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MANUAL
THERAPEUTICS
;i/
       BY L. MARTINET, D. M. P.

TRANSLATED, WITH ALTERATIONS AND ADDITIONS,

      ROBERT NORTON,  M. D.
  Extraordinary Member of the Medical Society of Edinbnrgh.
30.V/"
                /
         NEW-YORK
C. S. FRANCIS —252 BROADWAY.
    MUNROE AND FRANCIS—BOSTON.
1830. 
' 4j
WB
Clayton & Van Norden, Printers
     42 William-street. 
      W*  N CRUMPTON.
                    TQ


     . W. P.' ALISON, M. D., F. R. S. E.

FROFESSOR OF  THE INSTITUTES OF MEDICINE IN  THE
          UNIVERSITY  OF EDINBURGH;


            IN ADMIRATION OF THE


          VIRTUES AND LEARNING


   WHICH ADORN AND DIGNIFY HIS CHARACTER,


                AS WELL AS IN

 GRATEFUL REMEMBRANCE OF NUMEROUS OBLIGATIONS.


         THIS TRANSLATION IS INSCRIBED. 
ANNEX 
     PREFACE,

BY THE TRANSLATOR.
   In  undertaking the following' translation, I was
actuated by a conviction, not only of the value of the
original, but also of the want of a similar work, to
supply a vacancy in our  own  medical literature,
which, though abounding in systematic treatises
on theory  and   practice  conjointly,  contains
scarcely  one  which is exclusively devoted to The-
rapeutics, and  in which the intricacies of this de-
partment of medicine are very fully developed.

   It will be proper, and it may obviate prejudice on
account of its foreign extraction, to mention that
this work is not an exact translation; for, profess-
ing to offer to the English student a  manual of
practice, I considered  it necessary to sacrifice the
                     I* 
   VI                 PKE ACE.                        \
   doty of a translator to that of an instructer, when-    j
   ever the two seemed incompatible.

     The additions to the  original, when sufficiently    »
   definite and important, are included within brack-    -
   ets. [ ]  They consist  principally of  analyses of
.   English works, particularly those of Abercrombie,
   Armstrong, Bateman,  Maculloch,  Mills,  Prout,
   Scudamore, Thomson.

       Peckham Rye,
   ithoflith Month. 1829. 
CONTENTS.
                                          PAGE.
Dedication....................................  iii
Preface.......................................    v

             DISEASES OF THE BRAIN.

Arachnitis...................................,.  13
Acute Hydrocephalus...........................  Si
Chronic Hydrocephalus......................4.,  26
Apoplexy......................................  !i8
Encephalitis....................................  37
Softening of the Brain..........................  39
Epilepsy.......................................  40
Hysteria......................................  44
Chorea........................................  47
Catalepsy.......................,..............  48
Hypochondriasis.....................,..........  48
Mania.........................................  52
Nightmare.....................................  53

          DISEASES OF THE SPINAL MARROW.

Spinal Arachnitis...............................  54
Hydrorachitis................*.................  55
Inflammation and softening of the Spinal Marrow..  56 
viii               CONTENTS.

              DISEASES OF THE CHEST.-
                                             PAOt.
Laryngitis—Trachitis...........................  57
Croup.........................................  58
CEdema of the Glottis...........................  62      j
Pulmonary Catarrh.............................  63
Pertussis......................'.................  68
Suffocating Catarrh.............................  70
Pleurodynia....................................  71
Pneumonia.....................................  72
Qvlenia of the Lung...................•........  80
Gangrene of the Lung...........................  81
Haeninytysis ...................................  83
Phthisis........................................  85
Emphysema of the Lung.........................  93
Pleurilis.......................................  93
Hydrotnorax...................................  98
Pneumothorax.................................  99
Asthma....................................... 100

    DISEASES OF THE HEART AND LARGE VESSELS.
Aortitis....................................... 103
Aneurism ol the Aorta.......................... 104
Induration and Vegetations of the Valves........  104
t ericanli tis...................................  106
Dropsy of the t'ericardiiira.....................  108
Hyjienrophy of the Heart......................  109
Carditis.......................................  Ill
Palpitation....................................  Ill
Sjncoue.....................................  113
Angina 1'ectons,...........................-,,., 113 
                   (;onti-:nt.<                  ;*

             IHSEASE*  <>K I'HE  ABDOMEN.
                                              PAGE.
Stomatitis........................................117
Aphtha?......................-...................118
Glossitis.........................................119
Cynanche Toniillaris and Pharyngea...............119
Angina Pultacea, and Coutnneuse..................122
Cynanche Gangrenosa............................124
Indigestion......................................125
Gastritis.........................................126
Gastrodynia......................................129
Schirrhus.  Cancer of the Stomach................ 132
Hsematemesis....................................134
Gastroenteritis.....,.............................135
Cholera Morbus..................................143
Enteritis........................................145
Caeco-colitis—Dysentery.............,............146
Schirrhus, Cancer of the  Intestines................150
Nervous Colic— Entralgia........................ .150
Colica Pictonum.................................151
Schirrhus and Cancer of the Rectum...............156
Haemorrhoids....................................158
Intestinal Worms..........,......................161

             DISEASES OF THE LITER.
Icterus..............................,...........166
Hepatiti..................'....'...................167
Schirrhus, Cancer, Tubercles of the Liver..........169
Encysted Dropsy, Hydatidsof the Liver............170

             DISEASES OF THE SPLEEN.
Splenitis........................................172 
 x                  CONTENTS

          DISEASES  OF THE  URINART ORGANS.
                                              PAGE.    i
 Nephritis..................................,.....173    i
 Diabetes..............•..........................175
 Cystitis.........................................177
 Hematuria......................................180

      DISEASES OF  THE ORGANS OF  GENERATION.
 Amenorrhae......................................182
 Metritis..........................................184
 Schirrhus, Cancer of the Uterus...................187
 Menorrhagia.....................................191
 Leucorrhcea.....................................192
 Gonorrhoea.....................................194
 Orchitis........................................200   "1

           DISEASES OF THE PERITONEtTM.
 Peritonitis......................................203
 Ascites..........................................208

             DISEASES OF THE  TISSUES.
 Strophulus......................................211
 Licheu.........................................211     1
 P"»r'g'»........................................212
 Lepra.........................................212     *
 Psoriasis........................................213
 Pityriasis.......................................213
Ichthyosis......................................213  /  ''I
 Urticaria....................................., ..213
 Erythema.......................................214
Purpura.........................................214 
                   CONTENTS.                xi

                                             PAGE.
 Erysipelas.....................................214
 Pemphigus....................................219
 Impetigo....................................... 220
 Porrigo Tinea..............,................... 220
 Porrigo Favosa, Larvalis........................222
Ecthyma...................................... 222
 Psora-Scabies.................................. 222
Herpes........................................224
Furunculus—Anthrax........................... 224
Malignant Pustule—Carbuncle...................225
Opthalmia.....................................226
Coryza........................................ 229
Otitis......................................... 230
Tetanus....................................... 232
Articular Rheumatism..........................233
Fibrous Rheumatism............................238
Gout..........................................239
Phlebitis....................................... 242
Neuralgia......................................243
Neuritis........................................246

                GENERAL DISEASES.

Scorbutus......................................248
Syphilis........................................249
Scrofula.......................................251
Scarlatina, Rubeola
252 
; CONTEND
                                             PAGE. '
M iliaria........................................255
Variola.......................••...............255
Varicella..............................•........257
Typhus........................................258
Intermittent and Remittent Fevers................266
Poisoning
271
Irritating Poisons...............•...............  ** *
Poisoning by Narcotics..........................  "'4
Poisoning by Acrid Narcotics....................  274
                                                074
Septic Poisons.................................
Hydrophobia...............•..................*  275
Venomons Serpents...........................•  276
Stings of Insects...............................276
Poisoning by Gases..............................276
Asphyxia..............•........................277 
MANUAL
            OF


THERAPEUTICS.
        DISEASES OF THE BRAIN.


                ARACHNITIS.

  WHEN arachnitis has existed during a few days
only, and still exhibits the characteristic symptoms
of the first stage of this inflammation, namely, severe
pain in the head with fever; and when there is no
reason to doubt that these  symptoms proceed from
an affection of the brain, venesection should be im-
mediately practised, and the blood permitted to flow
until the morbid excitement of the vascular and
nervous systems is subdued.   It is recommended, in
affections  of the brain, to open a vein in the foot,
or, when the  violence of the attack makes it im-
portant to effect depletion as quickly as possible, in
both feet  simultaneously:  but the abstraction of
blood from the arm is less difficult in its execution,
and much more certain in its results.
  The quantity which should be drawn can only
be regulated by the intensity of the symptoms, and
the rtrength  of the  patient'6 constitution, unless
some  known  idiosyncrasy excites peculiar appre-
hension of extreme subsequent collapse.
                       2 
 14                AKACUM'11>.

   Tlie most advantageous opportunity for the  ab-
straction of blood is during the greatest exacerbation
of fever, as the loss of this fluid is better sustained,
as well as more necessary, at this than at any other
time.
   Infancy does not at all contra-indicate general
bleeding,  which should be practised whenever  the
veins are  sufficiently prominent; it may even be re-
peated if  no bad consequence ensued after the first
operation, and the symptoms of inflammation con-
tinue.
   Should the pain in the head continue with undi-
minished  severity  after a  second blood-letting, it  '
will be advisable to have recourse to leeches; these
may be applied at the base of the skull, behind'the
ears, upon the temples, or in the course of the jugu-
lar veins.  The flow  of blood will be greatly pro-
moted by the application of exhausted  glasses over
the punctures; by this means, also, a salutary revul-  'Jj
sion from  the internal  organs is established.
   If the congestion of the  face  is in  any  degree
more considerable on one side than on the other,
or if the patient has ever had epistaxis, we  should
apply the  leeches  within  the nostrils, taking care,
however,  by  pinching the nose, to  prevent them
from getting   up  too far, or escaping   into  the
pharynx.
   Should the pulse still maintain its strength, and
the patient feel little weakened by previous  bleed-
ings, we must  not hesitate to apply a greater number
or leeches; to the amount of thirty, or even fifty, in
an uthtit, and from five to twenty in a young child.*
 * It often happens to rhildren, that the blood flows too abundantly.
;>nd is not arreated by simple pressure.  In such a case, pinching the
skin between two fingers, wo must raiie the punctured spot; and
touch it with a stick of caustic, finely pointed far the purpose ; or,
if that fails, with a fine iron wire at a white heat.  Another erTec'tuil 
AKACILNlTiS.                15
Consider that it is only during an early period of in-
flammation in the brain, that we can  exercise any
power over it, and the necessity of a vigorous treat-
ment will be obvious.
  Such a treatment is peculiarly adapted to cases
of arachnitis which are accompanied by erysipelas of
the face,  or have arisen in consequence of a blow
on the head, or insolation.  On the other hand, it
is the least  jJroper when inflammation  of the brain
has supervened on the suppression of some sanguine-
ous  discharge ;  to  attempt to supply  the place of
which, by the application of leeches to its original
seat, is evidently the first indication;  though, even
in this case, general bleeding must be  resorted  to
if leeching fans.  It is always important, especially
in the arachnitis of children, to allay by emollient
cataplasms, irritation of the hairy scalp, while the
return of a formerly existing eruption should be en-
couraged.
  Dr. Bland has suggested the practicability of op-
 Eosing excessive  determination of blood  to the
 rain, by  compression of the carotid arteries,  and
in the hands of its author it  appears to have been
frequently successful:  in a thin subject this is easi-
ly accomplished, by drawing the carotids forwards,
towards each other, and then pressing them against
the larynx: in fat or muscular subjects, it is, neces-
sary  to  recline the  head  and  press  the arteries
against the vertebral  column.   This  compression
should be persevered  in the longer, as the cerebral
congestion is more considerable ; it must, however,
be occasionally interrupted.
plan is, to cover the wound with agaric, and press upon it a heated
silver spoon; the heat coagulates the blood, and thus a clot is formed,
which prevents any further flow. Lastly, wc may effectually obliterate
the orifice by  a littlo wedgo of wood, split up the middle, nnd used
es tweezers 
16               VKAfU.Nin^'.
   [Dr. Parry also has attempted to prove, that the
 flow of blood to the brain can be intercepted by thin
 means, the employment of which, he considers to be
 of the highest importance in the treatment of cere-
 bral affections: the general opinion appears  to be,
 that it is too difficult of execution, and too uncertain
 in its results, to be worthy of particular attention:
 at the  utmost, its influence  cannot be more than
 temporary.]
   The antiphlogistic treatment should be seconded
 by placing the feet in  hot water; or, if the patient
 cannot be taken out of bed for this purpose, manu-
 luvia may be substituted.  The irritation  thus ex-
 cited, will be still  greater on  adding  to  the water
 the flour of mustard, sea salt, potash, or  muriatic
 acid.
   Barley water, mead, mucilage, &c, form the best
 ordinary beverage, except in  cases  attended with
 constipation, in which, fluids that are gently laxative,
 such as whey, decoction of prunes, tamarinds, should
 be preferred.
  Lastly, it is important to remove the patient from
 the influence of every thing calculated to over-excite
 the brain, as noise, vivid light, and, especially, the
 presence of persons, who would call into exercise his
 moral feelings.
  Occasionally an epidemic, or some peculiar condi-
 tion  of the primce vice, seems to  give a character to
 whatever local inflammation may be  complicated
 with it.  In such  circumstances, the treatment of
 arachnitis must begin with evacuants.  Thus an in-
jection with one or two grains of tartarized antimony,
 and  a  gentle laxative, such as Seidlitz water, or
 Castor oil, render bleeding  more effectual, indepen-
 dent of their proper action. But before adopting this
 mode of evacuation, we must be  quite sure that no
 inflammation exists in the intestinal canal; otherwise,
 the aggravation which the abdominal disorder wouM 
                 ARACHNITIS.                11

hiifler, would be equally communicated to the mem-
branes of the brain.
  When worms, as so frequently happens with chil-
dren, are found to exist, we must not suffer ourselves
to be diverted from the proper treatment of arachnitis
by the erroneous opinion that they are the sole source
of the symptoms  which are observed  in the head.
After having attempted, by the administration of  a
purgative, to effect their expulsion, we must pursue
the plan already pointed out'; avoiding unnecessary
stimulation of the alimentary canal, which, at this pe-
riod of life, exerts so powerful an influence over the
brain. Even the application of leeches to the epigas-
trium, or anus, is sometimes a valuable auxiliary in
the treatment  of arachnitis in children,  especially
when it sets in  with vomiting although only sympa-
thetic, or during the existence of any abdominal in-
flammation.
  If an infant labours under arachnitis at the time of
dentition, during which its gums  are very painful,
two  or three leeches applied to the-mucous mem-
brane of the mouth will give much relief, and assist
the action of other measures.
  When arachnitis has arrived at its second stage,
recognised by great mental excitement, and confusion
of ideas, if the  inflammation has  attacked the hemi-
spheres ; or by drowsiness, if it is seated at the base of
the brain, we  may, in addition to the means recom-
mended above, make an incision in the jugular vein,
provided that the appearance of the blood previously
drawn, and the severity of the disease, call for it, and
it is  not contra-indicated  by  the debility  of the
patient.
   [As, however, there is only a very slight and indi-
rect  communication between  the external jugular
veins and the meningeal arteries, little superiority
cnn be justly attributed to this mode  of abstracting
                        2* 
1*
VKACHMTI.-.
blood ; which is, moreover, not altogether free iron
danger.]
  To oppose the return of cerebral congestion,  it is
proper to cover the head with thin linen cloths, re-
peatedly wetted with cold water, the temperature of
which  should be made gradually lower, to prevent
subsequent re-action.  Pulmonary catarrh, which is
sometimes the consequence of these cold applica-
tions, must be guarded against, by covering the chest
with flannel.
  We  can exercise a powerful control over the ge-
neral reaction, (that is, frequency of pulse with heat
of skin,) as well as over the cerebral disturbance, and
the convulsions which so frequently occur in children,
by directing a continued stream of cold water upon
the head, and if the organs ofthe chest are in a healthy
state, over the whole body ;  otherwise the patient
must be previously placed in a warm bath, up to the
neck.
  These affusions should be repeated as often as the
cerebral excitement, heat of skin, and frequency of
pulse, return; they must, however, be discontinued, if
the body does not readily recover its natural tempera-
ture, and especially if it remains cold; also, if the pa-
tient grows weaker and his pulse becomes smaller and
more frequent.  On  the contrary, when the general
heat, developement of pulse,  and signs of cerebral
congestion increase, it  becomes necessary, though
with much caution, to renew the  application of
leeches to the base ofthe skull.
  If the period of reaction and excitement has nearly
passed away, and the antiphlogistic treatment has not
succeeded  in overcoming the disease, but, on the
contrary, the body  in various parts is losing its sen-
sibility, and debility and stupor become extreme, with
almost total loss of intellect, and a small feeble pulse,
we  must no longer expect assistance  from the ab-
straction of blood;  if. however, this measure has not 
ARACHNITIS.                 19
juen pru v lously resorted to, a trial of it may be made,
though  with the utmost caution, beginning with the
application of a few leeches to the neck : we must ra-
ther endeavour to prevent the supervention of a fa-
tal collapse, by exciting counter-irritation on the in-
ferior extremities : dry cupping, and  the application
of sinapisms, or blisters, to the thighs and legs, an-
swer this purpose.  If, notwithstanding-, the state of
coma continues, a large blister made more powerful by
the addition of ammoniacal ointment,should be appli-
ed to the back ofthe neck; the irritation produced by
it will probably occasion a temporary excitement, du-
ring which other remedies  may be resorted to.
  Iii infants, mercurial friction at the angle of the
jaws, has often been followed by the happiest results.
  When bleeding, cold affusions and  blistering have
all failed to arrest the progress of this disease, a chance
of success still remains,  in a  violent stimulation of
the intestinal canal.  Frequently in such cases, have
we derived the greatest benefit from the employment
of large doses of tartarized antimony, which should be
taken as it were sheathed in some sirup or mucilagi-
nous fluid.   But as soon as the patient begins to re-
cover from  this state of  stupor, and his sensibility
awakens,  we  must suspend or  diminish the quantity
of the tartar emetic, lest we produce such an exces-
sive excitement, as may exhaust life.'  It will then be
proper to have recourse to injections ofthe decoction
of cinchona, to the administration of the acetate of
ammonia, camphor, the sulphate of quina, and ether,
in moderate quantities, watching  most  attentively
the effects of these remedies, and taking  care to sus-
pend them on  the first alarm ;  hot cataplasms are to
be applied to the feet, and afterwards sinapisms, which
should be shifted to various parts successively, of the
feet and legs; while the abdomen, chest and extremi-
ties, are to be rubbed with aromatic tinctures, ammo-
niacal liniment, or ether.  As soon as nature appears 
20
ARACHNITIS.
  to have recovered from the shock, consider that she
  has resources, little known to us, and often beyond
  our expectation,  and that it is often the duty ofthe
  physician simply to stand  on the defensive, and gain
  time.   Lastly, should the patient  escape through
  this danger, it will be advisable to keep up a blister
  in the inferior extremities : this precaution is espe-
  cially applicable to children, who are greatly disposed
  to relapses of inflammation.
    It can scarcely be necessary to suggest the cau-
  tion not to mistake, for this third stage of the dis-
  ease, the tendency to sleep, or the coma with strong
  reaction, which occurs in the second stage of arach-
  nitis at the base of the brain: in which, as we have
  before mentioned, hot pediluvia,  affusions, and  the
  tepid bath, are indicated.
    When arachnitis is accompanied from the first,
  with deep stupor, the powers of fife seeming almoFt
  exhausted, and no reaction ensuing;  when the  ab-
  sence of local paralysis  or of true coma, evinces
  that the cause of this prostration is neither effusion
  into the brain, nor disorganization  of its  structure,
  we must avoid the abstraction of blood,  especially
i by venesection, which would  only  increase the  ex-
  haustion of the patient;  and endeavour, by affusions
  of cold water, to recover the nervous system from
  the stupor into which it has sunk : affusion has, in
  this case, a double advantage; it arouses into action
  the  various functions, without waste  of strength,
  and restores sensibility to the  skin, thus enabling
  us to excite a cutaneous revulsion,  which would
  have been otherwise unattainable.   The water em-
  ployed for this purpose, should  be  of a much lower
  temperature  in  these instances, than  in those for
  which we have  prescribed it above;  it  being re-
  quired so much the colder, as the stupor of the pa-
  tient is the more profound ; but, on the other hand,
  the affusion must be  continued for a shorter time. 
             U.LXK aVOROCEPHALLs.        xil

und it will be necessary to keep  up the  warmth of
the patient's body, especially if reaction is estab-
lished with difficulty.   Permanent cold applications
to the head should not be employed, unless indicated
by head-ache, a flushed face, rapid pulse, or hot
skin, and then the application of leeches to the neck.
or the lancet, will be also necessary.
   If the  phenomena  of  arachnitis appear  very
gradually, or if the disease has already passed into
a chronic state,  its further  progress  will  be  most
effectually stopped by the continued action of arti-
ficial drains, such as a seton, inserted in the back of
the neck; moxa applied on each side of the verte-
bral column near the occiput;  and by the general or
local abstraction of blood, whenever cerebral con-
gestion  appears; also, in obstinate cases, by cold
applications and affusions; by the  habitual use of
aperients, (of which calomel is the best for children,)
unless some part of the alimentary  canal is inflam-
ed; by injections, and, lastly, by removing the patient
from the influence  of those causes  which keep up
inflammation, such as exposure to the sun's rays,  a
stimulating and  too abundant  diet, mental unea-
siness, &.C.
          ACUTE  HYDROCEPHALUS.

  The treatment  of acute hydrocephalus  of the
ventricles of the brain is to be  conducted through-
out its course as if it were arachnitis, of which in-
deed it is merely a variety, and from which it is scarce-
ly possible to distinguish it. ' The great  object of
the physician is to  prevent effusion, for experience
proves, that when this has occurred to any consider-
able extent, the resources of art are seldom avail-
able.   It may, notwithstanding, be asserted, that it
tf easier to effect the absorption of effused  fluid in 
22         ACUTE HYDROCEPHALIC.

hydrocephalus, than in arachnitis, in which altera
tipns of structure,  and the growth of false mem-
branes, present almost insurmountable obstacles.
   In infants, who, as is well known, are peculiarly
liable to this species of dropsy, the  serous  effusion
is formed with such astonishing  rapidity, that the
utmost activity is necessary to anticipate and obviate
it by medical treatment: it  is therefore  proper to
direct the application of leeches to the temples, and
of mustard pediluvia, whenever a child complains of
pain in the head,  although there may be no fever,
{>rovided that the origin of the sensation is manifest-
y in the head, and not in the stomach or bowels: in
this last case, it would be more serviceable to ap-
ply the leeches over the abdomen.
  If, to this head-ache, are  added vomiting, fever,
and  drowsiness;  while the tongue is  clean, large,
moist, and  without  redness; the  abdomen soft, of
natural heat, and free  from  pain on pressure;  and
the alvine evacuations of their usual appearance,
venesection, and  the application  of leeches to the
neck, must be employed, and repeated if the patient's
strength will permit, and he should appear to have
derived benefit from them; together with  the  ab-
straction of blood, pediluvia, irritating manuluvia,
cold injections, warm baths, and affusions, are to be
made use  of,  especially  at  the time of each  pa-
roxysm.   Immediately after the bleeding, blisters
and sinapisms  should  be applied to the inferior ex-
tremities.
  It is unnecessary to enter  into further  details of
the plan of treatment, as it is just the same as that
described under the word Arachnitis.
  The same measures-should be resorted to in cases
of convulsion of the limbs or face,  combined with
loss  of consciousness,  and coma, when these  last
symptoms have recently arisen, and the strength of
the patient is not too much exhausted.  In opposite
circumstances, any further loss of blood would only 
ACl.-TE HYDROCEPHALUS.
23
accelerate the fatal issue of the disease,  it is to
affusions, the continued application of cold water to
the head, and to Warm baths, that we must then
trflst, unless there is unnatural coldness of the sur-
face of the body, a 6tate of which we shall speak
more fully afterwards.
  But as soon as blood-letting ceases to be followed
by any ameUoration of the disease, if the symptoms
of affusion advance, and the  patient becomes gra-
dually weaker, with a pulse either extremely quick
or extremely slow, we must endeavour to produce a
powerful revulsion, by inserting a seton in the nucha,
applying moxa or the cautery over some part ofthe
skull, rubbing in antimonial or ammoniacal ointment
behind the ears, and by  mercurial frictions at the
angles ofthe lower jaw, or on the hairy scalp, so as
to excite profuse salivation.
   It is at this period, if the alimentary canal is free
from  inflammation, that  calomel is employed with
the greatest advantage, whether as a sialagogue, or
only as  a common purgative.  For either purpose,
four grains, or more if necessary, [and it is extremely
difficult to produce salivation in hydrocephalus,] may
be given three or four times in the day ;  but with
respect to this medicine, it may be well to observe,
that it is always prudent to commense with  small
doses, its action being so much varied by individual
peculiarities.  Rhubarb combined with the calomel
often makes it more efficacious : purgative injections
also are indicated.
   The employment of tartarized antimony, in nau-
seating doses of one grain rn a five or six ounce mix-
ture, of which a tea-spoonful is to betaken every
second  hour, has been by some practitioners highly
recommended in this stage of acute hydrocephalus,
but vomiting should generally be  carefully avoided
in inflammatory affections ofthe brain.
   If the disease still lingers, and the alimentary 
24.          ACjUTK IIYDllOCEl-UALLt.

canal remains unaffected, it will be allowable to at-
tain the patient's strength by tea-spoonfuls of white
wine or ether, or by small quantities of bark ; the
extremities and abdomen may be rubbed with cam-
phorated oil  or tinctures; at the same time giving
internally, either by the 6tomach or rectum, castor,
musk, ether, &c. although no great expectations  of
benefit from such substances can be entertained  at
this advanced period ofthe disease.
 1 In some cases we have known very strong coffee
dissipate the  drowsiness, recall the  lost warmth of
the skin, and thus become the principal cause  of
cure.
  We may include, among the remedies applicable
in these circumstances, the use of a very hot bath,
in which the patient is to be immersed for a few
minutes, and  then carefully wrapped up in flannels,
so as to excite a profuse perspiration.
  With respect to the internal administration  of
drastic  purgatives, as gamboge, colchicum, &c,
they ought to be looked upon only as a last resource;
doubtless the employment of these medicines has
been occasionally beneficial, but we ought  first  to
give more  probable measures a fair trial;  as fric-
tions, they are still less likely to be of use.
  If an attack of hydrocephalus has supervened on
scarlatina  or measles in a leucophlegmatic habit,
much benefit may  be expected from frictions over
the whole surface, with tincture of squill, or digitalis;
from the compound powder of ipecacuanha, nausea-
ting doses of tartar emetic, the acetate of ammonia,
vapour baths, and the application of blisters to the
extremities;  whenever the condition ofthe bowels,
and the absence of violent febrile reaction, and  of
any signs of cerebral congestion, render such mea-
sures safe.
  This plan,  though equally just in priuciple, ap-
pears lees successful in the hydrocephalus which 
              ACUTJC HYDROCEPHALUS.        26

 comes on suddenly in leucophlegmatic persons who
 have previously laboured under any organic affec-
 tion of the heart, lungs, or abdominal viscera.  In
 cases of this kind, it  is not allowable to abstract
 blood, unless there should be extreme dyspnoea, or
 a very disturbed action ofthe heart.
   Our prognosis of the local paralysis which, in
 acute hydrocephalus, arises from a partial serous
 effusion,  may be much more favourable than in
 those cases where this symptom depends on an al-
 tered structure of the brain; and this renders it the
 more imperative on the  practitioner to employ every
 measure  for the absorption ofthe fluid which is cal-
 culated to effect that object.
   The patient must drink nothing-but slops, made
 more nourishing if the  disease is protracted beyond
 the first or second week.—See also Arachnitis.
   [Dr. Abercrombie considers that active purging
 and the application of cold water in a long continued
 stream to the head, are, after bleeding, the most
 powerful remedies in hydrocephalus.  This author
 and Monro secundus agree in thinking that the  re-
 putation of mercury in  this disease is greater  than
 its efficacy.  Monro tertius states that he has cured
 hydrocephalus by the application of a large blister
 composed of tartar emetic and wax ointment to the
 bead, and the use of calomel combined with James's
 powdter.  Dr. Mills, in  an excellent paper  on this
'subject, in the Dublin Hospital Reports, recommends.
 at the commencement  of the disease, venesection,
 carried each time nearly to deliquium, in order that
 some permanent impression may be made  upon the
 circulation in the brain, and active purging; and as
 auxiliary  remedies,  a combination  of calomel and
 opiumi which is useful  by determining to the sur-
 face*  increasing the secretions, and allaying  the
 irritation of the nervous system;  the  tepid hath,
' used twice or thrice daily; tartarized antimony, in
                       3 
26         CHRONIC HYDROCEPHALIC.

doses varying from one fourth  of a grain to teii
grains, and when the  high excitement has ceased,
the application of blisters.]
        CHRONIC HYDROCEPHALUS.

  It is of little  practical importance whether  this
disease is congenital or acquired, but it is highly
important to take into  consideration the condition
ofthe patient's general health.
  If this is tolerable, and the disease stationary, we
must not run any risk of making the child worse by
very powerfuLineasures, as success in the treatment
of hydrocephalus will always greatly depend on the
preservation ofthe health in other respects.
  In this case, it is better to be contented to main-  '
tain a regular action of the bowels, by the exhibition  .-.
of rhubarb, castor oil, and calomel, in small doses:
eruptions on the head, or discharges from the ear,
which are so  common in childhood, are to be kept
up by poultices or epispastics, and, if their suppres-
sion has occasioned the disease, they should be rein-
duced by applying blisters over the place where they
formerly  existed.  We  should  order  nourishing
food, with small quantities of wine, and direct the
friends of the child to take every opportunity to
invigorate his  strength in the fresh open air; if the
state  of  the stomach will admit, bitters or tonics
will be proper; general dry rubbing, and  frictions
with the tincture of squill,  digitalis,  or cinchona,
over the trunk, should  be employed for the purpose
of exciting the functions ofthe  skin and kidneys.  If
there is  no danger  of weakening  the  patient too
much, the moxa may be applied along the sides of
the vertebral column, on the crown ofcthe head, or in
the neighbourhood ofthe mastoid processes. 
CHRONIC  HYDROCEPHALUS.
  ff the disease advances slowly, it may perhaps be
arrested  by the  habitual use of warm baths, im-
pregnated with  tartarized antimony; an ounce  of
the salt in each pailful of water, is a proper quantity
to begin wi'li: it may, however, be  gradually ele-
vated to four or five ounces.   This plan has been
attended with  the happiest results in the hands  of
Dr. Recamier and Dr. Andrieux, from whose obser-
vations its efficacy seems to depend on its producing
a copious flow of urine.   Under the employment  in
this way ofthe tartar emetic, the patient has grown
thin, and the size ofthe head has sensibly diminished.
  The method proposed by Goelis is also applicable
in this stage of chronic hydrocephalus.   It consists
in the internal  exhibition  of calomel  and juniper
berries, and frictions over the head with Neapolitan
ointment, afterwards covering it with a woollen cap,
so as to keep up a continual irritation on the scalp.
This physician assists the action of these remedies
by issues in the neighbourhood ofthe head, and the
long continued use of alkaline baths.
  But when chronic hydrocephalus advances, while
the debility ofthe patient leaves little room for hope
of his recovery,  a large  blister should be placed on
the head and suffered to remain during two or three
days, the vesicles, however, being occasionally punc-
tured.  This,  with  mercurial  frictions carried  to
salivation,and a powerful revulsion excited by means
of purgatives in  the-intestinal canal, (provided that
the stomach and bowels are in a healthy condition,)
comprises the whole but very inadequate treatment
of such cases.
  Compression has  been proposed by  Sir Gilbert
Blane  and Dr.  Barnard; it has seemed successful
in some instances, and if all other means fail  it  may
be employed as a last resource.
  Where cerebral congestion supervenes, it should
be  combated by bleeding and the use of pediluvia 
•J»                APOPLEXY.
&c. in the manner  described under Arachnitis and
Acute Hydrocejihalus.
  It is perhaps possible that this disease may  in
some cases be prevented by avoiding the practioe of
washing the heads of young children in cold water;
at least, it was to this practice that P. Frank attri-
buted the increased frequency of chronic  hydroce-
phalus during the last years of his life.
  If a child disposed to hydrocephalus, lives in a low,
hot, damp, or confined situation, it is very important
to remove him to some more elevated  and salubrious
spot.   The happiest effects from  this simple pre-
caution are daily witnessed in Valais, a district  in
which, as is well known, hydrocephalus  is almost
epidemic.
                APOPLEXY.

  The treatment of apoplexy includes two distinct
objects; the one relating to that condition of the
brain during the attack, which, if continuing long,
would  destroy life;  the other to the secondary and
less  dangerous consequences  of it.  At present,
therefore,  considering  only  the  immediate  phe-
nomena ofthe disease, namely, the loss of conscious-
ness with which it  begins, and the drowsiness, im-
perfection of the senses, and head-ache, which fol-
low, we shall establish  the principles of treatment
required  for the general congestion,  hemorrhagic
excitement, and the inflammation produced by the
effused blood, reserving till afterwards the conside-
ration of paralysis, the effect either of this coagulum,
or of disorganization ofthe brain.
   When an attack of apoplexy is recent, the imme-
diate and copious  abstraction of blood  should  be
resorted to, whatever may be the degree of para. 
APOPLEXY.
29
lysis;  this is  alike necessary to prevent hemorr-
hage, if it has not already supervened, or if it has.
to arrest its progress; and as success depends"in a
great measure on the promptitude with which we
oppose the hemorrhagic  impetus, it will  be best to
bleed from the arm, and even from both arms to-
gether, if the blood should run slowly.
  The paleness ot face and smallness of pulse which
exist in the  commencement of apoplexy, must not
prevent our having recourse to bleeding, so long as
the action ofthe heart maintains a certain degree of
strength; since, on the one hand, a pallid hue gene-
rally accompanies severe cerebral congestion, while,
on  the other, we  see the circulation gain energy
in proportion as the brain becomes by the abstrac-
tion of blood  relieved  from  the  load  which  op-
pressed it.
  If, after the first bleeding, the patient, is still sunk
in profound coma, with a full and regular pulse, we
must repeat the operation, especially if we discover
hypertrophy ofthe left side of the heart; in such a
case indeed it would be advisable to §\>en the jugu-
lar veins.   The powers ofthe  lancet should be aided
by applying to the back of the  neck leeches, fol-
lowed by cupping glasses. The cerebral congestion,
in the mean time, must be combated by cold water,
or ice applied  to the head, while revulsion to the
lower  limbs is established through the aid of sina-
pisms.
  If an attack of apoplexy has occurred in conse-
quence of  the suppression  of a hemorrhoidal or
menstrual discharge,  when immediate danger has
been  obviated  by the lancet, the application of
leeches to the  vagina, the inner  side of the thighs,
or the anus, will  often  be  sufficient  to prevent a
relapse.
  As any delay may lead to fatal hemorrhage,  r a
tedious if not incurable palsy, nothing should detf>r 
30                APOPLEXY.
us from the abstraction of blood as soon as possible
after  the seizure,  unless there should be such ex-
cessive  collapse, or such prolonged syncope, as to
threaten immediate death.   In tiiis case, the appli-
cation of boiling water to the epigastrium, sinapisms
to the feet, and dry cupping glasses to the nucha,
or between the shoulders, together with the employ-
ment  of irritating eneniata, frictions  with ammo-
niacal liniment, or aromatic  tinctures, will be neces-
sary to maintain the spark of life, when so near ex-
tinction.*  In such cases, the  happiest effects have
often  resulted from the internal use of musk, cam-
phor,  acetate of ammonia, cinchona, ether, and other
diffusible stimulants; but the moment that the pulse
regains  its  strength, and  the  skin its warmth,
bleeding must be practised.
   [In this, as in every other  case of extreme conges-
tion,  that is, when the surface of the body is uni-
versally cold, and  the  pulse  scarcely susceptible,
there is probably no remedy so powerful  as the hot
air bath, which at the same time arouses the heart
to  action, ana removes the accumulation of blood
by which it and the other internal organs  are op-
pressed.
   [As there may be no better opportunity, I will here
express my belief that in some at least of those most
unhappy instances in  which  women  shortly  after
delivery sink into a profound and fatal collapse, death
might be averted by the timely application ofthe hot
air bath.  In cases of this  description, the nervous
system has sustained such a shock that the blood no
longer flows through the capillaries ofthe surface;
it consequently accumulates about the central organs
  * Caie mu»t be taken to avoid narcotic substances, such, for
instance, as tobacco, which, from their direct influence over the brain,
would almost necessarily agravate the coma. 
APOPLEXY.                 31
of circulation, and the heart, sympathizing with the
nervous  system,  and oppressed with  its unusual
load, ceases to act.  The manner in which this con-
dition is removed by heated air has  been ju6t stated,
and is indeed obvious.]
  If apoplexy occurs while the stomach is loaded
with food, it is best to direct our earliest attention
to the more dangerous disease, that i6, the affection
of the brain, and without delay to abstract blood,
especially  as  this operation  will  often  occasion
vomiting, and thus accomplish both objects.   The
influence of a loaded stomach in producing apoplexy,
especially in those advanced in life, is well known.
  If, however, vomiting should^ not occur, it may be
easily provoked by tickling the fauces with a feather;
a plan always preferable to the use of emetics, being
free from the danger of exciting inflammation in the
stomach, or, which is no less to be  dreaded, of aug-
menting, by reiterated efforts to vomit, that cerebral
congestion which it is our great object to diminish ;
we may besides order soothing drinks, and  simple
or purgative  injections, so as to evacuate the  intes-
tinal canal more speedily.
  In each of these instances we must be careful not
to neglect the state  of the bladder, but to  assure
ourselves that the patient passes  his  urine freely;
otherwise, when there is paralysis  of this organ, its
contents may remain and accumulate  until inflam-
mation is excited;  besides, the absorption  of the
urine produces most  serious symptoms.
  After the patient has perfectly regained his con-
sciousness through the use of the lancet, we  must
still recur to it so long as the  intellectual faculties,
speech, or any of the senses, remain imperfect; and
if any pain in the head, however little, remains, (pro-
vided the patient be strong and not very old,) it will
be prudent even a third time to abstract blood; and
if, after all, some symptoms of cerebral  irritation 
32
APOPLEXY.
should persist, the application  of a few leeches to
the anus, or behind the ears, will be advisable.
  When, on the  contrary, an attack of apoplexy has
been slight, and the intellectual powers not much
affected, if the patient makes no complaint either of
stunning noises, uncomfortable  sensations, or pain
in his head, if the disease is confined to  simple con-
gestion or  very  limited paralysis, as of one eyelid,
the mouth, an arm, or leg, or merely of  the tongue,
we  may be satisfied with one copious bleeding, fol-
lowed by purgative injections, aperients, foot-baths,
and low diet.
  If, after an attack, characterized by sudden para-
lysis of one of the extremities, the paralysis should
leave this extremity and fasten on another, very ac-
tive treatment will be necessary, such as general
bleeding, repeated twice or thrice at short intervals,
with the application of ice to the head,  and blisters
to the lower limbs.
  But when, notwithstanding the measures here indi-
cated, the half paralyzed limb experiences acute pain,
and becomes the seat  of  a muscular rigidity which
has not previously existed, and when to  these symp-
toms are added heaii-ache and fever,(twocvidencesof
inflammation in the brain,) it is necessary, if the con-
dition of the patient prohibits further lo*>s of blood,
and the cerebral affections gain strength, to employ
cold applications to the head, tepid affusion, blisters
to the thighs, and purgative injections, and in addi-
tion, provided that the stomach offers no sign of irri-
tation, to have recourse even to diffusible stimulants
and drastic purgatives,in large quantities,the co-exis-
tence of apoplexy and cephalitis  being almost beyond
the influence of art.
   Apoplexy occurring in persons habitually subject
to rheumatism, does not admit of bleeding in the opi-
nion of some, and especially of Professor Recamier,
who has several times observed loss of blood in such 
APOPLEXY.                 3'S
cases aggravate the cerebral congestion: it is by
diffusible stimulants andsudorifics, as ether, tincture
of einchona,and the spirit ofmindererus, by sinapisms
and aromatic fumigations applied to the lower limbs,
that this phy.-i-.-lan attempts to arrest the progress of
paralysis, and hasten its cure.
  When apoplexy appears after the retrocession of
gout, it requires, first of all, the application of local
irritants to the  place which the gout occupied : in
other respects, the treatment must be the same as in
other cases.
 After having thus provided against the first and most
serious effectB of this disease, the patient should be
directed to take cooling^and laxative fluids; such as
whey, infusion of senna, and  the solution of cream of
tartar.- the strictest regulation of diet must be enfor-
ced, as long as any traces of cerebral disorder re-
main, and until all danger of inflammation from the
presence of a coagulum of blood  has passed  away.
Then only will it be safe to attempt to hasten the
return  of motility and sensibility to the paralyzed
part.
  Although it may be justly laid down as a general
principle, that paralysis is recovered from  only by
time, the duration of which  is dependent on the ab-
sorption of the blood extravased in the  brain ; yet
our knowledge of the  various organic  conditions
which may give rise to palsy, is too limited  to au-
thorize our rejection of every plan of treatment: and
as it has been proved by numerous facts, that very
trifling paralysis may follow  copious effusion, while,
on the other hand, an inconsiderable hemorrhage will
occasion complete  and very obstinate paraplegia;
and  when we consider, that loss  of motion, and
even of sensation, after having  long existed,  some-
times disappears rapidly  under the use of remedies,
although  we can  discover nothing   unusual  in the
teat or nature ofthe disease to explain the anomaly; 
< I                 APOPLEXY.
it  is certainly proper  to try any plan which expe-
rience has shown to be useful.  Of all of these we
will now take a general review.
   When the loss of sensation is incomplete, if is
common to hear the patient complain of sharp pains,
or a disagreeable  feeling of numbness, along the
affected limb.  In such cases, most decided benefit
and often even the entire removal of these sensations,
follows  the  application  of a blister near the origin
of the surrounding nerves.
  Among other remedies, galvanism may be men-
tioned as one ofthe most valuable; not only on ac-
count of its  energy,  but from its safety and the
facility  of its application,  as well as because the
practitioner is able to regulate its intensity, and the
direction of  its  influence.  To derive from it the
effect we desire, there must be only a partial loss of
the power of motion, and none of sensation, other-
wise success is  very  doubtful,; although, even in
such instances,  it has  sometimes occurred.   Dr.
Andrieux, who  has had much experience  on this
point, has never found  that galvanism occasioned
uneasiness  in the  head, or too  much excited the
brain: he applies  one of the wires (from  the  zinc
end) to the  cervical  or lumbar region, over the
transverse processes of the paralyzed side, while he
puts the other (from the copper extremity,) into a
basin of acidulated water, in which the patient places
the affected limb.
   We may also aid in restoring to the limb  its lost
sensation or motion,  by the application of moxa in
the course of the principal nerves which supply it,
the insertion of a  seton, cupping, and blistering.
As to frictions with tincture of cantharides, volatile
liniments, &.c. they are of little or no  use.
   When difficulty of motion is owing to nothing but
the stiffness  occasioned by want of use, douching
the affected limb willbeverv useful; we must.how. 
APOPLEXY.                 y5
ever, take care not to employ too much water, and
to have it warm, lest it should  occasion  congestion
within the brain.
  The use of strychnine, and the nux vomica, which
ha6 been lately recommended hi paralysis, should be
restricted to a very few cases, or rather entirely
abandoned ; for the spasmodic actions excited in a
paralyzed limb by these substances, appear to arise
from  inflammation of the brain,  an  event always
formidable in apoplexy; besides,  as we  have often
no control over  their action, it is scarcely prudent
to have recourse to them.
  Nearly the same may be said  of tartarized anti-
mony, the dose of which has%been pushed even to
sixty  or  seventy grains in the day, in the hope of
overcoming the paralysis.   But it is  scarcely war-
rantable  to expose a patient to  so dangerous and
doubtful  a remedy, especially as fife is in no degree
involved  in the continuance ofthe disease.
  The paralysis arising from a species of Neuralgia,
the phenomena of which resemble apoplexy, will be
spoken of under that word.
  The prophylactic treatment  of apoplexy, though
highly important, is little under the control of the
physician, and if it were, would not always be effec-
tual:   however, we  may lay  down  the following
rules, to which every one who is very stout, has a
great head, short neck, and largely developed heart,
should submit:—his diet should be light, with very
little  allowance of  wine,  and none of  alcoholic
liquors :  he must attend to the regular action of his
bowels,  and keep up all the discharges, natural or
accidental, to which he may be subject;  his head
should be lightly covered: lastly, he should avoid
hot baths, and  be cautious  of remaining  long ex-
posed to the sun, or heated rooms, which always
dispose to cerebral congestion.  If either of his pa-
rents  has fallen a victim to apoplexy, and  he is 
■ib'                APOPLEXY.
 above fifty years old, or  has  had occasional sen-
 sations of numbness, these precautions are doubly
 imperative.
   [The following is an analysis of the treatment of
 apoplexy recommended by Dr. Abercrombie, one of
 our latest and best writers on the subject.
   As soon as possible after the abstraction of blood,
 our first great object, means are to be taken for
 inducing active purging, as an essential part of the
 treatment: these measures, together with the ap-
 plication of cold water,  directed in a  continued
 stream against the crown of the head, an elevated
 position ofthe body, and exposure to a fresh air, are
 generally sufficient to effect the removal of the apo-
 plectic state.
  Weakness ofthe pulse and paleness of the coun-
 tenance do not  at all contra-indicate venesection ;
 [but if the pulse does not rise while the blood is
 flowing, the arm should be bound up before much
 has been lost, otherwise the patient may sink into a
 state  of irrecoverable collapse.  Bearing in mind
this criterion, it will generally be safe to employ the
lancet.]
  The exhibition of emetics in the early stage of
 apoplexy, is hazardous, and would probably be inju-
 rious ; but when the system has  been reduced by
evacuations, and some degree of coma continues,
 a mild emetic may be very  useful.  Nearly the same
observations  apply  to stimulants, which may,  if
necessary, be given with comparative safety, afte*
copious depletion.
  In the restoration  of paralytic  limbs, stimulants
 are often beneficial,  but  they must be  used with
caution: keeping the general system, at the same
 time, Low, is an important precaution.] 
ENCEPHALITIS.              37
               ENCEPHALITIS.

   As long as the symptoms of disorder in the head
 amount to nothing more than those of determination
 of blood, or when there  is only the coincidence of
 a slight disturbance ofthe intellectual and sensorial
 function,  with  fever, to  make us suspect the exis-
 tence  of  encephalitis, its  treatment should be in
 every respect that of the first stage of arachnitis;
 for, at this period, it  is quite impossible to distin-
 guish  these  two inflammations from  each other.
 We may begin by venesection, or the application of
 leeches behind the ears, or to the neck or temples;
 affixing cupping glasses over the punctures, as soon
 as the leeches relinquish their hold. The quantity
 o.f blood to be abstracted by the  lancet, must be
 regulated by the intensity ofthe cerebral and febrile
 symptoms, the strength and age ofthe patient, and
 above all, by the favourable or unfavourable effect
 of previous evacuations.   Along with  the abstrac-
 tion of blood, cold applications to the head, and hot
 irritating pediluvia, should  be made use of;  during
 the paroxysms it will be proper to employ the warm
 bath, or cold affusions directed over the whole body,
 unless the chest is affected; in which case  they
 must be confined to the head.
   But if, notwithstanding, the encephalitis still ad-
 vances, a thing very uncommon, and  if the symptoms
 characteristic of the  second stage,  or a lesion of
 the structure of the brain, appear;  that is, if con-
 traction, stiffness, or  spasm,  whether continued or
 intermittent, attacks  the muscles of either  of the
 extremities, or  of the face, we  must persevere in
 the application of refrigerants to the head, and re-
 peat the operation of bleeding, especially from the
jugular vein.
   These measures  must be vigourouslv pursued
                         4 
3b               ENCEPHALITIS."
unlessthe pulse is extremely feeble, and lliu surlace
ofthe body cold and pallid, when sinapisms must be
applied  to the feet,  with blisters to the neck or
thighs.  So  imminent is the danger, that we must
arm ourselves with all the powers of our art to con-
tend against it.
  When we  have  fulfilled  this first indication,
namely, to divert the rush of blood from the seat of
inflammation, we may act upon the bowels by laxa-
tives, or purgative  enemata, unless the disease has
either arisen from, or seems likely to be accompanied
by inflammation ofthe intestinal canal.  Whenever
inflammation exists within the abdomen, it is neces-
sary to introduce the catheter now and then.
  If the patient's  countenance is pale, the pain in
his  head permanent, and his pulse languid, while he
gets increasingly comatose and feeble, under an an-
tiphlogistic plan of treatment, we must abandon it,
and content ourselves with the employment of warm
baths, and occasional cold affusions;  giving inter-
nally three or four grains of musk every hour, with
camphor, ether, bark, &c. ; rubbing aromatic tinc-
tures over the surface, and lastly, with keeping up
life by the application of  dry cupping glasses, sina-
pisms and blisters.
  When the period of cerebral irritation has quite
passed away, and  paralysis of the muscles is suc-
ceeded by rigidity or spasm, it is time to leave off
antiphlogistic measures.
  If the patient is  sunk into a state of such  pro-
found coma, that all  his intellectual  powers seem
lost, and the only effect of febrile  reaction  is  a
greater frequency and irregularity ofthe pulse, with
diminished  heat of the surface;  in a  word, if the
collapse is  general, tonics, diffusible  stimulants, as
ether or wine, acetate of ammonia, camphor, musk,
castor, bark, &c. may be successively employed;
and lastly, counter-irritants to the skin:  but there
can be very little reasonable expectation of success. 
          SOFTENING OF THE BRAIN.       39

  If, on the contrary, as the inflammation recedes,
• lie mental faculties return, the pulse at the same
time becoming less frequent, the head-ache slight,
:md the affected limb gradually regaining its sensi-
bility, the case is analogous to that of the paralysis
after apoplexy, which we have already described.
Galvanism, the application of blisters, dry cupping
glasses, and moxa, in the course of the principal
nerves supplying the  affected limb, puncturing the
brain, if the disease has come on after a fracture of
the skull, and there seems little reason to doubt that
the paralysis  depends on a collection of pus in a
spot, the exact situation of which can be foretold :
the application of  a large blister, rubbing in tartar-
emetic ointment over the hairy scalp, the insertion
of an issue near the suspected seat of effusion,—
these are the means to which we  may have re-
course.
  As to the encephalitis which arises round scirr-
hous or tubercular tumours in the brain, it is seldom
possible to arrest its progress; it must be treated
as idiopathic inflammation, and  a  constant  drain
inunt be kept up.
  The  patient in general should  drink nothing
stronger than barley water or whey, while the acute
stage of inflammation lasts.
        SOFTENING OF THE BRAIN.

  After the minute details into which we have en-
tered on the treatment of the preceding diseases,
namely, encephalitis,  arachnitis  and apoplexy, we
need not be  detained  long in  considering that of
Softening of the Brain:  besides, its existence  is
marked hv no evident symptoms, until paralysis 
10
EPILEPSY.
comes on, and then it cannot be distinguished from
phrenitis;  and if the  diagnosis  were possible, it
would have no influence over our treatment, which
must be regulated by, and vary with, the concomi-
tant phenomena;  thus, antiphlogistic and refrigera-
ting remedies will be necessary, during the period
of stimulation and reaction;  cold affusion and bath-
ing, on the recurrence of a paroxysm ; and  the ap-
plication of counter-irritants to  the skin, after the
fever has given way to venesection or leeches; to-
nics, stimulants, or purgative  injections, when the
softening is in  an  advanced stage, or the age and
general condition ofthe patient prohibit any further
loss of blood; a negative treatment, if the disease is>
stationary : and, lastly, escharotics, moxa,  or gal-
vanism in the course of the nerves,  after paralysis
has come on.
                  EPILEPSY.

  Recent epilepsy, existing in a young robust sub-
ject, who is otherwise enjoying good health, must
be attacked by blood-letting in the intervals between
the fits, or before their accession, if any precursory
symptom, such as head-ache or giddiness, warns the
patient of their approach.
  When epilepsy follows the repression of any erup-
tion, drain, or sanguineous discharge, as menstrua-
tion,  epistaxis, piles, or an habitual bleeding, we
must either re-establish them, or supply their place
by blisters, escharotics, leeches to the anus, vagina,
nostrils, &c.  or by resuming the habitual venesec-
tion.   In this last case, especially, an issue should
be inserted in the arm, for bleeding often favours
plethora,  and aggravates cerebral congestions, as 
UPILEI'M.                  41
soon osfye suspend or relax the severity of our anti-
phlogistic treatment.
  If the circulating system is largely developed, with
a tendency to hypertrophy ofthe heart, considerable
benefit may be  derived from the  employment of
digitalis, or prussic acid, and the addition of nitre to
the ordinary bfeverage.
  If the patient is weak, delicate, and irritable,  and
the disease appears to be dependent on the condition
of the nervous system, we must endeavour, by cold
affusions and bathing, and by habits of regular mo-
derate exercise, to develope the muscular system, so
that it may predominate over the nervous:  in cases
of this description, tonics, bitters, and a nourishing
diet, should be recommended.
  When the  fits  of epilepsy are preceded  by  the
aura  epileptica,  the cause  of which may  be some
local irritation, as, for instance, the pain of a gang-
lion pressing on a nerve, dyspeptic uneasiness, or a
carious tooth—it  is necessary,  before  an  epileptic
habit  has become established, to remove this local
cause, by cutting the nerve above the place at which
the aura commences, by applying counter-irritants,
leeches  to the epigastrium, and  by extracting  the
decayed tooth, &c.
  However proper may be the treatment which we
have just described, it too often happens,  notwith-
standing, that the disease continues, especially if
the patient is hereditarily predisposed to it,  and  is
above fourteen years of age : hence it is necessary
to enumerate the various*remedies which have been
proposed, although their success has seldom justified
their reputation.
  In the first place, we may mention cold affusions,
the powder or infusion of valerian, which  has been
employed in doses, of two drachms up to one or two
ounces, every day; assafcetida  in large quantities,
camphor, the oxide of zinc, castor,  musk,  opium.
                      ■l* 
4 •<!
EPILEPSi
Dippel's animal oil, oil of turpentine, galvanism, digi-
talis, hellebore, mugwort, recommended by Burdach
and ilufoland, in doses of fifteen or sixteen grains, half
an  hour before the accession of a fit;  extract of
hyosciamus, stramonium,  etavesacre  seeds, gum-
resinous purgatives, and, lastly, mercury;  especially
if the patient has previously laboured under syphilis,
which has not been thoroughly cured.
  There is a second class  of medicines,  so violent
and dangerous, as to require, on the part of tho
practitioner, the utmost caution in their use; we
may mention, as instances, the acetate of lead, mix
vomica, arsenic and its preparations,  phosphorus,
which  should never be used but in  the minutest
doses  at first, and  lastly, the nitrate of silver, the
dying effect of which  on the skin, is not the only
objection to its employment; however, when com-
bined with a vegetable extract, according to the plan
of Semcntini, it appears, from the observations of
Baillie,  Brera, and Kruger, much less apt to excite
those violent inflammations which make the employ-
ment of this substance so extremely formidable.
  We may employ, either as secondary to  the means
above indicated, or as our principal treatment,  dry
cupping, the application of escharotics  along the
vertebral column, rubbing the head with ammoniacal
ointment, putting a blister, like a bracelet, round the
limb above the spot at which the aura  epileptica
begins, daily friction of the abdomen or extremities
with a tartar-emetic ointment, consisting, according
to the formula of Dr. Peysson, of a  scruple of the
salt with an ounce of lard.
  Whatever  may be, in other respects, the course
which  we  adopt, it will always be requisite to re-
move, or lessen the causes which hasten  the recur-
rence of the fits; such  as' a too abundant and too
rich diet, spiritous liquors, the abuse of  venery,
i oo rigorous a continence, residence in a  hot or im- 
EPILEPSY.                 43
pure atmosphere, constipation, long continued men-
tal exertion, or violent emotions ofthe mind.
  In some cases, certainly, epilepsy has  been suc-
cessfully treated by attacking a fit during its crisis:
of this nature is a case in which vomiting always
attended each attack, which was cured by the em-
ployment of emetics;  also, another related by Du-
mas, in which bark was equally  effectual; in this
instance, Dumas availed himself of a peculiar effect
of punch, in developing and rendering periodical the
epilepsy to which his  patient was subject, and over
which he had, by this means, easier control.
   An  attack may occasionally be prevented, or at
least put off, by  the inhalation of  some very power-
ful odour; it is therefore proper to recommend those
who are subject  to this  terrible malady, to carry
about  with them a bottle of strong volatile salts:
this is particularly  useful when the  fits  commence
with  an aura; in this last case,  placing a ligature,
or making strong pressure above the origin of it, is
still more serviceable. Compression  of thecarotide,
as soon as the fit begins, has cut it short, and even-
tually cured the disease, according to H. Earle, Dr.
Brown, and Dr.  Reid, (see Transactions ofthe Irish
College of Physicians,)  have  suspended  the fit, by
forcibly pressing upon the epigastrium.  The latter
of these gentlemen has also completely  put an end
to attacks  of epilepsy, by forcibly extending the
limbs  and fingers of his patients.
   During the continuance of a fit, the patient should
be laid on a mattress, and every thing with which
he might injure  himself, removed out ofthe way : it
is also necessary to keep open the mouth with a pled-
get of linen, to prevent him from biting his tongue
or lips.
   When the fit  is very feevere, and leaves either the
intellectual, motive, or sensorial faculties disordered,
it will be necesary  to abstract blood from a vein, or, 
41                HVSTEfUA.
if the patient's debility prohibits this, the application
of leeches  behind the ears, or  to the anus, may be
substituted, and for some days afterwards we should
direct the use ofthe cold affusion.
  [Dr. Baillie, after recommending the use of the
nitrate of silver and purgatives, gives the following
short directions for the management of an epileptic
patient.  " He  should live  very temperately,  and
avoid every thing which may tend to excite or harass
the mind;  he should eat animal food sparingly, ab-
staining altogether from wine, ale, &c.   The hair
should be cut short,  and  cold applied to the head
whenever the surface of it feels hot."l
                  HYSTERIA.
                    v
  The treatment of hysteria will be different, accord-
ing as it originates from an unnatural predominance
ofthe uterine system, or from an excessive irritability
ofthe brain and nervous system, which secondarily
re-acts upon the  uterus, more powerfully than upon
other organs.
  In the first case, leeches should be applied to the
vagina, or the inner side of the thighs, especially if
the menstrual discharge is scanty, or suppressed ; to-
gether with hipbaths and fumigations of assafcetida,
or aromatic vapours directed towards the uterus at
the periods of menstruation, and the use of demul-
cents : if hysteria depends on a bad habit, a few grains
of camphor may be given at night, and the patient
must not be allowed to go to bed until fatigued  by
exercise, or to he long in it; if all these means fail,
marriage may be recommended.
   In the second species of hysteria, the most suitable
remedies are  muscular exercise, according to the pa-
tient's strength,  regular manual and mental emplov- 
HYSTERIA.
45
ment, bathing, cold affusions, (t^Haeasures which
often have the effect of re-establishKg the menstrual
discharge,) bark, the preparations of iron, bitters, and
arornatics..
  If the catamenia are scanty, or altogether deficient,
while the patient  is plethoric, and the heart's action
greatly disturbed  by the disease, the abstraction of
blood from the arm will be advisable, together with
cold bathing, the use of digitalis, or prussic acid, and
such measures  as divert the blood from the centre
ofthe circulating system, towards the extremities.
  When irritation of the stomach and bowels is con-
nected with, or seems the  source of hysteria,  we
should begin our treatment with leeches to the epigas-
trium,warm baths, and a light diet: and indeed, what-
ever source of irritation may exist, our earliest atten-
tion must be directed towards it, and its removal will
frequently be followed by that ofthe nervous affec-
tion which it has excited.  By acting on this  prin-
ciple, the writer  succeeded  in  a very severe and
obstinate case, which depended on facial neuralgia.
  When  hysteria  follows the  repression of any
eruption, or old ulcer, the cure of ringworm, or the
cessation of some habitual  pain, &c. we must, in
like manner, begin  by causing its return, or substi-
tuting issues in its place.
  If these measures fail, we may try, in succession,
musk, castor,  assafastida, valerian, opium,  bella-
donna, ether,  amber,  camphor, antimony, friction
over the epigastrium with antimonial ointment, and
especially cold affusions, the employment of which
has often been successful  in  the  most  obstinate
cases.
  During a fit the patient's dress should be loosened,
so  that the circulation and respiration may be as
little as  possible embarrassed; cold water should
be sprinkled or rather dashed over the face, the body
laid in a recumbent position, with the head elevated. 
4b"                llYoTIUlA.
ond a current of air  admitted into the apartment.
She should be made to drink some aromatic water,
with ether, and the attendants may be employed in
rubbing the temples, abdomen and extremities with
ether; or if that  is not effectual,  and  the case is
urgent, cold affusion may be resorted to, care being
taken to put the patient afterwards in a warm bed.
  If, in the course of, or after a fit, threatenings of
severe cerebral congestion  ensue, it will be proper
to open a vein, or apply leeches, as it may happen,
and order the feet to be placed in hot water: but if
the faintness and coldness of the skin are so extreme
as to excite fear of a fatal issue, a contrary plan
must be pursued, namely, the application of sina-
pisms, and dry cupping glasses to  the abdomen,
frictions of volatile liniment, the internal use of dif-
fusible stimulants, as ether and aromatic tinctures,
and lastly, of irritating injections.
  [Hysteria being a physical disorder, may require
physical treatment; but moral  remedies are most
powerful, and in a large proportion of cases  suffi-
cient,  by opposing  the morbid state of  mind on
which  hysteria generally depends.   Thus, by threat-
ening, not as a punishment, but  as a  remedy, some
very painful or disagreeable measure, withholding
every expression of sympathy, and, on the contrary,
making the patient  feel that  she appears to her
friends foolish and ridiculous, the fit, in many cases,
will soon go off, and never return.  The practitioner
must not, however,  inconsiderately, and in all cir-
cumstances, pursue this mode of conduct, otherwise
he maybe guilty ofthe greatest inhumanity.! 
CHOREA.                  47
                   CHOREA.

  This  disease generally occurs in young persons,
and often ceases at the time of puberty; in under-
taking the cure of it, the physician should first ascer-
tain whether it arises from any injury of the brain,
or spinal marrow.
  If there is no  evidence of inflammation in these
organs,  or in the alimentary canal, or ofthe presence
of intestinal worms, and if,  which very rarely hap-
pens, menstruation is regular, cold bathing and affu-
sion will almost certainly be sufficient to effect  a
cure, when the disease is recent:  but, should they,
on the contrary, fail, we may try, one after another,
assafoetida, musk. castor, opium, galvanism, camphor,
valerian, belladonna, Dippel's  oil, and other  anti-
spasmodics.
  When chorea  has an intermittent character,  it
should be combatted by bark,  or some other  of its
preparations.
  Chorea often accompanies hysteria, as one of its
most prominent symptoms ;  aud, in such instances,
must of course be treated like it.  In  an instance
which came  under the observation  of the  writer,
it followed epilepsy.*   It is better in 6uch a  case to
do nothing, for a considerable time at least,  lest we
should bring back the original and more formidable
disease.
  [According  to Dr.  Hamilton,  purgatives  will
almost infallibly cure chorea; no medicines, proba-
bly, are equally useful in this disease, yet in some
cases they fail, although fairly tried.  Numerous
cases have  been pubhshed, illustrative of the great
efficacy of arsenic ; and the sub-carbonate  of iron
appears scarcely less powerful..]
• !*ce the Revue Medicale, Vol. IV. page 0, 
4*
HYPOCHONDRIAC.
                 CATALEPSY.

  If catalepsy is accompanied with sopor, so as  to
indicate congestion in the brain, it is prudent to ab-
stract blood, either by leeches or the lancet, and at
the same  time, to order cold applications to the
head, and counter-irritants to the feet.
  When assured of the reality of the disease, we
may attempt to cut it short, or prevent the return
of it, by the application of cupping glasses, simple or
armed, to the nucha, sternum, or epigastrium, by
cold affusion, flagellation of the extremities, tying
ligatures round them, or covering them with sina-
pisms.
  Should respiration be so slow as to threaten death,
it has been recommended to inflate the lungs  artifi-
cially, as in asthma; but it  appears to us from nu-
merous experiments on the power of galvanism over
the action of the heart and lungs, that the voltaic
pile would answer this purpose more effectually, one
ofthe wires being placed against the spinal column,
and the other over the stomach.
  In the intervals between the paroxysms, cold or
tepid bathing and affusion should be employed, to-
gether with antispasmodics, such as assafoetida and
ether, unless such medicines seem to injure the di-
gestive canal;  lastly, we should prescribe anthel-
mintics, if the disease appears to arise from worms,
and, if the attacks are periodical, cinchona.
            HYPOCHONDRIASIS.

  This disease is certainly one of the opprobia of
medicine; and if, as is generally thought, its phe-
nomena originate.in some  disordered condition of 
               11VP0CHONDRIAS1S.             49

 the digestive organs, it must be confessed, that the
 ordinary antiphlogistic plan,  according  to  which
 gastro-intestinal affections are treated, is very un-
 successful ;  otherwise we should not be so continu-
 ally teased with incurable hypochondriacs.  But, in
 truth, hypochondriasis does  not consist merely  in
 dyspepsia; the brain and nervous system take an im-
 portant part in its formation; and hence, it is always
 necessary  to  diminish nervous irritability, at the
 same time that we correct the disordered functions of
 the abdominal  viscera.   Moreover, other organs
 than any of these, may be the original seat of hypo-
 chondriasis; thus,  pulmonary  consumption is fre-
 J[uently its unsuspected cause.  We ought,  there-
 ore,  to investigate the state of each organ,  before
 entering upon any plan of treatment; this precau-
 tion would  enable us to avoid many serious errors :
 we should not, for instance, as often occurs from the
 neglect of it, aggravate a chronic gastritis, and hur-
 ry  the patient  into a state of organic disease  by
 means of stimulants, to the use of which we are
 tempted to resort, for the sake of the temporary al-
 leviation which they afford.
  Whenever there appears to exist any congestion
 ofthe brain, lungs or heart, it should be attacked by
 venesection, unless  a tendency to piles  makes  it
 preferable to apply leeches to the anus; and, indeed,
 the determining of blood towards this part of the
 body, is of acknowledged utility in hypochondriasis.
 We must second the effect of  bleeding by a bland
 diet, and the habitual employment of hot pediluvia.
  If the most prominent ofthe morbid sensations of
which the  hypochondriac complains,  appear to be
seated in the digestive organs, he must be very par-
ticular respecting diet, carefully selecting his food,
as his own experience  has taught him, always ex-
cepting stimulants, even if he should think them
safe or beneficial; and the  quaVitity  must not  he
                       5 
50
HYPOCHONDRIASIS
greater than  what the stomach can  easily digest;
regular exercise, as walking, riding on horseback,
and swimming,  should be recommended; and, in
fact, whatever has  a tendency to maintain the ge-
neral strength: lastly, if the patient presents evident
signs of chronic abdominal inflammation,  or is ap-
proaching the period of life, in which  organic disea-
ses of the abdominal  viscera are  most frequent, it
will be proper to insert an issue in the arm,  or in
the vicinity of the organ which we suspect to be la-
bouring under disease.  This precaution  becomes
an absolute necessity, when any ancestor of the pa-
tient has died from any organic complaint.
  In general, it is not advisable to continue a mu-
cilaginous slop  diet very long, as the stomach gets
weaker and weaker under it, and the system falls
into  a state of debility, which is sure to aggravate
the hypochondriacal  symptoms:  it is much better
to pass on after a time, to the employment of bit-
ters and aromatics, us the infusion of gentian or ca-
momile, mineral waters, as those of Vichy and Spa,
and  a  milk diet.   In some instances of hypochon-
driasis, we have known the employment of bark, a
little rhubarb taken before meals, and a few spoon-
fuls of wine in broth, perfectly restore the power of
digestion, and dissipate obstinate local pains, the
nature and precise seat of which it had been impos-
sible to ascertain: wearing a rather tight belt round
the waist has answered the same purpose ;  also the
application of a blister, which should be placed in
the neighbourhood of the pain, or  kept up for  some
time at the epigastrium: frictions of antimonial oint-
ment over this region, have been followed by equally
happy  results.
   The eructations  with which hypochondriacs are
bo frequently troubled, are often  prevented, unless
they depend on scirrhus ofthe 6tomach, by a glass
of cold water or an ice after meals; or by the subni- 
HYPOCHONDRIASIS.
51
trate of bismuth, in doses of four or six grains, and
the carbonate of lime or magnesia, a little before.
  Flatulence may be remedied by taking  mint  or
orange-flower  water, and  powdered charcoal, with
bark; by applying wet cloths over the abdomen and
wearing a belt, and by injections of cold water.
  Constipation should be obviated by drinking whey
and veal  broth, the use of aperient enemata, and of
neutral  salts,  which occasion  less dcvelopement of
gas than vegetable aperients.
  When the phenomena of hypochondriasis  occur
chiefly in the thoracic viscera, that is, when the pa-
tient complains of a sense of strangulation, of pal-
pitations, globus  hystericus,  asthma, suffocation,
yawning, faintness, &c, and no organic disease of
the heart or lungs  can be detected, we  may give
assafoetida,  either by  the  mouth or rectum, musk,
castor, digitalis, ether, valerian, extract of  hyoscia-
mus, oxide of zinc, carbonate of iron and chinchona,
ordering at the same time, cold baths and affusions.
  If hypochondriasis consists  principally in mental
hallucination,  so  that the patient is wholly under
the influence of some false notion, the first  thing to
be done is to divert the attention by travelling, and
every variety  of corporeal exercise, as swimming,
riding, gardening, &c.  It has  sometimes proved
beneficial to excite in the mind ofthe hypochondriac
some lively emotion, or suddenly arouse him from
his train of thought by exposing him in appearance
to imminent danger.  We must not avail ourselves
of any remedies which act by stimulating the diges-
tive organs, or, eventually, there will be two  diseases
to cure instead of one.
   When excessive irritability is the sole cause  of
hypochondriasis, as in the victims of the venereal
passions, cold bathing  and affusions, abandoning
j'jcious habits, marriage,  an 1 exercise, should be 
5'J                  11 A MA.
recommended, and, as soon  as  the  patient it> well
enough, scientific and literary pursuits.
  Lastly, the physician must ascertain the idiosyn-
crasies of his patient, endeavour  to trace out the
source of the disease, and modify its treatment ac-
cordingly ; for it may in one  case  aris« from a sup-
pressed discharge, and in another purely from moral
eauses.
                      MAMA.

   If the patient is plethoric, we should first abstract
 blood from the arm,  and afterwards apply leeches
 to the head, if there  are signs of great congestion
 in the brain; at the same time, the  head is  to  be
 kept  cool by wet cloths, the feet immersed in hot
 water impregnated  with some irritating substance,
 and the bowels evacuated by mild  injections ; we
 may next  apply blisters to the inferior  extremities,
 taking care to keep them open; lastly if necessary,
 setons, and the various counter-irritants about the
 occiput,  together with  the exhibition  of  strong
 purgatives, by the mouth or rectum, cold bathing
 and affusions,  and, especially, douching, may be re-
 sorted to.
    In general, maniacal patients should be subjected
 to a milk  or vegetable diet, and  in  very moderate
 quantity, otherwise dyspepsia is very apt to ensue.
 They must be removed,  as much as possible, from
 the influence of any source of mental irritation, and
 especially  from those individuals whose presence
 keeps up their delirium.   In all other respects they
' should be treated with indulgence, yet with firmness.
    Regular bodily labour, as in gymnastic exercises,
 and cheerful company, conduce much  to Hie cure-
 oft his disease. 
MtJHTMARE.
53
  Insane persons must  be incessantly watched, as
they frequently have a strong propensity to commit
suicide, or to the horrible and most injurious habit
of onanism.
  Mental derangement, which is induced by  the
suppression of a discharge of blood, of a cutaneous
eruption, or of any  habitual emunctory, requires,
as the basis of its treament, the re-establishment
of this supplementary yet natural fimption.  When
mania is a sequela  of arachnitis, encephalitis, or
gastro-enteritis, our treatment must be  directed to
the original disease.
  The  great tendency to relapse exhibited by per-
sons who have once  been attacked by this disease,
especially if predisposed to it, will lead a prudent
practitioner to recommend the habitual employment
of escharotics, general or local bleeding, and purga-
tives, at each change of the seasons, or whenever
any symptoms of cerebral congestion appear.
                  NIGHTMARE.

   Employment of the mind, and a very early and
 light supper, or rather none  at  all, should be pre-
 scribed for this  disorder.   The patient must not
 retire to  bed until he has exercised himself to fa-
 tigue ; a glass of lemonade, or a spoonful of distilled
 aromatic water, may be  taken  before  lying down,
 and the head must be elevated, on a hard horse-hair
 pillow.  If the nightmare continues, tepid baths in
 the evening, or cold affusions, may be resorted to.
   Lastly, if there exist signs of cerebral congestion,
 or of disease ofthe heart and large vessels, and the
 patient is plethoric, we may abstract blood from the
arm, and apply leeches behind the ears, to the anus.
or the precordial region.
                      5* 
DISEASES OF THE SPINAL MARROW
            SPINAL ARACHNITIS.

  Prom the very commencement  of thi;- disease,
that is, as soon as the patient begins to complain of a
sharp pain along the vertebral column, we must have
recourse to venesection and the application of twen-
ty or thirty leeches, with cupping glasses over the
seat  of uneasiness ;  favouring the actipn of  these
measures by refrigerating lotions along the  spine,
and by Yvarm baths, provided that the motion which
they occasion does not increase the patient's suffer-
ing ; rubefacients and blisters may be  applied to
the upper or lower extremities, in the hope of di-
verting the spinal inflammation, and, lastly, it will be
proper  to stimulate the intestines by drastic purga-
tives, Ibr in this disease there is much less danger
ofthe coincidence of gastro-enteritis, than in inflam-
mation of the  brain; besides, if it were to be  deve-
loped, its seriousness could not be put in competition
with an attack of arachnitis.
  These measures must be persevered in, as long as
theTe exists any rigidity ofthe trunk, or the general
and local symptoms indicate great excitement ofthe
spinal marrow; but as soon as collapse supervenes,
we must   stop  all  antiphlogistic  treatment, and
strive,  by  administering injections of  chinchona,
musk and opium, and by the  use  of sinapisms, to
prolong life, and bring about a happy termination.
   If the disease has become chronic, and one of the
limbs remains paralytic, either half stiff, or shaking
with constant tremor, it will be proper to apply moxa,
or some  escharotic,  in two or three places near the 
Hi DROKACHXTJ*.
■hi
transverse processes on the affected side, to galva-
nize the limb, and, if there is any local  pain, to ap-
ply a blister in the course ofthe principal nerves sup-
plying it.  These means are preferable  to hot baths,
which are beneficial only when a long continuance
of paralysis has brought on stiffness ofthe joints.
              HYDRORACHITIS.

  When hydrorachitis is externally visible, its treat-
ment, consists rather in preserving  the tumour from
the action of foreign bodies, than in attempting to
hasten the absorption of the fluid in which the dis-
ease consists.
  If hydrorachitis is  occasioned by an affection of
the spinal marrow, it is against this, that  our  re-
medial measures must be directed ; and it is to the
application of escharotics as near as possible to the
seat of disease, that we must then have  recourse ;
hut if the serous or sanguineous effusion is the con-
Heqncnce of a wound  or contusion ofthe  spine,  the
inflammation which may exist  must be  treated in
the  usual way, and this will include all the means
for producing  absorption,  which can be effectual.
   [In the second volume of the Med. Chir. Trans.,
Sir  A. Cooper  has described two modes of treat-
ment,  pursued by him in cases of spina bifida; the
one palliative only, the other radical. The first con-
sists in the  application of pressure, by means of a
truss; the second, in  repeatedly puncturing the tu-
mour with a needle, and exciting adhesion, and sub-
sequently applying pressure.  But there are many
cases of hydrorachitis which do not admit of cure;
these Sir A. Cooper has described in the following
passage.  " If the tumour is connected with an un-
natural enlargement of the head,  hydrocephalus is 
56
SOFTENING.
conjoined with spina bifida, and the water will ac-
cumulate  in  the  ventricles if  the  tumour in the
loins is attempted either to  be palliated or radically
cured.  If the lower extremities  are paralytic, or
the faeces and urine are discharged involuntarily,
there is no hope of  relief.  If the tumour has burst
at the time of birth, or bursts soon after, hydroce-
phalus will succeed."]
INFLAMMATION AND SOFTENING  OF  THE
              SPINAL  MARROW.

  The cure, or rather the treatment, of this inflam-
mation, is nearly the same  as  that of spinal arach-
nitis,  namely, by venesection, leeching, and cup-
ping, along the vertebral column, and the application
of blisters and sinapisms to the extremities ; but the
use of internal  remedies, as  drastics, purgatives,
camphor,  cinchona,  is  less effectual  in  myelitis,
from the great tendency of the spinal marrow to
disorganization ; when this inflammation has passed
into  a chronic state,  we  can only oppose  it by
establishing drains along the spine, and by the em-
ployment of counter-irritants, and galvanism. 
DISEASES OF THE CHEST.
   DISEASES OF THE AIR PASSAGES.

         LARYNGITIS—TRACHITIS.

  The tendency of these  inflammations to spread
over the whole mucous surface of the air passages,
and the readiness with which pulmonary congestion,
or even pneumonia, is formed in such cases, renders
it necessary, in the very beginning, to abstract blood
from  the arm, and immediately afterwards, unless
the patient is extremely feeble, to  apply fifteen or
thirty leeches  to the larynx or upper part  of the
trachea, promoting the flow of blood by means of
cupping glasses.
  In  addition, it will be proper to cover the neck
with emollient poultices, and employ hot pediluvia,
frequent sinapisms, the inhalation of warm water,
mucilaginous fluids, purgatives, injections,and opiate
draughts.   Lastly, absolute silence must  be en-
joined, and the temperature ofthe chamber be regu-
larly maintained between 60 and 70 Farh.
  After having thus subdued the most urgent symp-
toms, the throat or sternum, according as the larynx
or trachea  is  the seat of  inflammation, should be
covered with a large blister, which is to be kept up
as long as any traces of inflammation remain.
  If these measures fail, and there is neither great
febrile re-action nor inflammation in the alimentary
canal, the practitioner may have recourse to  an
emetic, purgatives, and the repeated application of
blisters to  the extremities.   But if  the disease
rapidly gains ground,  and  the  danger is growing 
58                 croup.
imminent, nothing but extreme  exhaustion must be
allowed to deter him from applying leeches  to the
throat, and acting on the bowels by drastic  purga-
tives : if suffocation seems inevitable, tracheotomy
must be performed.
   When the inflammation is in a chronic stage, the
employment of antimonial diaphoretics is indicated,
together with mucilaginous and aromatic drinks, the
insertion of an issue near the trachea, dry friction of
the whole body,  sulphureous waters, the habitual
use of flannel next the skin, and of woollen stockings.
  •If every thing else fails, and  the bowels are un-
affected, drastic purgatives  may be employed with
safety and advantage, as was fully proved by Dr.
Hamilton; it is necessary, however, to watch their
effects.
   [Acute laryngitis, on account  ofthe rapidity with
which it runs its course, is an extremely dangerous
affection, and  will generally prove fatal, unless a
most  active and powerful treatment be pursued.
Bleeding is so far from being sufficient, that Dr.
Bailie doubted whether it aided the  cure  of this
inflammation.  After the copious  abstraction of
blood, Dr. Armstrong advises the exhibition of col-
chicum, which has a remarkable power in subduing
the action ofthe heart, and inducing general relaxa-
tion.  I have seen great benefit follow the use of
calomel in very large doses.  In  the Med. Chir.
Trans, vol. 6, Sir G. Blane strongly recommends
covering the  whole  surface  of  the thorax with  a
blister.]
                    CROUP.

  When the practitioner is called to a patient whom
he suspects  to  have croup,  he must  not wait  to 
CROUP.
59
iis.sure himself of it, but lose no time in arresting
the progress of this frightful malady, for when once
a false membrane is formed, the case is generally
fatal.
  The first thing to be done  is, without doubt, to
employ the common antiphlogistic remedies;  but, to
derive from them their full benefit, certain precau-
tions are necessary.
   If, then, croup  is  only in its first stage, a false
membrane not having  yet been  formed,  leeches
should be applied to the throat, their number being
regulated by the intensity of inflammation, the  age
and  strength of the patient.   We  must not be
afraid of abstracting blood copiously, for an attack
of croup is sometimes dissipated at once by bleeding
carried to syncope ;  however, a very feeble pulse,
and  pallid countenance, will remind us that  it is
time to 6top.  When the  leeches  have fallen off,
cupping  glasses should occupy their place,  unless
the dyspnoea is great; and  lastly, an emollient poul-
tice  should be placed over the punctures.
   In infants, local bleeding is generally sufficient to
remove the cerebral and  pulmonary congestions,
which are so frequently complicated with croup ;
but when there is reason for believing that the bron-
chia, through their whole extent, are affected with
inflammation, general bleeding  should be practised.
   In an  incipient attack  of croup  in adults,  howe-
ver  slight,  venesection is  always  advisable;  it
should even be repeated two or three times, if the
patient is strong,  to  be more certain of preventing
the  congestions which we  have just  spoken  of, as
the  extension of inflammation  to  the trachea  and
bronchia, which is a thing not  very  uncommon in
adults; afterwards the local affection may be treated
by the frequent application of leeches.
   In addition to these  measures, a large   blister
should  be placed on the mucha,  and  armed  cup 
(JO
CROVP.
 ping  glasses to  the sternun,  or  betweeu  the
 shoulders ; the feet or hands should be immersed in
 hot water, and sinapisms,  and even blisters, un-
 less  the patient  is too  irritable,  applied to the
 inferior extremities.
   After having thus attacked croup in its first onset,
 we may seek the  assistance of emetics, if our anti-
 phlogistic measures have succeeded  in preventing
 the formation of a false membrane ; using, for this
 purpose, tartarized antimony, ipecacuanha, or,simply,
 titillation of the fauces with a  feather, which  will
 sometimes promote vomiting when other means fail.
 Emetics and nauseants, by increasing and altering
 the fluids which lubricate the mucous membrane of
 the  throat and larynx, loosen the false membrane,
 and make its  expulsion  by vomiting much easier.
   Some practitioners  employ local  bleeding, tarta-
 rized antimony, and emetic doses of oxymel of squill,
 all at one time ;  but  our treatment should always
 be regulated by the general state ofthe patient, the
 intensity of reaction, and the effects ofthe remedies
 which have been already employed.
   Other  practitioners  use embrocations  to  the
 throat,  and touch the  false  membranes either with
 sulphuret of potash and honey, or  honey and oxmu-
 riatic acid, (three parts to one of acid,) or lastly,
 with a  solution of the muriate of ammonia ;* but,
 when the progress of the disease has  not been
 arrested by all these measures, or the feebleness of
the patient has prevented the employment of blood-
letting early in the disease, when  the  pulse gets
smaller  and more rapid, and the general  condition
  * The only instrument necessary for this purpose is a thin slip of
whalebone, to one end of which is attached a piece of sponge imouud
with the wash;  it should be squeezed before introducing it into the
mouth, lest some of the liquid drop into the larynx. 
CROUP.
91
ofthe patient more unfavourable,  some benefit may
be derived from blisters in front of the neck, mer-
curial frictions about the lower jaw, so as to excite
a salutary  salivation, and the exhibition of tartar
emetic or of a  grain of calomel: every hour.  In
debilitated  constitutions, where  the inflammation
assumes as  it were a  low type,  the  sulphuret of
potash, given internally, has proved successful.  It
may be taken to the amount of some grains  in sirup
and  coffee, or with opium; purgative injections are
likewise very beneficial in these cases.
  The decoction of senega, cinchona, &c.  must
not  be employed till all danger  is over, and the
exhausted  condition  of the patient  requires some
support.
  When croup arises in a very nervous and irritable
habit, warm baths,  camphor, musk, alone or com-
bined with opium, assafcetida, and ether, will find
their place either along with or after the use of
antiphlogistic remedies.
  Cases sometimes  occur in which there are dis-
tinct remissions, with a total.absence of fever; then
it  will be  proper to  prescribe belladonna or the
tincture of opium, both of which, according to the
observations of Gregory and Rush, have frequently
been useful in such cases.
  Throughout the disease, an equable mild tempera-
ture must be preserved in the  sick chamber, and
the air may be impregnated with emollient vapours;
the patient should drink only mucilaginous fluids,
and, to avoid relapses, it will be prudent to  keep
open one or two blisters in the extremities,  as soon
as convalescence is established.
  Tracheotomy, in recommendation of which there
is only one fact—the employment of galvanism, as
proposed by Dr.  Phoebus of Philadelphia—and blow-
ing the powder  of alum into  the throat, through a
wooden  tube dilated in the  middle to  make room
                    6 
02
EDEMA OP THE  GLOTTIS.
for a kind of valve by which the return ofthe powder
is prevented, need further observations to estabhsh
their utility.  In regard to preservative measures,
they consist of little more than taking care to avoid
sudden changes of temperature, especially during
epidemic catarrhs.
         /EDEMA  OF  THE  GLOTTIS.

  We may apply to this affection, with little  ad-
dition, what has already been said of laryngitis, a
disease to which it is intimately related.
  As soon as the cause of suffocation is ascertained,
we must promptly have recourse to the operation of
laryngotomy, or what is better, introduce into  the
larynx a caoutchouc sound, of which the lower end
is open, and, as much as possible, of the shape of the
rima glottidis; this  instrument has a secondary  use
in compressing the  oedematous parts, but it is very
difficult for the patient to endure the irritation  ex-
cited by its presence, and then we may endeavour
partially to supply its place by introducing the finger
and thumb as far back as possible, and  squeezmg
the infiltrated parts.
  After  having  provided against  suffocation  by
laryngotomy, or rather by  use  of* the  sound,  we
should blister the sides of the larynx, the nucha, or
the inside of the thighs, and apply sinapisms to  the
feet, knees, or arms, at the same time giving inter-
nally an emetic every second hour, so as to provoke
frequent vomiting, placing a lage number of leeches
about the neck,and frequently renewing them, unless
the patient is extremely feeble, or the affection has
come  on during convalescence from some severe
disease;  lastly, the practitioner should act on  the
alimentary canal by purgative injections. 
PULMONARY  CATARRH.
03
           PULMONARY CATARRH.

  When pulmonary catarrh  is acute but not very
violent, if taken care of early, it generally requires
nothing more than the free  use of slightly diapho-
retic fluids, as common tea, sirup of capifiaire, [which
is prepared from the Adianthum Capiltus Veneris, or
Maiden Hair,] and the decoction of althaea, together
with confinement to bed.
  If these measures are not sufficient, we must next
prescribe demuleent  medicines, as coltsfoot, gum,
&c. which allay the cough by lining the fauces, and
thus sheathing them from the immediate contact of
the external air.
  A hot-water bath, or vapour bath, used imme-
diately before going to bed,  is extremely beneficial,
even in severe cases, provided that the patient is
careful to wrap himself well up in a flannel gown;
we  say as much of spiritous liquors, as punch and
hot negus, taken in a moderate  quantity.   Many
 Kersons have been cured by this means, after they
 ave been troubled a long time with  catarrh.  But
it will be prudent to confine this plan of treatment
to habits of languid irritability, and cases in which
there is no danger of bringing on gastritis.
  When, on the  contrary,  pulmonary catarrh is
attended with  fever, heat about  the  chest,  embar-
rassed breathing, and very severe and frequent fits
of coughing, the practitioner must not rest satisfied
with these simple measures, but abstract blood from
the  arm, and even repeat the  operation if the patient
is young, vigorous, or plethoric.   This active plan
is necessary, not merely to cut short the catarrh, but
to prevent pneumonia, and even phthisis, from super-
vening.
  Where inflammation ofthe mucous membrane of
the  sir passajes is less intense, and the patient  is 
G4        PULMONARY CATARRH.

weak, very young, or has already been bled in the
arm, leeches below each clavicle may be substituted;
but it is a general principle applicable to all pulmo-
nary affections, that general should be preferred to
local bleeding.
  The parenchyma ofthe lungs is too vascular, con-
gestions of blood, however short a time  they may
remain, are too mischievous, and alterations of tissue
too rapid, to allow the neglect of such a precaution.
  Inflammation of the minute ramifications of the
bronchia, the true suffocating catarrh, requires still
more imperatively general bleeding;  we must not
be afraid to repeat it even  four, five,  or six times, if
necessary  to overcome the attack.
  Indeed, such is the dangerous nature of this inflam-
mation, that our only chance of success is in crush-
ing it at its very commencement.  Thus, an emetic
at this period of the disease is often of the greatest
benefit. Immediately after the first bleeding, blis-
ters are to be applied to  the inferior extremities,
then upon both sides of the thorax, and if the  least
local pain remains, we must direct as many as fifteen
or twenty  leeches to the spot, affixing glasses over
the punctures when the leeches have fallen off; the
chest should be covered afterwards with  hot cata-
plasms.
  If, notwithstanding, the symptoms of inflamma-
tion continue with the same intensity, and the pulse
retains its frequency, we think, from the numerous
facts that have come under our  own observation,
that the practitioner should not hesitate, so long as
there is any chance of success, to exhibit  the tarta-
rized antimony in large doses as a counter-stimulant,
namely, to the amount of twelve or twenty grains in
a mixture, containing also half an ounce ofthe syrup
of poppies; a spoonful of this should be given every
second hour, until  the dyspnoea, fever, and  other 
I'LLMONARY  CATARRH.
65
 symptoms, are decidedly improved ;  it is proper to
 diminish the dose as the patient improves.*
   We may remark that  in severe catarrh,  and es-
 pecially in the suffocating catarrh, of which we have
just spoken, it occasionally happens that  opium,
 while it calms the cough, increases the pulmonary
 congestion; in that case it is better to substitute for
 it the recent powder of belladonna, syrup of white
 poppies, or lactucarium.
   In cases of catarrh, unless very severe, which oc-
 cur in young children, and are unattended with fe-
 ver, experience has shown that great benefit may
 be derived from emetics, given in small doses at near
 intervals.  The emetic renders expectoration easier,
 supplies the  absence of it, so common in children,
 and unloads  the stomach of the mucosities  which
 oppress it.
   While attaching to emetics the value which they
 deserve, in the catarrh of young children, we must
 not forget  how readily,  at their period of life, the
mucous membrane of the stomach  and bowels be-
comes  disorganized and softened ; it  is necessary,
therefore, to  avoid the exhibition of antimony,  and
select ipecacuanha, or what is perhaps better, to
excite vomiting by titillation of the uvula.  In old
persons there is much less danger, and they may be
useful  by  increasing the  cutaneous perspiration,
which is then very scanty.  Gentle aperients, how-
ever, as manna, castor oil, rhubarb, are very benefi-
cial in the treatment of catarrh occurring in early
life,  and should never be neglected.   The applica-
tion of blisters to the chest, sedative draughts, and
the powder of belladonna, beginning with the eighth
of a grain, may be tried, if other means fail.
  [» See the Note on this subject, at the end of the Chapter on
Pneumonia]
                     6* 
r»t>          PULMONARY  CATARRH.

   When catarrh is chronic, and consists  in a flow
of viscid mucus, without fever or  any indication of
pulmonary congestion, the most suitable treatment
is to apply several blisters  over the chest, and pre-
scribe decoctions of senega, lichen, &C, opiates to
allay the fits of coughing, and, lastly, prussic  acid,
provided that there is no tendency to inflammation,
otherwise  the  exhibition of the  hydrocyanic acid
would be likely to establish it.*
   If these measures fail, we may try  fumigations of
tar, frequent inspiration of the ether of tolu, and sul-
phureous waters, especially if drunk  at the springs,
and used at the same time as baths.
   Turpentines, the various  balsams, &c,  are often
useful, diminishing expectoration, and rendering the
breathing easier; the same may be said of the white
oxide of antimony and sulphuret of potash, if given
in very  minute quantities.   '
   Persons who  are  of a sluggish or an irritable
habit, often derive great benefit  from a  plaster of
Burgundy  pitch, sprinkled over with tartarized an-
timony, and left on the chest as long as the patient
can endure it.   Rubbing in tartar emetic  ointment
is equally efficacious.
   Sometimes, when there is no indication of organic
disease in the  lungs, the  sputa, instead   of being
opaque and mucous, consist of a transparent, viscid,
and frothy fluid: these cases are generally obsti-
nate ; we ought, therefore, without hesitation, to
employ against them our most powerful  remedies,
as emetics, blisters to the chest, frictions over the
whole body  with oil, together with the internal ex-
hibition of laudanum,  opium, belladonna, prussic
  * On the action of prussic acid in developing latent inflammation,
■ee the excellent Memoir of Jacob Bouchenal, on the Employment of
Hydroaanic Acid in Pulmonary Catarrh; also a paper by myself
on this subject, in the Revue Medicate for 1838, vol. iv. page 426. 
             PULMONARY  CATARRH.          67

acid, and if the cough returns periodically at night
and morning, or after meals, and is accompanied
with a sense  of suffocation, the sedative medicines
just  enumerated should be regularly given in the
intervals between the fits of coughing, and the pa-
tient confined to a low diet.
  When catarrh is unattended with  expectoration,
the absence of which makes coughing very painful,
tartar emetic ointment should be rubbed over the
chest, and the extraotof hyosciamus, belladonna, and
opium, exhibited either internally, or through the
skin deprived of its cuticle.   Some practitioners
give, in these cases, the sirup of poppies, in doses
of a  tea-spoonful at a time, draughts  containing
prussic acid, sulphuret of potash, alone or combined
with almond  confection, gum ammoniac, and, lastly,
baths impregnated with sub-carbonate of potash.
  Catarrh dependent on organic disease ofthe heart,
requires, in addition to the remedies above enume-
rated, those  which  exert a beneficial influence on
this organ.   Thus,  its too  violent action should be
opposed by digitalis, prussic acid, bathing, &c. and
the circulation through  the lungs relieved by the
employment  of the lancet.
  It sometimes happens, that an attack of chronic
catarrh resists every one of these measures.   We
must then investigate whether it does not arise from
the  suppression  of  some  disease,  as  ringworm,
herpes, tinea, haemorrhoids, or  an old ulcer,  &c.;
in such a case, it is  generally sufficient to re-esta-
blish the repressed disorder, or, if that is impossible,
to supply its  place by an issue.
  The prevention of catarrh" is highly  important,
especially to persons who  possess a  weak constitu-
tion, or  are  in any way predisposed to pulmonary
consumption: to such persons, a residence in a warm
and temperate climate, wearing flannel next to the
skin, and especially, keeping the feet warm and dry. 
fiS                pjER'irssifc.
should be recommended.  I have known several
persons who had been habitually troubled with colds,
every winter, entirely preserved  from them by the
simple precaution of using socks.
                 PERTUSSIS.

  General bleeding in the commencement of this
disease is seldom very beneficial, unless the patient
is plethoric, has considerable fever, or complains of
some local pain; and  even then, we may often ad-
vantageously substitute for it, the  application of
eight or twelve leeches below the clavicles; in like
manner,  demulcent  drinks  are rarely of much use,
and only allay irritation in a slight degree.   On the
contrary, it has been long observed, that emetics are
much more efficacious in diminishing the violence of
the fits of hooping cough; we would, therefore,
recommend their frequent exhibition, especially at
the commencement  of the attack;   always,  how-
ever, keeping in view the state of the mucous mem-
branes of the intestinal  canal, so as  to stop  the
vomiting, as soon as it seems attended with danger.
After having, for about a  fortnight, subjected the
patient to the action of emetics, or even, at the same
time, if the  attack is  very  severe, we  may endea-
vour to lessen the irritation of the throat, by the use
ofhyosciamus, opium, prussic acid, tincture of opium,
one ortwo drops of which should be taken every
second hour, and especially belladonna, in very small
doses, gradually increased.
  While these medicines are used internally, revul-
sion towards the surface is to be excited by external
applications.   Tartar-emetic  ointment, employed
according to the  plan of Autenrieth,  namely, by
friction over the abdomen,  has been frequently fol- 
PERTUSSIS.                 69
lowed by the happiest results:  but it should not be
forgotten, that this remedy is always painful, and
yet frequently inefficacious, and  sometimes even
prejudicial:  the application of this powerful medi-
cine must never be left to the  discretion of attend-
ants, as children have been even poisoned by the in-
ordinate use of antimonial ointment.
  Blistering the chest has, in general, very little in-
fluence over pertussis, and should be avoided, unless
acute pain, or some other symptom of inflammation
in the lungs, renders it necessary.
  Towards the termination of hooping cough, it is
generally proper to prescribe tonics, as gentian, cin-
chona, rhubarb, senega, preparations of  iron,  and
above  all, friction, especially with oil, over the sur-
face of the body, so as to  restore the functions of
the skin.
   When  pertussis assumes an intermittent  charac-
ter, sulphate of quina, bitters, &c. are indicated.
   During the  long  period which  hooping  cough
always occupies, it is prudent to examine  the chest
repeatedly,  to prevent the formation of any disease
in the  heart or lungs.  If any symptoms of cerebral
congestion appear, they must be met by the abstrac-
tion of blood, either  by leeches around the ears, or
if the  patient is plethoric, by the lancet.
   The diet of the patient must be 6trictly regulated,
and the quantity of food taken at once, very small:
he must not stir out in the evening or in damp wea-
ther ;  he should wear dry  and warm  clothing, and,
lastly, the place of  his residence should  possess a
mild and equable temperature.  (See also the pre-
ceding cWapter on Pulmonary Catarrh.) 
70          SUFFOCATING CATARRH.
          SUFFOCATING CATARRH.

   The first thing to be done  on an attack of dysp-
noea, so violent as to threaten suffocation, is to in-
vestigate its  cause.  We have  already considered
most of the affections from which it may arise, as
laryngitis,  croup,  oedema of the glottis, &e. and
have only to  describe the  treatment  of the sudden
suppression of expectoration  in chronic catarrh,
which, occurring principally  in  old persons, gives
rise  to  all the  characteristic phenomena of this
affection.
  Vomiting, provoked by tartarized antimony, is one
of the best means of re-establishing expectoration;
oxymel  of squills, ipecacuanha, acetate  of ammo-
nia,  may be employed for the same purpose; in ad-
dition to which, dry cupping glasses should be ap-
plied to the chest, blisters to the legs, and sinapisms
to the feet, while the bowels are unloaded by pur-
gative injections.
  Whenever the age and strength of the patient
permit, it is prudent to make one copious bleeding,
and even a second, if the first seems to  have pro-
duced the  least relief.  Belladonna, prussic acid,
and  the extract of hyosciamus, are said to be  ex-
tremely useful in relieving the distress occasioned
by impeded respiration:  assafcetida has  been equally
extolled, in doses of gij up to 3ij, or of 31J to 3ss.
if given  as a clyster. The inhalation ofthe vapour
of ether has often been found very beneficial.
  When this  complaint attacks a phthisical patient,
in consequence ofthe developement of acute inflam-
mation in the last portion of the  lungs left sound, it
is in the  highest degree  alarming.   Unless  the
patient  is decidedly weak,  blood  must  be  drawn
from a vein,  and revulsion set up in the  intestinal
canal and skin. 
PLEURODYNIA.              71
  When it is occasioned by the presence of a foreign
body in the  bronchia, the change of position of a-
calculus, or  the vicinity of a tumour, the efforts of
art are altogether futile, unless the cause of suffo-
cation has its seat in the larynx, and can be removed
by an operation.  See also Diseases  of the  Heart,
Asthma, Angina Pectoris.
               PLEURODYNIA.

  The remedy which should be first employed against
pain in the parieties ofthe thorax, unconnected with
inflammation ofthe pleura, is a hot cataplasm, com-
posed of vinegar, linseed and mustard.  If the pain
is very severe, and resists this mode of treatment,
it will be proper to apply twelve or twenty leeches
to the side, and afterwards cupping glasses.  Pleu-
rodynia will generally yield to  these  conjoined
measures, but if not, a blister will  complete  its re-
moval.  Diaphoretics, foot baths impregnated with
mustard, and rest in bed, may be employed as auxi-
liary measures.
  When pleurodynia has supervened on the  cessa-
tion of gout in the feet, it will be necessary to bring
back this  last affection to its original seat, by the
application of a sinapism.
  An attack, occurring in a rheumatic habit, is often
removed by vapour baths, sulphureous baths, and
douches.  Goupil has found acupuncture very bene-
ficial in cases of this kind.
  If the pains appear to be going  on to  a chronic
state, the practitioner  should make a most careful
examination  of his patient, to ascertain its precise
seat; as obstuiate pain in the side  often arises from
some unsuspected disease of the organs within the 
72               PNEUMONIA.
thorax, of the ribs, or  of  the  abdominal viscera;
occasionally it depends on a syphilitic affection.
   It is only after having thus ascertained the nature
of pleurodynia, that we can  prudently attempt  its
cure by narcotics, of which opium, hyociamus, and
stramonium are, in such cases, the  most valuable;
or, lastly, by antisyphilitic medicines, according as it
may arise from one  or  other  of the causes above
enumerated.   See also Pleuritis, Jfeuralgia, Rheu-
matism.
                  PNEUMONIA.

  If there are any established principles in medicine,
the propriety of venesection  in  pneumonia is one:
to derive from it, however, all the benefit which it
is capable of affording, certain precautions, of which
we are about to speak, must be attended to.
  It must  be practised in the earliest stage of the
disease, as soon as dyspnoea, pain, and loss of sound
in the chest, indicate its existence.  The abstraction
of blood  should be made from a large orifice, espe-
cially at  the  first time, and continued until a large
quantity  is drawn, unless the attack is very slight,
or the patient too young, old, or feeble, to bear much
evacuation.  The  lancet should be frequently re-
sorted to, as long as  the  pulse continues  full or
quick, the  sputa streaked with  blood, the natural
sound of the thorax imperfect, the r&le crepitant
audible, and above all, as long as there remains the
least embarrassment  of respiration.  The local pain
may generally  be  removed by  the application of
leeches,  followed by cupping glasses; and if the
febrile and inflammatory symptoms are slight, by a
blister.
   When the inflammation and fever run high, blood- 
PNEUMONIA.                73
letting may be repeated even four, five, or six times,
but there is seldom occasion to carry it to this ex-
tent,  especially as  the  treatment directed against
the local pain will be sufficient to remove the in-
flammation, after its first violence has been subdued.
It is almost superfluous to remark, that the stetho-
scope should be employed daily, to ascertain the con-
dition of the lungs, and  the effect  of the  remedies
employed.
   Neither the flow ofthe catamenia or ofthe lochia,
nor old  age nor  infancy, should deter us from the
general  abstraction of blood ; but if the  attack is
slight, any critical discharge, as from the rectum, or
membrane of the  nose, attended with an ameliora-
tion ofthe pulmonary symptoms, should modify our
treatment.
   Whenever  there is much fever,  venesection is
indicated, though little  disease should be detected
on precussion and auscultation; for the fever may
depend on  inflammation in a portion  of  lung  not
accessible to these modes of investigation, on disease
in some  other organ, or  on excessive irritability of
the vascular system, anyone of which causes would
equally require  the employment of antiphlogistic
measures.   In the last case, a warm  batlfmignt be
very beneficial, especially if the dyspnoea  is slight,
and the sputa contain no blood : under its  use  the
skin becomes soft, perspiration is  established,  and
the disease often shortened.  Where some  irritation
of the abdominal viscera is the cause of the febrile
reaction, bathing is equally beneficial.*
  " When bathing is prescribed in pleuropneumonia, the water
should reach only to the epigastrium, Uie upper part of the body
being carefully defended from the cold air, and kept warm; and the
rratient must not remain in more than half an hour.
                        7 
74                PNEUMONIA.
  Under certain circumstances, we must be particu
larly cautious  in the employment ofthe lancet; as,
when the pulse is very small and feeble, or the de-
bility and exhaustion  of the patient  great.;  when
bleeding has previously failed, or when it is evident
that suppuration,  especially if from  vomica?,  has
commenced.
  Whenever the pulse  is small, we should take
care to examine the  heart, to ascertain  whether
this arises from actual debility, or  from mere op-
pression  of strength; for  the  heart's action may
be  full  and powerful, while the pulse  is  scarcely
perceptible; in this case  it  becomes  developed, as
the blood flows, and after  the operation has been
once  or  twice performed, the pulse is large  and
soft.  Prom  this we  may  learn never to decide
against the  abstraction  of blood, merely from the
character of the pulsations at the radial artery ; a
similar rule is applicable to other appearances of
debility, which requires to be distinguished from the
oppression  of strength and stupor  always attend-
ing intense inflammation.
  In  every  doubtful  case, as in  old worn-out con-
stitutions, we should abstract a small quantity, cau-
tiously feeling our way ; and in determining whe-
ther to repeat the operation, a judicious practitioner
will be guided not merely by the condition of the
blood, but by the  effect produced  on the disease,
and on the pulse.
  The repeated application of blisters to the chest
and inferior extremities, is  generally indispensable
in cases of this kind.  When  the  first abstraction
of blood fails to assist, and especially if it has seemed
even to impede the progress of recovery, it would
be  openly opposing nature to have recourse to it  a
second time : under these circumstances, it is better
to  try an altogether  different plan  of treatment;
selecting, according to the state of the symptoms. 
PNEUMONIA.
75
one  or  other of those  which we are about to de-
scribe.
   When pleuropneumonia  is preceded and accom-
panied  by bilious  symptoms, without any decided
evidence of abdominal inflammation; when experi-
ence ofthe prevailing epidemic has shown the utility
of evacuating the  primee via?, and when  the symp-
toms of pulmonary inflammation exist only in ashght
degree, we should, first of all, prescribe an emetic
purgative, and continue or alter this plan of treat-
ment,  according to  its effects.   But if there  ap-
pears to be great pulmonary congestion, with urgent
dyspnoea  and a  full pulse, it is more  prudent to de-
fer the  exhibition of an  emetic, until after the ab-
straction of blood : in this species of  pleuropneumo-
nia,  gentle aperients are very useful, towards the
termination ofthe disease, and evidently aid in re-
storing the lung to its natural condition.
   It  sometimes happens,  that   pleuropneumonia,
though  treated  by the  antiphlogistic  method, by
bleeding, cou nter-irritants to the skm, and purgatives,
does not disappear; dyspnoea, and pain in the chest
remain, the sputa are expectorated in small quanti-
ty, and  with much difficulty, and there  is little fe-
brile remission ;  in a word, some mysterious cause
seems  to obstruct the progress of the  disease to-
wards recovery.   In some  of these cases, the exhi-
bition of  twelve grains, or a scruple of camphor,
musk, or castor, during the twenty-four hours, the
free use of wine or bark, together with warm bath-
ing and  affusion, dissipate every unfavourable symp-
tom, and, almost at once, restore the patient to a
state of convalescence.  Several instances of this
kind have fallen  under our own observation, some of
which have been published in the Revue Medicate.
   There is, moreover,  another method  of treating
pneumonia, namely,  by  counter stimulation;  this
plan originated in Italy, and has been partially in* 
70
r:SEUMOMA.
troduced into France.   Being convinced that tar-
tarized antimony, the grand agent in this system, is
indeed a most valuable remedy, when exhibited  in
large doses, I shall give the results which the expe-
rience of several years has taught one, as whom
few are so well qualified to form an opinion.
  The  following  extract  is  from   the work  of
Laennec.
  " As  soon  as I  recognise the  existence of the
pneumonia, if the patient is in  a state to bear vene-
section, I direct from  eight to sixteen ounces  of
blood, to be taken from the arm.   I very rarely re-
peat the bleeding,  except in the case of patients af-
fected with disease ofthe heart, or threatened  with
apoplexy or some other internal congestion.  More
than once I have even  effected very  rapid cures of
intense peripneumonies without bleeding at all; but,
in common, I do not think it right to deprive myself
of a  means so powerful as venesection, except  in
cachectic  or  debilitated subjects.   In  this respect
Rasori does the same.   I  regard  blood-letting as a
means of  allaying, for  a time, the violence of the
inflammatory action, and giving time  for the emetic
tartar  to act.  Immediately after bleeding, I  give
one  grain  of the  tartar emetic,  dissolved in two
ounces and a half  of cold weak infusion of orange
leaf, sweetened with half an ounce of  sirup of marsh  *
mallows or orange flowers, and this  1 repeat every
second hour  for six times;  after which  I leave the
patient quiet  for seven  or eight hours, if the symp-
toms are not  urgent, or if he experiences any incli-
nation to sleep.  But if the pneumonia has already
made progress, or  if the oppression is great, or the
head affected, or if both lungs or one whole lung is
attacked, I continue the medicine uninterruptedly,
in the same dose, and after the same intervals,  until
there is an amendment, not only  in the symptoms,
but indicated also by the stethoscopic signs.  Some, 
PNEUMONIA.               77
limes even, particularly when most of the above-
mentioned  unfavourable symptoms are combined, I
increase the dose of tartar emetic to  a grain and a
half, two grains, or even two grains and a half, with-
out increasing the quantity  of the vehicle.  Many
patients  bear the  medicine without  being either
vomited or  purged.  Others, and indeed the greater
number, vomit twice or thrice, and have five or six
stools the first day; on the following days they have
only slight  evacuations, and often indeed have none
at all.   When once tolerance ofthe medicine (to use
the expression of Rasori) is established, it even  very
frequently  happens, that the patients are  so much
constipated as to require clysters to open the body.
When the  evacuations are  continued to the second
day, or when there is reason to fear, on the  first, that
the medicine will be borne with difficulty, I add to
the six doses, to be taken in twenty-four hours, one
or two ounces of the  sirup of  poppies.   In general,
the effect of tartar emetic  is  never  more rapid or
more efficient, than when it gives rise to no evacua-
tion; sometimes, however, its  salutary operation is
accompanied by a general perspiration.   Although
copious purging and  frequent vomiting are by no
means desirable, on account ofthe debility, and the
hurtful irritation of the intestinal canal which they
may occasion, I have  obtained remarkable cures in
cases  in which such  evacuations had been  very
copious.  I have met with very few cases of pneu-
monia where  the patient could not bear the emetic
tartar; and the few I have met with, occurred in
my  earliest trials ;  insomuch, that this  result  now
appears to  me to be attributable rather to the inex-
perience and  want of confidence of the physician,
than to the practice.  I now frequently  find, that a
patient who bears only moderately six  grains with
the sirup  of poppies, will bear  nine perfectly  well
on the following day.   At the  end of twenty-four or 
7*                PNEUMONIA.

forty-eight hours at most, frequently even after two
or three hours, we perceive a marked improvement
in all the symptoms.  As soon as wc have obtained
some amelioration, although but slight, we may be
assured that the  continuation of-the  remedy will
effect complete resolution of the  disease, without
any  fresh relapse; and it is in regard to this point
more particularly, that the  greatest practical diffe-
rence between the emetic tartar and  blood-letting
consists.   By the latter measure, we almost always
obtain a diminution of the fever, of the  oppression
and the bloody expectoration, so as to lead both the
patient and the  attendants to believe that recovery
is about to take place : after a few hours, however,
the  unfavourable symptoms return with fresh vi-
gour ; and the same scene is renewed, often  five or
six  times, after as many successive venesections.
On  the other hand, I  can state, that I have never
witnessed these renewed attacks under  the  use of
the  tartar emetic."*
  Laennec is of opinion, that this  method may be
pursued at all periods of the disease ;  even after a
large portion of the lung has undergone  purulent
infiltration:  he calculates that the  mortality under
this system is about one in twenty-eight.
  Throughout the acute stage of pleuropneumonia,
the patient should be recommended to drink copious-
ly of mucilaginous liquids, which may be acidulated,
if there is any co-existence of bilious symptoms, and
the cough does not seem aggravated in consequence.
The patient should regularly take demulcent medi-
cines, with sirup  of poppies or laudanum; a warm
temperature should be maintained in  his chamber,
especially during  the night, and a very  low diet
must be  strictly enjoined, not even  broth being al-
lowed while any degree of fever remains.
* Forbes' Translation of Laennec. 
PNEUMONU.                79
  Towards tlie termination of the disease, if the
patient does not regain his appetite, and the alimen-
tary canal is  unaffected, a little aperient medicine
may be given with advantage ; it promotes the cure
of pulmonary inflammation, and removes the cough,
which is very apt to linger after the patient has be
come fairly convalescent.
  Should any symptoms  of relapse occur during
convalescence, we must, without hesitation or delay,
arrest its progress by  a prompt recourse to the lan-
cet, and not,  by merely negative measures, suffer it
uninterruptedly to pursue a  course, the termination
of which would probably be in an incurable phthisis.
   In chronic pleuropneumonia,  besides the use of
mucilaginous and demulcent drinks, it is necessary
to insert a eeton or issue at the point  of the chest,
corresponding to  the  scat of disease in the lun&j.to
apply numerous blisters, and  to avoid every thing
capable of exciting inflammation within the chest,
as  long  conversation, fast  walking,  or riding  on
horseback ; a very light, and especially a milk diet,
with total abstinence  from wine, must be  enjoined,
even though there may be no fever: flannel should
be worn over the whole body, to prevent the influ-
ence  of variations of temperature, and the  func-
tions of the  skin carefully  maintained by frictions
and sulphureous vapour baths.   Whenever the cir-
cumstances of the patient  put it  in his power, he
should select a residence enjoying a  southern  as-
pect, or  what is still better,  a warm and equable cli-
mate ;  and on the least increase of inflammation,
indicated by pain in the side and fever, we must re-
cur to the abstraction of blood by the lancet, cup-
 ping glasses, or leeches.  Lastly, to complete our
 description of the treatment of chronic pneumonia,
 it may be remarked, that much benefit is frequently
 derived from a repetition of emetics and drastic pur- 
<u
(EDEM \ OF THE LU.NG.
gatives, and the exhibition of tartarized antimony,
according to the system of Rasori.
  [It is difficult to believe that the exhibition of tar-
tar emetic in the manner recommended by Laennec,
can be devoid of danger;  yet, the high moral and
intellectual character of tMs great pnysician, for-
bids  the  unqualified rejection  of his statements;
moreover, in allusion to them, the late  Dr.  Cullcn
says, »«I know  them to be quite correct, from the
testimony of English physicians, eye-witnesses of
his practice."   Tominasini asserts, that out  of one
hundred  and fifteen cases of  pneumonia, treated
with the tartar emetic, (conjointly with  bleeding,
&.C.) only fourteen  died ;  and Dr. Forbes, who, as
an English practitioner, will, probably, be considered
a safer authority on this subject, says, " During the
last two  years, I have used the tartar emetic (after
pretty copious venesection however) in a good many
cases of pneumonia.   In  all, the termination was
favourable.  In no instance  but one have  I seen
any bad effects from it; and, in this,  it was incau-
liouslv administered without due reference to the
co-existence of gastric irritation.  The only objec-
tion to its use, appears to me to be the severity of its
operation, previously to  the  establishment of the
tolerance."]
           CEDEMA OF THE  LUNG.

  GEdema ofthe lung, whether idiopathic, a sequela
of measles, or co-existent with  a general dropsy,
requires  the  same  treatment  as this last  disease,
After having  applied  one or two  blisters on each
side ofthe chest, the whole surface ofthe body is to
be rubbed over with the tincture of squill, digitalis. 
          i.AN'i.KI >E  t'l  THE LUNUS.       "*1

»r sulphuric ether, and fumigations with valerian.
elder flowers, &c. made use of.
  White wine may he  recommended, and laxative
drinks  containing  acetate  of potash; an emetic,
especially of ipecacuanha, should be occasionally
prescribed, and expectoration promoted, by inhala-
tions of ether, of tolu, or by the internal use ofthe
acetate of ammonia, oxymel of squill, kermes ber-
ries, antimonial powder, &c.; the bowels must be
kept open by aloes, rhubarb, jalap, ammoniacum, &c.
   The treatment of oedema ofthe lungs, occurring
after an attack of pneumonia, or dependent on or-
ganic  disease of the  heart and  large vessels,  is
pointed out in the chapters on these affections.—
See Pneumonia, &c.
        GANGRENE OF THE  LUNGS.

  When gangrene of the lungs has attained to a
certain extent, it is beyond  the resources of art;
and consequently our  observations apply only to
gangrene of a  limited  portion of the pulmonary
tissue
  The  treatment of this affection  should  depend
altogether on the general condition of the patient :
unless this  principle is kept in view, we may fall
into serious errors.
  When gangrene of the lung occurs  in  a young
person, ofrobust constitution, and previously in good
health; when it has not arisen from any specific
source, and is neither epidemic, nor connected with
typhus, but appears  simply as a sequela of pneumo-
nia, either through  the  intensity of the inflamma-
tion,  or some accidental modification of it, as, for
instance, from extreme heat and when the pulse is
full and resisting, the skin warm, the countenance 
■>2        GANGRENE 01  I BE T.U.NGs.

little altered, and, in a word, the general health and
strength little impaired, we ought to try the experi-
ment of taking away a little blood.   If the blood is
firm and florid, with a buffy surface, if the  patient
feels decidedly better, and his pulse become fuller,
the antiphlogistic  treatment   may  be continued.
But if, on the contrary, the  blood is flabby, of a
greenish hue,  and fetid odour, and  no improvement
in the symptoms has taken place, it will be  well to
pause before venesection has aggravated the evil, and
have recourse to  tonics, and the application  of
counter-irritants to the skin.
  Every auxiliary measure ought to be sedulously
adopted : a  moderately  warm  atmosphere, impreg-
nated with soothing and balsamic vapours,  should
be maintained  in the chamber of the  patient, who
should inhale the  ether  of tolu,  drink copiously of
demulcents, alternately with a solution of the cnlo-
ruret of soda, beginning with a very small dose, and
gradually  increasing it: tonics and expectorants
are indicated, and when there is pain in the chest,
dry cupping and blistering;   hemoptysis  may be
counteracted by nitre, combined with conserve  of
roses ;  lastly, the patient must avoid  a  horizontal
posture, and if confined  to his  bed, should set up in
it, especially in very hot weather,  for lying on the
back tends to  produce stagnation  of  blood  in the
posterior part ofthe lungs, and sometimes evidently
accelerates death.
  In proportion  as the patient improves, and the
sputa lose their gangrenous   hue  and colour, we
may more  freely employ the  ordinary means  for
giving tone to  the system.
  When extreme debility accompanies the symp-
toms of gangrene in the lung, and still more if it
precedes them, and they succeed another affection,
which  has  already produced  great weakness,  or
seem to depend on the operation  of some  hurtful 
Il.EMurTVblJs.
S3
cause, all the stimulating powers of art should be
resorted  to, as the  exhibition of wine, camphor,
musk, ether, decoction of senega root, and the seeds
ofthe Phellandrium Aquaticum, and the application
of sinapisms to the limbs: blisters are apt to occa-
sion gangrene, and are consequently unsafe.
  It is always proper to place some solution of the
cldoruret of soda near the bed ofthe patient.
                HAEMOPTYSIS.

  When hemoptysis is slight, occurs  nfpersons
otherwise in good  health, and consists  simply  in
the expectoration of bloody  sputa,  without any
other symptom, it may in general be easily checked
by simple means.   A small quantity of blood should
be taken from the arm, and the patient's diet should
be mucilaginous, acidulated, and slightly astringent
liquids, as a decoction of coltsfoot or rice, containing
a little alum, nitre, or prussic acid.  These remedies
will usually be sufficient, especially if an antiphlo-
gistic regimen is observed; and the patient avoids
much conversation and walking about.
  But if the hemorrhage from the lungs increases.
or has been from its commencement abundant, at-
tended with a sense of heat in the chest, frequent
cough, dyspnoea, together with a full and hard pulse,
we must not be satisfied with a single abstraction of
blood, but repeat it the next, or even on the same
day, if the hemorrhage does not cease, and  the
pulse retains its fulness:  then, after having fulfilled
the most urgent indication, that  of  removing the
congestion ofthe lungs, we must endeavour to pro-
vide against its return, by the  apphcation of cupping
glasses to  the thighs, by the internal exhibition of
nitre in half ounce and ounce doses, in combination 
64
ll.EMOPIAsle.
with mucilage, by saline purgatives, bathing the leet
in warm water containing prussic acid, or covering
them with hot sinapisms,  and,  lastly, by the free
admission of cool air, and the use of ice, or ice-cold
drinks.
   When haemoptysis follows  the suppression of an
habitual discharge of blood, as ofthe catamenia, or
piles, it will be necessary to open a vein, and after-
wards apply leeches to the inside of the thighs, or
around the  anus, proceeding in other respects ac-
cording to the plan already laid down.
   We have hitherto  spoken only of bronchial he-
morrhage, that is, of  the  exhalation of blood from
the mucous surface ofthe  air tubes; but when hae-
moptysis  arises  from  pulmonary apoplexy, or con-
gestion of blood  in the lungs, the blood is thrown up
in such large quantities that it seems to be vomited.
In cases  of this  description,  the practitioner must
lose no time in abstracting blood from the arm, re-
gardless of quantity, for this operation is more effec-
tual, once thoroughly performed, than several times
imperfectly; and the loss of blood from venesection
is always much less important than that which takes
place from the lung.   After having thus facilitated
the restoration ofthe lung to its natural state, by two
or three  bleedings at short intervals, much benefit
may be derived  from  a drastic purgative, and the
administration of an injection of a similar kind.
   If the spitting of blood has not, as is generally the
case, entirely ceased, it will  be  proper to prescribe
large  doses  of nitre, and of the extract of rhatany
combined with conserve of roses.
   When haemoptysis is intermittent, that is, returns
at regular periods, bark, or the  sulphate of quina,
will be most useful.
   If the hemorrhage is  passive, connected with a
scorbutic habit, or with a low  asthenic fever, we
must employ stimulants'and tonics, especially iron. 
PHTHISIS.    »■
-JO
In a case of this kind, the author has known Bor-
deaux wine stop a profuse spitting of blood, after it
had reduced the patient to the lowest degree of ex-
haustion and debility.
  [In the ninth volume  of the Med. Chir.  Trans.
some cases are narrated, which appear to prove that,
occasionally, haemoptysis is produced  by the  exis-
tence of worms in the intestin^Ranal, and may be
cured by their expulsion :  it is, therefore, always
proper, especially when this species of hemorrhage
occurs in young persons^to ascertain whether these
insects are present or not.]
                   PHTHISIS.

   tSince the powers  of medicine almost invariably
 fail in overcoming this disease after it has arrived at
 its second stage, our  efforts must be directed to its
 prevention, or to arresting its progress, while the
 tubercles of the lungs are still in their crude state.
 For this purpose, it is necessary to make ourselves
 intimately  acquainted with the physical, physiologi-
 cal, and morbid peculiarities in the constitution of
 our patient, as the indications of cure  are to be
 sought for in his temperament, conformation,general
constitution,  and  hereditary  tendencies.    Thus,
 when a patient, born of phthisical  parents, with a
 deformed thorax, whose respiratory organs are easily
 disordered, and in whom there is reason to fear that
tubercles are gradually forming, puts himself under
our care, we must place him as far as possible in
the opposite extreme to those circumstances which
promote the developement of phthisis.  Thus, we
should  advise  his  removal to a  warm climate,
avoiding »  variable temperature,  and giving  the
                        8 
"titfJ                PHTHISIS.

 preference  to  the vicinity of the sea.*  flannel
 should be worn over the entire surface of the body,
 the  feet kept warm and dry by woollen stockings
 and thick shoes ; the clothing accommodated to the
 various  changes  of weather, the diet  solid  and
 nourishing, but light, so as not to create febrile ex-
 citement ;  and he < should be recommended to take
 moderate exercis<k according to his strength, and of
 the kind most agreeable to him.  All inordinate ex-
 ertion of the  larynx and lungs, as in singing  and
 public speaking, must be avoided, especially at that
 period of life  in  which these organs assume an in-
 creased developement, and become more irritable;
 but, on  the other hand, the habit of moderately
 loud reading, conjoined witli the other measures  of
 which we have speken, will be useful in strengthen-
 ing these organs, and dilating  the chest.  It  will
 also be advisable  at  this period of life, that is, be-
tween the fifteenth and twenty-fifth years of age,
to maintain an issue in the arm or thigh, in order
to keep  off from the lungs any irritation which
might be set up.   This precaution is  never  need-
less, unless in those cases where nature has antici-
pated it  by  some long established cutaneous erup-
tion, habitual local sweating, regular hemorrhage,
or some other kind of drain, the keeping up of which
has become essential to health; in this case  the
practitioner has nothing to do but to  leave nature
alone.
  With the same object in view, we should pay
attention, in females, to the state of the catamenia,
and  obviate the bad effects  arising from the sup-
pression or irregular performance of this function,
by opening a vein, and applying leeches to the inner
  * We know of no situations in which more advantages are com-
J>inj3d than the cities of Naples, Pisa, and Nice. 
                  PHTHISIC                 "H'l

bide ofthe thighs, the use of hip baths, and ertJma.tic
fumigations  directed towards  the uterus,  and by
bathing the feet in water impregnated with mustard.
These  means should  be employed  with  peculiar
diligence at the periods when the catamenia ought
to appear.
  This treatment, though rather regimeneal than
medical, has been too. often successful,—too many
who seemed threatened victims»to incipient phthisis,
or in whom pneumonia was stirring up a latent ten-
dency to the formation of tubercles, have owed their
fives to the adoption of it, to allow our hesitating to
insist on its importance.
   But if, notwithstanding all our pains to guard off
inflammation from the pulmonary organs, the symp-
toms announcing the  first  stage of phthisis  show
themselves, or an habitual dry  cough, spitting of
blood, dyspnoea, and sense of heat in the chest, pre-
clude all doubt of its existence, we  must then seek
to lessen the pulmonary congestion by the moderate
abstraction  of blood,  by establishing revulsion to-
wards the extremities, through  dry cupping and
bathing the feet  in hot water, and  by the use  of
demulcents,refrigerants, and aperients; the cough
may be quieted,  in some degree, by opium, sirup
of poppies, laudanum, prussic acid, &c, and, when
there is nothing to contra-indicate tbem, sulphureous
baths should be recommended for the same purpose.
If the spitting of blood continues, we must endeavour
to put a stop to it by the exhibition of nitre in large
doses, combined  with sirup or conserve of roses,
and  one or two drachms ofthe extract of rhatany.
   The patient must  be subjected to  a regimen,
which should be more or less strict, according to the
severity of the symptoms;  he should take nothing
stimulating or difficult of digestion, but such light
and yet nourishing articles of food-, as  milk, *aiep,
wgo. broth. &c 
 ?>                PHTHISIS.

   Under this  treament,  the  symptoms of phtliiMH
 will often  gradually disappear, and the disease re-
 main stationary and almost latent during a longer or
 shorter time, in proportion  to  the strictness with
 which the  patient obeys  the injunctions of his
 physician.
   Having thus traced the course which  should  be
 pursued to prevent the developement of phthisis, or
 arrest its progrear during  its incipient  stage, we
 may now proceed to the consideration of the treat-
 ment required,  when  the  tubercular  matter has
 become softened,  and  is making its way  through
 the bronchia.   Here, unhappily, we feel  obliged to
 acknowledge, not  only the general insufficiency of
 art, but also our conviction that the greater number,
 at least,  of the pretended  or apparent cases  of
 phthisis, in which a cure  is  said to have been
 effected, were in all probability merely instances of
 catarrh or  chronic pleuritis, the protracted duration
 of which  had brought on great emaciation.   The
 opinion that a few phthisical patients are happy
 enough to escape alive  from the  ravages of this
 disease, is, however, rendered in some  degree pro-
 bable, by  modern  discoveries, which demonstrate
 cicatrizations in the lungs, where  the  stethoscope
 had  previously detected the existence  of cavities.
 In the hope of producing this state of the affected
 organs, the only kind of cure  which can take place,
 the following plan must be pursued.
  If the fever is slight, the  perspirations  moderate,
 and the functions  of the stomach little disordered,
 we should endeavour  to clear the  lungs of the
 softened tubercular matter by promoting expectora-
tion ; the  best means  of doing this,  especially  in
 cases where either haemoptysis or chronic diarrhoea
 exists, is  the  exhibition of ipecacuanha, in such
 doses as to excite vomiting, every fourth  or  fifth
 day. employing  in the meanwhile the ordinary ex- 
fHlHIsus-.                 89
pectorants, as oxymel of squill,  and especially the
balsams, of which, however, the quantity must be
carefully regulated, lest they should  excite irrita-
tion  in  the stomach and bowels, or in the lungs.
Inhalations of the vapour of tar, tolu, ether; a com -
bination of aromatic and mucilaginous plants; pills
or mixtures,  containing turpentine, myrrh, or the
tolu  and Peru  balsams, answer this  purpose very
effectually: these substances have also the addi-
tional advantage of correcting the fetid smell ofthe
expectorated matter: a diluted solution of chlorine
will  have the same effect; but if, as often- happens,
it should occasion diarrhoea, the use  of it must be
discontinued.  On  the  other hand, we must en-
deavour to promote sleep, and quiet the cough, by
some  of the preparations  of opium,  belladonna,
prussic acid,  &c.
  The  atmosphere  in  which the  patient resides,
should be warm : a  pure fresh air is far  from being
beneficial: thus, phthisical patients are often impro-
ved  by dwelling in stables, in  low marshy  situa-
tions, or valleys open only towards the south.  The
diet  should be nourishing and easily digestible ; bit-
ters, as gentian, may be employed  with advantage,
alsochalybeates and anti-scorbutic medicines; never,
however, let them  be  given empirically, that is,
without some distinct object in view.  The ordinary
pectoral drinks, emulsions, and cows' or asses' milk,
should form  the basis of our dietetic treatment.
  Such are the measures, by which, is some  cases,
too few anis ! it may be possible to overcome phthisis
in its second stage; but when the  supervention  of
coUiquative sweats, excessive  diarrhoea,  frequent
paroxysms of coughing, constant fever, and the ex-
pectoration of pus, announce that  the  disease has
arrived at the last stage,  little more can be hoped
from the  powers of medicine.   For,  in spite ofthe
acetate of lead, bark, and bitters, given to diminish 
'HI
PHTHtM
 the profuse perspirations ;  in spite of the strictest
 attention  to diet, the use of mucilaginous,  farina-
 ceous food, of rhatany, ipecacuanha, opium, and par-
 ticularly opiate  injections, to counteract the diar-
 rhoea ; in spite ofthe belladonna, prussic acid, musk,
 stramopium, and white mustard  seed, given to re-
 lieve the difficult breathing, the patient sinks into a
 state of extreme emaciation^ to which, not unfre-
 quently succeeds,'even in young subjects, an attack
 of hemplegia.
   While any symptom of pulmonary  congestion, or'
 any pain* in the chest remains, it will be proper to ab-
 stract blood to a small amount, unless the patient is
 too weak; in which case, we must content ourselves
 with the applications of dry cupping glasses, blisters,
 mustard poultices to the feet, the employment of
 mucilaginous drinks,  and if there is no diarrhoea, of
 laxatives.
-  Whenever  phthisis is attended with regular ac-
 cessions of fever, the  employment ofthe  sulphate of
 quina must not be omitted ; as it is abundantly pro-
 ved  by  experience, that,  although th'e  febrile  pa-
 roxysms aTe, without doubt, under the influence of
 the pulmonary disease, yet the  intervals between
 them may  be made much longer.
   At the termination  ofthe second stage of phthisis,
 artificial evacuations  cease to  be useful, and only
 aggravate the debility ofthe patient: it will, there-
 fore, be better  to suppress them,  unless, as in the
 case of fistula in ano, they prove of decided benefit,
 or their suppression hastens the progress of the dis-
 ease.
   If bleeding is at all indicated to supply the place
 of some habitual discharge of blood, which has late-
 ly ceased,  and to allay  the irritation so frequently
 excited in  phthisical  patients by congestion in  the
 lungs, the  supervention of a severe  catarrh  or per-
 iiissis. and especially  of pneumonia, renders  It alto- 
PHTHISIS.                 91
wether indispensable ;  for  if the parenchyma  be-
tween the different tubercles becomes in the least
congested or inflamed; the functions of the lungs
are nearly suspended, and the patient rapidly sinks.
(See the chapter on Pneumonia.)
  Venesection, in order to fulfil the object designed
by it, or be of any  advantage,  must be sufficiently
copious to remove all inflammation, and yet not so
excessive  as to induce  a  state of great debility,
which  is the more  to  be dreaded, as the patient,
being liable  to repeated  attacks of the same kind,
will thu* become every  time less and less able to
resist them; it must, however, be borne in mind that
bleeding cannot prevent the developement of tuber-
cles, or arrest their progress,  much less  eradicate
them, and that its only real use is to restore the in-
flamed pa'renchyma of  the lung to its natural condi-
tion, and prevent the  further progress of inflamma-
tion.
   In regard to laryngeal phthisis, generally a sequela
of chronic laryngitis, (see this word,) it is almost al-
ways combined vvith a tubercular condition of the
lungs, and is  tolbe treated  on the same principles,
modified by  the different situation and function of
the organ, in which the  disease is seated; thus, so
long as the period of irritation remains, absolute si-
lence must be enjoined, together with the repeated
application of leeches  and  poultices  to the throat,
fumigations directed towards the larynx, and, lastly,
blisters and escharotics.
   If these remedies do  not effect the removal of
the disease, it  goes on to pulmonary  consumption,
and the probability of recovery  diminishes daily .•
aromatic fumigations have little influence, when the
larynx has become ulcerated, and we can then only
deplore the insufficiency of our art:  it is therefore
imperative at the commencement of this disease, to 
U2                 PHTHISIS.
advise a removal into a suitable climate, as the most
effectual means of arresting its progress.
   [I subjoin a brief analysis ofthe plan of treatment
recommended by Dr.  Armstrong in his valuable
work on  Pulmonary Consumption.
   In incipient phthisis, attended with marked con-
stitutional excitement, moderate  bleeding  is occa-
sionally of benefit;  employed  under other  circum-
stances; or carried to any great extent, it is decided-
ly injurious.   Powerful counter-irritation  on the
skin, at  an early period of the disease, is likely to
be useful, in  relieving, if not checking, pthisical
symptoms ; but the hopelessness of success, is gene-
rally, in the mind ofthe patient, at least, too strong
to encourage him to submit to, or the  practitioner
to urge 80 painful a remedy.  With respect to  di-
gitalis, the  temporary alleviation sometimes deri-
ved from it, is nearly  counteracted by  the debility
and nervous irritation which it ultimately produces.
The mineral acids appear  to be of very little use,
and by disordering the digestive organs, may prove
injurious.  Opium  is a valuable  remedy?  but we
should be mindful not to  give it in too large, or too
frequent  doses, lest it check the expectoration, and
oppress the lungs, through  its operation  on the
brain.  To moderate hectic symptoms, the sulphate
of zinc may be prescribed with advantage.  With
respect to food,  the principal rule is, that it should
support, without exciting the constitution :  in inci-
pient consumption, a  milk and vegetable  diet, is
mostly superior to every other, but in an advanced
stage ofthe disease, animal food, and even ale, when
they augment neither the cough nor the fever, may
be safely and advantageously  given.  The  threat-
enings of phthisis are best warded  off by a sea voy-
age, residence in a warm climate, flannel clothing,
cold or tepid sponging, moderate exercise, especial-
ly on horseback, and a nutritious diet.] 
RMPHYSEM V OP  THE MM;.       !M
        EMPHYSEMA  OF  THE  LUNG.

   Emphysema of the  lung,  being,  according to
Laennec, almost always the consequence of dry ca-
tarrh, the practical rules for its treatment are inclu-
ded in the chapter on that affection.   Thus,  wear-
ing flannel, keeping the feet warm, residence in a
warm chmatenot subject to  sudden  variations of
temperature, sulphureous baths, friction of oil, the
internal exhibition of the phellandrium aquaticum,
turpentine, juniper berries, decoctions of serpenta-
ria, and senega,  gum resins,  diuretics, if,  as very
commonly happens, there is anasarca, and  chaly-
beates,  when the patient is pallid,  cachectic,  or the
flow of the catamenia scanty,  constitute the  treat-
ment  of this affection.
  When the  difficulty of breathing is  considerable,
it is necessary to  draw blood from the arm,  as dis-
ordered respiration brings on a state of congestion
within the lungs, which does not fail  to aggravate
the disease already existing.
  Inter-lobular emphysema, the characteristic signs
of which are the dry crepitating rattle dgrosses bulles,
and the murmur frictions*, is a trifling affection,
and, when confined to the lung,  disappears sponta-
neously by gradual absorption ofthe air.  If the air
has made its way into  the  sub-cutaneous  cellular
tissue, a few punctures with a needle in those points
where it has  accumulated, will give exit to it.
                 PLEURITIS.

  When the patient  is  strong and plethoric, we
should endeavour on the first appearance ofthe dis-
ease, to arrest  its progress and prevent its exten 
94
PLEU1UT1S.
sion to  the  parenchyma of the lungs by a prompt
and active use of the  ordinary antiphlogistic reme-
dies.   Thus, a copious abstraction of blood should
be made from the arm, and, immediately afterwards,
fifteen  or twenty  leeches,  followed  by  cupping
glas'sesftahould  be  applied to the chest,  over the
chief seat  of uneasiness.
  If the patient continues to complain of pain, the
leeches must be renewed at once, without waiting
until the next day, and the chest covered with a
large poultice,  which will have  the double advan-
tage of promoting  the  flow  of blood, and, by  its
warmth, alleviating the pain.    Affixing  cupping
glasses  over  the punctures, as soon as the leeches
have fallen off, causes a very considerable determi-
nation of  blood towards the  surface, and is one of
the most efficacious means  which can be resorted
to in the cure of pleuritis: the benefit of blisters and
leeches are both combined in it.
  If, however, the  fulness  and frequency of the
pulse, painful and oppressed breathing, and heat of
skin, all continue after the first bleeding, it will be'
advisable to  open the vein a second and even a third
time, during the first two days, especially if the blood
has a cupped and buffy surface, the pulse also being
full and strong, and  the pain stationary in the chest,
without any symptom of approaching collapse,  if
there should be any danger of this  event, leeches
and  cupping glasses  must be  substituted  for the
lancet.
  A different plan of treatment may be adopted if a
patient  bears  blood-letting  very  ifi, while his di-
gestive  organs are not apt  to become disordered,
namely, the  exhibition of tartarized  antimony  on
the principle of  counter-stimulation.
  It may be given from the commencement of pleu-
ritis in the proportion of eight or  twelve grains, to
four or  six ounces  of water ; but as our great ob» 
PLEURITIC.
95
 ject in this case is to destroy inflammation, we
 should not continue the administration of the tartar
 emetic longer than is necessary for this purpose.
   When an attack of pleuritis comes on with great
 violence, after a sudden suppression of the catame-
 nia, it is equally necessary  to begin the treatment
 of it, with the  employment of general  and  local
 bleeding, and in addition, to endeavour to recall the
 menstrual  discharge by the apphcation of leeches
 to the  vagina and inner side of the thighs, also by
 the employment of hip baths, mustard pediluvia and
 diaphoretic drinks :  the great danger which attends
 a copious effusion into the cavity of the thorax, and
 the  always doubtful issue of pleuritis, authorize, if
 if they do not require, these active measures.
   It  sometimes happens, that  in spite  of all  the
 remedies  already  mentioned, the pain does not di-
 minish, the fever keeps up, the pulse continues small
 and wiry,  the breathing gets even more  laborious,
 and a state of stupor and  collapse  is  taking  the
 place of the original febrile  reaction.
   At this criticalperiod, the most decided benefit may
 be derived from the application of a large blister
 over the side, and if the  symptoms  of prostration
 are still more strongly  marked, other two  may be
 placed  at the same time on the inferior extremities.
 In this way, every unfavourable symptom will often
 vanish, as  if by a charm;  and where venesection
 and cupping failed altogether, a blister succeeds at
 once.
   Some physicians  avoid blisters during the  first
 stage of pleuritis, from a fear that their  too early
 application has a tendency  to promote effusion  into
 the chest, and keep up fever : but we  can truly say,
 that whenever we have previously employed gene-
 ral and local  bleeding, and they  have failed,  the
apphcation of blisters has not only never  increased,
but has almost invariably mitigated the severity of 
!*t)                PLKt'HITIS.

the symptoms, unltss  they have been resorted to
very early.
   The abstraction of blood is far from successful in
every case of pleuritis : tniai, sometimes, in conse-
quence  no doubt  of some idiosyncrasy, it  seems
even tojMgravate the disease ;'counter-irritation by
blisters  is then  our most  natural and rational  re-
source,  but  this also will occasionally succeed no
bette*, and the  patient ultimately gets well only
under the use of musk, camphor, castey, warm ba-
thing, &c.   The skill and prudence of the practi-
tioner must be exercised in prescribing these antispas-
modics ; we  can only point out  to  nim the general
principle,  at the same time warning him of the bad
consequences which may  arise from  its injudicious
application.
   When pleuritis  reigns  epidemically, and  exists
alone with a disordered state of the liver and bow-
els, especially  when also occurring  in a  wet au-
tumn, and in persons previously  weak, the  evacua-
ting plan of treatment should be  substituted for that
which is more strictly antiphlogistic.  Ipecacuanha,
tartarized antimony in injections, and purgatives,
are in this case most beneficial;  they either remove
all occasion for bleeding and blistering, or enable
us to employ them with safety.   As a general rule,
venesection  is improper in these  circumstances, and
should only be resorted to if some symptom clearly
indicates the propriety of it, as a full pulse, the ex-
tension of inflammation to the lung, or the robust
habit ofthe patient: the operation must be repeat-
ed, or not, according to its effects.
   However beneficial the abstraction of blood may
generally  be, either in cutting  short this disease
while in its first stage, or in checking  subsequent
effusion, it is of httle efficacy when  the forma-
tion of false  membranes has taken  place,  and the
thorax is  distended with serum  ; it is only by the 
PLELlixis.                97
employment of emetics every  third  or fourth day,
by the application of  blisters, and especially issues
or setons in several parts ofthe body at once, that ■
the effused fluid can became absorbed ; this then  is
the treatment of chronic pleuritis.   We must bear
in mind that  this disease is  always  tedious, and
that,  therefore, the  patient's  strength  should be
maintained in every way, which does not interfere
with it.
  For thist purpose,  he should take both  solid
and  liquid food,  and  reside  in an apartment kept
regularly  warm;  the exhibition of diuretics and dia-
phoretic  frictions, with the tincture of digitalis and
mercury,  and fumigation ofthe lower limbs, should
also be resorted to.
   If the patient's strength is not too much exhaust-
ed, a small bleeding from the  arm, followed imme-
diately by the employment  of several purgatives,
will be proper, and is sometimes sufficient to effect
the absorption of the effused  blood.   Large  doses
of tartarized antimony are not, according to Laen-
nec, of any decided benefit in chronic pleuritis,  it
should certainly be given to  those only  who  suffer
little from its use.   Lastly,  after every thing else
has  failed,  and  the  general  condition of  the pa-
tient is not such as to make the success of 6uch
an operation improbable, it will be  proper- to have
recourse  to  paracentesis.   After  the operation,
some fluid,  the nature of which may be varied ac-
cording to  circumstances, should be injected into
the cavity of th^ pleura, as one ofthe best means  of
preventing the introduction of air, and the bad effects
which generally result  from  it;  a6  the  lung be-
comes gradually permeable to air, less and less fluid
enters the chest, and at length adhesion is esta-
blished between  the  opposite surfaces  of the
pleura.
   The auxiliary and subordinate measures, of which
                        9 
MS
HYDROTHOKAX.
 we should avail ourselves in the  cure of pleuritis
 during its acute stage, consist in a strict regulation
 of diet, the use of mucilaginous and slightly diapho-
 retic drinks,  and, whenever there exists any cough,
 emulsions, or  draughts, containing sirup of,pop-
 pies, laudanum, &c.
   When  the .invasion of pleuritis  occurs with an
 attack of-fever, which  has been  preceded by a
 shivering fit,  like that of ague, we must lose  no
 time during the intermission in  employing the sul-
 phate of quina in sufficiently large doses to cut short
 the disease at once, even to the  amount of eighteen
 or twenty grains ; for when once fully developed,
 a pleurisy, although connected with an intermittent
 fever,  would not yield to remedies suitable to this
 last affection.—(See Intermittent Fevers.)
   We refer to Arachnitis and Peritonitis for men-
tion ofthe combination of pleuritis, with inflamma-
tion of other serous membranes,  a combination over
which  art can exert little influence.
                HYDROTHORAX.

  After the minute details which  we have entered
into on the  treatment of pleuritis, little remains to
be said on that of hydrothorax; this disease is. how-
ever, much less frequently attended with fever, and
therefore  we  may venture to take a wider  range
in our choice of remedies.   Hamilton recommends
the employment of drastic  purgatives,  and cites
various cases  in proof  of their success.   Digitalis,
in full doses,  either alone or combined with  squill,
calomel,  cream  of tartar, or nitre, in large  quan-
tities,  have all  proved successful in the hands of
different practitioners.   Fumigations  with juniper 
PNEl MOTHOHAX.              99
berries, frictions  with oil, mercury, or tincture ot
cantharides, may also be tried.
  If the patient is plethoric, and the disease con-
nected with some affection of the heart, we should
recommend the abstraction of blood :  this, and the
internal exhibition of squill, the frequent application
of blisters to the chest, and, lastly, paracentesis, con-
stitute the most essential  part of the treatment of
hydrothorax.
               PNEUMOTHORAX.

   As soon  as  pneumothorax has been ascertained
 to exist, it should be our first object, by aromatic
 and spiritous frictions, to promote the  absorption
 ofthe air; cupping should next be practised on the
 chest, and sinapisms or blisters applied to the lower
 extremities, and, lastly, the danger of suffocation is
 to be as far as possible obviated by a suitable posture.
 But when asphyxia is imminent, we must not hesi-
 tate to puncture the thorax for the purpose of giving
 exit to the air contained within it.  When the cause
 of pneumothorax  is a rupture of the air cells, in
 consequence of which the air has accumulated under
 the pleura, and then made its way into  the  cavity
 between the  reflections  of this membrane, there is
much reason to expect success from an operation;
on the contrary, this is very improbable when pneu-
mothorax depends on gangrene of the  pleura, or
on a communication between it and a tubercular
cavity. 
1(H)
ISTHM \
                    ASTHMA.

   Asthma is one of those disorders, the cure of which
 continues  to  baffle  the efforts  of the physician,
 whether, as is'most frequently the case, it exists in
 connexion with some organic disease of the heart
 or lungs, or depends on some merely nervous affec-
 tion.  But, however various in its nature this disease
 may be, the indications we have to  fulfil are always
 the  same, namely,  to  lessen the  severity of the
 patient's sufferings during the fit, and in the inter-
 vals to retard or prevent its return.
   In a paroxysm of asthma, the admission of fresh
 air, placing the patient in an upright posture, and
 loosening  his dress  so as to  render the action of
 the chest as free as possible, are the first things td
 be  attended to.   The  artificial  inflation of air by
 means of a pair of bellows, which is very easily per-
 formed, is of the greatest benefit.  At  the  same
 time,  sinapisms should be applied to the lege, and
 dry cupping glasses  to the base ofthe thorax, while
 friction with aromatic tinctures is practised along
 the vertebral  column.
   When these measures, which may be tried at
 orice, are  insufficient, we should next  give castor,
 sulphuric  ether,  camphor, assafoBtida, or  prussic
 acid.  If the abdomen is tense, and  the patient com-
 plains much of flatulence, a cold infusion of camo-
 mile,  containing a drachm of assafostida, should be
 administered  ; if the bowels are confined, an ounce
 and a half of castor oil, or some infusion of senna,
 should be  added to it.
   When this plan  of treatment fails altogether,-
 there is still  left a powerful and almost immediate
 remedy, viz.  galvanism.  At the H6tel-Dieu  the
 author has had frequent occasion to admire the re-
' marknble efficacy of  this agent  in the cure of * 
vsinxA.               101
ustiima; and those who attend the courses and ex-
periments  of Dr. Andrieux  are  almost daily wit-
nesses of its successful application in this disease.
We have known patients, in whom the paroxysms
were so severe and frequent as £o render it impossi-
ble for them to  engage in any occupation, entirely
restored to health by this means  in the course of a
few weeks.  Galvanism has  also this great advan-
tage over other remedies, that it  maintains respira-
tion  during the  attack, while it often, if employed
regularly, ultimately removes it.   Without hesita-
tion,  therefore, we assign to  it  the highest rank
among  the agents employed in the cure of this
disease.
   When a paroxysm of asthma occurs in a plethoric
habit, disposed to apoplexy, and there appears to be
considerable congestion in the lungs or brain, a small
bleeding from the arm will enable the practitioner
to employ other measures with greater effect.
   It is generally recommended, when the fit is going
off, to promote expectoration, which is often copious,
by tea, ipecacuanha, acetate  of  ammonia, the bal-
sams, preparations of squill, &c.
   In the intervals between the asthmatic paroxysms,
our fir&t object should be to remove, as far as possi-
ble, the exciting causes of it;  for this purpose, we
must study the mfluence of climate, season, winds,
diet, and occupation;  the physical and moral habits,
and even  diseases ofthe patient; thus only can
benefit be derived from medicines.  The  enumera-
tion of all those which have been recommended in
this disease  would  make a long  list; the principal
are valerian, sulphuric and nitric ether, ipecacuanha,
the gum resins, especially assafoetida  and opium,
extract  of hyoscyamus, belladonna,  prussic acid,
colchicum,  myrrh, sub-carbonate  of iron, coffee,
oxide of zinc, chalybeate waters, cold bathing  and
affusion, and, in cases where the  paroxysms return 
102
IfTHMA.
at» regular periods,  sulphate of quina, alone or in
combination with one or other ofthe preceding sub-
stances, according to the particular condition ofthe
individual.   No universal or even general-.rule can
he laid down;  this plan succeeds with one  person,
and that with another; thus, for some time, we are
obliged to feel our way as it were in the  dark, and
experience in each case alone enables us to arrive at
a knowledge-of its Juoantia  Ladentia.   It need
hardlybe remarked, that the mode of treatment just
pointed  out is \ applicable  only to  purely nervous
asthma, and that if there exists any comphcation of
disease of thejieart, lungs, or alimentary canal, our
remedies must be regulated accordingly.
  In every case where the catamenia are  deficient,
or an eruption or discharge of any kind is suppressed,
it is necessary to re-establish it, or supply its place ;
and similar attention must be  paid to the different
regimeneal  precautions relative to  climate, diet,
clothing, and exercise.—(See also Catarrh,  Angina
Pectoris, and other diseases which may be  combined
with asthma.)
  [Among the antispasmodics which have been found
useful in alleviating the paroxysms of asthma, the
author has omitted to mention, perhaps, the most
efficaciousj'namely, the smoke of stramonium inhaled
into the lungs. The employment  of galvanism, as
recommended by French practitioners,  has been
forcibly advocated in this  country by Dr.  Wilson
Philip.] 
108
DISEASES OF  THE HEAR?

    AND LARGE VESSELS.
                  AORTITIS.

  Aortitis, more  than .any  other inflammatory
disease, requires an energetic antiphlogistic treat-
ment, especially when the lining membrane of the
heart becomes involved  in the disease.  In several
cases of this kind which have fallen within our ob-
servation at the Hdtel-Dieu, the symptoms, namely,
extreme  frequency of the "pulse, sense of agony,
dyspnaea, and embarrassment of the pulmonary cir-
culation, have not given way until after four or five
copious bleedings from  the arm, and these  in the
space of a few hours.  Thus then the free abstrac-
tion of blood, repeated at near intervals, the appli-
cation of numerous leeches over the thorax or abdo-
men, according as the thoracic or abdominal portion
ofthe aorta may be affected, the frequent use of hot
pediluvia, acidulated drinks in large quantity, and
absolute rest, form the basis ofthe treatment of this
disease; lastly, digitalis, camphor and nitre  may be
given to calm the irritability of the vascular system,
either alone or in combination, according to the par-
ticular state of the case; however, in order to de-
rive much benefit from  these  medicines, especially
from digitalis, the stomach must be in a  perfectly
healthv condition. 
104
I NDtRATION  A.VD
         ANEURISM OP  THE AORTA.

   Ofthe various methods of cure which have been
employed in this dreadful disease, none has acquired
such general reputation as that of Valsalva.   All
other things being equal, the chances of success are
so much the greater, as the treatment begins early;
hence the necessity of a careful and minute exami-
nation the moment  that we suspect  any disease of
the heart or large vessels, especially if any tumour
is externally visible.
  The treatment of aortal aneurism being the same
as that of dilatation and hypertrophy of the heart,
we refer  to the  chapter on  these  subjects for a
description of the plan of  Valsalva and  Albertini,
simply remarking here, that when there is any ex-
ternal  protrusion, the application of ice  is very
beneficial.
 INDURATION AND VEGETATIONS OF THE
                   VALVES.

  Like  every  other disease  which  disturbs  the
functions of circulation and respiration, indurations
and excrescences of the valves of the heart require
the employment of  general  bleeding, as  soon as
the disease has attained any considerable degree of  -*
severity.  The abstraction of blood  should  be so
much the  less copious, as the disease is further ad-
vanced, and the general state of the  patient unfa-
vourable to the loss.   Leeches applied to the region
ofthe heart and to the anus, are very serviceable in
the intervals between general bleedings, or when the
vascular system is too full to bear it.  This, with
rigid abstinence, rest, and the copious use of diluents, 
           VEGETATION OF VALVES.         105

is all that is necessary in the absence of any leuco-
phlegmatic tendency;  but when disease of the heart
das arrived at its last stage, we may employ diu-
retics,  aperients,  the uva?  ursi,  nitre,  acetate of
potash, squill, iodine, digitalis, acetate of ammonia,
whey, and white wine; equates shpuld also be pre-
scribed, if necessary, to produce sleep at night;  a
combination of digitalis, with camphor, valerian, and
orange  leaves, is often very beneficial: we have
even, in some cases, known the almost perfect ces-
sation  of  dyspnoea  and palpitation follow  its use.  .
Unhappily this alleviation is only temporary.
   When these is much dyspnoea, absolute rest, the
upright posture, ami applying cupping glasses to
the thighs, and a blister over  the sternum, enable
the patient, for a time, to breath more freely.  The *
same may be  said of the employment, during the
latter stages of disease ofthe heart, of drastic pur-
gatives, a.s gamboge, croton oil. and tartar emetic.
We ought, however, before  exhibiting these violent
medicines, to ascertain tfie condition of the alimen-
tary ca nal, and assure ourselves" that no inflamma-
tion exists : in this case, the powerful revulsion, of
which the intestines are thus made the seat, con-
siderably  lessens the severity of  the  symptoms.
Ipecacuanha,  given  as an emetic, often produces
sknik r el teets.
   There is still another method of treatment, which
it would be improper not to  mention, and which we
have known to be successful in cases abandoned, as
hopeless, by the most eminent physicians.  It is pe-
culiarly adapted to jiersons of a nervous tempera-
ment, and to cases in which  the pulmonary system
is less affected than  the heart, the primary seat of
disease.
   In these cases, after a patient has been  so much
exhausted by the freqtient and copieus abstraction
of blood, as to make it dangerous to persevere any 
106
PERICARDITIS.
longer in tliis plan of treatment, and the progress
of the disease has been in no degree arrested by it;
the use of cold or tepid baths, according to the pa-
tient's inclination, has moderated the action of the
heart, and all the secondary symptoms  have gra-
dually diminished ; the power of digestion, which was
before extremely imperfect, has  returned, and in
many instances  the patient has continued to live a
long time in a very comfortable state, and in some
few instances has perfectly recovered.  Lastly, it is
proper to advise persons in whom the symptoms of
induration of the valves  have been detected, to re-
frain from any exertion in the slightest degree fa-
tiguing,  as running,  riding fast, walking up hill:
such  a person should maintain the utmost tempe-
rance and regularity in his habits, totally abstaining
from  wine, coffee, and every other  stimulant; in  a
word, he must guard against every thing, the in-
fluence of which extends  directly, or indirectly, to
the central organ of circulation.
                PERICARDITIS.

  This disease, though in the highest degree dan-
gerous, ought not to be regarded as incurable.  The
numerous instances in which we detect the  exist-
ence of pericarditis, on the post mortem examination
of persons who have died  m consequence of other
affections, is a sufficient authority for this assertion ;
and the inference is fairly deducible, not only that
pericarditis is often unsuspected during life, but also,
that so far from being necessarily,  and invariably,
fatal,  is often recovered from, even  when no treat-
ment has been directly aimed  against it.  On this
ground, therefore, we do not hesitate to recommend,
as a general rule, that in every case of pain '" ♦•"* 
PERICARDII la.             107
 region of the heart, accompanied with fever, active
 and powerful measures  should  be  adopted,  begin-
 ning with a large bleeding  from the arm, and fol-
 lowing it up by the application of twenty-five or
 thirty leeches, applying, afterwards, cupping glasses
 to promote still further the flow of blood.
   If, notwithstanding, the symptoms of pericarditis
 remain, or are not sufficiently mitigated to remove
 all apprehension, venesection must'be practised a
 second time, provided that the patient's strength is
 ever so little adequate to it; and, on this point, we
 must not be guided by thedevelopement ofthe pulse,
 but  by the general condition of the patient.  Im-
- mediately after this operation, a large blister should
 be  placed on the left side of the thorax,  merely
 leaving just room enough for the further application
 of leeches, if the violence of  the febrile reaction
 and the heat of the skin should make the antiphlo-
 gistic plan still necessary.
   But if  no impression should seem to be made on
 {he disease by these active measures,  it will be ne-
 cessary, while the pericarditis is still under  the in-
 fluence of medicine,  and affusion  has only com-
 menced, to set up in the alimentary canal, even at
 the risk of exciting a  gastro-enteritis, such a coun-
 ter-irritation  as shall  arrest  its  progress; for what
 is the danger of gastro-enteritis, compared to that
 of inflammation in the pericardium ?   Injections of
 tartarized antimony should therefore be administered
 for two or three  days  successively, or this medicine
 may be taken into the stomach in doses varying from
 twelve  to twenty-four grains.
   As soon as the symptoms of pericarditis appear to
 become milder, a constant  revulsion towards the
 lower limbs should be  maintained by a series of blis-
 ters, renewed every day; the bowels at  the same
 time being kept open  by aperient laxatives,  unless
 these medicines are decidedly contra-indicated : in 
1U8     dropsv  or mi:  pericardii; m.

this way, we may prevent the progress ofthe serous
effusion, which pericarditis  ijways has a tendency
to excite, or  at  least, promote adhesion.   After-
wards, the use of demulcent fluids, the strictest re-
gulation;of diet, so long as any fever remains, and
perfect rest, will  complete the cure  of acute peri-
carditis.
  But  when this inflammation  is  passing  into  a
chronic stage, we must have recourse to mercurial
frictions, carried even to salivation, insert a seton,
or issue, over the pracordial region, prescribe lax-
atives, diuretics, and sudorifics, as squill, digitalis,
nitre, ipecacuanha, Dover's powder, and, lastly,  if
these measures fail, puncture the pericardium in the
manner we shall presently describe.
      DROPSY  OF  THE  PERICARDIUM.

  Having already detailed the preventive treatment
of this affection, nothing further remains to be men-
tioned respecting it, except to describe the  opera
tion which has been proposed by several authors for
the cure of it.   The manner  in which Laennec re-
commends that  it  should be  performed,  is by per-
forating the  sternum with the crown of a trepan,
below the xyphoid cartilage;  that region  of the
thorax being, according to this  physician, the most
favourably situated, as enabling the operator to feel
and see the pericardium, before puncturing it.  De
sault, in both the instances in which he opened this
sac, made his incision between the cartilages of the
sixth  and  seventh left ribs ; but, before attempting
such  an operation,' which however is regarded by
some  practitioners  as free from  danger, it will be
advisable  to  ascertain positively the  existence of
fluid in  the pericardium, by a  slight  puncture with a 
'*.
         UM'EKTKOPHi  OF THE HEART.     109

very fine trocar.  After having  emptied the sac,
the operator should inject  into it some ir:ild unirri-
tating fluid, gradually diminishing the  quantity at
each time of injection, which will prevent the access
of air, and all the tiad consequences of its contact
with a serous caviry>
      HYPERTROPHY  OF THE HEART.

  Of all  the organic affections of the heart, hyper-
trophy, whether simple or combined with dilatation,
is the most susceptible of cure.   But in order to at-
tain this  desirable  object, an antiphlogistic plan of
treatment  must be rigorously pursued to its utmost
extent, before infiltration ofthe different tissues has
supervened.                                       %
  We are  now about to detail the method  adopted
by Valsalva and Albertini, in the.treatment  of aneu-
risms, a method which, at the present day,  is gene-
rally allowed  to be the most  useful.  In  the first
place,  the  patient  is bled copiously  from the arm,
and the operation  is repeated every third or fourth
day, or at  longer or  shorter intervals, according to
the  severity  of the  symptoms,  until  palpitation
ceases, and on application of the stethoscope, the
action ofthe heart communicates a very  feeble im-
pulse.  At the same time, the quantity of footf must
be diminished, and gradually reduced to six  or eight
ounces per diem, until the patient is made  so Veak
as scarcely to be able to  walk.  During the whole
of this period, perfect rest in bed is indispensable ; (
and an issueaor seton may be inserted in the  preecort
dial region  as a useful auxiliary measure.   This se--
vere treatment must be persevered in, even for seve-
ral months  after every symptom of disease in  the
heart has disappeared; we may then begin, gradual-
                       19 
 110      HYPERTROPHY Ol  THE HEART.

 ly, to increase the allowance of food, but the patient
 must not be permitted* before  'the end of a year, to
 return to his old habits of active  life, and he must
 confine himself to such occupations as are suitable
 to the nature of his disease.
   Wiien hypertrophy has already gone on to general
 infiltration, venesection is still useful to assist the
 operation of diuretics, and lessen  dyspnoea and pal-
 pitation ; while, on the other hand, nitre, digitalis,
prussic acid, squill, acetate of potash and purgatives
 should be given, for the purpose  of removing  the
leucophlegmatic condition ofthe patient.  Lastly, the
 catarrh, and oedema of the lungs,  which almost in-
 variably attend dilatation and hypertrophy of the
 heart, must be treated  according  to the principles
 already laid down, in treating of these affections.
 Prussic acid, preparations of opium and hyosciamus,
 are eminently  serviceable in  allaying cough and
enabling the patient to rest at night.
  When disease  of the  heart is confined to simple
dilatation, without hypertrophy, bleeding should be
employed with much greater caution, and restricted
to those instances in which an unusual severity of
 the symptoms require it.  Bitters, the various  pre-
 parations of iron, as the sub-carbonate, iron filings,
 chalybeate waters,  cinchona, &c, should be em-
 ployed in preference: in cases of this kind, we have
 seen very decided alleviation follow the use of vale-
 rian, cold bathing, and  the various antispasmodics,
 as  musk, camphor,  &c.   When  dilatation  of the
 hearths a consequence ofthe  contraction of its ori-
 fices, or any affection of the lung or pleura, our
 treatment should be principally directed to the ori-
 ginal disease. 
I'AROITIh.       «        111
                 -  CARDITIS.

  This  inflammation  requires  the  most energetic
antiphlogistic treatment, and success depends on the
activity with which it is employed.   In the first
place, a large quantity of blood must be drawn from
the arm, the operation being repeated several times,
and at short intervals, until the action of the heart
has returned  to its  natural frequency and  force.—
After having thus arrested the  further progress of
inflammation, and prevented congestion of the lungs,
leeches should be applied in great numbers, over the
prajcordia, which should be Kept  continually below
the  natural temperature, by the constant  applica-
tion of wet cloths, or a bladder containing ice.  In
the meanwhile,  the feet should  be bathed several
times during the day in hot water, impregnated with
mustard, and purgative  injections  administered,
which, by acting exclusively on the  large intestines,
may be employed without exciting vascular  reac-
tion.   When the pulse has become decidedly less
quick and forcible, we may safely have recourse to
blisters, applied to the inner side  of the thighs.  A
very spare diet, drinking copiously of mild fluids,
quietude of mind, and absolute rest, are very impor-
tant auxiliary measures.   See also Pericarditis.
                 PALPITATION.

  The first thing that should be attended to in the
cure of palpitation, is to ascertain its cause, as  our
treatment must vary  accordingly.   If it either de-
pends upon, or is connected with a plethoric state,
if it follows the suppression  of some discharge of
blood,  whether  menstrual, uterine,  hemorrhoidal, 
112
I'ALPl'I Al'lU.V
or nasal, natural or accidental, it is neeessary to take
blood from a vein,  and to supply the place of the
deficient emunctory by leeches, baths, &c.
   Where  palpitation appears to have been  induced
by excessive nervous susceptibility, as is often ob-
served in hysterical females, hypochondriacs, and in
those persons usually called nervous, the measures,
from the adoption of which we  may principally hope
for success, are tepid or cold bathing, according to
the inclination of the patient, dashing over  the face
cool water, the internal exhibition of digitalis, alone
or in combination with camphor, assafoetida in pills
or injection, valerian, cinchona, castor, subcarbonate
of iron, hydrocyanic  acid, sulphuric ether, tincture
of opium,  &c.  It is also proper to recommend that
every article of food, whether solid or liquid, should
be taken cold.   But if  this  complaint has  been
brought on by violent exercise, excess in study, ve-
nereal intemperance, or the use of stimulating food,
as spiritous liquors  or coffee, if it is dependent on
continued mental  uneasiness, powerful  passions,
&c.,it  is  essential  to the  recovery ofthe  patient,
that he should abandon his bad habits, and,  as far
as is in his power, regulate his passions.  Every thing
depends on the patient; the physician is called upon
to do nothing but silently look  on;  unless a change
in the tatient's habits of life is insufficient  to effect
a corresponding change in the  disease, and  then the
plan ol treatment already detailed,must be pursued.
   VV heo  palpitation follows the  repression  of gout,
rheiuniiism, ringworm, or sick head-ache, either the
original lipase must be brought back, or an artifi-
cial disciiarge substituted for it. 
4Y.NCOPI-;
11H
                  SYNCOPE.

  The first thing necessary in idiopathic syncope,
arising from some momentary or accidental cause, is
to place  the  patient in the horizontal posture, and
throw cold water over his face ; his dress should be
loosened, so as to assist respiration, and a current of
fresh cool air freely admitted ;  if these measures are
not sufficient, volatile and  pungent substances,  as
ether, ammonia, and eau de Cologne,should be held to
the nose, and the temples, lips, and nostrils rubbed
with  them.  As  soon  as consciousness returns, a
small quantity  of wine, cold  pure water, or some
aromatic  distilled water, containing  ten or twelve
drops of ether, or^some aromatic tincture, should be
administered.
  If syncope continues a longjtime, and,'nothing in-
dicates the existence of an internal hemorrhage,  in
which  case it would be  necessary  to  draw  blood
from the arm, wejnust endeavour to arouse the pa-
tient from this state, which is becoming alarming,
by frictions of the tincture of cantharides, ammoni-
aeal liniment, or hot spirit of camphor at the  precor-
dial region, and  along the inner side of the thighs;
by irritating enemata, and even by the application of
boiling water or moxa to the epigastrium.^  Symp-
tomatic syncope  will be spoken of under  the dis-
eases of which it is a consequence.
             ANGINA  PECTORIS.

  Angina pectoris is not"only,'in common with'most
affections of the nervous system,  a very intractible
disease, but from the importance of the organs sup-
plied by the affected nerves, it is in the highest de-
                     10* 
114
A > GIN A P1CT0RI?.
gree alarming, and often fatal; for, besides the im-
mediate dangbr attending each paroxysm, we have
also to dread the more distant consequences of their
frequent repetition, namely, organic disease of the
heart and  its connexions.   Moreover, the most ra-
tional and judicious plans of treatment hitherto de-
vised, almost invariably  fail.   It is, then, only be-
fore the paroxysms have become  very violent, and
while  the  disease is so recent that it has not become
habitual, that we can expect to root it out.
  For this purpose, it is necessary  to inquire into
the circumstances to which the  disease  owes  its
origin, those which exert any influence over the re-
turn ofthe paroxysms, the previous diseases the pa-
tient may  have laboured under, and his habits and
state of mind, and regulate our treatment accord-
ingly ; removing him, as far as possible, from the in-
fluence of the various causes which are likely  to
bring  on a fit, and re-establishing the diseases or se-
cretions which may have been repressed, or at least
supplying  their place by permanent artificial dis-
charges.   The patient should  always  walk slowly,
avoid  much exertion, restrict himself to a light and
Bparing diet and   regimen,  guard  against mental
agitation,  which almost always exercises an unfa-
vourable influence  over  this disease, and, in  short,
avoid  the  circumstances which favour a return of
the attack.
  Most of the remedies hitherto employed against4
angina pectoris, belong to the  class of antispasmo-
dics;  they are, camphor, guaiacum, castor, opium,
alone  or in combination with tartarized antimony, in
pills, containing half a grain of each, hydrocyanic
acid, the extracts  of conium,  and  hyosciamus, oil
of amber,  ether, the sulphate and oxide of zinc, and
infusions  of valerian, camomile, arnica  montana,
&c.;  each of these medicines  has appeared benefi-
cial in different instances, but their effects have not 
AM> IX A  PECTORIS.
\\U
been decided enough to induce us to select any one
as much superior to the others, except hi those cases
where there is very severe pain, and then, the pre-
ference should be given to narcotics : the best time
for their exhibition is the evening, a little before the
patient goes to bed.
  Much benefit has been occasionally derived from
rubbing in, below the sternum, either the oxyinu-
riate of mercury, mixed up with lard, in the propor-
tion of six grams  to an ounce, or the tartar emetic
ointment: m other instances,  blistering, cupping,
and the insertion of setons in the chest, have afford-
ed relief.   According to Laennec, the application of
two powerfully magnetic plates, the  one over the
  Erecordia, the other at  the opposite point, is often
  eneficial.
   In individuals of feeble constitution, cold bathing,
chalybeates, bitter tonics, cinchona, rhubarb, gen
tian, rich wines, and nourishing food, are necessary ;
if tbey have previously had an attack of rheumatism,
vapour baths, stramonium, the Aconitum  Napellus,
and Dover's powder, should be employed.   When
there is  great irritability of the nervous system,
while the lungs are  unaffected, cold  bathing, affu-
sions, valerian, assafoetida, musk, and castor, are pre-
ferable.  Lastly, if the  patient is  plethoric, blood
should be taken from the arm, and diluent and re-
frigerating liquids, with digitalis,  prescribed.
  During a paroxysm, we should have recourse  to
pediluvia  containing  muriatic  acid,  sinapisms,  or
what is better, to galvanism,  in the manner de-
scribed in  the chapter on asthma.  Dr.  Andrieux
has pubhshed some  very curious facts respecting
this subject, in his memoir on galvanism.*
  * See Revue Medicate and Journal dc Clenique, tome i. rnee
9U, annee 1894. 
 ' 10          \;ycix\ PECTORIS.

   The bowels  should  be kept open  by castor oil,
seidlitz water,  &c.  If any tendency to hypertro-
phy of the Mart exists,  a small quantity of blood
should be occasionally taken, by the lancet,  and an
issue inserted in the arm :  should the patient com-
plain of indigestion, greater attention must be paid
to his diet;  hot food should be  prohibited, and a
little aromatic water, or a small quantity of magne-
sia, may be given after meals, to prevent flatulence,
which is verv common in this disease.. 
Ill
DISEASES OF THE ABDOMEN.
DISEASES  OF  THE ALIMENTARY  CANAL..

               STOMATITIS.

  When inflammation of the  gums, or any other
part of the mucous membrane of the mouth, is at-
tended with considerable pain and tumefaction, it is
necessary to apply twelve or fifteen leeches to the
corresponding part of the jaw, or a smaller number
on the inflamed gums: sometimes, simply scarify-
ing them will answer the same  purpose; this, in
conjunction with the diligent use of pediluvia, poul-
tices to the cheek and tepid demulcent gargles, and
flannels around the head, will generally prove suffi-
cient.  When a carious  tooth is the  cause of the
mischief, it is better, first, to remove the inflamma-
tion, and to extract the tooth afterwards.
   In  the couenneuse stomatitis,  which, in  other
respects, requires the same treatment, the mucous
surface should be smeared, by means of a camel's
hair pencil, with a paste  formed of equal parts of
honey and muriatic acid;  and  if there are any small
superficial  ulcers, they should be touched with a
stick  of the nitrate of silver, pointed  like a pencil.
   When inflammation of the mouth leads to the
secretion of pulpy matter, it should be removed by
a  pair of forceps, or lint, carefully guarding against
injury to the  mucous membrane, and  the  mouth
washed with acidulated gargles.
   If the inflammation assumes  a gangrenous charac-
ter, the mouth is to be gargled with a solution of 
118                APHTH-E.
chloride of soda, mixed with decoction of bark <
this should be used as often as the patient wishes to
drink, in order to prevent the samous matter from
passing into the stomach:  the shreds should be re-
moved  by a pair of scissors or forceps, and the af-
fected parts sponged with a  pledget of lint imbued
with  lemon juice,  or diluted munatic acid, always
taking care to wash the mouth thoroughly afterwards.
  When this affection has been occasioned by mer-
cury, and is accompanied with  profuse salivation,
and remarkable fetor of the breath,  it is proper to
apply leeches once or twice  below the angle of the
jaw, and to prescribe gargles containing the decoc-
tion of  cinchona, or the bark of the pomegranate
tree, the  vinum opii, a solution of the sulphate of
zinc,  acetate of lead, or ofthe chloride of soda;  at
the same time, acting on the alimentary canal, by
means of laxatives.
  Fungous growths on the gums, in the chronic
stage of this disease, should be well  cauterized, or
they will be continually  springing up afresh.
                   APHTHAE.

  The treatment of aphtha?  is extremely simple,
consisting in nothing more than regimeneal precau-
tions, and the use of detergent washes, applied by
means of a camel's hair pencil, to the affected  parts:
for this purpose, we frequently, and with great suc-
cees,  employ a  weak solution of the chloruret of
soda.   Infants at the breast,  however,  will  derive
little benefit from any local application, without the
milk of a good nurse.   If the aphtha? are connected
with  a pustular, or  erysipelatous inflammation of
the remainder of the alimentary canal,  our  atten-
tion should be principally directed to this last affec-
tion.  See Gastro-enterith: 
(TRANCHE 10-NMLLAK1S,ETC.      llfj
              ■   GLOSSITIS.      f

  When inllammation ofthe muscular substance of
the tongue is considerable, blood must be promptly
drawn from  the arm, especially if any fever exists
along with it, at the same time applying leeches
around the jaw, and even at the sides ofthe tongue
if possible, and establishing a salutary revulsion, by
means of drastic purgatives, emetics, and mustard
pediluvia. If, notwithstanding, the  tumefaction of
the tongue increases, the patient complains much of
painful thirst, and is totally unable to  swallow, we
must endeavour to supply the place of drinking by
baths, injections, and keeping the tongue moist with
lemon juice  :  when suffocation appears imminent,
deep incisions must be made along the sides of the
tongue, and, if that is not sufficient, our last re-
source is in the performance of tracheotomy.
  For the treatment of suppuration,  gangrene, and
cancer of the tongue, we refer to the Manual  of
Clinical Surgery ; these affections not coming un-
der the care  of the physician.
CYNANCHE TONSILLARIS AND PHARYNGEA-

  In a  slight attack, unattended with fever, no-
thing more is required than the use of demulcent,
astringent, or acidulated gargles ; as, for instance,
the decoction of mallow, barley, or the bark of the
pomegranate, acidulated with vinegar or syrup of
mulberries, a solution of alum, and  lozenges made
of this salt and sugar, are also beneficial: along with
gargles, injections, mustard pediluvia  morning and
evening, hot  emollient cataplasms to the neck, and
inhalations ofthe vapour of boiling water, are to be
Employed. 
12.0      CYNANtllE TOtVSlLLARIS, ETC.

  But when the inflammation is more  considerable,
with severe^pain and fever, its progress  must be
opposed by more  vigorous  measures :  in this case,
if the tongue is clean, or only  slightly furred, and
nothing decidedly indicates a disordered condition
of the prima? via?, the first thing necessary is, the
apphcation of twenty or thirty leeches, according to
the severity ofthe complaint, and apparent strength
of the patient.  If the general symptoms of inflam-
mation exist to any  great  extent,  if there are any
indications of a plethoric habit, or of cerebral  con-
gestion, it will be advisable to abstract blood co-
piously from the arm before applying leeches.  The
effect ofthe bleeding will be promoted by the appli-
cation of emollient poultices, mustard pediluvia, and
the use of slightly laxative drinks, such as a solution
ofthe supertartrate of potash, a decoction of tama-
rinds, &c.; also, by purgative injections, unles diar-
rhoea, or some other symptom of intestinal irritation,
should be present.   Should any pain remain  after
the first application of leeches, they  must be at once
repeated,  and our subsequent treatment regulated
by the effect.
   But when cynanche is connected  with disorder of
the digestive organs; when  the tongue is covered
with a thick fur, and the patient has long complain-
ed of want of appetite, it would be  very injudicious
to adopt an antiphlogistic plan of treatment, which
would not exert  any influence over the complaint,
and would weaken the patient to no  purpose; on the
contrary,  our principal object in such circumstances,
is to clear out the primes vice; especially if the dis-
eases prevalent  at the time admit  the employment
of evacuants.  Thus, we should at once prescribe
an emetic of ipecacuanha, or an injection of tarta-
rized antimony, with half an ounce of the supertar-
trate pf potash, or sulphate of magnesia.   The al-
most immediate cessation of the symptoms of disor- 
         CYNANCHE lo.VSILLAHIS, &.C.      121

der in the digestive organs, as well as of the inflam-
mation in the throat, and the return of appetite, will
show the  propriety of this treatment.   Acidulated
or laxative drinks and purgatives will, afterwards,
be sufficient in many of these cases.
  It not unfrequently  happens, that inflammation is
combined with  bilious saburral  condition of the
prima vice, and that  the cynanche quickly disap-
pears when the employment ofthe lancet, or leeches,
precedes  that of emetics or injections; or, when,
on the contrary, these evacuants  precede the ab-
straction of blood, according as one or other morbid
condition may happen to  preponderate.  This ob-
servation applies not merely to individual cases, but
to whole epidemics;  thus,  I have seen numerous
cases of cynanche cured at once by emetics, when
the abstraction of blood had been previously made,
while others, in which  this preparatory measure
was omitted, have been, comparatively, unaffected
by them,  and vice versa.   Nothing but ignorance
or the prejudices of system, can cast a doubt on
a point  which has been long determined by the
most able physicians.  As  soon as suppuration of
the  tonsils has occurred,  the matter should  be
evacuated;  after  which,  demulcent   gargles are
necessary.
  Chronic inflammation  of the  velum  palati and
tonsils, requires, in addition to the treatment which
we have just described, the application of a  blister
to the nucha, and in some cases, partial  excision of
the indurated glands, or uvula. See also Stomatitis,
Angina Laryngea, Scarlatina.
11 
I'M
ANGINA PLLTACEA.
  ANGINA PULTACEA, AND COUENNEUSE,

  The  danger to be apprehended  from  angina
couenneuse arises principally from two circumstances,
namely, the extent of the affected surface, and the
imperfect transmission of air through the respiratory
tubes, when, as often happens, they become secon-
darily affected.  The fetid smell of the false mem-
branes and mouth, similar to that observed in ptya-
lism, is occasioned by an  accidental modification in
the secretions, not, in any degree, by mortification
of the affected parts, as  in  angina  gangrenosa; so
that although this inflammation appears, and, under
certain circumstances, is very dangerous, sometimes
terminating fatally in the course of  three or four
days; yet, generally, the treatment of it is success-
ful, especially when conducted in the manner which
we are about to describe.
  If the inflammation is considerable,  the breathing
laborious, and the patient comatose ; and if there is
any appearance of cerebral  and pulmonary conges-
tion, blood must be taken from the arm, and leeches
to the number of thirty, forty, or fifty, in a robust
and youthful habit, must subsequently be applied
round the  throat.  By this  active  treatment it is
sometimes possible to cut short the disease, and pre-
vent the formation of false membranes.  We  must
not hesitate to employ leeches or  the  lancet two
or  three times, if necessary.  Along with  these
measures should be associated blisters to the neck,
nucha, and front of the chest,  and sinapisms to the
inferior extremities, while the bowels are stimulated
by drastic purgatives.
  If, after having pursued  this plan  of treatment
until we have  arrested the inflammation,  or ex-
haused the patient's strength, recovery is prevented
solely in consequence of false membranes, we  must 
              ANC1NA PtLTACEA.            123

endeavour to effect their removal  by the  exhibition
of an emetic every second hour;  the same purpose
may be answered, though in a different way, by fre-
quently touching the  membranous  shreds  with a
paste, containing equal parts of muriatic acid and
the honey of roses; also, by blowing alum agamst
the back part ofthe throat.
  The use of antispasmodics, as musk, castor, cam-
phor, assafoetida, should be limited to those cases in
which some troublesome  symptom, connected only
indirectly with the original disease,  occurs in a ner-
vous habit of body:  then this class of medicines may
be administered with propriety, either by injections,
or by the skin deprived of its cuticle, if deglutition
is so difficult as  to prevent their being taken  by the
mouth.  See also the words Croup and Cynanche
Laryngea.
   It is scarcely necessary to  remark,  that if the
attack is slight, our treatment should  correspond
with it, and be restricted  to simple  applications, as
gargles, poultices to the neck, pediluvia, and a few
leeches.
   Cynanche pultacea, being generally a less serious
affection than the other, requires a less active treat-
ment.  The mouth must be cleansed with pledgets
of lint, and washed with acidulated gargles, espe-
cially of muriatic acid; and blisters should be appl ied
to the inferior  extremities.   It  would not  be  ad-
visable to abstract blood, unless the patient were
robust, or threatened with cerebral congestion or
inflammation; on the contrary, the  employment of
cinchona, and a tonic treatment,should be preferred.
 for an asthenic diathesis, especially in infants, ap-
 pears to be more intimately connected with this,
 than with th<? other  species of cynanche. 
IM--J        CYNANCHK li»\(;RK\'i»l.
          CYNANCHE GANGRENOSA.

  If malignant sore throat were the result of a very
high degree of inflammation, it would  be  easy to
prevent the developement of it by  attacking this
inflammation;  but this is not the case.   Its putrid
nature requires, from  the very commencement, a
stimulating and alterative plan of treatment, which,
however, is generally too slow in its operation to be
successful, on account of the rapidity with which
sloughs are formed.  Thus, we would  advise  the
practitioner to wait a little before he has recourse to
the abstraction of blood, when a pain in the throat
arises during the.prevalence of an  epidemic malig-
nant cynanche, when  it occurs in children, or very
delicate females, in any one who has been nurse to
a patient with this complaint, or has himself gangre-
nous spots on any part of his body, or when it occurs
along with any eruption of a livid hue.
  As  soon as we are satisfied  respecting the cha-
racter ofthe cynanche, our efforts must be directed
to the preventing of gangrene by emetics of ipeca-
cuanha, drawing in with the breath powdered alum,
or calomel, so as to  affect the back of  the throat
with it, directing the vapour of ether and ammonia,
or fumigations  of chlorine, towards this part, by
gargles, containing the chloride of soda, cinchona,
camphor, or horse radish, and all the other medicines
Of this  description.  At  the same time we  must
avail ourselves ofthe  repeated applications of sina-
pisms  to the extremities,  avoiding blisters, which
are apt to occasion gangrene of the 6kin : the body
should be rubbed with tincture of cinchona, or spirit
of camphor, while the patient takes rich wines,
acidulated  drinks,  decoction of bark, a solution of
the chloride of soda, sulphate  of quina,  camphor,
mupk, acetate of ammonia, sulphuric ether, and any 
                 INDIt-KSTION.              I'lb

other diffusible  stimulants which appear to agree
with the patient.
  As gangrene appears in the  back of the throat,
or,  even after the  complete formation of specks,
they should  be thoroughly  touched  with some
caustic application, as sulphuric acid, (in the propor-
tion of thirty or  forty drops in an ounce of honeyj)
muriatic acid, muriate  or nitrate of mercury, &c.
always  taking care to wash the  mouth thoroughly
afterwards.  In  other  respects, the internal treat-
ment resembles that  which we have just described.
  The patient should breathe a fresh  and  dry air,
and it may be useful to place basins, containing a
solution of the chloride  of  lime, around the  bed.
Lastly, when the sloughs begin to separate, the
same means must be employed  as in inflammation
of the gums.
                INDIGESTION.

  The treatment  of indigestion varies  with the
cause of it; thus,  when it is occasioned merely by
an  overloaded  state ofthe stomach,  nothing more
is necessary than to  walk out for some time in the
open air, drink copiously of diluent and gently stimu-
lating fluids, as infusion of camomile, tea, &c.  and
to unload the bowels by one or two injections;  if
these measures are not sufficient, vomiting, excited
by a grain of tartarized antimony, or by tickling the
uvula, may be resorted to.
  If, on the contrary, indigestion is to be attributed
to some bad quality ofthe food, or to poisonous  sub-
stances  having been mixed with it, no time should
be "lost in evacuating the stomach by an emetic or
oesophagus sound,  the subsequent treatment being
                       11* 
I2G
GASTRIUS.
regulated by the nature of these substances.—(See
the chapters on Poisoning.)
  When indigestion arises from temporary debility
of the stomach, as in consequence  of some power-
ful mental emotion, and after a very moderate use of
digestible food, it is necesary to give stimulants, or
antispasmodics, as ether, brandy, opium, &c.
  The treatment of indigestion, when symptomatic
of some disease ofthe stomach, or other organ, and
accompanying an attack of apoplexy or gout, is in-
cluded in that of the primary affection.   (See Gas-
tritis, Qastrodynia.)
                 GASTRITIS.

  While this inflammation is but slight, the simple
abstraction of every thing  hurtful is sufficient to
cure it.  The patient should drink freely of muci-
laginous  and acidulated liquids, and abstain  from
solid food;  the functions ofthe skin being promoted
by baths or pediluvia, and the  bowels kept open by
enemata.
  But if there is much pain, with a frequent pulse
and hot skin, and the tongue is florid and becoming
dry, it will be necessary, in  addition to these simple
measures,  to  direct the  application  of fifteen or
twenty leeches to the epigastrium, or in a larger or
smaller number, according to the severity of the
symptoms, the age, strength,  constitution, and pe-
culiar habits of the patient, having recourse to them
two or three times successively, if the inflammation
does not yield; when the leeches have fallen  off, a
large poultice should be  placed over the abdomen,
or if the weight  of this  produces  uneasiness, hot
fomentations may be substituted. But if the skin
is pungently hot, and the patient complains much of 
i.AfeTKrm.
121
thirst, considerable benefit may be derived from the
application of cloths, wrung out of cold acidulated
water, and from allowing the patient to gratify his
thirst in a similar way.
  If the inflammation is attended with high fever,
occurs in a plethoric habit of body, or in persons
dwelhng in situations  where  inflammatory com-
plaints generally assume a severe character, it is
most prudent to draw a moderate quantity of blood
from the arm, before trusting wholly to leeches and
tepid baths.  This rule is also applicable in cases of
gastritis,  occasioned by the patient having taken
some acrid and highly stimulating substance, which
is likely to excite inflammation over a  large surface
of the intestinal canal; in this case  it will  be  also
advisable to clear out the bowels by a mild aperient.
   When gastritis is  attended with frequent  vomit-
ing, which does not  appear to depend  upon inflam-
mation  of the brain, or any poisonous substance,
after we have ineffectually attempted to check it by
leeches, poultices, and cold applications, recourse
is to be had to the  warm, bath, which the patient
should use frequently :  he should be allowed to take
ices, suck the juice of lemons and oranges, and if
these means fail, fifteen or thirty drops of tbe  tinc-
ture of opium  may be prescribed.  Lastly,  the ap-
plication of blisters  to the extremities, and the in-
ternal exhibition of magnesia, subnitrate of bismuth,
and carbonic acid,  may succeed in removing this
distressing symptom.
   Gastritis sometimes occurs, with  a very small
pulse, considerable pain in the  stomach,  and a ten-
dency to  syncope, but  without febrile reaction, and
 with a cold skin. These cases require,  in the first
place, the evacuation ofthe contents of the stomach,
by titillation of the  uvula,  or by introducing a pro-
bang into the oesophagus, sinapisms to the extremi-
ties, and poultices to the abdomen, or friction  with 
las
GASTRITIS,
 aromatic tinctures,  spirit of  camphor, ethor, &c.
 The use of the warm bath and the abstraction of
 blood must be deferred till a later period,  when the
 skin has regained its warmth, and febrile reaction is
 established.  Whatever  measures  we adopt,  par-
 ticular attention should be paid to the effects  pro-
 duced by them, that they may be  discontinued or
 modified if necessary.  We  need not say more at
 present about this form of gastritis, as we shall have
 occasion to speak again  of it,  when on the subject
 of poisoning.
  In proportion as  the  symptoms  of gastritis be-
 come weaker, th% mucilaginous fluids to which the
 patient has been restricted may be exchanged for
 such as are  more nourishing, even slightly tonic.
 We must proceed cautiously, yet with more anxiety,
 to find out  what may suit each individual case, than
 to conform to any theoretical rule.
  Acidulated drinks, barley water, gruel, rice water,
 panada, boiled rice, will be proper m the first place;
 then mild bitters, as camomile, chalybeate waters,
 milk, &c.  This will enable  the  patient to return
 sooner, and with more safety, to his ordinary diet,
 and will prevent the stomach from falling into a state
 of too great atony;  but it must be continually kept
 in mind, that the greatest care is necessary iri regu-
 lating the diet of convalescents, and that instances
 of relapse  daily occur,  in consequence of giving
nourishing  food too soon.
  When gastritis has  passed into a chronic stage,
and  the stomach is  incapable  of supporting almost
any kind of food, it is necessary to be still more par-
ticular in our choice; the diet must be varied till
 we  discover that which  best  agrees  with the sto-
mach, while we endeavour by frictions with the dry
hand, or  with oil, by exercise, change of air,  and
keeping open a blister on one of the extremities, or
even the epigastrium, to lessen the morbid irrita- 
GASTRODYNIA.
129
iiility of the stomach, and restore its lost powers of
digestion.  Lastly, if every thing else fails, a last
resource is in a powerful  counter-irritation, excited
by means of tartar-emetic ointment, or escharotics.
  In some instances,  the employment of purgatives,
by stimulating the large intestines and unloading
them of fecal accumulations, is remarkably useful
in chronic inflammation of the 6tomach, especially
in persons habitually costive, or of a lymphatic tem-
perament.   The  best  way  of  administering pur-
gatives in these cases is  by  injection,  but we must
not persevere in their exhibition, unless some benefit
seems  to be derived from them.
  Instances  have occasionally been  met with, in
which cold bathing, affusion, and a cooling regimen,
have succeeded, after all  the remedies above enu-
merated had been tried in vain.—(See also Gastro-
dynia and Gastro-enteritis.)
                GASTRODYNIA.

   When a patient complains of a very severe pain
in the stomach, unaccompanied by any decided evi-
dence of inflammation in this organ, as a-florid hue
ofthe tongue, fever, or loss of appetite;  and when,
notwithstanding, digestion  is not prevented, and
pressure, so far from aggravating, rather diminishes
the pain, the principal indication is to alleviate the
patient's suffering,  and enable him to sleep, by the
exhibition of opium, hydrocyanic acid,  extract of
hyosciamus, or laudanum : we must select  such of
these medicines  as  seem  to agree  best with the
stomach; should it  be incapable of supporting any
of them, they may "be administered by the rectum,
or through  the skin deprived  of its  cuticle.   We
have often had occasion  to observe the good effects 
130
GAPTRODYN1A.
of ammonia, extract of aconite, and the sub-carbo-
nate of iron, especially when neuralgia of any part
has preceded  the  developement of gastrodynia, a
circumstance which strengthens the probability of
its non-inflammatory nature.
  In some cases,  the apphcation  of leeches and
cupping glasses to the  epigastrium, with very hot
poultices,  or sinapisms to the back, may be  bene-
ficial ;  but remedies of this kind should be regarded
rather  as  palliative, than as capable of curing the
disease. Nevertheless, they should not be neglected
whenever the violence of the pain  makes it advisa-
ble  to  try every thing which is in the least  hkely
to be beneficial.
  The gastrodynia which so generally accompanies
leucorrhea,  requires the exhibition of bitters, the
preparations of iron, infusion of hops, gentian, chaly-
beate waters, extract of taraxacum, combined with
iron  filings,  &c.  Except in patients of a plethoric
habit, the uneasiness of the stomach generally disap-
pears pretty quickly under this treatment, while the
discharge from the vagina at the same time diminishes.
  A feeling of heat in the stomach or cardialgia,
and pyrosis or the vomiting of a limpid fluid, princi-
pally occurring in the morning, will generally yield
to the employment of twenty grains of magnesia
daily,alone,or combined with sulphur;  orstillmore
certainly,  to the subnitrate of bismuth, in doses of
six or eight  grains, three  times a  day; unless the
symptoms of which the patient complains  depend
on some organic disease, a point which ought always
to be previously ascertained.
  Lozenges of carbonate of soda,  powdered  char-
coal mixed  up with sirup or honey, and taken by
spoonfuls  occasionally, lime water combined with
infusion of camomile or rhubarb, chalybeate waters,
Borne species of salad, &c. are all  extremely bene-
ficial in such capes. 
                 GAS1R0DYNIA.             131

  Attacks  of vomiting occurring in persons other-
 wise enjoying  good health,  and without any pre-
cursory or accompanying symptom of gastric v. nu\-
tion, are in general easily checked by giving anti-
spasmodics;  thus we may  prescribe with  great
advantage a few drops of the tincture of opium and
ether, some aromatic water, the acetate of morphia,
tincture of castor, assafoetida, musk, &c.  Much
benefit likewise is often derived from mineral waters
and ices; from the apphcation of ice to the epigas-
trium ;  dry cupping in the same region; passing  a
galvanic current from the vertebral column to the
pit of the stomach, and the administration of injec-
tions, containing a drachm of assafoetida.
  If, however, these nervous vomitings continue for
a long time, the permanent application of a blister,
or the insertion of an issue  or seton at the epigas-
trium, or at one ofthe extremities, will be required,
in order to  prevent  any organic  disease of the
stomach, which  the repeated exertion of vomiting
might otherwise occasion.
  The habitual costiveness which so very commonly
attends cardialgia  and pyrosis, is best obviated by
mild laxative suppositories, or by injections of one
or two ounces of oil of almonds ;  the frequent use of
copious injections should be  avoided, as tending to
increase the atony and torpor of the bowels; and,
when necessary, they should  be  cold, and not of  a
mucilaginous nature.  Neutral salts, in the opinion
of some physicians, are very injurious.
  With respect to diet, it is less important to follow
any fixed rule,  than to ascertain what appears to
agree best with the  stomach; every  thing which
causes flatulence should be avoided, and, in general,
preference  should be given  to  rice, salep, white
meats roasted, certain kinds of fish, as soles, trout,
whitings, fruits thoroughly ripe or preserved;  wine,
beer, mineral waters, &c. may be  allowed, if they 
i32             SCIRRHl'S,  ETC.
do  not offend the stomach; but, in some casea,
nothing seems to agree with it so well as pure water.
The simple practice of taking every article of diet
cold,has often removed every symptom of gastralgia.
The same may be said of taking an ice after meals.
Lastly, we should endeavour, by every kind of amuse-
ment, company, travelling, &c. to divert the atten-
tion ofthe patient from his complaints, and  to dimi-
nish the morbid irritability ofthe stomach, by recom-
mending habits of active exercise, residence in the
country, warm or cold bathing, and friction of the skin.
  It is  unnecessary to say, that excesses of every
kind should be guarded against, and that whenever
gastrodynia follows the suppression of any habitual
discharge or cutaneous eruption, it is necessasy to
re-establish it, or supply its place by an issue.
  SCIRRHUS.   CANCER OF THE STOMACH.

  The treatment of scirrhus, or cancer of the sto-
mach,  extends no further  than  to the palliation of
its most distressing  symptoms ;  and the physician
must be satisfied if he can retard and render tran-
quil the passage to  the tomb.   For this  purpose
the patient should, in  the first place, be  removed
as much as possible  from  the influence of every
thing prejudicial ;  he must abandon his occupation,
if calculated to favour the  progress of the  disease,
as is that  of  cooks,  shoemakers, hatters, clerks,
&c.  When the affection of the  6tomach  appears
to have supervened on the metastasis of any con-
stitutional disorder, proper remedies  to supply the
place of it should  be  exhibited;  a severe regimen
is indispensable; a very small quantity of food being
allowed, and that  of the lightest and least stimula-
ting description, as, for instance, milk, farinaceous 
SCIRRHUS, ETC.
133
vegetables,  and white  meats.  The patient must
drink nothing but water, either pure, or as in mine-
ral springs;  an  issue inserted in the epigastrium or
arm is very beneficial ; the surface of the body
should be covered with flannel, and  every other
precaution calculated to maintain the general health,
ought to be  adopted.
   It would  not be right to pass over in silence,  a
plan of treatment from which we  have witnessed
the happiest results,  and which does not interfere,
but  may be employed in conjunction with external
remedies, as the insertion of issues, &c.   It consists
in  depriving the stomach  of aliment;  the  patient
being supported merely by nutritive  injections, ad-
ministered more or less frequently, according to his
wants.   The great advantage of this method is,  that
the stomach, by being allowed  a  long interval of
perfect rest, has time to recover from the irritation
which has been excited in it.  The patient's strength
will be sufficiently maintained, by a very nutritive,
and at the same time, tonic diet; as of 6trongbroths,
soups,sugar, wine, &c.;  nothing being taken into the
stomach, except simple water.  One instance, among
several, in which this method of treatment has been
followed by complete success, has been published
by the author in the Bibliotheouc Mtjdiiale, tome i.,
annee 1820.
   If the patient makes any complaint of pain in the
epigastrium, it will be proper to try once or twice
the application of leeches, and  modify our subse-
quent treatment by the  success  of the experiment.
  These different measures, if put in practice  and
well persevered in, before the supervention of vomit-
ing and  sour or fetid eructations indicates a very
advanced  stage of the disease, may, in  some cases
at leabt, prevent the progress ofscirrbus, and  ulti-
mately make it safe to allow the patient to return
to a more substantial diet.
                        12 
 134             hj:matemesi>.

  But after scirrhus has proceeded to ulceration, and
has occasioned great emaciation and debility,  it is
scarcely allowable to subject our  patient to further
suffering by any severe  measures ; it is, however,
proper to recommend him to live on farinaceous ve-
getables and iced milk,  or, if the pylorus will not
admit the passage of food, the injection of nutritive
substances must be substituted.
  When the patient complains much  of sharp lan-
cinating pains, and is  unable to sleep  during the
night,  the administration  of opium, hyosciamus,
&c. by the rectum, will prove very serviceable.—
See also Gastritis, Gastrodynia and Hypochondriasis.
                H^EMATEMESIS.

  Ha?matemesis occurring in a strong and plethoric
habit of body, or supervening on the sudden cessa-
tion ofthe menses, or a hemorrhoidal flux, requires,
first of all, the  copious abstraction  of blood from
the arm,  and then the application of leeches to the
anus or vagina, according to the nature of the sup-
pressed discharge.
  If, notwithstanding,  the hemorrhage  continues,
the epigastrium should be covered with pounded ice,
dry cupping  glasses affixed to the thighs, and  the
patient directed to drink very cold acidulated liquids
which  may also be administered by the rectum.
  But  if  faintness comes on, and the body becomes
cold, the  whole surface, especially the thorax, must
be rubbed with stimulating tinctures,  camphorated
spirit,  eau de Cologne, &c.  The  application of
sinapisms to the feet, knees, and  legs, and even of
boiling water to the epigastrium, may be resorted
to, and the patient should  drink large  quantities
of a strong decoction  of cinchona or rhatany, until
the hemorrhage has ceased.   A tobacco injection 
            GASTRO-ENTERITIS.             135

may also be administered.   But if the vomiting of
blood is occasioned by the bursting of some tumour
or large blood  vessel, all attempts to restrain it will
probably prove equally  ineffectual.
  Haematemesis,  occurring  in  a  feeble scorbutic
habit, requires, on the contrary, a tonic treatment:
thus, mineral and vegetable acids, decoctions of cin-
chona  and rhatany, cold  bathing, and stimulating
frictions, are the most  suitable remedies.   When
consequent on cancerous ulceration of the stomach,
and therefore incurable, the strictest attention to
diet must be enjoined, as well as the other measures
before recommended.
  In every case  it is advisable,  after the  flow of
blood  has been checked, to guard against its return
by a careful regimen, and by continuing for a con-
siderable time to take  acidulated and astringent
fluids.
             GASTRO-ENTERITIS.

   So long as the symptoms of gastro-enteritis are
indistinct, and  consist  only  in  a slight degree of
head-ache  and fever, with loss of appetite, wander-
ing pains in the abdomen, and diarrhoea, nothing
more is necessary  than to confine the  patient to
his bed, prescribe a low diet, and mucilaginous or
acidulated drinks, according to his inclination.  Un-
der this simple treatment, all the symptoms will pro-
bably disappear in a  few days :  while  active mea-
sures, by disturbing the general health, might occa-
sion  more  serious consequences than the disease
itself, which in this slight degree tends spontaneous-
ly to its own cure.
   But when pain in  the abdomen is very severe,
the tongue red and  beginning to get dry, and  the 
 13b           (.A?lK()-i:.\TKRITl.^.

stomach with difficulty  retains any food ; when,
moreover, the patient complains much of thirst, the
abdomen feels hot  to the hand, and diarrhoea exists
to a great extent, it is necessary to apply fifteen or
twenty-five  leeches to the  6eat of pain, covering
the abdomen after they hove fallen off  with a large
poultice ;  and at the  same  time  administering  an
injection of  bran  or  starch.   The  application of
leeches, though in  a smaller number, should be em-
ployed a second, and even a third time, if any pain
in the  abdomen, fever, and diarrhoea continue : in
this last case, it will be better to apply the leeches
to the  anus.
   If, from the commencement of the attack, there
is great febrile reaction, with a hot skin, and if the
patient Is young, robust,  or of a sanguine tempera-
ment, it will be advisable to open a vein in the arm,
rather than to rely altogether on local bleeding; we
shall thus most certainly prevent the developement
of inflammation in any other organs, as well as ar-
rest its progress in those already affected.
  When an inflammatory condition is strongly mark-
ed, the blood being covered with a fibrinous crust,
and the pulse hard and full, venesection should again
be practised. Tiie evening exacerbation of fever
may be moderated  by the use of warm baths, unless
they appear  to aggravate the abdominal disorder ;
and on this  condition  also, we  may recur to the ap-
plication of  leeches, especially at  the  epigastrium
and  right iliac region, as long as the continuation
ofthe pain renders it necessary.
   If the heat of the surface ofthe body is extreme,
while  the skin is arid, the tongue red, dry, and be-
ginning to be covered with  a black crust, the pulse
very quick, small, or wiry, and, if along with these
symptoms a tendency  to stupor exists, it will be pro-
 per to employ a warm  bath, and afterwards cold affu-
sions to the  head, provided  that there is no thoracio 
i. ASTRO-ENTERITIS.            Ib7
 affection, and defer the abstraction of blood until the
 reaction occasioned  by the bath is fully  establish-
 ed ; then, if the disease has existed during a few days
 only, one bleeding should be made from the arm, and
 leeches afterwards applied to the abdomen, succeed-
 ed by cataplasms, and emolient  fomentations ;  di-
 luents should be freely administered, and even pure
 water,  if other liquids seem to disagree with the
 patient. Under this treatment, we have  very fre-
 quently observed  the  mouth become clean, the
 tongue moist, and  the skin  soft, almost immediately,
 while the subsequent local antiphlogistic  measures
 destroyed the abdominal inflammation, in a  much
 shorter time than would  have been otherwise re-
 quired.
   But, when gastro-enteritis  has already  continued
 during several days, as eight or ten,  and stupor and
 prostration of strength have supervened, the tongue
 and teeth being incrusted with sordes, the skin dry,
 and the pulse small and frequent; at this advanced
 period,  the abstraction of blood would probably in-
 crease the debility already existing, and, if it did not
 throw the patient into a state of tatal collapse, pro-
 mote ulceration in the parts  exposed, by lying in
 bed, to  constant pressure, as is especially the case
 with the integuments of the nates.  Moreover,  it
 must be borne in mind that this disease is very fre-
 quently attended,  in  a greater or less degree, with
 ulceration ofthe bowels, and that their cicatrization
 requires a certain  degree of vital  power, and a con-
 siderable space of time; also, that though the in-
 flammation may have been  overcome, the system is
 not in  consequence  restored  to its former healthy
 condition ; the evil has operated, and it is necessary
 to remedy it.
   We therefore  recommend the  utmost caution at
this period of gastro-enteritis, concerning the proper
management  of which there is even now considera-
                       12* 
lof
GASTRO-ENTERITIS.
ble difference of opinion : from very  extensive op-
portunities of observation at  the  H6tel-Dieu, we
have been led to prefer, before all others, the follow-
ing method of treatment.
  First of all, the patient is placed  in a warm bath;
his ordinary beverage is made gradually more tonic,
by adding a small qu::fftity of wine ; or two or three
grains of sulphate of quina are taken in a  pint of le-
monade, some light mucilaginous fluid, or very weak
beer: sometimes, however, it happens that all these
liquids are rejected, and that water only will stay on
the stomach.   If we observe that the tongue ceases
to get  drier,  it is proper to continue this plan  of
treatment by the exhibition of the sulphate of quina,
ether, and camphor, carefully  regulating the quan-
tity according to the effect produced.   In the mean
time, a succession of blisters is to be  kept up at the
extremities, especially  in those parts which, as the
inner side of the thighs, are least liable to be com-
pressed; for, in the state of prostration into which
the patient is sunk at this period ofthe disease, the
mere weight  of the body is often sufficient to occa-
sion gangrene.  Friction with aromatic tinctures, or
spirit of camphor, should be practised  over  the ab-
domen, and care taken that the contents ofthe blad-
der are  evacuated  two or three times during the
day; the mouth is to be repeatedly moistened  with
slices of lemon.
   It is better to avoid, as much as possible, a com-
bination of many remedies, and even to employ each
one  singly,  otherwise it is impossible to  refer to
their true source the effects which may  be produ-
ced.
   As soon as the pulse and general condition ofthe
patient will  admit, the employment  of leeches and
the warm  bath  may be resorted  to, if necessary;
but their repetition should depend upon the benefit
derived from them. 
G ASTRO-ENTERITIS.
139
   In every severe case, when the least improvement
 is manifest,  and there is any probability of the pa-
 tient's recovery, the medicines which he is taking
 at the time,  whatever they may be, should  be con-
 tinued, for any alteration might be followed by fatal
 consequences.  Nature  will do better without the
 interference of art, and the physician must be satis-
 fied to resign altogether into her hands the manage-
 ment of his patient, taking care however to remove
 every thing that may obstruct the progress of return-
 ing health.  If there should be exutssive  diarrhoea,
 it will be proper to prescribe demulcents, and injec-
 tions of starch, with a small quantity ofthe tincture
 of opium.
   While no ulcer has yet been formed on the sacrum,
 it may often be prevented by directing the patient to
 lie alternately on his right and left side,  otherwise
 it is very apt to occur during convalescence from a
 severe attack of gastro-enteritis.
   When this inflammation is only in its second stage
 it sometimes happens that the brain becomes sympa*
.thetically affected, the patient complaining of head-
 ache,  his face being  flushed, slight  confusion in his
 ideas, and stupor, being  apparent;  in this case, no
 time should be lost in employing cold affusion to the
 head, and applying leeches behind the ears:  even
 venesection will be advisable, if the patient's strength
 is sufficient.  (See Arachnitis.)
   When any other important symptom is  superadd-
 ed to those  of ga6tro-enteritis, as a head-ache which
 obstinately resists the abstraction of blood, hiccough,
 vomiting, pain in the ches-t.  &c, the most active
 measures must  be employed tor its removal, other-
 wise it will so retard the progress of recovery, that
 the patient will sink befoie it can be effected.  A
 blister, dry cupping, a warm  bath, or antispasmod-
 ics, as camphor, musk, or cinchona,  will often at 
140
I.AS PRO-ENTERITIS.
 once remove these unusual and inexplieable sympr
 toms.
   When gastro-enteritis arises under the  influence
 of debilitating circumstances, as the want of proper
 food, exposure  to an unhealthy  climate,  damp
 weather,  an enfeebled constitution, a  lymphatic
 temperament, or  a bilious  habit of body, a simple
 antiphlogistic treatment is not the  most successful;
 on the contrary, at any period of the disease, if the
 tongue is covered with a thick yellow fur, and there
 is a disagreeable  bitter taste  in the mouth, it is in-
 contestably established by experience, that the ad-
 ministration of an emetic of ipecacuanha, and an in-
jection  of tartarized  antimony with some neutral
 salt, effects, in most instances, the speedy  removal
 ofthe abdominal symptoms, the head-ache and fever.
 Some physicians have greatly exaggerated the dan-
 ger of this method of treatment; but the  human
 body, which does not lend itself to the support of
 systems and theories,  furnishes daily opportunities
 for seeing that tartarized antimony does not always
 provoke, any more than the abstraction of blood al-
 ways removes, gastro-enteritis; the rules of art must
 submit to the empiricism of nature.   It must, how-
 ever, be allowed, that where  much diarrhoea is pre-
 sent, we should hesitate to employ the  evacuating
 system, or at least do  so with extreme caution, so
 as to discontinue it as soon as  its action appears pre-
judicial.
   In feeble, lymphatic, or sluggish habits, the use of
 mucilaginous and demulcent diet-drinks, and warm
 baths, appear rather to prolong the complaint;  in
 such cases,  therefore,  a more stimulating plan of
 treatment may be adopted with advantage, and the
 use  of  bitters,  aromatic  and  chalybeate  waters,
 should be prescribed: the apphcation of a blister to
 one  of the extremities is  an  equally  beneficial re-
 medy in cases of this description.   Diarrhoea is 
G ASTRO-ENTERITIS.
141
counteracted most effectually by injections of starch,
with eight or ten drops of the tincture  of opium ;
but if it is profuse, and does not yield to these ene-
mata, it will be necessary to apply a few leeches to
the anus,  uidess the patient is too feeble to allow
the abstraction of blood ;  when it has become chro-
nic, ipecacuanha, cinchona, quassia, calumba, &c.
are indicated.   We  have even known instances, in
which tartarized  antimony,  in doses of one or two
grains; has  checked diarrhoea when passing into a
chronic state.
   A point of the highest importance  in the treat-
ment of gastro-enteritis, is  the regimen of the pa-
tient.  So long as  the inflammation is acute, and
attended with fever, it is impossible to be too severe;
during the whole of the  period of the disease, no
nourishment whatever can be permitted, unless it
continues  a very long time, in which case, we may
relax  a little, and allow the  patient to take slops
made gradually more and more nutritious, as barley
water, gruel, toast water, milk and water, chicken
broth, and veal broth, provided that the diarrhoea is
not aggravated.
   It must be constantly borne in mind, that perse-
vering abstinence is the most efficient and useful
auxiliary to which the physician can  resort;  yet,
when the stomach  is capable of supporting food,
rice and milk, arrow root, sago, salep, and cooked or
thoroughly ripe fruits should be given  in very small
quantities:  even then, until convalescence is per-
fectly established, the utmost caution is  requisite,
and it must not  be  forgotten that relapses, in  con-
sequence  of errors  in diet, are extremely frequent,
even  more so perhaps than is  generally thought.
Whenever, therefore, diarrhoea returns, or the pulse
becomes  more frequent towards evening, the  pa-
tient  must immediately be  subjected to a stricter
regimen. 
142           GASTRO-ENTERITIs.
  We shall now briefly recapitulate the rules which
we have laid down for the treatment of  gastro-en-
teritis.   When the attack is slight, notliing further
is necessary than  the copious use of mucilaginous
diluent  fluids, but  when attended by considerable
fever, pain, and diarrhoea, leeches must  be applied
over the abdomen, to restrain the severity of the
disease ; and, if the robust habit and age ofthe pa-
tient, the intensity of the  fever, and  other accom-
panying circumstances, afford  reason to fear that
inflammation may extend to other organs, it will be
advisable to draw blood from  the arm.
  By pursuing these measures, we may hope to pre-
vent the disease from assuming that  adynamic
character in which stupour, prostration of strength,
and a vitiated  condition of  the  secretions of the
mouth, render our treatment so embarrassing.  But
even in  this stage of the disease, it should be at-
tacked by the measures above pointed  out, if it has
not existed many days, and the abstraction of blood
has not  previously been  resorted to; previously,
however, employing baths and effusions, unless the
thorax is affected.
  It is  also at  this period that the application of
blisters  to the extremities is particularly useful.  If
the prostration of strength increases in consequence
of,  or, at least, notwithstanding, local bleeding, and
if the disease has existed  long, a tonic treatment
must be  combined with that more strictly antiphlo-
gistic.   In fact, on whatever principle  our manage-
ment of this inflammation may be founded, it must"
always be regulated by  its results: great simplicity
of prescription is therefore necessary, each remedy
being employed singly,  in order to ascertain  with
exactness its operation.
  Lastly, when the apphcation of leeches would, in
all  probability, only hasten the death of the patient,
 ^ arm baths may still be advantageously employed 
CHOLERA MORBUS.
143
to diminish the  frequency of the pulse, moisten the
mouth, and promote perspiration.  Such are the
principles of the treatment of acute gastro-enteritis.
  The cure of chronic inflammation ofthe stomach
and bowels, consists in  the  observance of a  strict
regimen, occasional  warm  bathing to restore the
functions of the skin, the permanent application of
blisters in  one  of the extremities, employment  of
frictions over the whole surface of the body, sul-
phureous  baths,  mild  demulcent drinks,  and,  if
diarrhoea exists  unattended  with fever, chalybeate
waters.
                           i
             CHOLERA MORBUS.

  When cholera morbus comes on  with the symp-
toms  of sub-acute gastritis, it requires  the same
treatment as this inflammation, that is, the frequent
application of leeches to the epigastrium and anus,
local being better than general bleeding, unless the
patient is very plethoric ; indeed, however doubtful
may be  the nature of this disease, whether consist-
ing in a  depraved  condition of the bile,  or in an
affection of a different kind, it is certain that the
mucous membrane of the alimentary canal becomes
before long inflamed.  On account  of the extreme
irritability ofthe stomach, which is such as scarcely
to allow any liquid to lemain in it, it is necessary to
employ the most powerful sedatives, and  especially
cutaneous stimulants; thus, the internal and external
exhibition of  ice, the application of  cupping glasses
and sinapisms to the epigastrium, the administration
ofthe tincture of opium and acetate of morphia, are
indicated.  Much larger doses of these medicines
than are usually necessary must be employed in this
disease, as, for instance, twenty, and twenty-five 
144           CHOLERA MORBUS.
 drops of the tincture of opium,  or a  quarter of a
 grain of the salt of morphia, taking care, however,
 gradually to diminish the quantity in proportion as
 the symptoms  become  less severe ;  effervescing
 draughts and ether often succeed in checking vomit-
 ing;  also the infusion of calumba or rhatany, and
 opiate injections, containing ten  or twelve drops of
 laudanum; the  application of sinapisms and blisters
 to  the extremities,  and  hot fomentations over the
 abdomen;  friction  with aromatic tinctures, [and,
 above all, the  hot air bath] should be employed to
 preserve a due  heat on the surface.
   When there is  severe vomiting' and muscular
 spasm,  conjoined with a constant tendency to
 syncope, it  is necessary to apply boiling water to
 the abdomen, and, if possible, excite the action of
 the heart, otherwise death will soon ensue: for
 this purpose, cold affusions are  extremely useful,
 but they would be attended with too much danger
 if the heat  of the skin  were greatly diminished,
 and reaction difficult; in this  latter case, rubbing
 the body with aroinatic  tinctures may be resorted
 to.
  In the cholera morbus which  prevails epidemi-
 cally  in certain countries, as in every other  ex-
 tremely dangerous  disease, the most opposite and
 empirical remedies have been prescribed,  as, for
instance, oil of camphor,  ammonia,  sulphate of
soda, musk,  ether, &c.;  but, hitherto, not a single
step has been made  towards  a  rational plan of
treatment.   It  ought, doubtless, to be foun-'ed on
the nature of the disease, and, if it is inflammatory,
the common  antiphlogistic  treatment, modified
according to peculiarities of climate, is as applica-
ble to it as to any other inflammation.
  When cholera morbus arises in consequencex>f
having taken poison, or certain kinds of food whi<4i
prove poisonous, in consequence of some personal 
ENTERITIb.              145
idiosyncrasy, our first object should be the evacu-
ation  of the alimentary  canal;  afterwards the
management of the  case  is to be  conducted on
ordinary principles.  {See also Poisoning)
  After we have succeeded so far as to  remove
the most urgent symptoms, nothing  further will
be necessary than  the employment of acidulated
and demulcent drinks, cold aromatic  infusions,
bathing,  and the strictest attention to diet.  As
soon as the patient is convalescent, a small  quan-
tity of Spanish wine may be safely  allowed if the
stomach can support it.
                 ENTERITIS.

   A slight attack of enteritis commonly requires
nothing more than the use of diluents and demul-
cents, Targe emollient cataplasms over the abdo-
men, warm baths, and a low diet.  But if the in-
flammation does not yield to  those  simple mea-
sures, or if it assumes from the first a more serious
character, the application of leeches to the abdo-
men is necessary, and must be frequently repeat-
ed so long as any pain exists; even general blood-
letting should  be  resorted to when enteritis is
attended with  high  fever.   This inflammation,
however, seldom exists uncombined with gastritis,
we may therefore refer  the  reader to  Gastro-
enteritis for further details.
   When inflammation of the bowels is passing into
a chronic state, counter-irritation is to be excited
ove^the abdomen, by antimonial ointment, and in
the extremities, by a repetition of blistei s; friction,
either with the dry hand,  or with oil,  should be
practised over  the  whole surface of the  body,
and sulphureous baths frequently employed, when
                       13 
 146       CJECO-COLITIS—DYSENTEEV.

 there is opportunity, and the patient should  gra«
 dually exchange the mucilaginous drinks to which
 he  was restricted while the  inflammation  was
 acute, for a more tonic regimen; thus, chalybeate
 waters may now be taken with advantage, a little
 wine ventured upon, and even light solid food, in
 very small quantities, and scrupulously  selected,
 so as to  avoid every thing calculated  to excite
 irritation in the bowels; lastly, he  should remove
 into the country, and there  take as much exercise
in the open air, as he is  able to support without
 inconvenience.
   Enteritis occurring  in  infancy,  a  frequent
 and very  dangerous affection, in consequence of
 its tendency to terminate in gelatinous softening
 ofthe mucous membrane,  requires the employ-
 ment of warm baths and emollient cataplasms, and
 the frequent application of  leeches, while the in-
 flammation is acute and attended with fever; but
 the efforts of the  physician will be ineffectual, if
he does not take  care that his infant patient  re-
ceives proper nourishment; such as the  breast of
a healthy  nurse can alone supply.  We have fre-
quently had occasion to observe the  very bene-
ficial effect of the application of sinapisms to one
 of the extremities, during a quarter of an hour or
twenty  minutes,  repeated  several times in the
course of  the day; blisters  also, when febrile re-
action is.on the uecline, are  very useful,especially
in preventing relapse.



       C.ECO-COL1TIS—DYSENTERY.

  When any portion of the ca?cum, or  colon,  is
attacked with  pain, the application of leeches  is
necessary until it is removed, or  at least very 
         i  ECO-COLITIs—DYSENTERY.      I 47

greatly diminished, unless, as occasionally, though
very rarely  happens, this mode of treatment has
evidently no influence over the complaint: at the
same time,  the abdomen should be covered  with
emollient cataplasms, or if pain is occasioned by
their weight,  flannel cloths, wrung  out of hot
mucilaginous decoctions, may be substituted; em-
brocations,  consisting of hot oil and laudanum, are
to be rubbed over the»abdomen, and if the patient
is capable of the  motion, he should be placed in a
warm bath  for a longtime, taking care to avoid
cold.  Together with  these measures, and espe-
cially in cases attended, as most are, with severe
pain, some preparation of opium should  be admi-
nistered, either by the  stomach, or in injections.
Five and twenty minims of laudanum, a grain of
the acetate of morphia, or the resinous extract of
opium, will fulfil the double indication of alleviating
pain in the  bowels, and moderating the very fre-
quent inclination to  evacuate the bowels;  also,
the ineffectual  straining, which, only  aggravates
the uneasiness.  When  the  patient is tormented
with excessive tenesmus, or when  there is an
abundant diarrhoea, the application to  the anus of
twenty  leeches,  will  prove the  most  effectual
anodyne, and injections of bran,  or starch,  with
six, eight, or ten minims of laudanum, may also
bt employed; but the use of enemata must not be
pe-severed  in,if no relief seems to be derived from
them.
  When there is acute inflammation of the colon,
it will be advisable to  administer them cold ; they
quen?h the  fire which is raging within.  On "the
other hand, perspiration is to be promoted  by drink-
ing copiously  hot liquids, of  a  demulcent and
slightly  astringent nature, such as the decoction
of althrea or Symphytum, rice  water, mucilage,
&c.  The strictest abstinence is necessary, and no
kind of nourishment, except such liquids as we have 
 148       C.ECO-COLITIS--DYSENTERY.

 mentioned, should be allowed while any pain in the
 abdomen or diarrhoea remains, or there is any rea-
 son to apprehend a  relapse.   Afterwards, the pa-
 tient may return very gradually to his ordinary diet,
 beginning with  milk and water, barley or rice wa-
 ter, then salep, arrow root, tapioca, rice, &c.   After
 some time,  chicken broth, beef tea,  &c. in small
 quantity at first, may be taken with safety and ad-
 vantage. Where the patient is plethoric, or  the fe-
 ver ardent, it will be prudent in the commencement
of the attack, to draw blood from  the arm, rather
than depend wholly on local bleeding.
  Whenever in inflammation of the.large intestines
blood is mixed with the stools, the  application of
leeches  to the seat of  pain and to  the anus, is the
more necessary, and must be  the  more frequent:
the treatment required in other respects, is exactly
 the same.
  As soon  as  the  disease has passed through its
acute stage, the pain having almost  disappeared,
while the diarrhoea continues nearly to  its former
extent,  and the patient is sinking into  a state  of
great debility, we must endeavour,  by the adminis-
tration of tonics, to recruit his strength ; however,
great caution and vigilance will be necessary to watch
 and  guard  against the renewal of  inflammation.
 For this purpose the sulphate of quina, or moderate
 quantities of Spanish  wine and catechu, may he
taken with  advantage.  If any disorganization, is
ulceration,  for instance,  has taken  place  in the
intestines, all that the physician can do, is, by a well
 regulated regimen,  to remove every obstacle out
 of the way of nature's curative processes.
  When dysentery is' complicated with  gastro-en-
 teritis,  encephalitis, or arachnitis, the  treatment
 must be modified, according to the predominance of
 one  or  other of these affections.   See  the words
 Arachnitis, Encephalitis, Gastro-enteritis. See 
         CECO-COLITIS—DYSENTERY.       149

  In debilitated constitutions, a chronic diarrhoea
very frequently exists, which though unaccompanied
by any evidence of irritation, is clearly referable to
an ulcerated state of the  bowels.   In cases  of this
description, a nourishing  but very light diet  is indi-
cated.   Wine may be taken in small quantity, and
the whole round of astringents, if necessary, may be
resorted to; as, for  instance,  infusions of  bistort,
quassia, tormentil, caluraba, acidulated and  chaly-
beate waters, ipecacuanha, cinchona, the extract of
rhatany, conserve of roses, and kino ; occasionally,
perhaps, it will be proper to try the effect of  an
emetic, and even a purgative;  Astringent and opiate
injections, wearing flannel next to the skin, friction,
blisters applied  to  the inner side of the  thighs,
vapour baths, long continued carriage  exercise,
and compression of the  abdomen  by means of a
bandage, are all means likely to prove of benefit.
  Inflammation ofthe large intestines, occurring in
infants, should be attacked during its acute stage by
leeches, fomentations, cataplasms, emollient injec-
tions, and warm baths.   If there is very little or
no fever, the frequent application of sinapisms, which
should be kept on for half an hour at each time, will
be  highly beneficial;  blistering the extremities will
answer the«ame purpose.   As for food, every thing
must  be prohibited except the nurse's milk, if  the
child  is still at the breast; or if otherwise,  mucila-
ginous  drinks, sweetened with a small quantity of
sirup of poppies.
  The  temporary diarrhoea which is apt to  occur
during dentition, if unattended with any evidence
of  irritation, requires nothing further than a well
regulated regimen.
                      13* 
150    NERVOUS  COLIC—ENTERAl.GU
        SCIRRHUS,  CANCER OF THt
                 INTESTINES.

   The treatment of scirrhus and cancer ofthe intes-
tines differs very little from  that which has been
described while speaking of scirrhus ofthe stomach
and chronic enteritis ;  it is, however, more important
to prescribe occasional aperients, especially Injec-
tions of oil, in order to prevent the accumulation of
fecal matter, the  common attendant on stricture of
the bowels.   When there is  much  pain, narcotics,
especially preparations of opium, should be adminis-
tered.
  Should any symptoms of inflammation arise, the
application of a few leeches to the abdomen, or anus,
and the use ofthe warm bath, should be resorted to.
It is always prudent, in this disease, to establish an
artificial discharge, by inserting an issue in one of
the extremities, or rather in the abdomen, near the
seat of disease.
  In regard to diet, every thing which occasion?
flatulence  must be  carefully avoided, the patient
should be restricted  to the lightest  food, and take
that only in very small quantities.
     NERVOUS  COLIC—ENTERALGIA.

  This affection may generally be removed by the
employment of warm baths, injections of oil, and hot
fomentations or cataplasms over the abdomen; or,
when these measures fail, by opiates, and a few
minims of ether, given in some aromatic water.  See
Gattralgia, also the following chapter. 
itUCl  JMt-TONlM.           i"l
            COLIC A  PICTONUM.

  Different methods of treatment have been adopted
in this disease, the principal of which we shall now
describe, pointing out by the way the modifications
and  variations  which  circumstances  may  render
necessary.  Let us commence by detailing the plan
to which both authority and  daily experience unite
in assigning the highest rank.
  Plan of treatment at  La ChariU.
  First Day.—A purgative  enema is administered,
consisting of a pound of infusion of senna and half
an  ounce of magnesia and emetic wine.  In the
course of the day, the  patient takes sixteen ounces
of a decoction of cassia, containing three  grains of
tartarized antimony, and an ounce ofthe sulphate of
magnesia;  in the evening, an anodyne injection is
prescribed,  and lastly,  the  following pill .-
  R Theriace, Opii ana granum.
  Second Day.—An emetic, consisting  of three
grains of tartarized antimony dissolved in four ounces
of water, is  to be taken twice, with the interval of an
hour between the two doses. Vomiting is promoted
by  drinking copiously warm  water,  and nothing
more is prescribed during the day, except a diapho-
retic drink, containing guaiacum, sarsaparilla, sassa-
fras and liquorice, and the repetition, in the evening,
ofthe anodyne injection and pill.
  Third Day.—The above drink is continued, with
the addition of six drachms of senna to each pint of
it, which is to be taken in four doses: afterwards,
tbe diaphoretic  mixture is to be taken alone.   At
four o'clock in the afternoon the purgative enema
is repeated; at six, the  anodyne enema,and at night
the opium pill.
  Fourth Day.—An eight-ounce purgative mixture
is administered; (infusion of senna six ounces, su!- 
 lOXi           COI.K A  I'M I'ti.NUM.

 phate  of soda half an ounce, salep a drachm, una
 sirup of buckthorn an ounce) the operation of this
 medicine is to be  promoted by diluents.   The
 diaphoretic drink, the anodyne enema, and pill, as
 before.
   Fifth day.—As on the third, namely, a combina-
 tion of the  infusion  of senna  and diaphoretic mix-
 ture : at four P. M.  the purgative enema, at six, the
 anodyne enema, and at eight, the opium pill.
   This plan has been variously modified by different
practitioners: thus, some administer  emetics more
frequently,  especially in cases attended with nausea
and a disordered state ofthe stomach;  others omit
the anodyne enema, and especially the opium pill,
on account  of their rendering the constipation more
obstinate, and chiefly endeavour to restore and main-
 tain the. alvine evacuations.
   Should the abdominal pain not yield, the employ-
ment of purgatives  must be  persevered in until the
eighth, tenth, or even twelfth day. And it will not
be safe to conclude that we have destroyed the dis-
ease, until,  for at least a week, and with the omis-
sion of all  medicine, except the  diaphoretic diet
 drink, the patient has remained free from pain, and
 the action of the bowels has been regularly kept up.
   In very severe cases of colica pictonum, when the
 pulse is frequent, the tongue of a florid hue and un-
 naturally dry, and when abdominal pain, instead of
 being diminished, is greatly aggravated by pressure,
 an antiphlogistic plan of treatment is clearly indica-
 cated; a vein should be  opened  in the arm, and
 leeches, to  the amount of fifty or sixty, afterwards
 affixed over the abdomen, around the umbilicus: the
 employment of cataplasms,  and  of warm baths,  in
 which the  patient should remain a long time, must
 follow  the  abstraction of blood.  These measures
 are equally proper, when pain in the abdomen per-
 sists, in spite  of the treatment adopted  at La 
GULK'A  ^ICTONL.M.            153
Charite.  Our own  experience fully  authorizes us
to make this assertion.
  When the bowels are obstinately constipated, and
the administration of purgatives would  be attended
with danger, it will be  proper to try the plan lately
proposed by Professor  Andrieux; it consists in di-
recting a galvanic circle towards the two extremi-
ties ofthe intestinal canal, so as to excite its peris-
taltic action and unload it of its contents.
  A method of cure has been recommended by Dr.
Ranque, Physician of the Hdtel-Dieu  at Orleans;
which, from the numerous instances in  which it has
proved  successful, has a strong claim to attention;
we shall therefore enter into a particular description
of it.
  Plan of Dr. Ranque.
  First Day.—The patient is first placed in a warm
bath, so as to render the skin more permeable to the
topical remedies applied to it, and more susceptible
of their influence : after leaving the bath, the whole
surface of the abdomen is  covered with a plaster
composed of resin and conium plaster, of each an
ounce and a half,  treacle half an ounce, camphor a
drachm, and sulphur half a drachm;  this plaster is
spread on linen cloth,  and  the surface  is sprinkled
over with a drachm of camphor, the same quantity of
tartarized antimony, and half a drachm of sulphur;
the whole lumbar region, from  the eleventh dorsal
vertebra to the sacrum, is encased in a similar man-
ner, except that the surface of the second plaster is
covered only with two  drachms of camphor: at  the
same time, the thighs  and legs are rubbed with a
liniment, composed of two ounces of distilled laurel
water, an ounce of sulphuric ether, and two scruples
of the extract of belladonna;  the half of this lini-
ment being used in the space of twenty-four hours.
When the bowels are  constipated, an  enema, con-
raining thirty minims of the tincture of belladonna 
 I'M            COLIC A Pt«;T0NtM.

 and four ounces of olive  oil, is administered.   Last
 ly, abstinence is to be strictly enjoined, the patient
 taking nothing, except barley water, whey, or some
 demulcent fluid.
   Second day.—In general,  the pains in  the  abdo-
 men are less severe, and vomiting has ceased ;  the
 liniment and the enema,  if the bowels continue slow,
 are to be repeated, and no alteration may be allow-
 ed in the patient's regimen,  unless the bowels have
 been freely opened.
   Third Day.—In the great majority of cases, the
colic no  longer exists, or only in a very  slight  de-
gree, and the alvine evacuations are re-established:
the surface ofthe abdomen being now covered with
small pustules,  the plaster  may be removed:  the
frictions and enema are to be continued.  If the
bowels are not open, the same regimen must be pur-
severed in.  But when the severity ofthe complaint
is in no degree diminished,  and little  irritation  has
been excited in the skin, it will be necessary to have
recourse to another plaster, similar to the first;  or
the application over the abdomen of a hot cataplasm,
sprinkled with the powder employed on the plaster,
may be substituted for it.
  Fourth Day.—This new application has general-
ly removed the  pain ;  the plaster or cataplasm is to
remain  until it  has excited the sensibility of  the
skin ; the appetite now begins to return, and a little
nourishment may be allowed.  The pustular erup-
tion over the abdomen is to be treated by refrigera-
ting and sedative lotions.
  If the hands and wrists are affected with paraly-
sis, they are to be rubbed with the liniment  before
prescribed; if amaurosis supervenes,or pain in  the
head continues  after the removal of the  colic,  the
temples, forehead, and nucha, are also to be rubbed
 u ith it; lastly, if after the sixth day there is no return 
COL1CA PICTONl/M.           155
of appetite, a gentle aperient, as castor oil, should be
administered.
  The tincture of nux vomica employed at an early
period of colica pictonum, both externally by means
of cataplasms applied over the abdomen, and inter-
nally in doses of twenty or thirty minims to a draught,
and from ten to fifteen in enema, taking care to di-
minish this  quantity, in proportion  as the severity
of the pain abates,  has, in like manner, in several
instances, been crowned with success.  It is neces-
sary, however, to remark, that the administration of
this powerful medicine requires much caution.
  The subsequent  paralysis, which  is so common,
must be counteracted by blisters, applied along the
course of the nerves, by stimulating liniments, and
vapour baths.  We have found the oil of turpentine,
taken  internally,  an admirable remedy, in cases
where paralysis of motion was connected with pain
of the sciatic and crural  nerves.   Galvanism also
has been  very successfully employed by Professor
Andrieux, in this description of paralysis, and the
purgatives by various practitioners,
  The prevention  of colica saturnina is a subject of
inquiry highly important to every person  engaged
in the manufacture  of any of the  preparations of
lead; it should, therefore,  be impressed upon those
who are exposed to  its attacks,  that the only pro-
bability of immunity consists in a careful observance
of the following directions.   Linen dresses must
be frequently renewed ; the workman should often
wash his whole body, and invariably before meals,
his hands; he must  be careful to protect his  food
from the dust of the manufactory, or workshop, to
take his meals in some other place, not to  continue
in his employment  during a longer period  than a
month at a time, and lastly, to abandon it altogether,
after he has been once attacked by disease ;  for ex-
perience proves, that each attack renders the suf- 
 l(ft} SCIRRHUS, AND CANUErJoI  THE REOTUH.

ferer  more  liable  to another.  Dryness, warmth,
and a  free  circulation of air, are also highly im-
portant.
 SCIRRHUS, AND CANCER OF THE RECTUM.

   A large proportion of the organic diseases of the
 rectum may be prevented by the vigorous employ-
 ment of antiphlogistic measures, by applying leeches
 to the anus, throwing up clysters  of mucilaginous
 or narcotic substances,  and establishing counter-
 irritation by the insertion of a seton or issue.  When
 the scirrhus is connected with syphilis, it  may be
 arrested in its incipient stage by antisyphilitic reme-
 dies, and by passing up  into  the  rectum,  a tent,
 smeared over with mercurial ointment.
  But when scirrhous disorganization is perfectly
 formed, it will be necessary to resort to other means.
 Dr. Recamier has. very recently proposed, in such
cases, the employment of compression.
  At the Hotel-Dieu, I have had several opportuni-
ties of observing the effects of this  remedy.  The
way  in which  it is applied is by distending the rec-
tum with pledgets  of lint introduced one after ano-
ther,  until a gentle compression is established by
means  of  these foreign bodies, which may also at
the same  time be  made use of to convey medicine
into the intestine ; tents of prepared sponge, cove-
red with the  hydriodate  of potash, and gradually
made larger, may  be employed for  the  same pur-
pose. If any ulcers exist in the rectum, they should
be cauterized  with the aid of the speculum, by the
nitrate of mercury, which is one ofthe best escha
rotics that can be chosen in such a case.11
* See the excellent Memoir i.t Palliird, Svr les Caustigvti 
           CANCER OK THE TECTUM.        157

  We may also,  by means of a syringe, introduce
into the rectum emollient cataplasms,  and render
them narcotic,  if the pain is so severe as to render
it necessary;  they should be retained  as  long as
possible.
  The occasional application of leeches to the anus,
may also prove highly beneficial at this period of the
disease, but when the patient's strength is already
greatly exhausted, a prudent practitioner will avoid
the abstraction of blood, and prescribe instead cata-
plasms to the margin ofthe anus, and hipbaths.
  In the mean  while, the trying pain which accom-
panies this disease,  should, as much as possible, be
alleviated by warm  bathing; douching, narcotic in-
jections, and the internal exhibition of the  extracts
of conium, hyosciamus, opium, lactucarium, acetate
of morphia,  laudanum; and  one or other  of these
substances,  combined  with lard, should be used as
an  ointment  around the anus.  If the stricture of
the rectum is so complete as to prevent the passage
of the fa?ces, we must prescribe  laxatives, and at
the same time, dilate the canal by tents, made larger
every time they are introduced; if necessary, even
the application  of escharotics may  be resorted to.
  In every case,  it becomes necessary, for the pur-
pose of opposing  the progress ofthe disease,  and
alleviating the severe  pain  which attends it,  to
estabhsh an  artificial discharge, by the insertion of
an issue or seton in the vicinity ofthe rectum, or in
the loins.
  Dr. Tavernier and myself,  have  lately had under
our  care a lady who for several  years  had been
treated by very intelligent practitioners for cancer
of the rectum, on examination of whose body after
death, it was discovered  that the  violent shooting
pains with which the patient was afflicted, especially
on going to stool, were occasioned by the presence
of a sharp spiculum of bone which had made it*
                       14 
158
HjBM0RRH0I1».
way from the rectum  into  the  adjoining  cellular
tissue, and there pressed against this intestine.  The
discovery of one instance of this kind, should put
us on our guard against overlooking others.
  The diet  which  it is proper to enjoin in this
affection, should consist of such things as contain
much nutriment in a very small bulk, so as to form
as little feculent matter  as possible; laxative drinks
should also be employed, to prevent constipation.
                HAEMORRHOIDS.

   So long as hemorrhoidal tumours  in  no degree
disturb the health, and are only troublesome,  it is
better to leave them alone, and  especially to avoid
suddenly suppressing them, otherwise, serious  and
even incurable diseases  may ensue, particularly if
the haemorrhoidaTflux has existed  a Jong time, and
become as it were constitutional:  in fact, it is then
a new function, as natural to the body as menstru-
ation;' the system is placed under its influence,  and
health is ever afterwards dependent upon its regular
performance.
   The physician must be content to do nothing more
than direct such regimeneal precautions, as are cal-
culated to restrain the discharge within due limits.
Thus, the patient must be restricted, especially at
the periods in which  hemorrhoidal  congestion  is
most apt to recur, to a light diet, consisting of ve-
getables, white meats, fruits containing much acid,
and  refrigerating drinks; wine  should be  allowed
only in very small quantity, andjdiluted with water;
mild beer  may often be substituted for it with ad-
vantage.
   Patients afflicted with hemorrhoids, should lie on
3 horse-hair mattress, and; if obliged to write, stand 
HEMORRHOID*.
l^lr
up to do it;  they should sit as little as possible, and
that only on hard cushions; above all, regular ex-
ercise must be enjoined.
  When this disease is attended with  a sense of
great heat and acute pain, considerable benefit may
be derived from the employment of cataplasms and
mucilaginous injections, as well as from the appli-
cation of spermaceti ointment or fresh butter, either
alone or mixed up with honey, taking care  (a pre-
caution which, however, cleanliness renders almost
superfluous) that these oleaginous substances do not
remain long enough to become rancid, and thus ag-
gravate rather than diminish the patient's suffer-
ings.  Lastly, the bowels should be kept open by the
use of laxative drinks.
  If the hemorrhoidal  tumours are large, or the
flow of blood from them considerable, the applica-
tion of fifteen or* twenty leeches in the vicinity of
the rectum, will prove highly useful, especially if
the patient is placed, as soon as the leeches drop off,
in a warm bath;  cold  injections and cataplasms,
with douching, may also be employed to promote
the same  object.   If the  patient  is plethoric, and
there is reason to apprehend determination of blood
towards any other organ, it will be proper to take a
moderate quantity of blood from the arm.
   We may sometimes effect their removal, by com-
pressing them, one  after another, with  the finger,
until they become perfectly flattened ;  but to derive
any permanent benefit from this operation, the fre-
quent repetition of it will be necessary.
  If the hemorrhoidal tumours are so large as almost
to block  up the anus, and render evacuation of the
feces extremely difficult,  or even  impossible,  we
must endeavour to re-open the passage through the
intestinal canal by the  introduction of a caoutchouc
sound,  tents  successively  larger, and  prepared
«,nonge. 
iritl
II.KM'ORRHOlDS.
    When 1 lie  tumours project beyond the verge of
  the anus, that is,  in  external piles, they must be
  pushed back by the finger, previously anointed with
  some oleaginous substance, and then kept back by a
  pledget  of lint or  linen, sustained  in its  place by
  means of a T bandage.
    The same measures must be resorted to when
  the hemorrhoids become strangulated by the sphinc-
  ter muscle ofthe anus ; but in this case they should
  be preceded by the employment of the  warm hip-
  bath, or  the application of a poultice to the seat of
  disease,  for the purpose both of facilitating reduc-
  tion, and rendering it less painful.  In either case, a
  roll of cloth should be attached to the middle ofthe
  chair in  which the  patient is  accustomed to sit, to
  prevent  the tumours from coming down  again.
    If the flow of blood is kept up by the presence of
  ascarides in the rectum, we must endeavour to clear
  the intestine of them, by simple  and mucilaginous
  injections,. and afterwards to  prevent  their forma-
  tion in the manner described under the word Asca-
  rides.
    When the bleeding from piles is not excessive, it
t ought to be encouraged ; but when it is so profuse
  as to occasion much debility, or occurs  in patients
  of a bilious temperament, it will be necessary during
  the  intervals to pay strict attention to the diet, for-
  bidding every thing of a stimulating nature, or diffi-
  cult of digestion, to  prescribe diluents,  emulsions,
  and bathing,  to keep the bowels regularly freely
  open, rather by mild laxatives, such as the confection
  of  cassia, tamarinds,  lemonade*,  &c. than by the
  daily administration of warm injections, which often
  produce  an opposite  effect, by promoting  a deter-
  mination of blood towards the  intestines.  At the
  same time almost absolute rest must be enjoined.
    Lastly, if the discharge of blood amounts to per-
  fect hemorrhage, all the resource!? of art  must be 
INTESTINAL  WORMS.           1 til
resorted  to, in order to arrest  it, the principal of
which are venesection, cold applications, and espe-
cially plugging up the orifice ofthe anus.
  It is scarcely necessary to remark, that this plan
of treatment is  applicable to those cases only in
which the intestinal hemorrhage is of  an  active
character, and occurs in plethoric subjects, otherwise
in good health; but in a lence-phlegmatic or scorbu-
tic habit, or in persons of debilitated constitutions,
we must pursue a very different course, in order to
arrest it;  the  employment of tonics, rich wines, a
nutritious food, chalybeate waters, cold bathing and
injections, consisting of infusion of roses, cinchona.
rhatany, punica granatum, &c
            INTESTINAL  WORMS.

  Daily observation teaches us  that children, per-
sons of a lymphatic temperament, and those who
have been long subjected to  a debilitating  regimen,
are liable  above all  others to  the production of
worms in the  intestines; yet, on the other hand, it
is no lese certain that these insects often exist along
with gastro-intestinal inflammation, and symptoms
are continually attributed to their presence, which
are occasioned solely by the existence of this in-
flammation. We would therefore recommend, that
before the administration of any vermifuge whatever,
for  all of them  are powerful stimulants, the con-
dition ofthe alimentary canal should be ascertained;
and when any  traces of inflammation are detected,
these medicines must be carefully avoided.
  The number of  substances to which has been
ascribed the power of destroying and removing these
entozoa,  is immense; all of them, perhaps, have
been occasionallv successful; but as there are some
                     14* 
Uiv!
IN IK-TIN A1, M'ORMi-.
which  may prove highly injurious, or which offer a
less probable chance of success, we shall confine
our attention tothose.the utility of which experience
has sufficiently demonstrated.
  Ascarides Lumbricoidcs___Infusions of the  fol-
lowing substances,  the  polypodium filix  mas, the
root  of the  tanacetum  vulgare, the seeds  of the
artemesia santonica, the  leaves and  tops of the juni-
perus sabina, the centaurea benedicta, and pumca
granatum;  in like manner, lemon juice, animal oil,
camomile,  mint, valerian,  camphor, assafoetida,
muriate of ammonia, calomel, rhubarb, jalap, castor
oil, and almost  all purgatives,  may  be ,employed
with advantage  in destroying  and  removing these
worms.
  Ascarides Vermiculares.—The situation of these
thread worms being in the  rectum, they  would
scarcely, in any degree, be affected  by the medicines
which  we have just enumerated as most effectual
against the long round worm ;  for none of these
vermifuges can kill the worms, which are protected
by the feculent matter  in which they are involved,
and, although purging  may eftect the removal  of
some of them, it is not likely to dislodge them all,
and can have no influence upon their reproduction.
The method which has  always appeared to the
author best calculated to cure this most disagreeable
complaint, consists in the complete expulsion ofthe
ascarides from the  rectum, and especially from the
lower  portion of it,  where their perpetual motion
excites an almost intolerable irritation and constant
tenesmus.   This object will not be attained by one
injection; two or three, administered at short inter-
vals, will be necessary.   The first is, to unload the
intestine of its  fecal  accumulation; the  second,
which should be cold, and consist  of a  solution of
muriate of soda, or of chloruret of soda diluted, or
vinegar and water, is feobe retained a? long as possible, 
intestinal worm.-.
168
lliis is givey with the design of killing and expelling
the worms which may have been left attached to the
mucous membrane of the  rectum.   Soon after this
second injection, the  third should be administered,
consisting of three or four spoonfuls of oil, or,  what
is still better, a thick mucilage of linseed or marsh-
mallow, which  will fulfil  the double indication of
mitigating the uneasiness which might otherwise be
occasioned by the  few remaining  in the rectum,
and protecting the mucous membrane from imme-
diate contact with those that may descend from the
upper part of the rectum.
  Another precaution, which  in general, is  by
itself sufficient, when the ascarides  are  few in
number, and do not occasion great  uneasiness, is
to solicit the action of the bowels regularly every
morning, and to resist any desire to go to stool in the
afternoon, otherwise, the pain and itching which
in general begin towards night, come on at an
earlier  hour, and with  much greater severity.
Lastly, when other means fail, we must have  re-
course to injections.
  Professor Brera has recommended a plan, which,
although not calculated to remove the disease, is,
at least, highly efficacious in mitigating the suffer-
ing which attends it: it consists in  introducing
into the rectum, a piece of lard or candle, which,
in addition to the emollient  property  common to
all  oleaginous  substances,  possesses  this  ad-
vantage, that it can be drawn out, bringing along
with it. the greater number of the ascarides in the
lower portion ofthe  rectum.
  The formation of worms is to be prevented by
guarding against all inflammation of the bowels,
and in this way, against the excessive excretion of
mucus, in which it terminates: by causing, through
a regular system of exercise, the muscular system
to predominate over the lymphatic, prohibiting all 
104          intestinal \\or>i>.
unwholesome, and indigestible food, and prescri-
bing various  tonics,  such as chalybeate mineral
waters, cinchona,  rhubarb, gentian, &c.
  Tcenia.—The removal of the symptoms occa-
sioned by the presence of tenia, is only to be ac-
complished by the expulsion of the worms. Among
the substances capable of  effecting  this object,
the bark ofthe punica granatum merits the high-
est  rank.  Indeed, the decoction of this substance
has recently acquired such great  reputation,  that
it would be wrong to employ any other remedy in
tenia, before  a trial has been made of this:  the
dose is two ounces of the bark, boiled in a pint of
water ; the  decoction  should be taken in  the
morning fasting, and succeeded by an ounce or an
ounce and a half of castor oil, to obtain  a  free
evacuation from the bowels.  This is the mode of
its employment recommended by Dr. Deslandes, a
physician who has greatly added  to our  informa-
tion on this point of therapeutics1,* and the author
can without hesitation affirm, that after having in
several cases given the bark ofthe pomegranate in
this manner, he has never known any bad  con-
sequences to  result.  It is proper to adopt  the
precaution of putting  the  patient on a low diet
during the day  in  which  this  medicine  is  ad-
ministered.
  The powdered root  of the male  polypody is
frequently successful in destroying tenia : it  con-
stitutes the  celebrated   specific of  Madame
Nouffer.
  Very pure filings of pewter, a  remedy extra-
  * Observations sur  l'cmploi de l'ecorcede grenadier,
lues a Anthenee de  Mldecine, et in£ere£s dans let
bulletins de cette soctete, Nouvelle Bibliotheque Medi-
cate, tome is. p. 76, annee 1825. 
INTESTINAL WORMS.
165
 vagamly extolled by Alston  and Block, may be
 resorted to in cases where other means  have
 failed.  The same may be said of sulphuric ether,
 muriate of ammonia, assafoetida, oil of turpentine,
 cold water, carbonic acid gas,  the  remedy of La
 Clutpelle, which  consists in the administration of
 five  ounces of huile de noix, succeeded two hours
 afterwards by  four ounces of Alicant wine ; these
 remedies being repeated for  several days succes-
 sively, until the  worm  is wholly expelled.   The
 employment of  it,  according  to Vetter, so en-
 tangles the tenia, that  a purgative is afterwards
 sufficient to effect its removal.  It is almost su-
 perfluous to remark, that the destruction of this
 worm cannot  be permanent  until the  head has
 been expelled.
 The sympathetic and secondary symptoms occa-
 sioned by the presence of worms in the intestines,
the principal of which  are convulsions, vomiting,
chorea, epileptic fits, head-ache,  tinnitus  aurium,
cough, pains and  cramp of the inferior  extremi-
 ties, &c, if accompanied by no other symptom,
 which can be regarded as indicative of any essen-
 tial disease of  the organ to which they are refer-
 red,  will disappear on the removal of the cause,—
the presence of worms.  It is, nevertheless, proper
in such cases, to combine with the more directly
vermifuge medicines, the exhibition of  valerian,
opium, castor,  oxide of zinc, extract of hyosciamus,
camphor, &c, also  the emplovment of the  tepid
bath. 
lot;
DISEASES OF THE LIVER.
                  ICTERUS.

  When an attack of icterus  is recent, has come
on spontaneously, and is unaccompanied with pain
in the right hypochondrium, or any evidence of in-
testinal  irritation, nothing further  is  required or
proper than abstinence, and  the use of aperients,
and of diluent  and acidulated drinks, which may
be rendered laxative by the addition'of half an ounce
of the supertartrate of potash or the sulphate of
magnesia.  When any degree o f fever exists,  and
pressure  over the seat of the liver and duodenum
excites  pain,  much benefit  will be derived from
the application of a dozen leeches to the region of
the abdomen, or anus, in addition to which, warm
bathB should be prescribed, and the hypochondrium
covered with  a large cataplasm.
  When the attack of icterus has come on gradu-
ally, has existed a long time, or does not appear to
be affected by the treatment which we have recom-
mended, it  generally  depends  on some  organic
disease ofthe liver, a chronic hepatitis, obliteration
of the ductus communis  choledochus by a  biliary
calculus, scirrhus ofthe  pancreas, &c. ; in  any of
these cases, the treatment must be wholly direct-
ed to the primary affection.
  The icterus of new-born infants,  the duration of
which is seldom prolonged beyond a  week, is not
a serious affection, and generally requires nothing
more than warm bathing, friction of the abdomen,
i at.aplasms to  the  right  hypochondrium, and the
milk of a  female who has been lately delivered, 
HEPATITIS.
Iti7
We must take care that  the liver is not compres-
sed,  and when  the meconium  is  not properly
evacuated, some  laxative  should be administered.
                  HEPATITIS.

   In the beginning of acute hepatitis, it is neces-
sary to bleed  freely from the arm, and to repeat
the operation,  as often as the severity  of the at-
tack, and the strength and age ofthe patient may
render it advisable.
  Venesection being by far the most efficacious mode
of abstracting blood in inflammations  of paren-
chymatous structures, it may  readily be supposed
to exert a powerful influence over an organ, whose
functions are so intimately connected with  the
venous circulation, as are those of the liver;  the
local abstraction of blood is only useful in remov-
ing local pain, especially  that which  seems to
depend on inflammation of the peritoneum cover-
ing the liver; for this purpose, leeches, together
with cupping glasses should be applied  along the
margin of the false ribs on the right side,; unless
the disease has succeeded to  a suppressed men-
strual or hemorrhoidal flux, when the abstraction
of blood from the anus may be preferable.
  It will be necessary to have recourse to the appli-
cation of leeches, as long as  any pain  remains.  In
the mean time, the cure of the disease  may be  pro-
meted by placing the patient frequently  and for a
long time in a warm bath, by applying cataplasms
or emollient fomentations over the  hypochondrium,
by mucilaginous injections, directing the patient to
drink  large quantities of acidulated, mucilaginous,
and slightly diuretic fluids, as the infusions of althea,
friticum repens, lemonade, and  oxymel.  Mild ape- 
163
llEPATHIs.
rients, as castor oil, should be prescribed, especially
if the  bowels are constipated, and  the  alimentary
c:iii:il appears free from any inflammation, the aggra-
vation of which might provoke the  return of the
acute  symptoms ot-hepatitis:  the  strictest absti-
nence must be enjoined, while any fever  remains.
  In certain cases in which stupor, prostration of the
vital powers, and a feeble soft pulse, prohibit the
abstraction of blood,  we have known  very great
benefit follow the administration of camphor, twelve
or fifteen grains of it being  taken  in a six-ounce
mixture.
  If, notwithstanding, the inflammation continues,
and symptoms of suppuration begin to appear, such
as repeated attacks of shivering, and a tumour per-
ceptible through the integuments, we must carefully
avoid drawing  blood, especially from the arm, for
bleeding in such circumstances would only bring on
death :  the practitioner should do nothing  but open
the abscess, and give exit  to the pus:  previously
taking care to ascertain jthat he has not mistaken
for an abscess of the fiver, a distended gall bladder.
He may, however, when^the symptoms are no longer
acute,  and nothing indicates the accumulation  of
pus in any cavity, promote its absorption  by pre-
scribing mercurial frictions over the hypochondrium,
or at the groin; a drachm of ointment is to be em-
ployed at each operation, which should be repeated
until salivation is effected.   Calomel alone* or com-
bined with jalap, opium and camphor, will also be
indicated, if the gastro-intestinal mucous membrane
is unaffected.
  When acute inflammation of the  liver has termi-
nated  in induration, or has  insidiously assumed a
chronic form, when this viscus has descended below
the margin of the false ribs, feels hard, and is sensible
to the  touch, it becomes necessary, every now and
'hen, to apply leeches to the hypochondrium or anus 
           SCIRRHUS, CANCER, ETC.         169

and to abstract a moderate quantity of blood from
the arm, when the general condition of the patient
will permit, especially if there should exist any or-
ganic disease of the heart.
  It will also be proper to insert a large issue in the
neighbourhood of the liver, put the patient  on a
course  o( Cheltenham waters, prescribe bitters,
laxatives and diuretics, along with the daily employ-
ment of feet baths containing muriatic acid, vapour
baths, and fumigation of the inferior extremities, a
measure recommended by several Italian physicians,
and, to re-establish suppressed discharges, hemorr-
hoids,  ringworm, sweatings of the feet, &c.  or, if
that is impossible, to supply their place by an issue,
recommend  moderate exercise on horseback; and,
lastly,  to restrict the patient  to a severe  regimen,
and remove every thing calculated to act as a stimu-
lant.
   Before concluding this chapter, it is proper to re-
mark, that in cases  of irtduration ofthe liver, where
no inflammation exists in the intestinal canal, very
great benefit is derived from drastic purgatives ad-
ministered judiciously, and with caution.
   We have seen cases of long established hepatitis,
in which almost every remedy recommended in simi-
lar circumstances, had been tried ineffectually,  and
which were accompanied by great enlargement and
induration, vanish as if by enchantment, after  this
plan of treatment  had been employed for  a  few
days.
SCIRRHUS, CANCER, TUBERCLES OF THE
                    LIVER.

  In consequence of the obscurity  in  which the
pathology Of these morbid alterations of structure
                       15 
 170        ENCYSTED DROPSV,  ETC.

 is involved, very little can be said respecting the
 treatment best  adapted  to their cure.   In general,
 the physician can do nothing more than moderate
 the irritability ofthe liver, and prevent inflammation
 of the stomach  or bowels, which is very apt to su-
 pervene in the course of organic hepatic disease, by
 the warm bath and mucilaginous drinks, and, if the
 symptoms are severe, by the application of leeches
 to the hypochondrium or epigastrium;  however, the
 abstraction of blood is rarely beneficial, and is almost
 always in the end more injurious than  useful in or-
 ganic affections of this kind, on account of the fre-
 quent occasion there is for its repetition, after it has
 been once resorted to.   Warm bathing, cataplasms
 and narcotics, given by the  rectum if they offend
 the stomach, may be made use of to«alleviate pain;
 an issue may be inserted in the right hypochondrium
 and pediluvia, containing muriatic  acid, employed
 daily.  In regard to diet, the  patient should select
such articles of food as he can digest most easily,
and in every respect he  must be placed in circum-
stances the most favourable to health.
 ENCYSTED DROPSY,  HYDATIDS OF  THE
                    LIVER.

  The cure of these diseases can be expected only
from a surgical operation ;  but we must have most
unequivocal evidence that the contents of the tumour
are fluid, by decided fluctuation, and by an explora-
tory puncture made with a  very fine trocar, before
having recourse to it.   As soon, however, as we are
satisfied on this point, and the condition of the pa-
tient is such as to justify us in exposing him  to the
risk of an operation, it should be attempted.   In the
first place, a  piece of caustic potash is to be applied 
           ENCYSTED DROPSY, ETC.         171

over the most prominent point of the tumour;  the
texture of the cutis  being  thus  destroyed, an in-
cision should  be made through  it, at the bottom of
which,  a second piece of the potassa fusa is to  be
inserted, so as to destroy the muscular structure in
the same way, and lay bare the parieties ofthe cyst.
The superiority of this process to that of  simple in-
cision, consists in its permitting the formation of ad-
hesions between the  parieties  of the cyst and  the
peritoneum, by which  the escape ofthe fluid into the
serous cavity of the abdomen is prevented. As soon
as the contents of the cyst are evacuated, it must
be injected with some liquid, at first emollient;  but
afterwards consisting of a  weak solution  of  the
chloruret of soda,  combined with decoction of cin-
chona, to prevent the  corruption of the pus, and ac-
cess of air into the cavity.   The injection  of this
liquid must be continued in this manner,  until  the
cavity of the  cyst  has  become obliterated.  The
history of a case in which a cure  was effected  by
this process, has been  recently published by the au-
thor*
♦Rovue Meaicale, tome iii. page 111. annee 1825. 
17M
DISEASES OF THE SPLEEN.
                 SPLENITIS.

 Although the pathology of the spleen is almost as
unknown as its physiology, the occurrence of sple-
nitis is sufficiently frequent to teach us that every
acute pain developed in this organ, especially when
combined with lever, requires antiphlogistic reme-
dies—the  general  and local  abstraction of blood,
baths, diluents,  and a low  diet.   As splenitis often
occurs along with intermittent fevers, it is proper,
in this latter disease, to examine the  left hypochon-
drium, and, in addition to ordinary remedies of ague,
to employ those which we have just  enumerated,
should this region be the seat of any tenderness or
tumefaction which  is  fairly attributable to  the
spleen;  by this means subsequent chronic  conges-
tions of this organ will be  obviated.  The  peculiar
yellowness of the skin, which-usually  accompanies
these affections may assist in  forming a diagnosis.—
(See Intermittent Fever.) 
1?J>
DISEASES OF THE  URINARY
            ORGANS.
                 NEPHRITIS.

   Whether nephritis is occasioned by the presence
 of sand or calculi in the kidney, or whether it depends
 on some  other cause, it  is equally necessary to
 attack it  at once by venesection, if the patient is
 strong and the fever considerable.  The repetition
 of this operation a second, and even a third time,
 will be called for, if the inflammation is severe ;  or,
 at least, the frequent application of leeches in large
 numbers to the lumbar region of the affected side;
 also cupping glasses to  the same place, or  to the
 perineum,  where  they  appear  to  be  peculiarly
 useful: it will also be proper to have recourse to
 immersion ofthe lower half of the body in a warm
 bath for two or three  hours, emollient cataplasms
 sprinkled with the tincture of opium, warm demul-
 cent drinks, as the infusion of althea, linseed tea,
 decoction of tussilago,  &c. taken in small quantities
 ot a time.
  After having, in this manner, lessened the violence
of inflammation, our next object should be to remove
any pain which  may remain, by anodyne embroca-
tions, as the spirit of  camphor and  laudanum em-
ployed over the loins, by injections containing eight
or ten minims of laudanum, and tenor twelve  grains
of camphor, along with  the internal exhibition of
opium,  sirup  of  poppies, lactucarium,  carefully
watching the action of these medicines, so as  to dis-
continue them if any bad eftect seems to ensue.
  When an attack of nephritis has supervened on
                   15* 
174
NEPHRITIS.
the suppression of hemorrhoids, or the catamonia,
it is obvious that the  first  and most  important
indication is to re-establish these discharges, or
supply their place by the application of leeches
to the anus, or vagina, by ho^ fomentations, hip
baths, pediluvia, &c.
  In chronic nephritis an antiphlogistic course is
less imperative ; it is, however, advisable to have
occasional  recourse to the local abstraction of
blood from the vicinity of the affected kidney by
means of leeches, to use the warm bath regularly,
to drink demulcent  liquids, and insert an issue or
seton in the lumbar region.
  Nephritic pains of a certain character, whether
habitual or only occasional, are frequently relieved
by  the employment of assafoetida,  a combination
of ether  and laudanum, half an ounce of the one
and a scruple of the other  to  be  taken in the
course of the twenty-four hours, by tepid baths,
and the various antispasmodics; but in  regard to
those which are  occasioned  by the presence of
sand, or  calculi,  and depend  on the volume or
position  of these concretions, the  only  way in
which relief can be expected, is by promoting their
expulsion ;  for this purpose, we must recommend
warm bathing, copious  drinking, especially  of
fluids  containing bicarbonate of soda and potash,
in doses extending from one scruple to one or
two drachms in the  course  of the day,  lime or
magnesia water, acidulated drinks of muriatic or
nitric acid,  infusion of triticum repens, uve ursi,
saxifrage,  asparagus  and whey, adding  a few
grains of nitrate of potash to each pint.   Some
of these  diluents, independent of their usefulness
in facilitating the expulsion of calculi, are also
calculated to prevent  their formation, as they are
well known to consist  principally of lithic  acid.
Of this kind are  the solutions of the carbonates 
DIABETES.               175
of potash, lime, and magnesia, and especially of
the bicarbonate of soda ; this last medicine, howe-
ver, on account of its sparing  solubility, is taken
most conveniently in the lbrm  of lozenges.
 Certain physicians have recommended abstinence
from all  food containing nitrogen ; and  it cannot
be doubted that, occasionally at least, great benefit
has been derived from the employment of farina-
ceous vegetables, rice, potatoes, beans, sugar, rye
bread, mild beer, &c.
   Such  a diet then it will be proper  to adopt,
together, with the use ofthe drinks above enume-
rated, selecting those which are least offensive to
the stomach.
  In the circle of his own observation, the author
has  several  times seen decided advantage ensue
from  the administration  of one, two,  or three
spoonfuls of  olive  oil,  combined with  an equal
quantity  of sirup of lemon, at  an  early  period of
nephritic  complaints.  In several instances the
pain has  been entirely removed by  it.
  Persons liable to the formation of gravel, should
avoid a  damp atmosphere, live in well aired apart-
ments, wear flannel  over  the whole surface of the
body, and, if there is reason to think that their place
of residence is favourable  to the developement of
the calculous disorder, to which they have"a natural
tendency, they ought to  remove into some more
congenial climate.
  The abscesses, which  sometimes  form in  the
vicinity ofthe kidneys, require to be opened early.
                 DIABETES.

  Of the numerous methods of treatment which
have been suggested for the cure of this disease, the 
176                DIABETES.
employment of tonics and animal food appears to
have proved most successful, and is  now the most
universally adopted.  While, therefore, on  the one
hand, we prescribe  astringent and tonic draughts,
such as the infusion of cinchona, calumba, rhatany,
quassia, gradually  diminishing  the  quantity every
day, and alum, kino, catechu, myrrh, turpentine, and
balsam of tolu, all  of which are said to have been
useful; it is necessary on the other hand to recom-
mend highly nutritious animal food, such as concen-
trated rich soups and jellies, with wine.
  At the same time we should endeavour to pro-
mote  diaphoresis by suitable medicines, especially
the compound powder of ipecacuanha, vapour baths,
and frictions.  In Milan,  the author saw diabetics
successfully treated by exciting a general eruption
over the skin, such, for instance, as the itch.
  In patients who are of a  plethoric habit, or who
complain of pain in the region ofthe loins, it will be
proper in the  first  place  to have recourse to  the
general or local abstraction of blood.
  [I subjoin an  analysis  of the treatment  recom-
mended by Dr. Prout in his work on this subject.
  In acute and recent cases, the propriety and even
necessity of general bleeding, repeated as often as
circumstances may require, is indisputable.   In pro-
tracted cases, however, occurring in  old subjects,
and wherever there is great  debility, this remedy
should be very cautiously employed.  The local ab-
straction of blood has also been found  beneficial,
particularly when  unusual fulness, heat, or tender-
ness about the stomach,  has been complained  of.
The bowels  should be kept freely open  by some
gentle aperient;  but mercury, saline, and other
medicines  hkely to act as  diuretics, are generally
to be avoided.  In regard to opium, it is very useful
in counteracting the nervous irritability so common
in  diabetes; it has also,  beyond doubt, in several 
                   CYSTITIS.                17*

instances greatly diminished the quantity of urine,
but it  does not appear capable of effecting more
than a temporary alleviation of the symptoms.   The
best preparation of opium is the pulvis ipecacuanha
compositus, on account  of its diaphoretic property..
In conjunction  with the  above  remedies, and with
the view of restoring the cutaneous functions, the
warm or vapour bath,  the  flesh brush, &c.  should
be employed ; the patient should  also wear flannel
next the skin,  and take  as much exercise as he is
capable of without fatigue.  He  ought to drink very
little, avoiding  in general cold liquids, which, being
taken  with greater avidity, it is difficult to take in
due moderation.   The solid food of the diabetic
patient should consist essentially of animal and fari-
naceous substances, and as little as possible of sweet
and acescent vegetables, for no other reason, how-
ever, than that  the former are more easily digested
than the latter. The quantity of food is as impor-
tant as its quality, and must be confined within very
moderate  limits.  Lastly, unless  the mind is tran-
quil, little benefit can be expected from any treat-
ment whatever.]
                   CYSTITIS.

  This inflammation, if existing in any considerable
degree, and attended with  fever, must be promptly
met by the abstraction  of blood  from the arm, and
the application of leeches, more or  less frequently,
to the hypogastrium,  perineum, and  anus.  The
effect of these measures is to be promoted by the
employment of warm  baths, in which  the patient
remains a long time, emollient cataplasms, injections,
low diet, drinking copiously of diluent  or  slightly
mucilaginous liquids, such as the infusion of althea, 
l?fc>
CYSTITIS.
the triticumrepens, common parsley, coltsfoot,whey,
&c. taken hot and in a small quantity at once, until
perspiration is established.  If the inflammation is
attended  with retention of urine, this  treatment
would be altogether applicable to it, but not always
sufficient, without having recourse to the introduc-
tion of the catheter; in regard to this instrument,
it is better to let it remain in the bladder, unless the
neck of this organ is involved  in the inflammation,
or the catheter excites irritation, or the largeness of
the canal renders its introduction easy.
  When  cystitis has been occasioned by  the  ad-
ministration of cantharides, it will be necessary, in
addition to the measures of which we have spoken,
to have recourse to camphor, taken  by the stomach,
thrown up the rectum, and employed as a liniment.
  Whenever inflammation ofthe bladder has been
preceded by the  suppression  of some sanguineous
discharge, long established cutaneous eruption, ul-
cer, ringworm, local sweating  in the feet or axille,
or a remarkable diminution ofthe general cutaneous
perspiration, which  is most frequently the  case, it
becomes necessary to re-establish  these  affections,
which have become habitually  necessary to the sys-
tem, or, if that is impossible, to substitute for them
the local abstraction of blood, the insertion of an is-
sue in their  ancient seat, hot  cataplasms, wearing
flannel, vapour baths, friction with the hand, either
dry or anointed with oil, and frequent  laxatives;
lastly, when chronic catarrh ofthe bladder, for such
is the character which  inflammation generally  as-
sumes in  these circumstances, is unattended with
pain or fever,  the employment of turpentine in the
form of pills, beginning with doses of twelve and
eighteen grains, or its essential oil, given in combi-
nation with mucilage, at first to the  amount of half
a drachm, then gradually increasing it up to  two or
three drachms in the  course of the twenty-four
hours, is often a very effectual  remedy. 
CYSTITIS.                179
  Conjointly with this medicine, the infusion  of
bark and the powdered leaves of the uve ursi, alone
or along with some mineral water, should be exhi-
bited ; an issue, or seton, being at the same time in-
serted in the perineum, and  the  tartar-emetic oint-
ment rubbed in at this region, the hypogastrium, or
inner side ofthe thighs.
  But if, on the contrary, the bladder appears, from
the existence of pain and dysuria, to be in a state of
great irritation, we must either employ warm baths
or the  other remedies before enumerated.  Injec-
tions a double courant, as recently recommended  by
Jnles Cloquet, are well worthy  of trial.
  But no permanent benefit can be expected in this,
any more than in every other disease, unless the pa-
tient is  willing to  submit to, and persevere in the
adoption of certain hygienic  precautions;  namely,
abstinence from every description of stimulating
food, perfect continence, which is the most impor-
tant of all, the habitual employment of flannel over
the whole  surface, keeping the feet carefully dry
and warm, daily friction, occasional bathing, residing
in a dry situation,  with a southern aspect  and in a
warm climate, and, lastly, avoiding violent exercise
of every kind, such as riding on horseback, forced
marches, long walks, &c.   The severity of our in-
junctions, in regard to diet, may only be relaxed  in
favour of persons greatly advanced in age; to these
the moderate use of wine may be permitted.
  The vesical catarrh which depends on stricture of
the urethra, or the presence of a calculus  in the
bladder, comes  more properly under the care ofthe
surgeon, as  its  cure can only be effected by means
of an operation. 
180             HEMATURIA.
                 HEMATURIA.

   Whenever hematuria occurs in persons of a
 plethoric habit, or appears to have been occasion-
 ed by the omission of an habitual  bleeding, the
 scanty flow of the catamenia, or of hemorrhoids,
 it is proper to abstract blood from  the arm, place
 the patient in a  bath,  and  prescribe the free use
 of diluent liquids, such  as the infusion of mucila-
 ginous  substances and whey.  It is a useful pre-
 caution to leave  a catheter  constantly in the
 bladder, in order that the blood may not accumu-
 late.
   If this hemorrhage is attended with local pain
 in the lumbar, or hypogastic region, it is necessary
 to apply leeches to the part  affected ; and, in
 cases of this description, we must never omit, ae
 soon as the patient becomes convalescent, to warn
 him against every kind of excess  in any of his
 habits of life, to enjoin strict temperance, and even,
if there  seems occasion, to  forbid altogether  the
 use of wine or rich stimulating food.
   When the discharge of blood is  very  profuse,
 and the strength of the patient is  rapidly failing,
 we must endeavour, by refrigerating applications
to the abdomen, perineum, and thighs; and by
injections into the vagina  of freezing water, to
check its progress ; the patient should be placed
in a very cold hip bath, and the extract of rhatany
internally administered.  As in these cases hema-
turia is sometimes the consequence  ofthe rupture
of a varicose vein, it is proper to leave a catheter
 permanently in the bladder.
   Whenever this affection occurs in persons who
have long been in a bad state of health,  of a de-
bilitated constitution, or scorbutic  habit, a tonic 
                 HEMATURIA.              181

system of treatment is indicated.  Preparations of
iron, cinchona, vegetable  acids, and cold bitter
drink, are, in tbese cases, our most valuable reme-
dies.   An  antiphlogistic  treatment would only
hasten death. (See also Scorbutus and Menorrhagia.)
1« 
182
DISEASES OF THE ORGANS OF GENE-
                  RATION.
                AMENORRHEA.

  When the suppression of the  catamenia ha6 oc-
curred suddenly, and has been occasioned by ex-
posure to cold or some depressing mental emotions,
a fit of anger, or any other similar cause, the first
object of the practitioner is to bring about a deter-
mination of blood to the uterus, by dry friction over
the thighs, hot fomentations over the hypogastrium,
irritating  pediluvia,  fumigations directed  towards
the uterus, a warm bath, or some aromatic  and hot
drink.   But if these means are ineffectual, it will  be
necessary  to have recourse  to  the application  of
leeches to the vagina.
  When amenorrhea has existed during  several
months, and does not depend on pregnancy, or any
other affection, its treatment must be regulated  by
the condition of  the individual.
  In a  plethoric patient, of a sanguine tempera-
ment, predisposed  to congestion about  the  heart,
general  bleeding, diluent drinks, bathing, diminish-
ing the quantity  of food, abstinence from wine and
other stimulants, are the means best calculated  to
restore the function of the uterus.
  In amenorrhea, depending on excessive irritability,
in a thin nervous female, with whom the catamenia
are habitually scanty, the remedies of most  efficacy
are cold bathing, cold affusions, if the  state of the
pulmonary organs does not prohibit it, and corpo-
real exercises, in which the  mind has  little share 
AMENORRHEA.
18U
 such as gardening and walking, and antispasmodic
 drugs.  It is important to watch over the digestive
 functions, improve  the appetite, allow the patient
 plenty of nutritious food,  and invite sleep by mode-
 rate daily exercise ; at the proper period for the ap-
 pearance of the menstrual discharge, it should be
 encouraged by fumigations of assafoetida,  directed
 towards the uterus, by means of an inverted funnel.
   If the female in whom the menses are obstructed,
 is of a lymphatic temperament, phlegmatic, much
 weakened by previous illness, and residing in a damp,
 ill ventilated situation, the habitual use  of wine and
 nourishing food, covering the body  with flannel,
 daily exercise, dancing,  and  marriage, should be
 recommended.  It is necessary to ascertain whether
 leucorrhoea exists, as  this affection  is  very common
 in such patients; the preparations of iron, as the
 subcarbonate, iron  filings, and  chalybeate waters,
 cinchona and bitters,  may then  be employed with
 benefit.  Lastly,  determination  of blood  towards
the uterus should be  promoted, especially at each
recurrence  of the proper period  of the menstrual
discharge, by the oil of turpentine in drachm doses
 daily, the application of dry cupping glasses to the
 loins and  hypogastrium, by  galvanism,  aromatic
 fumigations, and hot hip baths.   The local abstrac-
 tion of blood, which  is very seldom  beneficial in
cases of this character, is altogether contra-indicated
when a chlorotic condition attends amenorrhea.
  When this  affection  is the consequence of libi-
dinous excesses,  the  strictest continence must be
observed.   If the catamenia have been  long ob-
structed, and  nature  has substituted  some  other
evacuation, our object should be rather to  maintain
this new function,than to recall the old one. Lastly,
if the influence exerted  by the uterus  over the sys-
tem, is greatly disproportioned to the  age of the 
184               METRITIS.
patient, marriage and consequent pregnancy are the
only means of restoring an equilibrium.
  The regular performance of this important func-
tion, or, in other words, the prevention of amenorr-
hea, greatly depends on the removal of the predis-
posing or immediate causes, which vary almost in-
finitely, according to the temperament of the  indi-
vidual.
                 METRITIS.

  The treatment of this inflammation  is consider-
ably modified by the condition  of the uterus at the
time of its commencement.
  When occurring in a young female at the period
of the first menstrual effort, in which circumstances
it is often mistaken for amenorrhea, our object will
be to  assist this function by directing  fumigations
towards the uterus, by the employment of hip baths,
pediluvia impregnated  with mustard, dry cupping
glasses affixed over the hypogastrium, loins, or inner
side ofthe thighs, and the local abstraction of blood
from this latter place, or  from the groin, by means
of leeches.
  In inflammation of the  womb, occurring in  an
adult female not in the puerperal state, after having
made one moderate bleeding from the  arm, it will
be proper,  unless high fever  attends,  to have re-
course to the application of leeches to the hypogas-
trium,  perineum, and even the neck of  the  uterus,
especially when metritis is the consequence of vene-
real excesses, to direct the employment of warm
baths,  in which the patient should remain a long
time, emollient cataplasms, tepid injections of some
mucilaginous substance, and to restrict the diet to
whey, lemonade, or demulcent?. 
METRITI.-.
IS.'i
'  In metritis coming on after delivery, the condition
of the uterus is in several  respects peculiar: it ia
greatly increased in size,  its substance is more
Bpongy, more susceptible of extensive suppurative
inflammation,and the adjoining parts, as the ovaries,
peritoneum, &c. are more disposed to  take  on in-
flammation : these circumstances, together with the
  feneral excitement into which the system is thrown
  y the  efforts of delivery,  and the great change
which then occurs, all combine  to render a much
more active treatment necessary.
   General blood-letting is here indispensable ; and
it, must be repeated a second or even  a third time,
unless the patient is of a highly nervous tempera-
ment, of weak  constitution, rather  advanced in
life, or  has lost so much blood from  hemorrhage,
as to render further evacuations decidedly dange-
rous ; the practitioner, in forming  an opinion  on
this point, must not be  guided  by mere paleness
of face, for that may be  seen  in most  females
recently after delivery, but solely by the pulse
and general condition ofthe patient.
   Whenever  there is pain, it must  be attacked
 by the application of  leeches, in as large  a num-
 ber as its  severity requires, and  the strength of
 the patient permits.  Blisters also may be  applied
 to the inner side of the thighs, after  the abstrac-
 tion of blood  has obviated all fear of danger from
 excessive febrile reaction  ; at the same time, the
 employment of warm baths, the patient continu-
 ing in them for along time, of cataplasms, fomenta-
 tions, enemata, and injections into the vagina, will
 assist in moderating the inflammation, and prevent
 its extension to the peritoneum.  Should the skin
 be dry or less moist than during health, perspiration
 may be promoted by aromatic fumigations, direct-
 ed even into the  patient's bed, by means  of a  tin
 tube.
                      16* 
ISO
METRI'1 CS.
   If the  female is prevented from suckling,  or
metritis has supervened on an abortion, a  purga-
tive plan of treatment may be adopted, especially
if the attack  of inflammation is accompanied with
bilious symptoms, or the tongue is covered with a
thick fur^or evacuations ofthe prime vie have, in
other similar cases occurring about the same time,
appeared beneficial: when the mucous membrane
of the   alimentary  canal is  wholly free from
inflammation,  while  the  metritis  is  extremely
severe  and seems likely, ere long, to prove fatal,
it  has  been  recommended  to employ, together
with the ordinary antiphlogistic agents, the tar-
tarized antimony, in large doses, on the principle
of counter-stimulation.
  As auxiliary measures, it will  be proper,  to
enjoin  perfect abstinence from food, silence, the
removal of every thing calculated to excite uneasy
sensations, or powerful mental emotions.
  Metritis occasionally depends upon, or is aggra-
vated by, the presence of a portion ofthe placenta
1  f in the  uterus: this we must  then endeavour
to detach,  by fumigations, and emollient injections
into the uterus.  The same  measures are neces-
sary when this inflammation  has  terminated  jn
suppuration, and the pus flows through the vagina;
but if, on the  contrary, gangrene has supevened,
a solution of the chloruret of  soda should he
injected into the vagina, while we endeavour  to
maintain the  patient's strength by tonics.
  Chronic metritis, affecting  principally the neck
of the  uterus,  requires the insertion of issues in
the loins,  an  occasional bleeding from the arm, if
occurring in a young and robust female, the local
abstraction of blood by leeches, applied by means
of the  speculum, to  the very neck of the  uterus
itself;  douching, unless it occasions pain, injec-
tions of mucilaginous and demulcent liquids, hip
baths employ*1^ verv ferment'v dnrinnr one or two 
      SCIRRHl'S. CANCER OF THE UTERI US.   1*1

hours each time, emollient cataplasms, applied to
the further extremity of the vagina, a mild regimen,
and total abstinence from sexual intercourse, must
be enjoined, as indispensable to  the cure or even
mitigation of this affection : and, even then, long
perseverance on the part both  of physician  and
patient  will be necessary.  See Scirrhus  of the
Uterus.
   SCIRRHUS,  CANCER OF THE  UTERUS.

   The plan of treatment described under chronic
 metritis, is alike indicated in confirmed scirrhus of
 the os uteri.   We  may,  however,  observe  in
 addition, that as this organic disease exists gene-
 rally only at one certain period of life, that, name-
 ly, in which the catamenia begin to disappear, or
 at least is at that  period more  active in its  pro-
 gress, it is important, in order to prevent, scarcely
 less than in order to destroy scirrhus, to establish
 in good time some emunctory, which may, to some
 extent,  supply the place of the discharge  which
 has ceased.  For this purpose, a large issue may
 be inserted in the inner^side of the thigh, and any
 unnatural  determination  of blood  towards  the
 uterus, removed by the application of leeches, or
 even by taking a moderate quantity  of blood from
 the  arm,  when  the patient is plethoric.   The
 practitioner should always ascertain  the general
 state of his patient's health; whether, for instance,
 she is  subject to head-ache, colic pains, rheuma-
 tism, hemorrhage, piles, or cutaneous eruptions;
 and  whether there is in her family an hereditary
 tendency to  scirrhous affections; in  either case,
still  greater  precaution is necessary, and every
thing calculated  to promote  the  developement
or progress of organic disease  of this organ must 
l"»?  SCIRRHUS.  CANCER OF THE LTERUs.

be attended  to.   In a patient  thus  predisposed.
the occurance of inflammation  in the womb, re-
quires  the employment  of the  most active mea-
sures, and it will not be prudent to cease watch-
ing over her so long as any appearance  of irrita-
tion remains, or there is  any reason to apprehend
a relapse.
  In regard  to  the more specific  remedies of
scirrhus, besides  establishing artificial discharges,
we would recommend friction along the inner side
ofthe thighs, with the hydriodate of potash, to the
amount of half a drachm, or a drachm  daily, as
well as its application to the neck of the uterus.
The internal employment of iodine, as in the form
of tincture, is also proper, beginning with a few
minims, morning and evening, in a glass of some
mucilaginous liquid, or that of the extract of co-
nium in gradually augmented doses, combined with
the decoction of sarsaparilla. Together with these
medicines, a most severe regimen must be adopted,
the patient's allowance  of food never being ex-
tended beyond two ounces of bread,  and the same
quantity of roasted meat, twice during the day.
  This plan of treatment, which is very  generally
adopted in Germany,  and  partially  in  Paris,  is
successful in a sufficient* number  of  cases,  to
render it worthy of our most  serious  attention.
It is considered practicable to substitute the prepa-
rations of iodine  forthe conium, and to maintain the
cirafamis. But if the alimentary canal is the seat
of irritation, to however small an extent, it is evi-
dent that the employment of thete  various sub-
stances must be deferred until the  derangement
ofthe digestive organs has altogether ceased, and
that, if it should  return, they must be discontinued.
 In reference to this subject, we may here make
 the general observation, that not only in scirrhus
 and cancer of the  uterus, but  in every structural
disease of an organ, whose functions are not abso- 
      KCIRRHUs, CANCER or 1'HE UTERI's.   189

lately essential to life, the fatal termination is
delayed for a longer or shorter time, according to
the degree in  which the healthy condition of the
strictly vital functions, especially that of digestion,
is  maintained.   Hence, the great necessity of
caution not to  endanger the alimentary canal, by
persisting in the employment of measures, which,
instead  of alleviating  one  disease', keep up two.
In cases, therefore, in which the  digestive organs
are at all disordered, it appears to be  much more
prudent  to administer most medicinal substances
through the large intestines, which are much less
susceptible of irritation thaji the stomach and su-
perior portion of the alimentary canal, or through
the skin, deprived of  its  epidermis, or rendered
more permeable by means ofthe warm bath, Thus,
mercurials, if there is any  reason  to suspect a
syphilitic  affection,  narcotics,  to. which  it is
necessary to have recourse, in order to alleviate
the Bevere suffering which usually  attends this
disease; in a word, whatever remedies the nature
of the  disease, the individual condition  of the
patient, and the  combination  of symptoms, may
render necessary, ought to be administered by the
skin, rectum, or vagina.  This principle is  espe-
cially applicable to the employment of the active
medicines recommended by some physicians ; as,
for instance, the oxide of gold, lately recommend-
ed by  Dr. Chrestien, or Afontpellier;  which may
be rubbed in at the gums.   After having had, con-
jointly with Professor  Recamier, the care of nu-
merous cases  of organic disease of the uterus, the
author would state, as the result of his experience,
that the permanent application of pledgets of lint
imbued with some narcotic liquid, and retained in
their place by means of a wire, so as also to be able
to draw them out with facility, is the most effectual,
and at the same time, the safest  means of lessen
ing the pain of the uterus. 
190  SITRRHUs. < ANCI.R <>I  I'UK lii:Kl>.

  The most common anodynes are, the acetate oi
morphia, extract of opium, laudanum, lactucarium,
belladonna,  hyosciamus,  monkshood,  aconite,
prussic  acid,  which  may  be  administered in
clysters, blisters, or by the stomach, if the  con-
dition of that organ will permit; it should be re-
membered, that a medicine which appears not to
act when dissolved in, or combined with a second,
may, if given in a different manner, prove of the
greatest benefit.
  But when the excruciating pain, occurring for
a few moments every now  and then, in  some
females afflicted with  this disease, is not in any
degree relieved by narcotics, either on account
of their being rejected by the stomach, or because
their  action is in any other  way counteracted,
we may partially, though very imperfectly, supply
their  place  by hot cataplasms  over  the  whole
surface ofthe abdomen and thighs, if the pain ex-
tends along the extremities, by  embrocations of
hot oil in the same parts, dry cupping at the groin,
and general fumigation,  which, in  these  cases,
must be  performed  while the  patient lies in bed,
by means  of a tin tube, a plan which we  have
often  found to succeed very well.  Compression
of the os uteri, by means of a pessary, or  plug of
lint,  while the uterus is confined, on the  other
hand, by a bandage around the  lower  part ofthe
abdomen, has  occasionally been useful in the ex-
perience of Professor Recamier.
  For the manner of  applying escharotics to the
neck of  the uterus, removing this organ, or per-
forming  any of the operations which organic die-
ease in the uterus may require,  we refer the  stu-
dent to writers on  operative  surgery ;  we  may,
however,  remark,  that after  the operation, the
plan of  treatment  above described must  still be
persevered in ; otherwise, there  will be great dan- 
MENORRHAGIA.
191
ger of relapse.  Should the  patient be unwilling
to run the risk, or endure the pain of an operation,
much benefit may be derived, when the cancer is
Boft and  broken down, from cauterization of the
affected parts by the nitric oxide of mercury: by
this  means, it is possible to check, if not prevent
absorption, which otherwise will generally ensue,
and  give rise  to  the cancerous diathesis,  and
hectic fever.  After  each   apphcation of  this
escharotic, the vagina should be well washed out
by  injections, and  the patient  then placed in a
hip bath.
  The fetid odour which accompanies  cancerous
ulceration, or softening of the neck of the uterus,
is most  effectually destroyed by means of the
chloruret of soda, and the cauterization which we
have just recommended.
  The diet of a patient labouring under organic
uterine disease,  should consist of such articles of
food as are easily digested, and not of a stimula-
ting nature,  and they must be taken in very mo-
derate quantities ;  with these  restrictions,  the
inclination ofthe patient may be safely indulged.
                MENORRHAGIA.

  When menorrhagia  is  unconnected with any
organic  disease 01  the uterus, as  polypus,  or
cancer ;  is recent, and occurs in a  plethoric habit
of body, it requires the abstraction of blood from
the arm, and large quantities of acidulated  and
slightly astringent drinks, taken cold.  If these
remedies are insufficient, and the pulse and gene-
ral condition of the patient furnish  no contra-indi-
cation, a second bleeding is necessary ; also the
apphcation of cupping  glasses to the thorax, wet 
LV2             LENLORRUIEA.
bandges to  the hypogastrium, and,  when  the
alimentary  canal is unaffected, the internal ex-
hibition  of nitre, in some  mucilaginous  liquid :
lastly, recourse should be had to  cold injections,
or, when practicable, to the introduction  of ice
into the orifice of the vagina, and closure  of the
orifice ofthe uterus by means ofthe speculum.]
  When menorrhagia is attended with pain in the
uterus, emollient cataplasms sprinkled  over with
laudanum, will often greatly alleviate it.
  Chronic or passive menorrhagia requires the ex-
hibition of the various preparations of iron, cin-
chona, rhatany, acidulated drinks,  and  more than
all, a proper regimen ; this last point is especially
necessary,  when the disease originates in a disor-
dered condition of the digestive organs, which  is
kept  up  by the repeated loss of blood, day after
day :  we must take care, however, that our anxiety
to prevent debility does not lead us to overlook the
cause of the complaint in a  latent chronic  gastro-
enteritis.
                LEUCORRHGEA.

   When leucorrhoea is accompanied with itching, a
sensation of heat in the vagina, pain in the loins and
groin, a sense of weight about the uterus, in a word,
with  the symptoms of irritation, the most suitable
remedies are, warm baths, hip baths, emollient in-
jections, douching, and diluent drinks; if the symp-
toms continue, We must resort to the application of
leeches to the labia, or to the mucous surface ofthe
vagina, by means of a speculum perforated with a
certain number of openings.   But when the disease
is on its decline, the pain  and itching in the vagina
having c>?$ed, and the stomach and  bowels being 
LUCORRHOEA.             19-3
 unaffected, it will be proper, to prevent subsequent
 atony, and the long protracted discharge of which
 the mucous membrane of the vagina  is apt to be-
 come the seat, by chalybeate waters, oil of turpen-
 tine, extract of rhatany, fumigations of amber, &c.
   Astringent fluids, as the infusion of roses, or po-
 megranate bark, a weak solution of alum, or sul-
 phate of zinc, with a certain quantity of laudanum,
 should also be injected into the vagina, and retained
 there as long as possible.
   The internal exhibition of the tincture of iodine,
 in doses, at first, of two or three minims, and fric-
 tion witb the ointment of the hydiiodate of potash,
 are indicated, in cases of leucorrhcea which consist
 in  atony of the mucous  membrane of the vagina;
 in  these  cases,  also,  the balsam  of  copaiba,  ad-
 ministered at the commencement even of the com-
 plaint, and in doses varying from half an ounce to
 one or two ounces, has proved very useful.
   When leucorrhcea is constitutional,  and has ex-
 isted from childhood, more  benefit  will  be  derived
 from a judicious regimen than from medicines : the
 principal indication is to form such rules for the  re-
 gulation ofthe patient's diet, clothing, place of resi-
 dence, and exercise, as  are calculated  to give the
 sanguiferous and muscular systems a predominance
 over the lymphatic system : thus, roasted butchers'
 meat, vegetable bitters, wine, woollen clothes, flan-
 nel next to the skin, a spacious apartment, well ven-
 tilated, and with a southern or eastern aspect, a dry
 temperate climate, cleanliness, habitual dry rubbing,
corporeal  exercise  in  proportion to the strength of
the patient, and diversion of the mind, are the prin-
cipal measures to be resorted to for the purpose of
removing a leucorrhoeal discharge, and establishing
the general health in such individuals.   The inju-
rious practice of using feet stoves must be prohibited,
and anv ether bad habit which mav be discovered;
                        17 
1W             GONORRHOEA.
lastly, an issue or seton, kept open for a consider-
able time, even after the cessation of the discharge,
is a very salutary substitute for it, and preservative
against any metastasis of the  disease.  In some
cases, leucorrhcea spontaneously disappears at the
period of puberty, or marriage.
  Yet in plethoric females, general bleeding is often
very advantageous, and it is by an antiphlogistic plan
of treatment,  that  the leucorrhcea which  arises
about the period ofthe menstrual discharge is to be
removed.
  If this affection depends on amenorrhea, a chro-
nic gastro-enteritis, imperforation of the os uteri,
the repression of some cutaneous eruption, ulcer, or
hemorrhoids,  it will  be necessary  to  re-establish
these emunctories, and fulfil the various indications
which may present themselves,  before  we endea-
vour to check  the vaginal discharge.
  Uneasiness at the stomach,  a  sallow  hue of the
countenance, and  the  distressing lassitude so fre-
quently complained of by females affected with lu-
corrhoea, require tonic medicines, as the prepara-
tions of iron, cinchona, and bitters, unless the sto-
mach is evidently disordered by them.  See also
Metritis, Scirrhus of the Uterus, Menorrhagia.
                 GONORRHOEA.

  Acute inflammation of the  mucous membrane of
the urethra may be easily dissipated ; general bleed-
ing is unnecessary, unless  the attack is unusually
severe, is attended with great febrile reaction, oc-
curs in a patient of a plethoric habit, constitution-
ally disposed to inflammation,  or has extended, or
threatens to extend, to the neighbouring organs, as
the prostate, bladder, seminiferous vessels, epididy- 
GONORRHOEA.             195
mis; in all other cases, every indication will be suffi-
ciently fulfilled, by the application of leeches along
the canal, and at the perineum, by local  bleeding,
and the frequent  and  long continued  use  of hip
baths, unless,  as happens in some few cases, these
baths seem rather prejudicial:  emollient cataplasms
are to be  applied  over the affected parts, and  the
patient should drink copiously of diluent and muci-
laginous fluids, in  order that the urine may produce
less irritation as it flows over the  canal: linseed
tea, gum water, the infusion of althea, and a weak
solution of alum, will answer this purpose; absolute
rest must be enjoined, otherwise the cure  of this
inflammation will  become much more difficult  and
tedious.   If the  patient is tormented, especially
during the night, with acute attacks of pain, or fre-
quent erections, some sirup or decoction of poppies
may be added with much advantage to his ordinary
beverage; a few  grains of camphor, lactucarium,
&c.  may be employed for the same purpose;  also,
injections, containing six or  eight drops  of lauda-
num.   Much benefit may be derived  from bathing
the penis during the night, in a decoction of mal-
lows, by means of a bladder; these precautions will
generally prevent nocturnal pollution, by which in-
flammation is often kept up.
   In  a very slight  attack  of gonorrhoea,  the
symptoms  of which are  merely local, nothing
more is necessary than the use of mild  diuretics,
bathing, and the abstraction ofthe various stimu-
lants to  which the  patient is accustomed during
health, as  coffee, wine, highly  seasoned dishes,
&c.  Nevertheless, when  the acute stage of this
affection, that is, the  stage attended with pain,
has terminated, very  great benefit Is  often deri-
ved in cases both  of this  and the preceding cha-
racter, from  the  employment  of stimulants, af
the balams.  the leaves ofthe uve ursi,  the oil r. 
190             UONORRIUEA.
turpentine  to  the  amount of  a drachm,  or two
drachms daily, balsam of copaiba administered by
the mouth, or in an injection, alone  or combined
with  cubebs,  rhatany, the infusion  or tincture
of calumba, or  juniper  berries, substances  of
which  we shall speak more fully afterwards.
  As a  remedy particularly useful towards the
termination  of a long protracted genorrhoea, we
may mention the  employment of moderate and
permanent  compression  of the  penis, always,
however,  taking care to  intermit it  during the
night;  otherwise, erection taking place during a
profound  sleep, might occasion  very  injurious
consequences  ; moderate sexual  indulgence, and
absolute rest in bed, are  similarly useful ; indeed,
we have  seen cases of gonorrhoea yield  with
astonishing  rapidity to  these measures,  after
having  resisted all the ordinary remedies.
  It has been  proposed, to prevent the develope-
ment of gonorrhoea, by violently interrupting the
morbid action,  as  soon as the  earliest  symptoms
of it  appear,   for  this purpose,  the internal
exhibition of the  balsam of copaiba is generally
employed; of  which the quantity  that may  be
given, varies from half a drachm to two ounces du-
ring the day, according to the energy of its opera-
tion, which is almost infinitely variable; a drachm
being, in  some cases, sufficient to produce hyper-
catharsis, while in others, scarcely  any sensible
effects follow  the  administration of an ounce.
In  order  that  any benefit may be  derived from
the balsam of  copaiba in  gonorrhoea, it must not
excite more than  a gentle action ofthe bowels ;
otherwise, it will not only  occasion a gastro-enteri-
tis, but will be evacuated with the alvine diges-
tions,  and thus not become  absorbed, or  affect
the system.  The  best means of destroying its
nauseous  taste, is to combine it with magnesia : 
GONORRHOEA.
197
it may be thrown up the rectum  in a solution of
gum arabic, but its operation is less certain when
given  in this  way, than when it is taken by the
stomach.  When copaiba excites nausea, vomit-
ing, colic pains, or excessive purging, the employ.
ment of it must  be discontinued, the  alimentary
canal  left to recover itself, warm bathing  with
emollient soothing injections substituted, in short,
a totally opposite  plan of treatment  adopted.
The rectified oil of turpentine, in  doses  of a
drachm daily, alone, or in combination with honey,
or mucilage, may be used in the place of the bal-
sam of copaiba: concrete turpentine is of no use,
except towards the termination  of  gonorrhoea,
its  action not being powerful enough to  check
the inflammation  at an early  period.
  Cubebs, which, however, is even more variable in
its  action than copaiba, is another powerful remedy:
the quantity of this substance, which it will be ad-
visable to begin  with, should not greatly exceed a
scruple to a drachm of the powder every six hours:
though an ounce and  a  half is  given in the course
of  the day by some practitioners :  the extract,  or
powder of rhatany, is also employed for the same
purpose, either alone or combined with cubebs.
  In  the commencement of gonorrhoea, Croton oil
proves, occasionally, an admirable remedy : the best
mode  of administering this  powerful medicine,  is,
to give it in the  form of pills, each of which should
contain one minim of the oil, combined with a few
grains of gum and soap.*
  Of all these remedies it may be said,  that  very
frequently, as soon as we discontinue the employ-
  * See an article by Dr. Tavernier, inserted in the Bulletin* de
I'Alhenee  for October, 1835, the most complete eieay we have on
the action of Croton oil-
                      17* 
19b              GONORRHOEA.
ment of them, the gonorrhoea returns;  and  that
when, after an interval of some days, we again haw
recourse to them, they not only do not suppress, but
on the contrary, rather increase the  returning in-
flammation.  It is, therefore, the safest plan, to per-
severe in our treatment until the cure is  complete,
unless some unfavourable symptom appears, fairly
attributable to the medicines  which our  patient is
making  use of:   it is also advisable, after having
once discontinued remedies of this kind, not to have
recourse to them a second time, until we have well
assured  ourselves, by a  minute and comprehensive
examination, that there is nothing to contra-indicatc
their employment.
  With respect  to injections into the urethra with
wine, infusion of roses, solutions of the sulphate of
zinc,  acetate of  lead, sulphate of copper or  iron,
tincture or wine of opium, &c. there ere too many
instances  of  the  injurious effects of this mode of
treatment, even if employed only towards the ter-
mination of gonorrhoea, to make it worthy of much
attention.  In some cases, perhaps, they may prove
useful;  but sinapisms, or blisters to the thighs, may
always, in our opinion, be advantageously substituted,
for  them.
  Tins, perhaps, is a proper place to make a few
•reneral   observations on  antisyphilitic  remedies.
There is  no  occasion to have recourse to them in
case3 of gonorrhoea,  unless it  is certain that the
contagion was communicated by a person affected
with syphilis: the occasional, but very rure occur-
rence of apparent syphilis, several years after the
cure of a  gonorrhoea, whether in the same indi-
vidual, or in their children; and the successful treat-
ment of these affections by mercury, after the failure
of all the ordinary remedies, prove nothing beyond
the simple fact, that cases of this description may
be  cured  by mercury;  certainly, the coneluBinr; 
GONORRHOEA.              199
• amiot be legitimately drawn, that they were cases
of genuine syphilis.   Medicine is not a science of
sufficient certainty to authorize us in regarding as a
fact, what is nothing more than a probable inference.
In other diseases, how frequently does it  happen,
that one medicine succeeds after twenty others have
failed!  How many  practitioners are indebted to
bucIi a happy accident for  their reputation !  To
establish that a disease, cured by mercury,  is of a
syphilitic nature, the same evidence is necessary as
in establishing the nature  of any other poison, as of
hydrophobia, or variola; namely, the suspected per-
son must have communicated his disease to another,
and this second individual, in his turn, be capable of
reproducing it.   But such  evidence as this has never,
I believe, been adduced in favour of the opinion of
those  who contend that an antisyphilitic treatment
is necessary in every case of gonorrhoea.   Its par-
tial adoption, as proposed by some authors, is per-
fectly useless, and for that reason  prejudicial : for
the patient either has syphilis, in which case these
half measures  are  inefficient, or he has not,  and
then his system is tainted with the poison of mercury
for nothing.  It may, therefore, be concluded, that
an antisyphilitic plan of treatment should never be
resorted to, unless there are other evidences of the
existence of syphilis, than  the ordinary symptoms of
gonorrhoea.
   When inflammation of  the urethra occurs alter-
nately with rheumatism, or is a consequence of this
affection,  as in some instances mentioned by Dr.
Beaude; when it depends on some cutaneous erup-
tion, or arises spontaneously in a person of scrophu-
lons habit,  without previous intercourse, local reme-
dies are generally sufficient.   Our  principal object
should be to remove the primary affection on which
this depends.
   Gonorrhoea, which is simply occasioned by new 
200             ' ORCHITIS.
beer, the presence of a  calculus in the bladder, a
stricture of the urethra, or the pernicious habit of
onanism, will cease  on  the removal of the cause
which has provoked it.
  Lastly, when gonorrhoea disappears suddenly, and
a metastasis occurs in the supervention of orchitis,
an attack  of ophthalmia, which usually is in  this
case very severe,  or  any other  disease, it is neces-
sary, without delay, to restore the original discharge
from  the  urethra, by irritating injections, or by
keeping a bougie  in the canal.   But this metastasis
may generally be prevented by wearing a suspensory
bandage:  a precaution which should be adopted in
every case of gonorrhoea, and  persevered  in until
the complete  removal  of the complaint.   See also
Leucorrhcea.
                  ORCHITIS.

  As soon as the patient complains of a dull pain in
the epididymis, or along the course ofthe spermatic
cord, it is necessary to order the frequent prolonged
use of the warm bath, emollient and narcotic cata-
plasms,  and, above all, absolute rest in bed; this
last means alone, often being sufficient to arrest the
inflammation.  But when the pain has become very
severe,  while the tumefaction is already consider-
able, and increases, the local abstraction  of blood
by means of leeches, is indispensable.
  When we  employ a small number  of  leeches,
such as eight or ten, more irritation  is produced
by their punctures, than lessened by the  abstrac-
tion of blood they occasion;  it is therefore advi-
sable, however slight the inflammation maybe, on
no occasion to apply fewer than  thirty or forty.
  The author has been convinced ofthe propriety 
ORCHITIS.               *J01
 <f this recommendation by repeated observation at
the H6tel-Dieu.
  Even  when general bleeding from the arm has
been practised on account of a plethoric habit of
body, the number should not be reduced.  If the
application of leeches is not sufficient to remove
all the symptoms of orchitis inflammation, it must
be renewed frequently, before the  inflammation
has advanced too far  to terminate in resolution.
  The employment ofthe warm bath is generally
indicated, particularly towards night, in order to
prevent nocturnal pollution, (see  Gonorrhoea,) a
combination  always  injurious,  especially  when
the testicle is  much swollen: yet bathing often
increases  the  pain, probably in  consequence  of
the motion which getting  in  and  out of  the
bath  requires,  together with the  pressure of the
water, and weight of the depending scrotum.  It
is therefore  advisable not  to take  off the sus-
pensory bandage, but to wear it  constantly ; and
when, notwithstanding this precaution, the use of
the bath increases the pain, it must be discon-
tinued,  and we must depend upon leeches, cata-
plasms,  and diluent drinks.
  Care  must be taken to  keep the  bowels gently
open  by means of laxatives, for constipation  is
Bometimcs sufficient, even to-occasion orchitis,
especially on the left side;  and  if  combined with
it,  will  greatly impede  its resolution.  During
both night  and day, a soft pillow should be placed
between the thighs ofthe patient, so  that he may
not bring on a fit of pain by moving  his body
during sleep.
  If inflammation advances with great rapidity,
its  resolution  is equally  sudden ;  a very con-
siderable tumefaction will often disappear in a few
days: the  epididymis, however, which  is princi-
pally affected, continues somewhat hardened and 
~H)«J
ORCHITIS.
enlarged, resisting poultices, baths, and the balsam
of copaiba, which, in this case,  may be employed
as well as turpentine and cubebs, without danger.
(See Gonorrhoea.)
  Friction and  mercurial plasters, or  a plaster
containing the hydriodate of potash, may be tried,
and  if these  fail, time only will  effect the re-
duction of the tumour: they are unattended with
danger, unless the patient  is predisposed either
hereditarily, or in consequence of his advanced age,
to cancerous affections; in this  case, it  is advisa-
ble to insert an issue or seton  near the affected
organ.
  When orchitis supervenes on the cessation or
diminution of a gonorrhoeal discharge, and  espe-
cially when the gonorrhoea is  about to terminate,
the same treatment is required as in other cases.
  Lastly, after  an attack of orchitis, the testicle
remains for a long time peculiarly susceptible of
inflammation on the slightest occasion ; it is there-
fore  proper to recommend the habitual  use  of  a
close  suspensory bandage.  Antisyphilitic reme-
dies are, in the opinion ofthe writer, totally un-
called  for  and  inefficacious, either in removing
this  susceptibility, or the tumefaction subsequent
to inflammation.  See the remarks'on this subject
under Gonorrhoea. 
20,'J
DISEASES OF  THE PERITONEUM.
                PERITONITIS.

  On the first indication of peritonitis, blood must
be drawn from the arm to a large amount, and the
operation repeated soon afterwards, even until the
third or fourth time, if the patient is young, of a
plethoric habit of body; and if the pain continues
with very  little abatement, or the blood is rich,
with a cupped, bufly surface; immediately after
the first abstraction of blood from the arm, thirty
or forty leeches are to be  applied  over the abdo-
men, and renewed as often  as the continuance of
the pain  may render it necessary.  Emollient fo-
mentations or poultices, as  may  be most agree-
able to the  patient, should succeed the apphcation
of leeches, or if there  is room, should be used
along with them ;  lastly, the patient must be placed
in a warm bath, remaining in it as long as possi-
ble, that is  to say, two, four, six or eight hours, if
the peritonitis is very severe.   Even these mea-
sures, however, will be unsuccessful,  unless they
are employed at the onset  of the  attack, before
albuminous depositions, adhesions, or a  copious
serous effusion  has taken place: in  some indi-
viduals, the progress of peritonitis towards suppu-
ration (and the case is similar as it regards  other
serous inflammations)  is made with extreme  ra-
pidity ; so that this affection  is in the highest de-
gree dangerous, and often terminates fatally in a
very short time.
  There  is very little difference of opinion in
respect to  the  proper  treatment of peritonitis 
204             PERITONITIS.
during its first stage, and  the propriety of anti.
phlogistic  measures  is  acknowledged by  all
practitioners: there is, however, connected with
it, a  subject  of controversy, the importance  of
which claims for it  our consideration.   So long
as peritonitis  remains  acute, it  is very unusual
for the mucous membrane of the intestines to be
at the same time  in a state of inflammation ; on
the contrary, in most cases, it is pale, and without
any  apparent vascular  arborescence, and the
peristaltic action of the alimentary canal at the
same  time, as it were, paralyzed; thus occasioning
obstinate constipation. The  mucous membrane
being thus so little susceptible of influence from
inflammation of the peritoneumrsome practition-
ers have  suggested the possibility and  safety  of
making  this  extensive surface  the seat of  a
powerful  revulsion ;  there is every  inducement
to act on this opinion,  the correctness  of which
experience  appears to confirm ; for when  we
consider the rapid progress of peritoneal inflam-
mation, the  numerous instances in   which   it
resists the abstraction of blood, and the difficulty
which always exists during a state of disease, in
exciting  by artificial means a secondary  inflam-
mation, especially in a different tissue from that
primarily affected, it becomes  us  not to  be pas-
sive   spectators  of an unequal contest,  but  to
avail  ourselves  of every  measure  which offers
any probability  of success : for these reasons,
therefore, we ought to have recourse to the plan
of counter-stimulation.
  Tartarized  antimony, the action of which has
been  lately  so  much investigated,  is  indeed  a
most  efficient auxiliary in peritonitis.   Should  it
excite inflammation of the alimentary canal,  it
arrests the progress  of that in the  peritoneum,
tvhich is tar more dangerous ; if it only quickens 
EERlTOMTlf.              206
the action of the  mucous follicles, the excess of
action  on their part, will occasion an opposite
■t»te of the eerou6 membrane ; lastly, the ccunter-
stinulant property of this substance, sufficiently
ascertained as it respects other diseases at least,
laying aside all theory, deserves the attention of
every  piactical  physician,  whose office is to
rencve or miticate disease at the bedside ofthe
■ick, not to arrange theories amidst the abstrac-
tions cl the cabinet.
  Tartarized  antimory,  then,  exhibited merely
as an aperient, or in a larger quantity, according
to the  method of Rasori, may be employed in in-
tense  inflammation of the  peritoneum,  without
interfering  in any degree  with  the  ordinary
antiphlogistic measures.  The counter-stimulant
plan is particularly useful, when the debility of
the patient  makes the abstraction  of  blood  dan-
gerous : laxative  doses, on the contrary, are  bet-
ter adapted to cases ir.  which a bilious complica-
tion exit-ts, as in certain epidemics:  in some cases,
even ipecacuanha emetics may be resorted to, as
was done  with the happiest  effect,  by Dailcet.
See the work of this author on puerperal fever.
   The sympathetic vomiting which attends perito-
nitis, by no means eontra-indrcates the employment
of tartar-emetic;  it is necessary, however,  in  6ucb
circumstances, to combine an opiate with it, other-
wise it may be thrown up, and the patient lose all
the benefit of it.   Mild laxative and cooling drinks
should be  recommended.  Enemata are  injurious
throughout the first stage of peritonitis, but when
the patient is becoming convalescent, and the bow-
els art confired, they are very useful.
   Preparations of mercury, whether exhibited in
ternaUy, as  twelve or fifteen  grains  of  calomel
alor.e, or combined with extract of hyosciamus or
opium, taken in the course of twenty-four hours, or
                      18 
206
PERITONITIS.
 rubbed in over the abdomen or thighs, so as to pro-
 duce salivation, has been  equally extolled in cases
 of acute peritonitis, when employed along with the
 general and local abstraction of blood.
   The treatment of puerperal peritonitis is very
 similar to that already described.  The practitioner
 has the advantage of knowing the susceptibihty of
 a female, who has been lately delivered,  to this in-
 flammation, and may thus sometimes check it at its
 onset, or prevent its developement by judicious care;
 guarding his patient against  exposure  to cold, the
 total suppression of the lochia,  or powerful mental
 emotion ; by encouraging the flow of milk, and pro-
 hibiting  all stimulants, which the attendants  are so
 apt to think necessary in such circumstances.  See
 the word Metritis.
  When an  attack of peritonitis  has been  occa-
 sioned by a spontaneous perforation of the small in-
 testine, its progress is  extremely rapid; an anti-
 phlogistic treatment,  even if employed  without a
 moment's delay, would be totally inefficacious, since
 it could exert no influence over the cause, and the
 contents of the alimentary canal would constantly
 be escaping into the  peritoneal cavity.  Absolute
 rest is our only resource and  ground of hope; no
 warm bath, no purging, no  tartarized antimony can
 be allowed; an .enteritis is the source of the evil:
so that nothing, not even a little water, maybe taken
into the stomach,  but the  patient  must  satisfy his
thirst by sucking  slices of lemon.   Mercurial oint-
ment -may be rubbed in at the groin and axilie, but
nothing can be  expected, except from the efforts of
nature.   Yet, when there is no doubt as to  the ex-
istence of this disease, it is not allowable  to expose
the intestine by means of an incision made over the
termination of the ilium, and retain on the outside
of the abdomen, the perforated portion of intestine,
which ia often very small; at the same  time we are 
PERITONITIS-.
U07
 combating inflammatory symptoms by an energetic
 antiphlogistic plan of treatment,  and by mercurial
 friction ?  In short, are we not called upon to avail
 ourselves of any chance of escape from a-disease so
 rapidly and certainly fatal ?  We leave this question
 to the consideration of those  who, like  ourselves,
 know what it is to see patients who were apparently
 recovering from an  attack of enteritis, suddenly fall
 victims to this spontaneous perforation.
   When inflammation of the  peritoneum has be-
 come protracted, and effusion has already  taken
 pla ce, it will be proper to have recourse to laxatives
 and diuretics, unless they excite fever; vapour baths,
 dry rubbing, wearing flannel, and every other means
 calculated to promote the functions ofthe skin, may
 also be employed with advantage.   A very strict
 regimen, and abstinence from any  thing likely to
 excite irritation in  the digestive organs, are indis-
 pensable.
   Even at this late  period, should  the  patient's
 strength be sufficient, the moderate  abstraction of
 blood may be beneficial, by promoting absorption,
 and especially by preventing those occasional remit-
 tent pains so common in chronic peritonitis.
   This description of treatment would be very de-
 ficient, if it omitted  what is indeed one cf our most
 valuable  remedies in  chronic peritonitis, namely,
 habitual compression of the abdomen  by means of
 a  laced bandage  gradually  tightened.   We have
 known this simple application succeed in the cure of
 very obstinate cases of perineal inflammation. Should
 the bandage occasion pain, the general or local ab-
 straction of blood will enable the patient to support
 it without great uneasiness.
  In regard to the application of counter-irritants, as
 issues, moxa, &c. to the abdomen,  mercurial fric-
tions, the interna/ exhibition of calomel, and,  espe-
cially, drastic purgatives,  we shall  simply observe 
208               ascites.
that all of them have occasionally proved successful.
A judicious practitioner will  not have recourse to
them  empirically, without some reasonable prospect
of success.  (See the word Ascites.)
  [The employment of purgatives in peritonitis has
been  strongly condemned by  British  practitioners,
especially by Dr. Armstrong, who recommends, im-
mediately after bleeding continued nearly to syn-
cope,  the exhibition of four or five grains of opium,
or one hundred drops of the tincture, for the pur-
pose of preventing the hemorrhagic reaction which
follows  the copious  abstraction of blood, and the
stimulus of pain, as well as of inducing diaphoresis
and sleep.
  Drs. Alison and Brown have both acknowledged
the efficacy of this treatment: there is, however,
one exception to it,  namely, a dry, glazed state of
the tongue, during the existence of which Dr. Arm-
strong has  seldom found the exhibition of opium of
much benefit.]
                  ASCITES.

  Before entering on the treatment of ascites, the
physician should make a general examination ofthe
state of all the viscera of the body, particularly those
ofthe abdomen; for thence only can he learn what
remedies are adapted for any individual case.  When
dropsical effision is  occasioned  by organic disease
ofthe heart, liver, stomach, kidneys, or uterus, con-
gestion  of  the  spleen, a  protracted  intermittent
fever, or a  chronic peritonitis, the nature of these
affections allowing little reason to hope for much
amelioration, he must rest  satisfied with palliative
measures, carefully guarding against whatever ia
likely to accelerate the progress of the disease, or 
ASCITES.
209
disturb the general health,  and at the same time
endeavouring,  by the exhibition of diuretics and
diaphoretics, to remedy the deficient absorption of
which  the peritoneum, and, to a  certain  extent,
other organs are the seat.
  Whenever the patient  is plethoric, complains
of some  local  pain,  or has not previously been
bled, although not too weak to make the opera-
tion  imprudent, venesection may be resorted  to,
and, if  it seems useful, may be repeated,
  We have often seen  the abstraction of blood,
even in cases already far advanced, effect the
removal of the  effused fluid, and the patient has
regained  his former health ;  but when a leuco-
phlegmatic habit of body follows ascites, venesec-
tion  is  contra-indicated, unless both are  recent,
and exist  in persons  previously in good health, or
affected with some  cutaneous eruption.
  If the stomach and bowels  are unaffected, an
emetic  of ipecacuanha, given  every  second or
third day, may prove of great benefit, by restoring
the functions of the skin and promoting absorp-
tion.  Purgatives also are often extremely useful,
but it requires great discretion to accommodate
them to the present  and future condition of his
patient, and they should be continued or discon-
tinued according to effects.
  When  ascites is  unattended  with  fever, the
following  measures should be tried ; the applica-
tion  of  counter-irritants to the abdomen, the in-
ternal  exhibition of  digitalis, acetate of potash,
squill,  acetate  of ammonia, compound powder of
ipecacuanha, juniper, white wine,-diuretic drinks,
as whey, &c. containing in each pint one or two
scruples of cream of tartar, or nitre, the applica-
tion  of blisters  to the thighs,  frictions over the
abdomen with the  tinctures of digitalis, squill, or
guaiacum, fumigations with vinegar, elderjflowers, 
210                ASCITES
sage, junipe* berries, and, lastly, the preparation
of iron and cinchona, if the dropsical  effusion has
supervened on intermittent fever, and there is no
appearance of peritoneal inflammation : eruptions,
discharges, and old ulcers, must be re-established,
if there is any reason to think their repression
has exerted any injurious influence. But whatever
plan of treatment  it may  be  thought proper in
other respects to adopt, one thing is essential, viz.
the employment of a laced bandage, made  gra-
dually tighter; the patient should continue wearing
it, even after his recovery.
  If none of these measures succeed, but the ab-
dominal distention increases to such an extent as
greatly to impede  respiration, the  operation of
paracentesis will  afford temporary  relief; after
this operation  the bandage  is peculiarly  neces-
sary.
  When the patient is  gradually sinking under a
slow  fever,  it will  be  useless  torture, and  hasten
the progress of the disease, to employ active treat-
ment ; the practitioner must rest satisfied with pre-
scribing bland nutritive fluids, as milk, barley water,
and gruel; alleviating pain, when it exists, by opiate
injections, frictions with  some narcotic tincture or
ointment, or by draughts,  containing acetate of
morphia, tincture of opium, or sirup of poppies, and
endeavouring to render the unhappy  sufferer as
comfortable as his situation will permit.
  The treatment of encysted dropsy consists in the
general measures recommended for ascites, and the
operation, which is in fact almost the only remedy.
(See Peritonitis, Intermittent Fever, Measles, Scar-
latina.) 
ill
DISEASES OF THE TISSUES.
DISEASES OF THE SKIN AND CELLULAR
          AND MUCOUS TISSUES.

                STROPHULUS.

  [Exposure to undue degrees of heat and cold, the
irritation of rough flannel clothing, want of clean-
liness, and errors in the kind or quantity of food
given to children, are the principal sources of this
affection ; and their removal is generallly sufficient
to effect the  removal of strophulus, without any
medical treatment, either external  or internal, ex-
cept the employment of tepid baths and light ape-
rients.  See also Slomatis.)
                   LICHEN.

  [The different species of lichen appear to be little
more than different degrees of the same  affection,
and require the same treatment.   A low diet  and
regimen, avoiding exposure to the heat of the  sun
and violent exertion; tonics, especially the sulphate
of quina  combined  with the infusion of roses  and
diluted sulphuric acid, and in obstinately protracted
cases, the solution of .arsenic, are the principal re-
 JVote—The Sections on Diseases of the Skin, which are included
within bracket*, have been principally compiled from the works of
Bateman, Plambe, and A. T. Thompson.  Trans. 
212
LEPRA.
medies ; the troublesome itching is to be allayed by
sedative, and in slight cases, moderately stimulating
lotions.]
                   PRURIGO.

  [Cleanliness,  the use of the tepid  bath, and a
proper regulation  of diet, are the most important
remedies in prurigo: yet the abstraction of blood
and purging, or, on the contrary, the  exhibition of
tonics, will  occasionally be necessary;  as external
apphcations, artificial  sulphureous  baths, lotions,
with calomel and  lime  water, oxymuriate of mer-
cury, prussic acid, and acetate  of ammonia, often
afford great relief.]
                    LEPRA.

  [The principal points in the treatment of lepra
are, the maintenance of the general health, and in-
vigoration  of the constitution,  with  a debilitated
Btate of which it is generally connected : the inter-
nal exhibition of arsenic, or the oxymuriate of mer-
cury, combined with some tonic  decoction, may be
beneficial;  also, as  external applications, blisters,
lotions containing prussic  acid, liquor potasse or
muriatic acid, with frictions, and sulphureous baths,
for  the purpose of loosening  and detaching the te-
nacious scales.
  Occasionally, the  disease occurs in an inflamma-
tory state ofthe system; in which case,  bleeding
and purging  must precede the  use of tonics  ana
stimulants.} 
URTICARIA.              '.JIB
                 PSORIASIS.

  [The most effectual remedies in psoriasis, appears
to be the liquor potasse, in d< >&es of TT[ x x gradually
increased to TT[ c daily;  as next in efficacy, may be
mentioned the arsenical solution : when  occurring
in a plethoric or inflammatory state of the system,
moderate antiphlogistic  treatment is necessary.]
                 PITYRIASIS.

  [Pityriasis is, in general, a merely local disorder,
and requires no other medical  treatment than the
employment of slightly stimulating lotions.]
                 ICTHYOSIS.
f, •
  [This affection is very little under the influence
of medicines taken internally; the best external
remedies are the warm bath, moderate friction, and
compression.]
                 URTICARIA.

  [If urticaria is the consequence of having eaten
lobsters, muscles, or any similar  unwholesome
food, we should  first evacuate  the  stomach by a
powerful emetic,  and  then administer vinegar
and acidulated drinks ;  afterwards, nothing more
will  be necessary than  to  prescribe spiritous or
other  lotions, to  allay  the  intolerable  itching
which  accompanies the eruption. 
214
KRYSIl'ELA*.
  Urticaria occuring along with gastro-enteritis,
requires  no  particular treatment.  See  Gastro-
enteritis and Poison.']
                ERYTHEMA.

  [Mild laxatives, followed by the mineral acids,
comprehend all the medicines necessary  in  this
affection ; as a local application, however, a spirit-
ous lotion,  containing prussic acid, is very useful
in  allaying  the  pain  and troublesome   itching
which attend.]
                  PURPURA.

  [When purpura  occurs in persons  enjoying
good  general health,  and suffering no privation
of food or pure air ; and when it is accompanied
with symptoms of fever or internal inflammation,
an antiphlogistic treatment must be resorted to ;
on the  contrary, when the exciting causes and
the condition of the patient  indicate the depres-
sion ofthe  vital powers, tonics, wine, and the
mineral acids, in conjunction  with exercise in the
open air, are indicated.]
                ERYSIPELAS.

  In simple inflammation ofthe skin, unaccompa-
nied with much fever, that is, when the cutane-
ous  affection seems likely to terminate without
involving in the inflammation the organs contain- 
•HVSIPELAfe.             215
 ed in either of the three splanchnic cavities, and
 without suppuration of the subcutaneous cellular
 tissue, it is unnecessary, even when the erysipelas
 attacks the face, to do much more than to confine
 the patient  to  diluent acidulated  liquids,  keep
 the bowels open by mild aperients, order the feet
 to  be placed in hot  pediluvia impregnated with
 mustard, and pret>cribe a purgative injection.
   But when  erysipelas comes on with  strong fe-
 brile reaction, and the patient is young, the co-
 pious abstraction of blood from the arm is neces-
 sary, especially if the inflammation is seated in the
 face, head, breast, or any part in which the cellu-
 lar tissue is  abundant, and may become  involved
 in  the cutaneous inflammation.  We must early
 endeavour to guard  against its  extension to the
 internal organs, especially the  brain,  which  is
 very apt to occur when erysipelas  occupies the
 head.   In this last case, whenever there is  much
 tumefaction,  it will be  proper  immediately  after
 the  abstraction of blood from the  arm, to  apply
 leeches  to the neck, in no less  a number  than
 forty or sixty in  an  adult, so as completely  to
 arrest the progress  of inflammation; however,  it
 is well to adopt the precaution of applying twelve
 or  fifteen only at a time, that  the flow  of  blood
 may be readily checked, if any bad  consequences
 appear to ensue from tbeir application.
  If the patient is  plethoric and  has borne the
 abstraction of blood without inconvenience,  a se-
 cond  bleeding from the arm  will  be advisable.
 But these measures can be employed with benefit
 only during the first two or three days ofthe ery-
 sipelas, and in cases where there  is reason to ap.
 prehend the supervention of a cerebral affection.
 When symptoms of arachnitis  arise, the proper
remedies, as  before described, (see Arachnitis,)
must be resorted to; and, if the eruption has reced- 
216              erysipelas.
ed, a blister should be applied to the original seat
of it.*
   Lastly, an antiphlogistic plan  of treatment ia
never more useful  than when inliammation of the
skin has  been produce! by some external cause,
as a wound, exposure to the sun, &c.
   When  erysipelas and gastro-enteritis occur to-
gether, the proper  treatme.it ofthe latter is gene
rally sufficient to effect the cure ofthe former ; but
if the cutaneous irritation is very great, it will be
proper to apply leeches around the  affected part.
(See Gastritis, Gastro-enteritis.)
  If the tongue, instead of being dry and red, aa
it is when inflammation of the mucous membrane
exists, has, on the  contrary, a thick white or yel-
low fur, without any trace of redness or  dryness
at the apex, or around the border ;  if the patient
complains of a bitter taste in the mouth, and the
erysipelas has appeared \ii consequence of damp
weather,  after  having been  subjected  to a bad
diet, or at a time in which most prevailing disea-
ses assume a bilious character, evacuations of the
prim.E vie are much more efficacious  than the
abstraction of blood, and  the  experience of the
ablest practitioners of all ages, will justify us in
having recourse to them.  For this purpose  an
injection, containing a grain of tartarized antimo-
ny, is well adapted ; and we  should persevere  in
this mode of treatment, unless some  unfavourable
symptom should occur which is evidently attribu-
table to it.   We  may thus hope to prevent the
erysipelas from extending itself over several parts
ofthe cutaneous system.
   When the erysipelatous affection moves from
place to place, or, while it does not leave its origi-
  * See the Author's  " Traite"  de l'Aracbnitis Cere-
brale et Spinale." 
ERYSIPELAS.              217
nal seat, appears also at some other part,  in imi-
tation of rheumatism, the condition ofthe different
viscera, especially the serous membranes, requires
the most  vigilant care ;  the tendency to  inflam-
mation should be counteracted by the abstraction
of blood, and by the exhibition of aperients, unless
the mucous membrane of the bowels is inflamed ;
blisters should be applied to the extremities, and
vesication kept up, if the  case appears likely to
prove  very serious ; in  a word,  suitable means
must  be resored to,  whatever complication may
arise.   Some  practitioners endeavour to -fix  the
erysipelas, or rather, to change  its character, by
applying a blister in the very centre of the inflam-
mation.  This method of treatment might prove
dangerous, and even produce sloughing, if the cu-
taneous irritation were great, the patient pletho-
ric, or the erysipelas  of the  edamatous kind, or
attacking  an  individual   of cachectic habit,  and
previously out of health ; still more if it assumed
a gangrenous  character.
  During  the  prevalence of very  fatal epidemics,
and in typhus,  erysipelas is apt to terminate in gan-
grene ;  little,  therefore, can be done in these cases
by directly attacking the  secondary affection of the
skin;  and our  attention must be principally directed
towards the primary disease.  (See Typhus.)
  But  when the original  character of erysipelas is
gangrenous, a  peculiar plan of treatment is indica-
ted : tonics, generous wines,  the  nitric  oxide  of
mercury, as an  escharotic, the application of the
powder of bark, or lint wetted with a  solution of
the chloride of lime, in a  word, every antiseptic re-
medy,  external  or internal, should be employed.
(See Malignant Pustule.)
  Lastly,  wherever this inflammation may be seat-
ed, it will be necessary, should it terminate in suppura-
tion, to evacuate the pus as early as possible, and, if
                      10 
218
ERYSIPELAS.
confined under the hairy scalp, or any other part where
the  anatomical  disposition of the integuments is
similar, numerous and deep incisions will be required
for the purpose of giving exit to it.
   When the cessation of a menstrual or hemorr-
hoidal discharge, an habitual bleeding, or a cutane-
ous eruption, has occasioned erysipelas, it is necessa-
ry to re-establish it, or  supply  its  place by  the
general or local abstraction of blood, or the insertion
of an issue,  &c.  Similar precautions may be em-
ployed with much benefit against the periodical re-
turns of this affection.
   Erysipelas arising from some local source, a6 a
blister, issue, wound, &c. requires  nothing more
than tbe application of emollient cataplasms, sooth-
ing lotions, and local baths.
   [The  employment of incisions  in  erysipelas
having lately attracted much attention in this coun-
try, it may be useful to describe this remedy some-
what more fully than has been done in the text.
   It is only in phlegmonous erysipelas, that is, in
erysipelas attacking the cellular texture, as well as
the  skin, that incisions  are advisable.  They are
most effectual when the disease is seated in the ex-
tremities :  when in the face, they are seldom neces-
sary, but when under the aponeurosis of the head
they are very beneficial.   The length to which  in-
cisions should be extended varies according to the
circumstances of each case, such as the strength of
the patient's constitution, his habit of body, the ex-
tent  of the disease, &c. Numerous short cuts, or a
single  long incision, will equally answer  the end;
the incision should divide the skin, and the cellular
texture down to the fascia; it is not necessary to
penetrate the latter.   A double-edged bistoury is
the most convenient instrument for the purpose."—
Medico Chir. Trans, vol. xiv.} 
PEMPUIGI,.-.               119
                 PEMPHIGUS.

   Pemphigus, when occuring alone, is in no respect
 dangerous, and  does not require  active treatment;
 at first, nothing more is  necessary than to enjoin
 strict cleanliness, and to protect the  affected parts
 from getting rubbed.  If the  vesicles  are few in
 number, they should be  punctured sufficiently to
 evacuate their contents, and dressed  with  sperma-
 ceti ointment.  But when the inflammation of the
 skin is extensive, and attended with fever bleeding
 from the arm will be proper.   Medicine exerts little
 or no power over it, and it  will be useless to pre-
 scribe any thing but mild diluent drinks.
   Chronic pemphigus may  be benefited by  emol-
 lient tepid lotions, or  warm bathing, and  by oleagi-
 nous and narcotic  embrocations, if attended  with
 much itching; the  patient should  be confined to  a
 light diet, as milk, and, if there is no appearance of
 inflammation in the bowels, aperients may be occa-
 sionally  administered  with  advantage;  lastly,  if
 these remedies fail, a change of residence should be
 recommended.
   When pemphigus occurs in advanced life, and is*
 connected with general debility, or  seems hkely to
 terminate in gangrene, tonie medicines, as cinchona,
 bitters, a generous diet, and an allowance of wine,
 are the most important remedial measures.
   [This troublesome disorder appears generally
 connected with debility; and in consequence, a tonic,
 yet not stimulating plan of treatment, is indicated ;
 much purging is useless and even injurious;  the  ex-
 coriations which follow the rupture of the vesicles,
should be dressed with some mild ointment, or they
may be touched with the nitrate of silver.] 
220
PORRIGO-TINKA.
                  IMPETIGO.

   [Calomel, in doses of five or six grains, taken oc-
 casionally at bed time, and succeeded by a cathartic
 in the morning, appears to  be  peculiarly  bene-
.ficial in  this  complaint: sulphur combined  with
 soda, &c.  and the  vegetable acids with conium,
 have also  been  recommended.  To  allay  local
 irritation, nothing is so  effectual as  prussic acid,
 properly diluted, and combined with  the acetate of
 lead.  It can scarcely be necessary to observe, that
 in this,  as in every other instance, the hydrocyanic
 acid must be employed with the utmost caution, and
 its effects upon the pulse carefully observed.
   To remove the dry incrustations,  the  sulphur
 vapour bath, hot water, and emollient  poultices,
 may be employed.]
              PORRIGO-TINEA.

  In every species of tinea, it is highly important,
as soon as the complaint  appears,  to keep the
head  covered  with  emollient  cataplasms, and
lotions, to loosen and detach  the  crusts,  while
counter-irritation  is excited  in  the  superior ex-
tremities  by means of blisters.   When  there is
considerable itching, with heat and redness of the
skin, a few leeches applied to the hairy scalp will
sometimes occasion great  relief.  If, on the con-
trary, there is little irritation of the  skin, sulphu-
reous washes and  ointments will be  more useful.
  But when the inflammation has extended to the
follicles of the  hairs, it is necessary to eradicate
them: this operation may be performed by pluck-
ing them  out  one by one with a pair of forceps. 
l»ORRIGO-TINEA
221
or by application of a strongly adhesive plaster to
the affected part, to be forcibly torn off.
  The tinea of children being often  a  salutary
discharge, it is proper, after its cure, to supply its
place for a time by a blister; and if it has su-
pervened  on any serious  disease, it  will be im-
prudent to attempt its cure.
  [When the general health is impaired, its im-
provement should  be attended to, previous to the
adoption of any local treatment. In incipient ring-
worm, the  best  external application, after the
head has been shaven, is  undiluted mineral acid,
applied by means of a feather, over every affected
spot, and allowed to remain on for a few  minutes:
after each application of the acid, the head should
be  repeatedly washed  in warm  water.  When
there is excessive irritation of the scalp, the hair
should be removed by finely pointed scissors, in
preference to a razor, and for the  first few days,
no  stronger  external  application than  frequent
ablution with very  hot  water will be advisable.
In obstinate cases, the removal ofthe hairs affords
the  only  hope of  recovery ; this may be effected
with little suffering by the application of a poultice,
and afterwards of a lotion with the liquor potasse;
the  hairs may also be extracted one by one with a
pair of forceps.  In  promoting the restoration of
hair, that is, in porrigo decalvans, nothing is  so
useful as shaving round the bald spot, and the
assiduous application of spirit of turpentine,  or
any volatile oil.]
19* 
PSORA-SCA HI l..v
       PORRIGO  FAVOSA, LARVALIS

  [This disease is generally connected  with dis-
order of the general  health.  A strict and  ju-
dicious regulation of diet, and the employment of
aperients, alteratives, and tonics,  are the most im-
portant remedies: as  local applications, ablution
with tepid  water, emollient cataplasms, and the
unguentum  hydrargyri  nitratis dilutum, will be
found useful.]
                 ECTHYMA.

  [This affection is, perhaps, invariably dependent
on debility of  system; consequently, its treat-
ment consists in the use of nourishing food, change
of air, mental relaxation, and the exhibition of al-
teratives and tonics.  When the patient suffers
much from local irritation, a lotion containing ace-
tate of lead and prussic acid will afford great relief.]
              PSORA-SCABIES.

  When psora exists to a considerable extent, and
has already continued during a long  time ; when
the patient  is young, plethoric,  and complains
much of intolerable itching ; and when the skin is
greatly inflamed, it will be  proper, before adopting
any other measures, to begin our treatment with
a bleeding from the  arm,  and the employment  of
the warm bath; otherwise, we may  at once  re-
sort to the various empirical remedies which ex-
perience has sanctioned; the principal of these is 
PSORA->CABIE!-
223
sulphur, and indeed there are few cases of genuine
psora, which will  not yield to its steady employ-
ment.
  The  ointment recommended by Helmerich, is
composed  of two  parts of sulphur, one  of  pure
potassa, and eight of lard ;  it is to be used after
the surface  of  the body has been well  washed
with soap and  water.  An ounce  of  it should be
rubbed in before the fire, three times  every day;
the skin being afterwards again thoroughly wash-
ed in the same way.
  Pyhorel's plan is to combine a scruple or half a
drachm of the sulphuret of lime with a little oil,
and rub the affected  parts with it, morning  and
evening.
  The sulphur  ointment is to be employed to the
amount of an ounce, twice during the day, over the
whole affected surface.
  A solution of four ounces of the  sulphuret of
potash in  a pint and a half of water, to which is
added half an  ounce of sulphuric acid, applied
twice during the  day, as a lotion, may be substi-
tuted for  the ointment, and is in one  respect  su-
perior  to  it, viz. in  soiling the  clothes of  the
patient much less ; it must be remarked, however,
that it sometimes excites  great irritation of the
skin.  Lotions  of alcohol and  soap may also be
substituted, when this  medicine is very strongly
objected to; but they are much less efficacious.
Hellebore, staves acre seed, opium, the  ointment
ofthe nitrate of mercury, remedies formerly much
employed, are now exploded.
  The clothes of the patient should be thoroughly
fumigated with sulphur, and cleanliness, and  fre-
quent bathing, enjoined afterwards. 
\J2.4        V.CRCSCVl.l'S-— ^M'HRAX.
                  HERPES.

  [This eruption cannot be repressed, or its course
abridged, by any medical  treatment;  attention to
the general health is, however,  highly important in
preventing its extension and continuance; the local
uneasiness may be much  alleviated  by a lotion of
diluted alcohol and the  liquor plumbi acetatis dilu-
tus: relief may also  be afforded by puncturing the
vesicles.   In the cure of herpes prceputialis,the most
important point is cleanliness.]
         ♦7URUNCULUS—ANTHRAX.

  When the practitioner has been called in too late
to arrest the progress of inflammation in this affec-
tion, the only thing that remains to  be done is to
hasten suppuration, by the apphcation of hot emol-
lient poultices, or  of the ceratum resine  over the
centre of the tumour : but when the patient is 6een
soon after the boil has appeared, the summit of it
should be touched  with caustic, or rather, if there
is much  inflammation, and the pain  very severe, a
deep  incision should be  made into it, to remove the
tension of the skin; which, however,  it would be
still better to prevent, by applying, at an early pe-
riod,  a large number of leeches over the tumour.
If the boil ie  of very small size, and depends on a
disordered condition of the digestive organs, ape-
rients should form  the basis of treatment, and they
must, in such cases, always be continued for some
time after the complete disappearance ofthe tumour.
But  if it attends  inflammation in the alimentary
canal, it will  be necessary to  have recourse to the 
      M.ALIG.NANT PUSTELE--CARBUNCLE.   225

measures before recommended under the word Gas-
tro-enteritis.
  The treatment of anthrax should be the same as
that  of ordinary furunculus; it consists always in
arresting the disease  by cauterization, and copious
local bleeding :  a  deep crucial  incision is necessary
to prevent gangrene of the cellular tissue.
  The use ofthe tepid bath, and diluent and acidu-
lated drinks, may afterwards  be advantageously
employed.  Whenever a common boil,  or anthrax,
is opened, it is proper  to promote suppuration by
means of some digestive application, and  to  wash
the wound with a solution of the chloruret of lime.
    MALIGNANT PUSTULE—CARBUNCLE.

  The principal indication in both these affections,
is to prevent the communication of the malignant
matter to  the  surrounding parts,  and through the
system generally.
  This, to a certain extent, may be effected by the
application of escharotics, as the nitric oxide of mer-
cury, at an early period of the disease, before the
supervention of gangrene;  after which,  the plan
which we must adopt, consists in  making  incisions
across the tumour, not so deep as to wound any blood
vessel,  yet not too superficial;  (otherwise, in all
probability,  the malignant matter will not be eva-
cuated,) in removing, by means of a pair, of forceps,
the gangrenous shreds, and afterwards cauterizing
the bottom of the wound with nitric oxide of mer-
cury, to an extent beyond that of the disease.   The
whole affected surface should be covered with lint,
and compresses imbued with a decoction of bark, or
solution of the chloruret of lime:  or,w e  may sub- 
■I'M
UPflTHLMJ \.
 stitute for these, a kind of cataplasm made of the
 powder of kino and spirit of camphor.
   Together with this local treatment, the principal
 resource  in endeavouring to  check the progress of
 malignant pustule, we may also, with considerable
 benefit, prescribe the internal exhibition of the most
 powerful tonics, stimulants, and antiseptics; for in-
 stance, cinchona, sulphate of quina, camphor, spirit
 of mindererus, rich wines, acidulated drinks, and,
 above all, the  solution of tbe  chloruret of soda; the
 action of these medicines may be assisted by the
 addition of ammonia, a hot infusion of serpentaria,
 and, in fact, by any thing calculated to  excite per-
 spiration.  This plan of treatment is, however, in-
 dicated in those cases only, in  which a general in-
 fection ofthe  system accompanies the local disorder,
 or, in consequence ofthe late apphcation of caustics,
 is likely to ensue.
   The  prevention  of this affection  consists  prin-
 cipally in  the exercise of care, on the part of those
persons whose occupation obliges them to touch the
remains of animals affected with any malignant dis-
order, to wash the hands immediately afterwards in
■a weak solution of the chloruret of soda.
                 OPHTHALMIA.

  In a slight attack of acute ophthalmia, it is sel-
dom necessary to do more than  preserve the eyes
from the influence of light and fire, bathe them with
an emollient narcotic collyrium,  employ irritating
pediluvia, and laxatives or diluent drinks, and lastly,
to prohibit  wine,  spiritous liquors, coffee,  &c.
Cataplasms  are  useful whenever  their weight doea
not increase the  pain.
  If the sensibility ofthe eye is very gTeat, and the 
OPil'lU ALALIA.
227
 pupil contracted, the extract of belladonna should
 be applied around the base of the orbit, or a few
 drops of the aqueous solution of this plant may be
 introduced between the eyelids.
  In a severe attack of ophthalmia, attended with
 much pain, a copious abstraction of blood from the
 arm must be made without delay.   If the patient is
 plethoric, young, disposed to inflammatory attacks,
 and very feverish, the operation should be repeated
 the next day, while we act on the  alimentary canal
 by means of purgatives, and endeavour, by repeated
 leeching and cupping, to remove the inflammation
 in two or three days; lastly, as soon as the fever
 and pain have subsided, and the redness of the con-
junctiva has disappeared, much benefit  may be de-
 rived from the application of a blister to the nucha.
 By  this active treatment, we may  hope  to counter-
 act the tendency  of ophthalmia  to become pro-
 tracted.  As auxiliary measures, we should recom-
 mend the patient to keep his head elevated, to live
in a dark chamber, and rigorously  restrict him to an
antiphlogistic diet.
  If the patient lies awake and restless  during
the night, an opiate draught should be prescribed
 at bedtime.
  When ophthalmia is  attended with a purulent
discharge, a circumstance which  requires that the
part should be kept constantly bathed, it is proper.
at soon as the pain ofthe eye  has ceased, and the
acute stage quite passed away, to employ some
astringent  collyrium, as infusion  of roses, with a
few grains of sulphate of zinc, sulphate of copper,
or acetate of lead; or a weak solution of alum, with
a few drops ofthe tincture or wine of opium.  But
the most efficient remedy is the perfect exclusion
of light, maintained for a long period; and its adop-
tion will be likely to prevent relapse, so common
in ophthalmia, and any occasion forthe abstraction 
228             OPHTHALMIA.
of blood, and the various other measures which are
generally necessary  in chronic ophthalmia.  The
patient must abstain from reading, and working
by  candlelight, and  avoid hot rooms, and stimula-
ting food, even for a considerable time after con-
valescence  has begun.
  When ophthalmia is  kept  up by tumefaction of
the conjunctiva, new growths on that membrane,
or a varicose state of its vessels ; or when it de-
pends on the  presence of some foreign body, the
first duty  ofthe  practitioner is to perform the
operation indicated by these  various circumstan-
ces. If, on the contrary, it  has arisen in conse-
quence ofthe suppression of some periodical eva-
cuation, or  the discharge from an old ulcer, these
different discharges  must be  reestablished  before
&ny direct local application can be of avail; syph-
ilitic or scrofulous ophthalmia  is to be removed
by  removing the habit  of body on which it de-
pends ; the  insertion of an issue or  seton should,
however, not be omitted.
  In gonorrheal ophthalmia, the most active treat-
ment is necessary ; both general and local  blood-
letting must be carried to a great extent, while we
endeavour  to bring back the inflammation  of the
urethra, by the introduction of bougies smeared
with matter furnished by the conjunctiva.  Calo-
mel blown  into  the eye every  morning,  the
tincture of opium dropped between the eye-lids
in the evening, and  the exhibition of cubebs, are
useful auxiliary  measures.
  The principles of  the treatment of chronic oph-
thalmia should rest on those which we have al-
ready laid down.  But, in addition, it will be neces-
sary to recommend  the patient to abandon every
employment which has  an injurious influence on
the .sight, and to wear constantly green  or blue
spectacles.  If the alimentary canal is in a healthy 
CMRYZA.
220
Condition, it may be  made the seat of a more  or
less powerful  revulsion, by means of purgatives,
&c.   General friction, the employment of vapour
baths, the insertion of a seton, applying caustic
applications to the .sinciput, or mastoid regions,
scarification of the conjunctiva, lotions with  the
solution of the muriate  of baryta, the insufflation
of calomel,  alone or  combined  with  an  equal
quantity of sugar candy, and, lastly, dropping into
the eye, by means of a camel's hair pencil, one or
two minims of the tincture of opium, two or three
times  daily, are also useful  auxiliary  measures.
In a  plethoric habit,  a  bleeding  from the arm
should precede the use of the opium collyrium.
  In  intermittent  ophthalmia, we  must have re-
course  to cinchona, sulphate  of quina, opium, and
the removal of the various exeiting  causes of this
inflammation,  that we  must principally rely during
the intervals between the attacks, as it is by the or-
dinary antiphlogistic remedies that  they must be
attacked.
                   CORYZA.

  A slight attack of coryza is in general easily got
rid of, by the free employment of diaphoretic drinks,
care being taken, at the same time,to avoid exposure
to the damp and cold air.  When it is more severe,
very hot pediluvia, emollient fomentations, a few
leeches to  each nostril, re6t in  bed, and a low diet
are indicated. As coryzaimpedes respiration through
the nasal fosse, infants at the breast, who are at-
tacked with it, require to be fed with a spoon while
it continue?.
  When coryza is protracted, under a ehronicform,
or is apt to return on the slightest exposure to cold,
                      eo 
230                 OTITI?
a flannel  dress next  to  the skin,  and especially
woollen stockings and socks during cold damp wea-
ther, together with habitual dry rubbing, should be
recommended.  The application of a blister behind
the ear, purgatives,  and even  the insertion  of an
issue, may be resorted to, if, as  rarely happens, the
severity of the case renders it necessary.   Lastly,
if disease of any important organ supervenes on the
suppression of an habitual coryza, it is proper either
to re-establish the secretion of the scneiderian  mem-
brane, or supply its place by an artificial discharge.
                    OTITIS.

   The first  object to which a practitioner should
 direct his attention, when called upon to prescribe
 for a patient afflicted  with pain  in the ear, is, to
 ascertain whether any foreign body exists in the
 external meatus.  When ear-ache proceeds from in-
 flammation, blood must be drawn from the arm;
 and the pain, if very severe, may  be calmed by
 emollient fumigations, narcotic injections, &c.  Per-
 spiration should be promoted by hot drinks, as the
 infusion of camomile, common  tea, and  the feet
 immersed in mustard pediluvia, several times during
 the day, while the bowels  are kept open by means
 of purgative enema :  if, notwithstanding these pre-
 cautions, otitis goes on to suppuration, the discharge
of the pus must  be promoted by syringing the ear,
or by perforation ofthe membrana tympani, in cases
 where  the internal ear is the seat of inflammation.
 and there is  no  other way by which the pus can
escape.
  In chronic otitis, which almost always depends on
caries of the bone, and scrofula, the insertion of an
issue or seton in the neighbourhood ofthe ear, or a* 
MTl'Tl*.                 231
the nucha, injections into the external meatus of
warm water with honey, and afterwards, as the dis-
charge diminishes, with the decoction of cinchona,
or lime water, will be  proper.  Great  attention is
necessary to prevent secondary inflammation ofthe
brain or its meninges, which is very apt to super-
vene.  Lastly,  the bowels  should be  kept freely
open, and the internal treatment proper in cases of
syphilis,  or scrofula, must be employed whenever
otitis depends on one or other of these diseases.
   After perforation ofthe tympanum, a plug of cot-
ton should be worn in the ear, to moderate the in-
creased intensity of sound.
   When chronic otitis  depends on the suppression
of any natural or accidental discharge,  as an ulcer,
or cutaneous eruption, the remedy most likely to
prove successful,  is the restoration of the primarr
affection. 
232
DISEASES  OF THE MUSCULAR
    FIBROUS,  AND SYNOVIAL
              TISSUES.
                 TETANUS.

  Tetanus, whether consequent on a wound or not,
is a symptom of inflammation in the spinal marrow,
or in its arachnoid membrane ; the treatment there-
fore of these affections  is equally that  of tetanus;
when it is one of the symptoms of hydrophobia, it
requires no particular attention.
  The tetanus which appears idiophatic is almost
invariably fatal under  every  form of  treatment.
Opium, in large doses, musk, cinchona, assafoetida,
castor, phosphorus,  valerian,  carbonate of soda,
ammonia, drastic purgatives, tartarized antimony in
doses of twelve grams or a scruple daily, mercurial
frictions carried to salivation, cold affusion,  vapour
baths, the neuropathic method of Dr. Ranque, (see
Colica Pictonum,) galvanism, and the abstraction of
blood, have all been resorted to, and many have
seemed successful, but it is doubtful whether one
case has been really cured  by any of these various
remedies.   For this reason we  simply enumerate
them, and we recommend the practitioner to direct
his whole attention, from the earliest appearance of
tetanus, to the state of the spinal marrow ;  and, if
any external wound can be detected,  let him ex-
amine whether some foreign body, spiculum of bone,
or  wounded nerve, is not  the occasion of all the
symptoms ;  lastly, whatever plan of treatment he
may think proper to pursue, it should be regulated
by the condition of the patient, and the severity of
fhe symptoms. 
tRlTCl'LAR RHEUMATISM.        233
           ARTICULAR RHEUMATISM.

    As soon as pain occurs in any of the articula-
  tions, and its integuments become red and swollen,
  it is necessary, without waiting for  more decided
  evidence of the existence of rheumatism, to apply
  around  the  affected joint  a sufficient number of
  leeches to  remove  the  inflammation  at once:
  afterwards, emollient and narcotic cataplasms are
  to be placed over the inflamed surface, and perspi-
  ration at the same time excited by hot diaphoretic
  infusions, as tea, &c.  At  this  period, also,  the
  exhibition of the extracts of hyosciamus, aconite,
  and especially crude opium, in doses of half a grain
  or a grain every hour,  is of the greatest benefit.
  But the degree of fever, and the  condition of the
  prime vie, must  modify  the principles of treat-
  ment which we have just mentioned.
    Thus, if fever has preceded the articular inflam-
  mation, and the patient is young, it is more prudent.
  to abstract blood from  the arm once  or twice
  before  applying  leeches, the number  of which
  should be larger  or smaller, according to the  se-
,  verity of local inflammation,  and the  extent of
  the surface affected.  But,  although we thus  re-
  commend an antiphlogistic  plan of treatment,  we
  do not mean to assert that it is successful in every
  case; the local inflammation  is certainly  much
  ^essened, and often completely removed by it; but
  though the disease is thus driven from one part, a
  metastasis to another often  occurs,  and the dura-
  tion of the rheumatism is very little,  or not at all,
  abridged.  However  this may  be, the  local ab-
  straction of blood is free  from  objection ;  it
  generally alleviates pain, and almost always pre-
  vents rheumatism from passing on to suppuration,
  a  mode  of termination  much to be dreaded in
                        90* 
234      \RTlCU,.Ui RHEUMATISM.

every  articular  inflammation.   In  every  case,
emollient cataplasms  sprinkled with  laudanum
should, as well as leeches, be applied to the joint.
  When the stomach and bowels are in a perfectly
healthy condition, and several ofthe articulations
are affected at the same time; or when the rheuma-
tism appears to be owing to  excessive mobility
of the system, it is very advantageous, provided
that the patient is free from fever, to have re-
course to the employment of tartarized antimony,
a method of treatment which has been as unjustly
condemned on the one  hand, at it may have been
injudiciously eulogized on the other.  No remedy,
however excellent, proves invariably efficacious,
and though that of which  we are now speaking
forms no exception (o the general rule, it is suc-
cessful in a sufficient  proportion  of cases to de-
serve  the attention of a  practitioner who pays
deference only  to the voice of observation,  and
knows the obstinacy of a rheumatic affection.  In
many instances,  though not in all,  this medicine
greatly abridges the continuance of articular in-
flammation.   To exhibit tartarized  antimony to
the amount  of six, eight, ten, twelve, or more
grains,  in the course  of the  day,  is repugnant
to the  prejudices of our  education, and many
practitioners,  although they might  believe in its
efficacy,  would rather leave a  patient to himself,
to recover or not as it might happen, than obtain
a cure  purchased, in their estimation, at so dear a
price.  But we can assure them that daily ex-
perience demonstrates the safety of this treatment,
and that  it is very often supported without the
least inconvenience; the addition of a small quanti-
ty of sirup of poppies, forinstsnce, half an ounce,
is generally sufficient to prevent it from  acting
either as an emetic  or as a purgative;  and, if it
should produce a few evacuations from the bowels, 
ARTICULAR RHELAJATISM.       235
is that a  sufficient reason for rejecting a probable
remedy against a most obstinate disease ? besides,
we continually observe during its purgative action,
the fever lessen, the local inflammation disappear,
and the rheumatism, disturbed in  its seat, move
about from part to part, and soon leave the patient
altogether.  It is, therefore, in our opinion,  not
only justifiable, but imperative on the part ofthe
practitioner,  in every case of rheumatism which
is, or is likely  to become, general,  to employ  the
tartarized antimony: six grains, in  a mixture con-
taining half an ounce or an ounce  ofthe sirup of
poppies,  is a suitable dose to begin with, and, on
every succeeding day, it should be increased by
the  addition of two grains to the  amount taken
the  day  before,  until  the  articulations  are no
longer tumid and painful;  but, if the stomach and
bowels are much disordered by it, or if at the end
of the week the patient is little or no  better, a
sufficient trial  has been allowed it, and some otber
plan of treatment must be substituted.  Through-
out the period during which the tartarized anti-
mony  is  taken,  copious  mucilaginous  drinks,
especially gum water, should  be recommended to
the  patient;  and if much fever should exist, it
will be advisable to draw blood from the arm .- in
like manner, if any articulation appears likely to
suffer  more severely than the others, the local
abstraction of blood by means of leeches, together
with the  application of dry cupping glasses  and
blisters,  below and around  the  joint, will  be
beneficial: lastly, as under circumstances, we may
avail ourselves of emollient and  narcotic cata-
plasms, and protracted  local bathing, when it can
be  done without greatly disturbing the affected
limb.
  When rheumatism is attended with, and espe-
cially when preceded by a disordered condition oe 
 236       ARTICULAR RHEUMATISM.

 the digestive organs, the tongue being loaded, the
 patient complaining of a bitter taste m his mouth,
 and  evacuants being generally beneficial in the
 diseases which may happen to prevail at the time,
 it is proper to begin our treatment with the ex-
 hibition of an emetic, to be followed by purgatives;
 not, however, without keeping a strict watch over
 the alimentary canal, as well  as over the  seat of
 the primary affection, so as to persevere in or dis-
 continue this plan of treatment accordingly.
   The attempt  to  cure rheumatism simply by di-
 aphoresis, has never appeared  to us very successful
 when the disease was once fairly established, or ex-
 isted to any considerable extent; for, in fact, most
 rheumatic patients are spontaneously affected with
 abundant perspiration, and the continuance of their
 disease does not appear at all regulated by it.   Ne-
 vertheless, when the attack is but slight, confined to
 a few articulations, aud appears to have arisen from
 diminished perspiration, it  will be  very proper to
 prescribe antimonials, Dover's powder, hot aromatic
 drinks, or  fumigations, which may be directed into
 the  bed by means  of a tin tube.   On this  sub-
 ject,  we  may remark that  the oil of turpentme,
 which generally excites abundant diaphoresis, ap-
 pears to possess very little influence on acute rheu-
 matism.
   Numerous other  remedies have been proposed,
 and  often much employed,  sometimes  with great
 success, at other times without any : among these
 may be enumerated colchicum, cinchona, sambucus
 combined  with  nitre, camphor, ether,  ammonia,
 spirit of mindererus, &c.  It  may  be easily  con-
 ceived that, in a disease so obstinate and susceptible
 of sudden changes as rheumatism is  well known to
 be, in a disease  in  which an  inflammation of the
greatest severity in a moment disappears,  and  as
suddenly reappears in some other place, we are pe- 
*RT1«TLAR RIIKTMATISM.        237
i.uharly liable to be deceived respecting the action
of its remedies.   On the other hand, these may fail
in consequence of individual peculiarities, as in cases
where anchylosis, caries, or disorganization of the
articulating surfaces, has supervened on simple rheu-
matism, even in individuals apparently the least pre-
disposed.   Some persons seem so constituted, that,
with them, when a disease  has once established
itself in any organ, it is almost impossible to eradi-
cate it.  In such circumstances,  all that  the  prac-
titioner can  do is to recommend  warm bathing,
vapour baths, blisters, issues, moxa, &c. and he may
congratulate himself if only so successful as to save
the affected limb  from  amputation.
  When articular rheumatism is on the decline, and
the joints continue stiff and almost  immoveable,.
warm bathing, and especially the  employment of
douches, should be resorted to.
  It  would be  improper to conclude this chapter,
without alluding  to  the method pursued by  Pro-
fessor Hildenbrandt, of Pavia, who regards'rheu-
matism as resulting from a want  of equilibrium be-
tween the heat and electricity of the body, and the
heat  and electricity of the atmosphere.   In  con-
formity to this theory,  he covers  the skin, especially
the affected surface, with flannel, cotton, or glazed
silk, previously impregnated  with  some resinous
substance.
  [This chapter, however long, will be imperfect,
unless sufficient has been said to impress on  the
mind of the student the important truth, that rheu-
matism is  not to be cured, like an ordinary inflamma-
tion,  by the  lancet.   In the  words of a modern
author, "  We cannot  attempt to cure rheumatism
by bleeding, and other  evacuants, without imminent
risk of causing metastasis (perhaps  fatal) of the
disease to an important internal organ, most com- 
23?        FIBROUS RHEUMATISM.

monly to the  heart,  its investing  membrane, or
both."  v. Brown's Medical Essays.]
  [One moderate bleeding is all that Dr. Brown
ventures upon, after which he trusts to colchicurn
and opiate diaphoretics.]
  [In regard to chronic rheumatism, a  remedy,
namely, acupuncture, has been proposed by Dr. El-
liotson, which I  am the more anxious to mention,
from having had, through the kindness of this gen-
tleman,  ample  experience  of its  value.   " Ft  is
chiefly useful (observes Dr. E.) in the rheumatism of
fleshy parts, and the more so as the disease is less
inflammatory.   Indeed when the parts are hot, or
the pain is increased by heat, the remedy is generally
useless, and cannot  supply  the  place of antiphlo-
 fistic measures.  One needle allowed to remain an
 our or two in a part, is more efficient than several
used but for a few minutes.   The effects are often
magical.  The  pain  sometimes  ceases while the
needle is in the  flesh, but generally three or six ap-
plications to each painful part are required."  v.
Med. Chir. Trans, vol. xiii.]
           FIBROUS RHEUMATISM.

  In  acute  rheumatism, of a muscular or hbrout
structure, the abstraction of blood by cupping, or
the application of leeches, over the  punctures of
which cupping glasses are applied, is peculiarly be-
neficial ;  indeed  there are  few cases  of pleurody-
nia, lumbago, or stiff neck, in which such a treat-
ment fails.   Vapour baths, simple or medicated, sul-
phureous baths, friction  with the compound soap or
camphor  liniment, the  application  of  hot  narcotic
cataplasms,  or a sinapism, over the  part  affected. 
GOUT.                 239
are, with the abstraction of blood, generally suc:
cessful in fibrous rheumatism.
  In a chronic stage, the same measures are to be
adopted, with the addition  of the  employment of
colchicum or the acetate of ammonia ;  and, in these
cases,  the  patient should be recommended to go
warmly dressed, to wear flannel next the skin, and
oiled silk over the affected parts.   He should take
daily exercise, and, when in  his power, select a re-
sidence enjoying a southern  or eastern aspect.
                     GOUT.

   An attack of regular gout may sometimes be pre-
 vented, or at least rendered  much less violent, by
 having recourse, on the first indication of its ap-
 proach, to diaphoretic drinks, frictions, bath?, and,
 if the patient is plethoric, to the abstraction of blood
 from the arm.   But after its accession, a few leeches,
 when the inflammation is not very great, should be
 applied around the joint, and, afterwards, an emol-
 lient and narcotic cataplasm over it; but when there
 is a much higher degree of inflammation, it will not
 be advisable to attempt more than to keep the bow-
 els open and guard  against cold.   In  the intervals
 between the  attacks, a vegetable diet, temperate
 habits, and, above  all, regular exercise, must be en-
joined.   The patient should  wear  flannel  next to
the skin, taking care by this, as  well as by other
 means, especially  warm bathing, to keep up a free
 perspiration from the skin, and nealthy condition of
 the surface.  As for metastasis  of gout, that is to
 say, disorders  arising from the suppression of an
 arthritic attack, or simply occurring in agouty habit,
it is necessary to recall the original affection, if it
has really been suppressed, or treat that which has 
240                 ©our.
supervened, as would be  proper under other cir«
cumetances.   (See Articular Rheumatism.)
  [Tim following is a short analysis of the  plan of
treatment recommended by Dr. Scudamore, in his
treatise on this subject.]
  [When a paroxysm  is  announced  by any pre-
monitory symptoms, it may sometimes be  averted
by prompt attention.  If the true inflammatory dia-
thesis be  present in any considerable  degree, ge-
neral or local bleeding will be proper. Any tendency
to hemorrhoidal  discharge should be promoted by
aloetic and saline purgatives, and in all cases, con-
stipation of the bowels should be obviated.  Last-
ly,  a furred tongue, heartburn, nausea, and acid
eructations, indicate the propriety of administering
an  emetic]
  [Treatment ofthe Paroxysm.'—General bleeding,
however freely employed, affords very little relief to
the local inflammation, especially to the pain. Never-
theless, when  the pulse is full and hard, the  skin hot
the urine scanty and high coloured, and the bowels,
costive ;  or when any internal organ is affected with
inflammation, venesection is certainly  indicated,  as
if there was no gout present.—Emetics are indicated
only for the  purpose of evacuating the stomach of
irritating contents; thus employed, they are a valua-
ble remedy.  It is .on Cathartics and Diuretics, that
the  successful treatment of the paroxysm chiefly  *
depends.  Purgatives are useful, by unloading the
bowels  of fecal  accumulations, removing  vitiated
secretions, and,  in  exciting the vascular system
of  the  intestinal  canal,  occasioning  depletion,
which  is  also effected  by diuretics through the
kidneys.   Colocynth, calomel, colchicum, and anti-
mony, are the most suitable.  In general tbese medi-
cines should be administered until the gouty inflam-
mation subsides, and so long as the urine  deposits
any considerable sediment, the stools have an un-
natural appearance, or the tongue is furred.] 
GOUT-                 'Ml
  fift regard to colchicum given largely  as a spe-
cific, it m most instances, for a few trials, influences
the local symptoms very speedily; but  so far from
removing the cause of gout, it increases the dispo-
sition to it, and leads to the still more  calamitous,
because more  constant, sufferings of the chronic
form of the disease.   These remarks apply equally
to the eau ■medicinale.']
   [Sudorifics are seldom of much  benefit, and not
only injure the stomach, but  increase the  suscepti-
bility of the skin.]
   [Narcotics.—The extreme pain which generally
attends gout requires the administration of opium,
which is contra-indicated only by a constipated
state of the  bowels, and by great febrile excite-
ment : the  pulvis  ipecacuanne  compos and the
liquor opii sedativus are peculiarly useful ]
 [Local Treatment.—The benefit of applying leech-
es to a joint  attacked by gout is very doubtful;
sometimes, when the local inflammation  has been
thus diminished, it has suddenly  appeared in the
other  limb, and often, much debility of the joint
seems to be  the only result.  Warmth is also
injurious, for  it is  obvious, that confinement  of
morbid heat will increase the pain, and thus tend
to prolong the disease ; and if much perspiration
is produced, relaxation  and aebility Will follow.
An opposite practice, that of applying cold too/cr,
has  been recommended, but  the relief thus pro-
duced is less than the danger, and never so certain,
on account ofthe facility with which gouty inflam-
mation is  transferred from one part  to another :
yet a tepid evaporating lotion  is equally beneficial
and safe ; it may be composed of one  part of al-
cohol  and three  parts of mistura eamphore, ap-
plied to the affected part by means Of linen rags,
previously made warm by dipping in hot water.]
                      21 
242
PHLEBITIS.
  [In conclusion, it must be remarked that atten-
tion  to  diet is the most  important, and an  in-
dispensable  part  of  the  treatment of gout, not
only during the paroxysm, bat in convalescence.]
                  PHLEBITIS.

   At the  commencement of this  inflammation,
emollient and narcotic cataplasms, and local bath-
ing, kept up  for a long time,  are the best reme-
dies ; but, when it  has made any considerable
progress, both the general and local abstraction
of blood become  necessary to prevent the deve-
lopement of phlegmonous erysipelas, and the deep
suppurations in which it generally  terminates.
  John Hunter employed, very successfully, in this
affection, compression  above the inflamed part.
Dr.  Goupil states that this  remedy has  proved
equally successful in his own experience.*  It has
also been proposed to make a section of the vein,
whenever it is not so large as to become the seat
of a troublesome hemorrhage, and its situation
renders it easily accessible : tbis last method  is
the more worthy  of attention, as it  puts an effec-
tual stop to  the progress of the inflammation,
which has a constant  tendency to extend  in the
direction of the heart.
  * See  Nouvelle Bibliotheque Medicale, tome i. page
240,A. D. 1827. 
NEURALGIA.
243
                 NEURALGIA.

   When neuralgia is seated in the face or hairy
 scalp, and is not occasioned by the pressure of some
 tumour on a nerve, the following plan of treatment
 should be adopted: when the state of the stomach
 permits the exhibition of narcotics, we may give
 the acetate  of morphia, the extract of hyosciamus,
 conium, opium, aconite, stramonium, belladonna, or
 dulcamara,  beginning with a very small dose, and
 gradually increasing it until the patient is decidedly
 easier; but  if any Dad effects arise in consequence
 of these medicines, they must be taken in less quan-
 tity, or altogether discontinued:  it will, however,
 be proper to attempt to administer them by the skin,
 or in clysters, employing at the same time other re-
 medies.  It  often happens that narcotics either ex-
ert no influence at all,  or give  rise to unpleasant
symptoms,  when  taken  alone;   while  from their
combination with each other, or  with some  other
medicine itself equally injurious or inert, the great-
est benefit is derived: the principal substances of
 this clasB are valerian, camphor, musk, castor, guai-
acum, oxide of  zinc, preparations of  antimony,
emetic tartar, calomel, muriate of ammonia, rhubarb,
 &c.   Hence have arisen  the diversity and  compli-
cation of the remedies recommended in  this  affec-
tion ;  and as there is no class of diseases so fugitive,
and yet so stubborn, it is not surprising  that its re-
medies  are  at the same  time  so numerous and so
 few.   And thus we must not be discouraged  when
one fails,  but try some  other, for so long as the
structure ofthe nerve  is unaltered, there is a chance
of success ;  and for this  reason  also we would ex-
tend still further the list  of remedies, and  include
the tincture  of galbanum combined with ether, the
liquor arsenicalis with the thebiac  tincture, to the 
244
NEURALGIA.
amount of six minims three times during the  day,
tartarized antimony and opium in equal proportions,
commencing with one grain, which may be gradually
raised to several grains daily, for the individual ac-
tion of each  is neutralized by their combination;
the hydrocyanic acid,  in very minute quantities;
and, lastly, carbonate of iron,  the amount of which
that may be taken  with impunity, extends from a
scruple to one or two drachms daily.
  It will  also be proper to try such external appli-
cations as hold out any  reasonable prospect of suc-
cess, and  which are not very painful; such, for in-
stance, as frictions with ether, laudanum, compound
camphor or soap liniment, or  tincture of canthari-
des, galvanism,  and electricity, in the manner do-
scribed by Andrieux;  hot narcotic cataplasms, or
sinapisms over the seat of pain.  Cold applications
to the head are beneficial when the patient  com-
plains of a sense of ardent heat, and pain is increased
by  warmth;  lastly, cupping, flagellation of the
affected part, compression of the nerve,  cauteriza-
tion and  acupuncture, are occasionally useful in mo-
derating the  violence of a paroxysm.  If these  re-
medies afford no relief, or, for some  reason, a fair
trial cannot be  given to them, our only resource is
in more powerful measures,  such as mercurial fric-
tion,  continued until salivation is produced, the ap-
phcation of a blister in the course of a nerve, or a
plaster, the surface of which is sprinkled with tar-
tarized antimony,  placed 'behind the corresponding
ear, the  insertion of an issue,  burning with moxa,
and lastly, affusion of hot or ice cold water, accord-
ing to its effect.
   When neuralgia occupies a nerve ofthe extremi-
ties, as the brachial, sciatic, crural, &c. the remedy
most likely to be useful, is the apphcation of blisters,
which should extend, if possible, from one end to the
other of the affected nerve.  If the pain is extremelr 
NEURALGIA.
245
auite, the paroxysms frequent, and the affection de-
cidedly of a nervous character,  benefit may often
be derived from the  oil of turpentine, taken  inter-
nally ; and if this also fails, vapour baths,  sulphu-
reous or aromatic baths, moxa applied over the spot
in which the pain seems  concentrated,  where  the
nerve is mosr superficial,  and, in short, stimulating
frictions of every kind, should be tried.
  In intermittent neuralgia, whf-rever seated, cin-
chona, or the sulphate of  quina  admini.>teved in the
intervals between the attack of the disease, and on
each accession, ligature of the affected limb, apply-
ing exhausted glasses over the principal seat of the
pain, or  the various narcotics before enumerated,
may be resorted to.   In numerous instances of pe-
riodical neuralgia, coffee has been found very useful.
Lastly, the general and local abstraction of blood
when the patient is plethoric, may be tried as a last
resource, but in general, it is of little benefit, except
in those cases, in which the attacks  are extremely
violent.
  [" The chief and  the most energetic remedies in
neuralgia," observes Dr. Maculloch,  " be the form
what it may,  are  tonics;  and of these,  the  most
efficacious are bark and arsenic: the subcarbonate
of iron is far less generally beneficial.   f\ arcotics,
as a means of diminishing  pain  during the  painful
state, are nearly  useless,  unless  pushed to  such an
excess as to stupify the patient; in which case, it is
probable their effects are injurious, by  inducing indi-
rectly, that debility which so prolongs  and  aggra-
vates all the neuralgia.  But when the acute  stage
is past, they become useful, as tending to  remove
that soreness which remains after the  chief pain has
ceased, and also by reducing the general  irritation
which  has been excited by it.  The usual full diet
of persons in health, with a  rational use of wine,
forms an essential aid to the  cure, and has  often
                       21* 
246                VEURITIfc.
proved a cure in itself, when  used as replacing the
opposite and pernicious system.   The only local re-
medy from which I have really seen such advan-
tageous effects as to induce me to recommend it, is
the  application of  steam,  directed  by the  u^ual
means of a pipe to the affected part; while of course,
the same reasoning applies, if in a minor degree, to
fomentations and hot water.  I have often .succeeded
by means  of a blast of steam, in removing almost
instantaneously, a paroxysm of  the severest neural-
gia of the face."]
  [Dr. Maculloch condemns the practice of dividing
the affected nerve, and the late Dr. Baillie, speaking
of this  operation, says, " it  has in  some  instances
prevented a return  of the disease  for one or two
years, but has  not, as far as I  know, prevented it
permanently."]
                  NEURITIS.

  Although the  abstraction of blood is, as we have
just mentioned, of little utility in even  acute neural-
gia, whether ofthe face or extremities, its effect is
very different  in inflammation of the  nerves of the
arm or thigh;  a fact, of which experience has fully
satisfied us.   In this case, our first duty is to open
a vein in the arm, then to apply a large number of
leeches in the course ofthe affected nerve, to cover
the limb with  emollient  and narcotic cataplasms;
and, lastly,  to immerse it, for  as long a period as
possible, in a warm bath.   Sometimes, the severity
ofthe pain is such, that it is necessary to prescribe
opiates.   When the condition of the  stomach  and
bowels  does not prohibit  purgatives, they  should
be employed, as  they often prove remedies of great
efficacy in neuralgic disorders.  Irritating frictions 
                   \EIKITI:-.               24^

with tincture of cantharides, or oil of turpentine
combined with sulphuric acid, and the application of
moxa in the course ofthe nerve, will be proper at a
later period,  when  the  acute inflammatory symp-
toms have disappeared, and the neuritis has assumed
a chronic character, while the pain continues un-
diminished. 
24f
GENERAL DISEASES.
                 SCORBUTUS.

  The proper treatment, as well as the prevention
of scurvy,  is regimeneal,  rather than  medical; a
fresh  pure  atmosphere, moderate exercise, warm
dry clothing, wholesome food, a large proportion of
fresh  vegetables, beer, wine, and mental diversion,
are the principal points to  which our  attentions
should be  directed.   Vegetables, which contain a
native acid, as lemons, oranges, gooseberries, apples,
and especially, the juice of sorrel, taken to a large
amount, are ofthe greatest benefit.   Fruits, which
are thoroughly ripe,  roasted meat, fresh  fish, and
weak wine, should be the principal articles of food.
If the patient is not  too weak, occasional bathing
will  be advantageously employed ;  hemorrhage or
dysentery is  best checked by  mineral acids and
vegetable  astringents, both  internally  and exter-
nally, as kino, the bark  of cinchona,  pomegranate,
or oak,  the  roots of calumba, rhatany, bistort,, tor-
mentil, &c.   Some practitioners have met with re-
markable success in the employment of ipecacuanha
in cases of very obstinate  diarrhoea.  When there
are any ulcers, the best remedy is a lotion of vine-
gar and water, or of the decoction of bark; if the
gums are affected, they should be touched with a
pledget of lint, imbued with a mixture of honey and
a solution ofthe chloride of lime.  Gentle pressure
is advantageous, wherever the situation of the parts,
and other circumstances permit. 
SYPHILID                249
                  SYPHILID.

  In every affection, the syphilitic nature of which
is ascertained,  the  plan most commonly pursued,
is to put the patient on a course of mercury.   This
■ubstance may be  admimstered either  internally,
under the forms of submuriate, oxymuriate, &c. or
externally, as an ointment or fumigation, according
to the state of the digestive organs.   The prepara-
tion most generally employed, is the  chloride or
oxymuriate, dissolved  in distilled water, and  some
mucilaginous drink, so that the patient may take
the fourth part of a grain, or half a grain, daily :  it
may also be exhibited in the form of pills, combined
with opium, or any other  substance calculated to
diminish the gastric irritation occasioned by it.
  Calomel, the acetate and nitrate of mercury, are
also employed  with the same intention, but  much
less frequently: the  acetate or nitrate must be given
at first in  very minute doses, and gradually increas-
ed.
  Mercurial friction is practised in  the following
manner :  one or two drachms of ointment are rub-
bed in at each  time ; on the first day, the extremi-
ties on one side are  made the seat ofthe  friction, on
the next day, a warm bath is used, and on the third
day, the other  side  of  the body  is subjected to the
same process;   thus  employing  alternately, the
bathing and rubbing.
  Some practitioners treat syphilitic affections by
baths impregnated with  he oxymuriate of mercury;
for this purpose, the quantity must not exceed half
an ounce  at first, but may  gradually be increased
to two ounces.   This may be  of advantage when
others have failed, or cannot for some reason be em-
ployed.
  But whatever mnrfo «*"■> 'ministering mercury we 
250               SVI'HILIS.
may prefer, it cannot be employed with safety, while
a patient labours under  any other affection besides
syphilis.  Throughout the mercurial course, the pa-
tient must be restricted to a light diet.  He must be
careful not to expose himself to a cold <>* damp at-
mosphere, and should wear flannel  next to the skin,
especially when the cutaneous  surface is made the
channel through which mercury is introduced into
the system.
  Lastly, a purgative should  be  occasionally ad-
ministered, particularly if there is any danger to be
apprehended from  ptyalism ; and indeed, whenever
this supervenes, we should suspend  for a time the
employment of mercury.
  Diaphoretics, as sarsaparilla, guaiacum, sassafras,
are useful  auxiliary remedies, and the muriate  of
gold has been recommended as a perfect substitute
for mercury.
  [The following formula is given by Magendie.
    Muriate ofgold and soda crystallized, 1 grain,
    Powder of lycopodium or starch...   2 grains.
Begin with a fifteenth part of this quantity, and in a
very  gradual manner  increase the dose to the
strength of an eighth of a grain of the  muriate.  It is
to  be  applied  once a day, by frictions upon the
tongue and gums.]
  In conclusion, it may  be laid down as a general
rule, that in order to insure permanent success, the
employment  of antisyphilitic   remedies  must  be
persevered in, for  as  long  a period after the disap-
pearance of every symptom of syphilis, as the inter-
val between  the time of this event, and of the pa«
tient's entering upon his mercurial course. 
SCHOIULA.
251
                  SCROFULA.

  Many of the  observations applicable to scrofula,
have been Already  made, while speaking of the dis-
eases of the different organs in which it  may be
seated :  very little, therefore, need to be added here
concerning  its treatment, which  indeed,  is regi-
meneal, rather  than medical.   The  principal indi-
cation is to restrain the predominance of the lym-
phatic system:  thus, exercise, cleanliness,  warm
clothing, friction with aromatic tinctures, cold bath*
ing, large and well ventilated apartments exposed to
theeuri. a mild healthy climate, nourishing food, roast
meat, wine, beer, Sic. comprise nearly all the resour-
ces of which the practitioner can avail himself in the
prevention or cure of this  affection.  No medicine
can be recommended as capable of exerting much
immediate influence over scrofula ;  the preparations
of cinchona and  iron, and  vegetable  bitters, are,
however,  very  useful, in  keeping  up  the general
health.
  When the glands have become tumid, it is neces-
sary to employ along with  the measures above men-
tioned, frictions with the hydriodate of potash.  The
internal  administration  of the tincture of iodine is
objectionable, from its tendency to  excite inflamma-
tion in the  stomach. 
262
FEVERS.
        EXANTHEMATOUS FEVERS.

          SCARLATINA—RUBEOLA.

 The danger of these exanthemata, consists in their
being accompanied  with inflammation of some'
of the organs of the three  splanchnic cavities:
this complication may indeed be regarded as essen-
tial to scarlatina and rubeola; notwithstanding, in
ordinary cases, the treatment of these affections
is  extremely simple,  and not unfrequently little
more is required, than the employment of tepid
mucilaginous  drinks.  When the eruption  is en-
deavouring to establish itself, pediluvia, impreg-
nated with mustard, are very useful in promoting
its developement; at the same time, anodynes may
be given to allay the cough, while we  endeavour
to relieve the pain in the throat by the application
of emollient cataplasms, and the use of astringent
gargles.
  These measures, with the employment of ape-
rient medicines, and  the admission of fresh  air,
comprehend every thing necessary  to be done
during the first and second stage of simple rubeola
or scarlatina : when desquamation is nearly com-
pleted, and the mucous membrane ofthe stomach
and bowels is little or not at all effected, aperients
are especially indicated.  They abridge the dura-
tion of the pulmonary catarrh, and preserve the
skin from subsequent serous infiltration, to which it
remains for a long time predisposed.   The  pre-
vention of this dropsical effusion depends also very 
           SCARLATINA--RUBEOLA.        2£>3

materially upon the prudence and care of the pa-
tient in avoiding exposure to sudden changes of
temperature, covering the surface ofthe body with
flannel, during the whole period of convalescence,
and in the regular employment of bathing and dry
rubbing.
   But these  exanthemata do  not always  pass
through their various stages with the same  regu-
larity : thus, sometimes, at the  commencement of
the patient's illness, a complication of sympathetic
phenomena, and these of a very serious nature,
throw the utmost obscurity over even the nature
of the disease,  and exceedingly  embarrass the
practitioner in treating it.   Of this  description are
cerebral  congestions,  agitation, perpetual  rest-
lessness, great uneasiness, sense of suffocation, op-
pressive breathing, languor, head-ache, prostration
ofstrength,collapse, with or without reaction, &c.
   In such circumstances, it is necessary to make
a careful  examination into the state of every or-
gan of the body ; and to consider  what diseases
are most prevalent:  if there is reason to expect
that the affection will prove to  be  of an eruptive
nature, the practitioner should  wait for its de-
velopement,  without adopting  any active  treat-
ment, unless to remove some urgent local  symp-
tom.   Leeches  may be  applied behind the ears,
on the outside ofthe throat, below the clavicles,
or at the epigastrium; according as the symptoms
are those of arachnitis, angina,  bronchitis, or gas-
tritis.  Should there  be great  general  reaction,
which cannot be explained by the condition of any
one organ in particular,  the   abstraction  of a
moderate quantity of blood from the arm may  be
employed with much  benefit.   Lastly, sinapisms,
cold affusion, and the internal exhibition of stimu-
lants,  will be necessary in cases of  excessive
prostration, not immediately dependent on active
                      22 
 254        SCARLATINA—RUllEoLA .

 disease; but in other circumstances, we should in-
 terfere no more than to  promote the  functions of
 the skin by diluent drinks, pediluvia,  or  general
 bathing,  until the  disease  assumes  its decided
 character, when  the formidable symptoms, espe-
 cially those of gastro-enteritis, which  preceded it,
 will often suddenly vanish.   We must not, there-
 fore, whenever the internal mucous  membranes
 exhibit signs of irritation, hastily employ powerful
 antiphlogistic  remedies, but bear  in mind, that
 its natural tendency is to diminish, as  eruption ap-
 pears on  the skin.
   Whenever an  irruption suddenly recedes, and
 the recession cannot be explained by any internal in-
 flammation, the best means of restoring it, is  the
 employment of a hot water or vapour bath.
   When measles or scarlatina appears epidemically,
 it is highly important to  study the character of the
 epidemic, and modify our plan of tteatment accord-
 ing to the general influence of remedies over it, and
 the combination of symptoms in each case.
   Some  German  physicians  are  of opinion, that
 belladonna is a preservative from scarlatina,  and re-
 commend it to be used for this purpose,  morning and
 evening, in doses  proportioned to the ages of those
 exposed to the  contagion.  In every case,  it is the
 duty of  the  practitioner  to  recommend exclusion
 from  general society,  and the employment of lo-
tions,  with the solution of the  chloride of lime,
 especially in severe epidemics.  See also, Arachnitis,
 Coryza, Ophthalmia, Bronchitis, Angina, Laryngitis,
 Gastro-enteritis, fyc. 
VARIOLA.               255
                  MILIARIA.

  In mild miliary fever, uncombined with internal
inflammation, no other treatment is necessary than
the employment of diluents, aperients, and mustard
pediluvia.
  When this affection spreads  epidemically, there
iB  some  danger of  receiving it  from contagion;
washing the ekin with a solution of the chloride of
lime is the most certain  and powerful  means of
checking it: when  combined with any affection of
the brain, pulmonary organs, or those of digestion,
all its importance is derived from the internal dis-
order, against which alone, it is necessary to direct
our treatment.   We therefore refer the  reader to
these diseases, and to Rubeola and Scarlatina.
                  VARIOLA.

  Having already spoken so fully on the subject of
the first stage of exanthematous fevers, it would
be a repetition of what has been  already said, to
enter into details on the treatment which should be
pursued in variola, before the developement of the
eruption.   The principal object of attention should
be to defend  the internal  organs, especially the
mucous membrane of the pulmonary and intestinal
viscera, by the application  of leeches  and catap-
lasms to the abdomen, thorax, or throat, and the
use of demulcent drinks, gargles and injections ;  if
there is a high degree of fever, we  must without
hesitation draw blood frem the arm, for the super-
vention of pleuropneumonia, laryngitis, gastro-en-
teritis, or encephalitis, is much  more to be dreaded
than the cutaneous inflammation, however intense :
>ve can only, by preserving in  their full integrity, 
256
V ARIOLA.
the organs of the vital functions keep the patient
alive,  while the disease  passes through its various
periods, for it  is altogether impossible either to pre-
vent the developement of variolous pustules, limit
their extent, or prevent  their maturation.  It  has
recently been  attempted, and not without success,
to cut short the progress ofthe disease, by cauteriz-
ing the pimples, on the first  or second day of their
eruption ; the writer has effected the same object
simply by taking off the epidermis beyond the in-
flammatory areola,  and substituting for  the vario-
lous, an  ordinary inflammation, produced by  the
 Eoint ofthe lancet.   But va there not reason to be-
 eve, that suppuration  is  a necessary crisis, and that
by thus counteracting  the prescribed course of na-
ture, we shall prevent the cure which it would ef-
fect ?   Some unfortunate cases  seem to favour this
opinion ; yet experience  simply proves, that affec-
tions of the lungs, bowels, brain, and other organs,
are, in every  respect,  as severe in confluent as in
distinct  variola:   our experience is  at  present
scarcely sufficient to determine  whether it may be
possible, by a combination of local cauterizing, and
ordinary  antiphlogistic remedies, to prevent inter-
nal congestions, especially in the brain,  which, in
these cases, is most  subject to them, and to check
the ravages of variola.
  When the  eruption is confluent, it is proper to
evacuate each pustule, to prevent, or at least to
lessen, the bad consequences of the absorption of
 he variolous matter.
  A slight  attack of distinct small-pox requires  no-
.hing  further  than  tepid, diluent  and acidulated
drinks, aperients, and a cool fresh atmosphere.
  During convalescence, abscesses often  form in
various parts,  without  pain, or  any other symptom
of inflammation; the practitioner should open them
with a bistoury, as soon as he discovers their ex'-" 
\ A KM ELLA.
■257
mice, and it is his duty to assure himself whether
they exist or not.  See Scarlatina, Rubeola.
                 VARICELLA.

  Varicella, like distinct variola, requires no other
remedies than  demulcent and slightly diaphoretic
drinks, aperients, a cool fresh  atmosphere, and hot
pediluvia.
  Like  every other exanthematous disease,  vari-
cella, even in its earliest stage, is capable of giving
rise to internal  inflammation, more or less severe:
hence, the necessity of carefully investigating the
condition of the different organs.  But if, as in the
case we have described, when speaking of distinct
variola, there are no decided symptoms of visceral
disorder, except headache and fever, nothing more
is indicated than the employment of aperients, pedi-
luvia, and diluents; afterwards, the complaint should
be left very much to itself,  unless the  vesicles  are
very numerous on the face, or symptoms of cerebral
congestion arise;  when it  is advisable to abstract
blood : in other cases, rest in bed, abstinence, diluent
drinks, aperients, and fresh air, are  sufficient.
  Inflammation ofthe mucous membranes is seldom
severe in varicella ; it requires the  same  treatment
as when occurring under other circumstances.  See
Ophthalmia,  Coryza.  Pulmonary Catarrh, Gastro-
enteritis. 
FEVERS.
                   TYPHUS.

  After having already minutely detailed the plan
of treatment proper to be pursued in the diseases of
every organ ofthe body, it may appear superfluous,
if not inconsistent, to introduce a disease under the
name of typhus, since, whatever it may be, it can-
not but have some " local habitation."  Yet it can
scarcely be doubted, that there is a deleterious prin-
ciple, whatever may be its nature or source, which,
whenever the  body is exposed  to it, pervades the
whole system, excites disorder in every organ sus-
ceptible of its influence, and impresses upon  these
affections, a peculiar and identical character.  It is
to a morbid condition of a greater  or less number
of organs, thus modified, that the name of typhus
is appropriately given.  Yellow fever, plague, camp,
and prison fevers, express similar modifications.
  When the system is  under the  full influence of
this powerful and mysterious agent, the indications
by which we  distinguish local affections, are ob-
scured,  being, as it were, smothered under a univer-
sal stupor and oppression.
  In some cases, prostration of strength and stupor
form  the prominent and characteristic phenomena;
occurring in a longer or shorter time  after the com-
mencement ofthe attack, and generally terminating
in death. This variety of fever has received the
name of adynamic typhus.
  In  other cases,  the focus of disordered action is
sufficiently obvious;  thus the abdominal viscera are
very frequently the parts principally affected, as  in 
ivPHLB.                259
  ne yellow fever; while, in the typhus of the east,
 ihe axillary or inguinal glands, and the skin, have a
 Bimilar predominance.   (See Carbuncle  and Ma-
 lignant Pustule.)
   Under  whichever of these various appearances
 the disease may exist, it is one of the utmost dan-
 ger, and in a large proportion of cases, terminates
 fatally, often leaving behind very little appreciable
 change of structure.
   In the adynamic form  of typhus, where there is
 marked prostration of muscular strength, a  feeble
 pulse, and embarrassment of all the vital functions,
 it is necessary to sustain the powers of life by sti-
 mulants, as wine, opium, bark, &c; these, with the
 solution ofthe chloride of soda or lime, taken inter-
 nally,  sponging the surface of the body with the
 same liquid,  or with hot vinegar, friction with aro-
 matic tinctures, and clysters of the above substances,
 are the principal measures to which we should have
 recourse.   In this variety of typhus, blisters cannot
 be safely employed, as they are apt to occasion gan-
 grene  of  the part over  which they  are  apphed;
 sinapisms  are equally efficacious,  and free  from
 danger.
   But, whenever typhus sets in with febrile  reac-
 tion, and as long as this period of excitement con-
 tinues, a totally opposite plan of treatment must be
 pursued ;  for the life of the  patient  depends on our
 activity and decision in the employment of antiphlo-
gistic measures.   Of these, bloodletting is the most
valuable remedy which we possess, but it  must  be
practised without delay, or the time will be gone by
in which it can be beneficial or even safe.  While
the surface of the body is dry,  and  hotter than na-
tural, cold affusion or sponging is  highly beneficial,
 unless the patient complains of its being disagree-
able to his feelings, or  some pulmonary  affection
contra-indicates its employment. 
200
TYPHI*.
  Cutaneous revulsion, as by the application of si-
napisms to  the  feet, forms also a part of the treat-
ment proper during the period of excitement;  but
as sooii as collapse supervenes,  the  measures re-
commended in  the preceding paragraph  must be
substituted.
  When typhus puts on an intermittent or remittent
character, it requires the same treatment as the ma-
lignant intermittent fever.  See that  word.
  For the local gangrene, which not unfrequently
occurs in the course of typhus, consult the  words
Angina Gangrenosa, and Malignant Pustule.
  The prevention of typhus is a point which  ought
never to be neglected;  fumigations,  and especially
lotions of the chloride of lime, appear best calculated
to effect this most desirable and important object.
  Numerous minute  particulars are comprised in
the treatment of typhus, which have been already
pointed out under the words Gastro-enteritis,  Dy-
sentery, Cholera  Morbus;  it is, therefore,  unne-
cessary to repeat them here.
  [Among  the numerous English writers on the
subject of fever, scarcely any holds a higher rank
than the late Dr. Bateman.  I shall therefore sub-
join a short analysis of  that portion of this author's
work on Typhus, which relates to treatment.]
  [When fever has existed during one or two days
only, and excitement is not established, the prompt
evacuation of the stomach and bowels, by the ex-
hibition of  an emetic and purgative, will, in most
cases,  occasion the diminution, and in  some, even
the total disappearance  of the symptoms  of  fever.
The simple evacuation of the bowels does not ap-
pear to answer the purpose; and it is probably in
the effect of  vomiting in equalizing the circulation,
and determining to the surface, thus at  the same
time relieving the external chill and internal op-
pression, that the benefit chiefly consists.] 
XVFHUS.                261
   [After the stage of excitement has come on, it
 would be useless,  and even dangerous, to attempt
 to abridge the course of fever in this way ; this ob-
ject may, however, often be attained at an  early
 period by venesection and the  external application
 of cold water:  for the introduction of this latter
remedy, we  are  indebted  to Dr. Currie, by whom,
however, it was extravagantly extolled. Dr. Currie
recommended affusion, but ablution is now almost
universally substituted for it, as less  inconvenient,
fatiguing and alarming, and at the same time, equally
efficacious.   At any period ofthe disease, when the
skin is hot and dry, this remedy may  be employed
 with benefit.]
  [The power of venesection in cutting short fever,
is, at the present day, undisputed;  it should always
be  practised in proportion to  the degree of in-
flammation, and arterial excitement.   No supposed
ihdication of debility should deter us, for such symp-
toms depend on the oppression of strength  under
the influence of disease, not on its exhaustion.]
  [Throughout the whole course of fever,  the
bowels should be kept gently open, if necessary, by
the aid of aperients;  free ventilation is a most im-
portant measure, and its invigorating influence con-
tributes perhaps more than any thing else to support
the powers of life : cold acidulated drinks are  also
useful.]
  [Few medicines have attained greater celebrity
in the treatment of fever than antimony, in conse-
quence, probably, ofthe prevalence of the humoral
pathology, which is thought to rid the system ofthe
disease through the  cutaneous transpiration ;  but
perspiration  is now universally considered  a symp-
tom and consequence, not a cause ofthe cessation of
fever;  besides the diaphoretic property of antimony
is  very uncertain, and depends  on excitement,  a
state which it is our <reat ^biect to snbdn* "> 
202                TV I'll Us-
  [Opiates are, in general, decidedly injurious, and
the more so, in proportion to the disturbance ofthe
sensorium, the very symptom which they are  in-
tended to remedy ;  they augment thirst, heat, and
general distress, parch the tongue, and lock up the
excretions.]
  [When the plan of treatment  which we  have
pointed out, fails to arrest the progress of fever dur-
ing its early and  middleestages,  the disease gradu-
ally assumes a different and more serious character,
consisting, generally, in  some considerable altera-
tion in the intellect, pulse, muscular power, and ap-
pearance  ofthe tongue,  which renders the method
of treatment much more  difficult.]
  [If active delirium has come on, the abstraction of
blood is absolutely necessary, whatever may be the
state of the pulse,  and  cloths  repeatedly wetted
with cold evaporating fluids, should  be applied  to
the shaven  scalp.  A slighter degree of delirium
is often  at  once removed by the application of a
blister to the nucha; especially if at  the same time
the head is shaven  and kept cool, and the bowels
evacuated.]
  [When subsultus tendinum, picking of  the bed
clothes, low muttering delirium,  and  tremor of the
tongue have supervened, the disease is no longer
under our control; yet it  is important  that our
efforts should be so directed as to assist rather than
counteract those of nature.   These  symptoms are
directly and distinctly symptomatic of cerebral irri-
tation ;  and though it would be  imprudent to ven-
ture upon general bleeding at a period of the disease
when much actual  exhaustion of  the  physical
powers  has necessarily been produced, yet expe-
rience abundantly proves the safety and benefit of
local bleeding and blistering;  while no such benefit,
but, on the contrary, evident aggravation of the
symptoms, follow the use of wine and tonics, unless 
rvPHUS.
203
the skin and tongue were moist, and the pulse under.
120, and without any perceptible sharpness.]
  [There is, however, one  condition of fever, in
Which the liberal yet cautious exhibition of wine
and similar stimulants  is of the greatest benefit,
namely, a state of sudden collapse, in which  the
skin is covered with cold and clammy sweats,  the
tongue moist, but loaded;  the pulse very frequent,
but so feeble and wavering as to be scarcely per-
ceptible, and respiration imperfect and  laborious.
in such circumstances, which  occur principally in
old persons, the patient will die  unless stimulants
are given.   Yet even here their effects must  be
most carefully  watched, that  they may be dimi-
nished or  discontinued as  soon as the slightest
indication of over-excitement appears.]
  [There are two other modifications of the symp-
toms of fever, in which the moderate use of some
diffusible stimulant, as wine, appears to  be bene-
ficial, namely,  the state of torpor which  accom-
panies vibices, (in which purgatives are also neces-
sary,) and the  state of diarrhoea unattended with
tenesmus or much disturbance of the head.]
  [With respect to the exhibition  of cinchona in
fever,  it will be  sufficient to say that its ordinary
consequences are, that the tongue,  which the day
before was moist, and  exhibited a gray or yellow-
ish mucous fur, has become dry or even brown, the
skin is hotter or more parched, the  cheek flushed,
the pulse quicker and harder, thirst,  more intense,
and sleep disturbed.]
  [Purgatives may, in  general, be employed  with
advantage during the whole course of typhus ;  but
as their administration  is not wholly devoid of dan-
ger, it should not be resorted to unnecessarily, espe
rially when any disposition  to abdominal inflamma-
fion exists.]
  [In  the course of fever, troublesome symptoms 
2tH                TYPHUS.
frequently  arise, requiring  particular  attention:
among these may be mentioned  vomiting,  which
commonly yields to ten or twelve grains o? magne-
sia, taken three or four times a day, in peppermint
water : diarrhoea is another very troublesome symp-
tom ; in many, perhaps in most cases, it requires an-
tiphlogistic and emollient remedies, but in others the
hydrarg. cum creta, or the mistura crete with opium,
is sufficient.]
  [During convalescence, the most important thing
is the regulation ofthe quantity and quality of food;
tonics often appear to impede rather than promote
recovery.]
  [The principles of treatment pointed out by Dr.
Armstrong, in his lectures on typhus, are very simi-
lar.  In  order to adapt remedies with greater pre-
cision to the exact condition of the patient, he dis-
tinguishes three forms of continued typhus, the ar-
dent, the intermediate,  and the  extreme.  In the
first,  which occurs principally in young or  robust
subjects, and in  which the skin is  intensely hot and
dry, the pulse rapid,  full, and resisting, the tongue
furred but moist, the face flushed,  the respiration
hurried, and the brain much disordered, nothing can
save the patient's life but the copious abstraction of
blood at  a very early period.   The head should be
elevated, the  hair shaven off, and cold applied as
long as the heat continues higher than natural, while
the bowels  are to be kept gently open  by calomel
and rhubarb, assisted by castor oil.   In the  inter-
mediate  form, in which  the  symptoms are similar,
but less severe, the copious  abstraction of blood is
unnecessary, and occasions a debility which  adds
much to  the danger, and might have been avoided;
yet one or two  moderate bleedings from the arm
may be  employed with  much benefit.  In either
form, the fever assumes, about the termination ofthe
first week, a different and peculiar character ; the 
TVPHUs.
265
heat becomes less high on the surface,  the  pulse
comparatively soft and compressible, the respiration
feeble, the tongue dry, and covered with a brown
varnish, and the  muscular power  prostrate : mild
aperients, fresh air, quietude, a bland diet, coolintr
acidulated drinks, are then the only remedies whicS
can be employed with safety.]
  [The third form is that wherein the  symptoms
which, in other cases, supervene towards the end of
the first week, exist almost from the beginning.  In
all  cases  of this kind, general bloodletting is, at
any period, inadmissible:  we should  have recourse
to cautious leeching, when the patient complains of
constant pain in any important organ, the recumbent
posture, even while passing the stools or  urine, lest
syncope and death should supervene, aperients, a
light diet, diluted lemon juice, solution of chlorine,
one or two drachms of which, largely diluted with
pure water,may be taken in the course ofthe twenty-
four hours, and  above all, a constant current of fresh
air  from without.  Dr. Armstrong condemns, no
less than Dr. Bateman, the exhibition of bark : with
respect to wine, he lays down the following crite-
rion, by which we may judge  whether its  exhibition
in the last stage of fever, is beneficial or  injurious;
namely, if the skin becomes hot, the  tongue drier,
the pulse quicker, the breathing more hurried, and
the patient more oppressed,  or more restless, the
wine is prejudicial; if an opposite set of  symptoms
succeed its employment, it may, in moderate quan-
tities, prove highly useful.]
  [In the Edin. Med. and Surg. Journal,  numerous
cases  are related by Dr. Ahson, and  I have myself
seen many,  which appeared  to prove that typhus
may assume a character,  in  which the almost un-
limited employment of stimulants is necessary and
beneficial.] 
266  INTERMITTENT AMD REMITTENT FEVERS.
 INTERMITTENT AND REMITTENT FEVERS.

  In every intermittent fever,  it is impossible to
form a rational plan of treatment, until it has been
ascertained what organs are involved in the disease;
because the local  disturbance demands equally the
attention of the practitioner.  Yet, it must not be
forgotten, that the  intermittent fever is a specific
disease, depending on some peculiar condition ofthe
atmosphere, or occasionally on  some idiosyncrasy
in the patient, and that, consequently, the treatment
of it must be also specific.  Experience shows, that
when the attention  of the practitioner is occupied
exclusively with the local disease,  the  ague often
continues and even  becomes worse, and vice versa.
  In every case, therefore, of ague, in  which any
important organ is involved, that is, whenever it is
the seat of severe pain, and its functions are embar-
rassed, it is advisable to have recourse,  at an early
period, to the general or  local abstraction of blood.
This operation must never be practiced  during the
period of intermission,  while the skin remains cold.
  If the fever depended on the  local inflammation,
the first indication would, without doubt, in this as
in other cases, be to adopt the ordinary antiphlo-
gistic measures, and employ febrifuges only  as aux-
iliary and secondary remedies,  but  the opposite of
this is the truth.
  It is, therefore, in our opinion,  the duty of the
practitioner to begin at once the specific treatment
of ague, for delay tends  to induce visceral disorder,
and it is much easier  to  prevent irregular de-   1
terminations  of blood, by  curing the fever, of
which they are a part, than to destroy  the effects  '
which they leave behind them.  We would, never-   I
theless, recommend, that local and antiphlogistic  %
should accompany specific and febrifuge remedies,  j
to obviate the danger  which may arise from the 
   INTERMITTENT AND REMITTENT FEVERS. 267

too sudden suppression of ague, while some local
disorder has been overlooked.
  The bulphate of quina is the grand specific in
the cure of every species of intermittent  fever.
Like every other  therapeutical agent employed in
fevers attended  with periodical exacerbations, it
should be exhibited during the period of apyrexia,
it must be given in a sufficient quantity to prevent
the developement of the fit: four or six grains of
the sulphate in a mixture containing also a few
minims  of  sulphuric acid, are often sufficient for
this purpose ;  while  in  some case.-, even twelve
grains have  produced  little sensible eiiect. So
far as our own experience in  public and  private
practice is any authority, we  confidently assert,
that even a scruple, or twenty-four grains, may be
prescribed  with safety,  and the happiest results,
when smaller doses have proved unsuccessful.*
  It may be laid down as a general rule, that the
dose of a febrifuge should be proportioned to the
severity and frequency ofthe paroxysms, and that
a large quantity is  requisite in aged phlegmatic
individuals, and during a cold and damp season.
  If the stomach is in  such a state that the sul-
phate of quina cannot be taken in the ordinary
way, it may be administered by the rectum, and
even through  the skin, previously deprived ofthe
cuticle: in this last  case, the salt must be dis-
solved, and then mixed  up  with some oleaginous
substance; the quantity proper for this  purpose
is between six and twelve grains.
  From some recent researches, it would  appear
that the sulphate of cinchonia is a medicine  of
  * See the Revue Mcdicale, tome i. page 393.  annee
102-1. 
   20^ INTERMITTENT AND REMITTENT J EVER*.

   equal efficacy with the sulphate of quina :  its dose
   and mode of exhibition are  the same.
     If, owing to any  idiosyncrasy, the sulphate of
   quina cannot be  employed, the cinchona cordi-
   folia, quercus, cascarilla,  quassia,  menyanthes,
   serpentaria,  gentian,  sulphate of  iron, coffee,
   muriates of potash or ammonia, are excellent sub-
   stitutes.
     Frictions over the abdomen with tartar emetic
   ointment, the internal employment  of the liquor
   arsenicalis, are also  worthy of high commenda-
   tion.
     If, during the progress of a simple intermittent
   fever, any malignant symptom should arise, the
   dose ofthe sulphate of quina must be immediate-
   ly increased, especially if a very  short period of
   apyrexia  has succeeded  two threatening pa-
   roxysms, for the  third, if not checked,  very frer
   quently proves fatal.
     When  the  stomach does  not  well  support
   the sulphate of  quinine, much benefit is derived
   from combining  it with  opium,  musk,  camphor,
   canella, or it may be more  prudent to administer
   it by the rectum, or  the  skin.
     During a fit, it  is useless to attempt to  do much ;
   the patient must keep in bed; as soon as chilliness
   and shivering come on,  hot aromatic drinks should
   be administered ; and when the period of reaction
   succeeds, cold acidulated fluids are  indicated, as
   gentle  diaphoretics  are  in the sweating stage.
   During the interval of apyrexia, a moderate quan-
   tity of bland food may be allowed.
     In cases where it  is  important to cut  short an
   attack,  and in which no febrifuge medicines have
   been exhibited, it is  often  possible to effect this
   object by the gradual exhibition of the tincture of
   opium,  by the application of  several exhausted
v* glasses  to the epigastrium  and back, and lastly, 
     INTERMITTENT AND REMITTENT FEVERS 269

 by  a  ligature tied around each of the extremities,
 taking care,  however, to unloose any  one which
 may occasion much uneasiness.*
   Even in convalescence, after an attack of ague,
 the patient is not secure from danger, and  requires
 the watchful  care of his medical attendant: the least
 exposure to a cold  or  humid  atmosphere, an error
 in diet,  any  powerful  mural  emotion, or  the inju-
 dicious  employment  of medicine,  may  occasion a
 new attack, especially  when a patient resides  in a
 situation which  would predispose him to it: in this
 latter case, the practitioner should always recom-
 mend the removal into some more healthy situation.
   Persons who are exposed to a climate in which
 intermittent fever prevails epidemically, may most
 effectually  preserve themselves rrom its attack, by
 care in  avoiding sudden  changes  of temperature,
 conforming their dress to the varying state of the
 weather, and  by the habitual use of flannel clothing;
 keeping  out at  sea in  foggy weather,  and  passing
 the night in places which are regarded as centres of
 the miasma, are also to be carefully avoided.
   M'digntnt Intermittent  and Remittent Fevfr?.—
 As soon  as the malignant character of a periodical
 fever is detected, no time should be lost before the
 administration of the sulphate of quina or cinchona,
 to such an  amount as, if possible, to cut  short the
 disei.se at   once.   In   such   circumstances, even
 twenty grains, and  more, may be taken during  the
 interval of apyrexia, without danger.   If this inter-
 val is of short  duration, these salts may be dissolved,
 with the  assistance  of a few  minims of sulphuric
acid,  in  some  mucilaginous  mixture, which  the
patient should be directed to take in two or three
  * See some observations on this subject in the Bibli- • *
otheque M^dicale, anne", 1820.
                   23* 
270 INTERMITTENT AND REMITTENT FEVER-.

doses, at intervals more or less distant, according as
the period of  apyrexia is longer or shorter, or that
the last portion ofthe sulphate may be taken within
two hours, of the expected return ofthe paroxysm.
  But  when  the practitioner  is called in after its
accession, or has failed in  attempting to prevent
its developement,  all that he can do  is to provide
against the local and general consequences which
may be likely  to ensue in the brain, bpinal marrow,
heart,  alimentary  canal, skin, &c. by the various
means  recommended under  Arachnitis, ilncephn-
litis, Apoplexy,  Myelitis,  Ptrt;<m mnonia,  Gastro-
enteritis, Cholera Morbus^ Intermittent Fever. ' 
POISONING.
  Poisoning by Mineral and Vegetable Substances.
—In every case of poisoning; our first object is to
remove the. poisonous substance  by  provoking
vomiting; for this purpose, we should first try the
effect or tilling,- the stomach with warm water, and
ticklingtlu jvuia with a feather.  If these measures
do not succeed, an emetic must be administered, or
rather a •..<>ubie syringe  introduced,  by which li-
quids may be injected into and extracted from the
stomach at the same time.   When the nature of
the poison is known, and there is reason to believe
that it is still in the stomach, its antidote should be
administered.  But,  on the contrary, when it is
more probable that the poison has passed into the
intestines, a purgative draught and injections must
be resorted to without delay, to facilitate its ex-
pulsion.
  After having thus fulfilled these primary indi-
cations, the next object to which the practitioner
should direct his attention is the  prevention ofthe
secondary action  of the poison on the system ge-
nerally, especially on the mucous membrane ofthe
stomach and bowels.
  Into the details of the treatment necessary for
this purpose we shall now enter.
            IRRITATING POISONS.

   Preparations  of Arsenic___Administer large
dr aughts of sugar and water, a third part of which 
272         IRRITATING rOISON.*.

should be magnesia or lime water, and afterwards
milk, demulcents, farinaceous food,  and employ
whatever measures may be indicated by the degree
of inflammation.
  Preparations of Antimony.—Administer a weak
infusion  of gall nuts, or, if this cannot be easily
procured, a decoction of cinchona, or a strong infu-
sion of tea ;  crude opium also, in the  dose of two
or three  grains, is of considerable service after the
evacuation ofthe poison.
  Preparations oj Copper__Administer an albumi-
nous mixture, consisting of the whites of a dozen
eggs and a pint of water; or it this cannot readily
be  obtained,  a similar mixture of flour and water
may be  substituted;  flour acts as  an  antidote,
through  the gluten which  it contains.
  Preparations of Silver.—A weak solution of com-
mon salt instantly decomposes nitrate of silver.
  Preparations of Gold, Zinc, and Bismuth—The
same treatment is necessary as in cases of poisoning
by arsenic.
  Preparations of Mercury.—The albuminous mix-
ture (consisting of the whites of eggs beaten up
with water) and a mixture of flour  and water, are
the best antidotes against mercury.  The treatment
of the  secondary effects  of this substance is detailed
under Stomatitis and Colica Pictonum.
  Preparations of Lead and Baryla.—A weak solu-
tion ofthe sulphate of magnesia or soda, and,  when
any salt of lead  has been  taken, a solution of five
grains of the sulphuret  of potash.   See also Colica
Pictonum.
  Preparations of Pewter.—Milk diluted with water
is the best remedy, but it is not strictly an antidote.
  Nitrate f Potash.—(See Preparations of Arsenic.)
This salt, when taken during illness, is not, as  many
toxicologists assert, a poison, even  in  large doses. 
             IRRITATING POISON-.         27X

The same  observation partially applies to tartar
emetic.   See Pneumonia.
  Strong Acids.—Soap, lime, and magnesia copiously
diluted in water, decompose the acid, and form inert
salts.
  Hydrocyanic Acid.—The liquor ammonie, strong
coffee, and diluted mineral acids,  may be useful if
only a very small quantity of the poison has been
taken.
  Alkalies  and their compounds.—Administer the
vegetable acids.
  Phosphorus and  its compounds.—Iodine.—The
solution of magnesia and mucilaginous drinks.
  Cantharides.—Magnesia,  mucilaginous  drinks,
frictions, fomentations with camphor liniment over
the abdomen and organs of generation, protracted
warm bathing and blood-letting.
  Glass.—The  patient should be directed to take
such articles of food as may envelope the fragments
of glass, in order to prevent their mechanical action
upon the coats ofthe stomach and bowels; potatoes
and farinaceous food generally.
  After having  thus attempted to decompose 01
neutralize any portion ofthe poison which may re-
main in the alimentary canal, our next object should
be to remove the irritation which has been excited
by it, by the general  and local abstraction of blood,
cataplasms, fomentations, warm bathing, and the
various methods  recommended  under Gaitritis,
Enteritis, and Gastro-Enteritis. 
274           SEPTIC POISONS.
        POISONING  BY  NARCOTICS.

 Narcotic Poisons—Diluted vegetable acids, coffee,
and the abstraction of blood, whenever there are
any signs of cerebral congestion, constitute the
most effectual antidotes, after the stomach has been
evacuated by means of an emetic and the syringe
before described.
    POISONING BY ACRID NARCOTICS.

  JVarcotico-acrid  Poisons.—First,  evacuate the
stomach, then administer  vegetable  acids, coffee,
and if necessary, draw blood from the arm;  acids
must not  be given before the stomach has been
evacuated, as they would promote its  absorption.
  If the poisoning has  been occasioned  by nux
vomica, faba sancti ignatii, the upas tree, &c, ether
combined with the od of turpentine is an excellent
remedy; two drachms of each should be contained
in a mixture, of which a tea-spoonful is to be  taken
every five or ten minutes ; but the most important
object  is to maintain the pulmonary circulation by
artificial respiration, or  rather by means of gal-
vanism, for patients poisoned in  this  way dje in a
state of asphyxia.
              SEPTIC POISONS.

  Administer an  emetic,  and afterwards a  few
drops of ether, taken in aromatic  and  acidulated
water, or a purgative, if any poisonous matter re-
mains in the bowels. 
■ HYDROPHOBIA.
275
               HYDROPHOBIA.

  Every  attempt to cure hydrophobia having been
hitherto  unsuccessful, it is  not  worth while to
enumerate the various remedies which  have been
proposed.   The only  measure in which the least
confidence can be placed, and  this refers only to the
prevention, not to  the cure of hydrophobia, is the
complete excision of the part  to which the virus has
been applied, together with immediate and profound
cauterization ofthe wound, and the use of lotions
of chloride  of lime: that no  time may be lost du-
ring the preparations necessary for these operations,
it is proper  to clean the wound with water, and to
affix over it an exhausted glass, a wine glass or tum-
bler, for instance.
  However long it may be after the  application of
the poison that a practitioner is called in to the case,
he should make it an invariable rule to cauterize the
wounded part,  although  cicatrization  may  have
taken place;  for the virus may  remain latent for a
long time, and then propagate itself from that point
throughout the whole system.
  Although  the appearance  of pustules under the
tongue some days after inoculation by a rabid animal
is not quite  ascertained,  yet it will be well to look
for them, and destroy them should they be detected.
  When hydrophobia has fully declared itself, the
practitioner must act according to his own discre-
tion, employing any rational measure which his own
genius may  suggest.   By such experiments some
one may at length  be  happy enough to discover the
remedy of this opprobrium of our profession. 
276         POISONING BY CA>KS.
           VENOMOUS SERPENTS.

  Immediately after the bite, as trong ligature should
be tied above the affected part, if it is in one of the
extremities, and  an exhausted  glass aff xed to  the
wound, which as soon as possible must be cauterized.
Professor Paletta recommends placing the patient
before a great fire as a more effectual remedy than
any other:  it is proper to  cover the wound with
compresses imbued with oil and ammonia, to cover
all with very hot  flannels,  and  exhibit  a small
quantity of ammonia in a glass of some diaphoretic
liquid.
          STINGS OF INSECTS.

  An exhausted glass should  be affixed  over  the
wound, after which it should be washed with a solu-
tion of the chloride of lime, or  water  containing
a little  ammonia.   If inflammation supervenes,
compresses wetted with a solution of the acetate
of lead are useful.
          POISONING BY  GASES.

  Carbonic Acid—Carbonic Oxide.—After having
brought the patient into the fresh air, the first thing
which'should be attended  to in every case of as-
phyxia is to establish artificial respiration:  when-
ever oxygen gas can be procured for this purpose,
it is much better than common  atmospheric  air,
at the same time we must endeavour, by the em-
ployment  of every variety of stimulants, to kin-
dle up the almost extinguished spark of life. 
                   ASPHYXIA.  .             277

   Of such  agents galvanism  is by far the  most  '*
 powerful, and%hould  be resorted to as early as
 possible, one  of the  wires" being placed  in  the
 mouth, the bther in the rectum,  in the manner
 before described.  (Seepage 101.)
   Holding ammonia and  ether  to  the nostrils,   '#
 tickling the uvula with a feather, friction over the
 region ofthe hearjt with aromatic tinctures, aroma-
 tic vinegar, or spirit of camphor, the application
 of sinapisms to the thighs,  boiling water or moxa
 to the epigastrium, and exhausted glasses over the
 thorax, should be resorted  to in rapid succession.
 In every case it is most prudent to open a vein in
 the arm or neck.
   The secondary consequences of this species of
 asphyxia, such as pain in the head, spasms, local   '
 paralysis, and the various other symptoms of cere-
 bral disorder, which are apt to ensue, require the
 ordinary antiphlogistic treatment.
   Poisoning by Sulphuretted Hydrogen and Hydro-
sulphuret cf Ammonia.—In 'addition to  the mea-
sures recommended above, it is proper to have re-
course to thus internal exhibition of the solution of
the chloride of lime, and the inspiration of chlorine
gas, in order to decompose any mephitic gas which
may have found its way into the lungs.
   The secondary  effects  of this poison should be
combated by the lancet and cold affusions.
                  ASPHYXIA.

  .Isphyxiafrom want of respirable air.—Bringing
the patient into a fresh atmosphere, artificial res-   <£jtt
piration, galvanism, electricity, stimulating fr'ic-   .fic-
tions, purgative injections, counter-irritants to the   jtf
skin, and  general  bleeding, if there should exist 4MS 
278
VHMVXIA.
any symptoms of cerebral or pulmonary congestion,
constitute the treatment  to which* we must have
recourse.
 Asphyxiafrom drowning.—After having taken off*
the wet clothes, we should endeavour gradually to
restore the natural temperature of the surface by
means of hot napkins, placing the body  almost
horizontally, the head being a Tittle elevated, and,
if possible, make the patient swallow a few spoon-
fuls of come !tromatic stimulant:  the subsequent
treatment is the same as in cases of asphyxia from
carbonic acid.
 Asphyxia from hanging—The abstraction of blood
is  the best means of restoring life, and prevent-
ing any bad consequences.
  Asphyxia of new-bom infants.—In the first place,
clear the mouth from the mucosities  which pre-
vent the  access of atmospheric air to the lungs;
then blow air into the trachea ; if the infant ap-
pears robust, and the skin of a purple  hue,  the
blood should be permitted to flow  from the umbi-
lical cord ;  but if it is feeble and pale, stimulating
frictions, and plunging the infant into hot wine,
must be resorted to.
FINIS. 
Lately published, by C. S. Francis, New- Xork,
  ILLUSTRATIONS OF THE  PRINCIPAL
REGIONS  OF  THE  HUMAN   BODY,  IN
RELATION  TO  SURGICAL  ANATOMY —
Twelve folio plates, with letter press explanations.
The following is a list ofthe subjects of the plates,
which may be had either coloured or plain :—

PLATE I-  Inferior Lamina  ofthe Perineum in the Mule.
PLATE II. An interior view of the Perineum, and uf the lesser
  Pelvn ; more particularly to show the pelvic uud superior Perineal
  Aponeurosis.
PLATE III. A Dissection of Inguinal and Crural Hernia, by Sir
  Astley Cooper.
PLATE IV. Anterior part of the region of the Elbow ; the Veins
  being strongly injected, to show their nodosities, and the compara-
  tive number of valves in the superficial and deep-seated Veins.
PLATE V. Superior  Clavicular Region ; with the external part of
  the Steroo Mastoid Region.
PLATE VI. View ofthe upper Ilyoidean, the inferior (lyoidean, and
  Carotid Regions.
PLATE VII. Viqwofthe Axilla, the arm boing raised up.
PLATE VIII.  A Parellel Section of the Axis of the Perineum—of
  the hypogastric portion of the anterior Walls of the Abdomen—
  and of the Sacral Region, posteriorly a little to one side of the
  Median Line.
PLATE IX. Exterior View  of the Inguinal and Crural Canals-
PLATE X. Posterior view of the anterior Abdominal Parietes, to
  show the superior surface ofthe Inguinal and Crural Canals ; and,
  at the same time, a perpendicular and transverse soction of the
  Pelvis—U display the external Iliac Region, and the connexions
  of the Perineal Aponeurosis with those of the Walls of the lesser
  Pelvis.
PLATE XI. A view ofthe part posterior to the Knee, or Popliteal
  Space.
PLATE XII.  The ringers.
   COMPENDIUM  OF  OPERATIVE  MID-
WIFERY ;  or, the Manual and Instrumental Ope-
rations of Preternatural  Labours  reduced to  the
greatest  simplicity: preceded by an Investigation
of the Mechanism of Natural Labour.   From the
French  of Julius  Hatin,  Doctor of  the  Medical
Faculty of Paris, etc. etc. by Richard Tuite, M. D. 
  THE INFLUENCE OF MODERN PHYSI-
CAL  EDUCATION of Females,  in  producing
and confirming Deformity of the Spine.  By E.
W. DrjFFiis, Surgeon.
      In Press, to be published very shortly,

  A PRACTICAL  FORMULARY OF  THE
PARISIAN HOSPITALS,  exhibiting  the  pre-
scriptions employed by the Physicians  and  Sur-
geons of those establishments ; with Remarks, il-
lustrative of their doses, mode of administration,
and appropriate applications; also, General No-
tices of each Hospital, the diseases  it especially
receives, and medical doctrines of the practition-
ers who preside in it.   By F. S. Ratier, M. D<,
&.c.  Translated  from the third French edition.
with Notes and Illustrations,  bv R. D. M'Lei.la>\
M. D.. 1 vol. !8mo. 
 
 
 
NATIONAL LIBRARY OF
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NLM041428877