Ti;ft?tw':'i';'i,*;Y-t,*'»':':«:-'V-;'^.'fr*'.;.:'...... ; - 5a^i£Kt*vi!.:-. _•£;*•:.-:••'?■• :d-r;"' " £*'^d:d7:?d^—•..••- 1 •»'ji?it-i»^i'*-i;»:rir:',..-.w» >.v"'."~,\:.x;..: , i^iftliuTJi........*i .!•-..!»...■'-....!. ,„. &*&W'W;''7..V •:-..r.^-.:.:-•-..:'V\ K&Xit'nt:'t7--'-t» r;;^rsttr*-'• • v • - '3bwteia ^n^u:.*aTP!cjIlf^'Lir^T'' '-*:' """" "-"" '\%\'7 ' ' ffiffi^t^M**-J*VC^'^i*V*"^''"'"'''',^'"'':'*'^'^*^'-*' '■'"*-■ *^L**J^tJrrT*frr^*tM"*****•*'»*'*^* *'*-.*»*...'.•.'.",'77-■-' .' .".."'..'^Tt **» i* ^••Lyrl^ddd-v:-;;.-:: :.: J;-"/'**1^*^'*'■•'■' «■*«■*-*-«.♦,». ;». ■ ■• .r. UNITED STATES OF AMERICA WASHINGTON, D. C. GPO 16—67244-1 5339573�0249 DUE LAST DATE APR I 2 1962 V ^ x.z^^c.^r7y774 '••■•■ THE PRACTICE OF MEDICINE ON THOMSONIAN PRINCIPLES, ADAPTED AS WELL TO THE USE OF FAMILIES AS TO THAT OF THE PRACTITIONER. ■ CONTAINING PROPOSITIONS ILLUSTRATIVE OF THE PHILOSOPHY OF THOMSONISM. A BRIEF HISTORY OF THE SYMPTOMS, PECULIARITIES, AND GENERAL COURSE OF DISEASE IN ITS DIFFERENT FORMS AND VARIETIES ; WITH PRACTICAL DIRECTIONS FOR ADMINISTERING A THOMSONIAN COURSE OF MEDICINE, INCLUDING THE VARIOUS METHODS OF ADMINISTERING VAPOUR BATHS AND EfllETICS. AND % JHatetria JIKettfc*, ADAPTED TO THE WORK. BY J. W.J^OMFORT, M. D. PH HADE LP H i a: ...y u PUBLISHED BY A. COMFORT, 295 MARKET ST. • COATES, FB1NTZB. 1843. WI3 1843 xxx>:xxxxxxxxx>oooo< Entered according to the Act of Congress, in the year 1843» by J. W. Comfort, M. D., in the Clerk's Office of the Eastern District of Pennsylvania. X>C<>C<>OQO<>0^ TO DR. SAMUEL THOMSON, THE PHILOSOPHER IN MEDICINE, AND IPOTOJMH1B OF THE THOMSONIAN SYSTEM OF MEDICAL PRACTICE, THIS WORK IS WITH DUE RESPECT INSCRIBED BY THE AUTHOR. TO THE READER. Tins work is presented to the public as a Practical Guide in the treatment of di.sease, in accordance with the principles of medical science discovered and promulgated to the world by Samuel Thomson. The author does not claim to have made improvements upon the fundamental principles of the Thomsonian system of practice. Daily observation affords confirmatory evidence that this system is based upon correct principles; and that the remedial means therein employed are adapted to the cure of every variety of disease that is curable by means of medical treatment. What 1 have aimed at in the following pages, besides a description of the symptoms and peculiarities of the principal varieties of disease as detailed by medical authors, has been to point out that treatment best adapted to the different forms and stages of disease under various conditions of the system. Notwithstand- ing disease should be treated upon general principles, regardless of names, still there are varieties of it that demand more prompt and energetic treatment, than others in which the patient is apparently in a more dangerous condition. Thus in croup, for instance, an hours delay in applying the proper remedies may allow the disease to pass to an incurable stage. In the directions for treatment, repetitions have been intro- duced which to some may appear superfluous. This course, however, was deemed necessary in a family work. The Thomsonian system based upon correct principles, needs not the garb of mystery, often employed to conceal imperfection and to give to false knowledge the appearance of science. It is here before the community stripped of all disguise. The cause of the continuance of, disease being resisted and overcome by vi- tal action, medical treatment to prove beneficial must harmo- nize with the principle of life. This is the corner stone prin- ciple of Thomsonism, the starting point and guiding line for directing the treatment in every variety of disease, in all its stages. Although I have recommended some articles of medicine not 3 * TI TO THE READER. employed in the Thomsonian practice generally, still I am ntd an advocate for enlarging the list of remedial agents beyond what is necessary to fulfil important indications for the cure of disease. Indeed the more the practice is simplified and re- stricted to the employment of general remedies the more success- ful will it prove. The medicines introduced to the notice of the reader not recommended by Samuel Thomson, have been found beneficial for the purposes to which they are applied, and others contained in his materia medica of a less useful character have been excluded. Thomson's medical discoveries have as yet been illy appreci- ated by the majority of the people. The practice of medicine is vieA\ed as a science requiring great depth of learning to compre- hend, and a knowledge of the anatomy of the humansystem has been thought necessary in order to know how to apply names to disease and to prescribe the proper remedies. A knowledge of anatomy though useful to the practitioner and indispensable to the siirgeon, does not teach us the nature of the principle of life, nor afford the means of ascertaining the cause of disease, nor how to apply the proper remedies. The human body is composed of a congeries of organs, each of which performs a specific func- tion, yet all these varied actions are sustained by the same mo- tive power or principle of life: and thus a pure stimulant, cay- enne pepper, for instance, that will support vital action in one form of disease, will have the same tendency in every other case. Finally, as a general rule, a medicine will have the same ten- dency in disease that it has upon the constitution when in health. It is by this touch stone that all remedial agents should be tried- CONTENTS. Prepositions or Premises which form the basis or first principles of the science of medicine i Health 7 Disease " ib. Of the general causes of disease ib. Reaction and fever 9 PRACTICE OF MEDICINE. CHAPTER I. Sect. I. Intermitting fever—Ague and fever 17 II. Remitting, or bilious fever 23 III. Typhus, congestive, and yellow fever CHAPTER II. Eruptive Diseases. 31 Sect. I. Small Pox 41 II. Vaccination—cow pox—kine pox 49 III. Varioloid—modified small pox 53 IV. Varicella—chicken pox—swine pox 55 V. Measles 56 VI. Scarlet fever 59 VII. Nettle-rash—Hives 66 VIII. Erysipelas—St. Anthony's fire-—Rose 67 IX. Shingles 70 X. Scald Head 72 XI. Tetter 73 XII. Itch 76 XIII. Ring worm 77 XIV. Chafing in children 78 XV. Prickly heat CHAPTER III. Disease affecting the Chest and Lungs. ib. Sect. I. Bronchitis 79 II. Pulmonary consumption 85 III. Asthma, or phthisic 92 J V. Summer catarrh, or cold—Hay fever 96 viii CONTENTS. V. Whooping cough W VI. Pleurisy 99 VII. Catarrh—common colds 1°2 CHAPTER IV. Diseases affecting the Mouth and Throat. Sect. I. Croup—Hives 1°5 II. Quinsy 109 III. Mumps nl IV. Common sore throat 112 V. Aphthous sore mouth—infant's sore mouth 113 VI. Elongated uvula—falling of the palate 114 CHAPTER V. Diseases affecting the Stomach and Bowels. Sect. I. Colic 115 II. Cholera Morbus 117 III. Cholera infantum—cholera of infants 119 IV. Bilious colic 126 V. Colica pictonum—painters' colic 128 VI. Dysentery 131 VII. Diarrhoea—Relax 135 VIII. Peritonitis {Inflammation of the Peritoneum) 137 IX. Constipation 140 IX. Dyspepsia—indigestion 143 XI. Worms in the stomach and bowels 151 XII. Piles 155 CHAPTER IV. Sect. I. Rheumatism 160 II. Lumbago—rheumatism in the loins 169 III. Gout 77). CHAPTER V. Sect. I. Inflammation of the kidneys 174 II. Inflammafion of the bladder 178 III. Diabetes—excessive flow of urine 182 IV. Retention of urine 184 V. Stranguai'y (Difficulty and pain in voiding urine) 18$ VI Incontinenceof urine (Involuntary flow of urine) 190 VII. Suppression of urine {The kidneys ceasing to form urine) 192 contents. ix CHAPTER VI. Disease of the Liver. Sect. I. Acute inflammation of the liver 194 Chronic disease of the liver 196 II. Jaundice 200 CHAPTER VII. Sect. I. Apoplexy 203 II. Paralysis—palsy 207 III. Epilepsy (Convulsionfits—falling sickness) 214 IV. Infantile convulsions * 218 V. Chlorosis—green sickness 220 VI. Hysteria—hysteric fits 224 VII. Fainting 229 VIII. Hypochondriasis {Dejeciiou of mind—low spirits) 230 IX. St. Vitus' dance 235 X. Tetanus—locked jaw 240 XI. Hydrophobia {Bite of a mad dog, or other rabid animal) 244 XII. Neuralgia—Tic douloureux 248 CHAPTER VIII. Sect. I. Dropsy 252 CHAPTER IX. Sect. I. Scrofula 262 II. Goitre 267 CHAPTER X. Sect. I. Suspension of animation from drowning 270 II. Suspension of animation from carbonic acid gas 271 III. Suspended animation from lightning 273 CHAPTER XI. Various forms of disease of the Eyes. Sect. I. Inflammation of the eyes from taking cold 2,74 II. Rheumatic inflammation of the eyes 276 III. Suppurative inflammation of the eyes 277 IV. Scrofulous sore eyes 280 X contents. V. Blindness {Total or partial) 284 VI. Stye 285 VII. Fistula lachrymalis {Obstruction in the duct which conveys the tears from the eye into the nostril) 286 CHAPTER XII. Sect. I. Insanity—mental derangement 288 1 Mania—general insanity 290 2 Partial insanity 291 II. Delirium tremens—mania a potu {Craziness from drinking) 295 CHAPTER XIII. Sect. I. Head-ache 301 II. Sick head-ache ib. III. Tooth-ache 305 IV. Ear-ache 307 V. Running of the ears 308 VI. Deafness S10 CHAPTER XIV. Sect. I. Palpitation of the heart 311 II. Organic, or structural disease of the heart 31S CHAPTER XV. Sect. I. Bleeding from the lungs 317 II. Epistaxis {Bleeding from the nose) 320 III. Bleeding from wounds 322 CHAPTER XVI. Sect. I. Cancer* 325 CHAPTER XVI. Sect. I. Inflammation 330 II. Sprains 340 III. Bruises 342 IV. Severe bruises where the system receives a shock ib. V. Wounds of the scalp 346 VI. Wounds produced by sharp instruments 350 VII. Lacerated wounds 352 VIII. Bruised wounds 353 CONTENTd xi IX. Punctured wounds 353 X. Wounds of joints 355 Burns and scalds 356 XI. Chilblains 360 XII. Treatment of frozen limbs 361 XIII. Biles 363 XIV. Carbuncle 364 XV. Abscess of the female breast 365 XVI. Whitlow or felon 366 XVII. Hip disease 368 XVIII. White swelling 372 XIX. Ulcers 374 XX. Simple or healthy ulcer 375 XXI. Unhealthy ulcer ib. CHAPTER XVII. Venereal Disease. Sect. I. Gonorrhoea 380 Syphylitic sore, or chancre 384 Bubo—swelling in the groin 387 Secondary symptoms of syphilis 388 CHAPTER XVIII. Sect. I. Obstructed Menstruation 390 II. Treatment of fluor albus, or whites 392 CHAPTER XIX. Miscellaneous. Bee-stings 393 Nervousness—weak nerves 394 Polypus of the nose 395 Cramp in the legs and feet 396 Prolapsus ani—protrusion of the bowel ib. Hernia, or rupture 397 Strangulated hernia 398 COURSE OF MEDICINE. General directions for administering a course of medicine 402 Of the removal of morbid secretions, or false membrane from the coats of the stomach and bowels 411 Blood-letting ■ 412 Steam or vapour bath 415 xu CONTENTS. Hot-air bath 422 Partial steaming • ib. Of the utility of emetics in the cure of disease in general 423 Of the use of cathartics, or purgative medicines 431 Injections or enemas 436 Thomsonian Materia Mcdica 443 Lobelia Inflata 443 Preparations of lobelia 446 Third preparation of lobelia 448 Compound lobelia pills 449 STIMULANTS Which raise and sustain vital action, and assist the efforts of na- ture to remove disease. Capsicum—Cayenne pepper 450 Thomson's composition powder 454 Ginger 455 ASTRINGENTS AND DETERGENTS. Thomson's No. 3, or Medicine for Canker. Bay berry {Myrica C infer a) 457 Upland sumac {Rhus Glabrum) 458 White pond lily (Nymphia Odorata) 459 Wild red raspberry {Rubus Strigosis) ib. Witch hazle (Hamamelis Virginiana) ib. Evan root {Guem Rivctle) 460 Marsh rosemary (Statia Limonium) ib. Dew berry (Rubus Procumbens) ib. Crow-foot—Cranes Bill (Geranium Maculatum) 461 Beach-drop {Orbanche Virginiana) ib. TONICS-BITTERS. To strengthen the system and promote digestion. Peruvian bark (Cinchona qfficinulL) 4f 2 Quinine 4g3 White aspen and black aspen poplar (Populus Tremuloids, and Populus Grandidentata) 454 Balmony (Chelone Glabra) jb. Barberry (Berberis Vulgaris) ib. Golden seal (Hydrastis Canadensis) 465 Virginia snake root (Serpcntaria Virginiana) ib. CONTENTS* xiii Centuary (Chironia Angularis) 465 Red dog-wood—Red willow (Cornus Cericea) 466 Wild cherry (Prunus Virginiana) ib. Quassia ib. Tulip poplar (Liriodendron Tulipifera) 467 Columba ib. Thoroughwort—Bonesett (Eupatorium Perforatum) ib. Chamomile (Jlnthemis Nobilis) ib. Myrrh ib. Thomson's No. 6, or rheumatic drops 469 No. 5 syrup, or restorative cordial 470 Unicorn (Helonias Dioicia) 471 Bitter almonds, peach-meats and cherry stones ib. Spice bitters 472 Ladies spice bitters ib. Conserve of hollyhock ib. NERVINES. To quiet restlessness, calm nervous agitation, and promote sleep. American valerian (Cypripedium Humile, pubesccns, parviflorum, condi dum and spectabile) 473 Scull-cap (Scutellaria Lateriflora) ib. Hops 174 Carbonate of Ammonia 47 7 Camphor Oil of turpentine Oil of amber ib. 478 479 Oil of horsemint ib. Oil of peppermint Oil of anise seed 480 ib. Oil of caraway ib VEGETABLE BALSAMS, Balsam copaiva Balsam tolu 480 481 Balsam fir 10. Scabious (Erigeron Philadelphicnm and E. Canadense) 482 Pipsissewa (Pyrola Umbellata) >b XIV CONTENTS. Cleavers 428 Burdock ib. Prickly ash (Zanthoxylum Fraxineum) 483 Sarsaparilla ib. Guiacu-m wood 484 Worm wood 485 Tansy ib. Slippery elm (Ulmas Fulva) ib. ACIDS. Vinegar 486 Lemon juice ib. Elixir of vitriol 487 ALKALIES—ANTI-ACIDS. Super carbonate of soda 487 Bi-carbonate of soda ib. Salseratus ib. Hickory ashes 488 Charcoal ib. Lime water 489 Prepared chalk 490 Stimulating liniment 490 No. 3 pills 491 Of cough mixtures ib. Cough powder 492 VOLATILE LOTIONS AND LINIMENTS. Granville's lotion 492 Ammonia liniment 493 Soap liniment ib. Camphor liniment ib. Simple cerate 493 Basilicon ointment 2^ Thomson's salve ^ Astringent ointment 494 Pitch plaster ^ Thomson's strengthening plaster #' CONTENTS. XV Mustard plaster 494 Cayenne poultice 495 Emolient and slightly stimulating poultices 495 Mallow's poultice ib. Catnip poultice ib. Charcoal poultice ib. Yeast poultice 496 Myrrh poultice ib. Gum Arabic ib. Arrow root 497 Barley water ib. Milk porridge ib Oat meal gruel 498 Essence of beef, or beef tea ib. Chicken tea ib. Crust coffee ib. Panada ib. Mutton broth 409 Wine whey to. Egg tea ib. Drying roots and herbs ib. Brief remarks in relation to cleanliness, diet, &c. 500 POISONS. Means for counteracting the effects of concentrated acids 402 Means for counteracting the effects of concentrated alkalies ib. Corrosive sublimate 502 Arsenic 503 Antimony 504 Lunar caustic 505 Nitre—Saltpetre ib. Swamp sumac and poison vine ib. Opium 506 Belladonna (Deadly Nightshade) ib. Strychnia 507 Datura Strammonium (Gympson or Jamestown Weed) ib. PROPOSITIONS OR PREMISES, WHICH FORM THE BASIS OR FIRST PRINCIPLES OF THE SCIENCE OF MEDICINE, AND ILLUSTRATIVE ALSO OF THE PHILOSOPHY OF THE THOMSONIAN PRACTICE. I. Matter, in all its diversity of character, quality, form and combination, may be classed in two great divisions, namely: Organic and Inorganic matter. II. Organic Matter includes the two vast kingdoms of Na- ture; the Animal and the Vegetable kingdoms. III. Inorganic Matter includes all bodies not possessed of life, or such as are not endowed with a capacity for life. IV. Inorganic, brute or dead matter, is controlled or go- verned by laws or forces, embracing chemistry and natural phi* losophy. V. Organized or living bodies, though influenced to a cer- tain extent by the laws which govern inorganic matter, are sustained in their living state by vital laws, " which hold supre- N macy over and control those of physics and chemistry, which they modify and render subservient on many occasions to the purposes of vitality." VI. The principle of life is the same in all animated be- ings; and the human animal economy is governed by the same general laws. VII. Life, or the living state, is a series of actions or mo- tions in animal matter, of which organized bodies are alone susceptible. VIII. Without organization there cannot be life. And again, \ organized bodies, tliough possessed of a "capacity for life," require the aid of stimulants to call it into activity. IX. "Animal life can be supported only by external stimu- lants." X. Life is produced by the influence of heat or caloric upon organized bodies. 2 XI. Heat, or caloric, is the power or agent by which other stimulants, as atmospheric air, light, electricity, galvanism, food, drink, and medidne, are made to act upon the system. XII. Caloric brings into play that power (assumed to be an electro-galvanic influence) which is the immediate agent of those varied and complicated actions which forms and fashions the organs; conveys to and appropriates nourishment to every organ and tissue; ''sustains animal matter in a state of composition;" selects and expels effete or worn out matter by the pores of the skin, the kidneys, and other depuratory organs; car- ries on all the various secretions; endows the organs with sensa- tion; and enables them to react against, or resist the influences that tend to their destruction." The two preceding propositions form the corner stone or basis of the science of medicine. XIII. In the early period of animal life, until the organs become developed, heat is derived from the mother. As the organs become developed they are endowed with the power of producing or generating heat, and after birth the supply of ani- mal heat is dependent upon this function of calorification, or heat generating power. Thus vital action, first produced by heat, creates the power, or generates the influence necessary to the continuance of its actions. Heat is evolved in every part of the system, and the amount of caloric generated will be in pro- portion as vital action is greater. XIV. As the heat of the system is lessened, in proportion will vital action diminish. "If the system be deprived of calo- ric for a certain length of time, all the preservative, recupera- tive, and sanative phenomena cease. It is the same also as re- spects oxygen." XV. The stomach is the seat or " throneof the vital powers;" the main centre or source from which is radiated the nervous power, which, by the aid of heat and oxygen, carries on and governs the important vital functions of circulation, respiration, digestion, nutrition, assimilation, and the various secretions. XVI. The stomach is in almost every instance the seat of disease. When this organ is disordered the power of gene- rating heat and nervous influence is diminished, and consequent- ly the actions and functions of other organs become weakened or deranged. In fever, although the heat of the surface is in- creased above the natural standard, yet the amount generated may be less than is produced in a state of health. The secre- tions and transpirations from the skin and mucous surface being suspended, the heat is locked up in the system, and this, it would seem, is a wise provision for retaining the heat, in order to sus- tain the recuperative actions, and thus effect a crisis in disease. 3 Kxperiments have shown that in the most inflammatory disease, the blood contains less positive electricity than it does when taken from one in health. As the functions of the stomach and bowels are restored to a healthy condition a natural warmth and action becomes established throughout the system. XVII. The same means that will restore the natural tem- perature of the system, as pure stimulants and the^vapour bath, will also increase the electro-galvanic or nervous power, which governs the circulation and all the vital functions. XVIII. As the natural warmth of the system is reduced, either from a disordered stomach or from any other cause, the nervous power which maintains an equilibrium in the circu- lation is enfeebled; hence in disease a loss of the natural balance or equilibrium in the circulation of the blood is a common occur- rence. XIX. An undue accumulation of blood in a part is attended by a deficiency of it in other parts. Thus in fever there is an Unnatural quantity of blood in the surface and a corresponding deficiency inwardly; determinations of blood to the head are accompanied with a loss of blood ip the feet. XX. The same means that will correct a disordered stomach and "raise the heat" of the system to its natural standard, will tend to restore the natural balance of the circulation of the blood. XXI. As the natural heat and nervous power is reduced, either from cold, disordered stomach, or from any other cause, the functions of digestion, nutrition and assimilation become enfeebled or disordered. The same cause also deranges the secreting organs, as the liver and glands of the' mucous mem- branes. In many instances in disease the liver ceases to secrete bile; and the excessive thirst accompanying fever arises from diminished or suspended secretions of the glands of the mucous membranes. XXII. Whatever will cleanse the stomach, restore the na- tural heat and produce perspiration, will also tend to restore digestion, assimilation, the secretions, and in fine remove every derangement which occurs in the system. XXIII. The lower order of animals, as the hybernating species, will bear the abstraction of heat from their bodies without producing disorganization; they sink into a state of torr por and insensibility during winter, and on the return of warm weather are reawakened into life and activity. XXIV. In the higher order of animals and in man, the abstraction of heat cannot be borne below a certain degree, but for a limited period, without producing disorganization and death. Hence they are endowed with a'power to react against cold and other deleterious agents; and by thus establishing k\ 4 counteracting force or influence, life and organization is pre- served against causes tending to their destruction. Many of the symptoms which occur in disease, as pain and fever, are \ caused by the recuperative, life-sustaining actions, the organs being driven, as it were, to a new mode of action, with the design of counteracting the influence of offending causes, and regaining their lost vitality. XXV. Fever does not constitute a disease, but is always an evidence of the existence of an offending cause in the system, and which nature is struggling to remove. XXVI. Living beings are ever surrounded by agents orv powers which exert an influence in direct antagonism to the laws of life, tending to subvert or destroy vital action. Thus the living state is held, as it were, in a balance between oppos- ing powers. XXVII. The direct effect of cold and other morbific agents upon the system, is to weaken vital action, and to lessen the power of generating heat: hence disease of every form and variety commences with symptoms which show that the vital powers are weakened; these are lassitude, general debility, cold- ness of the surface and extremities, and chilliness. Cold and damp feet exert an influence in weakening and deranging the natural and healthy order of action in the system, and thus prove a fruitful source of disease. Dampness probably operates as a conducting medium by which the caloric, but more especially the electro-galvanic fluid escapes, not only from the lower extremi- ties, but also from the stomach and all the viscera of the abdo- men, by means of the nerves, which form a connecting chain of conductors or channels throughout the system, for the passage or circulation of this nervous fluid. As the nervous influence escapes from the system, the functions, over which it has control, become enfeebled and deranged. XXVIII. The first symptoms in disease prove a weakened condition of vital action. As the constitution reacts, a new train of symptoms ensues. The pulse becomes quicker and stronger; the surface becomes hot and dry, and the system is in a state of feverish excitement, or in other words, the patient has a fever. The constitution struggling against disease occasions the fever, and it is by this power of reaction that disease is over- come. Intermitting fever, as it is termed, commences with a chill. As the system reacts, fever comes on; and the recuperative efforts which occasion the fever, restore the heat, bring on perspiration and frequently other critical evacuations, more especially from the kidneys, by which the disease is partly or wholly removed, until the return of the succeeding chill, when the constitution in- stitutes the same preservative, recuperative train of action. In s eruptive diseases, as small-pox, measles, and scarlet fever, there are always in the commencement general debility, chilliness, and a disordered stomach. These are the direct effects of the mor- bific agent that produces the disease, and but for a counteracting influence, vital actions would be overcome. The constitution establishes a reaction or fever, by which the disease is thrown to the surface, producing an eruption on the skin. XXIX. The design of reaction or fever is to restore the lost heat and vitality, and remove all morbific or deleterious agents and their effects from the system, and thus preserve it from disease. XXX. A course of treatment that will cleanse the stomach and bowels and restore their natural action, and remove ob- structions from the system, will also remove fevers, by assist- ing to bring about what the fever is endeavouring to accomplish. When the offending cause is removed there will be nothing to excite fever or reaction. There is another and very opposite plan for subduing fever, to wit: By reducing the vital forces or the recuperative efforts of nature, by bleeding, purging, and the use of poisonous agents, as nitre and antimony. This, though the fashionable practice, is nevertheless unnatural, unsuccessful, and hazardous to the future health, if not to the life of the patients on whom it is practised. XXXI. An important indication in the treatment of all acute diseases, attended with high arterial excitement or violent fever, is to overcome the contracted or spasmodic condition of the ca- pillary vessels by relaxing the system with lobelia. XXXII. To effect a relaxation of the system there is proba- bly no agent of equal value with the lobelia inflata. This me- dicine exerts a surprising influence in equalizing the nervous power, and in relaxing the system, without weakening the vital properties. In many instances, however, fever may be removed by the same means alone that will overcome a chill, to wit: pure stimulants and the vapour bath. Medical men of the old school, have not made a proper distinction between pure sti- mulants that strengthen and promote a healthy action, and those m agents which occasion morbid excitement at the expense of the vital powers. Brandy and all alcoholic preparations aggravate fever, and hence it is inferred that all stimulants are improper in such cases. A patient, in a fever that would be injured by brandy, would in the same condition be benefitted by drinking freely of capsicum tea. It is as contrary to the theories of the regular practice, to use capsicum in scarlet fever as in any other form of fever, it being a disease of a highly inflammatory charac- ter, and yet a majority probably of the profession, make use of this article in scarlatina, and many of them depend exclusively upon it. 6 XXXIII. As a consequence of a reduction and derangement of vital action, there are in disease thickened, morbid secretions, by Dr. Thomson termed "canker," formed on the lining mem- brane of the stomach and bowels, and which in acute disease, as in dysentery, pleurisy, the various forms of eruptive disease and all other febrile affections, tend more or less to putrefaction, and thus prove deleterious to the constitution. The stomach be- coming coated with thickened tenacious secretion or " canker," is probably a general cause of a disease being protracted. It is an observation of Samuel Thomson, that " where there is a set- tled fever there is canker seated in the stomach." The tongue is more or less coated with " canker" or morbid secretions in diseases, and its appearance affords a criterion by which to judge of the condition of the stomach. A tendency in this "canker" to soften and clean off from the edges of the tongue, is usually one of the first signs indicating a favourable crisis in a disease. XXXIV. To remove the "canker," (I make use of this term because it is the one generally employed and understood by Thom- sonians) is of the first importance in the cure of disease. This requires in the first place the use of such means as will excite the secretions, and "restore the inward heat," by which, as Dr. Thomson expresses it, the "canker is ripened," and as these morbid secretions soften they may be removed by the use of Thomson's "No. 3," or "medicines for canker." The tannin and gallic acid contained in these vegetable preparations, have a strong affinity for the "canker," and by combining with it over- come its tendency to putrefaction, and they also detach it from the coats of the stomach, and thus remove obstructions to the secre- tions, and enable nourishment to be taken up by the chyliferous vessels. XXXV. In violent local determination of blood to a part or, organ, as in croup, inflammation of the brain, violent pleurisy, inflammation of the kidneys, apoplexy, &c. one of the most im- portant indications in the treatment is to overcome this undue determination to the diseased part by relaxing the system with lobelia, either by the stomach or administered by injection. The same course of treatment is applicable in profuse hemorrhage, as in bleeding from the lungs, nose, or uterine organs. XXXVI. Finally Dr. Thomson's "course of medicine" ful- fills all the important indications for the cure of disease in gene- ral; and, if judiciously applied, will effect a cure in all cases that are curable by means of medicine. 7 HEALTH. Perfect health may be defined to be that condition in which the principle of life, or vital power, holds supreme and undisturbed control over all the various actions in the body. DISEASE. Disease consists in a loss of vital power, or a weakened con- dition of the principle of life. Symptoms do not constitute disease. They are the immediate consequences of diminished vital power, or they may arise from the restoring efforts of the constitution. Thus the first symp- toms in disease, as languor and debility, coldness of the surface and chilliness, are the immediate effects of a loss of vital power, whereas when reaction takes place, many of the accompanying symptoms, as fever, pain, inflammation, vomiting, diarrhoea, and convulsions, are the consequences of the recuperative efforts of the constitution. Of the General Causes of Disease. Disease is produced by agents or powers which exert an in- fluence upon the system, not congenial to the vital prindple, or which are not in relation with, or adapted to, the laws of life. Exposure to cold and dampness; sudden vicissitudes of tem- perature; more especially when the system is in an exhausted condition; changes in the electric condition of the atmosphere; poisonous effluvia generated by the decomposition of vegetable matter; unwholesome food taken into the stomach; excesses in eating or drinking and in the indulgence of the sexual passions; and specific poisonous agents, such as produce small-pox, mea- sles and scarlet fever, are the general sources of disease. Cold and dampness are the most fruitful sources of disease. Their direct effect upon the system is to wreaken the vital power, and consequently diminish and subvert the healthy order of ac- tion in the system, and whatever organ or part of the body is weakest proportionably to its natural degree of vitality, that will be the part most likely to become diseased. Hence of any num- ber of persons exposed to cold and dampness, each may have a different form of disease. Thus one may have a pleurisy, ano- ther rheumatism, a third a simple catarrh, a fourth bronchitis, a fifth quinsy, a sixth neuralgia, a seventh sick head-ache, whilst another may be taken with bilious fever, and another with erysi- 8 pelas. In this way almost every variety of disease may be brought on by the same cause. Exposure to sudden changes of temperature, more especially from heat to cold when the system is exhausted from exercise, or the vital forces otherwise enfeebled may give rise also to a va- riety of forms of disease. A negatively electrified condition of the atmosphere has un- doubtedly an influence in lessening vital action, by abstracting a portion of the electricity from the system. It has been ascer- tained that a cloud highly charged with positive electricity, is surrounded by an atmosphere negatively electrified.* Hence one who is subject to rheumatic affections, will have his pains in- creased on the approach of clouds, by the negatively electrified state of the air, but when the clouds are over his head, the pains subside by the atmosphere surrounding him being changed from a negative to a positively electrified condition. There are per- sons of peculiar temperament subject to certain forms of disease, as asthma and catarrh, during mid-summer only, occasioned pro- bably by a condition,of the atmosphere which has the effect to lessen the amount of electricity in the body, or to derange its currents and thus pervert the healthy order of action in the sys- tem. That whilst it produces asthma in one it will occasion catarrh in another, dyspepsia in another, and in another rheu- matism. Many of the complaints peculiar to hot weather, as diarrhoea, dysentery and fevers, may occasionally arise, at least in part, from certain electric conditions of the air. Marsh miasmata.—The poisonous effluvia, or vapour, arising from the decomposition of vegetable matter, together with cold and dampness, are believed to be the principal causes of the fe- vers that prevail during the latter part of summer and in autumn, more particularly in low marshy districts of country. It is cer- tainly true that fevers prevail most in marshy places and near ponds of stagnant water. Newly cleared land evidently gives rise also to noxious vapours, from the decomposition that ensues on the exposure of the fresh earth to the sun. This will account for the prevalence of disease in newly settled places. The first effect of this miasmata upon the system is to weaken the vital powers; the strength becomes enfeebled; the appetite fails; there are languor, chilliness and aching pains; precisely such symptoms as might be produced by exposure to cold and dampness. These symptoms are the direct consequences of the * Edward's on physical agents and electricity. 9 poisonous effluvia weakening vitality, and as the constitution ral- lies to expel the poison, fever is produced. The greater part of medicines employed in the regular prac- tice, have no relation to the laws of life, but are repugnant to Nature, and injurious to the constitution. Such agents will mo- dify symptoms, or change the form of disease, but often, where a cure is effected, it is the result of the sanative efforts of the con^- stitution, in spite of medicine. Arsenic is often given in intermitting fever, and though it will stop the chill and fever, it establishes a permanent disease in the mucous membrane of the stomach and bowels, and thus produces chronic dyspepsia, attended by a swollen abdomen, which is seldom removed under a year, and sometimes termi- nating in dropsical affections. REACTION AND FEVER. Reaction is the effort of the vital powers to overcome disease, or a method established by nature to remove from the system whatever is offensive or injurious. Hence most of the symptoms in acute disease are but the recuperative actions resisting the force of disease. In hybernating animals cold diminishes vital action in pro- portion to the loss of heat; the animal continues in a state of tor- por and insensibility Until the return of warm weather, and then is reawakened into life and activity. The human organization though governed by the same vital principle, cannot bear a sus- pension of the vital action, or the temperature to be reduced be- low a certain degree, except for a short space of time, without endangering life* or producing disorganization of the parts in which the vital properties are sunk to a low grade. Hence, to preserve life against the threatening dangers which beset it, the human system is endowed with a power of reaction; a method established by Nature to resist the influence of those agents which bear no relation to the laws of life, or which tend to destroy the vital principle. Fever and reaction in excess, are," says professor Jackson, " precisely the same; they are properly symptoms rather than disease; they are salutary and sanative in design; they are the evidences of power and force which admit of remediate and curative operations; and they are in themselves the recuperative processes of the economy in action, instituted for its preservation." Therefore the " design of nature in dis- ease should be studied and aided." Dr. Samuel Thomson in his "remarks on fevers" says— " What is commonly called fever, is the effect and not the cause B 10 of disease. It is the struggle of nature to throw off disease. The cold causes an obstruction, and lever arises to remove it. This is universally the case. Remove the cause and the effect will cease." This theory of fever advanced by Dr. Thomson, and doubt- less original with him, was maintained by Sylvius and others of the early writers on medicine. But the failure of their prac- tice arose from the employment of remedies which tended to ag- gravate rather than assist the efforts of nature. The medical faculty have never made the proper distinction between pure sti- mulants, which raise and support vital action, and those which provoke an unnatural action, and ultimately exhaust the strength. It is to Samuel Thomson we are indebted for the discovery and selection of medicines which harmonize with the laws of life, and if judiciously applied are adapted to every variety of disease. "Again," says Dr. Thomson, "there is no other difference in all cases of fever, than what is caused by the different degrees of cold, or loss of inward heat, which (meaning cold and heat) are two adverse parties in one body contending for power. If the heat gains the victory, the cold will be disinherited, and health will be restored; but on the other hand, if cold gains the ascendency, heat will be dispossessed of its empire, and death will follow of course." # * # # * "When the power *>f cold is nearly equal to that of heat, the fever or strife between the two parties may continue, and occasion what is called a con- tinued fever. In ague and fever, the strife between the cold and heat occurs periodically, in some instances, every day, in others every second, and sometimes every third day." "In attempting to cure a case of this kind," says Thomson, " we must consider whether the fever is a friend or an enemy; if it is a friend, which I hold to be the fact, it should be aided by increasing the power of heat internally, and thus assist in driving out the cold, and life will bear rule." In alluding to the practice of regular phy- sicians in fever, Thomson says, " Instead of following the dic- tates of nature and aiding to subdue the cold, the doctor uses all his skill to kill the fever." * * * * " Support the fever and it will return inside where the heat belongs; the cold which causes the disease will be driven out, and health will be restored. In all cases of fever the cause is the same in a greater or less degree, and requires one general plan of treatment. Cold causes canker (a morbid secretion) in the stomach and bowels, and be- fore the canker becomes seated, the hot medicine alone, assisted by the vapour bath, will throw it off When the fever becomes settled, or continues to return, it is evidence of seated canker in the stomach and bowels. If the inward heat is kept up, the 11 canker will ripen and come off, and then there will be no more fever." "This idea is new," says Dr. Thomson, "and was not known until my discovery." " When a patient is bled," says Dr. Thomson, " it lessens the heat and gives double power to the cold; like taking out of one side of the scale and putting it into the other, which dou- bles the weight, and turns the scale in favour of the disease. By giving opium the feelings are deadened; the use of antimony, calomel and nitre, tends to destroy what heat remains, or more properly destroys the power in the system of producing heat, and plants new crops of canker, which will stand in different stages in the body, the same as corn planted every week will keep some in all stages of its growth; so are the different de- grees of canker. This is the reason why there are so many dif- ferent fevers as are named; when one fever turns another sets in and so continues, until the canker is all ripe, if the season is long enough; if not the cold and its effects take them off—then it is said they died of a fever. It might with as much propriety be said that the corn killed with frost died with the heat." * * " When a person is taken sick it is common to say, I have got a cold, and fear I shall have a fever; but no fears are expressed about the cold he has taken; neither is it mentioned when the cold left him. The fashionable practice when the fever rises is to destroy the heat, and the same means which they often use to cure the sick, would destroy the health of a well person. How much more reasonable it is when the fever rises to help it to throw off the cold which caused the disease." There are continued currents of " electro-galvanic" or nerv- ous fluid passing from the great centres of the system where it is generated, to the surface of the body, and also returning cur- rents from the surface inwardly. It is by these currents of nervous power that the circulation is attracted to the surface, and the venous blood returned to the heart. The force of the heart's contraction would be altogether inadequate to propel the blood to the surface against the immense pressure of the atmos- phere. Thus during the cold stage of intermittent fever the heat and nervous power are diminished, the blood recedes from the surface, and being collected in the internal organs, gives rise to the generation of nervous fluid, which being radiated through the nerves to the surface, attracts the blood to the skin, and thus reaction or fever is produced. To sustain the power of generating heat and nervous fluid by pure stimulants, will assist the fever in bringing on a crisis by perspiration, urine, &c. and then the fever subsides. 12 The means recommended by Dr. Thomson for "raising the heat of the system" and for "keeping the inward above the out- ward heat," are the same that arc required to sustain the gene- ration of the nervous power, and the regulating of its cunents outwardly and inwardly, and thus tend to maintain a proper balance in the circulation of the blood. In tracing the progress of fever we find it terminating in a restoration of the secretions, and by establishing some critical evacuation, more particularly by sweat and urine. This fact surely points out the design of nature in establishing fever or reaction. Thus in every case of acute disease which terminates favourably, we find a general warm perspiration, and an increased secretion of urine depositing a brick dust sediment, constituting almost invariably the more prominent crisis symptoms. The plan of treatment established by Dr. Thomson will assist the constitutional efforts in bringing about a crisis in disease, and without in the least degree aggravating the fever, but on the contrary will at the same time that it aids its efforts, generally moderate the violence of its symptoms. But take a case of re- mitting fever where the symptoms arc all favourable, bleed this patient every day, purge with active cathartics, give him ice water to drink, and pursue this course for a week, and in nine cases out of ten the fever will at the end of this time assume a malignant type, but which would have formed a crisis and the patient been convalescent if not interfered with. It is by reaction that the organization is sustained against all debilitating causes. Thus if a person in health be bled to faint- ing, reaction will follow, and the system may be brought into the same excited condition for which blood-letting is frequently employed; and the subsequent disturbance in the system will generally be greater in proportion as the vital powers are de- pressed by the loss of blood. I have heard Dr. Parrish relate a case of a man who had been for a length of time subject to frequent losses of blood from piles, and subsequently underwent an oper- ation, by which he lost a large quantity of blood. This, a few days after the operation, threw the system into a state of tumult- uous excitement, the face red, eyes sparkling, with a full bound ing pulse, and the carotid arteries throbbing very strongly, and, as the doctor stated, the patient exhibited symptoms, which every surgeon would have said demanded bleeding, when at the same time the patient was drained of almost all his blood, and the con- stitution was struggling against the effects of its loss. Not many months since, one of the physicians to the Blockley Hospital, a man of extensive experience, having been fourteen years in prac- tice, on examining a patient in one of the wards, asked of one 13 of the house physicians why that patient had not been bled, and immediately directed a pint of blood to be-drawn. The doctor was informed, however, that this patient had a surgical opera- tion performed a few days previous, and that secondary hemorr- hage had taken place, and the patient had been already nearly bled to death. Dr. Dunglison in a lecture mentioned the case of a patient in the hospital who was at sea a length of time without solid food, and labouring under great excitement, the doctor ordered him to be bled, but found that the blood was impoverished and almost deprived of its red globules, and that a different course of treat- ment was necessary, that the excited state of the nervous system arose from this impoverished state of the blood, requiring stimu- lants and generous diet. A frequent abstraction of blood will produce a determination to the brain, and the arterial system be thrown into a state of great excitement, presenting the same symptoms, which accord- ing to the doctrines of the schools of medicine, require the use of the lancet; the loss of blood being at the same time the sole cause of the excitement; the constitution reacting against the morbid effects of the loss of blood. How often does inflamma- tion of the brain ensue in remitting fever, and the disease be- come of a malignant character, probably in nine cases out of ten produced either by bleeding or purging, or by both; reducing the vitality so low that nature is driven to rally all her powers to " save a wreck:" the clashing forces struggle for the.ascend- ency which too often is decided in favour of the foe to life, aided probably by the college skill of the doctor, who errs, yet unde- signedly. Excessive loss of blood is not always followed how- ever by reaction; in some instances the system remains in a state of debility, accompanied by some chronic disorder, as dyspepsia, liver complaint, consumption, dropsy, &c. The doctrine that fever is disease, has given rise to the plan of treatment adopted by the regularly educated physidans. They aim to subdue vital force, considering the fever as an exalted condition of vital action and which requires to be reduced by sedative agents, which tend to destroy the vital principle; as niter, antimony, neutral salts, &c. together with blood-letting. This plan of treatment though sustained by the authority of great names, and by law and fashion, will probably be viewed by future generations as having been fraught with glaring incon- sistency, and which must necessarily have been attended with disastrous consequences. Such, however, is the force of educa- tion that great minds may imbibe errors which are easily seen 14 and detected by the unscientific. A patient may be brought to "death's door" by the treatment instituted to cure him, and be kept ill for months, and at the same time the physician get great, praise for his skill; the known liability to be ill from other causes, renders it difficult to determine as to the effects of the treatment. If the regular practice however was subjected to the same degree of rigid scrutiny as has been the practice of Samuel Thomson, and with the same prejudices to encounter, it would doubtless soon be abandoned, provided the general results of the Thomsonian practice were brought fairly before the community. The cause of disease may be so powerful that the reaction or fever cannot accomplish its design of establishing some critical evacuation, the vital powers being exhausted in the struggle. Thus yellow fever has been defined by Dr. Whytt, of Edinburgh " That fever which continues two or three days, and then termi- nates without any critical discharge, by sweat, urine, or stool, &c. leaving the patient excessively week, with a small pulse, easily depressiblc by any little motion, or by an erect posture; and which is soon succeeded by a jaundice colour in the whites of the eyes and skin, vomiting, hemorrhage, &c. without any fever. In that form of disease called typhus fever, the principle of life, is reduced below the point of healthy or efficient reaction; the power of the cause of disease prostrating the energies of life, and the reaction assumes a low malignant grade of fever. Re- mitting fever is sometimes converted into typhus fever, by blood-letting and purging, or from exposure to cold and damp- ness; food taken into the stomach which it cannot digest, has in frequent instances caused a fever to assume a malignant charac- ter, for as the action of the stomach is lost, or its energies op- pressed, the vital powers sink accordingly. Fever being the "friend," it may be asked, is a violent fever more favourable than one that is of a milder character? To this it may be replied. // the cause of disease be powerful, the reac- tion will require to be projmrtionably strong to oppose its influence, and therefore under circumstances requiring it, a high fever is more favourable. If the vital potvers be too feeble to establish an efficient reaction against a powerful cause, the fever will not be of a mild, but of a low malignant or typhus grade. If the cause of disease be weak, and the vital energies strong, the 15 fever will be of a mild character, and soon form a crisis, as in ordinary chill and fever. Though the force of disease may be weak and the general health much impaired, the fever may partake of a malignant character. Where the force of disease is powerful and the vital powers are in a depressed condition, the reaction may commence with a violent tumultuous excitement or fever, but these symptoms will be soon followed by great prostration and sinking of the vital forces. The recuperative or restorative design of fever is manifest in the eruptive diseases, as small-pox, scarlatina and measles. Beginning with a disordered stomach, which is the seat of the disease, the constitution reacts with the design of throwing the disease to the surface, and when this is accomplished, the dis- tress of the stomach is relieved. Patients have died of these diseases without the eruption appearing; the violence of the cause of disease prostrating the nervous energy, and suspending the function of calorification; the patient remaining cold and stupified as if stunned by a blow, or if there be fever it will be of a low typhoid character. In all such cases prompt measures should be instituted, in order to excite reaction, the only way by which the disease can be expelled. The plan recommended by Dr. Thomson is to lighten the air around the patient by the judicious application of warmth and moisture, and to give the most active stimulants, as the third preparation of lobelia, with a view to rouse the stomach from its state of torpor, and to evac- uate its foul contents, which in most instances occasions its op. prcssion, and the consequent depression of the nervous energy. There arc no means so efficient in bringing on reaction, as an emetic of the third preparation of lobelia and the application of warm vapour around the patient. Had those earlier writers and teachers of medicine who pro- proclaimed doctrines similar to those of Samuel Thomson in re- lation to fever, been fortunate enough to have discovered the proper means of assisting the efforts of nature, instead of resort- ing to the use of wine, brandy and other alcoholic preparations as stimulants, the practice of medicine would long since have been established upon a firm and unchangeable basis. But the injurious effects arising from the employment of such stimulants, induced them to change the theory, although nature proclaimed its truth in langnage too plain to be misunderstood. Hence for the want of a knowledge of the proper means to effect the indi- cations which this theory pointed out, namely: to assist Nature, 16 the doctrines and practice of medicine have been as change- able as the fashions in dress. " The history of practical medi- cine," says Dr. Eberle, "consists of little else than a review of the various doctrines which have successively risen and sunk again concerning the nature and treatment of fever." A great man advances a theory of medicine and the practice must conform to it. Thus Broussais when be exposed the errors of the prevailing doctrines in medicine, advanced the theory that all acute diseases arose from irritation in the mucous membrane of the stomach and bowels, and confined his remedies principally to leeches and gum water; denied his patients every kind of sti- mulant, because, as he supposed, every stimulant would increase the irritation. The announcement of the doctrines of Broussais influenced to a certain extent the practice of many physicians at one time in this country. A professor in the University of Pennsylvania commenced publishing a work on the " Principles of Medicine," but before the second volume was ready for the press, the doctrines of medicine became so changed, that the fur- ther publication of the work was suppressed. The first principles of medicine once established, and the pro- per means and remedies discovered for fulfilling the general in- dications of treatment, the practice of medicine must be simple, plain, and unchanging. PRACTICE OP MEDICINE CHAPTER L SECTION I. INTERMITTING FEVER—AGUE AND FEVER. The general causes of Ague—Noxious or poisonous vapours irt the air, called Malaria or Marsh Miasmata, arising from the de- cay and decomposition of vegetable matter in marshes, and from grounds inundated and then drained—The drying of mud front ponds that have been drained, the decomposition of vegetables, as flax, hemp and potatoes. Newly cleared land is supposed to give rise to deleterious exhalations from the decomposition pro- duced by the exposure of the fresh earth to the sun. Cold and dampness are frequently the exdting cause of the disease. The same cause or combination of causes that produce ague in one may cause dysentery in another, jaundice in another, and in another neuralgia. A person of vigorous constitution and in good health will best bear exposure to marsh miasmata without being effected by it. Symptoms and general course of Intermitting Fever.—The first symptoms presented in this form of disease are such as occur in the initial or forming stage of every variety of disease attended with fever, namely: general debility, loss of appetite, more or less distress at the pit of the stomach, obstructed perspiration, restlessness and languor, aching in the back and limbs, and in- creased sensibility to cold. The cold stage or chill.—The chill comes on with creeps along the back, and an irresistible desire toyawrn and stretch. There is a general coldness and contracted state of the skin, presenting that rough appearance called goose-flesh, and a sensation down the back as from trickling of cold water; the mind is confused and dejected, the pulse is small, contracted, frequent and firm. The jaws begin to quiver or chatter, and a general shivering 18 INTERMITTING FEVER. takes place over the whole body; sometimes these rigors are so violent as to shake not only the bed, but even the floor and par- tition. The breathing is hurried, and sometimes accompanied with a hacking cough, and a feeling of stricture across the breast. Vomiting is not an unusual occurrence, more particularly about the termination of the chill. The secretions of the mouth are suspended occasioning urgent thirst. The urine in this stage "is clear, colourless, without sediment, and often copious." The chill in some instances continues but a few minutes, and in others for several hours. Sooner or later reaction commences, and the patient experiences flashes of heat through the body, which increase until the chill is entirely gone and the fever be- comes fully developed; distressing vomiting often occurs at this period. The reaction or hot stage.—The blood which during the chill was confined to the internal organs and vessels, when reaction takes place is attracted to the surface: the countenance becomes flushed and the skin dry and hot; the pulse rises and becomes full and strong; the mind becomes more active, with a rapid flow of ideas; there is pain in the head, back and extremities, and not unfrequently more or less delirium, or as it is commonly express- ed the patient is "light-headed." The urine is scanty, and high coloured, but without sediment. The duration of the fever varies in different cases, but finally effects a crisis by a restora- tion of the secretions from the skin and kidneys, and thus termi- nating in The sweating stage or crisis.—As perspiration takes place the breathing becomes less difficult; the pulse softens, and a general abatement of all the distressing symptoms takes place as the per- spiration becomes general and free. The urine is high coloured and deposits a reddish sediment on standing. As the sweating continues the symptoms of disease continue to lessen until finally the patient is apparently free of disease. These stages, viz: the cold, the hot and the sweating stage, form what is termed a paroxysm of intermitting fever. These paroxysms occur periodically, either every day, every other day, or once in three days, and generally about the same hour of the day. During the intermission or interval between the paroxysms, the patient will in some instances be entirely free from all un- pleasant symptoms, except debility; more frequently, however, the patient experiences a considerable degree of indisposition, with loss of appetite, costive bowels, furred tongue, and much weakness. Intermitting fever, like every other form of disease, is subject AGUE AND FEVER. 19 to various modifications, depending upon the circumstances un- der which the disease occurs, in relation to the condition of the patient, and various other causes which may tend to modify dis- ease. Thus, if the disease is connected with a torpid state of the liver, the skin and whites of the eyes will be yellow, and it will be said the patient is bilious, or that he has a " bilious intermit- tent." When the disease attacks persons of shattered and exhausted constitution, the efforts of nature or the vital powers may be too feeble to establish an efficient reaction, forming what is called congestive intermittent. The cold stage will be unusually long, with stupor and deep seated pain in the head; vertigo, faintness and great oppression across the chest. The fever will be very slow in coming on, the skin being scarcely warm, and the patient will continue greatly oppressed, with a pale countenance and great oppression and anxiety of breathing; the pulse will be small, quick, and tense, and a distressed and burning sensation inwardly. Autumnal intermittents are apt to be connected with extensive derangement of the stomach, liver, and bowels, designated by writers as gastric intermittents. Signs which distinguish ague and fever from hectic fever. I. In hectic fever there is an absence of the distress in the back and limbs, which attends a paroxysm of intermittent fever. II. Hectic fever occurs at irregular periods. III. In hectic fever the hot stage is attended with a circum,- scribed flash on one or both cheeks ; without pain in the head which is a most distressing symptom in ague. IV. The pulse in hectic fever instead of being moderated by the subsidence of the paroxysm remains quick. V. The tongue which is furred in ague is clean and smooth in hectic. VI. In hectic fever the urine is muddy during the paroxysm, and clear after. In ague it is muddy or turbid after a pa- roxysm. VII. The mind is full of hope and confidence in hectic and desponding in intermittent fever. Intermitting fever very seldom proves fatal except where it 20 INTERMITTING FEVER. occurs in brokendown constitutions, or when complicated with extensive derangement of some important organ. In low marshy districts of country the disease is apt to become chronic, from the continued exposure to the cause; the countenance is sallow, the abdomen distended and the spirits sunken and dejected. Favourable signs. Each succeeding paroxysm occurring at a later period, scabby eruptions about the mouth and nostrils, cleaning of the tongue and restoration of the natural secretions of the skin and mucous membranes, and an improvement in the appetite; indicate a favourable termination of the disease. It frequently happens that an unusually severe paroxysm, without there being any assignable cause, terminates the disease, the patient becoming convalescent. Intermittent fever has its seat in the stomach and bowels, and subsequently other organs become affected, more especially the liver. An inactive torpid liver is doubtless a frequent cause of the disease becoming chronic. In such cases the skin and whites of the eyes become sallow, the abdomen swollen and the spirits sunken and dejected, and thofcdisease proving difficult of cure. Treatment.—The indications of treatment are to cleanse the stomach and bowels, together with other means for aiding nature in her efforts to expel the disease. Thomsons course of medicine—By its prompt action upon the stomach, bowels and skin, and by the fresh impulse given to the circulation and the secretions, will prove the most effectual me- thod of curing intermitting and all other varieties of fever. A very effectual plan is to commence with a course of medicine an hour or two before the time at which the chill comes on. In or- dinary cases where the paroxysms occur every other day the course of medicine will seldom require to be repeated more than two or three times to effect a cure, provided a proper intermedi- ate course of treatment is pursued. Treatment during the paroxysm—1st. Of the cold stage.— During the chill the patient should drink hot teas, as composi- tion, cayenne, or pennyroyal, and be covered warm in bed, and hot bricks or jugs of hot water placed at the feet and back, and third preparation of lobelia, tincture of capsicum, or some stimu- lating liniment rubbed along the spine. This will assist to bring on reaction and overcome the chill. Where the vital powers are in an exhausted condition, and insufficient to establish reaction, constituting what is termed con- gestive intermittent, an emetic of the third preparation of lobelia should be given to relieve the stomach of its foul contents and to AGUE AND FEVER. 21 arouse its sunken energies; and external warmth applied around the patient. After free vomiting the system will generally react, but if it should not the medicine must be continued, and the same administered by injection to the bowels, together with mus- tard plasters to the stomach, wrists and ankles. In some rare cases fatal congestion has taken place during the cold stage, for want of power in the system to produce reaction. Treatment during the hot stage.—When the fever comes on all dry heat may be removed from around the patient, but the hot medicine will be proper with a view to aid the reaction to bring on a crisis by perspiration. Where the fever is of a violent cha- racter and the patient greatly distressed, an emetic should be given, and the patient kept relaxed by broken doses of lobelia, given either alone or in the stimulating teas, and bathe the sur- face with whiskey, vinegar, salseratus water or simple water. Where the thirst is urgent, the patient craving cold drinks, they may be allowed him in small quantities. A draught of cold wa- ter will in some instances cause perspiration in the latter period of the hot stage. Acidulated drinks, as lemonade, are very grateful to patients, and may be taken in moderate quantities. The thirst however arising from suspended secretion of the mu- cous membrane of the mouth and throat will be more effectually relieved by capsicum tea than by cold drinks. Simple herb teas, as mint, pennyroyal and balm, are proper in any stage of the disease. Bathing the surface with spirits or vinegar when the fever is violent affords relief to the patient. Hot bricks wrapped in cloths wet with vinegar, will in some instances afford relief even during the fever. When the sweating stage comes on, all cold drinks are inad- missable. The patient should keep in bed and take hot medicine to favor and continuine the perspiration. When the perspi- ration ceases the body and limbs should be bathed with Thom- son's No. 6, and dry warm clothing put on. Treatment during the intermission.—The treatment during the interval between the paroxysms is to be regulated according to the circumstances of the case, and the condition of the patient. Thus in the first stage of the disease pure stimulants, as cayenne and composition, should be used with a view of sustaining the strength and aid in restoring the secretions. The compound lo- belia pills answer the place of the teas, two or three of which may be taken every three or four hours. Indications for the use of tonics.—When there is a complete in- termission of fever between the paroxysms, and the tongue be- 22 INTERMITTING FEVER. gins to clean, and assume a more natural appearance, tonics will come in play. Peruvian bark.—This is probably the most effectual tonic in intermitting fever, and given at a proper time, or under certain conditions of the system, no bad consequences probably would ever arise from its use, even in large doses. The advocates of Homeopathy in proof of their theory, assert that Peruvian bark continued to be taken by a person in health will produce a disease resembling intermitting fever. In certain conditions of the stomach, for instance where there is a redun- dancy of acid or the secretions otherwise deranged, Peruvian bark or other astringents, as hemlock and marsh rosemary, may produce a sense of oppression and constriction at the stomach, and even occasion intermitting fever. Peruvian bark however will not disorder a healthy stomach, nor will it produce inter- mitting fever, except under peculiar circumstances. In preparing Peruvian bark I usually combine it with a por- tion of Virginia snake root and orange peel, or with spice bitters, and give in the form of a decoction. It may also be prepared in tincture, or taken in good wine as Madeira, or sherry. Pre- pared in wine it should be taken just before or after meals. Quinine pills.—Pills composed of equal parts of quinine and capsicum, form a substitute for barks and all other tonics; and on account of the facility with which the pills are taken, they are generally preferred to any other preparation. Quinine con- tains the active principle of the Peruvian bark. I cannot dis- cover any objection to its use in a proper state of the stomach. A few hours before the period at which the chill comes on, the quinine or whatever tonic is used, should be given freely; when the patient is taking quinine, it will be proper to omit the use of bayberry and all other vegetable astringents. A great variety of tonics have been employed for ague, which answer in many cases equally as well probably as the Peruvian bark and its preparations, such as Thomson's No. 4 bitters, vari- ous species of the poplar and willow, the broad-leafed dog wood bark, wild cherry bark, columbo, gentian, quassia, Virginia snake root, and thoroughwort or bonesett. Before resorting to the use of tonics attention must be paid, as before mentioned, to the condition of the stomach, and not employ them whilst the tongue is dry and exhibits no tendency to clean at the edges. Neither should they be used so long as there is a feverish condition during the interval between the paroxysms. Relapses are liable to occur if the patient be exposed to the ex- citing cause. REMITTING OR BILIOUS FEVER. 23 Precautions.—Avoid cold and dampness; dress wrarm, and never go out in the morning or evening with an empty stomach. If the patient resides in a marshy district he should continue the use of tonics in order to invigorate the system. The cold shower bath may also be used as a preventive, where there is no particular organic disease, as an enlargement of the spleen or liver. The plan adopted by some practitioners and which generally proves successful in preventing a relapse, is to give the patient for instance half an ounce of Peruvian bark or eight or ten qui- nine pills, about the sixth day after the last chill, and then at the end of the next six days give a less quantity, and in this way continue giving the tonic, every sixth day lessening the quantity each time. If there are symptoms indicating a return of the disease, the patient should go to bed, cover warm and take freely of compo- sition or of capsicum tea, or what is better go through a course of medicine. SECTION II. REMITTING OR BILIOUS FEVER. A continuance of the fever to a greater or less degree during the interval between the paroxysms, constitutes the principle distinction between remitting and intermitting fever, in the lat- ter the reaction effecting a crisis terminates the fever, and which disappears until the succeeding paroxysm. But where the ef- forts of the constitution are insufficient to effect a crisis, the con- test continues and the fever is prolonged, constituting remitting fever. Causes.—Remitting or bilious fever is produced by the same cause or combination of causes as intermitting fever, such as marsh effluvia, exposure to high atmospheric heat when the powers of the stomach are feeble and the " internal heat" and nervous power are insufficient to maintain a proper balance in the circulation and determination to and from the surface; wear- ing damp clothes, errors in diet, exposure to wet and cold, de- pressing passions, &c. Persons who attend upon the sick, espe- 24 REMITTING OR BILIOUS FEVER. daily in cases of malignant disease, by being exposed to the de- leterious exhalations from the sick, together with the loss of their natural rest, and the confined air in the sick room, are liable to be taken sick, and frequently it happens that they will have the same form of disease as the patient on whom they had attended. Hence it often occurs that where one member of a family is taken sick with a "bad fever" as it is called, other members of the family are subsequently taken down with the same form of dis- ease. Symptoms___The first symptoms resemble those that usually occur in the first stage of intermittent fever, namely: languor and heaviness, yawning and heavy sighing, loss of appetite and distress at the pit of the stomach, pain in the head, back and limbs, alternate sensations of heat and cold, followed by a chill or by horripilations and languor. As reaction takes place and the fever rises, the pains in the head, back and limbs are increased. There is much distress at the pit of the stomach, with a total disgust for food, nausea, retching and vomiting sometimes of bilious matter, at others of a glazy mucous without bile; the tongue is thickly furred; the whites of the eyes become yellow, and the skin of a yellowish or sickly mixture of red and yellow; digestion is lost, and the bow- els torpid or very seldom moved; the stools are unnatural, gene- rally either clay coloured, or much darker than natural; the breathing is more or less oppressed, and a sense of tightness or stricture across the chest; the urine is scanty and high coloured; the pulse full, frequent, but seldom very hard or tense, and the skin is generally dry and hot." "These symptoms continue until the succeeding morning, when a gentle perspiration appears on the superior portions of the body and sometimes over the whole surface. The fever now abates, but a crisis is not effected, and the fever consequently does not entirely disappear, at least but for a limited period; the pulse continuing quick and irritated, and the skin is above its natural temperature. Usually in the course of an hour or two, the fever again rises, and continues as during the preceding day and night, and then abates for a short time in the morning, and in this way the struggle between the vital powers are the cause of disease, and continues until a crisis takes place, and the pa- tient becomes convalescent, or the disease assumes a more ma- lignant character by the vital energies becoming exhausted, in the struggle. -'There is however great diversity in the symp- toms and character of what is termed remitting or bilious fever, scarcely ever two cases presenting precisely the same aspects or regular train of symptoms. Thus in one the liver may be more disordered, and this will modify the symptoms; in another the REMITTING OR BILIOUS FEVER. 25 liver maybe less and the stomach more deranged, and the symp- toms will be modified accordingly. The degree of loss of vital force tends to modify the symptoms to a great extent- In most instances of remitting fever the symptoms are worse on every alternate day. In some cases the remissions or declining of the fever oc- curs soon after day light, in others after the sun is up, and in others not until noon or after. Great variations also occur in relation to the degree and duration of the remissions. In some the fever will almost or entirely disappear for an hour or two, or even for three or four hours, whilst in other cases the fever is so slightly moderated as scarcely to be noticed by the patient or attendants. In some rare cases the remissions are observed to occur in the evening or during some part of the night The disease continuing beyond the fifth or sixth day without forming a crisis or assuming a milder aspect, the vital powers will begin to give away, and if it continues unchecked over the ninth day or second week, the symptoms are very liable to assume an aggravated and sometimes dangerous character. Seated ori- ginally in the stomach, which may be very properly termed the "throne of life," as the functions of this organ are impaired and its energies weakened, so in proportion will other organs, such as the brain, liver, &c. become disordered, and the vital powers be prostrated. The tongue then becomes more thickly coated with brown fur, " delirium occurs more frequently and strongly; the skin acquires a more deeper tinge of yellow;" the bowels be- come tender to pressure, and distended with flatus; there is fre- quently an acrid heat on the surface, and a burning pain in the stomach and bowels, probably from the presence of vitiated acrid secretions ; and in frequent instances there are offensive dis- charges from the bowels; almost continued restlessness and ina- bility to sleep. In some instances the liver is prominently affected, loosing entirely the power of secreting bile, and in a state of congestion, causing a sense of great fullness and pain in the right side; vio- lent retching and vomiting, "without the ejection of bile, the matter thrown up consisting of glassy mucous," together with what may have been taken into the stomach. There is great torpor of the bowels; the tongue clean, or seldom remains furred but for a short time, beginning to clean along the middle; and to- wards the termination of the disease a copious discharge from the bowels of a dark pitch-like matter. "The liver frequently re- covers its action and relieves itself by pouring a large quantity of black bile, or perhaps blood, into the bowels, as is manifested by the copious, dark coloured or tar like al vine discharges, which usually occur in such cases. These large and very peculiar dis- charges, may indeed be regarded as the favourable crisis of such 26 REMITTING Oil BILIOUS FEVER. fevers; for convalescence generally soon follows their appear- ance, and except the disease be arrested by remediate treatment in the early period of its course, there are but few recoveries in which such discharges do not occur." In this form the stomach is doubtless the original seat of the disease, the loss of action in the liver being a consequence of loss of power in the stomach. The symptoms accompanying remitting fever present an almost infinite variety of modifications, but which it would be useless to attempt to describe, as the disease in all its diversity of charac- ter requires to be treated upon the same general principles. Favourable signs.—A general perspiration with a warm skin; a soft pulse; the appearance of scabby eruptions about the mouth; the urine depositing a copious sediment; the nervous system maintaining its integrity; and the tongue moist and beginning to clean. Unfavourable symptoms.—Low muttering delirium; a tym- panitic state of the abdomen; involuntary offensive discharges from the bowels; a very diminished secretion of urine ; the tongue soft and relaxed, possessing no elasticity; hiccough; the skin relaxed and inelastic, by pinching it up it returns to its natural position very slowly; cold wrists and hot hands, and the breath and perspiration having a peculiar death-like odour. Where there is a chain of these bad symptoms existing, the case may be considered as almost hopeless. Still recoveries do occa- sionally take place where many of these symptoms have existed. I have known patients recover in whom there was at the same time continued low muttering delirium, involuntary discharges from the bowels, tympanitic state of the abdomen, hiccough, twitchings of the tendons, picking of the bed clothes, deep heavy sighing, and cold sweats over the face and breast. It frequent- ly happens that a patient has a symptom which is considered as indicating great danger, hiccough for instance, but when uncon- nected with other bad symptoms, this nor any other single symp- tom is to be considered as a necessary cause of alarm. Treatment of bilious remitting fever.—A prompt and perseve- ring course of treatment should be instituted in the early stage of the disease, with a view to cut short its course, and thus pre- vent the disease extending to other organs than those primarily affected. Thomson's course of medicine constitute the most effectual means not only for hastening the crisis, but for relieving the symptoms. The course of medicine should be repeated daily in the first stage of the complaint, or at longer or shorter intervals as the case appears to require. Where there is violent pain in REMITTING OR BILIOUS FEVER. 27 the head with a high fever, it will be proper to commence the course by an enema, containing a portion of lobelia. One or two teaspoonsfull of lobelia powder administered in this way in luke- warm water, and retained fifteen or twenty minutes, will not only relax the system, but in most instances will answer the place of an emetic given in the usual way. This method of pro^ during relaxation is very effectual, and is of the first importance in the treatment of acute disease when the arterial system is struggling hard to overcome obstructions to the circulation of the blood, and it also tends to equalize the nervous influence, and aids in restoring the secretions. Whenever the system is re- laxed by lobelia, the face, breast, and hands, should be bathed with vinegar and water, spirits, or camphor and water; this affords great relief to the patient: the external covering should not be so great as to oppress or distress the patient. There are, however, no bad consequences to be apprehended from an emetic given in the usual way, even where there is a violent determina- tion of blood to the head, the symptoms being in almost every instance relieved by the vomiting. During the intervals between the courses of medicine, pure stimulants, as composition or capsicum tea, should be given oc- casionally, and frequent broken doses of lobelia, either in powder, infusion, tincture or in pills. When the fever is very high the face and breast, and even the whole surface may be bathed with cold water, vinegar and water, alcohol, brandy, camphor and water, or salseratus water. This is more especially adapted to the early period of the disease, or when the vital powers are sufficiently strong to bear these cold applications to the surface. Bathing the surface with whiskey is perfectly safe however in any stage of the disease, and where the patient is greatly exhausted this will generally afford relief and apparently give strength to the system. A great variety of teas and preparations for drink may be used in fevers, as pennyroyal, balm, mint, lemonade, apple tea, crust coffee, &c. A tablespoonfull of cold water may be frequently taken where the thirst is urgent and the patient desires cold drinks. Where the brain is much affected the feet should be kept warm and occasionally placed in warm water, containing mustard and salt, or hickory ashes. Injections are of especial benefit under these circumstances in diverting the nervous influence and con- sequently the blood from the head to the bowels. Not only in this are the enemas beneficial, but they relieve the bowels and aid in restoring their lost function. I have occasionally observed discharges of black vitiated bile evidently from the liver, by relaxation produced from an injection of lobelia, the obstruction 28 REMITTING OR BILIOUS FEVER. in the liver is in this way overcome, and the organ enabled to relieve itself from a state of congestion and oppression. Further remarks in relation to the course of medidne. 1st. Of steaming—When the patient is unable to sit up, or the system relaxed by the lobelia injections, the vapour should be applied according to the directions given for steaming in bed; and during the operation, the surface may be sponged with sim- ple cold water, or combined with vinegar or spirits. I have had patients in a vapour bath on a coucli or mattrass from an hour to an hour and a half at a time, and without proving in the least degree debilitating, but in many instances, by proper atten- tion, grateful and refreshing. In a case of recovery from one of the worst forms of fever, and when the patient had symptoms which arc generally considered as denoting a fatal termination, the patient was steamed in this way every day, for eight or nine days in succession, and with the most marked benefit. Where the heat of the surface is high it will be difficult to excite perspiration even by the vapour, with- out reducing the heat of the skin by bathing with whiskey or vinegar. When the skin is in a relaxed condition, and the pa- tient subject to profuse perspiration, the surface should be bathed with No. 6 after steaming. The shower bath is proper after steaming, provided the patient is able to set up during the steam- ing. A sudden dash of a pitcher of cold water over a patient in fever has been observed to be followed by perspiration and an im- provement in the disease. 2d. Of the emetic.—It is always proper to prepare the emetic in bayberry tea, and the stronger the decoction the more effec- tually will it cleanse the stomach. In the early period of the disease, when the fever is violent and the tongue dry and parch- ed, the lobelia powder should be steeped in the bayberry tea, adding the nerve powder or scull cap, and then strain, and half a teaspoonfull of capsicum added to each dose; or the patient may take the pepper separately in tea. In a later period of the disease, when the strength is greatly exhausted, the third pre- paration of lobelia may be used, adding a portion of lobelia powder. The following is a good form. Two teaspoonsfull of the liquid of the third preparation. One teaspoonfull of green lobelia, And a teacup half or two-thirds full of bayberry tea, To be well sweetened and taken at once, and the same re- peated two or three times, or as often as is foiuid necessary. REMITTING OR BILIOUS FEVER. 29 I frequently give emetics without the application of the va- pour bath; thus in low forms of fever, more especially if attended with delirium I have repeated the emetic three or four times in twenty-four hours without steaming, and continued this treat- ment for several days in succession, and with the most signal benefit. The propriety of administering the emetic frequently must be judged of by the effect produced. After the emetic or during its operation, in the early stage of the disease, the patient should take the crust coffee, barley water, or elm gruel, and be be careful to avoid taking raw milk, solid food, or sweet cakes, which are almost sure to oppress the stomach and aggravate the disease. When the strength is exhausted by the continuance of the disease, and more especially if there are typhoid symptoms, essence of beef, milk porridge and pepper; wine whey with car- bonate of ammonia will be proper, together with pepper tea, pepper sauce, No. 6, or bayberry tea and third preparation. Injections.—These cannot be administered too often; it is ad- visable to give one both before and after the emetic. In very bad cases attended with delirium, and a tympanitic state of the abdomen, I have found it necessary to use a tablespoonfull and even more of the third preparation of lobelia in each injection, in order to produce a sensible impression upon the bowels. The second steaming:—It is not in all cases necessary to ad- minister the bath after the emetic: nor should the patient be disturbed so long as he is comfortable and in a perspiration; when this ceases and the patient becomes uneasy, then it will be proper to give the bath. When the patient can set up he should be showered with cold water, or washed with vinegar or spirits; if in bed, change the bed clothes and also the clothes of the pa- tient. After the course a hot brick or bottle of hot water should he placed at the feet wrapt in a damp cloth, and if the patient can bear it, have one kept to the stomach. Care is necessary how- ever not to oppress and distress the patient with external heat, more especially when there is fever. When there is great tenderness of the abdomen, flannels wet with No. 6, or pepper sauce should be applied, and also a hot brick to favour perspiration and a proper action in the skin. A mustard plaster or pepper poultice is sometimes beneficial in such cases; but the mustard should be removed before it causes a blister; when the skin becomes red and the patient complains of its burning, it must be removed. As the tongue becomes moist and manifests a tendency to clean at the edges, the " canker medicine" should be used, in combi- nation with stimulants and tonics. A tea cup two-thirds full of 30 REMITTING OR BILIOUS FEVER. bayberry tea made very strong, adding a teaspoonfull of compo- sition in powder, is one of the most effectual remedies for scour- ing the morbid secretions from the coats of the stomach. This or some other form of the bayberry or No, 3, should be given two or three times a-day. In all malignant forms of disease termed fevers, where there is a strong tendency to putrefaction, No. 3 or bayberry in strong decoction, adding the No. 6 or third preparation of lobelia, are probably the most effectual of all other remedies. The pepper sauce has also obtained, high repute as a medicine in malignant fevers. Tonics.—As the secretions become restored and the tongue clearing, together with complete cessations of fever, the tonics recommended in the treatment of intermitting fever should be em- ployed. It very frequently happens that remitting terminates in intermitting fever or ague. Badly treated cases of ague are also often converted into remitting fever. A tea of the Virginia snake root is proper as a drink in any stage of the disease, and at the same time tends to support the strength. A tea of the scull cap or of the valerian may be used as a nervine, or the powder added to the other medicines. Diet.—During the early stage of the disease and until it as- sumes a favourable aspect, great attention to diet is necessary. When the stomach is unable to digest food, as is the case in the early period of remitting fever, nothing should be allowed the patient but crust coffee, barley water, elm gruel, kc. Many patients are injured by taking improper articles of food that the stomach cannot digest. In a more advanced period of the disease, essence of beef, chicken water, and mulld egg may be taken provided they are found to set well on the stomach. In a sinking state of the system wine-whey and carbonate of ammonia, or essence of beef are necessary to support the system in the way of nourishment. SECTION III. TYPHUS, CONGESTIVE, AND YELLOW FEVER. Designated by medical writers as different and distinct dis- eases, are but various modifications of a malignant disease, and consisting essentially in great prostration of the living powers or principle of life. Intermitting, remitting, bilious, continued, congestive and ty- phus fevers, (as they are termed) may arise from the same cause or combination of causes. They also are liable to run into each other as the cause of disease is more or less powerful, or as the vital powers become weaker or stronger. Thus an inter- mittent may by bad treatment or other depressing influence, be- come a remittent, and if the liver should be prominently disor- dered, the disease will receive the name ''bilious remittent." By a still further prostration of the vital powers, the disease may assume the congestive or typhus character. Then if nature should gain ascendency over the disease, the symptoms may re- assume the remittent type or the disease terminate in intermit- tent fever or ague. In persons of depraved or drunken habits, the recuperative powers are depressed or impaired, consequently under these cir- cumstances, disease is liable to assume a malignant character. Continued exposure to poisonous effluvia from the decomposi- tion of certain vegetables, or to exhalations from the body of one affected with a malignant disease, as yellow or typhus fever, by degrees and in an insidious way, may poison the system and prostrate the vital powers so low as to destroy the power of gen- erating heat and nervous influence, and the patient sink into a dangerous state of extreme debility and stupor, which would-be called yellow or conjestive fever. In some instances, from the force of the cause of disease, the vital energies are suddenly overwhelmed or the principle of life destroyed, the system being in a state of complete stupour and insensibility, as if stunned by a blow upon the head, or poisoned by a large dose of arsenic. Disease of such deadly character seldom occurs however in temperate latitudes, being confined principally to certain localities in hot climates. Not that a high temperature occasions the disease, but heat combined with mois- ture, gives rise to malaria or the deleterious gases which poison the system. Typhus and congestive fever prevail mostly during winter, but it very rarely happens that patients die without some 32 TYPHUS, CONJESTIVE AND degree of reaction occurring, as sometimes happens in particu- lar localities in hot climates. The following case tends to illustrate the insidious and dis- guised manner in which disease of the most malignant character sometimes takes hold of the system. A young man of this city whose health had become impaired by a succession of colds, be- came subject to bleeding at the nose, which occurred at frequent intervals, during the term of some weeks. In this exhausted state he bailed some offensive water from a cellar that was very damp, and he remained in the cellar for some hours. Soon after this he grew worse, and I was desired to attend him. He was able to walk about the room though extremely feeble and dull; he would converse, though with considerable hesitation; his skin was of the natural temperature or nearly so, but pale, relaxed, and without elasticity; his tongue was but very slightly coated, scarcely sufficient to change its natural appearance, and the pulse was apparently natural, manifesting no indications of ir- ritation or unnatural excitement. This patient gradually sunk and died in about two weeks, though the most powerful stimu- lants were used with a view to arouse the energies of the stomach and bring on reaction. There was no sign of fever, except an accasional flush on the cheeks towards the termination of the disease, neither did he complain of pain; and the stomach ap- peared altogether insensible to the most active stimulants from the commencement. There was a moisture on the skin during nearly the whole period of his illness. There was a peculiar expression of the countenance—a vacant stare, as though the chain of sympathies were broken up, and the brain not perceiv- ing what was going on in the system. This peculiar expression of countenance which might not be noticed by a common obser- ver; together with what is termed the " sardanic laugh" are always alarming. The sudden deaths sometimes occasioned by drinking cold water in very hot weather, and the system exhausted by hard labour or over exertion, Dr. Thomson says are owing to the loss of inward heat, occasioned by the cold water, and the outward heat being high there is a balance of power between the outward and inward heat, and that when this takes place the blood ceases to circulate. "The inward heat", says Dr. Thomson, "is the fountain of life, and as much as that has the power over the outward heat, so much we have of life and strength, and when we loose this power of heat our strength and faculties decay in proportion." The fatal diseases called "yellow and spotted fever," Thomson says, are caused by the loss of inward heat, or by a balance of power outward and inward. This theory of Thomson would appear perfectly plain and consistent with the law s of life and motion, provided there be no YELLOW FEVER. 33 distinction made between animal heat and the electro-galvanic or nervous fluid. They are evidently in inseparable connection, but it is usual, and doubtless proper, to make a distinction. Then the cause of sudden death under the circumstances above alluded to. may be owing to the immediate and total suspension of the power of generating nervous fluid, and as the circulation of the blood depends upon continued currents of nervous fluid pass- ing from the center to the surface, the moment it ceases to be generated, the blood must cease to circulate. The direct ten- dency of all poisons is to suspend the functions of calorification and inervation. Thus a large dose of arsenic taken into the sto- mach, immediately destroys the power in the system of produc- ing heat and nervous energy, and death becomes more or less sudden in proportion to the quantity of poison taken. If the dose is large there will be no reaction, nor any trace of inflam- mation discernible in the stomach after death; the vital princi- ple being suddenly destroyed, without the power of making an effort at reaction. But if the dose be not sufficient to destroy life under three or four days, there will be more or less reaction, and the stomach will take on inflammation. The inflammatory ac- tion is the struggle of nature against the effects of the poison. The term congestive or yellow fever would seem almost as ap- plicable to such a case as to the cases of malignant disease, pro- duced by poisonous agents in the air, and which sometimes de- stroy the vital principle almost as effectually as a large dose of narcotic poison. It has been observed in frequent instances were patients have died suddenly from yellow fever, that no traces of inflammation were discoverable in the stomach by examination after death; precisely as in a case of sudden death from a powerful dose of arsenic, the principle of life being suddenly destroyed, without the occurrence of fever or inflammation. The character of disease is as much modified probably by the condition of the system at the time the patient is exposed to the exciting cause, as by the power of the cause itself. Thus the same exposure to cold and dampness that wrou!d produce high inflammatory fever in one, would cause typhus fever in another; and the greater the loss of power in the stomach the more liable the system will be to malignant forms of disease: And like- wise whatever organ is weakest will be the more liable to be especially diseased. Thus, in some, the brain becomes early affected, whilst in others the liver is prominently disordered, and in others again the disease will be chiefly concentrated in the stomach and bowels, which is probably in all cases the original seat of disease called fevers. " I remember with pain," says Dr. Eberle, "the unfortunate lot of an amiable and intelligent friend. He was a man of healthy E 34 TYPHUS, CONGESTIVE AND constitution and fond of indulging in the pleasures of the table. He was seized with simple synochal fever from cold. His phy- sician bled moderately; the fever went on unchecked; he bled again and again daily; after the seventh bleeding there was still too much quickness and tension in the pulse; the lancet was inserted the eighth time, and the patient sunk almost immediately into a state of collapse. Stimulants, both external and internal, the most diffusive and potent, were now diligently applied, but all in vain; he lived but a few hours longer." Typhus Fever.—In the commencement of this form of disease there is usually much distress felt at the pit of the stomach, an entire disgust for food, giddiness or swimming of the head, ex- treme debility and dejection of spirits for some days before there is any fever. These are called the " premonitory symptoms," they are however the direct and immediate consequences of the cause of disease, and are a more aggravated form of the same train of symptoms that occur, in the commencement of ordinary "bilious" or "remittent fever." The premonitory symptoms in typhus fever, usually continue a week and sometimes much longer, when the patient is taken with a chill or rigour, attended frequently with sickness at the stomach and vomiting, confusion in the head and extreme de- pression of mind. This chilly state continues an indefinite pe- riod, varying from six to twelve hours, wiien symptoms of slight reaction occur, constituting a low malignant grade of fever. In this stage the symptoms do not differ from those which prevail in the more aggravated form of remitting or continued fever. But the powers of the constitution give way and the patient sinks into a state of " collapse," when the following train of symp- toms are presented, variously modified however in different cases. . Symptoms which characterize Typhus Fever.—Extreme mus- cular debility; a weak and frequent pulse; a stunned or stupi- fied condition of the brain, frequently with low muttering deli- rium; the tongue coated with a brown or black fur or crust; twitching of the muscles of the face; great difficulty of protrud- ing the tongue; " constant recumbrance on the back and sliding down towards the foot of the bed from deficient muscular power; difficulty of hearing, and insensibility to surrounding objects; a peculiar biting heat of the skin; hiccough;" a distended state of the abdomen, with tenderness to pressure; the urine pale, and foaming like beer when voided in a vessel; and as the disease advances there is a tendency to diarrhoea, the discharges being acrid and exceedingly offensive; the stupor increases, from which it is difficult for the patient to be aroused. Typhus fever, as it YELLOW FEVER. 35 is termed, varies greatly however, in regard to violence, and in the different modifications of the symptoms. Favourable symptoms.—A general moisture over the surface, with a warm skin; the tongue beginning to clean along the edges; the urine depositing a brick-dust sediment; the delirium subsiding, and the patient being able to sleep. A crisis seldom takes place until the thirteenth or fourteenth day from the com- mencement of the disease, and frequently not until the end of the third or fourth week. Recoveries from this form of disease are always slow, the patient remaining in a debilitated condition both of body and mind. Congestive Fever.—This name is applied to those cases in which the force of the cause of disease overwhelms the vital powers and prevents reaction. The patient continuing in a state of stupor and extreme prostration as in concussion of the brain by a blow upon the head. When the constitution makes a feeble effort at reaction, producing a low grade of fever, the disease may be termed typhus, but if the prostration of the living power is such as to prevent reaction, the disease will then re- ceive the name of " congestive fever." In shattered constitutions, or where patients are exposed to bad air, as on ship-board, or in the crowded wards of hospitals and jails, remitting fever sometimes assumes the congestive form from prostration of vital energy, the patient remaining in the chill and stupified, with swimming of the eyes, anxious expres- sion of countenance and great debility. Congestive Intermittents occur in certain locations in hot cli- mates. The chill becomes greatly protracted, and if reaction comes on, the fever will be of a low malignant or typhoid grade. It has been noticed in those places where malignant intermit- tents prevail, that a short chill followed by a vigorous reac- tion or fever, is favourable; but on the other hand a protracted chill followed by an imperfectly developed fever is unfavourable. Fellow Fever.—This form of disease does not differ essentially from the two preceding varieties. The symptoms are sometimes of a violent character in the commencement of the reaction; there is an intensely hot skin, flushed face, the eyes red, extreme head- ache, tormenting thirst, intolerance of light, pain in the loins and lower extremities, a sense of weight and tension at the pit of the stomach, white, and sometimes clean tongue. Distressing retching and vomiting occurs, the ejections sometimes so acrid as to excoriate the throat. There is a burning heat and tender- ness at the pit of the stomach, as though the patient had swTal- 36. TYPHUS, CONGESTIVE AND lowed some corroding acid; extreme restlessness and deep sigh- ing; a hopeless expression of countenance, and frequently delc- rium. , The fever or reaction seldom continues more than two or three days, when the fever subsides without any critical evacuation occurring, either by sweat, urine, or stool, leaving the patient extremely exhausted with a weak and easily compressible pulse, and soon followed with yellowness of the skin and whites of the eyes. " The patient now remains in a state of tranquil indiffer- ence, amounting to a sort of stupor, without any apparent con- cern as to present or future situation. This is an ominious calm; for after a few hours the pain and burning sensation in the sto- mach return with increased violence; the vomiting becomes fre- quent and distressing—the fluid brought up containing minute flakes or flocculi, resembling the crust washed from a port-wine bottle, but little or no bilious matter," and every thing that is swallowed is forcibly ejected. "This second paroxysm con- tinues commonly from twelve to thirty-six hours, when the ener- gies of the system are worn out in the struggle. The pulse sinks, the extremities become cold and clammy, the tongue is black, and " the matter thrown up consists of a black ropy fluid resembling coffee grounds suspended in a glary fluid." The burning in the stomach and bowels is distressing in the ex- treme. "Diarrhoea usually occurs at this period—the dis- charges being green, or black. Hiccough, violent delirium, hemorrhages, stupour and convulsions are apt to occur in fatal cases." Although the above describes the general characteristics of yellow fever, still a great diversity of modifications are present- ed in different cases. Thus in some instances the principle of life is destroyed in the onset of the attack, and the patient ex- pires without any symptoms of reaction occurring. " In other instances violent and furious delirium, or mania ushers in the disease, terminating in a few hours in insensibility and convul- sions. " Sometimes it commences and proceeds to a fatal termi- nation in so insidious a manner, that the patient himself and those about him are scarcely aware that he is much indisposed. In such cases there is, how ever, always a remarkable change in the expression of the patient's countenance, as well as in his usual temper and habits. In almost all instances of this disease, the countenance is expressive of intense anxiety and despair dur- ing its early period, and of gloom or sullen abandonment in the last stage." I have heard it stated by a physician that of two hundred patients sick of yellow fever that came under his care during the season of the prevalence of the disease in Philadel- phia, no two cases presented precisely the same modifications of symptoms. YELLOW FEVER. 37 Treatment of Typhus, Congestive and Yellow Fever.—In all those aggravated forms of disease, an energetic and persevering course of treatment should be instituted in the early stage of the disorder, before the energies of the system become exhausted. The disease commencing with a state of extreme prostration and stupour, the third preparation of lobelia should be given free- ly, also stimulating injections, and friction on the surface; to- gether with the vapour bath and stimulating applications to the skin, with a vicwr of aiding the feeble efforts of the constitution in causing a determination to the surface, and in establishing reaction. The third preparation of lobelia answers several important in- dications; besides its emetic properties it is a powerful diffusive stimulant, and it also possesses strong anti-ceptic properties. The third preparation of lobelia in a strong decoction of the bay- berry, I have usually found more effectual than any other pre- paration of medicine in low or malignant fevers. In many cases however, the medicine requires to be changed occasionally, more especially when disease becomes seated. In some instances the pepper sauce will suit the stomach for a time better than any thing else. When the tongue is dry and the patient craves acids, the pepper sauce will generally be found beneficial. A mixture of lemon juice and loaf sugar, in some instances will agree with the stomach for a time and be the only kind of nourishment that the patient can relish. Capsicum or Cayenne Pepper.—This is a pure and permanent stimulant, and may be administered in frequently repeated doses. Carbonate of Ammonia is a diffusive stimulant, and powerfully anti-acid, and may be given dissolved in capsicum tea or with other stimulants. Wine Whey is also a diffusive stimulant, it also affords nour- ishment to the system, and is particularly indicated where the disease has continued for a length of time, and the system is in a state of extreme prostration. As much of the pulverized car- bonate of ammonia as will lay on a five cent piece dissolved in a wineglass of the whey will overcome the tendency in the whey to sour in the stomach. The Vapour Bath.—"In all cases," says Dr. Thomson, " where the heat of the body is so far exhausted as not to he re- kindled by using the medicine, and chills or stupor attend the patient, then applied heat by steaming becomes indispensably ne- cessary." The steam may be applied to the patient on a mat- tress or couch. A moderate sweat continued in this way for an 38 TYPHUS, CONGESTIVE AND hour if the patient can bear it, is generally better than a profuse perspiration; in those cases of great prostration. If there be fever, or the patient is oppressed, the surface should be bathed with whiskey, vinegar, or water, and always when a patient faints, dash cold water or spirits in the face. It is very neces- sary to pay particular attention to bathing the surface, not only during the steaming, but at other times, when the skin is intense- ly hot, or the patient very low. After the bath the surface should be washed with vinegar or whiskey, or in very low cases, strong stimulants should be used, as No. 6, third preparation of lobelia, pepper sauce or stimulating liniment. The clothing of the patient should be changed frequently. In applying warmth to the patient in bed it should be a moist heat when the skin is dry or feverish, as from bottles of hot water or hot bricks wrapt in damp cloths; and when the patient is in a cold clammy sweat a-dry heat may be applied, as by bottles of hot water, or narrow bags filled with hot sand, salt or ashes, placed by the sides of the patient extending from the arm-pits to the feet. In a prostrate state of the system, or when the skin is very dry and hot, care must be observed not to occasion so high a degree of heat as to oppress the patient. Frequent bathing the surface is of great importance in all low or malignant forms of disease. It matters not whether the disease comes on with great excite- ment and delerium or with a -state of congestion and oppression, as regards the general course of treatment. The emetic and in- jections proper in a state of congestion and extreme torpor, are equally applicable wiiere there is great excitement in the system. I have in repeated instances observed a dose of the third prepa- ration of lobelia given in bayberry tea, to have great influence in moderating, and in some instances to overcome delerium; and on the return of the delerium, by repeating the dose, these symp toms again disappear; and in this way patients have in some instances been kept comparatively calm and quiet, and able occasionally to sleep, who would have been in a state of extreme restlessness and delerium without the medicine. If the third preparation of lobelia should produce a sense of stricture at the stomach, and pain in the head, as in some rare instances it does, more especially where the patient has a dry cough, and the secretions of the skin and mucous membrane are suspended, then the lobelia may be infused in baybery or com- position tea, and strained, and given as a substitute for the third preparation. It is recommended by some practitioners to use the cold shower bath in the first stage of the disease, where the fever is vehement. Of the utility of this practice I cannot speak from experience, never having used it except after the vapour bath. YELLOW FEVER. 39 In a more advanced period of the disease, the patient will re- quire to be nourished with wine whey, essence of beef, mulled egg, crust coffee, &c. Tonics.—When the tongue manifests a tendency to clear along the edges, with an occasional absence of fever, tonics will be proper, such as are recommended in the treatment of remitting and intermitting fever, as quinine, Peruvian bark, Virginia snake root, &c. The Virginia snake root may be used, how- ever, in any stage of the disease. It answers very well given in decoction with capsicum or composition tea. Recoveries from these low forms of fevers are usually very slow, and the tonics and other remedies require occasionally to be changed. Fifteen or twenty drops of the " elixir of vitriol," given in a wineglassful of some bitter infusion, forms a good tonic. The vapour bath is proper in any stage of the disease, more especially if the patient be permitted to lie on a couch, sofa, or mattrass, and thus avoid the fatigue of sitting up. Where the patient is able to sit up, the shower bath can be given after the bath, which is, in many instances, of especial benefit. The continued and frequent administration of emetics will not always be required when the disease becomes seated :- occasion- ally, however, an emetic may be needed to clear the stomach. It is in general a good rule to give an emetic whenever the pa- tient is oppressed at the stomach, or more distressed than usual. Patients in a state of convalescence sometimes crave hard cider, and under these circumstances, old bottled cider will be found to increase the appetite, and to add tone to the stomach. In all these low or malignant forms of disease, the floor of the sick room should be occasionally sprinkled with the chloride of soda; or the chloride of lime placed in dishes about the room. This will greatly improve the air of the room, and be an advan- tage to the patient, and afford protection to the attendants. In a recent conversation with Dr. Shaw, who had been prac- tising in the west, he mentioned the case of a female who was extremely ill with a form of disease that prevailed in that section of country, and proved frequently fatal, termed congestive typhus. The patient had retained nothing on the stomach for two days; she had cramps in the limbs, and a tympanitic state of the bowels. In this condition the doctor ordered an enema to be administered of half a pint of No. 6, which, producing scarcely any impression on the bowels, the same quantity was repeated, which was also retained, occasioning much distress. Shortly after, another in- jection was given, composed of nearly half a pint of the third preparation of lobelia. This likewise was retained, causing 40 TYPHUS, CONGESTIVE AND YELLOW FEVER. great distress in the bowels : the patient tossed about in every direction. On the following day the patient was able to sit up, and recovered rapidly. Dr. Shaw was of the opinion that the disease was on the point of terminating in mortification of the bowels, at the time these injections were given, but was prevented by their influence. I knew an instance where injections were repeated and retained until ten ounces of the third preparation were contained in the bowels at one time. This patient also recovered, after the symp- toms had assumed a very alarming character. I was called to New Jersey to attend a young man who was ill of what is termed malignant fever. I found the patient deli- rious ; with a dry and husky skin, and suspension of the secre- tions from the mucous membrane. I was informed that on the preceding day his physician, who pursued the old school practice, attempted to sweat the patient by placing hot dry bricks around him, and confining the patient by a cover held by assistants. This increased the distress so much, that it was with difficulty the patient could be kept in bed, being most of the time delirious, with a determination of blood to the head, and burning heat in the skin. Had the patient been in a cold sweat, the dry heat would have been very proper, but under the circumstances before described, such applications cannot prove otherwise than distress- ing and injurious. I gave this patient a preparation of salt, cayenne pepper, and vinegar, which excited the secretions of the mucous membrane, the patient beginning to raise large quanti- ties of tough mucous from the throat and mouth. A frame was made of hoops, and placed over the patient, and over the frame a quilt; under the quilt was placed a pan containing hot water. A hot brick was put in the water, and a steam created, which was continued for half an hour, wetting the face, and occasion- ally all over the surface with cool vinegar and water. This was not only borne well by the patient, but was comfortable. He sweat freely, and under the general course of treatment pursued in bad cases, he soon became convalescent, and reco- vered. In bad cases patients will generally experience more or less distress under the operation of a course of medicine; but this in general is to be considered more favourable than when the sensi- bility is dormant. I have repeatedly known patients to be much distressed, for many hours together, under the influence of the emetic and injections, and shortly after, the disease take a very favourable turn. Patients are generally extremely weak and prostrated on the turn of a fever, or more properly when the disease forms a crisis. CHAPTER II. ERUPTIVE DISEASES. SECTION I. SMALL-POX. This disease is characterized by a peculiar form of eruption which affects the skin during the progress of the disease. All the other symptoms are such as occur in other acute diseases. Small-pox is highly contagious, and may be taken at any period of life. Like measles and scarlet fever, small-pox very rarely occurs more than once in the same person. Previous to the introduction of vaccination by Dr. Jenner, the mortality from small-pox was very great; hence it has been dreaded more than any other contagious disease. Cause.—Small-pox is caused by a certain spedflc poison, com- municated to the system either by inoculation, or by breathing the effluvia arising from the body of one affected with the dis- ease. There are cases of small-pox, however, which arise from causes independent of exposure to the disease in others. From the period when the small-pox poison is first intro- duced, up to the time when its influence upon the system is first manifested, from seven to twenty days may ensue, though in the great majority of cases, this period is between the ninth and fourteenth day. Small-pox is divided by medical writers into two varieties— the distinct and confluent. There is no essential difference be- tween these, other than that the latter is a more malignant form of the disease. The eruption, instead of remaining in distinct and separate pustules, run together and form irregular masses, or patches. In some instances the pustules are confluent on the face, while they are distinct over the body. Symptoms and course of the distinct or milder variety.—In whatever way the small-pox poison is introduced into the system, 42 SMALL-FOX. it is carried to the stomach, and upon this organ its deleterious influence is first exerted. Chilliness and langour, loss of appetite, aching pains in the back and lower extremities, great thirst, nausea and vomiting, with pain and distress at the pit of the stomach, are the usual symptoms accompanying the forming stage of the disease. As the constitution reacts, the fever becomes developed, and generally, in the course of three or four days, the eruption ap- pears. The fever, in small pox, presents the same character as ordinary bilious fever, such as a hot and dry skin, furred tongue, costive bowels, pain in the head, and scanty, high colored urine. Bleeding from the nose is apt to occur during the first and second day of the fever. "The mind is dejected and confused, and towards the end of the third day the tongue usually acquires a bright red color." " Shortly before the appearance of the eruption, an unusual tendency to perspiration generally occurs in adults, and fre- quently much drowsiness, and sometimes coma" (or stupor) "su- pervenes at this period." "In children the eruption is some- times preceded by convulsions ; but the tendency to free perspi- ration very rarely occurs in them," In many cases the hands and feet are cold throughout the whole course of the disease, more especially in very young children. The eruption first appears on the face, and generally in the course of twenty-four hours is spread over the body and limbs, " consisting at first of red points, which by the middle of the second day present small elevations, with inflamed basis, which as yet discharge no serous fluid, if punctured, but the cuticle appears distended by a sort of semi-transparent plastic lymph. Towards the end of the second day, some of these pustules pre- sent small depressions in the centre; and on the following day these characteristic depressions become conspicuous in nearly all of them. Where there are but few pustules, they often remain elevated and pointed, with but a very slight central depression; but where they are numerous they become flattened, with dis- tinct depressions in the centre. As the pustules increase in size their flattened form becomes more conspicuous. About the fourth day they assume a whitish colour, and become surrounded by a pale red areola. When the pustules are very numerous, these areola run into each other, and give a uniform appearance of redness between the pustules. The fever always remits or entirely disappears as soon as the eruption is fully out. By the fifth or seventh day of the eruption, the serous fluid contained in the pustules begins to change its colour, " marking the stage of suppuration." As suppuration goes on, these pustules become distended with pus, and losing their flattened form, acquire a spherical shape." SMALL-POX. 43 The face begins to swell, generally, by the eighth day, and occasionally the eyes become entirely closed. The fever usually returns during this stage of the disease. " Towards the end of the tenth day, the swelling of the face begins to subside," and the hands and feet, and other parts of the body, become swollen and tender. Soreness of the throat, and a copious discharge of saliva, al- most invariably accompany the suppurative stage. " As the disease advances, the pustules become gradually yel- lower, and more opaque, and arrive at their full state of maturity about the twelfth day. After the pustules have acquired their perfect state of development, they sometimes remain stationary for several days ; but more commonly a brownish spot makes its appearance on the centre of each pustule as soon as the pro- cess of suppuration is completed, acquiring at the same time a rougher aspect, and a deeper yellow. Soon after this change the pustules begin to shrink, becoming gradually drier, darker, and harder, until the matter is converted into a brown crust." These scales are frequently formed on the face, when the " pus- tules on the extremities have scarcely arrived at maturity." The mild form of small-pox rarely leaves the skin permanently marked or pitted. Such is the process by which the constitution works off from the system the poison of small-pox,—first, by the reaction or fever, by which the disease is thrown to the skin, and then by certain mysterious actions, there is formed on the surface the same specific poison which caused the disease. These sanative operations of the constitution, however, are liable to be perverted by various causes, and the disease to assume a malignant and dangerous character. In some instances there is a strong tendency to putrefaction,—" The heat is acrid ; the perspiration clammy and offensive ; watery diarrhoea often oc- curs ; the face is bloated and red ; the eyes watery and inflamed ; and the appearance of the eruption, and its progress, are irregu- lar. The pustules commonly acquire a dark or livid hue; are sur- rounded by brown, or almost black margins; and become filled with a bloody serum instead of pus." Where the disease is of a violent or malignant character, the eruption, instead of being in distinct or separate pustules, appears in irregular masses, or patches, by the pustules running together. This forms the confluent variety of small-pox. Confluent small-pox assumes various modifications. In some instances the disease is highly inflammatory, commencing "with strong chills, succeeded by intense febrile heat; a frequent, full, and hard pulse ; high coloured and scanty urine ; flushed coun- tenance; sometimes delirium; and in children often with convul- sions." The tongue is dry and harsh, and frequently coated 44 SMALL-POX. with a dark or black fur, with excessive thirst. In some in- stances the brain becomes greatly affected, giving rise to violent delirium, stupor, and convulsions. " The tendency to profuse perspiration, so conspicuous in the distinct small-pox, is rarely observed in the confluent variety ; but profuse diarrhoea sometimes occurs shortly before the appear- ance of the eruption, and still more commonly during the suppu- ration." The pustules are generally "irregular in shape, and much less elevated than in the distinct small-pox, and the pai'ts not covered with the eruption are pale and flaccid." "In the more aggravated instances of confluent small-pox, it often assumes a typhus character." "The chilly stage is un- usually protracted; the pulse remains small, weak, and frequent, and the patient complains of much muscular prostration. Various symptoms of nervous disturbance are apt to occur—such as ver- tigo, faintness, twitching of the tendons, and even convulsions. The urine is colourless, and the face pale and sunken. The pus- tules come out slowly and irregularly, appearing simultaneously on every part of the body, yet sometimes first on the extremi- ties." " The eruption sometimes disappears on some parts without passing into the pustular state; and slight causes, such as cold, or mental agitation, may cause the whole eruption to recede ; in which case convulsions, or apoplexy, or fatal conges- tion and effusion into the lungs, are apt to supervene. Suppu- ration goes on slowly, and imperfectly ; the pustules becoming filled with a thin watery pus. The intermediate skin is seldom much tumified, and remains pale." Treatment.—Small-pox should be treated on general princi- ples, the same as in other forms of disease accompanied with fever. To cleanse the stomach by emetics ; to promote the action of the bowels by injections ; and to sustain the vital pow ers by pure stimulants, constitute the most important indications in the treatment of small-pox. The course of medicine administered in the early stage of small- pox, tends to relieve the distress, and to cause the disease to as- sume a favourable aspect. The course ofmedidne, however, will be proper at any period of the disease when the condition of the patient seems to require it. During the cold or forming stage, the patient should be kept warm ; but after the fever is established, the covering should not be too great, nor the room kept uncomfortably warm. It is also important that the room should be well ventilated. The patient's clothing should be changed every day, taking especial care that the fresh clothing be perfectly dry before it is put on. When the pustules arc distinct and not very numerous, and SMALL-POX. 45 the symptoms are of a favourable aspect, it will not be requisite to give much medicine. An occasional dose of the composition or pepper tea: or if the patient be a child, simple herb teas, as pennyroyal, sweet marjoram, or balm, will be sufficient. The bowels to be relieved, when necessary, by injections. When the symptoms are very distressing, or the patient unable to bear the fatigue of sitting up, emetics may be given without previously administering the vapour bath. Much benefit may be derived from broken doses of lobelia, when the fever is vio- lent. The Vapour Bath.—During the chilly or forming stage of small-pox, more especially when the efforts at reaction are fee- ble, and the cold stage consequently becomes more protracted, the vapour bath is of essential benefit, and when followed by an emetic will seldom fail to bring on reaction. The bath also prepares the skin for the reception of the eruption. During the eruption, an occasional vapour bath will prove beneficial, by promoting the secretions and exhalations from the skin, which is one of the principal outlets of disease. In the lat- ter stage of the eruption, when the scabs are coming off, the vapour bath will be of especial advantage in restoring the skin to a healthy condition, and thereby prove a preventive to the various affections which sometimes follow as a consequence of an unhealthy condition of the skin. While steaming, the patient may be washed or sponged over with castile soap and water, or with a weak solution of saleratus in water. The temperature of the water should be regulated to suit the feelings of the patient. A strong decoction of sumac berries and leaves, or of bayberry powder, adding a portion of cayanne, maybe given once or twice a day, in ordinary cases, or substituted for the composition and cayenne, and given several times a day. This also forms a use- ful gargle for the throat, which is in most instances, considerably affected. Cold Drinks.—Where the thirst is urgent, moderate quantities of cold water, or lemonade, may be allowed the patient, more especially after taking a dose of the hot medicine. The Diet.—During the early stage of the disease but little nourishment will be desired. Crust coffee, barley water, elm gruel, &c, are suitable in ordinary cases, until the disease is on the decline, when a more generous diet may be allowed, as chick- en tea, milk porridge, toast and milk, soft boiled eggs, custards, &c. In the confluent form of small-pox, where the symptoms indicate great prostration of the vital powers, wine whey and the essence of beef should be given as nourishment. Five or ten 46 SMALL-POX. grains of the carbonate of ammonia may be added to a wine- giassfull of the whey, as it tends to prevent acidity of the stomach, and also affords a grateful stimulous. Constipation of the bowels may be in a great measure overcome by a diet consisting principally of unbolted wheat flour gruel, calves' foot jelly, stewed prunes, indian gruel, well boiled, or bread cut in thin slices, well toasted, and softened with sweet cream, or boiled milk. When the disease is of a typhus, or otherwise malignant cha- racter, the treatment should consist of such means, both external and internal, as are best adapted to support the prostrate and sunken energies of the constitution, and to assist the stomach to cast off offensive matters, which tend to weaken and oppress its powers. I know of no better emetic, in such cases, than the liquid of the third preparation of lobelia, in a strong tea of the sumac or bayberry. A teaspoonful of the third preparation of lobelia to a tea cup half full of the above tea, and the dose re- peated every hour or two, should be continued until the symptoms become more favourable. I have found it necessary in some in- stances, to continue the use of the third preparation for several days and nights in succession, together with pepper tea, wine whey, and carbonate of ammonia. In some instances, the lobelia powder, put in hot bayberry tea, and then strained, answers better than the third preparation of lobelia. The patient's clothes and bed-clothes should be changed fre- quently. A feather bed should be avoided, except in the middle of winter: The "inwrard heat" should be maintained, to keep a determi- nation to the surface. This may be accomplished, in ordinary cases, by an occasional dose of composition or pepper tea, or by simple ginger, or pennyroyal tea. During the progress of suppuration, but more particularly when the scabs begin to form, patients are very liable to be restless and greatly distressed. There is probably no remedy for this equal to the vapour bath. I have seen patients in great suffering and distress, rendered comparatively comfortable and quiet, in a few minutes after applying the vapour bath. Applied in bed, as directed for steaming in bed, the patient will bear it from half an hour to an hour, and even longer. During the steaming, the surface should be washed over freely with castile soap and tepid water, or saleratus water, and after the bath, the bed-clothes, as well as the clothes of the patient, changed. I knew an instance where a patient being steamed at a time when the scabs were fully formed, and almost dry, that they came off in a body, and left the surface almost "raw," the dis- ease having been of the confluent form, and the eruption covering SMALL-POX. 47 almost the entire surface. An ointment made of sweet oil and lime water was spread on soft cloths, and applied over the body, and in two or three days the soreness was principally removed. This circumstance afforded an opportunity for gossips to astonish the neighbours by their description of the terrible effects of steam: fortunately for the " steam doctor," however, the patient reco- vered rapidly after. During any stage of the disease when the skin is very hot, the surface may be sponged occasionally with tepid water, and the external covering be kept light. It is injurious to a patient to keep his room very hot and close. The disease is more danger- ous in hospitals in consequence of the vitiated air. Tincture of lobelia and water answers very well to sponge the surface with ; but all kinds of oils or fat should be kept off, as they finally tend to aggravate the distress. A mixture of lime- water and sweet oil may be applied with benefit. The mucillage of slippery elm will afford relief, and may be applied to various parts in the form of a poultice. Camphor Liniment.—" Take of camphor, half an ounce; olive oil, two fluid ounces. Dissolve the camphor in the oil." This liniment is recommended as a means of preventing, or at least lessening pitting of the skin on the face. It is directed to be used in the early stage, soon after the eruption appears. The eleventh and thirteenth days are said to be the most dan- gerous periods of the disease. During suppuration, or in the latter period of the disease, the system should be nourished by the most nutritious diet that the stomach can take, such as wine-whey, milk porridge, essence of beef, mulled egg, &c. And in order to sustain the system in the latter period, the stomach should be well cleansed in the early stage of the disease, by courses of medicine. It is not in every case, however, that nourishing food can be taken, except in small quantities ; and under these circumstances, pepper and other stimulants must be used to sustain the restorative actions. To prevent Pitting.—Professors Chapman and others recom- mend slippery elm mucilage spread over the face, and covered with gold leaf, such as is used by the dentists, and to be applied on the third day of the eruption. I have tried the gold leaf in one case, but it did not succeed ; the case, however, was "of a desperate character, and I cannot say how it might answer in less violent cases. Others recommend the application of a sheep's caul, kept over the face, in order to exclude the air. To pre- vent pitting, it is important to exclude the light as well as the air. The gold leaf might be spread over the caul, which would prevent the admission of light. 48 SMALL-rOX. When the eyes are very sore, they should be kept covered With soft cloths wet frequently with rosewater or raspberry-leaf tea. Small-pox attacking females in a state of pregnancy, is con- sidered by the medical profession as always dangerous. The distinct variety of small-pox seldom proves fatal under judicious Thomsonian treatment; and even in the confluent form, unless under unfavourable circumstances, the system, by proper assistance, will " work out its own salvation." When the vital powers are greatly prostrated, and the disease assumes a typhoid or malignant character, it almost always proves fatal. Favourable Symptoms.—A well developed eruptive fever; the pustules remaining distinct, round, and filling with thick yellow pus, and a blush or areola, encircling their base. Unfavourable Signs.—When the reaction or fever that brings out the eruption is imperfectly developed, indicating want of vital power; a sudden subsiding of the swelling of the hands and face, with pallid countenance, or a striking in of the eruption, the case may be considered as of a highly alarming character. When- ever the symptoms assume an unfavourable aspect, a thorough course of treatment is required to arouse the sinking energies of the system. A Case.—I was called to attend on Mrs. P-------, who had violent symptoms of approaching abortion. She was in her third' month of pregnancy,—a period at which abortions are very liable to occur. A full course of medicine was given, which eased the pains for a time. On the following day, however, they returned, and I thought abortion must take place. The third preparation of lobelia was now given freely, until very copious vomiting ensued, when the pains ceased and did not again re- turn. On the following day an eruption appeared, and wiiich proved to be genuine small-pox. The eruption came out so thick that it ran together, and formed what is termed the confluent small-pox. The case proved to be of a severe character, but the patient recovered perfectly, and without having any return of bearing down pain, or other symptoms threatening abortion. The above case illustrates the safety and advantage of treating all violent forms of disease upon general principles, not regard- ing the name by which the disease may be designated. Thus, the same means that prevented the abortion, were precisely such as were adapted to throw the small-pox to the surface. And if the symptoms of abortion had been occasioned from other causes than that of small-pox poison, still the same general plan of treat- ment would be indicated. Thomsonians do not require to wait VACCINATION—COW-POX—KINE-POX. 49 for a disease to become developed, so that they can give it a name before they administer medicine. Hot medicine, and in violent attacks, a course of medicine cannot be given amiss. The same means that will assist nature in bilious fever, will do the same in small-pox, or in any other disease. It is at least pro- bable that the thorough treatment pursued in the above case, prevented abortion by cleansing the stomach, and throwing the small-pox to the surface. The question is frequently asked, whether the stimulating medicines, given freely, will not make the eruption greater than it would have been without it ? To this it may be replied: If the disease is not thrown fully to the surface, the eruption may be less, but the constitutional symptoms will be more violent and dangerous than where the eruption is greater, and the disease effectually thrown to the surface by pure stimulating medicines. To cast the disease off by the surface is the method established by nature, and these curative efforts should be aided. I am not in the habit of giving largely, hot medicine, in the early stage of the disease, nor to keep the patient covered uncom- fortably warm during the fever, nor in any subsequent stage of the disease. But a thorough course of medicine will be safe and useful in any stage of small-pox, and also the free use of pure stimulants. A course of medicine in the early stage of small- pox by cleansing the stomach, will tend to lessen the eruption, and at the same time remove the disease from the internal organs. Chronic affections often follow small-pox, owing probably, in many instances, to the disease not being effectually throw7n to the skin, and the determining powers not kept outward. SECTION II. VACCINATION—COW-POX—KINE-POX. The practice of vaccination originated in England, about the year 1796. It was introduced by Dr. Jenner. In the year 1775, Jenner, who was then a student of medicine, one day heard a dairy maid in the office, in conversation with his preceptor, declare that she was not afraid of the small-pox (which was at the time prevailing in the neighbourhood) for she had taken the kine-pox, and that dairy maids that had taken the dis- ease from the cows never took the small-pox. This declaration of the milk girl, first gave Jenner the idea of introducing the row-pox by vacination, as a means of protecting the system 50 VACCINATION--COW-POX--KINE-POX. from small-pox. Although it had been known in some of the dairy counties in England many years previous to the time of Jenner, that cows were subject to an eruptive disease which be- ing communicated to the hands of the milkers, produced pus- tules, which protected them from small-pox; yet no one before Jenner ever thought of introducing a preventive to the small- pox, by inoculation with the cow-pox matter. The opposition that Jenner met with from the medical pro- fession, in introducing this new practice, was of the most hostile character. Two physicians in London went so far as to declare through the public journals, that introducing the disease from an animal into the human system would convert mankind into a sort of mongrel, partaking of the nature both of man and beast. It was even denounced from the pulpit, as an invention of satan, and that the devil first introduced the practice by vaccinating Job. After many years of devoted attention to this subject, Jenner presented an essay to the Board of Physicians of London, con- taining an account of his experiments in vaccination, and fur- nished proof of the protection it afforded against small-pox. They, however, returned the essay, with the advice to suppress its publication, or otherwise he wrould be considered as either a "fool or a knave." The frightful and ridiculous accounts related concerning vac- cination, during its early struggles against popular prejudice, were probably not even surpassed in inconsistency, by the mul- titude of gross and palpable misrepresentations which are " wafted on every breeze," of the danger of steam and lobelia, and the dreadful consequences which they produce. The practice of vaccination, however, finally gained the con- fidence of many medical men, and it soon became generally adopted. Jenner on his first visit to the United States for the purpose of introducing vaccination, met with strenuous opposi- tion from the medical profession of Boston, where he first landed. Dr. Benjamin Waterhouse, then a Professor at Yale College, was the first of the medical faculty who adopted vaccination.— He introduced it into his own family, and about the same time Thomas Jefferson's family were vaccinated; and in a few years after, the practice of vaccination became generally adopted, not only in England and the United States, but throughout all civil- ized countries. There is too much evidence to admit of a doubt that vaccina- tion affords a protection, in general, against small-pox: that it occasionally fails of affording protection to the system, is equally certain; but it should be borne in mind, that there are many assignable causes for these failures, such as, when the matter used is of a spurions character, or its virtue destroyed by long VACCINATION—COW-POX—KINE-POX. 51 keeping, or wiiere erysipelatous inflammation takes place, and destroys the genuine character of the disease ; or where the pa- tient is affected with an eruptive disorder, and thus pervert or change the vaccine disease. I attended a female, not long since, who had the small-pox in a most violent form, and who had been vaccinated. On examin- ing the mark on her arm, I discovered a large smooth scar, nearly the size of a quarter of a dollar, showing that the scab must have been three or four times as large as a genuine vaccine scab, and that the inflammation had probably so modified the disease as to afford no protection against small-pox. The family of this female had been vaccinated, and they all escaped the small-pox. It is at least probable, that in the greater part of those cases of small-pox that occur after vaccination, the failure of vaccination in affording protection, has been in consequence of imperfection in the vaccine viris; its nature changed by ery- sipelatous inflammation; the vesicle broken, and the fluid escaped; or from the scab being injured or rubbed off soon after it is formed. Concerning Vaccination causing New Diseases.—That erup- tive diseases are sometimes occasioned by vaccination, is admit- ted: but many, and probably the great majority of instances of disease, occurring after, and attributed to, vaccination, arise from other causes, independent altogether of the vaccine viris. How often does consumption, scrofula, and chronic inflammation of the eyes, occur as a consequence of small-pox; and great numbers also die of the disease. Although small-pox may tend to purify the system, as Dr. Thomson asserts, yet there are few, probably, who have witnessed bad cases of it, that would wil- lingly take it, rather than run all the risks attendant upon vac- dnation. Characteristics of a genuine Vaccine Scab.—Not larger in cir- cumference than a five-cent piece, nearly round, and an indenta- tion, or eye, in the centre; smooth on the upper surface, and a bold and regular rounded edge ; of a mahogany colour; and of a horny appearance, and brittle. How to preserve the Scab___Kept from the air in a sealed gJAss vial, and in the dark, a scab will continue good for years. \ To prepare the matter for Vaccination.—Take a portion of the brittle part, near the middle of the scab—place it on a piece of glass or china, and put a drop of cold water on it, and when suf- ficiently soft, mash it with a knife-blade. 52 VACCINATION—COW-POX—KINE-POX. Season most Favourable.—In very cold or very hot wTeather vaccination is very liable to fail, requiring in some instances to be repeated several times before it will take. Age.—A child should not be vaccinated until after it is at least two months old. The usual time is about the fourth or fifth month. Precautions.—Be sure that the matter to be used is genuine. Do not vaccinate a child that is affected with any eruptive dis- ease on the skin. Persons predisposed to erysipelas should not be vaccinated at a time when that disease is prevailing. Place of Insertion.-^-The part to be preferred for introducing the matter, is just below the insertion of the deltoid muscle, on account of there not being so much motion in that part; or it may be done below the elbow, or under the knee on the calf. The General Characteristics of the Genuine Vacdne Disease.—■ First: little or no inflammation until, or after the third day from the time the puncture is made. Second: About the fourth or fifth day, a small point of inflam- mation, which gradually enlarges, and in about two days a small vesicle is formed, which is depressed in the centre, and without inflammation in the adjoining skin. The vesicle enlarges, re- mains circular, with a regular and well defined margin, more depressed in the centre, and a small crust begins to form in the centre of the depression, by the seventh or eighth day. Third: Between the seventh and eighth days, there is an are- ola or blush of inflammation formed around the margin of the pustule. This circle of inflammation enlarges, and frequently by the ninth day, it will be two or three inches in diameter, but remaining circular. The crust in the centre grows darker, " and the turged margin shining, as if the lymph were assuming the character of pus." Fourth: The vesicle generally reaches its acme by the eleventh day, when the surrounding inflammation begins to subside, first immediately around the pustule, and gradually declines towards the circumference, where it leaves, at last a mere ring. Fifth: The fluid in the vesicle becomes thick and turbid, and soon forms into a smooth crust, of a dark brown, or mahogany colour. The crust, in many instances, does not loosen and fall off under three weeks. " It leaves a permanent circular cicatrix, about five lines in diameter, and a little depressed, the surface being marked by many little pits, or indentations, denoting the number of cells of which the vesicle had been composed." VARIOLOID—MODIFIED SMALL-POX. 5S The Constitutional Symptoms attending the course of the vac- cine disease are generally very slight, especially in children. In some instances, there are chills and fever, and headache, which may need some attention, though generally they soon subside without any treatment. The glands under the arm are apt to be swollen and sore, and care should be taken to avoid lifting the child with the hands under the arms, as is the usual practice. Characteristics of Spurious or Imperfect Vaccination.—First: There is generally considerable inflammation and raising of the skin, on the second day after the puncture is made. Second: The scabbing commences by the third or fifth day from the commencement of the inflammation, and runs its course in a much shorter time than the genuine. Third: There is no depression in the centre of the pustule: it is raised up high, and has an irregular margin. " When the inflammation commences on the formation of the vesicle, and assumes an erysipelatous character early, with much swelling, and the pustule assumes a blue appearance, it should not be considered as genuine." Local Treatment.—When the inflammation becomes so great as to require attention, as it often does when the disease is of a spurious character, the parts should be bathed occasionally with tincture of lobelia, and apply a salve of simple cerate, or a pre- paration of sweet oil and lime-water. In some instances, a poultice of slippery elm and ginger, kept wet with the tincture of lobelia, answers better than salves. In severe cases, accom- panied with much pain, the bowels should be relieved by injec- tions, and the patient kept slightly nauseated with lobelia, or if necessary a vapour bath and an emetic given. Aviien the swel- ling is very great the arm should be kept at perfect rest, in a sling, or on a pillow. SECTION III. a VARIOLOID—MODIFIED SMALL-POX. This is an eruptive disease which bears some resemblance to small-pox. It is in general, however, of a much milder charac- ter, and runs its course in about half the time required for small- pox. Tt is the prevailing opinion among medical men, that vario- 54 VARIOLOID—MODIFIED SMALL-POX. loid is genuine small-pox, operating upon a system which has previously undergone vaccination. Symptoms.—The first symptoms are lassitude, langour, loss of appetite, chilliness, and bad taste in the mouth. These are succeeded by a chill in most cases, followed by fever. The fever, in some instances, is as violent as in severe cases of small-pox, though, in general, it is of a mild character. By the third or fourth day of the fever, the eruption begins to appear, and in the early stage, resembles the eruption in this stage of small-pox. There is seldom any fever after the erup- tion comes out. There is no secondary fever in varioloid, such as occurs in the suppurative stage of small-pox. In varioloid the eruption generally comes out at different periods, in successive crops; first on the face and breast, and often disappears there, by the time it first appears on the feet. By the fourth or fifth day the pustules begin to dry, and by the sixth or seventh day, begin to fall off; whereas, in small-pox, the scabs seldom fall off before the fifteenth day. The appearance and course of the eruption, in varioloid, is very diversified. In many instances there is a rash resembling measles, which precedes the eruption. It frequently happens that a portion of the eruption dries up in the course of two or three days, whilst another portion will become filled with a watery limpid fluid, by the first or second day, and by the fourth day, usually burst, and another set will become pustular, some- wiiat resembling small-pox pustules, and remain four or five days longer before they form into scabs. In some cases the eruption becomes confluent, by the vesicles running together in masses or patches; but even in this form of the disease, there is seldom any secondary fever. Varioloid is not often fatal under judicious treatment; much less so than genuine small-pox. Treatment.—The indications of treatment in varioloid are to cleanse the stomach, which is the seat of the disease, by an emetic; preceded, if necessary, by the vapour bath; the bowels to be regulated, by injections; and the constitutional efforts sus- tained by pure stimulants. In the more violent cases, where the patient is much distressed, the emetic or course of medidne should be repeated at proper in- tervals, as long as the symptoms present an unfavourable aspect. In many mild cases, simple herb teas, and a proper attention to diet will be sufficient. The vapour bath may be employed in any stage of the di.sease, VARICELLA—CHICKEN-POX—SWINE-POX. 55 and will be of especial benefit where the skin remains in an un- healthy condition after the eruption has passed off. Varioloid seldom leaves the skin permanently pitted. SECTION IV. VARICELLA—CHICKEN-POX—SWINE-POX. Chicken-pox is an eruptive disease, and generally of a mild character. Some medical writers maintain that varicella is a modification of small-pox, others contend that it is a separate and distinct disease. Chicken-pox is almost universally confined to children, and a second attack in the same individual is of very rare occurrence. Neither small-pox nor vaccination affords any protection against chicken-pox, nor does chicken-pox prevent small-pox. Peculiarities of Chicken-pox.—In general there is some slight fever for one or two days, when the eruption begins to be dis- closed, first appearing on the neck and back, in the form of small bladders filled with a pellucid fluid, which dry away and disap- pear on the seventh or eighth day,—before the small-pox passes through its first stage. The vessicle of chicken-pox will discharge itself on being punctured with a pin. A sinall-pox pustule is cellular and will not discharge its contents if punctured. In chicken-pox the eruption comes out in successive crops, some drying away whilst other crops are appearing, and thus continue for some days. The eruption produces a tingling feel- ing in the skin. Chicken-pox, however, like other forms of disease, assumes various modifications. Severe cases closely resemble genuine small-pox, leaving the same kind of pits in the skin. Chicken-pox is seldom attended with danger, instances of death from it being very rare. Treatment of Chicken-pox.—Where the case is so severe as to demand particular attention, the treatment should be conducted on the same plan as is recommended in the mild form of small- pox, cleansing the stomach by emetics; injections to relieve the bowels, and occasionally some mild stimulant, such as compo- 56 MEASLES. sition or ginger tea, or herb teas, such as pennyroyal, mint, &c. Where large sores are formed, they should be covered with some simple salve, to exclude the air, and favour the healing. section v. MEASLES. Measles are contagious, and seldom occur more than once in the same individual. This disease may be contracted at any period of life; but mostly occurs in childhood. The middle of winter is the season in which it generally prevails. The disease usually becomes developed either on the fifth or seventh day after exposure to the contagion; but occasionally it is not manifested until two, or even three weeks from the time the disease is contracted or imbibed. Symptoms.—Restlessness, chilliness, and shivering; pain in the head; an increased flow of tears, and a discharge of watery humours from the nostrils, are the usual symptoms in the first stage of the disease. Fever comes on; the throat becomes sore; there is hoarseness and a dry cough: thirst, nausea, and vomit- ing; hurried and oppressed breathing; and pain in the loins and back. Sometimes there will be profuse sweating. In about four or five days from the commencement of the fe- ver, the eruptions appear in small red spots, similar to flee-bites, first on the face, and then spreading over the body and limbs. As these spots enlarge, they unite and form red patches, of an irregular shape, leaving portions of the skin retaining its natural colour and appearance. When the disease is of a violent character, slight delirium often occurs about the third day from the commencement of the fever, and in children, convulsions are not unfrequent, a few hours preceding the appearance of the eruption. The eruption on the face usually reaches the height of its de- velopment, on the second day after its first appearance, and on the following, begins to fade and subside. The face is mostly swollen, and in severe cases, so much so as to nearly preclude the sight. The eruption on the body fades away in the same progressive manner in which it made its appearance; so that about MEASLES. 57 the eighth day from the commencement of the fever, it disappears finally on the back of the hands, where it remains longest. Looseness of the bowels is apt to take place when the eruption begins to decline, which is not unfavourable at this stage of the disease; but where a diarrhoea occurs just before the eruption is making its appearance, it is to be considered as an unfavourable occurrence, as it tends to interfere with the regular progress of the disease, or cause it to retrocede. Active purging with cathartics may produce the same effect. Measles occasionally resemble scarlet fever so closely that it would be difficult to distinguish between them. This, however, is a matter of little consequence, as the same course of treatment is applicable in both diseases. Although measles, in general, are not dangerous, yet, in per- sons of feeble constitution, and delicate in health, they occasion- ally become a very formidable disease, assuming the form termed congestive, or typhus. In this form of the disease the vital powers are prostrate; a proper reaction, or fever, docs not ensue, or takes place very slowly and imperfectly. The countenance is pale, and the breathing slow and oppressed; the pulse feeble and laborious; the extremities cold—in short, all the vital ener- gies are depressed. Infants are also liable to this form of mea- sles. Treatment—In ordinary cases of measles, much medicine is not required. The vapour bath and emetic in the early stage, will lighten the disease, and render the patient much more com- fortable; after which warm teas, as composition, ginger, penny- royal, summer savory, balm, &c, in order to keep a determina- tion to the surface, and promote perspiration, are proper. When the disease is of a more violent character, the patient much dis- tressed, or the eruption slow in coming out, a full course of med- icine should be given, and if the symptoms continue violent, repeat the course every day, until there is a manifest improve- ment. Between the courses an occasional dose of composition or gin- ger tea; or if there should be much fever, and the tongue dry, give cayanne tea; and if the cough is dry and hard, as is usually the case, add a small portion of lobelia to the tea, sufficient to produce slight nausea. A teacup full of bayberry tea, made strong, should be given at night to an adult, and half the quan- tity to children. Injections of composition tea, with a teaspoon- ful of green lobelia; or bayberry tea, with a teaspoonful of the liquid of the third preparation, to be used as the condition of the bowels may require. If the weather be cold, the patient's room should be kept warm, and of an equable temperature; and the patient avoid exposure II 58 MEASLES. to a current of air. Still, a proper ventilation of the room will be advisable, which may be effected without risk, when the patient is in bed. Where a stove is used in the room, a basin of water should be kept on it, to prevent the air from getting too dry. The diet should be milk porridge, chicken tea, gruel, and such other light nourishing articles, as are proper in ordinary fevers; avoiding strong coffee or tea, except the black tea. Confection- ary or sweet cake should not be given to children, as is fre- quently done; they are unfit for them in health, and much more so in disease. Affections liable to follow Measles.—There is no disease wiiich leaves the system as susceptible to the morbid influence of cold, as measles. In fact, the effects wiiich frequently ensue as a con- sequence of measles, are more unpleasant and troublesome than the primary disease. Consumption, inflammation of the lungs, scrofula, diseases of the eyes, rheumatism, eruptions about the head, and running from the ears, are not of uncommon occurrence after measles. The liability to these affections, however, will be greatly les- senned when the Thomsonian practice is employed. A vapour bath about the time the eruption disappears, and the skin is peeling off, will tend to restore a healthy action in the skin, and diminish the liability to secondary forms of disease. If the tongue have an unhealthy appearance, and other symptoms which indicate a disordered stomach and bowels, a full course of medi- cine should be given, and use some stimulants to keep up a de- termination to the surface, together with a dose of the bayberry or sumac tea once a day. Death seldom occurs from measles where Thomsonian treat- ment is employed. Under unfavourable circumstances, however, as when two or three patients are crowded in a small room, badly ventilated; or when it occurs in persons predisposed to consumption, or to scrofula, it occasionally becomes an unman- ageable disease. Diet—During the first period of the disease, and until the patient becomes convalescent, the diet should be light, such as elm gruel, rice, tapioca, sago, custards, crust coffee, &c.; and as the disease declines, a stronger diet may be allowed, as milk porridge, soft boiled eggs, chicken soup, &c. &c. Strict attention should be paid to keeping the feet dry, and to avoid exposure to cold and damp weather. SECTION VI. SCARLET FEVER* 'Scarlet Fever assumes many grades of violence, from a 'very mild to that of the most malignant form of disease. It is ^generally treated of under three varieties. First. The simple or milder variety. Second. The inflammatory, where reaction or fever is of a ?high grade: and Third. The malignant, where the vital powers are greatly ^enfeebled by the force of disease: the treatment, however, is to be conducted upon the same general principles, varying in prompt- mess according to the violence of the disease. General character and course of the simple variety.—Beginning with the usual premonitory symptoms of acute disease, such as paleness of the skin, loss of appetite, lassitude and chilliness. These continue for an indefinite period, " varying from one to three or four days," when reaction takes place, and the patient experiences flushes of heat, pains in the head, loins, and extrem- ities; sickness of the stomach; the skin becomes dry and hot, and the pulse frequent and quick. " Generally within the first forty-eight hours after the com- mencement of the fever, a scarlet eruption comes out, first on the face, and then successively, on the neck, trunk, and extremities." "The rash consists of innumerable red points, which, running into each other, gives a diffused blush over the skin." In some cases the eruption appears in patches, " leaving the skin in the intermediate space of its natural colour." Usually by the fourth or fifth day, the eruption and fever begin to decline; critical evacuations ensue, such as a copious dis- charge of urine, depositing a reddish sediment; a general warm perspiration; and sometimes diarrhoea. About the eighth day after the commencement of the eruption, the skin begins to roughen and peel off, at which time there is considerable itching over the surface. Sometimes the disease assumes a more violent character;— there is much distress and sickness of the stomach, together with severe head-ache and general weakness. The reaction or fever comes on early, " with a feeling of stiffness and dull pain in the muscles of the neck and under the ears, and angles of the jaws." The throat becomes swollen, whicli renders it difficult for the 60 SCARLET FEVER. patient to swallow; a hoarseness of the voice takes place, and there is a " sense of constriction in the throat." The fever as- sumes a high grade of violence; the skin is dry and harsh; the tongue dry and of a bright red along the edges, and over its sur- face the little glands, or papillae may be seen projecting. *♦ The eruption does not come out as early in this as in the milder form of the disease, and |t is seldom diffused over the whole surface— appearing in irregular and not very large patches, on different parts, more particularly about the elbows. In some instances the rash disappears, and reappears partially at unequal portions of time,but without any corresponding change in the general dis- order and the whole duration of the complaint is thus lengthened. If the disease begins to decline by the fourth or fifth day of the fever, the throat rarely ulcerates, the swelling and inflammation subsiding as the disease abates. Where the disease is more pro- tracted, " small ulcers are apt to form on the palate and tonsils, which are soon converted into superficial sloughs." •' There is always a considerable quantity of viscid mucus secreted in the fauces, which often concretes into white flakes on the inflamed parts and presents the appearance of ulcers, where in reality none exists." As the disease gives way, "the sloughs in the throat begin to separate, and leave red ulcerated surfaces, which generally heal without difficulty. Sometimes, however, instead of separating about the eighth day, the sloughs enlarge, become brown, and discharge an acrid saneous fluid; and in such cases the glands about the neck are generally swollen, hard, and pain- ful; and the patient is harrassed with painful diarrhoea and te- nesmus. The inflammation occasionally extends into the trachea, and the patient dies under symptoms of acute bronchitis. The brain often becomes prominently affected during the eruptive stage, giving rise to deep and sometimes fatal stupour. Malignant Scarlet Fever.—This form of the disease is marked by a general prostration of vital power. The reaction, though it may be apparently vigorous in the commencement, soon de- clines into a low, or typhoid fever. The eruption comes out irregularly, and is usually pale in the commencement, but " acquires a dark, or livid hue, in the pro- gress of the disease. The eruption often strikes in soon after its first appearance, and in two or three days reappears on some part of the body. The skin varies in its temperature; generally it is not very high, though occasionally there is a burning, acrid heat, over the surface. The brain is much affected early in the disease. The patient becomes delirious; the eyes are inflamed, and dull, and the cheeks suffused with a livid flush, readily distinguished from the bright red whicli occurs in a less malignant form of the SCARLET FEVER. 61 disease. "The tongue is dry and covered with a brown or dark fur, and the breath foetid." The ulceration of the throat assumes a very malignant character, and frequently it is converted into black and offensive sloughs, accompanied with an acrid se- cretion from the nose, which excoriate the parts with which it comes in contact. "The fever and ulceration of the throat fre- quently exist without there being any eruption developed during any period of the disease: this is called putrid sore throat. In some instances the vital powers are prostrated in the commence- ment of the disease to such a degree, that reaction does not take place. "Thepatient becomes pale, faint, and oppressed;" there is much distress and oppression at the stomach, with nausea and vomiting; giddiness, and a sense of weight in the head; and ex- treme debility. The breathing is oppressed, and sometimes there is a mixture of paleness and lividity on the cheeks. "The pulse is slow, irregular, and weak." "The bowels are torpid in the beginning, but towards the termination of the disease,, diarrhoea almost always occurs in fatal cases." The eruption is at first pale, or of a copperish hue, which subsequently be- comes purple. Malignant scarlet fever, in some instances, terminates fatally as early as the second, third, or fourth day. In other instances, the vital powers will struggle with the cause of disease for weeks, occasioning a low typhoid fever, until finally, either the disease or the energies of the system are exhausted, thus terminating either fatally, or in convalescence. A milder form of scarlet fever may assume a dangerous cha- racter, by twTo or more patients sick of the disease, being in the same room; more especially if the room be small, and the pa- tients kept near each other. The exhalations from a patient sick of scarlet fever, will sometimes occasion a tingling in the nose, and even in the skin of the physician or nurse; and when patients are placed near each other, the disease will always be- come aggravated by it, and in many instances, prove fatal. Scarlet fever, in its mild form, occasionally so closely resem- bles measles, that it becomes difficult to distinguish between them. The indications of treatment being the same, however, in both diseases, the difficulty of determining the name will oc- casion no embarrassment in directing the treatment. Causes.—Though evidently contagious, still there is the most conclusive evidence that the disease is frequently produced by atmospheric causes, together with exposure to cold and damp- ness. Treatment of Scarlet Fever.—A course of medicine, adminis- tered in the early period, will generally moderate the symptoms 62 SCARLET FEVER. through the whole subsequent course of the disease, and in some instances will almost break it up at once. In the mild form of the disease, after giving a course of medi- cine, or simply an emetic, as long'asthe symptoms are of a mild character, nothing more will be required than to give occasion- ally of some mild stimulant, such as composition or ginger tea, or simple herb teas, such as pennyroyal, catnip, sweet marjo- ram, &c, and an occasional enema, to relieve the bowels; to- gether with small doses of the tincture of lobelia, more especially at night. Where the symptoms are more violent, and the patient much distressed, a course of medicine should be administered daily, and small doses of lobelia given every hour or two, in composi- tion, bayberry, or pepper tea. It is not always requisite to ad- minister the vapour bath previous to giving an emetic, as in some instances free vomiting should be produced two or three times in every twenty-four hours. Where the tongue is dry, and the patient thirsty, the pepper tea will answer better than the com- position. Where the skin is very hot and dry, it will be diffi- cult to produce perspiration, even by the vapour bath, without frequently washing or sponging the surface with cold wrater, or tepid vinegar and water, or what is still better, salseratus water. A tablespoonful of cold water may be allowed the patient occa- sionally, where the tongue is dry. Sponging the surface with cold salseratus water, or weak ley, may be safely employed during the first two or three days of the fever, when the patient is very restless, and the skin hot and dry, and the patient is not chilled by it. After this period it will be safer to use tepid ablutions of weak ley, or salseratus water, to reduce the heat of the skin, and quiet restlessness. Injections are of essential benefit in the treatment of scarlet fever, as they not only relieve the bowels, but tend to equalize the circulation. They should be prepared in the usual form,— either of composition tea, adding a teaspoonful of lobelia powder; or bayberry tea, adding a teaspoonful of third preparation of lo- belia. In violent cases the injections should be repeated every two hours. An occasional injection prepared of lobelia powder and warm water, will be found of benefit in relaxing the system, when the fever is very high; the injection should be retained in the bowels fifteen or twenty minutes. Sometimes this will occa- sion free vomiting, and prove of especial benefit. Care will be necessary not to keep the patient too warm, externally, when the fever is high. A hot stove room is very oppressive to the sick, unless water is kept constantly evaporating on the stove, to pre- vent the air from becoming too dry. SCARLET FEVER. 63 Precaution—More than one patient affected with scarlet fever should never be admitted into the same room, where it can be avoided. This precaution is of the very greatest importance. Treatment of Malignant Scarlet Fever.—Generally, the reac- tion commences violently, the system being thrown into a state of tumultuous excitement; but, from the power of the cause of disease, the vital energies soon become exhausted, and the fever assumes a low malignant or typhoid character. In other in- stances, the vital powers are overwhelmed in the outset of the disease, and are unable to bring on reaction. The patient re- mains cold, and in a state of stupor, or he is thrown into convul- sions. In either case, the treatment should be prompt and energetic, consisting of emetics, of either the liquid of the third preparation of lobelia, or some other preparation of lobelia, rendered stimu- lant by the addition of capsicum, or the No. 6, and given in the bayberry tea. This, together with stimulating injections, and external warmth, will be the surest means of establishing reac- tion. To sustain the curative efforts of nature, active stimulants should be employed, as the third preparation of lobelia, in com- position, bayberry, or capsicum tea, wine whey, and carbonate of ammonia. A tablespoonful of capsicum tea, and as much wine whey, with about five grains of the carbonate of ammonia, forms an excellent stimulant in all low sinking states of the system. If the skin is dry, a moist heat should be kept around the pa- tient, as hot bricks wrapped in damp cloths; but where the skin is cold and clammy, a dry heat will be proper, together with warm frictions and stimulants to the surface. "The capsicum," says Dr. Eberle, " appears to be a particu- larly valuable remedy in this variety of the disease. This arti- cle was first employed in malignant scarlatina, by Dr. Stephens, in a very fatal epidemic which prevailed at St. Christopher's, (West Indies,) in 1787, and it has since received the decided ap- probation of many eminent practitioners." The form in which the faculty employ it, is similar to Dr. Thomson's pepper sauce —a tablespoonful of capsicum, and two teaspoonsful of fine salt, to half a pint of boiling water. Strain, and add an equal quan- tity of good vinegar. For an adult, a tablespoonful every half hour; for children, a less quantity, in proportion to their age. The throat to be frequently gargled or washed with it. " Ste- phens asserts that he employed this remedy in about four hun- dred cases, and with surprising success. The ulcers in the fau- ces soon cast off their sloughs, and commenced to heal; a general pleasant warmth was diffused through the system; and the vital powers speedily assumed a more active condition." There is, how ever, such an antipathy against cayenne pepper, that nurses 64 SCARLET FEVER. sometimes refuse to give it, because it makes the child cry, and they have heard others say it is too hot for children. I have never observed any ill effects from the use of cayenne pepper, either in the young or old, but many children die, who probably might have been restored to health, by a free use of this pure stimulant. The capsicum tea I find to answer as well, or even better tban the pepper sauce, more especially in cases where the stools arc of a green cast, or emit a sour smell. As much cay- enne as will lay on a five cent piece, and double the quantity of composition powder, mixed in a tablespoonful of bayberry tea, answers better, in many instances, than giving the tea without the powder; the dose to be repeated every two or three hours. When the patient is thirsty, pennyroyal, or any other simple herb tea, may be allowed to be taken freely. Applications to the Throat, externally.—In all cases where the throat is much affected, a warm poultice should be applied. This may be made of Indian mush, well boiled, adding a portion of ginger, and when the poultice is spread, cover the surface of it with lobelia powder. The poultice should be renewed, or warmed occasionally, and not allowed to become cold. Slippery elm, or flaxseed will answer as well as the Indian mush. Gargles.—In the early stage of the disease, the tincture of lobe- lia answers well as a gargle. The capsicum tea, or pepper sauce, however, forms the best gargle in scarlet fever, and may be used frequently during the whole course of the disease. Swabbing the throat with the capsicum tea, or pepper sauce, is still more effec- tual than the use of gargles; and in young children who cannot use the gargle, the swab must necessarily be used. This is to be done with a piece of sponge, or rag, tied firmly on the end of a stick. Dip the swab in the preparation, and rub over the throat. This is sometimes a difficult operation in children, but the bene- fit to be derived from it should induce nurses and parents to be persevering in its use. A soft piece of wood placed between the jaws, will enable the nurse to apply the swab more effectually. The child's head should be held firmly. The Diet, in the early period of the disease, should consist of liquids, such as barley water, arrow root gruel, crust coffee, elm gruel, and gum arabic water. In a later period of the disease, a more nutricious diet may be allowed the patient, as milk por- ridge, essence of beef, mulled egg, and egg custards. In a sink- ing state of the system, wine whey, with carbonate of ammonia, will be proper. Scarlet fever is liable to be followed by dropsical affections, from exposure to cold, or inaccuracies in diet, before the patient SCARLET FEVER. 65 has fully recovered from the primary disease. As long as the tongue remains coated, or does not present a healthy appearance, care should be taken to avoid exposure to cold or dampness; and the diet should be confined to such articles as are easy of diges- tion. I attended a little boy in Second street, who had anasarca, or general dropsy, following scarlet feyer. Under the treat- ment, the symptoms all became more favourable, and the patient began to recover rapidly; but from eating heartily of broiled mackerel, which his stomach could not digest, dropsy of the chest ensued suddenly, and the case terminated fatally in less than forty-eight hours after. An occasional vapour bath, followed by a shower bath, and the surface rubbed dry, and bathed over with some stimulating preparation, as pepper sauce, or No. 6 and water, equal parts, will tend to prevent dropsy, or other affections that might other- wise ensue, as a consequence of scarlet fever. The spice bitters, or other tonics, as Virginia snake root, or Colombo, should be given two or three times a day, to assist in restoring digestion. Where dropsy has ensued, the bath should be administered daily, as above directed, and followed sometimes by an emetic; broken doses of lobelia given either in tincture or pills, together with an occasional dose of composition or pepper tea; and as the swelling subsides, and the tongue becomes more natural, tonics will be proper. A Case.—I was called to attend a young man who had been ill of scarlet fever about a week. The rash had been from the beginning, alternately appearing and disappearing. The fever was of a low grade, and attended with delirium. The principal medicines used in this case, and which proved successful, were the liquid of the third preparation of lobelia, in a strong decoc- tion of bayberry tea,—a teaspoonful of the former to a teacup half full of the latter, repeated every two or three hours, in con- tinued succession for several days and nights; together with an occasional injection of the same kind of compound. This medi- cine always quieted the delirium for an hour or two, and occa- sionally under its influence the patient would sleep. As the de- lirium returned, the dose was repeated, and these symptoms would again subside. The patient generally vomited once or twice in the course of twenty-four hours, but seldom complained of sickness at the stomach. Under this treatment, together with an occasional vapour bath, administered on a mattress, the patient recovered. The diet consisted principally of wine whey and essence of beef. The Thomsonian practice is generally successful in scarlet fever, when applied in the first outset of the disease, though oc- casionally it baffles the most thorough and judicious treatment. I 66 NETTLE-RASH—HIVES. The treatment pursued in the above case is given in order to point out a course that may prove successful in other desperate cases. In bad cases of scarlet fever, the floor should be sprinkled three or four times a day with a few teaspoonsful of the chloride of soda, or the chloride of lime placed in vessels about the room. This is more especially necessary where there are more than one patient in the same room. SECTION VII. NETTLE-RASH—HI VE S. This is an eruption resembling the rash produced by striking the skin with nettles. The skin is raised, and whitish on the top, with a hardness and swelling around the margin, and more or less inflammation, and is attended with painful itching and tingling. There is a tendency in nettle-rash to disappear and reappear suddenly, and thus continues for several successive days. In some instances, the eruption comes on only at night, with an itching and tingling over the whole body, and when the skin is scratched or irritated, large weals immediately rise up, with a paleness or whiteness on the centre, and light red margins, at- tended with intolerable itching and stinging pain. Occasionally the disease becomes chronic, the swelling remain- ing stationary for weeks, or even months. Cause.—Nettle-rash is caused by a disordered condition of the stomach aud bowels. Eating shell-fish will sometimes bring it on. Balsam copaiva, where it disagrees with the stomach, will occasionally produce this kind of eruption. Treatment of Nettle-rash—The vapour bath, and a lobelia emetic, will, in many instances, remove the disease at once. If the first operation fail of effecting a cure, repeat it at proper in- tervals, until the general health is restored; giving occasionally composition or spice bitters; and cleanse the bowels by using in- jections, prepared in the usual form. In milder cases, purified charcoal, taken in composition tea, two or three times a day, together with one or two injections, will be sufficient to rectify the constitutional derangement. A friend of mine informs me that half a teacupful of saffron tea, sweetened, and taken at bed time, will overcome the symptoms. ERYSIPELAS—ST. ANTHONY'S FIRE, OR ROSE. 67 The Diet should be simple; avoiding all gross food. Where the disease has become seated, let the accustomed diet be changed to other articles of equally nutricious qualities. Local Applications—In recent cases, the tincture of lobelia, vinegar and water, or alcohol and water, may be applied imme- diately to the eruption. In chronic cases the stronger stimulants should be applied to the swellings, as the No. 6, third prepara- tion of lobelia, pepper sauce, or stimulating liniment, &c.— All eruptive diseases of this kind are to be treated upon the same general principles. SECTION VIII. ERYSIPELAS—ST. ANTHONY'S FIRE, OR ROSE. Tins form of disease is characterized by a redness of the skin, swelling, a tingling burning pain, and the formation of blisters on the inflamed surface. Erysipelas probably never occurs except there be previous derangement of the general health. Usually the first symp- toms are langour, chilliness, headach, loss of appetite, and other signs of a disordered stomach. These symptoms are followed by two or three days' fever, before the erysipelas makes its ap- pearance. In some instances the fever is violent; in other cases it is of a milder character, and occasionally, though very rarely, the inflammation appears simultaneously with the fever. " The inflammation comes out in the form of an irregularly circumscribed stain or blotch, which soon spreads over a greater or less extent of the contiguous surface." There is always more or less swelling, even at the commencement of the inflammation, and a burning, tingling pain, but the part does not throb or pul- sate, except in very violent cases, and where suppuration takes place in the cellular tissue. Usually by the third or fourth day, blisters are formed on the inflamed surface, filled with a "limpid or yellowish serum." In the course of two or three days, the blisters break, occasionally forming crusts, or large scales. In less than a week, in favour- able cases, the inflammation and swelling begins to subside; the skin becomes pale, or of a yellowish cast, and presents a rough appearance, and shortly after the old skin peels off. Erysipelas is generally confined to the skin, though in some instances, the inflammation extends to the adjacent cellular tis- 68 ERYSIPELAS—ST. ANTHONY'S EIRE, OR ROSE. sue. In cases of this kind, the pain is more severe, and the party become extremely tender, and painful on the slightest pressure. The constitutional disturbances are generally severe, and the complexion sallow, indicating derangement in the functions of the fiver. Frequently, in the severe form of the disease, suppu- ration takes place in the parts beneath the skin, and the patient experiences irregular chills. " The redness of the skin and the pain subside, but the swelling increases; there is much dougfii- ness, and the parts remain in this state for some time" before the pus will find its way to the surface. When the fluid escapes, it frequently has the appearance of whey, and contains shreds of cellular tissue, like tow, or shreds of cotton. The face and limbs are most liable to erysipelas. When it attacks the face, the swelling, in many instances, is so great as to entirely close the eye-lids. More or less mental derange- ment usually attends such cases, especially when the inflam- mation extends over a considerable portion of the scalp. The danger from erysipelas is not great, except when the brain is attacked by it, or when it occurs in vitiated or broken down constitutions, and the disease assumes a typhus character. There is a form of erysipelas which attacks females about a year old, appearing first on the vulva, and subsequently becomes in- wardly seated, and generally fatal. I have seen a case of this kind, attended with sloughing of the vagina, and where the in- flammation finally extended over nearly the whole of the body. This patient died in about three weeks from the commencement of the attack. In this case the stomach and bowels were much disordered previously to the occurrence of the erysipelas. In many instances, the disease is brought on by eating un- wholesome food. Treatment.—The most important indication for the cure of erysipelas, is to correct the disordered condition of the stomach and bowels. A Thomsonian course of medicine I have known in many in- stances to check at once the farther spread of the inflammation. Where the inflammation is on the face, the bowels should be re- lieved by an injection, before the emetic be given. In mild cases, and where the general health is not much impaired, the treat- ment may be correspondingly mild. An enema to evacuate the bowels, together with hot teas, to keep up a moderate perspira- tion, will be sufficient in the way of constitutional treatment, as long as the symptoms continue favourable. A wineglassful of lime water, adding half the quantity of boiled milk, given two or three times a day, may be taken to correct the secretions of the stomach. Where the countenance is sallow, indicating derangement of ERY8IPELAS—ST. ANTHONY'S FIRE, OR ROSE. 69 the liver, or where the fever is high, or the patient much dis- tressed, the treatment should be more thorough. The enemas should be repeated occasionally, always containing a portion of lobelia. An emetic should be given as often as every day, in violent cases, and continue to give broken doses of lobelia, in composition or bayberry tea, or lobelia may be given in the form of pills. A teaspoonful of lobelia powder, given by injec- tion in warm water, and retained in the bowels, will in general relax the system more, and prove more serviceable than admin- istered in any other way. Free vomiting may often be effected in this way. In all severe cases it is important to keep the system more or less relaxed by small doses of lobelia; and likewise to give occasionally, either composition or pepper tea. The room should be kept of a moderate temperature. Very hot stove rooms are pernicious. The parts affected should be kept elevated, if practicable:— thus, if on the face, the head must be raised higher than the body, or if on the limbs, they should be kept elevated, which fa- vours the return of the blood from the inflamed part. Of all means for the cure of erysipelas, emetics are the most effectual. Beside fulfilling other important indications, they have an influence in restoring the secretions of the liver. It is the opinion of some medical writers, that the liver is more or less diseased in all cases of erysipelas. Emetics may be given without previously administering the vapour bath, but where the inflammation is on the face, it will be proper to use the warm footbath, and an injection, previously to giving the emetic; and to continue warmth to the feet, by hot bricks wrapped in damp cloths. The Diet should be confined to the lightest kind of food, as slippery elm gruel, barley water, crust coffee, &c. In mild cases, or where the patient is on the recovery, more generous diet may be allowed, such as milk dishes, custards, boiled chicken, toast and tea, &c. Where the attending fever is of a low typhoid character, with great prostration of strength, stupor, or low muttering delirium, and coldness of the extremities, active stimulants should be em- ployed. The remedy most to be relied upon in such cases, is the liquid of the third preparation of lobelia, in a strong tea of the bayberry or sumac. The dose to be of the usual quantity, and repeated at intervals of from two to four hours. This medicine will cause the patient occasionally to vomit, and the matter thrown from the stomach is generally of a very foul character, consisting chiefly of thick brown flakes of morbid secretions, which had previously coated the mucous membrane,of the sto- mach, and which, if not removed, would continue to oppress the 70 SHINGLES. functions of that organ. I have witnessed recoveries under this mode of treatment, in various forms of disease where the symp- toms were such as are generally considered fatal. Beside the above remedy, the capsicum tea, carbonate of ammonia, Virginia snake root, wine whey, and essence of beef, may be employed to nourish and sustain the enfeebled forces of life. Local Applications___As a local application to the inflamed surface, the liquid part of the third preparation of lobelia has done well in all cases where I have employed it; for although a powerful stimulant, the patient generally has experienced less burning in the part than before its application. Soap liniment, opodeldoc, sweet oil and lime water, and tar ointment, may either of them be applied to the parts affected. There are some skins which all kinds of grease disagree with;—in such cases, a liniment would be improper. When the inflammation is on the limb, and the part remains swollen after the inflammation sub- sides, a bandage should be applied, commencing at the extremity of the limb, and bandaging upward. Where there is evidence of an accumulation of matter in the parts, deep incisions should be made in order to give the matter an early opportunity to escape. Children predisposed to erysipelas should not be vaccinated until the general health is restored. As a general rule, poultices do not answer a good effect in erysipelas, except when the parts ulcerate, or become gangre- nous; then the application of poultices maybe useful. In caseof simple ulceration, use a poultice composed of elm, ginger, pond lilly, and pounded cracker; but in case of gangrene, or mortifi- cation, the charcoal or yeast poultice will be more appropriate. SECTION IX. SHINGLES. This form of disease is characterized by a cluster or band of blisters on an inflamed surface, commencing, in most instances, on the right side of the abdomen. In some instances this band of vesicles extends down to the groin, in others it passes upwards. It is very rare that this eruption occurs on the left side of the body. " This disease bears a very close resemblance to erysipelas," SHINGLES. 71 and arises from a disordered state of the system. " Loss of ap- petite, lassitude, slight headache, nausea, more or less febrile irritation, together with scalding heat and tingling in the skin, and shooting pains through the chest and stomach, are the symp- toms which usually precede the eruption." The vesicles are transparent until the fourth or fifth day, when they acquire a yellowish or milky appearance, and in the course of a day or two break and form brown crusts, and in a few days after fall off. In some instances the skin ulcerates and leaves scars. Shingles very seldom attack any but young persons, and rare- ly, if ever, happen to children under three years of age. Not dangerous.—Shingles are rarely dangerous. The erup- tion, however, occurring in a highly diseased or exhausted con- stitution, may be followed by dangerous consequences, from the supervention of gangrene. Treatment of Shingles.—Little need be said in relation to the treatment of this disorder. The same local applications may be used as recommended in erysipelas, and when the general health is much affected, an emetic to cleanse the stomach will be proper. Mild stimulants to promote perspiration, composition, ginger, pennyroyal, &c. If tbe bowels require attention, use enemas. Lime water with milk is good to correct the secretions, wiiere the stools are acrid or of a greenish cast. The diet should be light, consisting of gruels, milk, toast and milk, elm gruel sweetened with loaf sugar, adding a portion of lemon juice. Cold drink in moderate quantities, may be allowed the patient, of which lemonade is generally the most grateful. When the bowels are costive, a gruel made of unbolted wheat flour, has a good effect. SECTION X. SCALD HEAD. This name is given to a certain form of eruption which comes on the head. It commences with small ulcers which discharge a humour that forms into thick crusts or scales. In some in- stances nearly the whole of the scalp becomes affected, forming a continuous mass or scab, attended with paroxysms of intolera- ble itching; and emitting an offensive odour. Sometimes the humour discharged is extremely acrid, producing an eruption wherever it comes in contact with the skin, and in this way the disease not unfrequently spreads partly over the face, and extends down the neck to the back and shoulders. The glands about the ears are often swollen. Scald head is occasionally met with in adults, though it is very generally confined to children, and unless correctly treated may continue even for years. Treatment.—The most important point in the treatment of scald head is the exclusion of air from the parts affected. To accomplish this, cut the hair off close, and apply Thomson's healing salve, or an ointment made of tar and suet; and put on a cap, either of bladder or of oiled silk. This will prevent the formation of scales, though the discharge of matter will continue until the parts heal. The cap should be taken off every day, and the parts that suppurate cleansed. By gently pressing a dry cloth on the parts, the pus will adhere to it, and in this way be removed. Then apply fresh ointment, and put on the cap, which should be rubbed over on the inside with tallow or oil, to prevent its adhering too closely to the salve or ointment. The head should never be wet with any kind of wash, except occasionally, when the itching is very annoying, which may sometimes be relieved by washing with a strong tea or tincture of bayberry or sumac. A strong tea made of common soot also answers a good purpose. Constitutional Treatment.—In bad cases a sweat and an emetic should be given every week or oftener, as the symptoms indicate. This will greatly facilitate the cure. Lobelia, given in small doses, is of especial benefit in all kinds of eruption. It may be given in pills, or in tincture, several times a day, in quantities merely sufficient to excite slight nausea. TETTER. 73 The composition powder, mixed with sugar and warm water, should be taken once or twice a day, more especially if the tongue be coated. The bayberry or sumac tea may be used for the same purpose. The spice bitters, or any other simple tonic may be used to strengthen digestion. Costiveness may generally he relieved by proper articles of diet, as stewed prunes, gruel made of unbolted flour, with the addition of a few raisins, stewed figs, rye mush, roasted apples, and ripe fruit in season. The diet, of course, is not to be con- fined to such articles exclusively. There is a scabby eruption that prevails among children gen- erally, commencing back of the ears, and frequently spreading over the cheeks, and on the head, resembling scald head. This eruption is to be treated the same as scald head:—apply the ointment to exclude the air, keep the parts dry, and restore the general health by appropriate constitutional treatment. The following preparation may be used in place of the exter- nal application above-mentioned. Liver of sulphur, three drachms, Spanish soap, one drachm, Lime water, eight ounces, Rectified spirits of Avine, ten drachms. To be mixed and melted together, and applied to the affected parts night and morning. SECTION XI. TETTER, There are various forms of eruptions to which the name tet- ter is generally applied, all of which, however, depend chiefly upon a disordered state of the stomach and bowels, and require much the same kind of treatment That which is termed dry tetter, consists of red blotches on the skin covered with pimples, which itch very much. The erup- tion forms white scales, like fine bran, which fall off, leaving the skin apparently healthy. The eruption reappears and repeats the same operation as before, and in this way will continue to disappear and reappear indefinitely. 74 TETTER. Pustular Tetter.—In this variety the eruption appears in clus- ters of small vessicles or blisters, containing at first a thin se- rum, which in a few days becomes yellowish, and breaking, form thin crusts or scabs, which fall off, leaving the skin in many in- stances in a healthy condition, except a slight degree of redness; occasionally the skin becomes excoriated. There is a sense of smarting, and sometimes pain attending the eruption. Not un- frequently the eruption reappears at intervals, and the disease this way may be prolonged for weeks or even months. Corroding, or Eating Tetter, as it is called, commences with small painful sores or ulcers, whicli soon spread into large spots of various forms and sizes, and discharge a thin watery humour. This humour is sometimes so acrid as to produce new sores wherever it comes in contact with the surrounding surface. This species of tetter is apt to spread rapidly and occasionally forms deep ulcers wThich are difficult to cure. There is another species of tetter, appearing in the form of hard, dry, red spots, usually about the size of a millet seed. This eruption is mostly observed on the face and neck, though in some instances, it extends over the whole body. Depending in general upon chronic derangement of some internal organ, es- pecially torpor of the liver, and obstinate constipation of the bowels, it not unfrequently becomes a seated disorder, and may be cured only by revolutionizing the constitutional efforts of the system. Treatment.—In some cases, the constitutional derangement or debility may be rectified by a change of habit. For instance, if the habits be sedentary, the patient should take exercise in the open air, especially after meals; and use especial care to keep the feet warm and dry. A change of residence from one part of the country to another, or from the city to the country, will, in many instances cure long standing complaints, where medicine, without change of residence, may fail. To regulate the bowels, which are generally costive where this kind of tetter exists, I have used the purified charcoal in composition, or spice bitter tea, with general success. The dose of the charcoal is a large teaspoonful three or four times a day. Two or three pills com- posed of lobelia and capsicum, taken at bed time, are useful also in regulating the bowels. The diet should be such as best suits the patient's constitution, avoiding, however, hot bread, sweet cakes, fat or salt meat, or strong coffee. Bread made of unbol- ted flour, is proper in all cases of costiveness. Washing or sponging the body occasionally with salt water, as soon as out of bed, and using friction to the skin with the flesh brush, or a dry salted towel, will give tone to the nervous system, and increase TETTER. 75 the constitutional strength. The vapour bath, followed by the shower bath, may be used when the patient is too chilly to bear the washing with cold salt water alone. Exercise in the open air, cleanliness, and warm clothing, are of importance in all dis- orders of this kind. An occasional course of medicine and the free use of bitters to restore digestion, may be necessary in effecting a cure in obsti- nate cases of tetter. Treatment of the Dry Tetter.—There are various washes and ointments that may be used with benefit. The best, however, according to my experience, is a tincture of sumac berries in No. 6., or the third preparation of lobelia, to be applied fre- quently, and the parts anointed, especially at night, with Thomson's healing salve, tar ointment, or yellow dock oint- ment. If the patient require medicine, or if the eruption be not cured by the above applications, an emetic, or a course of medicine will be the surest means of effecting a cure. An occasional dose of composition may be sufficient to rectify the stomach and bowels in slight cases, or, what would be still better, a dose of the com- position powder, taken in a strong decoction of bayberry. Treatment of Pustular Tetter.—Salt water is a good wash in this and probably in other forms of tetter. The parts should be kept covered with salve or ointment spread on soft muslin or linen, and not exposed to the air except when necessary to wash and apply new dressings. Tetter may be found difficult to cure, unless protected from the air, and kept dry. The constitutional treatment should be the same as in the former variety. In fine there is no form of the disease in which the general Thomsonian remedies, such as composition, spice bit- ters, bayberry, or No. 3, &c, may not be used with advantage. Warm clothing, exercise in the open air, cleanliness, and a well regulated diet, are of importance in all chronic diseases. Treatment of Eating or Corroding Tetter.—This variety of tet- ter demands a more active course of treatment, especially where there is a tendency in the disease to spread rapidly. A full course of medicine should be given and followed by the usual sti- mulants and astringents, such as composition, ginger, capsicum and bayberry, in order to promote perspiration, and to correct the secretions of the stomach and bowels. The yeast poultice, or a compound of white pond lilly, elm and ginger, wet with a strong tea of raspberry leaves, to be applied to the parts affected, and renewed at proper intervals until the 76 ITCH. ulcers assume a healthy appearance, when the salve or ointment may be used as recommended in pustular tetter. There are various forms of eruptions of the nature of tetter, all of which should be treated on the same general principles. In some instances tetter will spread over a considerable por- tion of the lower extremities, and sometimes over almost the whole of the body. A patient applied to me not long since, who had tetter over the whole surface of both legs, and the flesh was hard and swollen. The patient had been unable to sleep in bed for many months, on account of the tormenting itching, which came on at night, when covered in bed. The treatment, in such cases, should be to regulate the gen- eral health by the vapour bath, and emetics; together with the continued use of the compound lobelia pills, composition and spice bitters, and apply poultices made of elm, white pond lilly, and ginger; and after the parts run, and the swelling subsides, some simple salve may be applied: and cover the parts with silk oil cloth, in order to exclude the air. When it is necessary to cleanse the parts, the oil cloth must be again reapplied, and not ft permanently removed until the disease is entirely cured. SECTION XII. ITCH. This disease, it is said, is caused by an insect which pene- trates the skin, and produces small vesicles or pustules, forming into scabs, and attended with an intolerable itching. The wrists, and between the fingers, are the parts affected, though occasionally it is observed on other joints, and on various parts of the body, excepting the face. Treatment.—The sulphur ointment will cure the real itch, sooner, probably, than any other application. There are other remedies, which may be used with benefit, as frequently washing with salt water, or the preparation recommended by Dr. Thomson, which is spirits of turpentine, with about four times as much of No. 6: to be well shaken before applied. RING-WORM. 77 Sulphur Ointment is made by rubbing together one ounce of the flour of sulphur, and four ounces of lard. This ointment is to be applied every night. It is recommended that a part of the body only be covered with the ointment at a time,—say one fourth. The addition of a few drops of the oil of lemon will conceal the disagreeable smell of the ointment. SECTION XIII. RING-WORM. This name is applied to an eruption consisting of very minute vesicles, or blisters, closely compacted together, and which form a ring or circle. There is great diversity in the size of the ring, varying from an eighth of an inch to two or three inches in diameter. In the centre of the larger rings, the skin is of its natural appearance. "The eruption is always attended with a troublesome itching and tingling sensation." In four or five days the vesicles break, and form their crusts or scabs, which, in general, fall off by the eighth or ninth day. In some in- stances, new circles of the eruption appear in succession for several weeks. Treatment.—Ring-worm may be readily cured in most in- stances, by washing the part with the tincture of lobelia, or the No. 6, and applying an ointment made of the narrow-leafed dock root, grated and stewed in lard. The meadow-fern oint- ment is also a good application. When the eruption proves obstinate under the above local ap- plication, it will be proper to use constitutional treatment. A dose of composition or spice bitters two or three times a day, or take a teacup half full of bayberry tea, and stir in it a teaspoon- ful of composition powder: sweeten, and take night and morn- ing. Lime water in milk answers a good purpose, taken two or three times a day. A course of medicine, however, is the most effectual means of cleansing the system of all morbid hu- mours. An entire exclusion of air from ring-worm will mostly effect a cure in slight cases. SECTION XIV. CHAFING IN CHILDREN. Fat children are liable to chafe about the neck, and other parts, where the skin of different parts comes in contact. Treatment.—Apply scorched flour, or interpose a piece of muslin or linen slightly scorched, to absorb the secretions of the skin, which cause the excoriations. Where the buttocks become excoriated, or break out in sores from an acrid condition of the stools, apply some soothing lini- ment, as a mixture of lime water and sweet oil, and correct the secretions of the bowels by injections; and if the stomach be dis- ordered, give an emetic. The chalk mixture, or lime water, may be used with advantage, in correcting the acrid state of the secretions of the stomach and bowels. SECTION XV. PRICKLEY HEAT. Prickley Heat, as it is called, is caused by impurities in the blood, being thrown to the surface. Children are most liable to this eruption in very warm weather and during the period of teething. Derangement in the digestive powers are in almost every instance the original cause of the complaint. The erup- tion is mostly confined to the neck, breast and shoulders. Treatment.—A few doses of lime water, together with the use of the tincture of lobelia, in small quantities, merely sufficient to produce slight nausea, will, in general correct the derangement in the stomach and bowels. But the eruption will continue in many cases until the teeth are through the gums, and the irrita- tion has subsided. Local Application.—Bayberry or sumac tea made very strong will allay the itching, adding a teaspoonful of the tincture of BRONCHITIS. 79 lobeli^, to an equal quantity of the bayberry tea, frequently ap- plied Will cure the eruption. It sometimes happens that the eruption strikes in suddenly and the child becomes very sick, in which case an emetic of lo- belia in composition tea, will be proper, and injections adminis- tered prepared in the same manner as the emetic. CHAPTER III. DISEASE OF THE CHEST AND LUNGS. SECTION I. BRONCHITIS. The name bronchitis is applied to a disease of the lining membrane of the air vessels of the lungs and throat. It is a form of disease of very common occurrence, and is usually called catarrh or cold, either of whicli is a more appropriate term than bronchitis, which means an inflammation of the bronchial vessels, whereas the disease is not necessarily accompanied with inflam- mation, neither is it confined to the bronchial vessels. Stjmptoms.—This disease is greatly diversified, both in cha- racter and symptoms. Generally there is, in the first place, great lassitude, chilliness, loss of appetite, much oppression at the chest, the skin cold, the face pale, and the head heavy. The breathing becomes more or less short, and sometimes difficult. The cough is mostly slight at first, consisting of a mere hack, and, in some instances, dry; or the expectoration, in the com- mencement, is frothy or clear, and tough, like the white of an egg. In some instances there is no pain; in other cases, con- stant pain; and sometimes pain is only felt during the act of coughing. In most cases of bronchitis, there is more or less fever in the after part of the day, and a paroxysm of coughing comes on at night. There is langour, headache, and dryness of the skin, and in some few cases, profuse perspiration. There is 80 BRONCHITIS. usually more or less hoarseness, and a wheezing, or rattling breathing. 7 In the young and plethoric, a strong reaction comes on early in the disease: the pulse is high; the countenance becomes flushed, and the breathing hurried. Whereas, in the aged and feeble, there is seldom much inflammation or fever, as the sys- tem is not able to establish and support an inflammatory action. " Infants are especially liable to this form of disease. In them the disease manifests itself by a short, quick, oppressed, and Avheezing respiration; uneasiness on being placed in the recum- bent position; slight cough, somewhat hoarse at first, but humid and rattling as the disease advances; a uniformly pale, and anx- ious countenance, pulse frequent and tense; skin above the natu- ral temperature on the trunk, but the hands and feet are com- monly cool, or at the regular temperature." The disease, however, presents many grades of violence, both in the young and old. Sometimes the vital powers are in a sunken condition—there is low delirium, cold skin, weak pulse, blueness under the nails, and stupour. Sometimes there are paroxysms of difficult breathing, resem- bling that of asthma. Cause.—Cold and moisture operating upon debilitated frames. The disease occurring mostly in old persons and in weakly chil- dren. Fvvourable Signs.—Improvement in respiration, an easy ex- pectoration of a thick yellow matter, and more especially when the secretions of the nose are restored; the stools of a natural colour; and a general warmth and moisture of the skin. Unfavourable Symptoms.—Great distress and oppression, cold skin; little expectoration and ropy, like the whites of eggs; tend- ency to stupour or delirium, and a dry nose. These symptoms, most of whicli frequently attend the early stage, are not to be considered alarming, unless where they continue to exist in a later period of the disease. Distinguishing feature between Catarrh and Bronchitis___Ca- tarrh commences in the nose, and travels down, sometimes not reaching the lungs. Bronchitis begins in the lungs, and pro- ceeds up. Treatment— Slight attacks of the disease, in general, require nothing more than an occasional dose of the composition or pep- per tea, with broken doses of lobelia; the use of a warm footbath, and a strict attention to diet, and keeping the feet warm. BRONCHIT IS. 81 When the symptoms are more distressing, emetics will be pro- per : a full course of medicine is best in severe cases. The functions of the skin will be greatly assisted by the warm water bath, or vapour bath. Expectorants.—In the early stage of the disease, or as long as the cough is hard and dry, or the expectoration resembles the white of an egg, the patient should be kept slightly nauseated with lobelia, given in broken doses, either in the form of pills, tincture, or infusion. There are other articles which may be used to ease the cough, and promote expectoration, such as a tea of bran, flaxseed, elm, or liquorice root, acidulated with lemon juice, and sweetened with honey or rock candy; equal parts of olive oil, vinegar, and honey, stewed together, and taken fre- quently, in teaspoonful doses; onions or garlic sliced and covered with sugar, and kept moderately warm, form a syrup which answers a good purpose, more especially in patients of weak nerves. Carbonate of ammonia, given in hot wine whey, will afford great relief in cases of extreme oppression of breathing. When the bowels are costive, injections should be used. Lobe- lia administered in this way, in simple luke-warm water, some- times excites an almost magic influence in equalizing the circu- lation, and counteracting the undue determination of blood to the lungs. The system kept under the influence of lobelia, the ex- pectoration soon assumes a favourable aspect, except in very stubborn cases. The Diet, in the early stage of the disease, should consist of light food, as barley water, tapioca, rice, sago, crust coffee, elm gruel, milk porridge, &c. The expectoration becoming copious and yellow, with other favourable symptoms, the patient may be allowed a more strengthening diet, as fresh beef, mutton, soft boiled eggs, stale bread, &c. The expectoration presenting a favourable appearance, and the secretions of the nose restored, the quantity of lobelia may be lessened, and three or four times a day the patient should take a teacup half full of strong bayberry or No. 3 tea, adding a tea- spoonful of composition powder, or half a teaspoonful of capsi- cum to the tea, or the composition or pepper may be taken in the usual way. The spice bitters may be used as a substitute for the composition. An occasional emetic, or full course of medicine, will be proper at any stage of the complaint. Where the symptoms are violent, or the disease becomes protracted, a course of medicine will prove the most effectual. L 82 BRONCHITIS. Balsam Copaiva is a valuable remedy in protracted cases of catarrh or bronchitis. The dose, for an adult, is from fifteen to twenty drops three times a day. It may be dropped on sugar, or rubbed up with a small portion of slippery elm powder and sugar, adding a few drops of some agreeable essence, and suffi- cient water to make it convenient to take. The modern plan of pre- paring the balsam in capsules, is a still better form for taking. The tincture of myrrh, or Thomson's No. 6, may be used with benefit, more especially in the latter stage of the disease, and where the patient is affected with flatulency, or oppression at the stomach after meals, which is a proper time for taking it. Night Sweats.—From the debility usually induced in pro- tracted cases of bronchitis, night sweats are apt to occur. Under these circumstances, the medicine at bed time should consist of a strong tea of the bayberry or No. 3, and in the morning, the surface bathed with No. 6 or pepper sauce, avoiding exposure to cold air. The clothing to be put on perfectly dry. A flannel garment wet with salt and vinegar, dried and worn next the skin, is recommended by some experienced physicians to check night sweats. The vapour bath I have found of benefit in preventing night sweats in some cases. Depending, however, upon debil- ity, it will be difficult, in many instances, to prevent night sweats until the system gains additional strength. CHRONIC BRONCHITIS. From repeated colds, unwholesome air, and improper diet; bad treatment, such as bleeding and active purging, confirmed dyspepsia, or other constitutional disorders; bronchitis is liable to become protracted for many weeks, or even many months, and to become a seated complaint. It then receives the name of chronic bronchitis. To describe all the various modifications of symptoms which attend chronic bronchitis, would be a task difficult to perform, and of but little practical utility. The disease appears in every grade of violence, from a slight affection, to that of a deeply con- firmed, and sometimes incurable disease. A majority of the cases of consumption arise from neglected, or badly treated catarrh, or bronchitis. Clergymen are extremely liable to an affection of the throat which is usually called bronchitis, or the clergyman's sore throat. Symptoms in a well-marked case of Chronic Bronchitis.—A troublesome cough, and free expectoration; general debility and wasting of the flesh; short, oppressed, and wheezing respiration; BRONCHITIS. 83 paleness of the countenance, and hlueness Of the lips; chilliness in the early part of the day, followed by more or less hectic fever; night sweats, and extreme sensibility to cold; loss of ap- petite, with tenderness and distress at the pit of the stomach; and an unhealthy condition of the stools; more or less pain in the side or chest, particularly on coughing; and an inability to lie on one side. The symptoms, however, in chronic bronchitis vary accu d ingly as the character and circumstances of the case differ. Thus whilst in some cases the cough is frequent and harrassing; in others there is but little cough or raising, except in the morning. Night sweats and hectic fever, though common, do not always attend the complaint. The degree of derangement of the digestive powers varies greatly in different cases, and ex- erts a powerful influence over other important functions. In fine, it is upon the integrity of the stomach, that, in a great de gree, depends the cure of the disease in the lungs and throat. Stone and glass cutters are peculiarly subject to affections of the air vessels of the lungs, from mechanical irritation kept up by inhaling particles of dust. Treatment.—To correct the disordered stomach, promote di- gestion, and supply the lungs with fresh wholesome air, are especially indicated in the cure of chronic bronchitis. Thomson's Course of Medidne is the most effectual meansT vc cleansing the stomach and bowels; it also promotes the healthy functions of the skin, and the mucous membrane of the bronchial vessels. The course of medicine should be given as the circum- stances of the case require. A very good rule to be observed is,—that so long as the patient has an appetite, and is getting better, to omit the course. Morning is the best time for giving a course of medicine in chronic diseases. The skin should be bathed with some stimulant after the last bath in the course. An emetic in the morning before rising, the patient previously drinking some composition tea, will answer, in many instances, the place of a full course. The lobelia emetic to be prepared in bayberry or No. 3 tea. The simple No. 3 tea, made strong, will sometimes operate as an emetic, and afford much relief to the patient. From three to five of the No. 3 pills should be taken before meals, except when using Peruvian bark, or elixir of vitriol. The Peruvian bark, Colombo, Virginia snake root, wild cherry bark, gentian, spice bitters, Thomson's No. 4 bitters, should be given either singly or combined, where there is much debility and night sweats, and not confine the patient to a particular kind, but keep changing. I have used the elixir of vitriol with 84 BRONCHITIS. decided benefit, in cases of night sweats; from fifteen to twenty drops may be given in a wineglass of a tea of Peruvian bark, or of some other tonic, and repeated three or four times a day. The bayberry or No. 3 should not be used at the time of using the Peruvian bark or elixir of vitriol. Fresh Air___In chronic bronchitis the patient should use moderate exercise in the open air as much as possible, with par- ticular attention to keep the body and feet protected from the cold. There is an instrument recently introduced into use, called a respiratory, by wearing which the patient can go out in severe cold weather, and experience no inconvenience in the lungs from the cold. Recoveries from this disease are greatly facilitated by fresh air. A change of residence, more particularly to a pine country, or to the sea board, provided salt air agrees with the patient, will, in many instances, prove of signal benefit. Vegetable Balsams.—These are sometimes found of especial benefit in cases of chronic disease of the bronchial mucous mem* brane. The balsam copaiva, balsam tolu, and Canada balsam, are those generally employed. The balsam copaiva is consi- dered the best; to be given at first in doses of from twenty to thirty drops, gradually increasing the quantity to fifty or sixty drops, and repeated three or four times a day. (The dose and mode of preparing the other balsams will be found in the Mate- ria Medica.) The bayberry or No. 3 in strong decoction, and adding a tea- spoonful of No. 6, or a small portion of pepper, should be given as often as once a day, where the tongue is coated. A very good mode of taking the bayberry is by rubbing the powder up with honey, and then adding a portion of luke-warm water, or what is better, a tea of aspin, poplar, or some other tonic. Powder taken without being scalded, will, in many instances, make more impression upon the stomach than when taken in de- coction. The No. 3 pills may be used in place of the above preparations, if the patient be averse to liquids. The purified charcoal may be used with advantage where the bowels are costive. Inhaling the smoke of cayenne pepper, though a harsh reme- dy, has in many instances been attended with the most signal benefit. It is applicable to cases of long standing. The proper mode of doing it is to put a small portion of cayenne pepper on a red hot shovel, the patient being covered with a blanket, to confine the smoke; or let the patient breathe the smoke whilst in a vapour bath. I recently met with a gentleman from Massa- chusetts who had been affected with a harassing cough, which CONSUMPTION. 85 continued for many months without any abatement, although he had been under treatment in a Thomsonian infirmary. At length resorting to the inhaling of pepper smoke, his cough was cured in a few days. This gentleman described the effect of the smoke upon the lungs to be at first almost suffocating, and very dis- tressing, but in a short time the sense of suffocation passed off, perspiration became profuse, and the secretions from the eyes, nose, and mouth ran copiously during the operation. The secre- tions from the lungs, in a few hours after the first operation, changed their aspect, and were raised easily, and the mucous membrane wras speedily restored to a healthy condition. Inhaling the fumes of tar is in some cases of benefit in re- storing a healthy action to the mucous membrane of the lungs and wind-pipe. Patients have also been cured of chronic bron- chitis by being exposed to the influence of oak bark dust. The External Applications proper for the chest are stimulating liniments; mustard poultices or plasters; or strengthening plas- ters. Cayenne pepper strewed on the plaster will often render it more efficient. Diet.—The most nourishing kinds of food should be used, as eggs, custards, stale wheat bread, and all kinds of wholesome articles that may suit the stomach. Meats are allowable, unless they be found to disagree with the stomach, avoiding veal, fresh pork, sausages, and all food fried in fat. A milk diet generally agrees with the patient, such as porridge, rice and milk, boiled milk and toast. Where the bowels are costive, a gruel made of unbolted wheat flour, or bread made of the same article should be used. SECTION II. PULMONARY CONSUMPTION. The lungs are liable to various forms of disease, producing different varieties of consumption. OF THE PRINCIPAL VARIETIES OF CONSUMPTION. 1st. Tubercular Consumption___This variety of consumption commences with the formation of small roundish bodies (called tubercles) throughout the lungs; and as they increase in size, and suppurate, that part in which suppuration takes place is de* stroyed, or, its structure changed and rendered incapable of per- forming its natural function. 86 CONSUMPTION. Tubercles, in the first place, arc about the size of a millet seed, and generally are found in clusters or masses. There can be no doubt but that tubercles exist in the lungs of some persons for many years without increasing in size, or causing any consider- able inconvenience to the patient. Tubercular consumption prevails to a great extent in the Uni- ted States and in Great Britain, and is of all the varieties of consumption the most difficult to cure. This form of consump- tion occurs, almost exclusively, in scrofulous constitutions, or in persons of an hereditary tendency to tubercles. There are few cases of this form of consumption that commence in persons rising forty years old, the disease almost exclusively occurring between the age of fifteen and thirty. The Causes which usually bring on tubereular consumption in constitutions predisposed to the disease, are—repeated colds, or catarrhs; disordered stomach and bowels; sudden check of per- spiration after exhausting exercise; the introduction of antimony or mercury into the system;* the intemperate use of spirituous liquors; copious bleeding; excessive venereal indulgence; con- finement in ill-ventilated apartments; and unwholesome food. If one or both parents be predisposed to scrofula, or tubercular consumption, all their children will be liable to pulmonary con- sumption; whilst in other instances, this hereditary disposition will exist in some of the children only; the rest being entirely exempt from it. Children are more apt to partake of the con- stitution of the mother than that of the father. There are in- stances, however, where both parents have been consumptive, and all their children robust and healthy; and then, again, both parents may be healthy, and their children delicate and consump- tive. Symptoms.—Tubercular consumption commences with a short dry cough, which may continue for many months without expec- toration, except of small portions of glary mucous. The breathing short and oppressed, with a sense of tightness or un- easiness in some portion of the breast whilst taking a full inspi- ration. There is much debility, and a gradual wasting of the flesh; the appetite fails and the digestion is impaired, and the patient is very liable to have a catarrh on the slightest exposure to cold or damp air. As the disease progresses emaciation and debility increase; the cough becomes more harassing, and the breathing shorter and more oppressed; night sweats occur, which leave the pa- * Tubercles have been produced in the lungs of animals by giving tbem mer- cury by way of experiment. CONSUMPTION. 87 tient in an extremely languid condition. There is chilliness in the fore part of the day, followed by a flush on one or both cheeks, and a burning in the palms of the hands and soles of the feet. The tongue is usually coated with a thin white fur, or sometimes clean and of a pale pink colour. Sooner or later in the disease the tuberculous masses become softened into the consistency of pus, and portions of the suppu- rated matter are discharged into the air vessels, and coughed up in the form of a thick yellow-like or greenish matter, assuming the character of genuine pus, and frequently streaked with blood. When this change in the character of the expectoration occurs, the cough, in some instances, becomes less distressing, but the general weakness increases, the flesh continues to waste, night sweats become more profuse, and usually there is a slight chill in the morning and towards evening. After the evening chill, hectic fever comes on, during which the pulse is seldom less than 120 per minute. In the absence of fever the pulse is soft, lan- guid, and weak. As the disease advances, the expression of the countenance becomes changed, the eyes assume a pearly white- ness; the voice becomes weak and hoarse, or hollow; the feet swell, and a diarrhoea comes on, accompanied with rapid ex- haustion; the mind is in many instances free from depression; and but little impaired until near the termination of the disease, when there is apt to be some degree of delirium, and "occasion- ally total imbecility about a week previous to death." Of other Modifications of Symptoms.—In some instances tuber- cular consumption runs its course with scarcely any prominent symptom of disease in the lungs,—there being no pain or diffi- culty of breathing, and but little cough or expectoration. There is a general wasting of the flesh; night sweats; failing of the appetite; the countenance is pale, and the flesh soft and flabby. Frequently, in these cases, there is more or less blood raised, and sometimes the lungs bleed freely. As the disease advances, however, the cough becomes more troublesome, with frequent inclination to vomit, and a rapid wasting of flesh and strength. The bowels are generally either much constipated, or relaxed; the nose becomes pointed and cold; the lips pallid or blueish; a.nd the expression of the countenance is changed. 2d. Bronchial Consumption.—A variety of consumption which probably occurs next in frequency to the one just described, is seated in the mucous membrane of the air passages of the lungs and wind-pipe. Chronic bronchitis is the term usually applied to this form of disease, and whicli from old age, bad digestion, neglect, or improper treatment, is apt to terminate in confirmed consumption. This form of disease is mostly confined to chil- 88 CONSUMPTION. dren, and to the aged. The general character, symptoms, and treatment are described under the head of chronic bronchitis. The great majority of the cured cases of consumption have been of this variety. In some instances chronic bronchitis accompanies tuberculous consumption, the two forms of disease being blended. 3d. Consumption consequent on Pleurisy.—From bad treatment, or under unfavourable circumstances, pleurisy is occasionally followed by the formation of an abscess in the chest, which is apt to produce ulceration of the lungs and thus cause pulmonary consumption. The Symptoms which characterize abscess in the chest, are cough and difficulty of respiration; a sense of oppression or load in the chest on lying down; more or less pain and tenderness to pressure in the affected side; and above all, a dull sound given by percussion on the chest. These symptoms, together with the previous existence of pleurisy, will serve to distinguish the dis- ease. Sometimes the abscess ulcerates through the lungs into the air vessels, and is discharged by coughing. There are night sweats, hectic fever, and wasting of flesh and strength. After the ab- scess is in this way discharged, the patient may experience a mi- tigation of his sufferings, and occasionally there are recoveries; but more frequently the disease terminates fatally, and sometimes death suddenly takes place. 4th. Throat Consumption.—This variety of consumption con- sists of ulceration of the throat and wind-pipe. It is usually rapid in its course, and when fully seated before proper treat- ment is appped, it is mostly fatal. Cause.—Throat consumption is generally brought on by the neglect of repeated colds. Sometimes it follows measles and whooping cough. Symptoms.—In the first place there is derangement of the general health, such as want of appetite, feeble digestion, cold and torpid bowels, a diminished temperature of the body, and extreme sensibility to cold. There is uneasiness and pain in the wind-pipe, which is increased by coughing; the patient frequent- ly puts his hand to the throat, in consequence of the uneasy sen- sation in that part. The voice sooner or later becomes changed to a hoarse and feeble whisper. More or less pain is experi- enced in the throat on "bending the head backwards, or on turning it round." The cough is apt to be severe in the morn- CO\Sl MPTI0N. 89 ing, and is almost always brought on by attempting to swallow. The expectoration is slight, in some instances, and in others it is copious. When the disease is fully established, the countenance becomes pale, and the skin sallow; the flesh wastes rapidly, with chilli- ness followed by hectic fever towards evening, and profuse sweat- ing during sleep; the mind is dejected and irritable, and there is a haggard expression of countenance. There are cases in which the voice becomes indistinct, or en- tirely lost, in catarrhal affections, and the patient continues to enjoy good health. Treatment of Consumption—In tubercular consumption, even Thomsonian treatment, unless applied very early in the com- plaint, and under favourable circumstances, will seldom effect more than a mitigation of the symptoms, and in some degree checks the progress of the disease, There can be no doubt, how- ever, that in some instances where tubercles exist in the lungs, that by strict attention to the preservation of the general health, and a judicious use of medicine, when required, that these tuber- cles may continue for many years without being farther devel- oped, and even permit the patient to live to an old age. The general indications of treatment are—to correct the sto- mach and bowels with an occasional course of medidne; to pro- mote the secretions by a continued use of lobelia in broken doses; to sustain the circulation, and maintain a determination to the surface by the use of pure stimulants, such as capsicum and com- position, assisted by an occasional vapour bath; together with frictions on the surface with the flesh brush, horse-hair mits, or salted towel; stimulants to the skin, as pepper sauce, or stimu- lating ointments; and warming plasters on the breast, or between the shoulders. Fresh Air.—In the early stage of consumption the patient should seek the open air as much as possible, or at least should avoid small and tight rooms. Where a stove is used to warm a room, there should be a basin of whaler kept on it constantly, to prevent too much dryness. In severely cold weather, patients may take the air, wearing over the mouth the instrument called a respirator, which being kept warm by the breath, increases the temperature of the air that passes inwardly, and thus renders it more suitable for weak lungs. Ramadge's Tube.—Of the utility of this instrument in the cure of consumption, I cannot speak from my own experience or ob- servation, the practice having been but recently introduced. But from the testimony of those who have made repeated trials of it, M 90 CONSUMPTION. I cannot doubt of its utility in the early stage of tubercular con- sumption, and more especially as a means of preventing consump- tion in those who are predisposed to the disease. The Rev. Mr. Howe, who first introduced this tube into use in this country, asserts that the use of the instrument a few months will occasion so great an expansion of the chest and lungs, as to enable the patient to take in double the quantity of air than before using it. If its effects be such as are here stated, it will constitute at least one of the surest means of preventing tubercu- lar consumption. The construction of the Ramadge tube is such as to admit only a very small quantity of air at once, which occasions the patient to use considerable effort in order to get a supply of air to the lungs. The breath is then to be forced out through the tube which again requires extra exertion on the part of the mus- cles of the chest; and the retention of the air in the lungs it is said will occasion the gradual enlargement of them. The use of this tube would be injurious in the latter stage of consumption, or where the heart is diseased. Tubercular consumption is generally incurable, yet there are instances in which, after the tubercular matter is discharged, the cavity in the lungs becomes cicatrized, and the patient is restored to health. Treatment of Bronchial Consumption.—The character and symptoms of this form of disease are described under the head of chronic bronchitis. A vast majority of the cured cases of consumption have been of this variety,—the disease being seated in the mucous membrane of the bronchial vessels. This disease, though greatly under the control of medical treatment, under un- favourable circumstances may prove incurable. Thus when it occurs in persons far advanced in life; or when the constitu- tion is vitiated by intemperance. Confinement in the foul air of ill-ventilated apartments; an unwholesome diet; and frequent careless exposure of the feet to dampness, are also unfavourable to the cure of the disease. The course of treatment laid down for chronic bronchitis, will be proper in this variety of consumption, the latter being an ag- gravated or long continued disease of the mucous membrane of the bronchial vessels. The course of medicine must be repeated at proper intervals, as the symptoms demand. Preparations of lobelia—the tincture or pills—taken in small doses, and repeated several times a day. Where the expectoration is profuse, bitters should be taken to assist digestion and sustain the strength, and not confine the patient to any one preparation of tonics, but occasionally change them. CONSUMPTION. 91 The No. 3 pills should be taken at bed time, in the place of a decoction of bayberry, where there are night sweats. In case liquids oppress the patient, all medicines may be given in the form of pills. Quinine is a good tonic, and is very readily made into pills; the No. 3 pills form a substitute for the bay- berry tea; and the lobelia and capsicum may also be given in pills. It must be recollected that the No. 3 pills and quinine should not be given at the same time: one of them, however, may be used in the fore noon, and the other in the evening. The conserve of hollyhock may be used as a mild stimulant, tonic, and expectorant. Inhaling the smoke of burning pepper, unless the case be very deeply seated, promises much in the cure of this form of con- sumption. For directions in relation to diet and regimen, and the use of balsamic and other remedies, the reader is referred to the treat- ment of chronic bronchitis. In Consumption from Chronic Pleurisy, the same general plan of treatment should be adopted as in the former varieties, namely, —to cleanse the stomach and bowels, and promote a healthy ac- tion of the general system by an occasional course of medicine; broken doses of lobelia as an expectorant, and also to lessen mor- bid excitement; the No. 3 pills, or a strong decoction of bay- berry once or twice a day to prevent the accumulation of morbid secretions on the mucous coat of the stomach; the vapour bath to promote the action of the skin, and assist in equalizing the circulation; stimulants and tonics to restore and sustain the di- gestive and nutritive functions; and injections to relieve the bowels when required. In this form of consumption, or where there is evidence of an abscess in the chest, to inhale the pepper smoke would be of doubtful utility. Throat Consumption requires a plan of treatment similar to that required in chronic bronchitis. Persons experienced in sounding the chest with the stethcr- scope, and by percussion, may sometimes form by these means, a pretty accurate judgment of the character and extent of dis- ease of the lungs. As this method, however, requires long ex- perience and much tact, in order to distinguish by it the charac- ter of the disease, it will be useless to recommend it in a family work, more especially as it is of no utility in the cure. As the same general or constitutional treatment may be ap- plied with safety to all diseases of the chest, any anxiety on the part of the patient, or friends, or practitioner, respecting the pe- culiar forms which these diseases may assume, may be dispensed with, and these general directions with regard to the treatment 92 ASTHMA, OR PHTHISIC. persisted in. Even diseases of the heart have been cured by Thomsonian courses of medicine, with proper attention to diet and regimen. SECTION III. ASTHMA, OR PHTHISIC, Asthma is a disease of the organs of respiration, generally occurring in fits, or paroxysms. In some persons, the predisposition to asthma is induced. In others it is hereditary, beginning its attacks in childhood, and occurring at intervals through the whole course of a long life. Sometimes children will be affected with phthisic for a few years, and as they advance in age, become entirely free from its attacks. Although asthma may occur at any age, still those who are past the meredian of life are most liable to it. The Season of the year in which Asthma occurs, varies in dif- ferent individuals. Thus whilst in some the attacks are princi- pally confined to cold and damp weather, others are only liable to it during mid-summer. Others again may have it during any season. Causes.-—Asthma is in general a disease of enervation,—a deficiency of the nervous power which governs the function of respiration. Hence it may be brought on in a person predis- posed to the disease, by any cause that tends to weaken or im- pair the nervous influence, such as exposure to cold and damp- ness; inaccuracies in diet; over exercise or fatigue; venereal excesses; and certain electric conditions of the atmosphere. The disease, in the great majority of instances, is associated with feebleness of digestion. Absence of day-light depresses the ner- vous powers, and this will explain the cause why the disease generally comes on at night, and subsides on the approach of day-light. Asthma, in some instances, arises from organic disease of the heart. In other instances, a mere functional derangement of the circulating organs, will occasion an attack; and on the other hand, an attack of asthma will be attended by palpitations of the heart, which entirely subside as the paroxysm of asthma ASTHMA, OR PHTHISIC. 93 passes off. Asthma may be considered in general as a secondary affection, the primary seat of the disease being in the stomach. Not a Fatal Disease.—Asthma seldom proves fatal, though in some cases it is extremely difficult to cure. When connected with organic disease of the heart, it may prove fatal at any time. Symptoms.—Asthma is characterized by a sense of tightness across the chest, great difficulty of breathing, and a distressing sense of suffocation. It is seldom accompanied by fever. An attack of this disease is generally preceded by a sense of Weight and fulness at the pit of the stomach, and eructations, heartburn, flatulency, weight over the eyes, and itching of the skin. When the paroxysm comes on during sleep, the patient is apt to have frightful dreams, and to wake up in great distress, With a sense of tightness through the breast, great difficulty of breathing, and a short dry cough. " These symptoms soon ac- quire a most appalling degree of violence. The breathing be- comes wheezing, extremely laborious, gasping and suffocative; the countenance is expressive of intense anxiety and distress, and the heart usually palpitates violently. The desire for fresh aif in very violent cases, is inexpressibly urgent: the patient insists on the doors and windows being thrown open; and is totally un- able to remain in a recumbent posture. The extremities are generally cold and the skin moist and clammy; the face is bloated and livid, or pale, and the veins of the neck hard and turgid. After these symptoms have continued for an indefinite time, the breathing becomes less laborious and anxious, and towards morn- ing a copious expectoration of viscid mucous generally ensues, which always brings with it considerable relief. During the ensuing day the patient usually feels but little oppression or un- easiness in the chest. On the next night, however, the paroxysm of suffocative respiration returns; and in this way the disease proceeds, with remissions by day and exacerbations by night for three or four days in succession, and in some instances much longer, before it finally subsides." Paroxysms of asthma may occur at any period of the day or night, though they usually come after midnight. In some in- stances they continue without any complete intermissions of the difficult breathing, for several days or even weeks, but always worse at night. Treatment of Asthma.—In many instances, where the attack is slight, the tincture of lobelia given in composition or pepper tea, and placing the feet in warm mustard water, will be sufli- 94 ASTHMA, OR PHTHISIC. cient to afford great relief, and sometimes will overcome the symptoms. The Vapour Bath.—I have found the vapour bath not only to assist in breaking up paroxysms of asthma, but in many cases almost indispensable, as the emetic in some instances will not operate previously to the vapour bath being administered. The Hot Air Bath from Burning Alcohol.—When the skin is cool and inclined to moisture, the hot air bath will answer as well and be attended with much less trouble than the steam bath, more especially in hot weather, when fire is not required in sick rooms. The stimulating liniment, pepper sauce, or No. 6, should be applied over the surface after the bath. Previously to applying the stimulant to the surface, let the patient be showered, or washed over with spirits or vinegar, and then rubbed dry. Emetics.—These are the most effectual means for the cure of asthma. To prepare an emetic infuse the brown lobelia in a strong decoction of bayberry tea, the patient having taken pre- viously of pepper or composition tea, or let some capsicum be added to the emetic; this should be taken in the usual doses and repeated as often as necessary. The more the patient becomes relaxed the greater in general will be the relief. In place of the above compound, the liquid of the third preparation of lobelia may be used for the emetic, or a combination of the lobelia pow- der with the third preparation. A Course of Medicine given in the evening, or before the time the asthma comes on, or as soon as the first symptoms arise in- dicating its approach, will in general, keep off the paroxysm, or at least greatly moderate its violence. The tincture of lobelia will often fail in bad cases of making sufficient impression on the stomach; but the brown powder or the third preparation I never knew to fail in relieving the most severe paroxysms of asthma. Injections—are important in the treatment of asthma, and in some instances will afford instant relief. Lobelia administered in this way and retained, will relax the system as effectually as when taken into the stomach, and generally will excite free vo- miting. The Skunk Cabbage answers a good purpose in many cases of asthma, though in general far inferior to lobelia. ASTHMA, OR PHTHISIC. 95 Treatment during the remission or interval between the parox- ysms.—Broken doses of lobelia, either in tincture or the com- pound lobelia pills, together with an occasional dose of composi- tion or pepper, will often be sufficient. Where the disease be- comes protracted, howTever, and the system is in a feeble condi- tion, tonics will be useful. Bonesett tea, taken cold, I have found to be decidedly useful in some cases. The scutilaria or scull cap, may be used as a tonic, and answers as a nervine. English Garlic operates as a stimulant on the nervous system, and is therefore well adapted to cases of asthma, more especially where the disease being protracted, requires occasionally a change in the medicine. Let the patient chew and swallow a clove of the garlic every morning before breakfast. Stimulating applications to the surface.—In asthma the skin is usually below its natural temperature, and inclined to mois- ture. Where this condition of the skin prevails, the stimulating liniment, the No. 6, or pepper sauce, should be applied over the surface before going to bed. A plaster of the stimulating lini- ment spread over a piece of bladder or silk oilcloth, and bound on the pit of the stomach, will have a tendency to prevent the occurrence of the paroxysm. The same application may also be applied to the soles of the feet. Diet.—The first symptoms, in many instances, on the approach of an attack of asthma, are, an unpleasant sense of weight, or stricture, and coldness at the pit of the stomach; and this fre- quently occurs soon after eating. The stomach not being able to digest what had been taken, is oppressed, and asthma follows as a consequence of that condition of this great central organ. As long as the patient is liable to the attacks, especial care should be observed to avoid any article of difficult digestion, more espe- cially at the evening meal. Where the patient craves acids, the pepper sauce, or lemon juice and sugar will frequently be grate- ful to the stomach, and favour expectoration. A Cold Shower Bath every morning, by giving tone and vigour to the nervous system, will often prove especially useful in asthma, more particularly in hot weather. It may also prove a preven- tive to the disease. A dash of cold vinegar upon the breast will sometimes afford relief during the paroxysm, by producing reac- tion. SECTION IV. SUMMER CATARRH, OR COLD—HAY FEVER. There is a catarrhal affection of the mucous membrane, ex- tending from the nose to the lungs, which comes on in warm weather, and in some persons it occurs periodically every sum- mer. It is a disease of enervation; consisting essentially in de- fidency of nervous energy. The dust from fresh dried hay is very apt to bring on the dis- ease in those predisposed to it, and from this circumstance it is in some places called "hay fever." Other kinds of dust, how- ever, will have the same effect. In some delicate persons the slightest exposure to cold or damp air, will occasion catarrh. Dr. J. K. Mitchel mentions the case of a female who would invariably be siezed with a ca- tarrh from taking hold of a tumbler of cold water. Symptoms.—At first there are symptoms of indigestion, and a sense of fulness in the head. There is watering of the eyes, and the nose discharges copiously of a thin secretion. A cough gen- erally comes on, and an expectoration resembling that which attends ordinary colds. Treatment.—Tonics are particularly indicated. Colombo, gentian, Virginia snake root, barberry, xanthoxylum? balmony, and poplar, may either or all be employed. If the tongue be coated, or there be other symptoms of a foul stomach, a strong decoction of the bayberry should be taken as often as once a day, and if this be ineffectual an emetic may be administered. The surface of the body should be bathed occa- sionally with some stimulant, as pepper sauce, or No. 6. As a preventive use the shower bath, or sponge the body with cold water every morning for a few weeks before the time at which the disease usually comes on. SECTION V. WHOOPING-COUGH. This disease is contagious, and occurs but once in the same individual. It is almost exclusively confined to childhood, and generally prevails as an epidemic. This, like most contagious diseases, runs a certain course, or succession of stages, constituting its " rise, progress, and declen- sion." In some instances, however, the disease may be cut short by medicine. Whooping-cough is seldom fatal, except when under unfavour- able circumstances, as in weak and delicate infants a few months old, or when it attacks children of scrofulous constitutions. Under these circumstances it is liable to be followed by con- sumption, or other fornls of disease of serious character. Where the disease commences in the autumn, the cough is apt to con- tinue until the succeeding summer. Symptoms___The disease commences like an ordinary cold of catarrh, with languor, sneezing, hoarseness, cough, and occa- sionally oppression in breathing. The bowels are costive, the appetite bad, and digestion impaired. The tongue is mostly contracted, and pointed, and of a darker colour than it naturally is, and in most instances nearly clean, or very slightly coated. The cough is mostly dry during the first three weeks. About the end of the third week the spells of coughing con- tinue longer, they are more severe, and are attended by the pe- culiar sound called whooping. During the paroxysm of cough- ing the patient can scarcely get breath, occasioning a distressing sensation of suffocation, and the face becomes suffused with blood. The fit of coughing may last from half a minute or less, to four or five, or even ten minutes. Usually, after the third week from the commencement, there is a copious discharge of a viscid mu- cous, after a spell of coughing. Sometimes vomiting occurs whilst coughing, which frequently affords great relief to the pa- tient. In very aggravated cases, children are sometimes thrown into convulsion fits, from congestion of blood in the brain, occa- sioned by the violence of coughing, and the suspension of breath- ing during the paroxysm. After the expectoration continues free for a week or two, the paroxysms of coughing in many instances begin to decline both in frequency and violence; whereas in other cases the disease N 98 WHOOPING-COUGH. continues for six or eight weeks before there is any abatement in the violence of the cough. Treatment of Whooping-Cough.—Throughout the entire course of the disease the treatment should be regulated in ac- cordance with the nature of the case. Nauseating doses of lobe- lia promote expectoration—generally relieve the cough—quiet restlessness, and promote the secretions of the skin. In bad cases, where the breathing is much oppressed, or the patient is very restless, an emetic will be proper. The vapour bath will assist the operation of the emetic. A course of medicine will in some instances cut short the disease. Injections must be used where the bowels are costive, or other- wise disordered. Lobelia administered in this wray, in luke- warm water, and retained ten or fifteen minutes, will have a decidedly beneficial effect, especially where there is an undue determination to the head or lungs. Under its influence the circulation becomes more equalized; the system becomes relaxed; and very often free vomiting is produced. In the more advanced stage of the disease, where the secre- tions become profuse, attended with severe fits of coughing, whicli come on periodically, an emetic or an injection, as above described, administered previously to the time at which the paroxysms of coughing commonly occur, will mitigate the cough and favour the expulsion of the viscid mucous from the lungs. Cough Medidnes. — Liquorice-root tea; flaxseed tea, with lemon juice; a mixture of honey with sweet oil; onion or garlic syrup, are all good for the cough. The tincture or syrup of lobelia, however, is the best expectorant, and may be used in combina- tion with any of the above-named articles. Where convulsion fits occur, the third preparation of lobelia should be given, either alone or in bayberry tea, and injections administered. In giving lobelia as an emetic, in ordinary cases, it should be prepared in bayberry or composition tea. Stimulants are more particularly indicated in the advanced stage of the disease, where the appetite is bad, and the system in a feeble condition. A small portion of the composition pow- der in a wineglass of bayberry tea, and administered once or twice a day, will cleanse the mucous membrane of the stomach, and also furnish a stimulous to the vital powers of the system. It sometimes happens that the cough is protracted as a conse- quence of a want of vital power. In such cases tonics should be used, such as spice bitters, Virginia snake root, chamomile, Colombo, &c. PLEURISY. 99 The Cold Bath, if the patient remain in a feeble condition, after the whooping-cough, will have a signal influence in toning the system. It is safer to commence with the tepid bath, with the water at about 90 degrees, and gradually diminish the tem- perature as the patient can bear it. The patient should be sud- denly dipped, or showered, and immediately rubbed dry, and wrapped in a warm blanket. The proper time for administering the bath is in the morning. Change of Air.—To move from the city to the country, or from the country to the city; or even a change of residence in the same neighbourhood, will sometimes speedily cure the lingering cough and debility, which is apt to follow whooping-cough. SECTION VI. PLEURISY. Pleurisy is an inflammation of the membrane that lines the internal surface of the chest, which is called the pleura. This membrane also forms the external coating of the lungs. Any portion of the pleura is liable to become diseased, but that on the right side is more commonly affected. It is asserted by medical authors that pleurisy mostly attacks the robust and plethoric, but under my own observation the dis- ease has occurred almost exclusively in the dyspeptic, the feeble, or the intemperate. Under Thomsonian treatment, pleurisy is seldom fatal, unless complicated with extensive derangement of some important organ; or when it attacks age or debility, or vitiated constitu- tions. Causes.—Exposure to wet and cold; sitting in a current of air, or in a cold room, after severe fatiguing exercise, or sleeping in damp sheets, are common causes of pleurisy. Persons are often liable to be attacked with the disease after severe surgical operations. Symptoms.—An acute or lancinating pain in the side of the chest; hurried and painful breathing; a short dry cough, or attended with slight expectoration of a glary and almost colour- less phlegm, are the symptoms which characterize pleurisy. loo PLEURISY. The pulse in general is hard and frequent; the face flushed; the tongue coated; the skin dry and hot; and the urine scanty and high coloured. The symptoms, however, in this, as in other forms of disease, are modified by the various circumstances under which the dis- ease may occur, as the age of the patient, the strength of the constitution, the extent of derangement of important organs, es- pecially of the stomach and liver; or the degree of susceptibility of the lungs to become affected. Thus in the young and vigour- ous the reaction is apt to be strong, whilst in the aged and fee- ble the countenance may remain pale, and the pulse wreak. In some cases the breathing is greatly oppressed, whilst in others there is but little oppression, and no pain. The cough, which is usually harassing, is almost wanting in some instances. The expectoration, though in general colourless in the commence- ment, is occasionally tinged with blood, from the first, and when the disease extends to the substance of the lungs, the ex- pectoration is mostly copious, and consists of a ropy mucous, mixed with blood. The condition of the stomach modifies also the character of the symptoms, and influences, to a great degree, both the violence and the duration of the disease. The liver being torpid, or the flow of bile obstructed, the skin and eyes become yellow, or the countenance presents an appearance of a "sickly mixture of red and yellow." Inflammation of the pleura is very liable to produce adhesions between the side of the chest and lung, an occurrence, however, not productive of danger, and seldom of much inconvenience. But under unfavourable circumstances, an abscess is sometimes formed, which is always attended with more or less hazard to the patient. Favourable Signs.—A free expectoration of a thick yellow matter; an increased flow of urine, which on standing deposits a sediment; a general and warm perspiration, together with an abatement of the pain and oppression, indicate a favourable ter- mination of the disease. The unfavourable signs are, an increase of pain and oppres- sion; the cough continuing dry, or the expectoration resembling a dirty mixture of blood and water; a sense of suffocation, and a sudden raising up in bed, or a " constant effort by the patient to bare the breast and to raise his head and shoulders; a weak and irregular pulse; a livid appearance of the lips and counte- nance; a sense of burning on the surface and coldness internally, together with a rattling in breathing, and a tendency to deli- rium or stupour. These symptoms though indicative of great danger, should not be considered as necessarily of fatal omen, PLEURISY. 101 for recoveries occasionally happen after symptoms of the most alarming character have been presented. Slight attacks of pleurisy will, in general, require nothing more than warm teas, and small doses of lobelia, together with the vapour bath or foot bath to excite perspiration, and the pa- tient kept warm. When the symptoms are more violent, the patient should be kept under the influence of lobelia given in broken doses, and an occasional injection in very severe cases, composed of a tea. spoonful of lobelia in tincture or powder, in luke warm water and retained some minutes. An occasional dose of composition or a tea of bayberry and pepper should be given to assist in main- taining an equilibrium ol the circulation, and to excite and cor- rect the secretions of the stomach. The Vapour Bath is of great advantage in pleurisy: when the patient's strength will not permit his sitting up, the vapour can be applied in bed, and in this way continued for hours, if neces- sary. An emetic must he given occasionally after a vapour hath, or whilst the patient is in a perspiration by other means. A dry heat should not be applied around a patient when there is much fever, as it will increase the distress, before perspiration is induced. A warm poultice applied to the side will in many instances be attended with an immediate mitigation of pain. The poultice may be made of Indian mush, well boiled; or of boiled potatoes mashed; or slippery elm and flaxseed stewed together. A por- tion of ginger should be added to the poultice, and when spread the surface covered with powdered lobelia. The poultice should not be allowed to get cold, but kept warm by means of a hot brick, or jug of warm water placed in contact with it. Bilious Pleurisy, as it is called, usually commences with the symptoms of ordinary bilious fever. This and every other va- riety of pleurisy, however, must be treated upon the same gene- ral principles. In bilious pleurisy the course of medicine should be more frequently repeated than in simple pleurisy. The diet, during the active stage of the disease, may consist of the lightest kind of food, as elm gruel, barley water, crust coffee, arrow root, gum arabic water, or flaxseed tea, sweetened with honey. As the disease subsides, the quantity of lobelia may be less- ened, and the patient allowed more nourishing food, as essence 102 CATARRH—COMMON COLDS. of beef, boiled chicken, oysters, milk porridge, wild game, &c.f with stale bread and good tea or coffee. In some instances the treatment will require to be continued several days before an abatement of the disease be perceptible. The expectoration of a thick yellow matter is one of the first, as it is also one of the surest indications of a favourable change be- ing about to take place. Some medical writers state, that an increased oppression of breathing and suppression of expectoration is apt to occur in pleurisy about the fifth or sixth day. In cases of extreme prostration, from constitutional debility, or long continuance of the disease, a free use of wine whey with five or ten grains of carbonate of ammonia added thereto, say a wineglassful of the whey, and this dose given every hour or two, as the symptoms may indicate; in connection with capsicum and Virginia snake root tea—and if the cough be dry, or the expec- toration scanty, or of an unfavourable appearance, the lobelia should be used in connection with the above articles. Tonics—Such as spice bitters, Colombo, Virginia snake root, &c. are indicated where the patient remains weak after the dis- ease has passed off. A dose of composition or bayberry tea should be taken once or twice a day during the convalescence, until the tongue becomes clean and of a healthy appearance. • ' SECTION VII. CATARRH—COMMON COLDS. Catarrh, or common Colds, prevail to a greater extent than dis- ease in any other form. At particular seasons, especially in the spring and winter, when south winds prevail, the majority of persons exposed to the weather will be more or less affected with catarrh. Not only do catarrhal affections prevail more during the general thaws of spring and in open winters, but other forms of disease also prevail, to a much greater extent during those seasons when the atmosphere is chilly and charged with mois- ture, and damp from rain or from the thawing of frozen earth. The majority of cases of consumption originate from neglected colds, contracted during winter and spring. There is scarcely a form of disease that may not be produced by exposure to cold and dampness. Even contagious diseases, such as scarlet fever CATARRH—COMMON COLDS. 103 and measles, are much more common during winter and spring than at other seasons of the year; and in many instances child- ren are taken down with a contagious disease from certain con- ditions of the atmosphere, without their having been exposed to any one affected with the disease. Catarrhal Affections, like other forms of disease, arise from a loss of heat, and diminution of the nervous energy. When south winds prevail during spring and winter, the atmosphere is high- ly charged with moisture, which condenses on the walls and thus renders houses damp and unhealthy; the clothing of those ex- posed to the weather becomes damp, which, together with expo- sure of the feet to the wet ground, will almost necessarily occa- sion more or less disorder of the system. When the nervous en- ergy and heat of the system is reduced, digestion is enfebled and in proportion as the digestion is lost, will the system lose its power of generating heat. Hence " other circumstances being equal," a cold will be protracted in proportion as the digestive powers are weakened. Dr. Franklin used to say that he could bring on a cold by over eating. When the stomach is oppressed, less heat is generated in the system, and necessarily predisposes the person to take cold. Symptoms.—Most of the symptoms attending ordinary colds, are such as usually prevail in the first stage of almost every form of disease; such as lassitude, chilliness, furred tongue, loss of appetite, torpid bowels and a dry skin. There is usually more or less cough, which is dry at first, but when the cold is on the decline a free expectoration of a yellowr secretion takes place. The secretions from the nose are thin and watery at first, but be- come thick and copious as the disease abates. Extreme sore- ness of the throat is xery common in colds, attended with dry- ness of the parts, and pain on attempting to swallow. The breathing is greatly oppressed in some instances, and but slightly so in others. Generally more or less fever comes on in the after part of the day, and the patient is restless at night. Favourable Symptoms.—Cleaning of the tongue; a free ex- pectoration of thick yellowish, or cream-like mucous; the dis- charge of thick secretions from the nose; a tendency to perspi- ration, and a returning appetite, indicate a favourable and speedy termination to the cold. Treatment.—Ordinary colds require nothing more than an occasional dose of composition or capsicum tea, and a strict at- tention to diet, and care to avoid exposure to cold or dampness. Where patients are exposed to the open air, while engaged in 104 CATARRH—COMMON COLDS. their usual avocations, or to sudden changes of temperature, the hot medicine, such as capsicum and composition powder, should be taken in cold water. Taking freely of hot teas will open the pores of the skin, and may render the patient at the time, more liable to take fresh cold, if exposed to dampness, or a current of cold air. But where the patient is in bed, or not exposed to the cold air, hot teas should be taken to promote perspiration, assisted by warm applications to the feet. Simple teas of penny- royal, dittany, or chamomile, are beneficial, and may be drank freely, to induce perspiration. When liquids oppress the stomach, the compound lobelia pills will answer as a general medicine in all such cases. Where the cough is hard and dry the patient must be kept slightly nauseated with lobelia, and cough mixtures employed, such as flaxseed or elm tea, with the, addition of a portion of lemon juice and loaf sugar; onion syrup; bran tea; lemon juice , with loaf sugar; or liquorice root tea. For sore throat wrap a stocking around the neck on going to bed, and keep the neck warmly covered at all times. Molasses and butter melted together, adding a portion of cayenne pepper, taken at bed time, will be useful in sore throat. When the cough continues dry and hard, and the breathing oppressed, a course of medicine ought to be given, and the same repeated at proper intervals, until the symptoms become more favourable. Of the Consequences of Colds.—There is scarcely a form of disease that is not in the majority of instances, occasioned by " taking cold." The origin of almost every case of pleurisy, may be traced to a loss of heat and nervous power, either from exposure to cold and dampness, or from a loss of digestion by in- temperance in drinking, or overloading the stomach with food difficult of digestion; in which case the power of generating heat will be diminished in the same proportion as the stomach is op- pressed, or its powers enfeebled. In fine, the first symptoms in every acute disease, are such as indicate a loss of heat and nervous influence, and reason teaches that the treatment should be directed to restore the natural heat of the system, the loss of w Inch occasions the dis- ease. Whether a disease be brought on by exposure to cold and dampness, or be occasioned by an oppressed stomach, which lessens the power of generating heat, the indications for the treat- ment are the same. Exposure to cold and dampness, by abstract- ing heat and nervous power from the system, enfeebles the action of the stomach, and thus lessens the heat-producing power: the appetite becomes impaired, and the patient is affected with lassi- tude and chilliness; and disinclination to corporeal or mental ex- CROUP—HIVE*, 105 ertion. There is general torpor of the system, and extreme sensibility to cold. And again, if the stomach be oppressed by food that it cannot digest, the heat-producing power is weakened, and the patient will experience the same symptoms as from ex- posure to cold. In the first instance the heat is carried off by cold and dampness, and in the latter the power of producing heat is diminished. The effects of cold upon the system are exceedingly various: thus one whose digestion is strong may undergo long exposure to cold, but digestion being carried on vigorously, the lost heat and nervous power is soon supplied, and but little inconvenience is experienced. Whereas one of feeble digestion may become dangerously ill, by a very slight exposure. Thus, some women will remain for hours in a cold spring house, during the hottest weather, and experience no inconvenience, whilst in others it would be followed by dangerous illness, and probably occasion death. CHAPTER IV. DISEASE AFFECTING THE MOUTH AND THROAT. SECTION I. CROUP—HIVES. This dangerous disease is peculiar to childhood, usually oc- curring between the first and fifth year. Croup is caused by cold, or sudden changes of weather; or it may be occasioned by a disordered stomach or bowels. Symptoms.—The disease sometimes comes on suddenly, but generally its approach is gradual, with the usual symptoms that accompany a cold—Slight oppression of breathing, with a pe- culiar hoarse and shrill cough; the eyes are watery and heavy, and the child is dull and fretful. These symptoms frequently con- tinue some days before the disease assumes a violent form. The cough becomes at length more troublesome and shrill, and agi- 106 CROUP--HIVES* tates the child very much; the face becomes swollen and red; the breathing more difficult; the skin dry and hot, with a quick and tense pulse; and as the disease advances, the breathing becomes extremely difficult, accompanied with a hissing noise. Some- times the cough is quite dry, and in other cases there is a copious secretion from the wind-pipe from the commencement of the dis- ease. If the symptoms are not relieved, and the disease pro- gress in violence, the breathing becomes still more distressing, the child manifesting by its countenance and actions, the great- est degree of suffering; the head is thrown back; the eyes are half closed, and cast about with an imploring expression for re- lief; the face becomes pale, and covered with large drops of sweat; the lips livid; the voice becomes extinct; the extremities grow cold; slight stupor ensues; and finally the heat and sensi- bility continues to diminish until the breathing ceases. Spasmodic Croup, (as it is termed,) generally comes on sud denly, and without fever. The cough is not of that peculiar sound that generally characterizes common croup; and in some instances there is an entire absence of cough. Frequently Fatal.—The great danger attendant on croup, arises from obstructions in the throat or wind-pipe, preventing the free admission of air to the lungs. The obstruction may consist either in the formation of a false membrane in the wind- pipe,—filling up its cavity; swelling and inflammation in the epiglottis, or from spasm in the muscles of the throat. The free admission of air into the lungs being obstructed, the blood loses its vitality in proportion as the supply of air is lessened, and is thus rendered incapable of supporting life. Croup is extremely liable to terminate fatally to the patient, unless checked in its early stage by appropriate treatment. Treatment.—The means to be relied upon for the cure of croup are, emetics, injections, and the vapour bath. Emetics.^-In the early period when the symptoms are of a mild character, and the child in good health otherwise, an emetic of the tincture of lobelia may give immediate relief, and remove the disease. If this should not afford relief in a short time, say ten or fifteen minutes, the dose should be re- peated at frequent intervals, and injections administered, com- posed of composition tea, with the addition of a teaspoonful of lobelia powder, and place the feet in warm w ater. Vapour Bath.—Unless the patient be entirely relieved by the above means, the steam bath should be administered, and during CROUP—HIVES. 107 the steaming, bathe the head and face with whiskey, or vinegar and water, and if the patient be faint, dash cold vinegar or water on the breast. It is said that a sudden dash of cold water on the breast in croup has been found beneficial by exciting reaction, when the child had become affected with stupor. Where the symptoms are not so urgent as to require an im- mediate emetic—for instance, when the child has had a cold for two or three days more or less, which begins to manifest symp- toms of approaching croup,the vapour bath must be administered, previously to the emetic, in order to insure an effectual opera- tion. After the bath, a prompt emetic must be given, and frequent- ly repeated until the disease be expelled. The liquid of the third preparation of lobelia, with an equal quantity of brown lo- belia, forms the most efficient emetic: to be given in bayberry or sumac tea. In very young children, the brown or green lo- belia may be prepared in the above tea, or in composition tea, omitting the third preparation. The lobelia cannot be given too freely to a child in croup, and the more effectually the sys- tem becomes relaxed under its influence, the greater certainty there will be of effecting a cure. Injections.—These should be frequently administered in croup, not only with a view to relieve the bowels, but more especially to excite an afflux of blood to the bowels, and in this way to lessen the determination to the throat. I have on several occasions observed signal benefit by the administration of an injection of a small teaspoonful of green lobelia powder in luke warm water, and retained in the bowels ten or fifteen minutes, or even longer. No injury will arise if it should remain for hours. Under the influence of lobelia thus administered, free vomiting will very generally be produced, the system will become relaxed, and the symptoms of croup diminish, and sometimes entirely disap- pear. The treatment should be pursued as long as symptoms of croup continue, or until the case prove hopeless. There are few cases of croup, probably, but might be cured by Thomso- nian remedies, if early and perseveringly applied. But after the disease has reached a certain stage—for instance, the wind- pipe nearly closed by the formation of a false membrane, within its cavity; or effusion has taken place in the substance of the epiglot- tis, and thus permanently enlarge it, the obstruction in breath- ing which must necessarily attend either of these conditions, will be almost certainly fatal. External Applications.—A poultice composed of brown lobelia, pulverized, adding a portion of slippery elm, wet with hot water, 108 CROUP—HIVES. and applied to the upper part of the throat, is highly recom- mended by some practitioners. The poultice must not be allowed to become cold. By having two poultices, and changing them as the one applied becomes cooler, full benefit will be obtained without exposing the throat, except momentarily, to the air. It is important to protect the skin of the throat, after a poultice has been applied; and after the removal of the poultice, the skin may be bathed with No. 6, or stimulating ointment, and covered with flannel or cotton. Cases of croup are sometimes cured even after the symptoms have assumed a character indicative of a fatal termination. Dr. Chapman mentions a case of croup to which he was called, in which the disease had continued for three days without the symp- toms having been relieved, and as a last resort, they placed the child in a vapour bath, and as soon as the patient began to sweat, the symptoms were relieved. The child w as kept in the bath three hours, and recovered. I knew an instance of croup, where a child nine months old took two ounces of the third preparation of lobelia in the course of seven hours, and was cured, when a much milder course of treatment would very probably have failed. The free use of the third preparation of lobelia, and the continued application of the vapour bath, together with stimulating injec- tions, will be the most effectual means where the powers of life are far exhausted. The steam bath, by warming the blood, and expanding the tissues, gives the air greater access to the lungs—the vitality of the blood is increased in proportion as the supply of air is greater, and the warmth imparted to the skin at- tracts the blood to the surface, and tends to equalize its circula- tion. I have never applied the vapour bath in a case of croup, without relief to the symptoms, though in far gone cases the ben- efit will not be of long continuance. A child, held on the lap, will bear a moderate steaming for several hours at a time, pro- vided a proper attention be paid to bathing the head and surface of the body, and giving stimulants. The vapour should be of a temperature sufficient to keep the skin warm, and the patient in a moderate perspiration. In violent cases the lobelia may he given during the application of the bath. Children are subject to asthma or phthisic, which, in many of its symptoms, resembles croup. But any one acquainted with the croup cough, will be able to distinguish it from asthma. With regard to treatment, however, that which would be most effectual in croup, would be equally appropriate in asthma. SECTION II. QUINSY. This form of disease is characterized by inflammation and swelling of the tonsil glands, which are situated on each side of the throat and behind the root of the tongue. Sometimes the inflammation is confined to one side, in other instances both tonsils are affected. Symptoms.—At first there are symptoms of constitutional dis- order, as chilliness, loss of appetite and furred tongue, followed by more or less fever. The throat becomes swollen and swal- lowing is painful. As the inflammation and swelling increase, the efforts to swallow become more difficult and painful, and in some instances the patient is entirely unable to swallow. The voice becomes indistinct or whispering, and in some cases, the breathing is much embarrassed; the pulse is generally full and frequent, and the face red and tumid. There is usually a tough ropy mucous secreted on the inflamed surface, which is expelled with considerable difficulty. The swelling of the tonsils is al- ways observable externally, and the parts are very tender and painful to pressure. Inflammation of the tonsils is extremely liable to terminate in suppuration. In many instances an abscess will be formed, and discharge in a few days from the commencement of the in- flammation. There is chilliness at the time the ulcer is forming. Causes.—Persons predisposed to quinsy are liable to an attack from a sudden check of perspiration, more especially after severe exercise or fatigue. Exposure to cold damp air, and standing on damp ground, are the principal exciting causes of this dis- ease. Quinsy is rarely attended with much danger when properly treated from the commencement. Treatment.—To promote perspiration, and to cleanse the sto- mach and bowels, are the most important indications for the cure of quinsy. A full course of medicine will be proper in the com- mencement, as the surest means of moderating the violence and lessening the danger of the disease, and in some instances it will put a sudden stop to a further increase of the inflammation and swelling. 110 QJJINSY. In violent cases the patient should be kept slightly nauseated by broken doses of lobelia in composition or such other warm teas, as are good to promote perspiration. When there is great dif- ficulty in swallowing, the lobelia may be administered by injec- tions, in small portions of luke-marm water, and retained. Vo- miting may be very readily effected in this way, and prove of benefit in any stage of the disease. A strong tea of bayberry, or sumac with a portion of cayenne pepper given occasionally, and more especially when the coating on the tongue begins to soften, is peculiarly serviceable to cleanse the stomach. The feet should be kept warm, and occasionally placed in warm water. Gargling the throat frequently with very cold w-ater, or vine- gar and water, appears to be particularly serviceable in this af- fection, at the same time taking freely of the hot medicine to sus- tain the circulation and promote perspiration. Gargles of pep- per sauce, or of bayberry and pepper, may also be employed with a view to excite the secretions and clear the throat of mu- cous. The tincture of lobelia may be usefully employed as a gargle. Poultices.—Slippery elm, ginger and green lobelia, forms a good poultice, to be applied warm to the throat, and to keep the poultice from getting cold, five or six thicknesses of flannel should be applied over it; or in place of a poultice, spread a plaster of stimulating liniment, or salve, on a piece of silk, oil- cloth, or bladder, and apply to the throat; this last application is preferable to a poultice at night, on account of the liability of the poultice becoming dry and cold. Inhaling the vapour from vinegar may give relief. When an abscess is formed in the tonsil, and the patient great- ly distressed from the swelling, it should be opened with a lancet in order to allow the matter to escape; an operation attended with no danger, and one which gives immediate relief. After the abscess has discharged, a gargle of bayberry or sumac tea should be used, adding a portion of the No. 6, or tincture of myrrh. Preventives.—Those predisposed to quinsy, should make it a practice to gargle the throat every morning with cold water, and occasionally sponge the body with cold water, immediately on rising in the morning; and keep the feet dry and warm. SECTION IV. MUMPS. This is a disease of the parotid glands, which are situate be- low the ears, and behind the angle of the jaws. It is contagious and often prevails epidemically. Sometimes the gland on one side only is affected, which does not prevent the disease from occurring subsequently on the other side; but where both glands are affected, there is rarely ever a second attack. Children and young persons are the most liable to this dis- ease. Mumps is not a dangerous affection, though from exposure to cold, it is liable to be translated to other glands: in the male, to the testes; and in the female to the mammse, and the former particularly, requires judicious and thorough treatment. Symptoms.—There is swelling below the ear, extending part- ly over the cheek and neck, and stiffness of the jaws. The swell- ing increases and the parts become hard and extremely tender, and in some cases the patient is scarcely able to move the jaws. The swelling usually begins to lessen by the fourth or fifth day. There is more or less fever from the commencement, attended with restlessness, and sometimes slight delirium. Treatment.—Mild cases seldom require other treatment than keeping the parts warm, and to use some mild stimulant, with a view to promote moderate perspiration, as composition, ginger, or pennyroyal tea- When the symptoms are more severe, the bowels should be re- lieved by injections, and the stomach cleansed by an emetic. If the symptoms continue to be distressing, broken doses of lobelia should be given with warm tea. The local applications to the swelling, should consist of vola- tile liniments; sweet oil and spirits of hartshorn; or camphor, opodildock, &c. and the parts kept warm with flannel or cotton. Especial care should be taken to avoid taking cold. When the disease is translated to the testes, a full course of medicine should be administered, and the patient kept in a per- spiration by being in bed, and drinking of warm teas, and bro- 112 COMMON SORE THROAT. ken doses of lobelia. In severe cases the patient should lye on his back and have the testes supported by a soft cushen, and fre- quently bathed with volatile liniments, or apply a soft emollient poultice. The poultice should be wet occasionally with warm water to prevent it from hardening. Stimulating applications should be made to the parotid glands, as bathing with the third preparation of lobelia, or using warm poultices containing mus- tard or pepper, and kept warm. SECTION IV. COMMON SORE THROAT. Soreness of the throat arising from the same causes as quin- sy, is distinguished from the latter by the absence of much swell- ing in the tonsil glands, and no tendency to terminate in ab- scess.- Sore Throat is a common attendant on colds, and is usually preceded by chilliness and flushes of heat, checked perspiration, and impaired digestion. The throat is dry at first, and there is pain on attempting to swallow; cough, and sometimes an inclina- tion to vomit. There is a discharge of a thick yellowish mucous takes place sooner or later, and the soreness and inflammation subsides. The treatment should consist of hot medicines to warm the stomach and bowels, and promote perspiration, assisted, if ne- cessary, by the warm foot bath or vapour bath, and the feet kept warm. An Emetic will be of benefit in severe cases, and small doses of lobelia given to produce slight nausea. This is more particu- larly indicated when the skin is dry or where there is fever. The best Gargle for sore throat is capsicum tea; or pepper sauce. When the inflammation subsided, and a thick yellowish mucous is secreted, astringent gargles should be used, such as sumac or bayberry tea. There is a variety of other remedies useful for colds and sore throat, as flaxseed, or slippery elm tea, with the addition of a portion of lemon juice, and sweetened with rock candy; honey and vinegar, molasses and fresh butter stewed together with the APTHOUS SORE THROAT. 113 addition of a portion of red or black pepper, is a good remedy for ordinary sore throat. Filling a stocking with hops moistened with hot vinegar, and applying it to the throat at night, will generally put a stop to the further increase of the inflammation. This is a good application in the early stage of quinsy. The Constitutional Treatment for sore throat, is precisely such as should be employed in bronchitis, catarrh, quinsy, or any other disorder of the kind. Herein is the excellency of the Thomsonian system: embracing a few general principles, which are applicable to all cases. The human constitution is governed by general laws which are unvarying and unchanging. And although disease may appear in a variety of forms, yet it is al- ways the same in principle, requiring but few general reme- dies, applied to suit the circumstances of the case. SECTION V. APTHOUS SORE MOUTH. In this disease there is a secretion which forms in patches over the tongue and mouth resembling whey curd. In some cases the disease spreads and covers the tongue, and occasionally extends to the stomach and bowels, appearing at the anus,— these parts becoming excoriated. Local Treatment.—In the first place rub off these white patches with a dry rag; then wet a finger, and cover it with fine bay- berry powder, and rub over the tongue and sides of the mouth. Then lay on the tongue some finely powdered chalk, mixed with an equal quantity of loaf sugar. These applications will gen- erally cure in a few times repeating. Rubbing the dry powder over the surface stimulates the mucous glands, and changes the secretions to a healthy condition. Constitutional Treatment, in mild cases, is seldom necessary, more than to allow the child to swallow the chalk and sugar laid on the tongue. In more obstinate cases, give the child two or three times a day, a tablespoonful or more of the strong decoction of bayberry or sumac, with the addition of half a teaspoonful of powdered P 114 ELONGATED UVULA. chalk, and sweetened. And if there be symptoms of the disease having spread throughout the stomach and bowels, besides th« above mixture, give three or four times a day, half a teaspoon- ful of composition powder, in a tablespoonful of bayberry tea; and use injections to regulate the bowels. If this is not suffi- cient, apply the vapour bath to warm the blood, and give an emetic to cleanse the stomach. SECTION VI. ELONGATED UVULA—FALLING OF THE PALATE, The uvula, a small fleshy body, hanging from the middle of the arch of the palate, over the root of the tongue, is liable to become elongated, from exposure to cold and damp weather, or from an acid or otherwise disordered stomach. Sometimes there is but a slight lengthening of the uvula, and in other in- stances it becomes greatly elongated, having sometimes the ap- pearance of a bladder of water, and is very troublesome to the patient from the unpleasant sensation occasioned by it in the throat. From a frequent occurrence of this affection, the uvula is liable to become permanently elongated, and to excite frequent cough- ing, which in some instances does injury to the lungs. Cough of long standing is sometimes cured by the removal of a part of the uvula, where it had become elongated. Treatment.—Recent cases of this affection may, in general be readily cured by a few doses of composition, or of bayberry and pepper, and using a gargle of black pepper and whiskey, or a strong decoction of some vegetable astringent, as bayberry, su- mac, witch hazle, or marsh rosemary, adding cayenne pepper. When the uvula becomes permanently lengthened, and excites troublesome coughing, a portion of it should be cut off, provided the above gargles have no effect in exciting it to contraction. The clear No. 6, or the third preparation of lobelia, may be also used as a gargle where the parts have been long affected. » * CHAPTER V. DISEASE AFFECTING THE STOMACH AND BOWELS. SECTION I. COLIC. Colic is usually divided by medical writers into at least three varieties, namely, Accidental or Flatulent Colic, Bilious Colic, and Colica Pictonum, or Painter's Colic. 1. Flatulent Colic.—This species of colic is produced by a collection of wind or flatus in the stomach or bowels, from indi- gestion. Persons of weak digestion and acid stomach are liable to colic from inaccuracies in diet, or from drinking freely of cold liquids, such as lemonade, ice water, or cold milk. Colic generally comes on an hour or two after eating, yet sometimes immediately after. Before the pain seizes the patient, he gen- erally feels a sensation of fullness and distress at the pit of the stomach. In some instances the food passes into the bowels im- perfectly digested, and the colic does not come on until several hours after eating, and the pain is chiefly about the umbilicus or navel. When the pain is severe the patient bends his body forward, and twists about with his hands pressing hard upon the abdomen. The pain is generally lessened whenever there is wind forced upward or downward. Sickness at the stomach almost always accompanies colic, and if free vomiting take place, the distress is greatly mitigated, and sometimes entirely re- lieved. Distinguishing Signs.—A disposition to press the hand upon the belly; the bending and twisting of the body; the frequent belch- ing of wind, and absence of fever, serve to distinguish colic from inflammation of the stomach. In painter's colic, the abdomen, instead of being distended, is contracted, hard, and rigid, and the pain comes on and increases by slow degrees. Treatment of Flatulent Colic.—In colic there is a want of power in the stomach or bowels to contract and expel the wind. 116 COLIC. The chief indication, therefore, for the treatment, is toadminis- ter such stimulants, by the stomach or by injections, as will ex- cite contraction, and expel the flatus. Stimulants.—There are a variety of stimulants, either of which may answer in mild cases; such as capsicum or composition tea, Thomson's No. 6, oil of juniper, spirits of turpentine, or essence of peppermint. The teas must be drank as hot as the patient can bear them. Emetics.—A prompt emetic of lobelia is the most effectual means for curing ctdic, when the pain is in the stomach. The liquid of the third preparation of lobelia to be given in hot com- position or bayberry tea; or the lobelia powder and No. 6, used in place of the third preparation. The Vapour Bath, not only has a tendency to relieve colic, but it assists the operation of the emetic; the bath, however, will seldom be necessary except in very severe cases, and in case the system be very cold or torpid. Injections.—When the pain is seated in the bowels, injections may be given, prepared in the usual way. A prompt emetic, however, will generally overcome pain in the bowels. When the stimulating injections are expelled suddenly, without afford- ing relief, the lobelia powder should be administered in warm water, and care should be observed to retain them as long as possible. External Applications.—Flannels wrung out of hot water, or wet with hot whiskey, or No. 6; or hot bricks wrapt in damp cloths, should be kept to the stomach and bowels. Heat applied to the feet is also beneficial. Anti-adds.—ln most cases of colic there is acid in the sto- mach, interfering with the free operation of emetics, which requires to be neutralized by alkalies, such as salaeratus, bi-car- bonate of soda, or a tea of hickory ashes. Soot tea answers the same purpose, and will of itself, when drank freely, cure mild cases of colic. When lobelia is not at hand, or cannot be readily obtained, a teaspoonful of mustard in warm water, a tumbler of warm soot water, or w arm chamomile or bonesett tea, may be given to pro- duce vomiting. Infants are peculiarly liable to colic pains, which may be re- lieved generally by the most simple remedies; as warm tea of CHOLERA MORBUS. 117 catnip, ginger, calamus, or mint. Adding a few drops of the essence of peppermint, or tincture of lobelia, will render the teas more effectual. Soot tea is very good for colic in infants: emetics, however, are sometimes necessary. SECTION II. CHOLERA MORBUS. This form of disease is occasioned by indigestion and want of vital power in the system to generate heat and nervous influence. It is common in hot weather, but more particularly in autumn. Symptoms.—Cholera morbus usually comes on suddenly, com- mencing with distress and pain at the pit of the stomach and in the bowels, followed by severe vomiting and purging. When the symptoms are violent, the strength is rapidly exhausted, and great distress is felt at the pit of the stomach. The thirst is excessive—and in many instances, the patient is harassed by cramps in the muscles of the abdomen and lower extremities, and the pulse is usually irregular and feeble. The severe and continued retching, and strong efforts to vomit, generally occa- sion more or less bile to be thrown up, whicli is observable also in the evacuations from the bowels. The aggravated form of this disease which prevailed a few years since, received the name of Asiatic cholera. Cholera is generally rapid in its course and frequently termi- nates fatally, under unfavourable circumstances; as when it oc- curs in vitiated and broken down constitutions, or when the pa- tient is subjected to an improper course of treatment, such as large doses of narcotics, or calomel; or when the vital powers are prostrated by the loss of blood. Causes___There are certain atmospheric influences that evi- dently predispose the system to cholera morbus. The general exciting cause of the disease is, a sudden check to perspiration; unwholesome food, or that which is hard of digestion; intemper- ance, and drinking copiously of cold water on an empty stomach. In some seasons, almost every person that is sick will have more or less of bowel complaint. Intermitting fever sometimes com- 118 CHOLERA MORBUS. mences with a violent attack of cholera morbus. During the season that the cholera prevailed throughout this country, almost every person had, more or less, a looseness and disorder of the bowels, showing very plainly that there must have been a cause in the air which tended to weaken the vital principle and enfee- ble the powers of digestion. Treatment of Cholera Morbus.—The most important indica- tion in the treatment of cholera morbus, is a thorough emetic and a free use of injections. The vapour bath should be adminis- tered, or hot bricks, or bottles of hot water, wrapped in damp cloths placed around the patient. As long as the symptoms of retching and purging continue, together with pain and cramp, the third preparation of lobelia must be given in full and frequent doses. A milder stimulant, for instance, as composition, will in many instances be thrown off the moment it is sw allowed, with- out producing a sufficiently beneficial result. I have witnessed cases in which every thing swallowed had been rejected instant- ly, with the exception of the third preparation of lobelia w Inch always remained several minutes before it was thrown off, and would bring morbid matter from the stomach, which could not have been throwrn off without it. I know of no form of medi- cine of equal efficacy, in all bad cases, as the third preparation of lobelia in bayberry tea. Patients in many instances have con- tinued retching and vomiting for hours in succession, raising scarcely any thing, yet by taking a vapour bath to warm the blood and restore the nervous power, or excitability of the sys- tem, followed by a prompt emetic, large masses of undigested food have been thrown off, and the stomach become settled in a short time. Therefore it will not do to be satisfied without giving an efficient emetic, as long as the stomach continues its efforts to relieve itself, or the system sinks into a collapsed state. Even though the system should not contain any thing that requires to be removed, and the retching continues from an unsettled, or as it is termed, an irritable condition of the stomach, the emetic would be as likely to quiet the stomach as any medicine that could be given. Dr. George M'Clellan stated in one of his lectures, that in the post mortem examinations that he made where patients died of cholera, he invariably found the stomach more or less filled with masses of undigested food, and in many instances observed sub- stances, that must have been swallowed many days previous to their death. The doctor adopted the practice of giving prompt emetics in every case that came under his care, and by this course of treatment he succeeded in raising every patient sub- jected to this mode of treatment. Flannels wrung out of hot brandy or No. 6, should be applied over the abdomen. * CHOLERA INFANTUM. 119 After the disease be checked, which it almost always is, under thorough Thomsonian treatment, the patient must remain quiet, and warm in bed, and take occasionally some spice bitters and pepper tea; or the No. 5 syrup, or cholera syrup may be taken occasionally. I have very little confidence in cholera syrup, or any thing else short of an emetic, except in light cases. The digestion being left weak, care will be necessary to regu- late the diet, and to avoid all kinds of fruit, pastry, and every thing difficult of digestion. Milk porridge, barley water, cus- tards, &c. will be proper; and, if the patient desire it, he may take moderately of boiled or broiled ham, and also the thin part of a salt mackerel boiled, but neither broiled nor fried. To allay thirst the mouth and throat may be gargled frequently with cold water, but cold liquids must not be swallowed, except in very small quantities. Capsicum tea by exciting the secre- tions, will generally allay thirst. A mustard plaster over the pit of the stomach will have a ten- dency to allay the vomiting and relieve the pain; taking care to remove the mustard, however, before it produces a blister. SECTION III. CHOLERA INFANTUM—CHOLERA OF INFANTS. Infants are especially liable to bowel complaints arising from indigestion, particularly when they are teething. When there is both vomiting and purging, it is called cholera infantum. It seldom comes on suddenly violent, as it happens in the cho- lera of adults; generally commencing with diarrhoea, which continues several days, before vomiting take place: occasionally however, the vomiting and purging comes on simultaneously. Infantile cholera, like that of adults, arises from a loss of the power of digestion; the food being imperfectly digested, becomes sour and acrid, and offends the stomach and bowels, similar to an irritating cathartic; for instance, mandrake, or jalap. The constitution endeavouring to cast off the undigested matter by vomiting and diarrhoea. Cholera of infants is usually much more protracted in dura- tion than that of adults; generally continuing for several days, and not unfrequently it becomes chronic. In many instances, however, the vital powers sink rapidly, and the disease, if not 120 CHOLERA INFANTUM. subdued, will become suddenly fatal. Where the disease is un- checked, the strength soon becomes greatly exhausted; the flesh wastes rapidly; the countenance becomes shrunken and pale; the extremities cold; the belly swollen and hot; the skin dry and husky, or cool and flaccid; the discharges from the bowels fre- quent, w-atery, and acrid; the little patient doses with his eyes half closed, and rolls his head when awake. The eyes become sunken and glassy; the lips blue; the breath cool; and finally the patient sinks into a state of insensibility, and in many in- stances dies with symptoms of dropsy on the brain. Patients have recovered from this disease, however, even after the occur- rence of the above symptoms. A feverish state of the system is always more favourable than an opposite condition. In many instances the evacuations from the bowels consist of a deep green fluid—the green colour probably is owing to the acid in the bowels, acting upon the colouring matter of the bile. Thomsonian treatment will generally succeed in curing cho- lera infantum, if timely and properly administered. Treatment of Cholera Infantum.—The same general course of treatment is required in this form of disease, as in that for adults—relying chiefly upon the vapour bath, emetics, and in- jections, in the early stage, together with the use of stimulants to support the vital powers, to determine the blood to the surface, and to promote healthy secretions; astringents to "remove the canker;" anti-acids and absorbents to neutralize acid; and finally tonics to restore digestion. The Vapour Bath.—Whoever has witnessed the effects of steaming in cholera infantum, must become convinced of its util- ity. I have, in many instances, seen little patients made com- fortable, at least for a time, by the bath, when they before were suffering the most severe spasms of pain. It is a universal opinion among practitioners of the old school, that the liver is in a state of torpor in this disease, and by failing to secrete bile oc- casions th6 stools to be of a light colour. From the close sympathy existing between the skin and the liver, the vapour bath, by its prompt action upon the skin, tends to restore action in the liver. Besides this, the vapour bath, when well applied, warms the blood, and also thins it, by quickening its circulation through the lungs. Steaming will also increase the natural sensibility of the system, and cause the emetic and other remedies to operate more promptly and effectually. The best mode of steaming infants is to do it on the mother's lap, or if they can sit on a table-chair this will be better. The steam- ing may be continued from fifteen minutes to half an hour, and repeated as often as the case may require, washing over the sur- CHOLERA INFANTUM. 121 face occasionally while in the bath, with spirits, vinegar, or simply with water. The shower bath, or dipping the child in- stantly from the steam into a tub of cold water, may be prac- ticed with perfect safety, except in very low cases, when there is not heat or nervous energy sufficient to excite reaction. Ex- citing reaction in this way, it is in many instances of especial benefit, more particularly in chronic cases. After this, the pa- tient should be clothed warmly, and have a flannel bandage over the abdomen, which may be wet occasionally with No. 6, or the third preparation of lobelia. There is no form of disease in which I have found the vapour bath more beneficial than in bowel complaint. To keep the head constantly wet with vinegar and water, when steaming, is both grateful and beneficial to the patient, Emetics may be prepared in various ways. I have generally found the following form to answer as well as any other: An even teaspoonful of green lobelia, Ditto of No. 6, In a small teacup, half full of very strong bayberry or No. 3 tea. The lobelia to be added to the tea when moderately hot. To be strained and sweetened; and to an infant give a tablespoonful every ten or fifteen minutes, until free and full vomiting is produced. In severe cases I have used the third preparation of lobelia, to- gether with a portion of the green lobelia, adding the bayberry tea. Green lobelia in composition tea does very well in many cases. In cases where I have deemed it necessary to continue the use of a diffusive stimulant, and occasionally to relieve the stomach by vomiting, I have given the liquid of the third preparation of lobelia in a small quantity of boiled milk. The best time for giving an emetic is immediately after steaming; still it may be given at any time without the previous use of the bath. In some cases it may be necessary to repeat an emetic every two or three hours; in other cases once or twice a day; and in others still less frequently: the nature of the case, however, will point out when an emetic is necessary. I have never witnessed any injury to arise from a too frequent repetition of prompt and efficient emetics in cholera infantum; but on the contrary, patients are apt to be permitted to suffer, and even to sink, from oppres- sion of the stomach, which might have been relieved by the early administration of emetics, before the powers of the constitution had sunk under the effects of the disease; and the heat and nerv- ous energy become too far exhausted for medicine to have a pro- Q 122 CHOLERA INFANTUM. per effect. The operation of an emetic has a beneficial influence upon the liver in arousing it from a state of torpor. Injections.—In the early stage of bowel complaint, an injec- tion repeated three or four times will, in some instances, be suffi- cient to check the further progress of the disease. They should be prepared in the usual form, of composition tea and green lobelia, or tincture of lobelia; or of a strong decoction of some suitable astringent, such as bayberry, sumac, raspberry leaves, or dewberry root, adding a portion of No. 6 and green lobelia, or a small teaspoonful of the third preparation of lobelia. When the evacuations are green, denoting the presence of acid, or if they be of a frothy acrid character, a portion of salseratus, or a teaspoonful of the bi-carbonate of soda should be added to the injection. When the parts become sore and irritated from re- peated evacuations, or the frequent introduction of the syringe pipe, a gum elastic tube, made for the purpose, placed on the pipe of the syringe, will cause much less irritation than the me- tallic pipe, and by introducing the gum elastic tube four or five inches, the injection will have a more decidedly beneficial effect. In those cases where injections, given with an ordinary syringe, are immediately rejected the gum elastic tube, or a large catheter must be used for the purpose of throwing the injection so far into the bowels as to prevent its immediate expulsion, without having the desired effect. Composition Powder.—As much of the composition powder as Will lay on a ten cent piece, rubbed up with an equal quantity of sugar, and then stirred into a tablespoonful of strong bayberry, or sumac tea, and given, repeating it every two or three hours, will in general prove far more beneficial than the composition tea alone. In slight cases, this dose repeated two or more times a day, will be sufficient to check the disease, at its commencement. The composition, prepared in this way, may be given in all cases, and when repeated two or three times a (lay, or as the case may require, it frequently has proved more effectual in my hands than any preparation of cholera syrup that I have ever used. Capsicum, though unpleasant to administer to children, is ne- vertheless one of the most valuable medicines in all Cases of dis- ordered bowels. There are few cases, probably, of cholera in- fantum, that may not be cured by a timely and free use of cay- enne pepper. An additional quantity of capsicum added to the composition or spice bitters, will render their use more effectual. A very good way to administer pepper to children, is to add it to a small quantity of boiled milk. It is generally more effectual, however, given in the form of simple tea sweetened. CHOLERA INFANTUM. 123 When the tongue is dry and the patient thirsty, the pepper tea should be used instead of the composition and bayberry. I fre- quently combine pepper with ginger, making a strong tea of them, and give a teaspoonful with the addition of ten or fifteen drops of the tincture of lobelia every half hour. External Applications.—These may consist of stimulating lin- iment, No. 6, or the third preparation of lobelia applied to the ab- domen; or warm poultices over the region of the bowels, composed of composition powder and green lobelia, moistened with warm water, enclosed in gauze or book-muslin, and applied to the parts. The poultices must be kept warm, for if they become cold they will be likely to do harm. It is a good plan to have two poultices and change them when they become too cold or dry. Mustard plasters over the stomach are useful in some cases, more particularly where the stomach remains irritable and the patient continues retching after the operation of an emetic. The mustard must be removed before it draws a blister. Anli-adds.—A weak tea made by pouring boiling water upon common soot and sweetened, will relieve colic pains, by caus- ing the removal of the flatus from the stomach. The soot tea, or salseratus, or bi-carbonate of soda, is sometimes necessary to be given to neutralize the acid in the stomach, before an emetic will operate effectually. Diet.—During the active stage, or until the disease be checked, a most careful attention will be necessary in the seleGtion of food. It is better to give the patient no food, at least for a reasonable length of time, than to introduce such into the stomach as it can- not digest. Bermuda arrowr-root, gum arabic, crust coffee, cof- fee made of scorched rice pulverized; milk porridge, Irish moss, boiled milk, oat meal gruel, or barley water, forms the most suitable article of diet. It will be proper in severe cases to use some one of the above articles for infants that have not been weaned, for the mother's milk will in some cases be thrown up in solid masses soon after it is swallowed, or passed off by the bowels in an indigested state. The excessive thirst attending the disease will induce an infant to take the breast almost con- stantly, and take large quantities of milk into the stomach, which sometimes forms into masses of cheese-like substance, and will greatly increase the suffering, and even endanger the life of the patient. Drink, as well as food, should be given in very small quantities. A teaspoonful of gum arabic water, or of barley water, is as much as should be given at once, in cases where the stomach is very weak; this quantity, however, may be given very frequently. 124 CHOLERA INFANTUM. As long as food passes through the bowels undigested, such articles of diet must be given as are least disposed to sour or ferment, such as calves' foot jelly, gum arabic water, and crust coffee, and even these in very small quantities. The thirst may arise from a curative action in the stomach, and if large quantities of liquids be taken, the stomach may thereby become oppressed, and unable to recover its diminished vitality. As the stomach and bowels become more settled, and the stools present a more favourable appearance, such as small portions of natural fseces, with thick secretions, in appearance, J like small flakes of a skin-like substance, together with bilious matter, showing that the functions of the liver are being restored, then stronger food may be given, as chicken tea, essence of beef, with crackers or stale bread, and milk porridge. Salt should be add- ed to the food, as this is a most important article in most cases where patients are recovering from sickness. Patients, in re- covering from cholera very often have a craving for salt food, as old bacon, and salt fish, which will be found not only to gratify the patient, but will tone the stomach, and cause an immediate improvement in the symptoms. The thin part of salt mackerel boiled, or a small piece of salt ham boiled, or broiled, may be given, and the use of it continued, provided it be found not to disagree with the stomach or bowels. " I have seen many chil- dren recover," says Dr. Rush, " from being gratified in an in- clination to eat salted fish, and the different kinds of salt meat. In some instances they evince an appetite for butter, and the richest kinds of gravies from roasted meat, and eat them to the obvious relief of all their symptoms." Patients are subject, however, to morbid cravings for food, which may be found to disagree with the digestive organs, and it will therefore be ne- cessary to exercise proper discretion in granting much indul- gence to extraordinary cravings for particular articles of food or drink. A child may crave sweet cakes, as ginger bread and pound cake, and yet they may be decidedly injurious; or there may be a craving for cold water, wiiich if given too freely, might occasion fatal symptoms. To restore digestion, the No. 5 syrup may be used, or a tea made by steeping in boiling water, equal portions of powdered black or sweet birch bark, aspen, poplar, and pounded cherry stones. The tea to be sweetened with loaf sugar, and given in tablespoonful doses three or four times a day. This preparation will in many instances cure ordinary diarrhoea, both in children and in adults, and is not unpleasant to take. It becomes more effectual by the addition of a portion of No. 6. A strong tea of the poplar bark alone, will answer as a tonic. When the disease becomes chronic, and medicines have failed of effecting a cure, or if the child be subject to frequent CHOLERA INFANTUM. 125 relapses, there is probably no means so likely of success, as a change of air, or the cold shower bath. It frequently happens that taking a child with this disease from the city to the country air, will in a few days restore the appetite, and the patient will begin to gain rapidly in flesh and strength. The Cold Salt Water Bath.—In most cases of chronic disease of the bowels, where the patient continues feeble and emaciated, much benefit may be derived by dipping the patient every morn- ing in a tub of cold salt water. If the patient be excessively weak, it will be prudent to temper the water at first by adding a portion of hot water. After being dipped, the child should be wrapped in a blanket, and placed in a warm bed, in order to favour reaction; and if the child becomes wTarm in fifteen minutes or half an hour, it will most certainly be beneficial. I have, in repeated instances, known cures to be effected by the daily use of the cold bath, where medicine had apparently lost all effect. Lancing the Gums is often of benefit in the early stage of cho- lera infantum; more particularly when the diarrhoea first com- •mences; but where the disease has prostrated the strength of the little sufferer, and more particularly if the gums be spongy, cutting them will not only prove useless, but hazardous, on ac- count of the excessive bleeding which is liable to take place when the gums are in a spongy state. Preventives.—Cleanliness; cold baths in the morning; avoid- ing all unripe fruit, sweet cakes, pastry, &c; lancing the gums when teething; residence in the country, and a flannel bandage over the abdomen, are good preventives. SECTION IV. BILIOUS COLIC. When colic is accompanied with bilious vomiting, or the skin and whites of the eyes become sallow, it is termed bilious colic. The supposition that an overflow of bile occasions the disease, has given rise to the name of bilious colic, when in reality the liver is in most instances in a torpid condition, and secretes less bile than when in a state of health. The digestion being impaired or suspended, the bowels cold and inactive, the bile is not used, and being retained in the duodenum, it is drawn into the sto- mach by the act of vomiting, and thrown up. A vitiated state of the bile is doubtless a frequent cause of the sickness and vomiting, but this unhealthy condition of the bile is an effect, and not the cause of the disease. Bilious colic is more liable to occur in autumn, and especially in localities where ague and bilious fever prevail. In most instances the general health is considerably deranged before the attack of colic is manifest. The appetite is impaired; the tongue coated with fur, and the bowels costive, or otherwise disordered. The skin is dry, and frequently there is pain and soreness in the back; an uneasy sensation at the stomach, bad taste in the mouth, headach, nausea, and sometimes vomiting. These symptoms are followed by cutting pains in the stomach and bowels; sickness at the stomach, and vomiting : frequently bile is thrown up. The pain increases, and in many instances, assumes a very violent character. There is great prostra- tion of strength, and usually some attending fever. The bowels in almost every instance, are obstinately constipated, having lost their power of action. As the disease continues, the abdo- men becomes sore and tender to pressure, and in most instances the complexion has a yellow tinge. The duration of the disease varies greatly in different cases, and as it occurs under different circumstances, sometimes it is overcome in a few minutes, by proper treatment in the commencement, and in other cases it will continue with more or less severity, at intervals, several days in succession. Treatment of Bilious Colic.—A full course of medicine timely administered, will overcome the pain, and check the further progress of the disease in a great majority of cases. BILIOUS COLIC. 127 Emetics are more effectual in general, than any other curative means in the treatment of bilious colic. Even where the pain is wholly confined to the bowrels, it is generally relieved by free vomiting, together with the relaxation produced by the lobelia. In sudden attacks, where the pain is violent, an emetic of the third preparation of lobelia, or of lobelia powder and No. 6, must be given without waiting to administer the vapour bath. If, after the full operation of the emetic the pain continues to return, a full course of medicine will be necessary, or the emetics con- tinued, together with the application of hot fomentations to the abdomen; or the application of hot bricks, wrapped in damp cloths to that part. In some cases the emetic will require to be frequently repeated. When the patient has warning of the ap- proach of the colic, a regular course will be more likely to keep it off than a simple emetic without the bath and enema. There are many persons subject to periodical returns of bilious colic. Such persons are generally dyspeptic, and exhibit marks of a torpid liver. I have known several cases of long standing effectually cured by an occasional course of medicine, together with apropriate intermediate treatment, and strict attention to diet. The bowels being obstinately constipated, will require the aid of injections, more especially if the pain be chiefly in the lower bowels. The usual stimulating injections may be used, and they always should contain lobelia. In obstinate cases I have wit- nessed great relief afforded by introducing a stomach tube, or large catheter, eight or ten inches into the bowels, and passing an injection through it; the introduction of the tube, however, requires care, and sometimes it is difficult to accomplish it, even by those who have had experience in the operation. Where the abdomen is not very tender to pressure, an injection of spirits of turpentine is highly recommended by many practitioners. The mode of preparing is to rub together a tablespoonful of turpen- tine, and the yolks of two eggs, adding a pint of warm water; or mix the turpentine with some dry slippery elm powder, and then add the warm water. I have used injections of the lobelia powder in warm water, and had the patient to retain them, for the purpose of effecting relaxation of the system, which has gen- erally been attended with decided benefit. The Warm Bath generally affords considerable relief, and may be used to prepare the system for an emetic. External Applications.—Besides the vapour and warm bath, much benefit may be derived by the application over the abdo- men of warm stimulating poultices, hot fomentations or mustard plasters. The mustard must not be allowed to form a blister. 128 COLICA PICTONUM. After the disease is subdued and if the nervous system becomes weak and agitated, the valerian, or scull-cap tea may be adminis- tered; the latter answers both as a nervine and a tonic. To prevent a relapse, the patient should take a dose of spice bitters occasionally, or some other warm medicine, and pay strict at- tention to diet. I do not know of an instance of bilious colic in which the Thomsonian practice has failed, when perseveringly applied, not only to remove the pain at the time, but in every case a per- manent cure has been effected, even where patients have been subject to frequent attacks of the disease during a period of from two to twenty years. The plan generally to be pursued, is to administer an emetic, or a full course of medicine, wiien there are symptoms of a disordered stomach, or of an approaching spell of colic. A Case.—J. M. E. had been subject to attacks of bilious colic, and applied to the Homoepathic practice, after the regular treat- ment had failed. The Homoepathic medicine gave him almost instant relief from the pain, and he continued to use the medi- cine whenever the attack of colic come on, until finally the spells become much more frequent, and attended with neuralgic pains throughout the system. He became alarmed, and placed himself under Thomsonian treatment, and by taking a few courses of medicine, at proper intervals, and stimulants inter- mediately, he was effectually cured. This patient had not more than two returns of the spells after the first course of medicine was given him. The above case illustrates the fact, that although a medicine may overcome pain, it may, at the same time not only fail of re- moving the disease, but may lay the foundation for another form of disease still more troublesome. section v. COLICA PICTONUM—PAINTER'S COLIC. This most distressing malady which has received a variety of appellations, such as painter's colic, lead colic, and dry belly- ache, is caused by exposure to the fumes, but more particularly to the dust of white lead. Painters, and more especially those who assist in the manufacture of white lead, are liable to this form of disease. COLICA PICTONUM. 129 Symptoms.—As the system becomes gradually poisoned by the metallic substance, the general health is correspondingly impaired. There is an uneasy sensation at the stomach; failing of the appetite; constipation of the bowels; general debility and lassitude; a sense of weight and constriction in the abdomen, with transient pains in the stomach and bowels. By de- grees the symptoms become more distressing; the pain in the stomach and bowels increases; the abdomen is hard, and instead of being distended, as in other forms of colic, it is retracted, and the natural action of the bowels is suspended. Vomiting almost always accompanies this disease; and immediately after vomiting the patient experiences more or less mitigation of the pain. This disease is not only of an agonizing character, but it is apt to be protracted in duration, continuing in many instances for two or three days with but slight mitigation of the suffering. In the more violent cases the pain extends from the bowels up to the chest and into the arms, and downwards to the bladder and rectum, accompanied with a distressing sensation of weight and bearing down, and frequently great difficulty in evacuating the bladder. Cold sweats break out over the face and extremi- ties; and, in some instances, there is delirium, stupor, and con- vulsions. If the disease be not subdued, the vital powers begin to sink; the abdomen becomes swollen and puffy, yet with an abatement of the pain; the thirst is excessive; the sight is im- paired; the feet become swollen; the countenance pale and hag- gard; there is difficulty of breathing, and finally the patient sinks into a state of stupour terminating in death. By a continued exposure to the poisonous influence of lead, the vital powers become so far exhausted, as to be insufficient, even by the aid of medical means to eradicate the poison from the system, and to restore the organs to a healthy condition. Pa- tients that have had two or three attacks of painter's colic sel- dom recover fully from the effects of the poison. The appetite is bad; digestion greatly impaired; the natural temperature of the body very low; the extremities always cold; the bowels con- tinue obstinately constipated; the spirits sunken and depressed; the complexion sallow and of a leaden hue; the flesh wastes away; the skin is dry, harsh and contracted; the temper is peevish and sullen, and the countenance is expressive of gloom and suffering. In the first attack of the disease, however, it is almost always curable; though it requires several days in almost every instance to effect a favourable crisis in the disease. In most instances a cure may be effected, aided by the recuperative efforts of nature, during the first attack. Treatment.—Painter's colic requires the same general plan of treatment recommended for the cure of biliom colic. R 130 COLICA PICTONUM. The Vapour Bath besides fulfiling other important indica- tions, will prove more effectual than any other means used to remove the poison from the blood. Besides applying the steam, hot poultices composed of pepper and flour, or warm fomentations should be applied to the abdomen. When the vapour bath is found to afford sensible relief, it may be continued for several hours together; the patient being on a bed or mattress, and the surface bathed occasionally with whiskey, vinegar or water; either cold or tepid, as may be most agreeable to the patient; and give occasionally of pepper or composition tea. A poultice composed of lobelia powder and slippery elm, wet with No. 6, will answer a good purpose. Emetics are as essential in this form of disease as they are in that of bilious colic, or cholera morbus. In many cases free vomiting affords almost the only relief from pain, until the dis- ease be subdued. The third preparation of lobelia answers well for the emetic, except the tongue be very dry, and the medicine occasion a sense of tightness or stricture across the breast; when this happens the lobelia powder should be prepared in a tea of the bayberry, with the addition of a portion of cayenne pepper. Capsicum is one of the best and purest of stimulants, and may be given freely in all cases when the secretions of the mucous membrane are suspended, occasioning dryness of the tongue and throat. Injections.—These will be of great service to moderate the pain. They may be administered frequently, especially if they afford relief. Besides the stimulating kind, an occasional in- jection of two or three teaspoonfuls of lobelia powder, given in hike warm water, and retained in the bowels will tend to overcome the rigidity of the muscles, and alleviate the nervous spasms. The extreme torpor of the bowels would render the utility of cathartics, to say the least, extremely doubtful; they would have a tendency to harass the stomach, and if not ejected by the sto- mach might become absorbed into the blood. The true indica- tion of treatment for getting rid of the poison, is to stimulate the system, and by this means those organs, designed for re- moving deleterious agents from the system will have their cura- tive action increased. Astringents are especially beneficial in all cases of painter's colic. A strong decoction of the compound of the bayberry and sumac berries, does better than the tea of the bayberry alone. I succeeded in curing a case of the disease that had become chronic, the patient having been several years employed in Mr. DYSENTERY. 131 Wetherill's white lead manufactory, where he was daily exposed to the deleterious fumes of this noxious mineral. In this case I found astringents peculiarly beneficial, administered three or four times a day, with the addition of a small portion of capsicum. This patient also used injections of the same, and occasionally had a vapour bath and an emetic. Large quantities of a thick membranous substance were passed from his bowels, 'by the injections. It must be borne in mind that painter's colic is not to be cured in general, short of several days, and in some instances not un- der two or three weeks. During the convalescence the patient should take tonics, and once or twice a day, a teacup half or two-thirds full of a decoc- tion of the bayberry and sumac berries, and avoid exposure to the fumes of lead. Precautions.—Those engaged in the manufacture of white lead should make use of fat meats, or use freely of palm oil at meals, and never be exposed to the lead in the morning with an empty stomach. A tablespoonful of palm oil taken in the morning is said to afford protection to the stomach against the effects of this mineral poison. SECTION VI. DYSENTERY. This disease is characterized by severely griping pain in the bowels; a frequent inclination to go to stool; and the evacua- tions consist of blood and mucous. Sometimes the evacua- tions consist chiefly of mucous—at other times they are very bloody. These dysenteric symptoms are generally preceded by lassi- tude, chilliness with flushes of heat, loss of appetite, torpid bowels, bad taste in the mouth, and nausea. From the commencement of dysentery until there be consider- able amendment, the natural faeces of the bowels are retained, or voided in very small quantities, consisting of small hard balls, called scybalse. The passing of these hard balls through the diseased bowels, is attended with severe pain. Dysentery prevails most (luring the latter part of summer, and also in autumn. 132 DYSENTERY. Causes.—Perspiration suddenly checked by cold, especially where the system is exhausted from over exertion, is a common cause of dysentery. "A cold and moist autumn succeeding a warm and dry summer, is peculiarly favourable to the produc- tion of dysentery. Dysentery frequently prevails as an epidemic in low marshy districts of country, probably from the continual influence of marsh effluvia and dampness. The same causes that produce dysentery in one person may occasion bilious fever (as it is called) in another; and hence it often happens that both forms of disease prevail at the same time, and some patients will have all the symptoms of dysentery and bilious fever at once. Among the occasional causes of dysentery may be mentioned unripe fruit, and other unwholesome articles of food, taken into the stomach. Dr. Thomson, in his Narrative, makes mention of a malignant form of dysentery which prevailed in the town of Jericho, in 1807, where out of twenty cases under the treatment of the medical faculty, but two recovered. The inhabitants became alarmed, and sent an express for Dr. Thomson, who began to treat the disease according to his system of practice, and of thirty cases which came under his treatment, all except two recovered. "I had," says the doctor, "but little medicine with me, and had to make use of such as I could procure at this place. I found the cause of the disease to be coldness and canker; the digestive powers being lost, the stomach became clogged, so that it would not hold the heat. I made use of red peppers, steeped in a tea of sumac berries, and sometimes the bark and berries, to raise the heat and clear off the canker, which had the desired effect. After taking this tea, those who were strong enough I placed over a steam, as long as they could bear it, and then put them in bed. Those who were too weak to stand, I contrived to have set over the steam, and this repeated as occasion required." To restore digestion, the doctor made use of a syrup made of black birch bark and cherry stones bruised. Treatment of Dysentery.—Dr. Thomson's course of medicine fulfils all the necessary indications in the cure of dysentery.— The course should be repeated daily in bad cases. During the intervals between the courses of medicine, or when the disease is of a mild form, not requiring a course of medicine, any one of the following preparations may be given at intervals of one or two hours, viz: A strong decoction of bayberry or of bayberry 'and sumac, adding a portion of cayenne pepper, and sweetened; or the pepper alone in tea or in pills, with an occasional dose of the abo>e decoction. DYSENTERY. 133 Another preparation.—Composition pow7der and sugar, each a teaspoonful, rub them together, and add a teacup half full of hike-warm water, to be stirred together before taken. Prepared in this way the composition has a better effect than when scald- ed in boiling water. Another.—Take of fine bayberry powTder and sugar, each a teaspoonful, add two teaspoonsful of No. 6; mix them together, and, if preferred, a wineglassful of luke-warm water may be added, or to half a pint of No. 6 add a tablespoonful of finely powdered bayberry, shake the mixture eccasionally, and for a dose take a teaspoonful, with a teaspoonful of sugar; this may be taken with the addition of a portion of bayberry tea. For children and delicate females, milder preparations may answer, such as bayberry tea well sweetened, adding to it a por- tion of the composition powder; or a simple tea of the bayberry, or composition well sweetened. The Vapour Bath is signally beneficial in dysentery, and may be frequently administered; and will afford much relief to the patient. After the bath and the patient is rubbed dry, apply stimulating ointment, the third preparation of lobelia, or No. 6, over the surface. Bottles of hot water or hot bricks, wrapt in damp cloths, should be kept to the feet and abdomen. As a substitute for the vapour bath, in mild cases, wrap the body, from the hips to the arm-pits, with a bandage of flannel. The constant application of warmth and pressure, is of great im- portance, and well adapted to all cases of bowel complaints, both acute and chronic. The flannel roller should be applied even when the vapour bath is administered, and also when the patient goes to stool, in order to protect the body from the air. Injections.—The inflammation that exists in dysentery is the result of the reaction of the constitution to overcome the debility or loss of vitality of the parts. Injections assist the healthy ac- tion, and remove acrid secretions. They should be composed of astringents and stimulants. A strong decoction of bayberry, dewberry root, or raspberry leaves, adding a teaspoonful of the liquid of the third preparation of lobelia, to half a pint of the tea; or scald a teaspoonful of pepper with the other articles; add a teaspoonful of lobelia powder, and stir the mixture. Lobelia in some form, either the powder or liquid of the third prepara- tion, should generally be added. A large teaspoonful of lobelia powder infused in half a pint of warm water, or half a pint of composition tea, may be used in place of the more stimulating injections. ♦When the stools are very offensive, the purified charcoal 134 DYSENTERY. should be added to the injections, and also given occasionally with the medicine otherwise taken. In the place of the charcoal the chalk mixture may be used; or the bi-carbonate of soda or salseratus. The chief objection to frequent injections, is the irritation pro- duced by the metallic pipe of the syringe. It should be well covered with oil or tallow; or a gum elastic tube made for the purpose, placed on the metallic pipe. Professor Chapman, in a lecture on dysentery, in 1840, stated, that at Vera Cruz, the only successful treatment in the malig- nant dysentery that prevailed there, consisted of giving the pa- tients freely of cayenne pepper tea, and using injections of the same. A case of dysentery occurred in Chester county, of the most severe character, in which a quarter of a pound of cayenne pep- per was used by injection and given in tea during one night, together with a large quantity of the hot drops, and bayberry tea. The patient speedily recovered, and no doubt by means of this energetic treatment. Diet.—This must be of the lightest kind of food, such as bar- ley water, arrow root gruel, weak chicken tea, sago, rice, slip- pery elm, Iceland moss, the bene plant, &c. When the patient becomes convalescent, stronger food may be given, as boiled chicken and wild game. To assist in restoring digestion, the spice bitters and other tonics may be employed. Favourable Symptoms.—"The appearance of bile, and natural faeces in the stools, indicate a favourable change." When the pain, and inclination to stool, "and tenderness of the abdomen abate, at the same time that the skin is uniformly moist, we may regard the case as approaching a state of convalescence; and more certainly if the stools assume a more natural appear- ance." SECTION VII. DIARRHCEA—RELAX. This complaint is a consequence of indigestion. It prevails most during hot weather, and presents in different cases, great diversity of character, being in some instances an obstinate and painful disease, and in others a slight affection. Children are extremely liable to this form of disorder throughout the hot summer months, and also in the damp and changeable weather of autumn. General Causes.—Diarrhoea may be produced by any cause which weakens the power of digestion. The usual causes are continued spells of damp, murky weather; wearing damp clothes; a sudden check to perspiration, when the system is exhausted by fatigue; unwiiolesome articles of food, especially sour fruit; and drinking too freely of cold liquids, as ice water or lemonade. Symptoms.—At first there is usually loss of appetite, general debility, coldness of the feet, and bad taste in the mouth. The patient experiences unpleasant sensations at the pit of the sto- mach: there is generally a rumbling through the bowels, followed by copious evacuations, consisting of thin offensive secretions, and imperfectly digested food, and frequently attended with pain. The skin is either cool and clammy, or dry. When the disease comes on suddenly and is attended with vomiting, it is called cholera morbus. The colour of the stools in many in- stances, is light, indicating a want of bile: in other instances they are partly composed of vitiated bile. Diarrhoea, Dysentery, and Cholera Morbus, may arise from the same cause, or combination of causes. Distinguishing Marks between Diarrhoea and Dysentery.—In diarrhaa the bowels are in a relaxed condition, with copious evacuations, consisting chiefly of imperfectly digested food, and generally free from blood or mucous. In dysentery the bowels are costive, the natural faeces retained, and the stools consist principally of blood and mucous, small in quantity, and the dis- ease is attended with severe griping, and a frequent inclination to go to stool. 136 DIARRHCE A—RELAX. Treatment of Diarrhoea.—In slight cases, a few doses of com- position or bayberry tea, with the addition of No. 6, will, in gen- eral, check the disorder, and correct the digestion. A variety of other remedies may be used for this complaint, such as cho- lera syrup, Thomson's No. 5 syrup, lavender brandy, burnt brandy and loaf sugar, chalk mixture, lime water, and purified charcoal. Salt and wrater is a remedy in many families. When the symptoms are more distressing, or the case proves obstinate, the most effective means will be a full course of medicine, succeeded by the use of the hot medicine, and the pa- tient kept comfortably warm and quiet. In the commencement, in many instances, but more especially when the disorder has been checked, bitters should be used to re- store digestion. Flannel Bandage.—Persons subject to frequent attacks of diarrhoea, may derive great benefit by wearing a flannel band- age covering the whole of the abdomen. This will keep the skin regularly warm, and prevent a sudden check to perspira- tion from the vicisitudes of the weather. This simple plan of bandaging the belly, will generally prevent the summer com plaint in children, even during their second summer, provided they be bathed daily, and a proper attention paid to their diet. When the disease becomes protracted, and the symptoms dis- tressing, a prompt course of treatment should be pursued until the disease be removed. The vapour bath and emetics should be repeated as the nature of the case may require. In cases of children I have frequently witnessed more benefit derived by one vapour bath and an emetic, than would have been accomplished probably in two or three days under a mild course of treatment. When medicine has to be forced upon children it is certainly best to give such as will be the most effectual to break up the dis- order. Let the No. 3, or bayberry powder be made into a strong de- coction, and to a teacup half full of this tea, add an even tea- spoonful of composition powder. This given two or three times a day, will be an effectual remedy in most cases of simple diar- rhoea. The No. 3 pills may be used in place of the decoction. Injections of the above tea, adding a portion of No. 6 and green lobelia, or a teaspoonful of the third preparation of lobelia, will be found especially beneficial to strengthen the bowels. Diet.—Especial attention to diet is necessary in all bowrel complaints. In general, milk porridge, well prepared, will agree well with the stomach, and in some cases will check the PERITONITIS. 137 disorder, by confining the diet to it alone, or with the addition of stale bread cut thin and toasted thoroughly, or soda or water crackers. Fruit of every description is apt to disagree with the bowels in diarrhoea, unless it be fresh picked, and eaten with some solid food. Boiled rice and milk, Bermuda arrow root, elm gruel, sago, tapioca, fresh eggs slightly cooked, essence of beef, boiled chicken, crust coffee, and Irish moss, are such articles as are generally adapted to cases of diarrhoea. Rice scorched, ground, and made into coffee is a favourite remedy with some for this complaint. I have known cases of chronic diarrhoea cured by a free use of capsicum at meals. SECTION VIII. PERITONITIS. (INFLAMMATION OF THE PERITONEUM.) Disease of the peritoneum (the membrane lining the cavity of the abdomen, and which also forms the external coating of the bowels) is not of very frequent occurrence: when it does take place, howrever, it is in many instances extremely difficult to cure, unless a vigourous and persevering course of treatment be instituted in the first onset of the disease. Causes.—Long exposure of the body to cold after fatiguing exercise, is the usual cause of peritonitis. It may arise, also, from other causes, as taking too freely of ice water; mechanical injuries of the bowels: the escape of faeces into the cavity of the belly from wounds of the intestines, or by ulceration through the coats of the bowels; wet and cold feet; and, in females, from bad management during, or after confinement. In two fatal cases that came under my notice, one was brought on by washing the body in cold water, the patient remaining undressed until the body became completely chilled: the other case was produced by standing some hours in cold water, up to the middle, in a well. Symptoms.—The first symptoms are such as usually occur in the commencement of other forms of disease, such as chilliness, lassitude, pain in the limbs, and distress at the pit of the sto- mach. In some instances an acute pain is felt in some part of S 138 PERITONITIS. the belly, from the commencement. In other instances, and even those of the most rapidly fatal character, there is scarcely any pain felt during any period of the disease. The Symptoms which Characterize this Disease, are extreme tenderness to pressure over the surface of the abdomen, and the patient assumes a bent posture in order to relax the muscles of the belly; with constipation of the bowels, and pain of an acute character, generally confined at first to a small space, and spread- ing gradually, and sometimes shifting suddenly from one spot on the belly to another. In most instances there is at the com- mencement of this disease, and always in the latter stage, if the disease terminate fatally, more or less vomiting. The counte- nance is pale, and expressive of extreme anxiety and distress. " Generally, in the course of from twenty-four to thirty-six hours, the abdomen becomes swollen, tense, and elastic from flatulent distention of the intestines, and extremely tender. Re- spiration is oppressed and laborious in the latter period of the disease; inspiration especially, being short, difficult, and attend- ed with an expression of pain in the countenance. The secre- tion of urine is almost invariably more or less diminished, and in some instances, almost wholly suppressed. When the peri- toneal coat of the bladder is the seat of inflammation, the evacu- ation of urine will almost uniformly be suspended, and much pain felt in the pelvis. The peritoneal covering of the inferior surface of the diaphragm is occasionally the principal or sole part of this membrane that is inflamed, and in this case almost constant hiccough attends. In most instances the peritoneal inflammation terminates by the sixth or seventh day, either in resolution, or fatally. In some cases its course is much more rapid, the patient sinking by the second or third day from the commencement. Occasionally however, the disease is prolonged to the thirteenth or fourteenth day. This disease is extremely liable to terminate in gangrene. "When this occurs, the abdominal pain suddenly subsides; the pulse becomes very small, frequent, and often intermitting; great muscular prostration ensues; the extremities become cold and clammy; and the countenance pale, hollow and contracted;" there is a sort of gulping up of the liquids when swallowed, and usually more or less delirium. When peritoneal inflammation ensues after confinement (con- stituting puerperal fever) the louchial discharge ceases, and the secretion of milk is suspended, or nearly so. Under such cir- cumstances the disease is mostly rapid in its course. Treatment.—There is probably no form of disease requiring PERITONITIS. 139 more vigorous treatment than peritonitis. The first and most important remedy is a vapour bath, which should be continued for hours together; the patient being on a cot or mattress, if too weak to sit up; and at the same time frequent and full doses of the third preparation of lobelia should be given, together with lobelia injections, composed simply of lobelia powder in luke- warm water, and retained, if possible; and as often as every hour or two, an additional injection, consisting of a tablespoonful of the liquid of the third preparation of lobelia in bayberry tea. In place of the vapour bath, blankets wrung out of hot water, may be applied to the abdomen, or a large poultice composed of elm powder, green lobelia and ginger, applied all over the belly, as hot as can be borne, and to be kept warm by bottles of hot water or hot bricks placed close to it, or it may be taken off and warmed when necessary. It is important to relax the system in the early stage of the disease, by giving besides the third preparation of lobelia, fre- quent doses of an infusion of the brown lobelia. The more the system becomes relaxed by the lobelia in the early period of the disease, the greater will be the chance for the inflammation to establish a favourable crisis. When a favourable crisis takes place, and the system sinks into a state of extreme exhaustion, as is frequently the case, more especially when the disease occurs in the puerperal state, diffusive stimulants should be employed, as wine whey, carbo- nate of ammonia, the third preparation of lobelia, capsicum tea, &c. " There is a period in some cases of abdominal inflammation when the disease is nearly subdued, yet a tendency to gangrene exists from deficiency of vital power. At such a time the pain will vanish, the pulse become weak, the vital powers sink, and a coldness overspread the body. These symptoms are too often indicative of mortification; but every experienced practitioner must have occasionally witnessed cases of recovery even from this alarming state." Therefore the free use of stimulants under these circumstances, may have the effect to turn the scale in fa- vour of recovery, and even if mortification should have taken place stimulants can do no injury. SECTION IX. CONSTIPATION—COSTIVENESS. Costiveness, in general, is a consequence either of diminished peristaltic action of the bowels, or of a torpid liver. The habitual use of purgative medicines destroys the natural tone of the bowels, and thus proves one of the most common causes of constipation. A patient becomes uncomfortable in consequence of the slugglish state of the bowels, and a dose of physic is taken. In a few days, however, the same bad feelings return with loss of appe- tite, furred tongue, and bad taste in the mouth; there is heavi- ness and languor, and oppression at the stomach. The patient supposes he is bilious, requiring another dose of physic to purge off the accumulation of bile, and in this way continues its use at frequent intervals, harassing the stomach and destroy- ing the natural action of the bowrels. Costiveness is sometimes constitutional, and in general it arises from causes which de- press the nervous energy, such as sedentary habits, foul air, in- temperance, or all kinds of deleterious medicines, whether mine- ral or vegetable. The practice of giving anodynes to infants weakens the tone of their howels, and in numerous instances the foundation of habitual costiveness is laid. It is very common in the old practice for a physician to recommend laudanum, or some other preparation of opium, for children and infants when sick, and on the following day prescribe a dose of oil to move the bowels, which had become torpid in consequence of the ano- dyne; the physic disturbs the stomach and impairs digestion; and the little patient consequently becomes fretful; another dose of anodyne is administered, which benumbs the sensibility of the nervous system, and the child sleeps, but the medicine instead of removing the disease, rather increases the difficulty; costive- ness continues, and another cathartic is prescribed, and thus one medicine is given to counteract the bad effects of the other. Not only is such a course generally pursued in the treatment of infants and children, but a similar one is resorted to by many physicians in the majority of cases of sickness, in adults that are placed under their care. It is very rare to find a person affect- ed with obstinate constipation of the bowels who has never been in the practice of taking cathartics. There are persons constitutionally costive, whose bow els are not moved oftener than once a week, and yet the general health CONSTIPATION. 141 remains good. Such instances, however, are very rare, for most persons feel more or less uncomfortable without an evacu- ation as often as once in twenty-four or forty-eight hours. Means to Remove Costiveness.—There is a great diversity of remedies and means to restore the action of the bowels. A Proper Diet.—Certain articles of food will in a great many instances keep the bowels regular, such as stale bread, or gruel made of ground wheat, unbolted, indian bread, ripe fruit, rye mush, oat meal gruel, and calves' foot jelly. No certain plan of diet can be proposed that will suit every one. Bread made of unbolted wheat flour will probably agree with almost every one, and its efficiency has been so well attested as not to admit a doubt of its efficacy. I have known obstinate cases of con- stipation overcome by the free use of a gruel made of the un- bolted flour, together with the use of cayenne pepper, and the entire absence of every kind of cathartic. In the use of the un- bolted bread or gruel, other kinds of food need not be excluded. Animal food is necessary to the health of some, and should be used when it agrees with the stomach. Beef, mutton, and all kinds of wild game are as readily digested as vegetables. Charcoal.—Finely pulverized charcoal, taken in large tea- spoonful doses, repeated three or four times a day, is a valuable remedy for costiveness, especially when constipation is accom- panied by a sour stomach and heartburn. Costiveness arising from pregnancy, may in most instances be removed by the free use of charcoal. In the latter stage of pregnancy, however, it is sometimes necessary to resort to the use of stimulating enemas, in order to evacuate the bowels. The charcoal should be first moistened and rubbed into a paste, and it will then mix readily with liquids. I generally direct it to be taken in composition or spice bitters tea. It may be taken, also in simple warm water, or in boiled milk. The dose is from a teaspoonful to a tablespoonful, repeated three or four times a day before meals. White Mustard Seed is a favourite remedy used by many to stimulate the bowels, and overcome costiveness. The usual dose of the mustard seed is a tablespoonful once or twice a day, taken in warm water or molasses. Capsicum.—This is one of the purest and best of stimulants, and is especially beneficial in most cases of torpid bowels. Taken freely at meals, it will not only assist the action of the bowels, but will be sufficient, if used freely, to cure many cases of dys- pepsia. There are many kinds of food that may set well on the 142 CONSTIPATION. stomach, if highly seasoned with cayenne, but which without it would occasion oppression, and distress the stomach. Those who do not relish food highly seasoned with pepper, may take the cayenne immediately after eating, in a little cold water, or as some prefer, swral!ow the whole pods of the bird-pepper. These pods are not thicker than a small goose quill, and scarce- ly ever an inch in length, so that half a dozen may be swallowed at a time, and no burning produced in the mouth. Ten or fifteen of these pods taken daily will be sufficient, in general, to keep the bowels regular. Astringents.—When the tongue is thickly furred, and not dry or parched, the astringents recommended by Thomson will be useful by cleansing the cankered bowels and increasing their tone. The best astringent is the bayberry, or a compound of bay- berry and sumac. The No. 3 pills may be used in place of the above powder in decoction. Injections assist very much in cleansing the bowels of morbid secretions, and also have a ten- dency to increase their tone. Bitters.—Vegetable bitters are particularly indicated when the system is relaxed, as in recovery from sickness when the bowels remain torpid. A teaspoonful of barbary powder taken two or three times a day will be sufficient to keep the bowels regular, in those cases where tonics are indicated. The golden seal, balmony, or black aspen poplar may be employed for the same purpose. In continuing the use of tonics it is proper to change one for another, or to compound them differently every few days. Injections should be used occasionally until, by other means, the natural action of the bowels be restored. When constipation is attended with piles, an injection of a strong decoction of the witch hazle, at bed time, retained in the bow7els until morning, will in general procure a passage from the bowels, and also assist in curing the piles. Cleanliness, exercise in the open air, the warm bath, the shower bath, the daily use of the flesh brush or salted towel over the surface, and whatever else will invigorate the nervous sys- tem, will have a salutary effect upon digestion, and assist the peristaltic action of the bowels. The habit of soliciting a stool at a certain hour daily, more especially in the evening, though it may fail at first, if per- severed in, will generally prove successful. Three or four of the compound lobelia pills, taken at bed time, have proved successful in many cases, in regulating the bowels, and in promoting the secretion of bile. SECTION X. DYSPEPSIA—INDIGESTION. Digestion is accomplished by a series of actions extremely complicated, liable to derangement from various causes. Hence dyspepsia is a common complaint, and prevails in all classes of society. Causes—Dyspepsia in many instances is a consequent of original feebleness in the constitution. Apart from this, the fol- lowing are among the common causes of indigestion. 1. Exposure to Cold and Dampness—especially Damp Feet.— This is a common cause of dyspepsia in the country during damp seasons of the year. 2. Tobacco.—The inordinate use of this article is a fruitful source of dyspepsia. It causes imbecility of mind, and in some instances, melancholy. 3. Purgative Medicines—The long continued use of cathartics impairs the functions of the stomach and bowels, and in frequent instances, where there is but slight derangement in the stomach at first, "the drugs are poured down," and the case becomes one of confirmed dyspepsia. 4. Anodynes—All the various preparations of opium, such as laudanum, Godfrey's cordial, kc, enervate the stomach, and weaken the power of digestion. Hence Dyspepsia often takes place in childhood by the prevailing practice of giving anodynes during infancy. 5. Sedentary Habits.—Persons engaged in sedentary pursuits —seamstresses, shopkeepers, shoemakers and tailors, are liable to dyspepsia, especially when confined to small and ill-ventilated apartments. 6. Unwholesome Food.—Many who by a proper diet might have enjoyed good health, are tormented with indigestion, in consequence of the use of food difficult to digest, such as hot bread, fresh pork, hot cakes, sausages, pies, &c. Hearty sup- pers, especially of such food as sausages, hot cakes, and strong coffee, cause restless and disturbed sleep, frightful dreams, and nightmare. 144 DYSPEPSIA. 7. Blood-letting.—Many cases of dyspepsia may be traced to the profuse depletion frequently practiced by physicians in pleu- risy, and in the various forms of acute disease attended with high fever. The system becoming exhausted from loss of blood, the organs are left in a languid condition, incapable of perform- ing their functions properly, and in many instances occasion confirmed dyspepsia. 8. Mercury.—Professor Chapman asserts that the majority of cases of chronic affections of the liver prevalent in the South- ern states, is owing to the inordinate use of mercury, it being a practice among the physicians to administer it in enormous doses. Digestion never can be properly performed whilst the liver is diseased, and therefore, all such cases are more or less dyspeptic. 9. Intemperance is a fruitful cause of dyspepsia. The prac- tice of taking a morning dram, which prevails in some districts of country is usually followed sooner or later by indigestion. 10. Abstinence may be practiced too rigidly to be compatible with health, and it may even produce dyspepsia. The exclusive use of a vegetable diet, together with cold water at breakfast and supper, in the place of good tea or coffee, is calculated to ener- vate the stomach. There are cases in winch an exclusively vegetable diet suits the stomach, but with the great majority of mankind, animal food, such as beef, mutton, or wild game, will be found more easy of digestion than a vegetable diet. 11. Bad Teeth.—Irritation of the gums arising from teeth that are either decayed or affected with tartar, is a frequent cause of dyspepsia. A lady from Natchez consulted professor Chapman for dyspep- sia of long standing, and the doctor perceiving the bad condition of her teeth, suspected this to be the cause of the dyspepsia; the decayed stumps were removed, the mouth put in good condition, and the dyspepsia was soon cured. Subsequently this lady had a new set of teeth put in, but which being badly done, the dys- pepsia returned with great violence. The teeth where removed, and by being properly adjusted, so as not to irritate the gums, she was soon restored to perfect health. 12. Piles often produce dyspepsia, and in many instances the dyspepsia may be cured by their removal. 13. Moral Impressions.—From the close sympathy existing DYSPEPSIA. 145 between the brain and stomach, moral impressions have a con- trolling influence over digestion. If a man, soon after eating a hearty meal, hear bad news, his digestion will at once be weak- ened, if not suspended. Close application to study soon after meals, by concentrating the nervous energies in the brain, weak- ens the power of the stomach to perform digestion. In fine any cause that weakens the nervous energy, impairs the digestive functions: hence venereal excesses are a common cause of dyspepsia; It is a general impression that dyspepsia prevails most among the higher ranks of society, and that the poor, notwithstanding their hardships, are generally blessed with vigorous digestion. The great majority of cases of dyspepsia that I have met with, have been among the hard labouring classes, more especially in those whose business required them to be indoors, as cotton and woollen manufacturers, weavers, shoemakers, tailors, &c. The wealthy pay greater attention to bathing, they sleep in large and airy rooms, and partake of the best of food. Symptoms of Dyspepsia.—A low temperature of the body; op- pression, tenderness, and distress at the pit of the stomach; tor- pid bowels; heart-burn; frequent belching; sour eructations; offensive breath; and often some degree of fever or excitement after meals. In some instances the appetite is irregular, or de- praved, craving green fruit; sometimes the appetite is entirely gone; the spirits are variable, and frequently depressed. In the more aggravated form of dyspepsia, the mind is liable to become much depressed, approaching in some instances to extreme melancholy, with harassing belchings; water brash; stools clay coloured, indicating the absence of bile, the skin is dry and husky, yet sometimes cool and clammy; there is wast- ing of the flesh and ulceration of the tongue and mouth. Pain in the head, palpitation of the heart, dizziness and temporary blind- ness, and violent pains in the shoulder and side, are symptoms frequently attending dyspepsia. Sometimes in dyspepsia the sensibility of the stomach is so obscured that the derangement of the digestive organs is scarce- ly perceived by the patient, the principal symptoms being devel- oped in parts remote from the stomach, where sensibility is more acute. Such is the degree of insensibility in the stomach, that it may become diseased and give rise to almost every variety of disorder without any particular symptoms of derangement being manifest in its own peculiar region. Disorders produced by Dyspepsia.—Dyspepsia long continued, not unfrequently brings on consumption, especially when there is constitutional weakness of the lungs. T 146 DYSPEPSIA. Many, if not most of the cases of bronchitis, are a secondary effect of dyspepsia. Clergymen are very liable to disease of the throat, occasioned more by mental labour soon after meals, than by their public speaking. The liver possessing a close sympathy with the stomach, be- comes torpid and inactive in many instances, in consequence of the cold and weak condition of the latter. More especially does this occur in the intemperate. Bilious colic and sick headach are brought on in consequence of bad digestion. Tetter is not unfrequently dependent upon indigestion, and in some instances cannot be cured until the stomach is cleansed, and digestion restored. Asthma is generally connected with dyspepsia. The stomach, in fine, possessing a controlling influence over the functions of the various organs of the body, may, by having its powers enfeebled, bring on an endless variety of disordered symptoms in other parts. More especially is the train of evils resulting from dyspepsia multiplied and aggravated when the stomach is harassed by the use of cathartics, anodynes, and other deleterious drugs. Treatment of Dyspepsia.—Dr. Thomson's course of medidne, administered at proper intervals, as the symptoms indicate, to- gether with proper intermediate remedies, will effect a cure in a great majority of cases. If the continuance of the disease de- pend upon bad habits, a cure cannot reasonably be looked for w hilst they are continued. If close confinement in uuhealthy apartments be the cause of dyspepsia, exercise and fresh air will be as essential as medi- cine. When dyspepsia arises from a bad condition of the teeth, they should be attended to by the dentist, and by one who is properly acquainted with his profession. Purgative medicines impair the tone of the stomach, leaving the bowels costive, and therefore should be dispensed with in dyspepsia. Emetics.—An emetic of lobelia, prepared in the usual form, will sometimes relieve the stomach sufficiently without the ne- cessity of a full course of medicine. To promote a healthy action of the skin, an occasional vapour bath, or wrarm bath, and the daily use of the flesh brush or salted towel, will be the most effectual means. DYSPEPSIA. 147 Capsicum.—The free use of cayenne pepper at meals, will be sufficient to cure*dyspepsia in many instances. It is useful to prevent heart burn and water-brash, and has a tendency to re- gulate the bowels. Composition Powder.—Dyspepsia of a mild character may be cured by taking a dose of composition two or three times a day. When the patient is exposed to the weather it is best not to pre- pare the composition in boiling water, but first mix the powder with sugar, and then add half a teacup of luke-warm water, stir the mixture well and swallow it before it settles. The Spice Bitters may be taken in the same way, and for the same purpose. The Conserve of Hollyhock is a mild stimulant and tonic, and useful in cases of feeble digestion. It is a convenient medicine for persons travelling. Charcoal.—Purified charcoal being an absorbent and anti-sep- tic, and operating as a mechanical stimulant to the bowels, may be used with advantage in cases of sour stomach, attended with costiveness. The dose is a large teaspoonful to be rubbed up with about an equal quantity of sugar and water, and then add a tea- cup two-thirds full of a tea of composition or spice bitters, taken on an empty stomach, and repeated two or three times a day. In dyspepsia accompanied with a pale tongue, relaxed skin, and general debility, stronger tonics must be used, such as Dr. Thomson's No. 4 bitters, quassia, wormwood, &c. either pre- pared in decoction or in tincture. When there are symptoms of dyspepsia with extreme insensi- bility of the stomach, benefit may be derived from mechanical means, as riding on a rough trotting horse, or in a rough car- riage after dinner, or punching or kneeding the stomach as dis- covered and introduced by a Mr. Hallstead of New York, who was cured of dyspepsia attended by extreme insensibility of the stomach, by making a false step, by which his stomach received a severe jar. Alkalies.—Where there is a large amount of offensive gas ejected, either upwards or downwards, the use of lime water will be beneficial. In cases of simple acidity of the stomach, the super carbonate of soda, or salasratus, will neutralize the acid. Chalk may be used for the same purpose, and in some instances will have a better effect than soda or saleeratus. 148 DYSPEPSIA. The following was a favourite remedy with the late Dr. Phy- sic of this city. Take a quart of hickory ashes, and a teacupful of com- mon soot, pour on them a gallon of boiling water. The dose a wineglassful after meals. A decoction of wormwood and hickory ashes fulfils the pur- pose both of a tonic and anti-acid. In some cases of dyspepsia, acids will be found to be more beneficial than alkalies, even though there should be acid in the stomach. A mixture of vinegar, salt, and pepper, will be of benefit in many cases. From ten to thirty drops of the elixir of vitriol, in a wineglassful of water, or of bitter tea, three or four times a day, will be grateful to the stomach, and assist diges- tion. A tablespoonful of dry wheat bran, two or three almonds, or a teacupful of boiled milk, will relieve heartburn. Colic.—Dyspeptics are liable to cholicky pains, from an accu- mulation of gas in the stomach, which may generally be relieved by Thomson's No. 6, or the volatile tincture of guiacum, given in hot water, composition or pepper tea, and swallowed as hot as the patient can bear. The oil of amber, spirits of turpentine, or oil of juniper may be used for the same purpose. Ten drops of the oil of amber, rubbed up with sugar, and mixed with a small quantity of slippery elm mucilage, will sometimes remove the severest forms of colic, especially when the stomach is very weak. When the case is very severe, the vapour bath, followed by an emetic of the third preparation of lobelia, will be the surest means of relief. Pain in the Bowels.—This may generally be removed by in- jections. A stomach tube, or large gum elastic catheter, intro- duced eight or ten inches into the bowels, and the injection passed through it, will give relief in cases where the injections given in the usual way have little or no effect. Great benefit may be derived from hot fomentations, or a warm poultice ap- plied to the abdomen. Costiveness.—A torpid condition of the bowels exists in most cases of dyspepsia, and in many instances it is difficult to over- come, where purgatives have been freely used. Bran bread, or bread made of unbolted wheat flour, is an excellent remedy for costiveness. Cayenne pepper, or pepper sauce, used freely at meals, or immediately after eating, will assist digestion, stimu- late the bowels, and frequently be sufficient to overcome the con- DYSPEPSIA. 149 stipation. Clean wheat bran, charcoal, and white mustard seed, act as mechanical stimulants to the bowels, and may be used ac- cordingly. Injections may be used to evacuate the bowels when necessary, until by a proper course of treatment, and a well- regulated diet and regimen, their natural action become restored. Avoid aggravating the bowels by the use of cathartics, as it will be difficult for the bowels ever to recover their natural tone and action, as long as the patient continues to take every week, or every few days, a dose of cathartic medicine. Diet in Dyspepsia.—No system of diet can be laid down, suited to every case of dyspepsia. Milk generally agrees with dyspeptics. Milk porridge, boiled milk and rice, Indian mush, well boiled, allowed to become cold, and eaten with boiled milk, and boiled milk and toast, are suit- able articles of diet in most cases of dyspepsia. More especially is a milk diet proper for the morning and evening meal. Milk, when taken cold and in large quantities, sometimes forms an in- digestible mass, of a cheese-like substance, occasioning great oppression at the stomach. As a substitute for milk when it disagrees with the patient, cocoa or chocolate, black tea, or what is better, the anti-dyspep- tic cocoa, prepared by A. Comfort, of Philadelphia, may be used. In some cases of dyspepsia, coffee, well prepared, may be taken, not only with impunity, but with advantage. Much of the evil arising from the use of coffee, is owing to the bad quality of the article, and to the careless manner in which it is frequently roasted and prepared. Of animal food, all kinds of wild game when in season, eggs, chicken, turkey, fresh beef and mutton, are the most digestible. Salt pork agrees with many. Fresh pork disagrees with the dyspeptic in almost every instance, yet, notwithstanding, some cases have been cured by eating broiledTresh pork, although such cases are very rare. In some, animal food of every description will disagree with the stomach. All kinds of soups are objec- tionable from their liability to sour in the stomach; though in small quantities they may not disagree with it. There is not the same objection to essence of beef, as to soups. Bread made of unbolted wheat flour has become a favourite article of diet for dyspeptics, and answers well in the majority of cases. Toasted bread agrees well with many. It should be cut in thin slices and toasted through, so as not to have it doughy in the middle. Bread should not be eaten until at least twelve hours old. Hot cakes should be avoided. Cakes, however, made of Indian mush which has been previously well boiled, will agree with many. Regularity in meals is important. No 150 DYSPEPSIA. food should be taken between meals. If a person of feeble di- gestion eat a piece of gingerbread or pie, an hour before dinner, the appetite will be weakened, and then if the patient eat the usual meal, the food will oppress the stomach. Besides the remedies already enumerated for the treatment of dyspepsia, there is yet one equally beneficial and suited to al- most every case, viz: A strong decoction of the powdered bayberry, with the addi- tion of a portion of cayenne pepper, and sweetened. This will remove morbid secretions, which in most instances coat the stomach and bowels in dyspepsia, and which must be re- moved before digestion can be restored. Occasionally this dose produces pain, and sometimes vomiting, from which the patient experiences benefit. No apprehension of bad consequences need be felt from the pain which this dose occasionally produces; it arises from wind or gas in the stomach, which may be relieved by taking No. 6, in very hot water, or by taking hot water alone; or essence of pepper mint: or it may be relieved by hot applica- tions to the abdomen. The above preparation is more especi- ally applicable when the tongue is coated. The No. 3 pills may be taken as a substitute for the bayberry tea and pepper. Change of Air.—A change of residence from the city to the country, or from the country to the city, or removing to a dif- ferent neighbourhood, will in many instances restore digestion, when other means have all failed. I have observed the most remarkable change effected in dyspeptics by a few weeks' resi- dence in a pine country, or on the sea-bord. The benefit wiiich dyspeptics receive from visiting mineral springs, arises, pro- bably, in the majority of cases, from the change of air, cheerful society, absence from care, and probably from the interruption of bad habits. Cleanliness in person and in dress, promotes digestion, and exhilerates the mind. An occasional vapour bath, followed by a shower bath, is one of the best means for promoting a healthy action in the skin. When the patient is languid and nervous, a shower bath every morning will prove a powerful tonic to the nervous system, and in some instances will cure dyspepsia. The daily use of the flesh brush or salted towel will also invigorate the system, cheer the spirits, and promote digestion. SECTION XI. WORMS IN THE STOMACH AND BOWELS. In treating of worms, Dr. Thomson makes the following ob- servations. "A great deal is said about worms causing sick- ness, and there is scarcely a disease that children arc afflicted with, but which is attributed to worms. The doctors talk about worm complaints, worm fevers, worm colics, kc, and give me- dicine to destroy the worms: by so doing they frequently destroy their patients." The views of Dr. Thomson concerning the cause of wTorms, to wit: that they are produced by a disordered state of the sto- mach and bowels, are doubtless correct. Different Spedes of Worms.—There are 1st. The Long Thread Worm, which varies from an inch and a half to two inches in length. About two-thirds of its length is almost as thin as a horse hair, the remaining and posterior part being considerably thicker, terminating in a rounded or blunt extremity. 2d. The Maw or Thread Worm.—"This is a very small white worm—the male being not above two lines in length, with rounded or blunt extremity anteriorly, tapering to a point pos- teriorly. The female is considerably larger, being from four to five lines in length, terminating in an extremely fine extremi- ty posteriorly, resembling the point of the finest needle. These worms are found only in the large intestines, and principally in the lower part of the rectum, where they are often collected in almost countless numbers," occasioning a most annoying sen- sation of burning and tickling in the rectum. 3d. The Large Round Worms.—These are a species of worms varying in length from three to ten or twelve inches, and about the size of a common sized goose quill. These worms inhabit the small intestines, and occasionally ascend into the stomach. "The symptoms indicating their presence are equivocal, but are commonly considered to be, starting in the sleep, itching of the nose, irregular, or excessive appetite, emaciation, kc Never- 152 WORMS IN THE STOMACH AND EOWI.LS. theless, these worms are often suspected of being present where they do not exist." 4th. The Tape Worm.—The tape worm sometimes acquires a great length,—thirty to forty feet, and even longer. " It is about half an inch in breadth, flat, white, and composed of a series of joints, resembling in shape, a gourd seed. It inhabits the upper portion of the bowels and stomach. The Symptoms usually accompanying the presence of worms in the stomach or bowels are—paleness of the countenance, with occasional flushes on the cheeks; picking the nose; variable ap- petite, sometimes voracious—at other times entirely gone; offen- sive breath; copious secretion of saliva; and the tongue furred. The belly is swollen, and there are transient pains through the bowels, and starting in the sleep. These symptoms, however, may all exist, independently of the presence of worms, and even when there are worms, most of the attending symptoms may arise from a disordered condition of the stomach and bowels. "The reason," says Dr. Thomson, "why children are more troubled with what are called worm complaints, is because they are more subject to he disordered in their stomachs and bowels than grown persons. When children are sick, and their breath smells bad, it is said they have worms, and every thing is laid to them; but this is owing to disease caused by canker, for there is nothing in the nature of worms that can affect the breath. In cases of this kind, the only thing necessary is to cleanse the sto- mach by getting rid of the cold phlegm, and restoring the diges- tive powers, when there will be no difficulty with the worms." The practice of giving poison to kill worms in the stomach and bow els, as Dr. Thomson says, " is like the story related by Dr. Franklin, of a man who was troubled with a weasel in his barn, and to get rid of the weasel he set fire to his barn and burnt it up." "I had the following relation," says Dr. Thom- som, " from the doctor who attended the cases;—three children had what he called a worm fever; and he undertook to kill the worms. One of the children died, and the doctor requested liberty to open it, to find out what would destroy worms, in or- der to know how to cure the others; but the parents would not consent. A second died, and the parents consented to have it opened; but after searching the stomach and bowels, to their surprise, no worms could be found. The third soon after died. The fact was, their death was caused by canker on the stomach and bowels, and the medicine given increased the difficulty by drawing the determining powers inward, which aided the cold to promote the canker." WORMS IN THE STOMACH AND BOWELS. 153 Treatment.—The difficulty of ascertaining whether a child that is sick has worms, should occasion no embarrassment with regard to the treatment to be pursued. The stomach and bowels being disordered, the indications for the treatment will be the same whether the patient be affected with worms or not, '"I have had," says Dr. Thomson, "a great deal of expe- rience in what are called worm complaints; and after having become fully acquainted with the real cause, had no difficulty in curing all that I have undertaken." * * * * * " My practice," says he, "has been what I recommend to others to do in cases that are called worm complaints; to give the composition powder, or No. 2, to warm the stomach, a tea of No. 3, to remove the canker, and the bitters, or either of the ar- ticles described under No. 4, to correct the bile. If they are bad, carry them through a course of the medicine, and give the bitters. When there are nervous symptoms, give the nerve powder. Injections should also be frequently given. The but- ternut syrup is very good. If there should be danger of mortifi- cation, make use of No. 6, both in the medicine given and in the injections." The composition I have found to be most effectual when the powder is given in luke-warm water, or in a strong decoction of bayberry or sumac. This mixture given two or three times a day, together with small doses of the tincture of lobelia, re- peated every two or three hours, will, in many instances, remove a 11 symptoms supposed to be occasioned by worms. The compound lobelia pills given immediately after meals, will be found beneficial in such complaints, and they may be used as a substitute for the composition and tincture of lobelia. A mixture of vinegar and salt given three or four times a day, is of especial benefit in correcting a disordered stomach, especially when the patient craves acids. Milk boiled with a portion of tansy may be used to restore digestion; and sometimes it will cause the expulsion of worms from the bowels. Lime Water.—When the stools are green or of an acrid cha- racter, or if the patient be affected with sour breath, and acid eructations, lime water should be given to correct the secretions. The usual way of administering lime water is to add about an equal quantity of boiled milk. To be taken two or three times a day. Charcoal.—When the bowels are constipated a teaspoonful of purified charcoal may be taken two or three times a day in boiled milk. This will overcome costiveness, and it is high- ly beneficial in the cure of what arc called worm complaints. r; 154 WORMS IN THE STOMACH A3D BOWELS. Emetics, or a Course of Medicine should be given occa- sionally, as long as there is fever, or the tongue continues fur- red, and composition powder, capsicum, or spice bitters, to be administered twice or three times daily. Wiien the fever has disappeared and the tongue is moist and cleaning, bitters may be given. When the patient continues in delicate health, after the above treatment, a cold shower bath in the morning, or a change of air, will be found particularly useful. A change of medicine occasionally will be proper in long-standing cases; thus a certain kind of bitter may be given for a few days in succession and then change it for another; salt and vinegar may agree with the stomach for a time, and then require to be laid aside for some other remedy. Worm Seed, or Jerusalem Oak, (Chenapodium Anthelmenti- cum) is much used for expelling worms. Of the efficacy of this article I cannot speak from observation, never having used it. The Volatile Oil of the worm seed, is generally used; the dose for a child is from four to ten drops mixed with sugar, and given in the morning on an empty stomach, and in the evening at bed time, which may be continued several days in succession. Treatment for the removal of the Maw or Thread Worm.—This species of worm being located in the rectum, is usually termed seatworm. These may be removed by the daily administration of injections, composed of a strong decoction of bayberry or su- mac, adding a teaspoonful of No. 6. After the worms are ex- pelled the injections should be administered every few days, to prevent their return. If the general health be deranged, con- stitutional treatment will be required. Such as the daily use of stimulants and bitters, and occasionally an emetic, or a full course of medicine. These small worms are contained in a tough mucous, lining the bowels, and being imbedded in it will frequently resist the most powerful cathartics, but administering stimulating in- jections to excite the secretions and render them less dense and tenacious, and followed by the use of injections of a strong de- coction of bayberry or sumac, adding a portion of No. 6, will seldom or ever fail of evacuating the worms when their use is persevered in. In obstinate cases of seat worms, an injection of a simple decoction of the bayberry or sumac should be adminis- tered at bed time, and retained in the bowels through the night, and in the morning administer another, containing a portion of the No. 6, or the third preparation of lobelia. Treatment for Expelling Tape Worms.—Every species of in- testinal worms, is supported by the cold mucous or " canker," PILES. 155 lining the bowels. Dr. Thomson's general plan of treatment, namely: first to give stimulating medicine to warm the stomach and bowels; then use the No. 3 to remove the " canker," and bitters to restore digestion, is adapted to all cases of worm com- plaints. This is a plan of treatment adapted to all cases of dis- ease of the stomach and bowels, whether worms be present or not. No small amount of injury has been done by experiments that have been practiced by physicians upon patients supposed to be affected with tape worm. A great variety of remedies and modes of treatment are recommended by different medical wri- ters; one claiming to have been successful in expelling tape worms by a certain method of treatment; whilst another declares that a different and even opposite courseof treatment has proved more successful in expelling the worms. Dr. Eberle gives no less than seven different plans of treatment recommended by men who have been considered eminent in the profession. Most of the remedies employed by the medical profession for the ex- pulsion of tape worms; such as tin filings, and irritating cathar- tics, frequently cause the formation of a false membrane on the mucous surface of the bowels, which will sometimes pass off in the form of a white skin, in pieces varying from half an inch to a foot, or even two or three feet in length, and this substance no doubt has frequently been mistaken for tape worm. Some writers speak of having cured many hundred cases of tape worms, but probably in forty-nine cases out of every fifty, the supposed tape worm was nothing more than the white skinny sub^ stance above alluded to. SECTION XII. PILES. This is a disease of the veins of the rectum, which prevails to a great extent in both sexes, and in all classes of society. Piles commence by an eplargement of the veins in the rectum, forming tumours filled with dark blood, which become extreme- ly painful on going to stool, and frequently they discharge a con- siderable quantity of blood; they are then called bleeding piles. When blood is not discharged they are termed blind piles. Sometimes the tumours emerge from the anus, forming external 156 PILES. piles;, when confined within the rectum they are denominated internal piles. 1st. External piles.—These are at first formed within the rec- tum, by the blood collecting and forming into clots in the en- larged veins, and are afterwards forced down by the passage of hardened foeces, and by straining efforts to evacuate the bowels, attended with extreme pain, in some instances for many hours. Piles are soft at first, but generally become harder in the course of a few days. When the disease continues for a considerable time, a portion of the intestine is forced down every time that foeces are passed from the bowels, and requires to be pressed up by the hand. In some instances the patient will be unable to return the protruded intestine, in consequence of the inflammation and extreme ten- derness of the parts. Under these circumstances the patient is compelled to remain in a recumbent position, being unable to walk or even to sit upright. The extreme pain which some- times continues for many hours after the bow els have been mo- ved, is caused by the piles being pushed down, and when the sphincter muscle of the rectum contracts, it grasps them firm- ly, and thus operating as a ligature upon them, occasions in- tense pain. 2d. Excrescences in the form of whitish fleshy bodies are apt to be formed around the verge of the anus, in consequence of frequently repeated inflammation of the diseased veins, by which their sides, as it were, are glued together, and adhesive matter is thrown out, wluch becomes organized, and a hard vascular swelling is produced. These excrescences are apt to occasion ir- ritation and chafing of the parts, and although containing nu- merous blood vessels, they may be cut away with a pair of sharp scissors, without the least hazard to the patient. 3d. Internal Piles may exist far in the rectum, without occa- sioning pain, or much inconvenience, the discharge o/blood be- ing the first symptom of their existence. By the frequent pass- ing of hardened foeces, a relaxed condition of the bowels, or by the use of purgative medicine, the intestine is gradually drawn downward, and finally is protruded beyond the anus every time the bowels are moved, forming prolapsus ani. Under these cir- cumstances there is generally much constitutional derangement and more'or less fever. Piles on their first appearance seldom continue for a long in- terval, they disappear and sometimes do not return, but more generally they return at intervals, until finally the parts become PILES. 157 permanently diseased, proving a continued source of annoyance and frequently causing severe pain. When a number of piles exist low down in the rectum, the pas- sage of hard foeces is rendered extremely difficult and painful in consequence of the cavity of the intestine being nearly closed by these tumours being formed into a body near the orifice of the rec- tum. "Among the most common consequences of piles is a»kind of tenesmus, with a protrusion of the inner tunic of .the rectum, so as to form a prominent and extremely sensitive ring around the anus—particularly after each attempt to expel the foeces." Piles are very liable to burst, followed by a discharge of blood, on which the tumours disappear, and the distressing symptoms abate until other piles are formed, which also burst and their contents are discharged; and in this way some patients will be subjected to frequent discharges of blood, which may become so profuse as finally to weaken and impair the general health. Causes of Piles—The free use of purgative medicines may be regarded as the most common cause of piles. They may, how- ever, be produced by any cause that weakens the digestion, or occasions an obstruction to the free circulation of blood through the veins of the rectum; such as venereal excesses, the intempe- rate use of ardent spirits, sedentary habits, long continued diar- rhoea, dysentery, tight lacing, gravel in the bladder, lifting heavy weights, pregnancy, difficult labours, obstinate costive- ness, obstructions in the liver, and disease of the lungs. Treatment.—In the early period of the formation of piles, the use of injections of some active astringent, as a strong decoction of bayberry bark, dewberry root, sumac, or witch hazle leaves, will relieve the symptoms, and may check a further develope- ment of this annoying complaint. When violent pain attends the piles, relief may be obtained by the patient sitting over steam, or by the application of a warm poultice, composed of slippery elm and lobelia moistened with warm water. Besides these applications, the patient should drink freely of composition, or bayberry tea, with the addition of a portion of capsicum. This will, in some degree, counter- act an undue determination of blood to the rectum. An emetic will commonly relieve the pain when the above means fail, un- less the disease be of long standing. Although the pain may be increased during the efforts to vomit, yet the circulation of the blood will soon become more equalized through the system, and the pain thereby mitigated. The excitement occasioned by the piles, causes an undue determination of blood to the rectum, which may always be counteracted to a greater or less degree 158 PILES. by the influence of a prompt emetic of lobelia, more especially when aided by the administration of a vapour bath. During the past two years I have attended many patients af- fected with piles, and some of them were cases of long standing, and have invariably succeeded either in curing them, or in affording signal relief to the patient by the use of injections, pre- pared by steeping in boiling water a compound of aspen poplar bark, bayberry powder, and witch hazle leaves. The decoc- tion should be strained, administered luke-warm, at bed time, and retained until morning. Patients will find no difficulty in retaining this injection, as it contains no stimulant to excite the peristaltic action of the bowels. An injection retained through the night will commonly cause an easy movement of the bowels in the morning, even in the most stubborn cases of constipation. The injection must be repeated every night until a cure is affect- ed. Besides the above treatment, I have usually prescribed the compound lobelia pills, a course of medicine when the system is much disordered, together with bitters to restore digestion. Dr. Thomson, in his Guide to Health, mentions the case of an "elderly man, in South Reading, who had been confined to his bed for seven weeks with the piles, and seven doctors had attended him before I was sent for, and he had continued to grow w^orse. The doctors had operated on one side, and said they must on the other; it was their opinion, as well as his, that he was in a decline. The side they had operated upon was much worse to cure than the other. I carried him through a regular course of the medicine twice in three days, when he was able to go out of doors. The injections were composed of No. 3, steep- ed, and a small quantity of No. 2 was used; warm tallow was applied several times a day; and occasionally the parts were washed with the above tea. He had been dieted very low; I re- stored his digestive powers, his appetite returned, the sores heal- ed, and his general health amended to such a degree, that he was no more confined with that complaint." Injections prepared and used as directed in a former para- graph, retained through the night, have in some instances en- tirely checked the discharge of blood from piles, where the bleed- ing had previously returned at frequent intervals for a period of several years, the wan appearance of the patients showing how much they suffered from the excessive loss of blood. I have al- ways found it necessary in such cases, to give stimulants and bitters, and sometimes a courseof medicine. External piles that remain soft may be lessened, and some- times dispersed, by w ashing frequently with a tincture of bay- berry, or by applying some ointments containing astringent properties;—for instance, witch hazle, or sumac leaves, or rhattany root stewed in tallow or mutton suet, adding a small PILES. 159 portion of beeswax to render it more adhesive. If external piles should continue until they become hard, they may be punctured by the point of a lancet, and the clot of blood must be squeezed out, and the parts wrashed with tincture of bayberry, and then ointment or tallow applied. It is easy to distinguish between piles, and those fleshy excrescences which sometimes form about the margin of the anus: piles have a dark fivid appearance, whilst fleshy excrescences have a light colour, and feel spongy. Excrescences.—These are small bodies of a fleshy appearance, sometimes varying from half an inch'to an inch and a half in length, and being well supplied with blood vessels and nerves, they sometimes become a source of great annoyance. "The mode in which these excrescences are produced is as follows:—The inflammation of the piles glues the sides of the veins together; adhesive matter is thrown out, which becomes organized, and a hard swelling, in which there is a number of vessels, is produced. The excrescences project from the surface a little way up the anus, whicli is chafed and rendered extremely irritable from this cause. These excrescences are easily re- moved by a pair of sharp scissors, or applying a ligature very tightly, so as to obstruct the circulation: the latter method is much more painful than excision. When a portion of the intestine protrudes every time the bowels are moved, the injections previously spoken of'will prove the most effectual means of curing the disorder. Diet.—This is of the first importance in severe cases of piles attended with obstinate constipation of the bowels. When the passage through the bowrels is greatly obstructed by piles, and the parts are highly sensitive and painful, the diet must consist of such articles of food as are most likely to prevent costiveness, such as gruel made of unbolted wheat flour, or bread made of the same material, rye mush and molasses, or cream, Indian mush and cream, stewed prunes, in small quantities, eaten with stale bread or biscuit. Ripe fruits, calves' foot jelly, kc CHAPTER IV. SECTION I. RHEUMATISM. The origin of this form of disease may be traced to constitu- tional disorder, and loss of vital power. Cold and dampness are the exciting causes of rheumatism in almost every instance. Where, however, there is a strong pre- disposition to the disease existing, inaccuracies in diet, over ex- ertion, loss of rest, or any other depressing influence may occa- sion the disease. I never knew a case of rheumatism that was not preceded or accompanied by a greater or less degree of de- rangement in the digestive power. Patients, however, will sometimes insist that nothing is wrong about the stomach or bowels. The low degree of sensibility in the stomach and bow- els induces patients to consider that no derangement exists in these organs, when at the same time, their functions may be so far depressed and deranged, as to give rise to the most painful affections in other parts of the system, as gout, rheumatism, headach, neuralgia, erysipelas, &c. Parts Affected.—Rheumatism generally attacks the larger joints, the hip, shoulder, elbow, or knee, and frequently the small joints become affected, more especially those of the fingers and toes. The head, heart and brain are also liable to this form of disease. Varieties.—When rheumatism attacks the young and athletic, the disease is usually accompanied with inflammation of the dis- eased parts, attended with swelling, extreme tenderness, and frequently a redness of the skin, and generally there is more or less fever, especially at night. Such a case would be termed acute or inflammatory rheumatism. When the disease occurs in the aged and infirm, and especially in those of broken down constitutions, the powers of nature are too feeble to establish an efficient curative action; the affected parts will remain pale, and seldom much swollen; the disease will be fixed in certain joints RHEUMATISM. 161 and not shifting about; there will be absence of fever and thirst, and the affected joints much less tender than in the former va- riety. This is called chronic rheumatism. The symptoms, however, in different cases, present great diversity of character, from the most acute and inflammatory tothatof the lowest grade of chronic rheumatism; so that in some instances it will be diffi- cult to decide whether to call the disease acute or chronic. Mercury sometimes occasions disease of the joints resembling rheumatism, and it also affects the membrane that covers the bone, and is most apt to be seated on the long and flat bones— the tibia or shin bone, the arm bones, shoulder blade, skull, &c. Sometimes it commences with a protuberance rising on the bone, without inflammation or pain, and either remaining stationary, or gradually disappearing under proper treatment, or, as is more commonly the case, the part becomes extremely painful, and is frequently follow-ed by suppuration. This disease is not always confined to the covering of the bone, but occasionally the substance of the bone itself is diseased, occasioning its decay, attended with a discharge of acrid and offensive matter. Symptoms of the Acute or Inflammatory Variety.—The disease generally approaches in a gradual manner, with a sense of cold- ness or numbness in the limbs, loss of appetite, weakness and langour. These symptoms continue for several days, or even weeks, in some instances, before reaction takes place, and the parts become either swollen, painful, or inflamed. Pain, tender- ness, with a slight degree of swelling and redness of the joints, characterize inflammatory rheumatism. " The patient generally lies on his back, and avoids every motion of the body or limbs; or if he does move, he experiences a sudden aggravation of pain; he cries out, and muscular motion is promptly checked. There is little langour or debility, and but little disturbance of the mental faculties." The tongue is thickly coated, and there is usually perspiration on the face, and frequently on the whole body, which is acid, and exhales a peculiar odour. The urine is acid, and deposits a sediment, especially as the disease declines. The pain and distress is more aggravated at night, frequently attended with fever, and sometimes slight delirium; or as it is usually expressed, the patient is "light headed." In some in- stances all the limbs are affected at the onset, the patient being almost helpless. In other cases the disease is confined first to the lower extremities, and then sooner or later it extends to the shoul- ders, neck, elbows, and hands. If the patient fall to sleep he is apt to be awakened by a sudden jerk or contraction of the mus- cles, causing severe pain. The functions of the liver are in many instances conspicuous- ly disordered in rheumatism, attended with sallowness of the V 162 RHEUMATISM. skin, whites of the eyes, and occasional sickness and vomiting of bile. After a spell of vomiting, the patient experiences tem- porary abatement of the rheumatic pains. Although bile be thrown off by vomiting, it does not prove that there is an unu- sual quantity formed; digestion being suspended or greatly im- paired, the usual quantity of bile is not used in the process of digestion. Not dangerous.—Rheumatism rarely proves fatal, except when seated in the brain, or translated to the heart, or other important internal organs. Duration of the Disease.—The length of time required for the cure of rheumatism, varies in different cases, from a-few days to several weeks, and even months. Inflammatory rheumatism is universally admitted to be more easily cured than chronic. In- flammation is the curative process by which nature overcomes the disease, and when the inflammatory action subsides without affecting a crisis, or the vital powers are prostrated by blood- letting, purging, or the use of nitre, antimony, &c, the disease is fixed in the system, and receives the name of chronic rheuma- tism. "Some practitioners," says Dr. Willan, "continue to let blood in most cases of acute rheumatism, thinking themselves justified in their mode of practice by the sizy appearance of the blood. The same principle might lead them to empty the whole sanguiferous system; for every time blood-letting is repeated, the blood becomes more dense or sizy. I have further observed that, by bleeding repeatedly, the pains, swellings, and febrile symptoms, were not only aggravated at the time, but often pro- tracted infinitely; at least, I have seen them continue, under such a mode of practice, upwards of two months." Treatment of Rheumatism.—It is admitted by the opponents of Thomsonism, that the Thomsonian practice is suited to the cure of rheumatism. Experience has fully tested the insufficiency of the regular practice in the cure of rheumatism; and that in many instances, where this practice has failed, the disease has been cured by the aid of warm weather alone. The Constitutional Treatment is to be conducted upon general principles, with this great point always in view, namely: to aid nature in her efforts to restore the diseased parts to a healthy condition. Vitality being weakened, the treatment must be adapted to cleansing the stomach and bowels; to " ripen and remove the canker;" to support the "internal heat," and to re- store digestion. In general capsicum is the best stimulant. It may be taken RHEUMATISM. 163 in tea or in pills, or in combination with composition, or bayberry. Pills composed of equal quantities of capsicum and lobelia, are especially beneficial. Lobelia.—Besides pure stimulants, broken doses of lobelia should be given, sufficient to excite slight nausea, in order to produce some degree of relaxation. The above pills answer a good purpose, two or three of which may be given every hour or two. • The lobelia may be given in various forms, in pills, tea, powder, tincture, or in the third preparation. Lobelia and pepper are particularly indicated in the first stage of the dis- ease. A Course of Mediane, early administered, before the disease becomes seated, will in some instances effect a crisis, provided the patient be kept warm in bed, and use be made of stimulants to continue perspiration. Upon the degree of integrity of the general health retained, depends in a great measure the ra- pidity of the cure. Thus, if the digestive powers be greatly prostrated, or if there be chronic disease of the liver, the treat- ment will require to be continued for weeks, in many instances, before the rheumatism can be cured. The parts affected in rheumatism possess a low degree of vitality, and when they be- come diseased, so as to occasion inflammation, it is usually very slow in its progress to a favourable termination. When the patient can be got out of bed without causing great pain, and can bear to sit up, the full course of medicine should be given, either daily or at intervals of several days, as the case may seem to require. When, however, the disease has become seated, and the pa- tient cannot be moved without great pain, and more especially during the early period of the disease, emetics may be given without the bath, for in some instances it is better for the patient to be kept at rest, with a moderate and regular heat around him, than to have the inflamed parts aggravated by getting out of bed, and by frequently changing the clothing. When the skin is dry and hot, external dry heat may cause the patient more dis- tress, and an increase of pain. The chamber is sometimes too cold to admit of the exposure of the patient's body to the air, and under such circumstances the steaming may be dispensed with. The Vapour Bath.—There is a period in rheumatism, or a cer- tain condition of the system, when the vapour bath will prove most signally beneficial; under other conditions of the system it is apparently of but little benefit, the relief afforded being only momentary. As a general rule it is the most effectual, either before the disease becomes firmly seated, or whilst it is forming a 164 RHEUMATISM. crisis, or after it has reached its height, and also on its decline. In most cases, however, it is beneficial in all stages of the dis- ease, provided the patient can be moved without great pain. The patient should be showered after steaming, or washed with spirits or vinegar, rubbed dry, and the surface bathed with stim- ulating liniment, No. 6, or pepper sauce. Emetics aid very much in bringing the disease to a crisis. I have found a prompt emetic, either with or without a previous steaming, to afford more relief than any other remedial means. I attended a young man a few months after his arrival in this country, from England, who was taken down with rheumatism. He soon became almost entirely helpless, with great pain, and redness, and swelling in his joints. The tongue was heavily coated, and the skin pale and relaxed, with an occasional flush on one or both cheeks; generally with perspiration on the face and body emitting a sour smell. I gave this patient a teaspoonful of the liquid of the third preparation of lobelia, in a teacup half full of bayberry or No. 3 tea, about every two hours, and con- tinued the use of it for two weeks, when the tongue began to clean, and the soreness to abate. He was then steamed every day, and recovered rapidly. Sometimes the medicine would produce no sickness, except once or twice a day, when vomiting would come on, by which he always obtained relief. I do not say that this patient might not have been cured sooner by thorough courses of medicine, but the season of the year, and the situation of the room, prevented it. I have not mentioned this case as an extra- ordinary one, but merely to point out a course of treatment that may be pursued where the regular course cannot be given. In many cases I have found the compound lobelia pills effectual, given in doses of from three to four every two or three hours. In the early stage of rheumatism, it is important to relax the system, if the inflammotory action be very high, or the patient feverish; not however to break down the curative action, but to remove a part of the difficulty against which nature is strug- gling. Injections may be used as the state of the bowels seem to re- quire. When the rheumatism is principally seated in the lower extremities, injections of the third preparation, or of some form of lobelia, in the No. 3 lea, are especially indicated. The circu- lation in the lower extremities is to a greater or Jess degree in- fluenced by stimulating injections. The parts affected by rheumatism possess a low degree of sen- sibility, and when they become so much diseased as to excite reaction and occasion inflammation, it frequently requires several weeks before the parts are restored to a healthy condition, even RHEUMATISM. 165 under the most judicious and persevering course of treatment. The condition of the stomach, bowels, and liver, influences in a great degree both the violence and duration of the rheumatism. Case.—Mr. J------, whose health had been feeble for two or three years, attended with sallowness of the skin, was attacked with rheumatism, so as to be helpless. I was applied to, and administered two courses of medicine with marked benefit at the time, but he soon relapsed. I gave it as my opinion to the pa- tient, who wras a man possessing high intellectual attainments, that there was a false membrane coating his stomach and bow- els throughout, which must be removed by a persevering course of treatment before the rheumatism could be cured. Dis- couraged at not finding more permanent relief from the opera- tions he had undergone, he determined, on making a trial of the regular practice. Colchicum, and a great variety of other reme- dies were used both internally and externally, but with no good result, but on the contrary, with a manifest exhaustion of strength. I received a message requesting me to call on Mr. J------again. I found him evidently worse than when I left him. He said he had become convinced that what I had previ- ously told him in regard to the false membrane was correct, and desired that a thorough course of treatment should be pursued until the stomach and bowels should be cleared of this false mem- brane. Accordingly, a thorough course of treatment was pur- sued, and in about two weeks the false membrane began to be dis- charged, sometimes passing from the bowels in pieces a foot long. At the end of three weeks the patient was cured, and has ever since enjoyed better health than during several previous years. Where a joint is distorted by rheumatism—for instance, the foot turned in, or the wrist bent, drawing the hand down, or sidewise—the case is generally very slow to recover. When rheumatism becomes deeply seated, requiring a long course of treatment, it will be advisable occasionally to change the medicines, or at least to alter the form, or to combine them va- riously. Besides the remedies already noticed, may be men- tioned, gum guaiacum, balsam copaiva, oil of juniper, and white mustard seed. Simple herb teas are frequently found beneficial in promoting perspiration. The gum guaiacum is to be pulverized and taken in molasses. The dose- an even teaspoonful two or three times a day. The balsam copaiva may be taken in doses of from fifteen to twenty drops, first rubbed up with a teaspoonful of slippery elm and sugar, with the addition of a little water. This should be repeated three or four times a day. The oil of juniper is to be prepared and taken in the same way. 166 RHEUMATISM. The dose of the white mustard seed is a tablespoonful twro or three times a day. I have known rheumatic patients to be benefitted by eating rawr onions, more especially in chronic cases. The compound lobelia pills are well adapted to all cases of rheumatism; and on account of the facility with which they may be taken, they will generally be preferred to decoctions. In many instances I have succeeded in curing rheumatism by a free use of the above pills, together with an occasional course of me- dicine. After a course of medicine, diluent drinks should be given with a view to continue a moderate perspiration. A weak infusion of bonesett, chamomile, or elder blossoms, or a tea of composition, spice bitters, ginger, or capsicum, may be used as the nature of the case may require, or the fancy of the patient dictate. Tonics should be used when the disease is on the decline, and the patient clear of fever. More particularly are tonics indicated when the system is in a weak and relaxed condition. AVhere the case requires the continued use of tonics, they may be changed occasionally with advantage. Various kinds of tonics may be used, such as aspen poplar, peruvian bark, guiac shavings, columbo, balmony, quassia, golden seal; or garden bitters, as wormwood and tansy. They may be prepared in decoction or in tincture. Thomson's No. 6 is also a good tonic. The Diet in rheumatism, as in every other disease, should be adapted to the condition of the digestive powers. In the acute or inflammatory form of the disease, digestion is in general either suspended or much enfeebled, requiring the lightest kinds of food, such as crust coffee, barley water, elm gruel, toast and tea, milk porridge, &c. When a patient is suffering acute pain, the digestion is imperfect; and when the stomach is oppressed with food that it cannot digest, the rheumatic pains will be ne- cessarily aggravated. In a more advanced period of the disease, or when it becomes chronic, a stronger diet may be required, such as soft boiled, or poached eggs, stale bread and butter, moderate quantities of fresh beef, roasted or broiled, mutton, wild game, together with wholesome vegetables. In some cases animal food agrees with the stomach, and in others an almost exclusive vegetable diet will be most proper. Local Applications.—There is probably no form of disease in whicli so many different local applications have been recom- mended as in this. In some instances local applications are ser- RHEUMATISM. 167 viceable, and in others they prove entirely useless. And again, an application that agrees with one case, will increase the pain in another; and the same application that may ease pain in one stage of the disease, may prove entirely useless, or even injuri- ous at another period. Thus, raw cotton, bound on an inflamed joint may excite perspiration and relieve pain in one, and in an- ' other it will increase it. Many will find relief from warm poul- tices, whilst in others the pain will be aggravated by them.. In general, warm poultices and volatile liniments are beneficial. Thomson's No. 6, with a portion of camphor, or four parts of No 6 to one of spirits of turpentine, will be particularly useful in many cases. Two ounces of olive oil, mixed with half an ounce of " water of ammonia," form a volatile liniment, appli- cable in the acute or inflammatory stage of rheumatism. The stimulating liniment frequently alluded to in this work, prepared by my brother A. Comfort, is one of the best external applica- tions for rheumatism that I have ever made use of, and generally answers in both the acute and chronic forms of the disease. After rubbing the parts well with the liniment, they should be bound up with flannel or silk oil cloth. The following poultice is highly recommended by some who have used it. Take of slippery elm, four ounces, Wheat bran, do. Capsicum, one ounce, Brown lobelia, do. Fine salt, two tablespoonsful, Soft soap, half a pint. Mix these together, and sufficient warm water to make into a proper consistence for a poultice, and apply it. The poultice must be wet occasionally to prevent it from becoming dry and hard. Dr. Shaw informs me that he used this poultice with the most marked success, in a case of chronic rheumatism. After applying the poultice some time, ulcers were formed on the sur- face over the diseased parts, but which healed under the repeated application of the same poultice, and the joints were rapidly re- stored to a more healthy condition. In some instances the pain and inflammation will fix upon a part for a day or two and then suddenly change to another place, and in this way will fly from one limb to another; and a part that will be extremely painful, red and swollen, and tender to pressure, may, in the course of a few hours, be entirely free from inflammation or pain. I attended a gentleman recent- ly affected with acute rheumatism, where warm applications, except steaming, increased the pain, and where almost instant 168 RHEUMATISM. relief was found by applying a cold poultice, made of grated raw potatoes: the disease in this case was confined principally to the feet, not affecting the larger joints. In deep seated cases of long standing, sea bathing, cold shower baths, or travelling over a mountainous country will sometimes affect a cure. When rheumatism attacks the brain or heart, or other internal organs, the treatment must be thorough in the commencement, for if the disease become firmly seated, particularly on the brain, it will sometimes terminate fatally, although the most vigorous measures may have been pcrseveringly employed. Rheumatism very rarely, however, becomes translated to inter- nal organs under the use of Thomsonian remedies, but it is not an uncommon occurrence under a depleting course of treatment. Almost every writer on medicine furnishes testimony to the dan- ger of copious bleeding in rheumatism, from the liability of the disease being thereby translated to the heart and other internal organs. During the past winter I attended a young man with a severe attack of pericarditis, or rheumatism of the heart. The patient was seldom able to lie down except after a vapour bath and an emetic, but would sit all night in a bent posture, experiencing severe pain from efforts to cough, or to take a deep breath; the pulse was irregular and extremely feeble; there was great op- pression of breathing, and the voice low and very feeble; the pain was seated in the region of the heart, the limbs were all affected with rheumatism and bis feet very much swollen. In this case I found no other means so effectual as a course of me- dicine. The bowels were obstinately constipated, and seldom moved by injections. This patient recovered in the course of a few weeks, under a general stimulating treatment, together with an occasional vapour bath and an emetic. As in all cases that I have attended of seated disease, a false membrane was passed off from the bowels, and flakes of it were frequently thrown up by vomiting. SECTION II. LUMBAGO—RHEUMATISM IN THE LOINS. This form of rheumatism is to be treated upon the same ge- neral plan as that recommended for rheumatism, namely: by courses of medicine; pure stimulants; astringent, or " canker medicine;" and finally by tonics. Twenty or thirty drops of the spirits of turpentine, three or four times a day, is an effectual remedy in many cases of lum- bago. The use of the turpentine, and an occasional vapour bath, together with a strengthening plaster to the back, may succeed in curing light cases. The stomach and bowrels, how- ever, are in most instances disordered, and require a course of medicine, and the use of stimulants, such as capsicum and com- position, prickly-ash, No. 6, &c. Prickly-ash.—This medicine in decoction, taken freely, is decidedly useful in chronic rheumatism wherever it is located. The prickly-ash, finely pulverized, may be added to the spice bitters in the proportion of one part of the former to four parts of the latter. SECTION III. GOUT. Gout is a constitutional disease, being always connected with a disordered state of the digestive organs. The disease usually comes on by fits or paroxysms, and the attacks in most instances occur at night. The pain is generally seated in the ball of the great toe, though it is liable to attack other parts of the limbs, and also internal organs, namely: the stomach and kidneys. Its hereditary tendency.—Some families are peculiarly predis- posed to gout, almost every member of a family being more or less affected by it in advanced life, when the digestive powers usually fail. This hereditary tendency to gout may be trans- mitted from parents to children, through several generations. W 170 GOUT. The same debilitating cause that would produce gout in one predisposed to the disease, might occasion pleurisy, erysipelas, or some other form of disease in another. Not confined to the luxurious and indolent.—Gout though prin- cipally occurring in those who have " feasted and drank abun- dantly" still it does occasionally attack individuals who have lived temperately, and have led an active life. In every case of the kind, however, that I have had a knowledge of, the patient was dyspeptic, and had a sallow complexion, indicating a torpid state of the liver. Causes.—When there is a predisposition to gout, an attack may be brought on by almost any debilitating cause, such as exposure to cold or dampness, overexertion, or taking more food into the stomach than can be digested, thus causing debility of the general system. The disease is most apt to occur in persons of a peculiar confirmation of body, with alimentiveness large, and who are habituated to eating largely of the richest kinds of food, together with the free use of wine and brandy. At length the digestive powers become enfeebled. The habit of eating heartily having become established, more food is taken than the stomach can digest; the imperfectly digested food form acids, the gene- ral system becomes disordered, and gout follows. When this disease attacks individuals who lead an active life and are temperate in their habits, it is owing to constitutional disorder; the general health being more or less impaired previ- ously to the gouty attack. The Ordinary Symptoms of Constitutional Disorder which gen- erally precede an attack of Gout, are, uneasiness and distress at the pit of the stomach; frequent belching of wind; sour eructa- tions; furred tongue; a sense of tightness and weight in the ab- domen; "giddiness; great lassitude; yawning, and stretching of the limbs; cramps in the muscles of the legs; drowsiness, with disturbed sleep, depressed spirits, and debility. In some in- stances a disagreeable itching of the skin comes on a few days previous to the attack, and in most cases the urine has a deep red colour." Coldness of the extremities, with a sensation of numbness is very often experienced before an attack of gout. Characteristic Symptoms.—Iu most instances an attack of gout commences at night. It is attended by severe pain, tenderness, and throbbing in the ball of the great toe; chilliness or ri- gors, soon followed by reaction; the skin becomes hot and dry, and the pain violent and throbbing, as though there was a con- tinued succession of electric shocks passing through the tender GOUT. 171 part. At the approach of daylight, the pain abates, and a pro- fuse perspiration ensues. " In some instances the pain and fever continue with unabated violence, until about the middle of the following night, when they decline under a moderate flow of sweat—the patient sinking into a quiet sleep towards morning. In very severe attacks, however, no obvious remission of the symptoms takes place, until the third or fourth morning. Yet in all instances, the sufferings of the patient are greater during the fore-part of the night than in the day. When the affected part is examined in the morning, after the accession of the pa- roxysm, it is found swollen, red, and the veins of the foot greatly distended with blood." The tenderness is so great, that the least pressure or motion in the part, occasions excruciating pain. The temper during the paroxysm, is irritable, the patient being difficult to please. The duration of the first attack of gout, varies from four or five to eight or nine days; "but in subsequent attacks, it is often protracted beyond the second, or to the end of the third week. After the disease has subsided in one foot, it sometimes attacks the other, and passes regularly through its course as in the first instance. After an attack of gout the general health of the patient is usually much better than it was for some time previous to the attack. The disease however returns at longer or shorter inter- vals, in some instances only once in a few years—in others every year, and after the constitutional energies become greatly enfee- bled, the patient will seldom be entirely clear of it, except during mid-summer. • Chronic Gout.—From great exhaustion of constitutional ener- gy, gout is apt to assume the chronic form, and instead of occur- ring in paroxysms at different periods, the parts become perma- nently affected, not with acute inflammation, but by "chronic wandering, and irregular pains, bearing much resemblance to chronic rheumatism." " The pain in chronic gout is usually moderate during the day, the patient experiencing only a sense of alternate heat and coldness in the affected parts; at night, however, it is generally severe and aching. A feeling of numbness and weight is expe- rienced in the diseased parts, and slight cramps are apt to occur during the fore part of the night, and the sleep is restless, and interrupted by sudden startings. The affected joints retain their natural, or present only a slight purplish hue; but they become oedematous, tender, and more or less stiff, and the neighbouring muscles arc weakened or diminished in size. The inflammation often passes successively from one joint to another, or leaves its original scat, and fixes upon some distant joint, and after 172 GOUT. having remained there for a while, returns to the part it had left." " There is rarely any very conspicuous fever, but the diges- tive and biliary organs are generally very permanently derang- ed. The dyspepsia attending this form of the disease is partic- ularly characterized by great oppression, and flatulent disten- tion of the stomach after a full meal, together with heartburn, and occasionally a sense of coldness in the stomach. The bow- els are usually torpid or affected with mucous diarrhoea; the urine is turbid, and often charged with mucous; the skin dry, contracted, and sallow7; the bilious secretion deficient; and both the animal and vital functions much impaired. The temper in this variety of the disease is always very irritable, dissatisfied, morose, irresolute, and sometimes gloomy or hypochrondical. In some instances, pain is occasionally felt in the kidneys, or neck of the bladder, and generally matter is discharged with the urine. Gout is not exclusively confined to external parts, but is liable to attack the stomach and other internal organs, and also the brain. Cold applications to the diseased extremities, copious bleeding, continued active purging, or any other debilitating in- fluence may occasion gout to be translated to internal parts. "When an acute attack of gout passes to the brain, coma, furi- ous delirium, or symptoms of apoplexy, speedily ensue." When it fixes upon the stomach, violent cramps or spasms of this organ ensue, which in many instances terminate fatally, or reaction becomes established exhibiting symptoms of inflammation in the stomach. Treatment.—A paroxysm of gout will require the same gene- ral plan of treatment as any other violent attack of disease. A course of medicine will relieve the violence of the symptoms and assist in bringing about a crisis. In the premonitary stage before the reaction or pain comes on, a course of medicine will lighten the severity of the pain, and shorten the paroxysm. Treatment during the paroxysm.—An attack of gout should be treated in the same manner as a case of bilious colic, or in- flammatory rheumatism; applying the remedies as the urgency of the symptoms may require. The bowels to be relieved by the use of enemas; the system warmed by the vapour bath, and the stomaeh cleansed by emetics. During the paroxysm, the vapour bath may be administered frequently, provided the pa- tient finds relief from it. Emetics.—Free vomiting will sometimes relieve the pain after GOUT. 173 all other usual means have failed. After vomiting, the patient should take capsicum tea freely, or a teaspoonful of the third preparation of lobelia, in a tea cup half full of composition or bayberry tea, frequently repeated. In very severe cases I have found it necessary to repeat the above named doses at intervals of fifteen or twenty minutes, and continue them for hours in suc- cession. Injections.—Much benefit may be derived from an occasional enema, made actively stimulating with the third preparation of lobelia; when there is much fever it will be proper to adminis- ter an injection of lobelia powder in luke-warm water, to be re- tained, and repeated until the system becomes more or less re- laxed under their influence. In some, this treatment will cause a great degree of relaxation, in others, the bowels may be almost insensible to the impression of the lobelia, and scarcely any visi- ble effects be produced. When the disease attacks the stomach, or other internal or- gans, the treatment will require to be prompt and vigorous, de- pending chiefly upon the third preparation of lobelia, or a like preparation administered in frequent and full doses. Medicine, however, will in some cases fail of having the desired effect without the aid of the vapour bath, or the application of warm bricks, wrapt in damp cloths, placed around the patient. As superabundance of acid in the stomach will sometimes prevent or greatly retard the operation of the emetic, the use of salaera- tus, or bi-carbonate of soda, will then be required. Local Remedies.—In general, stimulating and volatile liniments afford more or less relief. The parts should be wrapped in flannel or cotton, provided the pain be not increased thereby. Intermediate Treatment.—After a paroxysm of gout, the treat- ment should be directed to effect a restoration of the general health, and thus to overcome the liability to another attack.— This may in many instances be accomplished by an occasional courseof medicine, together with pure stimulants, the "anti- canker medicine," and at a proper time the use of powerful to- nics. The continued use of the compound lobelia pills at night, will have a good effect on the bowels. In some cases where individuals are subject to attacks of gout, the habit of eating too freely of rich food has become so fixed with them that the sto- mach continues to be oppressed with more food than can be di- gested, and thus the patient is subjected to continued returns of gout. In the chronic form of gout, besides an occasional course of medicine, the use of strong infusions of vegetable bitters, will 174 INFLAMMATION OF THE KIDNEYS. often prove beneficial. Gum guiacum, spirits of turpentine, and savine, (juniperus sabina) may also be found useful in the chronic form of the disease. CHAPTER V. SECTION I. INFLAMMATION OF THE KIDNEYS. The kidneys may become diseased from various causes, such as exposure to cold and dampness, intemperance, blows, contu- sions and strains, the use of cantharides and other irritating di- uretics, translated rheumatism or gout, and the formation of gravel in the kidneys. Where there is constitutional weak- ness in the kidneys, they may become diseased and take on in- flammation by almost any debilitating influence, but more espe- cially from cold and damp feet. Symptoms—Arising from disorder of the general system, or from exposure to cold, constitutional derangement, such as chil- liness and languor, loss of appetite, torpid bowels, flushes of heat, and fever, precede inflammatory action in the kidneys. When this takes place there is tenderness to pressure, and pain in the region of the kidneys, which is greatly aggravated by a sudden jar, from making a false step, or by suddenly bending the body forward. The pain is apt to shoot down towards the bladder and thighs. "With these symptoms are usually con- joined fever, nausea and sickness, retching and vomiting, colicky pains and constipation. The urine assumes a variety of appear- ances,—it is high coloured, ropy, depositing sediment, foetid, or bloody. Terminations.—Inflammation of the kidneys, under proper treatment, generally terminates in a restoration of the parts to a healthy condition. The Favourable Signs are a subsiding of the pain; a general warm perspiration; a copious discharge of urine, generally INFLAMMATION OF THE KIDNEYS. 175 either turbid or charged with mucous; clearing of the tongue; and subsidence of the sickness and vomiting. Where acute inflammation of the kidneys does not terminate in, resolution (the restoration of its natural action) by the seventh or eighth day, suppuration very commonly ensues, and an abscess is formed. The symptoms denoting the formation of an abscess, are shiverings and fever, occurring at irregular intervals, resem- bling ordinary ague or hectic fever; a pulsating pain in the kid- ney; a feeling of heaviness or numbness in the affected part; and great irritation of the bladder and urethra. Abscess of the kid- ney may "point externally, and be discharged, or it may open into the abdomen, and occasion severe and fatal peritonitis." In other instances the matter passes down the ureters into the blad- der, and is discharged with the urine. In some instances an ab- scess will continue to discharge in this way for many months, and even years. Treatment.—To moderate the violence of the pain, and at the same time to aid the efforts of nature in bringing about a favour- able termination of the disease, Thomson's course of medicine, in the author's opinion, is decidedly the most beneficial. The Course of Medicine should be given early in the attack, and repeated daily if the symptoms demand it. There will be little inconvenience in vomiting, as straining efforts will sel- dom increase the pain to any great degree w hen the system is relaxed by the lobelia and vapour bath. Injections.—The kidneys may be greatly influenced by medi- cines administered by injection. To move the bowels, they should be made stimulating, and contain a portion of lobelia. When the skin is hot and dry, the secretions of the mouth suspended, and the pain in the kidney severe, broken doses of lobelia should be given by the mouth, and administered by injection with the view of producing continued nausea, and the patient should take freely of pennyroyal or other simple herb teas, and an occasional dose of pepper or composition. The Vapour Bath.—From the close sympathy existing between the skin and the kidneys, the vapour bath will prove highly ben- eficial, and may be administered frequently. Where the patient cannot bear the fatigue of sitting up, the steam should be applied to the patient on a couch or mattress. Not only is the vapour balh useful by exciting perspiration, but it attracts the blood to the surface, and thus lessens the undue determination to the dis- 176 INFLAMMATION OF THE KIDNEYS. eased part. The same effect is produced by the emetic. The vapour bath is more especially indicated where the secretion of urine is nearly, or wholly suspended. For where the functions of the kidneys are suspended, those of the skin should be promo- ted, otherwise the urea will remain in the blood and occasion serious consequences. In some instances, however, the patient requires to be kept in a state of perfect rest, and other means should be used for promoting perspiration. External Remedies.—Besides the vapour bath, warm bricks wrapped in cloths dampened with vinegar and water, should be placed under the bed-clothes, and as near the patient as can con- veniently be borne, and warm poultices applied to the small of the back, and kept warm, either by placing a hot brick against them, or as they become cooled, they should be taken off and re- applied as hot as can be borne. Diet.—This should at first consist of such articles as crust coffee, elm gruel, barley water, &c, and continued in until the inflammation subsides, and a favourable crisis take place. When an abscess forms, the general health must be sustained by a proper use of pure stimulants, " anti-canker medicine," and mild tonics, spice bitters, or a tea of poplar bark. The Symptoms of Calculi, or Gravel in the Kidneys, independ- ently of inflammation are, excruciating pain in the region of the kidneys dow n to the bladder; constant sickness at the stomach, with frequent retching and vomiting; pain in the inside of the thigh; retraction and pain in the testes, and stranguary. The gravel may pass off and give perfect relief, or the pa- roxysms may continue, and inflammation ensue. I visited a patient who had symptoms of gravel in the kidneys, under the care of Dr. Fonerden. The patient had taken two or three courses of medicine, and at the time I saw him, the sys- tem was very much relaxed under the influence of lobelia, and he had what are termed the alarming symptoms; and the family of the patient being unacquainted with the effects of the medi- cine, were much alarmed. During this relaxation, the patient in voiding urine, passed a calculous or gravel stone, about three quarters of an inch in length, as thick as a common goose quill, and was immediately relieved. Gravel in the kidneys arises from a disordered condition of the digestive organs, and is generally associated with full living, particularly in persons predisposed to gout. When the calculi are first formed in the kidneys, they are generally of acid deposites. The urine will be high coloured INFLAMMATION OF THE KIDNEYS. 177 and will change litmus paper to red, and deposites a sediment of red, yellow, or pink colour on standing. This acid character of the urine attends childhood and persons about the age of forty. As the constitutional energies become more enfeebled, the cha- racter of the gravel is apt to change from that of an acid to an alkaline deposite; the urine becomes pale, and deposites a white sediment or crust on standing. Treatment of Gravel in the Kidneys.—To relieve the pain, and facilitate the expulsion of the gravel, and at the same time to lessen the tendency to severe inflammation, a regular course of medicine will prove most effectual. Besides the course of medicine, injections of the lobelia pow- der should be given occasionally with a view to relax the system, and lessen the determination of blood to the kidneys A tea- spoonful or two of the third preparation of lobelia, in a teacup half full of bayberry tea, should be given every hour or two, when the pain is severe. Whether the disease be gravel or in- flammation in the kidneys, lumbago, gout, or rheumatism, the treatment here recommended will be proper in each case. Alkalies should be used in combination with the other medi- cines, when the urine is acid,—salaeratus or the bi-carbonate of soda; the former is to be preferred. Alkalies must be occasion- ally used, as long as the urine indicates the existence of acid. Adds.—When the urine is pale, and deposites a white crust, or sediment, acids should be used, as vinegar, or the pepper sauce, especially at meals. Lemon juice may be used in drinks, or a beverage may be made of other kinds of acid fruit. Predisposition to the formation of gravel is to be overcome by restoring the general health by the use of pure stimulants, "anti- canker medicine" and tonics, besides the use of alkalies or acids, as the case may require. An occasional course of medicine will be very useful to restore the general health. Change of Air.—In deeply seated complaints, benefit is derived in many cases, from a change of residence, where medicine fails of effecting any permanently good result. A few weeks' resi- dence at the sea shore, or in a pine country, or among moun- tains; at the mineral springs, Schuyley's mountain, Saratoga springs, and other like places of fashionable resort, has in many instances renovated the general health, and removed the ten- dency to gravel, where medical treatment has failed. SECTION II. INFLAMMATION OF THE BLADDER. This is a disease of rare occurrence, except in a chronic form, the bladder not being liable, generally, to acute inflammation. Causes.—Acute inflammation of the bladder is sometimes oc- casioned by repelled gonorrhoea. It has also been produced by the use of cantharides, (Spanish flies,) and by the excessive use of turpentine. The disease is accompanied by a disordered state of the digestive functions. Inflammation of the bladder may also be brought on by injuries inflicted by blows, retention of urine, or by the use of forceps in labour, or by the injudicious in- troduction of the catheter. When the bladder is predisposed to disease, exposure of the feet to cold and dampness may occasion inflammation,—still the disease is of rare occurrence. The Symptoms are,—an almost constant desire to pass urine; burning pains in the region of the bladder, which frequently shoot through the testes, and down the thighs; and extreme tenderness in the region of the bladder. The patient is seldom able to pass much urine, and that which is voided is of a deep red colour, and frequently tinged with blood. There is much distress at the stomach, with sickness and vomiting. The bowels are costive, and if the inflammation extend to the rectum there will generally' be more or less dysenteric symptoms. More or less reaction attends acute inflammation of the bladder. The skin is dry and hot, the pulse quick, the tongue coated and dry, with excessive thirst; the patient is extremely restless, and the countenance is expressive of great anxiety. When the neck of the bladder is inflamed, there w ill be retention of urine, and any attempts to introduce the catheter or bougie causes extreme suffering. Terminations.—Inflammation of the bladder terminates either in resolution, suppuration, gangrene, or a thickening of the coats of the bladder. Favourable Signs.—When the inflammation is about to ter- minate in resolution, which signifies a restoration of the parts to their natural condition, there will be general perspiration, with inflammation of the bladder. 179 an uniformly warm skin; subsidence of the pain; the parts'less tender to pressure; and a free discharge of urine, with but little pain. Suppuration—Inflammation of the bladder very rarely termi- nates by suppuration. When this does occur, the pain and fever are lessened; the patient experiences chills or rigours, and a white matter is discharged with the urine. Gangrene occurs much more frequently than suppuration. When gangrene is about to take place, the pain and fever sud- denly cease; there is great prostration of strength; "cold ex- tremities; profuse and clammy perspiration;" pulse weak and frequent; hiccough; confusion of mind; and a death-like expres- sion of countenance. Sudden and severe attaeks of acute inflammation of the blad- der usually run their course to a favourable or to a fatal termina- tion, by the seventh or ninth day. In some instances the dis- ease becomes seated, or as it is expressed in medical language, the inflammation assumes the chronic form. Treatment.—Severe attacks of inflammation of the bladder, require energetic treatment in the early period, and a perse- vering course to be continued until the disease abate, or the case prove hopeless of cure. As in all severe attacks of disease, re- peated courses of medidne must be chiefly relied upon, or the system kept under the influence of lobelia, which will aid in equalizing the nervous influence, and will promote perspiration. Injections to the bowels must be used freely in order not only to remove their contents, but also to influence the action of the bladder. The lobelia powder, administered by injection, and retained, will tend to relax the neck of the bladder, and favour the escape of urine; and besides this, it fulfils other important indications, equalizing nervous influence, and promoting the va- rious secretions. Occasionally lobelia administered in this way will produce sickness and vomiting, and greatly relieve the pain in the bladder. The Vapour Bath is useful in inflammation of any internal or- gan or tissue. It attracts the blood to the surface, and power- fully assists to equalize its circulation; it relieves pain; aids the efforts of nature to overcome obstructions; and renders the sys- tem more susceptible to the impressions of medicine. The bath is to be repeated as the circumstances of the case may require; and if the patient find relief by the bath, it may be administered very frequently. If, however, the patient be more easy when 180 INFLAMMATION OF THE BLADDER. kept quietly in bed, with warm poultices applied to the parts, the bath may be disused for the time. Most physicians of the old school use the vapour bath in this disease. Poultices composed of indian mush and flaxseed, stewed an hour or more, then adding ginger and green lobelia, or compo- sition powder, must be constantly applied to the abdomen. A poultice prepared by stewing wormwood and tansy in vinegar, and thickened with indian meal or slippery elm, may be used. Diet.—During the active stage of the disease, the stomach will not digest any food except it be of the most bland and mild cha- racter,—elm gruel, flaxseed tea, adding a small portion of loaf sugar,—barley water, and crust coffee. If the tongue be thickly coated, the patient should take occa- sionally a strong decoction made of sumac leaves and berries, adding a portion of cayenne, or of the third preparation of lobe- lia. This preparation is also well adapted to those cases where suppuration occurs in the bladder, or the inflammation assumes the chronic form. Chronic Inflammation of the Mucous Membrane of the Bladder is a common form of disease. i Symptoms.—" Slight lancinating pains, attended with a sense of burning in the region of the bladder, and a feeling of w eight and tenderness in the perinaeum; frequent and harassing desire to pass urine, with occasional spasmodic action of the bladder and urethra. The urine is loaded more or less with a tenacious mucus. Slow fever generally attends, accompanied with thirst; general debility, particularly about the back and loins; and in protracted cases, much emaciation and exhaustion supervene. There is generally considerable derangement of the digestive functions; loss of appetite; sometimes nausea and vomiting: cos- tiveness; tongue covered with a white or brown fur; and the skin is harsh and dry." Chronic inflammation of the bladder is often associated with gout, and scrofula. It prevails most in the aged and infirm, and more especially in the intemperate. Treatment—Chronic inflammation of the bladder is to be cured by a course of treatment best adapted to restore the general health, together with stimulating injectious to the bowels, composed of a strong decoction of sumac leaves or ber- ries, adding a portion of cayenne and lobelia; and a free use of an infusion or tea, of either pipsissew a, sumac bark, leaves, or INFLAMMATION OF THE BLADDER. 181 berries; uva ursi, or bear berry; or buchu. An infusion of peach tree leaves is highly spoken of by some practitioners. Balsam copaiva has been used with much benefit in this disease. An occasional Course of Medicine, and the patient kept in a perspiration for several hours after, will in general prove the most effectual method for the cure of chronic as well as acute in- flammation of the bladder. When the patient is infirm and far advanced in life, it will generally be useless to attempt to effect a cure, more especially if the disease be of long standing. The treatment in such cases should be of a palliative character. The same symptoms that accompany chronic inflammation of the bladder attend, also, disease of the prostrate gland, stone in the bladder, stricture of the urethra, and ulceration of the neck of the bladder. The constitutional treatment, however, will require to be the same in each case under similar conditions of the general health. Thus, if the stomach be disordered, an emetic will be proper whether the patient is affected with stone, or with simple inflammation of the bladder. If there be reten- tion of urine from spasm of the neck of the bladder, or from stric- ture of the urethra, the vapour or warm bath, and injections to the bowels, to relax the parts, will be equally applicable in either case. A German applied to me affected with retention of urine, and the introduction of a catheter twice a day had been required for the three preceding weeks. A full courseof medicine was given, and he did not need the use of the catheter after. Even where re- tention of urine is occasioned by stone in the bladder, a full course of medicine may overcome the difficulty in many instances, al- though permanent relief is not reasonably to be expected by it. Where there is a stone in the bladder that is very hard, it can be removed only by an operation. SECTION III. DIABETES—EXCESSIVE FLOW OF URINE. The more prominent Symptoms, of this form of disease, are— a profuse discharge of urine; excessive thirst; voracious appe- tite; clean tongue; dry skin; and wasting of the flesh. Character of the Urine—Various derangements in the system may exist, accompanied by an increased flow of urine, but essen- tially different from diabetes. Diabetic urine contains sugar, giving it a sweet taste and smell; " and if dropped and partly dried upon linen or paper, it is glutinous and adheres to the fin- fiers. The amount of urine discharged varies in different cases, but it is always very great; and in some instances seven or eight quarts have been discharged in the course of twenty-four hours, and this continued for several weeks in succession. Causes.—A depraved state of the digestive functions, and an exhausted state of the vital powers, are the essential causes of this complaint. The disease prevails commonly in old age, and in constitu- tions broken down by intemperance or debauchery. It some- times prevails in children after protracted cholera infantum. The disease difficult of cure.—Occurring as a consequence of a worn-out or broken-down state of the system, genuine diabetes is very rarely cured. Recoveries from it, however, do happen under a judicious and persevering course of treatment. Where the disease is not overcome, the strength and flesh con- tinue to wraste, hectic fever occurs, and frequently consumption of the lungs, dropsy, and apoplexy supervene. Instances have occurred in which several members of the same family died of diabetes, thus showing, as it would seem, a here- ditary tendency to the disease. The disease, in some instances, arrives at its course in a few weeks, whilst in others it will continue for many months, or even years. Treatment.—The important indications are to restore the di- gestive and nutritive functions. To accomplish this, the prin- cipal dependence must be upon courses of medicine in the early stage of the disease. There are no means so effectual in revo- DIABETES. 183 lutionizing the system, and in breaking the chain of disorder- ed action as courses of medidne. Yet in diabetes, unless ad- ministered in the very onset of the disease, and under favoura- ble circumstances in relation to the constitutional vigour of the system, even these will be found unavailing. If the constitution be broken down, or the patient advanced in life, it would not be advisable to subject the patient to any unpleasant operation by medical treatment, for under the circumstances first mentioned there cannot be a reasonable hope entertained of effecting a cure. It must be borne in mind, however, that the system is liable to disorders attended with a profuse discharge of urine, differing essentially from diabetes. Repeating the Course of Medicine.—In the early stage of the disease the course of medicine may be frequently repeated, pro- vided the patient should experience benefit by the operation. When the condition of the stomach does not require the emetic, the bath may be applied daily, with a view to relax the skin, and cause a determination to the surface. The vapour bath may also have an influence in changing in some degree, at least for a time, the thickened state of the blood, which in diabetes is ob- served to be thick like molasses, probably owing to a loss of its natural temperature, and a weakened state of circulation. The caloric and electricity imparted by the vapour bath, exert a most decided influence in vitalizing the blood, by facili- tating its circulation through the lungs, and by restoring its natural temperature. When the patient is too feeble to bear sit- ting up, the vapour bath may be applied in bed, and in this way a moderate perspiration continued by it for an hour or two. When the skin is very dry and harsh, it may be difficult to ex- cite perspiration, and the patient will consequently be more or less oppressed with heat, and require frequent sponging over the face and body with tepid wrater, or vinegar and water until per- spiration be brought on. Capsicum tea or other stimulants should be given, together with nauseating doses of the tincture of lo- belia. The sumac leaves and berries made into a strong decoction, adding a small portion of cayenne, will be proper to be occasion- ally given; and during the first period of the disease, frequent doses of the tincture of lobelia, or the eompound lobelia pills, should be administered. Tonics will be proper, more especially where the symptoms assume a more favourable aspect. The thoroughwort or bone- sett may be used as a tonic in any period of the disease, and where this treatment requires to be long continued, an occasional change or alternation of the tonics may be appropriate. 184 RETENTION OF URINE. The No. 3 pills may be used as a substitute for the sumac tea, if the patient prefer this convenient form. Stimulating liniments, pepper sauce, or No. 6, should be ap- plied to the surface of the body and limbs, after a vapour bath, and friction to the skin daily persevered in. Diet.—The food must consist of the most nourishing kind that the stomach will bear. Eggs, beef, mutton, milk, kc, answer well in many cases. Meat, in the early period of the disease, however, and more especially if there be fever, will be improper. Vegetables, in most instances, disagree with the stomach, and in some cases, even a small piece of bread will do injury. Animal Food is recommended in diabetis. In some instances, however, it will not suit the stomach,—when custards, arrow root, eggs, milk porridge, rice and milk, &c. may be substituted. From the feeble state of the digestive powers, and the vora- ciousness of the appetite, there is an extreme liability to eat more than is proper. The clothing shonld be very warm, and especial attention is necessary to keep the feet dry and warm. Exercise in the open air is beneficial where the patient is able to get out, either to walk or to ride. Diabetes, however, is very seldom cured, when it occurs in depraved, or otherwise broken down constitutions: these com- monly form an insuperable barrier to the success of the practi- tioner, though a ray of hope may be still held out, as in the most desperate cases cures are sometimes effected. SECTION IV. RETENTION OF URINE. The urine may be retained in the bladder either from inflam- mation or constriction in the neck of the bladder; mechanical obstructions in the neck of the bladder or urethra; or from a loss of the power to contract the bladder, and expel its contents. 1st. Inflammation in the Neck of the Bladder is one of the most common causes of obstruction to the passage of urine. . The in- flammation may arise from a diversity of causes, such as the ap- RETENTION OF URINE. 185 plication of fly blisters to any part of the body or limbs; the in- ternal use of turpentine, or cantharides; disease of the prostrate gland, or of other parts in close sympathy with the bladder; ex- posure to cold and dampness; an acrid state of the urine; re- pelled gonorrhoea; and constitutional disorder, more especially in gouty patients. 2d. Mechanical Obstructions.—These are gravel in the neck of the bladder, or urethra; stricture of the urethra; enlargement of the middle lobe of the prostrate gland; prolapsus uteri; and pressure of the uterus upon the neck of the bladder during preg- nancy. 3d. Paralysis, or a loss of power to contract the Bladder, occurs from injury of the brain and spinal marrow; palsy of the lower half of the body; malignant disease, as typhus fever; blows or falls upon the back; over-distension of the bladder from reten- tion of urine caused by mechanical or other obstructions; inju- ries sustained during child-birth; from exhaustion of nervous power from bad habits or from old age. Treatment.—Whether the retention of urine be occasioned by inflammation, or spasm in the neck of the bladder, or urethra, or from mechanical obstruction, the constitutional treatment proper in the one case, will be equally applicable in the other. Mechanical obstructions, however, in many instances, require other means besides constitutional treatment. In ordinary cases, retention of urine may be relieved by evac- uating the bowels by injections containing a portion of lobelia, together with the use of means for equalizing the circulation, and producing perspiration, by hot stimulating teas, and the vapour or warm bath, or a blanket wrung out of hot water, folded several times, and laid over the abdomen, or by applying a bag of hops, wet with hot vinegar. Injections.—One of the most effectual remedies for stoppage of urine, is the use of injections of lobelia powder, in luke-warm water, and caused to be retained in the bowels. This, together with the application of warmth to the surface, as above mentioned, will seldom fail of removing the difficulty, unless the retention should arise from gravel in the urethra, or neck of the bladder, or from other mechanical obstructions. Even when there is a mechanical obstruction, the above means should be used, with a view to relax the parts, which will not only afford relief, but render the removal of the mechanical obstruction less difficult. The Vapour Bath fulfils several important indications in the stoppage of urine. It seldom fails of affording more or less re- ' 186 RETENTION OF URINE. lief from pain, and, in some instances, will be sufficient, when well applied, to remove the obstruction, more especially when it is occasioned by inflammation, or spasmodic contraction in the neck of the bladder, brought on by exposure to cold and wet. Medical men most generally resort to tobacco injections, in severe cases, for the purpose of producing relaxation. This, however, sometimes produces serious consequences, from the poi- son of the tobacco being absorbed into the blood. The lobelia will answer every good purpose that could be desired from the tobacco, and without any risk to the patient of bad consequences from its employment, even in large quantities. In aggravated cases it may be found necessary to use powerfully stimulating injections to the bowels, with a view to prevent stagnation of the blood, in the diseased parts. For this purpose, the liquid of the third preparation of lobelia will be proper, and may be used in larger or smaller quantities, as the case requires. Emetics.—In some instances retention of urine is associated with extensive derangement of the stomach, so that emetics may be found not only advantageous, but necessary; and when the ob- struction is not overcome by the means above stated, it will be proper to give an active emetic of the third preparation of lobe- lia, or some like preparation, such as the brown lobelia, given in bayberry tea, adding a teaspoonful of capsicum to each dose. The vapour bath previous to the emetic will render the latter more effectual. Retention of urine is always more or less dangerous when con- tinued over twenty-four hours without any urine passing. It is therefore highly important to persevere in the treatment until the obstruction be partially or w holly removed. Thus in some cases it may be found necessary to keep the patient fully relaxed, for many hours together, under the influence of the lobelia injections, and also to repeat the emetics every two or three hours, together with the frequent application of the vapour or warm bath, or a constant moist heat kept around the patient. The drink should consist chiefly of elm gruel, flaxseed tea, watermelon-seed tea, barley water, &c. Introduction of the Catheter.—When the catheter can be intro- duced it gives instant relief, but when the urethra or neck of the bladder is highly inflamed, it will be worse than useless to at- tempt to pass a catheter. When the system is fully relaxed, the catheter may in some instances, be introduced by one acquainted with the proper manner of using it. Much harm, however, often arises by repeated attempts to pass the catheter when there is much inflammation. It is in paralysis of the bladder that the use of the catheter sometimes becomes indispensable. But in RETENTION OF URINE. 187* those cases attended with a burning pain in the neck of the blad- der, with tenderness to pressure, and a continued and painful desire to pass urine, the catheter cannot be introduced safely even by the most skilful surgeon, and every attempt made to in- troduce it, only tends to increase the difficulty. Tapping the Bladder.—When gravel is lodged in the neck of the bladder, or in the urethra, and in cases of stricture, every effort to overcome the obstruction may sometimes prove abortive Under these circumstances, the last and only re- source is in tapping the bladder, as the only means of saving the patient's life, This operation, of course, will demand a sur- geon, and one who is fully acquainted with the anatomy of the parts. In retention of urine from falling of the womb, or from its re- troversion, the introduction of a bougee may be sometimes ne- cessary. Treatment of Retention of Urine from Paralysis of the Bladder. —The chief dependence here must be in the use of the catheter, stimulating injections to the bowels, together with the employ- ment of such remedies as tend to give tone to the bladder, either by general constitutional treatment, when the circumstances of the case require it, or by the use of stimulating diuretics, such as the oil of juniper, balsam of fir, or Peruvian balsam. In low forms of fever, the bladder, in some instances, looses the power to contract and expel the urine, and becomes greatly distended, which, if not relieved, may occasion serious conse- quences. This should be borne in mind by those who have the charge of patients very ill of typhus, or other malignant forms of fever; and when there is evidence of a great accumulation of urine, as will be manifested by a hard tumour in the right side of the belly, means should be used for evacuating it; and when hot fomentations to the abdomen, and stimulating injections to the bowels fail of producing a discharge of urine, it should be drawn off by the introduction of a catheter; or at least an attempt should be made to accomplish it. In severe injuries of the back, paralysis of the bladder frequent-; ly occurs, and requires the repeated use of the catheter until the power of contraction is restored to the bladder. When it depends upon the debility consequent upon old age, then fresh air, vapour baths, friction to the surface, stimulating diuretics, and if the patient can bear it, occasionally a shower bath in the morning must be employed. The urine should be drawn off before the bladder becomes greatly distended, for if this be permitted to occur, it tends still further to weaken the bladder. In some instances, to prevent distention of the bladder, the use of * 188 STRANGUARY. catheter will be required three or four times in the course of twen- ty-four hours, in order to afford an opportunity to the bladder to regain power to contract and expel its contents. Onions mashed fine, and applied to the perineum, are said to have had a good effect in many instances, in restoring the tone of the bladder. SECTION V. STRANGUARY. (DIFFICULTY AND PAIN IN VOIDING URINE.) When the urine is voided with great difficulty, and in small quantities, attended with severe burning pain, and a continued desire to urinate, it is called stranguary. The difference, there- fore, between stranguary, and retention of urine is, that in the former, the urine passes, though it may be by mere drops, and attended with a painful desire to void it; whereas in the latter there is a complete obstruction to the passage of urine. Causes.—Stranguary is in almost every instance associated with constitutional disease. It is liable to occur at any period of life, sometimes attending the period of teething in children, and it, is very common in old age. The application of a fly blister to any part of the body, will occasion stranguary in some; and the same effects are sometimes produced by the internal use of turpentine. Gout, gravel, and piles, are often attended with difficulty and pain in voiding urine. The intemperate use of spirituous li- quors; venereal excesses; exposure to cold and dampness, or whatever else tends to derange the general health, may occasion stranguary in persons predisposed to it. "Nervous and hyste- rical females are liable to extremely violent pains in the neck of the bladder and urethra, and which are generally most intense- ly felt immediately after discharging urine." Stranguary in the old and feeble, is sometimes occasioned by an enlargement of the prostrate gland, but more commonly it arises from other causes, as disease of the coats of the bladder, irritating acids in the urine, and gravel. STRANGUARY. 189 Treatment.—Infants may be relieved of stranguary by the warm hip bath, or fomentations to the belly, together with the use of injections to the bowels, composed of half a teaspoonful of the tincture of lobelia, or the same quantity of green lobelia in composition tea. If the general health be much deranged, an emetic may be employed, followed by the use of flaxseed, or wa- termelon-seed tea, and occasionally by small doses of the tincture of lobelia. When stranguary is occasioned by a blister, this of course should be removed, and the patient take mucilaginous drinks, as elm, flaxseed tea, kc. If this does not remove the difficulty, re- course should be had to fomentations and injections. When it arises from the use of turpentine,, the same constitutional treat- ment above recommended, will be proper. Associated with gout, the chief dependence must be on consti- tutional treatment, with a view to correct the acrid state of the urine, and to restore the general health. As a means of afford- ing relief during severe attacks, the warm bath, vapour bath, or hot fomentations should be used, together with injections con- taining a portion of lobelia. When it arises from gravel constitutional treatment will be also proper, for which an occasional course of medicine will prove the most effectual. Wiien the urine is high colored, and deposites a reddish or yellow sediment on standing, alkalies should .be used, such as salaeratus, bi-carbonate of soda, or a tea of hickory ashes When stranguary is occasioned by irritation from piles, a strong decoction made by steeping witch hazle, or sumac leaves in boiling water, should be administered by injection, and re- tained in the bowels for several hours, which will lessen irrita- tion in the piles, and in this way the occurrence of stranguary may be prevented. The lobelia injections and hot fomentations may be found necessary to relieve the immediate symptoms of painful irritation. When accompanied with hysterical symptoms, an emetic or a full course of medicine will be necessary. The same constitutional treatment that will cure hysteria, will also remove stranguary. When the stranguary arises from prolapsus, or other displace- ment of the womb, the same constitutional treatment will be proper, more especially the enemas containing lobelia; the vapour bath, and hot fomentations. It sometimes happens, how- ever, in displacement of the uterus, and more especially in its retroversion, that the introduction of a gum elastic bougee into the bladder to draw off the urine, becomes necessary before the displacement of the uterus can be overcome. Females affected with fluor albus, or whites, are subject to se- vere burning pain on voiding urine, in consequence of an ex- 190 INCONTINENCE OF URINE. tremely irritable state of the urethra. Injections of a strong decoction, prepared by steeping witch hazle or sumac leaves in boiling water, adding a small portion of capsicum, should be used two or three times a day, with a female syringe, beside resorting to the usual means for restoring the general health, by which the parts will become strengthened.. When attendant upon old age, or occurring in constitutions exhausted by debauchery and intemperance, a permanent cure of stranguary is not to be anticipated : a relief of the symptoms will be all that can in general be effected by any course of treat- ment whatever. SECTION VI. INCONTINENCE OF URINE. (involuntary flow of urine.) Incontinence of Urine, though not in general attended with pain, is nevertheless, in many instances, a very troublesome com- plaint. It prevails most during childhood, and in old age. Inability to retain the urine, with children, is commonly ow- ing to constitutional weakness in the urinary organs. Some- times it arises from an acrid state af the urine; and occasionally it is caused by gravel. Weakness of the urinary organs may be induced by frequently having wet and cold feet. The aged and feeble are especially liable to incontinence of urine, from weakness or paralysis of the sphincter muscle of the bladder, by which the urine is retained at the command of the will. In some instances the action of this muscle is completely lost, and the urine is continually passing off by drops as fast as it enters the bladder from the kidneys. This complaint is fre- quently associated with palsy and gout. Involuntary dis- charges of urine often take place in protracted fevers, where patients are extremely low, and observation proves it to be an unfavourable symptom. In fine, the same causes that produce retention of urine in one, may occasion stranguary in another, and in another an inability to retain the urine. Thus gravel, or stone in the bladder, whicli frequently occasions a stoppage of urine, in other instances will cause the urine to pass off involun- tarily. INCONTINENCE OF URINE. 191 Treatment.—Incontinence of urine in children, is in most in- stances removed by the natural increase of constitutional strength. When the general health is impaired, constitutional treatment will be required, such as, an emetic to cleanse the stomach, and if the stools exhibit an unhealthy appearance, injections may be used to advantage, not only in correcting the bowels, but also to add strength to the urinary organs. The injections are to be prepared in the ordinary form. A strong tea made of the sumac bark, leaves, or berries, or of the aspen poplar bark, will be beneficial in strengthening the urinary organs, either in the young or old. For an adult, a teacup two-thirds full, and for a child, a wineglassful of the tea may be taken two or three times a day. If the urine be high coloured, and deposites a sediment on standing, alkalies must be used, such as bi-carbonate of soda, salaeratus, a tea of hickory ashes, or lime w ater. A cold shower bath in the morning; friction to the surface with a salted towel, nourishing diet, exercise in the open air, and whatever else tends to invigorate the system, will also strengthen the urinary organs. Children often evacuate the urine involuntarily at night dur- ing sleep; and in some instances this habit continues even to adult age. Voluntary discharge of urine frequently takes place under the influence of a dream. "Incontinence of urine," says Mr. Charles Bell, "never takes place but when the boy is asleep upon his back; and the cure is a very simple one. He is to accustom himself to sleep upon his face or side; the urine is not passed, nor is he excited to dream of making urine, while he keeps this posture. The circumstance is unaccountable, until we reflect upon this master-spring of the neck of the bladder— the sensible spot, a little behind and below the orifice of the blad- der. When a person lies upon his belly, the urine gravitates to- wards the fundes; but when he lies upon his back, it presses upon this sensible spot, and distends that part of the bladder which is towards the rectum." Long continued inability to retain the urine, more espe- cially when associated with old age, is in general an incurable complaint. SECTION V1I< SUPPRESSION OF URINES (THE KIDNEYS CEASING TO FORM URINE.) Suppression is to be distinguished from retention of urine, as in the former the kidneys ceasee to select the urine from the blood, consequently none is formed; whereas in retention the urine is formed, but the passage by which it escapes from the bladder is obstructed. The chief danger attending retention of urine is over distention of the bladder; but when the urine is not formed in consequence of a loss of action in the kidneys, the suppression is of serious consequence if long continued. The loss of action in the kidneys is a consequence of great de- rangement in the system, and seldom occurs except in the last stage of disease, when the living powers are fast sinking and the patient beyond the reach of recovery. Suppression of urine, however, does occasionally take place under circumstances dif- ferent from those above mentioned, that is: it sometimes oc- curs when the living pow7ers are not so far exhausted but that the patient may recover under energetic treatment. Symptoms.—The suppression may be either partial or com- plete, and the only certain method of determining the suppres- sion is by introducing a catheter into the bladder. Suppression of urine cannot continue long without producing serious consequences. " There is fever,-thirst, a taste similar to that of urine in the mouth, and a smell of urine in the perspi- ration; to these nausea, vomiting, sometimes of fluids, having an urinous odour, and hiccup succeed; and to these oppressed breathing, delirium, and eventually stupor, and convulsions. Treatment.—Suppression of urine ca^s for prompt and ener- getic treatment, with a view to excite action in the kidneys. When the suppression takes place with a group of other symp- toms, denoting a fatal termination, as in the last stage of a dis- ease, all remeuial measures must of necessity prove useless.— When there is a probability of a recovery being effected, stimu- lating injections should be administered to the bowels, and a SUPPRESSION OF URINE. 193 tablespoonful of the third preparation of lobelia may be used in each injection, and repeated frequently. Steaming is of the greatest importance, not only to throw the urea out of the blood by perspiration, but it sustains and aug- ments its vitality by the heat and electricity imparted to it, and by quickening its circulation through the lungs. Emetics will also aid in restoring action in the kidneys. Hot stimulating poultices must be applied to the urinary re- gion, or small of the back, and kept warm. The patient should be kept in a perspiration,—this is very im- portant. The treatment above directed will be applicable not only to the suppression of urine, but also to the removal of the constitu- tional disorder which may have caused the loss of action in the kidneys. It must not be inferred that I would recommend a thorough course of treatment in those cases where the patient is evidently in the last stage of disease, and past the hope of re- covery. Case.—I attended a gentleman near Germantown, who had been confined to his room nearly the whole of the winter, and he having, as he supposed, suppression of urine, desired me to at- tend him. No urine had passed during seventy-four hours, and this was unaccompanied by any distention in the region of the bladder. He complained of pain and heaviness in the head, showing that the disease was assuming a serious aspect. A tho- rough course of medicine was administered, and stimulating in- jections repeated frequently, together with the free use of stimu- lating medicine. Not long after this treatment had been com- menced, the kidneys resumed their functions, and the patient re- covered rapidly: the enemas^used for restoring action in the kidneys, had the effect also of removing the original disease, which had occasioned the suppression. \ Z CHAPTER VI. SECTION I. DISEASE OF THE LIVER. ACUTE INFLAMMATION OF THE LIVER. Acute inflammation of the liver does not occur frequently in temperate climates. Causes.—Inflammation of the liver may be induced by blows or other injuries in the region of the liver; a sudden check to perspiration after violent fatiguing exercise; by gall stones, which are hardened concretions formed in the gall bladder, and found in the ducts; or it may be occasioned by the same in- fluence that produces intermitting, or remitting fever. The symptoms attending acute inflammation of the liver are exceedingly diversified. Generally there is deep seated pain in the right side about the false ribs; which is considerably aggra- vated by pressure. There is usually pain in the shoulder, and in some instances the pain is confined exclusively to that part. A deranged condition of the stomach and bowels always accom- panies this disease, attended with more or less nausea and vomit- ing. The stools are generally light coloured; and the urine yellow, or red. Professor Mitchell mentions the case of a boy whose liver was wounded by the discharge of a gun, in which no pain was expe- rienced except in the shoulder. In another instance, a negro who was run through the liver with afsword cane, complained of pain in the shoulder, and insisted strongly that the wound was there. Pain in the shoulder is not, how ever, a constant attend- ant of inflammation of the liver. Neither does costiveness al- ways prevail, for sometimes there are acrid secretions from the liver, whicli cause purging. The skin is generally hot and dry, and has a very sallow ap- pearance. The patient can lie with case on the affected side. INFLAMMATION OF THE LIVER. 195 As the disease advances, the nervous system becomes affected; there is great anxiety, and sometimes delirium. The duration of acute inflammation of the liver varies from four or five to ten or twelve days, when it terminates either in a restoration of the natural action of the organ, or in the formation of an abscess; or it may become a chronic disease. There is always more or less danger attending acute inflam- mation of the liver. Much, however, will depend upon the promptness of treatment in the early stages of the disease. Inflammation of the liver is frequently complicated with pleu- risy, and inflammation of the lungs. The stomach and bowels are always disordered, and probably, in the majority of in- stances, the stomach is diseased antecedent to the liver. Treatment.—Acute inflammation of the liver requires the same general course of treatment as pleurisy, or inflammation of the lungs. A full course of medicine must be given early in the disease, and repeated daily, if the symptoms be violent, until a crisis be effected. If .the patient cannot sit up, a moist heat may be applied to the feet and around the body, in place of the vapour bath. The system should be relaxed by broken doses of lobelia. Injections are especially indicated, not only to relieve the bow- els, but to equalize the circulation, and also to effect a relaxa- tion of the system by lobelia administered in this way. Continued retching, and vomiting, by operating as a sort of exercise to the liver, has a beneficial influence upon it, enabling it to replace the loss of morbid secretions by more healthy ones. Stimulants must be given with a view to equalize the circu- lation; to maintain a determination to the surface; and to excite the secretions of the mucous membrane of the stomach and bow- els. More especially should pure stimulants be freely used in the advanced stage of the disease. Capsicum tea is the best stimulant; and if the skin be dry, portions of lobelia pow7der or tincture must be added. Local Applications.—A warm poultice must be applied to the affected side, and a hot brick, or a bottle of hot water placed so as to keep the poultice warm. The Diet must be light, consisting chiefly of gruel, barley water, crust coffee, &c. In the more advanced period of the disease, when the strength is greatly exhausted, it will be ne- cessary to give wine-whey and essence of beef. Bitters may be used to restore digestion, after the tongue be- gins to clean, or the disease has formed a crisis. 196 CHRONIC DISEASE OF THE LIVER. The Symptoms denoting the formation of an Abscess in the Liver, are—irregular chills or rigours; pain and sense of full- ness in the region of the liver; and night sweats. When this group of symptoms is manifested after acute inflammation of the liver, of several days' continuance, it furnishes strong evidence that suppuration has taken place. The abscess may point to the surface and be discharged externally; or the pus may be dis- charged through the gall ducts into the bowels; or it may escape into the cavity of the abdomen, and occasion fatal peritonitis. Abscesses of the liver have in some instances penetrated the lungs and their contents discharged by coughing. An abscess having formed, the indications for the treatment are,—to support the strength of the patient by the use of pure stimulants and bitters, and by a nourishing diet. The articles of diet, however, must be such as are suited to the condition of the enfeebled digestive powers. 2. Chronic Disease of the Liver.—Although acute inflamma- tion of the liver is of rare occurrence, yet no organ in the body, with the exception of the stomach, is more liable to chronic de- rangement of its functions, than the liver. A disordered sto- mach is in almost every instance the cause of disease in the liver. A deranged liver is almost always a torpid one. Dyspepsia is mostly attended with a deficiency in the secretions of bile, from a want of proper circulation of blood through the liver. Cos- tiveness is in general the consequence of a want of bile, and the use of purgative medicines with a view to overcome a costive habit is worse than useless, as they aggravate and weaken the bowels, without restoring the action of the liver. The intem- perate use of alcoholic drinks is very apt to produce finally, tor- por of the liver, and in some instances this organ becomes greatly enlarged, as a consequence of intemperate habits. A disordered stomach lessens the nervous power which gov- erns the function of the liver, and consequently the circulation of the blood through the liver is enfeebled, and the secretion of bile diminished; and if the cause that occasions the disorder in the liver be continued, as in habitual drunkenness, the liver may lose its power to perform its functions, at least for a time, even though the habits of the person may have become reformed. The continued use of active cathartics, more especially of mer- curial preparations, are pernicious, not only to the liver, but to the stomach and bowels. Close and intense study, confinement in illy-ventilated apartments, and exposure to cold and dampness, depressing passions, and excessive losses of blood, frequently occasion torpor of the liver. Derangement of the functions of tlve liver, however, are in most instances, but one link in a chain of disordered functions, from loss of vital power in the system. CHRONIC DISEASE OF THE LIVER. 197 Thus torpor of the liver is associated with acute disease, such as dysentery, cholera morbus, pleurisy, erysipelas, and autum- nal fevers. When patients are bled largely during an acute disease, the excessive loss of blood may occasion torpor of the liver, continuing for years, accompanied with dyspeptic symp- toms. If the debilitating influence occasioning torpor of the liver be continued, the circulation will become more obstructed and feeble, and finally the organ may lose its power to secrete bile, occa- sioning inveterate dyspepsia, dropsy of the abdomen, o*r jaun- dice. Hence disease of the liver which at first is but a link in a chain of disordered functions, and which may be readily cured by correcting the disorder of the stomach, may finally be the cause of a new train of disordered action throughout the system, requiring a long course of treatment to effect a cure. Symptoms attending chronic affections of the liver are extreme- ly diversified. The most obvious symptom indicating obstruc- tion to the flow of bile, is a yellowness of the skin and whites of the eyes. The liver, however, may have its functions greatly disordered, without there being any appearance of sallowness of the skin. Sometimes there may be a low grade of inflammation in the liver, occasioning shooting pain in the side and shoulder, accompanied with a dry, harsh, contracted state of the skin; loss of appetite, bad taste in the mouth, extreme restlessness at night; and dizziness of the head. In such cases digestion is always impaired, there is flatulency and distress after meals, attended with heartburn, and constipation of the bowels. In some cases the patient will be affected with occasional diarrhoea, the stools presenting various appearances, sometimes clay-coloured; in other instances bilious; or they may be slimy and hard, or have a green appearance. Sometimes the liver becomes enormously distended and bard, filling at least half the cavity of the abdo- men, and its margins are distinctly felt by pressing the hand on the abdomen. Treatment—Depending for most part upon a disordered sto- mach, the indications for the cure of disease of the liver are, to correct the disordered condition of the stomach and bow els, and to warm and invigorate the system by the use of stimulants and tonics, and by a well regulated diet. Torpor of the liver may be more readily overcome in most in- stances by a course of medicine, than by any other means. If the disease become seated, it will be necessary in most cases to repeat the courses of medicine, and during the intervals between them, to use bitters freely; and if the bowels be costive, take 198 CHRONIC DISEASE OF THE LIVER. three or four of the compound lobelia pills after each meal and also at bed time. * Acids.—Especial relief may sometimes be obtained by the use of pepper sauce, taken in moderate doses three or four times a day, and more especially at meals. The Vapour Bath by its influence in restoring the functions of the skin, may be employed with benefit in diseases of the liver or of any other internal organ. Thomsonians, therefore, in ap- plying remedies, do not require a particular investigation to as- certain the precise location of the disease, nor to know what name nosologists would very learnedly apply to it; for the same general treatment will be applicable to every other form of dis- ease. Thus the vapour bath which proves beneficial in curing disease of the liver, will be equally applicable to disease of the kidneys, bladder, lungs, pleura, bowels and bead, and in fine it may be administered in almost any disease with safety, though it does not always prove beneficial. Emetics.—The most efficient means, to remove obstructions of the liver, in general, are the application of the vapour bath, fol- lowed by a prompt emetic. Cases of very stubborn character have been cured by continued vomiting from sea-sickness, the patient being in a relaxed condition, similar to that produced by the influence of lobelia upon the system. In cases of long stand- ing, however, and when the disease is associated with old age or an exhausted constitution, the frequent repetition of a course of medicine might be harassing to the patient, and fail to effect a cure. A change of organization in the liver having taken place, as it sometimes happens when the disease has been long continued, a palliation of the symptoms, by stimulants and tonics, is all that would be advisable by way of medicine,—as a radical cure, under such circumstances, is rarely to be accomplished. The functions of the liver maybe influenced to a greater or less degree by means of medicine operating upon the bowels. Hence injections will be useful, not only to relieve the bowels, but when properly prepared and administered, to exert a beneficial influence on the liver. Lobelia administered in this way, and retained, diffuses its influence throughout the whole system, and at the same time that it occasions relaxation of the organs, it tends to restore their proper functions. Again, injections are useful to cleanse the bowels from morbid secretions, by which they are more or less coated, in nearly, if not in all cases of seated disease, with but little regard to name or location. The morbid secre- tions alluded to, usually pass off in the form of flakes, and some- times in pieces, from a few iuches to a foot, or even a yard in CHRONIC DISEASE OF THE LIVER. 199 length, having somewhat the appearance of an intestine. Pa- tients not aware of the frequency of its occurrence, sometimes become alarmed at the passage of this kind of substance from the bowels. There are, however, few if any recoveries from seated disease, in which there has not been more or less of this morbid secretion passed from the bowels. Foot Bath.—The following mode of preparing and using a foot bath, is recommended by many practitioners who have tried it, namely: " Into a glass vessel, capable of holding a pint or more of fluid, put eight ounces of water, and then pour in four ounces of nitric, and the same quantity of muriatic acid. One ounce of this mixture to a gallon of water will form a bath of medium strength. The feet and legs of the patient are to be immersed in this bath at the temperature of about 96°, and kept there twenty minutes or half an hour, just before going to bed. This should be done every night, and the same bath will remain good for five or six nights." The utility of the warm foot bath cannot be doubted, and as there can no harm arise from the use of the acids, they should be added as above directed. If the tongue be coated with fever, a strong decoction of the bayberry or sumac, with the addition of a teaspoonful of compo- sition powder, or half the quantity of capsicum, may be taken once or twice a day. The use of bitters is indicated in chronic affections of the liver. If there be any cases in which the bitter root (apocy- num androsoemifolium) may be used with advantage, it is in chronic affections of the liver. It must be given in pills, or the powder, taken iti luke-warm water, but not in sufficient quan- tity to produce purging. In every form of seated disease, when medicine is required, for many weeks, o.r even months, in succession, an occasional change of remedy for an equivalent one, will be proper. Dandelion—The dandelion, either in the form of an extract or decoction, may be used with especial advantage in chronic disease of the liver. I have observed symptoms indicating extreme torpor of the liver, brought on by retirement from active business. In such cases the patients should resume their former active habits. SECTON II. JAUNDICE. A diseased condition of the system is sometimes attended With obstruction of the natural passage of the bile, occasioning a yellow tinge in the skin and whites of the eyes, which is termed jaundice. The digestive powers are always more or less weakened, and general coldness and torpor of the system prevails before the symptoms of jaundice appear. The suspension of the flow of bile may arise either from obstructions in the gall ducts; from coldness and torpor of the liver, or from deficiency of nervous power; yellowness of the skin being merely a symptom arising from obstruction in the passage of bile into the bow7els. A jaun- diced appearance of the skin is very commonly observed in low forms of fever, arising from suppression of bile; thus yellow fe- ver, as it is termed, receives its name from the yellow colour of the skin. " When people have what is called jaundice," says Dr. Thom- son, "it is the prevailing opinion that they have too much bile, and it is said they are bilious. This is a mistaken notion, for there is no such thing as there being too much gall: it would be more correct to say there was not enough. The difficulty is caused by the stomach being cold and foul, so that the food is not properly digested; and the bile not being appropriated to its natural use, is diffused through the pores of the skin, which becomes of a yellow colour." Symptoms.—The most obvious symptoms in jaundice, are yellowness of the skin and whites of the eyes, loss of appetite, bad taste in the mouth, costive bowrels, high coloured urine, en- feebled mental powers, and a dry state of the skin. The pulse is frequently unaffected: it is sometimes slower, and at other times quicker than natural. Yellowness of vision is frequently one of the first symptoms indicating the approach of jaundice, which may arise from the humours of the eye becoming tinted with the yellow colouring matter of the bile, and transmitting yellow rays of light. The patient is generally either restless and unable to sleep, or continues in a state of somnolency or stupor. The Colour, in jaundice may vary from a light yellow to that of a deep green, or almost black. JAUNDICE. 201 Location.—Jaundice is sometimes confined to the face and neck, in other instances it is diffused over the whole surface of the body and limbs. The Approach of Jaundice.—Generally the disease comes on in a gradual manner, associated with symptoms of indigestion; "a general feeling of languor; disinclination to bodily and mental exertion; an irritable and dejected temper; weakness of appe- tite; constipation; acid eructations; slow and painful digestion; flatulent pains in the bowels; a slight feeling of fulness and ten- sion in the epigastrium, (pit of the stomach); restlessness at night; a turbid urine, usually depositing a copious pitchy sedi- ment; slow and languid pulse; more or less nausea; and frequent transient chills, alternating with flushes of heat." After these symptoms have continued for a few days, a disagreeable itching over the whole body takes place; the taste becomes bitter; the stools whitish or clay coloured; the urine of a deep saffron hue; and finally the whites of the eyes, and the skin about the lips, neck, and forehead, assume a yellow colour, which speedily ex- tends itself until the whole surface acquires an uniformly yellow hue. Sometimes the disease comes on suddenly, with severe pain and distress at the pit of the stomach, attended with frequent vo- miting, and an entire disgust for food. The duration of an attack of jaundice is extremely varied. In some instances it passes away in the course of a few days, whilst in others it will continue for months, and occasionally the dis- ease assumes the chronic form, in consequence of permanent de- rangement of the digestive functions, and continues for years ac- companied with symptoms of dyspepsia. Treatment.—Jaundice being merely a symptom, arising from previous disease, it is to be overcome, or removed by correcting the derangement of the general health. The symptoms being violent, the treatment must be thorough and early applied. A course of medicine should be given, and repeated every day or every other day, until the symptoms be- come more favourable. Besides a course of medicine, the com- pound lobelia pills may be given, together with an occasional dose of capsicum in composition. Tonics.—The most powerful kinds of bitters are required in jaundice. In sudden and violent attacks, the bitters may be em- employed after the symptoms abate, but when the disease comes on in a gradual manner, they may be employed from the first, in combination with stimulants. A tablespoonful of the expressed 202 JAUNDICE. juice of green wormwood, added to an equal quantity of whiskey* taken three times a day before meals, has been used by some with special benefit. Dr. Thomson in treating of jaundice, says: " lhave attended many cases of this kind, and never had any difficulty in effecting a cure. My method is to give No. 2, or the composition pow- ders, to raise the internal heat, and No. 1 to cleanse the stomach, and promote perspiration; then give the bitters, No. 4, to regu- late the bile and restore the digestive powers. If the complaint has been of long standing, and the system is much disordered, they must be carried through a regular course of medicine; and repeat it as occasion may require, and at the same time give the bitters two or three times a day, until the appetite is good and digestion restored." Sometimes jaundice is occasioned by gall stones being lodged in the gall ducts, attended with violent paroxysms of pain in the right side, near the pit of the stomach, and continued straining ef- forts to vomit, the stomach at the same time forcibly rejecting any thing that is swallowed. In a case of this kind, the vapour bath must be applied; and the system placed in a state of relax- ation by lobelia administered by injections; together with full and frequent doses of the third preparation of lobelia, until the symptoms are relieved. Gall stones have been removed in many instances, by the operation of emetics. Straining efforts to vomit, when the system is warmed by the vapour bath, or by the application of hot bricks wrapped in damp cloths, around the patient, and relaxed by the influence of lobelia, will form the surest means of removing obstructions, either in the gall ducts, or in the liver. A warm stimulating poultice, applied to the pit of the stomach, will relieve the pain. The warm foot bath, prepared in the manner described in the treatment for chronic disease of the liver, has been used with marked advantage in jauncice. Celandine, agrimony, blood root, hemp seed boiled in milk, besides many other articles and compounds, have been recom- mended as specific remedies for jaundice, not one of which, how- ever, can be relied upon. Although patients may recover from jaundice, under the use of celandine, hempseed, or some other of the reputed specifics, there is no evidence that the disorder w ould not have been removed sooner under Thomsonian treatment. I have known jaundice cured by Thomsonian treatment after vari- ous other remedies and modes of treatment had been tried with- out success; but I have yet to see the first case cured by other treatment, after the Thomsonian practice, judiciously applied, has failed. ♦ APOPLEXY. 203 Change of Air.—In seated disorders, a change of residence will frequently be attended with a decided improvement in the general health. Diet—In jaundice the digestive powers are always weak, and therefore a strict attention to diet must be observed. In the commencement of the disease, and more especially if the symp- toms be violent, the diet should be confined to the lightest kinds of food. In cases of long standing, it may be more nourishing, but it must be easy of digestion. As a general rule, in jaundice, butter, and all kinds of fat meats disagree with the stomach. Attacks of bilious colic are frequently accompanied with a jaundiced hue of the skin, and whites of the eyes. And in fe- males there is sometimes a yellow tinge in the skin, after an attack of hysteria. The same general course of treatment, how- ever, will be adapted to all cases. CHAPTER VTL SECTION I. APOPLEXY, Symptoms.—A sudden suspension of consciousness; a loss of the power of voluntary motion; stupor; heavy and laborious breathing; and a slow and full pulse, are the symptoms w7hich characterize apoplexy. An attack of apoplexy occasionally comes on suddenly, with- out any precursory symptoms. More commonly, it is pre- ceded by giddiness, and a sense of weight and deep seated pain in the head, ringing in the ears, and dimness of sight. These symptoms may occur a few hours, or they may continue for a week, or even for months previous to the attack, and occasion- ally they disappear without the occurrence of an apoplectic fit. In some cases the attack comes on suddenly, the patient sink- ing at once into a profound stupor, from which he cannot be in any degree aroused—resembling a deep sleep—and each expira- tion attended with a puffing of the lips, and a frothy saliva blown out with a sputtering noise. These cases generally prove fatal 204 APOPLEXY. in a few hours. In other cases, the patient may be seized with deep seated pain in the head; sickness and vomiting; tremor of the limbs; dizziness; confusion of mind; and then gradually sink into a state of stupor, from which he will partially recover, so as to converse, and be able to sit up, and probably w7alk about, but will still complain of pain and distress in the head, attended with giddiness and confusion of ideas. After a few hours the brain becomes oppressed, and a state of complete insensibility ensues. Sometimes an attack of apoplexy comes on with palsy of one side, loss of speech, pain in some part of the head, and vertigo, —the patient retaining his consciousness. By degrees, the brain becomes more oppressed and consciousness is gradually lost, until finally a deep stupor ensues. Deep intoxication sometimes so nearly resembles apoplexy that it may be difficult to distinguish between them. The breath, however, will detect intoxication, together with the relaxed state of the muscles, particularly those of the jaws, the reverse of which occurs in apoplexy. In cases of suspended animation and fainting, the pulse and respiration is almost imperceptible, whereas, in apoplexy, the pulse is strong, and respiration full. Apoplexy always Dangerous.—When there is a total loss of consciousness, the respiration accompanied with deep snoring, a sputtering from the lips, loss of the power of swallowing, and the eyes fixed, the case may be considered as almost hope- less. Still we are informed that recoveries do take place, even after these symptoms have occurred. Duration of the Apoplectic attack.—This varies from a few minutes to several days. Death seldom takes place before the , second and third hour, and in some cases not until the fourth or sixth day from the commencement of the attack. Medical writers of extensive observation, among whom I may mention Hippocrates, consider the occurrence of fever, in the early stage of apoplexy, a favourable symptom. Where the pupil of the eye will contract by the near approach of a lighted candle, when there is a warm and gentle perspiration, the breath- ing free and regular, without noise or sputtering, together with the ability to swallow, a gentle diarrhoea, or when a copious dis- charge of urine is observed, hope may reasonably be entertained of a recovery. Cause of Apoplexy.—The immediate cause of apoplexy in most instances, is pressure upon the brain, suspending the function of innervation, or the generation of nervous fluid. APOPLEXY. 205 One whose conformation of body is corpulent, with short neck and large head, and whose advanced age, or intemperate habits have rendered his vital powers weak, will be liable to apoplexy from various causes. The most usual exciting cause of apoplexy is over distention of the stomach by excessive indulgence in eating food of difficult digestion; together with the intemperate use of alcoholic li- quors. Exposure to extreme cold, by exhausting the heat of the body, and causing the blood to recede from the surface and form in- ternal congestion, is capable of producing apoplexy. Severely protracted chills have been observed to give rise to this disease. Positions of the body which favour a flow of blood to the head or impede its return to the heart, stooping with the head low, lifting great weights, and wearing tight corsets have been known to bring on a fit of apoplexy. It is only, however, where the predisposition to apoplexy exists, that it is liable to be brought on by such causes. Among the occasional causes of apoplexy may be mentioned, excessive evacuations. The celebrated Boerhaave cites a case of apoplexy, apparently produced by excessive bleeding from the nose. Diabetes and cholera sometimes terminate fatally with symptoms of apoplexy. Excessive loss of blood is frequently followed by an extraordinary determination of blood to the brain. Experiments which have frequently been tried on animals by abstracting large quantities of blood, and finally by bleeding them to death, go to prove, as has been observed on dissection, that dropsy, together with an engorged state of the blood vessels of the brain and spinal marrow, are a general consequence of ex- cessive losses of blood. Treatment.—Such means and remedies are indicated in the treatment of apoplexy, as are best adapted to equalize the cir- culation of the blood throughout the system, and restore the functions of the brain, which are alwrays suspended in this disease. Injections.—These are of the first importance in the treatment of apoplexy. The third preparation of lobelia should be em- ployed, or some other combination of lobelia;—for instance: the lobelia powder and No. 6. One, two, or three tablespoonsful of the third preparation of lobelia may be administered at a time, in half a pint of luke-warm water, composition, or bayberry tea. This must be frequently repeated, with a view to attract the cir- culation from the head; and thus lessen the pressure of blood 206 APOPLEXY. upon the brain, and to arouse the nervous energy of the system to carry on the circulation with healthy activity. Mmetics.—If a patient have an attack of apoplexy within a few7 hours after a hearty meal, free vomiting will be imperatively demanded. The third preparation of lobelia must be poured into the mouth, and will be much more likely to be swallowed than a preparation of lobelia less (stimulating. The impresssion of a powerful stimulant in the throat will excite the act of swallowing, and the medicine will be taken info the stomach, when the lo- belia powder in luke-warm water, or composition tea would fail to excite the act of swallowing, whilst the patient is uncon- scious. When the functions of the brain are suspended, as they are in apoplexy, large doses of medicine will be required in or- der to effect vomiting; or as an efficient aid to excite vomit- ing, the lobelia powder may be administered by injection in luke-warm water and retained. A tablespoonful of the powder may he used in the injection which must be repeated promptly if necessary. External Applications.—Warm applications to the feet, fric- tions to the surface, cold applications to the head, the vapour bath applied to the lower half of the body, and the surface bathed frequently with stimulants—pepper sauce, No. 6, or the third preparation of lobelia—constitute the external means proper to be employed in the treatment of apoplexy. The head must be kept elevated, and the pillow occasionally turned over, or changed for another to keep the head sufficiently cool. "A robust man," says Dr. Eberle, "about fifty years of age fell down in a fit of apoplexy about an hour after taking a full meal of animal food, together with several glasses of brandy and water. The coma was profound, and the respiration sterterous and sputtering. He was immediately bled to the extent of about forty-eight ounces, but although the pulse was considerably re- duced, no perceptible improvement ensued. Twenty grains of the sulphate of zinc were with difficulty introduced into the sto- mach, and free vomiting ensued in about ten minutes after. Al- most immediately after the contents of the stomach were throwm off, he became better." The patient recovered. The sulphate of zinc, being an active poison, would have proved detrimental had it not been speedily thrown off. On account of the danger attending the administration of active poisonous emetics, most medical writers recommend milder articles,—camomile tea, ammonia in water, or mustard in warm water. But the sensi- bility of the stomach is generally too dormant to be acted upon by these milder remedies. Apoplexy, however, is a disease Which frequently baffles all remedial means. PARALYSIS. 207 Favourable Symptoms__When the stupor becomes less pro- found, with some degree of awakened sensibility; the breathing regular and not sterterous, or sputtering from the lips; together with a general warm perspiration, some hope may be entertained of a favourable issue. Preventive Measures.—When symptoms arise which denote the approach of apoplexy, such as headach and giddiness, dim- ness of sight, numbness of the extremities, drowsiness, faltering of the tongue, night mare and stupor, a course of medicine should be given as the most efficacious means of preventing an attack, SECTION II. PARALYSIS.—PALSY. Symptoms.—These are a loss of the power of voluntary mo- tion, sometimes of feeling, in one half or some portion of the body, the patient not losing his consciousness. In some instances there is loss of the power of motion, but without loss of feeling in the parts. In other cases sensibility and the power of motion are both lost. This is termed numb palsy. In general the paralysed parts are colder than other parts of the body; they become soft and flaccid, sometimes puffy and dropsical. Very often patients complain of great coldness in the affected parts. Sometimes a peculiar tingling, or creeping sensation is felt in the affected parts, as if small insects were creeping over them." " When palsy arises from disease of the brain, it is generally attended with an impairment of the mental powers—amounting in some instances, to complete imbecility. The memory espe- cially, is apt to suffer in this affection; and sometimes in a very singular manner." Thus some patients will lose the power of recollecting certain words, or names, sometimes even their own names,, the memory being gone in relation to other things."— "The natural temperament and disposition also sometimes suffer a total change from a stroke of palsy. Individuals of amiable and placid dispositions have become sullen, peevish and irrasci- ble; and persons of an irritable and passionate temperament, have been rendered mild and simpering by a paralytic seizure. 208 PARALYSIS. Varieties of Palsy.—Paralysis of the whole of one side of the body is called Hemiplegia. When both legs and the hips are palsied, it is termed Para- plegia. When a single limb, or a particular part of the body is para- lysed, it constitutes the Paralysis Partiales of authors. 1. Hemiplegia—Palsy of one side.—Palsy of one side of the body is more observed than any other form, "this disease is very closely allied to apoplexy," the latter being in general a more severe form of disease. An attack of apoplexy is very often either preceded or followed by palsy. Generally a stroke of palsy is preceded by symptoms of con- stitutional disturbance, loss of appetite, costive bowels, distress or extreme insensibility of the stomach, giddiness and pain in the head, continual drowsiness, more or less impairment of speech, confusion of mind, and loss of memory. Palsy is not a very fatal disease.—Sometimes patients recover from a stroke of palsy in a few days after the attack; occasion- ally the disease terminates fatally, but most commonly the pa- tient recovers gradually, until he is able to move about, contin- uing in this state in some instances many years without further improvement. Sometimes the recovery is complete. Paraplegia—Palsy of the lower half of the body.—This form of palsy usually comes on in a gradual manner. The patient at first experiences numbness in the legs, succeeded by more or less difficulty in walking: his gait is awkward, and he requires a cane to assist in balancing his body. The bladder becomes more or less paralysed, the urine being voided in a small weak stream, and at length passes off involuntarily. The bow7els are gener- ally constipated; but when the sphincter muscle of the anus be- comes paralysed, the foeces are evacuated without the consent of the will. In some cases the palsy is complete, the patient be- ing unable to walk, or even to support himself in a sitting pos- ture. In other instances the patient retains some degree of power over the motions of his legs, so that with the assistance of a cane or crutches, he is able to move about. In persons past the age of forty, this form of palsy is gener- ally occasioned by disease of the brain. In children, the para- lysis is in most instances caused by injuries of the spine. 2. Partial Palsy.—Sensibility and voluntary motion depend upon a nervous fluid, which is generated at the great centres of the nervous system, the brain and spinal marrow, and is con- ducted from these centres to every part of the system, through the medium of the nerves, which act as conducting wires to the TALSY* 209 nervous fluid. There arc nerves of motion, and there are nerves of sensation. If a nerve of motion be cut, the part to which it is distributed will become paralysed. And if a nerve of sensa- tion be destroyed, or injured so that it is incapable of conduct- ing the nervous fluid, the part to which it leads will lose the power of feeling. If a portion of the brain or spinal marrow lose the power to generate nervous fluid, that part of the body will become affected whose nerves arise from that part. Thus one side of the body having lost the power of feeling, we know that the disease is seated in that portion of the spinal marrow in which its nerves of sensation originate. If that portion of the spinal marrow from which the nerves of motion arise, is dis- eased, the parts will become paralysed to which they lead. And if both the anterior and posterior columns of one half of the spi- nal marrow lose their functions, that side of the body will be af- fected with loss both of motion and feeling. In partial palsy, when a single muscle or small portion of the body is paralysed, it is generally owing to disease in the nerve which is designed to distribute nervous power to the part. Paralysis of one side of the face alone, is sometimes occasioned by injury of the nerves leading to the part affected. Of the Causes of Palsy.—A loss of power in the stomach is frequently the original cause of palsy, more especially when the disease attacks one side of the body. Although the immediate cause of paralysis is a loss of function in some portion of the brain or spinal marrow, still the original cause in most instances, is seated in the stomach. The functions of the brain and spinal marrow, as well as those of every other organ in the body, are to a greater or less degree influenced and governed by the state and condition of the stomach. Thus a person advanced in years, and predisposed to palsy from a weakened condition of some portion of the brain or spinal marrow, will be liable to an attack of it from prostration of the powers of the stomach. Both apoplexy and palsy are frequently brought on by undigested food in the sto- mach, long continued exposure to severe cold or to dampness, the intemperate use of spirituous liquors, loss of rest, over exer- tion, grief, fear, and by other depressing influences, all of which operate to disorder the functions of the brain, through the medium of the stomach. "Among the exciting causes of partial paralysis, the poison- ous influence of lead is the most remarkable. The tendency of this article, to produce paralysis of the fore-arm and wrists, is peculiarly strong, as is evident from the frequent occurrence of palsy in persons who work in lead mines, plumbers shops, and in manufactories of white lead. 2B 210 PALSY. Treatment of Palsy.—In the early stage of palsy, a vigorous course of treatment is demanded, with a view to restore the lost function of that portion of the brain or spinal marrow, the im^- mediate cause of the disease. Whether the loss of nervous power be occasioned by pressure of blood upon the parts, or from loss of power through mere debility, or even should it depend upon disease originally seated in the brain, a course of medicine will be especially indicated, besides the continued use of such reme- dies and means as will prove most successful in equalizing the circulation, and restoring the vitality of the stomach and bowels* The Course of Medicine should be commenced with an injec- tion. In most instances the bowels are extremely insensible, re- quiring the injections to contain strong stimulants, in order to produce the desired effect. A tablespoonful of the third prepa- ration of lobelia, in half a pint of bayberry tea, forms a suitable injection in palsy, though in some instances double or treble the above quantity will be required, in order to make a sensible im- pression upon the bowels. Wiien the patient is unable to sit up, the vapour bath will of course be applied in bed. It is always better to steam the patient on a couch or mattress, and thus avoid dampening the bed upon which he usually lies. Patients upon a couch or cot-bed will bear the continued application of the vapour for several hours in succession; the body to be washed over frequently with whiskey vinegar, or simple cold water during the steaming. When the patient is so situated as to be able to bear the steam a considerable length of time, an emetic should be given during the process of steaming. The best form of an emetic is the liquid of the third preparation of lobelia, adding a portion of brown lobelia powder, and given in a strong tea of the bayberry or su- mac. I have observed more benefit from emetics than from any other means. To assist the operation of the emetic, and to bring the system more completely under the influence of lobelia, it will be highly important to administer an injection of lobelia powder, in luke-warm water. The course of medicine proves most ef- fectual when the patient becomes very sick, and the system is fully relaxed under the operation. The Compound Lobelia Pills may be used with benefit. I have a case of palsy now under treatment, and the patient has so far recovered as to be able to walk. The use of the above pills, to- gether with an occasional emetic and the steam bath, followed by a shower bath two or three times a week has constituted the prin- cipal treatment in this case. She is now using bitters, and the bowels are relieved by injections. Palsy, however, is a disease from which patients recover very PALSY, 211 slowly, and therefore, in deeply seated cases, it will not be ne- cessary to pursue a very thorough course of treatment, except during the earlier stages of the complaint. Thus after admin- istering a few courses of medicine, repeating them every day, or every few days, the course of medicine may be omitted, ex- cept occasionally, say at intervals of one, two, or three weeks, as the circumstances of the case may seem to require. When there is oppression at the pit of the stomach, fever, foul tongue, or general distress, an emetic should be given. Capsicum is the best remedy to warm the stomach and bowels and restore the secretions of the mucous membrane. It may be taken in in the form of pills, powder, or decoction. The com- pound lobelia pills contain a large portion of pepper, and an- swer as a substitute for other preparations of pepper. In all cases of palsy, the mucous membrane of the stomach and bowels is more or less coated with morbid secretions, which must be removed, or otherwise the disease will continue. When the tongue begins to clean around the edges, or the coating which covers its surface begin to soften, then the capsicum should be taken in bayberry tea. The pepper stimulates the secretions, sustains the circulation, and causes a determination to the sur- face; the bayberry combining with other foul secretions of the stomach and bowels, causes them to become detached, leaving the mucous surface clean, A mixture of salt, vinegar and pepper, is grateful to the sto- mach in many cases, and is usually found beneficial where the patient craves acid. The pepper sauce, or simple salt and vine- gar, may be employed in many cases of disease, with signal bene- fit to the patient. In palsy the bowels are generally costive, requiring an occa- sional injection. In palsy of the lowrer half of the body, the most powerfully stimulating injections will be required, in order to make a sufficient impression upon the bowels. Mustard Seed.—A tablespoonful of white mustard seed taken two or three times a day will stimulate the bowels to action, and is well suited to cases of palsy. Mustard Seed and Horse-Raddish were favourite remedies with the late Dr. Barton, of Philadelphia, who used them with much advantage in the Pennsylvania Hospital. Tonics.—In an advanced period of the disease, or when the system is in a relaxed and feeble condition, strong tonics will be required; such as Peruvian bark, quinine, Thomson's No. 4 bitters, wormwood, quassia. Prickly ash bark or berries may be added to the bitters. 212 PALSY. External Remedies—Besides the vapour and shower baths there should be a continued application of warmth to the affected side; the skin occasionally to be bathed with pepper sauce, third preparation of lobelia, stimulating liniment, or No. 6. Fric- tions of the surface with a flesh brush or salted towel, two or three times a day will be of advantage. Occasionally a pepper poultice or mustard plaster may be applied to the nape of the neck, extending eight or ten inches down the spine. When mus- tard is applied, it should not remain on so long as to produce a blister. Paraplegia—(Palsy of the lower extremities,) requires the same constitutional treatment as above described, adapting the remedies, however, to the circumstances of the case- The bladder is frequently paralysed in this form of palsy, sometimes requiring the use of a catheter, to prevent an over distention of the bladder. The bowels require stimulating injec- tions, and the free internal use of compound lobelia pills, and capsicum, or pepper sauce. The Hip Vapour Bath is adapted to this form of palsy. The parts, however, being in some instances devoid of feeling, are liable to be scalded by the steam unless particular attention is paid to regulate its temperature. Especial care will also be necessary to prevent the feet from being burned by hot bricks when they are placed near them. Children are sometimes affected from birth with unusual de- bility, and want of power over the legs. Such cases require the cold salt water bath, or shower bath, frictions of the surface with a salted towel, fresh air, wholesome food, stimulating ap- plications to the skin, together with internal constitutional reme- dies, when the general health is bad. If the digestion be feeble, or the bow els disordered, with a foul tongue and bad breath, an emetic must be given, repeated when necessary, and mild tonics used—spice bitters, poplar bark tea, or gentian. Palsy of the lower half of the body, when of long standing, is often incurable. It is therefore important to institute a thorough course of treatment in the early stage of the disease, before it be- comes immovably fixed. Palsy, however, sometimes arises from causes that cannot be removed, even though prompt remedial measures be early applied. For Palsy of the Tongue the patient should keep some stimu- lant in the mouth, such as pepper, ginger, cloves, conserve of hollyhock, &c. In severe cases the third preparation of lobelia must be employed. PALSY. 213 In Paralysis of the Optic Nerve, termed amaurosis, a course of medicine frequently repeated in the early stage of the disease, will prove the most efficient means of cure. This disease fre- quently originates in a disordered stomach. It is not every case of amaurosis, however, that can be cured even by the most prompt and persevering course of treatment. Palsy of one side of the Face has been cured by emetics. A full course of medicine will be more effectual. If the paralysis arise from a destruction of the nerve, as when the nerve is cut, there is, of course, no cure for such a case. Mercurial Tremor—(Shaking Palsy.)—"This disease affects workers in mercury,—chiefly those employed in silvering mir- rors." Symptoms.—At first there is slight tremor in the limbs, and sometimes salivation; " afterwards convulsive agitation of the limbs whenever they are moved. The articulation becomes im- perfect. The hands are so agitated, that a partly filled cup cannot be conveyed to the mouth without spilling the liquid. On attempting to walk, the limbs dance and perform irregular movements. Whilst sitting still, the patient may remain free from chorea; but on every exertion of the volition, and on every occasion of mental agitation, the irregular movements are re- newed. The sleep is disturbed; the patient wakes alarmed by terrific dreams; nervousness and debility attend; and the bow- els are constipated. Treatment.—In the onset of the complaint, a removal from the influence of the cause; vapour baths, and an occasional course of medicine, together with stimulants and tonics, and exercise in the open air, may succeed in effecting a cure, or at least prevent it from getting worse. SECTION III. EPILEPSY. (CONVULSION FITS—FALLING SICKNESS.) An attack of this disease is characterized by a loss of con- sciousness, and by a jerking or convulsive motion of the muscles. Sometimes the fit comes on suddenly, without any previous symptoms indicating its approach; at other times it is preceded by various symptoms of constitutional disorder, with giddiness, stupour, pain in the head, and confusion of mind. Some patients experience a sensation like that produced by a stream of cold va- pour, commencing in the feet and gradually extending itself until it reaches the head, when the patient immediately becomes insen- sible. If the patient be standing or sitting when he is seized with a fit, he suddenly falls and is totally insensible, the eye- balls are distorted, the breathing greatly interrupted, the face swells, and convulsions ensue, which generally continue from five minutes to half an hour. In some cases the convulsive action of the muscles, particularly those of the face, are frightfully vio- lent; the whole face is agitated; the eyeballs roll; the lips and eyelids are convulsed; the tongue is often spasmodically thrust from the mouth, which with the grinding of the teeth, and foam- ing at the mouth, gives the countenance a horridly wild expres- sion. Sometimes the teeth are firmly pressed together; at other times the jaws are widely and fixedly distended. The limbs of both sides of the body are equally convulsed in some cases, but more frequently the muscular powers are stronger on one side; and occasionally one limb only is affected with spasm. "The heart palpitates rapidly; the pulse is usually contracted, irregular and frequent; and respiration oppressed, laborious, and in violent cases, sonorous. About the termination of the paroxysm, a considerable quantity of frothy saliva usually flows from the mouth; and in some cases the foeces and urine pass off involuntarily." Sometimes the convulsions stops uddenly, but more commonly they decline gradually. The breathing becomes more'free, the countenance assumes a more natural aspect, and the patient falls into a profound sleep. The patient is languid and stupid, and when he awakes, he has no recollection of what has passed. EPILEPSY. 215 The character of an epileptic fit varies greatly in different Cases. In some instances it passes off in a few seconds—in others it continues for hours. The paroxysm is most apt to be protracted in children. Some patients are subject to convulsions at night only; others are liable to an attack at any period of the day. With some, the fits come on at regular intervals. Dr. Eberle mentions a case where the paroxysm returned regularly on the night of each full moon. Sometimes there will be but one paroxysm. In other instances the patient will have them in continual succession during a peri- od of many hours, sometimes passing from one into another, un- til he has had twenty, forty, or even sixty fits, in the course of twenty-four hours. Causes.-—Convulsions may be caused by disease seated exclu- sively in the brain or spinal marrow; or the epileptic paroxysm may be induced by a disordered condition of the stomach or bow- els, the functions of the brain being thereby sympathetically de- ranged. Sudden fright has been know7n to bring on epilepsy. Excessive loss of blood has frequently led to convulsions. In children, convulsions are often occasioned by undigested food in the stomach, and from worms in the stomach or bowels. In some families the children are peculiarly liable to convul- sions during the period of teething. Small-pox, scarlet fever, and measles are occasionally attended by convulsions, more especially just before the eruption appears; and also when the eruption leaves the surface for the internal organs, or as it is commonly expressed, when the disease strikes in. The use of laudanum predisposes children to epilepsy. Suppressed menstruation, and diseases of the uterine organs are sometimes attended with convulsions. Venereal excesses and abuses, and the intemperate use of al- coholic liquors are among the exciting causes of epilepsy. Distinguishing Symptoms between Epilepsy and Hysteric Con- vulsions.—In epilepsy there is a total loss of consciousness, whereas in hysteria some degree of sensibility remains. 2. The eyes are more distorted, and the face more suffused and livid in epilepsy than in hysteric convulsions. 3. In epilepsy there is usually foaming at the mouth, which is absent in hysteria. 4. In hysteria the paroxysm docs not terminate in a deep sleep, as it does at the close of an epileptic paroxysm. 5. Hysteric convulsions are generally attended by involuntary paroxysms of laughing or crying, and a sensation of a ball in the throat, none of which accompany epilepsy. Epilepsy and 216 EPILEPSY. hysteria may proceed from the same cause, the symptoms being of a more aggravated character in the former than in the latter. Treatment.—An important indication in the treatment of epi- lepsy, and every species of convulsion is to overcome the spas- modic action of the muscles. The third preparation of lobelia is the remedy chiefly to be relied upon, this being the most efficient anti-spasmodic medicine in use. In many instances an attack of epilepsy may be prevented by the patient taking a tablespoon- ful or even a teaspoonful of the third preparation of lobelia, when the first symptoms of an approaching attack make their appearance. Many persons, however, have no warning of the approaching paroxysm, but fall suddenly into a state of insensi- bility. The third preparation of lobelia may be given during the convulsions, without any risk of strangling the patient, the stimulous of the medicine in the throat, sometimes exciting the action of swallowing, and thus the medicine will be easily taken into the stomach. When the third prepation is not at hand, the tincture or a simple tea of lobelia may be used. Emetics.—An oppressed or otherwise disordered stomach, is a frequent cause of convulsions in children demanding the use of emetics. If the convulsions be so strong as to prevent sw allow- ing the medicine, it must be administered freely as soon as the paroxysm subsides, with a view to prevent a return of the con- vulsions. The third preparation of lobelia is the most efficient emetic. The lobelia, however, may be given in tincture, or the powder alone in luke-warm water. Injections.—These when rightly prepared and administered, are as effectual in overcoming convulsions, as medicine taken into the stomach. They maybe administered during the parox- ysm, provided the convulsions do not prevent it. In Adults wiio have been subject to frequent attacks of epilep- sy, during several successive years, the disease often proves in- curable. Yet an effort should be made, for in some instances cures have been effected, even under circumstances which have promised little hope of success. Whenever patients have warn- ing of an attack several hours previous to its occurrence, a course of medicine should be administered, and whilst steaming, keep the head wet with cold water, or vinegar, or occasionally dash a tumbler of cold water in the face. If a full course be not given, the feet of the patient may be placed in warm water—an injec- tion administered, followed by full and frequent doses of the third preparation or some other form of lobelia, and the head kept wet with spirits, vinegar, or cold water. A dash of cold Epilepsy. 217 Water in the face, or the application of volatile salts to the nos- trils, w ill sometimes prevent an attack, at least for a time. Patients are apt to injure the tongue during the paroxysm of epilepsy, unless prevented by the insertion of a piece of wood or cork, between their teeth. In cases of long standing, it may be useless to attempt to do more during a paroxysm, than to pro- tect the patient from injury. After a Paroxysm, in children, and in all cases where there is reason to believe that the disease is occasioned by a disordered stomach or bow els, an emetic must be given as soon as the pa- tient can be made to swallow. If the stupor continue, injections must be administered. Vomiting may be effected in this way, by the lobelia powder, administered in warm water, and retained in the bowels. When convulsions are caused by suppressed menstruation, or a disordered condition of the uterine organs, the patient must be kept warm in bed, stimulating enemas used to the bowels, warm applications to the feet, and an emetic given whenever the symp- toms demand it. Thus, if a female be subject to epilepsy or even hysteria, at a certain time in the month, she should go through a course of medicine a day or two previous to the time when the paroxysm is apt to occur, and continue for several days the use of the means above mentioned. Epilepsy is generally incurable when it is caused by an or- ganic disease of the brain or spinal marrow. When it arises from other causes, such as indigested food in the stomach, affec- tions of the bowels, liver, or uterine organs, a cure may be effected. I knew an instance of a man in Baltimore who was cured of epilepsy byr a single course of medicine. He had been subject to occasional attacks of the disease for about two years previous to his taking the course of medicine. Exercise in the open air, a well regulated diet, cold shower bath in the morning, frictions of the surface, and tonics medicines will be proper means of invigorating the system. <2C SECTION IV. INFANTILE CONVULSIONS. Convulsions frequently occur in childhood, and more espe- cially in infancy. During this tender period, the functions of the brain are liable to become disordered, or suspended, from various causes. In some large families of children, the predis- position to convulsions is so strong that every one of them will have fits during the period of teething. In other families this form of disease is very rare, although the gums may be equally irritated and painful, and the digestion even more impaired. Causes.—Indigested food in the stomach, irritation of the gums from teething, or worms in the stomach and bowels, are the general causes of convulsions in infants and children. The use of anodynes, laudanum, and various other prepara- tions containing opium, predispose infants to convulsions by their tendency to produce congestion of blood on the brain. The following circumstance was related to me by a lady, intimately acquainted with the family in which the melancholy affair hap- pened. A nurse wishing to visit a friend, gave an infant a dose of laudanum, that it might not need attention in her absence. Soon after it was given, the child was seized with convulsions, which continued to return at frequent intervals, requiring con- stant wratching day and night up to the time when this statement was made to me, being a period of two years. The faculties of the mind were destroyed by the fits, with scarcely the possibility of remaining for life other than an idiot. Thousands of children have their intellectual powers injured by being forced to swallow anodynes. Laudanum occasions sleep by producing partial congestion of the blood in the brain; and it eases pain by benumbing the sensibility of the nervous system. Children are peculiarly liable to convulsions during the early stages of eruptive disease,—small-pox, measles, and scarlet fe- ver.1 More especially are they apt to occur a short time previ- ous to the eruption. On the event of the eruption striking in, convulsions are very frequently observed. In very young in- fants, the cold stage of " fever and ague" is sometimes accompa- nied by convulsions. infantile convulsions. 219 In children, as well as in adults, the cause of convulsions is sometimes seated originally in the brain or spinal marrow, ren- dering medical means unavailing. Fatality.—Death from convulsions, though of very rare oc- currence in adults, in infants and children is by no means un- common. " In ordinary constitutions there is but little to be apprehended from convulsions during infancy, when the attacks are slight and of short duration; and this observation applies especially to those instances which, instead of leaving the infant in a dull lethargic condition, are almost immediately succeeded by the natural cheerfulness of the child." Unfavourable Symptoms.—When the convulsions are of long continuance, attended with a dark, or purple appearance of the countenance, palsy of one side, or of a limb, squinting, and diffi- cult and sterterous breathing, the symptoms may be considered unfavourable. Treatment—Infantile convulsions are caused in the great ma- jority of instances by constitutional disorder, the seat of which is in the stomach and bowels, and require for their cure that kind of treatment which is proper to cleanse the stomach and bowels, and restore their natural functions, and also to equalize the cir- culation of the blood and nervous fluid. The first symptoms usually observed in convulsions are, a spasmodic contraction of the muscles of the chest and throat from loss of nervous power in these parts: the breathing is almost suspended, and congestion of blood on the brain ensues, followed by convulsions. Anti-Spasmodics are especially indicated in the treatment of convulsions, of whicli the third preparation of lobelia is the best probably that can be used. I have never heard of an instance of a child being suffocated by stimulating medicine, but I know of two instances in which death was occasioned by the use of castor oil. When stimulating medicine reaches the throat, in- stantly the windpipe is closed against its passage, and thus the medicine is conducted to the right passage to be carried into the stomach, notwithstanding the unconsciousness of the patient. When the sensibility is very low7, a substance like castor oil might glide into the wind-pipe instead of the proper passage, and in this way occasion suffocation. It is only during the pa- roxysms that I would think of giving the third preparation of lobelia alone to a child, but I often give it in this way during convulsions. 220 CHLOROSIS. The third preparation of lobelia, not only is the best anti-spas- modic, but it is also the most efficient emetic, containing suffi- cient stimulous to enable the stomach to act promptly. It may be given alone or combined with luke-warm water, bayberry tea, or added to about twice its quantity of boiled milk. In the absence of the third preparation, lobelia may be given in the form of tea, made by adding warm water to the lobelia powder; or the powder mixed with an equal quantity of No. 6, and given in bayberry or composition tea. A stimulating injection must be administered as soon as prac- ticable, and repeated as often as the circumstances of the case demand it. When the convulsions subside, the use of lobelia should be con- tinued with the view to prevent a return of the paroxysms, un- less the patient have previously vomited freely. The use of injections is particularly indicated on account of their tendency to attract the circulation to the bowels, and thereby lessen the pressure of blood upon the brain. If the patient remain in a state of stupour after the paroxysm, stimulating injections should be administered and the feet placed in warm water, a por- tion of mustard or capsicum added to it; or a vapour bath ad- ministered, the child being held in the parent's or nurses' lap. If the head be hot, cloths wet with cold water or vinegar must be applied. When the gums are swollen and irritated benefit may be de- rived by cutting them down to the teeth. Frictions and stimulating embrocations along the course of the spine will be found useful. section v. CHLOROSIS—GREEN SICKNESS. The term cldorosis is applied to a form of disease in which there is marked paleness of the skin, absence of the natural red colour of the lips, swelling of the eye-lids, a soft and flabby state of the skin, loss of flesh, general coldness of the system, a ten- dency to a swelling of the feet and ankles, loss of appetite, and CHLOROSIS. 221 torpor of the bowels. The tongue is pale, swollen, and more or less furred. Menstruation is deficient, and sometimes this evac- uation is entirely suppressed. There is frequently a craving for pickles, chalk, or cinders. As the disease becomes more deeply seated, the countenance is still more palid, and sometimes* assumes a yellow or greenish appearance. " The skin is smooth, but is preternaturally dry. The tendency to dropsical swellings of the feet and ankles in- crease, but there is seldom any further wasting of the flesh. "The tongue clears and becomes smooth, but continues pale, with a slight but peculiar appearance of transparency, and has a lilac hue. The patient is affected with languor, lassitude and even serious weakness, being at once reluctant and unable to un- dergo fatigue." There are often severe attacks of pain in the side and head, palpitation of the heart, faintness and a sensation of suffocation. The bowels are inactive, with occasional attacks of diarrhoea; the stools are dark, foetid and scanty. The diges- tion is always greatly impaired, yet patients will sometimes have a craving appetite for food, as well as for indigestible substances, such as tea-leaves, coffee grounds, morterfrom old walls, chalk, pickles, or charcoal, &c. There is a peculiar tendency in this disease to a bleeding from the nose, stomach and bowels, or uterus. The blood discharged is pale and watery, sometimes scarcely producing a stain on linen. An attack of chlorosis though not free from danger, is generally curabie by judicious treatment early applied, before the disease assumes an inveterate character. In chlorosis the amount of heat generated in the system is much less than is produced in a state of health; every organ in the body is in a torpid condition; the secretions are diminished, but little bile is formed; the mucous membrane of the stomach and bowels is coated with thicker secretions forming a false mem- brane; digestion, assimulation and nutrition, are imperfectly performed; and the blood is in a weak and impoverished condi- tion. Treatment.—The general course of treatment indicated for the cure of the above form of disease is as follows: 1st. To warm the system by the use of pure stimulants and external warmth. 2d. Courses of medicine.—To be administered as the circum- stances of the case may demand. 222 CHLOROSIS. 3d. Injections to evacuate and tone the bowels, and also to act upon the uterine functions, through nervous influence. 4th. The continued use of pure stimulants and the strongest kinds of bitters or tonics. Gentle exercise, fresh air, and a light nourishing diet are important curative means in the treat- ment. Course of Medicine.—There is no plan of treatment that can fulfil so many important indications for the cure of this disease as a course of medicine. Under its influence a new action is awakened throughout the whole system. The steam imparts warmth to the blood, equalizes its circulation, strengthens the nervous energy, increases the sensibility of the stomach to the impression of medicine, and for a time restores the functions of the skin, by which morbific matter is thrown off from the blood. The chest expands more freely, affording a greater supply of air to the lungs, thereby augmenting the vitality of the blood. By the emetic the stomach is relieved of matter which had oppressed its functions; the efforts to vomit whilst the system is relaxed tends to remove obstruction in the liver and in other important organs. The stimulus of the medicine augments the secretions and occasions a determination to the surface. Injections relieve the bowels, and through the medium of the nerves exert a benefi- cial influence upon the uterine organs, the functions of whicli are always deranged in chlorosis. Lastly, but not least in im- portance, under the operation of the course of medicine, more or less of the false coating or " canker" becomes detatched and removed from the coats of the stomach and bowels. This false membrane must be removed before the general health can be restored. I have known, on several occasions, quarts of a skinny-like substance discharged by the bowels in cases of chlorosis, which probably had been formed in the early period of the disease. Repeating the Course.—As a general rule the course of medi- cine will require to be administered most frequently in the ear- lier period of the disease. When the disease has become deeply seated, and the system cold, torpid, and much weakened, it may not be necessary to repeat a course oftener than once in two or three weeks. Preparing the Emetic.—In ail cases where there is great want of tone in the stomach, and a general torpor throughout the sys- tem, the liquid of the third preparation of lobelia is the most ef- fectual emetic. It should be given in a very strong tea of bay- berry or sumac. Milk porridge, or gruel seasoned with salt and pepper, must be given both during and after the operation of the emetic. CHLOROSIS. 223 Injections arc necessary, not only to stimulate the bowels to action, but when properly prepared, they exert an influence over the functions of the uterine organs. Hence, during the men- strual period, or at the time that this evacuation is looked for, an enema composed of bayberry tea, adding a teaspoonful of the third preparation of lobelia; or of composition tea, adding a tea- spoonful of lobelia powder, should be administered two or three times a day. The patient to be kept warm in bed, with warm bricks to the feet, and abdomen, or back, and an occasional dose of composition, capsicum, or spice bitters administered. The vapour bath should be omitted during the menstruation, un- less the discharge should continue too long, and become very profuse. In chlorosis the stomach is colder than natural, re- quiring the assistance of stimulants and tonics, in order to facil- itate digestion. The time for taking the stimulants, more espe- cially pepper, is at meals; and tonics immediately before or after. The Compound Lobelia Pills may be used as a general medi- cine in all cases of chlorosis. Ten or twelve of these pills may be taken daily, and they furnish a moderate and permanent stimulus to the stomach and bowels, and exert a beneficial in- fluence in correcting their secretions. When liquids oppress the stomach, or the patient prefers medicine in the form of pills to decoctions, tonics as well as the stimulants may be given in this form—such as quinine pills, and pills composed of bitter extracts. Gum myrrh is a useful tonic in Chlorosis. It may be formed into pills, and three or four taken after each meal, or the myrrh may be finely pulverized, mixed with quinine or bitter extracts, and the compound formed into pills. White mustard seed or prepared charcoal muy be used to aid in stimulating the bowels to action'. The Diet must be light and nourishing, not to be confined however, to vegetables. Wild game, fresh beef and mutton, eggs, and whatever is found to agree with the stomach. Pastry and hot bread of every description must be avoided. SECTION VL HYSTERIA—HYSTERIC FITS. Hysteria presents in different cases a great diversity of symptoms. It mostly occurs in paroxysms. Symptoms—At one time "the fit consists of excessive laughter alternating with crying or screaming; and at another with men- tal alienation, rapid and incoherent talking, singing, suffocating spasms in the throat, a wild and furious expression of counte- nance, raving, gnashing the teeth, tearing out the hair, beating the breast with the hands, biting, &c. Occasionally these symp- toms subside withont terminating in convulsions. More com- monly, however, convulsions of a terrific character speedily en- sue." During the spasms "the body is usually ridgidly bent backwards, or variously and most povVcrfully contorted; the breast is projected forward, and the head drawn backwards; the face is swollen; the tongue protruded, or the jaws firmly closed; the eyes rolling, prominent, and red; the teeth gnash; the fists are clenched; the arms spasmodically thrown about* and the abdominal muscles powerfully contracted; in short, the whole muscular system is thrown into such violent spasms that Scarcely any effort of the by-standers is sufficient to restrain the contortions, or prevent the patient from being thrown out of bed." "When the paroxysm ceases, the patient is left in an exhausted or stupid and somnolent condition, which in the course of an hour or two passes away without leaving any other affections than a feeling of general soreness, and a slight pain in the head and pit of the stomach." Sometimes instead of spasms, stupor and insensibility ensue, the limbs are in a relaxed condition, the jaws firmly closed, the eyes shut, the countenance nearly natural, the breathing irregu- lar, the pulse slow and regular, the extremities are cold, and the power of swallowing is lost. Young females sometimes remain in this condition many hours, or even the whole day or night. Causes.—Indigested food in the stomach; sedentary habits; suppressed or difficult menstruation; damp and cold feet; and violent mental emotions—excessive joy or grief—are causes of hysteria. hysteria. 225 Hysteria never occurs in childhood, it being almost exclusive- ly confined to the period which intervenes between the fourteenth and fiftieth years. It is almost peculiar to females, still the disease, in a mild form, sometimes happens to men, more espe- cially to those who lead a sedentary life, and are of a delicate and nervous temperament. Patients subject to hysteric fits, arc apt to feel a tenderness in some part of the spine when it is pressed upon, whicli fact has led some physicians to view hysteria as a disease depending up- on irritation of the spinal marrow7. Other theorists contend that its seat is in the uterus, whilst others again locate the dis- ease in the brain. It would be useless in a practical point of view7, to attempt to sustain or refute any of these theories, as the disease, in all cases, must be treated upon general principles, ap- plying the remedies to suit the emergency of the case. Treatment.—Hysteric fits are generally preceded by extreme languor, coldness of the hands and feet, and distress at the pit of the stomach. At this period stimulants should be given,— capsicum, composition, or spice bitters. No. 6, essence of pep- permint, or lavender brandy, may be also used to expel wind from the stomach. The feet should be placed in warm water, and volatile salts applied to the nose. If the symptoms be not relieved by the above means an emetic must be given, and the patient warmly covered, and warm bricks applied to the feet. The Vapour Bath—Warm vapour applied to the surface soothes nervous agitation, and is signally beneficial in all cases of hysteric affections. When the system is very cold, the bath preceding an emetic will materially assist the operation of the latter. Injections.—Stimulating enemas are scarcely less important, both as a preventive and curative means, in hysteria. The liquid of the third preparation of lobelia, or the lobelia powder in No. 6, is to be administered in warm water, bayberry, com- position, or skull-cap tea. When there is a violent determina- tion of blood to the head, the use of stimulating enemas are particularly called for, as they prove an efficient means of equal- izing the circulation of the blood, and of sustaining and equal- izing the nervous influence. Mustard plasters applied to the feet, ancles, and wrists, may have a beneficial influence in sooth- ing nervous agitations. Antispasmodics.—The third preparation of lobelia is the best antispasmodic, and it also answers as an emetic and stimulant. 2D 226 HYSTERIA. This medicine may be given in teaspoonful doses at any time when the patient can swallow. Even during hysteric convul- sions, the liquid of the third preparation poured into the sides of the mouth when the teeth are firmly closed, will have an influ- ence in shortening the paroxysm, even though the medicine should not be swallowed. Musk may be employed with benefit in hysterical paroxysms. The high price of the article, however, together with the circum- stance of its being rarely found in the shops free from adultera- tion, has occasioned the almost entire abandonment of its use in practice. Castor—This is a stimulant and antispasmodic, and may be used in hysteria. The dose is from ten to twenty grains, given in a bolus, or rubbed up with elm powder, and then sufficient water added to make it easy to swallow. When violent paroxysms of hysteria take place in consequence of a sudden check to the flow of the menses, stimulating enemas to the bowels must be administered, in addition to the general treatment above mentioned. A tablespoonful of the third pre- paration of lobelia may be administered at one time, in severe cases; or two teaspoonsful of spirits of turpentine, rubbed with a little dry elm powder, or beat up with the white of an egg, adding a teaspoonful of the third preparation of lobelia, and half a pint of warm water, or simple herb tea. The enemas are to be repeated until the desired effect be produced. Warm fomentations are useful to relieve pain in the chest ov abdomen. If the head be hot, cloths wet with cold water, spi- rits or vinegar, may be applied, and changed frequently. "In that variety of paroxysmal hysteria," says Dr. Eberle> " in which the patient lies in a state of torpor and insensibility distinct from syncope, I know of no remedy so effectual for dis- pelling the attack as an emetic." If the patient cannot be made to swallow, lobelia administered to the bowels in full doses and retained, will have the same effect upon the system as when taken into the stomach. A mustard plaster, or pepper poultice applied to the pit of the stomach, will aid in exciting vomiting. When mustard is employed it should be removed before it blis- ters the skin. During violent paroxysms of hysteria it will be useless in many instances, to attempt to administer medicine until the spasms subside. As soon as the spasms give way, and the pa- tient can swallow, an emetic should be given with a view to pre- vent the return of the convulsions. The best form of emetic in all such cases is, a large teaspoonful of the liquid of the third HYSTERIA. 227 preparation of lobelia, with about an equal quantity of lobelia powder, mixed in a teacup two-thirds full of bayberry or sumac tea. The emetic is to be repeated until vomiting be effected. Acids in the stomach interfere with the operation of emetics, and whenever the emetic is slow in its operation, a teaspoonful of the bi-carbonate of soda, or half the quantity of salaeratus should be given, dissolved in a teacupful of lukew7arm water. Chronic Hysteria.—Unmarried females whose digestive pow- ers are greatly impaired, who are of a weak habit of body, and possess an easily excited temperament, and more especially those who are subject to profuse or too frequent menstrual evacuations, are peculiarly liable to hysteric symptoms. " They are always complaining of some unpleasant or painful sensations; their tem- per is variable, often fretful, sometimes animated, talkative, and anon peevish and gloomy; they pass often rapidly from laughing to crying, from gaiety to melancholy, from despondency to hope, and vice versa, from the most trifling causes. They often com- plain of various distressing sensations in the abdomen, head, and cfeest, flatulency, a rumbling noise in the bowels, severe colic pains, a sense of weight and bearing down in the region of the uterus, pain in the neck of the bladder, dysury, a feeling of emptiness or fullness and tension at the pit of the stomach, vari- able appetite, slow digestion, eructations, occasional spells of great anxiety and alarm, palpitation of the heart," faintness, a peculiar sensation of weight, or of numbness in the top of the head, severe pains in the head, breast, or other parts of the body, and sometimes the sensation of a ball rising in the throat. Treatment of Chronic Hysteria.—Hysteric symptoms that have been of long continuance, can be cured only by restoring the general health of the patient. To accomplish this, an occasional emetic, or course of medidne, stimulants and tonics, are the reme- dies chiefly to be employed. Dr. Dean, of Harrisburg, (Pa.) observes, "in some cases where the patients had laboured under this disease for ten years, and during that time had, by the advice and directions of respec- table physicians, exhausted, with at most, but temporary bene- fit, the whole class of remedies which are usually prescribed, I have, by the continued exhibition of vomits, either entirely re- moved the complaint or so far removed the habits of diseased ac- tion in the stomach, that anti-spasmodic and tonic medicines would in general complete the cure." (Eberle.) The proper time for giving an emetic or a course of medicine is when the. patient feels more distress than usual. Tonics.—Gfum myrrh is a useful tonic in hysteric complaints, 228 HYSTERIA. when the disease is associated with an excessive flow of the men- ses. The myrrh should be finely pulverized, and formed into pills, three or four of which may be taken after meals; or a de- coction made of it by steeping it in boiling water. Other tonics, such as columbo, gentian, balmony, unicorn root, barbary, Virginia snake root, and prickly ash, may be employed either simply or in combination. When the patient has a craving for some particular substance, such as acids, chalk, or charcoal, they should be used unless they are found to disagree with the stomach. I have in several instances known patients to eat freely of bread and butter dipped in vinegar, which agreed with the sto- mach. . • Charcoal is decidedly beneficial where the bowels are habitu- ally constipated, or when the patient is harassed with sour eruc- tations or heartburn. When the bowels are habitually costive, to use injections of a decoction of aspen poplar and bayberry bark at bed time, and retain them until morning, will relieve the bowels and at the same time increase their strength and tone. Purgative medicines must be avoided, for notwithstanding they may afford momentary re- lief, yet eventually the functions of the bowels will be always weakened by them. By a proper course of constitutional treat- ment, joined with a well regulated diet and regimen, and an abandonment of cathartic medicine, the functions of the bowels will become restored, unless there be an organic derangement, stricture of the rectum, for instance. I have in repeated in- stances been surprised to find the bowels recover their function so as to be moved naturally in so short a period under such a course of treatment as above alluded to. Yet where patients have been habitually costive for many years, and the bowels sel- dom moved unless provoked by a cathartic, the free use of char- coal and bitters, stimulating injections to move the bowels, to- gether with the injection at bed time, as before mentioned, the use of bread made of unbolted flour, or gruel made of the same material, besides other articles of food that are nourishing and easy of digestion, will generally prove successful in restoring the natural action of the bowels in the course of a few weeks. Injections composed of salt and molasses, each a tablespoonful, adding a pint of luke-warm water, and a teaspoonful of green lobelia powder, will sometimes succeed in procuring a passage from the bowels when the usual stimulating injections have failed. SECTION VII. FAINTING. A deficiency of arterial blood in the brain is the usual cause of fainting. Thus persons bled whilst sitting up will faint much sooner than when lying with the head on a level with the body. Persons who are very weak, sometimes faint from sitting up when confined by sickness. Some faint at the sight of blood; others from sudden fright or from any other violent mental emo- tion. Symptoms.—These are, sudden loss of sensibility, and of the power of motion; the breathing and pulse scarcely perceptible, or entirely suspended, and the countenance and lips pale and bloodless. Treatment—The immediate cause of fainting being a defi- ciency of arterial blood in the brain, the most important indica- tion for recovering the patient is to place the head as low or lower than the level of the body, with a view to favour a supply of blood to the brain. Cold water may be sprinkled or dashed on the face; all tight dresses loosened; and salts of hartshorne, calogne or camphor applied to the nose. If fainting occur in a close room or crowded assembly, the patient must be taken into the open air, and if the weather be very wTarm, fanning will be of advantage. A person fainting in an assembly is very apt to be so closely surrounded by the by- standers, as to intercept the circulation of air around the patient. This should be prevented on all occasions where a patient has fainted. I have known patients to faint from setting up to take a va- pour bath. When they first begin to feel faint, a dash of cold water in the face, holding the head downward for a few moments; for instance resting the head low on a chair, and applying some volatile stimulant to the nose, usually revive the patient and enable him to continue in the bath the usual time required in steaming. If the tendency to faint should continue, the patient must be placed in bed. SECTION VIII. HYPOCHONDRIASIS. (dejection of MIND—LOW SPIRITS.) This unhappy and ill-forboding state of mind, is principally confined to persons in advanced life, and it is always associated with feeble digestion. There is distress at the pit of the sto- mach; flatulency and acid eructations; extreme coldness of the hands and feet; torpid bowels; and either a dry, or cold and clam- my state of the skin. Very frequently the countenance is sal- low, indicating a torpid state of the liver. Characteristic Symptoms.—" A disposition to seriousness, sad- ness and timidity as to all future events; an apprehension of the worst and most unhappy state of them, and therefore, on slight ground, a dread of approaching evil." The patient thinks and talks about his unhappy condition, and observes every change of feeling in his body with apprehensions of danger. In some instances the nervous system will be shocked with the most tri- fling noise, causing the patient to startle even at the dropping of a knife at the table, and occasion a very unhappy state of mind, sometimes exciting a revengeful feeling, even against their off- spring. I have known patients labouring under this distressing weakness to be unable to bear the slightest noise from the play- ing of their own children, requiring them to be kept out of sight and hearing. In other instances the mind sinks into a kind of sullen gloom, with constant forebodings of coming evil. Causes.—The immediate cause of this dejected state of mind, technically called, " hypochondriasis," is exhaustion of nervous power. Severe mental labour, indolent habits, inveterate dys- pepsia, domestic trouble, debauchery, the excessive use of to- bacco, or the long continued use of opium, are, in many in- stances, the remote cause of that dejected state of mind conse- quent upon a torpid and enfeebled condition of nervous energy. The habit of viewing the dark-side, only, of events, and yield- ing the imagination to gloomy forebodings, exerts a depressing influence upon the brain—weakens the energies, and consequent- hypochondriasis. 231 ly impairs the powers of digestion, and thus may be laid a foun- dation for continued despondency. The advice contained in the following lines may be found ap- propos to those of a desponding disposition. " Never look sad—nothing so bad As getting familiar with sorrow; Treat him to-day in a cavalier way, And he'll seek other quarters to-morrow." " Long you'd not weep, would you but peep At the rbight side of every trial; Fortune you'll find, is oft most kind, When chilling your hopes with denial." " Let each sad day, carry away Its own heavy burden of sorrow; Or 'tis likely ijou'llmiss, half of the bliss That comes in the lap of to-morrow." " When hope is wreck'd, pause and reflect If error occasioned your sadness; If it be so, hereafter you'll know, How to steer to the harbour of gladness." Patients advanced in years, however, whose nervous energy is greatly exhausted, have not the pow7er to prevent despondency of mind, auy more than they can prevent a fit of ague at will.— The general health must be improved, and the nervous influence aroused from its torpid state before the mind can be raised from its sunken, dejected condition. Treatment.—When depression of mind is caused by a disor- dered state of the system, the most effectual medical remedies are, courses of medicine administered at proper intervals, to- gether with the use of composition, or cayenne and bayberry, followed by the use of bitters. A course of medidne, by cleansing the stomach, and awakening a new action in the system, will frequently be attended with the most happy effects upon the mind. In deeply seated cases, how- ever, the course of medicine will have to be repeated occasional- ly for a period of several months, before the general health can be thoroughly restored. Capsicum is the best stimulant, and should be taken at meals 232 hypochondriasis. or soon after eating: the powder may be taken in luke-warm or cold water, or it can be taken in the form of pills. The compound lobelia pills answer as a stimulant, and they will act efficiently on the secretions, both of the skin and mucous membrane of the stomach and bowels. I attended a patient whose mind was greatly depressed from ill health, who took from forty to fifty of the compound lobelia pills daily, besides three or four teaspoonsful of capsicum, without making any sensible im- pression on the stomach and bowels. After taking several courses of medicine, and continuing the use of the stimulants above mentioned, a skinny substance began to pass from his bowels, and continued to pass from them for weeks. At the time this skinny substance was passing, the patient experienced frequent griping pains in the bowels, a symptom whicli is com- plained of under the use of Thomsonian remedies in seated dis- eases. The above treatment, together with the use of bitters, exercise in the open air, and a light nourishing diet, succeeded in restoring the general health of the patient, and raised his spi- rits from a state of extreme depression and melancholy. During the summer of 1837, when Brandreth's pills had come into general use through the influence of ingenious adver- tisements, circulated through the medium of newspapers, one of Brandreth's agents called at my office for advice. He was la- bouring under great depression of mind, being scarcely capable of overseering the business of a small shop, of which he had the charge. He had taken his own pills until they had destroyed the tone of bis stomach and bowels, occasioning the dejection of spirits under which he had four months been labouring. I pre- scribed composition powder to be taken in luke-warm water four times a day. After this remedy had been continued two or three days, a full courseof medicine was administered, which together with the subsequent use of tonics, effectually restored his system, and consequently his mind to a healthy condition. There are cases of low spirits in which moral influences are of more importance in the cure than medical treatment. In two in- stances I have known despondency and extieme dejection of spirits to be occasioned by a retirement from business. In one of these cases, the patient took several courses of medicine, but still the low7 spirits continued until he resumed business, and his former active habits. In the other case the gentleman also re- sumed his former active habits, by which the strength, both of body and mind, were reinstated. When the nervous energy becomes depressed from too close application of the mind to study or business, exercise in the open air, travelling, and cheerful society arc important. HYroCHRONDRIASIS. 233 Reading entertaining books, and every kind of innocent amusement should be indulged in, to divert the mind, and bring new objects into view, when it is not convenient for the patient to perform a journey. Various Means have been successfully employed for the cure of the hypo, as it is usually called. The following is from the Medical Companion, written by James Ewell. " Some hypochondriacs have fancied themselves miserably afflicted in one way, and some in another—some have insisted that they were tea-pots, and some that they were town clocks. This that he had a big belly, another that his legs were glass— one that he was extremely ill, and another that he was actually dying. But I have never heard of any of this blue-devil class whose extravagance ever yet came up to the following, which was related to me by my noble hearted old friend, the late Dr. Stevenson, of Baltimore, whose name sounds in my ears as the summary of every manly virtue. "This hypochondriac, who, by the bye, was a patient of Dr. Stevenson's, after ringing the change on every mad conceit that ever tormented a crazy brain, would have it at last that he was dead, actually dead. Dr. Stevenson having been sent for one morning in great haste by the wife of his patient, hastened to his bed side, where he found him stretched out at full length, his hands across his breast, his great toes in contact, his eyes and mouth closely shut, and his look cadaverous. " 'Well, sir, how do you do ? how do you do this morning V asked Dr. Stevenson, in his blustering, jocular way, approach- ing his bed-side. 'How do I do!' replied the hypochondriac faintly, * a pretty question to ask a dead man!' ' Dead!' re- plied the Doctor. * Yes sir, quite dead: I died last night about twelve o'clock.' "Quick as lightning Dr. Stevenson caught his cue, which was to strike him on the string of his character, on which the Doctor recollected he was very tender. Having gently put his hand on the forehead of the hypochondriac, as if to ascertain whether it was cold, and also having felt his pulse, he exclaimed in a doleful tone, 'Yes, the poor man is dead enough—'tis all over with him, and the sooner he can be buried the better.' Then stepping up to his wife, and whispering her not to be frightened at the measures he was about to take, he called to the servant, 'My boy, your poor master is dead, and the sooner he can he put under ground the better. Run to Mr. C----m, for I know he always keeps New England coffins by him, ready made, and do you hear, bring a coffin of the largest size, for your master 2E 234 HYPOCHONDRIASIS. makes a stout corpse, and having died last night, and the wea- ther being warm, he will soon begin to smell.' " Away went the servant, and soon returned with a proper coffin. The wife and family, having got their lesson from the Doctor, gathered around him and howled no little, while they were putting the body in the coffin. Presently the pall-bearers, who were quickly provided, and let into the secret, started with the hypochondriac for the church-yard. They had not gone far before they were met by one of the towns-people, who, having been drilled by the facetious Stevenson, cried out, 'Ah, Doctor! what poor soul have you got there?' " 'Poor Mr. B----' sighed the Doctor, 'left us last night.' " ' Great pity he had not left us twenty years ago,' replied the other, * for he w;as a bad man.' " Presently another of the towns-men met them with the same question, 'And what poor soul have you got there, Doctor?' •"Poor Mr. B----,' answered the Doctor again, 'is dead.' " ' Ah, indeed!' said the other, ' and so the devil has got his own at last.' "' Oh, villain!' exclaimed the man in the coffin, 'if I was not dead, how I would pay you for that.' " Soon after this, while the pall-bearers were resting them- selves near the church-yard, another one stepped up with the old question again: ' what poor soul have you got there, Doctor?' " ' Poor Mr. B----,' he replied, ' is gone.' " 'Yes, and to h—11,' said the other, 'for if he has not gone there, I see not what use there is in such a place.' "Here the dead man, bursting off the lid of the coffin, which had been purposely left loose, leaped out, exclaiming, ' Oh, you villain! I am gone to h—11, am I!—well I have come back again to pay such ungrateful scoundrels as you are.' A race w7as im- mediately commenced between the dead man and the living, to the petrifying consternation of many of the spectators, at sight of a corpse bursting from the coffin, and in all the horror of a wind- ing sheet, racing through the street. After having exercised himself into a perspiration by this fantastic chase, the hypochon- driac was brought home by Dr. Stevenson, freed of all his com- plaints. And by strengthening food, generous wine, cheerful company, and moderate exercise, was soon restored to perfect health." The disordered state of mind exhibited in the above case, doubtless was occasioned by a torpid circulation of blood through the brain, and from extreme deficiency of nervous energy. Whether any other means than those resorted to by Dr. Steven- son could have succeeded in arousing an action in the system sufficient to cure the disordered imagination of the patient is a question not readily answered. ST. VITUS' DANCE. 235 " A certain hypochondriac, who for a long time fancied him- self dying of a liver complaint, was advised by Dr. Crawford, of Boston, to make a journey to the state of Ohio. After an excursion of three months, be returned home, apparently in good health; but upon receiving intelligence of the death of a twin brother who had actually died of a schirrus liver, he immedi- ately took the staggers, and falling down, roared out that he was dead, and had, as he always expected, died of a liver complaint. Dr. Crawford being sent for, immediately attended, and asked the hypochondriac how he could be dead, seeing he could talk. But still he would have it that he was actually dead. Where- upon the sagacious Doctor exclaimed, ' Oh yes, he is certainly dead, and it is more than probable his liver was the death of him. However, to ascertain the fact, I will hasten to cut him open before putrefaction takes place.' And thereupon, getting a carv- ing knife, and whetting it as a butcher w7ould to open a dead calf, he stepped up to him and began to open his waistcoat, wiien the hypochondriac, horribly frightened, leaped up with the agility of a rabbit, and crying out, 'Murder! Murder!!' ran off with a speed that would have defied a score of doctors to catch him. After running a considerable distance, until he was almost ex- hausted, he halted; and not finding the doctor at his heels, soon became composed. From that period this gentleman was never known to complain of his liver; nor had he for more than twenty years afterward, any symptoms of this disease."—Ewell's Med- ical Companion. SECTION IX. ST. VITUS' DANCE. Symptoms.—It commences with twitching or jerking of the muscles of some portion of the body, generally first observed in the face or in one of the limbs. These sudden contractions of the muscles are usually slight at first, occurring only occasion- ally, and more particularly when the mind is grieved or agitated. By degrees these jerking motions increase, until, in many in- stances, almost every muscle in the body is affected with spas- modic contractions. In many instances the contractions are much stronger on one side of the body, and frequently they are confined almost exclusively to the left side. " From the imper- fect command of the will over the voluntary muscles, the patient, 236 ' st. virus' dance. when he attempts to walk, has a starting, hobbling, and irregu- lar gait, with an awkward dragging of one of the legs." Some- times the arms and legs are thrown into such confused motions, that the patient will be unable to walk, or even to stand alone. He is often unable to direct his band to his mouth, requiring to be fed by another person. "At first the expression of the countenance, in the intervals of the spasmodic motion, is that of good humour and content- ment." In a later period of the disease, howrever, the counte- nance loses its expression of cheerfulness, the temper is irritable, and sometimes the intellect is enfeebled. " Slight paralysis oc- casionally occurs on one side of the body." When the patient sleeps, the jerking motion of the muscles is entirely suspended. Patients affected with St. Vitus' Dance are generally worse at a particular time of the day. The appetite is variable; sometimes voracious—at others fee- ble. The tongue is slightly coated, and generally somewhat contracted. Digestion is more or less impaired: the bowels are usually inactive, and the stools seldom have a healthy appear- ance. St. Vitus' dance is usually confined to the period of life which intervenes from the eighth to the twentieth year. Causes.—Constitutional disorder, more especially a deranged condition of the digestive organs, is the chief cause of St. Vitus' dance. Among the occasional causes of this disease are, violent mental emotions; sudden fright, or anger; "repelled cutaneous eruptions;" suppression of the menses; and exposure to cold and damp. Not Dangerous.—St. Vitus' dance very rarely proves fatal. The few instances that have been known to terminate fatally, with "slow irritative fever" have probably been experimented upon by medicines which have poisoned the stomach, and des- troyed the vital principle. Duration.—In some instances this disease continues only a few days; in others it is prolonged to many months, or even years. When the disease is wholly dependent upon a disordered condi- tion of the stomach and bowels, it is more readily cured than wiien it has been brought on by sudden alarm or other violent emotions of the mind. Girls attacked with St. Vitus' dance, about the age of thirteen or fourteen, are seldom permanently cured until menstruation becomes fully established. The disease is also apt to become protracted when associated with chronic derangement of the general health. st. vitus' dance. 237 Treatment.—The following plan of treatment I have known to succeed in curing several cases of St. Vitus' dance, viz :—In the first place, give broken doses of lobelia, sufficient to occasion slight nausea; a course of medicine administered occasionally; a shower bath every morning, sometimes preceded by a vapour bath; and as the tongue begins to clean, or the skin becomes pale,, and the system relaxed, give tonics. On administering Broken Doses of Lobelia.—Lobelia may be administered in the form of pills, tincture, or the powder mixed in warm water. In some cases I have found it necessary to give as much as a teaspoonful of brown lobelia powder at a time, and this frequently repeated in order to effect even slight nausea. I have been surprised at observing the slight effect produced in even young children, by full doses of lobelia. In the case of a little girl labouring under St. Vitus' dance, the brown lobelia powder was given in full doses, and frequently repeated without producing the slightest nausea, or causing any perceptible degree of relaxation, until several courses of medicine had been given. At the end of the third week from the commencement of the treat- ment, the patient became much distressed and deathly sick under the influence of lobelia administered after the vapour bath. She tossed about in every direction, and continued in this wray six or seven hours, the system being much relaxed. After this opera- tion, the patient began to mend rapidly. The compound lobelia pills are convenient to take, and may be used with as much ben- efit, probably, as any other form of lobelia. From twelve to twenty pills should be taken daily, and continued as long as the disease remains. The Vapour Bath is particularly beneficial in St. Vitus' dance, especially when the skin is in an unhealthy condition. The bath may be repeated daily, 6r every few days, as the circumstances of the case may indicate. After steaming, the patient must be showered with cold water, rubbed dry, and the surface bathed with No. 6, or some stimulating linament. Emetics—These may be given once a week, or at longer or shorter intervals, as the character of the symptoms may demand. Brown lobelia powder, infused in strong compo- sition tea, is a proper form of emetic to administer to children. Lobelia administered by injection, in warm water, and retained several minutes, will occasion vomiting and relax the system as effectually as when swallowed. I have been sent for on several occasions where families have become alarmed by the extreme relaxation occasioned by lobelia injections. All that is required is to bathe the face, breast, and hands with spirits, or vinegar 238 ST. VITUS' DANCE. and water. It is well, however, to give occasionally some stimulant, No. 6, capsicum tea, composition, or even simple herb teas, pennyroyal or mint, together with some light nourishment —milk porridge or chicken tea. I never knew an instance of St. Vitus' dance in which the disease did not moderate after the patient was fully relaxed under the influence of lobelia. I have on several occasions, however, given from six to eight teaspoons- ful of lobelia powder to patients labouring under this form of disease, without causing any perceptible relaxation, or effecting even slight sickness; and then again, at another stage of the dis- ease, one teaspoonful, or even half that quantity, will operate ef- fectually both in cleansing the stomach, and relaxing the system. The Cold Shower Bath is much employed in the treatment of St. Vitus' dance. This remedy is particularly appropriate in the more advanced stage of the disease, after the stomach has been thoroughly cleansed. The proper time for administering the cold shower bath, is in the morning, as soon as the patient is out of bed. After the bath is administered, the patient must be rubbed dry, wrapped in a blanket, and put in bed, and remain there half an hour, or longer. Tonics.—The spice bitters may be used in any period of the disease. In the more advanced stages of it, stronger tonics will be required. Quinine, wormwood, centuary, balmony, golden seal, or Virginia snake root. The scull-cap {Scutellaria lateri- flora) may be employed both as a tonic and nervine. It may be taken singly in decoction, or combined with other tonics. Injections.—When the bowels are very costive, injections may be used occasionally composed of salt, molasses, and water, ad- ding an even teaspoonful of green lobelia to each injection. Lo- belia administered by injection, and retained, will benefit the pa- tient as much as when taken into the stomach. When the dis- ease has been of long continuance, however, or the patient feeble and emaciated, the vomiting will be best effected by the third preparation of lobelia taken into the stomach.. Astringent, or anti-canker medicine.—In the latter stages of the disease, or during any period when the tongue is coated and manifests a tendency to clean, a strong decoction of bayberry or sumac, or of the two combined, must be given as often as once a day. In every case of St. Vitus' dance that I have attended, there has been a false membrane discharged from the bowels, and flakes of a similar substance thrown off by vomiting, about the time the disease gives way. Indeed I have some- times been inclined to believe that a coating of thickened secre- ST. VITUS' DANCE. 239 tions over the mucous membrane of the stomach and bowels wTas a principal cause of the disease being protracted. The fact that patients recover soon after such a substance is observed to pass from the bowels, furnishes some proof in support of this opinion. May it not be the presence of a false membrane lining the sto- mach that renders this organ so extremely insensible to the im- pression of lobelia, observable in many instances in St. Vitus' dance. The No. 3 pills will answer in the place of the astringent teas, and are much more readily taken. From three to six of these pills may be taken three or four times a day on an empty sto- mach. Sea Bathing has been found particularly beneficial in the cure of St. Vitus' dance. The diet must be nourishing, and easy of digestion, such as boiled milk and toast, stale bread, crackers, fresh beef and mut- ton, poultry, eggs, custard, boiled rice, and all wholesome ve- getables. All kinds of confectionary, cakes, hot bread, and pastry, must be avoided. The supper should always be light. When St. Vitus' dance is dependent upon, or associated with, obstructed menstruation, the method of treatment already laid down will he appropriate to the case. Particular attention, however, will be necessary to keep the feet dry and warm, and to use frequently warm foot baths. When the period arrives when the patient expects to be unwell, stimulating enemas should be administered to the bowels, composed of pennyroyal tea, ad- ding a teaspoonful of lobelia powder to each, or of bayberry tea, with the addition of a teaspoonful of the third preparation of lo- belia; the foot bath used daily, and the patient drink freely of composition or pennyroyal tea, and if the general health be much deranged, an emetic given. If there be much pain in the back or loins, the patient should be kept warm in bed, and bottles of hot water or hot bricks wrapt in damp cloths applied to the back and feet. SECTION X. TETANUS.—LOCKED JAW. Causes."^Locked jaw is sometimes caused by wounds; in other instances it is brought on by exposure to cold, when the vital powers are in an enfeebled condition. Sleeping in the open air, is very commonly an exciting cause of tetanus in hot climates. The use of narcotic poisons may also occasion tetanus. Wounds of the head, gun-shot wounds, and punctured wounds in the soles of thefeet, and palms of the hands, are the kinds most apt to oc- casion locked jaw. "Tetanus is particularly apt to follow wounds in which a nerve is partly divided or lacerated, without being completely divided." Symptoms.—This formidable disease usually comes on in a gradual manner. At first there are pain and stiffness in the back of the neck, slight spasms in the muscles of the throat, and dis- tress at the pit of the stomach. In some instances these symp- toms continue several days before the jaws become fixed. As the disease increases, the jaws become stiff and at length immovea- ble; great distress is felt at the pit of the stomach; the whole, or a part of the muscles of the body and limbs become rigidly and tpermanently contracted—the head is thrown backward, and the body is bent either backwards, forwards, or sidewisc. Sudden paroxysms of pain, and retraction at the pit of the stomach oc- cur at freqUent intervals, attended with violent spasmodic con- traction of the muscles. " These paroxysms last usually but a few minutes—the muscles of the trunk and extremities resuming for a while, a comparatively relaxed state; but those of the jaws remain firmly contracted during the remissions. In the latter period of the disease, the spasms remit but slightly and tran- siently: the patient is in an almost continued rack of torture; the muscular contractions are general and extremely violent; the countenance becomes frightfully distorted; copious sweats break out; the pulse is quick and irregular; the respiration hur- ried and laborious; the voice grating and unnatural; the eyes dim k and watery, and the jaws immoveably locked. Towards the fatal termination of the disease, slight delirium generally occurs. At this period a severe spasm often terminates the scene." "The usual mode of termination in fatal cases is by apo- plexy. In some instances, all the muscles become completely relaxed a short time before death takes place. The patient LOCKED JAW. 241 seems to have emerged from his terrible malady. Every part of the body is in the ordinary state of relaxation. Suddenly, however, extreme prostration of strength ensues. He becomes insensible and comatose; the countenance assumes a cadaverous expression, and death speedily follows." Duration—Locked-jaw usually terminates before the fifth or sixth day. Occasionally however, the disease is protracted for weeks. Favourable Symptoms—The remissions between the parox- ysms becoming complete and of longer duration; a tingling sen- sation in the extremities, as if ants were crawling over the parts; a moist, and uniformly warm skin; an increased flow of saliva from the mouth; " and above all when the patient enjoys sleep," strong hopes may be entertained of an eventual recovery. Locked jaw occasioned by causes whicli operate upon the sys- tem generally, such as sleeping on damp ground, or sudden ex- posure to extreme cold, is in general less fatal than when the dis- ease is caused by wounds. Preventive means in case of Wounds.—For severe wounds, more especially gun-shot wounds, especial care should be ob- served to prevent the admission of cold or damp air to the wound. This will be the surest means of protecting the patient from locked jaw. Warm stimulating poultices must be applied to the parts to favour suppuration. When a punctured wound is received in the palm of the hand or sole of the foot, for instance, from a nail or pin, the wound should be cut open, and No. 6 or spirits of turpentine poured in, and this repeated several times a day, and a warm poultice ap- plied, with a view to occasion suppuration. Locked jaw rarely or never occurs from such wounds when they discharge matter. "It has been observed," says Dr. Ewell, " that the less inflam- mation there is in the injured part, the greater will be the lia- bility to tetanus. This circumstance has suggested the propri- ety of exciting inflammation in the wounded part by means of irritating applications." In almost every instance where locked jaw has been brought on from punctured wounds, as when a nail has penetrated the foot, the disease has not appeared until after the wound has closed, and the part free from inflammation. If the patient be dyspeptic, or the general health otherwise deranged, a course of medicine must be given, followed by the free use of composition or capsicum, with a view to keep a de- termination to the surface. "An equable and comfortable tem- perature, with a simple diet, and rest, arc important auxiliaries in preventing this disease after wounds." 2 F 242 LOCKED JAW. Treatment of Locked Jaw.—On the first appearance of symp- toms which indicate the approach of locked jaw, such as slight spasms in the throat, a sense of stricture and distress at the pit of the stomach, and stiffness in the neck and shoulders, a tho- rough and persevering course of treatment must be instituted. The means chiefly to be relied upon, are vapour baths, the third preparation of lobelia, and powerfully stimulating injections. A full course of medicine must be administered without delay; after which the third preparation must be continued in teaspoon- ful doses, in bayberry tea, repeating the dose every hour or two as the circumstances of the case may require. When the symp- toms are severe, the third preparation may be given in table- spoonful doses, and repeated as often as every half hour, until the symptoms assume a more favourable aspect, when the quan- tity may be lessened accordingly. Steaming is highly important in the treatment of locked jaw, and in the early stage of the disease, and when the patient can sit up without difficulty, the vapour bath should be administered two or three times a day. The patient should be dashed with cold water at the close of the steaming, and after being rubbed dry, the surface bathed with No. 6, and when the patient is in bed, hot bricks, or bottles of hot w7ater, wrapped in damp cloths, applied to the feet. Injections composed of a teaspoonful, or even a tablespoonful of the third preparation of lobelia, in bayberry or composition tea, must be administered at intervals of every two or three hours. The strictest caution must be observed to protect the patient from the influence of cold air on getting out of bed, when he is in a perspiration. Unless the air in the room be at the summer temperature, the patient should continue under the bed- clothes. When there is great difficulty in swallowing, the injections retained several minutes, and frequently repeated, will prove nearly, or quite as beneficial as if the medicine were taken into the stomach. When the spasms are violent, a tablespoonful of lobelia pow- der may be administered occasionally by injection in lukew-arm water, and retained, with a view to relax the muscles. When the third preparation of lobelia can be retained in the bowels, it should be used in general, in preference to the simple lobelia powder. ■ Wine Whey, or wine alone, may be given in large quan- tities. Wine whey not only affords a stimulous, but it supplies the system with nourishment. The difficulty of obtaining pure wine, more especially in the country, is the chief objection to LOCKED JAW. 243 the employment of this article. Madeira and Sherry are the most suitable, the latter to be preferred on account of its being free from acid, when pure. Quarts, and even gallons of wine have been used daily in cases of locked jaw, with success. If, however, the disease be occasioned by a gun-shot or other wound, attended with inflammation, and the patient have a dry tongue, and hot skin, wine alone will be apt to form acid in the stomach and aggravate the symptoms. Local Treatment.—If the disease arise from a gun-shot wound, or from any injury attended with sloughing, or with symptoms of mortification, a poultice should be applied, prepared in the following manner, viz: To a pound of wheat flour, add half a pint of yeast, and a large tablespoonful of fine ginger, and after mixing them well together, set the mixture by the fire until it be- gins to rise, then spread and apply it. The poultice must be kept warm, and changed morning and evening. When a punctured wound is the cause of locked jaw, the wound should be opened with a lancet or other instrument, and every effort used to excite inflammation and the formation of matter, by pouring spirits of turpentine in the fresh wound, and apply- ing warm stimulating poultices, such as a mixture of slippery elm and cayenne pepper. If the injury be on the hand or foot, the part should be steamed occasionally in order to attract an afflux of blood to the part, and favour the formation of pus. Either a mustard plaster or pepper poultice must be kept ap- plied to the spine, extending from the nape of the neck eight or ten inches down the back. The mustard should not be allowed to cause a blister. The Diet must be nourishing and easy of digestion, such as wine whey, essence of beef, chicken tea, oysters, eggs, custards, milk porridge, kc SECTION xr. HYDROPHOBIA. (bite of a mad dog, or other rabid animal.) This terrific disease is occasioned in the human system by the bite of a rabid animal. The poisonous saliv a from the mouth of the animal is conveyed by its teeth into the wound, and when absorbed and carried into the system, brings on hydrophobia. When this dreadful disease becomes firmly seated in the sys- tem, there is scarcely the possibility of effecting a cure by any medical treatment. Therefore when an individual is bitten by a mad animal, the most prompt measures should be used to pre- vent the absorption of the poison which may have been deposited in the wound. The most important preventive means, is cutting out the parts that are bitten, or burning with a red hot iron, or with caustic potash. Hydrophobia seldom occurs until three or four weeks after the bite is inflicted. More commonly the disease docs not become developed until the sixth or seventh week after the insertion of the poison. "It is said that the disease comes on much earlier in hot climates than in temperate latitudes." The disease how- ever, may generally, if not always be prevented by cutting out the parts bitten, or by cauterizing it with a red hot iron, down deeper than the wound itself. When persons are bitten through their clothes, the poisonous saliva will in general be rubbed from the teeth as they pass through the clothing. Thus many who have been bitten by mad animals have escaped hydrophobia without having the w7ound either cut out or cauterized with a red hot iron, having relied upon some reputed specific, such as elecampane stewed in milk, or other equally simple preparation, which could have had no possible effect in preventing the absorption of the poison, if it had been deposited in the wound. It is doubtful whether hydropho- bia was ever prevented in a single instance by any of these re- puted preventives. The reason w by the disease has not come on when no other means have been used than those falsely called preventives, is simply because the poison was either rubbed from the teeth of the animal by the clothing, or from some other cause did not happen to be deposited in the wound. A case of hydrophobia occurred not long since in Lancaster HYDROPHOBIA. 245 county, Pa. The patient after being bitten by a mad dog, used no other means to prevent the disease than a preparation that was supposed to be a certain preventive to the disease. Poison, however, happened to be deposited in the wound, and being al- lowed to remain there, it was absorbed, and by contaminating the system, brought on hydrophobia, of which the patient died. Means to be employed to prevent Hydrophobia.—Any one on be- ing bitten by a mad dog, or other rabid animal, should immedi- ately have the wound washed with cold water, and then, as soon as possible, have the surrounding flesh cut away, as deeply as the wound had penetrated, or sear the whole of the wound with a red hot iron, or with caustic potash, in order to remove or destroy the poison. The sooner the parts are cut away, or cauterized, after the bite, the more certainly will it prevent hydrophobia. If this should have been neglected at first, even for several days after the bite, it should still be done. Doctor Marshall Hall on the treatment of hpdrophobia makes the following observations : "But the most important point in practice is to excise the part on which the bite has been inflicted, early, nay immediately, if possible, but late rather than not at all: indeed it is not too late if the symptoms have not yet appeared." Besides the local treatment above mentioned, constitutional treatment should at once be instituted, with a view to assist the constitution to expel the poison from the system, in case there should be a portion of it absorbed. A course of medicine must be administered every few days, and the patient take broken doses of lobelia; drink skull-cap tea; keep the bowels regu- lar by the use of injections; have a vapour bath administered every day, and use light nourishing food. When the above pre- ventive measures are early employed, there would be scarcely the possibility of the occurrence of hydrophobia. Symptoms of Hydrophobia.—"The only symptom which is never wholly absent in this disease, as it affects the human species, is the extraordinary dread or horror of liquids—more especially of water. Patients labouring under rabies, may indeed some- times experience a temporary abatement, or even absence of this torturing symptom, but in all instances it occurs in a greater or less degree, and generally remains throughout the whole course of the malady. In general the mere sight of liquids, or the sound of pouring water from one vessel to another, brings on violent suffocative spasms; and the attempt to swallow water, or to bring it to the lips, commonly excites a degree of horror and agitation truly frightful. Even the sight of polished surfaces, as of a mirror, or the rustling sound of bed curtains, or of run- ning water, will in the more violent grades of the disease, imme- 246 HYDROPHOBIA. diately renew the spasms and feeling of horror. Occasionally, however, this extraordinary horror is only manifested against water; for patients have been known to take small quantities of other fluids, as of soups, milk, and wine, in a luke-warm state. The thirst is always extremely urgent, and although the suffer- ing from this source is generally very great, the patient does not attempt to swallow any liquids. The secretion of saliva is pro- fuse, and from an inability to swallow7 it, the patient continu- ally spits it out in every direction, often desiring those around him to stand aside, as conscious that he might thereby injure them. During the whole course of the disease occasional remis- sions occur. Whilst these continue, the patient often appears calm, talks deliberately about his feelings or his affairs, and cautions those about him not to approach him too closely when under the paroxysm of madness, lest he should injure them. Not- withstanding this partial calm, there is always a peculiar wild- Bess and appearance of alarm in the expression of the counte- nance; the motions are quick and hurried; the eyes cast about with an air of suspicion; and if the patient attempt to lie down and obtain some rest, he usually soon starts up again with great agitation and anguish of feeling. During the exacerbations, the expression of the countenance is wild, furious, agitated, and ago- nizing; the eyes are blood-shot, sparkling, projecting, and ex- pressive of rage and terror; the muscles of the face, throat, and chest, and sometimes of the extremities, are thrown into spasms; respiration is interrupted or convulsive; the arms are thrown about; the fists clenched: the teeth violently gnashed; the mouth foaming; with an unconquerable disposition to bite every thing that comes within the patient's reach. In violent paroxysms furious and maniacal ravings occur, attended often with an en- tire absence of consciousness. These paroxysms usually last from about fifteen to thirty minutes." There is seldom any fever in hydrophobia, except sometimes in the later period of the disease. The pulse is generally natu- ral, except towards the termination of the disease, when it be- comes quick, irregular, and weak. The countenance is pale, except during the paroxysms,—then the face is turgid and flushed. The power of generating heat in the system is almost suspended, the patient being extremely sensitive to cold and shudders at the slightest gust of air. The skin is dry and con- stricted, the bowels inactive, " and the blood drawn from a vein is often dissolved and very fluid." Duration of the Disease.—Hydrophobia, in most instances, ter- minates fatally by the second or third day from its commence- ment. It has, however, occasionally been protracted to the fourteenth or fifteenth day. HYDROPHOBIA. 247 Treatment.—When symptoms or* approaching hydrophobia ap- pear, such as, spasms in the throat, and a dread of water, prompt and energetic treatment must at once be instituted. The vapour bath, and preparations of lobelia are the means chiefly to be re- lied upon. Third Preparation of Lobelia.—This must be given in table- spoonful doses, and frequently repeated. Injectiens composed of two or three teaspoonsful of lobelia powder in luke-warm water must be administered and retained, with a view to relax the system and equalize the nervous influence. This form of injection should be repeated so as to cause the system to be con- tinually relaxed. A tablespoonful of the third preparation of lobelia may be occasionally added to the injection, for the pur- pose of stimulating the peristaltic action of the bowels, and to aid the curative efforts of the constitution to resist the disease. When the patient cannot swallow liquids, injections are to be chiefly relied upon. Especial care will be necessary to protect the patient from the influence of cold air. The Vapour Bath.—From experiments that have been made in France, the vapour bath promises to be the most effectual means for the cure of hydrophobia that has ever yet been tried. A physician in France by the name of Buisson, who, on being attacked with symptoms of hydrophobia, went into a vapour bath at the temperature of 140% and after remaining there some time, all the symptoms of hydrophobia left him, and he came out of the bath entirely cured. This took place in the first onset of the disease,—the only time, probably, when this or any other remedy will prove successful. M. Buisson, in a paper which he read before the Paris Academy of Arts and Sciences, wherein he details his own case, asserts also that he had, since this ex- periment upon himself, treated eighty cases of persons bitten by mad dogs, and succeeded by the use of vapour baths, in curing or preventing the disease in every case, except in that of a child who died during the treatment. There cannot be a doubt that the vapour bath is the most effect- ual means of removing poison from the blood. The bath should therefore be early and perseveringly applied, keeping the patient in as long as it can be borne, which, in some instances, will be several hours. The temperature of the bath should be as high as the patient can bear. About the time the patient is to leave the bath, a full dose of the third preparation of lobelia should be given. The bath must be repeated at frequent intervals, say every few hours, as long as it promises any hope of being suc- cessful. SECTION XII. NEURALGIA—TIC DOULOUREUX. Symptoms___This form of disease is characterized by a suc- cession of darting pains, which come on and pass away with the suddenness of an electric shock, shooting along the course of the affected nerve. " It comes on in sudden paroxysms, with longer or shorter intervals of more or less complete freedom from suffering. In general, much pain is experienced throughout the whole course of the paroxysm, with frequent transitory shocks of darting pain, so extremely agonizing as often to cause a temporary loss of reason and consciousness." When the dis- ease is seated about the head or face, the surrounding parts, du- ring the paroxysms of pain, are extremely tender, and usually somewhat swollen; the slightest touch suddenly causing severe darting pain. " In very violent attacks of the disease, we gen- erally find the neighbouring muscles affected with spasms, and occasionally spasmodic twitchings occur in the muscles of parts distant from the place where the pain is located. When the disease occurs in the nerves of the face, the saliva is often se- creted very copiously, and in nearly all instances of this kind, there is a profuse flow of tears from the eyes during the parox- ysm." It frequently happens in recent attacks of the disease, that the paroxysms come on at a particular hour of the day, preceded by coldness of the extremities, and sometimes chilliness; observing as much regularity with regard to the time of its coming on and passing aw7ay by perspiration, as regular intermitting fever or ague; the patient, during the interval between the paroxysms, being quite free from pain. Of its Location.—Neuralgia is most apt to attack the nerves of the face and jaws; still, any portion of the nervous system is liable to be diseased in this way. The optic nerve has occasionally been affected with neuralgia, *> the pain being described by the patient, as severe as if a red hot *' needle were passed through the centre of the eye. The nerves of the extremities are liable to neuralgia, the parts becoming suddenly swollen and inflamed, and shifting about from one part to another, so that a part that is extremely pain- ful, tender, and inflamed one day, may be entirely free from NEURALGIA. 249 pain or soreness on the following one, another part having become affected. This form of disease is generally called flying rheum- atism. It is of no importance in practice whether the disease be called neuralgia or rheumatism, except that in neuralgia mus- tard plasters or pepper poultices should be applied to the spine : the constitutional treatment is to be conducted upon the same principles in both forms of disease. When the great sciatic nerve that passes through the hip near the head of the thigh bone is affected, it is called sciatica, or sciatic pain. Causes.—Neuralgia is in the majority of instances occasioned by taking cold, or from other causes by whicli the stomach and bowels are disordered. Frequently, however, it is produced by local causes, such as decayed teeth, wounds of the scalp, and injury of a nerve. Case.—Mrs. R----, of South wark, struck her forehead about the middle of the eyebrow, against the corner of a stone door. Shortly after the accident she was seized with yiolent pains in the part, and, shooting over that side of the head, it became swollen, and evidently larger than the opposite side. On taking cold, or when the system became disordered from any cause, the patient was apt to have violent paroxysms of darting pain in the side of the head, which was generally re- lieved by a sweat and emetic. The disease continued to return at intervals, during a period of two years. A singular circum- stance connected with this case, was that the teeth of the upper jaw of the affected side, became entirely encased with tartar, ex- cepting their crowns. Case—Miss ----, of New Jersey, had been subject to fre- quent attacks of neuralgia in one side of her face during a pe- riod of eighteen months, accompanied with loss of digestion and continued painful diarrhoea. This patient experienced scarcely any benefit from medical treatment until she had some decayed teeth extracted from the upper jaw of the affected side, upon which the pains ceased, and her general health was restored. 0 Treatment—There are few cases of neuralgia in which the stomach and bowels are not prominently disordered in the first stages of the disease, requiring the employment of emetics to cleanse the stomach, and the use of stimulants and external warmth to promote perspiration. Of the Vapour Bath.—Whether the disease be of recent occur- rence, or of long continuance, the use of the vapour bath is par- ticularly indicated. There are probably few physicians who 2 G 250 NEURALGIA. have used the vapour bath extensively in neuralgia that have not sometimes found it to cure the disease after every other remedy had failed. In the treatment of neuralgia it is of the greatest importance to bring on perspiration, and favour its continuance by the application of external warmth, together with the use of pure stimulants internally. After a vapour bath the affected parts should be anointed with the stimulating liniment, or other stimulating preparations : No. 6, or third preparation of lobelia. Emetics are peculiarly beneficial in all recent cases, and when- ever the disease is occasioned by constitutional disorder. I have repeatedly observed immediate and complete relief afforded by the operation of an emetic. Even when tic douloureux is produced by local causes, such as decayed teeth, or injuries of the head, emetics, especially when preceded by the vapour bath, will prove the most effectual, and sometimes the only means of relief. Injections are beneficial when the disease is fixed about the head, accompanied with a determination of blood to the head, and coldness of the feet. Cases of this kind may, very gener- ally be relieved by placing the feet in warm water, and employ- ing a stimulating injection to relieve the bowels, followed by one composed of lobelia powder and warm water, and retained with a view to relax the system, and equalize the circulation. Stimulants.—When the attack is violent and protracted, be- sides the use of emetics, and the vapour bath, the patient should take freely of capsicum or composition, together with broken doses of lobelia. Compound Lobelia Pills.—When the disease has become deep- ly seated, requiring a long course of treatment, the above pills may be substituted for other stimulants, and the No. 3 pills may be used as anti-canker medicine. Charcoal.—A superabundance of acid in the stomach commonly attends neuralgia, for which I have found the purified charcoal a valuable remedy. It may be prepared in composition or spice , bitter tea, and taken three or four times a day. The charcoal .» %\ is more particularly adapted to chronic cases of neuralgia, at- ^ tended with acidity of the stomach, and costive bowels. When the disease occurs periodically, like ordinary ague, the patient being free from pain during the interval between the paroxysms, the case should be treated precisely as a case of in- termitting fever or ague: first by cleansing the stomach, and using NEURALGIA. 251 freely of pure stimulants until the tongue begins to clean, and the secretions of the skin and mucous membrane are restored ; and then by giving freely of tonics, of which Peruvian bark or quinine are the most efficient. In neuralgia of the extremities, usually termed flying rheum- atism, besides the constitutional treatment already described, benefit may be derived by stimulating applications along the course of the spine, stimulating liniment, mustard plasters, or pepper poultices. For " ague in the face," which is only another name for neu- ralgia, Dr. Thomson recommends a portion of cayenne pepper wrapped in gauze or book muslin wet with No. 6, and applied between the cheek and the jaw of the affected side. This will cause the secretions to flow freely, and relieve the pain. I at- tended an old lady in Southwark, who had a severe attack of neuralgia in the lower jaw, who experienced relief by keeping a portion of the liquid of the third preparation of lobelia in the mouth. The greatest benefit, however, was derived from the use of stimulating injections containing a portion of lobelia, to- gether with the vapour bath, and by the system being kept slightly relaxed by broken doses of lobelia. When neuralgia is brought on by decayed teeth, they must be removed before a permanent cure can be looked for. It is not a proper time to extract teeth during a paroxysm of pain, more es- pecially if the jaw should be swollen and inflamed. In sciatica, (neuralgia in the hip,) besides the " course of medi- cine," and general constitutional treatment already described, benefit may be obtained by the internal use of the oil of turpen- tine. A teaspoonful may be taken three times a day before meals. It may be taken mixed with a small portion of honey, or rubbed up with a teaspoonful of sugar, and then adding a little water. Neuralgia of the Stomach is characterized by severe pain at the pit of the stomach, which often darts into the breast and to the spine, and is " rather relieved than aggravated by pressure." The pain is often relieved by taking a full meal, or a draught of stimulating drink. The tongue is covered with a white fur; the appetite variable, sometimes natural, at others craving, and then again extremely indifferent. There is an abundant flow7 of saliva; absence of thirst; and often a repugnance to liquids. The pain which is relieved by eating, is apt to return a few hours after meals, accompanied with a feeling of weight at the stomach; harassing belchings, and extreme depression of mind. In severe cases " the patient sometimes experiences difficulty of breathing, palpitations of the heart, wandering pains and peculiar sensations of coldness, especially in the arms, loins, and lower extremities. The sleep is sometimes good, sometimes agitated, and sometimes 252 DROPSY. the patient is unable to sleep at all: yet in the morning the pa- tient gets up refreshed, and feels quite well, till breakfast renews the suffering. Many of the symptoms attending neuralgia of the stomach, are such as frequently accompany ordinary dyspepsia, so that it may be difficult to determine whether the disease be ordinary dys- pepsia, or neuralgia. The same general plan of treatment, how- ever, will be suited to each form of disease, varying the reme- dies to suit the emergency of the case. When the symptoms are very distressing, a course of medicine will be proper, more es- pecially when the distress comes on after meals. A teaspoonful of the tincture of lobelia, taken in a tablespoonful of warm water, or mint tea, will seldom fail of relieving neuralgic pains in the stomach. It may be necessary, however, to repeat the dose. "I have myself," says Dr. Eberle, "suffered much from this complaint, (neuralgia of the stomach,) and have taken opium in large doses; but I have found another remedy, which is less ruinous in its consequences, and far more permanent in its good effects, than this narcotic. This remedy is the saturated tincture of lobelia inflata; a few tablcspoonsful of which has never failed to give me speedy relief, and to procure me long intervals of ex- emption from the disease. I have also," says the Doctor, " used it in the case of a gentleman in this city, with the happiest effect, but further than this my experience in the use of this article does not go." Stimulating Liniments, and various volatile lotions, may be applied externally with much advantage in cases of neuralgia. CHAPTER VIII. SECTION I. DROPSY. Dropsy is an unnatural accumulation of fluid in one or more of the cavities of the body, or in the cellular tissue, interposed , ^ between the skin and flesh. Classification of Dropsy.—1st. Ascitis—When the fluid is col- lected in the cavity of the abdomen. 2d. Hydrothorax,—When the effusion takes place in the cavity of the chest. 3d. Anasarca,—Dropsy in the cellular tissue. DROPSY. 253 In many instances dropsical effusions take place in various parts of the body at the same time. Thus in some patients there are ascetis, hydrothorax, and anasarca, all at once. General Causes of Dropsy.—These are, "obstructions to the flow of venous blood," arising from disease of the liver, heart, or lungs: excessive loss of blood; disease of the kidneys; debil- ity, especially after scarlet fever and measles; chronic diarrhoea; the use of arsenic; purging with drastic cathartics; or the abuse of mercury. In marshy districts of country dropsy often succeeds imperfectly cured ague. Exposure to wet and cold fre- quently causes dropsy in those predisposed to this form of dis- ease. In a great majority of cases dropsy comes on gradually; yet, in some instances the dropsical condition has been experienced very suddenly. Professor Chapman mentions the case of a gen- tleman from Virginia who, by plunging into a cold bath, the body being at the same time greatly fatigued and in a free per- spiration from severe exercise, brought on a dropsical effusion in a few hours after. Another gentleman from South Carolina went into a very hot water bath, after a fatiguing ride on horse- back one very hot day, and was also taken suddenly with dropsy. In another instance dropsy was suddenly produced by a person lying down on the ice, who was much fatigued by skating. He was seized with cold, which was followed in a few days by dropsy. The General Symptoms of Constitutional Disorder attending Dropsy are, languor and lassitude; paleness of countenance; a dry and husky skin, without any tendency to perspiration; gen- eral coldness and torpor of the system; scanty and high-colored urine; constipation of the bow7els, or the stools of an unnatural appearance; and the appetite variable, yet generally impaired. Dropsy is the effect of an obstruction in some important or- gan, or of general debility and derangement throughout the sys- tem. 1. Ascitis—Dropsy in the cavity of the Abdomen.—Dropsy in the cavity of the abdomen is generally associated with an exten- sively diseased liver or spleen, occasioned, in most instances, either by drunkenness, long-continued agues, or inveterate dys- pepsia. Dropsy, however, being the effect of previous disease and debility, may therefore be produced by almost any debili- tating influence, such as cold and dampness, a sudden check to perspiration, confinement in foul air, or the use of unwholesome food. Pregnancy, and tumours in the cavity of the abdomen, have, 254 DROPSY. in some instances, been mistaken for dropsy. A collection of water in the cavity of the belly, however, may be very readily distinguished from a tumour, or from pregnancy. One of the surest means for ascertaining the presence of water, is by plac- ing the palm of the hand on one side of the belly, and with the other hand to tap lightly on the opposite side, which will cause a distinct fluctuation or wave to be felt by the hand placed on the abdomen, provided there be a collection of fluid within. In drop- sy the swelling is uniform on both sides of the abdomen, and when the patient lies on the back, the liquids will press out the sides and flatten the middle; whereas, in pregnancy or tumours, there is usually more swelling in one side, and the form of the swelling is but slightly altered by lying on the back. A collec- tion of water in the cavity of the abdomen will occasion difficulty of breathing, from the pressure of the fluid upon the diaphragm, when the patient lies down with the hips raised higher than the chest. Dropsy is attended with symptoms of constitutional dis- order, which are mostly absent in pregnancy. Dropsy of the abdomen has been cured in many instances by the Thomsonian practice, when other plans of treatment have failed. 2. Hydrothorax—Dropsy in the Chest.—Dropsy in the chest, like other forms of dropsy, is the consequence of a disor- dered condition of the general system, or arises from obstruction in some important organ. In this form of dropsy patients sel- dom experience much inconvenience from it, until the accumula- tion of water becomes so great as to interfere with respiration. The dropsy may take place only in one side of the chest, yet more commonly the effusion occurs in both sides. Distinguishing Symptoms.—These are, a dull sound produced by percussion, (tapping on the chest with the ends of the fingers.) whilst the patient is in a sitting posture. Great difficulty of breathing produced by pressing firmly upon the abdomen, just below the ribs, which, by forcing up the diaphragm, causes the water to rise in the chest, and thus it interferes with respira- tion. A sense of suffocation on lying down; " starting during sleep;" great agitation: and an habitual cough. The symptoms above mentioned, however, may attend other forms of disease, without there being an accumulation of water in the chest. Thus asthma and disease of the heart may occasion the same oppression of breathing that occurs in dropsy of the chest. The same difficulty of lying down attends asthma as in dropsy of the chest. Asthma, however, usually comes on by paroxysms, whereas in dropsy of the chest the oppression of breathing and inability to lie with the breast low continues DROPSY. 255 without intermission. If, together with the symptoms before mentioned, characterizing dropsy of the chest, there be a ten- dency to dropsy in other parts, as in the feet, and beneath the skin covering the chest, sufficient evidence will be afforded to war- rant the conclusion that there is water in the chest; and although it may be difficult to determine whether the disease be dropsy, asthma, or disease of the heart, it should occasion no embarrass- ment to the practitioner in directing the treatment, for the same general plan of treatment will be equally appropriate to each case. Thus the vapour bath which will relieve asthma, will prove beneficial in dropsy, wherever it may be located. Lobelia, whicli is the most effectual remedy for asthma, is the article chiefly to be relied upon, both in dropsy of the chest, and disease of the heart. In dropsy of the chest or abdomen, a sudden subsidence of the swelling in the legs and feet, without an increased secretion of urine, is an unfavourable symptom, as in most instances the patient dies soon after this occurs, and sometimes very sud- denly. 3. Anasarca—Cellular Dropsy.—This form of dropsy gen- erally commences in the feet, and the swelling ascends, and in some cases extends over the whole surface of the body. Some- times the swelling will be confined to the legs and feet; or to the face, hands, and feet. Pressing a finger firmly against the swelling, will leave an indentation or pit, which will remain a considerable length of time after the pressure has been removed. This serves to dis- tinguish cellular dropsy from swellings arising from other causes. Thus milk-swelling, as it is termed, has the appear- ance of dropsy, but pressing a finger upon it, will not leave such indentations as remain after pressure upon dropsical swel- lings. Generul Causes.—Cellular dropsy is peculiarly liable to occur from exposure to cold after scarlet fever and measles. Females are liable to dropsy of the lower limbs during the later period of pregnancy, in consequence of pressure upon the veins, thus obstructing the circulation. Extreme exhaustion from loss of blood; " exposure to cold when the system is under the influence of mercury; the long continued use of arsenic;" chronic diar- rhoea; "repelled cutaneous eruptions; great debility and ex- haustion; chronic gout; organic disease of the kidneys, &c, are the most common causes of this variety of dropsy. Dropsy of the cellular tissue is more readily cured than dropsy of the chest or abdomen, More especially is it less difficult of 256 DROPSY. cure when it comes on suddenly, and is accompanied by fever and considerable activity of pulse, without great prostration of strength. But when it comes on very gradually, attended with coldness, and extreme torpor of the system, or when it depends upon extensive derangement of important functions, as those of the stomach, liver, kidneys, or spleen, the cure is mostly very difficult. Still more difficult is it when connected with dropsy of the abdomen or chest, constituting general dropsy. Treatment of Dropsy in general.—The most important indica- tion for the cure of dropsy, is to correct the disordered condition that causes it. An occasional course of medicine is the most effectual means to restore a healthy action throughout the system, and it will be required in most cases of dropsy. As a general rule the course should be repeated more frequently in the early stage of dropsy than when it has been oblong standing. Of the Course of Medicine.—1st. The Vapour Bath.—This ful- fils important indications in the treatment of dropsy. It im- proves the condition of the skin—effects a determination to the surface—excites free perspiration—diffuses a natural warmth through the system, and by augmenting sensibility, causes the emetic to operate more effectually. It is an observation of Dr. Thomson's, that one emetic after steaming will prove as effectual in removing disease, as four emetics given without the bath. A vapour bath in the evening will enable a patient to rest more comfortably through the night. Dropsical swellings of the limbs that occur after scarlet fever and measles, may be effectually removed in many instances by the use of vapour baths, together with giving a dose of composition powder three or four times a day. 2d. The Emetic.—The most decided benefit is derived from the frequent administration of emetics, more especially in the early period of dropsy. Cases of dropsy have been cured by spontaneous vomiting. Dr. Eberle mentions a case of dropsy of the abdomen cured by spontaneous protracted vomiting. The relaxation produced by the lobelia, together with the retching and straining effort to vomit, will, in some instances, overcome obstructions in the liver and other organs. In general dropsy, when the internal heat, or constitutional energies are greatly exhausted, and the disease is of long continuance, emetics will be of little use, except as a means of affording relief when there is great oppression at the pit of the stomach. When patients are very low, the emetic should be made of the liquid of the third preparation of lobelia in strong bayberry tea, or infuse the lobe- DROrST. 257 ha powder in the bayberry tea, and add two or three teaspoons- ful of No. 6 to each dose of the emetic. In the earlier period of the disease, and more particularly if fever exist, the system should be relaxed by a fi-ee use of the lobelia. An injection of lobelia powder in luke-warm water, retained, will assist in re- lieving the system, and will also favour the operation of the emetic. Patients sometimes experience much distress during the operation of an emetic, in deeply seated complaints, but re- alize great benefit after the operation, from its effect. 3d. Injections.—If the bowels be costive, an injection should be administered previously to the bath. Stimulating injections, containing a portion of lobelia, exert a beneficial influence, by arousing the nervous energy, and thus give an additional im- pulse to the circulation of the blood, and an increased action to the absorbent vessels. The kidneys may also be stimulated to increased action by injections. To favourtiie operation of the me- dicine, the patient must be kept warm, and take freely of capsi- cum, or composition tea. 4th. A Vapour Bath, after the emetic, completes the course of medicine. The patient should be allowed to remain in bed after the operation of the emetic, as long as he continues in a perspi- ration. When perspiration ceases, the second bath may be ap- plied; and the patient showered with cold water, or washed with spirits, rubbed dry, and the surface bathed with some stimulant, such as No. 6, pepper sauce, or stimulating liniment. After this the patient must be kept warm, either in bed or by being warmly clad, and continue the use of stimulating medicines, to "support the internal heat," and maintain a determination to the surface. Where perspiration cannot he continued, or an in- crease in the secretion of urine he induced, the use of the usual stimulants, capsicum or composition tea will be required. The medicine must be given chiefly in the form of pills, or the pow- ders taken dry, or in a very small quantity of water. The com- pound lobelia pills answer both as a stimulant and relaxant, and they should be taken in sufficient quantity to occasion a slight and continued nausea. Nervines.—Scullcap or valerian tea, may be used at night to promote sleep, or the nervine may be taken with other medi- cine. Diuretics.—In certain conditions of the system, the use of di- uretic medicines will be beneficial, by increasing the secretion of urine. An increased flow of which is among the first symp- toms indicating a favourable termination of dropsy. But where 2 H 25$ DROPSY. the loss of power in the kidneys depends upon a great degree of constitutional derangement, it will be useless to rely upon diu- retics to cure the dropsy. First resort to general constitutional treatment, and as the health improves, diuretics will be benefi- cial. A great variety of diuretics are employed in the treatment of dropsy. The following, I am informed, was a favourite re- medy with the late Dr. Parrish. Take parsley root, English mustard seed, horse radish, and burdock root, grated fine; put them into a stone jug with a pro- per portion of sound cider. To be taken several times a day. If this should increase the flow of urine without occasioning un- pleasant feelings in the stomach, it should be continued as long as it is found to be agreeable. A strong tea of the sumac, more especially of the roots and berries, answers in some instances as a diuretic, besides the im- portant indication which it fulfils of cleansing the stomach and bowels of " canker." Oil of Juniper.—The diuretic effect of Holland gin depends upon the oil of juniper contained in it. Juniper oil is one of the best of diuretics, and may be used with advantage in many cases of dropsy. The dose of the oil is from five to fifteen or even thirty drops, rolled up with a teaspoonful of slippery elm powder and sugar, adding a little water before taking. To be repeated three or four times a day. Whilst taking diuretics, the vapour bath may be occasionally administered, and the patient must take freely of the compound lobelia pills, or capsicum tea. In most cases of dropsy of the belly, it becomes necessary to drain off the water by tapping. This, tliough a very easy and safe operation, requires to be done by one acquainted with the operation. I shall, therefore, not attempt to give directions for performing it, but merely observe, that I have found a thumb lancet the best instrument for tapping in dropsy; a canula closed at the end and perforated with'holes to admit the escape of the fluid, is to be incerted when the lancet is withdrawn. With a lancet in good order, the operation of tapping does not occasion more pain to the patient than is caused by bleeding in the arm. The trochar{the instrument generally employed for tapping) has no advantage whatever over the lancet, and with the latter the operation can be performed with much less difficulty, and with ' one tenth of the pain to the patient that would be caused by the introduction of the trochar. In some instances the operation of tapping requires to be several times repeated. There are cases recorded where the operation has been performed more than one hundred times in the same patient. Even in cases where there is no probability of a cure being effected, the operation of tap- DROPSY. £59 ping will frequently bo called for as tho only means of relief to the patient. Tonics—When the disease has been of long standing, the stronger kinds of tonics should be used, more especially after a few courses of medicine have been administered. A strong tea of quassia, wormwood, balmony, or golden seal, may be taken once or twice a day, together with the pills before mentioned. External application.—Bandaging the swollen parts, more especially the legs and abdomen will be beneficial; and after tapping the use of a bandage becomes indispensible. Before ap- plying the bandage, the stimulating liniment, No. 6, or pepper sauce must be applied to the skin; or the bandage must be wet with strong salt water, and dried before it be applied. Fric- tions of the surface with a salted towel or flesh brush will be of more or less benefit. Elaterium, or the squirting cucumber, is a remedy generally employed in the treatment of dropsy by physicians of the old school. It is a powerful cathartic, acting with great violence upon the stomach and bowels, often exciting inflammation and sometimes occasioning death. The elaterium will sometimes remove the water, but the injury which it does to the digestive organs, will more than counterbalance the benefit derived from the reduction of the dropsy. Dropsical affections removed in this way are almost sure to return, except when the effusion is confined to the lower extremities, and which might have been removed by vapour baths and the use of composition. And when dropsy returns, after having been removed by the use of elaterium, or other hydrogogue cathartic, the digestive powers being prostrated by the cathartic, will increase the difficulty of permanently effecting a cure. Dr. Thomson in his Narrative makes mention of several cases of dropsy, in which he succeeded in effecting a cure, after the regular practice had failed, and the disease had been considered as incurable. He treated them upon his general plan of giving freely of the " hot medicine, to support inlerual heat, and to con- tinue perspiration, assisted by external warmth, and occasional- ly by a course of medicine. And in dropsy of the abdomen, he drew off the water by tapping, in the usual way, after passing the patient through several courses of medicine, in order to re- store a more healthy action in the system, and thus lessen the liability to a return of the dropsy. The character of the fluid drawn off by tapping varies in dif- ferent cases. Sometimes it will be high coloured like strong 260 crcrsY. coffee, or it may be thick and ropy; more frequently, however, it resembles ordinary urine. Hydrocele, or dropsy of the scrotum.—When this occurs in in- fants, as it sometimes does at birth, it is called congenital hydro- cele. It may he distinguished from hernia, by the transparency of the parts, and the absence of slight vermicular motions. It is generally readily cured in infants and children, by applying some mild stimulant, the scrotum being kept in a suspensary bag, by which moderate pressure upon the parts is maintained. Hydrocele in adults, frequently demands the operation of tap- ping the scrotum. From a tendency to a reaccumulation of the water, the operation will require to he repeated many times, in some cases, before a cure takes place. The late Dr. Physic re- lied almost exclusively on tapping for the cure of hydrocele, re- peating the operation until the water ceased to accumulate. Hydrocephalus—Dropsy in the Brain.—Effusion of water in the brain rarely occurs except in children, between two and five years of age. Symptoms.—Pain in the head, especially across the brows, or in the back of the neck; constant motion of one or both hands; sickness and efforts to vomit; a disposition to be in a lying pos- ture; a deranged condition of the bowels; an eruption on the face, resembling very minute drops of water; stupour and con- vulsions, attend dropsy of the brain. The above symptoms usually accompany hydrocephalus. Pre- cisely the same group of symptoms occur, how ever, without there being any effusion of water on the brain. Dr. Chapman recently attended in consultation on a case, where there was every cha- racteristic symptom of dropsy of the brain, but on examination after death, there was no appearance of water in that organ. Causes—An originally feeble constitution; exhaustion from disease; exposure to wet and cold; together with the reducing plan of treatment practised by the medical profession, constitute the principal source of dropsy of the brain. Severe attacks of diarrhoea or infantile cholera, arc frequently attended with effu- sion of water in the brain; the dropsy being merely a link in the chain of effects resulting from loss of vital power. Active purg- ing, when the system is in a state of exhaustion, may occasion symptoms indicative of hydrocephalus. Dr. Travcrs, who in reputation is excelled by few in the pro- fession, advances the opinion, that the depletive treatment pur- sued bv the profession occasions, in many instances, those symp- dropsy. 261 toms indicative of dropsy in the brain, whicli so frequently are found in children. A physician discovers symptoms of inflammation in the head, and adopts a depletive course of treatment under the false im- pression that the inflammation is the source of danger. A child is taken, for instance, with cholera morbus, and the purging and vomiting continuing for some time, the brain consequently becomes exhausted, and nature sets up her restorative action, oc- casioning symptoms of inflammation of the brain: this feverish or inflammatory action is the means which nature employs to restore the lost vitality of the brain, and to sustain its functions, and these curative efforts should be aided instead of being pros- trated by a depletive course of treatment. Where the pulse is strong, and the skin hot, the chances of a cure are much greater than when there is general torpor and a cold skin. Treatment.—The existence of dropsy in the brain cannot be determined to a certainty, as the symptoms which attend collec- tions of water in the brain also accompany an inflammatory ac- tion in it. Precisely the same symptoms also arise from determi- nations of blood to the head from exhaustion of strength. The treatment, however, applicable to one case, will be equally suit- ed to a similar condition of the general system in the other. The treatment must be directed to assist the efforts of nature. The means to be employed are injections, the vapour bath, emetics, the warm foot bath, volatile stimulants applied to the head, whiskey or vinegar, together with frequent doses of stimulants, which may be rendered more efficacious by the addition of small portions of lobelia. Sometimes an oppressed stomach will occasion symptoms re- sembling those arising from inflammation of the brain, and be entirely relieved by the operation of an emetic. Even though there should not be foul matter burthening the stomach, still a lobelia emetic may prove beneficial, more especially if there be fever. Where there is an active determination of blood to the brain, accompanied by fever, the system must be kept under the influence of lobelia in broken doses, taken into the stomach, or adminis- tered by injection to the bowels. For although an inflammatory action be necessary to the lost vitality of the brain, still there may be an undue determination of blood, and concentration of nervous influence to the head, which may require to be regulated by the* means above mentioned, together with the use of the vapour bath, foot bath, pepper poultices or mustard plasters to the feet, and * cooling applications to the head. The strength is to be supported by the use of the stimulants usually employed, and by a light nour- ishing diet. In fine, inflammation, dropsy, and all other disor- 262 SCROFULA. ders of the brain, arisiug from constitutional disease, are to be treated upon the same general principles. Sijmptoms denoting a recovery.-—A heavy sediment in the urine, or if it have a foetid smell, the pulse softening, and a run- ning from the nose. This last, denoting the restoration of the se- cretions of the nose, is to be depended upon more than any other symptom, as indicative of a recovery. Bad Symptoms.—Blindness or deafness, deep stupour, spasms, a copious discharge of pale urine, watery discharge from the bowels, and twitchings of the muscles are symptoms which indi- cate an unfavourable ^termination of the case. CHAPTER IX. SECTION I. SCROFULA. The name* scrofula is applied to forms of disease differing materially in their general aspect. Thus, a child afflicted with sore eyes is said to be scrofulous; another has an eruption on the skin which is called scrofula; a third will have a disease in the hip, which receives the name of scrofula; whilst a fourth has swellings in the glands of the neck, also called scrofula. These are forms of disease which are apt to occur in persons of delicate and feeble constitutions, generally termed scrofulous. Children possessing what is called the scrofulous constitution are usually of small frame, with pale and delicate skin; the mus- cles imperfectly developed, the flesh being soft and flaccid, with light hair, blue or grey eyes, long eye-lashes and large upper lip. The head (particularly the posterior part) is usually large, and the temples flattened or somewhat depressed. There is, in gen- eral, a great proneness to slight catarrhal affections during which the wings of the nose and the upper lip are apt to become swollen. The edges of the eye-lids are much disposed to become inflamed, and when the scrofulous tendency is strongly devel- SCROFULA. 263 oped, the tarsi (under edge of the eye-lids) "are constantly red and tender." The digestive powers are feeble, the appetite va- riable, and the bowels seldom in a healthy condition. The pa- tient is very sensitive to cold, and his temper generally irritable. The intellectual powers are usually very strong. In female children of scrofulous constitution, "a leucorrha^al discharge is apt to occur from time to time; and in very young children, excoriations behind the ears, scaly eruptions about the head, and lips," and sore eyes are frequently observed. It very often happens that children exhibit a strong tendency to scrofula, but become healthy without the disease having ever become further developed, except occasionally by slight swrellings in the glands about the neck. Sometimes the disease breaks out early in life, and in others it does not appear until after the age of puberty. In some the disease is of short duration, the patient soon becoming entirely healthy; in others the constitution sinks under the ravages of the disease, and the case terminates fatally, most commonly by tubercular consumption. Occasionally the disease breaks out in childhood, and continues for years, or even during a long life, the patient enjoying tolerably good health with the exception of swelling of the glands about the neck, and probably more or less discharge of matter from those that have suppurated; or if the disease be located in the hip, the patient may recover, except from the lameness and deformity which al- most always follows as a consequence of the hip disease. Causes.—Although scrofula is far more likely to occur in children of a peculiar delicacy of constitution, still it is occasion- ally observed in those who have inherited sound constitutions. The disease essentially consists in debility and obstruction in the glands; and the same cause, for instance, exposure to cold, producing obstructions in the glands of one of a scrofulous con- stitution, may, by frequent repetition, together with unwholesome diet and confinement in close apartments occasion the disease in one of a naturally good constitution. Children are especially liable to slight swelling of the glands under the jaw and on the neck, during teething, and when they have eruptions behind the ears or on the head. Arising from such causes, these slight enlargements of the glands almost al- ways pass away without any attending serious consequences. "A cold, humid, and variable atmosphere, more especially when aided by deficient nourishment, appears to have a strong tendency to favour the development of the scrofulous habit." Children who work in the large cotton and woolen manufacto- ries of England are peculiarly liable to scrofula. The disease also prevails among the children of the poor, when they are bad- 564 a CIO? OLA. ly clothed, sleep in small close rooms, and who live on unwhole- some food, badly cooked. Scrofula frequently occurs as a consequence of taking cold after measles, scarlet fever, or whooping cough. Preventives—"With children who exhibit marks of a constitu- tional tendency to scrofula, a small frame, pale skin, soft and flac- cid condition of the flesh, light fine and thin hair, long and slender neck, with a weak and irregular appetite, an unhealthy condi- tion of the bowels, and a tendency to eruptions about the head, or to swelling in the glands of the neck, means should he employ- ed to renovate and strengthen the constitution, in order to pre- vent the development of scrofula. Regular exercise in the open air. warm clothing, sleeping in a large room, wholesome, nour- ishing food, shower baths, or bathing in cold salt water in the morning, and friction to the surface, are the means chiefly to be relied upon, not only for renovating the constitution and prevent- ing the development of scrofula, but they are also important aux- iliaries in the cure of the disease after it has become manifest. Treatment of Scrofulous Tumours, commonly called Kings Evil—When the glands about the neck become swollen, and hard, but not inflamed, the tumour should be rubbed gently fif- teen minutes, or half an hour, every morning and evening, and a poultice of flour or slippery elm powder wet with salt water applied. The poultice to be kept on night and day, and occasion- ally wet with saltwater. If the appetite be variable, or the bowels are in an unhealthy condition, an emetic or full course of medicine will be of signal benefit in aiding to diminish or scatter the swel- ling of the glands. The course of medicine must be repeated whenever the condition of the patient appears to require it. Compound Lobelia Pills.—One or two of the compound lobelia pills after meals, and at bed time, will be useful, by correcting the secretions of the stomach and bowels, and preventing cos- tiveness. Tonics are proper in every stage of scrofula, when the patient is languid and weak. The spice bitters, gentian, Virginia snake root, quinine, or garden bitters, may be employed, occasionally changing them, as the fancy of the patient, or the judgment of others may determine. The Diet must be nourishing and easy of digestion. Boiled milk and toast, eggs, custards, mutton, the tender part of fresh beef, all kinds of wild game, stale bread and butter, potatoes, and boiled rice, are suitable articles of diet in scrofula. SCROFULA. 265 Fresh air, moderate exercise, cleanliness, salt water baths, frictions to the surface with a flesh brush, or salted towel, are of as much importance in the cure of scrofula as medical treat- ment. Close and crowded school rooms, arc improper places for children predisposed to scrofula. It is equally important for such children to avoid getting their feet damp. It is not sufficient to wear merely tight shoes, but the soles should be very thick, to prevent dampness from penetrating them. It is of lit- tle avail, as a preventive to disease, to clothe the body warm, whilst the feet are unprotected from cold and dampness. When a scrofulous tumour becomes painful and inflamed, warm emollient poultices must be applied with a view to favour suppu- ration, and prevent its being converted into an indolent ulcer. Elm, pounded cracker, white pond lilly and ginger, combined together, and whet with warm water, will form a suitable poul- tice. The poultice may require to be wet occasionally with warm water, to prevent its being hard and dry. If the disease be accompanied by high fever and severe pain, a course of medi- cine will be required, together with the use of broken doses of lobelia, and once or twice a day a teacup half full of strong bay- berry tea, or four or five of the No. 3 pills. If the tumour have been inflamed, throbbing, and at the same time the patient af- fected with chilliness, followed by fever, and after the lapse of some days or probably a week or more, the tumour becomes soft and fluctuates under the fingers, and a blush of red is observed on the skin, the tumour may he opened and the same stimulating poultice applied as long as the abscess discharges; after which some kind of salve or plaster must be applied to protect the part from the influence of the air. Abscesses along the lower jaw, must always be opened from inside the mouth. Of the Indolent Abscess.—It sometimes happens that a scrofu- lous tumour, after being more or less inflamed for a time be- comes soft, and exhibits positive signs of its containing pus, but there will be no pain in the part, and the skin over the tumour will be cool, the patient clear of fever, and the system in a tor- pid condition. This condition of things arises as a consequence of the constitutional strength being too weak to raise or con- tinue the proper degree of inflammation sufficient to carry on healthy suppuration. The efforts of nature subside without ac- complishing its design, and the abscess becomes converted into one of an indolent character, which should not be opened, but stimulating liniments or strengthening plasters applied to the tumour, and the constitutional energies restored by the use of tonics, the vaporr bath, and shower bath; a course of medicine every few weeks to cleanse the stomach and bowels; and a cold 2 I 266 SCROFULA. salt water shower bath in the morning, provided the patient does not remain chilly after it. If a glow of warmth comes on in the course of fifteen minutes or half an hour after the bath, it will certainly be beneficial. These means, together with fresh air and wholesome food, may succeed in causing the absorption of the contents of the abscess; or if it should break, or require to be opened, the constitutional efforts will be better able to carry on the healing process. In all cases where a large abscess is either forming, or has discharged its contents, the most nourishing diet must be allowed the patient to supply the system with strength to carry on her healing operations. In case of cold or indolent abscess, wine whey forms a suitable article of diet when the stomach is too weak to take much solid food. Under circum- stances of this kind bitters must also be used freely. A Scrofulous Ulcer is to be known by "its occurring after a suppurated scrofulous tumour—the peculiar dull red, or purple colour of its edges—its remaining indolent for a length of time, neither increasing nor diminishing in size, and its being attended with that peculiar state of health which invariably prevails in the scrofulous constitution." Treatment of Scrofulous Ulcers.—Constitutional treatment is more important than local applications in the cure of this kind of ulcer. The means above mentioned for cleansing the stomach and bowels, and for improving the health, will be especially adapted to this form or stage of scrofula. Stimulating poultices must be applied to the ulcer, containing a large portion of astringent— either white pond lily, or bayberry, and the poultice wet with a strong tea of the same. Indolent ulcers maybe stimulated to a more healthy condition by filling them with dry, and finely pulverized marsh rosemary, bayberry, or rhattany root, and then apply a poultice or salve over the whole, repeating it morning and evening. " We have known a sea voyage to heal scrofulous ulcers of bad character which had resisted years of medical treatment." Marshall Hall. When a scrofulous abscess, after being evacuated, continues to discharge more or less for a great length of time, it should be syringed with castile soap and water, and in order to stimulate a more healthy action of the parts, inject into the cavity weak ginger tea, or a tea made from the inner bark of a young ches- nut tree, repeating it every day, and apply over the surface a stimulating poultice, or strengthening plaster covered with pep- per. * Sarsaparilla.—A simple syrup of sarsaparilla, when properly prepared, may be used with decided benefit in sorofula, more es- GOITRE. 267 pecially when the disease has been of long continuance, and the patient feeble and emaciated. I have, in some instances, observed a rapid improvement in patients on taking a syrup of sarsapa- rilla. The cases in which I have known the most benefit derived from using the syrup, have been patients in whom the disease had apparently become exhausted, and the system left in a lan- guid, impoverished condition. It is questionable whether more benefit is not derived from the sugar of which the syrup is com- posed, than from the sarsaparilla. On many occasions I have become acquainted with cases of scrofula in which patients have taken from twenty to sixty bottles of Swaim's and other prepa- rations of sarsaparilla without experiencing any benefit from them. Most of the cases of remarkable cures effected by Swaim's Panacea, have been of the character above alluded to—the dis- ease having come to a stop, and the system being in a condition in which a syrup of sugar afforded the most appropriate kind of nourishment to the system, that by its use new blood was made more rapidly, furnishing to the system that nourishment which it required in order to regain strength and flesh. SECTION II. GOITRE. This form of disease, although resembling scrofulous swell- ings of the glands, is essentially different from scrofula. Goitre is an enlargement of the thyroid gland, situated low on the front part of the neck, and covering a portion of the wind- pipe. Scrofula is seated in the lymphatic glands, which occupy a different position from the former. The thyroid gland possesses alow degree of vitality, and its use has never been ascertained. The lymphatic glands have a higher degree of vitality, and they are known to perform important functions. This difference of character between the thyroid and lymphatic glands affords an explanation of the cause of the difference between goitre and scrofula. In the first stages of goitre, the tumour is soft and spongy to the touch,—The strin covering it has a natural appearance, " and is moveable over the enlarged gland." As the disease progresses, the tumour becomes harder, and after the lapse of many years, it sometimes becomes very large, and of a gristly or cartilagi- 26S GOITRE. nous structure. The usual progress of goitre is very slow, re- quiring many years before the tumour acquires much size, and, 1 in many instances, it never becomes so large as to occasion great inconvenience to the patient. In some, however the tumour oc- cupies almost the whole of one side of the neck, extending from the clavicle (collar bone) to the ear. Goitre is very seldom at- tended with pain or inflammation, and in these particulars, it differs materially from scrofula in general; yet sometimes goitre is attended with darting pains, when the tumour is very large and indurated. The skin and cellular tissue covering the thyroid gland, yield- ing readily to pressure, admit the gland to become very large, without pressing upon the wind-pipe to such a degree as to in- terfere with respiration. When the gland becomes greatly en- larged and hard, it generally occasions some embarrassment in breathing, swallowing and speaking. Goitre prevails epidemically among the inhabitants of valleys situated at the base of high mountains. "In no part of the world is the disease so prevalent, and so distressing in its cha- racter, as in some of the valleys of the Alps and Appenines. In certain districts of Switzerland and Savoy, almost the whole of the indigenous population are more or less affected with goitrous enlargements. In the valley of the Rhone, at Martigny, St. Maurice, Aigle, Villeneune, Bourg, Lucerne, and at Dresden, and in the vallies of Piedmont, this disease is extremely com- mon."—Eberle. Some experienced surgeons have mistaken goitre for aneurism of the carotid artery. It has likewise been mistaken for an en- largement of the jugular vein. When only a portion of the gland becomes enlarged, and remains soft, it may be difficult for even an experienced surgeon to determine whether the disease be aneurism, enlargement of the jugular vein, or goitre. Causes.—Great diversity of opinion prevails among medical men in relation to the cause of this singular disease. Whilst some suppose it to be brought on by drinking water impregnated with lime, and other calcarious substances, others have advanced the opinion that the use of snow water is the cause of the dis- ease. Others have contended that goitre is produced by the use of water entirely devoid of carbonic acid ; and others again have conceived it to depend upon particular articles of food. A more plausible theory of the origin of the disease, is that whicli attri- butes it to atmospheric influences—a humid, dense atmosphere, and the absence of electricity in the air. "In#nany deep, damp, and woody valleys, goitre is extremely prevalent; but in propor- tion as we ascend towards the more elevated and dry situations, on the sides and tops of the adjacent mountains, the disease be- GOITRE. 269 comes less and less frequent. It is well known, moreover, that when young persons affected with goitre remove from the valley in which the disease was contracted, to high and dry situations, the tumour almost always becomes considerably diminished in size, and in many instances disappears altogether."—Edinburg Med. and Surg. Journal. Not Dangerous.—Goitre is not a dangerous form of disease, being very rarely known to prove fatal, except in those situations where it prevails as an epidemic. Treatment.—This disease is evidently an obstruction in the gland, and is to be cured only by removing this obstruction. The means to be employed for restoring the circulation in the obstructed gland, are frictions with flannel, or with the warm hand; and the use of stimulating liniments and warm fomenta- tions. The application of the vapour and shower bath, and oc- casionally a full course of medicine, are important, more espe- cially in the earlier stages of the disease, whilst the tumour re- mains soft. Patients residing in a district where goitre prevails epidemic- ally, will derive more benefit by a removal to a more elevated situation, where the disease does not prevail, than from any med- ical treatment. Washing the tumour with salt water, and sea bathing, are said to be beneficial in removing goitre, more especially in its earlier stages, before the tumour becomes of a cartilaginous or gristly texture. Iodine, in the form of ointment, applied to the tumour exter- nally, is considered by some as an effectual remedy for dispersing the tumour. CHAPTER X. SECTION I. SUSPENSION OF ANIMATION FROM DROWNING. When a person is taken out of the water soon after drowning, "the face exhibits a turgid and livid appearance: the eyes are open and staring; the limbs somewhat stiff; the tongue thrust a little beyond the teeth; and the epigastrium tense and tumid." It is questionable with many physicians whether animation can be restored in drowned persons, after the heart has ceased its molions. There is sufficient evidence, however, to establish a belief, that under favourable circumstances, life may possibly be restored, even after the heart has ceased to act. When a person is drowned in very cold water, it will be more difficult to restore animation, in consequence of the heat of the body having been abstracted by the cold. It is generally believed that in drovvning, water is conveyed into the lungs, but as long as life remains the glottis is closed, preventing the admission of water into the wind-pipe. Treatment.—As soon as the patient is rubbed dry, and covered warm, stimulating injections should be administered. A table- spoonful of the third preparation of lobelia, or even two or three ounces may be administered at once in lukewarm water. No other means can be employed that are so well calculated to arouse the nervous influence, and excite respiration, as powerful stim- ulants administered by injection to the bowels, or introduced in- to the stomach by means of a stomach-pump or gum-elastic catheter. The injection should be frequently repeated. In the place of the third preparation of lobelia, pepper tea or No. 6 may be employed. The patient should be wrapped in warm dry blankets, and hot bricks, or bottles of hot water, covered with damp cloths, placed at the feet, and around the body, or the vapour bath applied. The body and limbs may be rubbed with the warm hand, or with dry flannels. Stimulants, such as pep- per sauce, or No. 6, should also be applied to the surface. The SUSPENDED animation. 271 external heat must be applied gradually, as the " inward heat" will be very much exhausted. The steam, however, may be of the usual temperature, by observing the precaution to wet the face and surface of the body frequently with cold spirits or vin- egar. Unless there is some degree of sensibility existing, it will be difficult to introduce medicine into the stomach, except by means of the stomach-pump or catheter. In attempting to introduce a tube into the stomach, care will be necessary to avoid the wind- pipe : the jaws should be opened wide, the head turned back- wards, and the end of the tube placed against the back part of the throat, which will direct it into the right channel. As soon as the tube is introduced, stimulants may be conveyed through it into the stomach. The third preparation of lobelia should be employed, if at hand ; or if not to be obtained, capsicum tea, No. 6, or brandy, may be substituted. Symptoms which accompany returning animation.—Twitch- ings of the muscles about the mouth; soon followed by efforts to breathe; sudden motions of the limbs; " a small and weak pulse, beating at irregular intervals; and a discharge of frothy fluid from the mouth." As soon as the patient can swallow, stimulants such as the third preparation of lobelia, or pepper tea, must be given in small doses, and these frequently repeated. Wine whey and essence of beef, should be given as nourish- ment, and especial care should be taken to keep the patient com- fortably warm. Vomiting is often induced when animation is being restored, which is always a favourable symptom. SECTON II. Suspended animation from Carbonic Add Gas. Carbonic Acid Gas, produced by burning charcoal, when tak- ing into the lungs undiluted with atmospheric air, will very quickly destroy life. The gas not only excludes oxygen from the lungs, which is necessary to life, but it exercises a deadly influence upon the nervous system, speedily destroying its sensi- bility. A person in a tight room where there is a furnace of burning charcoal, will soon become affected with giddiness and faintness; 272 SUSPENDED ANIMATION. followed by stupour and insensibility, and unless carried into fresh air, life soon becomes extinct. Many deaths have been occasioned from sleeping in rooms in which charcoal was burn- ing, and where there were no means for the escape of the gas. Carbonic acid gas being heavier than atmospheric air, settles next the floor and fills the room from below upwards. Hence a person lying on the floor, would become affected by it, and sink into a state of insensibility; whilst another person occupying a position near the ceiling would be very little, if at all, affected by it. This affords an explanation why dogs and cats are sooner affected than men, in the same room—the animals inhaling the gas, whilst a man would be above it. Treatment.—In suspended animation from the inhalation of carbonic acid gas, the patient must be removed immediately into a current of fresh air; and cold water dashed on the face and breast. If the patient be entirely insensible, the clothing should be stripped from the body, and cold water dashed on the head and breast, or the head raised and a stream of cold water poured upon it. Sometimes the first dash of the cold water will occa- sion a convulsive effort to breathe. A stimulating injection should be administered as early as possible, and frequently repeated. The third preparation of lo- belia with luke-warm water, will form the most effectual injec- tion, and in the absence of this, some other stimulant, as com- position or pepper tea, wine, or vinegar and water, The sur- face of the body and limbs should be rubbed freely, and bathed with whiskey or vinegar, and if the patient can swallow, stimu- lants must be given in small doses and frequently repeated. When breathing becomes fully restored, the patient may be rubbed dry, and placed in bed, and should continue to take fre- quently of stimulants, such as, capsicum, composition, or wine whey, with carbonate of ammonia. If the patient has not vom- ited, the third preparation of lobelia may be given in bayberry tea, and the dose repeated until vomiting takes place. In some instances, after vitality is restored, vigorous reaction ensues: "the heart palpitates vehemently; the pulse is full, strong, and hard; the vessels of the head turgid, and a disposi- tion to heavy sleep ensues. Under these circumstances the third preparation of lobelia must be given freely, with a view to give the stomach power to regulate the circulation; -and in order to place the system more fully under the influence of lobelia, injec- tions composed of lobelia powder in warm water must be admin- istered. The face and breast should be bathed with vinegar or spirits; and warmth applied to the feet. SECTION III. Suspended Animation from Lightning. Persons struck by lightning require the same treatment as above directed : to dash bucketsfull of cold water over the face and breast, and to apply stimulating injections to the bowels, are the most important means for restoring animation. Case—The following case is reported in the fifth volume of the PhiladelphiaBotanic Sentinel, by Dr. Imri Spruill, of North Carolina : " Mr. Lewis Harrell was called last May to a negro woman who had been struck by lightning; and, said he, when I got there I saw about twenty men standing around a negro wo- man, who appeared to be (as it was thought by all) in the ago- nies of death, and speechless. Knowing the efficacy of the Thomsonian remedies, I gave her a large dose of the third pre- paration of lobelia, which soon aroused her, and enabled her to speak. On making an examination I found that the lightning had struck the back part of her head, and passed obliquely to the breast, tearing a new homespun cap up like gun wadding, and taking a strip of skin off in its way two inches wide, and extending over the breast and lower part of the abdomen to the groin, leaving a streak from the groin down to the sole of the foot. Her under garment was split throughout its entire length with as much precision as though it had been done with a knife. Two or three courses of medicine were administered, and she recovered rapidly. 2lv CHAPTER XI. VARIOUS FORMS OF DISEASE OF THE EYES. SECTION I. Inflammation of the Eyes from taking Cold. When the eyes become inflamed by taking cold in them, the inflammation is usually in the membrane that covers the white of the eyes, and the inner surface of the eye-lids. The direct effect of cold upon the eye is to weaken and debilitate it; and the inflammation that ensues is an effort of nature to remove the effects produced by the cold. Symptoms.—These are a redness more or less extended over the white of the eyes; an appearance of inflammation on the un- der surface of the eye-lids; a feeling of sand in the eye; a profuse secretion of tears, and sometimes a thick matter in the cor- ners of the eyes, and about the eye-lashes, and a strong light is intolerably painful. Local Treatment.—In inflammation of the eyes proceeding from cold, all kinds of cold applications are to be avoided: for al- though they may afford temporary relief, they scarcely ever fail of exercising an injurious influence. It is in inflammation of the eyes, arising from wounds or bruises, that cold applications are sometimes found useful. Even physicians of the old school, deprecate the use of cold applications in that variety of inflam- mation of the eyes, which they term catarrhal ophthalmia. Moderately stimulating w ashes, and warm poultices may be employed with more advantage in all cases of inflammation of the eyes, arising from cold. Eye Washes.—In the early stages of the inflammation, ben- efit may be derived by washing the eyes occasionally with warm catnip tea, a weak infusion of lobelia, or even with a weak tea of capsicum. The object of stimulating washes is to increase DISEASE OF THE EYES. 275 the secretions from the inflamed mucous membrane. It is in this way that stimulants lessen inflammation of the mucous membranes. The design of the inflammation is to restore the secretions, and hence the application of pure stimulants operates in harmony with the designs of nature. Astringent washes of every description are improper in the earlier stages of the inflammation, except there be a stimulous in the wash sufficient to overcome the drying effect of the astrin- gent. Astringent washes are applicable to chronic inflammation of the eyes. Poultices of elm, flaxseed, or indian mush, adding a small portion of ginger, applied to the eyes warm, and wet occasion- ally with warm catnip tea, or warm water, will prove service- able if not continued too long at a time. The constant applica- tion of a poultice for several days, would relax the parts so much that the cure might be retarded thereby. The poultice should be covered with gauze or book muslin to prevent its ad- hering to the eye. Constitutional Treatment, in inflammation of the eyes, is, in many instances, of greater importance than local applications. Inflammation of the eyes is generally associated with a disor- dered state of the system. The eyes being weakened by a weakened condition of the vital powers of the system, are thus predisposed to disease from the impression of cold, and when in- flammation comes on, the cure will be greatly facilitated by im- proving the condition of the general health, either by the use of pure stimulants—composition, capsicum, or simple herb teas, together with the use of the warm foot bath, and a careful avoid- ance of cold; or by a course of medicine, followed by the use of the stimulants above-mentioned, with a view to promote perspiration, and sustain and strengthen the curative efforts of the constitu- tion. If there be violent pain in the head, injections should be used, containing a portion of lobelia; the feet kept warm, and broken doses of lobelia given in combination with the stimulants. Inflamed or sore eyes from dust, seldom require any other attention than to wash them with warm milk and water. « SECTION II. Rheumatic Inflammation of the Eye. The globe of the eye, except the transparent portion in front, containing the pupil, and an opening on the back part, for the passage of the optic nerve, is covered by a membrane of a fibrous structure, similar to the tendons of muscles and ligaments about the joints. It is inflammation of this fibrous structure that con- stitutes rheumatism. When the fibrous membrane of the eye becomes inflamed, it is attended with pain which resembles rheumatic pains, and hence it is termed rheumatic ophthalmia. The difference therefore between catarrhal ophthalmia and rheum- atic ophthlamia, is the difference in the location of the disease: in the first, the inflammation is seated in the mucous mem- brane of the eye—in the latter, the inflammation is seated in a fibrous membrane, beneath the mucous membrane. Symptoms.—These are violent pain in the ball of the eye, "extending to the temples, teeth, lower jaw, and internal ear. The pain is continuous, with occasional fits of aggravation, and is almost always much more severe at night than during the day. The white of the eye is of a yellowish-red tinge, terminating ab- ruptly at the cornea—whicli latter (the transparent part of the centre of the eye ball) becomes dull, cloudy, and, as the disease advances, more opaque in the centre than at thecircumferance." "The flow of tears is at first diminished, but in the course of the disease, it becomes copious. Causes.—Rheumatic inflammation of the eye is generally brought on by exposure to cold and dampness. More especially is it apt to occur from exposure to cold when the system is un- der the influence of mercury. Treatment.—Constitutional treatment is necessary in most cases of rheumatic inflammation of the eye. The means to be employed are such as will restore the natural warmth of the sys- tem, cleanse the stomach and bowels, promote perspiration and restore digestion. First give stimulants, composition, or capsicum tea, and if the pain be severe, attended with an undue determination of blood to the head, the feet must be placed occasionally in warm DISEASE OF THE EYES. 277 water, containing a portion of mustard; and stimulating injec- tions containing a portion of lobelia, administered once or twice a day, and the patient kept warmly covered to favour perspira- tion. If this course of treatment prove insufficient to relieve the pain, a course of medicine must be given and repeated ac- cording to the urgency of the symptoms. The compound lobelia pills if taken in doses of two or three pills every two hours, will not only afford sufficient stimulous in ordinary cases, but by them the system is brought under the continued influence of lobelia, which is of the highest importance, more especially in the earlier stages of the disease. When the disease becomes chronic, which means that it be- comes protracted and unaccompanied with fever, or other symp- toms of reaction, gum guiacum, and bitter tonics, are to be em- ployed, together with the general course of treatment above re- commended. Local Applications.—In the early stages of the disease when the secretions of the eye are deficient, and the pain in the eye severe, moderately stimulating applications, either in the form of poultices or washes, are indicated for the purpose of restoring the secretions of the eye. A weak infusion or diluted tincture of lobelia, or weak capsicum tea, may be used for this purpose, and the same kind of poultice applied as recommended in ca- tarrhal ophthalmia. SECTION III. Suppurative Inflammation of the Eyes. Symptoms.—This variety of disease of the eyes is marked by a sudden swelling of the eye-lids, attended with a copious discharge of a thick white or yellowish matter. In severe cases the eye-lids become enormously swollen, more especially the up- per lid. There is more or less pain in the eyes, even in the milder form of the disease, and where the swelling is very great, the attending pain is usually violent. The mucous membrane covering the eye-ball becomes also much swollen, rising up like a spongy mass, and sometimes overlapping the pupil. A copi- ous secretion of pus takes place soon after the svvelling com- mences, though sometimes the matter does not escape, as it is formed, in consequence of the swelling, causing the eye-lids to 278 DISEASE of the eyes. be firmly closed. The pus being thus retained, distends the eye- lids in the form of a round fluctuating tumour, the contents of which, sooner or later, escape from between the eye-lids. In the severe form of the disease, there is always considerable con- stitutional disorder and generally high fever at night. Under a proper course of treatment the symptoms, even in this severe form of the disease will generally begin to moderate in the course of a few days, and the eye gradually recover, and become restored to a healthy condition. Occasionally, however, the ball of the eye suppurates, partially or wholly destroying the sight. Infants are occasionally attacked with sudden swelling and inflammation of the eyes, attended by a free discharge of mat- ter. In them the disease very rarely injures the eyes perma- nently. A very destructive form of disease of the eye prevailed epidem- ically, and to a great extent, in Egypt, " during the British ex- pedition under Sir Ralph Abercromby." This disease received the name of Egyptian opthalmia. Causes.—The Egyptian opthalmia was supposed to be caused by a suddenly variable temperature—an atmosphere loaded with dampness and humidity, by the prevalence of a "hot wind loaded with fine particles of sand, and a bright and piercing light of the sun. Another and more frequent cause of the disease in this coun- try is the accidental application of certain poisonous substances to the eye, more especially the matter from the venereal disease. The disease, as it occurs in infants soon after birth, is occa- sioned by some morbid secretion being introduced into the eye at the time of the infant's birth. On this subject Dr. Eberle ob- serves, " I have never known a single instance of this disease occurring in infants soon after birth, when, upon inquiry, I did not learn that the mother had been affected with leucorrhoea, or some other morbid vaginal secretion." Of the Consequences of this form of Disease.—As it occurred epidemically in Egypt at the time above mentioned, the disease proved very destructive to the eyes. The introduction of the matter of the venereal disease into the eye sometimes occasions a loss of its sight, and this form of disease is always difficult to cure. As the disease occurs in young infants it is seldom fol- lowed by serious injury of the eye, the matter occasioning the disease being of a less destructive nature than that of gonorrhceal poison. A mild form of suppurative inflammation of the eye is sometimes occasioned by constitutional disorder, and also from ordinary atmospheric influences, but which seldom or never oc- casion any serious injury to the eye. DISEASE OF THE EVES. 279 Treatment.—In all violent attacks of suppurative inflamma- tion of the eye, a vigorous course of constitutional treatment is imperiously demanded. The patient should have a thorough course of medicine administered early, and the same repeated daily, until the disease begins to decline. If it should be incon- venient to administer a regular course of medicine, the warm foot bath must be used, and composition or cayenne pepper tea given freely: after this an emetic must be given, and if the symp- toms continue to be of a violent character, doses of lobelia in composition tea, must be continued every hour or two; stimu- lating injections administered three or four times a day; hot bricks wrapped in damp cloths placed at the feet; and the head kept elevated by pillows. If there be high fever, with vio- lent pain in the head and eyes, benefit will be derived by admin- istering a small teaspoonful of lobelia powder in luke-warm water, by injection, and retained. This will relax the system, and generally cause the patient to vomit, from which he will in- variably obtain more or less relief from his sufferings. When the disease is of a mild form, and also when it is on the decline, a less energetic treatment will be required—merely giving occasionally composition, ginger, or pennyroyal tea, to favour a determination to the surface, and warm applications to the feet. In all cases, however, when the eyes are very much swollen, the system must be placed under the influence of lobelia, and continued in a state of moderate relaxation, more particu- larly during the early stages of the disease. In infants constitutional treatment is seldom necessary, unless the disease of the eyes be brought on by a disordered condition of the stomach and bowels. If the bowels be disordered, injec- tions must be administered. These may be prepared of simple bayberry tea, adding half a teaspoonful of the tincture of lobelia to each injection, and the same given by the mouth in small doses: a teaspoonful of bayberry tea with four or five drops of the tinc- ture of lobelia, repeated four or five times a day. Local Applications.-^-As the disease occurs in infants, I have found a weak infusion of lobelia, combined with raspberry tea, to be an effectual application. The eyes to be washed occasion- ally with the above tea, warm. All cold applications are inju- rious. It may be necessary, in some instances, even in infants, to apply a warm emollient poultice. Slippery elm powder, white pond lily, and crackers rolled fine, with a small portion of ginger, forms a suitable compound for a ponltice, which should be wet with warm water. The same local applications, viz: lobelia and raspberry tea, and warm poultices, will be proper in the early stages of the same disease, without regard to the age of the patient, or the 280 DISEASE OF THE EYES. cause of the disorder. In a later period of the disease, in adults, when the swelling has subsided, and the eye-lids are in a relaxed condition, Dr. Thomson's eye-water, simple tincture of myrrh, a tincture of myrrh and bayberry, or No. 6, will be suitable ap- plications. When the disease has been produced by the appli- cation of venereal poison, the eyes should be frequently washed with a strong infusion or tincture of lobelia. In all cases where the disease has become protracted, and the patient is in a feeble condition, tonics, such as quassia, worm- wood, Peruvian bark, Virginia snake root, gentian, &c, must be given, together with stimulants and nourishing food, in order to excite and sustain the curative efforts of nature. SECTION IV. SCROFULOUS SORE EYES. In this variety of disease of the eyes, the inflammation is mostly confined to the margins of the eye-lids, attended with extreme sensibity to light, a profuse secretion of tears, and a thick matter exuding from the edges of the eye-lids and the roots of the eye-lashes, which glues the lids together during sleep. This form of disease prevails most in childhood, occurring in those of delicate constitution. Sometimes the eyes become diseased from want of cleanliness alone. In some cases the patient cannot bear the light to come to the eyes, he keeps them constantly closed, places his hands over them, and lies with his face downward. Scrofulous disease of the eye is generally protracted in dura- tion—in many instances continuing with a greater or less degree of severity many months or even years, until by the aid of medi- cine, and other means, or by the natural increase of strength, the constitutional powers are invigorated and the disease there- by removed. Treatment.—Scrofulous sore eyes, being a constitutional dis- ease, depending upon a feeble organization, not only demands constitutional treatment, but in the great majority of cases, re- quires a considerable period of time to effect a permanent cure. In general, much medicine will not be required. Exercise in the open air, wholesome nourishing food, warm clothing, keep- DISEASE OF THE EYES. 281 ing the feet dry and warm, cleanliness, a cold shower bath or sponging the body with saltwater in the morning, and frictions of the surface with the flesh brush or salted towel, are important means for improving the general health, and strengthening the constitution. When the appetite is bad, the breath offensive, or the stools exhibit an unhealthy appearance, an emetic will be beneficial: this will operate still more effectually after the administration of a vapour bath. In recent cases the operation of an emetic will generally be followed by a manifest improvement in the condition of the eyes, and sometimes it alone will effect a cure. The Compound Lobelia Pills may be used with benefit in al- most all cases of chronic disease, whether it be of a scrofulous character or otherwise. These pills do not affect the bow7els in the way that cathartics operate; they stimulate the peristaltic action of the bowels, and excite the secretions of their mucous membrane without disordering the functions of the bowels, or weakening the vital powers; whereas cathartics disorder the stomach, and weaken the functions of the bowels. The contin- ued use of a cathartic—for instance, a small dose of Epsom or Glauber salts, taken daily, or every few days, by provoking irritation in the bowels, and lessening the determination of blood to the surface, may diminish the inflammation of the eyes; but the constitutional disorder will be increased, because digestion must necessarily be impaired, by the action of the salts—they merely changing the symptoms of the disease without restoring the health. Let a child in good health be purged with salts every day, and this continued for a week, the digestive pow7ers at the end of the week will be impaired, the warmth of the system will be re- duced, and the bowels will remain enfeebled and inactive for several days after. The absurdity of administering such medicine to one whose constitution is feeble, and the general health de- ranged must be apparent to every unprejudiced mind. To change the symptoms of disease by the use of cathartics, or by administering poisons, is one thing, but to remove disease from the system, is quite a different matter. Purified Charcoal may be used with advantage in cases of cos- tiveness, more particularly when accompanied with an acid con- dition of the stomach. The dose is a teaspoonful two or three times a day, taken before meals. Salt and Vinegar—When patients have an inclination for acids, such as vinegar, or lemon juice, as they frequently have in scrofulous complaints, w here digestion is impaired, a mixture of salt and vinegar will sometimes be found of signal bcnelit in improving digestion. 2L 282 DISEASE OF THE EYES. Tonics must be given when the patient is in a feeble and re- laxed condition. Spice bitters are proper to be given during any period of scrofula: they may be given both as a mild tonic, and a stimulant, supplying the place of stronger stimulants and tonics, in milder cases of the disease. Sarsaparilla.—A simple syrup of this article is an admirable medicine for scrofula in certain conditions of the system. I have occasionally observed the most marked benefit from its use in cases where the disease had apparently come to a crisis, the patient remaining in a weak and languid condition. But whether the patient be most benefited by the sarsaparilla or by the syrup of sugar, is not very easy to decide. Local Treatment.—In scrofulous sore eyes, it will be found on examination that some of the eye-lashes are dead, and thus oper- ating as foreign bodies to the parts, occasion very disagreeable itching in the eye-lids, and the formation of matter at their roots. The removal of these dead eye-lashes, therefore, is im- portant in the cure of the disease. A little observation will teach one how to distinguish the living from the dead lashes, and they are very easily removed, without pain, by a pair of tweez- ers. I have, on several occasions removed, at one time, over one hundred dead eye-lashes from the eye-lids of a patient af- fected with sore eyes; and sometimes this is all that is required in the way of treatment; the eyes becoming w7ell soon after. In scrofulous constitutions, however, the disease of the eyes will rarely be radically removed until the general health be restored, or at least manifestly improved. Astringent and stimulating washes may be used with more or less benefit in sore eyes of long continuance. The preparation called Thomson's eye w7ater, may be employed. Where the sensibility of the eye is very acute, this eye-water may be modi- fied by a teaspoonful of strong tea made of witch-hazle leaves, or poplar bark, added to a teaspoonful of the eye-water. The diet must be light yet nourishing; fresh beef and mutton, poultry, wild game in season, eggs, boiled rice and milk, boiled milk and toast, toast and cream custard, stale bread and butter, black tea, chocolate, and all wholesome vegetables may be used; provided they be found to agree with the stomach. When scrofulous sore eyes are accompanied with eruptions on the face, or running sores behind the cars, the treatment should be the same as already described, observing especial care when vapour is administered to protect the skin surrounding the af- fected parts from the irritating secretions which the steam will cause to be discharged from the eruptions. The secretions from DISEASE OF THE EYES. 283 such eruptions sometimes accompanying scrofulous sore eyes, are so acrid that they produce an eruption on the surrounding parts wherever they are touched by them, and in this way the disease will spread over almost the whole of the face and some- times extend from behind the ears down to the shoulders, and cover a portion of the back. This may in general be prevented by bathing the parts surrounding the eruption with No. 6, or the tincture of lobelia, immediately after the bath, the parts being protected at other times when the eruptions are discharged. These eruptions require the same plan of treatment recom- mended for the cure of scald-head, namely: to prevent the admission of air to the eruption by the application of salve or ointment, together with the use of medicines for correcting the general health. Case.—A little boy, living in Christian street, was affected with scrofulous sore eyes, attended with eruptions over the face and back of the ears, and after the disease had continued more than eighteen months, the patient was placed under Thomsonian treatment, which speedily improved the general health, but the eruptions suppurated freely, causing extensive patches of raw surface secreting pus. Necessary care was not taken for pre- venting the discharge from affecting the surrounding parts, and the disease consequently commenced spreading considerably.— The parents became discouraged, and applied again to the old practice. The treatment next pursued consisted in the con- tinued use of salts, and cooling applications to the surface.— Under this course of treatment the determination of blood to the surface was lessened, the system became cold and inactive, and as the disease left the face, the hip and knee became affected with scrofula, attended with years of suffering, and followed by distortion of the limb. Is it not probable that the cooling treat- ment occasioned the disease to become fixed in the hip, which would have been kept on the surface and eventually cured under Thomsonian treatment, and the disease thus prevented from seating itself in the hip? SECTION V. BLINDNESS. (total or partial.) A total or partial loss of sight is caused by a variety of forms of disease of the eye, or more properly, different parts of the eye are liable to become diseased, occasioning loss of vision. Thus blindness may be produced by disease of the optic nerve, whicli conveys impressions to the brain. This form of disease is called amaurosis. A very common cause of blindness is an opacity of the crys- talline lens, or its capsule, designated by the term cataract. Sometimes a total or partial loss of vision depends upon dis- ease of the transparent cornea of the eye, which is liable to be- come clouded and thickened; and occasionally it becomes very much swollen, bulging out from the centre of the eye-ball, form- ing a tumour as large as a cherry. The eye is also liable to dropsy, cancer, and to gangrenous ulceration; which happily, however, are of very rare occurrence. Symptoms of Amaurosis—Disease of the Nerve of the Eye.—In this form of disease the eye does not present any particular ap- pearance of disease upon a superficial examination, except that the expression is vacant, but on a closer inspcctetion we find the pupil dilated, and on applying a lighted candle near, the con- tracting power of the pupil is observed to be either lost, or greatly diminished. "There is frequently the sensation as if a cloud were before the eye," and the pupil often presents a greenish appearance. The sight is obscure, or the power of see- ing is lost. Causes.—Close and long continued application of the eyes to minute objects, more especially by candle light; paralysis of the optic nerve from disease of the brain, or from constitutional dis- order, is the usual cause of amaurosis. Treatment.—Almost the only hope in cases of amaurosis, is an early and vigorous course of constitutional treatment, with a view to restore the circulation of nervous fluid in the diseased nerve. Frequently, however, the disease depends upon causes DISEASE OF THE EYES. 285 that render all medical means abortive; still a trial should be made as by it the sight may possibly be restored, or at least greatly improved. Many cases have been cured by the use of emeties. When amaurosis is connected with manifest derangement of the general health, there is stronger reason to anticipate benefit from the operation of emetics, but still more from full courses of medicine. Besides constitutional treatment, stimulating washes should be frequently applied to the eye, such as capsicum tea, or Thom- son's eye water, and the patient continue as much as possible in the light. The frequent application of volatile salts to the nose, and snuffing freely of composition or other stimulating powder, may assist in restoring'the function of the optic nerve. Cases of amaurosis have been cured by the application of elec- tricity and galvanism. Concerning the Treatment of Cataract little need be said here, as the disease is one which requires an operation by the hands of a surgeon. In the incipient stage of cataract, however, a pro- per course of constitutional treatment may in some cases pre- vent the further progress of the disease, and even cause the ab- sorption of the cataract. The constitutional treatment for cat- aract does not differ from that recommended in amaurosis, SECTON VI. STYE. The formation of a small abscess on the eye-lid, called a stye, is of very frequent occurrence. It is generally occasioned by a disordered condition of the stomach. Sometimes it is caused by the presence of a dead eye-lash, the abscess being found at the root of it. Treatment.—When the stye becomes painful and considerably inflamed, cooling applications should be made to the eye—fre- quently wetting the eye with cold water, or applying a poultice of slippery elm, or of flaxseed stewed with Indian meal, until it becomes well softened. If there be a dead eye-lash in the cen- tre of the stye, it should be pulled out, which sometimes, when 286 DISEASE OF THE EYES. done early, will check the further progress of the abscess. Rub- bing the stye, when it first appears, with cold metal, a silver spoon or knife blade will, it is said, prevent an abscess from be- ing formed in many instances. SECTION VII. FISTULA LACRYMALIS. {Obstruction of the duct which conveys the tears from the eye into the nostril.) The tears and mucus secreted in the eye are conveyed into the nostril through a small duct, which is liable to become ob- structed by various causes, and then the tears instead of passing into the nose, are obliged to flow over the cheeks, proving a source of extreme annoyance. The obstruction may take place at the inner corner of the eye, where the duct commences, and may be remedied by the careful introduction of a fine silver or gold pin through the duct into the Lachrymal sac, which is an enlargement of the duct about a quarter of an inch from its commencement. If the obstruction be seated in the duct below this little sac or bag just alluded to, the tears will pass down into the sac, and being retained there in consequence of the obstruction below, it becomes swol- len into a round tumour as large sometimes as a chesnut. The tumour will be situated a short distance below7 the eye near its inner corner. By pressing upon the tumour the contents will be forced upwards and pass out at the eye, or if the obstruc- tion below the tumour be not complete, the tears contained in the sac may be forced into the nostril. "The complaint sometimes remains in this state for years, with little incon- venience, pressure being occasionally made upon the sac to empty it." Sometimes the tumour suppurates and breaks ex- ternally, and the tears will pass out through this opening, and flow over the cheek. The sac is now very liable to frequent attacks of inflammation and suppuration. Treatment.—In the early stage of this complaint, constitu- tional treatment, particularly the vapour bath with an emetic, DISEASE OF THE EYES. 287 have in some instances overcome the obstruction and effected a permanent cure. The disease, however, is seldom curable by constitutional treatment—the only chance of success by it is in the early stage, and especially when the obstruction is owing to inflammation and swelling of the duct. When these exist the use of the vapour bath, together with relaxing the system fully by lobelia, and promoting perspiration and an equal circulation by the use of stimulants, such as capsicum or composition, may prove successful in restoring the duct to a healthy condition. When the tears flow over the cheek, and the lachrymal sac, just below the eye, is not swollen, it affords evidence that the obstruction is in the duct between the eye-lid and the lachrymal sac. This obstruction may be removed by passing a small sil- ver or gold pin down the duct into the sac. Sometimes the lachrymal sac becomes diseased, and secretes from its surface a thick matter which does not pass readily through the duct, and the sac becomes distended, requiring to be pressed upon in order to force the thick matter up to the corner of the eye, or down into the nose. A gentleman not long since told me that he was cured of an obstruction in the duct that leads the tears into the nose, by the operation of a course of medicine. The disease had continued for many months, the tears passing over the cheek. During the operation of the emetic the tears resumed their natural chan- nel by the removal of the obstruction in the duct. It is not to be inferred, however, that many cases of this affection can be removed by a course of medicine. It is only under particular circumstances that we can reasonably anticipate a cure by con- stitutional treatment. A common practice in this complaint is to introduce a gold or silver tube down the course of the duct, and thus lead the tears into the nostrils. In some cases this tube answers a good pur- pose—in others it does injury. CHAPTER XII. SECTION I. INSANITY—MENTAL DERA NGEMENT. Insanity depends upon a diseased condition of the brain, Which is the organ of the mind. "The mind consists of a plurality of innate and independent faculties, a congregation of separate and primary powers."— {Fowler.) Each faculty of the mind has its especial organ, and when only a part of the brain is diseased, those faculties only will be deranged or destroyed which are located in the diseased part. Thus the doctrines of phrenology explain the reason why an individual may be insane on some subjects, and at the same time quite rational on others. There is a close and intimate sympathy existing between the mind and the body, so that a change in the condition of the one will vary the condition of the other. AVho has ever experienced a flow of good spirits during a fit of ague, or in the commencing stage of small-pox, or in the early stage of any other form of disease, when the brain is deprived of its due supply of blood and nervous energy. In proportion as the nervous energy of the brain is enfeebled, and the supply of arterial blood to it lessened, so in proportion will the mind become enfeebled—it cannot be otherwise—yet still the mind may be free from insanity. Cases occur, however, where the brain receives so small a supply of arterial blood, in consequence probably of long continued inve- terate dyspepsia, that it does not generate a sufficient quan- tity of nervous fluid to support the mind, and consequently it sinks into a state of imbecility, and sometimes into insanity. A blow upon the head, producing concussion of the brain, stops at once the operation of the mind until the brain recover from the shock. And again, sudden impressions made upon the mind exert a powerful influence upon the brain and digestive organs. INSANITY. 289 Too close attention to study, immediately after dinner, weakens digestion by causing an afflux of nervous energy to the brain, and thus determining it from the stomach, enfeebles digestion. A sudden shock of the mind soon after a meal, such as sud- den flight or some distressing news, will suspend the power of digestion. This intimate connexion existing between the mind and the body leads us to perceive the cause of mental derange- ment in the diseased condition of the organs of the mind. Causes.—In some families there exists a predisposition to in- sanity, so that several members of the same family will be af- fected with the disease. Moral influences by disordering the organs of the mind, occa- sion insanity. Thus, by close, long continued, and deep study, the blood vessels of the brain may become diseased, and so far derange the functions of the brain as to occasion insanity. A great variety of moral influences,—disappointed love, religious enthusiasm, fanaticism, excessive joy, jealousy, and long con- tinued depression of mind, sometimes produce insanity. Physical causes.—These are excessive losses of blood, exhaus- tion from long continued, inveterate dyspepsia, habitual drunk- enness, injuries of the head, abscess in the brain, the inordinate use of mercury, the use of narcotic poisons, and a diseased con- dition of the stomach and bowels. Some of the early writers on medicine have maintained that mental derangement has its seat in the stomach—the diseased condition of the functions of the brain being the consequence of a disordered condition of the sto- mach. Chances of cure.—Of the cases of insanity that occur, probably less than one half are cured. The great majority of cures take place within the first year from the commencement of the dis- ease. After the disease has continued without intermission over three years, there is little hope of the patient being restored to perfect reason; still recoveries sometimes take place after the fifth or sixth year from the commencement of the derangement. It is stated by physicians who have attended in lunatic asylums, that partial insanity and melancholy, are more difficult to cure than a general derangement of the mental faculties unattended with melancholy. It is also ascertained that patients who have a distinct recollection of recent occurrences, ''with an oblivion of events long passed," are more easily cured, than those who have a recollection of events long past, but who cannot remember oc- currences that have recently transpired about them. " In gene- 2 M 290 MANIA. ral, acute and furious mania is much more under the control of remedial management than low, torpid, and fatuous insanity. Mental derangement from physical causes, generally yield more readily and permanently than when it arises from moral causes. A recovery of the general health of the system, without a cor- responding melioration of the mental disease, is said to be an unfavourable sign." {Eberle.) 1. MANIA--GENERAL INSANITY. Symptoms which characterize general Mental Derangement, or Mania.—These are a rapid succession of incoherent ideas, and violent excitement of the passions, expressed by great agitation, loud vociferation, singing, menaces, and fury. Torpor of the bowels, cold extremities, variable appetite fre- quently craving, sudden and frequent variations of temper, the patient often manifesting a vicious disposition, an inability to sleep much, and frightful and distressing dreams, are symptoms which generally precede the occurrence of mania. "When the disease is once fully developed, the expression of the countenance is wild, and often furious; the eyes are promi- nent, sparkling, and in constant motion; the patient sings, whistles, vociferates, halloos, walks too and fro with rapidity, or stands still with his hands and eyes often raised towards the heavens; he does not sleep for many nights, sometimes not for several-weeks; he often manifests great muscular power; the skin is dry, cool, and occasionally covered with profuse perspi- ration.0' It is stated that the exhalation of a peculiar and disa- greeable odour from the body, and excretions is peculiar to ma- niacs. " In the violent grades of mania, the mind forms erroneous perceptions of the impression of external objects on the senses, or the senses convey erroneous impressions to the mind. In this case the patient does not recognize the persons and objects around him ; mistakes friends for strangers, and commonly vis- itors for his relations, loses the consciousness of his individuality, and is ignorant of the place he occupies, of his rank and condi- tion in society, and of the lapse of time. The imagination is sometimes so powerfully excited, that its representatives prev ail over those of the senses. The patient hears voices, holds conver- sations with persons whom he imagines are present, and in some cases these voices harass him wherever he goes, by day and by night, in public and in private. Sometimes the empire of voli- tion seems to be entirely suspended, and the patient is no longer MANIA. 291 master of his ow7n determinations. An irresistible impulse leads him to injure himself, or to inflict injury upon others, to tear the clothes from his body, run out naked into the streets, leap out of the windows, and to commit other acts of fury." 2. PARTIAL INSANITV. In this form of mental derangement a part of the organs of the faculties, or of a single faculty of the mind, only, is dis- eased so that the patient will be insane upon one subject and en- tirely rational on others. "This is by far the most common form of mental derange- ment, and it is always entirely free from delirium or paroxysmal raving." In that variety which is usually denominated hypochondriasis, the hallucinations relate to the patient's own body, or to the circumstances whicli he conceives have an especial sinister in- fluence upon his own system, fortune, or happiness. The sug- gestions of his morbid imagination are taken for realities. He believes himself afflicted with some certain incurable and fatal disease, particularly with consumption, cancer, or stone, and above all, with impotency and the venereal disease. He fancies that some poison has been maliciously introduced into his system; or that he has a living animal, or some other very injurious sub- stance in his stomach or bowels. Some patients believe them- selves transformed into inferior animals," and others^imagine themselves to be made of glass, wax, butter, &c. Unnumbered throngs on every side are seen, Of bodies changed by various forms of spleen. Here living tea-pots stand, one arm held out, One bent; the handle this, and that the spout; A pipkin there, like Homer's tripod walks, Here sighs ajar, and there a goose-pie talks. Men prove with child, as powerful fancy works, And maids turned bottles, cry aloud for corks. Pope. Some patients are insane on the subject of religion; others upon the subject of love, wealth, or ambition. I knew a minis- ter, a member of the society of Friends, who visited England and returned again entirely insane on the subject of religion, but was perfectly sane on other subjects. 292 PARTIAL INSANITY. Treatment of Mental Disease. The medical profession have almost abandoned the use of medicine in the treatment of insanity, depending almost exclu- sivelyupon moral influences—a removal of the patient from home, and kind treatment, are the means chiefly relied upon by those who have had long experience in treating mental disease. From the good success that has attended Thomsonian treat- ment in several cases of insanity that have come to my know- ledge, I cannot entertain a doubt that many, very many cases of insanity, depending upon a disordered condition of the stomach, or upon a diseased state of the system generally, may be cured by that system of practice. The failure of the old school prac- tice of medicine furnishes no just criterion to judge of the effects of Thomsonian treatment. A patient may have taken emetics of tartarized antimony, without being benefited, and yet be greatly benefited by a Thomsonian course of medicine. Mer- curial preparations, cathartics, cupping, leeching, together with the use of all the remedies which are employed by the med- ical profession for reducing what they call morbid excitement, may fail of doing good, when an opposite and more rational course of treatment may prove successful in removing the dis- ease, by aiding nature. Case.—I attended a female last winter who had become insane through religions enthusiasm. She had been in feeble health for many years. On my first visit I found her uuder the bed, and when brought from her hiding place, she manifested a high de- gree of mental excitement, frequently bursting forth in a contin- ued and rapid strain of imprecations and curses, until she became exhausted, when she would lie down for a time and sometimes hide her head under the pillow, or throw her limbs about as though suffering bodily distress. In this case I found the most signal benefit from giving lobelia emetics. Every time she vomited freely, and the system became relaxed under the influence of the lobelia, she became quiet and would sleep several hours. Under this treatment, namely, an emetic given at intervals of one or two days, and broken doses of lobelia given at intervals of every two or three hours, as the patient could be persuaded to take them, not resorting at any time to compulsory means except the patient made an attempt to go out of the room. During the operation of the fourth or fifth emetic a large mass of thick dark green matter was thrown from the stomach, the muscular system became fully relaxed, the patient continuing many hours very sick and much distressed, after which she became calm and com- posed and had no return of insanity except in a very slight de- gree. PARTIAL INSANITY. 293 In Another Case of Mental Derangement occurring in a young man, of this city, medicine appeared to have scarcely any appre- ciable effect on the disease. The derangement had approached' in a gradual manner, his family and friends having frequently observed him to be absent minded, and occasionally disposed to melancholy, secluding himself from the society of his own fami- ly ; and then again to form some scheme for regenerating the world, or to attempt to engage in some wild speculation. This condition of mind continued several years before he became en- tirely insane, Although medical treatment appeared to have scarcely any effect, yet under kind treatment from his family the mental derangement improved so that he was removed to the fa- mily of a friend, and from that time he began to recover more rapidly, until all the symptoms of insanity disappeared. When the insanity is general, and comes on suddenly, attend- ed with great excitement and even furious delirium, it is in gen- eral much more under the control of medical treatment, than when it is accompanied with melancholy and a torpid condition of the system, or when the case is one of partial insanity. " One of the first measures in the treatment of mania, should be to remove the patient from his friends and home, and to place him in some quiet and secluded situation. Dr. Rush strongly insists upon the importance of separation and proper seclusion; and the most eminent of the English, German, and French wri- ters, advise the adoption of this measure." " Let it be observed, however, that in recommending separation and confinement, it is not intended to object to regular exercise in the open air, and the enjoyment of the society of suitable persons during the pa- tient's intervals of comparative calmness. Whenever the weath- er is favourable, and the patient's condition will admit of it, free air and ample exercise should be allowed. The mutual associ- ation of patients similarly affected, and particularly during con- valescence, has also a favourable tendency." Idleness is unfavourable to the recovery of patients affected with partial insanity ; they should be allowed, and even persua- ded to engage in amusing exercises, "as playing at quoits, the chase, shooting, and even chess, checkers, cards, and push-pin; should be preferred to idleness." {Rush.) The Medical Treatment generally pursued in the different asy- lums, and hospitals for the insane, is the chief objection to these institutions, Established for the purposes of benevolence and philanthropy, and under the government of persons experienced in the management of the unfortunate insane, and with the ad- vantages which they afford in relation to discipline, exercise and amusement, these institutions, apart from the medical treatment 294 PARTIAL INSANITY. practised upon the patients, should receive the sanction and sup- port of every member of the community. , "In the furious state, insane patients should never be contra- dicted, however absurd their opinions and assertions may be, nor should we by our answers deny their requests, when it is proper to grant them. In the second grade of the disease, we should divert them from the subjects upon which they are de- ranged, and introduce as it were accidentally, subjects of another and of an agreeable nature. When they are upon the recovery, we may oppose their opinions and incoherent tales, by reasoning, contradiction, and even ridicule." {Rush.) When insanity is brought on by the sudden suppression of the catimenia from cold, the treatment must be directed to the re- moval of this obstruction. The means to be employed, are, the warm stimulating foot baths, stimulating enemas, the vapour bath, emetics, and the free use of the compound lobelia pills. When the patient is in a sunken and depressed condition, a course of medicine will awaken an action in the system, and in recent cases, it will be certainly beneficial. Insanity, which sometimes follows child-birth, is generally curable by medical treatment. The most important of whicli are stimulating enemas, containing a portion of Lobelia; Emetics; the continued use of broken doses of lobelia in composition, or pepper tea, warmth applied to the feet, and the vapour bath and shower bath used when practicable. In many of the cases of insanity the patients will have a mor- bidly craving appetite, so that they will eat four times as much as is necessary, or the stomach can receive without impunity. In such cases, therefore, it is necessary to allow the patient as much food only as will be requisite for his sustenance, and not allow7 him to overload and oppress the stomach. SECTION II. DELIRIUM TREMENS—MANIA A POTU. (craziness from drinking.) This is a species of mental derangement occasioned by habitual drunkenness; or, by the intemperate use of opium. Symptoms—The disease comes on after the excessive drinking of ardent spirits. The digestive powers are prostrated by the poi- sonous effect of the liquor; there is distress at the pit of the sto- mach, loss of appetite, nausea, great agitation and distress of mind, and tremulous motions of the limbs. As the disease continues the countenance of the patient becomes more expressive of alarm and suspicion; there is continual rest- lessness, and increased mental agitation. The tremour of the hands increase, and in some instances, the whole muscular sys- tem is agitated as though the patient were labouring under a fit of ague. " The eyes are cast about with quick and scrutinizing glances, or often fixed, apparently, upon some object that at- tracts the attention for a moment, and then quickly withdrawn. The patient is unable to sleep, either by day or night. He fan- cies that he sees snakes, cats, mice, and other animals in his room, and disgusting vermin crawling over the bed and on his clothes, or fancies that various persons have entered his room, for the purpose of robbing, killing, or injuring him. To avoid these and other horrid illusions, he often calls out loudly for assist- ance; runs to the door to make his escape, or to the window to leap out; is greatly agitated, vociferates, threatens, and some- times raves violently. Sometimes he fancies that he hears loud and strange noises around him over head, in an adjoining apart- ment, or loud and frequent knocking at the door. His mind and body are in a continued state of action? he calculates, pro- jects, walks hurriedly about the room, thinks he picks up money, runs up to the window, and calls out to some imaginary person in the street, starts with terror and agitation from the presence of frightful and disgusting apparitions, insists that he is well and confined with some sinister intentions against him, and re- quests to be suffered to go out in pursuit of his usual occupation. 296 delirium tremens. If the patient be flatly contradicted, he usually becomes much ex- asperated, and insists with vehemence on the correctness of his notions ; but when he is soothingly dealt with, he will now and then answer questions mildly and even distinctly; and by judi- cious management, may, in general, be restrained without any violent coercive measures." The skin is cool and generally covered with perspiration. In some instances the symptoms are slight, and pass off in the course of two or three days : whilst in others the patient becomes furiously crazy, does not recognize any one, halloos, or talks continually, and is controlled with difficulty. The Duration of Mania a Potu varies from two days, to se- veral'weeks, and in some instances it has been observed to con- tinue several months. Under a proper course of treatment, the patient will in general be restored to reason in less than a week from the commencement of the delirium. Much depends, how- ever, upon administering the remedies early in the disease, as in many instances when the disease is fully seated, it is with the greatest difficulty that the patient can be persuaded to take suf- ficient medicine to produce much effect. Mild cases of the dis- ease have frequently been observed to terminate speedily after spontaneous vomiting, or the supervention of diarrhoea. Fatality—Delirium tremens rarely terminates fatally, except when it occurs in patients affected with extensive disease of the liver, or other important organ, or the constitutional energies are broken down, either by disease, or by a long course of intempe- rance. Unfavourable Symptoms—A rapid and very small pulse; cold- ness of the limbs, the skin covered with cold sweat, constant de- lirium: the pupil of the eyes contracted, and twitching or work- ing of the muscles of the face, are symptoms indicating danger. Favourable Symptoms.—One of the most favourable symptoms in mania a potu is an ability to sleep tranquilly, even though it may be of but short duration. The practice of giving opium to produce sleep is often attended with injurious consequences, it prostrates the power of the stomach, and in many instances it increases the wakefulness and aggravates all the symptoms. At most it does but blunt the sensibility, without removing the cause, or restoring to the system its lost vitality. Mania a potu essentially consists in a weakened condition of the vital principle. The functions of the stomach are prostrated —digestion is suspended ; the system is not supplied with nourishment; the temperature of the body is reduced ; the bowels MANIA. 297 are torpid or they may be provoked by the acid state of their contents, occasioning diarrhoea ; the nervous power is enfeebled ; and the brain is deprived of its natural healthy stimulous, the morbid effects of the liquor having also previously weakened its functions. Nature struggling to regain her lost power occasions the excited condition of the system attending mania a potu. Treatment.—The treatment indicated for the cure of mania a potu is to be such as will aid the efforts of nature to throw off the disease. This is all that medicine can do to benefit the patient in any case of disease. The warm foot bath, vapour baths, emetics, pure stimulants, astringent or anti-canker medicine, and injec- tions are the means chiefly to be relied upon for the cure of this disease. The warm foot bath should be used before giving an emetic, and in mild cases it may supply the place of the vapour bath. The Vapour Bath relieves the symptoms by equalizing the cir- culation of the blood and nervous influence, restores for a time the natural heat of the system, and thus increases the sen- sibility of the stomach to the impression of medicines, rendering their operation more effective—throws deleterious substances out of the blood by exciting free perspiration and a determination to the surface : in fine it aids the effects of nature generally, to bring about a crisis, and castoff the disease. After steaming and the patient is rubbed dry, the surface may be bathed with No. 6, or stimulating liniment. Emetics.—I have invariably observed more benefit derived from the use of emetics than from any other means. Sometimes mania a potu is observed to terminate by spontaneous vomiting. Merely evacuating the stomach is not sufficient, however, ex- cept in cases of a very mild character; the mucous membrane is in most instances thickly coated with morbid secretions, which require the continued use of stimulating and anti-canker medi- cine for two or three days, besides frequent vomiting, before the stomach will become cleansed of morbid secretions, and its power of digestion restored. The third preparation of lobelia is the best form, yet it may be taken either in powder, infusion, or in tincture. Whatever form of lobelia is used, it should be given in sumac or bayberry tea. After the operation of an emetic, if the symptoms be not very much relieved, a teacup half full of a strong decoction of bayberry or sumac, adding from a tea- spoonful to a tablespoonful of the liquid of the third preparation of lobelia, must be given every hour or two, as the patient can be persuaded to take it,—this supplies the place of all other me- dicines. Sometimes it requires considerable management to in- 2 N 298 MANIA. duce the patient to take medicine. Thus if a patient have a craving for liquor, he will often take a dose of medicine on the promise of having after it some gin or brandy, or whatever other liquor he may crave ; after taking the medicine a teaspoonful or more of the liquor should be given, diluted with water. I have known instances where lobelia has been taken freely in brandy and water, the patient obstinately refusing to take it in any other way. Some writers advocate the use of alcoholic liquors, as a remedy in this disease, whilst others oppose its employment on all occasions. I have in a few instances given patients liquor, but have never as yet observed any good effects resulting from it, but on the contrary, the symptoms have been almost invari- ably aggravated by it, except when given in very small quanti- ties. The disease requires stimulants, but they should be pure stimulants, and not the same poisonous articles that occasioned the disease. Although mania i potu seldom occurs whilst the patient continues to drink, the symptoms first appearing after the drinking is stopped, yet it is the drink that prostrates the vital powers and occasions the derangement which essentially consti- tutes the disease; and the longer the drinking be continued the worse it will be for the patient. The long continued use of opium will cause mania a potu, and the practice of prescribing this article as a remedy in disease, is almost if not equally as absurd as to give a patient brandy to cure a disease brought on by its use. It is very desirable that the patient be able to sleep, not however by means of a drug that will deaden the sensibility of the brain, prostrate the powers of the stomach, and probably produce se- rious congestion in the blood vessels of the brain, and prolong the disease. In a mild case of the disease a dose of opium may sometimes cause the patient to sleep, and not be materially in- jured by it; but in those cases, a vapour bath and emetic, followed by broken doses of lobelia, would bring the disease to a crisis much sooner, and the cure be more complete than by the use of opium, or probably by any other means. During the act of vomiting the patient's head should not be al- lowed to be lower than the level of his body, for the action of the blood vessels of the brain being weakened, the blood circulates sluggishly through them. This requires that the head be kept somewhat elevated, in order to favour the returning circulation. When the skin and extremities arc cold an injection should be administered and also a vapour bath, before giving an emetic. If these cannot be accomplished in consequence of the strenuous opposition of the patient, still the lobelia should be given in some form. If injections can be given the lobelia powder may be ad- ministered in this way in luke-warm water, which if retained will occasion vomiting, and exert even a more beneficial influ- ence upon the system than when taken into the stomach. MANIA. 299 Injections—Besides the plan just spoken of for placing the sys- tem under the influence of lobelia, stimulating injections will prove of especial service to the patient. By relieving the bowels they withdraw the excitement from the head. Tonics.—When the disease is overcome, bitter tonics may be used to restore digestion. Of the efficacy of Thomsonian treatment in reforming drunkards. Case I.—A man employed in the sheriff's office in this city, had indulged in the use of strong drink, until he became so much a slave to it that he was rarely entirely sober. He was sensible that he was on the high road to ruin, and occasionally he would form a resolution to quit the degrading practice ; but the func- tions of his stomach had become so much impaired that hisjsystem was not furnished with sufficient stimulus, from food, to support the energies of his mind, and in moments of extreme mental de- pression, he would again resort to his accustomed drink, and as soon as one glass was taken his resolution was overcome, and he relapsed back into his former habits. Speaking to a friend one day of his anxiety to quit drink, and of his unsuccessful attempts to do so, from the occasional hankering for stimulus, his friend advised him to get some of the Thomsonian composition powder, and when he felt the want of a stimulus to take a dose of the com- position. He accordingly obtained the composition and on taking it as directed, it furnished an agreeable stimulus, without disordering the brain; overcame the desire for liquor, and at the same time restored the tone of his stomach to a healthy condition; so that in the course of a year he became changed from drunkenness and wretchedness, and enjoyed perfect health and a fine glow of spirits. He is now actively engaged in the temperance cause and through his example and persuasion others have been induced to resort to the use of the composition powder, with the same happy result. Case II.—A merchant of this city who had formerly resided in the south, had contracted the habit of excessive drinking, and was occasionally attacked with mania a potu. Having experi- enced good effects from vomiting he determined on taking a course of Thomsonian medicine, to have his stomach thoroughly cleansed and then to refrain from the use of strong drink altogeth- er. He stated to me that he had often resolved to quit the degra- ding practice, but that his spirits sometimes became so much de- pressed and his appetite so bad, tiiat his resolution to refrain from liquor gave way, and he would again take a glass;—this was soon succeeded by another, and thus he would go on drinking until 300 MANIA. his stomach turned against it, when he would be attacked with symptoms of mania a potu. After this patient had placed him- self under Thomsonian treatment he did not relapse again into his former habits except on two or three occasions, and then a course of medicine was administered, and the general course of treatment adopted that is recommended for mania a potu, which shortened the duration of the disease, and by the daily use of pure stimulants the digestive powers were finally restored so that the patient was exempt from that state of mental depression, which had so frequently led him to resort to spirituous liquors. This gentleman has continued a sober man during the past two years, and doubtless will continue so. Case III.—During the summer of 1838, a man called at my office, and gave me the following history of his case. When about the age of thirty he became dyspeptic from close attention to business, and experienced at times extreme lowness of spirits, with trembling of his hands. An acquaintance recommended brandy and water, which he took and experienced temporary re- lief; continuing to take his glass of brandy and water, when- ever he felt the want of a stimulus, he at length found that the dyspepsia was gaining ground, and that the attacks of nervous weakness were more frequent, requiring a more frequent repeti- tion of the brandy; and finally his nervous energy became so prostrate that he was induced to fly to his accustomed stimulus, the first thing in the morning, and to continue under its influence during the whole of the day. It was now sixteen years since he commenced the use of brandy, and (said he) "to speak plainly, I am a confirmed drunkard." He was willing to submit to any course of treatment, that would restore his digestion, so that he could do without the brandy, which he was sensible had gained the upper hand of him. I told him if be was anxious to quit the use of brandy, I had no doubt that he could do it and be restored to health. He placed himself under treatment, which consisted in an occasional course of medidne and the free use of cayenne pepper more especially at meals, and when he felt the want of his accus- tomed stimulus to take a dose of No. 6 or of composition. The result was most happy—he quit the use of brandy without much difficulty; his digestion was restored, and he now enjoys good health, not having taken any kind of intoxicating drink during a period of more than two years. The above are not the only cases of the kind that have occur- ed under my own immediate observation ; I could mention seve- ral others of equal interest and importance, where men addicted to drunkenness have become reformed partly through the aid of Thomsonian treatment, which affords a pure stimulus, entirely free from intoxicating properties, and at the same time has the effect to correct and strengthen the digestive functions. CHAPTER XIII. SECTION I. HEADACHE. Pain in the head in most instances is occasioned by a disor- dered condition of the stomach. Slight attacks of headache may very often be removed by having the head rubbed freely with the hands, whicli favours the returning circulation from the head. Bathing the forehead with some volatile stimulant, as No. 6, spirits of camphor, or harts- horne, or with simple vinegar, or whiskey, will sometimes re- move it. When the feet are cold, they should be warmed by the foot bath, or by other means, and the patient take composition or pepper tea. Snuffing composition or No. 6 up the nose by stim- ulating to excitement the secretions of this organ, will sometimes cure simple headache. When the pain is violent and not relieved by the means already mentioned, an emetic or the repetition of three or four stimulating injections to relieve the bowels and attract the circulation from the head, will seldom fail of curing the pain. SECTION II. SICK HEADACHE. When there is pain in the head attended by sickness at the sto- mach with or without vomiting, it is termed sick headache. It always arises from a disordered condition of the stomach ; pa- tients almost always experiencing much relief from the pain in the head after free vomiting. 302 SICK HEADACHE. In many instances sick headache occurs periodically ; in some the attacks come on every week, in others at intervals of two or three wreeks. Persons predisposed to this form of disease are es- pecially liable to an attack, from some change of habit, for in- stance, missing a regular meal, riding in the cold, or sitting some hours in a crowded assembly. Inacuracies in diet, fatiguing exercise, exposure to cold, and getting the feet damp, frequently occasion an attack of sick headache. Treatment.—The best remedy for sick headache is an emetic. This taken in the commencement of the attack will not only mode- rate the symptoms but very generally after the free operation of an emetic all the distressing symptoms will be speedily removed. If the feet be cold apply the warm foot bath or vapour bath and let the patient take a dose of composition or pepper tea before the emetic be given. Injections—I have known sick headache speedily cured by the use of injections alone. Prepared in the usual form of com- position or pennyroyal tea, adding a teaspoonful of lobelia, the injections will relieve the pain in the bead, and if applied too intheonset of the attack, will never fail of proving beneficial. In milder cases and when the stomach is not very materially disordered, it may be sufficient that the patient get to bed, drink some warm tea, and have warm applications to the feet. Sleep.—When a patient can obtain a few hours sleep, the head- ache is generally cured for the time, whether they have or have not taken medicine previously. Thepractice however of taking an emetic in the commencement of sick headache, and repeating it every time that there are symptoms of an approaching attack, will not only prove the most effectual means for relieving the symptoms, but if the practice be persevered in, and medicine be taken to strengthen digestion the liability to the attack will be greatly lessened, and in most cases the patient will be freed alto- gether from the attacks. Bitter tonics should be taken once or twice a day, more especi- ally after dinner. Wormw7ood, centuary, balmony, golden seal, quassia or almost any combination of bitters may be employed. It is the tonic principle that is needed, and it is not important that any one particular article should be employed. Alkaline Bitters.—Take a handful of wormwood and a table- spoonful of hickory ashes, pour on a pint of boiling water; a wine glass full to be taken after meals, cold. This preparation is ap- plicable in cases of heartburn or sour eructations. SICK HEADACHE. 303 Salt and Vinegar.—A disordered condition of the stomach will in some instances be rectified and digestion restored by the use of salt and vinegar. In these cases patients have an inclination for acids. Costiveness almost universally attends sick headache. The majority of patients take some kind of purgative medicine to re- move costiveness, which leaves the bow els in a worse and weak- er condition than they were before ; the costiveness continues and more physic is taken, and in this way many persons continue this practice for a succession of years until finally the digestive powers become so much weakened, and the functions of the bowels prostrated to such a degree that without a most careful attention to diet, a natural passage from the bowels is seldom procured. It is indeed doubtful which has done the most injury to the human constitution the use of purgative medicine or of strong drink.— Costiveness is occasioned by a weakened condition of the func- tions of the bowels, and to assist and strengthen the peristaltic ac- tion of the bowels, and excite the secretions of their mucous mem- brane are the essential indications for the cure of habitual cos- tiveness. In many instances this may be effected by the daily use of bread made of unbolted wheat flour, or by taking every evening for supper a gruel, or mush made of the same material, and avoiding the use of cathartics. The bran is supposed to act as a mechanical stimulus. Where costiveness is attended by heartburn or sour eructations, finely pulverized charcoal will be found especially beneficial; purified charcoal should be used when it can be obtained. The dose is a large teaspoonful taken in composition or spiced bitter tea, or it may be taken in boiled milk. It should be taken an hour or two before meals. Capsictun taken freely at meals or immediately after, will stimulate the action of the bowels, and, in many cases of con- stipation, will be sufficient to overcome it. Injections—Where the use of purgative medicine has been continued for a succession of years, it may be necessary, besides the means above mentioned, to assist the bowels occasionally by the use of the syringe. There is probably not a case of obstinate constipation of the bowels, in which the mucous membrane of the bowels is not coated with thickened secretions—forming a complete false membrane, whicli occasionally passes off in long pieces, somewhat resembling an intestine. The removal of this false coating from the mucous membrane of the bowels is essential to the restoration of their natural functions. Purgative medi- cines operate upon the bowels as a foreign substance,—something not congenial; and provoke an action—an effort to cast off the 304 SICK HEADACHE. offending substance, causing the mucous surfaces to throw out a coating of thickened secretions to shield them from the deleterious impression of the cathartic; therefore cathartics instead of clean- sing the bowels of "canker" as Dr. Thomson expresses it, give the canker a deeper hold, and thus add to the difficulty. That which is required for cleansing the lining membrane of thickened morbid secretions or canker, is to excite the bowels by pure stim- ulants, capsicum, composition, and compound lobelia pills; and the use of stimulating and astringent injections. Patients subject to attacks of sick headache should use the pre- caution, to dress very warmly whenever they ride out in cold or damp weather. With regard to headache being occasioned by getting the feet damp, too few persons in the community are fully sensible of the influence which dampness applied to the feet, excites over the digestive functions, and of the extent of derange- ment which it frequently occasions. Another Variety of Headache.—Severe pain in the forehead and eye balls, is sometimes occasioned by disease of the frontal sinuses which are small cavities in the bones of the skull, immediately above the eye brows. These small cavities are lined with a mucous membrane whicli is continuous with the mu- cous membrane of the nose. The disease is occasioned by taking cold; and prevails during the cold and damp weather of spring and autumn. The disease is in no wise dangerous, but some- times continues several days, and occasionally for weeks before the pain is removed. In the first place the mucous membrane is weakened by the influence of cold, inflammation ensues which terminates in the free secretion of a thick, yellow or greenish matter, which is discharged by the nostrils and then the pain usually subsides. Treatment.—Besides constitutional treatment such as, taking freely of warm stimulating teas, to favour perspiration, benefit will be derived from breathing through the nose, the vapour of vinegar and water, and using the composition powder, or cayenne pepper as a snuff, which will excite the secretions, and in this wray afford relief. * Not unfrequently is this form of headache accompanied with a deranged condition of the system generally, the affection in the head being a mere branch of disease, the root of which is in the stomach and bowels. Hence in violent cases of headache accom- panied with symptoms indicating a disordered condition of the stomach and bowels,—a furred tongue, loss of appetite, bad taste in the mouth, costive bowels, and chilliness, and flashes of heat —the system must be warmed by the use of stimulants internal- ly ; and external warmth applied either by warm bricks placed TOOTHACHE. 305 around the patient or a vapour bath, administered, followed by an emetic to cleanse the stomach, and if the bowels require'assist- ancc let it be done by enemas. After this the patient may take occasionally of some stimulant—composition, spice bitters, gin- ger, or simple herb teas, and avoid exposure to the cold or damp- ness. I have never known a case of headache that was not either cured or greatly relieved by a vapour bath and emetic. SECTION III. TOOTHACHE. The curableness of toothache by local applications depends greatly upon the condition of the tooth and the cause of the pain. Thus if the tooth be hollowed, and the pain arise from the pre- sence of acrid matter in the decayed part, or from exposure of the nerve to cold, the pain may be greatly relieved by filling the hol- low of the tooth with cotton wet with the third preparation of lo- belia, oil of cloves, spirits of hartshorn, No. 6, or spirits of cam- phor ; together with warm applications to the cheek, such as bags of hot ashes, salt or sand, or a towel folded up and applied as hot as can be borne. When a dry heat docs not answer the purpose, a small bag of hops or of bitter herbs dampened with vinegar, or cloths wrung out of hot water may be applied. Toothache may be cured in many instances, by placing the feet in warm water, and taking freely of composition or pepper tea. In violent cases an emetic should be given, followed by broken doses of lobelia; stimulating teas and warm applications to the feet. A very intelligent and experienced Thomsonian once told me that he generally prescribed a dose of the third prepar- ation of lobelia for toothache, and said that it seldom failed of re- moving the pain. It very often happens that an abscess forms at the extremity of the root of a tooth which finally swells out the gum, forming what is commonly called a gum bile. External applications are seldom of permanent benefit in such cases, the only certain cure is the extraction of the tooth. After the abscess discharges, the pain generally vanishes. When a tooth has become diseased at its root, it will most probably be a frequent source of annoyance as long as it remains in the jaw, as plugging will seldom answer any good purpose in such cases. 2 0 306 TOOTHACHE. Whenever teeth begin to decay externally they should be plug- ged by a dentist well acquainted with the business. Persons re- siding in the country are too apt to neglect their teeth when they begin to decay, and do not apply to a dentist until they experi- ence the disadvantage of the loss of some of their teeth and the partial decay cf others. A skilful dentist can generally prevent the further decay of a tooth if timely applied to. Although the teeth may be preserved by plugging them, yet they are often ruined by too much filing. Dentistry like the Thomsonian sys- tem, has been greatly abused by quacks, who have engaged in it without being acquainted with its principles. A dentist properly acquainted with his profession will be very cautious how he uses the file, knowing as he does the importance of preserving the enamel of teeth, and of the liability of a rapid decay of them when a portion of the enamel is destroyed, I have known indi-- viduals condemn dentistry altogether; because they have observed their teeth to decay more rapidly after having had them filed. It is quackery in dentistry that should be condemned, and not the principles of the science. There is scarcely a branch of science the principles of w hich can be more plainly demonstrated, than that of dentistry. Having made allusion to Thomsonian quacks I will explain myself; not meaning to be understood as applying this term to every one who engages in the practice without having had a regular medical education,—indeed some of the most successful practitioners that I have ever yet known, have been men without a regular medical education—who have established a correct method of reasoning upon things in general, and possessing good common sense, w/ere able to comprehend the true principles of Thomsonism by reading the works of its founder, and possess- ed sufficient moral courage to pursue the treatment thoroughly and perseveringly, as their mature judgment dictated, uninflu- enced by the slander of gussips, the opposition of the prejudiced, or the timidity of professed friends. I would apply the term quack to one (whether he have been educated in a college or on a farm) who announcing himself a Thomsonian doctor, and railing against all mineral poisons, employs mandrake and other vegetable poisons, and deleterious compounds, as improvements on the Thomsonian system ; and who instead of being governed in his practice by the general principles of the Thomsonian sys- tem, employs inefficient syrups, and worse than useless cathartics in the place of Thomsonian medicine. Such practitioners may very properly be termed quacks in medicine. DISEASE OF THE EAR. SECTION IV. EARACHE. This distressing complaint is of frequent occurrence. It pre- vails most in early life. Causes.—Pain in the ear is generally a consequence of expo- sure to cold and dampness. Those who are predisposed to this form of disease, are extremely liable to an attack by getting their feet damp. Children are peculiarly liable to a discharge of matter from the ear, and they generally suffer more or less pain for several days before the ear begins to discharge, attended with a flushed countenance and some degree of fever. Treatments—When earache is caused by cold, it may be re- lieved by steaming the side of the head and using the warm foot bath. Steam maybe applied to the ear through a funnel placed over a vessel containing boiling water. If there should not be sufficient steam, a small hot stone should be put in the water.— After the steaming, a portion of cotton wet with the tincture of lobelia, should be kept in the ear, or dry cotton may be employ- ed if the tincture cannot be readily obtained. The heart of a roasted onion put in the ear will sometimes relieve earache; it should be hot, or as warm as can be borne. If there should be an abscess forming, the same course of treatment may be pur- sued; or apply a warm poultice to the ear, with a view7 to hasten a discharge of the matter. Syringing the ear with warm soap suds will sometimes relieve the pain. If the system be much disordered, an emetic will be beneficial, after which broken doses of lobelia may be given in order to cause a moderate degree of relaxation of the system, and to equalize the nervous influence. Case.—A little girl of scrofulous constitution, who had been subject to a running from her ear, was attacked with violent pain in the ear and side of the head, attended with an extremely offensive discharge from this organ. A variety of local remedies 308 RUNNING OF THE EARS. were employed without any apparent benefit. After having suf- fered continued pain for two days and nights, a full course of medicine was administered, which afforded complete relief. Af- ter the course small doses of the tincture of lobelia were given every two or three hours, and about the fourth of a teaspoonful of green lobelia was administered by enema, whenever there w7as a return of the pain, which gave immediate relief, and ena- bled the patient to sleep. section v. RUNNING OF THE EARS. A discharge of matter from the ears is by no means uncom- mon in children. Those of a scrofulous constitution are more liable to it, still it is often observed in children who are not pre- disposed to scrofula. This disease occasionally injures the hearing, though more commonly it is not attended by any permanent injury to the hearing, even though the discharge continue at intervals during a period of several years. The running in many instances is from the parts immediately below the cavity of the ear. In the first place a small abscess is formed near the cavity of the ear, and breaks into it and is thus discharged. In other instances the disease is confined to the membrane lining the cavity and drum of the ear. Treatment.—When a child of a weak and delicate constitu- tion is affected with running from the ear, a permanent cure is rarely accomplished until the general health be improved. It is therefore of more importance in such cases to use means for im- proving the constitutional health, than to depend upon any ap- plications to the ear. There are no means so effectual for improving the health as an occasional emetic, or a full course of medicine. If the tongue be coated, a strong tea of bayberry must be given once or twice a day, or in place of this use the No. 3 pills. Pipsissawa—A strong tea or syrup of pipsissawa, may be used with benefit in this and other forms of disease in children, more especially in scrofulous eruptions. RUNNING OF THE EARS. S09 Yellow dock, sarsaparilla, and guiac shavings, combined in equal portions, simmered an hour, and then strained, sufficient sugar added to form a syrup, and then simmered again, forms a useful syrup in all cases ef running sores in children, more particularly in cases where the disease has been of long continu- ance. The dose of the syrup is from a tablespoonful to a wine- glassful, according to the age of the patient. Tonics.—When the discharge is profuse and the patient debili- tated, the spice bitters, or some other form of tonic must be em- ployed, unless the syrup above mentioned be given. • Local Applications.—Syringing the ear with castile soap and water, or with a strong tea of bayberry, will be beneficial. A strong tea made by steeping in boiling water a compound of bay- berry, aspen poplar bark and gum myrrh, will not only serve to cleanse the parts, but will strengthen the healing efforts of nature. Many persons doubt the propriety of syringing the ear with stimulating teas, supposing that they may be carried into the head. The drum of the ear which is not more than an inch and a half from the external opening of the ear, forms a barrier to the passage of substances beyond it; neither is there any dan- ger from dropping stimulants, such as No. 6, into the ear. When the discharge has been long continued, No. 6 alone, or combined with about an equal quantity of bayberry or poplar bark tea, should be dropped into the ear two or three times a day, or if this be very painful, a simple tea of myrrh may be used, either of its usual strength or diluted with water or bay- berry tea. In some instances the matter discharged is so acrid that it excoriates the ear, causing the surface of it and the parts below the ear to be continually sore and inflamed; the glands back of the ears and on the side of the neck are apt to be more or less swollen; and sometimes an eruption appears over a part of the head and face, which very often continues for weeks, and sometimes it requires several months for the eruption to be en- tirely cured. Where tlje external ear becomes excoriated, or sores break out on the skin; the parts must be kept from the air by the application of tar ointment, or some kind of adhesive salve, in order to protect the raw surface from the atmosphere. Apart from constitutional treatment there is nothing of more importance in the cure of eruptions, of the character above men- tioned, than to protect the parts from the action of the air. It does not make much difference what kind of salve or ointment is used, provided it will effectually exclude the air. In most instances the parts suppurate and discharge freely soon after applying a salve or ointment, but by continuing the application, 310 DEAFNESS. so as to keep off the air, the parts will soon heal, unless the sys- tem be much diseased, and the healing power of the constitution thereby enfeebled. When the parts suppurate freely, the oint- ment or salve will of course require to be removed daily, in or- der to cleanse the parts, but the exposure should not be continued longer than is necessary to dress the sores. Such eruptions should never be dried up by the application of lead water, or driven into the system by the use of salts, or other such cooling medicines. For although they might not be followed by immedi- ately bad effects, yet serious consequences have often resulted by applying lead water, or a solution of corrosive sublimate to eruptions on the face and head; and by drawing the determining powers from the surface by purging. Hence some physicians advise parents to use no means to cure eruptions about their chil- drens heads, considering the eruption as a safe-guard against internal disease that might prove of far more serious conse- quence. I have never known any bad effects to arise from cur- ing eruptions about the head upon the Thomsonian plan. The internal remedies used for curing the disease, will also prevent it from seating itself in the system. SECTION VI. DEAFNESS. Deafness may depend upon palsy or other diseased condi- tion of the nerve of hearing; from thickening of the drum of the ear, or it may proceed from disease of other parts of the internal apparatus of the ear. Hardness of hearing sometimes depends upon a collection of hardened wax in the drum of the ear. Complete* deafness is very rarely cured. When hardness of hearing is occasioned by indurated wax in the ear, it is very readily remedied by syringing the ear with warm soap suds, made of castile, or palm soap. A convenient way to syringe the ear, is to have the warm suds in a basin with one edge of it placed against the neck immediately below the car, and inject the liquid into the ear. with sufficient force to reach the farther extremity of the cavity. The syringing to be continued until the wax softens and is washed out. CHAPTER XIV. SECTION I. PALPITATION OF THE HEART. An irregular beating, and fluttering motion of the heart, very frequently attends dyspepsia, sick headache, neuralgia, asthma, consumption, hysteria, gout, constitutional debility, and in persons of nervous temperament, it is frequently occasioned by any slight derangement in the system. The use of strong coffee, tobacco, an oppressed condition of the stomach from food that is hard of digestion, grief, anxiety or any sudden emotion of the mind will in some, occasion irregular throbbing and flut- tering motions of the heart. Of all the cases of irregular palpitations of the heart, there is probably in nine of every ten of them, no disease of the heart; the irregularity of the motions of the heart being caused by a weakness and derangement in the nervous system. A disordered state of the stomach weakens the nervous power, and the weak- ened condition of the nervous influence, may occasion disorder of the functions of the heart, constituting what is termed a func- tional disease of the heart. Thus sick headache and palpitation of the heart are often associated ; both arising from the same cause. Treatment—Palpitation of the heart being in most instances merely a symptom of disease, the original seat or cause of which is generally a disordered condition of the stomach, it docs not demand any especial treatment, apart from that which is re- quired for correcting the disordered condition of the stomach, and restoring digestion. Thus a patient may have an attack of hysteria, accompanied with violent pain in the head, and palpi- tation of the heart—these being mere symptoms arising from con- stitutional disease, the seat of which is commonly in the stomach, the same course of treatment will be sufficient to remove all these different symptoms. If ten thousand persons were to become diseased from one general cause, there would probably not be 312 PALPITATION OF THE HEART. two cases in which all the symptoms of disease would be pre- cisely alike. Whilst in one there might be sick headache with palpitation of the heart, another might have palpitation of the heart without sick headache, and another sick headache without the irregular throbbings of the heart. Asthma in one would be accompanied with fluttering of the heart, in another it would be accompanied with headache alone, whilst the majority would probably be exempt from any functional derangement of this organ. Disease of every variety is produced by a weakened con- dition of the principle of life, and notwithstanding the great di- versity in the symptoms which are presented in the various forms of disease the general indications of treatment are few, and the necessary remedies also are few and simple. If palpitation of the heart be accompanied with manifest symp- toms of a foul stomach, an emetic will be the best remedy; whicli should be preceded by the vapour, or the warm foot bath. When irregular palpitation of the heart becomes of so frequent occurrence as to need especial attention, the indications of cure, are, to restore the natural balance of the circulation of the blood, to cleanse the stomach and bowels of " canker" and strengthen digestion. This will prevent the heart from becoming perma- nently diseased in its structure; a circumstance which sometimes occurs in consequence of long continued palpitation of the heart depending upon constitutional disorder, and general debility. Persons of full habit of body, whose digestive powers are en- feebled by a long continued course of excesses in eating and drinking, and the inordinate use of tobacco, are very liable in advanced life to frequent attacks of strong, irregular throbbing, and tremulous motions of the heart. I knew an instance where a gentleman was confined to the house several months labouring under symptoms of disease of the heart, yet by the free use of Thomsonian remedies, consisting chiefly of capsicum, a com- pound of the astringent or anti-canker medicines and bitters, he recovered perfectly from all symptoms of this disease. Palpitation of the heart sometimes depends upon a weakness and soreness in some portion of the spine, the stomach not being materially disordered. Here it will be proper to employ the vapour and shower bath, stimulating applications to the spine, together with such constitutional treatment as the condition of the general health may demand. SECTION II. ORGANIC, OR STRUCTURAL DISEASE OF THE HEART. The preceding section treats of functional derangement of the heart, unattended with a change in the structure of the heart itself. Under the present head I shall make some brief obser- vations in relation to structural disease of the heart, and point out the appropriate treatment. The heart, like other organs of the body, is liable to changes of structure, such as an enlargement of its dimensions, with unu- sual thinness of its walls, enlargement of the ventricles of the heart, disease of the valves, the formation of cartilage within its cavity, &c, all of which depend originally upon a disordered condition of the system, or upon an originally feeble organiza- tion. Violent mental emotions have been observed to cause dis- ease of the heart. Instances have occurred in which sudden ter- ror, anger, or excessive joy, has determined the blood so vehe- mently to the heart as to cause immediate rupture of its ventri- cles." Of the Symptoms.—Many of the symptoms which attend dis- ease of the heart, also accompany other forms of disease, so that even experienced physicians sometimes find it difficult to distin- guish disease of the heart from mere sympathetic derangement. Asthma is very frequently attended by palpitation of the heart; and again, structural disease of the heart is accompanied by dif- ficult respiration resembling asthma. Patients affected with disease of the heart experience great oppression and difficulty of breathing on using exercise; the same symptoms attend on asthma and dropsy of the chest; and even when patients are extremely feeble, and without being affected cither with asthma, dropsy, or disease of the heart, they are liable to experience great oppression in the chest, difficulty of breathing, and violent pal- pitation of the heart from over exertion. The livid hue of the lips observed in cases of heart disease, alike accompanies parox- ysms of asthma. The inability to lie down, however, only con- tinues during a paroxysm of asthma; whereas in disease of the heart it is generally continued, or at least the patient can sel- dom lie on the right side, with the head on a level with the body; the same, however, attends hydrothorax. The pulse 2 P fc 314 DISEASE OF THE HEART. which is irregular in structuii disease of the heart, is also inter- mitting in functional disease of the heart, and also in other vari- eties of disease. Alarming dreams and sudden startings dur- ing sleep, with a distressing sense of suffocation which are men- tioned among the symptoms attending disease of the heart, are by no means peculiar to that form of disease alone. "When we find a patient complain of more or less habitual dyspnoea," (difficulty of breathing) "greatly aggravated by corporeal exertion; slight oedema, (dropsical swelling) of the feet: a puffy and anxious appearance of the countenance, with a livid hue of the lips; frequent palpitations or tremulous action of the heart during the paroxysms of dyspnoea; the occasional sudden occurrence of an elastic puffy swelling of the lower eye-lids and the upper lip; an irascible temper; quick and short inspira- tions; a deep purple and bloated aspect of the face during the paroxysms of difficult breathing; with an absence of the pecu- liar wheezing and rattling noise in the lungs; and a free secre- tion of urine: when these symptoms are noticed, we have strong reasons for presuming that there exists some disease of the heart."—Eberle. Diffiadty of Cure.—The majority "of cases of confirmed struc- tural disease of the heart, are probably incurable; yet by espe- cial care on the part of patients to avoid excesses of eating, drinking, exercise, &c, together with the employment of means to support the natural warmth of the body, by which the deter- mining powers will be kept to the surface, and the blood caused to flow to the extremities, and thus be prevented from being con- fined to the internal vessels crowding upon and oppressing the heart, the symptoms may be much relieved, and in some in- stances cures have been effected even when the disease had as- sumed a very serious character. When death takes place from disease of the heart, it is generally very suddenly, and sometimes without any previous symptoms indicative of more than usual danger. Treatment.—An important indication in the treatment of dis- ease of the heart, is to maintain an equal circulation of blood throughout the system. The means to be employed are the warm foot bath, the vapour bath, pure stimulants taken into the sto- mach, stimulating enemas, frictions of the surface, stimulating liniments, or embrocations applied to the extremities, and lastly, yetof still greater importance, the administration of an occasional course of medicine. The continued use of broken doses of tinc- ture of lobelia, will prove beneficial. If the system be in a re- laxed condition, and the complexion pale, bitters must be also employed. DISEASE OF THE HEART- 315 Case.—A young man, by the name of Bullock,.who was la- bouring under disease of the heart, of a severe character, the throbbings of the heart being constantly violent, and irregular, and his flesh much wasted. The physician who attended him was a man of considerable eminence in the profession, and declared the case to be an incurable disease of thejieart. It was pro- posed to the physician that the patient be taken-to the country. He replied that it would be altogether useless, as the disease was of that character which afforded no grounds for hope of recovery. Under these discouraging circumstances, the patient was taken to a Thomsonian infirmary, which was under the superintend- ance of Frederick Plumer, and there he had a course of medi- cine administered to him every few7 days. Under this treatment he improved so much that after the twentieth course of medicine was given, he was almost free from symptoms of disease of the heart. This gentleman subsequently regained perfect health and engaged in the study of law7, and now resides in one of the southern states. In another instance a gentleman of my acquaintance, past his fiftieth year, who had been a full liver, was confined to the house several months with well marked symptoms of disease of the heart. By a careful avoidance of all injurious influences, and the continued daily use of Thomsonian remedies, this patient be- came entirely free from symptoms of heart disease, his general health being fully restored. The above are the only cases of disease of the heart (admit- ting them to have been of that character) in which to my know- ledge the effects of a persevering and well applied course of Thomsonian treatment in this disease has been fully tested___ The tendency of Thomsonian treatment in equalizing the circu- lation, and improving the general health, and the remarkable influence of lobelia in equalizing nervous energy even when ad- ministered in small doses, affords sufficient ground to warrant confidence in the practice even though the disease may hereto- fore have baffled the treatment pursued by the medical profes- sion. Excesses of every kind to be avoided.—Persons labouring under disease of the heart, cannot observe too much caution in the avoiding of excesses, in eating, drinking, and in exercise. If the stomach be oppressed with too much food, or by the food being hard of digestion, it will more or less disturb the equi- librium of the circulation of tiie blood and thus increase the dis- turbance in the regular action of the heart. Much the same ef- fects will be produced by exposing the feet to dampness whicli causes the blood to recede from the sarface and oppress the heart. 516 DISEASE OF THE HEART Too much exercise is apt to occasion great distress at the heart, with violent palpitations. Many persons may question the propriety of administering a course of medicine, to a patient labouring under disease of the heart. Experience has proved however, that a patient affected with disease of the heart who is unable to walk a square, without experiencing the greatest distress and difficulty of breathing will go through a fnll course of medicine without affecting him in this way, to any considerable degree. During the winter of '38 1 was requested to visit a patient a Mr. Kates, who was labouring under a most severe form of disease of the heart. The case was utterly hopeless of cure, his legs were dropsical requiring to be punctured every few days to drain off the fluid ; there was an accumulation of water in the cavity of the abdomen; he was extremely emaciated, and the action of the heart continually violent, labouring, and irregular, so that it was with difficulty that he could walk a few steps without sup- port, and he was compelled to continue night and day in a sitting posture. I commenced treating the case with the view only of affording relief, and alter applying the steam bath daily, which he bore very well, and having taken composition tea, occa- sionally, three or four days, 1 administered a full course of medi- cine, and did not perceive any unusual excitement or increased difficulty of breathing during the operation; not even immediate- ly after vomiting. This circumstance admits of a ready ex- planation, namely: the means employed equalized the circulation of the blood, and thus prevented it from crowding upon the heart. Thus a patient labouring under a paroxysm of asthma, who is unable to walk across a room, or scarcely to stand erect, will be materially, if not entirely relieved by a thorough emetic, and still more certainly by a full course of medicine. I attended a patient living in Woodbury, N. J., a man in ad- vanced life, labouring under a most severe form of asthma at- tended with well marked symptoms of organic disease of the heart. It was with difficulty this patient could walk ten feet, and he had not lain down during a period of twelve months.— Every extra effort would cause violent throbbing and distress at the heart, still this patient would go through a course of medi- cine and feel much relieved during the operation. The course of treatment adopted in this case, which consisted chiefly of the free use of the third preparation of lobelia, given in a strong de- coction Of bayberry and sumac berries, repeating the dose when- ever the symptoms of oppression were more distressing, together with the daily application of the vapour bath, warmth to the feet, the use of injections, and stimulating liniment to the surface, not only removed the asthma, but so far restored the natural action of the heart, that the patient in a few weeks after the commence- • BLEEDING FROM THE LUNGS. 317 ment of the treatment, was able to walk a mile, without expe- riencing much inconvenience from the exercise. The same course of treatment that is adapted to the cure of asthma, is precisely that which is required in disease of the heart or dropsy of the chest, so that however difficult it may be to decide the precise character, form or location of the disease, the indications of treatment are, to equalize the circulation, re- store the natural warmth of the system, cleanse the stomach by emetics, the bowels by enemas, and strengthen digestion. A physician by long experience in the use of the stethoscope, may be enabled to form a very accurate opinion in relation to diseases of the heart. This kind of knowledge, however, does not teach us how to cure disease. A man may be a perfect anatomist, and yet be a very unsuccessful practitioner. A knowledge of the construction of the human system, and a knowledge of the laws of life are so distinct, that the one may be understood, without any correct knowledge of the other. CHAPTER XV. SECTION I. BLEEDING FROM THE LUNGS. Raising blood from the lungs occurs under various conditions of them, and although it generally occasions alarm, it is not always attended with danger. Though generally connected with pulmonary consumption or with a predisposition to that disease, still frequent instances have occurred where persons have been subject to bleeding from the lungs, for many years, without much inconvenience ; and, occasionally persons live to an advanced age who have been subject to these frequent dis- cbarges of blood. The opinion so generally prevailing, that bleeding from the lungs is always caused by the rupture of a blood vessel is erro- neous. Still this does occasionally happen, in the advanced stage of consumption in consequence of ulceration of the vessels. But in the great majority of instances the blood oozes through the in- finitely small vessels which terminate on the lining mpmbraneof 318 BLEEDING FROM THE LUNGS. * the air passages ; these vessels being in a relaxed, or otherwise diseased condition, are unable to resist the pressure of blood upon them. The same occurs in the lining membrane of the nose : the blood escapes from the mouths of the vessels without their being ruptured. The quantity of blood discharged varies greatly in dif- ferent individuals; and, also at different periods, in the same patient. A free discharge of blood from the lungs is usually preceded by coldness of the extremities ; a sensation of tightness and op- pression at the breast ; distress at the pit of the stomach ; palpi- tation of the heart; chilliness; agitation of mind; "alternate paleness and flushing of the face; and often a disagreeable salty or sweetish taste in the mouth." To distinguish bleeding from the lungs, from bleeding from the stomach : observe that where blood is vomited it comes from the stomach; and when raisedkby haucking or coughing it is from the lungs. Causes.—Bleeding from the lungs may arise from various causes, such as, the presence of tuburcles in the lungs ; exposure to cold and dampness; over-exertion ; disordered stomach ; "the suppression of habitual evacuations; and obstructions in the liver, or spleen." Rarely proves fatal.—Patients seldom die of bleeding from the lungs; for although the bleeding may be profuse, it is seldom so great as to endanger life. Frequent copious bleeding from the lungs, however, may occasion such a degree of debility and coldness of the system, that dropsy, consumption, or marasmus, will ensue, and which may prove incurable. Treatment.—The important indications for checking the es- cape of blood from the lungs, is to equalize its circulation through- out the system. An undue accumulation of blood in the lungs is always attended by a corresponding deficiency in other parts. In cases of slight bleeding, placing the feet in water as hot as can be borne and drinking freely of hot composition tea to excite perspiration, and assist in equalizing the circulation, may be suf- ficient to check the bleeding. But where this is not sufficient, a full course of medicine administered will prove the surest means of equalizing the circulation. If the patient be very feeble hot bricks wrapt in damp cloths may be kept at the feet, in place of the vapour bath; and a prompt emetic given. I have never wit- nessed a case in which bleeding from the lungs continued, after the free operation of an emetic. The lobelia should be given freely, not only with the view to produce free vomiting but also to relax the system. Stimulating injections containing lobelia, are • BLEEDING FROM THE LUNGS. 319 especially beneficial, by the influence which they exert in deter- mining the blood from the lungs. The patient must be kept quiet as possible, and avoid conversation. After the bleeding is checked the warm application to the feet should be continued, to- gether with an occasional dose of composition to maintain an equilibrium in the circulation ; and if the patient be feverish, or restless add such a portion of the tincture of lobelia to the compo- sition as will merely occasion slight nausea. Bayberry and su- mac berries steeped in boiling water making a very strong tea, ad- ding a portion of cayenne, sweetened, and drank freely, will be as effectual a remedy as can be taken, excepting the emetic. Profes- sor Chapman in his lectures, relates the circumstance of his being called to attend a young man who was bleeding freely from the lungs, and as the doctor entered the room the patient vomited in consequence of a large dose of medicine that he had just taken, and the bleeding immediately ceased. The fact of the hemorrhage from the lungs ceasing when the patient vomited together with the conviction that it admitted an easy explanation, induced the doc- tor to make a trial of emetics in similar cases. Accordingly in the next case that came under his care, which was that of a young woman who was bleeding profusely, and the usual means, salt, and acetate of lead, having failed, an emetic of ipecacuanna was given, whieh produced active vomiting, and the bleeding im- mediately ceased. The next case of the kind was that of a young Woman who had been subject to raising blood, in consequence of suppression of menses. The usual remedies having also failed, the doctor resorted to an emetic, and with entire success : not only did the emetie check the flow of blood from the lungs, but it removed the obstruction which occasioned the bleeding. Dr. Chapman declares that more than thirty years experience has convinced him that emetics are the most effectual means for checking bleeding from the lungs : rarely ever failing, and no danger attending the operation, when under the direction of a judicious practitioner. In the advanced stage of consumption or when there is extreme prostration of strength, the patient should not be subjected to over-exertion, either by getting up, or by conversation. It is in cases unconnected with deep consumption, that a thorough course of treatment will be more appropriate. Persons not in deep consumption who are liable to attacks of raising blood from the lungs, by taking an emetic or a full course of medicine, as soon as there are symptoms which indicate approaching hemorrhage, it will in almost every instance prevent the bleeding ; and this will not only be a means of preventing hemorrhage at the time but will also prove the most effectual means of restoring the general health, and thus remove the pre- disposition to raising blood. 320 EPIS TAXIS. Common table salt is a remedy generally resorted to for spit- ting blood, which together with placing the feet in warm water, will sometimes be successful in stopping the bleeding. In bleeding from the stomach I have found emetics to be suc- cessful in checking the hemorrhage. When the stomach is dis- tended by an accumulation of blood, or other substances, the bleeding may continue until the stomach is relieved of its op- pression, by a prompt emetic, and stimulants given to excite it to contract. On several occasions I have administered the liquid of the third preparation of lobelia in a strong decoction of the bayberry, or sumac, which has invariably succeeded in checking the bleeding after v omiting has occurred. The vapour bath, and injections to the bowels are as much indicated in bleed- ing from the stomach as in hemorrhage from the lungs. SECTION II. EPISTAXIS. (BLEEDING FROM THE NOSE.) Bleeding from the nose, as it usually occurs in young and healthy persons; or where it is caused by slight injuries, does not require particular attention. Confirmed into a habit, how- ever, it is liable to bring on disease of the lungs, by its draining the system of so much blood. Bleeding from the nose often takes place during the active stage of fever, and more especially when it is attended with great fullness of the, head. From the frequent occurrence also of bleeding from the nose about the turn of fever, it is considered by many as a crisis symptom and has been cited as an argument in favour of blood- letting in fever; but it should be recollected that the escape of blood from the nose is the effect and not the cause of the favour- able change in the disease ; the vessels of the mucous membrane of the nose being debilitated by disease, are unable to resist the force of the circulation, when it is restored to these parts, by the increase of. vital power. Bleeding from the nose occurs in a condition of the system the EPISTAXIS. 321 opposite to that above mentioned, namely: in the"sinking stage of malignant diseases, as typhus and yellow fever: the blood ap- parently becoming dissolved and deprived of its tenuity, escapes from the vessels, they having lost their power of contraction.— This is an unfavourable occurrence, as it tends to reduce the already enfeebled strength of the patient. Occasionally bleeding from the nose assumes a serious aspect where it occurs in aged persons, and where there exists exten- sive derangement in some important organ, as the stomach, liver, spleen, kc, sometimes proving, under such circumstances, extremely difficult of control. Enormous [quantities of blood are sometimes lost from the nose. From five to eighteen, and even thirty pounds have, in some instances been lost in a few7 days. The bleeding it is said always ceases when the patient faints. Treatment.—Persons predisposed to bleeding from the nose, should be careful to avoid all exciting causes, as exposure to cold, especially cold damp feet; heavy lifting, stooping with the head low7, hot stove rooms, &c. The indications of treatment in this are the same as in bleed- ing from the lungs, namely: to equalize the circulation, and give tone to the vessels from which the bleeding proceeds. In its milder form, and where remedial means are deemed ne- cessary, placing the feet in warm water, bathing the face in cold vinegar and water, or whiskey and water, and taking a dose or two of composition or pepper tea, will be sufficient. Stimulating injections, containing a portion of lobelia will al- ways be found beneficial, and in obstinate cases almost indis- pensable. Pressing the sides of the nose together with the thumb and finger, opposite the bleeding vessels, will in common cases prove effectual, provided the pressure be continued a sufficient length of time to allow the blood to coagulate and block up the vessels. If the pressure be made below the bleeding vessels the blood will pass down the nostrils into the throat, the hemorrhage not being checked. In cases of a more obstinate character, depending upon ex- tensive derangement of the general health : or where it has be- come a confirmed habit, a course of medicine should be re- peated at proper intervals, together with proper intermediate treatment, with injections, and the usual means employed by Thomsonians for improving the health. The following is from Dr. Samuel Thomson's narrative— " While at Exeter, I had a case of a young man, son of Col. N. Gilman, who was in a decline. He was about fourteen years old, and had been troubled with bleeding at the nose. They had 2Q 322 BLEEDING FROM WOUNDS. made use of such powerful astringents, with corrosive sublimate snuffed up the nose, that the blood vessels in that part seemed to be shrunk up, and his flesh much wasted away ; I carried him through a course of medicine which caused an equal circulation of blood throughout his body, then raised a natural perspiration, and restored the digestive powers so as to support the body with food instead of medicine. The bleeding from the nose ceased and in a short time he recovered his health." When bleeding from the nose occurs in an exhausted state of the system, with cool skin, flesh soft and flabby, and the counte- nance pale, besides the employment of means for equalizing the circulation of the blood, stimulating and astringent applications should be made to the bleeding vessels to excite them to con- traction. No. 6, or the third preparation of lobelia, adding a portion of bayberry, may be introduced into the nose by means of a piece of cotton and a probe. Burned Cork.—It is said that a quill filled with the ashes of burned cork and the ashes blown into the nostril immediately after cleaning out the clotted blood, has succeeded in arresting bleeding from the nose in some very obstinate cases. Spirits of Turpentine.—When bleeding from the nose occurs in what is termed typhus fever, the following is a good remedy: a teaspoonful of spirits of turpentine beat up with the yolk of an egg, and a teaspoonful of this given at a time to the patient re- peating every ten or fifteen minutes. Occurring, however, in the sinking stage of malignant forms of disease, when the blood has become apparently dissolved or deprived of its fibrin, but little benefit is to be anticipated from any remedy. SECTION III. BLEEDING FROM WOUNDS. Cuts made by a sharp edged instrument, bleed more than wrounds of the same or even much greater extent, made by a rough edged instrument, a saw for instance; or when with the cut the parts are much bruised. Nature's method for stopping the flow of blood___When an artery or vein is divided the surface of the inner coat of the ves- BLEEDING FROM WOUNDS. 323 sel commences, throwing out a gluey substance which gradually fills up the cavity of the vessel, and prevents the further escape of blood. In this way the cavity of the vessel becomes gradu- ally filled so that in the course of half an hour an artery or vein the size of a small crow quill may entirely cease to bleed.— When a vessel is torn or bruised its cavity becomes closed much sooner than when it is cut with a smooth instrument. Lacerated wounds seldom bleed long; and sometimes very extensive wounds of this kind are attended by very little bleeding from the com- mencement, even when large vessels are torn asunder. Wounds about the extremities or in any part where the vessels are not larger than a crow quill seldom requires the vessels to be taken up and tied, as the vessel will become plugged up in the manner above described, without any serious loss of blood, pro- vided advantage be taken of position and pressure used. Position.—In wounds of the extremities, for instance, on the hand or arm, that bleed freely the parts should be held above the head; or if on the foot or leg, the patient should lie down and have the limb raised higher than the body. Pressure.—Much may be done by pressure in arresting bleed- ing, more especially where the cut vessel is situated in bony parts, for here the pressure will be more effectual. Pressure may be made by a piece of sponge, or a compress of folded cloths held or bound firmly upon the parts, until the bleeding ceases. When an artery is cut the blood will be thrown out in jets and its colour will be red ; whereas when a vein is cut dark blood is discharged. Large veins may be checked from bleeding freely, by applying firm pressure on the vein above and below the wound. There is more or less danger to be apprehended from tying a vein ; this therefore is to be avoided, unless the vein be large and the bleed- ing cannot be checked by other means. Large arteries that are cut require a ligature, unless the bleed- ing should not be very profuse. A person in full health may lose large quantities of blood, and soon have this loss restored provided his digestion be not destroyed by the loss of blood.; Whereas in disease where the digestive functions are prostrated the loss will not be restored, for a much greater length of time; for new blood cannot be formed without chyle, and chyle is formed from food that is passing through the process of di- gestion. Vessels on the head seldom require tying, as pressure can be effectually made upon them in consequence of the vessel lying near the bones of the head. Tying the vessels on the head is also apt to be followed by erysipelas provided the parts have been 324 BLEEDING FROM WOUNDS. bruised, unless great care be taken to protect the parts from the air. An artery that is only partly cut off will bleed much longer than when.it is completely divided. Hence when it is ascertained that a vessel is partly divided it should be entirely severed, which will enable the ends of the bleeding vessel to contract and retract and to become filled up by the lymph which exudes from the inner coat of the vessel. If an artery or vein be partly di- vided only, it will be difficult for the vessel to become filled with lymph, so that even a small artery that is partly cut in two, may continue to bleed a long time. The only means of ascer- taining whether a vessel be partly divided is by searching at the bottom of the wound by clearing away the clotted blood, and then applying a sponge to cleanse the wound so as to seize the vessel with a pair of forceps, and if it be found to be partly cut off let it be entirely divided. Some surgeons recommend pinching and twisting the ends of bleeding vessels with a pair of forceps or tweezers, which cause the inner coat of the artery to throw out lymph more rapidly, filling it much sooner than would have been accomplished without this measure. When persons lose so much blood as to cause fainting, the bleeding generally ceases. Relaxing the system by giving lo- belia, even though active vomiting occur, is an effectual method of checking bleeding from the uterine organs. Dr. Chapman mentions his being called in consultation with the late Dr. Physic, in a case of hemorrhage from the uterus, which having assumed an alarming character, all the means usually resorted to by the profession having failed, Dr. Chapman from witness- ing the effects of vomiting in other forms of hemorrhage, deter- mined on trying the experiment of giving an emetic, which re- sulted in effectually checking the bleeding. In another case of a lady from a distance, who was subject to uterine hemorrhage, the discharge of blood becoming so profuse as to endanger her life, consulted Dr. C. who instituted a course of emetics, with the happiest effect. On being threat- ened with an attack of bleeding she commenced with the emetics and took six in eight days. The hemorrhage w7as checked, men- struation returned, and her health wras restored. In the unimpregnatcd state, where hemorrhage arises from a state of extreme exhaustion, from previous loss of blood, by which the blood has become thin and watery, scarcely possessing fibrin sufficient to coagulate, then filling up the vagina with a sponge, or cotton'or soft cloths should be resorted to in case the hemorrhage is not checked by other means. CHAPTER XVI. SECTION I. CANCER. Cancer is a malignant disease, generally seated in the gland^ though no portion or tissue of the body is altogether exempt from the liability to become diseased in this way. Thus the lips, tongue, skin, stomach, ovaries, uterus, and even the bones are subject to cancer. Cancer, like tubercles in the lungs, is the consequence of a de- fect of the living principle in the part, together with a vitiated state of the constitution. A female in good health, receiving a bruise upon the breast, would soon recover from it, for if the flesh he so much injured as to destroy its vitality, the parts surround- ing it will take on active inflammation, terminating in suppura- tion, and after the matter is discharged, adhesive inflammation heals the parts. Or if the parts be merely weakened by the bruise, adhesive inflammation will produce a hardness of the part, which however, will disappear without the formation of matter. In a certain depraved condition of the constitution or defective organ- ization, a bruise upon the breast, instead of being removed by one of the methods above described, namely: by means of in- flammation, the part that is injured by the bruise does not take on inflammation but gradually becomes converted into a sub- stance which operates as a foreign body in the system, the efforts of nature being insufficient to remove it by inflamma- tion and suppuration; it becomes converted into cancer. Various kinds of tumors and indolent ulcers are often mis- taken for cancers. Cancer doctors and doctresses are very apt to apply the name cancer to indolent sores and swellings, in or- der to gain a reputation for curing them; or probably from an inability to distinguish between true cancer and disorders that are not of that character. It is observed that unmarried females and those who have never borne children, are most liable to cancer of the breast. 326 CANCER. Cancer of the Female Breast. Symptoms—When first discovered, a cancerous tumour is usually about the size of a marble, and is extremely hard and moveable. The disease progresses very slowly, attended now and then with a sense of uneasiness in the part, but without in- flammation of the skin. " Sometimes the attention is first at- tracted to the bosom by a drop of bloody serum having stained the linen opposite the nipple, it having flowed from one of the lactiferous tubes. Sometimes a distinct and sharp pricking pain leads to the discovery of the swelling." There is rarely much pain felt in the part in the early stage of cancer, but after a time the patient experiences turns of exces- sive darting, or burning pains in the tumor, which are apt to oc- cur at intervals of about two weeks. As the tumor becomes painful it is observed to enlarge, but true cancer rarely ever be- comes larger than two or three inches in diameter, except when the disease invades the whole gland, rather than commencing in the form of a distinct tumor. As the disease advances the paroxysms of pain become more frequent, and are often intensely severe as though " the parts were pierced with a knife or the nerves of the breast torn out." " Prior to menstruation (about four days) the breast feels fuller, heavier, and much more painful. After the tumor has attained a considerable size, which in some instances requires many months or even years, the nipple is observed to become shorter, being drawn in by the milk ducts, whicli are pushed out of their course by the tumor ; " frequently also the nipple becomes red, inflamed, excoriated, and sometimes ulcerated." A change is also produced in the appearance of the skin ; it is puckered so as to resemble a cicatrix, and this arises from its adhesion to the surface of the cancer." At this stage of the disease the parts around the cancer become more firm and harder than natural and little tumors are generally perceptible in the parts surrounding the cancer. During the progress of cancer the glands under the arms almost alwrays become more or less swollen and hard. "Exists for years without destroying life."—Months, and sometimes years roll on, and the disease continues in its adhesive stage: .and it may even destroy life without ever suppurat- ing ; but frequently it proceeds to a suppurative inflammation : then the skin appears of a livid redness; the pain becomes even more severe ; a slight sense of fluctuation, or rather of yielding, is perceived in the part, which gradually ulcerates and dis- charges only a bloody serum ; for true pus is not generated.— Pus is attempted to be produced; but it is not formed on a truly CANCER 327 malignant surface, but only upon the surrounding parts if they be ulcerated." Cooper. " Character of the sore.—The surface of the sore feels hard, like the original tumor, and is remarkably insensible to pressure; and you therefore will observe the patient wipe it and handle it with a degree of roughness and want of gentleness, which sur- prises those who are unaware of its little sensibility." (Cooper.) Cancerous ulcers are apt to bleed frequently. The bleeding may be checked by a compress of carded cotton, lint, or soft muslin cloths, applied to the part and confined by a bandage, so as to make moderately firm pressure upon the bleeding ves- sels. As the ulceration proceeds a deep cavity is formed, some- times extending to the breast bone. Patients affected with cancer are apt to complain of rheumatic pains in various parts of the body more particularly in the loins and thighs. As the disease extends, the arm upon the diseased side becomes swollen ; there is frequently much difficulty in breathing, the patient being unable to lie down ; a sense of stricture and spasms at the pit of the stomach, is often experienced, and sometimes at- tended by vomiting. Finally the constitutional energies become exhausted and the patient sinks under the disease. It should be recollected, however, that it is not every case of cancer that destroys life, even when the tumor is not removed. Sometimes the disease remains stationary for many years. The female breast is very liable to tumors that do not par- take of the cancerous nature. A cancerous tumor in the breast is rarely ever observed in females under thirty years of age. Treatment—The chief indication in the treatment of cancer is the employment of such means as are best adapted to improve the condition of the general health. An occasional course of medicine, together with the daily use of stimulants—cayenne, composition, or spice bitters, and broken doses of lobelia in pill or tincture, given every two or three hours constitute the remedies principally to be employed in the way of constitutional treat- ment. If there be acidity of the stomach, and the bowels costive, pur- ified charcoal will be beneficial. It may be taken prepared in composition or spice bitters tea. The dose of the charcoal is a large teaspoonful ; to be repeated two or three times a day be- fore meals. When a violent paroxysm of pain comes on, it may be miti- gated by the use of the warm foot bath, or of the vapour bath, and the use of enemas composed of some mild stimulant, such as weak composition or pennyroyal tea, with the addition of a 328 CANCER. teaspoonful of lobelia, cither the powder, tincture or third pre- paration. Whatever tends to equalize the circulation of the blood, and of the nervous power, will relieve pain, no matter where it be situated. The free use of pure stimulants, cayenne and compo- sition, containing small portions of lobelia, will also be useful in relieving paroxysms of pain. Difficulty of breathing will be relieved by the treatment above mentioned. The same remedies are also indicated for the relief of the dry and harassing cough which often attends cancer, more especially in its more advanced stages. Tonics will be proper with a view to strengthen digestion— such as spice bitters, balmony, &c. Diet.—" It is supposed that a vegetable diet, and food afford- ing little nourishment is conducive to recovery. There is no greater mistake. Whatever weakens leads to an increase of the disease, and to a more rapid termination of the existence. Low living, renders the person irritable, quickens the pulse, and makes the constitution feel the disease more strongly. Vegeta- ble diet has not the least beneficial influence over this com- plaint."—Cooper's Lectures. Applications to the Timor—During the earlier periods of cancerous tumors they should be kept warm, and the skin in a perspiration, by the application of some simple kind of salve spread on silk oil cloth, or by wearing a piece of rabit skin with the fur side to the breast. Poultices are to be applied when the tumor softens and the skin becomes inflamed. The poultice may be made of elm, gin- ger, and cracker, or any soft emollient substance, adding a por- tion of ginger, to render it moderately stimulating. Local Treatment for Open Cancer. Cancer.—Many reputed cures for cancer have been introduced into use in the form of salves, plasters, and balsams, but which upon the whole have doubtless been of far more injury than bene- fit. Powerful caustic and corroding poisons, as preparations of arsenic, are applied by some cancer doctors, to almost every kind of indolent ulcer they meet with, and if it should heal, it is announced as a case of cancer cured; whereas in true cancer such applications would probably have little effect other than to irri- tate the parts and aggravate the sufferings of the patient, with- out accomplishing a cure. CANCER 329 Extract of Sheep Sorrel—The use of this article appears to have operated very favourably in some cases of cancer. The extract is obtained by evaporating the juice of the sorrel/in"tin or pewter plates set in the sun, until it acquires the consistency of tar. This is spread on thin leather or silk oil cloth and ap- plied to the cancer, renewing it daily. Extract of Red Clover Blossoms.—This preparation is recom- mended by Dr. Thomson as a valuable application in cases of open cancer. I cannot speak from personal knowledge of the efficacy of this remedy. Caustics.—Small cancers situated in the skin, as in cancer of the lip, the frequent application of the caustic potash, or lunar caustic, may succeed in removing them. After each application of the caustic, an emollient poultice or mild salve may be ap- plied. Lounsbemf s Plaster.—A Baptist minister, by the name of Lounsberry, residing in Connecticut, prepares a plaster which appears to be gaining considerable reputation as a cure for can- cer. I have witnessed the effects of this plaster in but one case of cancer, and I must say that I was much surprised and grati- fied at the effects produced. The Case.—Mrs. Harding, residing in Second street, had a true cancer in her right breast, for which she had consulted the principal surgeons in the city, one of which advised its removal by an operation, whilst every other one that she applied to told her it was too late to operate. I had examined this tumor every week or twro, during a period of two years after it had become an open cancer. Various kinds of plaster were employed, with- out effecting any change for the better. On the application of the plaster above mentioned, the cancer began to assume a dif- ferent aspect, and in the course of a few weeks, a distinct divi- sion took place between the cancer and the living flesh, and finally the whole of the cancer came away, leaving a cavity, the surface of which had a healthy appearance. Several months have elapsed since this cancer was removed, and although the parts are not entirely healed, yet there is no appearance of a return of cancer in the part. In this case, howT- ever, as it often happens in cancer, the constitution is contami- nated with the disease, there having been for two years past symptoms indicating the existence of cancerous tubercles in other parts of the body, and which must eventually terminate fatally to the patient. I do not know the composition of Lounsberry's plaster, yet I have observed that when it is applied to a raw surface, it does 2Q 330 INFLAMMATION. not corrode or even occasion inflammation. This plaster is much less painful to the parts than cancer plasters are in ge- neral. I should not recommend a secret medicine designed to be taken inw7ardly, but as this plaster does not appear to possess any deleterious quality, I should not hesitate to employ it. If there be a cure for cancer it ought to become universally known. With regard to the removal of cancer by the knife, it is cer- tainly less objectionable than to have it destroyed by the appli- cation of caustic, unless the cancer be very superficial, and even then the knife would be less painful than caustic. Cancer depending in the great majority of instances upon con- stitutional disorder, is seldom effectually cured by an operation. In four cases out of five the disease breaks out in another part of the body in the course of a year after a cancer has been thus re- moved. Cancers situated in the skin may be effectually re- moved either by the knife, by the application of plasters, or by caustic, and sometimes the disease does not return even where the seat has been in a gland, for instance, in the breast. CHAPTER XVI. SECTION I. INFLAMMATION. Inflammation is a restorative action instituted by the con- stitution to heal wounds, repair injuries, and to remove extrane- ous bodies lodged in the flesh. Thus if a bruise be inflicted upon a part, an inflammatory action is established to restore the part to a healthy condition; wounds are healed by the same means; if a splinter be lodged in the flesh inflammation is established by which matter is formed around the splinter, separating it from the living parts. A wound cannot heal without inflammation, except in case of a smooth cut by a sharp instrument, and the wound be immedi- ately closed so as to exclude the admission of air into it. In order to repair an injury, the part must receive a greater sup- inflammation. SSI ply of blood than is natural to it when in a healthy condition. The blood furnishes the substance that unites wounds. "Inflammation may be considered as a genus, of which there are many species. It may be divided into healthy and unhealthy. The healthy is that whicli will always take place in a healthy constitution or part, and is rather to be considered as a restora- tive process than a disease. Unhealthy inflammation is that which takes place in an unhealthy constitution or part, and will vary according to the kind of unhealthiness of that constitution or part."—Hunter. A wound that heals readily in a healthy constitution may in a vitiated or disordered condition of the health become a very troublesome and protracted sore. If a person in good health re- ceive a bruise, so severe as to destroy the vitality of a portion of flesh, the first step which nature takes for repairing the,in- jury is to direct an increased supply of blood to the part, and set up an inflammation in the injured parts, occasioning increased heat, with redness and swelling. The inflammation causes the cells of the cellular tissue to become blocked up, which prevents the disease from spreading to the surrounding parts. The flesh feels firm, and the swelling is circumscribed, as is observed in the case of a common bile. $The next point is to remove the por- tion of flesh which was killed by the bruise. This is accom- plished by means of an inflammatory action, converting the parts immediately surrounding the dead flesh into pus or matter, which separates the dead from the living flesh; the pus finds its way to the surface and is discharged. The parts having become freed from the dead flesh, the next step is to heal the cavity.— This is also accomplished by an inflammatory action; granula- tions are formed on the sides of the cavity, by which the parts are united. In case of a bruise that does not kill any portion of the flesh, an inflammatory action is established, and the coagu- lable lymph supplied by the blood is diffused through the cellu- lar tissue rendering the parts more or less swollen and firmer than natural, but no pus will be formed; the swelling and hard- ness gradually subsiding until the parts are restored to a healthy condition. When a person is stung by a bee, nature quickly brings on inflammation, in order to block up the cellular tissue around the poisoned part, and thus prevent the poison from be- ing absorbed, or extending further. A broken bone cannot unite without inflammation. Cases have occurred where broken bones have not united by bony union, in consequence of the broken parts being frequently subjected to motion, breaking up the knitting of the bone, until finally the inflammation has subsided, and the parts not being supplied with sufficient blood to furnish material, and sustain the action necessary to unite the broken bone, a false joint is formed. 352 Inflammation Dr. Physic devised a plan for effecting a reunion of the bone in such cases, by forcing a threaded needle through the limb, between the surfaces of broken bones, and leaving the thread in the part for the purpose of exciting inflammation, and thus fur- nishing the means necessary for a reunion of the bone. Although inflammation be a restorative or healthy action, it is liable to become perverted into an unhealthy one, or at least the constitution may fail of accomplishing the design of inflammation. Thus if a person of scrofulous constitution, or whose system is in an otherwise unhealthy condition, should receive a bruise which destroys the vitality of a portion of flesh, the inflamma- tion that ensues will be extremely liable to assume an unhealthy character, the efforts of nature being too feeble to establish healthy inflammation, and instead of being circumscribed as in case of a bile, it may spread over a considerable extent of surface, form- ing what is called erysipelas; and when matter is formed in the injured part, instead of being confined to the spot where it is se- creted, as it is when the inflammation is of a healthy character, it spreads to a greater or less extent through the surrounding parts, which become swollen, doughey, and without extra heat attending, and may require a long time for the parts to become re- stored to a healthy condition in consequence of the want of power in the system to establish an efficient inflammatory action. A simple incision in the flesh from a sharp instrument, that heals rapidly in a healthy constitution, may become converted into an indolent ulcer in one of an unhealthy constitution. An injury upon the skin, that would be followed by healthy inflammation, and the part restored to a healthy condition in a short time in a young man would be apt to become converted into an indolent ulcer, and probably continue for years in an old man in feeble health. The healing power is sometimes almost destroyed in constitutions poisoned by the use of mercury: the simple scratch from a pin, causing a long continued running sore. Blisters have occasionally been observed to become gangrenous, in conse- quence of extreme prostration of the healing powers of the sys- tem; the constitutional energies becoming too far exhausted to establish healthy inflammation, and to sustain the action neces- sary to heal the parts. Inflammation may assume an unhealthy character in consequence of the severity of an injury—destroy- ing almost the vitality of the surrounding parts. This fact is frequently noticed in gun-shot wounds, the parts surrounding the wound being deadened, the vessels of the parts have not suf- ficient power to carry on a healthy inflammatory or restorative action. Inflammation in internal organs is no less curative in design, than when it is confined to external part's of the body. Poison INFLAMMATION. S33 taken into the stomach is followed by inflammation of its mucous membrane, unless the dose be so large as to destroy the vitality of this organ. The direct tendency of poison is to destroy the principle of life, and inflammation is the means whicli nature employs to counteract the effects of the poison and preserve the life of the parts. The inflammatory action existing in the mu- cous membrane of the stomach in those forms of disease called fevers, is the restorative power of nature in action. No person ever recovered from a low form of fever without some degree of inflammation having existed in the stomach. In inflammation of the stomach medicine should be given that will excite the secre- tions, for which there is no article superior to cayenne pepper. Inflammation of the throat is relieved and its efforts aided by gargling with pepper tea, which excites the secretions and re- lieves the congested vessels. It is ascertained that the mucous membrane of the stomach seldom exhibits marks of inflammation when patients die soon after an attack of some highly malignant form of disease, for instance, yellow fever: the force of the cause of disease having suddenly prostrated the living principle so low that the constitution is unable to establish an inflammatory ac- tion. I have invariably employed cayenne pepper tea in every variety of fever, attended with symptoms of inflammation of the stomach, and have never observed the inflammation to be aggra- vated by it. Inflammation on the surface of the body may re- quire cooling applications, to lessen the determination of blood to the parts; whereas inflammation in a secreting surface, like that of the mucous membrane of the stomach, require stimulants such as are used by Thomsonians, which restore the secretions. Spontaneous Inflammation.—In the common form of bile, we observe an instance of spontaneous inflammation. The inflam- mation is not less a curative action when it occurs spontaneously from constitutional causes, than when it occurs after local in- juries. In small pox, the inflammation attending the eruption is the curative action of the system. It has been observed univer- sally, that where small pox pustules are distinct and surrounded by a well developed inflammation, that there is but little ground for apprehension of danger; but when the eruptions are sur- rounded by an imperfectly developed inflammation, or the inflam- mation assumes an unhealthy character—being converted into erysipelas, there is great danger of an unfavourable termination of the disease, or at least that the efforts of nature will prove in- sufficient to eradicate the disease effectually from the system, thus leaving the patient affected with chronic symptoms. When a dentist applies arsenic to the nerve of a decayed tooth, at first there will be a sensation of coldness in the part, which will soon be followed by pain and inflammation; the inflammation 334 INFLAMMATION-. is necessary to prevent the deadening effects of the arsenic from extending further along the nerve: by establishing a division line between the live and dead portions of the nerve. If a person have his foot pierced hy a nail, followed by inflam- mation in the part and some discharge of matter there is sel- dom any danger to be apprehended; but if the wound be deep and closes without there having been inflammation in the part, means should be taken to excite inflammation in the w7ound, otherwise the patient will be more or less liable to lockjaw. Case.—A young man residing in Trenton, N. J., received a few weeks since a severe injury in the hand by the discharge of a gun. The wound was dressed with emollient applications, and it exhibited no marks of inflammation even after the lapse of several days from the time the injury was inflicted. At length the patient was seized with lock jaw and died in the course of two or three days after; the injured part not having been at any time sore or inflamed. "Let us suppose that two women receive each a blow on the breast, one with a healthy and vigorous constitution, and the other with a system worn down with care, anxiety and disap- pointment, and in a constant state of chronic feverish excitement in which the secretions are imperfectly performed, and is thus predisposed to the formation of cancer: in the first individual, the inflammation produced will be strictly healthy, going through its different stages, until the cure is accomplished; but in the other, owing to constitutional peculiarity, the same extent of in- jury will produce cancerous disease; an affection over which all remedies hitherto tried have little control, and extirpation is but an uncertain mode of relief." Cooper's Lectures. Inflammation sometimes occurs on the extremities of aged per- sons in consequence of debility. There being a tendency to stag- nation of the blood in the parts in consequence of a want of power in the vessels; the constitution directs an unusual supply of blood there in order to give increased power to the vessels, and this effort is frequently attended by inflammation of the skin. Finally whenever nature is called upon to repair an injury, such as a bruise, cut, or wound of any description, or to over- come debility in a part, however produced, she performs the cure by means of inflammation. It must be borne in mind however, that the efforts of nature often require the aid of medicine and other means for the regulation and sustaining of her restorative actions. Thus in a common bile there may be an undue accu- mulation of blood in the parts, causing so much swelling and pain as to prove detrimental to the sanative inflammatory efforts.— Here means should be employed for lessening the determination INFLAMMATION. 333 of blood to the part, facilitate its return to the heart, and to re- duce the external heat of the inflamed part when it is too high* Chronic Inflammation.—When inflammation fails of accom- plishing its object, and instead of coming to a crisis, becomes seated, it is termed chronic inflammation. Suppose that an in- dividual is attacked with erysipelas, and the inflammation in- stead of forming a crisis and disappearing in the course of a few days as it usually does, should become seated in the part, the ef- forts of nature being too feeble to restore the parts to a healthy condition; such would be termed chronic inflammation. Acute inflammation is often converted into chronic inflammation by im- proper treatment, weakening the power of action and thus frus- trating the designs of nature. I once saw a labouring man who lost the use of one of his hands in consequence I believe of the continued application of cold lead water to erysipelas. The in- flammation covered the back of the hand and extended up nearly to the elbow. Lead water w7as applied by the direction of a physician, and the application of it continued three weeks. The parts became so much weakened that the vessels apparently lost the power of action, the muscles became stiff and rigid so that the hand became useless. It is not unlikely that this patient under a different course of treatment would have retained the use of his hand. TREATMENT O* INFLAMMATION IN GENERAL. Constitutional Treatment.—When the general health is disor- dered inflammation is liable to assume an unhealthy character. Hence constitutional treatment is in many cases of the greatest importance as a means of curing inflammation: by aiding the ef- forts of nature. Thus if a patient in bad health receive a severe injury he should he carried through a course of medicine, repeat- ing it if necessary; together with the continued use of pure stim- ulants to sustain the secretions, and aid in equalizing the circu- lation, and promoting perspiration. Severe injuries always oc- casion more or less derangement in the system weakening the restorative power of the constitution, and increasing the lia- bility to the occurrence of unhealthy inflammation; erysipelas for instance. If an individual receive a severe injury, as a blow upon the head or fall from a height, soon after eating a full meal, his di- gestion will be suspended, and the imperfectly digested food will still further oppress the functions of the stomach and aggravate the symptoms. Under such circumstances an emetic should al- ways be given no matter in what part the injury may be situated. There is no better form of emetic than the following. 336 INFLAMMATION. A teaspoonful of the third preparation of lobelia, and one of green lobelia powdered, adding a teacup two-thirds full of strong bayberry tea, sweeten and give at once, repeating the dose as often as necessary; if the injury be on the head, the emetic may be preceded by the warm foot bath or vapour bath, and an enema administered, with a view to determine the circulation to the bowels, and thus lessen the tendency to a great determination of blood to the head. Although an injured part requires a supply of blood greater than is necessary when that part is in a healthy condition, still there may be too great a determination of blood to the injury, or there may be too great a collection of blood in the part in consequence of the weakened state of the vessels, they being unable to return the blood by the veins into the general cir- culation. I doubt whether any intelligent physician, whose mind was not influenced by prejudice or warped by preconceived opinions, could witness the effects of a thorough Thomsonian course of medicine, without perceiving the philosophy of its ap- plication, in all cases of inflammation, wherever seated. The constitutional disturbance after severe injuries is some- times very great, requiring strict attention. The treatment for constitutional shocks or disturbances will be pointed out here- after. During the first stages of inflammation, if there be general fe- ver, or a dry and hot skin and foul tongue, or if the inflamed parts are very painful, or the patient restless and distressed, then, besides a course of medicine, the system should be relaxed by giving broken doses of lobelia, and occasionally a dose of composition or pepper tea, or of simple herb teas, pennyroyal or ditany. The physician who asserts that such a course of treatment as I have just described, will aggravate inflammation, or have any other tendency than that of hastening its progress to a favoura- ble termination, has imbibed false principles in medicine, instead of the truths of the science. The above course of treatment is not to be restricted to the first stages of inflammation; it is during this period that it is in general most required. It will be proper, however, during any stage of inflammation when the symptoms appear to demand it. " When you are required to take charge of patients suffering from an injury, which demands a length of time for its restora- tion, you must be exceedingly careful how you take away blood from the system generally, but must in preference adopt local bleeding; for if, as I have observed, you adopt a system of free depletion, nature will not be equal to the restoration of the in- jured parts, and the most disastrous consequences will follow the indiscriminate employment of blood-letting. There is not INFLAMMATION. 337 a greater error than this in the practice of surgery." Cooper's Lectures. The following case is related by Sir Astley Cooper, as an in- stance of the fatal consequence of over-bleeding. " A stout man was admitted into Guy's hospital, having a simple fracture of the tibia, with considerable contusion of the surrounding parts; a day or two after his admission, he had severe constitutional irri- tation and acute pain, with spasmodic action of the muscles near the seat of injury. To relieve these symptoms, the dresser was directed to take some blood from the arm of the patient, which he did; but thinking it proper that faintness should be produced, as a proof of its effects upon the constitution, and forgetting that the patient was in a recumbent position, he abstracted so large a quantity of blood, that all power of restoration was completely annihilated and the man died." The above case is but one of thousands, and probably tens of thousands, whose existence has been cut short in this way. When an individual is badly hurt, it is the almost universal practice among physicians to bleed, under the impression that it will lessen the tendency to inflammation. So far as it relaxes the system and occasions perspiration, it may lessen the pain, and for the time present over excitement of the part, but there is as much probability of such a course of practice perverting the salu- tary efforts of nature, the inflammation consequently assuming an unhealthy character, as that it will lessen the tendency to vi- olent inflammation. The administration of a vapour bath will be attended with all the good effects that can result from bleed- ing, and without the liability to any of the danger consequent upon the loss of blood. Vapour Bath.—To restore the secretions of the skin is an im- important indication in the treatment of inflammation, whether it be seated in external or in internal parts. The administration of the vapour bath, together with the use of pure stimulants, as capsicum or composition tea, and broken doses of lobelia, will restore perspiration and likewise excite the secretions of the mu- cous membrane of the stomach, which is equally important in the treatment of inflammation. These are remedies which harmo- nize with the living principle, and at the same time that they re- lieve the suffering of the patient, they aid the efforts of the con- stitution in repairing injuries. In the later stages of inflammation for instance, where there is a free discharge of pus from a part, and the patientis clear of fever, bitter tonics may be given. When the tongue is furred and manifests a tendency to clean around the edges, or the coating on the tongue softens, then the astringent, or anti-canker medicine should be employed occa- 2R 338 INFLAMMATION. sionally, with the view of clearing the mucous surface of these morbid secretions, or canker. Diet.—In the early stages of inflammation, and more especi- ally if the tongue be coated, or the general health deranged, the diet must be confined to such articles as require but [little effort to digest them, snch as light gruels, toast and tea, barley water, rice, milk porridge, &c. It is better that the patient have a scanty supply of food than to take such as the stomach cannot digest, for this will always operate against nature. It is not so much low living that is demanded, but it is the want of power to digest strong food that must be regarded. When the patient is in a relaxed condition with absence of fever, cleaning of the tongue, and a tendency to warm perspira- tion, the diet should be nourishing—eggs, custards, oysters, beef steak, mutton, wild game, bread and butter, and whatever the patient may fancy that does not disagree with the stomach, avoiding of course articles that are known to be hard of diges- tion, such as hot cakes buttered, sausages, sweet cakes, fresh pork, and corned beef. Of External applications in Inflammation.—In acute inflam- mation, attended with great heat and swelling in the parts, the application of cotton or soft cloths kept constantly damp with whiskey and water, or vinegar and water will afford relief. Al- though inflammation be a restorative action, still it often needs the aid both of internal and external remedies, to assist the con- stitution and the vessels of injured parts in regulating the in- flammatory action. A wounded part requires a greater supply of blood to repair the injury, than is sent to this part when in a healthy condition; yet without proper treatment there may be an undue accumulation of blood in the part, occasioning unnecessary pain and acting injuriously both upon the injured part and upon the general health. Poultices are useful in recent cases of inflammation, as in biles, felons, severe bruises, and also in injuries where the flesh is much torn or lacerated. In pleurisy though the inflammation is seated in inward parts, still experience proves the utility of poulticing the affected side provided the poultice be kept warm. Slippery elm, white pond lilly, powdered cracker and ginger form a poultice adapted to all cases where there is inflammation. In erysipelas, and in all cases where an inflammation has been long continued, cold applications'and emollient poultices are im- proper. Local steaming and stimulating applications are here required, to increase the power of the enfeebled vessels. It is in active inflammation, such as attends common biles and wounds INFLAMMATION. 339 in healthy constitutions, that the use of external cooling remedies is indicated. Warmth and Moisture.—Warm fomentations, and the appli- cation of steam or warm vapour, may be employed with safety in all cases of inflammation; and generally these applications af- ford relief even in acute inflammation, by exciting perspiration. In chronic inflammation, for instance, as it occurs on the legs of aged persons, stimulating applications should be applied either in the form of liniment, or poultice. Case.—During the summer of'39 I was called to visit an old lady residing in Water street, who had chronic inflammation on both limbs, extending from the ankle joint to the knee, the parts being much swollen. The case was one of long standing, but W7as cured by steaming the limbs every two or three days, and covering the diseased parts with a poultice composed of the dregs of No. 6, slippery elm bark and white pound lilly. The poul- tice wras spread on silk oil cloth in order to prevent evaporation, and to retain the heat. The patient also took composition pow- der in luke-warm water three or four times a day; and the feet were elevated upon a chair, when the patient was out of bed. Position___When inflammation is seated about the head, it should be elevated above the level of the body; or, if it be seated on a limb, it also should be raised higher than the body. This lessens the determination of blood to the inflamed part, and by the aid of gravity favours the return of the blood from the parts inflamed. Case—"I was sent for" (observes Astley Cooper) to see a gentleman farmer, in the neighborhood of Rayleigh, in Essex, who for a long time had been subject to a very severe inflamma- tion in both his legs; they were of a very dark red colour, much swollen, and gangrene was threatened in them; the constitutional irritation was great, and his tongue covered with a brown fur: wiien I saw him his legs were resting in a tub of cold water, and on his taking them out they smoked. I bad him immediately placed on a sofa, and contrived to rest his legs upon one of its ends, so as to raise them much higher than his body; the vessels soon began to unload themselves, and in a short time the redness of the skin was much lessened; I then applied flannels, which had been dipped in tepid water, and afterwards in warm water; this produced a free perspiration, by which the skin became unloaded; the swelling and pain consequently diminished. He gradually recovered, and in six weeks was able to ride a considerable dis- tance. It would be absurd to attempt to cure extensive inflam- 340 SPRAINS. mation in a limb, if it were allowed to remain in a depending posture." In inflammation about the hand, for instance a felon or bile, is rendered extensively painful by the hand being allowed to hang down. Rest.—During the active stage of inflammation the parts should be kept at rest; this is more particularly necessary in in- flammation of the joints. Pressure. —In chronic inflammation of an indolent character, more especially when accompanying abscesses, carbuncle for in- stance, benefit will be derived from pressure: by bandaging the parts or applying strips of adhesive plaster. Erysipelas some- times leaves the parts thickened and hard after the inflammation has subsided; here pressure will be required, to excite action in the absorbent vessels for the purpose of removing the swelling. Friction.—In chronic inflammation of the joints, rubbing the parts briskly, excites the circulation and is frequently followed by very marked benefit. In disease of the general system,/ex>er is nature's hand-maid; in local diseases her chief dependence is upon inflammation.— Hence in no case of fever or inflammation should we aim to sub- due or break down fever or inflammation, but to assist the ef- forts of nature, by means which harmonize with her established lawrs. SECTION II. SPRAINS. Sprains are caused by a sudden wrench or twisting of a joint by which the ligaments or tendons are either torn or violently stretched. The wrist and ankle joint arc those most liable to sprains. Sprains are attended with severe pain at the time of the injury, which sometimes continues for hours. Soon after the accident the parts begin to swell in consequence of blood escaping from the vessels that are ruptured. SPRAINS. 341 Immediately after a sprain the joint can he readily moved; whereas in a dislocation, the joint is stiff and rigid in conse- quence of the contraction of the muscles. When inflammation comes on to repair the injury from the sprain, the parts become more swollen and extremely tender, so that the slightest motion in the joint will cause pain. Treatment.—In sprains the first thing to be attended to, is to prevent blood from being effused into the parts from the ruptured vessels. This may in a great measure be prevented by pouring a stream of cold w7ater upon the part soon after the accident, and keeping the part in an elevated position. The stream of cold water drives the blood from the parts and contracts the vessels. It may be continued fifteen or twenty minutes at a time and re- peated, two or three times in the course of the first three or four hours after the injury. By this time the torn vessels will have become closed and the parts then require to be kept warm and bathed frequently with salt and vinegar, No. 6, or stimulating liniment. When inflammation occurs, evaporating lotions, as alcohol, or whiskey, diluted with water, and warm fomentations as worm- wood stewed in vinegar must be used. Steaming the part occa- sionally will prove especially beneficial. If it be the wrist joint that is sprained, the arm must be carried in a sling; or if it be the ankle joint it should be placed on a chair whilst the patientis sitting up, and avoid producing motion in the injured joint. Application of Splints.—To secure the joint from motion, splints should lie applied. This is more particularly necessary in injuries of the wrist joint. If motion in the joint be not pre- vented whilst the broken tendons, or ligaments are uniting, by means of inflammation, it may break up the new adhesions, and thus greatly retard the case. It is not until after the inflamma- tion has entirely disappeared that motion in the parts should be allowed. After the inflammation and extreme soreness has subsided, the part remaining swollen, the action of the absorbent vessels must be promoted by rubbing the parts occasionally with the warm hand, or dry flannel, and then applying stimulating liniments or embrocations, and bandage the joint as tightly as can be borne comfortably, always commencing the bandage at the end of the limb. Steaming will also promote the action of the absorbents. A joint that has been once badly sprained, will in general re- main weak a considerable length of time, and be more easily sprained than before. When there is violent pain in the parts, as generally happens immediately after the injury, the patient will experience relief by taking a dose of the third preparation of lobelia, or a dose of lobelia powder, in composition or pepper tea- SECTION III. BRUISES. A slight bruise requires in general but little attention, the in- jury being soon repaired. ~ A very painful abscess sometimes forms in the heel, in conse- quence of a bruise. This kind of abscess is commonly called a stone bruise. The proper treatment for a stone bruise when first felt is the application of steam to the part to promote perspira- tion, and keeping the foot on a chair when sitting up. If these do not restore the circulation of the part and remov e the sore- ness, after being repeated two or three times, a warm poultice must be applied to keep the parts relaxed and in a perspiration, until the abscess points, or there be other evidence of the existence of matter in it; the part may be opened, and the poultices contin- ued until the abscess ceases to discharge pus freely; after which some kind of salve or plaster must be applied to exclude the air from the cavity. SECTION IV. SEVERE BRUISES, BY WHICH THE SYSTEM RECEIVES A SEVERE SHOCK. In all cases of severe bruises the vital powers of the system Will be more or less prostrated by the fall or blow which occa- sions the bruise. A man receives an injury, for instance, a se- vere blow upon the head, falls from a height, or is thrown from a horse with such violence as to cause concussion of the brain—he will lay senseless and pale; the pulse weak; the breathing fee- ble, and in some instances scarcely perceptible. The patient may recover his sensibility in the course of a few minutes. If, however, reaction should not take place, and consciousness in a measure be not restored, in a few minutes after a severe injury, means should be taken to bring on reaction. These are: rub- SEVERE BRUISES. 343 bing the surface with the warm hand or warm flannel, keeping the head on a level with the body, administering stimulants by the mouth and also by injection, and the application of external warmth, either in the form of steam or by the application of warm bricks; and bathing the surface and extremities with stimu- lants. Injections—Stimulating injections constitute the most efficient means of restoring animation in persons that are seriously stun- ned by an injury. Two or three teaspoonsfnl of the third pre- paration of lobelia should be administered in half a pint of luke- warm water; if this medicine be not at hand, almost any stimu- lant may be employed, such as capsicum or composition tea, No. 6, or even vinegar and water or brandy and water. Emetics—The operation of emetics is decidedly beneficial in cases of great prostration after severe injuries. If the system sustain a sev ere shock, within an hour or two after the indi- vidual has taken a hearty meal, free vomiting will be highly ne- cessary. A severe shock to the system, suspends at once the power of digestion, and if there be undigested food in the sto- mach, it will oppress the powers of life, and may prevent or greatly retard the occurrence of reaction. No danger is to be apprehended from exciting vomiting under such circumstances, namely: where a person is severely injured within an hour or two after taking a meal. The best form of an emetic is the third preparation of lobelia, given in bayberry tea; or the lobelia powder maybe given, adding a portion of No. 6, or capsicum. When a person is severely stunned soon after a full meal, ren- dering it necessary to produce free vomiting, the usual emetic, (lobelia) not being at hand, a tablespoonful of ground mustard given in warm water, or the patient made to swallow warm salt Water freely, may answer as an emetic. Forcing the feathered end of a quill, far down the throat, is sometimes resorted to, in order to produce vomiting. Animation being restored the use of pure stimulants must be continued, in small doses, aided by the application of external warmth, with a view to sustain the system, and excite moderate perspiration. » Steaming is of great service to patients who have been badly bruised. It is always safe to apply the vapour bath, the patient being placed on a couch or mattress, when he is too feeble to sit up. When there is fever, and the patient restless it will not do to apply dry heat externally, and even when a moist heat is ap- plied during fever it may be necessary to bathe the face and sur- 344 SEVERE BRUISES. face of the body with cold whiskey and water or vinegar and water. External Applications to Injuries.—In the case of a bruise, the flesh not being torn or cut, warm fomentations are to be applied —a poultice of wormwood stewed in vinegar and thickened with rye meal, flannel wet with No. 6, or with salt and vinegar, or bathing with stimulants and applying silk oil cloth over the parts to favour perspiration. When the flesh is both torn and bruised, a poultice must be ap- plied, and renewed daily until the parts suppurate and cease to discharge matter freely, when a simple dressing of salve will answer a better purpose than a poultice. Whatever emollient substance the poultice be made of, a portion of ginger must be added to render it moderately stimulating. Bruises on the head, may be treated by the application of No. 6, or salt and vinegar. If the scalp should be cut, the edges of the wound must be properly adjusted, the hair cut away, and strips of adhesive plaster applied across the wound leaving space for the escape of the blood and serum that oozes from wounds in general; soft lint must be laid over the wound, and a bandage or cap applied. If the patient complain of great heat in the part, the head may be wet occasionally with whiskey, vinegar, or with No. 6. The application of No. 6 to a wound, is useful, as it stimulates the vessels and aids them to carry on healthy inflam- mation, by which the wound is healed, or the injury repaired.— A severe injury never wTas healed nor injured parts restored to a healthy condition without the aid of inflammation. Therefore in severe injuries the indications are not to subdue inflammation, but to aid and regulate the healing efforts of nature, by sustaining an equilibrium in the circulation, promoting the secretions both of the skin and internal organs, regulating the temperature of the inflamed part, and supplying the stomach with food suited to its condition. If two individuals one in vigorous health and the other feeble and with but little constitutional vigor, should both receive a severe wound of equal extent; in the healthy person the inflammation in the part will be of a healthy character and run its course quickly; whereas in the other the efforts of nature being feeble and the blood not so richly supplied with nourish- ment, the inflammation will be more liable to assume an un- healthy character or the wound be tedious in healing. And again when a patient is in bad health, the system does not possess the same power to maintain an equal circulation of blood through- out the system as when in health, and therefore congestion or an undue accumulation of blood in injured parts will be more likely to occur. SEVERE BRUISES. 345 When there is an undue determination of blood to an injured part, occasioning much swelling and hardness, attended with a sense of great heat and pain, the parts should be kept wet with evaporating lotions, as camphor and water, alcohol and water, or vinegar and water; the patient should be taken through a course of medicine, if the severity of the symptoms demand it, together with the continued use of stimulants and broken doses of lobelia, with a view to promote perspiration, and excite the secretions of the stomach and bowels aided by the application of external warmth. Severe injuries are in general followed by more or less fever, in the course of a few days after the injury: the tongue will be- come dry and furred, the skin hot and dry, and the pulse in- crease in hardness and quickness. In this condition of the sys- tem stimulants—capsicum, ginger, composition or simple herb teas must be given, together with small doses of lobelia, bathing the surface when needed, with alcohol and water, or vinegar and water, and occasionally the administration of a vapour bath, fol- lowed by an emetic, if the system be much disordered, or the in- jury assume an inflammable appearance. Case.—A young man engaged in a manufactory, had his arm caught between two large cog-wheels, winch tore the flesh from one half of the arm from a few inches above the elbow up to the shoulder, and split off a portion of the arm bone which caught in between the cogs, and stopped the machinery. The shoulder and part of the back were bruised into a jelly. The physicians of the village wrere called, who decided that the arm must be taken off at the shoulder, and appointed the hour for performing the operation. The patient, however, requested that his step- father a Thomsonian physician who resided some miles distant, should be sent for. On his arrival he applied a poultice over the whole of the injured parts, carried him through a course of medi- cine; occasionally repeated it, and gave freely of stimulants to promote the curative action of the system, and in six weeks the,wounds were perfectly healed. If the great vessels and veins of the arm had been broken off, no treatment could have saved the patient's arm; but when these are not destroyed, however severe the injury may be, there is a probability of saving the limb. Case.—Mr. R— was thrown violently upon the pavement by the overturning of a sulkcy, which left him for sometime senseless and bruised him internally, so that breathing was painful, and he raised small quantities of blood. After his sensibility was re- stored and he conveyed home, two physicians that had seen him shortly after the injury, called to ascertain how7he was, and 2 S 346 WOUNDS OF THE SCALP. on being apprised of the fact that Mr. R. was a Thomsonian, they requested to know what medicine he was taking; and when some composition tea was handed them and they were informed that this was the medicine the patient was taking, they manifested great surprise and gave it as their judgment that such medicine would throw the patient into a fever and endanger his life. Mr. R. however took freely of hot medicine, was steamed every day, was taken through one course of medicine, and recovered rapidly without the occurrence of a bad symptom. Physicians employ bleeding and purging to prevent inflammation, and al- though they may relieve pain at the time, yet it enfeebles the curative efforts of nature, increasing the liability to unhealthy inflammation, and doubtless in many instances destroys the life of the patient. The practice of bleeding in injuries is so generally adopted by physicians of the old school, that it is thought by the community to be necessary, and when a person receives a severe injury every one is recommending bleeding as the first and most important remedy, so that sometimes it requires no small amount of courage to withstand this popular mania for bleeding. SECTION v. WOUNDS OF THE SCALP. Wounds of the scalp, more especially when the parts are bruised and lacerated require strict attention, such wounds being often observed to be followed by serious consequences. A simple cut through the scalp with a sharp instrument, heals in general* without difficulty, except in persons of depraved habits, or in bad health from other causes. W'ouUds of the scalp are particularly liable to produce erysipelas, which sometimes affects the brain so as to endanger life. Treatment.—In severe injuries of the head, the edges of the wound must be properly adjusted, the hair shaved off closely around the edges of the wound, the parts washed with whiskey and water, or with warm water, lint laid on the wound, and a bandage applied. In bandaging the head especial care must be observed to have the hair combed smooth into its natural posi- tion, for if a lock of hair be turned the wrong way and bound down, it will occasion soreness of the scalp. Wounds of the scalp must never be stitched. WOUNDS OF THE SCALP. 347 The Dressing not to be Removed too soon.—In wounds not only of the scalp, but of every other part, the dressing should not be removed so as to expose the wound to the air until the fourth, or fifth, or even the eighth or ninth day after the occurrence of the injury. If the injured part become painful and very hot, the head must be dampened with whiskey or vinegar, and be kept elevated. Wetting the parts around the injury with No. 6 oc- casionally, and even permitting it to come to the wound will les- sen the tendency to erysipelas, or unhealthy inflammation. Ad- hesive inflammation is necessary—injuries cannot be repaired without it, and I know of no local application superior to the No. 6, to stimulate the vessels and assist them to establish adhesive inflammation. Constitutional treatment should always he employed in wounds of the scalp. Soon after the w7ound is inflicted, the patient should be carried through a course of medicine, more especially if the wound be severe, and repeated as often as the condition of the system may require it. If the bowels be costive, they must be evacuated by the use of the syringe. Perspiration.—It is important to promote the secretions and exhalations of the skin by the use of stimulants that neither dis- order the brain, nor aggravate inflammation. Capsicum, com- position, or ginger tea may be used freely and with safety. Sim- ple herb teas may be employed for the same purpose. The feet must be kept warm. When a patient is feverish, a small portion of lobelia should be added to the stimulants given, and the sur- face bathed occasionally with some alcoholic preparation. Should symptoms occur denoting inflammation of the brain— pain in the head, flushed countenance, intolerance of light and sound, and delirium, the system must be placed under the influ- ence of lobelia, taken in the usual way, and also administered by injection. A tablespoonful of brown or green lobelia may be administered by injection at a time, prepared in luke-warm wa- ter, and retained; and occasionally a stimulating one also may be administered—or a tablespoonful of the third preparation of lobelia in bayberry tea. I have frequently given the third pre- paration of lobelia to patients labouring under symptoms of in- flammation of the brain in low forms of fever, and have invaria- bly observed good effects to result from it; in many instances after vomiting, the delerium has very materially moderated, and in some instances disappeared for a time. In inflammation of the brain from injury of the scalp, it will be proper to relax the system by the lobelia enemas, and the ap- plication of vapour to the body before giving an emetic of the third preparation of lobelia. This treatment must be permanent- 348 WOUNDS OF THE SCALP. ly employed, for inflammation of the brain often proves fatal un- der any mode of treatment. The hair must be cut short and the head raised upon pillows, and cloths applied wet with alco- hol or vinegar, or if there be erysipelatous inflammation of the scalp, No. 6, or the third preparation of lobelia must be used on the inflamed part, whilst on other parts of the head the first men- tioned articles may be used. When there is evidence of matter under the scalp, an opening should be made with a lancet, to allow the pus to escape; after which especial care must be observed to shield the parts from the air by a stimulating poultice or plaster spread upon oiled silk, and if a poultice be employed it must be kept moist with warm water containing about one-fourth of its quantity of No. 6. Equal quantities of composition powder and slippery elm. mixed with lard, form a suitable poultice in erysipelas, attended with the formation of matter in the parts. The practice advocated by some physicians and denounced by others, of prescribing bark and wine to patients labouring un- der erysipelas of the scalp, when the secretions are in a great measure suspended, is not much less objectionable than the ab- surd practice of bleeding patients "almost to death," in inflam- mation of the brain. In the earlier stages of erysipelas the me- dicine employed should be such as excite the secretions both of the skin and of the mucous membrane of the stomach and bow- els. Hence when the tongue is dry, as a general plan of treat- ment, use pepper tea, either alone or combined with simple herb tea, such as pennyroyal, balm, kc and broken doses of lobelia, and apply a moist heat to the surface of the body and feet. A case of erysipelas that would be aggravated by the use of bark and wine, would be relieved and benefitted by the treatment as above described. In any case of fever in which the secretions are suspended, bark and wine would prove more or less deleterious, whereas the treatment above mentioned would relieve the symp- toms and assist nature to gain the ascendency over disease. Inflammation of the brain is always attended with danger, and therefore in injuries of the scalp, or concussion of the brain, treatment sheuld be early applied to cleanse the stomach, pro- mote the secretions, and sustain the equilibrium of the circula- tion, as the surest means of preventing inflammation of the brain. Even slight injuries of the scalp should not be neglected, as very small wounds of the head, have frequently been observed to oc- casion dangerous symptoms through neglect or exposure.— Wherever the scalp is the least torn or cut, it must be protected from the air, otherwise erysipelatous inflammation may be the consequence. Case.—Win. B. Smith received a severe blow upon the side of f WOUNDS OF THE SCALP. S49 the head from some machinery in an iron foundry, which left him senseless a considerable length of time; the scalp was cut to the bone, the wound being about two inches in length and lacerat- ed at the edges. This wound was dressed with strips of adhesive plaster (the hair having been previously shaven from the edges of the sore) dry lint applied and the head carefully bandaged.—• This patient was placed under a course of Thomsonian treatment, the vapour bath administered every day, and means used for pro- moting perspiration, and also other secretions, such as com- position or pepper tea, and warm bricks to the feet; and the bowels regulated by the use of enemas. On removing the dress- ing from the head, on the seventh or eighth day I found the wound healed, by "first intention" as it is termed, a circum- stance rarely occurring in wounds of this kind. A physician residing near the place where this accident happened was sent for immediately after the accident, who observed to some of the patient's friends, that if he (the patient) was not bled, his life would be endangered. The patient however, was neither bled, nor purged: and although the shock was very severe he recovered without the occurrence of an unfavourable symptom. Diet.—In all cases of severe injuries the diet should be light. Gum arabic mucilage, elm gruel, milk porridge, toast and tea, custard, and oat meal and indian gruel form suitable articles of diet when the digestive powers are in a prostrated condition. In a later period when the injured parts are secreting matter freely, or the patient is free from any considerable degree of fever the tongue moist and the patient is disposed to perspiration, then a more nourishing diet will be required, as chicken soup, beef steak, mutton, eggs, stale wheat bread, &c. Tonics.—When an injured part or an abscess discharges mat- ter freely and the system is in a relaxed condition, bitters must be taken to strengthen digestion. SECTION VI. WOUNDS PRODUCED BY SHARP INSTRUMENTS. Simple cuts made by sharp instruments heal more readily than any other kind of wound of the same extent. In treating a simple wound, the first thing to attend to is to arrest the bleeding. If an artery be cut the blood will be of a bright red colour, and come in jets; dark blood comes from veins. When a blood vessel is cut or torn, a gluey substance is secreted by the coats of the injured vessel which gradually plugs it up and entirely stops the escape of blood. Arteries the size of a crow quill though they may bleed rapidly at first, will soon be- come plugged up by this admirable processs of nature. An intelligent person once related to me the following circum- stance to prove that some persons possessed the power of stopping the flow of blood without seeing the patient. A young man who was cut badly continued to bleed profusely until the family be- came alarmed, and sent a messenger off post haste to a dutch- man, who lived twenty miles distant, who it was thought pos- sessed the power to stop bleeding. On the messenger arriving at the residence of the dutch doctor, and made known his mis- sion, he was asked the name and age of the patient, on being in- formed in these particulars, he told the messenger to go home now, that the bleeding w7ould be stopped before he got back; and sure enough the bleeding had ceased, because nature had been all this time filling up the vessels until they had finally become closed. The dutchman however received the credit of stopping the blood and of saving the young man's life. Pressure.—Unless when a large artery be cut the bleeding may be arrested in a short time by pressing upon the parts with a sponge or a compress of folded linen or muslin. Position.—Bleeding from a cut upon the extremity of a limb may be partly arrested by holding the limb above the level of of the body; aided by pressure upon the part. Dr. Bellvil who was a very eccentric, but most distinguished physician, of Trenton, N. J., was sent for in great haste to as- sist another doctor to take up an artery that was bleeding. The messenger informed the Dr. that the cut was in the hall of the thumb and that the doctor who was there had been searching two hours for the artery without being able to find it. The doc- WOUNDI PRODUCED BY SHARP INSTRUMENTS. 351 tor was surprised that a physician should be probing the parts and keep the blood running by searching for an artery in a part where the vessel would soon stop bleeding if bound up and left alone, refused to attend the summons, and told the messenger to go home and bind up the wound, and cut the d----d doctor's head off. Cleansing the Parts.—After the bleeding is stopped, or so nearly so as to admit of the wound being dressed, the parts should be cleared of all extraneous substances and the clotted blood removed from the surface and edges of the wound. Placing the injured parts in their proper position is the next step and this is of some importance. In a simple straight incision there is seldom any difficulty in keeping the sides of the wound in a proper position, unless when the wound is extensive and cut across a muscle,—for when a muscle is cut across the contraction of the muscular fibres will separate the sides of the wound and break up the new adhesions as they are formed by the healing process. When a portion of flesh is badly cut stitches may be required; the stitches should be made with a fine sewing needle, threaded with cotton or silk, and should not penetrate beneath the skin. Adhesive Plaster.—Never cover the whole of a wound with ad- hesive plaster, but put it on in strips leaving sufficient inter- spaces to allow the escape of blood and serum from the wound. Lint is to be applied over the strips and the part properly bound up. Bandaging the Limb.—In cases where muscles are cut across, for instance, a deep cut across the calf of the leg, or across the thigh, or the fleshy part of the arm, the limb should be bandaged from its extremity up to the next joint above the injury. Thus if on the calf of the leg the limb should be properly bandaged up to the knee and kept in a flexed position, and all motion of the limb avoided until complete union has taken place. Evaporating Lotions.—When a wound becomes hot and pain- ful, evaporating lotions, alcohol, or camphor and water must be applied, or the parts kept wet with cold water; still the dressing must not be removed, except so far as to loosen it, if it becomes too tight. A bandage should always be wet before it is applied, otherwise it will shrink and become too tight; in which case it becomes necessary to wet it after it is applied. In large wounds stitches are generally preferable to adhesive plaster, for the parts require the application of evaporating lo- 353 LACERATED WOUNDS. tions, which will render adhesive plaster of little use. Where, however, the sides of the wound can be kept in perfect apposition by bandaging, both the adhesive plaster and stitches may be dis- pensed with. Removing the dressing too soon may very materially retard the cure; this should therefore be avoided until several days or even a week has elapsed after the occurrence of the injury, un- less it becomes painful or offensive from the putrefaction of the blood and secretions confined under the dressing. Constitutional Treatment.—A simple cut seldom requires con- stitutional treatment; still slight wounds are sometimes observed to become converted into very troublesome sores through neg- lect, and exposure to cold and dampness. In large cuts consti- tutional treatment will be necessary when the patient is in bad health, or the wound becomes very painful or assumes an un- healthy appearance. The constitutional treatment indicated will not differ from that already recommended in injuries of the scalp. A single course of medicine will sometimes cause a wound that presents an unhealthy appearance to become greatly improved in its general aspect in the course of a few hours. SECTION VII. LACERATED WOUNDS. Lacerated wounds are made by rough instruments which tear the fibres of the flesh. Lacerated wounds rarely bleed to any considerable extent; even large arteries may be torn asunder without occasioning much loss of blood. Lacerated wounds are more difficult to heal than a smooth cut, they seldom unite without the formation of pus. They are also much more liable to be attended with unhealthy inflammation, and constitutional disorder, than wounds made by a sharp and smooth edged instrument. The Treatment, both local and constitutional, is the same as described for wounds produced by sharp instruments, except that lacerated wounds demand more attention both in relation to evaporating lotions to the parts, and constitutional treatment. SECTION VI11. BRUISED WOUNDS. These are wounds in which portions of flesh are torn, mashed or bruised so as to destroy the vitality of the injured parts. Treatment.—Warm fomentations and moderately stimulating poultices are required in order to favour suppuration—the method employed by nature to remove the disorganized flesh. When the dead parts have sloughed away, the poulticing is to be aban- doned; the sides of the wound drawn together, by strips of ad- hesive plaster, and the air excluded from the wound by salve spread upon soft linen or muslin and applied over the parts, and then properly bandaged. If the parts continue to form matter freely, lint should be applied to absorb the pus. The dregs of No. 6, mixed with about an equal quantity of elm form a good poultice. The Constitutional Treatment should be regulated to suit the exigencies of the case. Promote the secretions by the use of pure stimulants; if the system be much disordered administer a course of medicine; and during the process of suppuration give tonics. The Diet should be nourishing provided the patient be clear of fever and the tongue clean, or cleaning. section IX. PUNCTURED WOUNDS. Wounds made by pointed instruments, dirks, hooks, scissors, nails, &c, are much more liable to be followed by serious conse- quences than cuts made by sharp edged instruments. Punctured wounds in tendonous parts, as the palm of the hand and ball of the foot are far more dangerous than when they hap- pen in fleshy parts devoid of tendons. Punctured wounds in the palm of the hand or in the bottom 2T 354 PUNCTURED WOUNDS of the foot are apt to close up without the occurrence of adhesive inflammation or the discharge of matter. Such wounds are fol- lowed frequently by much constitutional disorder, and sometimes by locked jaw. When matter is formed at the bottom of a punc- tured wound in the palm of the hand, sole of the foot, or in other tendonous parts, as about large joints, it may be confined and be prevented from passing off by the firm and dense tissues about these parts, and require an opening to be made by a lancet to allow the matter to escape. Treatment.—In punctured wounds means should be employed to excite adhesive inflammation, by pouring in the wound No. 6, or spirits of turpentine, and then apply a stimulating poultice to the part. The poultice should contain a considerable portion of cayenne pepper, so as to attract blood to the part and establish adhesive inflammation and suppuration. It is the deficiency of blood in tendonous parts, as in the palm of the hand and sole of the foot, that occasions punctured wounds in these parts to close without the occurrence of inflammation, or the formation of pus. If the hand or foot be piereed by a rusty nail, the w7ound should be cleaned out by a probe, or syringe with soap suds, or simple warm water, and then pour into the wound No. 6, or spirits of turpentine, and apply the stimulating poultice. If the stimulating poultice after continuing on several hours, should become extremely painful, causing an unnecessary afflux of blood to the parts, it may be removed and one less stimulating applied, which must be kept warm, and the limb elevated by a sling, if on the hand; or if the wound be on the foot, it should be raised on a chair when the patient is sitting up. Constitutional Treatment is highly necessary in cases of severe punctured wounds, more especially if the wound be about a large joint, or in the palm of the hand, or ball of the foot. A course of medicine should be first given, after wiiich the patient should take sufficient of composition, pepper tea, spice bitters, or other stimulants to promote a healthy action throughout the system. In proportion as the vital power is strong, in the same propor- tion will the constitution be able to resist the influence of dis- ease. A man whose stomach is in a healthy condition, and whose digestion is good, will be much less liable to have his sys- tem seriously disordered by a local injury, than one whose sto- mach is foul, and his digestion imperfect. Exposure to cold and dampness and excesses of every kind should be avoided by those who have received a punctured wound. SECTION X. WOUNDS OF JOINTS. A wound of a large joint, for instance, of the knee where tho pavitj7 of the joint is cut into so as to allow of the escape of the joint-water is an accident of the most serious character. When such a wound occurs in an aged person, or in one of an un- healthy constitution the patient very rarely recovers the use of the joint and it not unfrcquently terminates fatally. Young persons of vigorous constitutions may in general recover from such injuries, still there is great danger attending wounds of the large joints. Treatment.—In wounds of a joint the first and by far the most important point in the treatment is the closing of the wound im- mediately, in order to exclude the air from the cavity of the joint. Dry dressing must be put on and as soon as the parts are well secured from the air the limb must be bandaged com- mencing at the foot and carrying it up to the knee; the wound should be covered with lint, and the knee well bandaged. The object of applying a dry dressing is to favour the healing of tbe parts without the formation of matter, and of excluding the air from the joint. A poultice must never be applied where joints are cut into, until after the lapse of several days, and the part9 exhibit marks of suppuration, or the formation of matter—then it will be proper to apply a poultice. When the joint is dressed a splint must be applied to the under side of the limb in order to prevent the possibility of motion in the parts; for if motion be allowed in the joint, the new adhe- sions will be broken up, and a union by the first intention there- by prevented. As the parts swell the dressing must be loo- sened. After the wound is dressed, the dressing immediately over the wound must be kept wet with No. 6 or "the tincture of lobelia, as a means of exciting adhesive inflammation. After this has been applied a few hours, if the joint beeome very hot and pain- ful, the dressing may be kept damp with alcohol or vinegar. Constitutional treatment must be early applied unless the sys- tem be comparatively clear of disorder. Injuries of large joints, however, are necessarily attended with much constitutional dis- order, and more especially if the wound dees not heal without 356 BURNS AND SCALDS. suppuration occurring. The bowels are to be regulated by the use of injections; the secretions promoted by giving stimulants' such as capsicum, composition, or simple herb teas; and when there is fever, give small doses of lobelia in combination with the stimulants. In aggravated cases there is no means upon wiiich so much reliance can be placed as upon full courses of medicine and the free use of the third preparation of lobelia. The diet must be light at first, avoiding everything that is unwholesome, or hard of digestion. In the more advanced stages of the injury the diet must be nourishing, provided the stomach can digest it. If the wound suppurate tonics must be given unless the tongue be dry and the patient feverish, and even under these circum- stances the spice bitters may be used. Wounds of the large joints require great exertion on the part of the constitution, to repair the injury, creating the necessity for all the support that can be afforded by stimulants, tonics and nourishing food. SECTION X. BURNS AND SCALDS. For slight burns or scalds in which the skin is not.^destroyed, the best application is cold water, either holding the part in a basin of cold water or apply cloths on the parts, kept wet with cold water or whiskey and w7ater. This is to be continued until the smarting ceases; then cover the parts with an ointment pre- pared of sweet oil and lime water, or bind dry cotton on, or cover the parts with oiled silk. When blisters are formed avoid breaking the skin until the parts have had time to secrete a layer of lymph on the surface of the burn, which will protect the parts from the action of the air. The best way to open a blister is to pierce it in several places with a needle, and then cover the parts with a thick layer of carded cotton, or soft muslin cloths kept damp with alcohol and water, or whiskey and water, and this continued until the parts cease to be painful; or apply some simple ointment; the one above mentioned is to be preferred. Avoid removing the dressing until several hours or even a day or more has elapsed. Removing the dressing too soon breaks up the tender skin that nature forms, aggravates the burn, and BURNS AND SCALDS* 357 greatly retards the cure. Whatever dressing be applied to a burn, which is found to relieve the pain, whether it be dry cot- ton, cloths wet with evaporating lotions, sweet oil and lime wa- ter, or a poultice of scraped potatoe or carrots, it should be al- lowed to remain on, at least for several hours, or even much longer, unless there be a necessity for its being removed. When the outer skin is removed at the time of a burn or scald, I mean the skin that raises up where a blister is formed, the parts should be covered as speedily as possible, with an ointment of lime water and oil, lime water and milk, or of lard and com- mon soot from the chimney well rubbed together. Whilst the ointment is preparing, the part may be held in cold water or wet cloths laid on to relieve the pain. The ointment must be spread on linen or muslin, and when applied, cloths or cotton may be laid on this dressing, kept damp or wet with cold, wa- ter, to relieve the pain. The under dressing must not be re- moved for two or three days; indeed it is better to let the first dressing remain on until a new skin be formed on the burned parts. When a part is seared so as to destroy the skin, from live coals or a red hot iron, a poultice must be applied; for when the under layer or true skin is disorganized, suppuration will take place and instead of a new skin being formed as there will be when only the outer layer of the skin is removed, the parts will heal by drawing together, and thus form a scar or seam in the skin. The poultice recommended by Dr. Thomson which consists of a compound of slippery elm, white pond lily root, cracker, and a small portion of ginger, all finely pulv erized and wet with a strong tea made of raspberry leaves, form as good a preparation probably as can be devised. The poultice will re- quire to be wet occasionally, and when the parts are suppurat- ing freely a fresh one must be applied daily, until the suppura- tion is completed, when a salve must be employed to shield the parts from the air, until they are healed. When granulations shoot up, forming what is termed proud flesh, they should be covered with burned allum, or finely powdered marsh rosemary before the salve be put on. Where parts are scalded under clothes, and the clothing can- not be removed without breaking or removing the skin, it should remain on, keeping the parts wet with alcohol and water, or with simple cold water, and not removed for several hours unless the clothing prove a source of irritation to the parts. After the pain subsides through the continued application of evaporating lotions, the clothing over the burn may be saturated with some one of the ointments above mentioned, in order to exclude the air. * 353 BURNS AND SCALDS. Constitutional Treatment.—Severe burns or scalds generally occasion great prostration of the powers of life, manifested by chilliness,coldness of the surface, extreme prostration of strength, a weak pulse, and sometimes stupor or delirium. Under these circumstances stimulants and emetics must be given. If an in- dividual receive a severe burn or scald soon after taking a hear- ty meal, the food will not be digested, and if not thrown off by vomiting, it will oppress the vital powers. It is always safe, and generally highly necessary to give an emetic after a severe burn or scald. The best form of emetic for all cases where the vital powers are prostrated, is the liquid of the third preparation of lobelia, or the lobelia powder, steeped in strong composition or bayberry tea, adding a portion of cayenne pepper, or No. 6. Stimulants.—Stimulants, such as here recommended, given internally, will not aggravate a burn or scald on the surface. By giving stimulants we aid the constitution in maintaining the natural equilibrium of nervous power betw een the great centres of the system and the surface of the body, which is an important indication in the treatment of all forms of disease, whether ge- neral or local. The stimulants to be employed are capsicum, composition, or ginger tea. These stimulants may be given at all times; and when there is fever, broken doses of lobelia should be added to them, or taken separately; and if the skin be very hot and dry, bathe it with vinegar and water or spirits and wa- ter, to reduce its temperature dow n to the sweating point. Vapour Bath.—There is no objection to the use of the vapour bath in cases of scalds and burns, the parts being kept covered by the dressing during the steaming. When the patient remains in a torpid or sunken condition, or the burn or scald becomes very painful after the lapse of a day or two, or at any subsequent period after the first pain from the injury has subsided, the va- pour bath will prove especially beneficial, not only in relieving the pain in the parts, but it will aid the healing efforts of the con- stitution. I recently attended an old lady who had her foot bad- ly scalded, and not being treated properly in the first place—the dressing being frequently removed, the lymph wiiich was thrown out by the raw surface, designed to form a new skin, was taken off by the frequent changing of the dressings, and the scalded surface assumed an unhealthy appearance, the foot was extreme- ly painful, which continued for weeks with but little intermission, except when the parts were wrapt in wet cloths and cold water applied. All the applications that were made to the foot failed of exciting the healing power, or to make any favourable change in the part until the vapour bath was resorted to: the foot was steamed from an half to three quarters of an hour at a time with- BURNS AND SCALDS. 359 out any dressing on, and this repeated daily until a new skin was formed over the foot. This patient experienced more benefit from a general steaming than when it was merely applied to the foot. To Prevent Deformity—Great deformities are apt to take place after severe burns, when the true skin is destroyed. If, for instance, the palm of the hand and between the fingers be badly burned, the natural tendency in the parts will be to con- tract: the hand to be clenched and the fingers to unite together. This is to be prevented by binding a splint on the back of the hand, the splint being sawed at the extremity, so as to furnish a separate splint for each finger. The parts must be first dressed and then the splint applied. Especial care must be observed to interpose dressing between the fingers to prevent their uniting together. I once witnessed a very painful and bloody operation on a man whose arm had grown fast to his side in consequence of a severe burn, the proper care not having been taken to pre- vent the burned surfaces from coming together when healing. Severe burns on the neck are almost necessarily followed by more or less deformity. I have seen several cases where the chin was drawn down to the collar bone, the patients being unable to raise the chin from the breast. A severe burn on the inside of the arm at the elbow would naturally tend to bend the arm when healing; and if allowed to heal in this position the patient will ever after be unable to straighten the arm. This deformity is to be pre- vented by applying a splint to the back of the arm, so as to keep the limb straight. I have heard Dr. George M'Clellan relate a case of a child that was severely scalded over the greater part of its body, and the mother in her fright, wrapped the child in carded cotton, a heap of which happened to be in the room at the time, which soon relieved the pain so that the child dropped asleep, and when the cotton was removed, the skin w7as not blistered. The doctor re- lates another instance of a boy who was severely scalded by fall- ing into a soap boilers kettle, when some one in the establish- ment spread out a blanket, covered it over with soap-fat and soot well rubbed together, laid the boy on the blanket and then wrapped him in it. This dressing was not removed until a new skin was formed over the scalded parts, and the patient was soon well. SECTION XI. CHILBLAINS. Chilblains are most liable to occur on the heel, the toes, and sides of the foot. The parts affected are somewhat swollen, red, and at particular seasons of the year, or on warming the feet by the fire they itch very much and are painful. Causes.—Chilblains are produced by severe coldness in apart being too suddenly warmed by the fire. Preventive measures.—When the feet or hands are benumbed by cold, and great pain is occasioned as they begin to warm, they should be placed in cold water and kept there until the parts cease to be painful, when they are removed from the cold water; or the parts may be bathed or rubbed with alcohol, whiskey, opodildock, or spirits of camphor, and kept away from the fire, orfrom a warm room as long as there is pain experienced. Treatment.—Chilblains, unless properly treated, may continue to be occasionally swollen and prove a source of great annoy- ance for years, unless proper means betaken to overcome the de- bility of the vessels of the parts. A very good plan of treating chilblains is to bind on the parts a poultice composed of wheat bran, soft soap, and fine salt; the poultice to be continued on an hour or two at a time, and then the parts to be bound up with oiled silk and not allowed to be near the fire. The oiled silk to remain on several days. Another plan of treatment is to rub the parts with oil of turpentine, and then rub on stimulating ointment on a piece of bladder or silk oil cloth, and bind it on the parts. This application to be repeated every night until the parts are restored to their natural condition. SECTION XII. TREATMENT OF FROZEN LIMBS. When a part is benumbed or frozen, the most important indi- cation in the treatment is to regulate the temperature around the frozen part, carefully guarding against warmth until the ves- sels recover sufficient strength to carry on the circulation. A frozen part should never be thawed by the application of exter- nal warmth, or it will be followed by violent inflammation if not by mortification. It would seem that the application of warmth to a frozen part, destroys the natural equilibrium of nervous energy between the great centres of the system and the surface of the body. In such cases the blood which is attracted to the surface by the warmth, is not circulated or returned back as it should be, a tendency to putrefaction or disorganiza- tion occurs, attended with violent inflammation, followed per- haps by mortification. A part that is frozen must be kept in cold water, even adding snow or ice to it, and this continued until the parts are complete- ly thawed, and then the temperature around the part should be increased very gradually, not allowing a sudden change from cold to warmth. Covering the frozen parts with snow is a good practice. If a person besides having his limbs frozen should be greatly benumbed and chilled throughout the body—nearly frozen to death—he should not be taken into a warm room, but be laid in a room without fire. It would be even better that the patient remain in a barn than to be placed in a temperature much above that of the external air. I have heard a case related of a man frozen severely and stiff, who w7as restored by being placed in a cask of pickled cabbage, commonly called sour-crout. Stimulants must be given to support the living powers.— Cayenne pepper, composition, ginger tea, carbonate of ammonia, warm brandy toddy, and No. 6 in w7arm water may be employed as stimulants; and wine whey, essence of beef or chicken tea may be given as nourishment, until the powers of digestion are in- creased so that other kinds of food can be digested. Stimulating injections will aid in restoring animation. When a part of a limb is frozen without the body being very much benumbed with cold, the patient may remain in a comfort- ably warm room, observing the precaution to keep the frozen part 2 U 362 TREATMENT OF FROZEN LIMBS. in cold water, or enveloped in snow7, until it be thawed; and then the parts may be wrapt in cloths kept damp with whiskey, alco- hol, spirits of camphor, or vinegar. A most important indica- tion in the treatment of frozen parts is to "keep down the out- ward heat" of the injured parts, or a stagnation of the blood in the parts will be the consequence. When through improper ma- nagement in the first place or from other causes, a part that has been frozen becomes inflamed, threatening mortification, a poul- tice must be applied, composed of elm, white pond lily, cracker and ginger; the poultice to be kept wet with cold water, and the limb elevated. The yeast poultice mentioned in the materia medica may be employed. The patient should also be placed under active constitutional treatment, in order to aid the efforts of nature. A full course of medicine should be administered and frequently repeated in all cases where mortification is threaten- ed, and stimulants given freely to excite the secretions, and in- crease the power of action in the enfeebled vessels, thus lessening the tendency to conjestion of blood in the parts. It is common in the old practice to prescribe bark and wine in cases of morti- fication; such remedies, however, when the secretions are sus- pended, the tongue being dry and the skin dry and harsh, will necessarily prove injurious. But if a patient in the condition above described, be carried through a course of medicine, and followed by a free use of cayenne or composition tea, adding small doses of lobelia, the symptoms will generally assume a more favourable aspect, and certainly never be aggravated by it. Tonics.—There is a condition of the system when barks and wine will prove of great benefit in cases of mortification, or in cases of recovery from the effects of freezing. When the tongue is cleaning, and moist, and the surface of the body inclined to mois- ture, tonics may be given freely. Peruvian bark, quassia, co- lumbo root, Virginia snake root, balmony, golden seal, quinine, poplar bark, or spice bitters, maybe employed either separately or combined together. Diet.—The diet in mortification should be of the most nour- ishing kind, provided the digestive pow7ers he not too far pros- trated. When the tongue is dry and parched and the patient feverish, gum arabic or slippery elm mucilage, essence of beef, barley water, &c. will be the most suitable. But when the tongue is moist and cleaning, the skin warm and relaxed, the patient may take eggs, beef steak, mutton, chicken, wild game, custards, milk boiled, milk porridge, &c. In some cases of ex- treme debility, wine whey and even wine may be given.— No. 6 taken in warm water sweetened is an excellent tonic and stimulant. SECTION XIII. BILES. Treatment.—In the earlier stages of biles warm fomentations and poultices are required to soften and relax the parts and to favour suppuration. The core of a bile consists of dead cellular tissue, and inflam- mation is necessary to bring on suppuration or the absorption of the parts surrounding the dead cellular tissue, in order to sepa- rate it from the living parts. It is therefore better to avoid opening a bile too soon, as that may interfere with the operations of nature, and retard rather than hasten the cure. There is a time however, when a bile should be opened and not allowed to break spontaneously, or it may destroy so much of the skin as to leave a large scar. After a bile has been opened the parts must be poulticed until the swelling and inflammation subside. In all running sores it is better to have a poultice spread on oiled silk, or something that will prevent evaporation. As a general rule poultices should be made more stimulating after an abscess or bile is opened than before, and if the parts be much relaxed and colder than natural, equal portions of composition powder and slippery elm will form a very good poultice. Washing or syringing the cavity of biles with a strong tea of bayberry or sumac adding a portion of No. 6, is very useful, it promotes granulation and assists the healing action. When the matter is discharged and the swelling in a great degree disappeared, poultices may be laid aside and salve spread on soft muslin or linen substituted, and wash the sore occasion- ally with the tea above mentioned. When the cavity of the bile Is obstinate in healing, No. 6 may be poured into it, or wet a piece of lint with the drops and let it remain in the sore, applying a salve over the parts. Constitutional Treatment is not required in common cases of biles, except it may be to lessen pain by relaxing the system or with a view to prevent other biles. Biles very often occur after scarlet fever, measles and small pox* SECTION XIV. CARBUNCLE. The carbuncle never occurs in a healthy constitution. It may arise from the same cause that produces biles, but instead of healthy inflammation observed in case of a bile, termina- ting in the formation of what is termed healthy or laudable pus, it assumes an unhealthy character accompanied by burning pain. The swelling assumes a dark red or livid appearance, and instead of pus being formed or contained in a single cavity and with a core in the centre, as in the case of a bile, the swell- ing becomes soft and feels spongy and small vesicles or belbes are formed on the skin as in erysipelas, and an acrid fluid is dis- charged from numerous openings or small ulcers on the parts.— The fluid which escapes resembles a mixture of flour and water; the small ulcers run together and form openings sufficient to al- low portions of the dead cellular tissue to escape resembling shreds of tow or cotton. Tbe cheek, neck, and back are the parts most liable to car- buncle. Carbuncle is not in general dangerous yet it is slow in its progress, and difficult of cure. Treatment.—The local treatment in the first place should con- sist of warm fomentations and poultices. Experienced sur- geons advise the early opening of the carbuncle, and applying a poultice made of port wine and ground flax-seed. A poultice of composition and elm, or of yeast and ginger may be used in the place of tjjpe port wine poultice. Syringing the cavity with strong bayberry tea, and then pouring in a portion of No. 6 will be of especial benefit in exciting a more healthy action in the parts. Local steam ings will also aid the lining parts to cast off the dead cellular tissue. Constitutional treatment will be required in all cases of car- buncle, employing every means to correct the diseased con- dition of the general health, and to strengthen and support the constitution. In the first place the patient must be carried. through a full course of medicine every few days and during the intervals use freely of composition, pepper or spice bitters. As the constitutional symptoms wear a more favourable aspect, clean- ing of the tongue, a general warmth through the body, with a ABSCESS OF THE FEMALE BREAST. 365 moist skin, then tonics, such as bark and wine, quinine, gentian, columbo, and Virginia snake root must be given freely, and the patient allowed a nourishing diet, eggs, milk porridge, custards, beef steak, mutton chops, boiled chicken, wild game, stale bread, cream, toast, &c. Fresh Air.—When the state of the weather and the condition of the patient will admit of it, he should ride or walk out to re- ceive the benefit of fresh air and exercise, observing especial care, however, to keep warm. SECTION xv. ABSCESS OF THE FEMALE BREAST. Gathered breast as it is commonly termed, is chiefly though not exclusively restricted to females after confinement It is generally occasioned by a large accumulation of milk, exposure to cold, or from sore nipples. The frequent exposure of the breast to the air, more especially when the skin is covered with perspiration is a common cause of gathered breast. Treatment.—As soon as the breast begins to be hard or pain- ful from too great a flow of milk, it should be bathed frequently with some evaporating lotion, whiskey, brandy, warm vinegar or spirits of camphor and water, or cloths applied and kept moist with some one of the above articles. This will lessen the secre- tion of milk. But if the breast cakes and become* painful and cannot be eased by the means above mentioned together with fre- quently drawing the breast it should be steamed frequently, and covered with a plaster of salve, to keep the skin soft and moist. A hole must be cut in the centre of the plaster to admit the nip- ple. When a lump is formed in the breast from taking cold in the part or from irritation of the nipple, steaming the breast fre- quently and applying a plaster of salve, or a poultice composed of equal parts of green lobelia and elm, if early applied will gen- erally prevent suppuration, easing the pain and scattering the swelling. If the system he much disordered, an emetic or a course of medicine will prove beneficial in removing obstructions in the breast, and preventing suppuration. Placing the patient under ' 366 WHITLOW OR FELON. the influence of lobelia given in broken doses so as to occasion slight nausea will be useful in moderating pain in the breast and by the relaxation thus produced will aid in removing obstruc- tions. If the use of the above means fail of discussing the swelling and the breast continues to be very painful and throbbing, w7arm poultices must be applied with a view to favour suppuration and to bring the matter as speedily as possible to the surface. When suppuration is about to take place there is a severe throbbing pain in the part, and the patient experiences chilliness, and a blush appears on the skin covering the swelling. It is better to delay opening a gathered breast until the matter approaches near the surface. After the abscess is opened or breaks spontaneously a poultice composed of composition and elm or flaxseed; or of elm, white pond lily, and ginger must be ap- plied, and the poulticing continued until the discharge of matter has nearly ceased, when the parts may be covered with some kind of salve, and moderate pressure applied to favour the union of the sides of the cavity. SECTION XVI. WHITLOW OR FELON. Whitlow is an extremely painful swelling, mostly confined to the fingers, and particularly to the middle or last joint, or it is seated under the nail. This painful affection often becomes protracted in duration in consequence of pus or matter being formed beneath the tendons, or under the membrane that covers the bone, requiring a con- siderable length of time for it to find its way to the surface. Causes.—Felon or whitlow is sometimes caused by a bruise, in other instances it is occasioned by a slight wound on the skin; even the scratch of a pin, if frequently irritated or not protected from the air may affect the parts near the bone and produce a felon. Occasionally it comes on without any appreciable cause. Treatment.—In the outset of a felon placing the hand in alco- hol, brandy or vinegar, und continuing it several hours at a time and afterwards wrapping the finger in cotton kept wet with spirits of camphor, alcohol, or vinegar will sometimes prevent WHITLOW OR FELON. 367 the formation of matter. And even though it should fail of pre- venting suppuration it will mitigate the pain. A plaster com- posed of lime and soft soap, is a favourite remedy with some for whitlow or felon. If the swelling continue to increase attended with severe throbbing pain, the above or some other form of poultice must be kept on the parts, wetting it occasionally as it becomes too dry, and when there is evidence of the existence of matter in the part, it should be opened, either with a lancet, or in the w7ay Dr. Thomson recommends, which is, to burn pieces of spunk about the size of a large pea, on the part until the flesh becomes dead- ened down to the matter, and then to open it. When this method is employed the band and the diseased finger except the part on which the spunk is to be burned should be held in cold water du- ring the operation. A pair of forceps or tweezers may be used in setting fire to the spunk and placing it on the finger. Dr. Thomson does not advise this plan of burning spunk upon the part, until there is a purple appearauce in the part indicating the approach of matter towards the skin. Another plan recommended by Dr. Thomson to facilitate the approach of the matter to the surface is to slack a small piece of lime on the finger. In doing this the hand should be placed on wet cloths, and a small roll of the same placed at each side of the finger to prevent the lime from falling off. A piece of un- slacked lime about the size of a shellbark nut is to be laid on, then wet, and allowed to remain as long as the patient can bear it, or until it becomes cold. This may be repeated occa- sionally until there is some appearance of matter, when an open- ing should be made. Before an opening be made, any kind of emollient poultice may be applied to favour suppuration; but after pus begins to be dis- charged a stimulating poultice must be employed. Equal por- tions of slippery elm, white pond lily, and ginger form suit- able compound for the poultice. Indian mush, flaxseed stewed in milk, or any other soft substance may be employed adding a portion of cayenne pepper or ginger. During this stage of the felon the poultice should be spread on oiled silk, or a piece of bladder to prevent evaporation. When the swelling and inflammation has in a great degree disappeared, poulticing may be omitted, and Thomson's healing salve applied. When matter is discovered under the nail, a portion of the nail must be cut away to allow the pus to escape. When an opening is made by a lancet in the earlier stages of a felon the matter being deeply seated, care must be observed to avoid cutting open a joint. A lancet may be safely introduced down to the bone except immediately at the joint. 368 HIP DISEASE. Constitutional Treatment.—The pain attending a whitlow or felon, may be mitigated by using means to excite perspiration and by placing the system under the influence of lobelia, given in broken doses, to the extent of producing slight nausea. If the system be much disordered an emetic or a full course of medicine will be especially beneficial. Patients may sometimes procure sleep by having the hand raised upon pillows, and taking tincture of lobelia in sufficient quantities to cause slight sickness. SECTION XVII. HIP DISEASE. Disease of the hip joint is of very common occurrence; and although it prevails most among children, still the disease not unfrequently attacks adult persons. Causes.—Although the hip disease be occasioned in many in- stances by a fall, yet it rarely happens in persons of sound and vigorous constitution. A bruise upon the hip that occasions scarcely any inconvenience to one of a healthy constitution, would be liable to cause the hip disease in one of feeble organiza- tion, or who is of a scrofulous constitution. Symptoms.—In the majority of instances of hip disease the first thing of which the patient complains is a pain in the knee. The pain is in some cases slight at first, in other instances it is severe from the commencement, preventing the patient from sleeping at night, except at short intervals. The patient is observed to limp and the knee becomes bent. As the disease ad- vances the patient complains of severe pain about the hip or groin, yet in some cases the pain is almost exclusively confined to the knee during the whole progress of the disease. Duration of the Disease.—The hip disease is usually slow in its progress, seldom terminating its course in less than a year. Occasionally under favourable circumstances and a proper course of treatment, the parts resume a healthy condition in the course of a few months; but unfortunately in the great majority of cases, the disease continues for years, though seldom attended •with severe pain, except at intervals, and more especially in the early stage, and when suppuration is about t© take place. niP DISEASE. 369 Termination.—Few patients recover from the hip disease without more or less distortion of the limb of the affected side. Sometimes the inflammation of the joint terminates in resolution, still this is of very rare occurrence, for the parts possess so low a degree of vitality that the restorative efforts of nature are in- sufficient to prevent disorganization of the diseased parts in un- healthy constitutions. A part of the body that is well supplied with red blood, will recover from disease much more readily than parts which receive but a small supply of arterial blood. Hence the tissues about the joints receiving very little red blood are very slow to recover from djsease; most commonly the inflam- mation terminates in suppuration about the joint, the matter taking different directions, sometimes pointing to the surface in the region of the joint; in other instances the matter travels down into the groin forming a fluctuating tumor; or it may pass down the thigh, sometimes almost to the knee. In most in- stances the parts finally heal but the joint remains stiff, and the limb shortened. The head of the thigh bone is sometimes entirely destroyed leaving the limb several inches shorter than the sound one. In very feeble constitutions the disease some- times terminates fatally, the powers of the constitution being worn out by disease. Treatment of Hip Disease in its early stage.—In the outset of this disease the means chiefly to be relie&upon, are the vapour bath, rest, stimulating applications, occasionally an emetic, broken doses of lobelia, and warm teas to promote perspiration. The Vapour Bath may be administered daily during the early period of the disease. When the patient has been steamed twenty minutes or half an hour, he may be showered'with mode- rately cold water, rubbed dry and bathed with vinegar or spirits. After the bath the hip must be covered with stimulating oint- ment, or with salve to which a portion of pepper has been added. The parts should then be covered with oiled silk, or a rabbit skin or buckskin to promote perspiration and keep the parts warm. Rest is very important in the early period of the disease. A splint carved or moulded to fit the limb in a straight position or nearly so, may be applied with benefit in the early stage of the disease. It will not only favour the cure by keeping the joint at rest, but may prevent deformity of the limb, provided the dis- ease terminate without the occurrence of suppuration. After the disease becomes permanently fixed, then to confine the pa- tient with a splint will be useless or oven injurious; he should be allowed to use crutches, and when the weather will permit to have the benefit of the open air. 2 V 570 HIP disease. Emetics must be given whenever the condition of the patient demands their employment. It is in the early period of the dis- ease however, that they are more particularly indicated. The proper time for giving an emetic is shortly after a vapour bath has been administered. If the patient be very feeble and pale, the emetic of lobelia should be combined with stimulants, as compo- sition, pepper and bayberry, or with No. 6 and bayberry.— There is no period of the disease when an emetic will not prove of benefit if the stomach be foul, or when the patient is suffering severe pain. Broken doses of lobelia must be given frequently in the early stage of the complaint, more especially if the disease be attended with severe pain or fever. Warm teas of pennyroyal, mint, and ginger may be taken to promote perspiration. In a more advanced period of the hip disease, it will be useless as before mentioned to keep the parts at perfect rest, or to con- fine the patient by the use of a splint. Neither will it be neces- sary to give much medicine, except occasionally as the condition of the patient demands it. Cleanliness, fresh air, nourishing diet, salt water bath or sponging the body with salt wrater, and friction of the surface are chiefly to be relied upon when the dis- ease has become permanently fixed. When the parts are pain- ful how7ever, or the general health disordered medicine must be employed. When suppuration takes place, an abscess may be formed at the hip, or the pus may pass down into the thigh, forming a fluctuating tumour there. All experienced surgeons now agree that abscesses about the hip should not be opened until at a late period, or when the matter comes so near the surface as to threat- en the destruction of a considerable portion of the skin, when it is better to make a small opening with a sharp lancet, draw- ing off only a part of the matter at a time, and then closing the opening with a piece of adhesive plaster. Abscesses in the thigh often contain from half a pint to a quart of pus, which being secreted at the hip joint passes down between the muscles and thus collects in the thigh. Where an abscess is formed in a part thus remote from the joint it may be opened with safety. When pus is discharged either spontaneously or by opening the abscess, every means should be employed for sustaining the patient's strength; and the use of tonics, nourishing food, exercise in the open air, saltwater bathing, a change of residence, for in- stance, from a city to the country, to the sea board, or to a mountainous or pine country should be resorted to. HIP DISEASE. 371 Sick children are apt to be indulged in eating sweet cakes and various kinds of dainties between meals, which impair digestion and destroy the natural appetite. And although the patient have the gratification of eating a sweet cake he loses not only the en- joyment but the benefit of a meal. When patients who are reco- vering from sickness and more especially children, require food between meals it should consist of such articles as milk porrige, toast and milk, crackers, stale bread, custards, or crust of bread. Pepper Poultice.—In the earlier stages of the hip disease and also after an abscess has formed, and where matter has been discharged and the parts remain in a pale and flaceid condition a poultice composed of equal portions of cayenne pepper and slippery elm powder may be applied occasionally with decided advantage. Warm Fomentations.—In the earlier stage of hip disease, when the parts arc painful, besides administering vapour baths, bags of hops, or of bitter herbs, wet with hot vinegar, maybe applied to the hip, and kept w7arm by hot bricks or bottles of hot water. Pressure.—Whenever the hip will bear pressure without occa- sioning pain, it must be applied, with a view to support the en- feebled and relaxed vessels. This maybe done by a bandage of flannel or of muslin, put around the hip. After pus has formed and discharged, or the parts are still secreting matter, pressure should always be applied, in a degree suited to the condition of the parts. Children who inherit scrofulous constitutions are in general favoured with superior intelligence, so that although they may be physically w7eak, yet superiority of mental power, enables them to pursue professions which require intellectual rather than muscular strength. It must be born in mind, however, that chil- dren of scrofulous constitution, will not bear close confinement in crowded school rooms without materially injuring their health. It is better in such a case that their education be neglect- ed, in early life, and that they receive the benefit of the open air which will prove the most effectual means of improving the constitutional health. SECTION XVIII. WHITE SWELLING. The knee joint is observed to be more frequently affected with white swelling than any other of the joints. It seldom happens in others than in those of feeble constitution, and more especially in the scrofulous. The hip disease so prevalent among children of bad constitutions is a disease of the same character as white swelling. The hip disease prevails mostly in children under twelve years of age; whereas white swelling is most prevalent in adults. Causes.—The most frequently exciting cause of white swelling is exposure to cold. A person of a sound constitution may bear an exposure to cold without that inconvenience which would occa- sion such a degree of debility in one of scrofulous constitution as to cause white swelling. When the vitality of a part is reduced below7 a certain point, the constitution establishes inflammatory action with the de- sign of sustaining the vitality of the part. Thus the membrane that lines the cavity of the knee joint by the influence of cold, may be so far deprived of its vitality, as to call upon the consti- tution for an increased supply of blood in order to prevent the death of the parts, and to repair the injury already sustained in the affected parts. A new supply of blood is sent to the knee, an inflammatory action is established which under favourable circumstances may terminate in resolution—the parts being re- stored to a healthy action. Under circumstances less favourable the inflammation may terminate in adhesion—the joint being stiffened but without any destruction of the parts. Under cir- cumstances still less favourable, for instance, where the consti- tutional health is very bad, or the vitality of the diseased parts reduced beyond the power of reparation, then suppuration of the parts will take place, matter will be discharged, and the disease necessarily become of long continuance and extremely painful. Portions of bone are destroyed in many instances by the process of absorption. Treatment.—The indications for the cure of white swelling are to correct and support the general health, and to employ such local means as will aid in bringing the inflammatory action in the diseased parts to a favourable termination—either WHITE SWELLING. 373 in resolution, or anchylosis (stiffening of the joint) or if suppu- ration occur, to favour the occurrence of adhesive inflammation and stiffening of the joint which will be the only " safeguard of the patient," after suppuration has taken place. An occasional course of medicine should be administered in the earlier stage of the disease, or at any period when the pa- tient is suffering severe pain. Besides the course of medicine the spice bitters should be taken two or three times a day, and a dose of composition or of bay- berry and pepper at night. These remedies however, may be given in a different form, to suit the fancy of the patient. Thus the No. 3 pills w ill supply the place of the bayberry and pepper, and when the tongue is dry the compound lobelia pills will be appropriate. Injections moderately stimulating and containing a portion of lobelia will be useful not only to assist the action of the bowels, but by the influence which they exert over the circulation of the lower extremities. An injection of composition tea, adding a portion of lobelia powder, retained fifteen or twenty minutes or allowed to remain in the bowels, will seldom fail of relieving pain in the diseased limb, and it it will also in many instances cause free vomiting. Tonics.—In a later period of the disease and more particularly wiierc suppuration has taken place and the parts are discharging matter, bitters may be employed with a view to strengthen the digestive powers so as to allow the patient to take nourishing food, to support the constitution in her curative efforts. In the earlier stages of the disease, composition, pepper, spice bitters and lobelia are generally indicated, whereas in its more advanced stages, tonics, syrups, generous diet, fresh air, and gentle ex- ercise are called for. Local Treatment.—In the earlier stages of white swelling, and all affections of this character steaming and fomentations will be found beneficial. The steam may be applied for half an hour or even an hour at a time, and after this the stimulating lini- ment may be applied to the parts, and then bind them up in oiled silk or flannel. The limb must be kept warm and at rest. In the place of applying the steam in the usual way, the patient sit- ting in a chair, a bag filled with boiled potatoes, or with hops wet with vinegar, may be kept to the parts constantly, keeping a hot brick to the bags, or have two and change them so as to keep one constantly warm to the parts. This latter method is gene- rally to be preferred, as by it a regular warmth may be applied S74 ULCERS. many hours or even days, without putting the patient under the necessity of sitting up. Bandages.—Even in the earlier stages of white swelling, mo- derate pressure will be beneficial provided it can be applied with- out occasioning too much pain. If the disease be in the knee joint the limb must be bandaged from the end of the foot to the knee, first applying stimulating ointment, No. 6, or pepper sauce. Dr. Thomson's Poultice for White Swelling.—Take fresh comfrey root and scrape or grate it fine until you obtain half a pint. To this add the white of two or three eggs well beaten, and a gill of brandy, or sufficient to make it of a proper consistence for a poultice; spread this and bind it on the affected parts as firmly as can be borne, renewing it as often as it becomes dry. When the parts suppurate, the disease becomes extremely painful and protracted in some cases to several years duration. In severe cases the constitution may become exhausted, the patient sinking under the effects of the disease. In treating this and every other disease attended by inflamma- tion it should be borne in mind that inflammation is not the first change in the parts from a healthy condition. Coldness and loss of vitality in the part is the first change from a healthy state, and inflammation follows as an effort of the constitution to preserve the vitality of the parts, and protect the joint from de- struction; and although these efforts are frequently baffled from want of constitutional energy, or from great debility of the parts diseased; still the design of the inflammation is the same, and the treatment should be directed to correct and support the gene- ral health and to promote the circulation in the diseased joint by the various means already mentioned. SECTION XIX. ULCERS. Some medical writers divide ulcers, into three classes, namely. healthy, unhealthy, and specific ulcers. An ulcer is generally of a healthy character where it occurs in one of a healthy constitution, and more especially in the young and robust; whereas the aged and feeble,"and especially those of intemperate and desolate habits are subject to ulcers of an unhealthy character, and very ULCER. 375 difficult of cure. Syphilitic, cancerous, and scrofulous ulcers, are generally considered as being of a specific character. SECTION XX. SIMPLE OR HEALTHY ULCER. Causes.—Simple ulcer arises from some local injury, a bruise, cut, or burn; or it may follow abscesses or biles. Characteristic marks of the healthy Ulcer.—The surface of this ulcer has a florid appearance, raised above the edges, discharges a creamlike pus, that has no odour; " and the edges of the sore are whitish and nicely adapted to the surface." Treatment.—The simple healthy ulcer seldom requires any thing more than to be protected from the air by the application of some simple salve. A healthy ulcer may become converted into one of an un- healthy character by frequent exposure to the air or toother in- jurious influences. If proud flesh rise up in the sore, a poultice of finely powdered marsh rosemary, bayberry, or alum, must be sprinkled upon the parts and salve applied; or instead of the powder apply dry lint to the proud flesh, cover the edges of the sore with salve, and apply moderate pressure to the sore. SECTION XXI. UNHEALTHY ULCER. An unhealthy ulcer may be extremely irritable inflamed and painful; or it maybe indolent and almost devoid of sensibility— In aged persons a bruise upon the skin is apt to occasion an un- healthy ulcer, " the parts being too weak to carry on the actions necessary to its recovery." A great diversity of appearances arc presented by unhealthy ulcers. 376 ULCERS. The irritable ulcer is generally characterize! "observes Doctor Gibson" by the following appearances. The edges of the sore are ragged, undermined, and sometimes almost serrated. The parts for some distance beyond the ulcer are red and inflamed and often (edematous. Irregular hollows occupy the bottom of the ulcer, and contain a thick greenish or reddish matter, which is so extremely acrid as to excoriate the adjoining skin. In place of granulations may be found a white or dark red spongy mass, extremely painful and shedding blood upon the slightest touch." "Inflamed Ulcers___Here you have a serous discharge from the sore; a bloody ichor, composed of serum and the red particles of blood; a disposition in many cases to slough; the surface covered with a brown incrustation; and the skin and surround- ing parts highly inflamed." Castle's Manual of Surgery. "Gangrenous Ulcers.—In ulcers of this kind, the surface is per- fectly free from any discharge; the surrounding edges of a livid appearance, with small vesicles or blistered spots on them; and the patient suffers much from irritative fever." Indolent Ulcer.—This is the most common kind of ulcer. The edges of the sore are raised, and rounded, giving the appearance of a deep cavity to the ulcer. The surface of the sore is cover- ed to a greater or less extent with a slight coloured crust, and is extremely insensible to the touch. In general there is a free , discharge of a tenacious matter from the sore, differing essen- tially from healthy pus. This kind of ulcer is in almost every instance seated on the leg. and the nearer it is to the ankle the more difficult it is of cure. TREATMENT OF UNHEALTHY ULCERS. Constitutional treatment is in general necessary in the cure of unhealthy ulcers, besides its influence in exciting a healthy ac- tion in the vessels of the diseased part; a proper course of consti- tutional treatment secures the constitution from the bad conse- quences that might otherwise ensue from the healing of long standing ulcers. I have known ulcers of many years standing, to be entirely healed in a short time, under Thomsonian treat- ment and the general health of the patient still continue to im- prove. Unhealthy ulcers will in many instances be observed to assume a more healthy appearance, after the patient has been carried through a course of medicine. In cases of long standing the va- pour bath and emetic, or a full course of medicine will be re- ULCER. quired to be administered as often as every week or two, and re- peated several times, together with the daily use of stimulants, capsicum, composition, auti-c-anker medicine, and tonics, and a proper course of local treatment, before the sore will assume a healthy condition, and secrete the cream-like pus, observed in healthy ulcers. In confirmed drunkards, ulcers are often very difficult to heal; constitutional and local treatment proving ineffectual, so long as the habit of excessive drinking is continued in. Besides an occasional course of medicine, the following plan of giving the medicines (first proposed to me by Dr. A. C. Logan) I have found well adapted to almost every case of chronic disease, namely: A dose of Thomson's anti-canker medicine in the morn- ing before breakfast, a dose of the No. 4 bitters before dinner, and composition at bed-time. If the bowels be costive, from three to six of the compound lobelia pills should also be taken at bed-time. Dr. Logan's Alterative Syrup.—This syrup is made by com- bining equal portions of tincture of lobelia, No. 6, and simple syrup of sugar. To be taken in doses of from one to two or three teaspoonsful, repeating the dose several times a day, but particularly shortly after or within an hour or two after meals. The use of this syrup fulfils many important indications for im- proving the general health. Sarsaparilla Syrup.—In mercurial syphilitic, or scrofulous ulcers, the simple syrup of sarsaparilla, or a syrup made of a compound of sarsaparilla, guiac shavings and yellow dock root, will be found useful. Local Treatment in Unhealthy Ulcers.—In the first place, sti- mulating and astringent washes and poultices must be employed to stimulate and give tone to the enfeebled vessels; and when the ulcer has begun to secrete thick yellow or cream-like matter, and healthy granulations are formed upon the surface of the ulcer, then fresh salve may be applied; or shave the hair from the skin around the ulcer, and apply strips of adhesive plaster, which should encircle about two-thirds of the limb, pressing the edges of the ulcer towards each other when the ad- hesive straps are put on, and leave small interspaces between the straps, for the escape of pus or whatever secretions may be formed. If the ulcer be on the leg, the limb should be bandaged, commencing at the end of the foot and extending the bandage above the ulcer, so as to apply moderate and equable pressure to the limb. This will, in general, enable the patient to walk out, or to pursue his daily avocation, the bandage furnishing support 2 W 378 ULCERS. to the blood vessels and aiding them to carry on the circula- tion. Indolent ulcers may require actively stimulating poultices, such as a compound of cayenne pepper, bayberry and elm, or of composition powder. Dr. Samuel Thomson informed me that he had cured indolent ulcers by applying the dry powder of cayenne pepper, brown lobelia and bayberry, and then adminis- tering a course of medicine. Another plan of treating unhealthy ulcers, is to fill the ulcer with bees-wax and Burgundy pitch melted together and applied as warm as the patient can bear. This is to be bound on, and renewed as often as may be required. Change of Remedies.—Every one who has treated ulcers of long standing must have observed the utility of occasionally changing the local treatment. An application that will answer well at one time may prove useless, or even worse than useless, at another. The extract of red clover, (Thomson's cancer balsam) has been highly recommended by some practitioners of the old school as a valuable remedy in indolent ulcers. The extract of sheep sorrel may be used for the same purposes. It must be borne in mind, however, that in cases of long stand- ing sores, a course of medicine should be administered and re- peated if necessary, in order to prevent any bad effects that might otherwise arise from the healing up of ulcers. To Prevent a Return of Ulcers.—When an old sore has healed, the part should be bound in flannel, wetting it every day with No. 6. The flannel will not require changing, as the myrrh will prevent its becoming in the least degree offensive. Beja- min Thomson, formerly of Boston, showed me a flannel bandage that he had worn around his shin two years, and by having it wet occasionally with No. 6, it wras entirely devoid of offensive- ness, and afforded a protection against ulcers, of which he had been many years subject to. Gangrenous Ulcers.—"In ulcers of this kind, the surface is per- fectly free from any discharge; the surrounding edges of a livid appearance, with small vesicles or blistered spots on them; and the patient suffers much from irritative fever." Treatment.—Where a part is threatened with gangrene or mortification, the yeast poultice should be applied, and the pa- tient carried through a course of medicine, followed by the free use of cayenne pepper tea, third preparation of lobelia in bayberry tea; the compound lobelia pills, ginger or composi- tion tea. As nourishment give wine whey, essence of beef, or ULCERS. 379 any other kind of nourishing food that may suit the condition of the stomach. If the parts be excessively hot and inflamed, the poultice may be kept wet with the tincture of lobelia, simple water, or with wild indigo root tea. Ulcers arising from disease of the Vdns.—The veins of the leg are more liable to disease than veins in any other part of the system, giving rise to the formation of ulcers along the course of the larger veins. The circulation of the blood being impeded or obstructed by the diseased condition of the vein, ad- hesive inflammation is established, forming a small tumour un- der the skin; the skin over the tumour is observed first to roughen and peel off, and then a crust is formed, and finally an ulcer breaks out. These ulcers may, in most instances, be heal- ed without great difficulty, but the vein continuing diseased, new ulcers are formed, and in this way they may continue to break out until by frequent ulceration the vein becomes obliterated, when the ulcers will cease to return. Treatment.—Besides adopting the usual means for restoring the general health, when it is disordered, the limb upon which the ulcer or ulcers exist must be accurately bandaged from the foot to the knee, or a laced stocking worn, for the purpose of supporting the debilitated veins of the leg and to assist them to to carry on the circulation, by which the tendency to obstruction will be lessened. In the selection of local application for the ulcer we must be governed by the circumstances of the case. If the parts around the ulcer are swollen and inflamed poultices must be applied, until the inflammation subside when fresh salve may be substi- tuted. When the ulcer is slow in healing finely pulverized bay- berry, alum root, or marsh rosemary should be put into the ulcer dry, every time it is dressed, and salve spread upon oiled silk or a poultice applied. Friction.—Rubbing the limb briskly every morning and even- ing may prev enttbe formation of new ulcers by removing obstruc- tions to the circulation of the blood in the veins. Rest and Position.—When the ulcer is in an irritable condition and the parts surrounding it swollen and inflamed, the patient should refrain from walking much, but keep at rest, with the af- fected limb elevated on a chair while sitting up. If the patient have been affected a considerable length of time with this form of ulcer, it may be worse than useless to confine himself to the house, provided the condition of his general health and the state 380 GONORRHOEA. of the weather will permit of his going out. The limb must be bandaged or a laced stocking worn always, when the patient is walking about, or pursuing his usual avocation. Steaming—In many instances benefit will arise from steam- ing the legs occasionally when affected with varicose ulcer. The vapour may be applied as hot as can be borne, and this continu- ed from half an hour to an hour, or even longer at a time. Af- ter the steaming the limb may be rubbed over with stimulating ointment. ULCERS UNDER A NAIL. Ulcers sometimes form at the root of thenail, which may con- tinue to prove a source of annoyance for months or even years, unless the dead portion of the nail be removed. Sometimes it be- comes necessary to remove the whole of the nail before the parts will heal soundly. If Ihe root of a nail become separated from the surrounding parts by ulceration or by an injury the nail will operate as a foreign body, keeping up a continual irritation and ulceration of the parts until it is removed. CHAPTER XVII. SECTION I. VENEREAL DISEASE. The term venereal disease is applied to two forms of disease differing essentially in their general aspect. The one in the male consisting of an inflammation in the urethra attended by a dis- charge of thick matter; whilst the other is an ulcer called chan- cre situated externally to the urethra. GONORRHOEA. Symptoms.—The first symptoms are a burning sensation on passing water, accompanied with inflammation and a discharge of thick matter from the urethra. In the course of a few days GONORRHOEA. 381 the burning sensation on passing urine, subsides, but the inflam- mation and discharge of matter seldom disappear under eight or ten days, and very frequently continue many months. In the female the symptoms are much more obscure, and so closely resemble diseases arising from other causes than venereal poison that in many instances it is difficult to form an opinion as to the true character of the disease without having a history of the case, and even then an erroneous opinion might be formed by even experienced physicians. It should also be borne in mind that men are liable to disease of the urethra resembling gonorrhoea in many particulars, but arising from causes wholly distinct from that of gonorrhoea! poi- son. The peace of families has in some instances been destroy- ed, by a wife or husband being affected with symptoms resem- bling those attending the venereal disease, at the same time the accused party is entirely innocent. Instances have occurred in which symptoms of gonorrhoea have occurred in men, in conse- quence of the wife being affected with a severe form of fluor albus, or whites, each party accusing the other of infidelity. Of the general course of the disease in the male.—Under proper treatment and with great care and attention on the part of the patient in relation to diet, rest, &c, the disease will in many in- stances disappear in the course of a week or two. It often hap- pens however that the disease is neglected in its first stage, the patient being unwilling to make his disease known; or he will not lie by without some plausible excuse for so doing, in order to evade suspicion, by which course the disease is often aggra- vated and becomes protracted to many months duration. Where the general health is much disordered, and the patient of a scrofulous constitution, w ant of proper care and treatment, the use of improper remedies, or when the venereal poison has been of the more malignant character, the disease is very liable to be- come extremely harassing and painful. The inflammatory ac- tion in the urethra failing to overcome the disease, either from the debility of the parts, neglect, or from improper treatment, then it generally happens that lymph is thrown out in the parts along the course of the urethra forming a hard cord and when erections occur as they often do during sleep from the determi- nation of blood to the parts, it occasions what is termed chordee which is so extremely painful that the patient is induced to jump out of bed and apply cold water to the parts, and this in many instances has to be repeated many times during the night. These erections are not only extremely annoying to the pa- tient, but they aggrav ate the symptoms and cause the disease to become more protracted in its duration. Where the disease has been of long continuance, the patient is 382 GONORRHOEA. in most instances left with what is termed gleet, consisting of a slight discharge from the urethra of a transparent mucous, re- sembling the white of an egg, wiiich is the effect of a weakened condition of the parts. In the female the disease is much less troublesome; in many instances causing little inconvenience, and is also much more readily cured. Treatment.—In the first stage of gonorrhea the patient should avoid using much exercise. His diet should be restricted to the lightest kinds of food, such as gruels, stale bread, toast and tea, &c. A gruel made of elm or of unbolted wheat flour arc well suited to the early stage of gonorrhea. The digestive powers are in general more or less weakened during theearly stage of the disease, and if food be taken that is hard of digestion, it will retard the cure. And again, if strong food, such as butter and meat be used, the urine will be more acrid and irritating to the inflamed urethra. When the general health is in a bad condition, or the patient feverish, or the skin dry and harsh, a course of medicine will be particularly serviceable; after which the patient should take every hour or two a small dose of lobelia, either in the form of tincture, powder, or in pills; drink freely of elm gruel, flax seed tea, barley or gum arabic water; and morning and evening take a teacupful of a strong decoction of sumac or bayberry. The teas should be taken warm, with the view to promote perspiration, which is of much importance in the early stage of the disease, provided the patient remain in the house. If the bowels be costive they must be relieved by injections, composed of composition, bayberry, or pennyroyal tea, adding a teaspoonful of the tincture or powder of lobelia. External Applications.—During the first period of the disease, and particularly if there be much heat and an undue accumula- tion of blood in the parts, wet cloths should be applied and kept w7et with warm water, and occasionally with the tincture of lo- belia, or with alcohol, or whiskey and water. This by prevent- ing too great a collection of blood in the part will relieve the symptoms, and may shorten the duration of the disease. In many instances, however, the patient to avoid suspicion and to conceal his unfortunate condition, continues to pursue his usual avocation, without applying the proper remedies, by which the disorder becomes aggravated and its duration very much lengthened. In the early stage of the disease the tincture or a tea of lobe- lia dropped into the urethra shortly after passing water, will facilitate the termination of the inflammation. GONORRHOEA. 383 In a more advanced stage of the disease.—After the passing of urine ceases to cause burning sensations, then astringent and stimulating injections into the urethra will be useful; commen- cing with a simple tea of baybery or sumac adding a small por- tion of the tincture of lobelia. In a still later period of the dis- ease the discharge having been for some time profuse, a portion of No. 6 or pepper must be added to the tea in sufficient quantity to make a sensible impression on the urethra. I have known undiluted No. 6 to be used in some chronic cases for injections. Balsam Copaiva.—This article is much used for the cure of gonorrhoea, and when pure and taken at a proper time, it is a valuable remedy. It should not be used in the first stage of the^ disease, nor until the inflammatory symptoms have abated. Neither should it be employed if the patient be feverish, the skin being hot and dry, the tongue coated, redder than natural and inclined to dryness. Under these circumstances the balsam is almost sure to disagree with the stomach. In general this medi- cine may be used to advantage in the course of ten days or two weeks from the commencement of the disease. If the symptoms do not improve under its use in the courseof a few days it should be laid aside for the time. The dose and methods of preparing may be seen in the materia medica under the head of balsam co- paiva. Chordee as it is termed depends upon the deposition or extra- vasation of lymyh in the parts along the course of the urethra, which feels hard like a cord. This condition of the parts oc- casions severe pain at times, more especially at night, compell- ing the patient to apply cold water to the parts to ease the pain. The local treatment for chordee consists in the use of fomenta- tions and poultices. In the commencement of chordee, its further progress may often be checked by steaming the parts an hour or two by placing a hot brick in a basin containing a small portion of water, and sitting over the steam, or wrap a hot brick in damp cloths and place it as near the parts as can be borne, in bed. A poultice composed of elm, white pond lilly, and green lobelia, should be kept on the parts during the night and through the day applying salve spread upon oiled silk. The poultice should also be spread upon oiled silk to prevent evaporation. When the patient is about his usual avocation, the compound lobelia pills may be taken three or four times a day. Camphor appears to have a benefical influence in checking the symptoms of chordee. A piece of gum camphor the size of a large pea to he taken at bed-time, together with three or four lobelia pills. After the symptoms of chordee have subsided the poulticing ■384 GONORRHOEA. may be omitted: still some kind of salve should he used in the way above described. Wliere the disease has continued several months, but unattended with chordee, the parts being in general colder than natural, then injections must be employed frequently, with a view to excite healthy action in the debilitated vessels of the mucous membrane of the urethra. Equal portions of bayberry and poplar bark tinctured in No. 6 form a suitable injection in cases of long stand- ing gonorrhoea or in gleet. In females this disease is to be treated upon the general plan already described, except that the injections are to be adminis- tered to the vagina instead of the urethra. In females where the disease has continued several weeks, a sponge wet with bay- berry or sumac tea and No. 6, should be introduced into the va- gina, allowing it to remain two or three hours, and then changed for another prepared in a similar way, and in this way continue these applications several days together, unless they be found to disagree. SYPHILITIC SORE, OR CHANCRE. Tins species of the venereal disease differs materially from the one just treated of. It usually commences with the forma- tion of a pimple, surrounded by inflammation. As the disease progresses an open sore or ulcer is formed, termed chancre.— When the chancre is seated upon the skin and does not advance more deeply, it may in general be cured without much difficulty; but when it is situated on the glans penis, it is more difficult of cure, or at least it requires a longer time for a cure to be effect- ed. In individuals of depraved and filthy habits, and under other unfavourable circumstances, as where mercury is given, the sy- philitic sore sometimes assumes a highly malignant character, occasioning extensive sloughing of the parts. The poison may likewise become absorbed and carried into the system, occasion- ing what are called the secondary symptoms of syphilis. A swelling in the groin termed bubo, is a very common attendant upon chancre. Treatment.—An important point to be kept in view in treat- ing syphilis, is to prevent it from extending to the system. For this purpose no plan of treatment probably can be adopted with so much certainty of success as a course of medicine given every day or every few days in the commencement of the disease; and during the interval between the courses, to place the system under the influence of lobelia, taken in small doses; together GONORRHOEA. S85 with the use of composition and injections to regulate the bowels. A course of medicine will not be necessarily required in every case of this disease, still its operation will prove beneficial in all cases, and in all stages of the complaint, and when the disease has a malignant character, it must not be omitted. Local Treatment.—The sore in the commencement should be poulticed with a compound of elm, white pond lily, and lobelia powder, wet with the tincture of lobelia, and spread upon oiled silk, bladders, or something that will prevent the poultice from drying rapidly; or if the sore be so situated that a poultice can- not be applied to it, it should be wet with the tincture of lobelia several times a day. When an open sore or ulcer is formed the poulticing should be continued, wetting the ulcer two or three times a day with No. 6, or with the liquid of the third preparation of lobelia. Chancre is seldom cured under two or three and very often it continues for six weeks. Patients very naturally become dissatisfied with the treatment, and are induced, unless they discover a manifest improvement in the condition of the sore, to make a change, under the errone- ous idea that they may find a remedy that will eradicate the dis- ease in a few days. Dishonest and ignorant empirics who adver- tise to make a speedy cure in all cases, are applied to, but failing to cure, others are applied to, and thus by frequently changing the treatment, the disease becomes aggravated and protracted much beyond what it would have been if it had been left entirely in the hands of nature. A man who advertises to cure the vene- real disease in a short time, and without fail, may be set down at once as one who depending upon the credulity of others for sup- port, has sacrificed honesty and truth for motives of gain. The reason why the failures of these empirics are not more generally known, may be readily seen. No one who has the venereal dis- ease will expose himself in order to expose those who have decei- ved him and fleeced him of his money. The medical profession though more honourable in general than the class above alluded to, have not as yet settled upon any general plan of treating syphilis. The opinion of the great guns of the profession concerning the effects of mercury in this disease, have been, and still are extremely various. Formerly it was believed that mercury w7as a specific for syphilis, not be- cause it proved to be a specific, but because high authority had pronounced it to fresuch. More recently, however, this doctrine has been exploded by the highest authority in the profession, and the use of mercury not only declared unnecessary in the cure of syphilis, but pernicious in the extreme, unless given with the 386 GONORRHOEA. greatest caution. Professor Gibson, of this city, in his work on surgery, recommends the use of mercury in cases of chancre, hut he now honestly declares mercury to be altogether improper, tending to convert a simple chancre into one of a malignant or corroding character. P. Ricod, surgeon to the Venereal Hospi- tal of Paris, in a recent " Treatise on Venereal Disorders," in the course of his observations on the employment of mercury in chancre observes: "By one party it is declared, that no cure can take place, no repose be enjoyed, no future health anticipated un- less mercury be used, and by the other, future disease and death are predicted if this remedy be employed." " Again," observes the same writer, "Prejudice attaches us to the principles in which we are educated, and renders them objects of affection; and hence the obstinacy with which men cling to ideas with which they are familiar. The experience of the world has shown that partisans are sternly adhesive; that truth is more frequent- ly imagined than perceived; that the value of a reason is too seldom accurately measured; and that minds satisfied with par- tial knowledge, far out-number the warm conscientious lovers of philosophy. We can readily perceive the reason why men spurned the great principle promulgated by Rose and Thomson. It was a heavy blow aimed at a favourite and long cherished opinion; but the truth will stand fast, despite the efforts of the boisterous declaimer, or the insidious endeavours of the smiling sophist. Rose and Thomson demonstrated an important truth, they incontrovertibly proved, that mercury is not necessary to the cure of chancre as chancre; and this the intelligent ingeni- ous mind will acknowledge, however much it may dissent from their method of applying it." When chancre is accompanied with a high degree of inflam- mation or swelling, the part should be steamed two or three times a day, and a moist warmth constantly applied, either by means of a hot brick or bottle of hot water wrapped in damp cloths. This course of treatment may be employed with advan- tage in any stage of the complaint. And when the disease wears a malignant aspect, it must not be omitted. When the ulcer has been discharging freely for sometime, the sore should be filled every day with bayberry, marsh rosemary, or alum root, finely pulverized,put in dry, and the whole cover- ed with salve spread upon oiled silk. The ulcer is sometimes so situated that it cannot be reached except by injections; for instance, when its seat is on a part where the skin is drawn over, and swollen to such a degree that it cannot be drawn back. Under circumstances of this kind lo- cal steaming and warm fomentations must be employed, and the sore syringed often with lobelia tea, or tincture of lobelia; and if GONORRHOEA. 387 there be a free discharge of matter, bayberry tea must be em- ployed, adding tincture of lobelia and No. 6. Whenever a syphilitic ulcer is extending, it is necessary to apply active stimulants, as No. 6 and the third preparation of lobelia, with the view to excite adhesive inflammation in the cellular tissue to prevent the further extension of the ulceration. When a chancre discharges matter freely, the dressing must be changed frequently, and every precaution used to prevent other parts from being inoculated with the poison; whereas when the sore is in a healing condition, the dressing should not be re- moved oftener than twice in twenty-four hours. A good plan of dressing a healing sore is to cover the edges of the ulcer with salve; and to apply lint to the centre of the ulcer, the sore then may be dressed without disturbing the healing process going on at the edges. The practice of destroying the syphilitic pimple or ulcer as soon as it appears or within the first few days, by applying lunar caustic, is strongly advocated in a " Practical Treatise on Ve- nereal Disorders," by Philippe Ricord, M. D. surgeon to the Venereal Hospital of Paris. In the case of a pimple this writer recommends that it be cut open, and then apply the caustic, which should be pointed, wiien the sore is small, so that the bottom of it may be effectually cauterized. Ricord states that if this treatment be applied early a chancre may usually be cured in eight or ten days, when it would require several w7eeks if left alone to run its course. If this declaration can be substantiated by experiment the practice should certainly be adopted. It generally happens, however, that a physician is not applied to in this disease until the lapse of several days or even weeks after its first appearance. BUBO—SWELLING IN THE GROIN. Both gonorrhoea and syphilis are apt to occasion a swelling in the groin, termed bubo. When a bubo is occasioned by gonorrhoea, it very rarely suppurates; but when it arises from the absorption of syphilitic viris, suppuration is apt to take place. Treatment.—Warm fomentations, volatile liniments, or lo- tions, and protecting the parts from cold, are all that will be re- quired in the local treatment of bubo attending gonorrhoea. When bubo occurs in one who has a syphilitic ulcer, the pa- tient should keep in bed, and cotton wadding or soft muslin cloths wet with the tincture of lobelia applied to the parts, and 388 GONORRHOEA. retained by having a bandage placed around the hips and another passing under the thigh, over the groin and fastened to the hip bandage. The patient should also be placed under constitutional treat- ment. A full course of medicine is the most efficient method of treatment that can be devised—it is suited to all cases, and to all stages; it harmonizes with nature and aids her efforts to work off disease. The courses of medicine are to be repeated as the exigencies of the case demand. In the milder cases, unattended with much swelling or pain in the groin, and where the general health is not prominently disordered, a course of medicine may not be demanded; here the patient should keep warm in bed take the compound lobelia pills to the amount of from ten to fif- teen pills every day; regulate the bowels by injections; and take a dose of composition, or of bayberry and pepper two or three times a day. When the swelling in the groin is very painful and throbbing, poultices must be applied with a view of favouring suppuration. The poultice so often mentioned, censisting of elm, ginger, white pond lily and cracker, may be employed, until the bubo is opened or breaks spontaneously, when a more stimulating and astringent poultice must be employed, such as equal portions of composition and slippery elm; or to the first mentioned compound add a portion of capsicum and bayberry, the poultice being spread upon oiled silk to prevent evaporation. If the parts do not heal readily the cavity of the bubo should be syringed every morning and evening with bayberry or No. 3 tea, adding a por- tion of No. 6. When the swelling has subsided, and the parts become relaxed, lint wet with No. 6 may be introduced into the cavity of the abscess and some kind of plaster applied to exclude the air from the parts. SECONDARY SYMPTOMS OF SYPHILIS. From the want of proper treatment of chancre and more es- pecially where the patient has been subjected to a mercurial course of treatment for the disease, the syphilitic poison may be absorbed and carried into the blood, and finally become seated either in the mouth, throat, nose, bones, or upon the surface of the skin. When the disease attacks the roof of the mouth, an ulcer is formed, the bone is made bare and exfoliates, forming an open- ing between the mouth and the cavity of the nose, and changing the sound of the voice. If the disease be seated in the tonsil, an ulcer is formed, pre- senting the character of chancre. When the mucous mem- brane of the nose beoomes diseased by the syphilitic poison, the GONORRHOEA. 389' patient is very liable to lose some portion of the bones of the nose. Sometimes the secondary symptoms of syphilis appear in the form of copper coloured eruptions on the skin. These eruptions are slightly raised, scarcely ever painful, but are apt to itch especially in the after part of the day. "There is a greater variety of character in these venereal erup- tions than in any other symptoms of the complaint; not only in appearance but also in size. In some you will find the eruptions of considerable magnitude, appearing as if a portion of copper coloured skin laid upon the surface, but unattended with ulcer- ation. In others you will observe deep ulcerations with a rag- ged edge; in a third, there will be scaly eruptions, covering very large surfaces in various parts of the body." Syphilitic erup- tions are generally readily cured. When the disease attacks the periosteum of the bones, " the pa- tient experiences in the evening a sensation of pain in the bone, which afterwards becomes the seat of the node. The pain does not immediately produce a swelling; but in the course of a few days, a painful swelling appears in the evening, which disap- pears again on the following morning, and leaves no pain. At this time the periosteum (membrane that covers the bone) only becomes affected with inflammation; in a short time a deposit takes place between it and the surface of the bone; this deposit is, in the first instance, only a serous fluid, but a cartilaginous substance is soon secreted, which is gradually converted into bone, and is technically called a node. Treatment of the secondary symptoms of Syphilis.—Whatever part may be the seat of the disease, the same general constitu- tional treatment will be demanded in each case. The vapour bath, an occasional course of medicine, together with the use of spice bitters, composition, Dr. Logan's alterative syrup, sar- saparilla syrup, and compound lobelia pills are the means and remedies chiefly to be employed. When an ulcer is formed on the roof of the mouth, it should be wet frequently with the tincture of myrrh. Where the bone has exfoliated and formed an opening into the cavity of the nose the opening may be filled with cotton or a plate worn over it by which fluids will be prevented from passing into the nose, and the voice will be natural. The chief reliance for the cure is in constitutional treatment. In ulcer of the throat the tincture of myrrh, No. 6, a strong decoction of sumac leaves and berries, and tincture of lobelia, may be employed as gargles. Breathing the steam from hot w7ater a portion of lobelia being thrown in the water occasionally, 390 OBSTRUCTED MENSTRUATION. will prove beneficial when the disease attacks the mouth throat or nose. Where the nose is diseased the patient should frequently resort to the breathing of steam through the nostrils, and the parts should be syringed occasionally with bayberry or sumac tea ad- ding a portion of No. 6 or the simple tincture of myrrh. Syphilitic eruptions are in general very readily cured by the use of the vapour bath, a course or two of medicine, bathing the eruptions with a preparation made by adding sumac berries to No. 6, or with the third preparation of lobelia, and then apply the stimulating ointment or some kind of salve to protect the parts from the air; this last is more particularly needed in case of ulceration. Where the periosteum of the bone becomes diseased, and there is evidence of the existence of fluid between the periosteum and the bone, attended with throbbing pain and a blush upon the skin, it should be opened, and the part poulticed until the swell- ing and inflammation subside, when a strengthening plaster must be applied, and if the parts be slow in healing, syringe the cavity with tincture of myrrh. In many cases the swelling will fluctuate, proving the exist- ence of a fluid, but unaccompanied with pain, and without in- flammation or a blush of red upon the skin; here it will be im- proper to make an opening into the swelling, but steam the limb daily, apply stimulating embrocations, keep the parts warm and bandaged, and employ constitutional remedies. CHAPTER XVIII. SECTION I. OBSTRUCTED MENSTRUATION. Derangement in the function of menstruation may be occa- sioned by a variety of causes, the most prominent of wiiich is ex- posure to cold and wet during the menstrual period, or imme- diately preceding the time of its occurrence. This function may be either partially or completely suspended. Some females during this period experience pain almost as sc- OBSTRUCTED MENSTRUATION. 391 verc as labour pains, and which continue in some instances seve- ral days, in others only a few hours. When menstruation does not come on at the period of life at which it usually does, it is termed suppressed menstruation.— The symptoms usually attending the complaint, and the treat- ment indicated will be found under the head of chlorosis or green sickness. An excessive flow of the menses depends upon constitutional debility or a disordered condition of the system, and the same course of treatment that regulates this secretion when too profuse, may be found equally applicable when this function is partially or wholly obstructed. Various derangements of the system are observed to follow as a consequence of obstructed menstruation, such as violent pain in the head, bleeding from the nose, violent fever, delirium, bleed- ing from the lungs, and violent pain in the side, back or loins. Treatment.—Whether the obstruction be partial or complete the case will require to be treated upon the same general princi- ples. The indications of treatment are to restore the natural warmth of the body to excite and sustain the capillary circulation, to correct the disordered condition of the stomach and bowels, and to strengthen the nervous energy which governs this and every other function of the body. The remedies and means to be em- ployed to fulfil these important indications, are pure stimulants; the vapour bath, emetics, anti-canker medicine, and injections to the bowels. These remedies to be applied according to the circumstance of the case; when the symptoms are violent the re- medies must be applied more liberally, than in slight derange- ments. There are no other means so effectual in restoring the func- tion of menstruation as regular courses of medicine; and the free use of injections to the bowels, containing stimulants and lobelia. Half a pint of strong pennyroyal tea adding a teaspoonful of No. 6 and as much green lobelia and bayberry or sumac tea, adding a teaspoonful of the third preparation of lobelia; or composition tea adding a teaspoonful of green lobelia, may be employed. In some instances it is only necessary to soak the feet two or three times a day, to use a few injections, drink freely of warm pennyroyal tea, and keep covered warmly in bed, with a warm brick placed at the feet. In other instances the case will demand the frequent repetition of a course of medicine, together with the frequently repeated use of the other means already mentioned, more particularly the in- jections. The functions of the kidneys, bladder and uterus, may be more immediately and effectually influenced by means of in- jections than by medicine taken into the stomach. 392 OBSTRUCTED MENSTRUATION. When the derangement has become seated, and depends upon constitutional debility, the patient should seek the fresh air, use moderate exercise, sponge the body with cold salt water in the morning, repeating it twice or three times a week, apply fric- tion to the surface with a flesh brush or salted towel, and take such medicine as the circumstances of the case may demand, ob- serving especial care to keep the feet dry. The use of tonics are indicated when the derangement has been of long standing and the patient weak and relaxed. The ladies' spice bitters which contain a portion of gum myrrh and unicorn root, may be employed as a general tonic and stimulant in such cases. In nine cases out of every ten of the cases of obstructed men- struation, the derangement is occasioned by exposure of the feet to cold and dampness. Standing upon a damp pavement or upon wet ground, in thin soled shoes, is very apt to occasion obstruc- tions in the system, not always to be removed without consider- able difficulty. SECTION II. TREATMENT OF FLUOR ALBUS, OR WHITES. When this complaint is attended by general debility, which is its most common cause, a permanent cure cannot be antici- pated without an improvement in the general health. To effect this a course or two of medicine will be required in most in- stances, to cleanse the stomach and bowels; after winch the ladies' spice bitters, or some other form of bitters should be taken be- fore meals; and a teacup tw7o-thirds full of bayberry or sumac tea adding a teaspoonful of composition powder, or half a tea- spoonful of cayenne pepper to the tea every night or morning to keep the stomach from becoming foul. This dose will some- times vomit but never unless the stomach be disordered, and then it will always be beneficial. Half a pint of a strong decoction of equal portions of sumac or witch hazel leaves, and poplar bark administered by injection to the bowels every night at bed- time and retained until morning will not only improve the con- dition of the bowels, but it will also strengthen the uterine or- gans. Injections with a female syringe must also be employed. In the early stage of the complaint, or when the parts are irrita- ble, a simple decoction of bayberry or sumac may be employed; BEE-STINGS. 393 but where the sensibility of the parts is blunted, stimulants, as No. 6, or cayenne must be added to the anti-canker tea, in quan- tity sufficient to be felt very sensibly; the injection to be repeat- ed several times a day. Sponging the body with salt water in the morning, friction to the surface, wholesome and nourishing diet, are important means to improve the general strength. When the complaint is attended with prolapsus uteri, besides the means already mentioned, Mr. Betts's abdominal supporter or a similar apparatus should be worn. This subject, however, will be treated of more fully in a work on Midwifery, which will probably be published next year, 1844. CHAPTER XIX. MISCELLANE 0 US. BEE-STINGS. When a person is stung by a honey bee, wasp, hornet, yellow- jacket, or humble bee, a severe pain is felt in the part soon fol- lowed by inflammation, and swelling. It is the poison injected into the wound that causes the pain and inflammation. The de- sign of the inflammation is to block up the cellular tissue, and prevent the poison from spreading. Hence inflammation is ne- cessary, to secure the system from injury by the poison. The inflammation, however, may extend much further than is neces- sary for accomplishing the object for which it is instituted, name- ly: to protect the parts surrounding the wound from the effects of the poison, and prevent its absorption into the system. All that is necessary in these cases, in general, is to apply to the parts tincture of lobelia, salt and vinegar, or spirits of harts- horne, by means of cotton or soft cloths kept wet with some one of the above articles. If after the above treatment the parts continue to swell very much, and look somewhat like a dropsical swelling, the patient should be steamed, and have an emetic administered. 2 Y NERVOUSNESS.—WEAK NERVES. This question is often put to physicians. What shall I do to strengthen my nerves? It is not at all times that the proper re- medy can be pointed out, without some inquiry into the patient's habits, occupation, &c. Thus one of a nervous temperament, may by the free use of tobacco, either by chewing, smoking, or snuffing, become extremely nervous from its effects. Whilst one will use tobacco freely without apparently weakening his nervous system, another will have his nerves very much weakened by using it even in moderation. The use of any of the narcotic poisons, debilitates the nervous system. Hence opium eaters are apt to have their nervous sys- tem shattered, and consequently they suffer extreme depression of mind, except when the brain is under the immediate influence of the narcotic, which preduces a kind of hallucination of mind, bordering sometimes upon mania. The intemperate use of strong drink also weakens the nerves, occasioning tremulous motions of the hands and sometimes of the whole muscular system. De- pressing passions, venereal excesses, too close application to study, more especially in confined and unwholesome air; dys- pepsia, and in fine whatever weakens the system generally, will w7eaken the nerves; and in persons of nervous temperament, a disordered state of the nerves frequently forms a most prominent symptom, and then the patient is said to be nervous. Attend- ing in a family not long since, a female in middle life inquired of me if w7e had not a medicine that would strengthen the nerves. I perceived that her nerves were extremely weak, and having ascertained that she was a great smoker, I told her wiiat I be- lieved to be the chief cause of the nervous weakness, which it ap- peared had never occurred to her as having such a tendency.— Protracted illness, more especially when poisonous drugs are used as medicine, is apt to leave the nervous system in a weak condition, sometimes continuing for many years. The same means that will restore the general health and strengthen diges- tion, will strengthen the nervous system. If the nerves are weak in consequence of a disordered condition of the stomach, the ori- ginal cause must be removed before the nerves can be strength- ened. The use of the cold shower bath, or sponging the body every morning with cold salt water; frictions to the surface with the flesh brush, salted towel, or horse hair mitts, together with ex- ercise in the open air, are important means for invigorating the nervous system. POLYPUS OF THE NCSE. 395 The use of the various narcotics employed ia the regular prac- tice, as belladona, stramonium, fox-glove, &c. are injurious and very weakening to the nervous system. Nervines.—-Cypripedium humlie, (Thomson's nerve powder) scutilaria latrifolia (scull cap) are chiefly employed as nervines in the Thomsonian practice. These may be used on many oc- casions with much benefit, as a moans of promoting sleep and of quieting nervous agitation. A collection of acid in the stomach frequently occasions wakefulness, and an excited condition of the nervous system, in which case a dose of sah-eratus, or bi-car- bonate of soda, in luke-warm water, is a good remedy. Lobelia, though not a narcotic, exerts a marked influence in calming nervous excitement. There is no remedy of equal value in quieting fretfulness and wakefulness in infants and children, as the tincture of lobelia, given in small doses. Although it may not produce sleep with as much certainty as laudanum, or some other preparation of opium, yet the fact of lobelia being free from any deleterious quality, gives it the preference to narcotics. POLYPUS OF THE NOSE. Polypus of the nose is seldom observed in others than those of scrofulous constitution. It is generally brought on in conse- quence of repeated catarrh or cold. During the first stage of catarrh, the mucous membrane of the nose becomes dry, then a free secretion of thin fluid is pro- duced, terminating finally in a thick pus-like secretion. This is the natural course of catarrh as it passes to a favourable ter- mination. Whereas in scrofulous constitutions the mucous mem- brane when diseased by repeated colds, may be too far debilitat- ed to establish that kind of inflammatory action necessary to the formation of those salutary secretions above mentioned, and in- stead of their being a thick yellowish secretion, which terminates the disease, leaving the parts in a natural condition, a tough, semi-transparent substance is formed on some portion of the lin- ing membrane of the nostril, wiiich adheres to the parts and in- creases in size, until in some instances it fills one side of the nostril, and frequently becomes extended down the posterior na- ries, so as to be seen and felt in the throat, behind the palate. Polypus is composed of albumen, and in time becomes, in some degree organized, blood vessels 1 eing shot through it from the the mucous membrane. A substance similar to polypus of the nose is sometimes formed on the uvula of the palate, resembling the soft part of an oyster 396 prolapsus ani. arising from the same cause, though not so generaly confined to those of scrofulous constitutions as the former disorder. Treatment.—Polypus of the nose in its early stage may in many instances be dispersed by black pepper, composition pow- der or finely pulverized blood root snuffled freely up the nostril. If the polypus be so large as to obstruct the passage of air through the nostril, the powder should be blown upon the polypus through a quill. Constitutional Treatment.—When the general health is much deranged constitutional treatment must be instituted to restore a more healthy action in the mucous membrane. When the uvula becomes affected in the manner above descri- bed, having the appearance of the soft part of an oyster, or of a blister, gargling the throat frequently with a mixture of black pepper and whiskey, pepper sauce, or strong bayberry or sumac tea and pepper, will in general effect a cure in the course of a few days. Polypus of the nose cannot in every instance be removed by the means above mentioned, as in many cases nothing short of a sur- gical operation will effect its removal. CRAMP IN THE LEGS AND FEET. Cramp in the feet and calves of the legs, may in numerous instances be prevented by the patient rubbing the feet and legs up to the knees with the stimulating liniment, and wearing woo- len or worsted stockings at. night. A bottle of hot water or a hot brick placed at the feet on going to bed, will also prove a preventive to cramp. Most persons who are attacked with cramp at night, are forced to jump out of bed before the muscular spasm can be over- come. PROLAPSUS AN I—PROTRUSION OF THE BOWEL. In this complaint a portion of the intestine protrudes from the anus. Causes.—Constitutional weakness of the parts; the use of pur- gative medicine, especially aloes, pills; and violent straining at stool, are the principal causes of the complaint. Treatment.—The first point to be attended to when prolapsus HERNIA. 397 takes place, is to return the protruded intestine. This is gene- rally easily accomplished early after the protrusion of the bowel takes place, by simply pressing upon the parts. In some cases it is best to introduce the finger, previously oiled, into the intes- tine, and pressing gently upon the parts until the bowel is re- turned into its proper place. If the parts become much swollen and inflamed, fomentations should be employed by causing the patient to sit over a vessel containing boiling w7ater, or vinegar and water; or a warm poul- tice applied, composed of lobelia powder and elm, and the pa- tient nauseated with small portions of lobelia, before any attempt is to be made at returning the intestine. If vomiting should occur from the small doses of lobelia, pressure must be made upon the protruded bowel at the time. The means to be employed for strengthening the bowel are injections of a strong decoction of sumac or witch hazle leaves, and retained in the bowels several hours, and this repeated dai- ly. An injection of the kind above mentioned, administered at bed time, may in general be retained until morning. In many cases the intestine does not protrude except when the bowels are moved. If the prolapsus be liable to occur at other times, a tight bandage or a truss made expressly for this com- plaint must be worn until the parts become strengthened. If the general health be deranged, constitutional treatment will be required. Washing the body in cold salt water in the morning will prove beneficial in invigorating the system. " In infants a fresh protrusion of the rectum may sometimes be prevented by making them set on a high close stool, with their feet hanging freely down. Every thing tending to produce either diarrhoea or costiveness should be avoided."—Castles' Manual of Surgery. HERNIA, OR RUPTURE. Hernia in the great majority of instances commences about the groin, forming at first a small tumour, but, if neglected, the protruded intestine is apt to descend gradually along the course of the spermatic chord, and sometimes forms a large tu- mour in the scrotum. Causes.—The usual exciting causes of hernia are violent sneezing, heavy lifting, and hard straining. In most instances the protruded intestine forming the tumour, is readily returned into the cavity of the abdomen by slight pres- sure upon it. This is called reducible hernia. S98 STRANGULATED HERNIA. In some cases adhesions take place, preventing the return of the tumour into the abdomen, forming irreducible hernia. Occasionally the protruded intestine becomes strangulated in consequence of a stricture at the upper part, or neck of the tu- mour, constituting a most formidable and dangerous form of dis- ease. From estimates that have been made, it would appear that one of every ten or twelve of the individuals in the commu- nity, are effected with hernia, or rupture, and still strangu- lated hernia is of rare occurrence. The strangulation may be either partial or complete; and a patient may experience severe pain in the parts without there being any stricture. It is assert- ed by experienced surgeons that strangulation is most liable to occur where the hernia is very small. Treatment—In the treatment of reducible hernia, the first point is to return the protruded intestine into the cavity of the abdomen, and then apply an appropriate truss. By attending to the rupture when first discovered, and applying a truss, a per- manent cure will in many instances be effected. The truss must be worn constantly except when the person is in bed, and always be put on again before rising from it. During an effort to laugh or sneeze, the hand should be pressed against the parts, unless supported by a truss. Of the various kinds of trusses introdnced into use, there arc probably none superior to Dr. Chase's, of Philadelphia. In simple irreducible hernia the tumour should be supported by a bag, to prevent its further enlargement. STRANGULATED HERNIA. When hernias becomes strangulated, violent pain is experi- enced in the part and throughout the belly, attended with sick- ness and vomiting, and more or less fever. If the stricture con- tinue without being relieved, the most distressing symptoms ensue. The patient continues to retch and vomit and the con- tents of the bowels down to the stricture are sometimes thrown up; the extremities are cold; the pulse small, quick and hard." " After a time hiccough comes on, the pulse is hardly percepti- ble, respiration w7eak, and the whole body covered with a cold clammy sweat. Mortification now takes place, beginning in the protruded viscera and extending to the neighbouring parts. The patient suddenly becomes easy, the swelling of the belly subsides, and the tumour of the part diminishes, and the skin covering it sometimes changes its natural colour for a livid hue." Ry pressing the tumour with the fingers, a crackling or crepitus will be perceived, as though bubbles of air were STRANGULATED HERNIA. 399 bursting under the pressure of the fingers. "This crepitus is the sure indication of gangrenous mischief within. In this state it goes up spontaneously, or is returned with the smallest degree of pressure; a discharge is made by stool, and the patient fan- cies himself better. This feeling, however, is of short duration, hiccough and the cold sweats increase, convulsive symptoms come on and the patient soon expires." Treatment of Strangulated Hernia.—The use of the vapour or warm water bath, and relaxing the system fully by giving the patient freely of lobelia, and administering it also by injec- tion and retained, constitutes the treatment most likely to over- come the stricture. After the patient has been in a vapour or warm water bath, he should be wrapped in a blanket, and kept warm in bed provided perspiration continue. If the skin become dry and the patient be oppressed with heat, the surface may be bathed with spirits or vinegar. The most important means for the cure of strangulated her- nia is the use of lobelia injections. They may be prepared by adding lobelia powder to simple warm water. The brown emetic is to be preferred, a teaspoonful or even a tablespoonful of which may be administered at a time and retained. When the system becomes relaxed, an attempt should be made to return the protruded gut into the cavity of the abdomen, not by simple pres- sure upon the tumour, but by placing a hand at each side of the tumour, and as gentle pressure is made by the palms of the hands the tumour should be drawn backwards, by which the contents of the intestine will be more likely to return into the cavity of the abdomen. Another method is to grasp the tumour with one hand, making moderate pressure, and with the finger of the other hand, endeavour to push small portions of the intestine through the stricture. This should not be attempted, however, until the system has become more or less relaxed by the use of lobelia given freely, and administered by injections; together with the application of the steam or warm water bath. A patient vv ho has a strangulated hernia should keep the body bent forwards, and the knees drawn towards the belly. The po- sition generally to be preferred, is on the back with the hips and shoulders raised, and the thighs drawn up. When the above treatment fails of removing the stricture, af- ter being perseveringly employed, the last resort is an operation. This, however, will require a surgeon. Although few recover after an operation, still it may save life in some cases. The operation itself is not severe, nor dangerous, but it is rarely per- formed until mortification is about to take place. COURSE OF MEDICINE. The following process constitutes a Thomsonian course of medicine. 1st. A steam or vapour bath. The patient taking during the operation a (lose of composition or pepper tea. 2d. An emetic, prepared and administered according to the directions hereafter given. 3d. An injection to operate upon the bowels. In most cases it is better to administer an injection at the commencement, be- fore the vapour bath, and repeat it after the emetic operates. 4th. Alter the operation of the emetic, the vapour bath is again applied, to restore a natural warmth to the system, or as Dr. Thomson expresses it, "to set the wheels of life in proper ac- tion." When the patient has remained a sufficient length of time in the bath he must be showered with cold water, or spon- ged with whiskey or vinegar, rubbed dry, and in most instances it is best to bathe the skin with salt and vinegar, or No. 6. 5th. Light nourishment is to be given after the emetic ope- rates, either before or after the last bath, as the inclination of the patient may dictate. Milk porridge is generally given as nourishment after a course of medicine, and when the patient inclines to take it during the operation, it may be given, as it will assist the operation of the emetic. In sudden attacks of dis- ease, however, as in fevers, pleurisy, &c. crust coffee, elm, gruel, barley water, or gum arabic water will be more suitable The above process, termed a course of medicine, first insti- tuted by Samuel Thomson, is the most effectual, consistent and philosophical plan of treatment ever devised for the cure of dis- ease. By courses of medicine, together with the usual interme- mediate treatment, disease may be cured that has resisted every other plan of treatment; and even though it fail of effecting a cure, still the treatment will not injure the constitution—the de- clarations of medical men to the contrary notwithstanding. The medical profession manifest a degree of prejudice against the Thomsonian practice that is wholly inexcusable. As guardians of the health and lives of the community, they should know bet- ter than to make the outlandish, false and absurd assertions which many of them do in relation to the Thomsonian practice. 2 Z GENERAL DIRECTIONS FOR ADMINISTERING A COURSE OF MEDICINE. 1st. The Vapour Bath—Various methods are employed in the application of the vapour or steam bath; the usual plan, how ever, is to place the patient upon a tight bottomed chair, throwing a quilt over him, leaving the head uncovered; a ilat bottom- ed bason or dripping pan is to be placed under the chair, a quart of hot water poured in, and put into it a red hot brick or stone. If the brick be entirely red hot it should be set in sidewise at first, or the steam may be too warm for the patient to bear; in a few minutes the brick may be placed with the flat side down. Three bricks will be sufficient provided they are thoroughly dry and red hot on one side. If the steam be too hot the quilt may be raised from the floor so as to admit the cold air, and when the patient feels oppressed with the heat, the face and head must be frequently wet with vinegar and water or whiskey, and occa- sionally the body of the patient should washed or sponged with cold or tepid water; during the latter part, or at the close of the steaming, a shower bath must be used, or the patient washed in cold water or spirits. The feet may be more effectually steamed by placing a stool upon the chair, the patient sitting upon the stool and resting the heels upon the edge of the seat of the chair. A small tin boiler and pipe for conveying steam either into a steam closet, or under a chair, is more convenient than hot bricks, and the steam can be more easily regulated than when bricks are used. Steaming in bed—When a patient is too weak to sit up, the steam maybe applied to the patient in bed by means of hot bricks wrapt in damp cloths, or by placing a frame work made of three barrel hoops, with the ends cut off and tied to two strips of plas- tering lath, or something of about the same length. This frame is placed over the patient and a cover spread on, leaving the head uncovered. The steam to be conveyed through a pipe from a boiler, or it may be generated by putting basins under the cover containing a little hot water, and placing hot bricks therein. .Patients who are too weak to sit up, will often bear the steam applied in this way an hour or even more by using the precaution to wet the face frequently, and the body occasionally with whiskey and water or vinegar. The steam box or closet possesses many advantages over the usual mode of steaming on a chair, the greatest of wiiich is the facility of applying tho shower bath. This, however, may Bourse of medicIne. 403 be done very readily without the steam box. Open the cover at the neck and pour a pitcher of cold water upon the head of the patient, having an old quilt or carpet placed under the chair to catch the water. The patient may continue in the bath from fifteen minutes to three quarters of an hour, or even longer, as the circumstances of the case may require. Sometimes patients feel faint while in the bath, which may arise simply from sitting upright, or it may depend upon a disordered condition of the stomach. A dash of water in the face, fresh air, and wetting the head with vinegar, will overcome faintness and oppression. Some patients will swoon away on sitting up a few minutes whether they be in a steam bath or not. There is no danger to be apprehended from fainting, except in very sunken states of the system, as in low cases of typhus fever, &c. All that is required when fainting occurs, is to lay the head as low or even lower than the body, sprinkle some cold water in the face, and apply hartshorn, or some smelling salts to the nose. Of the thousands of vapour baths that have been administered under my observation, I have never seen but three patients faint during the operation. The Emetic.—There are many modes of preparing an emetic. For ordinary cases the following will be found effectual. A teaspoonful of the third preparation of lobelia: A teaspoonful of green or brown lobelia: A large teaspoonful of sugar: Rub these well together in a teacup, and then pour on a tea- cup two-thirds full of strong bayberry or No. 3 tea, nearly scalding hot: stir it occasionally and take it luke-warm. A similar dose is to be repeated in the course of twenty mi- nutes or half an hour. It is seldom necessary to take more than two doses, still more may be given if required. I have on many occasions given two and three ounces of lobelia in administering a course of medicine. In all cases of seated disease where the stomach is weak and the system relaxed, the emetic should be combined with the more active stimulants, such as the formula above mentioned, ad- ding freely of No. 6, or pepper to the emetic. In low Cases of protracted fevers there is no better form of emetic than the liquid nf the third preparation of lobelia in strong bayberry or No. 3 tea. Another Method of Preparing the Emetic.—Take a large heap- ing tablespoonful of bayberry or No. 3 powder and an even teaspoonful of cayenne, pour on half a pint of boiling water; and then add a teaspoonful of nerve pow;dcr, whpn it settles pour or 404 COURSE OF MEDICINE. strain offline tea, and whilst moderately hot add four teaspoons- ful of green or brown lobelia powder, and sweeten. This may , be taken at once or at tw7o or three times at intervals of fifteen or twenty minutes. The stronger the bayberry tea the more easily and effectually will the emetic operate. Another Plan of Preparing the Emetic.—Take a teaspoonful of lobelia powder, half a teaspoonful of nerve powder, and two large teaspoonsful of No. 6. Pour on a tea cup two-thirds full of strong bayberry or composition tea, sweeten and take warm*— The dose to be repeated three or four times at intervals of fifteen or twenty minutes. And again, the lobelia powder may be mixed in strong com- position tea, sweetened, and taken in the usual doses. This last is the way in which emetics are usually prepared for children. After the emetic is given the patient need not take much drink until the emetie operates. It is a practice with too many nurses to force the patient to drink a cup of medicine every few minutes during the operation of a course of medicine. It is much better to allow the emetic to remain on the stomach as long as it will, or at least an hour or two. Where it is desired to make the emetic operate it may generally be effected by giving the patient a dose of pepper tea or a teaspoonful of the super-carbonate of soda, or half a teaspoonful of salseratus dissolved in a tumbler half full of luke-warm water. In cases of great debility the pa- tient should take occasionally during the course of medicine, a dose of pepper tea or of composition and No. 6; and after vomit- ing, milk porridge, chicken tea, or some other kind of nour- ishment, seasoned with pepper. 3d. The Injection.—In most cases it is better that an injection be administered in the commencement of the course, before the vapour bath is administered, and another after the operation of the emetic. The injection may be prepared in the same way as an emetic. A very common form for injections is half a pint of composition tea adding a teaspoonful of nerve powder to the tea whilst hot, and when hike warm a teaspoonful of lobelia powder and as much No. 6. This answers for common cases. Where there is canker in the bowels, and in case of dysentery, cholera morbus, &c. the bayberry or No. 3 tea should be used, adding the liquid of the third preparation of lobelia, or two or three teaspoonsful of No. 6, and a teaspoonful of green lobelia. If the bowels be much disordered, injections will in general occasion more or less pain and distress for a short time, the pa- tient, nevertheless experiences much relief from the operation. An injection containing lobelia if retained in the bowels will COURSE OF MEDICINE. 405" often cause sickness at the stomach and vomiting, and effectual- ly relax the system. Recent attacks of disease have in many in- stances been broken up by such an operation. As a general rule I have observed that patients experience the most benefit from in- jections that occasion the most distress and pain. Lobelia pos- sesses a property of arousing the sensibility of the stomach and bowels, so that if they are diseased it causes the patient to feel the disease. 4th. The Second Vapour Bath.—The proper time for adminis- tering the last steam bath in a course of medicine as a general rule is, when the patient ceases to sweat, or becomes 'restless after the operation of the emetic. If the patient continue to retch and vomit a long time, there is nothing so effectual in settling the stomach as a steaming. When the steaming has been con- tinued long enough, the patient must be showered with cold water or washed with vinegar11 or spirits, rubbed dry, and kept warm. It is beneficial in many cases to bathe the surface with No. 6, pepper sauce, or stimulating liniment, after the last bath, and when the patient is rubbed dry. This is more especi- ally needed where the skin is in a relaxed condition, as in chronic rheumatism, bronchitis, asthma, consumption, &c. Sometimes the skin is extremely sensitive to stimulants, and if applied too freely will occasion a severe burning sensatian in the skin, which may continue several hours. Food.—Some persons on reading Dr. Thomson's work, un- derstand him to say that patients after a course of medicine may take almost every kind of food. It is those cases where the ap- petite and digestion are restored that Dr. Thomson alludes to when he speaks of giving almost any kind of food that the appe- tite may crave. In most cases of disease the digestive powers are too feeble to digest any but the lightest kinds of food, such as barley water, crust coffee, arrow root gruel, gum arabic water. Even milk porridge which is generally given after a course of medicine is not adapted to cases of fevers, severe pleu- risy, inflammation of the lungs, and in the early stages of al- most every sudden attack of disease. It is far better that a pa- tient in the early stage of a severe attack of disease, abstain from food altogether than to take such as will oppress the stomach. From three to six hours is in general required for a full course of medicine; and except in urgent cases, it is better to allow the emetic to remain on the stomach an hour or two, or at least to avoid forcing the patient to drink largely of teas soon after the emetic is taken. A Short or Partial Course of Medicine.—In very many in- 406 COURSE OF MEDICINE. stances a full course of medicine is not required; all that is ne- cessary is to restore the natural warmth of the body, and then to give an emetic, dispensing with the second bath. Emetics without Steaming.—In sudden and violent attacks of disease, as in croup, fits, colic, sick head-ache, cholera morbus, and in fine all sudden attacks of disease, an emetic may be given without the previous administration of a vapour bath, or any other preparation. Hot bricks wrapped in damp cloths, placed around a patient, may take, in many cases, the place of the vapour bath. Thus in cases of low fevers, as they are termed, it often becomes ne- cessary to vomit a patient every day when he is too weak to sit up. In rheumatism, when the patient cannot be moved without occasioning severe pain, it may be better, especially in cold weather, to give emetics without moving the patient from the bed. If the weather be warm, however, it will, in the majority of instances, be better to have the patient regularly steamed and showered. Steaming when the patient is too weak to sit up.—When a pa- tient is unable to sit up, the vapour bath may be applied on a couch or mattress, by means of a frame made of three barrel hoops and two or three plastering laths or something of about the same length and size. Eight or ten inches of each end of the hoops must be cut off and the laths tied to the hoops so as to form a frame which must be placed over the patient, and a quilt thrown over, leaving the patient's head uncovered. The steam to be conveyed under the cover through a pipe, or by placing a red hot brick in a basin containing a small quantity of water un- der the frame. In the place of the frame above mentioned, the patient may have the bath administered on a settee or sofa. Pa- tients who are too weak to sit up will bear steaming in this way an hour or more at a time. The face and breast should be bath- ed occasionally with vinegar and water, or spirits and water, the patient taking a small dose of stimulating tea several times during the operation. Preparing the Patient for a Course of Medicine.—In sudden at- tacks and in all cases of acute disease a course of medicine may be given as before stated without any preparatory medicine; whereas, in chronic complaints, as in consumption, deep seated dyspepsia and in cases where the system is in a cold and torpid condition, a course of medicine will prove more effectual by the patient taking composition several times a day and three or four compound lobelia pills at night, and continuing the use of these medicines several days before the course is administered. COURSE OF MEDICINE. 407 Repeating the Course of Medicine.—In the first stages of disease and more especially if the attack be violent the course of medi- cine, or at least a partial course may be repeated daily until the symptoms abate. In small pox, measles, and scarlet fever, the disease will run its course, and all that we can anticipate from the operation of medicine in these cases is to relieve the symp- toms, and aid the constitution to work off the disease in the way which nature or the God of nature has established. In chronic complaints as in long standing dyspepsia, consumption, chronic gout, and rheumatism and whenever there is absence of fever, a course of medicine will seldom become necessary oftener than once in two or three weeks. In fine there are many cases of seated disease in which more reliance is to be placed upon fresh air, a change of residence, travelling, sea bathing, and a strict attention to diet and regimen, than upon medicine, Remarks concerning the various symptoms attending the operation of a Course of Medicine. I have heard persons say that they never felt better than when going through a course of medicine, excepting the few7 minutes when the sickness and vomiting came on; and then again under a different condition of the system, patients will experience great pain and distress from the effects of the medicine. The tenden- cy of the course of medicine is to arouse the sensibility and to assist the efforts of nature to overcome obstructions, cast off mor- bid matter from the stomach, and to restore a natural action throughout the system; and hence the more the system is dis- eased the more distressed the patient will be when he is made to feel his real condition. At one time a patient may vomit by merely taking a dose of composition tea, whilst at another, when the stomach is in a dif- ferent condition, half a dozen doses of composition will not oc- casion the slightest sickness. Thus a patient with a very foul stomach, will become very sick from taking a dose of composi- tion or of bayberry and pepper during the first steaming in a course of medicine, and after the operation of an emetic and the stomach becomes settled, a pint of composition may be taken without causing vomiting. It often happens, however, that the stomach will not be settled until after the last bath, the patient vomiting freely on having his system warmed by the steam, and by taking stimulants; after which the stomach will not be dis- turbed by these medicines, even though they be taken freely. A vapour bath when administered previously to an emetic, or when the emetic has not operated effectually, may occasion sick- ness at the stomach, and cause the patient to feel weak and fainty for a time, but will increase the strength when the stomach is not 408 COURSE OF MEDICINE. foul. I have on many occasions ebserved a patient on taking a course of medicine to be much stronger after the last steam, who had felt weak and relaxed from the first in consequence of the disordered state of the stomacli. Patients sometimes become sick during the first part of the steaming, and feel as though they cannot sit up, or bear it any longer, but- by throwing cold water in the face and allowing fresh air to come to the patient, the sickness will pass off in a short time, and when perspiration becomes free the patient will experience no difficulty in sitting in the bath the usual time required for the operation. When the stomach is cold and contains acid, a dose of pepper or composition tea is apt to cause pain in the stomach, more especially during the first steaming in a course of medicine. In such cases the pain is relieved when the patient belches wind or gas from the stomach. Some No. 6 in hot water, taken as hot as the patient can bear it, will cause the gas to be sent up and the patient is thus relieved. Essence of pepper mint, lavender, or any thing that is good to expel wind from the stomach may be employed. The operation of an emetic, which in certain conditions of the system is attended with scarcely any unpleasant feelings, under other circumstances, for instance, where there is great derange- ment in the stomach and bowels will be accompanied by distress- ing sickness and pain. The relaxation and sickness sometimes produced under the influence of lobelia, is said to be very much like extreme sea-sickness. Probably no case of death has ever been occasioned by sea-sickness alone, although it sometimes lasts many days or even weeks, the patient continuing to retch and vomit almost incessantly. The alarming symptoms as they are termed, seldom or never occur to any considerable degree under the operation of a course of medicine, except where disease is deeply seated, or in patients of a peculiarly nervous temperament. Much, however, depends upon the form of the emetic. Thus the lobelia seed given with- out much stimulus will occasion more or less relaxation of the system in almost every instance; still the same form and quan- tity of the medicine will produce great diversity of symptoms in different conditions of the stomach; and in persons of different temperament. I have observed half a teaspoonful of the brown emetic (lobelia seed) to bring on what are called alarming symp- toms, in patients who during a preceding course of medicine bad taicen five teaspoonsful without producing such symptoms. The following case will serve as an illustration of what I have assert- ed. An elderly man by the name of Smedley, who had seated consumption, had several thorough courses of medicine adminis- tered to him without occasioning other symptoms than those COURSE OF MEDICINE. 409 which usually attend the operation, until the ninth course, when the first dose of emetic, which was a small one, brought on the alarming symptoms, so called, that continued more than fourteen hours, when he vomited freely, and soon after fell asleep, and when he awoke he had scarcely any recollection of the strange condition which he had been in during the continuance of the alarming symptoms. This operation appeared to benefit him more than all the previous treatment. In many instances patients will experience pain in the stomach or bowels, soon after taking the emetic, but which generally continues but a short time, yet sometimes for several hours. In other cases, and more especially when disease is deeply root- ed in the system, the patient whilst under the influence of a course of medicine will exhibit symptoms, well calculated to alarm those who have not witnessed them before or who do not know that there is no danger to be apprehended. Some will complain of distress in the bowels, throw themselves about the bed, utter broken sentences, speak in a hurried and unconnected manner, sob and breathe very irregularly, get out of bed, make frequent efforts at stool, and be constantly changing position. Some- times the system will become completely relaxed, and still the pulse have nearly its natural strength; the countenance will be pale, the skin cool, the breathing irregular, and the patient thirsty. During the continuance of these symptoms, there is great commotion in the stomach and bowels as though the vital forces were concentrated there to root out disease. I am fully con- vinced from a great deal of observation that during alarming symptoms the nervous influence is chiefly concentrated in the great sympathetic system of nerves which govern the functions of the internal organs, by which a new action is established and disease removed. When a patient is very much relaxed under the influence of the emetic, his face, breast and hands should be bathed with vinegar or whiskey, and take occasionally some stimulants, either pepper or composition tea, No. 6 in w7arm water, or milk porridge well seasoned with pepper. If the patient crave cold water it may be allowed to be taken in small quanti- ties; still pennyroyal or other simple herb tea is more suitable. In a great number of instances where patients under my treat- ment have had the alarming symptoms during the operation of a course of medicine, very little perceivable effect was produced by any thing that was done. The medicine previously given having taken effect, it seemed to require a certain time for its full operation upon the system, varying in duration, however, according to the circumstances of the case. In some instances the alarming symptoms will pass off in the course of an hour from the time of their commencement, whilst in others they may continue six or eight hours, or even much longer. I once had a 410 COURSE OF MEDICINE. patient, who continued with the alarming symptoms thirty-six hours, after which she slept several hours and the next day was better than she had been for several preceding months, and de- clared that she would not object to going through a simi- lar operation. On the following week another course was ad- ministered to this patient, distressing symptoms came on such as occurred during the preceding operation, and continued over twenty-four hours. With a view to shorten the duration of the course, I at the suggestion of Dr. John Smith commenced giving the patient the third preparation of lobelia in tablespoonful doses repeating the dose every twenty minutes until twelve tablespoons- ful were given, and although this evidently assisted the opera- tion of the medicine, still the alarming symptoms continued about thirty hours. This case was one which scarcely promised even a hope of recovery, yet after undergoing three such opera- tions her health greatly improved, to the astonishment of all who knew her case. The following symptoms will often be observed during the operation of a thorough and efficient course of medicine, in cases where the disease is deeply seated, and especially when it is about giving way, to wit: soon after the emetic is taken the patient complains of pain or distress in the stomach, which soon extends to the bow7els; he is continually changing his position; rubs his stomach and bowels and complains very much of dis- tressing feelings. The breathing becomes irregular, respiration being sudden, somewhat like the sobbing of a child. The distress- ing feelings in the bowels subside, but the patient remains re- laxed, the skin colder than natural and contracted; the mucous membrane of the nose is dry, inducing the patient to pick or rub his nose frequently; the tongue and mouth are dry, attended with more or less thirst. The patient makes efforts to get out of bed, frequently feels like having a motion from his bowels; talks in an unconnected manner, and sometimes lies completely relaxed, apparently too weak to raise his hands, and the coun- tenance is pale and contracted. After the lapse of a few, but usually in the course of four hours, and frequently much longer, the patient vomits freely, after which he goes to sleep, his skin becomes moist, he sleeps sweetly, and when he awakes feels much better than he did previously to the operation. Thomsonians are frequently applied to in desperate cases, where it is impossible to determine whether the disease is curable or not, and notwithstanding the grave charges so frequently against the Thomsonian practice when it fails of removing dis- ease, still a trial should be made, so long as the circumstances of the case furnish grounds for a reasonable hope of success. Courses of medicine are sometimes administered with the view only of affording relief to the patient, the disease being evidently COURSE OF MEDICINE. 411 incurable; and yet it would seem that a portion of the commu- nity, and some who ought to know better, attribute every death that occurs where Thomsonian treatment is employed, to want of skill in those who have charge of the case. Among the great mass of desperate cases that come under Thomsonian treatment deaths will, in the very nature of things, occasionally happen unexpectedly and under unfavourable circumstances. In the early period of my practice I was called to attend the wife of Samuel Wheeler, of Wilmington, Del., and found Mrs. W. as I then thought in a condition to be benefitted by a course of medi- cine, and had determined on having one administered. A dose of composition was prepared, but before it was sufficiently cool to be taken, she expired. Had I arrived two hours earlier than I did, doubtless Mrs. W. w7ould have died whilst under the oper- ation of a course of medicine, and although the medicine might have prolonged the life of the patient a short period, still she could not have survived many hours longer than she did, as mor- tification had already taken place. Courses of medicine doubt- less have been and will again be administered to patients on the very verge of dissolution, creating not only an unfavourable impression in the neighbourhood where it happens, but a highly coloured and distorted occount of the case is carried to various parts of the country. The general good success, however, at- tending the Thomsonian practice, affords sufficient evidence to establish the belief that it is based upon correct principles, and that this system furnishes the means wiiich the constitution re- quires to overcome disease; for although it does, and must neces- sarily fail sometimes of effecting cures, yet what evidence have we that it will not prove successful when properly applied, in all cases that are curable by means of medicine. Most patients experience an unusual degree of weakness and general distressed feeling aboutthetime a disease is giving way; the patient feeling discouraged, under the impression that the course of medicine, or other treatment is too hard for his consti- tution. In every case of deeply seated disease, that I have treat- ed and a cure has been effected, the patient was discouraged about the time that the disease was giving way: the system being re- laxed, attended with loss of appetite, disgust for medicine, and frequent pain and distress in the bowels. Of the removal of morbid secretions or false membrane from the coats of the stomach and bowels. In disease of every form and variety the stomach and bowels are more %r loss coated with thickened tenacious secretions, which are often thrown up by vomiting in the form of little flakes of a skinny like substance; and passed off from the bowels 412 BLOOD-LETTING. sometimes in small pieces and at other times in strips a foot or more in length. The first that I ever saw of this false mem- brane was in the summer of 34. I had administered a course of medicine to a patient, and accidentally discovered that a large quantity of a skinny like substance had passed from his bowels. This fact struck my attention at the time, and from that period to the present time 43, I have found it to be universally present in all cases of disease, at least with very few exceptions, and as a general rule disease begins to yield as this false membrane passes away. There is no plan of treatment that can be adopted that would prove as effectual in removing this coating of morbid matter from the stomach and bowels, as courses of medicine and a free use of cayenne pepper and bayberry. Avoid cathartics as they occasion still greater derangement in the secretions, and if given freely to one in perfect health they will be very likely to occasion a false membrane to be formed on the mucous membrane of the bowels. The indications of treatment are—to restore the secretions by courses of medicine, or by the use of pure stimu- lants and the vapour bath, together with the use of bayberry or other of the anti-canker medicines. An essay from the pen of the late Dr. Thomson of Edinburgh appeared in a medical journal published in the year of 1836 in which the writer gives a considerable number of cases in which a false membrane was discharged from the bowels in different diseases, and patients affected with chronic diseases, were re- stored to health after the passing off of the false membrane from the bowels, which sometimes closely resembled an intestine.— The passing away of this substance in the cases reported does not seem to have been brought about by medical treatment but rather by the efforts of nature, and generally after a sudden at- tack of fever, colic, or other acute attack of disease. This subject tliough of great importance in a medical point of view, has not to my knowledge ever engaged the attention of the medical profession in this country. Dr. S. Thomson in using the term "canker" has allusion to morbid secretions coating the stomach and bowels, and through his discoveries we are furnish- ed with the knowledge of the best means to effect their removal. BLOOD-LETTING. Taking away blood does not remove the cause of disease but, on the contrary its direct tendency is to prostrate the curative BLOOD-LETTING. 413 actions of the constitution, and although patients may experi- ence relief from pain, by the abstraction of blood, still the cure may be very much retarded by it and it may cause the death of the patient. A person in health may lose a large quantity of blood without experiencing other inconveniancethan debility, for when digestion is carried on with considerable vigor the blood is soon replaced. But in di.sease where the digestive powers are greatly impaired or suspended, the loss of blood cannot be readily sup- plied, and if the bleeding be carried to a great extent the patient will be very apt to remain a longtime in feeble health, and very probably be left with some deeply seated chronic disease, dyspep- sia, liver complaint, consumption, or dropsy. The blood furnishes the organs with power to carry on their functions, and to resist the causes of disease; and in proportion to the quantity of blood taken from the body will the system lose its power of resisting disease. An undue accumulation of blood in a part is always attended by a deficiency of it in other parts, and w7e have sufficient evidence to warrant the assertion, that the Thomsonian practice, if properly applied, will prove more effectual in equalizing the circulation of the blood than any other plan of treatment that has ever been pursued—the patient still retains his blood to aid in restoring his lost health. A patient having a good constitution may, in the early stage of disease, be bled profusely, and recover bis health, not in con- sequence of the loss of blood, however, but in spite of the bleed- ing; whereas in a later period of disease, where the vital powers of the patient are much enfeebled or in very young or very aged persons, the loss of even a few ounces of blood would be very liable to be followed by extreme prostration, and probably cause the death of the patient. That blood-letting removes pain, les- sens fever, or relieves the head, is no evidence that it cures dis- ease, for these very symptoms, pain and fever, are in general, the consequence of the vital powers resisting disease; and what can be more absurd than to break down the living power, in or- der to relieve pain. But blood-letting will not always relieve pain, except the patient be brought so low7 by it as to destroy his sensibility; and very often in cases where pain is relieved by a copious bleeding, it will return again in a more aggravated form, the constitution having to struggle not only against the cause of disease, but also against the effects of the loss of blood. Formerly it was the universal opinion that blood-letting was necessary in cases of severe bruises, to prevent the occurrence of inflammation. Experience and observation, however, does not confirm the propriety or necessity of this practice. Look on the other hand and we will find that the most experienced surgeons admit the danger of drawing blood in cases of severe injuries, especially immediately after an injury, before the system reacts. 414 BLOOD-LETTING. Dr. M'Clellan in lecturing upon the subject of severe injuries and the prevailing practice of bleeding patients immediately af- ter their occurrence, said: " By far the greater portion of deaths which occur in these cases, are occasioned by too frequent and continued bleedings before the system has had time to recover from the shock. Thousands and tens of thousands of lives have been destroyed by this practice." A physician of the old school told me not long since, that for- merly he thought he must bleed whenever he saw evidences of inflammation, but that within the last few years he bad almost abandoned this practice of bleeding, and found that his patients now recovered more speedily and effectually even from inflam- matory diseases than when he resorted to its use. The fact is, in the regular practice there are no general established prin- ciples for treating disease; almost every physician having his favourite hobby. Thus one will prescribe anodynes under the same circumstances that another would employ bleeding, while a third w7ould administer some favourite cathartic; and a fourth depend exclusively upon counter-irritation, such as cupping, blisters, &c. • A patient is taken with pleurisy for instance, and his physi- cian bleeds him and the pain is relieved; on the following day the pain returns, and the doctor resorts to the same means which relieved the pain before, and in this way the bleeding is often re- peated until the vital powers are sunk too low to react, and the patient sinks from loss of blood, or if he recovers, it is ge- nerally by very slow degrees. Dr. Marshall Hall in his work on the morbid and curative ef- forts of the loss of blood, has given a number of cases proving the fact, that though a blood-letting may relieve pain it may cause the death of the patient. In cases of a severe bruise the old school doctrine is to bleed and purge, with a view to prevent inflammation. When a pa- tient is injured inflammation is necessary, in order to repair the injury. This is nature's method—injuries cannot be repaired without inflammation, and the more vigorous the general health of the patient is, the sooner will the injury be repaired, and the less liability will there be of the inflammation assuming an un- healthy character. An ordinary bilious or remitting fever is often converted into a disease of a malignant character by blood-letting. In like manner healthy inflammation may assume an unhealthy charac- ter by reducing the vital principle—the restorative power, by taking blood. That a patient may experience relief from losing blood is not positive proof that bis condition is improved or his situation less dangerous by it. Taking away blood to relieve pain is as tin- STEAM OR VAPOUR BATH. 415 philosophical as to give arsenic or any other violent poison for the same purpose. The cause of disease is not removed by either plan. There are poisons which when administered even in Ho- moepathic doses will relieve pain and change the form of disease but will not remove the cause; for although patients get well under such treatment, it is through the efforts of nature in de- fiance of the poisonous medicines. Physicians prescribe arsenic in intermitting fever, which will change the symptoms—there may be no more ague, but a disease will remain more difficult to get clear of than ague. Pain that would be relieved by an ordinary blood-letting, would be more effectually removed by a Thomsonian course of medicine, or even by a vapour bath. Under the bleeding prac- tice pain is relieved by prostrating the power of reaction; where- as under Thomsonian treatment the circulation is equalized, and the obstructions removed that cause the pain. The fact of the matter is just this: under favourable circum- stances a patient may lose a large quantity of blood without en- dangering his life; but under other circumstances the loss of a few ounces would cause the death of the patient. STEAM OR VAPOUR BATH. Although the use of the vapour bath as a means of curing disease, was employed many centuries back, still the principle upon which it operates in removing disease, was not fully ex- plained, nor its utility in aiding the operation of medicine ap- preciated before the time of Samuel Thomson. The vapour bath constitutes an important part of the Thom- sonian system of practice, fulfiling several important indications in the cure of disease. It diffuses warmth through the system, equalizes the circulation, imparts electricity to the blood, and increases the sensibilities of the system to the impression of medicine. "I had but little knowledge of medicine," says Samuel Thom- son, when through necessity I discovered the use of steaming, to add heat or life to the decaying spark; and with it I was ena- bled by administering such vegetable medicines as I then had a knowledge of, to effect a cure in cases where the regular prac- titioners had given them over." "In all cases where the heat of the body is so far exhausted as not to be rekindled by using the medicine, and being shielded from the surrounding air by a blanket, or being in bed, and 416 steat: c~i vapour bath. chills or stupor attend the patient, then applied heat by steam- ing becomes indispensably necessary; and heat caused by steam in the manner that I use it, is more natural in producing per- spiration than any dry heat that can be applied to the body in any other manner; for a dry beat will only serve to dry the air and prevent perspiration in many cases of disease, where a steam by water or vinegar would promote perspiration and add a na- tural warmth to the body, and thereby increase the power of life and motion and aid in removing disease."—Thomson. We often hear persons say that when they were bled the blood was almost black, and so thick that it would scarcely run, and they conceive that their blood was bad and bad better be taken away. The blood becomes thick and dark in consequence of its slow and torpid circulation for want of heat. Place a patient in the condition just mentioned, in a vapour bath at a proper temperature, and in less than twenty minutes the character of this blood will be changed, so that instead of being almost as thick and dark as molasses, as it was before the steaming, it will be of a natural colour and consistency, in consequence of the warmth and electricity imparted to it from the steam, which also restores the natural current of its circulation through the lungs. There is scarcely a form of disease or a condition of the sys- tem in which the vapour bath may not be employed, not only with safety but benefit. One of the most important objects gain- ed by the application of the. vapour bath is adding warmth and electricity to the blood. It has been ascertained that in disease even of the most inflammatory character, the blood contains less electricity than it does when in a healthy condition, and by ap- plying the vapour bath in the early stage of pleurisy, or rheu- matism; the disease in many instances will be removed by it. Disease of an inflammatory character generally proceeds from cold, and the buffy coat which appears on blood drawn from one labouring under an inflammatory disease, may be attributed to the want of a sufficient amount of heat and electricity in the blood. Dr. Marshall Hall in his Practice of Medicine, p. 340, observes: " Some practitioners continue to let blood in most cases of acute rheumatism, thinking themselves justified in their mode of pi'actice by the sizy appearance of the blood. The same principle might lead them to empty the whole sanguiferous system; for, every time blood-letting is repeated, the blood be- comes more and more dense, or sizy. I have further observed," says he, "that, by bleeding repeatedly, the pains, swellings, and febrile symptoms, were not only aggravated at the time, but often protracted infinitely; at least I have seen them continue, under such a mode of practice, upwards of tw7o months." The vapour bath may be employed with immense benefit in STEAM OR VAPOUR BATH. 417 disease of the urinary organs: as stranguary, gravel, retention of urine, inflammation of the lungs, kc I have known a slight attack of jaundice cured by a single va- pour bath followed by an emetic. In croup where the disease has continued several hours, the vapour bath is almost indispen- sible, in order to restore the natural warmth of the blood, and assist the operation of the medicine. Professor Chapman in a lecture last winter, said that he had recently been called to a case of croup in consultation where the application of the vapour bath proved effectual after various other means had been employed three successive days without effecting any change for the better. The patient continued in the bath three hours at a time. In croup the blood is sometimes in a condition which occasions the formation of a false membrane in the wind pipe, which if not ar- rested finally fills up the cavity of the wind pipe to such an ex- tent as to cause suffocation. In such cases besides the free use of lobelia and stimulants the vapour bath must be perseveringly applied with a view to restore the natural warmth of the blood and thus overcome its plastic condition. In asthma when the system is in a cold and torpid condition, medicine will often fail of affording much relief without the pre- vious use of a vapour bath. In this form of disease I have found the hot air bath to be as effectual as the vapour bath, and it may be administered with much less trouble. Ordinary headache is speedily cured by a vapour bath. In dysentery and bowel complaints in general the use of the vapour bath is attended by the most signal benefit. In eruptive diseases, nettle-rash, small pox, scarlet fever, va- rioloid, and measles, the vapour bath may be used with benefit at any stage of the disease. If the eruption be slow to appear, ap- plying a vapour bath will bring it out to the surface; or if there be a tendency to retrocession or striking in of the eruption the vapour bath should be applied, or at least a moist heat should be applied around the patient, and powerful stimulants given, as the third preparation of lobelia, and stimulating injections. In every stage of small pox the vapour bath is grateful to the pa- tient and aids the constitution in working off the disease. In the later period of small pox when scabs are forming and the patient much distressed, the steam bath will afford more relief than any other means that can be employed; and when the scales are dry and falling off there can be no better means employed for restoring the natural healthy condition of the skin than steaming. Scarlet fever and measles arc very liable to be followed by dropsy, run- ning of the ears, swelling of the glands, kc. arising in part from an unhealthy condition of the skin, which may be remedied by steaming the patient two or three times about the termination of the eruptive disease. 3 B 418 STEAM OR VAPOUR BATH. The duration of erysipelas may be shortened and the symp- toms mitigated by steaming, and in severe cases it should not be neglected. The vapour bath may be employed with especial benefit in all cases of dropsy except when the disease is incurable. In violent colds and catarrh where the breathing is greatly oppressed or the skin dry and husky, or cold and clammy, and the patient much distressed, the use use of the vapouriiath be- comes highly necessary, not only to relieve the distressing symp- toms but to facilitate the operation of medicine. Thousands of patients die annually of consumption that in its early stage is curable under Thomsonian treatment., In all cases of falls or bruises, steaming is almost infallible; and is much better than bleeding, as in the common practice which only tends to destroy life instead of promoting it. If the person is not able to stand over the steam, it must be done in bed as has been described. Give the hottest medicine inside that you have, and keep the perspiration free until the pain and sore- ness abates, and the strength will soon be restored. If the ad- vantages of this mode of treatment were generally known, bleed- ing in such cases, or in any other to remove disease would never be resorted to by the wise and prudent." Samuel Thomson. In peritonitis whicli is a most fatal form of disease after it has progressed to a certain stage, the vapour bath should be prompt- ly and perseveringly applied, besides giving largely of lobelia and pure stimulants. In inflammation of the lungs, liver, stomach, bow7els, or any other of the internal organs the use of the vapour bath will be found to relieve pain, assist the operation of medicine and shorten the course of the disease. In " low fevers" as they are called where the heat and strength of the patient are far reduced, I have observed marked benefit to result from the application of steam to the patient. A patient who is too weak to set up or even to raise his head, will bear steaming on a coucji or mattress in many instances over an hour without being debilitated by it, provided proper attention be paid to bathing the face and surface of the body occasionally with spirits or vinegar and giving stimulants. The most re- markable recoveries from " low malignant fev ers," as they are termed, that I have known have been w here the vapour bath has been administered frequently and the third preparation of lobelia administered freely both by injection and to the stomach. In these cases the steam was of course applied to the patient in bed or on a settee. The vapour bath forms an important auxiliary in the treat- STEAM OR VAPOUR BATH. 419 ment of rheumatism, gout, lumbago, palsy, hysteria, chlorosis, neuralgia, consumption, fevers of every variety, scrofula, &c.— Finally the application of warmth to the body by means of steam aids the efforts of nature to overcome disease of every variety, that is curable by the aid of medical treatment. " Some who practice according to my system" (observes Dr. Thomson) boast of carrying their patients through a course of medicine in a shorter time without the trouble of steaming; this is easily accounted for; steaming is the most laborious part of the practice for those who attend upon the sick, but the most useful to the patient: as one full course of medicine, in which the patient is steamed both before the emetic is given and after it operates, will in general be more effectual in removing disease than four emetics without the steaming." The steam bath affords a protection to the system against sickness; and when applied in the early stage of many forms of disease will effectually prevent it from becoming seated, by re- storing the lost heat, promoting the secretions, and removing obstructions. If the efficacy and safety of the steam bath in midwifery was generally known, the practice of bleeding would become entirely abolished; for no sensible woman would willingly submit to be bled, who had a knowledge of the utility of steaming, and more especially of courses of medicine. By means of the vapour bath and lobelia the muscles may be more effectually relaxed than by bleeding, and at the same time the secretions are promoted and nature assisted without the least possible degree of danger to the patient, from the treatment. For pain in the back and loins during pregnancy the steam bath may be used with much benefit. False labour pains will be removed by the use of the vapour bath; whereas true labour pains will be increased by it. This fact I have seen tested on many occasions. Not long since I re- ceived a message to attend Mrs. C----g in Currant alley, who it was supposed was in labour. The patient had regular pains about every fifteen minutes, which had continued over twenty hours. I directed a dose of composition to be given, and an in- jection of composition tea with a teaspoonful of green lobelia to be administered. These had the effect to diminish the frequency and intensity of the pains. A vapour bath was then applied which dispersed the pains entirely, and Mrs. C----g had no more return of pains until the lapse of two weeks when they re- turned, and the same means wrere employed as on the previous occasion above spoken of, and the pains being true labour pains they were strengthened and aided by the same treatment that ex- pelled the false pains. 420 STEAM OR VAPOUR BATH. The above is only one of many instances in which I have known false labour pains entirely to disappear under the use of the va- pour bath, lobelia and stimulants, and I have never yet seen this treatment fail to increase and assist true labour pains. If Mrs. C----g had been under the treatment of the old school practice, and ergot had been administered, as it very often is under the same circumstances that attended this case, the uterus would have been thrown into violent spasmodic contractions, and it is not easy to say w hat the consequences might have been. It can- not be questioned but that in thousands of instances ergot has been given, and then the forceps resorted to, in cases of premature or false pains that would have been dispersed by the use of the va- pour bath, lobelia, and pure stimulants. In disease that comes on by paroxysms as in ague, hysteria, and neuralgia, a very signal influenced exerted by a vapour bath administered a short time before the paroxysm is expected to come on. Opinion of various writers concerning the Vapour Bath. " The vapour bath is attended by the very best effects, par- ticularly in chronic ailments, and there can be no question that its action is chiefly on the skin, and through that medium on the nervous system. As a means of determining to the surface, promoting cutaneous exhalation, and equalizing the circulation, it is second to no remedy now in use; and consequently, in a va- riety of affections which this process is calculated to relieve, it may be employed with every prospect of advantage."—Combe's Physiology. " To the wars between Napoleon and Russia is western Eu- rope indebted if for nothing else, to the introduction of vapour baths. Prussian soldiers having constructed them in the north of Prussia, some of the Prussian physicians were induced to ob- serve the effects of this new fashion of bathing. They soon found that it cured various diseases, such as rheumatism, and cutaneous affections, and were not slow in giving notoriety throughout Germany by means of various publications. The king of Prussia caused a bath to be constructed at his palace; and in 1818, the Princess Marianne, sister-in-law of this sov- reign was present at the opening of the first public vapour bath at,Berlin and allowed it to receive her name."—Eclectic Journal of Medicine. "Of all Turkish remedies the vapour bath is the first and most efficacious in rheumatism and cutaneous diseases. I have seen them removed in one fourth part of the time in which they are commonly cured with us."—Dr. Madden. "If life be nothing but a brief succession of ideas, the rapid- STEAM OR VAPOUR BATH. 421 ity with which they now pass through the mind would induce one to believe, that in the few short minutes whicli he has spent in the bath, he has lived a number of years."—Sir John Sinclair. " The vapour bath may be used with decided advantage in all seasons, as it is in Prussia, and in Asiatic countries. It is a vulgar error, contradicted by general experience, to sup- pose that vapour, or warm bathing, is contra-indicated in win- ter, as disposing those who bathe to contract colds."—Doctor Schmidt. " Major Long, wiio made an expedition to the Rocky Moun- tains subsequent to the time of Lewis and Clark, informs us, also, that the Indian sweating baths, as he terms them, are in high repute for the cure of many disorders. He remarks, that they are generally constructed near the edge of a water course, and formed of pliant branches of trees, stuck into the ground in a circle, bent over at the top and covered in every part with bison robes. Some of them contain only one person and others four or five. The invalid enters with a kettle of water and some heated stones, on which the water is sprinkled until the requisite degree of steam is produced. When it is thought that the per- spiration is sufficiently profuse, the patient is taken out and plunged into the water, previously breaking the ice if the stream is frozen. He is is not subjected a second time to the action of the steam but covers himself with his robe and returns home." Mattson's American Vegetable Practice. " Lewis and Clark mention a remarkable cure which was performed with the vapour bath, during their expedition. One of their men had so great a weakness in his loins, that he could not walk, nor even sit upright without extreme pain. They ex- hausted the resources of their art upon him in vain, and at length at the suggestion of an Indian hunter, and at the request of the pa- tient himself, they placed him in a vapour bath, with the steam as hot as it could be borne. In twenty minutes he was taken out, plunged twice in rapid succession into cold water, and re- turned to the bath. During this time he drank freely of horse- mint tea. At the end of three quarters of an hour, he was again withdrawn, carefully wrapped, and suffered to cool gradually. The morning after the operation, he was able to walk and nearly free from pain."—Ib. The prevalent fear of catching cold, which deters many from using the vapour bath, even more than from warm bathing, is founded on a false analogy between its effects and those of pro- fuse perspiration from exercise or illness. The latter weakens the body, and by diminishing the power of reaction renders it susceptible of injury from sudden changes of temperature. But the effects of the vapour bath properly administered are very dif- ferent. When not too warm or too long continued, it increases 422 STEAM OR VAPOUR BATH. instead of exhausting the strength, and by exciting the vIV ac- tion of the skin, gives rise to a power of reaction which enables it to resist cold better than before.—Combe's Physiology. HOT AIR BATH. Various kinds of apparatus have been constructed for the pur- pose of applying the heat from burning alcohol to the body for the cure of disease. The following method will do very well where there is no apparatus for the purpose at hand, namely:— Place a teacup tw7o-thirds full of alcohol, or any kind of spirits that will burn, in a bowl containing sufficient cold water to come within half an inch of the top of the cup. Set these under a wooden bottomed chair, about the centre; place the patient on the chair, remove all clothing and throw a quilt over the patient and chair, leaving the head uncovered. Set fire to the alcohol under the chair, and if it becomes too hot, the quilt may be rais- ed at the bottom so as to admit cold air. In applying this bath care will be necessary to prevent the cover from coming in con- tact with the blaze. When the patient becomes oppressed with the heat the face and breast must be washed with cold water, vinegar or spirits. Mr. Pendleton of this city, invented an apparatus by which steam is produced by the blaze from burning alcohol, rendering the hot airless dry and oppressive to the patient. This apparatus was constructed upon the principle of a chafing dish. The lamp four or five inches in diameter, with eight or nine wicks, and a tin basin set in a frame over the lamp. By pouring hot water into the basin and lighting the wicks steam is generated in suffi- cient quantity to render the air from the burning lamp sufficient- ly moist, to answer in most cases the place of a regular vapour or steam bath. Where the skin is cool, relaxed and tending to perspiration, as in chronic rheumatism, asthma, &c. the hot air bath may be employed in place of the steam bath. A quilt is preferable to blankets for covering the patient when the vapour or hot air bath is applied. If blankets or sheets be employed they should be clean, otherwise the air in the room will become contaminated with foulness. • PARTIAL STEAMING. The plan of applying steam to the lower half of the body, w7as first introduced by Dr. A. C. Logan. To administer the hip vapour bath the cover must be fastened around the waist, instead of the neck. It is particularly applicable to cases of palsy of the lower extremities, hip disease, white swelling, indolent ul- EMETICS. 423 cers on the limbs, obstructed menstruation, strangulated hernia, swelled testicles, and dropsy of the legs. Applied in this way to the lower half of the body it may be borne without inconvenience for an hour or even several hours together, and much credit is due Dr. Logan for this method of steaming in certain cases. Toothache, pain in the face, swollen and painful breast, may be relieved by the application of steam to the affected part. In cankered sore throat, scarlet fever, quinsy, and in severe colds attended with dryness of the throat and oppressed breath- ing, benefit may be derived by inhaling the vapour from hot vin- egar and water. The following is from Constable's Miscellany, as given by the celebrated Urban Chevreau, Secretary to Christine of Sweden. CURE OF FEVERS IN SWEDEN. " One thing which I saw7 in Sweden surprised me. The pea- sants who have fever, take a quantity of beer, into which they put ginger, cloves, cinnamon, and having heated it as much as their mouth and stomach will bear, they drink it off. The prac- tice is successful." " They have also another remedy which would appear a startling one to inhabitants of our climate. They have dry stoves which they call bastou, into which they enter naked, and when the perspiration is profusely produced on all the body by the heat of the stove, they immediately come out, and lie down among the snow, or, if they can swim, throw themselves into the water. Our physicians may judge how far their aphorisms agree with the experience of these peasants." This was pub- lished during the life of the author who died in 1701 and may serve to show to the incredulous/acwJty that steaming is no new doctrine and it also exhibits a striking analogy to the practice of our North American tribes in cases of fever. CF THE UTILITY OF EMETICS IN THE CURE OF DISEASE IN GENERAL. Thomsonian emetics constitute the most effectual remedy em- ployed in the treatment of disease. There is scarcely a form or variety of disease in which the use of emetics will not prove be- neficial, and in many intances they are indispensably necessary to the recovery of the patient. Previous to the discovery of the medical properties of lobelia by Samuel Thomson, poisonous articles were employed almost 424 EMETICS. exclusively as emetics. Even now the medical profession con- tinue to prescribe the same deleterious articles, notwithstanding the evidence afforded of the efficacy of lobelia emetics in cleans- ing the stomach, and likewise knowing—as .they might know if they would that it possesses no deleterious qualities. In some cases of slight or sudden attacks of disease, all that is required by the operation of an emetic is merely to throw off the foul contents of the stomach, which had oppressed and dis- tended its functions. But where disease has become seated, other important objects are obtained by the operation of Thomso- nian emetics. They relax the system, and in this way overcome obstructions, equalize the circulation of the blood, and of the nervous influence; invigorate the energies of the stomach, and remove morbid secretions from its mucous surface; restore the secretions, and in fine to assist the constitution in resisting dis- ease, and thus aid her efforts in restoring to health. Whenever there is a general fever pervading the body, it is evidence of a diseased condition of the stomach; and hence in fever, the use of emetics are particularly indicated. Whether a fever arise from the cause of undigested food in the stomach, worms in the intestines, its energies sunken or its functions prostrated by the poisonous influence of marsh effluvia, or from previous exposure to cold, Thomsonian emetics are indicated. In measles, scarlet fever, and small pox the disease will be rendered more mild in its character, less dangerous, and some- times of shorter duration by the early administration of a Thom- sonian emetic. In diseases of children, emetics constitute by far the most effi- cient remedy. Vomiting is nature's method of relieving the sto- mach in infancy. We can scarcely do wrong in giving emetics to sick children, more especially at an early stage of disease.— In cases of sudden attacks of fever, croup, convulsions, &c. lo- belia should be given freely, either the powder in warm teas or in simple warm w7ater, the tincture, or the third preparation.— The latter is particularly adapted to cases of spasms, and in cases where the heat of the system is very low, and in the ad- vanced stages of disease. No danger need be apprehended from vomiting a child too much in croup, nor in any other violent at- tack of disease; nor of relaxing the system too much with lobe- lia. In protracted chills, where the patient is in a stupor, the third preparation of lobelia should be given freely, with the ap- plication of external warmth and friction to the surface with a view to bring on reaction. " Emetics" (observes Professor Chapman) however beneficial they may operate as mere evacuants, produce effects not less sal- utary in another way. Whatever may be the cause, fever as EMETICS. 425 has already been shown, is a result of sympathy, having, for the most part, the primary Sink of its ultimately lengthened and com- plex chain, in (he stomach. To expel, therefore, the offending cause, or to subvert the nascent impression whicli may be created, before it becomes invigorated, diffused, and fixed, vomit- ing is obviously the remedy." "Erysipelas of the face, I have benefitted, or entirely re- moved by vomiting—and in several instances, have derived scarcely less advantage from the same remedy, when the brain becoming affected, stupor has supervened." Emetics administered in the early period of scarlet fever will sometimes exert a most signal influence in moderating the vio- lence, and in shortening the duration of the disease. In case of bleeding from the lungs the effect of the operation of emetics is to attract blood from the lungs and diffuse it through the system by which the bleeding will be checked___ Warm foot baths, or the vapour bath should be employed to aid in restoring the natural equilibrium of the circulation of the blood. " In support of this practice, it may be proper to men- tion, that it appears on good authority, that the late Dr. Willis, so celebrated for his skill in the treatment of mania, and especi- ally the cure of George III. of England, resorted to emetics in all cases of hemoptysis" (bleeding from the lungs) and declared that the lengthened experience of nearly half a century had taught him to confide in them above all other means as well on account of their safety as efficacy." Chapman's Therapeutics. In bleeding from the stomach in which case blood will he raised by vomiting, the employment of active emetics are indi- cated, not only for dislodging accumulations of blood in the stomach, whicli may have oppressed its energies; but to cause a distribution of blood throughout the system, and to strengthen the weakened capillary vessels of the mucous membrane of the stomach. I have found the third preparation of lobelia given freely, together with the application of the vapour bath, to be successful on several occasions of bleeding from the stomach, and have never known it to fail in checking the hemorrhage. In uterine hemorrhage the flow of blood may in general be controlled by active emetics, aided by the use of stimulating enemas to the bowels. In severe colds and sore throat; either from inflammation or the existence of ulcers, emetics are of great utility. Emetics are more effectual than any other remedy in the cure of consumption, bronchitis, and other forms of disease of the chest. The most severe paroxysms of asthma may be overcome by a thorough emetic, more especially when the emetic is preceded by 426 EMETICS. the application of a vapour bath, rendering the system more sensitive to the impression of medicine. In pleurisy and inflammation of the lungs, emetics may be employed with great advantage, more especially in the early period of the disease. I have never observed the act of vomiting to be attended with much pain or difficulty in the most violent cases of pleurisy and inflammation of the lungs. As a patient sickens the system becomes relaxed, which affords an explana- tion why a patient may vomit with so little pain or difficulty when there is active inflammation in the pleura or lungs. "In their wide and pervading operation they (emetics) sub- due or have a tendency to subdue vascular action, to remove cuta- neous constriction, promote absorption from the lungs, facilitate expectoration, lessen dyspnoea, cough and sanguineous discharge, to calm the system by equalizing excitement, and thus re-esta- blishing that just balance in the distribution of the blood, on which the restoration and maintenance of health so materially depends." In whooping cough more benefit may be derived from the use of emetics than from any other remedy. In violent cases an emetic should be given daily, or even two or three times a day. In those cases when violent paroxysms of coughing are observed to come on at certain periods, it is a good practice to place the patient under the influence of lobelia, given even to the amount necessary t© cause free vomiting previously to the time at which the paroxysm of coughing usually comes on. Emetics form an important part of the treatment for rheuma- tism, lumbago, gout, neuralgia, &c. No remedy under my ob- servation has produced so much relief in these forms of disease as active emetics; their efficacy will be greatly enhanced by the previous application of a vapour bath. Of the various remedies that have been employed in the treat- ment of dyspepsia, emetics have proved the most successful.— Even in cases where there is extreme tenderness at the pit of the stomach, an emetic after a vapour bath will afford more re- lief in general than any other remedy. In the early stage of dyspepsia digestion, in most instances, may be restored by one or two active emetics, followed by the free use of cayenne pep- per at meals. Sick-headache depending upon a disordered condition of the stomach may be more speedily relieved by a prompt emetic than by any other remedy. Besides the speedy relief which the ope- ration of emetics afford, they sometimes break up the disease al- together, the patient being freed from subsequent attacks. Emetics are well adapted to the cure of every variety of colic, or cramp in the stomach. " To induce general relaxation, and EMETICS. 427 to excite the biliary secretions, a deficiency or suspension of which, he considers as an accessary cause of some of the cases of obstinate constipation in colic, Professor Hosac has given emetics, as he states, with great success."—Chapman. In diarrhoea, dysentery and cholera morbus, digestion is lost, and the stomach contains more or less foul matter, and its mu- cous surface is coated with thickened secretions, oppressing its functions, whicli increase the distress of the latter, and favour the disease. Hence to excite free vomiting is particularly indi- cated in the cure of such disorders. Besides relieving the sto- mach of foul matters, Thomsonian emetics exert a beneficial in- fluence upon the secretions, cause a determination to the surface, restore capillary circulation, and aid the efforts of nature to re- store healthy action in the mucous membrane of the bowels. Epilepsy, or falling sickness, is in many instances occasioned by an oppressed or otherwise disordered state of the stomach, demanding the use of emetics. " By exhibiting them just be- fore the accession of the paroxysm, they will often prevent it, and even if they fail in this respect, they render it milder and of shorter duration. Nor is this all which they accomplish. By the strong and direct impression made on the stomach, the com- mencement in that organ of the wrong association constituting the disease, is broken, and afterwards it yields more readily to tonics." "Nearly the same view7s, I think, may be taken of hysteria. Even admitting that the disease is mostly radiated in the uterus, it does unquestionably often proceed from gastric irritation, and demands to be treated accordingly. Whatever may have been the immediate cause of the paroxysm, I have found, when ex- ceedingly vehement, no remedy half so effectual as vomiting. It promptly allays the convulsive agitations of the nervous sys- tem, and produces a state of mental composure which invites to sleep."—Chapma n. Apoplexy brought on, as it often is, by a mass of undigested food in the stomach, calls for the free exhibition of emetics, of which the third preparation of lobelia is the most appropriate. Lobelia should also be administered by injection and allowed to be retained in the bowels, to assist in exciting vomiting, relax the system, and equalize the nervous influence. Even if the seat of apoplexy be in the brain, and incurable, as it often proves to be, still the treatment can do no harm. Mania is generally associated with, and not unfrequently de- pendent upon a disordered condition of the stomach. Many cases have been cured by free vomiting with stimulating emetics. In long-continued dyspepsia, as in other forms of seated dis- ease, the mucous membrane of the stomach becomes more or less coated with a false membrane; a general torpor then pervades 428 EMETICS. the system, the nervous energy is prostrated, and the energies of the mind often greatly depressed. In such cases there is no plan of medical treatment which promises equal success with that of the frequent use of the steam bath and stimulating emetics. These means will prove the most effectual in restor- ing the secretions, and causing the detachment and removal of the false membrane lining the stomacli. Without effecting this the functions of the stomach cannot be restored. I have on many occasions observed that patients who had been long affected with dyspepsia, are very liable to experience severe pain under the operation of an emetic, and often complain of feeling worse about the time the disease is taking a favourable change. Affections of the head in general proceed from derangement of the stomach, so that not only in sick-headache are emetics in- dicated, but the most violent neuralgic pains in the head, ac- companied with extreme tenderness of the seal]), will sometimes be promptly relieved by free vomiting. "Early adopting the notion," says Dr. Chapman, " that this complaint proceeds from a morbid condition of the stomach, the only two cases of it which have come under my care, I have managed by emetics, and had reason to be entirely pleased with the result. Even genuine tic-doloreux, the neuralgia of some writers, has been cured, in several instances, by this same practice, and with such facility as to place it, in my opinion, decidedly above all other modes of treating this most painful, and hitherto nearly unmanageable affection." Diseases of the eye, as amaurosis, and acute inflammation of this organ, have been more successfully treated by active emetics than by any other plan. It is in the early stage of amaurosis, however, that so much reliance is to be placed upon emetics. The operation of emetics in connection with the use of the vapour bath are applicable to cases of dropsy. Besides clean- sing the stomach, placing the system under the relaxing influ- ence of lobelia promotes the action of the absorbent vessels, and consequently the use of this remedy is particularly well adapted to cases of dropsy. Emetics form an important part of the treatment for the cure of jaundice. 1 know a case of this form of disease which was cured by the administration of a vapour bath and an emetic, the patient having taken freely of composition and compound lobelia pills a few days preceding the bath and emetic. Cases that are more deeply seated, however, will require as do other forms of seated disease a repetition of courses of medicine, together with the appropriate intermediate treatment. An occasional emetic will be serviceable in every variety of scrofula. EMETICS. 429 Persons labouring under the poisonous effects of mercury will experience benefit from the use of the vapour baths and emetics. It is asserted by some medical writers that diabetes has been cured by the operation of emetics. This disease, however, is often incurable, as in many instances it is the consequence of the wearing out of the constitution. Torpor of the liver, which attends jaundice and bilious fever, has frequently been removed, and the functions of this important organ restored through the influence of vapour baths, and active emetics. To restore the natural temperature of the blood and im- part electricity to it, by the steam bath; to relax the system with lobelia; together with the influence of straining efforts to vomit constitute the most effectual means of relieving congestion of the liver, and of restoring its functions. Lobelia administer- ed by injection, and retained, exerts the same beneficial influence upon the system as when taken into the stomach. Whenever the system experiences a severe shock, as by fall- ing from a height, a violent blow, or by a severe burn or scald, digestion will be suspended, and if the accident should happen soon after, or within an hour or two after the patient has taken a hearty meal, the stomach should be evacuated by an active emetic. This may save the patient a great deal of suffering and materially lessen the danger of the injury. Thomsonian emetics may be employed with perfect safety du- ring every stage of pregnancy; and most of the derangements of the system consequent upon that state, such as a feeling of fulness, dizziness, or violent pain in the head; pain and distress in the back and loins; extreme sickness; water brash; and distress at the stomach, may be relieved and frequently entirely removed, for a time at least, by an active lobelia emetic preceded by the use of an enema, and a vapour bath. I have known females to be carried through from three to nine Thomsonian courses of medicine during the last two weeks preceding their confinement, invariably deriving benefit, and generally complete relief from distress, by their operation. A full course of medicine adminis- tered just before confinement is incomparably the best plan of treatment that has ever been adopted for insuring an easy and safe labour. Child bed fever, convulsions, and other forms of disease which sometimes come on after confinement, doubtless in the great ma- jority of instances may be prevented, or at least the system be placed in a far better condition to resist the influence of the usual exciting causes of disease, by a course of medicine administered in the first stage of pregnancy. The condition of the stomach excites a controlling influence over local diseases, such as painful swelling in e\ery part of the 430 EMETICS. body, swelled breast, and swellings in the groin, neuralgia, local inflammation, gout, disease of the kidneys, carbuncle, af- fections of the spine, abscesses, kc In the early stage painful swellings in the groin and in other glands may in many in- stances be brought to a crisis and dispersed without suppuration taking place, by administering vapour baths and emetics, to- gether with a proper use of injections to assist the action of the bowels. Just so much as the stomach is disordered will local diseases be- come generally more difficult of cure. I have known indolent ulcers of several years standing to be healed in a few weeks, chiefly by improving the condition of the system generally and more particularly that of the stomach, by Thomsonian courses of medicine, of whicli the emetic constitutes undoubtedly the most important part of the treatment. Even when the seat of disease is located principally in the brain, emetics may be given with great advantage in many cases. If a person be injured on the head or on any part of the body, and the accident occur soon after the patient has taken a hearty meal, a prompt emetic should be given, or the patient be made to vomit freely by some means. If this be neglected the stomach will be oppressed by a mass of undigested food, aggravating the symptoms, and causing the patient much suffering. When any poisonous substance has been swallowed, an emetic should be given promptly. The third preparation of lobelia is the most effectual form of emetic in such cases. When any substance is lodged in the throat, means should at once be taken to cause vomiting. Where this cannot be effected by running a finger into the throat, an emetic of lobelia should be given. If the patient cannot swallow an emetic, vomiting may be effected by administering one or two teaspoonsful of lo- belia powder in warm water by injection, and retained in the bowels. Besides producing vomiting this treatment will relax the system and thus tend to overcome the rigity of the parts in which the foreign substance is lodged, and lessening the diffi- culty of its being removed. Finally in disease, the stomach is more or less coated with thickened tenacious secretions, for the removal of which there is no remedy so effectual as a lobelia emetic given in combination with capsicum and a strong decoction of bayberry or sumac. The stomach possesses a very low degree of sensibility, so that its functions may be greatly depressed or disordered without the patient experiencing any symptoms of disease, except in parts re- mote from the stomach. One who is subject to a weakness in any part of the spine will experience an increase of the disease by the stomach becoming more disordered than usual. In many OF THE USE OF CATHARTICS. 431 instances disease of the spine has been cured by the use of the vapour bath and emetics. Eruptions of the skin, such as scald hand, nettle-rash, and tet- ter, are occasioned in general by derangement of the digestive functions and these eruptions may frequently he more effectually cured by emetics than by any external applications. The operation of an emetic and more especially of a full course of medicine is of especial benefit as a means of preparing the system for surgical operations. Case—A few months since I was desired to visit the wife of a gentleman a few miles from the city, who it was supposed was labouring under cancer of the uterus. She had been subjected to frequent purgings, several large bloodlettings, and she was often cupped. This course of treatment proved not only useless but the patient was getting worse under it. On commencing taking Thomsonian stimulants she began to improve; a few courses of medicine were given from which she experienced great benefit. They equalized the circulation, removed the swelling in the lower part of the abdomen, relieved the pain and soreness, under which she had been labouring, and finally by the daily use of tonics and an occasional vapour bath, and enemas per vagina and also to the bowels the symptoms of cancer of the uterus have almost en- tirely disappeared, and the general health of the patient is re- stored. The above is only one of hundreds and even of thou- sands, where the employment of Thomsonian emetics have proved successful in removing seated diseases when the regular practice had failed of doing any good whatever. OF THE USE OF CATHARTICS, OR PURGATIVE MEDICINE. Evert substance which operates upon the bowels as an active cathartic whether it be mineral or vegetable is injurious.— There is a wide difference between restoring the natural action of the bowels by aiding nature, and that of provoking an unnatu- ral action in them by means of cathartics. We know the general effect of cathartics in a diseased state of the system, by ascertaining their effect upon the system when in a healthy condition. Every physician will at once admit that the use of cathartics is injurious to persons in health—directly tending to disorder the stomach, impair digestion, lessen the de- 432 OF THE USE OF CATHARTICS. termination to the surface, weaken the power of generating heat, diminish the nervous influence, and ultimately prostrate the functions of the bowels. If a person in health take daily a dose of purgative medicine sufficient to produce a free operation, and continue the practice a few days, it will disorder the stomach and weaken the functions of the bowels, so that they will be left either relaxed and irritated, or constipated. Costiveness is the consequence of the peristaltic action of the bowels being in a weakened condition. Hence costiveness is the effect and not the cause of disease; or at least it is merely one link in the chain of effects arising from loss of vital power, or a weakened condition of the principle of life. A patient applies to a physician for advice. He tells the doc- tor that he has pain in the head; feels very drowsy and heavy; and has no appetite. The doctor enquires about the condition of the patient's bowels, and ascertaining that they are in a consti- pated condition; discovers a cause for the headache and drowsi- ness, and he directs a cathartic in order to remove the difficulty. But the enquiry should have been extended further to ascertain the cause of the costiveness, and "apply the axe to the root of the tree," instead of employing means which merely change the symptoms, and interfere with the curative operations of nature. By tracing disease to its primary source, we find it to arise from loss of vital power, and this should always be kept in view in the treatment of disease. Medicines often get the credit of curing disease, even where they may have had the effect to increase the distress of the patient and lengthen the duration of disease. It is no easy matter to determine the effects of some medicines in slight attacks of disease, or in acute disease in general.— Thus a person by some inaccuracy in diet, or from exposure to cold and dampness, feels indisposed to day, takes a dose of salts, eats nothing or at least only something very light, keeps him- self warm, the physic operates and to-morrow he will be almost well again, except that he will be costive a few days in conse- quence of the salts he had taken. The patient attributes the re- storation of his health to the dose of salts, yet doubtless his health would have been as speedily and more perfctly restored by the abstinence whicli he had observed and being kept warm, without the purging. Purging like blood-letting will modify the symptoms without removing the cause of disease; ultimately tending to disorder the system, and prostrate the vital forces. It will be admitted by every physician that in a sunken state of the system, or in very aged persons, the use of purgative medicine is not only hazard- ous but, in many cases if given to the extent of exciting free purging they would cause the death of the patient. It is by the efforts of nature that disease is cured. Medicines OF THE USE OF CATHARTICS. 433 are only serviceable when they aid the efforts of nature. When the stomach is foul, a dose of composition, or bayberry tea, is apt to cause vomiting; not because the medicine possesses emetic properties, but that the sensibility of the stomach is increased, and by being made to feel its diseased condition it makes an ef- fort to evacuate its foul contents. The stomach may thus be excited to vomiting by the use of medicines that are not in the least degree deleterious, and taken by one whose stomach is either in a healthy or a very insensible condition, will not occa- sion the least degree of nausea; and if taken freely every day would not prove injurious to the stomach, nor even derange the appetite. Lobelia, the best of all emetics, does not possess poi- sonous or deleterious qualities, and doubtless occasions vomiting partly by increasing the sensibility of the stomach. Antimonial wine, tartar emetic, and sulphate of zinc are poisonous, and when taken into the stomach nature makes an effort to cast off the of- fending substance by the act of vomiting. Thus by one plan of treatment we aid the stomach, whereas by the other the stomach is aggravated and its functions deranged. Cathartics are agents which do not harmonize with the laws of life, and when taken into the stomach the constitution makes an effort to remove the offending substance by purging. The deleterious influence of cathartics provokes the bowels to action upon the same principle that a portion of tainted meet will pro- duce looseness of the bowels and violent purging. It is urged by some that many diseases pass off with a loose- ness of the bowels, and that nature sanctions the propriety of purging. But it should be borne in mind that the forced action from a cathartic is different from the action which results as a consequence of the bowels recovering their functions at the crisis of disease. In the first case the bowels arc aggravated and pro- voked to action, whereas in the latter it is the recovery of their lost functions. Some have endeavoured to prove the advantage of using cath- artics by selecting a few isolated cases, where especial benefit appeared to result from their employment, the medicine having been given at a favourable period of the disease. Thus a patient may have several courses of medicine administered, which may bring the disease almost to a crisis, and just at this time take a dose of cathartic medicine, and the next day the disease be bro- ken up, not in consequence of having taken a purge, but because the disease was forming a crisis when the cathartic was taken, and although it does more harm than good, still the disorder be- ing just at its termination, the patient would improve more ra- pidly, and very erroneously suppose that he had received more benefit from the cathartic than from courses of medicine. I have known patients relieved of rheumatic pains by being 3 D 434 OF THE USE OF CATHARTICS. freely purged with powerful cathartics; but I have never yet seeo a patient really benefitted or the cause of disease removed by such treatment. A physician may obtain a large practice, whose course of treatment may in every instance be detrimental to the recovery of his patient, nature still struggling against the disease and the treatment, health becomes restored, and the doctor receives much credit for his skill.' more especially where a patient recovers who has been nearly deprived of vitality by his treatment. There are thousands of persons in the community who con- tinue in bad health year after year, in consequence of the habit- ual use of purgative medicines. After commencing the use of purgatives the bowels being weakened by them, they become more costive; to overcome this more physic is taken, which may relieve, but it weakens digestion, and is followed by increas- ed torpor of the bowels. I have frequently conversed with per- sons who had been in the habit of taking a dose of purgative me- dicine regularly once a week or oftener, and had continued in this practice from five to fifteen years; the bowels finally becom- ing so torpid as scarcely ever to be moved except provoked by the irritating effects of a cathartic; whereas if no purgatives had been used many of these patients might have enjoyed good health. The exclusion of cathartics constitutes one of the distinguish- ing features of the Thomsonian practice of medicine, and no one can justly claim the title of Thomsonian who is in the habit of prescribing either mineral or vegetable cathartics. It is incon- sistent to denounce all mineral poisons, and at the same time administer vegetable poisons, such as mandrake, an article which has been laid aside by the medical profession generally as too irritating to be used with safety; and yet many who claim to he Thomsonian doctors employ mandrake to a great extent in their practice. Castor oil which is one of the mildest cath- artics, occasions purging, because it is indigestible and offensive to the stomach and bowels. I once heard Dr. Samuel Thomson make the remark, that the practice of taking physic (purgatives) was like borrowing from Peter to pay Paul—which may afford some relief, but does not diminish the debt. In like manner a dose of purgative medicine may afford relief, but it does not remove the cause of disease. In treating cases of constipation of the bowels, even of long standing, I have in many instances been agreeably disappointed by finding their natural action to be in a great measure restored in the course of from two to four weeks under a course of treat- ment in which no purgatives were used. In certain conditions of the stomach and bowels, for instance, when they contain a portion of acrid secretions, the use of medi- OF THE USE OF CATHARTICS. 435 cine that possesses no cathartic properties, may be followed by purging. Thus cayenne pepper or composition powder, taken freely when the bowels contain a superabundance of acids, will increase the sensibilities of the mucous membrane, and may cause the acid or acrid secretions to operate as a purgative.— But by continuing the use of composition or pepper until the acid is removed, the medicine may be taken in increased quantities and no cathartic effect will be produced. In like manner a dose of purgative medicine may be made to operate by giving stimu- lants to increase the sensibility of the bowels to the morbid im- pression of the cathartic, and stimulating the restorative efforts of nature to cast off the deleterious substance. A deficiency of bile, in consequence of want of action in the liver is a very common cause of costiveness, and under these circumstances cathartics are decidedly injurious. The object to be kept in view in the treatment of disease is to aid the efforts of nature; to husband the resources of the consti- tution, in order that lost action may be restored. Nature has established certain methods for removing disease, and for re- gaining her lost power, and the use of medicine or other employ- ment of means that do not harmonize with these curative actions though they may change the symptoms and procure relief, still the designs of nature will be frustrated, and her energies crip- pled. In illustration of what I have here asserted, I will sup- pose a patient who is sick of what is termed bilious fever, to be left entirely in the hands of nature, except so far as to take simple warm teas and be protected from all injurious influences— Watching the progress of the case we find the fever continuing without any abatement, except at short intervals in the morning; the tongue becomes even more thickly coated, the bowels re- main costive, and all the symptoms continue, without any per- ceptible change until the ninth day, for instance, and then we perceive the edges of the tongue beginning to clean, the bowels are moved freely, the fever abates, perspiration ensues, and the patient gets well, say in a few days. Now under such circum- stances by what method is disease removed? It is by the con- stitution " husbanding her resources"—retaining the heat by which these actions are sustained, which resist the influence of the causes of disease, and by which the secretions and all other functions are fully restored. Now7 suppose this patient had been placed under the treatment of a physician of the old school, and an active cathartic had been given, causing a free operation upon the bowels, would this have restored the lost function of the bow7els? No: it would have aggravated the bowels and drained the system of a portion of its strength. In this way, by fre- quent purgation and blood-letting, disease is undoubtedly pro- longed to four or five weeks duration, which if left in the hands 436 INJECTIONS OR ENEMAS. of nature alone, would have found a crisis in less than two weeks and the patient subjected to much less suffering. There are means, however, by which nature may be assisted, the duration of disease shortened, pain relieved and life prolong- ed. To Dr. Samuel Thomson are we indebted for the detection and exposition of the errors of the regular practice of medi- cine; the discovery of the first principles of medicine; and of a system of practice which does not clash with nature's efforts, but operates in harmony with life; and when properly applied will prove the most speedy and effectual means of restoring health that has ever been introduced. It has been urged as an objection to the Thomsonian practice that all diseases are treated alike* or that the same remedies are used in all cases. The fact that Thomsonians treat disease upon general principles, without regard to the name of disease, is in reality a strong point in favour of its correctness. Thus a thousand different forms of disease may be produced by one general cause, and that course of treatment that will assist na- ture in one form of disease will do it in another. And again, the same course of treatment that will cleanse the stomach when it has become disordered by exposure to cold, will also do the same when disordered through inaccuracies in diet, dissipation, loss of rest, exposure to foul air, &c. kc. kc. INJECTIONS OR ENEMAS. Many important objects may be accomplished by the use of injections in cases of sickness; and in many instances they con- stitute the most important means for the cure of disease. In disease, the bowels are generally either constipated or ef- fected with diarrhoea, and in either case the use of injections, though not always necessary, may nevertheless be employed with advantage. The mere evacuation of the foecel contents of the bowels is not of so much importance in the cure of disease as is generally supposed. To restore healthy action in the bowels is the great object to be kept in view; and it is better that a patient submit to some unpleasant feelings from costiveness than to ha- rass his stomach and bowels by taking cathartics. When aliments leave the stomach, they pass quickly through the small intestines, a distance of about thirty feet in a liquid state, and when received into the large intestine are there retain- ed to undergo a kind of second digestion. Hence the scat of INJECTIONS OR ENEMAS. 4S7 costiveness in almost every instance is in the lower bowels, and within the reach of the influence of injections. " Whatever is good to cure disease when taken into the sto- mach, is likewise good for the same purpose given by injection, as the grand object is to warm the bowels and remove canker. In all cases of dysentery, cold, piles, and other complaints, where the bowels are badly affected, injections should not be' neglected. They are perfectly safe in all cases, and better that they be used ten times when not needed than once neglected when they are. In many violent cases, particularly where there is danger of mortification, patients may be relieved by administer- ing medicine in this way, when all other means would fail."— Dr. Samuel Thomson. Lobelia administered by injection and retained, operates upon the general system, as effectually as when taken into the sto- mach. Indeed a greater degree of relaxation may be effected by the same quantity of lobelia administered by enemas than when taken into the stomach. Often I have observed a most striking change for the better produced in violent attacks of disease by a lobelia injection retained. Obstruction in the sys- tem, wherever situated, appears to be more effectually removed by relaxing the system with lobelia than by any other means. Not that we are to depend, however, upon this treatment, to the exclusion of the use of stimulants and the vapour bath. Of the various methods of preparing Injections; together with fur- ther remarks in relation to their practical application. Half a pint of warm composition tea, adding a teaspoonful of green lobelia powder, forms a suitable injection for ordinary cases of disease, where the symptoms are not of a dangerous or violent character, nor the bowels badly disordered. The above preparation is also well suited to common cases of disease in infants and children. When there is reason to believe that the bowels are "canker- ed" or coated with thickened tenacious secretions or a false mem- brane, as they are in dysentery, diarrhoea, and in obstinate cases of disease of every description, the following form of injection will prove more effectual than the one before mentioned, namely: Half a pint of bayberry or No. 3 tea, made very strong and after it is strained or settled and poured off, add a large tea- spoonful of the liquid of the third preparation of lobelia; or take a large tablespoonful of bayberry powder, and- a teaspoon even full of cayenne pepper, pour on half a pint of boiling water, and when it settles and is sufficiently cooled, pour.off or strain the liquid, and add a teaspoonful of No. 6, and a teaspoonful of either brown or green lobelia powder. 438 INJECTIONS OR ENEMAS. In violent cases the quantity of third preparation or of the pepper and lobelia must be increased to double or treble or even to ten times the quantity above mentioned. Thus in malignant forms of disease as in what are termed typhus or congestive fe- vers, I have generally found it necessary to administer a large tablespoonful of the third preparation of lobelia at a time by in- jection, and frequently repeat it, and continue it several days, in order to sustain vital action, and prevent mortification. I have known patients to recover from malignant forms of disease chiefly I believe through the influence of powerful stimulating in- jections, administered every hour or two, and in this way con- tinued from one to four or five days. In some of these cases the sensibility of the bowels was so low that from four to six injec- tions would be retained, before an operation was effected or the bowels made sensible to the impression. Stupor, convulsions, suspended animation from drowning, the inhalation of carbonic acid gas, or from any other cause; palsy of the extremities, paralysis of the bladder, lockcd-jaw, and mental derangement, are, in general, more within the control of powerful stimulating injections than any other means. A disease often becomes chronic, in consequence of the mucous membrane of the stomach and bowels being coated with a false membrane. By observing the character of the evacuations from the bowels during the course of disease we perceive that about the time that a favourable crisis takes place there will be more or less of a skinny like substance escaping from the bowels and which had previously coated their mucous membrane. To re- move this substance from the lower bowels, (where it is chiefly situated) the use of injections are particularly indicated. Thus long standing cases of dyspepsia are cured by the removal of a false membrane from the stomacli and bowels, by means of courses of medicine and taking freely of composition powder, or of bayberry and pepper, together witbrthe daily use of an enema. Powerful purgative medicines though they may sometimes bring away false membrane when notJoo firmly adherent, yet as they neither restore the lost functions of the bowels nor establish healthy secretions, the bowels will consequently become more "cankered" by the use of cathartics; whereas under Thomsonian treatment the same courseof treatment that removes " canker" restores the functions of ibs bowels, and promotes healthy secre- tions. ,^g: •:£"' ' In cases of obstinate costiveness and where the chief object is merely the evacuation of the bowels, the following will be found sometimes to aus#er a better purpose than those already men- tioned. -7-&t' ^wfex ." X:':-,r-7^7^iy'--. "••.. . ••-.•>,.;. yy;Ww?y^)7 --t^ • INJECTIONS OR ENEMAS. 439 A tablespoonful of salt, Do. do. molasses, And a pint of warm water. This may be rendered more effectual by the addition of a tea- spoonful of the third preparation of lobelia, or of the lobelia pow- der. In bad cases of piles the powerful stimulating injections should not be employed except under some peculiar circumstances, for instance, in paralysis of the lower extremities or of the bladder, or rectum, suspended animation, or in cases of extreme prostra- tion from illness. When a patient is affected with piles, and or- dinary injections are found to make the piles worse, I have never found any plan of treatment more effectual than a strong tea of witch hazel, sumac berries, bayberry, or poplar bark, used by injection at bed-time and retained until morning. This dimin- ishes the piles, relieves the soreness of the parts, and generally procures a motion from the bowels in the morning. Immense benefit may very often be derived by placing the sys- tem under the influence of lobelia administered by injection and retained ten or fifteen minutes, and indeed no harm will arise from it even though it should remain in the bowels many hours. In all violent attacks of disease one of the most important indi- cations is to relax the system by lobelia either taken into the stomach or administered by injection in luke-warm water. If stimulants are employed in the jjgjjl'ction the lobelia will pass off before the system will be effectually influenced by it. In vio- lent cases of croup besides giving lobelia by the mouth, a tea- spoonful of the powder in a tea cup full of luke-warm water should be administered by injection, and this repeated if the case prove obstinate of cure. In severe cases of scarlet fever attend- ed with an undue determination of blood to the head, and in fine whenever there is vehement fever attended by a h&S*f and tense pulse injections of lobelia powder in hike warm, water/ by relax- s:y. ing the system will very greatly assist the effttr^i0fil'ie,constitu- ' tion to overcome obstructions, and restore tlielunctions of the bowels. The practice of placing the system under the influence of lo- belia administered by injection and retained is not to be confined exclusively to cases in which there is a high fever. Di.sease that has become seated, whether accompanied with fever or not, has often been removed by means of lobelia injections. Some months since a daughter of my brother was taken with a sore mouth of an extremely distressing character, and various kinds of remedies, together with the use of the steam bath and the usual stimulating injections having faffed to effect a favour- able change in the symptoms, and the disease having continued nearly two weeks a lobelia injection was administered arid re- 440 INJECTIONS OR ENEMAS. tained, which relaxed the system very much, aroused a new ac- tion in the bowels, occasioning considerable pain and distress for a time, but the symptoms of the sore mouth at once assumed a more favourable aspect, and in a short time it was well. Lobelia retained in the bowels will always produce for a time more or less pain and distress, by greatly increasing the sensi- bility of the parts, and as it were, attracting the nervous influ- ence to the bowels, removing obstructions, and restoring their lost functions. Patients may be effectually vomited by lobelia administered in the manner just described; the vomiting and re- laxation of the system even continuing longer than when an emetic is taken in the usual way. In children, except when the symptoms are of a violent cha- racter, the third or even the fourth of a teaspoonful of lobelia powder administered by injection may be found sufficient to pro- duce the desired effect upon the system. In a case of malignant scarlet fever in a child of Mr. John Lippincott of N. J., four large teaspoonsful of brown lobelia powder were administered by injection in bayberry tea, and retained from four o'clock P. M. until seven o'clock next morning, and during this period half a teaspoonful of the liquid of the third preparation of lobelia was given by the mouth every half hour. After this severe struggle of the constitution aided by medicine against the disease, the pa- tient began to mend and finally recovered, and doubtless by the energetic and persevering course of treatment instituted by Dr. Lee the attending physician in the case. In all cases of obstinate obstructions in a part, attended with violent pain and strong pulse, as in severe pleurisy, inflamma- tion of the brain, inflammation of the lungs, croup, &c. lobelia should be used freely, either given by the mouth or administered by injection and retained. In some instances it will be neces- sary to repeat the injections at intervals of every four or five hours, with a view to overcome obstructions if there be seated in- flammation; to equalize the circulation of the blood and of nerv- ous power. In this way we obtain all the benefits that can pos- sibly result by relaxing the system by blood-letting, and with- out any danger of the serious consequences wiiich not unfrequent- ly result from the loss of blood. Lobelia administered by injection exerts a more prompt and effective influence upon the kidneys, bladder and uterus, than when taken into the stomach. Hence in all cases of disease of any of these organs, or in parts within the vicinity of the lower bowels, the use of injections will constitute a very essential part of the treatment. Violent inflammation of the kidneys, strangulated hernia, in- flammation of the neck of the bladder, retention of urine, painful stricture of the urethra and inflammation of the uterus, demand INJECTIONS AND ENEMAS. 441 the prompt employment of lobelia injections, besides the usual constitutional treatment proper to be employed in such cases. Habitual costiveness is rarely cured by the use of ordinary in- jections alone; other means must be employed, as the circum- stances of the case require. Sometimes a free use of cayenne pepper at meals'will restore the natural action of the bowels. In administering a course of medicine in deeply seated disease, no matter by what name it may be called, it is a good practice to administer a stimulating injection previously to the steaming, and after the bath repeat the injection composed simply of half a teaspoonful of lobelia powder in warm water, so that it may be retained, and then give the emetic of the third preparation of lo- belia or some other preparation of lobelia combined with stimu- lants in bayberry tea. I attended a lady at Moores Town, N. J., who continued nine days without any motion from the bowels, notwithstanding in- jections were administered daily. She experienced no apparent inconvenience from the constipation of the bowels, and being in a state of extreme prostration, this patient would probably not have recovered if her stomach and bowels had been aggravated by cathartics, or even by laxatives, the mere stimulous of dis- tention arising from the presence of foecal matter in the bowels, assisting in supporting the strength of the patient. 3 E THOMSONIAN MATERIA S1EKA: C ONTAINING A GENERAL DESCRIPTION OF THE MEDICAL PROPERTIES AND USES OF THE VARIOUS MEDICINES AND COMPOUNDS EMPIOTED IN THE KUtmimnixn practice. LOBELIA INFLATA—EMETIC HERB. There are several species of lobelia, none of which, how- ever, except the inflata appears to possess medical properties of sufficient importance to entitle them to a place in the materia medica. The Lobelia inflata presents several peculiarities by which it may very readily be distinguished from every other plant. It grows in every kind of soil, but is to be found most plentifully in old pasture fields, and in fields that have been in grass a year. Lobelia does not come to maturity the first year of its growth. It is a biennial plant, rising but very little above the surface of the ground during the first summer, and on the following one it blossoms and seeds. The lobelia pods or cap- sules are very easily distinguished from those of any other plant. No one except Dr. Samuel Thomson has any just claims to the discovery of the medical virtues of lobelia. This like many of the most useful discoveries that have been made, w7as the re- sult of accident. Thomson during a period of twenty years, commencing with early boyhood, had often observed the singu- 444 MATERIA MEDICA. lar effect of lobelia upon persons by chewing a small portion of the plant, before it occurred to him that it possessed any valua- ble medical properties. The small quantity generally taken, and the persons that took it being generally in good health, af- fords an explanation why the medical virtues of lobelia so long escaped the discriminating mind of Thomson after having wit- nessed its effects so often. The idea of its being useful as medi- cine originated from observing its powerful effects upon a man who had swallowed some lobelia without knowing what it was. The man became very much relaxed, vomited freely, sweat pro- fusely, and in a short time after ate a hearty dinner, and de- clared that he never had any thing to do him so much good.— This circumstance induced Samuel Thomson to make a trial of it for cleansing the stomach, which resulted in the conviction that it possessed important medical properties—that it was pow- erful in removing disease, and harmless to the system. "In giving a description of this valuable herb," (says Samuel Thomson) "I shall be more particular, because it is the most important article made use of in my system of practice, without which it would be incomplete, and the medical virtues of which and the administering of it in cases of disease I claim as my own discovery. The first knowledge I ever had of it was obtained by accident more than forty years ago; and I never had any infor- mation whatever concerning it, except what I have gained by my own experience. A great deal has been said of late about this plant, both in favour and against its utility as a medicine; but all that the faculty have said or published concerning it, only shows their ignorance on the subject; for there is very little truth in what they have stated concerning its medical proper- ties, except wherein they have admitted it to be a cure for the asthma." The powerful effect produced upon the system by the use of lobelia, more especially where there is much disorder, has doubt- less induced many to believe that it is poisonous. The asser- tion, however, that lobelia is a poison is not true; " but on the contrary,/ as Dr. Thomson very justly observes, " there is no vegetable that the earth produces more harmless in its effects on the human system, and none more powerful in removing disease and promoting health." " I am confident" (observes Professor Tully, of Yale Col- lege) the old woman's stories in the books to the contrary not- withstanding, that lobelia is a valuable, a safe, and a sufficient- ly gentle article of medicine; and I think the time will come when it will be much better appreciated. Little, however, of its value can be specified within the compass of a single sheet of paper." The great majority of medical men have set their faces against MATERIA MEDICA. 445 lobelia and the Thomsonian practice in general, with a degree of prejudice and stubbornness, which reflects no credit upon the profession. At the trial of Dr. Frost, of New York, and on other occasions where regular physicians have given testi- mony before " courts of justice," in relation to the properties of lobelia inflata, their evidence has been based upon the infor- mation they had obtained from medical authors who knew as lit- tle as themselves of its properties from experimental observa- tion. I have used lobelia extensively during nine years, most of this time having had a large practice, and I am fully confirmed in the belief that all that Samuel Thomson has said concerning the properties of lobelia is true. The longer I use it the more rea- son I have to prize it above all other medicines. This simple herb which may be found in every kind of soil, and on the top of hills and in valleys, contains medical properties not possessed probably by any other substance, either mineral or vegetable. The powerful influence it exerts on the system, and the many important indications which its use fulfils in the cure of disease, justly entitles it, in point of medical virtue, to be placed at the head of medical agents. Lobelia operates as a pure and powerful stimulant to the great sympathetic system of nerves, which control the functions of the stomach, bowels, and all the internal organs. Under its sti- mulating influence the stomach and bowels are made to feel their diseased condition, the vital powers are concentrated to the seat of disease, the restorative efforts of nature are called into action to expel disease, and during this conflict of the restorative ef- forts of nature against disease, patients frequently experience distress and pain in the stomach and bowels, the system becomes relaxed, to such a degree in some cases that the patient thinks he is going to die—a feeling persons often experience during sea-sickness. " When this medicine is given to patients that are in a de- cline, or are labouring under a disease of long standing, the symptoms indicating a crisis will not take place until they have been carried through from three to eight courses of medicine; and the lower they have been the more alarming will be the symptoms. I have seen some who would lay and sob for two hours like a child that had been punished, not able to speak or to raise their hand to their head, and the next day be about and soon get well. In cases where patients have taken considerable opium, and a course of medicine is administered, it will, during the operation, produce the same appearances and symptoms that are produced by opium when first given; the opium having lain dormant is roused into action by the enlivening effects of the course of medicine, and they will be thrown into a senseless 446 MATERIA MEDICA. state; the whole system will be one complete mass of confusion, the patient tumbling in every direction; will require two or three persons to hold them in bed; they grow cold as though dying; remaining in this way from two to eight hours, and then awake like one from sleep after a good nights' rest, and become entirely calm and sensible as though nothing had ailed them. It is sel- dom that they have more than one of these turns, as it is the last struggle of the disease, and they generally begin to recover from that time. I have been more particular in describing these ef- fects of lobelia in particular cases, where disease is deeply seat- ed, as they are very alarming to those unacquainted with them, in order to show that there is no danger to be apprehended as it is certain evidence of a favourable turn of the disease."—Dr. Thomson. Preparations of Lobelia. m To prepare the green lobelia powder the herb should be gath- ered when in blossom; dry it in the shade, and as soon as it is thoroughly dried, strip or beat off the leaves and pods, reduce it to a fine powder, and keep it secluded from the air, dampness and from light. This forms the green lobelia powder. This prepa- ration of lobelia is generally employed as an emetic in ordinary cases of disease, and for children in general. It is usually given in strong composition tea, or in a strong decoction of bayberry or sumac, adding a portion of cayenne or of No. 6. The green lobelia powder is not as efficient an emetic as lobe- lia seed pulverized, and therefore in severe cases the latter is to be preferred. In severe cases when it is proper to relax the system fully as in violent attacks of fever, pleurisy, inflammation of the lungs, violent pain, strangulated hernia, kc. the pulver- ized lobelia seed should be employed. General directions for preparing emetics will be found under the head of courses of medicine. 2d. To prepare a tincture of lobelia take the freshly dried herb in any stage of its growth, before the leaves become yellow and put it in alcohol, whiskey, or in madeira or sherry wine— Tinctured in vinegar it is a worthless preparation. The tincture is a convenient form of administering lobelia to children as an expectorant in whooping cough, and affections of the breast in general. Ordinary attacks of croup may be cured by giving promptly and freely of the tincture of lobelia. As an emetic the lobelia powder or the third preparation is to be preferred to the tincture; but when it is desired to place the system under the influence of lobelia in a moderate way, as in cases of tight cough, disease of the chest in general, dyspepsia, palpitation of the heart, scrofula, and in fine, in a great variety of cases of disease, MATERIA MEDICA. 447 * the use of the tincture of lobelia forms a very convenient and use- ful preparation, given to an extent to produce a slight degree of nausea. I have observed the use of the tincture of lobelia taken in doses of from half to a teaspoonful every hour or two, to be attended with very great benefit in very many cases of dyspepsia, consumption, and in diseases of the breast in general. Tincture of lobelia forms a substitute for the various kinds of anodynes in general use, such as Godfrey's Cordial, Para- goric and other preparations containing opium. Given to infants and children in small doses varying from five to twenty drops, it quiets restlessness, and disposes to sleep. Administered in this way lobelia has a soothing influence upon the system. Lobelia is not narcotic, it possesses no such properties. Taken in small doses by those who are attending upon the sick the tincture of lobelia will be useful in protecting the sys- tem from disease. Lobelia Seed.—To obtain lobelia seed the herb should be col- lected when the pods have turned yellow. If left until the cap- sules are fully ripe and dried, the pods being open at the top the seed will fall out unless great care be taken in gathering.— To prepare the seed for use, they must be finely pulverized in a mortar or by grinding. The lobelia seed exerts a much more powerful influence upon the system than the green powder, or the tincture. The alarm- ing symptoms as they are so called, are seldom produced by the use of any other preparation of lobelia than the seed. A free use of the brown lobelia will rarely fail of relaxing the system; and as this is a point of great importance in the cure of disease attended with high fever or violent pain, the brown lobelia pow- der should be employed, or at least a portion of it combined with the green powder. In cases of strangulated hernia; inflamma- tion of the kidneys, bladder, or uterus; peritoneal inflammation; stranguary; apoplexy; violent fever, such as often attends scar- let fever; severe cases of rheumatism; locked jaw; violent cramp in the stomach; severe cases of croup; St. Vitus' dance; palsy; painters' colic; severe forms of pleurisy and inflammation of the lungs; dropsy of the chest; and in bleeding from the lungs, ad- ministering a portion of brown lobelia powder by injection so as to be retained, constitutes a most important part of,the treat- ment. We are not to depend however upon this alone. In treat- ing disease, in general there are several important objects to be kept in view7 in regulating the treatment. These are to restore the natural temperature of the blood; equalize the circulation; remove obstructions; excite vomiting; sustain the restorative ac- tions; promote perspiration, and other secretions; cleanse the stomach and bowels of "canker"; and assist digestion. The theans and remedies to be employed to fulfil these indications, 4 48 MATERIA MEDICA. are—the vapour bath; pure stimulants as capsicum, and com- sition; lobelia emetics prepared as directed under the head of a course of medicine; broken doses of lobelia, injections of lobelia retained; bayberry or other of the No. 3 or anti-canker medi- cine; and lastly, bitters. Third Preparation of Lobelia. Directions for Preparing.—Take an ounce of lobelia seed pul- verized; an ounce of cayenne pepper; and an even tablespoonful of nerve powder. Mix them together, and add between half a pint and a pint of No. 6. To be kept in vials or bottles tightly corked, and not allowed to remain in a hot place. This prepa- ration given in strong bayberry or No. 3 tea, forms an efficient emetic. It is a powerful agent for assisting nature to overcome disease, and may be used with perfect safety. The dose is from a teaspoonful to a tablespoonful, to be repeated as the circum- stances of the case may demand. I knew an instance where a child but nine months old, took three ounces of the third pre- paration of lobelia during one afternoon. It was a case of croup, which had continued two or three days, before this thorough treatment was adopted. The patient recovered through the agency of the treatment. The third preparation of lobelia is particularly adapted to violent attacks of disease, as in fits, bilious colic, cholera mor- bus, locked jaw, poisons taken into the stomach, suspended ani- mation from drowning, lightning, or from inhaling carbonic acid gas; difficult cases of croup, and asthma; gout, palsy, and in all cases of violent pains and inflammation in the kidneys, bladder, &c. An effectual plan of treating violent attacks of disease is, to administer lobelia powder by injection to he re- tained, and giving the third preparation by the mouth. In preparing emetics for adults I generally combine the third preparation and lobelia powder. In all cases where the strength of the system is in a sunken condition, in protracted fevers, ma- lignant small pox, .measles and scarlet fever, where the eruption is slow in appearing for want of vital action, or where there is a tendency to a retrocession or striking in of the eruption the use of the third preparation of lobelia is particularly indicated. •In many cases, for instance in fevers where the patient is very low, the third preparation of lobelia may be taken in tea- spoonful doses^epeated every hour or two and continued a day or even longer, without occasioning vomiting. If it should not cause vomiting, however, it need not occasion the least degree of anxiety, as it can do no harm under any circumstances. To sustain vital action, and prevent mortification in malig- nant forms of disease, for instance in the advanced stages of MATERIA MEDICA. 449 wbat are called fevers, there are no means more effectual than the free use of the third preparation of lobelia in the stomach and administered by injection. The quantity to be used must be regulated by the effect produced. In some instances I have found it necessary to use a tablespoonful or more in an injection, and this repeated every two or three hours and continued seve- ral days and nights in succession and with the most happy ef- fects, especially in low forms of fever. In treating of the third preparation of lobelia, Dr. Thomson observes. '-This preparation is for the most violent attacks of disease, such as locked jaw, bite of mad dog, drowned persons, fits, spasms and in all cases of suspended animation, where the vital spark is nearly extinct. It will go through the system like electricity giving heat and life to every part. In cases w here the spasms are so violent that the patient is stiff, and the jaws become set, by pouring some of this liquid into the mouth between the cheek and teeth, as soon as it reaches the glands at the root of the tongue the spasms will relax, and the jaws will become loosened so that they will open; then give a dose of it, and soon as the spasms abate repeat it and afterwards give a tea of No. 3 for canker___ This course I never knew to fail of giving relief. It is good in less violent cases to bring out the measles and small pox." * * # * # # i liave cured three dogs with this preparation, who were under the most violent synnptoms of hydrophobia; and one of my agents cured a man with it who had been bitten by a mad dog; and I have not the least doubt of its being a specific for that disease."—Dr. S. Thomson. I have never known of a patient being suffocated by having the third preparation of lobelia poured into the mouth, even where the patient was in a state of unconsciousness at the time. In giving the third preparation as an emetic and on ordinary occasions, it should be given in bayberry or No. 3 tea, made very strong. Externally applied, the third preparation of lobelia, will prove beneficial in cases of rheumatism, lumbago, palsy, erysi- pelas, asthma, weakness of the spine, pain in the side, dropsi- cal swellings, chronic pleurisy, chilblains, some species of tetter and in tic-doloureux. Compound Lobelia Pills. Directions for making.—Mix equal portions of pulverized lo- belia seed and cayenne pepper, and about one-fourth the quan- tity of finely pulverized gum arabic; add sufficient water to form the mass into a proper consistency to be formed into pills. The compound lobelia pills may be used as a general medi- cine where patients prefer taking them to liquids. They are 3 F 450 MATERIA MEDIGA. particularly adapted to cases of dropsy, as the desired im- pression may be made by medicine, without the use of liquids. Where a disease has become seated, as in dyspepsia, rheuma- tism, gout, asthma, tetter, scald-head, consumption, costiveness, jaundice, St. Vitus's dance, piles, palsy, neuralgia, scrofula, &c. these pills may be employed in the place of the stimulating teas; and as intermediate medicine where courses of medicine are given. The use of these pills will in many instances occasion more or less uneasiness and pain in the bowels, until a more natural warmth and action are restored to the bowels, and then they will cease to produce pain unless taken in large quantities. 'She use of these pills promote the natural action of the bowels. They possess no cathartic properties. If there be a great ac- cumulation of acid in the bowels, a free use of these pills may cause the acid to be more sensibly felt, and produce purging. In the same way a dose of cathartic medicine may be made to ope- rate more quickly by increasing the sensibility of the mucous membrane of the bowels by stimulants. Dose.—In cases of rheumatism, dropsy, &c. when it is proper to place the system under the continued influence of medicine, from tw7o to four pills may be taken about every two hours. In ordinary cases of dyspepsia and costiveness, from two to four or five of the pills may be taken at bed time. STIMULANTS Wiiich raise and sustain vital action, and assist the efforts of na- ture to remove disease. CAPSICUM—CAYENNE PEPPER. "Numerous species of capsicum, inhabiting the East Indies and tropical America, are enumerated by botanists, the fruit of which differing simply in the degree of pungency, may be indis- criminately employed. The capsicum baccatum, or bird pepper, and the capsicum frutescens, are said to yield most of the cayenne pepper brought from the West Indies and" South America; and Ainslie informs us that the latter is chiefly used in the East Indies. The species most extensively cultivated in Europe and this country, is that recognized as officinal by the pharmacopses, namely: the capsicum annuum. The first two are shrubby plants, the last is annual and herbaceous."—U. S. Dispensa- tory. MATERIA MEDICA. 451 Capsicum is a pure and permanent stimulant, its direct effect upon the system, when taken, is to raise and support vital action, it restores a natural warmth to the system, increases the power of generating nervous influence, by which the secretions are in- creased, a determination to the surface is produced, and the circu- lation of the blood equalized. Cayenne pepper, therefore, is an important agent in the treatment of disease, always assisting nature and operating against disease, whether it be attended by chilliness or fever. It is as congenial to the living principle in man as the sun is to the life of the vegetable kingdom. The greater part of the cayenne pepper sold by grocers and apothecaries, contains very little strength, and therefore should not be used as medicine. The American pepper though inferior in strength to the im- ported, will answer in ordinary cases of disease provided it be properly dried and prepared. The African pepper however, is always to be preferred when it can be obtained pure. Large quantities of damaged capsicum are landed in our sea- port towns, so that the greatest degree of circumspection is ne- cessary in purchasing the article. Those who deal largely in Thomsonian medicines should either purchase the article in the pod so that they may know its qualities and have it ground under their own inspection; or purchase it of those who are a judge of the article and have it ground in mills where no poisonous drugs are allowed to enter. "I shall not" (says Dr. Thomson) undertake to dispute but that cayennehad been used for medical purposes long before I had any knowledge of it; but it is equally true that the medical fa- culty never considered it of much value, and the people had no knowledge of it as a medicine, till I introduced it by making use of it in my practice. That it is one of the safest and best ar- ticles ever discovered for the removal of disease, I know to be a fact from long experience. Mention is made of cayenne in the Edinburgh Dispensatory, as chiefly employed for culinary pur- poses, but tlrat of late it has been employed in the practice of medicine. The author says " there can be little doubt that it furnishes one of the purest and strongest stimulants which can be introduced into the stomach; while at the same time it has nothing of the narcotic effects of ardent spirits. It is said to have been used with success in curing some cases of disease, that had resisted all other remedies." "All this" (observes Thomson) "I am satisfied is true, for if given as a medicine it will always be found useful; but all the knowledge they had of it seems to have been derived from a few experiments that bad been made, without fixing upon any particular manner of pre- paring or administering it. ########## " When I first began to use this article" (says Thomson) it 45£ MATERIA MEDIC A. caused much talk among the people of Portsmouth and the adjoin- ing towns; the doctors tried to frighten them by telling them that 1 made use of cayenne pepper as a medicine, and that it would burn up the stomach and lungs as bad as vitriol. The people generally, however, became convinced by using it, that all that the doctors said about it was false, and thus proved their ignorance of its medical virtues, and that in making these assertions they were influenced by a feeling of malice towards me. It soon came into general use, and the knowledge of its being useful in curing disease was spread all through the country. I have made use of cayenne in all kinds of disease, and have given it to patients of all ages and under every circumstance that has come under my practice; and can assure the public that it is perfectly harmless, never having known it to produce any bad effects whatever. It is doubtless the most powerful stimulant known, it is congenial with nature, having a direct tendency to raise and maintain the natural heat of the system upon which life and health so materi- ally depend. It is extremely pungent and when taken sets the mouth as it were on fire; this lasts, however, but a few minutes, and I consider it essentially a benefit in many cases as it causes a free flow of saliva from the glands of the mouth and throat." An important object to be kept in view in the treatment of dis- ease of every variety, and in e\ery stage, is to assist the efforts of nature by the use of stimulants. And the use of cayenne pep- per, although not necessary in every case of disease, may still be given with safety under all circumstances. To one not fully acquainted with the effects of cayenne pepper upon tite system, it may appear a strange practice to give the ar- ticle in cases of fever. Singular as it may seem, it is neverthe- less true, that excepting lobelia there is no other article of equal value with cayenne pepper in the cure of fevers in general. As to the declarations of physicians that the use of cayenne inter- nally will aggravate fever, or that it will increase inflammation in the stomach and bowels, given even in large quantities, is contradicted by the experience and observation of thousands of men and women, possessed of as much common sense and as ca- pable of appreciating the effects of medicine as the medical pro- fession. Experience has proved that cayenne pepper is the best re- medy known for inflammation of the throat; and where is the proof that it has not the same curative effect in inflammation of the stomach and bowels. Cayenne relieves inflammation of the stomach and bowels by exciting the secretions. As a general rule in disease, cayenne pepper or Thomson's composition, should be used until the disorder is broken up. In ordinary cases of colds, catarrh, mild cases of fever, recent attacks of dyspepsia, or almost any kind of ailment not too deep- MATERIA MEDICA. 453 ly seated, the free use of cayenne pepper tea, together with par- ticular attention to diet, and avoiding exposure, will afford suf- ficient assistance to nature to remove the disease. The efficacy of a free use of cayenne pepper in promoting di- gestion, no one will pretend to deny. Its use will he found bene- ficial even in those cases of indigestion or dyspepsia attended by extreme tenderness at the pit of the stomach. The best time to take cayenne in cases of dyspepsia is with food, or shortly after meals. In dysentery, where most medical men influenced by the doc- trines of the schools, consider the use of active stimulants very improper, yet even in the most infiammatory form of the disease cayenne pepper may be used not only with safety, but with especial benefit. The use of cayenne pepper is particularly in- dicated in cases of dropsy, jaundice, long standing cases of tet- ter, costiveness, flatulency, rheumatism, arid gout. In fine it may be used with perfect safety in all cases of disease. The utility of cayenne for the cure of scarlet fever and malig- nant sore throat is admitted even by the medical profession; and would they but try its efficacy in all other forms of fever, they would find it as beneficial as in scarlet fever, notwithstand- ing its use is contra-indicated by the popular, though false doc- trines propagated in the schools of medicine. 1 once heard professor Revere of Jefferson college observe, that almost every one knew cayenne pepper to be one of the best remedies for an inflamed throat, " and it is impossible," said he, " for us to ex- plain why it is not equally beneficial in inflammation of the sto- mach or bowels." Cayenne pepper applied to the skin will produce redness and increase the heat of the part, and aggravate acute inflammation on the surface of the body; but when applied to a secreting sur- face, as the mucous membrane of the stomach or bowels, it pro- motes the secretions from these surfaces, and in this way re- lieves inflammation, and assists in bringing about a favourable termination to disease. Cases of chronic diarrhoea of long standing have been cured by using freely of cayenne pepper. The usual dose of cayenne is from a half to a teaspoonful. It is usually taken in the form of tea, made by pouring boiling wa- ter upon the powder. Sugar may be used freely in the tea. In certain conditions of the stomach, and more especially when it is empty, taking a dose of cayenne will occasion pain for a few minutes. The pain appears to arise in consequence of a sudden development or generation of gas or wind in the stomach, the pain subsiding as soon as wind is expelled. No harnr is to he apprehended, however, from pain occasioned in this way, hut on the contrary, we often find that patients experience a re- 454 MATERIA MEDICA. markable change for the better immediately after experiencing a severe spell of pain from taking a dose of cayenne pepper. About four years ago I prescribed medicine to a man who had been dyspeptic, and otherwise in feeble health, for twenty years, and on taking the first dose of Thomsonian medicine, wiiich con- sisted of a teacup half full of strong bayberry tea and a large teaspoonful of cayenne pepper, (instead of half a teaspoonful as I had directed) he was suddenly seized with violent pain in the stomach, a cold sweat broke out, and for some time he was help- less. After the pain had subsided, be fell asleep, slept several hours, and when he awoke declared that he had not felt so well at any time for many years. The patient continued the use of the medicine and his health was soon restored. When patients experience severe pain in the stomach after tak- ing a dose of pepper, warm applications—a hot brick or flannel wrung out of hot water applied to the pit of the stomach will generally relieve the pain. Taking pepper tea in very small quantities frequently repeated will seldom occasion pain, even on an empty stomach. As a gargle in ulcerated sore throat there is no remedy in point of efficacy equal to cayenne pepper. A preparation of vinegar, salt and cayenne pepper has been a long time in high repute in some southern countries as a remedy for malignant sore throat and scarlet fever. Tonics and other medicines arc rendered more active and ef- ficient by being combined with a portion of cayenne. Cayenne pepper applied externally is very useful in many cases, as in rheumatism, dropsy, and in ajl cases where the use of external stimulants are indicated. Poultices of pepper may be employed with great advantage in a great variety of cases, as in chronic rheumatism, cold abscess, white swellings, hip dis- ease, indolent ulcers, disease of the spine and in all cases when it is necessary to stimulate the vessels of a part by the direct application of a stimulant. THOMSON'S COMPOSITION POWDER. To make Composition Powder.—Take three pounds of finely prepared bayberry root bark, one and a half pounds of best gin- ger, three ounces of cayenne, and three ounces of cloves. All these are to be finely pulverized, and thoroughly mixed and pass- ed through a sieve. A variety of formulas for preparing composition powder have been published as an improvement upon that of Thomson's.— Some recommend the addition of a large portion of butterfly root (asclepais tuberosa) others sassafras root; either of wiiich MATERIA MEDICA. 455 however, are comparatively useless articles, and when added to Thomson's composition powder they occupy the place of ar- ticles possessing properties of far greater efficacy in the cure of disease. The composition powder made of genuine articles is adapted to all cases of disease, and hence it forms a most important and useful medicine for general family use. The composition, besides its stimulating qualities, contains as- tringent or anti-canker properties. It may be used with safety in all cases of disease, and it is more employed by Thomsonians as a general medicine than any other article or compound. In- deed the composition is so universally applicable in the treat- ment of disease in general tiiat an enumeration of the varieties of disease and ailments in which this medicine may be used with advantage would comprise a list of almost every form of disease to whicli the human system is subject. Dose-—The usual dose of composition powder is a teaspoonful scalded in a teacup half or two-thirds full of boiling water. sweetened and drank warm. This is the proper mode of prepar- ing the composition when the patient is confined to the house, or going to bed; and when it is desired to produce perspiration. The following is a better way of preparing the composition for persons exposed to the weather, namely: Take of composition powder and sugar each a teaspoonful, rub them together dampen- ed with a little water; then add a teacup half full of luke-warm or cold w7ater, stir it together well and take before it settles. A dose of composition sometimes occasions pain in the sto- mach, frequently nausea, and sometimes vomiting, more especi- ally in those unaccustomed to its use, but never except the sto- mach be more or less disordered. In preparing composition, even for children, it should be made strong and be well sweetened; a wineglassful of composition tea made strong, will in general prove more beneficial to the patient than three times the quantity if made weak. GINGER. The dinger plant "is a native of Hindostan, and is cultivated in all parts of India. It is also cultivated in the West Indies, whither it was transplanted from the East."—U. S. Dispen. The common ginger of the shops is obtained almost exclusive- ly from Calcutta. The best ginger comes from Jamaica, and is usually termed Jamaica ginger, or white ginger. The supe- riority of the Jamaica ginger arises from the manner in which it is dried. The best roots are selected, the skin taken off, and then dried separately in the sun. The common ginger, as sold 4 56 MATERIA MEDICA. by storekeepers and apothecaries is often deprived of almost all its strength by long keeping and altogether unfit for medical pur- poses. In making composition powder the Jamaica or white ginger should be used, unless the common ginger can be obtained fresh and of a good quality. Medical Properties.—Ginger is a pure mild stimulant, and as such it may be employed in all cases of disease; its use can injure no one. Ginger tea forms a valuable medicine for infants and children. In fine it may be employed as a mild stimulant in all cases of disease. Ginger tea is much employed as a remedy for colic in infants. Its use promotes digestion and lessens the liability to colic. In mild cases of measles, scarlet fever, small-pox, and vario- loid, ginger tea, may be employed as a general stimulant. Combining ginger and cayenne in about equal portions forms a sufficiently active stimulous for general use in the treatment of disease. Tonics may be rendered more efficient and less unplea- sant to the taste by the addition of a portion of ginger. ASTRINGENTS AND DETERGENTS. {Thomson's "No. 3, or Medicine for Canker.") Strange as it may appear, it is nevertheless true, that one of the most important indications for the cure of disease has been as yet overlooked by the medical profession, namely: the removal of morbid secretions from the mucous membrane of the stomach and bowels, by the use of astringents. Further remarks in re- lation to the subject of morbid secretions may be found on pages 6 and 411-1*2 of this work. The medical profession employ astringents, but they are gene- rally of a directly binding nature and prescribed with the view only of constringing, or to give tone to textures that arc in a re- laxed condition, as in chronic diarrhoea and passive hemorrhage. Dr. S. Thomson by a long course of experiments discovered a number of articles "good for canker" as he terms it, wiiich may be taken freely without producing costiveness. Bayberry, upland sumac, white pond lily, and wild raspberry leaves, are the articles principally employed for cleansing the stomach and bowels of morbid secretions or " canker," and to overcome their tendency to putrefaction. MATERIA MEDICA. 457 BAYBERRY. {Myrica Cirefera.) Of the articles mentioned under the head of astringents, the bark of bayberry root is the best adapted to general use as an internal remedy. Bayberry root bark should be collected in the fall after the commencement of frost, or early in the spring before the leaves put forth. Bayberry is a very important article in the Thomso- nian practice, and great care should be taken to obtain that which is good. There are large quantities of bayberry sold that have been collected in an improper season, mixed with other bark, and mouldy, and consequently possesses but little, if any, medical virtue. Composition powder made of such bayberry as above mentioned, old and worm eaten ginger root, and damaged pepper, would prove a useless medicine; whereas when pre- pared of good materials, it constitutes one of the most valuable medicines ever compounded. I have myself seen in the warehouses of wholesale druggists, large quantities of bayberry bark, that bad been purchased at a very low price, but it was wholly unfit for medicine, a consider- able portion of it being in a state of decay. The best bayberry is found in a sandy soil, and near the sea. The principal Thomsonian store in Philadelphia is supplied with bayberry from the coast of New7 Jersey, where it is collected in the proper season. To prepare for taking.—Bayberry and all other astringent articles, are usually taken in the form of decoction. Bayberry tea to be effectual, should be made strong by steeping the bark, either pulverized or unpulverized in boiling water. Two large teaspoonsful of pulverized bayberry powder to a teacup two- thirds full of boiling water will form a tea of the proper strength to answer the purpose for wiiich it is generally given. Astringent teas should never be made in an iron vessel. A strong tea of bayberry, adding a portion of cayenne, con- stitutes an important medicine in the cure of disease in general. This preparation though not so much used as the composition powder, is yet more effectual in cleansing the stomach and bow- els of "canker." A teacupful of strong bayberry tea taken when the stomach is foul, will sometimes cause vomiting, but never unless the stomach be disordered. As a preventive to disease in general there is probably nothing better that can be taken than an occasional dose of bayberry and cayenne. ^ 458 MATERIA MEDICA. The most important indications for the cure of disease, nam* ly: to "support the internal heat and to overcome canker," are fulfiled by the use of bayberry and cayenne. An emetic of lobelia prepared in a strong tea of bayberry or sumac, will operate more effectually, and at the same time occa- sion less sickness than when given in pennyroyal tea, or luke- warm water. UPLAND SUMAC. {Rhus Glabrum.) The bark, leaves, and berries of sumac are employed for me- dical purposes, and next to bayberry are the best remedy for cleansing the stomach and bowels of "canker." There are three species of the sumac, each of which possesses similar pro- perties, and may be used for the same purposes. The species above named is most used. One species (rbus copallinum) is called dwarf sumac, scarcely ever reaching the height of six feet, and is found in dry rocky ground. A strong decoction of the bark of the root of the dwarf sumac is employed as a sove- reign remedy for venereal diseases by the Chippewa Indians. The leaves of the sumac should be collected in the autumn be- fore they are bitten by frost, and when fully dried, should be packed away and kept secluded from the air. Sumac Berries should be collected soon after the first hard frost. The dust or powder that coats the berry is the part em- ployed for medical purposes. Dr. A. C. Logan who has col- lected and prepared large quantities of this article, has the ber- ries thoroughly dried in an oven, and then rubbed over a sieve, by which process the powder is rubbed off and separated from the seed. This powder, generally called sumac dust, is used for cankered sore mouth, and when combined with bayberry pow- der in the proportion of one ounce of the sumac to four ounces of bayberry, forms a better anti-canker medicine than the bay- berry alone. This compound I have used of latter years as a substitute for the compound which Dr. Thomson calls No. 3, and where I have mentioned No. 3 powder in the practice, it is this compound that has been alluded to. The powder from su- mac berries and No. 6, mixed together, form a v aluable remedy for tetter and ringworm; and also a wash in cases of indo- lent ulcers and cankered sore mouth. Sumac Bark should be collected when the leaves are off, or after they have commenced falling. A 6trong decoction made MATERIA MEDICA. 459 of the bark, or of the bark, leaves and berries combined, may be used with advantage in affections of the kidneys, and in all cases of weakness of the uterine organs. "The gum which exudes from the bark on being punctured. during the summer, is beneficial in gleets and obstruction of tha urine."—Malison's American Vegetable Practice. WHITE POND LILY. {Nymphia Odorata.) White pond lily grows in ponds and ditches and is readily distinguished by its beautiful white flower. The root of the pond lily possesses astringent qualities, and may be employed in combination with, or as a substitute for bayberry and sumac when the latter cannot be obtained. The difficulty of collecting and preserving this root, and the fact of its being inferior to bayberry or sumac in point of medical virtue, has occasioned it to be almost abandoned except in making poultices. The pond lily roots should be collected in autumn or very early in the spring, washed clean, cut into strips and strung upon thread to dry. WILD RED RASPBERRY. {Rubus Strigosis.) This shrub grows in great abundance in New England, and also in some southern sections of this country. The leaves, which are the only part employed for medical purposes, arc a mild astringent, and so agreeable to the taste that many families use it as a substitute for imported tea. A strong tea of raspberry leaves is a useful remedy for ordi- nary bowel complaints of infants and children. To be efficient, however, it should be made strong. In treating of this article Dr. Thomson observes: "it is the best thing for women in tra- vail of any article I know of." He recommends a strong tea of it to be given, sweetened, adding a portion of cayenne. A tea of the raspberry leaf, adding milk and sugar, is good for infants and Dr. Thomson asserts that it will prevent sore mouth. WITCH HAZLE. {Hamamclis Virginica.) The leaves of the witch hazle furnish an active astringent, and a strong decoction of this article may be used with much 460 MATERIA MEDICA. benefit as an injection in piles, prolapsus uteri, and in com- plaints peculiar to females. The leaves should be collected in the autumn before they are injured by the frost, dried out of the sunshine, and as soon as dry they should be either pulverized or packed in a box and secured from the air. Witch hazle is of too binding a nature to be taken in ordinary cases without a portion of cayenne being added. When used as an injection in female complaints a small portion of cayenne should be scalded with the leaves. EVAN ROOT. (Geum Rivale.) This plant is peculiar to low marshy ground, and has re- ceived a variety of names, viz: chocolate root, water avens, throat root, purple avens. It possesses slightly astringent and tonic properties, and may be used with benefit in diarrhoea, dy- sentery, and in bowel complaints in general. MARSH ROSEMARY. (Statia Limonium.) This plant, the root of which is used for medical purposes, is found only in salt marshes. The root of marsh rosemary is a powerful astringent, and is chiefly employed as a remedy for sore mouth and throat. The powdered root has a good effect upon old sores, the powder be- ing put dry into the sore, and a poultice or salve, applied. In long standing cases of piles, where the rectum is in a very re- laxed condition, or in fluor albus or whites, when a powerful astringent is required, a portion of marsh rosemary added to witch hazle, or sumac, will form a better injection than either of the latter articles alone. The marsh rosemary is not taken internally on account of its binding nature. DEW BERRY. (Rubus Procumbeus.) The root of the dew berry and also that of the black berry plant, may be used as a substitute for bayberry, or sumac, in dysentery and in bowel complaints in general. MATERIA MEDICA. 461 CROW-FOOT—CRANES BILL. {Geranium Maculaium.) This plant may be found in many sections of this country. The root possesses actively astringent qualities. A decoction of this root has been used by injection with benefit in long standing Venereal disease and fluor albus. The root boiled in milk is a good remedy in bowel complaints of children, more especially when the disease has continued several days, and the patient's tongue not dry, and there be absence of fever. BEACH-DROP. {Orbanche Virginiana.) A decoction of the root of the beach-drop may be employed for the same purposes as that of the crow-foot. The powdered root is a good application in cases of open cancer and indolent ulcers. The powdered root of the beach-drop, crow-foot, or marsh rosemary, stewed in fresh tallow, may be employed as an oint- ment for external piles and eruptions on the skin. TONICS—BITTERS. To strengthen the system and promote digestion. The use of bitters are particularly indicated in the latter stages of acute disease, when fever has subsided and the tongue is cleaning; and in all cases where the system is left in a relaxed condition, with feeble digestion after a disease has been broken up. In the suppurative stage of small-pox, and in cases of large abscesses that are secreting matter freely, bitters should be em- ployed, in combination with pure stimulants, with a view to promote digestion and furnish the system with the necessary strength to carry on her healing operations. In chronic disease in general, bitters may be employed indiscriminately, provided the surface be moist and the patient clear of fever. The vegetable kingdom furnishes a great variety of bitter tonics, of which those mentioned under this head are believed to be the best, and sufficient to fulfil the indications in which tonics are employed. 462 MATERIA MEDICA. The chief objection to the use of bitters during the active stage of disease is on account of their tendency under these circum- stances to dry up the secretions. PERUVIAN BARK. (Cinchona Officinalis. The genuine Peruvian bark is one of the most effectual tonics ever employed for the cure of intermitting fever or ague. It may be used as a general tonic in all cases where the use of this class of medicines is indicated. As a general rule powerful tonics should not be employed in the first stage of disease attended with fever and a dry coated tongue. Under these circumstances bit- ters unless combined with a large portion of cayenne, would re- press rather than promote the secretions, and aggravate the dis- ease. When by the free use of cayenne and oti.cr appropriate remedies the secretions are restored, the tongue cleaning and the skin w7arm and disposed to perspiration, then Peruvian bark or other tonics may be employed with advantage. Peruvian bark is rendered more efficient as a tonic by com- bining with it Virginia snake root, cloves and cayenne popper. I frequently mix equal parts of Peruvian bark and spice bitters, and have always found it a good preparation. A tea made of equal parts of Peruvian bark and liquorice root is a good remedy for colic in infants, more especially where the spells of colic are observed to come on periodically. The title Jesuit's bark has been applied to the Peruvian bark, from the circumstance of the Jesuits having had the chief con- trol of the sale of the article during its first introduction into use in Europe about the year 1640. There are three species of Peruvian bark imported to this country, the pale, yellow and red. At one time the red bark was esteemed the most valuable. This induced druggists to convert other species into red bark by adulterations which so materially lessened the efficacy of the bark, that at one period the red bark was little used. Each species of bark above mentioned is efficient as a tonic, provided it be free from adulterations. Peruvian bark is most active when taken in substance, mixed with some liquid, as a tea of spice bitters, Virginia snake root, a solution of liquorice, or simply with water. The unpleasant taste of the bark will scarcely be perceived when it is taken in a solution of liquorice. When the bark cannot be taken in substance its virtues may be extracted by boiling water, and taken in decoction. A small portion of orange peel, liquorice root, or spice, added, will im- prove the flavour of the tea; and where there is acidity of thesto- MATERIA MEDICA. 463 mach a portion of the sup. carbonate of soda, orsalseratus should be added. Peruvian bark is often taken in wine, and with the most happy effects in many instances, as in recovery from disease where the strength of the patient has been very much exhausted. Dose—The quantity of bark taken at a time varies from that of a teaspoonful to an ounce. Whilst some recommend it in small doses repeated every hour or two, others direct an ounce to be taken at once. More especially is it recommended to be ta- ken in large doses, in cases of intermitting fever where by a proper course of treatment the system is placed in a condition that warrants the free use of tonics. When Peruvian bark or quinine is used, all astringent me- dicines, viz: bayberry, sumac, No. 3, pills, &c. must be laid aside at the time, as the tanin and gallic acid in the astringents, form an insoluble compound with the active principle of the bark, rendering it inert. Astringents may be used in the forenoon and barks in the afternoon, or vice versa. Three important indications in the treatment of disease are: 1st. To restore the natural warmth of the system. 2d. To cleanse the stomach and bowels of "canker," or morbid secre- tions; and 3d. To restore digestion. The first requires the use of pure stimulants, and sometimes the application of the vapour bath; the second, the use of astringents and detergents; and the third, tonics. Hence the general indication for the use of tonics is when the secretions are restored and the stomach and bowels cleansed of " canker." QUININE. Quinine is the active principle of Peruvian bark, and may be used as a substitute for the bark. Quinine has sometimes been discovered to be adulterated with starch, stearin, sulphate of lime and sugar. There are means, however, of detecting adul- terations in quinine, for a knowledge of which the reader is re- ferred to the U. S. Dispensatory. Quinine is usually taken in the form of pills. Eight quinine pills of the usual size are supposed to be equivalent to an ounce of Peruvian bark. A pill to contain a grain of quinine, (equal to a drachm of bark) must be considered larger than pills are generally made. It is believed that quinine is rendered more active by the ad- dition of cayenne pepper. As a cure for intermittent and other forms of fever, when the condition of the system is favourable for the exhibition of tonics, there is probably no remedy of equal value with quinine. This 464 MATERIA MEDICA. medicine, however, is so easily taken, that it may be used too indiscriminately. It may be continued until large quantities have been taken, the system at the same time not being in a condition to be benefitted by its use. WHITE ASPEN AND BLACK ASPEN POPLAR. {Populus Tremuloides and Populus Grandidentata.) The bark of these species of poplar possesses valuable tonic properties. Poplar bark constitutes an important part of the spice bitters. A very strong decoction of poplar bark may bo employed as a tonic in any case where a tonic is needed. The white aspen is not so bitter as the other species, and may be very readily given to children. It is well adapted to cases when the bowels are left in a weak and relaxed condition after dysentery, diarrhoea, kc. In treating of the poplar Dr. Thomson says: "The inner bark made in tea is one of the best articles to regulate the bile and re- store the digestive powers, of any thing I have ever used. The bark may be taken from the body of the tree or from the limbs, or the roots, and the outside shaved off and preserve the inner bark, which should be dried and carefully preserved for use." Poplar growing in low ground is said to have stronger quali- ties than that which grows on dry soil. BALMONY. (Chelone Glabra.) This herb, commonly called snake head, is found in low marshy ground and along the sides of brooks and ponds. Balmony is a strong bitter and may be employed as a general tonic, either singly or in combination with other bitters. The leaves stems and flowers are the parts employed. The herb should be collected when in blossom. BARBERRY. (Berberies Vulgaris.) The bark of every portion of this shrub possesses tonic powers, and it is a good article to restore digestion. Barberry, balmony and poplar bark finely pulverized and mixed together in equal proportions constitute Dr. Thomson's No. 4 bitters.— This is a valuable compound and may be employed in all cases where a strong tonic is required. MATERIA MEDICA. 465 GOLDEN SEAL. (Hydrastis Canadensis.) This plant which has received a variety of names, as Ohio kerkuma, yellow poccoon, and turmeric root, is highly esteemed as a tonic by some Thomsonians. The root is the part used, which should be collected in the fall, well dried and reduced to powder. Golden seal is found in great abundance in Ohio and Indiana, and it is from thence that the principle supply is obtained. The usual dose is a teaspoonful of the powder, taken in warns water, or steeped in boiling water, and the tea only used. VIRGINIA SNAKE ROOT. {Serpentaria Virginiana.) This plant, the root of which contains both tonic and stimu- lant properties, grows plentifully in many sections of the United States, and it is said to be a native of this country exclusively. The Virginia snake root may be employed with benefit in fe- vers and in a variety of forms of disease, when the usual bitter tonics irritate the stomach. The usual dose of the powdered root is a^tcaspoonful. To makethe infusion pour a pint of boiling water on half an ounce of the root, and let it steep in a covered vessel; boiling the root dissipates its medicinal properties. CENTUARY. (Chironia Angularis.) " Of the centuary we have the above species, wiiich is not in- ferior to the European. It is a beautiful annual plant, growing abundantly in the middle and southern states, and every part of it is medicinal, though the flowers possess the most efficacy. It is a pure bitter, with some little aromatic flavour, neither un- pleasant to the taste nor offensive to the stomach; and is resorted to by every description of practitioners, regular and irregular, in our intermittent, and remittent fevers. Like some other arti- cles, it has an advantage over the Peruvian bark, of being sus- ceptible of employment in every stage of these diseases. The usual mode of prescribing it is by strong infusion, wiiich is di- rected to be taken without much limitation."—Chapman. 3 H 466 MATERIA MEDICA. RED DOG-WOOD—RED WILLOW. {Cornus Sericea.) "This species of cornus is usually six or eight feet in height, with numerous erect stems, wiiich are covered with a shining reddish bark, and send out opposite spreading branches. The leaves are opposite, petiolate, ovate, pointed, entire, and on the under surface covered with soft brownish hairs. The flowers are small, white, and disposed in terminal cymes, which are depressed and woolly. The fruit consists of globular, berry formed drupes, of a cerulean blue colour, and collected in bunches.—U. S. Dysp. • The red dog-wood is found growing in low wet lands, and along streams in almost every section of the United States.— The bark of this shrub contains valuable tonic properties, and many experienced practitioners assert it to be equal in efficacy to the Peruvian bark, and it may be employed as a substitute for the latter article. Growing in our own country it can be obtained genuine, whereas a great portion of bark imported as Peruvian, is a spurious article, containing little or none of the medical properties of Peruvian bark. WILD CHERRY. (Primus Virginiana.) The bark of this tree has tonic and astringent properties. As a tonic it is inferior in efficacy to either the red dog-wood, or Peruvian bark. It is adapted to cases of consumption, hec- tic fever and scrofula, and in chronic bowel complaints. It yields its properties to alcohol, and to hot and cold water. Boil- ing the bark destroys its medicinal powers. QUASSIA. This tree, the wood of which contains the bitter principle as it were in a concentrated form, is a native of Surinam, Jamaica, and the Caribbean islands. This medicine was first introduced into use by a West India negro named Quassia, who employed it as a secret remedy, which proved successful in the cure of the malignant fevers of that country. The secret was " disclosed to a Mr. Rolander, a Swede. Specimens were taken to Stockholm by this gentleman in the year 1756, and the medicine soon became popular in Eu- MATERIA MEDICA. 467 rope. The name of the negro has been perpetuated in the gene- ric title of the plant." Quassia may be employed as a tonic in cases of general de- bility. It is usually prepared in infusion in combination with other tonics, columbo, gentian, Virginia snake root, and orange peel. Tonics are found to be more effectual by occasionally substi- tuting one article for another, or by frequently changing the compound. TULIP POPLAR. (Lirioden^ron Tulipifera.) The bark of this tree may be employed as a tonic, though it is inferior in point of efficacy to the aspen poplar. COLUMBA. Columba root possesses considerable power as a tonic, and as such may be used either alone or in combination with other tonics. THOROUGH-WORT—BONESETT. (Eupatorium Perfoliatum.) A warm infusion or a decoction of this plant will operate as a nauseant and emetic; when taken cold it acts as a tonic only. Bonesett has been extensively employed of late years in the treatment of intermittent, and remitting fevers. It is employed as a diaphoretic, emetic, and tonic. CHAMOMILE. (Anthemis Nobilis.) Chamomile furnishes an agreeable and valuable tonic. It has been a long time employed as a medicine. A warm infusion of chamomile is often employed in domestic practice to excite perspiration in case of colds. A strong tea of chamomile drank warm will sometimes operate as an emetic. As a tonic or sto- machic, the cold infusion is usually employed. MYRRH. Gtm myrrh exudes from the body of a small tree grow- 468 MATERIA MEDICA. ing in Arabia, Felix and Abyssinia, called Balsamodendron myrrha. As the juice exudes it hardens and adheres to the bark. Two varieties of myrrh are distinguished in the market—the India and the Turkey myrrh—the former imported from the East Indies, the latter from the Levant. It is said that the India myrrh is collected in Abyssinia, and thence taken to the ports of Hindostan, while that which goes under the name of Turkey myrrh, is brought from Arabia by the route of Egypt."—U. S. Dysp. There is a great difference in the quality of myrrh. That whicli comes from Turkey is of a brighter colour, and more free from impurities than the East India myrrh. "When of good quality it is reddish-yellow, and translucent; of a strong pecu- liar and somewhat fragrant odour, and a bitter aromatic taste. It is brittle and pulverizable, presenting when broken, a shining surface, which in the larger masses is very irregular." Myrrh is actively tonic, somewhat stimulant, and possesses in a high degree antiseptic properties. It constitutes the most essential ingredient in Thomson's No. 6, or rheumatic drops— one of the most valuable preparations, as a general family me- dicine ever introduced into use. Myrrh has been employed with much benefit in chronic diar- rhoea, and diseases of the lungs or chest, attended with a free ex- pectoration and general debility. Its use is also well adapted to female complaints, when unattended by fever. Myrrh may be taken in the form of pills, infusion, tincture, or the powder may be taken suspended in a liquid. To make Myrrh Pills—Take a table spoonful of finely pulve- rized myrrh, and of pulverized gum Arabic and loaf-sugar, each a large teaspoonful. Rub these up with a quantity of water sufficient to form a paste, and make into pills. To make an Infusion of Myrrh.—Steep an even teaspoonful of pulverized myrrh in a teacup of boiling water, and add a large teaspoonful of sugar, and a small portion of cinnamon. To make a tincture of Myrrh.—Put three ounces of powdered myrrh, and a quart of alcohol, or fourth proof brandy, into a stone jug and boil half an hour in a kettle of water, or let it ma- cerate several days in a warm place. To prepare the Powder for taking.—Rub together half a tea- spoonful of myrrh and a teaspoonful of sugar, then add a teacup half full of luke-warm water, or a tea of cinnamon or liquorice root, stir the mixture, and take before it settles. MATERIA MEDICA. 469 When myrrh is taken in the form of pills or powder, care should be observed to select that of the best quality. Myrrh prepared in either of the forms above mentioned, is applicable to cases of general debility, accompanied by a relaxed condition of the bowels, and an absence of fever. Dr. S. Thomson informs us, that he has discovered it to be a valuable remedy in what are called worm complaints in children. The efficacy of Thomson's No. 6, and third preparation of lobelia, in preventing mortification in disease of a malignant or putrid tendency, may be partly at least attributed to the myrrh contained in these preparations. Applied to fresh wounds the tincture of myrrh excites healing action and lessens the liability to the occurrence of un- healthy inflammation. It is also a useful application in old sores, ulcerated sore throat, running from the ears, aphthous sore mouth, spongy gums, sore nipples, &c. The tincture of myrrh is also employed to promote the exfoliation of bones. In sinuous ulcers, and cavities that continue to discharge matter in conse- quence of a debilitated state of the vessels of the part, tincture of myrrh injected into the cavity repeated daily will seldom fail of establishing the inflammatory action necessary to the production of granulations and a union of the sides of the cavity. Where the parts are too sensitive to admit the tincture to be used undiluted it may be combined with water or Bayberry tea. In cases of scrofulous ulcers, white swellings, hip disease, and wherever there is a free discharge of matter from a part, and the system is in a relaxed condition the internal use of myrrh will prove especially beneficial. After a vapour bath and the patient is rubbed dry, washing the surface with tincture of myrrh, affords a means of protection against cold, and strengthens and improves the condition of the skin. This practice is especially useful in cases where the skin is relaxed, and the patient feeble, as in chronic bronchitis, con- sumption, chronic pleurisy, asthma, dropsy, chronic rheumatism, chronic diarrhoea, marasmus, and in every other form of dis- ease attended by general debility. Thomson's No. 6 or Rheumatic Drops. To this compound a variety of additions have been made by different individuals as an improvement upon Dr. Thomson's preparation. The value of this preparation as a medicine de- pends chiefly upon the myrrh which it contains, and no article can be substituted that will prove more beneficial than myrrh for the purposes to which the No. 6 is generally applied. To prepare No. 6.—Take one ounce of peach-meats pounded, 470 MATERIA MEDICA. an ounce of African pepper, one pound of powdered myrrh, and a gallon of fourth proof brandy. Put these into a stone jug, and boil it half an hour in a kettle of water, the jug to be un- corked. This preparation is employed as a general family medicine by Thomsonians. It is an excellent tonic and particularly useful, taken immediately after meals, to remove or prevent flatulency, and relieve oppression of the stomach. Ordinary colic may be speedily cured by taking freely of the No. 6. It is an effectual cure for ordinary colds provided the patient avoid exjiosure, and improper articles of diet. Sickness at the stomacli, and even severe spells of sick head-ach will be relieved and frequently cured by a free use of No. 6, together with warm applications to the feet to favour perspiration. It also constitutes a valuable remedy for bowel complaints in general. Taken alter meals it will prove a preventive against the summer complaint. In deeply seated colds attended by a free expectoration of a thick yellowish secretion, the use of No. 6 will be found benefi- cial. Truly there is scarcely an ailment, in which this prepara- tion may not be used with benefit, except when the secretions are suspended, as in violent fever attended by a dry tougue. In the latter stages of disease, the No. 6 may be employed as a re- storative, and when there is a tendency to putrefaction, its use is almost indispensable to the recovery of the patient. As an external application No. 6 has been found useful in rheumatism, neuralgia, nightsweats, dropsy, consumption, and in all cases when the skin is in a relaxed condition. It may al- so be employed to great advantage in sprains, bruises, fresh cuts, indolent ulcers, putrid sore throat, sloughing ulcers, gangrene, and as a preventive to mortification both internally and exter- nally. No. 5 Syrup or Restorative Cordial. Take of white and black aspen poplar each half a pound, bark of the root of Barberry one pound, and boil them a few minutes in two gallons of water, then strain and add seven pounds of good sugar, and simmer until the sugar is dissolved, then skim it and add half a pound of finely powdered peach meats, and three quarts of good brandy. Dose.—Half a wineglassful three or four times a day. This syrup is useful in cases of recovery from sickness attend- ed with a weak and relaxed condition of the bowels. Another method of preparing a restorative cordial is to em- ploy the tincture of myrrh in place of the brandy. MATERIA MEDICA. 471 This last preparation may be employed for all the purposes lor which myrrh is taken internally. UNICORN. (Helonias Dioiria.) This plant, the root of which possesses tonic properties, is found plentifully in most of the middle, and in several of the western states. It has received a variety of names; Blazing Star, Devils Bit, and Blazing Star Wort. The root is in ge- neral about an inch and a quarter in length, from a quarter to three-cigths of an inch in diameter, and its lower extremity ter- minating abruply, as though it had been broken off. " The root leaves continue green aii winter, and spread upon the ground in the form 01 a star. They are four or five inches long, narrow at the base, and terminated by a somewhat tapering point. The stem of the male plant is a foot or more in height, and termi- nates in a long, drooping, and very graceful spike of flowers, which arc of a dirty white colour. They remain in bloom from June to July. The stem of the female plant is erect, much taller than the other, and is furnished with flowers of a larger size.—Mattson's A. V. Practice. . The author above quoted observes: "The aletrisfarinosa, or star grass, which has also received the name of unicorn, is often mistaken for this plant. It is similar in growth and appearance, but may be identified by its sharply pointed leaves, and brittle, scaly looking root. It possesses tonic properties, but it is also narcotic and purgative, which renders its use objectionable and sometimes hazardous." This plant, the aletris farinosa, has been introduced into Dr. Hersey's work on Midwifery, and also Dr. John Thomson's Materia Medica as the true " unicorn root" used by Thomsonians. The root of the helonias dioicia, though spoken of by some in terms of the highest praise as a remedy, particularly adapted to complaints peculiar to females, yet it is very doubtful wether it possesses any specific properties apart from those of a general tonic. BITTER ALMONDS, PEACH-MEATS, AND CHERRY STONE MEATS. All these articles contain valuable tonic properties. The essential oil obtained from bitter almonds and peach meats by distillation, and supposed to contain prussic acid, does not exist 472 MATERIA MEDICA. in the almond in its natural state, but is the result of chemical action, which takes place during the process of distillation. Dr. S. Thomson has of late years in preparing No. 6, employ- ed liquor, in which pounded cherry stones have been kept for some time, which he calls " cherry spirit." This is an improve- ment on the old method. SPICE BITTERS. The spice bitters are variously compounded by different indi- viduals. Sometimes 1 have met with spice bitters that were ac- tively cathartic, and on other occasions containing so much of cloves and cinnamon as to prove decidedly binding to the bowels. The following is a good formula: take of black and white aspen poplar bark, finely pow7dered, each three pounds, of gin- ger two pounds, golden seal two pounds, cinnamon one pound, cloves one pound, prickly ash bark half a pound, cayenne half a pound, and eight or nine pounds of white sugar. These are all to be finely pulverized, thoroughly mixed together, and then run through a sieve. Next to composition and No. 6, the spice bitters are more em- ployed than any medicine or compound in the Thomsonian ma- teria medica. The usual dose is a teaspoonful prepared in de- coction with boiling water, or the powder may be taken with a small portion of luke-w7arm or cold water. The spice bit- ters prepared according to the above formula, afford a mild sti- mulant and tonic, which may be used with great benefit in many cases, and with safety under all circumstances. As a tonic in intermitting and remitting fever, and in cases of extreme de- bility and obstinate dyspepsia, the spice bitters are not to be re- lied upon, stronger tonics will here be demanded. LADIES' SPICE BITTERS. Adding finely powdered myrrh and unicorn root to the com- mon spice bitters in equal quantity with the cloves, constitutes wiiat are termed Ladies' Spice Bitters or Woman's Friend. This preparation is well adapted to cases of general debility and especially in complaints peculiar to females. To make Conserve of Hollyhock.—Take of poplar bark, bay- berry, golden seal, cloves, cinnamon, and American valerian each an ounce, and half an ounce of cayenne, all finely pulve- rized, mix them well together and pass the compound through a sieve. Incorporate this powder and half an ounce of the oil of pennyroyal thoroughly with one pound of Hollyhock blossoms, MATERIA MEDICA. 473 previously pounded into a jelly, and form it into balls of the size of a large marble and dry them, or put it into jars to pre- serve it in a moist state. The conserve of hollyhock possesses the same properties as the spice bitters, but is rather more active both as a stimulant and tonic. It may be used on all occasions to promote digestion, to warm the stomach and bowels, and also as a preventive to dis- ease. It is a convenient medicine for persons while travelling. NERVINES. To quiet restlessness, calm nervous agitation, and promote sleep. AMERICAN VALERIAN. Several Species.—Cypripedium humile, pubescens, parviflo- rum, condidum, and spectabile. Common names.—Moccasin flower, Noah's ark, wild lady slipper, umbil and valerian. Each of the above named species of valerian possesses the same medical properties. The root is the part employed for medical purposes. The root of the American valerian dried and pulverized constitutes the powder known among Thom- sonians by the name of nerve powder. This powder is usually combined with emetics in giving a course of medicine. It is more particularly needed when the patient is of a nervous tem- perament. From half, to a full teaspoonful may be added to each dose of emetic. The powder may also be taken in hot water sweetened, or it may be added to any of the medicines when the the condition of the patient requires it. The root should be collected in the autumn, washed clean, carefully dried, and kept from the air. SCULLCAP. (Scutellaria lateriflora.) This herb has recently been introduced into use as a nervine. It is found growing in meadows and along streams of water. There is a species of scullcap found upon upland, particularly 474 MATERIA MEDICA. in stubble fields : whereas the species employed for medical pur- poses is found only in low and marshy land. I have not made sufficient trial of the scullcap to form an opinion as to its medicinal powers. It certainly possesses tonic properties, and it may be that its powers of quieting nervous agitation, and tranquilizing nervous excitement depends simply upon its tonic properties. New remedies are apt to be overrated when first introduced, more especially by those who claim the honour of introducing theni. I am not one to advocate an ex- tension of the Thomsonian materia medica much beyond its pre- sent limits, still from testimony adduced in favour of the scuta- laria I do not doubt that its introduction into our materia medi- ca will be a valuable acquisition. The top of the plant is the part employed, which should be collected when the plant is in blossom, carefully dried and pre- served from the air. It may be taken prepared in the same man- ner and for the same purposes as Thomson's nerve powders. HOPS. Hop tea may be used with benefit as a means of quieting ner- vous agitation and promoting sleep. Hops are most employed in protracted fever and delirium tremens (craziness from drink). The yellow powder which may very readily be obtained from hops by rubbing and sifting them contain the active principle of hops. This powder (called lupulin) by being rubbed up in a warm morter will form a paste which may be made into pills, and taken for the purposes above mentioned. I have now made mention of the important articles contained in the Thomsonian practice, and I believe sufficient for the suc- cessful treatment of every form and variety of disease which the human constitution is liable to, that curable by the agency of medicine. All disease should be treated upon general princi- ples, the great object always to be kept in view is to assist nature. The general indications for the cure of disease are—1st. To strengthen and sustain vital action by the employment of pure stimulants and the vapour bath. 2ndly. To evacuate the sto- mach by emetics, and the bowels by injections. 3rdly. To cleanse the mucous membrane of the stomach and bowels of morbid se- cretions or canker, by the use of astringents and detergents. And 4thly. to restore digestion by the use of tonics. As a general stimulant there can be no better article employed than capsicum, It may be used in all cases and under all cir- MATERIA MEDICA. 475 cumstances, and of itself is sufficient for the cure of almost every form of disease of a mild character. This together with the remaining articles mentioned under the head of stimulants are amply sufficient to accomplish all the purposes for which stimu- lants are employed. As an emetic the lobelia inflata is superior to any other article that can be employed ; and prepared and administered as direc- ted in this work, no substitute can be used that will answer as well. Besides its emetic powers, lobelia furnishes the surest and most effectual means that can be employed for relaxing the system, removing obstructions, restoring the secretions, lessen- ing violent excitement of the arterial system, and of maintain- ing an equilibrium of nervous power, and without the least de- gree of danger to be apprehended from its use. To cleanse the mucous membrane of the stomach and bowels, of thickened tenacious secretions or "canker" we have bay- berry and sumac; and when these are collected in the proper season and carefully prepared they will be sufficient for all the general purposes for which this class of medicines are pre- scribed. To strengthen Digestion.—After the secretions are restored and the stomach cleansed of foul secretions, we are supplied with a variety of articles from the vegetable kingdom contain- ing the bitter principle. In the different classes of articles above mentioned, we have medicines wiiich besides fulfiling the general indication above mentioned, also supply the purposes of diaphoretics, expecto rants, nervines, emmenagogues, anthelmentics, and antispasmo dies. Thus the composition powder while it acts as a gentle stimulant, promotes perspiration and expectoration ; and if taken in substance operates as a detergent—scouring the mucous mem- brane of the stomach and bowels of canker. The composition powder also possesses slightly tonic properties; and is good for wTorm complaints, and strengthens the nerves. A vast majority of the obstructions and ailments which occur in the human system, depend originally^upon diminished power in the stomach—digestion is impaired, the secretions become thick- ened and coat the mucous membrane of the stomach, the power of generating heat and nervous influence is enfeebled; and what- ever part of the system is weakest, that will be the part in which obstructions will be most liable to occur. The first and most important object, therefore, in the treatment of disease is to rec- tify the disordered condition of the stomach, and then particular expectorants, diuretics, &c. may be employed with advantage- Thus in dropsy, for instance, the functions of the skin and kid- neys are deranged or in a great degree suspended, inconsequence 476 MATERIA MEDICA. of loss of power in the stomach : and in the great majority of in- stances, particular diuretics as they are termed, will prove of little or no benefit until the condition of the stomach is improved. Acid in the stomach may be neutralized by taking an alkali, but the alkali does not remove the cause of the superabudance of acid. Costiveness may be removed for a time by the use of a ca- thartic but it will not restore the natural function of the bowels, but on the other hand the cause of the difficulty will be increased thereby. Torpor of the liver is in most instances a consequence of derangement in the stomach, and to restore the natural action of the liver requires the use of means which will cleanse the mucous membrane of the stomach, restore its secretions and invi- gorate its actions, by which the liver will be furnished with the supply of nervous energy necessary to the performance of its healthy functions. A Thomsonian course of medicine exerts a beneficial influ- ence upon every important vital function, and will prove the most effectual means of removing obstructions in any part of the sys- tem. An acute disease (attended by fever) that cannot be cured by the aid of Thomsonian courses of medicine, judiciously adminis- tered, is not curable by any other treatment. At least this is true as a general rule. Not that regular courses of medicine are necessary in all cases, nor even in the majority of cases of ordinary attacks of disease. To keep the patient warm, and re- store the natural action of the stomach, and to cleanse it of canker by the use of composition, or cayenne and bayberry, is all that is absolutely required in ordinary attacks of disease. The introduction of deleterious or inefficient articles and com- pounds into use by professed Thomsonian or Botanic practi- tioners has materially retarded the progress of Thomsonism. A man becomes well convinced of the efficacy of Thomsonian re- medies, and perceiving that it is a simple and plain practice, engages in it. At first he uses no remedies but the general Thomsonian medicines; but not fully comprehending the prin- ciples of the system, he after awhile begins to tamper with cath- artics and other worse than useless articles, not because he did not find Thomson's remedies successful, but more from a wrong conception of the true principle of treating disease. He hears of a certain article that is said to act specifically upon the liver; another that is a specific for dropsy: he is told of a certain cath- artic that purges without causing debility*, and that it may be used on all occasions with safety being entirely vegetable: until final- ly he strays entirely from Thomsonism into a complete empy- rical practice, employing remedies that are liable to do serious mischief. MATERIA MEDICA. 477 The articles and compounds hereafter mentioned are to be employed rather as auxiliary remedies in the treatment of dis- ease in general, except in slight derangement of the system, where these weaker and less efficient remedies alone may prove sufficient. CARBONATE OF AMMONIA. " Carbonate of Ammonia recently prepared is in white, mo- derately hard, translucent masses, of a striated and crystalline appearance, of a pungent smell, and a sharp penetrating taste." U. S. Dysp. Exposed to the air carbonate of ammonia soon becomes changed to a white appearance, and in its texture resembles chalk: when it is no longer of benefit as medicine. Carbonate of ammonia should be preserved from the air by being kept in a glass jar entirely air tight; cut into pieces and put in a vial, or it may be dipped in melted bees-wax, and as it is wanted for use, cut off as much as is needed, and apply a piece of wax to cover the part exposed. Medical Properties and Uses.—Carbonate of ammonia is a dif- fusive stimulant, and powerfully anti-acid. Its use is adapted to exhausted states of the system, as in congestive and typhus fever, and wherever extreme debility prevails. The dose is from five to ten grains, or about as much of the powdered ammonia as will lay on a five cent piece. It may be taken dissolved in wine-whey, pepper or Virginia snake root tea; or it may be taken in the form of pills. The dose to be re- peated every hour or two, as the circumstance of the case de- maud. Carbonate of ammonia though much inferior to the third pre- paration of lobelia in point of medicinal powers, may still be employed with benefit in combination with the third preparation, or with other stimulants, in cases of extreme prostration. The unpleasant taste of the ammonia may be disguised by dis- solving it in gum arabic water sweetened with loaf sugar, and to each dose add a drop of the oil of cinnamon. CAMPHOR. Camphor is obtained chiefly from Japan, where it is found in distinct grains interspersed throughout the roots and wood of the Laurus camphora, a forest tree of that country. Camphor exists in small quantities in some native trees and plants of this 478 MATERIA MEDICA. country—the common sassafras, and in rosemary, sage, pep- permint, thyme, starwort and lavender. Camphor is seldom employed internally except in case of colic. It may be taken in the form of spirits of camphor, or take a piece of camphor about the size of an ordinary grain of corn, rub it up with a portion of gum arabic, myrrh, and loaf sugar, then add a wineglassful of water, stir it well and take at once. Camphor dissolved in Thomson's No. 6, forms a useful ap- plication in cases of sprains and bruises. OIL OF TURPENTINE. The oil of turpentine is obtained from common turpen- tine by the process of distillation. Internally it may some- times be used with benefit in children affected with worms; and also as an adjuvant remedy in low forms of fever. " There is a particular state of fever usually attended with much danger, in whicli we have found this remedy uniformly successful. The condition of things alluded to, is one which occurs in the latter stages of typhoid fever or lingering remittents, in which the tongue having begun to throw off its load of fur in patches, has suddenly ceased to clean itself, and becoming dry and brownish: the skin is at the same time dry, the bowels torpid and distend- ed with flatus, and the patient sometimes affected with slight de- lirium. Under the use of small doses of the oil of turpentine, frequently repeated, the tongue becomes moist and again coated, the tympanitic state of the bowels disappears, and the patient goes on to recover as in a favourable case of fever. We are dis- posed to ascribe the effect, to a healthy change produced by the oil in the ulcerated surface of the intestines."—U. S. Dysp. The oil of turpentine given internally has been found useful in cases of lumbago and sciatica. It has also been employed in severe cases of bilious colic. A tablespoonful of the oil of tur- pentine beat up with the yolk of an egg, and half a pint of warm water added, may be employed with benefit as an injec- tion in severe cases of bilious colic. Next to the third preparation of lobelia the oil of turpentine is probably the best remedy, used by injection, in cases of tympa- nites—a swollen condition of the abdomen—which often occurs in malignant forms of disease and in peritoneal inflammation. A teaspoonful of oil of turpentine beat up with the yolk of an egg, and a teaspoonful of the mixture taken at a time, and occa- sionally repeated is said to be one of the surest of means of check- ing bleeding from the nose in typhoid fever. Oil of turpentine has been much extolled as a remedy for tape worm. It has also been found useful in neuralgia, locked jaw, dysentery, and in long standing weakness of the urinary organs. MATERIA MEDICA. 479 It is not, however, to be considered a specific for any disease; but in certain conditions of the system, it may be employed with benefit. The dose is from five to thirty drops. It may be taken drop- ped on sugar, or combined with mucillage of elm or gum arabic and sugar. As an external application it may be usefully employed in combination with Thomson's No. 6, in low forms of fevers, when the skin is colder than natural. This compound also forms a useful application in case of rheumatism and palsy. It is a good application in chilblains, and also in the cure of various species of eruptions. OIL OF AMBER. "Amber is a kind of fossil resin of vegetable origin, occur- ring generally in small detached masses, in alluvial deposites, in different parts of the world. It is found chiefly in Prussia, either on the sea shore where it is thrown up by the Baltic, or un- derneath the surface, in the alluvial formations along the coast." U. S. Dysp. Amber has also been found in Maryland and New Jersey. Oil of amber is obtained by putting a quantity of powdered amber and an equal weight of sand, into a glass retort and a gradual heat applied by means of a sand bath; an oil exudes, which is separated from the other matters, which should be kept in tightly corked bottles. The oil of amber thus obtained is sub- jected to a process of distillation with water, when it is ready for medical purposes. Medical Properties and Uses.—Rectified oil of amber is an an- tispasmodic and stimulant, useful in hysteria, violent colic, hic- cough, and in water brash attended with cramps or spasms. A dose of the Oil of Amber is from five to fifteen drops, rubbed up with a portion of gum arabic or slippery elm and sugar, and then add a portion of water. As an external application it is useful in palsy and chronic rheumatism. OIL OF HORSEMINT. Oil of horsemint may be used internally in cases of colic, heart-burn, water brash, and in gout or spasms in the stomach. The dose is from two to five drops mixed with sugar and water. The oil of horsemint applied to the skin produces a very sudden rubefacient effect, causing redness of the skin and even blistering, 480 MATERIA MEDICA. OIL OF PEPPERMINT. The oil of peppermint is used to relieve colic, overcome nau- sea, and check vomiting. The dose of the oil is from one to three drops, first rubbed up with sugar and then water added. The Essence of Peppermint is made by combining tw7o ounces of the oil with a pint of alcohol. The dose of the essence is from ten to twenty drops. OIL OF ANISE SEED. The oil obtained from anise seed is well adapted to colic pains in infants, on account of its mildness. The dose is from three to fifteen drops, rubbed with a small quantity of loaf sugar and then add a teaspoonful or tablespoonful of hot water. OIL OF CARAWAY. Oil of caraway is chiefly employed to disguise the taste of me- dicine, and is much employed by nostrum venders to give an agreeable flavour to syrups and pills. VEGETABLE BALSAMS. BALSAM COPAIVA. Balsam copaiva is obtained from the copaifera officinalis. This tree is a " native of Venezula, and grows in the province of Carthagena, mingled with the trees which afford the balsam tolu. It grows also in the West India islands particularly Trinidad and Martinique, where it is said to be naturalised. The juice is obtained by wounding the tree; and the operation is said to be performed several times in the same season. As it flows from the wound, it is clear, colourless, and runs thin, but soon ac- quires a thicker consistence and a yellowish tinge." Balsam copaiva has long been employed as a remedy in go- norrhoea and fluor albus. In a favourable condition of the sto- mach the use of balsam copaiva is particularly beneficial in the above named complaints. It may also be employed with advan- tage in chronic bronchitis attended with a copious expectoration of thick yellowish secretion. It has also been found serviceable in cases of chronic diarrhoea. MATERIA MEOICA. 481 The dose of copaiva is from fifteen to thirty drops, repeated three or four times a day. It is usually taken rubbed up with powdered gum Arabic or powdered elm and sugar, adding a drop or two of the oil of peppermeut or cinnamon, to which add a sufficient quantity of water to form it into a consistency con- venient to be taken. Another method recommended for taking this medicine is, to drop the copaiva in a wineglass half full of water, and immediately drop on it a few drops of a bitter tinc- ture ; the copaiva is collected in a globule and may be swallow- ed without imparting its peculiar taste to the mouth. Recently, however, the balsam copaiva is taken enclosed in capsules, by which both the taste and odour of the article are completely dis- guised. BALSAM TOLU. Balsam tolu is obtained from a tree growing near Carthagena. It is obtained by making incisions into the trunk of the tree from which a juice exudes wiiich is allowed to concrete. On keeping, the balsam becomes hard and brittle like resin. The dose is from half to an even teaspoonful of the powdered balsam. "The best form of administration is that of emulsion made by triturating the balsam with mucillage of gum Arabic and loaf sugar, and afterwards with water. Balsam tolu is found beneficial as a remedy in long standing cough, chronic catarrh and bronchitis. FIR BALSAM. Canada Balsam. The tree which furnishes this balsam grow7s in Maine and Ca- nada. The balsam collects in blisters on the body of the tree, which are pierced and the liquid received into vessels. I7sgS#—Balsam of fir is employed for the same purposes for wiiich balsam copaiva is used. The fir balsam is inferior to the balsam copaiva in point of medicinal powers. The usual dose is about twenty drops. It may be taken rubbed up with a portion of su- gar or gum Arabic. The following named herbs may be usefully employed as mild stimlants and to promote perspiration, to wit: pennyroyal, ditany or horsemint, cartnip, thyme, spearmint, sweet-marjo- ram, and summer-savory. 482 MATERIA MEDICA. SCABIOUS. Errigeron Philadelphicum and Errigeron Canadense. Each of the above species of the errigeron, grow plentifully in the fields in the vicinity of Philadelphia. By some the erri- geron is called fleabane. A tea. of the scabious is an important remedy in cases of gra- vel, and inflammation of the neck of the bladder ; and may be used freely in complaints of the kidneys and bladder. A de- coction of this herb may be usefully employed as a common drink in a variety of disorders, such as gout, dropsy, and dy- sentery. PIPSISSEWA. (Pyrola Umbellata.) This evergreen of winch the tops and roofs are both used, possesses some valuable medical properties. A decoction of this plant may be used with benefit as a common drink in scrofulous eruptions, rheumatism, dropsy, and in complaints of the urinary organs in general. Sweetened with honey and drank freely it will in general promote the discharge of urine, relieve strangu- ary, and assist expectoration. In order to obtain the full strength of the pipsissew a in de- coction, it should be boiled half an hour in an earthen vessel. CLEAVERS. There are several species of the cleavers all of which possess similar properties. A strong decoction is said to be useful in urinary obstructions, and in inflammation of the urethra of neck of the bladder. BURDOCK. The root of Burdock cut into thin slices and put into sound cider, adding a small portion of horseradish and mustard seed, furnishes a wholesome drink ; and in certain conditions of the stomach—where the patient has a desire for cider, as is often the case after fevers, this preparation may be found not only grateful but it will also strengthen the digestive functions. In dropsy, after the stomach has been cleansed, and the patient has passed through a course of general constitutional treatment, MATERIA MEDICA. 483 (his cider preparation will generally provebeneficial, giving tone to the stomach and promoting the secretion of urine. PRICKLY ASH. (Zanthoxylum Fraxineum.) The prickly ash is a bush growing in wet and shady places, and seldom exceeds in height ten feet. "The leaves are alter- nate and pinnate, consisting of four or five pairs of leaflets, and an odd terminal one, with a common footstalk which is some- times prickly on the back, sometimes unarmed. The leaflets are nearly sessile, ovate, acute, slightly serrate, and somewhat downy on their under surface." " The flowers are small and of a yellow colour, growing in little clusters close to the branches. They appear in May, in advance of the leaves. The seed ves- sels have the appearance of berries; and during the summer change from a green to a red ; in the autumn they assume a brownish colour,, and open by three valves: exhibiting a black polished seed in the centre."—Mattson. " Dr. Bigelow informs us that the Aralia spinosa, or angelica tree, which grows in the southern states, is occasionally con- founded with the zanthoxylum fraxaneum, in consequence partly of being sometimes called like the latter prickly ash. Its bark, however in appearance and flavour is entirely different from the zanthoxylum.— Wood and Bache. The bark and leaves of prickly ash are extremely pungent when chewed. The pulverised bark seed and capsules, added to other tonics constitutes a good medicine in cases of rheuma- tism where a tonic is wanting. A decoction of these articles alone or combined with cayenne or composition may be used in any stage of rheumatism. It is stated that a decoction of the prickly ash bark is a useful remedy in venereal complaints, fluor albus, and in general weakness of the urinary organs. The berries may be used to impart an agreable flavour to wine bitters. SARSAPARILLA. There are various species of sarsaparilla, only a few of which according to the observation of some travellers possess any val- uable medical properties. The American sarsaparilla appears to be entirely inert. Indeed the majority of that which is im- ported is of little value, from which circumstance no doubt it has lost its reputation with many as a medicine. " The only crite- rion of good sarsaparilla which can be relied upon is its taste. If it have a decidedly acrid impression in the mouth after hav- 484 MATERIA MEDICA. ing been chewed for a short time, it may be considered efficient; if otherwise, it is probably inert." To prepare a simple decoction of Sarsaparilla.—Bruise tho- roughly the roots of good sarsaparilla, sift out the dirt, pour on boiling water, and let it steep two or three hours by a fire in a covered vessel: strain and sweeten with sugar or honey. To make Sarsaparilla Beer.—Take of sarsaparilla root bruised one pound; guiac shavings, anise seed and liquorice root each two ounces; good molasses one pound; and half a dozen bruised cloves; pour upon these two gallons of boiling water, and shake the vessel several times a day. After fermentation takes place it is fit for use. Compound Decoction of Sarsaparilla.—Take half a pound of bruised sarsaparilla bark of the root of sassafras sliced, guia- cum wood, rasped, liquorice root bruised, each an ounce; pour on these ingredients half a gallon of boiling water and let it boil a quarter of an hour and strain. Excepting the omission of one article, this decoction is an im- itation of the celebrated Lisbon diet drink. The decoction may be sweetened with rock candy, sugar or honey. Syrup of sarsaparilla may be made in the following manner. Take of good sarsaparilla bruised two pounds; guiac shavings three ounces; red rose leaves, and liquorice root bruised, each two ounces; add to these ingredients five quarts of diluted alco- hol, and let-it macerate fourteen days, then strain through thick muslin. Evaporate the tincture by means of a water bath, to four pints and a half; then add eight pounds of refined sugar, and simmer until it forms a syrup. Then take a teacup half full of the syrup and add to it a teaspoonful of the oil of winter green, mix them thoroughly and stir it into the whole of the syrup. Uses.—Sarsaparilla cither in decoction or syrup, is often found beneficial in scrofula where the patient is in an emaciated and feeble condition; in mercurial disease; secondary syphilis; various eruptive diseases; and in a great variety of complaints of long standing attended with emaciation and debility. GUIACUM WOOD. Guiacum wood is imported to the United States from the West Indies, in the form of logs or billets. It is commonly called lignum vita?. It is possessed of some medicinal properties, and is employed in cases of chronic rheumatism, cutaneous erup- MATERIA MEDICA. 485 tions and scrofula. The wood is kept by apothecaries in the form of raspings or shavings. The wood yields the greater part of its properties to boiling water. It is seldom, however, administered alone, being mostly combined with other articles, particularly sarsaparilla. The concrete juice of the guiacum tree, commonly called gum guaiac, is employed for the same purposes for which the decoction of the wood is given. It may be taken either finely powdered and mixed with molasses or sy- rup, or in the shape of emulsion with powdered slippery elm, sugar and water, or in tincture. The dose of the powder is from half to a teaspoon even full. Guaiac is sometimes added to Thomson's No. 6, and administered internally in cases of rheumatism, gout, female weakness, mercurial disease and sy- philitic taint of the system. WORM WOOD. This garden shrub possesses the bitter principle in a high de- gree, and may be employed as a bitter tonic. TANSY. Tansy is used both as a tonic and vermifuge. For children supposed to be affected with Worms, the leaves either in the green or dried state, are boiled in milk, and a wineglassful given three or four times a day. It is particularly adapted to a feeble and relaxed state of the system where the use of tonics are indi- cated. SLIPPERY ELM BARK. {Ulmus Fulva.) Slippery elm bark is employed as a demulcent, by stirring the finely ground bark into hot water, or by pouring hot water upon the bark unground, and allowing it to steep. The mucil- lage of slippery elm bark is very nutritious, and it may be em- ployed as an article of diet in fever, pleurisy, inflammation of the lungs, scarlet fever, diarrhoea, dysentery, and in any other form or variety of disease, especially when accompanied with fever, for the stomach is very rarely in a condition to di- gest food when it is so much disordered as to occasion fever, ex- cept the food be of the lightest kind, such as elm gruel, barley water and gum arabic water. A mucillage of slippery elm sweetened with loaf sugar or rock candy, adding a portion of lemon juice, is a good remedy for cough that is attended by fever and a dryness of the tongue. 486 MATERIA MEDICA. To form an emollient poultice there is no article superior to finely powdered slippery elm bark. ACIDS. VINEGAR. The use of vinegar on food promotes digestion in particular conditions of the stomach. With the addition of salt and cay- enne pepper, it constitutes pepper sauce. This preparation is useful as an internal remedy in many cases of disease, and par- ticularly so in some cases of fever, where the patient desires or craves acids. I know families who depend almost exclusively upon the internal use of a mixture of salt and vinegar in all cases of dysentery and bowel complaints. Although this is un- doubtedly a valuable remedy, yet certainly not one to be relied upon exclusively, in diarrhoea or dysentery. Pepper sauce forms one of the best applications for the cure of ulcerated sore throat which so often attends scarlet fever. The throat must be swabbed with the mixture and a dose occasionally adminis- tered. On many occasions wiien patients have expressed a de- sire for acid, I have directed them to take stale wheat bread dipped in vinegar, and it has agreed well with the stomach in every case where I have recommended it. Within the past month a patient of mine eat freely of bread soaked in vinegar and continued to take it three or four days, not only without receiving any injury from it, but on the contrary it was evi- dently of especial benefit as a medicine. This patient was af- fected with a form of disease winch would have been termed congestive fever by medical men in general. Some dyspeptics find nothing to set so well on the stomacli as bread and butter dipped in vinegar. Even incases of sour sto- mach, vinegar or lemon juice has been found in some instances to suit the stomach better than alkalies. Lemon juice may be used for the same purposes as vinegar in cases of sickness. Very often we find that a mixture of lemon juice and sugar, in the form of syrup, to suit the stomach re- markably well in cases of disease, particularly in fever. Pepper sauce is useful as an external application in case of sprains, bruises, rheumatism, &c. MATERIA MEDICA. 487 ELIXIR OF VITRIOL. This preparation consists of sulphuric acid, alcohol, and the essential oil of ginger and cinnamon. I have employed elixir of vitriol with especial benefit in some cases of disease, and though seldom employed in the Thomsonian practice, still I do not perceive any objection to its use as a me- dicine in the diluted state in which it is administered. It may be employed to moderate night sweats, and as a tonic in intermit- ting fever or ague, particularly when the system is brought into a condition to admit of their use. In hectic fever and in con- sumption attended with urgent thirst, a few drops of the elixir of vitriol, added to a glass of water, will prove grateful to the taste, and tends to check thirst. The dose of elixir of vitrol is from ten to thirty drops taken in a wineglassful of water, or in ginger or bitter tea. It is of- ten given combined with a decoction of Peruvian bark, in cases of remitting fever. ALK ALIE S—ANTI-A CID S. Super Carbonate of Soda—Bi-carbonate of Soda. Soda is obtained from the ashes of sea weeds. It is subjected to certain processes by which it becomes purified and w7ell adapt- ed to general use as an anti-acid, in the form of the sup. carbo- nate, or bi-carbonate of soda. It is a stronger anti-acid than pearl ash, and is preferable to the latter on account of not being as liable to impurities as pearl ash is on exposure to the air or from long keeping. Soda is preferable to salseratus for neutralizing acid, and in assisting the operation of emetics. Sup. carbonate of soda will generally overcome heartburn, and affords great relief in case of acidity and distress at the sto- mach after eating. It is a favourite medicine with epicures. SALAERATUS. Salaeratus as it is commonly called is the bi-carbonate of pot- assa. It is employed in the place of pearl ash, being less liable to impurities than the latter. It is used for the same medical pur- poses as the sup. carbonate of soda. It is more used by Thomso- nians than the sup. carb. soda, but it is not so strong an alkali as soda and it is more unpleasant to take. 438 MATERIA MEDICA. HICKORY ASHES. A tea made by pouring boiling water on hickory ashes, may be employed as an anti-acid when bi-carbonate of soda or salaera- tus cannot be obtained. A tea of hickory ashes has been used with much benefit in some cases of dyspepsia attended with a superabundance of acid in the stomach. The following w7as a favourite remedy for dyspepsia with the late Dr. Physic : "A quart of hickory ashes, a teacupful of soot, and a gallon of boiling water." Dose.—A wineglassful of the tea immediately after meals. CHARCOAL. The charcoal employed for medical purposes is generally ob- tained from those who manufacture gunpowder. In their esta- blishments the charcoal is burned in iron cylinders by wiiich it is freed from all impurities ; then being finely pulverized for the purpose of powder making, it is well adapted also for medi- cal purposes. Common charcoal is rarely entirely clear of im- purities, and consequently it is not so'well adapted to medical purposes as that prepared by the powder makers. There are processes however for purifying the common charcoal and fitting it for medical purposes, as follows :—Fill a crucible with ordi- nary charcoal reduced to fine powder, and lute on a perforated cover. Then expose the whole to a strong red beat, and con- tinue the ignition as long as a blue flame issues from the aper- ture in the cover; when this ceases, allow the charcoal to cool and transfer it immediately to bottles which must be kept well stopped."—U. S. Dysp. Another method.—"Take any quantity of thoroughly burnt charcoal, very light, sonorous and pure, made from the wood of the linden tree, willow, poplar, or some other of the lighter woods and moisten it with water. Reduce it to powder in an iron mortar, or by means of a mill ; and having mixed it with water to form a thin fluid mass, let it stand for a few days ; after which place it in linen cloths, to drain. Make up the paste into round cakes, and expose them to the rays of the sun until they are thoroughly dried. By this process of insulation, the charcoal, it is stated in the codex is deprived of all adventitious colour and smell, and is singularly improved in efficiency."—Ibid. Chemical properties and uses.— Charcoal is absorbent and MATERIA MEDICA. 489 powerfully antiseptic. Fresh meat may be preserved for months by being enclosed in a box of charcoal. Tainted meat may be sweetened by placing it in powdered charcoal. Charcoal may be used with especial benefit in many cases of dyspepsia attended with putrid or sour eructations. It also proves a mechanical stimulant to the bowels and may be employ- ed to overcome costiveness. In fevers when there is a sour taste in the mouth, charcoal mixed in pepper tea and given freely is attended with good results. I have made considerable use of charcoal combined with other medicine in obstinate costiveness, and have invariably found it useful. It is a good remedy for constipation and heartburn, which so often attend the latter stages of pregnancy. The dose of charcoal is from a teaspoonful to a tablespoonful, to be repeated three or four times a day. To prepare the pow- der for taking, it should first be formaed, into the form of a pasta with a little sugar and water, and then it w ill combine readily with liquids. By preparing it in spice bitters, composition, or pepper tea, the patient will obtain the benefit of both medicines in one dose. For children it may be mixed with boiled milk. It is stated by some persons who have travelled through the sickly districts of the western and southern states, that by using char- coal freely, even strangers unaccustomed to the climate may reside in those districts without being attacked with disease. LIMEWATER. To prepare Limewater.—-Take of fresh burnt lime two ounces, nut it in an earthen vessel and pour on half a gallon of cold water; stir it occasionally with a piece of wood, and in the course of three hours put it into glass vessels and keep them corked. Pour off the clear part only for use. " Limewater is good to neutralize acidity in the stomach, to correct offensive breath, and overcome putrid eructations. A la- dv of this city informs me that for several years her diet consist- ed of boiled milk with the addition of about one fourth its quan- tity of limewater; almost every other kind of food soured in the stomach causing distress and vomiting. Persons subject to offen ive eructations, which they say taste like rotten eggs will find especial benefit from the use of limewater. . Chronic erup- tions in children are generally attended with acidity of the sto- macli which may be relieved by the use of limewater. It may ml employed with benefit in children who have worms, having the effect as it is asserted to dissolve the tenacious mucous in the stomach and bowels which supports worms. It is also useful in ordinary bowel complaints of children. 3 L 490 MATERIA MEDICA. The dose of limewater for an adult, is from two to four ounces. It should be combined with about an equal portion of milk. The dose to be repeated three or four times a day. PREPARED CHALK. Prepared chalk is obtained by rubbing a portion of common chalk in an iron or earthen mortar, with a small portion of wa- ter ; and when rubbed very fine it is put into a larger vessel, and a considerable quantity of water added ; then it is to be thoroughly stirred so that the fine particles of chalk will be sus- pended in the water and the impurities, sand, &c. will remain in the bottom of the vessel or soon settle. This water containing Ihe fine chalk is to be poured into another vessel, and when the chalk settles, the clear water is to be poured off, and the chalk dried. Medical Properties and Uses.—Prepared chalk is anti-acid and absorbent, and as such it may be employed with benefit in dis- eases attended with a superabundance of acids in the stomach and bowels. A teaspoonful of prepared chalk mixed with a teacup half full of strong bayberry or composition tea sweeten- ed, forms a useful preparation in bowel complaints of children. In severe cases the use of the vapour bath, emetics and injections must be chiefly relied upon ; prepared chalk is to be employed merely as an auxiliary remedy, STIMULATING LINIMENT. There are a great variety of stimulating liniments, but that which is frequently alluded to in the practical part of this work, is prepared by my brother, A. Comfort. The basis of this liniment is gum elastic. It is an imitation of Col. Jewett's liniment, and which I know to be beneficial as an external appli- cation. It contains a large portion of essential oils and the li- quid of the 3rd preparation of lobelia. This liniment is one of the best external applications I have ever employed. This lini- ment is well adapted to neuralgia, rheumatism, and chronic erup- tions. I have also found it especially beneficial applied to the surface after a vapour bath in cases of asthma, chronic bronchi- tis, chronic pleurisy, night-sweats, marasmas, St. Vitus' dance, cholera, infantum, and dropsy ; and wiierever the skin is in a cold or relaxed condition. Spread upon oiled silk or soft lea- ther, it forms a useful plaster in cases of pain in the side, disease of the chest, swollen joints, consumption, &c. &c. MATERIA MEDICA. 491 No. 3 PILLS. No. 3 pills are often mentioned in this work in the directions for the treatment of disease. They contain the medical pro- perties of bayberry root bark, obtained by first making a strong tincture of the hark, and by a slow heat the alcohol and water are evaporated leaving an extract in the vessel. A glass vessel must always be employed for obtaining the extract of bayberry or of any of the astringent medicines. Iron or German silver spoons should not be employed in preparing medicine for patients or at least, they should not be allowed to remain long in any astrin- gent tea. The No. 3 pills may be used in many instances as a substitute for bayberry tea, more especially in chronic disorders, excepting dropsy, as in this form of disease the compound lobelia pills will always be found more serviceable. OF COUGH MIXTURES. A great diversity of compounds and syrups may be employ- ed with benefit in cases of cough, yet none of them are to be re- lied upon further than as a means of relief : the general Thom- sonian treatment constitutes the surest means of curing cough. A course of medicine will often relieve a cough when all other means have failed. Dr. S. Thomson in treating of cough, observes "The gene- ral opinion is that cough is an enemy to health, and ought to be treated as such ; but this I hold to be altogether an error, for cough is the effect and not the cause of disease. When the lungs are diseased there will be a collection of matter, which must be thrown off; and the cough is like the pump of a ship, which discharges the water and prevents her from sinking : so also the cough throws off what collects in the lungs, which if suffered to remain would soon putrify and cause death." The correct way to cure a cough is to remove the cause and not to deaden the sensibilities by the use of anodynes; for though these may afford relief for a time, they directly tend to impair the functions of the stomach and bowels. There are circum- stances, however, under which it may be proper to administer anodynes ; for instance in cases of deep consumption where the cough is so extremely harassing as to prevent the patient from sleeping at night. Ordinary cough caused by cold may be cured by taking com- position or pepper tea; whereas, in cases of seated disease of the lungs courses of medicine will be needed. A variety of cough mixtures however of a mild character may be employed 492 MATERIA MEDICA. with more or less benefit in cases of hard cough or difficult ex- pectoration. The most effectual cough medicine that I have employed apart from Thomsonian courses of medicine is lobelia given in broken doses either in the form of tincture or in powder. COUGH POWDER. Eq,ual portions of lobelia powder, powdered liver wort, and finely pulverized skunk cabbage root freshly dried, may be some- times used with more benefit than lobelia alone. In recent cough, demulcents, gum arabic, slippery elm, flax- seed, and Irish moss mucillage, may be useful, more especially if the patient be feverish and inclined to drink, whereas in coughs that have been of longstanding, or have become deeply seated, they will seldom prove of essential benefit. Mucillages may be rendered more agreeable to the taste, and their medicinal proper- ties improved by the addition of lemon juice and sweetened with rock candy, loaf sugar or honey. The following preparation is often employed as a cough me- dicine. Take a tablespoonful of powdered liquorice root, add a pint of boiling water, then strain, and sweeten with a tablespoonful of honey, and add the juice of half a lemon. To a wineglassful of this mixture add half a teaspoonful of the tincture of lobelia. Repeat the dose every two or three hours, as the circumstances of the case may demand. Thomsonian pepper candy and conserve of hollyhock are much used for cough, and they are generally found to answer a good purpose. Several other cough mixtures are mentioned in the treatment of colds and bronchitis, whicli it is unnecessary to describe here. VOLATILE LOTIONS AND LINIMENTS. Take of aqua ammonia 5 tablespoonsful, Spirits of rosemary 4 ditto, Spirits of camphor 1 ditto. This compound forms the celebrated Granvill's Lotion, at one time considered as almost a certain cure for neuralgia or tic-dou- loureux, and acute rheumatism. The mode of applying it is to wet a piece of cotton with it, and lay it on the part affected. It MATERIA MEDICA. 493 must not be rubbed or it will blister the part. Neuralgic pains have been cured in many instances by the application of Gran- vill's lotion. AMMONIA LINIMENT. Take of water of ammonia one tablespoonful, of sweet oil six tablespoonsful, and mix them thoroughly. This liniment is chiefly employed in inflammatory rheuma- tism, sprains and bruises. CAMPHOR LINIMENT. Camphor liniment is prepared by dissolving half an ounce of gnm camphor in four fluid ounces of sweet oil. This prepara- tion may be used in cases of bruises, sprains, acute rheumatism, &c SOAP LINIMENT. This liniment may be prepared by dissolving an ounce of camphor, and of oil of rosemary and oil of origanum, each a fluid drachm in a pint of alcohol; then add three ounces of cas- tile soap, and keep it several days in a warm place. The above compound forms an article extensively employed as as external application, under the name of opodeldoc. SIMPLE CERATE. Melt together one ounce of spermaceti and three ounces of white wax; and then add six ounces of olive oil. Simple cerate may be employed as a salve to protect raw sur- faces from the air. It contains no irritating properties, pro- vided it be made of good articles. BASILICON OINTMENT. Basilicon ointment is prepared by melting together jive ounces of resin, eight ounces of lard, and two ounces of yellow bees-wax. This ointment is employed as a salve in cases of ulcers, burns, scalds and chilblains. THOMSON'S SALVE. Take of bees-wax and fresh butter, each one pound; of tur- pentine one and a half pounds; and three quarters of a pound of 494 MATERIA MEDICA. balsam of fir. Simmer by the fire until all the wax is melted, and then strain. This preparation commonly called Thomson's healing salve, may be employed to protect injured parts from the action of the air, and in this way assist the healing efforts of nature. This and the basilicon ointment may be used for the same purpose. ASTRINGENT OINTMENT. Take a pound of sheep suet, melt it and add two ounces of witch hazle or sumac leaves that have been collected in the proper season and well dried. Simmer these half an hour or more, and strain whilst warm. This ointment may be used with benefit in cases of piles, chafing, chopped hands, sore nipples, &c. PITCH PLASTER. Take of Burgundy pitch and Venice turpentihe, each one pound, melt them together, and add an ounceof cayenne pepper, and when it cools, if it be found too hard, melt it over, and add a portion of sweet oil. This may be employed as a general strengthening plaster. THOMSON'S STRENGTHENING PLASTER. To make this take an equal quantity of burdock and mullen leaves, sufficient to fill a large kettle, fill it with water, and boil an hour or more; then strain and boil the liquid down to the con- sistency of molasses: then add one pound of resin and five ounces of turpentine for every quart of the extract, and after simmer- ing until the greater part of the water is evaporated, pour the compound into cold water, and work as the shoemakers do their wax. The addition of cayenne improves the effect of this plaster. MUSTARD PLASTER. A simple mustard plaster may be prepared by mixing ground mustard and warm water to form a proper consistency for a plaster. If it is desired to weaken the plaster, wheat or rye flour may be added. A very common form of preparing mustard plaster is to take equal quantities of ground mustard and wheat or rye flour, and moisten them with vinegar. Mustard plasters are often found serviceable when* not left on so long as to occasion a blister. MATERIA MEDICA. 495 CAYENNE POULTICE. Take equal quantities of cayenne and slippery elm powder, mix them with warm water to form a proper consistence for a poultice. Cayenne may he advantageously employed in cases of weak- ness of the spine, chronic rheumatism of joints, white swelling, hip disease, chronic pleurisy, painter's colic, lumbago, palsy, and indolent ulcers. EMOLLIENT AND SLIGHTLY STIMULATING POULTICES. Take of slippery elm powder twro parts, white pond lily root, pulverized, one part, pounded cracker one part; mix with warm water. This poultice may be used in all cases of biles and tumours attended with inflammation, and in cases of injuries when the flesh is lacerated. It also forms a suitable poultice for acute in- flammation of the eyes, and when a part is burned with a red hot iron or live coals, so as to sear the flesh. MALLOWS POULTICE. Take of mallows either in a green or dried state, steep them ' in milk and thicken with elm powder, ground flaxseed or fine Indian meal. This forms a useful poultice in the early stage of biles, felons, whitlows, kc After a boile or abscess breaks, or is opened, a more stimulating and astringent poultice should be applied, such as the one first described, with the addition of a proper portion of ginger. CATNIP POULTICE. Catnip leaves steeped in water, and thickened with slippery elm, ground flaxseed, or fine Indian meal, form a poultice that may be applied with especial benefit in cases of ear-ache, and in acute inflammation of the eyes. CHARCOAL POULTICE. Take of purified charcoal three parts, ginger one part, slip- pery elm two parts; mix them in warm water. This poultice is applicable in cases of putrid and offensive ul- cers, and also in gangrene. 496 MATERIA MEDICA. YEAST POULTICE. Take a quantity of yeast and thicken with a mixture made of equal portions of ginger and rye or wheat flour. Set it in a warm place until it begins to rise. The yeast poultice may be employed in all cases of gangrene, mortification, kc sloughing and offensive ulcers. MYRRH POULTICE. Equal quantities of the dregs of No. 6 and slippery elm pow- der, moistened with water, may be employed with especial ad- vantage in cases of indolent ulcers, carbuncle, and long stand- ing inflammation. This form of poultice requires to be moist- ened occasionally, more particularly when it is applied to a part in whicli there is an unnatural degree of heat. GUM ARABIC. Gum Arabic exudes spontaneously from the bark of a tree that grows abundantly in many parts of the continent of Africa. " Calculated by nature for a dry and sandy soil," the tree that furnishes this gum "flourishes in deserts where no other trees will grow, and even the date tree perishes. We are told that the camels attached to the caravans derive from it their chief sustenance in many of those desolate regions in which Africa abounds." Uses.i—Gum Arabic dissolved is employed as an article of diet in sickness. The mucilage of it is well adapted to cases of disease where the stomach and bowels are extremely irrita- ble, and where other articles of diet disagree. It is useful as a demulcent, as well as affording nourishment in catarrhal affec- tions, pleurisy, inflammation of the lungs, and in inflammation of the urinary organs. A very good mode of preparing it is to dissolve it in composition, pepper or ginger tea. Prepared in stimulating tea I have found it to agree well with patients affect- ed with diarrhoea and dysentery, and particularly in bowel com- plaints of infants and children. It is not to be exclusively relied upon, however, as a cure in those forms of disease, but to supply the system with nourishment, and being combined with a stimu- lant, another important object is obtained. It is asserted that six ounces of gum iArabic taken daily is sufficient to sustain life in a healthy adult. The Moors and Negroes who collect this gum, depend almost exclusively upon it for sustenance whilst they are engaged in collecting and conveying it to market. MATERIA MEDICA. 497 ARROW-ROOT. Arrow-root is obtained from the root of a plant which is a native of South America and of the West Indies. The greater part of the article kept in the shops called arrow- root, is largely adulterated with potatoe starch finely prepared. It is believed by some, however, that potatoe starch is equal to arrow-root in every particular, except that the former is not so agreeable to the taste. Uses.—Arrow-root is employed as an article of diet in fevers, and in bowel complaints of infants and children. To make Arrow-Root Gruel—Mix a tablespoonful of the pow- der in cold water to the consistence of paste, and then pour this gradually into a pint of boiling water, stirring the water as the paste is poured in. Sweetened with loaf sugar and a portion of lemon juice added, it forms a very agreeable article of diet. For infants and children arrow-root is usually prepared with boiled milk. BARLEY WATER. To make Barley Water—Take two tablespoonsful of pearl barley, wash it in cold water, and then put it into a sauce pan adding a quart of cold water, palce it over the fire and let it boil slowly until the water is reduced nearly one half. Barley water may be rendered more palatable by having a small hand- ful of stoned raisins or some pieces of liquorice root stewed with it. When done it is to be strained. The addition of ginger not only improves the taste but affords a mild and pure stimu- lant, and promotes digestion. Barley is mentioned in the earliest records of history as an article of diet in sickness. It is extensively used in cases of general fever, and in inflammatory affections, when the condi- tion of the stomach will not admit of food, except it be in the form of a demulcent. To make Milk Porridge.—Take of wheat flour a tablespoonful, mix it with cold water to the consistency of paste, pour it into a pint and a half of boiling water, and after boiling fifteen or twenty minutes; add half a pint of milk. As soon as it be- gins to boil, after the milk is added, it will be fit for use. It must be salted to suit the taste, and when patients prefer it, loaf sugar may be added. Milk porridge, properly made, is an agreeable and nourish- 3 M 498 MATERIA MEDICA. ing article of diet, and the one mostly taken during and after a course of medicine, except in the early stages of violent forms of disease, as in violent fever, inflammation of the lungs, &c. In giving milk porridge to patients, a small portion of cayenne should be added, except in cases of children who refuse to take it with pepper in. In making milk porridge for children, a piece of ginger root bruised may be added to the water before the gruel is made. In ordinary colds and in disease of a mild character, when the digestive powers are not very much prostrated, milk por- ridge may be used at any stage of the complaint. To make Oat Meal Gruel.—Take of coarsely ground oat meal three tablespoonsful, and put it in a pint of boiling water; let it boil gently half an hour, stirring it occasionally. Then strain and add a little nutmeg, wine and butter. When the oat meal is finely ground, it should be sifted and mixed with cold water to the consistence of batter, and then poured into boiling water, allowing it to boil gently, and to be stirred frequently. To obtain the Essence of Beef or Beef Tea.—Take from one to two pounds of fresh lean beef, cut it into small pieces, sprinkle it with a little salt and put it into a dry and perfectly clean por- ter bottle, or into a glass or stone jar, and cork it moderately tight. Set the bottle or jar into a kettle of water, and boil the water an hour or more, and then remove it before the bottle is taken out, it may otherwise be broken by the sudden change of temperature. Essence of beef is highly nutritions and very easy of digestion, and consequently forms an important article of diet in disease attended with extreme debility, as in the advanced stages of fevers, pleurisy, small-pox, dysentery, kc. Chicken tea may be made in the same manner as above des- cribed, and employed for the same purposes. To make Crust Coffee.—Take some of the crust and thin slices of stale wheaten bread, toast it thoroughly, so that there shall be no part of it unbrowned; pound it and pour on boiling water, and after steeping ten or fifteen minutes strain, and it is ready for use. It may be sweetened and a portion of milk or cream added if the patient prefer it so. Crust coffee is nourishing and generally agrees well with the sick. To make Panada.—Take some slices or stale wheaten bread, pare off the crusts, and boil them in water four or five minutes, then take out the bread, and & little of the water it was boiled in, MATERIA MEDIGA. 499 beat it fine, and add sugar and nutmeg, and if proper a little fresh butter and some wine. To make Mutton Broth.—Take two pounds of the lean part of mutton, and boil it slowly two or three hours in two quarts of water, adding a proper quantity of salt and some parsley. The fat must be skimmed off. Chicken broth may be made in the same w7ay. The chicken to be cut up before it is boiled. A small portion of rice or pearl barley may be boiled in with the chicken. By cutting mutton in thin slices and pounding it, half an hours boiling will be sufficient. To make Wine Whey.—Put a pint of new milk into a sauce pan that will hold at least two quarts; set it over the fire and when it is in full boiling and raised to the top of the vessel, dash in it a large wineglassful of Madeira or Sherry wine; set the sauce pan off and do not stir it for four or five minutes; then pour the clear whey from the curd, into a bowl and sweeten it with loaf sugar. When it is desired to have the whey more stimulating use more wine. Good currant wine may be used when neither the Madeira or Sherry can be obtained. Wine-whey contains a large amount of nourishment which is readily absorbed without undergoing the usual process of diges- tion in the stomach. It operates also as a diffusive stimulant, and hence it is an important article in the treatment of typhus fever, and in other forms of disease where the vital energies are much enfeebled. The chif f objection to the use of wine-w7hey is its tendency to become acid in the stomach. This, however, may in a great degree be prevented by adding to each dose of the whey from five to ten grains of the carbonate of ammonia. EGG TEA Beat up the yolk of a fresh egg and pour on half a pint of water. A little wine, salt, and sugar may be added. This is highly nutritious and generally sets easy on the stomach. Another Method.—-Take the yolk of a hard boiled egg mash it in a bowl with a silver spoon; then add sufficient of boiling water to make it thin enough to be drank. It may be seasoned to suit the taste of the patient. Drying Roots and Herbs.—The more speedily roots, barks and herbs are dried after being collected, the better will their medi- cal properties be retained. - * 500 MATERIA MEDICA. Bayberry root bark, white pond lily root and other astrin- gent articles, may be dried either in the sun or in an oven.— White pond lily root cannot be dried properly without either being strung on a string and hung up, or placed in an oven.— Much of the bayberry root bark in the market has been so long in drying that it is often moulded and in a state of decay. Bay- berry root bark should be dried in an oven of a moderate heat, and then all its medical properties will be retained in a state of purity. Small fibrous roots such as Virginia snake root, and American valerian, may be very readily dried in a warm room or in the sun. Medical Herbs retain more of their natural flavour and medical properties by being dried quickly in an oven at a moderate tem- perature soon after they are collected. When thoroughly dried they should be pounded and put into air tight vessels, or packed in boxes and secured from the air and from dampness. BRIEF REMARKS IN RELATION TO CLEANLI- NESS, DIET, &c Washing the body in cold water every morning, two or three times a week, exhilirates the spirits, promotes digestion, strengthens the nerves, and is an almost sure preventive against taking cold. It is a very bad practice to sleep at night in any of the cloth- ing worn through the day. It occasions restlessness, wakeful- ness, and terrifying dreams. Few persons in the community are aware of the importanceof keeping the feet dry. During the seasons of the year that the ground is wet and muddy, farmers would find great benefit by wearing wooden soled shoes, as has long been the practice in England. Walking early in the morning before breakfast agrees with many, but with dyspeptics in general it tends to impair rather than to strengthen digestion. Persons of weak digestion should use moderate exercise in the open air soon after meals. This will promote digestion better than taking rest. Severe mental or physical labour immediately after meals weakens digestion. Eating between meals is a very injurious practice, unless the food taken be easy of digestion, such as milk porridge, gruel, &c. Allowing children to eat ginger cakes, mint sticks, and other sweet meats between meals, destroys their natural appetite, make them feel distressed, and consequently they are cross and fretful, and when the regular meal time comes they have no appetite, but MATERIA MEDICA. 501 become hungry before the next meal time; and in this way the stomach is harassed with such food as a child ought never be allowed to eat. When food is given a child between meals it should be good bread and butter, boiled milk, milk porridge, egg custard, or some kind of gruel. If a person having a weak di- gestion eat an apple or piece of pie, or sweet cake, an hour or half an hour before dinner, it will, nine times out of ten, destroy his appetite for dinner. The sick however, often require food in small quantities and frequently repeated, more especially in recovering from sickness. Under these circumstances it may be given in this way, but it should consist of such articles as are easily di- gested. Persons of weak digestion should take food as warm as they can eat it. The assertion that food, with the exception of bread, is more wiiolesome when cold thanj when warm, is contradicted by observation. The opinion that vegetable is more easy of digestion, and bet- ter suited to the human constitution than animal food, is not cor- rect. There are some individuals of a peculiar organization, who may feel better by using an exclusively vegetable diet, but with the great mass of mankind, a diet of animal and vegetable food, combined, is more conducive to health and strength than a diet restricted to vegetables. Beef and mutton, either roasted or broiled, is less difficult of digestion than vegetable food in general, Veal and fresh pork are hard to digest, more particu- larly is veal unwholesome when the calf has been kept bleeding slowly two or three days in succession, in order to make the meat look white and delicate. By this abominable practice, the ani- mal is made sick, and consequently the meat diseased. Poultry, salt pork boiled, turtles, fresh fish, eggs, and all kinds of wild game, are more easy of digestion than vegetable food. I have known dyspeptics who found no kind of food to suit them as well as a tender beef steak, broiled, and eaten with stale wheaten bread and butter. When the liver is torpid, and •- but little bile secreted, fat meat of every description is unwhole- some, but when the liver secretes healthy bile, fat meat is easily digested and is very nutritious. A great portion of the fresh fish brought to our market are kept too long to be entirely wholesome. The practice of taking any kind of spirituous liquors upon an empty stomach, has a tendency to break down the constitu- tion, causing a state of both physical and mental depression. A good constitution may bear it for awhile, but if the practice be continued, the digestive functions will sooner or later become impaired under its deleterious influence. Persons when riding in cold weather require double the cloth- ing needed when they are about their accustomed avocations. 502 roisoNS. And again, some persons require double the clothing that others need to keep them warm, Thus a man of a robust constitution and in vigorous health, may bear an exposure to cold with im- punity, when one in feeble health would become frozen. POISONS. MEANS OF COUNTERACTING THE EFFECTS OF CONCENTRATED ACIDS. When through mistake, or otherwise, sulphuric, muriatic, or nitric acid, in an undiluted state is taken into the stomach, the best remedy is calcined magnesia, which being an alkali neu- tralizes acid and renders it comparatively harmless in the sto- mach. If magnesia be not at band, prepared chalk or common chalk may be taken freely, or drink freely of strong soap suds. As soon as means are taken to neutralize the acid, green or brown lobelia powdered should be given in large doses, in order to ensure free vomiting. It may be very difficult to produce vomiting before the acid is neutralized. Alkaline injections should be administered, followed by an injection containing a portion of lobelia. Means of counteracting the effects of Concentrated Alkalies, such as Caustic Potash, Caustic Soda, pure Volatile Alkali, and Quick Lime. When any concentrated alkali is taken into the stomach, the means to be employed to prevent fatal effects is the free use of vinegar or of lemon juice. Two tablespoonsful or more of vin- egar or lemon juice should be added to a glass of water, and the patient continue to drink it freely; and as soon as possible give an emetic of lobelia. In all difficult cases, steaming is highly important. CORROSIVE SUBLIMATE. This preparation of mercury is a deadly poison, from one to three grains taken into the stomach is sufficient to produce death. This poison is decomposed and rendered inert by mixing it with the whites of eggs. When corrosive sublimate has been POISONS. 503 taken into the stomach, the whites of eggs beaten up in a little water should be given as soon as possible, even to the amount of a dozen eggs or more, and commence at the same time taking freely of lobelia, either the powder in warm water, or in the form of the tincture, or third preparation. If eggs are not at hand, let the patient drink largely of milk in the place of the eggs. No time should he lost to have something upon the stomach and to excite vomiting, and whilst other remedies are in preparation the patient should drink warm water, and endeavour to excite vomiting by putting a finger or a feather in his throat. When the system is poisoned by the external application of corrosive sublimate, the same course of treatment will be required as above described. ARSENIC. When arsenic has been swallowed, vomiting should be ef- fected as soon as possible. The best plan of treatment is to mix Iobeiia in any form in warm water sweetened, and give it freely. Lime water may also be given if at hand. A piece of slackened lime thrown into some warm or cold water, will form lime water in a few minutes. It should be strained through linen or mus- lin, as there will not be time to allow it to settle. After free vomiting is produced the patient should be steamed, kept warm, and take freely of pure stimulants, as pepper, ginger or compo- sition tea, and occasionally a dose of lime water. A large dose of arsenij will in general cause vomiting, and therefore is not so dangerous as a smaller one. A large dose of this poison taken into the stomach and not shortly thrown off by vomiting, will destroy life in a few hours. I recently witnessed a most distressing case of the effects of arsenic, a large dose of which had been taken for the purpose of self destruction. The poison occasioning vomiting the principle part was thrown up; yet a sufficient quantity still remained in the stomach to occasion the most disastrous consequenees.— The constitution established an inflammatory action in the sto- mach to overcome the effects of the poison, but the attending physician instead of aiding this restorative action prescribed se- datives, such as were calculated to frustrate natures' efforts— At the time that I saw this patient she was taking a preparation of morphine, and small doses of nitre. Nature at this time had been struggling six weeks to overcome the effects of the poison. The patient was suffering from extreme racking pains through all her limbs and yet had lost the power of moving them, which with the distress in her stomach and frequent long continued efforts to vomit, together with the remorse felt for having made this rash attempt at self destruction presented the most 504 POISONS. distressing spectacle I ever witnessed. The inflammatory action established was the only means by wiiich the constitution could recover from the deadening effects of the arsenic, and this effort should have been aided by employing the vapour bath, and pure stimulants internally to support the secretions and promote the natural warmth of the system. Physicians of the old school may say that such treatment would aggravate the inflammation al- ready existing in the stomach. They are taught to believe that it would, but it remains with them to prove it. I know experiment- ally that such a course of treatment would have no other effect than to aid the sanative efforts of the constitution. Arsenic is prescribed both by the Homoepathic and old school physicians in Homoepathic doses as a cure for intermitting fever and various other complaints; an unreasonable and injurious practice which ought never to have been introduced; for it only removes one form of disease by establishing another. And the long continued and distressing dyspepsia which almost always follows the use of arsenic is in nine cases out of ten more dis- tressing and harder to cure than the original disorder would have been for-which the arsenic was prescribed. The best plan of treatment that I have found in cases of dyspepsia occasioned by the use of Fowler's solution and other preparations of arsenic is an occasional course of medicine, and a free use of cayenne pepper with food, or taken shortly after meals. ANTIMONY. Many patients have been greatly injured, and not a few lives destroyed by the use of tartarized antimony commonly called tartar emetic. This and the other preparations of antimony oc- casion vomiting upon the same principle that arsenic causes it. Tartar emetic when taken in ordinary emetic doses, if it do not cause vomiting it is apt to produce active purg- ing attended by severely griping pain, followed by general pros- tration of the digestive powers, and loss of tone in the bowels. The best antidote for the antimonial preparations is lobelia given in bayberry, sumac, or raspberry leaf tea; or, it may be taken in strong table tea. After free vomiting is produced the patient should continue to drink strong table tea, and stimulants. If the patient be cold and chilled, a vapour bath must be adminis- tered to aid the operation of the medicine, and to throw the poison out of the blood provided any should have been absorbed. In cases when.the vital powers are greatly prostrated by the poison the liquid of the third preparation of lobelia should be given as an emetic administered in strong bayberry or table Ua, or by injection. POISONS. 305 LUNAR CAUSTIC—NITRATE OF SILVER. The best antidote for lunar caustic when swallowed, is com- mon salt dissolved in w7ater. This should be swallowed freely and an emetic of lobelia given. NITRE—SALTPETRE. Nitre so much employed in the regular practice is "observes Orfila," venemous both to man and to animals, even where ap- plied to wounds. The direct effect of nitre upon the system when taken inter- nally is to weaken and destroy vital power. Hence it is called a sedative, and medical men governed in their practice by a false theory of treating disease employ this article in fever with a view to lessen arterial excitement. The necessary result of such treatment is to weaken the restorative actions—to saddle nature with a greater burden and at the same time cripple her energies. Nitre has sometimes been taken in doses of from half an ounce to an ounce, in mistake for Epsom salts. Taken in this quan- tity it is apt to cause violent vomiting, purging of blood, convul- sions and sometimes death. TREATMENT. When a large dose of nitre has been swallowed the patient should drink largely of mucilaginous drinks, as flaxseed tea, or mucilage of slippery elm, and take freely of lobelia until copious vomiting be produced. If the system be in a cold and torpid condition the vapour bath must he employed, and a moderate and continued warmth applied to the patient in bed, and he should take freely of pure stimulants. f Dr. Samuel Thomson was the first one to call the attention ot the community to the worse than useless practice of employing saltpetre in curing meat. It hardens the fibres of meat, and renders it more difficult of digestion. Poisoning from the fumes of Lead. -This subject is treated of under the head of painters' colic. Poisoning from Swamp Sumac, {Rhus Vernix)and from Poison issnZpnhon Oak.—The poisonous effects ot the above named or never attended by serious consequences. The best external application is tincture of lobelia^ salt and vinegar. In severe 506 POISONS. cases vapour baths should be administered and an emetic given, the patient continuing to take broken doses of lobelia in combi- nation with composition, pepper or ginger tea. OPIUM. Opium for medical purposes is generally taken in the form of laudanum. Notwithstanding the poisonous nature of this drug, it is one of the general medicines employed in the old school practice. It eases pain by occasioning a partial stagnation of blood in the brain and in this way blunts the sensibilities— smothering disease without removing the cause. When an over dose of laudanum has been taken, the patient should be made to vomit as speedily as possible. Lobelia in any form may be given freely, and the patient should be made to drink of bayberry tea or strong coffee. If the patient be in a stupour, the liquid of the third preparation should be poured down the throat and a tablespoonful of the third preparation ad- ministered by injection, followed by an injection of brown lobelia powder in warm water with a view to aid the operation of the emetic. Mothers would be very cautious how they gave laudanum to make their children sleep if they were acquainted with the prin- ciple of its operation, and were fully sensible of the injurious consequences which such a practice is liable to produce, not only upon the physical, but also upon the mental powers of infants and children. BELLADONNA. {Deadly Nightshade) This powerfully narcotic poison is chiefly found about old buildings, and along walls in shady places. The plant grows to the height of from two to three feet, and bears a round berry which is at first green, then red, and finally they assume a deep purple colour and not very unlike a cherry in appearance.— Children allured by the inviting appearance of the berries are not unfrequently induced to eat them and become poisoned. The symptoms which follow an over dose of the deadly night- shade are dryness in the throat, dizziness and a swimming sen- sation in the head, partial blindness, and difficulty of swallow- ing. The indications of treatment, are to excite free vomiting; and to sustain vital action by the use of stimulants. Belladonna is employed to a considerable extent by homce- 507 POISONS. pathic practitioners, particularly in the treatment of scarlet fe- ver. Strong poisons given even in very minute doses may change the symptoms of a disease, but instead of aiding the con- stitution to cast off disease in the way which nature has provided, the recuperative actions of the system are weakened, and the de- signs of nature frustrated. 'Tis true that patients recover UDder this treatment and probably better than under the old'school practice, but where is the evidence that those patients who get well under such treatment would not have recovered even more perfectly without the medicine. Nature does a great deal which medicine gets the credit of. STRYCHNIA. Strychnia is one of the most active poisons employed in the old school practice. " With the exception of prussiac acid, it is perhaps the most violent poison with which we are acquainted, and should therefore be administered with great caution."— U. S. Dispensatory. Administered even in Homoepathic doses it is capable of pro- ducing the most distressing symptoms. Professor Chapman of the University of Pennsylvania asserted that he had been called to two cases of Tetanus produced by strychnia prescribed by a Homoepathic physician. The injurious effects of strychnia are believed to arise from the poison being absorbed and carried into the circulation. The indications of treatment are to give freely of the third prepara- tion of lobelia or other active stinfulants and administer the va- pour bath, with a view to assist nature to clear the system of the poison. DATURA STRAMONIUM. This plant commonly called Gympson or Jamestown weed grows about hog-pens and in other places where the soil is very strong. The leaves and seeds of this weed contain a narcotic poisonous principle. Children are sometimes poisoned by eat- ing the seeds of this plant. "When taken in quantities suffi- cient to affect the system moderately, it produces more or less cerebral disturbance, indicated by vertigo, head-ache, dimness or perversion of vision, and confusion of thought, sometime! amounting to slight delirium, or a species of intoxication." The treatment should consist of emetics, and injections follow- ed by the use of composition and other stimulating teas, and when the heat of the system is far reduced the vapour b«th will prove beneficial. ERRATA. Page 24, ninth line from the bottom, instead of "the vital powers are the causes of disease," read the vital powers and the cause of disease. 113, for " Apthous sore mouth," read " Aphthous," kc 133, second paragraph under the head of vapour bath, for, "when the vapour bath" read after the vapour bath. 154, eighth line from the bottom for " evacuating" read expell- ing. 160, Chapter IV. should be VI. 330, Chapter XVI. should be XVII. 193, third line from the bottom for " enemas" read means. 211, eighteenth line from the top for " cavities" read coating. 182, sixth line from the bottom, for " arrives at its course," read terminates its course. 265, second paragraph fifth line for "whet" read wet. 424, eighth line for "destended its functions" read disturbed its functions. 492, under the head of Cough Powder, 1st line, for "liverwort" read liquorice root. 337, seventeenth line, "where existence" read where life. 489, sixteenth line, for "formaed" read made. INDEX, Abscess in female breast 365 Belladonna 506 Apoplexy 203 Balmony 464 Ague and fever 17 Barberry ib. Amber, oil of 479 Bonesett 467 Anti-acids 487 Bitter Almonds 471 Aphthous sore mouth 113 Bitters, spice 472 Antimony 504 Balsam Copaiva 480 Asthma 92 Balsam Tolu 481 Arsenic 503 Balsam Fir ib. Anise seed oil 480 Barley Water 497 Acids 486 Bi-carbonate of soda 487 Alkalies 487 Burdock 482 Astringents 456 Black Aspen Poplar 464 Aspen poplar 464 Basilicon Ointment 493 American Valerian 473 Beef, essence of 498 Ammonia liniment 493 Beef tea ib. Astringent ointment 494 Brief remarks in relation to Arrow-root 497 cleanliness, diet, &c. 500 Bath, steam or vapour 415 Gauses of disease in general 7 Bath, hot air 422 Congestive fever 31 Blood-letting 412 Cow-pox 49 Bilious fever 31 Chicken-pox 55 Bilious colic 126 Chafing in children 78 Bronchitis 79 Consumption 85 Bladder, inflammation of 178 Catarrh or summer cold 96 Bite of a mad dog 244 Common cold 102 Blindness 284 Croup 105 Bleeding from the lungs 317 Common sore throat 112 Bleeding from the nose 320 Colic 115 Bleeding from wounds 322 bilious 126 Bruises S42 Cholera Morbus 117 Burns and scalds 356 Infantum 119 Biles 363 Colica Pictonum 128 Bubo 387 Constipation 140 Bee-slings 393 Costiveness ib. Bowel, protrusion of 396 Chronic disease of the liver 196 Bayberry Beach-drop Bitters 457 461 .£6. Convulsion Fits Convulsions of Infants Chlorosis 214 218 220 510 INDEX. Craziness from drink 295 Diabetes 182 Compound Lobelia Pills 449 Disease of the liver 194-6 Capsicum 450 Dropsy 252 Cayenne Pepper ib. Drowning 270 Composition powder 454 Delirium tremens 295 Crow-foot 461 Deafness 310 Cranes-bill ib. Disease of the heart 313 Chelone Glabra 464 Disease of the hip 368 Centuary 465 Detergents 456 Columba 467 Dewberry root 460 Chamomile ib. Drying roots and herbs 499 Conserve of Hollyhock 472 Datura stramonium 507 Cypripedium 473 Deadly nightshade 506 Carbonate of Ammonia 477 Camphor ib. Erysipelas 67 Cherry stones 471 Elongated uvula 114 Caraway 480 Excessive flow of urine 182 Copaiva, balsam ib. Epilepsy 214 Cinchona 462 Eyes, inflammation of, from Cleavers 482 cold 274 Caustic potash 505 rheumatic inflammation Canada balsam 481 of 276 Charcoal 488 suppurative inflammation Cathartics 431 of 277 Canker 411 scrofulous sore 280 Course of medicine 401 Ear-ache 307 Cramp in the legs and feet 396 Epistaxis S20 Chancre 384 Emetics, utility of, in curing Carbuncle 364 disease 423 Corrosive Sublimate 502 various methods of prepar- Chilblains 360 ing 403 Crust coffee 498 Enemata 436 Cancer 325 Evan root 460 Chalk, prepared 490 Eupatorium perfoliatum 467 Cough mixtures 491 Erigeron Philadelphicnm 482 Cough powder 492 canadense 482 Camphor liniment 493 Elixir of vitriol 487 Cayenne poultice 495 Elm 485 Catnip poultice ib. Essence of beef 498 Charcoal poultice ib. Egg tea 499 Chicken tea 498 Fever and reaction 9 Disease defined 7 intermitting 17 general cause of Ib. remitting 23 Dysentery 131 bilious ib. Diarrhoea 135 typhus 31 Dyspepsia 14S congestive lb. INDEX. 511 Fever, yellow Falling of the palate Falling sickness Fainting Fistula lachrymalis Felon Fluor albus Fits, convulsion hysteric Frozen limbs False membrane, coating the stomach and bowels in disease 6-411 Fir, balsam ' 481 ib. 114 214 229 286 366 392 214 224 361 Inflammation, its use, &c. 330 of the kidneys 174 of the peritoneum 137 of the bladder 178 of the liver 194 of the eyes from cold 274 Indigestion 143 Insanity 288 partial 291 general 290 Injections, practical application of 436 Green sickness 220 Jaundice 200 Goitre 267 Joints, wounds of S55 Gonorrhoea 380 Gout 169 Kine-pox 49 Ginger 455 Golden seal 465 Liniment, stimulating 490 Guiacum wood 484 volatile 492 Granville's lotion 492 ammonia 493 Gum Arabic 496 camphor ib. soap ib. Health defined 7 Lotions, volatile 492 Hives 66 Lunar Caustic 505 Hysteria 224 Lime water 489 Hypochondriasis 230 Lemon juice 486 Head-ache 301 Lady-slipper 483 Hydrophobia 244 Ladies' Spice Bitters 472 Heart, palpitation of 311 Liriodendron Tulipifera 467 disease of 313 Lumbago 169 Hip disease 368 Lead colic 128 Hernia 397 Liver, inflammation of 194 strangulated 398 chronic disease of 196 Hay-fever 95 Locked-jaw 240 Humamali's Virginiana 459 Lightning 270 Helonias dioicia 471 Lacerated wounds 352 Hollyhock, conserve 472 Lobelia Inflata 443 Hops 474 preparations of 446 Hickory ashes 488 third preparation of 448 pills of 449 Intermitting fever 17 (Measles 56 Itch 76 iMumps 111 Infantile cholera US Mania 290 Infants sore mouth 113 Mad Dog, bite of 244 512 INDEX. Mania a potu 295 Menstruation,obstruction of 390 Myrica Cirifera 457 Marsh Rosemary 460 Myrrh 467 pills of 468 infusion of ib. powdered ib. tincture of ib. Mixtures for cough 491 Mustard plaster 494 Mallows poultice 495 Myrrh poultice 496 Mutton broth 499 Milk porridge 497 Nitrate of silver 505 Nettle rash 66 Neuralgia 248 Nervousness 394 Nymphia Odorata 459 No. 3 456 No. 6 469 No. 5 470 Nitre 505 Nervines 473 No. 3 pills 491 Nightshade 506 Organic disease of the heart Obstructed menstruation Oil of turpentine Oil of amber Oil of horsemint Oil of peppermint Oil of anise seed Oil of caraway Ointment, Basilicon astringent pile Oat Meal Gruel Opium Pulmonary consumption Phthisic Pleurisy Painters Colic Peritonitis Piles Paralysis Palsy Palpitation of the heart Punctured wounds Protrusion of the bowels Prolapsus-ani Polypus of the nose Prickly heat Preparation of lobelia Pills of lobelia and cayenne Pills of myrrh Peruvian bark Poplar, white and black aspen tulip Peppermint oil Prunus Virginiana Peach meats Poisons Poisoning from nitric acid sulphuric muriatic caustic potash caustic soda volatile alkali quick lime corrosive sublimate 313 arsenic 90J antimony lunar caustic 479 nitrate of silver ib. nitre or saltpetre 480 fumes of lead ib. swamp sumac ib. poison vine 493 opium 494 belladonna ib. deadly nightshade 498 strychnia 506 datura stramonium Jamestown weed 85 gympson weed 92Pipsissewa 99 Prickly ash 128 Pyrola umbellata 137 Prepared charcoal 155 207 ib. 311 353 396 ib. 395 78 446 449 467 462 464 468 480 466 461 502 ib. ib. ib. ib. ib. ib. ib. ib. 503 504 505 ib. ib. ib. ib. ib. 506 ib. ib. 507 ib. ib. ib. 482 483 488 488 Index. 513 Prepared chalk Pitch plaster Plaster, Thomson's strength ening Poultice, cayenne Thomson's catnip Mallow's charcoal yeast myrrh Panada Quinsy Quinine Quassia Reaction and fever Remitting fever Ring-worm Rheumatism in the loins Rheumatic drops Relax Retention of urine Rheumatic inflammation of the eyes Running of the ears Rupture Rubus strigosis Raspberry leaves Rubus procumbens Red willow Restorative cordial Rose . Saltpetre Stramonium Strychnia Strengthening plaster Simple cerate Soap liniment Stimulating liniment Small pox Scarlet fever Shingles Scald head 490 Summer catarrh 96 494 Summer cold ib. 1- Sore mouth 112 ib. Stranguary 188 495 Suppression of urine 192 ib. St. Vitus' dance 235 ib. Scrofula 262 ib. Suspended animation from ib. drowning 270 496 from carbonic aci d ib. gas 271 498 from lightning 273 Suppurative sore eyes 277 109 Scrofulous sore eyes 280 463 Stye on the eye-lid 285 466 Sick head-ache Structural disease of the 301 9 heart 313 31 Sprains 340 77 Severe bruises 342 160 Scalp, wounds of 346 169 Simple ulcers 375 469 Swelled breast 365 135 Swelling in the groin 387. 184 Stimulants 450 Sumac 458 276 Serpentaria Virginiana 465 308 Spice bitters 472 397 Scull-cap 473 459 Scabious 482 ib. Sarsaparilla 483 460 decoction of 484 ib. beer ib. 470 compound decoction 67 of ib. syrup of ib. 505 Slippery elm 485 $07 Sup. carbonate of soda 487 ib. Salaeratus ib. 494 Strangulated hernia 398 493 ib. Typhus fever 31 491 Tetter 73 41 Tooth-ache 305 5E • Tetanus 240 7( > Ticdouloureux 248 7S [(Treatment of frozen limb; i 361 3 O 514 INDEX. Thomsonian Materia Medi Vapour bath 415 ca 443 Virginia snake root 465 Third preparation of lobelia 448 Valerian 473 Tincture of lobelia 446 Vegetable balsams 480 Tulip poplar 467 Vinegar 486 Thoroughwort ib. Volatile liniments 492 Tincture of myrrh 468 Thomson's No. 6 469 Whooping cough 97 Turpentine, oil of 478 Wounds of the scalp 346 Tolu balsam 481 by sharp instruments 350 Thomson's salve 493 lacerated 352 strengthening plaster 494 bruised 353 punctured ib. Uvula elongated 114 of joints 355 Urine, excessive flow of 182 Whitlow 366 retention of 184 White swelling 372 difficulty in voiding 188 Weak nerves 394 involuntary flow7 of 190 Worms 151 suppression of 192 White pond-lily 459 Ulcers 374 Wild raspberry leaves ib. healthy 375 Witch hazle ib. unhealthy ib. White aspen poplar 464 Upland sumac 458 Worm wood 485 Unicorn 471 Wine whey 499 Uimus fulva 485 Yellow fever 31 Vaccination 49 Yeast poultice 496 Varioloid 53 Varicella 55 Venereal 380 Zanthoxylum fraxineum 483 PHILADELPHIA THOMSONIAN MEDICINE STORE, J/a £p<77 tMarfet Street. The proprietor of this establishment has constantly on hand a general assortment of Thomsonian medicines, which will be sold in quantities to suit purchasers. The compounds are prepared of the very best articles, and neatly put up with directions for using. Especial care is taken that each article is collected in the proper season, in order that it may contain all its medicinal properties. Also for sale the most approved syringes, and every other article in his line of business. All of which will be sold low for cash. Orders from any part of the Union attended to. AARON COMFORT. \\ G.*I.ClUr*:vfAft NLM010507305