriol in powder; keep this for twenty-four hours in a moderately warm place, and when the vitriol is dissolved, strain the li- quor through a fine cloth for use. Let this liquor be dilut- ed with soft water to such strength as the eye can bear with- out much sensation of pain, and apply it at night, avoiding exposure to the cold air the next morning. Cold Cream. R Oil of sweet almonds, two ounces. Spermaceti, half an ounce, White wax, half an ounce. M. Put them into a close vessel, which put into a skillet of boiling water; when melted, beat them up with rose water 724 APPENDIX. until the whole becomes cold. This forms an elegant oint- ment, and is a useful application to sore nipples and other excoriated parts. Compound Powder of Ipecacuanha. Dover's Powder. ft Ipecacuanha powdered, opium,of each one drachm, . Sulphate of potash, one ounce. M. Trifurate them thoroughly togefher. This powder is the most efficacious sudorific we posses* in doses of fifteen or twenty grains frequently repeated. Sal nitre may be substituted for the sulphate of potash when that is not at hand. Alkaline Solution and Neutral Mixture. ft Carbonate of potash (salt of tartar,) half an ounce, Water, six ounces. Mix and dissolve. The neutral mixture may be formed by adding gradually to (he foregoing an equal quantity of the vegetable acid, or in such proportions as to neutralize the mixture. Ointment for the Itch. ft Hog's lard, fwo pounds, Flowers ot sulphur, one pound, Sal ammoniac, crude, in fine powder, one ounce, Roof of white hellebore in fine powder, one ounce, Essence of lemons, one drachm. M. Scotch Ointment for the Itch. ft Hog's lard, one pound and a half, Flowers of sulphur, one pound, Unguentum citrinum, three ounces, White hellebore powdered, half an ounce, Red saunders powdered, two ounces. M. The red saunders is used merely as a colouring ingredi- ent. Either of the above ointments will prove an effectual cure for the itch if properly applied on tjje extremities and joints for two or three nights in succession, or upon the parts particularly affected. In obstinate cases sulphur should be taken internally twice in a day. APPENDIX. 725 Spirits of turpentine properly mixed with hog's lard will also prove an effectual cure for the itch. Wash for Gutta Rosea, or Pimpled Face. ft Rose v.jter, six ounces, Flowei i of sulphur, half an ounce, Acetite of lead, one grain. M. Shake it well, dip a soft rag in it and wet the affected part of the face night and morning. Let it remain on the face as long as convenient. Beef tea. Cut one pound of lean beef into thin slices or shreds, and boil it in a quart of water for twenty minutes, taking off' the scum as it rises. After it grows cold the liquor should be strained, in whjch state it resembles a light infusion of green tea, has a very grateful flavour, and \s more strengthening than other broths. Another. Cut a pound of beef, first deprived of ifs fat, into small pieces so as lo be put into a quart bottle. The bottle well corked, without the addition of water, should be put into a small pot of cold water, which should be boiled for three or four hours. The liquor should then be poured out of the bottle and made savory with a little salt and any agreeable spice. Rush. Instead of boiling the meat, Dr. Mease advises to reduce it to a pulp with a wooden pestle in a mortar, and then to express all its juice. After straining this liquor, a little spice may be added, and an equal or larger proportion of boiling water. Thus the whole essence of the meat will be preserved, part of which would be volatilized by cooking. Half a pound of beef in this way is nearly equal to one pound used according to the former method. But on mature deliberation it appears to be a common er- ror that any liquid substance whatever is more easily digest- ed, or better suited to weak and impaired stomachs than animal food in its solid form. APPENDIX. Wine Whey. Poor equal parts of white (Lisbon) wine, and skimmed milk into a bason ; and after they have stood for a few min- utes, add a double portion of boiling water. In a short time the curd will collect and subside at the bottom; (he whey is now lo be strained and sweetened wilh sugar : a sprig of balm or slice of lemon will greatly improve its flavour. Dr. Mease. To render the preparation of this excellent article of diet and medicine more prompt and easy, says the late Dr. Rush, a single runnet or dried calf's stomach should be cut into small pieces and infused in a quart of sound old Madei- ra wine. One or two table spoonfuls of this wine will turn two quarts of milk without exposing it to the action of fire. This tincture will retain its virtues for years. Mustard Whey. Boil one ounce and a half of mustard in powder in a pint of milk, and an equal portion of water, till the curd be en- tirely separated, after which the liquid is strained through a cloth. Dr. Mease. This preparation is one of the most pleasant and effica- cious forms in which mustard can be given. A tea-cup full sweetened with sugar taken three or four limes in a day, is exceedingly beneficial in low fevers as a cordial di- aphoretic. Vinegar and lemon whey may be formed in the same man- ner as wine whey. Alum Whey. Boil two drachms of powdered alum in a pint of milk till il is curdled; then strain out the whey. This astringent preparation is often employed with advan- :agr in uterine haemorrhage and in diabetes. The dose is two or three ounces, or as much as the stomach will bear, several times in the day. Various cooling and pleasant drinks useful ic fevers may be prepared as follows: APPENDIX. 727 Barley Water. Take a handful of either pearl barley or the common sort, wash it clean first in cold and afterwards in boiling water, then simmer it in a quart of water for an hour; when half done, put into it a bit of fresh lemon peal and a little sugar. Or any vegetable acid may be added to render it agreeable. Lemons or apples cut in slices, tamarinds, currants fresh or in jelly, cranberries, dried whortleberries infused in boil- ing water and sweetened with sugar or syrup, these may be so prepared and varied in form as to suit every taste, and to answrer the purpose of pleasant, cooling, and salutary drinks in all febrile complaints. Such drinks should always be kept in a covered vessel. Toast and Water. Toast slowly a thin piece of white bread till exlremely brown and hard, but not the least black, then plunge it into a jug of cold water and cover it over an hour before used. Arrow-Root Jelly. Be careful to procure that which is genuine, for it is often counterfeited. Mix a large spoonful of fhe powder with a tea-cup of cold water by degrees, then pour this into a pint of boiling water, stirring it well, and when it boils it is finish- ed. A little sugar and nutmeg may be added. In this man- ner a sick person may be supplied with a fine supporting meal in a few minutes. Sago. First wash it well in cold water, then boil it slowly in wa- ter or milk until it swells to a proper thickness. If boiled in water it will require a little sugar, spice, and wine, or a bit of lemon peel to give it a pleasant taste and flavour. Boiled Flour. Take a pound or two of fine flour, tie it up as tight as possible in a linen rag, dip if repeatedly in cold water, and dredge the outside with flour till a ciust is formed around 728 APPENDIX. it, which will prevent the water soaking into it while boiling. It is then to be boiled till it becomes a hard dry mass. Two or three table spoonfuls of this may be grated down and boiled in milk and water to a proper thickness anil sweeten- ed to the patient's taste, and a little nutmeg or other spice may be added. This forms an excellent food in dysentery and in bowel complaints of children. Lime Water. Pour one gallon of water gradually on half a pound of quick lime in a glazed earthen vessel, stir them well togeth- er, and after the lime has settled strain the water through paper, or pour it off quite clear, which should be immediate- ly put into bottles, closely corked. It is not material wheth- er the water poured upon the lime be cold or hot, but the air must be kept from it as much as possible during the pro- cess. Lime water is directed in gravelly complaints and in affections of the stomach from acidity. It is also employed externally as a lotion to foul ulcers. Goidard's Extract of Lead. R Litharge, one pound, Vinegar made of French wine, two pints. Put them together into a glazed earthen pipkin and let them boil or rather simmer for an hour or an hour and a quarter, taking care to stir them all the while with a wooden spatula. After the whole has stood to settle, pour off the liquor which is upon the top into bottles for use. With this extract Goulard makes his vegeto-mineral wa- ter, which he highly extols in various external disorders, such as inflammations, burns, bruises, ulcers, &c It is made by putting two tea spoonfuls or one hundred drops of the extract to a quart of water, and four tea spoonfuls of bran- dy. The proportion of the ingredients may be varied to suit the particular case. Wheu used as eye-water it should be made of such strength as not to excite severe pain. This preparation is strongly recommended in all cases where sat- urnine applications in general are indicated. VPPENDIX. 729 Blistering Plaster. ft Venice turpentine, six ounces, Yellow wax, two ounces, Spanish or American flies in fine powder, three ounces, Powdered mustard, one ounce. Melt the wax, and while it is warm add fo it the tur- pentine, taking care not to evaporate it by too much heat. After the turpentine and wax are sufficiently incorporated, sprinkle in the powders, continually stirring the mass until it be cold. If the Venice turpentine is not easily procured, the common white turpentine, softened with a little tar, may be substituted. This form is preferable to those made of oil or lard, which tend to retard the stimulating effect of the flies. Another. ft Yellow wax and mutton suet, of each three pounds, Yellow resin, hog's lard, and flies in fine powder, of each one pound. The ingredients being first melted together, the flies are to be sprinkled in when nearly cold. Savin Ointment. ft Fresh leaves of savin bruised, one pound, Bees-wax, half a pound, Lard, two pounds. Melt together the wax and lard, boil therein the savin leaves until they become crisp, and strain through a linen cloth. Or, ft Dry leaves of savin in fine powder, one pound, Simple ointment, five pounds. M. The savin ointment was first brought into notice by Mr. B. Crowther, an English surgeon. It is intended for a stimulating application to blistered parts after the cuticle is removed, and is extremely well adapted to the purpose of continuing a discharge from a blistered surface. It must be used in a stronger or weaker degree in proportion to the excitement produced on the patient's skin. 92 i".'U» VPPEND1X Ditculitnt Plaster. ft Common litharge plaster, one ounce, Hard soap, four drachms, Sal ammoniac, crude, in fine powder, two drachms. Melt the plaster and soap together, and when nearly cold add the sal ammoniac. This is an excellent discutient application in cases of indurated tumours either of the female breasts or other parts. N Plaster for Lumbago, or Sciatica. ft Camphor, two drachms. Dissolve it in an equal quantity of spirits turpentine, and add of Yellow basilicon, one ounce, Common black soap, half an ounce, Carbonate of ammonia (volatile sal ammoniac,) half a drachm. Spread this on leather and apply it to the pained part. Remedies for Warts and Corns. Warts are readily cured by the application of the lunar caustic, or the nitric or sulphuric acid. If these should fail, they may be cut off with a knife, or by tying their necks with a ligature, and afterwards apply to the root a little of the vegetable caustic mentioned in page 712, or the lunar caustic dissolved in water. Corns are always caused and greatly aggravated by tight unpliable shoes, which should in every instance be avoided. The following method will be found very convenient and useful. From eight to twelve pieces of linen, smeared with an emollient ointment, and having an aperture cut in the mid- dle exactly adapted to the size of the corn, are to be laid over each other, and so applied to the foot that the corn is to lie in the opening in such a manner that it cannot be touch- ed by the shoe or stocking. Mr. S. Cooper (Dictionary of Surgery) recommends as infallible to rub the corn twice a day with emollient ointment or volatile liniment, and in the interim lo cover it with a sof Icning plaster. Every morning and evening the foot is to be APPENDIX. 731 immersed for half an hour in warm water, and the corn rub- bed with soap ; after which all the white pulpy outside of the corn is to be scraped off, taking care not to give the least pain. By this treatment the corn will be totally extirpated in eight or twelve days. The following plasters will be found as useful as any that have been employed. Plasters for Warts and Corns. ft Dissolve one ounce of gum galbanum in vinegar ; evap- orate the solution to a proper consistence, and add half an ounce of common tar, two drachms of simple diachylon plaster,twenty grains of verdegrease,and an equal portion of sal ammoniac : let the two last ingredients be finely- powder- ed, and the whole be duly incorporated. ft Gum ammoniac, two ounces, Yellow wax, two ounces, Verdegrease, six drachms. Melt the gum and wax, and add the verdegrease in pow- der. A plaster made of equal parts of gum galbanum, saffron, and camphor, will be found useful. ERRATA. Page 3, line W from top, after appearance, add " —12, line 13, for hypothesis, read hypotheses— 30, line 7 from bottom, for Iruhn, read Kuhn—62, line 10 from bottom, for Key, read Hey—67, 11 from top, for exertion, read excretion—67, 13 from top, for deteties, read dietetics—80,2, do. for course, read coarse—84,11 do. for element, read aliment—207,11 from bottom, for providing, read provided—221, 12 from top, for occionel,read occasional—227,15 trom bottom, et ubique, for spirits of nitre dulcis, read tpi itus nitri dutcit— 230,3 from top, for mucous, read mucus—268, 5 from bottom, for icteroides, read icterodet—271,13 from top, for scabious, read scabrous—283, 14 do. d?le vegita'jle—292, 8 do. for Rillie, read Kellie—333,13 do. for opisthotomot, read opis- thotonos—458, 3 do. for conveying, read carrying—526,20 do. for portion, read potion—537, 3 do. for opisthotonus, read opisthotonos—542,4 from bottom, for Waren, read Warren—597, last line, for assimuUtion, read assimilation—600,3 from bottom, et ubique, for prostrate gland, read prostate gland—610, 7 do. for of, read or. INDEX. ABORTION .... Absorbent laxative mixture Acidities in children - Affusion of cold water in fevers After pains .... Ague...... cake .... Air, various qualities of effects of, on the body corrupted by the respiration of men and animals ... of large towns, to be avoided pure, of great importance for children - - - 70. of mines and wells when stag- nated proves fatal caution in this respect when suffered to stagnate in hospitals, jails and ships, is a source of disease - - - is rendered impure by hot fires in close rooms - the most effectual preservative from foul, is cleanliness - foul, corrected by the growth of vegetables bath - - - - - Alkaline solution Alum curd - - - - - whey . - - - Amalgam of tin a valuable vermi- fuge . - - - - preparation ol Amaurosis - - Amenorrhea - Anecdote of Charles 5th of a celebrated empiric of the court of Madrid of Vesalius - >• of the University of Sal- amanca - Animal food more nourishing than vegetables - Anasarca - - - - - Anger, effects of on the constitution Angina maligna - Anti dysenteric mixture Aptha, see Thrush Apoplexy - - - - Apples, wholesome vegetables - 628 721 221 272 633 289 296 67 69 70 ib. 212 71 ib. ib. ib. ib. 72 671) 724 723 726 254 711 646 614 13 173 14 143 13 82 554 98 400 722 223 519 93 Apple Peru, description and vir- tues of .....687 Apricots, their qualities 9i Aquapendent, a learned Italian physician - - - - 10 Arachne .... 7(x> Arbutus uva ursi, description and use of 686 Ardent spirits, effects of as they appear in a fit of drunkenness 104 Chronic effects of their habitual use - - - 108 their effects upon the mind.....110 effects upon prop- erty .....Ill arguments in favour of their use answered - - 112 cases in which a small quantity may be taken with safety - - - - 113 substitutes for - ib. cautions and direc- tions respecting their use - 116 means of preventing their general use suggested - 122 remedies for pre- venting the pernicious effects of the habitual use of - - ib. remedies for a fit of drunkenness - - - - 123 remedies to pre- vent fits of drunkenness and to destroy a desire for - - 124 many singular ex- amples .... 125—128 retard digestion 87 Virow root jelly, how prepared 727 Vrsenic, poisonous effects of - 484 principal ingredientin the plasters of Cancer doctors - 169 Fowler's solution of - 71L Artichokes, properties of - 92 Artificial mineral waters - 705 Ascites, see dropsy Asparagus, its qualities - - 92 Asthma.....546 Atmosphere, constituent parts of 68 y. Atrophy.....4*°" iEscuIapious, a celebrated Greek physician .... 6 Aura epileptic* - - 522 7'M INDEX Bacon, qualities of Ballston water, its properties aud uses diseases in which it may be advantageously employ- ed ...... Bard Dr. John, author of an ac- count of malignant pleurisy - notice of - Bard Samuel M. D., extract from his eloquent discourse on medi- cal education ... Barley water, how prepared Barnet Dr. William, opens hospit- al for inoculation for small-pox Baron Haller obliged to flee the city of Paris for dissecting dead bodies - - - - - i science of medicine promoted by his zeal and abili- ties -..... Bathing and the various kinds of Baths - - - - Barton Dr. Benjamin, notice of 31. his remedy for worms - death of Bears whortleberry, description and use of Beef, its properties tea, how prepared - Beer, a good beverage Bees, stings of - - Birds, flesh of, its qualities - Bites of poisonous animals a mad dog - . - a rattlesnake a viper - - - - Ulackberry - - - - Bladder, inflammation of stone in becomes paryletic when too much distended - Bleeding at the nose Blistering plaster, how prepared Blood, course of through the lungs, discovered by Servetus Blood, circulation of, discovered by Dr. William Harvey great importance of the dis- covery - - - - - Blood spitting, or coughing vomiting of Bloody stools - - - - urine - Blood-shot eye, method of cure Boiled flour .... Bond Dr. Thomas, author of medi- cal memoirs - lectures on clin- ical medicine 88 7i b 675 16 34 63 727 14 670 149 255 33 686 87 725 86 495 90 488 ib. 495 ib. 704 459 603 130 609 729 16 11 427 611 000 612 647 727 16 30 Bone-set, description and virtues of o&9 Botanic garden established at Cam- bridge ..... Botanv study of cultivated in the 1'ni'ti-d Slat.-, Bo\ Iston 1 )i'. Zabdiel, first inocula- te i' <>f small-pox in New.England published his- torical account of inooulated sniidl-pox in 1726 Boylston Ward Nicholas, Esq. his donation of medical books to Harvard University appropriates a fund for the improvement of the art of medicine - - - - - Brain fever .... Brain, inflammation of Bread, properties of Breasts, female inflammation of I abscess of Brunonian theory, notice of Buboes - Buchan Dr., remarks of - Burns and scalds, treatment of - Butler, properties of 48 ib. 43 ib. 269 389 91 635 637 62 502 172 654 89 92 Cabbage, qualities of - Cadwallader Dr. author of essay on the Iliac passion in 1740 Calomel pills .... Calvin John, accessary to the cru- el death of Servetus - Camps when foul, produce epi demic diseases - - - - Cancer - - - - Cancer doctors, impositions of Candidates for examination by Mass. Med. Society, qualifica- tions of.....52 for fellowship, how ad- mitted ----- 50 for graduation, qualifica- tions of - 32. 38. 44. 56 16 720 179 514 169 Candy for cough - Canker, treatment of - Cardialgia . . . - Cardites..... Carrots, properties of Cataract . - - - - Catarrh or cold, how contracted treatment of epidemical - - - Cathartic pills - Celery, qualities of Creliaca - Cephalalgia - Cephalea - - » ■' Chalmer's Dr. Lionel writes on te- tanus and on fevers • Chancres..... 714 238 473 426 93 647 74 410 416 718 96 584 461 ib. 17 501 INDEX. 73j Charcoal vapour, dangerous effects of - - - - Cheese, not easy of digestion Cherries, properties of Chicken or swine pox Chilblains, causes and cure of Child-'drth, treatment of women in, before, and after deliver}' - Children, management of - clothing of food of --.- weaning of exercise of - importance of pure air for 70. diseases of - - retention of meconium red,white and yellow gum cutaneous eruptions snuffles ... hiccup - excoriations acidities, gripes and flat- ulency thrush or aphthsea tumours of the scalp tongue tied vomiting - fever from taking cold inflammation of the lungs dentition or teething - cholera infantum - 231 canker of the mouth croup hydrocephalus convulsions hooping cough rickets ... worms - - - - tinea, or scald head - chilblains measles chicken pox - scrofula, or king's evil distorted or club feet venereal disease - milk blotches - crusta lactea Chisholme Dr. strong advocate for tlie mercurial practice in yellow fever Chlorosis - - - - - Chocolate, properties of - Cholera infantum - - 231 morbus - Chordee - - - - - Chorea - - - ' - Churches should be ventilated Church yards in populous towns, pernicious effects of - Clavus hystericus *■ - 461 Cleanliness, great importance of 71 the most effectual pre- 72 89 93 260 257 631 197 200 203 209 210 212 213 214 215 ib. 217 219 ib. 221 223 225 ib. 226 227 228 ib. 233 238 239 244 246 247 230 251 2., 6 257 268 260 261 264 265 216 ib. 24 615 95 233 581 496 520 72 . ib. 528 134 scrvative against foul air - Clossay Dr., notice of Clothing, observations on Clothes catcbiiig fire Cobweb - Cocum, description and virtues of Cotfee exhilarates the animal spirits promotes digestion Cold, effects of on the body - Cold, see catarrh ... Cold bath, see bath Cold cream .... Colden Cadwallader, Esq. author of several publications Cold plague, mode of treatment by Dr. Jennings ... water, dangerous effects of drinking when the body is hot may be used in fevers the best remedy for frozen limbs .... affusion of, an effica- cious remedy in fevers when moot sale and use- ful ...... Colic bilious .... flatulent .... hysteric - - - - nervous or Devonshire College of physicians and surgeons in the city til" New-York in Herkimer county College of medicine in Boston,des- cription of Collyria..... Compound powder of Ipecacuanha Compound aloetic [(ills Consultations how to be conducted not on all occasions productive of beneficial effects a physician should not consult w ith those who are enemies to him - - - w ith unqualified per- sons prohibited tlie fellows of Mass. Med. Society - - 5S. Consumption, causes of 72. 132.136 pulmouary nervous Contagion, definition of of plague not communi- cable to persons at a distance of small-pox not com- municable through the ait- causes by which it is excited into action - - - means of prevention Dr. Haygarth's rules .latent period of may be communicated by infected clothes and furniture method of purification bv Dr. Liml - - - - 71 34 135 665 702 693 94 116 69 410 725 16 682 133 278 75 272 273 479 478 481 ib. 34 40 45 722 724 720 154 15C 157 157 137 431 446 174 182 183 18C ib. 187 185 188 18<> ?36 INDEX. method of destroying, by means of the mineral :.ci - - ib. utility of this so- ciety ib. qualifications entit- ling candidates to examination by the censors - - 52 consultations with unqualified persons prohibited the fellows 53 vending or using secret medicine prohibited 54,170 officers of Mass. Med. Society - 54 Medical Institution of New-Hamp- shire, school at Dartmouth col- lege 55 Medical Institution of Rhode-Isl- and, connected with Brown U- niversity ... ib. Medical Institution of Connecticut connected with Yale college 56 requirements INDEX. T41 of medical students - 56, 57 profesBors,num- ber of students, and expenses of lectures, ike. - - 58, 59 Medical Institution at Baltimore 59 Medical Societies and schools estab- lished in most of the states of the union - - ib. auspicious effects of these - - - 60 graduates, annual number of in the United States - 59 education, importance of extracts from an eloquent dis- course on - - - 63 Medical Repository,first periodical medical publication in the Uni- ted States ... 60 its high char- acter acknowledged - - 61 Medical and Philosophical Journal ib. Medical andPhilosophieal Register ib. Medical and Surgical Journal of New-Eugland - - ib. Medieal fees, how regulated 161,162 prescriptions - - 684 libraries recommended 160 Menstruation and its irregularities 614 Mephitis influential in producing epidemic diseases - - 178 Mercury in fevers, observations on 284 in high repute as an an- tidote to small-pox - 17 the practice exploded 19 adopted in yellow fever 23,284 in typhus, &c. 24,21*5, in yellow fever in the West-Indies - ib. Mercurial practice, dissertation on 52 Middleton Dr. Peter, notice of 18,34 Miliary fever ... 356 Milk fever - - - 634 blotches - - - 216 diet recommended - 84 properties of - - 88 Milton, town of, vaccinate the inhabitants - - 27 Military surgeons and physicians examined by a medical board by order of Washington in 1775 19 names of - 20 Miller Dr. Edward, notice of 2C, 61, 149,179 his definition of conta- gious diseases - - 175 Mineral waters of Ballston, 8cc. the diseases in which they may be advantageously employed 675 artificial, how pre- pared - - - 704 Miopia - - - 648 Mitchill Dr. John, notice of - 16 Mitchill Dr.Samuel L. notice of 60,179 denies the efficacy of acid fumigation to destroy con- tagion - - . 190 Molasses and Mater, wholesome drink - - - - 16 Morgan Dr. John, notice of 30 Morveau, his method of destroying contagion by means of mineral acids - - - 180 Mumps - - - . 4<»9 Muscles, observation on - 91 Mustard whey ... r^jfi Mutton, qualities of - - 87 N. Nephritis Nervous diseases colic fever Neuralgia 457 519 481 Si >7 46C New-England Journal of Med. and Surgery, notice of - - 61 Nichols John, Esq. donor to the Med. School of Harvard Univer- sity .... 4., Nitric lac ammoniac - - 714 Night mare .... 536 Non-naturals - - - - 67 Nurses, qualifications of - 159—205 Nostrums, absurdity of - - 170—171 Noxious vapours, effects how re- moved ... 663 O. Oats, properties of - - 91 Odontalgia - - 463 Ogden Dr. published Observations * on Malignant Sore Throat - 18 Ointments for the Itch - 724 Ophthalmia - - - 391 Opisthotonos - - 537 Onions, qualities of - - 93 Opium, poisonous effects of - 487 Osmund royal, description and vir- tues of - - - 691 Otitis - - - - 395 Oysters, properties of - - 91 Oxygen a constituent part of the at- mosphere - 68 P. Painful diseases not attended with fever ..... 461 Palpitation of the heart - - 542 Palsy - - - - - - 543 Paracelsus, his eccentric character 8 his elixir of life - - ib. father of quackery » 9 his schemes to procure longevity preposterous - - 148 r i-: INDEX. Paraphlegia 543 Paraphimosis - 497 Parsley ► - - 93 Parsnips, properties of - - ib. Passions, observations on - - 96 Pastry, bad qualities of - - - 91 Patent medicines impudently palm ed upon the public - - - 169 Peaches, properties of ... 94 Pears, properties of - - - 93 Pease, properties of - - - - 92 Pectoral decoction for colds - - 713 Pediluvium - ... 670 Pericarditis .... 426 Peripneumonia notha - - - 341 Dr.Huxham's account of - - - 342 Mr. John Bell's account of - ... 343 Peripneumony, or pneumonia - 423 Perspiration insensible,the most im- portant of all natural evacuations 131 variouscausesby which it may be obstructed 131, 132, 133 Phimosis ... 497 Phlegmasia dolens -' - - 647 Phosphate of iron - - - 707 Phrenitis .... 389 Phthisis pulmonalis ... 431 Physick Dr. Phillip S. notice of- 31 Physician,qualifications and duties of 148 examples for his imitation 149 how to conduct in the chamber of the sick - - 151 a drunken physician an odious character ... 153 rules to be observed in consultations - - 154—156 with whom consultations should be declined - - 167 principles of honour should be observed among physicians 157 high responsibility of - 163 principles of religion in- culcated - ib. opinion of Dr. Gregory on this head .... 164 disinterested sentiments of Dr. Sydenham - - ib. Phytolacca decandra, description and virtues of - . - 693 Piles, description and cure of - 594 Pills, cathartic - - 718 fcetida with opium - ib. Lockyer's - - 719 chalybeated myrrh - - ib. calomel - - 740 compound - ib. Piummer's - - ib. aloetic compound - - ib. saturnine anodyne - - 719 for cough - - - 716 Pimpled face - - 653 Plaster discutteni . 73ti for lumbago - • ib for warts and corns - 731 Plague, contagion of does not eon- tarainate the atmosphere - 182 Pleurisy - - - - 419 Plums are nourishing - . 93 Poisons, various kinds of - - 484 Pork, properties of - . 88 Pothos fcetida, description and vir- tues of 692 Potatoes wholesome food - - 92 Poke weed .description and virtues of 693 Pregnancy and its concomitant dis- eases ... (26 Prescott Dr. Oliver, his disserta- tion on ergot ... 697 Primitive inhabitants, their con- dition .... 4 their expe- dient to obtain medical knowl- edge ' - - - -5 Pringle Sir John, his remarks re- lative to contagious diseases 177 Puerperal fever - - S59 Pulmonary consumption 431 Putrid and malignant fever 215 sore throat - - 400 remedy for 721 Pyrosis .... 473 Q. Quackery, see Empiricism Quacks, their conduct d isplayed 166 how distinguished - 168 Quarantine regulations necessary 188,192 QuinSy - - - 397 R. Radishes, properties of Rattlesnake, bite of Remittent fever - Rheumatism, acute - chronic Rice, a nourishing food Rickets, treatment of Ringworm, treatment of - 93 495 - 298 575 - 577 91 - 250 - 653 Rubus villosus and procumbens 704 Ruptures, treatment of - 657 Rush Dr. Benjamin, notice of 30, 31. 60. 179.234 bit enquiry into the effects of ardent spirits - - 104 death of - - - 33 S. Sago - - - - Sal aeratus, preparation of Salids, properties of 7*7 710 !**■ INDEX. (4:j Saliva.....133 Savin ointment .... 729 Scalds and Burns, treatment of 6.54 Scald-head ... 256 Scarlatina anginosa, or maligna 400 Scarlet fever - . 366 School medical, see medical school Scirrhus and cancer - - ?14 Scrofula ... 261 Scull cap, description and virtues of - - - - 694 Scurvy - - - 563 Scutellaria lateriflora - - 694 Secale cornutura - - 696 Seltzer water, preparation of 706 Semicupium ... 670 Servetus Michael, discovered the lesser circulation in 1553 - 9 burnt for heresy ib. Shippen Dr. William, first ana- tomical lecturer in America 30 Shortsightedness - 648 Shower bath, see bath Skunk cabbage, description and virtues of - - - 692 Sleep, observations on - - 99 Small-pox inoculation first intro- duced in Boston in 1720 - 14 controversy relative to this subject - - 15 patronized by Dr. Cot- ton Mather*, - - - ib. Dr. Z. Bolyston makes his son the first subject of ex- periment - - ib. hospitals first established in the vicinity of Boston iu 1764 17 established atCambridge and Brookline in 1775, and 1776 18 visited Boston in 1752 17 and 1776 8c 1792, which occa- sioned a general inoculation - 19 proportion of deaths 17. 19 its inoculation - 368 Smyth Dr. Carmichael, destroys contagion by acid fumigation 189 Smoked hams, properties of - 88 Soda water - - 706 Solution arsenical,Fowler's,how pre- pared - - - 711 of tartar emetic - 717 alkaline - - 724 Sophora tinctora, description and virtues of 700 Spermaceti mixture - 704 Spinage, properties of - - 92 Spleen, inflammation of - 457 Spotted fevrr, notice of - 28 account of and mode of treatment - - 331 method of treatment by Dr. Page - - 348 Spurred rye or ergot, historv and virtues of 696 Steam batli - . 676 Stearns Dr. John, first discovered the use of ergot - . 697 Stings of bees and hornets . 495 Stomach, inflammation of - 447 Stone in the bladder . . 603 Strabismus or squinting - 647 Strawberries, properties of - 94 St. Anthony's fire - . 385 St. Vitus' dance - . 52fi Strangury ... 504 Styptic tincture - . 721 Sugar maple, affords a wholesome drink - - . - 115 Sydenham Dr., notice of - 149 his disinterested sentiments ... 164 Syphilis, characteristics of - 506 Syphilitic virus, how communicat- ed - - . .505 Surgeons and mates of American army examined by a medical board by order of Waskinotoh in 1775 ig T. Tape-worm, remedy for - 255 Tar-water, how prepared - 723 Tea, observations on - 94 use of, counteracts a desire for ardent spirits - - 119 Teething ... 228 Temperance, important virtue in a physician - - - 153 Tennant Dr., notice of - 16. 34 Tetanus, (Trismus) - - 537 Tetters, treatment of - 652 Thacher Thomas, author of a guide in small-pox and measles in 1677 14 Theories medical, revolutions of 12 Theoretical s) stems adopted in our seminaries - - - 62 Thermometer, moral and physical one - - - 106 Thomas Dr., his opinion respecting the cause of yellow fever 181 Thompson Dr. notice of - 17 Thorn apple, properties of - 687 Thoroughwort, description and virtues of - - 689 Tic doloureux, description, treat- ment of ... 466 Tinea capitis - - 256 Tincture of blood-root - - 712 styptic - - 721 Toast and water, a useful drink 727 Tobacco, injurious effects of 146 Tongue tied ... 225 palsy of -.- 545 Tooth-ach - - 46f> Trotter Dr4,. his opinion of t\*p ii«<' 744 INDEX. ofwiue .... 86 denies the efficacy of acid fumigation ib. Trumpet weed, virtues of 690 Truss, how to be applied 660 Tumours of the scalp in infants 225 Turkeys, properties of 90 Turnips, qualities of - 93 Tussis epidemica - 24 Tympany ... 561 Typhoid pneumonia noticed, 29 description and treatment of ... 341 mode of treat- ment by Dr. Jennings - 682 Typhus fever, remarks on 176 varieties of 268 mitior 307 gravior - 315 icterodes 324 u. Ulcers venereal, how distinguished 507 Universal remedy, absurdity of 171 Underwood Dr., notice of 210. 262 Uriue, suppression of - 600 incontinence of - 599 discharge of, how promoted 130 Uva ursi, description and virtues of 686 Vaccination, first information of announced in the United States in 1799 - - - 25 its prophylactic effi- cacy fully established - 27,28 Vaccine inoculation - - 381 Valetudinarians cautioned against the use of foul air - - 69 cautioned against the use of ardent spirits - - 117 Veal, properties of 87 Vegetable acids, salutary and useful ib. caustic ... 712 Venereal disease - - 496 Venison, qualities of - 58 Vesalius, Professor at Padua 9 anecdote of 143 Viper, bite of - - - 495 Virulent gonorrhaea - 496 Virus syphilitic, how communicat- ed 505 Vomiting in children - 226 W. Warren Dr. John, notice of - 149 commenced the first course of anatomical lec- tures, and was first professor in New-England - - 41 his definition ol contagion and infection - - 177' his dissertation on mercurial practice referred to - - 23. 24. 285. 287 Wash for Gutta Rosea, or pimpled face ... 7'j, Water cold, danger of drinking when hot - - - 13,i may be allowed in fevers - - . 277,278 affusion of in fevers 272 Water, how to correct when pu- trid - - - - 85 Waterhouse Dr. Benjamin, vaccin- ates his son as the first subject in the United States - - 25 vaccinates the in- habitants of New-Bedford - 27 Waterhouse Henry S. on ergot 699 Weaning children - - 209 Weights and measures used in medicine ... 883 Wild indigo, deseription and vir- tues of - - - - 700 Williams Dr. Nathaniel, notice of 16 Willich Dr., his remarks on nos- trums panaceas and specifics 171,172 Wilson Dr., his definition of conta- gion and infection - - 175 Wind purifies the atmosphere, &c. 69 easterly, bad effects of - ib. in the stomach and bowels 535 Wine, observations on the use of, 86 a good substitute for ardent spirits - - - - 114 Wine whey, how prepared - 726 Worms - - - - 251 Y. Yeast for medical purposes - 717 use of in putrid fever - 322 use of in putrid sore throat 406 Yellow fever, different periods of its appearance in our country 20 its visitation in the city of Philadelphia in 1793, number of victims - - 21 its appearance in the town of Boston in 1798 and 1802 ib. controversy relative to its origin and contagious char- acter - - - 22 depleting remedies in, adopted by Dr. Rush - 23 causesof - 179. 181 is a contagious dis- ease according to the Royal College of Physicians of London 19'- THE END, ^ ' 1 >o& 1* f^e-a . ' -! lit. V\JZ 1.1 ■:: 13 I', c-l. .' &