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UNITED STATES OF AMERICA
WASHINGTON,  D. C.
GPO  16—«7244-l 
 
 
              FAMILY
MEDICAL   ADVISER.
GIVING SUCH INFORMATION
PRACTICE  OF  PHYSIC,
    DISEASES OF WOMEN AND CHILDREN,

AS MAT PROVE USEFUL IN FAMILIES WHEN REGULAR PHYSICIANS CANNOT
             READILY BE PROCURED.

     SELECTED, ARRANGED AND COMPILED

                FROM THE

        BEST MEDICAL AUTHORS:
|0tjl
                  TOGETHER WITH

             HIS OWN OBSERVATIONS

                    IN THE

     TREATMENT OF DISEASES, GENERALLY;

                TO WHICH IS ANNEXED

  ANATOMY, SURGERY, MATERIA MEDICA,

                     AND

          MANY VALUABLE PRESCRIPTIONS.

                     BEING

      A USEFUL COMPANION AND GUIDE
FOR INTELLIGENT HEADS OP FAMILIES, OVERSEERS OP PLANTATIONS AND MANUFACTORIES,
            MASTERS OF VESSELS, AND TRAVELLERS.



           BY  DOCTOR J. J^OYD,
       PRACTISING PHYSICIAN IN THE COUNTY OF PHILADELPHIA, PA.



                J) I) il a b e 1 p I) i a:

       PUBLISHED BY J. B. LIPPINCOTT & CO.
           Stereotyped by J. C. D. Christman 8? Co.

                     1845. 
i%AS
          Entered, according to act of Congress, in the year 1845, by
                          DOCTOR  J.  BOYD,
in the clerk's office of the District Court of the United  States  in and for the
                      Eastern District of Pennsylvania. 
PREFACE.
  It  has been my impression for  a long time, that a medical
work  like the present, is much needed in this country.  But when
I first signified my intention of publishing the following sheets, I
was told by my friends that it would draw on me the resentment of
the whole medical faculty.  As I never could entertain such an
unfavourable idea, I was resolved to make the experiment, which
indeed come out pretty much as I expected.   Many, whose learn-
ing and  liberality of sentiment do  honour to  medicine, received
the book in a manner which at once showed their indulgence,  and
the falsity of the  opinion that every physician wishes to conceal
his art; whilst the more selfish and narrow-minded, generally the
most  numerous in every profession, have  not  failed to persecute
both the book and its author.
  The medical profession has opposed, at all times,  the publica-
tion of works on  domestic medicine, and it has been the custom
of the public  to  attribute their opposition to a selfish motive.
The projector of the present  treatise, however, does full  justice
to the character  of his professional brethren, well knowing  the
immense sacrifices of time, money and comfort, which they cheer-
fully  encounter in their unceasing  and ill-requited  exertions to
promote the cause of humanity.
  It forms no part of the  author's intention, to induce an under-
estimate  of the necessity of medical advice, when such advice  can
be obtained ;  but, at the same time, he is not so warmly attached
to what may be considered right in the abstract, as to cast aside
all considerations  of expediency.  We must deal with  society as
we  find it; and it is a well-known  fact, that  even among those
who are  enabled, both by wealth and location, to command the
services  of the best practitioners,  a very considerable number
prescribe, and will continue to prescribe, for themselves and their
families,  when labouring  under complaints which they consider
simple, and easily cured.   Persons of another and more numerous
class,  endeavour to elude the payment of fees by adopting  the
                                                    iii 
VI
PREFACE.
 lie ; let it stand or fall by its own merits.  All that is asked for it
 is a fair examination.
   To be true to our original intention, in offering this work to the
 public, we shall avoid all those arts by which the composers of
 treatises on  domestic  medicine have endeavoured to encourage
 the credulous in the belief, that by a few hours' study, and an oc-
 casional reference to a book, they could supersede the necessity
 of advice from  those whose lives and  observations  are devoted
 exclusively to the study of disease.
   We  shall  endeavour to engross in the present work such in-
 formation only,  as may be  safely  and advantageously  communi-
 cated to the intelligent who  are not of the profession, in order to
 enable them to save human life and suffering where higher as-
sistance is inaccessible or unobtainable in time, without encourag-
ing that rashness which induces the empiric, and certain ignorant
professional sectaries, to rush into fearful responsibilities, unne-
cessarily or  criminally.   We ardently hope the  result of our la-
bours will be such as to leave us  chargeable with no follies com-
mitted  in the sick room under the sanction of our authority. 
THE
FAMILY   MEDICAL  ADVISER.
                     THE PULSE.
   The pulse consists in the alternate contraction  and dila-
tation of the heart and arteries, by which contraction, aided
by the  force of the heart,  the blood is propelled through
every part of the body.   As the beats of the arteries corre-
spond with the motions of the heart, we judge, by the pulsa-
tion of the arteries, of the state of the circulation, and from
this we derive many important indications in disease.  The
frequency of the pulse,  in  health, is about 72 beats in a
minute, or it ranges between 60 and 80; but in some it is
slower, without any derangement of the  health.   The pulse
is quicker in women than in men; it is quicker in the san-
guine than in the melancholic temperament; in  youth, than
in age.   The pulse of  an infant in tire first days of its life,
is from 130  to 140.  During the first year, it is from 10S to
120.  From the state of the pulse, taken  in conjunction with
other symptoms, wre judge of the  existence of inflammatory
complaints, of the state of debility, and of the effects of cer-
tain medicines.   In feverish complaints it rises to 100, 120,
168, or even to be uncountable.  In certain  diseases, as
water in the chest, it intermits and becomes irregular, and
the same effect is produced by the use of the foxglove.  In
some persons the pulse is naturally intermitting;  in others it
intermits from disorders of the stomach and bowels, and also
from emotions  of the mind.  The artery generally chosen
to  ascertain  the state  of the circulation,  is the radial ar-
tery, where it is superficially seated in the wrist; but when
this is inconvenient, the temporal artery, at the  corner of
the lower jaw, may be taken.  In feeling  the  pulse,  some
attentions are requisite.   In many, the circulation is quick-
                                               7 
8
RULES OF  DIET.
 ened by any mental agitation: and, therefore, the entrance
 of the  physician, or his  questions and  remarks on  the pa-
 tient's  case, may quicken the  pulse, which should  be felt,
 therefore, both at the commencement and termination of the
 visit.

                    RULES  OF  DIET.

   All persons have an interest in the general  principles of
 diet, and however diversified  their condition and circum-
 stances, these principles admit of a ready and  simple appli-
 cation to all.   We shall  offer then, for the especial  benefit
 of these persons, some few remarks on diet, the choice of
 food, and the regulation of meals.
   One substantial meal of animal food is sufficient  for the
 daily supply of a man in health, engaged in business  involv-
 ing ordinary labour.  The custom, therefore, of taking meat
 for  breakfast, and again at supper, is perfectly unnecessary,
 and unquestionably pernicious.   The principal meal  should
 be taken at about one or two o'clock, so as to occupy about
 the  middle of the waking period.  The animal food should
 consist  of one dish only, and that of easy digestion.
   Of meats, the perfectly healthy kind, among which the
 choice is nearly indifferent, or  may be  determined by indi-
 vidual experience, are beef, roasted or broiled, mutton, lamb,
 or venison;  of poultry, chickens, roasted or boiled, are among
 the least objectionable; of fresh fish, most descriptions, boiled
 or broiled, with the exception of salmon, which is too rich; of
 vegetables, rice and potatoes are the lightest and most nutri-
 tious.   Peas, beans, and simlins, can be indulged in by most
 with impunity; and the tomato possesses properties which ren-
 der it, for a  relish, as salutary as it is grateful.   Among those
 articles  usually introduced, which are to be received  with
 distrust, are  the salted meats generally: such  as ham, salted
 beef, pork, &c.   These are objectionable on account of the
fat they contain, and  the form  in which it  is  presented-
but in small quantities, and particularly with the aid of some
condiment, such as mustard, or horse-radish, they are borne
well.
   Fresh pork, whether young or old, is unwholesome to all
but hard-working men.  The flesh of the goose is oily and
its nutritive  qualities not easily extracted, except by a strong
stomach.  Many meats, however, which  are too  rich to be
eaten alone, are improved by combination with vegetables 
RULES OF DIET.
9
and by the addition of acids and other stimulants.   Thus,
salad, and even cucumbers, when dressed, assist the digestion
of ham or pork;  and, on the same principle, a goose may be
disposed of with the aid of that well known sauce which is
obtained by boiling apples in cider.
   Among culinary vegetables, the turnip and onion possess
valuable properties which establish their claim to extensive
use.  The class  of preparations termed puddings, have not
found  much favor in the eyes of the learned; and probably
no  one of the  tribe has been more generally denounced than
the dumpling.   Yet the experiments of Dr. Beaumont go to
show that neither beef nor mutton is so soon disposed of by
the human  stomach as this same dumpling.  We mention
this, not to encourage the imprudence of eating them, but to
show that the rapidity with which an article  is digested in a
strong stomach, is no proof whatever of its  fitness for a weak
one.   Water is of course the best beverage.   The best sub-
stitute, when water is found to encourage  the formation of
acidity in  dyspeptics,  is  perhaps a little  tea, of moderate
strength, taken after, not during, the meal.  For the morning
and evening meals, custom has so fully established the use
of coffee and tea, that any attempt at interference would be
hopeless.  It may be useful, however, in order to determine
a choice in  doubtful cases, to allude to  some of the circum-
stances by which their respective effects are found to differ
from each other.   As a general  rule, coffee acts  more espe-
cially  on  the  digestive, and tea  upon  the nervous  system.
Coffee, to most persons, is laxative; and it is this effect, the
absence of which is missed when its use is first abandoned
for that of tea or other liquids.   Coffee in  any quantity is
apt to  be followed, in persons of weak digestion, by a pecu-
liar sensation  of  faintness at the  pit of the stomach, occur-
ring about two hours after the  meal is taken.   It is usually
most  marked  in  warm weather, and is accompanied by a
sense of debility and relaxation.
   Coffee  and tea  produce wakefulness; but the latter  is
more certainly followed by this effect.  In most persons, tea,
especially when taken towards evening, produces a brighten-
ing of the intellect, and agreeable sensation  of gaiety and
cheerfulness, which do not belong in the same degree to the
use of coffee.  An occasional change from  one to the other,
is better than a long continued perseverance in either.
       2 
10
COSTIVENESS
                    COSTIVENESS.

   We do not here mean to treat of those astrictions of the
bowels which are the symptoms of diseases, as of the cholic,
the iliac passion, &c„ but only to take notice  of that infre-
quency of stools which  sometimes happens, and which in
some particular constitutions may occasion diseases.
   Costiveness may proceed from  drinking rough red wines
or other astringent liquors;  too  much  exercise, especially on
horseback.   It may likewise proceed from a long use of cold,
insipid food, which does not sufficiently stimulate the intes-
tines.  Sometimes it is owing to the bile not descending to
the intestines, as in the jaundice;  and at other times it pro-
ceeds from diseases of the intestines themselves, as a palsy,
spasms, torpor, tumours, a cold dry state of the intestines, &c.
   Excessive costiveness is apt to occasion pains of the head,
vomiting colics, and  other complaints of the bowels.  It is
peculiarly hurtful to hypochondriac and hysteric persons, as
it generates wind and other grievous symptoms.  Some peo-
ple, however, can bear costiveness to a great degree.  I knowT
persons who enjoy pretty good health, yet do not go to stool
above once a week, and others  not above once a fortnight;
indeed I have heard  of some who do not go  above  once a
month.
   Persons  who  are  generally  costive should live upon  a
moistened and  laxative  diet;  as  roasted or  boiled  apples,
pears,  stewed prunes, raisins, gruels  with  currants,  butter,
honey, sugar, and  such like.  Broths with  spinage, leeks,
and  other soft pot-herbs, are likewise proper.  Rye bread,
or that which is made of a mixture of wheat and "rye toge-
ther, ought to be eaten.  No person troubled  with costive-
ness should eat white bread alone, especially that which is
made of fine flour.   The best  bread  for keeping the body
soluble is what in some parts of this country is called meslin.
It is made of a mixture of wheat and rye, and is agreeable
to those who are accustomed to it.
   Costiveness  is increased by keeping the body too warm
and by every thing that promotes the perspiration;  as wear-
ing flannel, lying too  long in bed, &c.   Intense thought and
sedentary life are likewise  hurtful.  All the  secretions  and
excretions are promoted by moderate exercise without doors
and by a gay, cheerful, sprightly temper of mind. 
INTERMITTING  FEVER.
11
   The drink  should be  of an opening  quality.  All ardent
spirits, austere and astringent wines, as port, claret, &c, ought
to be avoided.  Malt-liquor that  is fine, and of a moderate
strength, is very proper.  Buttermilk, whey, and other watery
liquors, are proper, and may be drank in turns, as the patient's
inclination directs.
   Those who are troubled with costiveness, ought, if possi-
ble, to remedy it by diet,  as the constant use of medicines for
that purpose is attended with many inconveniences, and often
with bad  consequences.*   I never knew any one get into
the habit of taking medicine for keeping the body open, who
could leave it off.   In time the  custom becomes  necessary,
and generally ends in a total relaxation  of the bowels, indi-
gestion, loss of appetite,  wasting of the strength, and  death.
   When the  body cannot be kept open without medicine,
we would  recommend gentle  doses  of rhubarb to be taken
twice or thrice a week.  This  is not so injurious to  the
stomach as aloes, jalap, or  the other  drastic purgatives so
much in use.   Infusions of  senna  and manna may likewise
be taken,  or  half an ounce  of soluble tartar  dissolved in
water-gruel.   About the  size of a nutmeg of lenitive electuary
taken twice or thrice  a  day generally answers  the purpose
very well.   See Diseases of Child-bed Women.

                 INTERMITTING FEVER.

   A regular paroxysm of  intermitting fever consists of three
stages,  and may be thus  described:
   The patient first exhibits  evidence of languor and debility,
unwillingness to move, and a disposition to yawn on  motion,
as if aroused from sleep.   At this period, the extremities, if

  * The learned Dr. Arbuthnot  advices those who are troubled with costiveness,
to use animal oils, as fresh butter, cream, marrow, fat broths, especially those
made of the internal parts of animals: as the liver, heart, midriff, *&c.  tfe like-
wise recommends the expressed oils of mild vegetables: as olives, almonds, pis-
tachios, and the fruits themselves; all oily and mild fmits, as figs; decoctions oi
mealy vegetables: these lubricate the intestines; some saponaceous substances,
which stimulate gently, as honey, hydromel, or boiled honey and water, unrefined
sugar, &c.                                           r         t
  The doctor observes, that such lenitive  substances are jroper tor persons or
dry, atrabilarian constitutions, who are subject to astriction of the belly, and the
piles, and will operate when stronger medicinal substances are sometimes inef-
fectual; but that such lenitive diet hurts those whose bowels are weak and lax.
He likewise  observes, that all watery substances are lenitive, and  that even
common water, whey, sour milk, and buttermilk, have that  efiect: that new
milk, especiaUy asses' milk, stimulates still more when it sours on the stomach;
and that whey, turned sour, purges strongly. 
12
INTERMITTING FEVER.
examined, will be found cooler than usual, though as yet no
change in temperature is obvious to himself.  Presently the
chill commences, invading the back and then the rest ot the
body, with a progress which is  felt, and described as creep-
ing or crawling.   The  state of chill, when perfect, is marked
by  a  sense of extreme cold, which demands instant  aug-
mentation of all the usual warmth, the  nearest possible ap-
proach to a fire, and additional clothing, or the protection ot
a bed; by all which, however, it  is but little relieved.  At
the same time  there is a tremor, or shivering.  After a  cer-
tain time, the sense of cold begins to  remit, and occasional
hot flushes are experienced.
  This state of things indicates the approach of the second
stage.  There are many other  appearances and  symptoms
peculiar to each, or common to all the stages of fever, some
of which it will be proper  here to  notice.  In the cold stage,
the pulse is frequent, small, and often  irregular.  In the hot
stage, the pulse becomes regular, hard and full, and increases
in these qualities, till the sweat begins to break out.
  In the sweating stage, the pulse becomes softer  and less
frequent.  The appetite, of course, disappears from the com-
mencement until the conclusion of a paroxysm, and in gene-
ral, an absolute aversion to food takes its place.   Together
with this, there is often sickness at the stomach, and vomit-
ing of a bilious matter.   This  may occur either in the cold
or the hot stage, but is  most common in the former.  Thirst
and dryness of the mouth and throat continue during the
whole paroxysm, but abate as the sweat flows freely;  head-
ache, attended with a peculiar throbbing in the temples, to-
gether with pain in the back, and afterwards in the  limbs.
  The interval between the paroxysms of an intermitting, is
a period  of comparative health; and the time which elapses
between  the commencement of successive paroxysms is that
which determines the type of the  disease.   If this period be
twenty-four hours, the  fever is termed  quotidian, or  daily;
if forty-eight,  so  that the  second  paroxysm occurs on the
third day, counting from  the first, inclusive, it is a tertian;
if seventy-two hours, a quartan.   Regular intervals are rarely
protracted beyond this  period.
   As respects the remote or external causes of chills and
fevers, they are  now generally allowed to be marsh mias-
mata ; that is, the exhalation  arising from vegetable  sub-
stances, partially immersed in a moist soil, and  acted  upon 
INTERMITTING FEVER.
13
by the rays of a hot sun, although it frequently happens that
febrile miasma  appears to be generated independently of this
precise combination of causes. Very many of the rivers in our
Western and Southern States, on the margins of which spring
a luxurious vegetation, especially if their banks are low, and
periodically inundated, are favourite haunts of this affection.
But there are facts in regard to the  salubrity or unhealthi-
ness of river situations, which are difficult to be reconciled
with any precise theory;  and our own Schuylkill furnishes
an example of a river flowing on quietly from year to year in
the same channel, and nourishing the same vegetation on its
borders, yet in the course of a few years Completely changing
its character.
   Treatment of intermitting fever divides itself naturally into*
first, the management during the paroxysm;  and secondly*
that which is proper during the interval.   As respects the
former, it is to  be observed, the  obvious  design of nature is
to obtain relief by means of the sweating stage.  The object
of art, then, would be to accelerate, as much as possible, the
access of this stage;  in other words, to shorten the cold fit;
for, when the hot fit is once induced, the sweating is seldom
long in following it.  To accomplish this object,  besides in-
dulging the inclination of the patient for warmth externally-,
we supply  him largely with warm diluent  drinks:  as hot bar-
ley-water,  flax-seed infusion,  sage or balm tea, &c.   Lauda-
num  and  camphor are frequently employed to  shorten the
cold stage.   Camphor is what is termed a  diffusible stimu-
lant, and therefore well suited to effect the purpose.  A tea-
spoonful of paregoric  tincture, which combines  the virtues
of opium and camphor, may be  often given  with good effect
at the commencement of the cold stage  of an intermitting,
combined with  the sudorifics above alluded to.  When much
headache  is  felt  from the commencement,  and  particularly
if  the patient be  troubled by ineffectual retching without
vomiting, it is highly proper to give an emetic of a grain of
Tartarized antimony, with twenty of ipecacuanha.  At the
end of twenty-five or thirty minutes, the dose may be repeated,
if no emesis be  produced;  warm water should be taken freely
to promote the  operation.   This dose is  proper for an adult.
But  the most important consideration in intermitting fever, is
how to prevent the return of a paroxysm.  For this purpose,
the Peruvian bark, or its preparations, has  been employed
almost exclusively from the time its virtues  became  known
                            B 
14
INTERMITTING FEVER.
to the civilized world.   A  modern improved  method, by
which the use of the bark in substance,  has been  super-
seded, is  to  extract the  bitter principle, or  quinine, in
the  form  of  a  sulphate.   In  exhibiting it,  the  best  rule
is  to commence  its use  immediately after  the close of
the paroxysm, and continue it at intervals of one hour in
quotidian, two hours  in tertian, and three  in  quartan ague.
In order to secure a proper condition of the system, use some
cathartic medicine, if the evacuations are not  spontaneously
regular.   If the case be a protracted one, the liver and spleen
almost invariably become diseased; and  this  state is gene-
rally accompanied by a jaundiced hue of the eye.  It is then
proper to  have  two doses, of five grains each, of calomel,
taken at bed-time on successive evenings, followed by a little
oil or salts in the morning, if the calomel does  not operate
by nine o'clock; this should be done before  exhibiting the
tonic.  When, under the use of quinine, the paroxysms do
not  cease, but occur at longer  intervals, we  are gaining
ground,  and  may  calculate  on success with  a  little delay.
When, on the contrary, the intervals grow shorter, we  are
losing ground, and may  feel  assured  that some additional
treatment  is necessary to moderate the violence of the hot
stage.  The saline draught and the neutral mixture, if there
be sickness,  and sweet spirits of nitre,  given in doses of
thirty drops every  half hour, will often accomplish the  pur-
pose.  They should be aided by cold drinks  and affusions,
or even by the lancet, when the pulse  is  very  high, the  skin
very hot and dry,  and the paroxysm long.  Sometimes the
intermission is rendered imperfect by the continuance of an
obscure, harassing, low fever, through the sweating stage and
the interval also.   Quinine should not be given under these
circumstances until the intermission  is rendered complete;
which may be  generally effected by one  or  two doses of
calomel, as ordered above, and the exhibition,  during the in-
terval, of  an  infusion of Virginia snake root,  in the  propor-
tion of one ounce to a pint of hot water, a wine-glass full
to be taken cold every  hour during  the  interval  and  the
sweating stage.
   The  powers  of quinine and  bark are  prodigiously in-
creased by the  addition  of minute portions of sulphate of
copper and opium.   The  following  prescriptions we  have
found capable of arresting  a great majority of  chills, when
givr-n during a single interval;  a large portion of the balance 
INTERMITTING FEVER.
15
yield after  two  intervals;  and very few, indeed, resist their
use after three intervals.  The first prescription is intended
for those who prefer taking medicine in the form of pills;
the second, for those who  entertain a disgust for that mode
of administration:—

      1.  Take sulphate of quinine,                    12 grains.
             sulphate of copper, in powder,      -     2  "
             opium, in powder,    -       -           2  "
             gum arable, in powder,     -       a sufficient quantity.
  Make these into a mass with a few drops of water, and divide it into
twelve pills.   Dose—one pill every two or three hours.

      2.  Take sulphate  of quinine,    -     -      -  12 grains.
             sulphate  of copper,       -       -       2  "
  Put them in a six ounce phial, with two ounces of water, and shake them
well.  Then add—
             Elixir of vitriol,       -     -      -  24 drops.
             Laudanum,      -      -       -      30  "
  Shake the phial again,  and then fill it with water.  Dose—a tablespoon-
ful every two or three hours.

   The  medicine given as ordered above, according to the
length of the interval, should be continued till  bed-time on
the day  on which the chill is missed for the first time, and
this day should be noted.
   There is a strong tendency, in an  intermitting which has
been checked, to return on the seventh, fourteenth, or twen-
ty-first  day.   To prevent  this disaster, a dose of one  or
other  of the above prescriptions  should be taken  in  the
morning, at noon and  at  night, on  each of the  days  here
named, counting from the  day on which the paroxysm first
failed to appear, viz : the sixth, seventh, and thirteenth.  By
faithfully following this  direction, the  patient will very rare-
ly experience another attack for at least six months;  which
is as long an indemnity as can reasonably be asked by those
who continue to reside  in an infected district.
  Although quinine  may be almost with certainty depended
on  for remedying an attack  of  intermitting fever, and  the
system remains secure for a time, continued exposure to the
same malaria will again induce it,  and even  a removal to a
more salubrious climate is not always  a safeguard.  The in-
dividual  who has frequently  suffered, sometimes retains  a
remarkable susceptibility to the  disease  for years.  In some
individuals, simple exposure to cold will often be  sufficient
to induce an attack.  For a while, these relapses are cured 
16
BILIOUS FEVER.
with the same ease as the first attack; but after some time
the quinine seems  to lose its effect.   Under these  circum-
stances, Fowler's solution, an arsenical preparation, has been
found a valuable substitute.   It is employed in doses of ten
drops, taken at intervals;  but it is an  article altogether too
dangerous for domestic  use.
BILIOUS FEVER.
  A paroxysm of intermitting, as before described, may be
considered as a type or model of all  febrile  affections, to
which all bear more or less resemblance.   But there is a
large class of fevers, in which the regular sequence of symp-
toms which belongs to the  intermitting fails to be observed.
The access, it is true, is usually with chill, which is succeed-
ed by a sensation of heat; pain in the  head and back, loss
of appetite, thirst  and' restlessness,  are also  present.  But
these fevers differ wholly from  regular intermitting in  the
following circumstance.  The commencing chill is less vio-
lent, and not often attended with absolute rigour or shaking;
the hot stage, when fully formed, may continue with little
change in the degree of heat for many hours or even  days;
and there is no regular termination by sweat.
  The natural state of the  functions,  instead of being re-
stored at the expiration of six, eight, or ten hours, oftentimes
does not return for as  many weeks;  but  once restored, the
whole force of the morbific action  is exhausted, and there
remains no tendency to a new paroxysm;  such is the general
character of bilious fevers.
  The  commencing symptoms  of bilious fever  have been
described.  Its approach is insidious, and generally the stage
of chill has already been succeeded by heat before it attracts
notice.  Then  the patient is found with flushed face, suf-
fused eyes, hot skin, quick, hard pulse, tongue loaded with
secretion,  thirsty,  very restless, and in  the severer  cases
slightly delirious, yet without other  pain than  that  referred
to the head, and an aching sensation in the back and  limbs.
The disease is seldom allowed to make progress without in-
terference; for experience  has so  fully  proved the utility of
attempting to arrest it, and so clearly pointed out the means
of so doing, that these means are probably universally resort-
ed to.   The relief urgently demanded at this period, is to be
gained in a very large proportion of  cases by the simple ex- 
BILIOUS  FEVER.                    17
hibition  of  an emetic; in a  smaller number by the  same
remedy, preceded  by bleeding, and a still smaller,  perhaps,
by bleeding alone.   The latter is most beneficial  when it
produces  free perspiration, and excites vomiting, which it
not unfrequently does.   The rejection of the contents of the
stomach, followed  by a free discharge of bile, gives great re-
lief to the head, and  serves, in many  instances, wholly to
arrest and break up the fever.  Should the latter not hap-
pen, the patient obtains, after some hours, a remission of the
symptoms;  the  pulse  becomes slower  and softer, the  skin
more cool, the countenance brighter, thirst less, and the mind
clear and tranquil.   These favourable changes, when transi-
tory only, are most usually remarked in  the early part of the
day; towards evening an aggravation again takes place; when
this  alternation  has continued for a few days,  one of two
things takes place.   Either gradual improvement occurs with
the recovery of appetite,  a natural coolness of the skin, the
restoration of the strength, &c; or the fever changes its type.
The return  of daily febrile action ceases to be observed, or
becomes very slight.   The pulse  sometimes falls  below its
natural standard to sixty,  or even fifty^eats, per minute.
  Cleanliness may be justly ranked as first in  importance
among the duties of a sick room.   We do not hesitate to lay
it down as a general rule, that there is  no state or stage of
fever, in which the exposed parts of the person  may not be
daily washed, the linen about  the person daily changed, and
the bed  daily made.  For the mere  purpose of washing,
slightly tepid water may be used; but there is a refreshing
influence in the  application of cold water to the  face, hands
and wrists, during the heat of continued fever, which is some-
times indescribable,  and  which is not attended with any
subsequent ill efiect.   The mouth and  teeth should not be
neglected at any period, and as soon as  his strength will per-
mit, the patient should be encouraged to  attend to them for
himself.   As respects the neatness of the sick room, the ne-
cessity of removing every article which  is, or is likely to be-
come, offensive,  little need be said.  Among the nuisances,
however,  that are apt to collect in a sick room, and to
which too much indulgence is shown, are the phials, boxes,
papers, &c> the contents of  which are  but partially  con-
sumed.   Let them be  banished without hesitation, as soon
as their use is discontinued.  Ventilation  is important at all
times and seasons.
       3                   b2 
18
BILIOUS  FEVER.
   No patient of any age should be urged to  eat, nor should
the nutritious liquids be insisted on, unless by express order
of a physician.   His food should be cautiously administered
to him during convalescence.   No rule can  be given in re-
gard to the cravings which are felt by a convalescent patient.
On one subject connected with the management of the sick
room, we must be excused for speaking with some severity.
We allude to the admission of unnecessary or improper at-
tendants and visiters into the apartment;  not only in fevers,
but in the whole range of nervous complaints, even when
mild.  A practitioner who so far  forgets the duties of his
station as to raise his voice, or indulge his temper, or annoy
the patient with disagreeable conversation, or alarm him by
appearing after indulgence  in dissipation, whatever  be his
talent or standing, should be tolerated only when no more
reasonable or creditable assistance can be possibly obtained.
   Religious services in the  sick room should be very short
and very quiet.   Singing, and especially in concert, is  very
reprehensible.   A clergyman who knows the true duties of
his calling, and prefers the true service of his master to the
exercise  of petty influence, or  the gratification of  a  silly
vanity, will always consider the advice of the  medical at-
tendant, both with regard to the time and duration of his
services.
  But what shall we say to the  kind friends whose anxiety
for  the patient induces them to  insist on  admittance.   The
face of a friend  is often more serviceable than medicine,
more invigorating than wijue;  but the faces of  a dozen, are
worse  than  intoxication.   Independently of  the noise and
excitement produced, the mere presence of numbers poisons
the very air which the sick man breathes, and  renders  even
the healthy liable to contract disease.   This habit of crowd-
ing a sick room is chiefly noticed  among the vulgar, and is
often tolerated by anxious friends,  for fear of  giving offence.
There are two  pests of the sick room with which we  have
no  patience.   They are of both sexes, but of totally distinct
species;  though too frequently both are relations of the pa-
tient.  The first^mild, kind, and  actuated  by the best of
motives—is a soothing and low voice, which  flows, however,
with an almost ceaseless current; inquires into all the feelings
of the patient and all the directions of the physician;  begs
the  former to be  of good cheer,  and trust  in  Providence,
hoping that every thing is for the  best; and states that Mr, 
YELLOW FEVER.
19
A-----, and Mrs. B-----, and little C----, all laboured under
 just such symptoms;  that the first was  saved  from death's
door by good Dr. E----, under a totally different course of
treatment; that the second seemed to be doing well  for a
long time under the attending physician, but died unexpect-
edly on the  fifteenth day; and that poor little  C----reco-
vered  directly  under the use of  cayenne pepper  and hot
baths.   The kind friend leaves, the room with the assurance
that the patient looks very ill, but  exhorts him to be of good
cheer and hope for  the best;  quietly breathing in the ear of
the nurse or wife; "My dear, it's a very  bad  case;  had you
not better call in Dr. E----V
   The other annoyance is of an opposite  character.  Rough,
strong, active, and blustering, according to the sex,  they en-
ter the room with a hurried, heavy tread.  If of the mascu-
line variety, he accosts the patient in a loud tone, in some-
thing like the following  terms :—" Come, come ; this will
never do.  You are nervous.   You would be well enough if
you would but  think so, and throw your medicines out of the
window."  We have suffered less than  many from  the folly
of these friendly homicides;  having made it through life a
principle of action, always to cause their immediate ejectment,
or to  abdicate  ourselves;  but having witnessed incalculable
suffering from such  proceedings, and hoping that a few may
be startled by these true pictures, into something like a rational
course of conduct, we have sketched them from the  memory
of former years.

                   YELLOW FEVER.
   The symptoms  of the first stage.—Faintness, giddiness, and
slight chills;  then sudden evolution of intense febrile  reac-
tion, with severe pain in the head,  inflamed eyes, intolerance
of light, dry and  burning  skin, great thirst, pain in the  loins
and lower extremities, tongue covered with whitish mucus,
or but  little  altered from its healthy aspect;  nausea and
vomiting; transient  and  partial sweats.  This stage  lasts
from twenty-four to sixty hours.   The disease sometimes
commences with  sudden  loss of muscular power,  and de-
pression of nervous energy; the patient falling down  as if
stunned by a blow.
   Second stage.—With the  exception of vomiting, all the
symptoms abate; the  pulse sinks to  the natural standard,
the heat of the skin becomes reduced, and the patient  finds 
20
YELLOW FEVER.
 himself much relieved.  The vomiting however  continues:
 the fluid ejected containing  membranous floculi;  the desire
 for cold water is urgent, but  when swallowed,  is immediate-
 ly rejected; the skin of the neck and breast acquire a yellow
 tinse.  This stage lasts from twelve to thirty hours.
   Third stage.—Pulse sinks  ; frequent and forcible vomiting;
 matter  thrown  up  of a  black colour,  resembling  coffee
 grounds, suspended in a glairy fluid; an acrid or burning sen-
 sation in the stomach; diarrhoea of green or black matter;
 whole surface of a dirty yellow; hemorrhages violent; de-
 lirium, insensibility, and convulsions.
   Cause.—The  effluvium generated by animal  and vegetable
 matters, in a state of putrefactive decomposition, its common,
 remote  cause.   Hence its almost continued prevalence in
 the marshy districts of intertropical regions.   This  opinion
 is disputed  by many; but  a great majority of those whose
 knowledge on this point is derived from personal observation,
 maintain its correctness.
   Persons arriving in hot climates, where the  disease is en-
 demic, are almost exclusively obnoxious to it.   Persons hav-
 ing once had the disease, lose, in some degree, their suscepti-
 bility to a subsequent attack.  The influence of the  remote
 cause is promoted by intemperance, excessive  fatigue in the
 sun, exposure to the  damp and  cool  night air, &c.  Black
 vomit, bilious matter, appears to proceed from sanguineous
 transudation in the stomach.  The liver is torpid and con-
 gested, the biliary secretions being deficient.   The  yellow
 colour of the skin is probably the result of a vicarious secre-
 tion of a bilious  matter into the  subcutaneous texture.
   Treatment.—Much diversity of sentiment exists in relation
 to the treatment of this disease.  It  appears, however, that
 the weight of good  authority is in favour of  full bleeding,
 mercurial purgatives, cold  affusions, and applications to the
head; the free use of mild diaphoretic or acidulated  drinks.
 In the first period of the disease, prompt and decisive bleed-
ing is particularly beneficial in the commencement of violent
 cases, where the pulse is full  and hard.
  In the second stage, mild aperients, diaphoretic and cool-
 ing drinks;  enemata;  calomel, with a view to  its constitu-
 tional and  aperient effects; cold affusions, with tonics and
 stimulants, if the pulse becomes  feeble.
  In  the third stage, stimulants and tonics; enemata.   The
 usual saline diaphoretics  are of little or no service  in this 
TYPHUS  FEVER.
21
form of  fever.   The vigorous employment of quinine is
strongly recommended by some during the remissions.   The
blood should be drawn in an erect or sitting posture, and in
a full stream.   In this way, faintness is the  sooner induced,
and the advantages of bleeding gained, with the least possi-
ble loss to the system.   The effect of the  blood-letting, in
reducing the system, is  to  be immediately followed by  a
powerful cathartic.   An  ounce of Epsom salts must be re-
peated every four hours till full operation is produced.  If the
salts be rejected, or if the vomiting be severe, a spice plaster
should be applied, and lime water and milk (one tablespoon-
ful of each) may be given every five or ten minutes; and the
moment  the retching is lulled, a  dose of fifteen grains of
calomel in  our country, or twenty in a tropical  climate,
should be administered*  Cold lemonade, half  a wine-glass-
ful at  a time, may be safely given, after this, for three or
four hours;  when, if the stomach be  composed, and thirst
great, cold drinks  should be  taken  freely.   Sweet spirits of
nitre, forty drops  every two  hours,  in  a little water; the in-
fusion  of Virginia snake-root, a  wine  glassful  every  two
hours; and if there be little  tendency to the head remaining,
the Dover powders, ten  grains every three  hours;  the  two
latter articles alternated every hour and  a  half, with some
warm tea in the interval, act very powerfully.   The mercu-
rial course cannot be attempted by the domestic practitioner
under any circumstances, with safety.

                   TYPHUS  FEVER.

   Typhus fever is by no means so common a disease  as is
generally supposed.   The term typhus is frequently applied
to fevers  essentially distinct from  typhus.  Synochous and
catarrhal fevers, are often improperly denominated typhus.
   Symptoms of the forming stage.—Lassitude, giddiness, and
dull pain in the head;  a peculiar, uneasy sensation  in the
stomach; nausea, and sometimes vomiting; want of appetite;
thirst; pale and shrunken countenance; tremor of the hands;
eyes dull and heavy.
   Stage of invasion.—Slight chills;  tongue  whitish or clam-
my; entire disgust  for food;  nausea  and vomiting.   This
stage lasts from  six to  twenty-four hours.   The foregoing
sketch  applies to typhus in its  regular  form.   Typhus  is
subject to various important modifications. 
22
TYPHUS  FEVER.
   The organs most liable to become the seat of inflammation
are the  lungs, the  brain, the intestinal canal, the liver, and
the peritoneum.   The mucous membrane  of the alimentary
canal, and the arachnoid of the brain, are the most commonly
effected.
   Causes of the typhus fever almost peculiar to the cold sea-
sons of the temperate climates.   I have seen it during the
hottest weather in summer, propagated by a specific conta-
gion ; deficient and unwholesome food, and the contaminated
air of confined and crowded apartments.
   Symptoms.—Free and spontaneous vomiting in the begin-
ning, particularly when  it  relieves  the giddiness,  generally
indicates a  mild  course of the disease.  Hemorrhage from
the nose, about the seventh day, is favourable.  Very mani-
fest  remissions  in  the  morning  are always a good  sign.
Moderate diarrhoea, during the first days, is favourable; but
when it occurs in the  later periods of the disease, it is a very
bad sign.   Great thirst,  in the  stage of collapse, is favoura-
ble ;  so also is a moist tongue  in  this stage.  The absence
of important or  violent  local inflammations always a  good
sign.  Diminution of  the frequency of the pulse, and of the
acrid heat of the skin, is favourable.  Among the symptoms
which  are  particularly  unfavourable, are:  great change in
the expression of the countenance  in the beginning of the dis-
ease ; entire absence of thirst; constant and violent delirium;
and swelling of the parotid glands.  The most dangerous signs,
in the last stage, are: blindness;  involuntary flow  of tears;
palsy of the tongue;  constant low  murmuring, and  entire
abandonment  of himself; a very  frequent and  small pulse;
pain in the region of the bladder; tenderness of the abdo-
men; continued  motion  of the  hands and fingers; hiccough;
aphtha in the mouth;  suspension  of urine, &c.
   Treatment.—The first object is  to  remove,  as  much as
possible, the remote cause,  or  to  lessen its activity.   With
this view, the patient is to be removed from the confined and
contaminating air  in which the disease was contracted; or,
if this cannot be done, the apartment in which  he  lies must
be freely ventilated.   In the forming stage, the indications
are:  to  overcome the  torpor of the  external  capillaries; to
determine the circulation to the  surface;  and interrupt the
morbid  sympathetic actions throughout the system.   For
this purpose, emetics are highly serviceable, given soon after
the attack of the disease, they will often interrupt its course 
TYPHUS  FEVER.
23
After the operation of the emetic, mild purgatives should be
employed.   Two or three alvine evacuations should be pro-
cured daily.
  Calomel, in the early stages of the disease, is often deci-
dedly useful.   Slight mercurial influence, the most effectual
means of rescuing typhus in its early stages—two grains of
calomel may be given every four hours, until the  gums be-
come slightly inflamed.   The constitutional influence  of
mercury is generally pernicious after the disease is fully de-
veloped, its  benefits being restricted to the first five  or six
days.  Diaphoretics, beneficial in this and subsequent stages:
such as the infusion of boneset, catnip, sage, &c.
  The  affusion of cold water is often highly useful.   As the
stage of collapse approaches, the temperature of the water
should be  raised.  Cold  affusions  are  improper when the
skin is below the natural temperature, and a sense of  chilli-
ness is present, or when there is profuse perspiration.   Com-
mon salt may be added to the water when  there is  much
prostration.
  Bleeding is very rarely called for in cases of simple typhus.
  Stage of collapse.—In  this stage,  stimulants and  tonics
are the  appropriate remedies.  Wine, serpentaria, ammonia,
opium, ether, camphor, and musk, are the  most useful.  Of
these,  wine,  ammonia,  camphor, and opium, are the best.
When stimulants render  the  pulse fuller  and  slower, and
the skin moist and  cooler, they may be continued with con-
fidence; but when  the pulse  becomes more frequent and
corded, the countenance flushed, with an increase of restless-
ness and delirium, under their use, they are doing injury, and
must be discontinued.   Camphor, combined with nitre and
calomel,  is  particularly  serviceable  where there  is  much
delirium.
  Diet.—Solid food is injurious; farinaceous and mucilagi-
nous substances are the only nutriments admissible.   Barley
water, and oat-meal gruel, should  be freely allowed in the
stage of collapse.
  In  typhus fever, complicated  with  local inflammation,
bleeding, in the second stage, is often indispensable; it must
be  early employed; delayed beyond the  thirty-sixth  hour
after the beginning of the inflammation, it will most com-
monly do harm.  Sufficient blood should be  drawn at once
to make a decided  impression on the system.  Small bleed-
ings, however frequently repeated, afford no permanent ad- 
24
SCARLET FEVER.
 vantage.  Calomel, with opium, is a valuable remedy after
 proper depletion.  One grain of each  may be  given  every
 four hours. • This remedy is hurtful when the inflammation
 is seated in the brain.

                   SCARLET FEVER.

   For many years past, this disease  has been  regarded, in
 most of the  States, as the  most dangerous and formidable
 affection of childhood, where not immediately destructive to
 life.   Scarlet fever often prostrates the nervous power of the
 system, and lays the foundation for permanent debility.
   According to the views  of many medical writers, scarlet
 fever and malignant sore throat, often epidemic, and  both
 specific, are yet to be regarded  as distinct diseases, although
 it is  allowed that the latter is generally accompanied with a
 scarlet rash.
   Scarlet fever, when epidemic,  does not seem to be  de-
 pendant  for  its production  on contagion  alone.  When,
 however, this source can be traced, it appears to take  effect
 in about three or four days.
   The eruption, which is nearly simultaneous with the  fever,
 consists at first of minute red points, soon confounded in a
general  blush, which extends itself over the whole  surface,
but is chiefly manifest on the face and breast.   The colour
 of this blush is  a bright scarlet, not seen in measles, nor in
 any other disease.  On  close examination the small points
 of the skin will  still be found inflamed, and slightly promi-
nent ; but the  roughness thus produced has not the coarse-
ness  felt in measles.   The appearance of a full and exten-
sive  efflorescence is  a  favourable  sign; for the fuller  the
eruption, the  milder  will be the febrile symptoms, and  the
affection of the throat.   The approach of the latter, which
may  occur as soon, or even  sooner than the rash, is marked
by a difficulty of swallowing, and  sense of soreness.   On
examination, the  tonsils,  and the neighbouring parts of the
passage, are found swollen and intensely red;  and, in a short
time, patches of a white or ashy colour are observed, which
indicate  that  ulceration  of the  mucous membrane  has
already  taken place.  As the  swelling and ulceration  in-
crease, every attempt to swallow is  attended with much dis-
tress, and  frequently  liquids  taken into the mouth are forced
into  the nostrils.  During this state of the parts, the  fever 
SCARLET  FEVER.
25
suffers no  permanent diminution and  little remission;  the
thirst is extreme ; the skin hot;  headache intense; the sleep
broken by  dreaming;  startings, and twitchings of the limbs,
and not unfrequently  delirium, is present.
  Meanwhile the eruptions, perhaps, after fading and re-ap-
pearing, finally subside.  On the sixth or seventh day of the
fever, the whitish sloughs are loosened and thrown off, the
ulcers heal, with relief to all the symptoms; and in favoura-
ble cases the disease  terminates from the sixth to the ninth
day.  When it is otherwise,  death may take place from the
violence of the fever at  an  early period, or the fever  may
pass into a typhoid state, with a  series of  symptoms nearly
resembling those which have been described under the head
of bilious  fever, and  which may run on  for six or  eight
weeks, though usually with eventual recovery.
   Scarlet fever is more frequent in children than  in adults;
and, among the  latter, in women than in men.  Its severity
and  danger, however, both augment  with age.  It occurs, in
general, but once during life; but instances of a second at-
tack are said to be  more frequent than in measles.
   Treat?nent.—In treating this disease, as its absolute arrest
by any  means,isnottobe  expected,  three objects  are to  be
kept in view.  1.  To moderate  the violence of the febrile
action.   2. To  subdue those symptoms which  immediately
threaten life.  3. To counteract debility.
  For the  first purpose, the principal agent which has been
relied upon  is,  cold,  applied externally to the  surface  by
sponging  and bathing; and  internally,  by  the  use  of  iced
water, and ice itself.   Other  means  of moderating the fever
are offered by the  administration of the neutral  salts, and
especially of nitre,  which,  when swallowed in substance, in
small portions, is thought to produce a beneficial local action
on the throat itself.
   The  second object is to be answered, in cases  where the
inflammation and swelling are excessive, by general bleeding,
and  the abstraction of blood from the neck, by leeches.
   The  third is perhaps the most important, as the stage  of
debility soon arrives,  and  the condition of the system which
accompanies it  must be promptly met.  As  soon,  then, as
the active fever subsides,  if  a state  of languor, prostration,
and   debility  succeed; if the tongue remain  loaded,  the
bowels  torpid, and the spirits depressed;   especially if the
ulcers refuse  to heal, and assume a foul and unhealthy as^
       4                    C 
2G
CATARRHAL FEVER.
pect. no time is to be lost.  Bark, wine, and the acids, must
be given internally, gargles of the same character employed
for  the throat, and every means resorted to  for  preventing
irritation of the digestive system, and supplying it with mild
nourishment.  The typhoid state, to which we have alluded
as a sequel common to this disease,  and to  measles, is pecu-
liarly protracted and obstinate in children.  Sometimes such
a degree of debility is induced, that the  articulation is wholly
lost, the limbs are perfectly paralyzed, and the mental powers
prostrated.   In this state, it is through the stomach, an organ
only a little  less weakened than the others, that these are to
be slowly re-established.  The patience, perseverance, and
care, necessary to  the task, can  only be realized by one to
whom the charge  has been committed.  From day to  day
the  same discouragements are renewed, and it is  only after
weeks of patient and assiduous labour that hope seems to
dawn, and  the efforts of affection and  duty, once more pro-
mise to be crowned with success.
                 CATARRHAL FEVER.

  Symptoms.—At first, lassitude and slight chills; followed by
more or less febrile reaction, attended with a frequent, quick,
and somewhat tense pulse; severe pain in the head, face, or
jaws; sneezing, dry cough, and hoarseness; a watery discharge
from the eyes and nose;  eyes red and painful; transient stitches
through the chest; frequent rheumatic pains in the back and
extremities.   There are considerable remissions in the morn-
ing, and exacerbations in the evening.   During the first three
or four days, the  urine is high coloured and free from sedi-
ment.  About the fourth or fifth day, the febrile symptoms
begin to decline;  the urine then becomes pale and turbid, and
the bronchia becomes thicker and yellowish.   The existence
of the  latter cause is inferred from the circumstance of this
form of fever occasionally occurring  epidemically, and  ex-
tending itself over whole continents, and even passing from
one continent to another.
   Causes.—Atmospheric vicissitudes;  a specific miasma, or
a peculiar constitution  of the atmosphere.  Irritation and in-
flammation  in the mucous membrane lining the respiratory
passages, with disordered action of the cutaneous capillaries.
   Treatment.—Moderate bleeding in the young and robust;
in the  aged and infants generally unnecessary, and often im- 
CHILD-BED FEVER.
27
proper.   Mild laxatives useful in all cases;  mild diaphoretic
drinks:  such as infusion of boneset, sage, camomile, &c; to-
gether with pulvis antimonialis, spiritus mindereri, or spiritus
nitre dulce, are important remedies.   Blisters to the breast,
when the  pneumonic  symptoms  are  severe; mild expecto-
rants to relieve the cough.

                  CHILD-BED FEVER.

   So many diseases accompanied with feverish excitement,
occur in the puerperal state, that the appellation at the head
of this article might be supposed to  apply to a great variety
of ailments; but  medical men  wish  it to be restricted to a
disease of peculiar symptoms, and of great malignity; though
they are not all agreed  either upon the exact train of symptoms
which occur, or upon  the method of treatment most success-
fully pursued in them.   In treating of  a disease which has
been the occasion of much controversy among physicians, it
would be quite  inexpedient to bring disputed points  before
the  general reader; but we may say  a little  to quiet the
minds and inform the judgments of those who are likely to
consult  this work.  When  a  woman,  within three or five
days after delivery, is seized with shivering, followed by heat
of skin, thirst, flushing, headache, &c,  she need not  be ap-
prehensive that she is  seized with puerperal fever; it may be
the milk-fever, which soon abates when the bowels are open-
ed, and when the child sucks freely^ it may be from sup-
pression  of the lochia, which  are  often restored by warm
fomentations and a dose of castor oil; or a little cold and
imprudence in fancying  herself too  well, may have occa-
sioned  the  unpleasant  symptoms,  which  although  really
febrile,  do not constitute real puerperal fever.   But when a
woman has had  a comparatively easy labour, when the dis-
charge  is moderate, when the milk has begun to flow, when,
between forty-eight hours and  six days after delivery, she is
seized towards evening with cold and shivering, when  she af-
terwards becomes hot and restless, when she loses all care about
her child, lately so interesting to her; when  she  has  a fixed
pain over the eyebrows, or a feeling of tension, as if  a cord
were forcibly bound  round the forehead, when  the pulse is
small and quick,  when the belly is tender, tense and sore to
the touch—then  it is  time for the friends  of the patient to
take the alarm, and to get prompt assistance, taking care not
< 
28                  CHILD-BED FEVER.

to agitate or distress the patient herself, by showing their
anxiety or apprehensions.                           .
  Puerperal fever is distinguished by frequency of pulse, op-
pression, sickness,  and headache; by want of sleep, some-
times with delirium; by pain in the belly, slight at first, and
afterwards increasing, so that the patient cannot bear the
weight of the bed-clothes.   The eyes are without animation,
the countenance is pale and ghastly, and the whole  appear-
ance  indicates great oppression  and anxiety.   The patient
commonly lies on her back, and  if laid on her side, soon re-
turns to her former posture.  Vomiting  sometimes  occurs
very early; and as the disease advances, it  is so severe that
nothing will remain on the stomach;  and there is a discharge
of dark  coloured  fetid matter,  resembling  coffee  grounds.
The  heat of the skin is not very great, the pulse soon be-
comes feeble, the tongue is brown, but the  patient does not
complain much of thirst.  At first, the bowels are bound, but
there is soon a discharge of fetid, frothy stools.  In many
cases, neither the milk nor the lochia are  suppressed.   The
patient inquires but little after her child.   Soon the strength
sinks, the natural evacuations  are made involuntarily, the
mouth and tongue become foul and dark  coloured, delirium
takes place, and the  patient dies, generally about  the fifth
day  of the  disease, though  some linger on a little  longer.
The fever generally attacks on the second or third day after
delivery.    i
   No particular circumstance in the labour seems to be in-
strumental in producing this  disease.  It comes on  after the
most natural and easy delivery;  it also may come on after a
flooding, which has weakened the patient so much, that we
might suppose inflammation  or  fever impossible.   The dis-
ease, in many cases, is brought on by exposure to cold, pre-
mature exertion, irregularities in diet, and agitation of mind.
   Puerperal fever occasionally  prevails  as  an epidemic  in
particular districts; and it has  occurred  in hospitals, even
when regulated, at a time when it has not been prevalent in
the city where the hospital is situated.  It has also, in some
districts, appeared to  follow  the practice of individual  mid-
wives or accoucheurs; all those who have been delivered  by
certain practitioners for some weeks, having been seized with
the  disease; while other practitioners in the  same  city, of
equally extensive practice, have not had any case  under their
care.  Many physicians think the progress  of the complaint 
CHILD-BED FEVER.
29
is so decidedly that of typhus, with inflammation of the peri-
toneum, that they have  not a doubt about considering it as
a typhoid peritoneal inflammation; for the peritoneum has
often been found inflamed  and covered with an albuminous
effusion, which has induced the French physicians to call it
a deposition of milk, though it has no connection with that
secretion.
  We have  partly, in our introductory remarks, anticipated
the mention of some of  the particulars which distinguish the
true puerperal fever from other febrile affections of child-bed.
It is distinguished from  inflammation of the peritoneum, oc-
curring under ordinary  circumstances, by there  being more
despondency, general  debility,  and  headache;  while the
thirst, heat of the skin, and flushing of the face, are less.  In
common peritoneal inflammation, the pain increases rapidly
when  it has  once  begun, and is very much increased by
pressure;  the attending fever is more inflammatory than
typhoid.   In inflammation of the womb, there is much pain
when that region is pressed; also pain in the back, shooting
to the groins; difficulty of voiding urine, and suppression of
the  cleansings.   In puerperal fever,  the pain and swelling
are most remarkable over the pit of the stomach;  and when
pressure is made there,  a doughy feel  is communicated to the
hand of the examiner.
  In hospitals, the  disease is most generally fatal.  The ear-
lier the attack, the  more tense the belly, and the  less com-
plaint  the  patient makes, the danger is the greater.  If the
pulse continues at  its first frequency, or if it increases, the
disease will be  likely to prove mortal.  If the  fomentation
of the  belly does good, if the pain on pressure is less, if there
be an equal,  warm, and copious  perspiration, our hopes  are
somewhat better.
   The treatment of this fever is a subject of great difficulty.
In the early  part of the disease, when the strength is not yet
greatly impaired,  blood-letting  should be employed  freely.
When the disease has lasted several days,  and symptoms of
debility have come on,  then in all probability large bleedings
would only hasten  the  fatal event.   Leeches to  the abdo-
men will be  proper in nearly all cases;  and after their appli-
cation, if this part continues still painful and tense, covering
it with cloths wet with cold water, is a practice strongly re-
commended  by many  practitioners.   An  emetic of  ipeca-
cuanha, on the very first appearance of the disease, has seemed
                            c 2 
30
INFLAMMATION  OF THE EYE.
in some instances to check its progress, and in others to ren-
der it  milder; but on  the second, or any subsequent day,
emetics are attended with no benefits whatever.  From the
earliest period of the disease, we are to pay attention to the
bowels, and procure regular  and free  evacuation of them,
even by medicines of considerable activity; taking  care to
prevent and check any exhausting diarrhoea.  The laxatives
we employ are the compound powder of jalap, or calomel in
frequently repeated in  pretty large doses, from  six  to eight
grains, three times a day, working it off by infusion of senna,
or by neutral salts.  A clyster should  be early thrown up,
and the bowels  fomented.  We also expect good from  an
equable and gentle perspiration, which in this disease we
may attempt to  bring  out by Dover's powder,  by camphor,
or warm sudorifics.  The patient may partake of light and
easily  digested  food, as  animal jellies, sago, and  the like.
Such seems to be the safest practice,  and in some cases it is
successful;  but puerperal fever is always to be regarded as a
very dangerous disease.  When the woman is to recover,
the unfavourable symptoms abate but slowly, and  the weak-
ness continues long.
   When the disease has occurred  in hospitals, the lying-in
wards should be shut up for some time, after being complete-
ly fumigated and whitewashed.

           INFLAMMATION OF THE EYE.

   The eye is an organ so complicated in its structure, that
it is subject to a great variety of diseases.   Acute  inflamma-
tion of the eye, when at all severe, is commonly attended
with violent reaction.   The fever is  generally high, and the
case requires the  most  vigorous general as well  as  local
treatment.
   Blood-letting should be freely employed when the consti-
tution of the patient will bear it.   It is often advantageous
to bleed  even to fainting.  The diet should  be as strict as
possible, and both  eyes should  be  positively protected from
light.  Saline cathartics should be as freely given  as the pa-
tient's  strength will bear.  When the iris is inflamed, it may
be  known  by the  formation of a narrow redness  evidently
shining from deeper parts, through the white membrane, in
that place where it is thin; by a reddish, dusky, or unnaturally
mottled appearance of the coloured  membrane of the eye- 
BLEEDING FROM THE  NOSE.
31
by an unusual smallness, and sometimes irregularity, of the
pupil;  by pain, deep-seated in the ball of the eye;  often very
intense pain across the front of the forehead, above the eye-
brows.   In this  state  of things the  mouth  must be touched
with mercury, by giving a  pill of half a grain of calomel and
half a grain of opium,  four or five times a day.   While the
general treatment  above  described is  pushed with vigour;
omitting all purgatives, for fear of retarding the action of the
mercury.   When the gums appear a little sore, and the saliva
begins to be increased, the  mercury must be discontinued;
and if the saliva  begins to run  high, a gargle of  borax  and
sage tea, and a purge  of sulphur and cream of tartar, should
be  given, followed by occasional exhibition of a mercurial
pill whenever the  salivation appears likely to cease; so as
to keep up a gentle action on the mouth for several days.
   In inflammation of the front  part of the  eye, which is
much  more common, the whole surface of the inside  of the
lids, and the white part of the  ball, are generally reddened.
The  lids  are  swelled and  puffy, the  eye watery, and the
edges  of the lids, in mild cases, are generally agglutinated in
the morning.   The pain is commonly  superficial, and is of
the  burning and  smarting  kind.   The  general treatment
being  carried on  as vigorously as the violence  and  rapidity
of  the case seem to require, the best local  measures are the
use of the infusion of pith of sassafras  and weak lead water.
Cold  applied to the lids  gives great relief.   In  addition to
the general treatment already given, the best plan  of local
treatment is to apply  four  or five American leeches directly
to  the ball of each  affected  eye, avoiding the  clear part.
When the leeches are pretty full, cut off a quarter or half an
inch of their tails with a very sharp knife, or pair  of scissors,
disturbing them as little as possible by  the operation.  They
will then continue to  suck for a long time, evacuating them-
selves as fast as they fill; they may be made to fall off quickly
by application of salt.   After the operation, the eye should be
covered with a light, cold bread and milk poultice, containing
a little sugar of lead.  By this  mode  of treatment we have
generally succeeded admirably well. •

            BLEEDING  FROM THE NOSE.

   Bleeding  from  the nose occurs spontaneously,  under  a
great  variety of circumstances, in many of which it may be 
32
BLEEDING FROM THE NOSE.
 regarded as unquestionably a salutary evacuation.   We have
 already noticed its occurrence in catarrh, in which disease it
 often affords immediate relief to the inflamed mucous mem-
 brane.  In other cases, the inflammations relieved by hemor-
 rhage from the nose are located in  distant parts; as for ex-
 ample, in the  throat, the lungs,  or the  membranes of the
 brain.   The discharge is often of advantage when it super-
 venes upon  local plethora or congestion, such as is produced
 in the vessels of the brain by close mental application.  It is
 a common  occurrence, and often equally  advantageous, in
 children who are undergoing the natural changes which take
 place as they approach the age of puberty.   In violent pa-
 roxysms of  passion  or  emotion, and in  powerful muscular
 exertions, the rush of blood to the  head would much more
 frequently occasion apoplexy, were it  not  that the  sudden
 flow of blood from the nose often comes on and checks the
 attack.  In  these cases, hemorrhage from the nose  cannot
 be regarded  in  the light of  a disease, but the amount lost in
 certain  instances becomes in  itself a  source of  immediate
 danger,  and  in  others the vessels of the mucous  membrane
 becomes debilitated by habit or disease, in such a  manner as
 to lose in part their power of retraction.  It is certain, how-
 ever, that when bleeding from the  nose has become purely
 passive, it will proceed, if not checked by art, till it produces
 the most  alarming  symptoms.  The  quantity  lost under
 these circumstances is sometimes enormous.   Eight, twelve,
 and even twenty-five pounds, have been known to flow be-
 fore the bleeding stopped.
   Treatment.-^-The bleeding may frequently be arrested by
 the most simple means.   The  application of cold to almost
 any part of the body will produce contraction  of  the blood
 vessels;  placing a cold body, as a piece of iron  or  ice, on the
 neck or back, will  often be  sufficient.  A chill may be in-
 duced by the application of ice to the forehead and temple;
 injections of astringents into the nostrils, have often arrested
 hemorrhage;  and of  these, the best  is the saturated solution
 of alum, or  a plug of lint steeped into  the solution  may be
 inserted in  the nostriL   The powdered leaves of the  St.
John's wort has succeeded  so  admirably in several cases of
 of obstinate bleeding from the  nose, that we cannot but re-
commend  it to  further notice.  I have  found bleeding from
the arm to be a sure remedy, after all others had failed. 
JAUNDICE.
33
                      JAUNDICE.

  Jaundice is  recognized by the yellow hue  of the skin,
which is most marked on the chest, and which extends itself
to the  membrane covering the  eye-ball, and  to the nails.
Along with these appearances, the stools will be found more
or less clay-coloured; while the urine, on the contrary, is of
much deeper tint than ordinary, and communicates a decided
yellow tinge to paper or linen.  These changes are com-
monly explained by supposing that the bile  secreted  by the
liver is prevented from getting into the intestines, and that,
entering the blood as bile, it is thus carried  into the cutane-
ous vessels, and imparts to the skin its peculiar  colour, while
the office of conveying it out of the system is transferred for
the time to the kidney.   It is generally brought on either by
imprudence in diet, such as  eating fermented, acrimonious,
or otherwise indigestible food, by drinking  cold water when
heated, or  by  mental emotion.   The latter may be either
sudden, as  a burst of anger or terror, or gradual,  as depression
and  melancholy.  Long exposure to  external heat produces
jaundice.  The attack commences with a sense  of fullness
at the stomach, attended with nausea and pain.   To these
succeed vomiting, and»the rejection of all articles of food or
medicine.  The  pain increases in severity, and  shoots to-
wards the left  shoulder, or spreads to  the loins.   The belly
is usually distended, and the bowels costive.   The deep yel-
low of the urine in  the progress of the malady often changes
to a dark red,  like the colour of venous  blood.   Long con-
tinued jaundice, however, generally depends on,  or is con-
nected with, chronic disease of the liver itself.  In this case
there is generally no pain, but the digestion  becomes de-
ranged, and the strength is gradually impaired.   This is the
form of the disease  which is  brought on by long continued
residence in hot climates, especially in persons of luxurious
habits, and also by frequent attacks of intermitting fever.
   Treatment.—The chief object is to stimulate the liver to
a healthy secretion.   For this purpose, an  emetic is usually
given at first, which at once excites an increased flow of bile,
and  causes it to be thrown into the  stomach  itself.   This
treatment  often  produces entire relief.  If, however, the
jaundiced  hue of the skin continues unabated, the  emetic
must be followed by a cathartic, in which calomel should at
least be a part.  Five  grains of this  article, combined with
       5 
34
JAUNDICE.
two or three times the quantity of jalap, forms an excellent
purge in cases of this description.   The soreness and tender-
ness on pressure, in the region of the stomach and the liver,
may be relieved  by some external irritation.   A mode of ap-
plying this, which has been considered  as peculiarly appro-
priate, is the nitro-muriatic acid  bath;  prepared by uniting
two parts of nitric to three parts of muriatic acid, and dilut-
ing the mixture with forty to fifty pints  of water.  This
mixture thus  prepared is about as acid  as  common vinegar,
and is sufficiently active to produce  slight pricking when ap-
plied  to the skin.  This bath was applied in India (where
its use was first introduced)  to the whole surface by immer-
sion ;  but it is sufficient to employ  it as a  foot bath, and at
the same  time to  sponge with it the surface of the  body.
Employed  locally  to  the region  of the liver, it  may be of
double  the strength  above directed;  the greatest inconve-
nience which can follow its use, being a sort of rash upon
the skin, attended with some itching and a discolouration of
the surface.  Most children, when three or four days  old,
exhibit a  yellow state of the skin, for which the officious
nurse would promptly administer the saffron or sweet marjo-
ram tea very plentifully, with a view to keep out the yellow
gum, and thus torture the child with a distended stomach, more
annoying than even the disease itself   Very young children
are, however, occasionally subject to such serious derange-
ments of the functions of the liver, as not only to occasion a
deep  yellow tint of the skin and the whites of the eyes, but
also to impart the same colour to the urinary discharges, while
the stools are pale or clay-coloured, from a deficiency of bile.
The  proper  distinction  between the  common  yellow skin,
which may be said to require  no  other attention than clean-
liness, and the real jaundice, which  manifests serious  disor-
der of the internal  organs, is this:  that the yellow state of
the skin in the  first  affection  is  unattended by  any uneasi-
ness,  yellowness of the  urine or costiveness; while in the
latter, the white of the eye is yellow;  the patient is restless,
fretful, and vomits frequently, or exhibits symptoms of nausea,
and  is little inclined to  take the  breast;  the stools, when
they  occur, are  whitish,  or clay-coloured; the  urine stains
the diapers,  and very frequently the  slightest pressure over
the stomach or liver produces pain.   This last is an unfa-
vourable  sign.  The  latter train of symptoms will require
prompt and skilful treatment.   If the child be free from 
JAUNDICE.
35
fever  and tenderness in the stomach or liver, two  or three
grains of ipecacuanha should be given every ten or fifteen
minutes, until vomiting is produced; and if the disease should
be obstinate, this must be repeated  every two or three days,
till the stools assume a bilious or dark green colour.  Avoid
the use  of emetics, if there be  any marks of inflammation in
the stomach, liver or  bowels.   In any case, however,  the
bowels  must be kept freely open,  and  the best purgative is
calomel, followed by magnesia or castor oil.  We  are much
in the habit of giving a tenth or a twelfth of a grain of calo-
mel, with one  and a half grains of  the bi-carbonate of soda,
and a little powdered gum arabic, every hour, until  eight or
ten doses have been taken;  then if the bowels be not moved
with bilious evacuations, we give a teaspoonful of castor oil,
or about as  much magnesia.   Our success with this practice
has been so uniform  in the  course of a few days, that we
rarely find it necessary to use  any other medicine.   It is fre-
quently  necessary to  repeat the calomel  and oil every  few
days,  even after convalescence has  commenced, for the pur-
pose  of keeping up the healthy action  of  the  liver.   The
warm bath  is  very good.  Gentle  frictions over the whole
cutaneous surface are useful.   When  inflammation of the
stomach and  liver is manifested by great tenderness  under
the slightest pressure, with fever and vomiting,  accompanied
by great anxiety and distressful  features, four or five Ameri-
can leeches should be  applied to the part;  or, if they cannot
be procured, an ounce or two of blood should be taken from
a vein in the arm or leg.  If this do not relieve the affection,
spread a piece of leather or muslin, with a layer of blistering
ointment as thick as a wafer; then with the blunt edge of
your spatula, or  knife, scratch  a number of furrows in various
directions upon  the ointment;  fill these fissures with spirits
of camphor; cover it with book or  mull muslin,  and apply it
with a tolerable tight bandage to the skin over the region of
the liver; allow this to remain on about two hours, then re-
move it; and  if the skin appear very red, lay this  plaster
aside, and dress the  part With  a  soft  poultice; repeat  this
poultice as it becomes cool or dry, and evacuate the blister
as soon as  it is formed.  By this process the patient will
experience very little pain from the blister, while the internal
disease  is very much relieved by it.  If a  troublesome  and
debilitating  diarrhoea should occur after the disease has exist-
ed some days, half a grain of the bi-carbonate of soda, and a 
36
ASTHMA.
quarter of a grain of Dover's powders, should be given, and
repeated every three or four hours, until the irritation of the
bowels  is allayed, and the  diarrhoea arrested.   When the
jaundice has either been neglected, or has not yielded to the
means already directed, two grains of the soda maybe given
with ten grains of the extract of dandelion, dissolved in a
little warm water, two  or three times a day.  If  the  little
patient should  suffer  much from  flatulence, or spasmodic
pains, let three or four grains  of assafcetida  be dissolved in
about the same number of tablespoonsful of warm water, and
used as an injection into the bowels; if this does not pro-
duce relief, give two or three drops of sulphuric ether, in a
teaspoonful of hop tea, keeping up, at the same time, gentle
but brisk frictions on the  back and abdomen, if the patient
can bear them.

                       ASTHMA.

  Asthma rarely  appears before  the age of puberty, and
seems to attack men more  frequently than women, particu-
larly of full  habit.   It  seems  to depend upon  a  particular
construction of the lungs.   The attack is usually  preceded
by premonitory symptoms:  such  as  drowsiness, headache,
itching  of the  skin, heart-burn, sickness, weight  over the
eyes, &c.  Its attacks are most frequently during  the  heat
of summer, in the dog days, and in  general commences about
midnight.
  It is characterized by inexpressible  anxiety, very laborious
wheezing and suffocative breathing;  great  tightness  about
the chest; countenance bloated and  livid, sometimes pale;
cold extremities; intense  desire for cool, fresh air; incapa-
bility of lying down; pulse frequent and irregular;  abdomen
distended with wind; cough, at first dry; a  copious expec-
toration of viscid mucus  occurring in the  course of some
hours, bringing with it considerable temporary relief.   The
symptoms remit greatly during the ensuing  day.   On the
next night, however, the fit generally returns.  In this man-
ner it often  continues for six or seven days, and sometimes
much longer.  In plethoric habits, the countenance  is flushed
and  turgid  during the fit;  but in others rather  pale  and
shrunk;  in  the former,  some  difficulty of  breathing,  and
wheezing usually remains in the interval; in others the re-
covery is more complete.  On this is founded the common
distinction of asthma into the  humid   pituitous, or  catarrhal, 
COLDS AND COUGHS.                 37
and  the dry,  spasmodic, or nervous forms.   The exciting
causes are various: accumulation of blood, or viscid mucus
in the lungs, noxious vapours, a cold and  foggy atmosphere,
or a  close, hot air, flatulence,  accumulated feaces, violent
passions, organic diseases in the thoracic viscera, &c.
   Treatment.—Bleeding.  When the disease arises from the
suppression of some  habitual  evacuation, and  is  attended
with general plethora, blood letting is indispensable.   When-
ever the pulse is  hard and tense, emetics are advantageous.
When gastric irritation exists, from indigestible diet, or other
causes, purgatives are beneficial; when the bowels are dis-
ordered, take chalk, mixed with rhubarb.   Narcotics, hyosci-
amus,  stramonia,  tobacco.,  and  opium,  have been recom-
mended.^ They  are  occasionally palliative, particularly  in
protracted cases.   The root of the  stramonia is  to be cut
fine, and smoked in a pipe.  Lobelia inflata I regard as de-
cidedly the most valuable remedy we possess for arresting  or
mitigating  the asthmatic paroxysm.   My own  experience
corresponds entirelyrwith that of other practitioners of medi-
cine who have written very ably upon the treatment of this
distressing  disease.  I  have known a violent fit of asthma
completely allayed in the course of a few minutes by the
above treatment.   A cup of very strong coffee will often pro-
cure much relief;  or digitalis, in combination with small doses
of opium.   Galvanism has of late years been employed with
much advantage by Dr. Philips and others.  Tonics, such
as quinine,  carbonate of iron and bitters, with occasional
mild cathartics, moderate exercise, and above all a light and
digestible diet, with the use of the cold shower bath, are  to
be used during the intervals of the attacks,

                 COLDS AND COUGHS.

   Colds are caused in all  cases by obstructed perspiration.
The  symptoms are so generally known, that we shall not
spend time  in enumerating them.  It may not, however,  be
amiss to observe,  that almost every cold is a kind of fever,
which only differs in degree from some  of those  that have
already been treated of.
   No age, sex, or  constitution, is exempted from this disease;
neither is it in the power of any medicine or regimen to pre-
vent it.   The inhabitants of every climate are liable to catch
cold,  nor can  even the  greatest circumspection defend them
at all times from its  attacks.   Indeed, if the human body
                             D 
38                 COLDS AND COUGHS.
could be kept constantly in an uniform degree of warmth,
such a thing as catching cold would be impossible: but as
that cannot be effected by any means, the  perspiration must
be liable to many changes.  Such changes, however, when
small, do not affect the health; but when great, they must
prove hurtful.
  When oppression of the breast, a stuffing of the nose, un-
usual weariness, pain of the head,  &c, give ground to believe
that  the  perspiration  is obstructed, or in  other words, that
the person has  caught cold, he ought immediately to lessen
his diet, at least the usual quantity of his  solid food, and to
abstain from all strong liquors.   Instead of flesh, fish, eggs,
milk, and other nourishing diet, he may eat light bread pud-
ding, veal or chicken broth, panada,  gruels, and such  like.
His drink may be water gruel, sweetened with a little honey;
an infusion of balm or linseed, sharpened  with the juice of
bitter orange or lemon;  a decoction of barley  and liquorice,
with tamarinds, or any other cool, diluting, acid drink.
   Above all, his supper should be light; as small posset, or
water gruel sweetened with honey, and a little  toasted bread
in it.   If honey should disagree with the stomach, the gruel
may be sweetened with treacle or  coarse sugar, and sharpen-
ed with the jelly of currants.   Those who have been accus-
tomed to  generous liquors, may take wine whey instead of
gruel, which may be sweetened as above.
   The patient ought to linger longer than usual in bed, and
to encourage a gentle  sweat, which  is  easily brought on
towards morning by drinking tea, or any kind of warm diluting
liquor.   I have often known this  practice  carry off a cold in
one day, which in all probability, had it been neglected, would
have cost the patient his life, or have confined him for some
months.   Would  people  sacrifice a little time to ease and
warmth, and practise  a moderate  degree of abstinence when
the  first symptoms appear, we have reason to believe that
most of  the  bad effects which flow from  an obstructed per-
spiration might be prevented.   But,  after  the  disease  has
gathered strength by delay, all attempts  to remove it often
prove vain.   A pleurisy, a peripneumony, or a fatal consump-
tion of the lungs, are the common effects of colds which have
either been totally neglected, or treated improperly.
   Many attempt to cure  a cold, by getting drunk; but this,
 to say no worse of it, is a very hazardous experiment.  No
 doubt it  may sometimes succeed, by  suddenly restoring the 
COLDS AND COUGHS.
39
perspiration; but when there is any degree of inflammation,
which is frequently the case, strong liquors, instead of re-
moving the malady, will increase it.  By this means a com-
mon cold may be converted into an inflammatory fever.
  When those who labour for their daily bread have  the
misfortune to catch cold, they cannot afford to lose a day or
two, in order to  keep themselves warm,  and take a little
medicine; by which means the disorder  is often so  aggra-
vated as to confine them for a long time, or to render them
ever after unable to sustain hard labour.  But even such of
the labouring poor as can  afford to take care of  themselves,
are often too hardy to do it; they affect to despise colds,  and
as long as they can crawl  about, scorn  to be confined by
what they call a common cold.  Hence it is that colds destroy
such numbers of  mankind.  Like an  enemy despised, they
gather strength from delay, till at length they become invin-
cible.  We often see this verified in travellers, who, rather
than  lose a day in the prosecution of their business, throw
away their lives by pursuing their journey, even  in the  se-
verest weather, with this disease upon them.
  It  is certain, however,  that colds may be too much  in-
dulged.  When a person,  for every slight cold, shuts himself
up  in a warm room, and drinks great quantities of  warm
liquor, it may occasion such a general relaxation of the solids,
as will not be easily removed.  It will, therefore, be proper,
when the disease will permit, and the weather is mild, to join
to the regimen mentioned  above, gentle exercise:  as walking,
riding on horseback, &c.   An obstinate cold, which no medi-
cine can remove, will yield to  gentle exercise and a proper
regimen of diet.
   Bathing the feet and legs in warm water has a great  ten-
dency to restore the perspiration.   But care must be taken
that the water be not too warm, otherwise it will do hurt.
It should never be much warmer than the blood, and the pa-
tient should go immediately to bed after using it. Bathing
the feet in warm water,  lying in bed, and drinking warm
water gruel,  or other  weak liquors, will sooner take off a
spasm, and restore  a perspiration, than all the hot sudorific
medicines in the world.   This is all that is necessary for re-
moving a common cold; and  if this course be taken at the
beginning,  it will seldom fail.
   But when the symptoms do not yield to abstinence, warmth,
and diluting  liquors, there  is reason to fear the approach of 
40
COLDS AND COUGHS.
some other disease, as an  inflammation of the breast, an ar-
dent fever, or the like.  If the pulse, therefore, be hard and
frequent, the skin hot and  dry, and the patient complains of
his head or breast, it will be necessary to bleed, and to give
five grains of pulvis antimonialis, or James's powders,  every
three or four hours, till they give a  stool.
   It will likewise be proper to put a blistering plaster on the
back, to give two tablespoonsful of the saline mixture  every
two hours, and in short to  treat the patient in all respects as
for a slight fever.  I have  often seen this course, when ob-
served at the beginning, remove the  complaint in two or three
days, when the patient had all the symptoms of an approach-
ing ardent fever, or an inflammation of the breast.
   The chief secret in preventing colds lies in avoiding, as
far as  possible, all extremes  either of heat or  cold, and in
taking care, when the body is heated, to let it cool gradually.
   Of a Common Cough.—A cough is generally the effect of
a cold, which has either been improperly treated, or entirely
neglected.  When it proves obstinate, there is always reason
to fear the consequences, as  this shows a weak state of the
lungs, and is often the forerunner of consumption.
   If the cough be violent, and the patient young and strong,
with  a hard quick pulse,  bleeding will  be  proper;  but in
weak and  relaxed habits, bleeding  rather prolongs the dis-
ease.   When the patient spits freely, bleeding is unnecessary,
and sometimes hurtful, as it tends to lessen that discharge.
   When the cough is not attended  with any degree of  fever,
and the spittle  is viscid and tough, sharp pectoral medicines
are to be administered: as gum ammoniac, squills, &c.   Two
tablespoonsful  of the  solution  of  gum ammoniac may be
taken three or four times a day, more  or less, according to
the age and  constitution  of the  patient.  Squills may be
given various ways;*  two ounces of the vinegar, the oxymel,
or the syrup, may be mixed with the same quantity of simple
cinnamon water, to which  may be  added an ounce of  com-
mon water, and an ounce  of balsamic syrup.  Two table-

  * Take Mixture of ammonia,     -    -      .     .     -  5i oz.
     "   Oxymel of squills,     -      -     .      .     .       x a'
  Make a mixture; of which take two desert spoonsful often, or when the cough
is troublesome.  Or—
  Take Mucilage of gum arabic,      -     -     .     .      -  5 oz.
   "  Oil of sweet almonds,  '   -     -      .     .     .     j u'
   ut  Syrup of Tolu, ----..        j u
   "  Solution of sub-carbonate of ammonia,                     ^ ^Tm
  Make an emulsion, of which take one tablespoonful frequently. 
COLDS AND COUGHS.
41
spoonsful of this mixture may be taken three  or four times
a day.
  A syrup made of equal  parts of lemon juice,  honey, and
sugar candy, is likewise very proper in this  kind of cough.
A tablespoonftd of it may be taken at pleasure.
  But when the defluxion is sharp and thin, these medicines
rather do hurt.  In this  case, gentle opiates, combined with
diaphoretics, oils, and mucilages,* are  more proper.   A cup
of an infusion of poppy leaves, and marsh-mallow roots, or
the flowers of colts foot, may be taken frequently; or a tea-
spoonful of paregoric elixir may be put into the patient's
drink twice a day.  Infusion of boneset is also a very proper
medicine in this case, and may be taken in the quantity of a
teacupful three or four times a  day.
  In obstinate coughs, proceeding from a flux of humours
upon the lungs, it will often be  necessary, besides  expectorat-
ing medicines, to  have recourse to issues,  setons, or some
other drain.   In this  case I have often observed the most
happy effects from a Burgundy pitch plaster applied between
the shoulders.   I have  ordered  this simple remedy in  the
most obstinate coughs, in a great number  of cases, and in
many different constitutions, without ever knowing it fail to
give relief,  unless there were evident signs of an ulcer in the
lungs.
  About the bulk  of  a nutmeg of Burgundy pitch  may be
spread thin upon a piece of soft leather, about the size of the
hand, and laid between the shoulder blades.  It may be taken
off  and wiped every three or four days, and  ought to be re-
newed  once a fortnight or three  weeks.   This is indeed a
cheap and  simple medicine, and  consequently apt to be  de-
spised; but we will venture to affirm, that the whole  materia
medica does not afford an application more efficacious in al-
most every kind of cough.   It  has not indeed always an im-
mediate effect; but, if  kept on  for some time, it will  succeed
where most other medicines fail.
  The only inconvenience attending this plaster is the itch-
ing which  it occasions; but surely this may be easily borne

  *  Take Solution of the acetate of ammonia,   ...     3 drs.
     "  Mucilage of G. acacia,     -      -     -     -     -  1 oz.
     "  Syrup of Tolu,......1 dr.
     "  Tincture of opium,   -     -     -     -     -     - 25 drops.
  Make a draught; to be taken at bed-time. Or—
  Take Compound powder of ipecacuanha,      -     -         10 grs.
                Make a diaphoretic powder.
        6                  d2 
 42                  COLDS AND COUGHS.

 with, considering the  advantage which the  patient may ex-
 pect to reap from the application;  besides, when the itching
 becomes  very uneasy, the plaster may be  taken off, and the
 part rubbed with a dry cloth, or washed with  a little  warm
 milk and water.  Some  caution indeed is necessary in dis-
 continuing the  use  of  such a plaster;  this, however, may be
 safely done by making it smaller by degrees, and at length
 quitting it altogether in a warm season.*
   But coughs  proceed from  many other  causes besides de-
 fluxions upon the lungs.  In  these  cases  the cure is not to
 be attempted by pectoral medicines.  Thus,  in  a cough pro-
 ceeding from the foulness and debility of the stomach, syrups,
 oils, mucilages,  and all kinds  of balsamic,  do  hurt.   The
 stomach cough  may be  known  from one that is  owing to a
 fault in the lungs by this, that in the latter the patient coughs
 whenever he inspires, or draws in his breath fully; but in the
 former that does not happen.
   The cure of this cough depends chiefly  upon cleansing
 and strengthening the stomach; for which  purpose gentle
 emetics and bitter purgatives  are most proper.   Thus,  after
 a vomit or two, the sacred tincture, as it is  called, may be
 taken  for a considerable time, in  the dose  of one or two
 tablespoonsful twice a day, or as often as it is found neces-
 sary, to keep the body gently open.  People may make this
 tincture themselves, by infusing an ounce of hiera picra  in an
 English pint of white wine, letting it stand a few days, and
 then straining it off for use.f
   In coughs which proceed from a debility of the stomach,
 the  Peruvian  bark  is likewise of considerable  service.   It
 may either be chewed, taken  in powder, or made into a tinc-
 ture along with  other stomachic bitters.
   A nervous cough can only be removed  by change of air,
 and  proper exercise; to which may be  added the use of gen-
tle opiates. Instead of the saponaceous  pill, the paregoric
 elixir,  &c, which  are  only  opium disguised,  ten,  fifteen,
twenty, or twenty-five drops of liquid laudanum,  more or less'

  * Some complain that the pitch plaster adheres too fast, while others find diffi-
culty in keeping it on. This proceeds from the different kinds of pitch made use
of and likewise from the manner of making it.  I generally find it answers best
when mixed  with a little beeswax,  and spread as cool  as possible.  The clear
hard,  transparent pitch answers the purpose best.                       '
  t In the state of the stomach productive of this particular kind of cough, bene-
ficial effects are derived from small doses of ipecacuanha.  A person mav bemn
Jnt St°,negrain at S°°n' Enf  an°ther at night> SracMly augmenting the
dose till it occasions some degree of nausea.                       5 
CONSUMPTION.
43
 as circumstances require, may be taken at bed time, or when
 the  cough is most troublesome.*   Immersing the  feet and
 hands in warm water will often  appease the violence of a
 nervous  cough.
   When a cough is only a symptom  of  some other malady,
 it is in vain to attempt to remove it without first curing the
 disease from  which  it  proceeds.   Thus, when  a cough  is
 occasioned by teething, keeping the body  open, scarifying
 the  gums, or  whatever  facilitates the cutting of the teeth,
 likewise  appeases the cough.  In like manner, when worms
 occasion  a cough, such medicines as remove these vermin
 will generally cure the cough; as bitter purgatives, oily clys-
 ters, and such like.
   Women, during the last  month of pregnancy,  are  often
 greatly afflicted with a cough, which is generally relieved by
 bleeding, and keeping the body  gently open.  They ought
 to avoid  all flatulent food, and to wear a  loose, easy dress.
  A cough is not only a symptom, but is often likewise the
 forerunner of diseases.  Thus, the gout is frequently ushered
 in by a very troublesome cough, which affects the  patient for
 some days before the coming on of the fit.   This  cough  is
 generally removed by a paroxysm of the gout, which should
 therefore  be  promoted, by  keeping the extremities warm,
 drinking warm  liquors, and bathing  the  feet and legs fre-
 quently in lukewarm water.

                    CONSUMPTION.

   The greatest number  of consumptive cases develope them-
 selves, without severe, inflammatory symptoms, and arrive at
 full maturity almost without the  subject of them  suspecting
 that he has any serious disease.   The  commencing symptom
 is a slight and short cough, which soon becomes habitual,
 but which  is so little remarked by the patient, that, if asked
 the question,  he will unconsciously deny having any cough
 whatever.  In answer to  more  particular inquiries, he ac-
 knowledges that he has had a slight cold, but believes  him-
 self to be wholly rid of it at present.  This  state may  con-
 tinue for a year or more, without any other complaint on the
part of the patient, than that he  is  more, liable to take cold

  * Take Oxymel of squills,     -     *     *    -     *    {oz.
     " Paregoric elixir,   -     -     -    -     -    -2 drs.
  Of which a tablespoonful may be taken three or four times a day. 
44
CONSUMPTION.
than formerly, and that cold produces cough.  These aggra-
vations may still be relieved, and no alarm or anxiety expe-
rienced.  The cough, thus increasing and remitting, is often
unattended for a  long time by any expectoration whatever.
But at length it becomes more constant, and is attended with
the raising of phlegm from the lungs, especially in the morn-
ing.   The discharge by degrees alters its appearance, becom-
ing more abundant, and at length, yellow or greenish, and of
a corrupted appearance.  As these  changes  advance,  the
breathing becomes more difficult than before, and emaciation
and weakness increase.   Many of the natural secretions are
now checked; and females particularly perceive a change of
system, which is, in reality, the effect of pulmonary disease,
though often regarded by themselves as the  cause  of  the
cough.  Up to this period, the pulse may not have been ma-
terially affected; but feverish symptoms now begin to mani-
fest themselves by the occurrence of a slight chill, or, at least,
a feeling of chilliness towards evening.  This is the com-
mencement of hectic fever.  It is soon found that the fever
comes on at regular periods, and that two paroxysms  occur
in the course of every twenty-four hours, with equally well
marked symptoms.   The morning fever comes  on  about
noon, the patient at this time experiencing  rather heat than
chill, with a  flush in the cheek, which, as the disease  ad-
vances, becomes  one of its  most striking  characteristics.
Some  remission  then follows; but in the evening, another
paroxysm succeeds, in which the cold stage is decidedly pre-
dominant, so that the patient always requires an increase of
clothing.  This  chill is  followed, particularly  towards  the
termination of the disease, by very abundant sweats, which,
however, are never accompanied by any sensation of warmth!
These night sweats, as they are called, form another of the
prominent marks of consumption.  In the progress of the dis-
ease, a pain in one or the other side is felt,  and becomes
nearly constant;  this is aggravated by cough, and by particu-
lar positions of the body.   Spitting of blood, burning heat in
the palms of the hands and soles of the feet, are symptoms,
which always show themselves in the  course of the disease!
As the case approaches a fatal result, the tongue is observed
to become peculiarly clean, red, and shining, the eyes assume
a pearly lustre, and the feet swell.
   Treatment.—One of the most important remedial measures
in every variety of the disease, is, to restore and maintain the 
BRONCHITIS.
45
 regular action of the cutaneous exhalents.   This is done by
 wearing flannel next the skin, by minute doses of tartarized
 antimony, and by avoiding  atmospheric vicissitudes.  We
 must also endeavour to remove every source of irritation, and
 prevent, as much as possible, an inflammatory condition of
 the system.   With this view, a strictly antiphlogistic regimen
 is to be enjoined, together with occasional small  bleedings,
 where  the pulse demands it, the use of digitalis, and  mild
 aperients, with gentle exercise on horseback, or in a carriage.
 Another important measure is, to divert, as much as practica-
 ble, the undue determination of blood to the pulmonary sys-
 tem, by means of blisters, cupping, and tartar emetic ointment,
 applied to the breast.  Balsam copaiva is an excellent reme-
 dy.   The inhalation of tar has of late years been much ex-
 tolled in the  cure of consumption.   Stramonium and  pul-
 verized  ipecacuanha, in the proportion of one-fourth  of a
 grain of the  former, with two grains of the latter, taken three
 times daily.   Digitalis and squills, when effusion has taken
 place, should be  given.   The bark of the wild cherry tree is
 a valuable tonic  in consumption.
   The following recipe will  be  found good for a cough  in
 consumption.

    Take Powdered gum arabic,    -     -      -   2 drachms.
      "    do.   Liquorice root,    -     -      - 2   do.
      "  Warm water,           ...   4 ounces.
  Mix them; then add—
      Spirits nitre,  -                        -   2 drachms.
      Antimonial wine,      -     -     -     - 2   do.
      Tincture of opium,         -     -      -   50 drops.
  Mix;—then take a tablespoonful for a dose three or four times a day.

                     BRONCHITIS.

   This variety of pulmonary inflammation generally comes
on  by great oppression and  tightness in  the breast; with
cough;  severe pain  in  the  forehead, greatly  increased by
coughing;  expectoration; at first, a viscid and frothy, white
mucus, becoming mixed with blood as the disease advances;
sometimes vomiting;  febrile excitement  not violent; pulse,
and heat of the surface, not much above the natural standard;
tongue  moist and  white; countenance pallid; little  or  no
pain in the chest; the pain dull, and attended with very op-
pressed breathing.  There is in this disease a particular ten-
dency to effusion into the substance of the  lungs; and it is 
PLEURISY.
 generally from this occurrence that the  disease proves fatal.
 The lungs  do not  collapse; the  bronchia  is filled with a
 tough mucus, mixed with bloody serum and pus;  a  frothy
 fluid escapes from the substance of the lungs,  when cut.
 The mucous membrane of the bronchia is manifestly the
 principal and primary seat of the disease.
   Treatment.—Emetics are among the most useful remedies
 in this  disease;  they may  be often advantageously repeat-
 ed two or three times.  Moderate bleeding in the commence-
 ment is often beneficial; mild saline cathartics are  very good.
 Expectorants of the stimulating  kind—such  as polygala
 senega,  and  gum ammonia—are beneficial.   Active stimu-
 lants must be given with the expectorants, when  the pulse
 becomes very small, frequent and  soft.   Camphor and car-
 bonate of ammonia, are the most valuable for this purpose.
 In the commencement of the disease, small doses of calomel
 and  opium allay the cough, and promote  expectoration.   I
 have seen much benefit derived from large emollient poultices
 applied to the thorax.  The inhalation of the steam of warm
vinegar  and water, is very good; boneset tea is serviceable,
nay,  indispensable, and must be  taken very warm.
PLEURISY,
   The  true pleurisy is  an inflammation of that membrane
called the pleura, which lines the inside of the breast.  It is
distinguished into the moist and dry.   In the former the pa-
tient spits freely; in the latter, little or none at all.   There
is likewise a species of this disease, which is called the spu-
rious or bastard pleurisy, (Peripneumonia Notha,) in which
the pain is more external, and chiefly affects the muscles be-
tween  the ribs.   The  pleurisy  prevails  among  labouring
people, especially such as work  without doors, and  are  of
a sanguine constitution.   It is most frequent in the  sprine
season.
   Causes.—The pleurisy may be  occasioned by whatever
obstructs the perspiration; as cold northerly winds;  drinkine
cold liquors when the body is hot; sleeping without doors on
the damp ground; wet clothes; plunging the body into cold
water,  or  exposing  it to the cold air, when covered  with
sweat,  &c.   It  may  likewise be  occasioned by  drinkine
strong liquors; by the stoppage of usual evacuations, as old
ulcers, issues, sweating of the feet or hands, &c;  the sudden 
PLEURISY.
47
striking in of any eruption, as the itch, the measles, or the
small-pox.   Those who have been accustomed to bleed at a
certain  season of the year, are apt, if they neglect it, to be
seized with  a pleurisy.   Keeping the  body too warm  by
means of fire, clothes, &c, renders it more liable to this dis-
ease.   A pleurisy may  likewise  be  occasioned by violent
exercise, as running, wrestling, leaping, or by supporting great
weight, blows on the  breast, &c.   A bad conformation of the
body renders persons more liable to this disease, as a narrow
chest, a straitness of  the arteries of the  pleura, &c.
   Symptoms.—This, like most other fevers, generally begins
with  chilliness  and  shivering, which are followed by heat,
thirst, and restlessness.  To these succeeds a violent prick-
ing pain in one of the sides among the ribs.   Sometimes the
pain extends towards the back  bone, sometimes towards the
fore part of the breast, and at other times, towards the shoul-
der blades.  The pain  is generally  most violent when  the
patient draws his breath.
   The pulse in this  disease is commonly quick and hard, the
urine high coloured;  and, if blood be let, it is covered with
a tough crust, or buffy coat.   The patient's spittle is at first
thin, but afterwards it becomes grosser, and is often streaked
with blood.
   Diet.—Nature generally endeavours to carry off this dis-
ease by a  critical discharge of blood from some part of the
body, by expectoration, sweat, loose stools, thick  urine, or
the like.   We ought, therefore, to second her intentions by
lessening  the force  of the circulation,  relaxing the vessels,
diluting the  humours, and promoting expectoration.
   For  these purposes, the diet ought to be cool, slender, and
diluting.   The patient must avoid all food that is viscid, hard
of digestion, or that affords much nourishment; as flesh, but-
ter, cheese, eggs, milk, and also every thing that is of a heat-
ing  nature.   His drink may be  whey, or an  infusion  of
pectoral and balsamic vegetables.
   Barley water, with a little honey or jelly of currants, mixed
 with it, is likewise a very proper drink in this disease.   It is
 made by boiling an ounce  of pearl barley in three English
 pints  of water to two,  which  must afterwards be strained.
 The decoction  of figs,  raisins, and barley, are likewise very
 proper.  These and other  diluting liquors  are not  to be
 drank  in large quantities at a time;  but the patient ought to
 keep continually sipping them, so as to render his mouth and 
48
PLEURISY.
 throat always moist.   All his food and drink should be taken
 a little warm.
   The patient should be kept  quiet, cool, and every way
 easy.  His feet and hands ought daily to be bathed in luke-
 warm water; and he may sometimes sit up in bed for a short
 space,  in order to relieve his head.
  Medicine.—Almost  every person knows, when  a fever is
 attended with a violent pain of the side, and a quick, hard
 pulse, that  bleeding is necessary.  When  these  symptoms
 come on, the sooner this operation is performed, the better;
 and  the  quantity must at first be pretty large, provided the
 patient be able to bear it.  A large  quantity of blood let at
 once in the beginning of a pleurisy, has a much better effect
 than repeated small bleedings.  A man may lose twelve or
fourteen ounces of blood as soon as it is certainly known that
he is seized with a pleurisy.  For a younger person, or one
of a delicate constitution, the quantity must be less.
  If, after the first bleeding, the pain, with the  other violent
symptoms, should still  continue, it will be necessary, at the
distance  of twelve or eighteen  hours, to take  eight or nine
ounces more.  If the symptoms  do  not then abate, and the
blood shows a strong  buffy coat, a  third  or even a fourth
bleeding may be requisite.   If the pain of the side abate, the
pulse become softer, or the patient begin to spit freely, bleed-
ing ought not to be repeated.   This operation  is seldom ne-
cessary after the third or fourth day of the fever, and ought
not then to be performed, unless in the most urgent circum-
stances.
  The blood may be many ways attenuated without bleed-
ing.   There are likewise many things that may be  done to
ease  the pain of the side without this  operation, as  foment-
ing, blistering, &c.   Fomentations may be made by boiling
a handful of flowers of elder, camomile, and common  mal-
lows, or any other soft vegetables, in a proper quantity of
water.   The herbs may be either put into a flannel bag, and
applied warm to the side, or flannels may be dipped in the
decoction, afterwards wrung out  and  applied to the  part af-
fected, with as much warmth as the patient can easily bear.
As the clothes grow cool, they must be  changed, and great
care  taken  that the patient do  not catch cold.  A  bladder
may  be filled with warm milk and water, and applied to the
side, if the above method of fomenting be found inconvenient
 Fomentations not only ease the pain, but relax the vessels^ 
PLEURISY.
49
and prevent the stagnation of the blood, and other humours.
The side may likewise be frequently rubbed with  a  little of
the volatile liniment.
   Topical bleeding has often a very good  effect in this dis-
ease.  It may either be performed by applying a number of
leeches to the part affected, or by cupping, which  is both a
more certain and  expeditious method than the other.
   Leaves of various plants might likewise  be  applied to the
patient's side with advantage.   I have often seen great benefit
from young cabbage leaves applied warm to the  side  in a
pleurisy.  These  not only relax the parts, but likewise draw
off a little moisture, and may prevent the  necessity of blis-
tering plasters; which, however, when other things fail,  must
be applied.
   If the pain continue after repeated bleedings, fomentations,
&c, a blistering plaster must be applied over the part affect-
ed, and  suffered  to remain for two days.   This not  only
procures a discharge from the side, but takes off the spasm,
and by that means assists in removing the cause of the dis-
ease.  To prevent a strangury When the blistering plaster is
on, the patient may drink freely of the gum arabic emulsion.
   If the patient be  costive, a clyster of thin water gruel, or
of barley water, in which a handful of mallows, or  any other
emollient vegetable, has been boiled, may be daily adminis-
tered.   This will  not only empty the  bowels, but have the
effect of a warm fomentation applied to the inferior viscera,
which will help to make a derivation from  the breast.
   The  expectoration may be promoted by sharp, oily, and
mucilaginous medicines.*   For this purpose, an ounce of the
oxymel, or the vinegar of squills, may be added to six ounces
of the pectoral decoction, and two tablespoonsful of it taken
every two hours.
   Should the squill disagree with the stomach, the  oily emul-
sion may be  administered; or, in place of  it, two  ounces of

  * Take Oil of sweet almonds,     ....    1 ounce.
     " Syrup of marsh mallows,     -      -     -     -  4  do.
     " Mucilage of gum arabic,                        2  do.
     " Pure water,    -     -     -     -     -       3  do.
     " Solution of the sub-carbonate of ammonia,       -     £ drachm.
  Make a mixture.   Or—f
   Take Best olive oil,     -    -     -     -     -     1 ounce.
     " Mucilage of gum arabic,     -      -     -     -  2  do.
     " Oxymel of squills,  -----     3 drachms.
     " Sub-carbonate of ammonia,   -     -     -    -  1 scruple.
  Make a mixture; of  which take a little often, or during the urgency of the
cough.
       7                    E 
50
PLEURISY.
the oil of sweet almonds, or oil of olives, and two ounces of
the syrup of violets, may be mixed with as much sugar candy
powdered as will  make an electuary of the  consistence of
honey.   The patient  may take  a teaspoonful of this fre-
quently, when the cough is troublesome.  Should oily medi-
cines prove  nauseous, which is  sometimes  the  case,  two
tablespoonsful of the  solution of gum ammoniac in  barley
water, may be given three or four times a day.  Expectora-
tion, and a determination to the skin, may also be promoted
by small nauseating doses of antimonials, taking care, how-
ever, not to excite vomiting; but assisting their  action by
frequent small draughts of some mild, diluent liquor,  as  bar-
ley water, or thin gruel, &c*
  If the patient do not perspire, but has a burning heat upon
his skin, and passes very little water, some  small doses of
purified nitre and camphor will be of use.  Two drachms of
the former may be rubbed  with five or six  grains of the lat-
ter, in a mortar, and the whole divided into  six  doses, one
of which may be taken every  five or six hours, in  a little of
the patient's ordinary drink.
  We shall only mention  one medicine  more, which some
reckon almost a specific in the  pleurisy, viz: the decoction
of the seneka rattlesnake  root.  After bleeding  and other
evacuations  have been premised, the patient may take two,
three, or four tablespoonsful of this  decoction, according as
the stomach will bear it, three or four times  a day.   If it
should occasion vomiting, two or three ounces of simple  cin-
namon water may be mixed with the quantity of decoction
here directed; or it may be taken in smaller doses.  As this
medicine promotes perspiration and urine, and likewise keeps
the body easy, it may be of some service in a pleurisy, or any
other inflammation of the breast.
  When the skin is very hot and dry, saline draughts,! or
solution of acetated ammonia, may be administered with ad-
  * Take Emetic tartar,     -     ,.     -     .     .     9 „.;.,,
     « Distilled water, -     --.-..   J %™™s
          . Take two tablespoonsful every three or four hours.
  t Take Lemon juice,    -     -     .    .     .     j 1 ounce
     " Sub-carbonate of potash,     ....   i5jraAm
     u ivTint watpr                                   aracnm.
       Mint water,.....! ounce
     " Pure water,       -     -     -     .     -     3  do
     « Nitrate of potash,.....1 drachm.
     " Syrup of Tolu,                                1 ounce
houS^ & mixtUre '~°f which the d0Se may be three tablespoonsful every four 
PLEURISY.
51
vantage.  To allay pain, ease the cough, stop diarrhoea, when
it arises, or procure sleep, we may employ opium*
  If the bowels require evacuation, strong purgatives ought
not to be  given; but gentle aperients, of a cooling nature,
should be used, particularly at the commencement of the dis-
ease.   For this purpose, Epsom salts, f  and manna, in an
infusion of senna, or castor oil, will be the most proper;  and,
as opiates  evidently tend to check expectoration, which it is
desirable to promote, they ought, if possible to be  avoided;
but if absolutely necessary, from the exhausted state  of the
patient  for want of sleep, they may be given, combined with
some diaphoretic;  e.  g. the  compound  powder of  ipeca-
cuanha, ten grains, &c.  If the patient's strength be much
exhausted  by  the disease, it will be necessary at this time  to
support him with frequent small draughts of wine  whey,  or
the like.
  When the pain and fever are gone, it will be proper, after
the patient has recovered sufficient strength, to give him some
gentle purges, such as senna and salts, castor  oil, &c.  He
ought likewise to use a light diet of easy digestion, and his
drink should  be buttermilk,  whey, and  other things of a
cleansing nature.

  Spurious Peripneumony, or Bastard  Pleurisy.—That
species  of pleurisy which  is  called the bastard, or  spurious,
generally goes off by keeping warm for a few days,  drinking
plenty of diluting liquors, and observing a cooling regimen.
  It is known by a dry cough, a quick pulse, and a  difficulty
of lying on the affected side;  which  last does not always
happen  in  the true pleurisy.   Sometimes, indeed, this disease
proves  obstinate, and requires  bleeding,  with   cupping, and
scarifications of the part affected.  These, together  with the
use of nitrous and other cooling  medicines, seldom  fail  to
effect a  cure.   Blistering is often useful in this  disease, to re-
lieve the difficulty of breathing,  and oppression at the chest;

  * Take Solution of acetated ammonia,     -     -        3  drachms.
     "  Mint water,    -----      1 ounce.
     "  Tincture of opium,  -     -      -    -     -  25 minims.
     "  Syrup of Tolu,  -----      2 drachms.
     "  Antimony wine,    -     -     -    -     -   12 drops.
                       Make a draught.
  t Take  Epsom salts,     .....     2 drachms.
     "  Manna,     -     -     -     -     -     -  3   do.
     "  Infusion of senna,       ....     H ounce
                  Make an aperient draught. 
52
heart-burn.
and if nausea prevail, a gentle  emetic  may  be prescribed.
We may be satisfied with the use  of antimonials, as in the
true peripneumony.                                  .  .
  Through the whole course of the disease the antiphlogistic
regimen,  such as  oatmeal, barley,  rice, &c, will be proper.
Where great debility prevails, or where the patient has been
accustomed to a free use of fermented liquors, a small quantity
of wine will be admissible.
                    HEART-BURN.

  What is commonly called the heart-burn is not a disease
of that organ, but an  uneasy sensation of heat or acrimony
about the pit of the stomach, which is sometimes attended
with anxiety, nausea,  and vomiting.
  It may proceed from debility of  the stomach, indigestion,
bile, the abounding of an acid in the stomach, &c.   Persons
who are liable to this  complaint ought to avoid stale liquors,
acids, windy or greasy aliments, and should never use violent
exercise  soon after a  plentiful meal.   I know many persons
who never fail to have the heart-burn if they ride soon after
dinner, provided they have drank ale, wine, or any fermented
liquor; but are never troubled with it when they have  drank
rum or brandy and water, without  any sugar or acid.
  When the  heart-burn proceeds from a debility of the sto-
mach, or indigestion, the patient ought to take a dose or two
of rhubarb; afterwards he may use infusions  of the Peruvian
bark, or any other of the stomachic bitters, irrwine or brandy.
Drinking a cup of camomile tea, with fifteen  or twenty drops
of elixir of vitriol in it, twice or thrice a day, will strengthen
the stomach  and promote digestion.  Exercise in the  open
air will likewise be of use.
  When bilious humours  occasion the  heart-burn, a  tea-
spoonful of the sweet  spirits of  nitre, in a  glass of water, or
a cup of tea,  will generally give ease.   If it proceeds from
the use of greasy aliments, a dram  of brandy or rum may be
taken.
  If acidity or sourness of  the stomach occasions the  heart-
burn, absorbents are the proper medicines.   In this case an
ounce of powdered chalk, half an ounce of fine sugar, and a
quarter  of  an ounce  of gum arabic, may be  mixed' in an
English quart of water, and a teacupful  of it taken as often
as is necessary.  Such as do not choose chalk, may take a 
HEART-BURN.
5*
teaspoonful of super-carbonate of soda.   But the safest and
best absorbent is magnesia alba.   This not only acts as an
absorbent, but likewise as a purgative;  whereas chalk, and
other absorbents of that kind, are apt to  lie in the intestines,
and occasion obstructions.  This powder is not disagreeable,
and may be taken in a cup of tea, or a glass of mint water.
A large teaspoonful is the usual dose; but it may be taken in
a much greater quantity when there is occasion.   These
tilings are now generally made up  into lozenges, for  the
convenience  of being carried in  the pocket, and taken at
pleasure*
  If wind be the cause of this complaint, the  most proper
medicines are those called carminatives:  as aniseeds, juniper
berries, ginger, canella alba,  cardamom seeds, &c.   These
may either be chewed, or  infused in wine, brandy, or other
spirits; but these ought never to be used, unless they are ab-
solutely necessary, as they are only drams in  a dry form, and
very pernicious to the stomach.   One of the safest medicines
of this kind is the tincture made by infusing an ounce of rhu-
barb, and a quarter of an ounce of the lesser cardamom seeds,
in an English pint of brandy.  After this has digested for two
or three days, it ought to be strained, and  four ounces of white
sugar candy added  to it.  It must stand to digest a second
time, till the  sugar be  dissolved.   A tablespoonful of it may
be taken occasionally for a dose.
  I have frequently known the heart-burn cured, particularly
in  pregnant  women, by  chewing green tea.   Two  table-
spoonsful of what is called the milk of gum ammoniac, taken
once or twice a day,  will sometimes cure the heart-burn.
  As pregnant women are very subject to this uneasy sen-
sation, they should first consider whether it proceeds from
any of the causes already explained; in which case the medi-
cines prescribed  under each head will  probably remove it.
But if the internal sense  of  heat be owing  to  the state of
pregnancy itself;  if it arises  from the consent  between the
stomach and the  womb, and is  not accompanied with much
spitting, or any acid eructations, the white of an egg,  mixed
with a little sugar and water, will  often afford the only relief
that can be expected  for some time.
  * The heart-burn, if very troublesome, may be almost immediately removed,
by taking fifteen or twenty drops of the purified soap lees, the aqua kali puri of
the shops, in a cup of linseed tea, or of milk.
E 2 
54       ENLARGEMENT OF THE HEART.—APOPLEXY.
           ENLARGEMENT  OF THE HEART.

   Among the most common causes of the enlargement of the
 heart, are rheumatism and diseases of the spine.  The sub-
 ject  is introduced here in order to remove the impression
 that diseases of the heart are necessarily fatal.
   The heart may be greatly enlarged, yet, under a judicious
 treatment and regimen, the patient may so far recover as to
 enjoy general good health.  The disease may be recognized
 by the violent motion of the heart, and frequency of palpita-
 tions; by the pulses of the heart being felt over parts of the
 chest where they are not generally perceived, and by a kind
 of hissing or rushing sound striking upon the ear, when it is
 applied to the chest.   This sound has been compared to the
 blast  of a bellows.
   The  Treatment of  this complaint must necessarily consist
 mainly in removing the cause, be it diseased spine, rheuma-
 tism,  or any other disturbance to the  nervous power of  the
 organ.  Much  may be done in some  cases, in  arresting the
 progress or effecting the removal of the enlargement, by les-
 sening the force and frequency of the pulse, and the quantity
 of the circulating fluid.  These objects are attained by means
 of rest and freedom from excitement;  the careful use of  the
 lancet;  strictly moderate and mild diet;  and the administra-
 tion of digitalis, which has a singular influence over the pulse,
 but it must be used with caution.

                      APOPLEXY.

   Apoplexy makes its attack chiefly at an advanced period
 of life, and most  usually on those who  are  of a  corpulent
 habit, with a short neck, and large head; and who lead in-
 active lives, make use of full diet, or drink to excess.  The
 immediate cause of apoplexy is a compression of the brain,
 produced either by an accumulation of blood in the vessels
 of the head, and distending them to such a degree as to com-
press the medullary portion  of the brain, or  by an infusion
of blood from the red vessels, or of serum  from the exhalants;
which fluids are accumulated in such quantities as to occasion
compression.   These states, of over distension  and of effu-
sion, may  be  brought on  by whatever increases the  afflux
and impedes the blood in the arteries  of the head; such as
violent fits of passion; great exertions  of muscular'strength- 
APOPLEXY.
55
severe exercise; excess in venery; stooping down for any
length of time; wearing any thing too tight about the neck;
overloading the stomach;  long exposure to excessive cold, or
a hot sun;  the sudden  suppression of any long accustomed
evacuation.   Apoplexy  is  sometimes preceded by headache,
giddiness, dimness of sight, loss  of memory, faltering of the
tongue in speaking, numbness in the extremities, drowsiness,
stupor, and nightmare; all denoting an affection of the brain;
but it more usually happens that, without much previous indis-
position, the person falls down suddenly; the countenance be-
comes florid; the face appears swelled, and puffed up; the
vessels of the head, particularly of the neck and temples, seem
turgid and distended with blood; the eyes are prominent and
fixed; the breathing is difficult, and performed with a snorting
noise, and the pulse  is strong and full.   Although the whole
body is affected with the loss of sense and motion, it neverthe-
less takes place often more on one side than the other.  The
side least affected is  somewhat convulsed.  If the fit is of a
long duration, the respiration laborious,  and the person far
advanced in years, the disease in all probability will termi-
nate fatally.  In some cases, it goes off entirely, but it most
frequently leaves  a  state of mental imbecility behind  it, or
terminates  in death.  Even when an attack  is recovered
from, it most frequently returns again, after a short period of
time, and in the  end proves fatal.  In dissection,  blood  is
often found effused on the surface and in the cavities of the
brain; and in other instances a distension of the blood-ves-
sels is observed.
   Treatment.—All compression should be removed  from the
neck, the patient laid with his head a  good deal raised, and
a free admission of cool air allowed.  Then blood should be
taken  freely from the arm, or the temporal artery, or the
jugular vein; which it maybe sometimes necessary to repeat,
if the symptoms continue, and the  patient is still plethoric;
cupping or leeching  may lessen the congestion in the brain.
The next object should be thoroughly to evacuate the bowels
by some active purgative, as  calomel and jalap, or an infusion
of senna and salts, repeated  every  few hours till it operates;
stimulant injections will also be proper, particularly if the pa-
tient cannot swallow, to be composed  of common  salt, mo-
lasses, infusion of senna and castor oil.  Cold water should
be applied to the head, the hair  being  previously shaved;
apply  a  blister to the  back of the neck.   Mustard to the 
56
PALSY.
feet may also be useful, particularly if these are cold.   Eme-
tics  are  sometimes  useful.   Take twenty grains ot ipeca-
cuanha, with two grains of tartar emetic, given in a little
syrup or molasses.   If an emetic  operation  be obtained, it
should be followed by the administration of  a powerful ca-
thartic, which may be aided in its operation by a stimulant
injection.
                         PALSY.
  Palsy  is a loss or diminution  of  sense  or motion, or of
both, in one or more parts of the body.  Of all the affections
called  nervous, this  is the most suddenly fatal.   It  is more
or less dangerous, according to the  importance of the part
affected.  A palsy of the heart, lungs, or any part necessary
to life, is mortal.  When  it affects  the stomach, the  intes-
tines, or the bladder, it is highly  dangerous.   If the face be
affected, the case is bad, as it shows that the disease proceeds
from the brain.   When the part affected feels cold, is  insen-
sible, or  wastes away,  or when the  judgment and  memory
begin to fail, there is small hope  of a cure.
  In some instances the disease is confined  to  a particular
part or set of muscles;  but it more usually happens  that one
entire  part of the body, from the head downwards, is affected,
which is known by  the name  of hemiplegia.  If the  power
of motion and sense of feeling in the half of  the body, taken
transversely, be  impaired, the  complaint  is denominated
paraplegia.
   Causes.—The immediate cause of palsy is any thing that
prevents the regular exertion of the nervous power upon any
particular part of the muscle or part of the body.   The oc-
casional and  predisposing causes   are various,  as wounds
of the brain, or spinal  marrow;  pressure upon the  brain, or
nerves; very cold or damp air; the suppression of customary
evacuations; sudden fear; want of exercise; or  whatever
greatly relaxes the system, as  drinking much tea*  or  coffee.
The palsy may likewise proceed from wounds of the  nerves
themselves, from the poisonous fumes of metals or minerals,
as mercury, lead, arsenic, &c.
  * Many people imagine that tea has no tendency to hurt the nerves  and that
drinking the same quantity of warm water would be equally pernicious.  This
however, seems to be a mistake.  Many persons drink three or fourcups of
warm milk and water daily, without feeling any bad consequences- vet the
same quantity of tea will  make their hands shake for twenty-four hours  That
tea affects the nerves, is likewise evident from its preventing sleep, occasioning
giddiness, dimness of the  sight, sickness, &c.                     ««u«s 
PALSY.
57
   When  palsy attacks any vital part—such as the brain,
heart, or lungs—it soon terminates  fatally.   When it arises
as a consequence of apoplexy, it generally proves very  diffi-
cult of cure.  Paralytic affections of the  lower extremities,
ensuing from any injury done to the spinal marrow, by blows
and other accidents, usually prove incurable.
   Treatment.—In young persons of a full  habit, the palsy
must be treated in the same manner as the sanguine  apo-
plexy.  The patient must  be bled,  blistered, and have his
bowels opened by sharp clysters or purgative medicines.   But
in old age, or when the disease proceeds from  relaxation or
debility, which is generally  the case, a quite  contrary course
must be pursued.   The diet must be warm and invigorating,
seasoned  with  spicy and aromatic  vegetables, as mustard,
horse-radish, &c.   The drink may  be generous wine,  mus-
tard whey, or brandy and  water.   Friction with the  flesh
brush, or a warm hand, is extremely proper, especially on the
parts affected.  Blistering plasters may likewise  be applied
to the affected parts with advantage.   When this cannot be
done, they may be rubbed with the volatile liniment*   One
of the best external applications is electricity.  The shocks,
or other vibrations, should be received on the  part affected;
and they ought daily to be  repeated  for several weeks.
   As a gentle stimulus to the parts, urtication may sometimes
be used;  warm bathing, the bath waters,  electricity, galvan-
ism, are  all attended, in many cases, with much benefit, and
therefore ought not to be omitted.
   When the disease affects several different parts of the body,
as in hemiplegia  and paraplegia, stimulants  should be  used
both internally and externally.  Those in most use are mus-
tard  seed, horse-radish, and volatile  alkaline salts or spirits,
and ether, as directed below.f

  * Take Compound camphor liniment,    -     -         1 ounce.
      "  Oil of turpentine,     -     -     -     -     - 3 drachms.
            Make a liniment. Or—
  Take Spirits of camphor,    -     -      -     -     -   1 ounce.
    " Tincture of Spanish flies,   -    -     -     -     2 drachms.
    " Solution of sub-carbonate of ammonia,       -      -   i ounce.
  t Take white mustard seed, two teaspoonsful in a teacupful of cold water.
                             Or—
  Take White mustard seed, bruised.     ...    2 ounces.
    " Horse radish,   -     -      -     -     -     -  2 ounces.
    " Orange peel,     ...      -     -      $ ounce.
    « Pump water,  ------  2 pints.
  Make a decoction, and strain; of which a teacupful may be taken three times
a day; adding occasionally 20 drops of the tincture of valerian.
       8 
58
ABSCESSES.
   Vomits are very beneficial in this kind of palsy, and ought
frequently to be administered.   Cephalic snuff, or any thing
that makes  the patient sneeze,  is  likewise of use.   Some
pretend to have found great benefit from rubbing the  parts
affected with nettles;  but this does  not seem to be any way
preferable to  blistering.   If the  tongue be  affected, the
patient  may gargle his mouth frequently with brandy and
mustard; or he may hold a  bit of sugar in  his mouth, wet
with the compound spirits of lavender.   The wild valerian
root is  a very proper medicine in this  case.  It may either
be taken in an infusion with sage leaves, or half a drachm
of it in powder may be given in a glass of wine three or four
times a  day.   If the patient  cannot use the valerian, he may
take of sal  volatile oleosum, compound spirits  of lavender,
and tincture of castor, each  half an ounce;  mix these toge-
ther, and take forty or fifty drops in a glass of wine three or
four times a day.   A tablespoonful of mustard  seed, taken
frequently, is  a very  good  medicine.   The patient ought
likewise to  chew  cinnamon, bark, ginger,  or  other warm
spiceries.
   Although  in every instance a  dangerous  disease, palsy,
particularly at an advanced period of life, is sometimes re-
moved by the  occurrence of a diarrhoea, or fever.   A feeling
of warmth, and a slight, pricking pain, as if stung by ants in
the parts affected, with returning  sensation and  motion, are
favourable symptoms.
  Exercise is of the utmost importance in the palsy;  but the
patient must beware of cold,  damp, and moist air.  He ought
to wear flannel next his skin; and, if possible, should remove
into a warmer climate.

                      ABSCESSES.
  An abscess is a collection of matter in a sac, produced by
inflammation, giving the surrounding parts a tendency to the
ulcerative  process, so as to  lead  to their absorption.   Ab-
scesses  are dangerous according  to their size, number, and
situation.  A great  number of small abscesses on the surface
of the body—as in small-pox—frequently terminate fatally.
They are also dangerous from their being situated in vitally
important parts: such as the brain,  heart,  or lungs.   Ab-
scesses  are  either  acute or chronic; the former having a
common course of three weeks;  the  latter  much slower in
their progress. 
DROPSY.
59
   Treatment for acute abscesses.
    Take solution of acetate of ammonia,    -      -    6 ounces.
      "  Sulphate of magnesia,  -      -     -     - 1  do.
      "  Tincture of opium,                        l drachm.
   Mix them..  BosE-r-three tablespoonsful three times a, day.
   The best local treatment is—linseed or bread poultices.—
 No stimulating applications would answer.
   Treatment for chronic abscesses.—Use stimulating poultices,
 made of yeast, vinegar, and flour, with a solution of common
 salt.  Mercurial plaster is very good.  When it is necessary
 to open an abscess, you should do it early, as the early dis-
 charge  of matter is the prevention of scars.

                        DROPSY,
   The immediate cause of dropsy is an  undue accumulation
 of fluid, either in the cellular  substance which intervenes be-
 tween  the  skin and  the  muscular tissue, or in  the  serous
 cavities.  The quantity of effused fluid, in either of the situa-
 tions just referred to,  is  dependant upon two opposite  pro-
 cesses—deposition and absorption.   It is evident that either
 an augmentation of the former, or a diminution of the latter,
 would be adequate  to the  production of the disease.   Ac-
 cordingly it has always been a subject of discussion, whether
 dropsy should be considered an active or a passive affection ;
 whether the capillaries should be  considered in fault for sepa-
 rating too  much, or the absorbents for  taking  up too little.
 Cellular dropsy  generally shows  itself in  the  lower  limbs,
 where it is marked by a cold, diffused swelling, which, when
 pressed, retains a pit  or impression of the  fingers for some
 time.   It  may be either a symptom of some internal  effusion,
 or a  distinct affection.  In either event, however, the pro-
 gress  is  slow.  The swelling appears first about the  feet and
 ankles, and is more or less observable through the day, disap-
pearing much during the night, from the  recumbent posture.
By degrees it becomes more permanent, ascends higher, affects
the legs and thighs, and finally  may even reach the  trunk
and  face; which  latter becomes pale and bloated.  If the
disease  advance, the skin of the legs  gives way, and the ac-
cumulated fluid either collects in sacs under the cuticle, or
oozes out in drops.

   In Dropsy of the Chest,  or  Hydrothorax, the fluid is   •
accumulated in the cavity of the pleura.   The peculiar symp- 
60
dropsy.
toms are, a sense of oppression in the chest; difficulty of
breathing during exercise or while lying down;  livid coun-
tenance ; irregular pulse, and palpitation.

   In Dropsy of the Abdomen, the  water is usually con-
tained in the peritoneal  cavity;  and its presence is readily
recognized by the sense of fluctuation which is produced
when  one  hand is placed  on one side of the belly,  and
the opposite side is gently struck or tapped with the other.
This form of dropsy is often complicated with  more or
less  disease of the'liver.   The  quantity of fluid  collected
has been, in many instances, surprisingly great.   Eleven gal-
lons have been  discharged through an  artificial opening at
one time.   The symptoms, with the exception  of the gradual
swelling of the belly, which cannot fail to be  remarked, re-
semble very closely those of dropsy of the chest; but there
is less embarrassment of breathing.
   The three forms of dropsy which  have been mentioned,
especially the first and  last, are  very frequently united, and
arise from causes in many respects similar.   They form the
sequel to fevers and inflammatory affections, especially of the
pleura and the  peritoneum, and  are often  among the signs
of the decay of constitutions, impaired by climate  and hard
labour.
   Treatment.—The treatment is chiefly directed to two ob-
jects :  the evacuation of the effused fluid, and the prevention
of its return.  In the former case, scarifications made with a
lancet through the integuments, will permit the effused fluid
to escape;  and in the latter, a more complete evacuation may
be effected by tapping.   But as  these means  are  palliative
merely, they are now never employed except  under  urgent
necessity.   To cause the evacuation of the superfluous fluid
through the natural channels, emetics, sudorifics, and blisters,
have been often  resorted  to; but the principal  remedies  em-
ployed have been,  first, the drastic cathartics, which, from
their peculiar operation, have been termed hydragogues, and
which produces abundant  liquid evacuations  from the ali-
mentary canal;  and secondly, the diuretic class, which cause
a like tendency  of the fluid to the  urinary passages.   The
particular remedies of both classes are numerous; but we
must  be content with adverting  to  the principle on  which
they act.  It is not our purpose  to  encourage  the  domestic
practitioners in their employment. 
DROPSY.
61
  The re-accumulation is prevented by whatever has a ten-
dency to strengthen the constitution, and increase the vigour
of the  absorbent system; and hence  tonics,  especially the
vegetable bitters and the preparation of iron, have always
been considered as among the best.
  I have subjoined a general prescription to be administered:

    Take Infusion of dandelion,      ...    4 ounces.
     "   Extract     do.      -     -     -     - 2 drachms.
     "   Carbonate of soda,  -      -     -     -    |   do.
     "   Cream of tartar,       -     -     -     - 3   do.
     "   Tincture of rhubarb,            -     -    3   do.
     "   Tincture of hyosciamus,   -     -     -    20 drops.
  Mix.  One-third to be taken three times a day.

  Dropsy of the Brain, is a disease which very often comes
on gradually, and almost imperceptibly; commonly beginning
in the same manner as convulsions.   The child  is wakeful;
or, if asleep, it grinds its teeth, and often  starts or rouses up
suddenly, alarmed and  screaming.   Its bowels become irre-
gular,  and the  discharges  have an unnatural  appearance;
they are often  green, slimy, or watery.  The countenance
is usually pale, and anxious or disturbed.   The  eye-lids are
half shut whenever the  patient is exposed to the light.
   Children who can speak, complain of pain  in  the  fore-
head;  and even in  small infants, suffering is indicated by a
constant disposition to apply the hand upon the head.   As
the disease progresses, vomiting occurs,  and becomes very
frequent, especially when the child is set upright.  It is very
restless,  and tosses its head from side to side, evincing much
suffering by  its groans, or whining.   Its  skin  is dry, and
generally rather hot; the pulse is frequent and hard, but not
full.   Soon after this, the child appears dull and stupid, and
inclined to sleep constantly.  There is  not only a general
inactivity, but also a palsy of one or more of the  extremities,
by which it is rendered  motionless, except a slight twitching
of the toes or fingers.   One or both  eyes may  now be ob-
served to squint; and either remain fixed, or be  in constant
motion.   The pupil of the  eye may be found either unnatu-
rally contracted or dilated ; convulsions soon follow; and, after
a lingering agony, death closes the scene.  The affection often
creeps  on so insidiously, that it escapes  the observation of
even the anxious mother.   Sometimes the first thing known
is the convulsion.
   Treatment.—The  fever  should be  kept down by  such
                            F 
G2
LIVER COMPLAINT.
means as invite the blood away from the brain; and for this
purpose the bowels should  be purged;—say for a child two
and  a half years of  age, give five or six  grains of calomel,
and the  same  quantity of rhubarb, to be followed the  next
day by a dose of magnesia, Epsom salts, or castor oil.   1 hese
must be  repeated every day until the discharges become more
natural.   During all this time, the most simple diet only can
be allowed the patient: such as boiled milk, barley water,
arrow root, rice water, &c.   If any sore behind the ear  shall
have been recently dried up, it must be  again opened  by a
blister.  A free bleeding from the arm will be necessary, and
afterwards leeches to the temples, and back  of the head, or
cups to  those parts and the back  of the  neck.   Keep the
extremities warm, the bowels open, the head cool, the room
dark and quiet.  After  bleeding and purging, the  Dover's
powders are good to quiet the  patient.   They should be
given with caution; and the head,  at the same time, should
be covered with a cap wrung out in cold water, and its  tem-
perature constantly kept under.  A blister behind the neck
would be useful after the system  has been sufficiently re-
duced by bleeding and purgatives.
                 LIVER  COMPLAINT.

  The presence of inflammation of the liver is recognized
by the following symptoms :-^Together with chill and fever,
there occurs pain on the right side, under the arches of the
false ribs.   The  pain is accompanied with some degree of
soreness, and tenderness on pressure.   The skin is usually
yellow, and the stools clay coloured.  Thirst, a furred tongue,
and nausea, are  also  symptoms; and there is a short,  dry
cough, dependant, as is generally thought, on irritation of the
diaphragm, with  which the liver lies in close  contact.   If it
be on the  surface of the organ, the suffering is greater than
when it is more deeply seated.   On the other hand, jaundice
is a more  prominent symptom, when the disease affects the
substance  of the organ, than when it is limited to  the surface.
In the latter case, the duration of the disease is  often short,
and a revolution takes place on the third, fourth, or fifth day.
This result is often marked by critical hemorrhage from the
nose, by copious bilious discharges from the bowels, profuse
sweat, or turbid urine.  Inflammation of the substance of the
liver, when  not  checked, occasionally forms an abscess;  an 
LIVER COMPLAINT.                 63
occurrence recognized by severe chills and external swelling
over the part, sometimes  accompanied  by distinct but deep
seated fluctuation.
  The  course  taken by the  matter, under  these  circum-
stances, is various.  Sometimes it  approaches the  surface,
and the surgeon is enabled  to give it vent; sometimes it dis-
charges itself into the neighbouring portion of intestine;  in
which case the pus is discharged  by  vomiting  or purging,
often producing a fatal termination within a few hours; and
sometimes  it passes through the diaphragm into the chest,
opening either  into  the  pleural cavity, where it forms  an
empyema, or into the lungs, from which it is rejected in large
amounts by the mouth.   In a few instances the  abscess has
been known to open into the cavity of the abdomen, where
it produces extensive inflammation and death.
  Abscess, however, from acute hepatic inflammation, is ra-
ther uncommon.   The substance of the organ is  more likely*
to take other changes, and  to become indurated  and altered
in structure, with increased  liability to irritation from  the
action of  remote causes; and thus the  inflammation is ren-
dered chronic.   In this form, the pain is less acute, and there
is less sympathetic  disturbance  and general fever.  Both
acute and chronic inflammation of the liver,  are frequently
accompanied with pain in the right shoulder, a symptom too
vague to be much depended on, and one to which undue im-
portance has been attached.
  The  abuse of drastic cathartics, especially such as  are
commonly sold as specifics, will sometimes bring on an  at-
tack of this kind.  In these cases the presence  of nausea will
render proper the administration of an  emetic;  and if chill
and general fever be manifested, a gentle  perspiration must
be excited and  encouraged, the boneset tea and sweet spirits
of nitre being among the best means of effecting this purpose.
If the emetic fail to move the bowels, a gentle dose of salts
or oil may be employed for this purpose.
  General bleeding is not found to exert the same beneficial
influence in this disease which it exhibits in pleurisy, or lung
fever.  It is useful at the outset in severe cases; but it must
be vigorously followed up by cupping  or leeches to the  af-
fected side.  These  may be  advantageously  succeeded  by
fomentations, or, when the  force of the pulse has  been  di-
minished,  by a  blister; the  latter being best suited to the su- 
64
DYSENTERY.
 perficial form  of inflammation, the  former to that which  is
 deeply seated.
   The former treatment will naturally come under the cog-
 nizance of the regular practitioner.  The  occurrence of se-
 vere  and repeated chill, after the second  or third day, will
 inspire a suspicion  that suppuration  is taking place, and sug-
 gest the necessity of employing those means which are found
 to accelerate this process;  of which, heat  and  moisture, ex-
 ternally employed,  are the most important.
   The care and management of hepatic  abscess, however,
 demands all the resources of practised surgical skill.  Chro-
 nic inflammation of the liver, though, as  above stated, fre-
 quently a sequel of the acute  affection, is often  developed
 insidiously, and, under this form, the  disease deserves a sepa-
 rate consideration.   As seen in temperate  regions, it is often
 induced by long continued habits of excess, or supervenes in
•obstinate intermittents.  It is indeed generally accompanied
 with fever of a remitting character, having a daily evening ex-
 acerbation.  The pain is  often obtuse, or even absent; but
 the organ, on  examination, will generally be  found  harder
 and larger  than natural, while the digestion is imperfect, the
 bowels costive, and the  stools  usually clay coloured.   This
 form  of the disease is too often the index  of a decayed and
 broken constitution, and, as such, yields with great reluctance
 to the most judicious treatment.

                     DYSENTERY.

   Dysentery is an inflammation of the mucous membrane of
 the intestinal canal, attended by fever, frequent bloody or mu-
 cus stools,  followed by severe straining  efforts, which expel
 a little of the mucus that naturally covers  the surface of the
 intestine.  This generally resembles a mass of jelly, is often
 mixed with blood, but always unmixed with any of the natu-
 ral bilious  discharges from the canal.   This  evacuation re-
 lieves the  pain for  a moment;  but after a long interval, the
 same  desire returns,  and is followed  by  the  same result.
 Continued fever, which is increased towards evening, accom-
 panies the disease,  and, with the increase  of fever, the  local
 symptoms  are also  aggravated.   As the disease advances, the
 true mucus character of the stool is exchanged for one hav-
 ing rather  the  appearance of matter from  an ulcer or  open
 sore.   When the disease is epidemic, and of severe charac- 
DYSENTERY.
65
ter, the patient often dies with extensive  inflammation; and
if  neglected, the disease frequently passes  into  a chronic
form.  The slimy and bloody discharges  in this disease, are
undoubtedly dependant on inflammation of the mucous mem-
brane lining the  bowels.  The tismus, or  straining in dysen-
tery, is one of its most striking symptoms, and shows com-
pletely, independent of any solid matter in the  intestine, the
desire  for evacuation.  A teaspoonful of some fluid matter
arouses the activity of the part when in  this irritable state,
even more than  actual distension when  the bowels are  in
health.   This straining, when the disease has  continued for
some days, becomes the cause of much pain and faintness.
   Treatment.—Dysentery, when in  its incipient  stage,  the
only one which we propose to  consider,  is simple.   If evi-
dently  the  result of excess, if accompanied with nausea, or
other symptoms  of  deranged stomach, or if  simply attended
with fever and headache, an emetic will be highly proper;
but this remedy is absolutely inadmissible when the disease
prevails as an  epidemic.  In ordinary cases, the effect of  an
emetic, given at  the invasion of this disease, is highly salu-
tary, and often succeeds in arresting its progress.
   In the  first place, there is a  stronger sympathy between
the stomach and the rectum and  colon, than  between any
intermediate portion  of the canal;  secondly,  an emetic is
often the most complete of all cathartics;  producing evacua-
tions in both directions, and changing the whole of the se-
cretions of the canal.   Thirdly, an emetic is one of the most
powerful sudorifics; indeed, we  know of no single remedy
so likely, when administered at the very outset of the disease,
to effect a complete cure;  but where the  case  has been suf-
fered to  run on  unchecked to the third or fourth  day, we
cannot recommend this mode  of  treatment with the same
confidence.  Diaphoretics are among the most valuable  cu-
rative means in this disease.  The bowels having been ade-
quately evacuated  by mild  laxatives, and  bleeding  having
been resorted to  where the violence of the febrile symptoms
demanded, diaphoretics, in  conjunction with calomel, is the
sheet anchor of  our hopes.  Dover's powder is a peculiarly
excellent diaphoretic in this complaint   Six grains of Do-
ver's powder,  with  three or four grains of calomel, may be
given every six  hours.  A combination  of  calomel, opium,
and antimonial powder, is an excellent diaphoretic anodyne.
Blisters, leeches,  or  emollient poultices, to the abdomen, often
       9                  f2 
66
COLIC.
prove highly beneficial.  Balsam copaiva is a valuable medi-
cine in chronic  dysentery.   Warm fomentations are highly
advisable.   Mucilaginous drinks, such as flaxseed tea, barley
and gum water, mucilage  of slippery elm bark, and of the
pumpkin seed, are grateful, and do much good by lubricating
the surface of the canal.  Mucilaginous injections with lau-
danum, are  very necessary in a low stage of the disease.
  As an emetic  :,—*
    Take Ipecacuanha,     ...      -    20 grains.
      "  Tartar emetic,       -     -      -      -  2  do.
  Mix; and divide  in two doses.  If one do not operate in half an hour,
then take the other.   Drink warm water freely.

  As a cathartic :—
    Take Dover's powder,
      "  Calomel,
     "  Tartar emetic,
  To be taken every six hours, if necessary.

                        COLIC.

  Colic is divided into three varieties, according to the na-
ture of the exciting causes.

  Flatulent Colic—so called from the  prominent symp-
toms of indigestion and flatulency  which  attend  it.   It  is
produced by irritating and  indigestible  articles of diet, and
debility of the digestive  organs.  The colic  pains come on
an hour or two after the indigestible diet is taken.  Some-
times the food passes into the bowels in an  imperfectly di-
gested state, and then the  pain does not come on  so soon,
and  is  felt low  down in the  abdomen.   At  first there is a
sense of distension in the pit  of the stomach, followed soon
by pain, which rapidly increases, until it acquires an intense
degree of violence. - The pain occasionally remits.   During
that time the patient throws himself about, and presses firmly
on his abdomen  with  his hands.  Large quantities of air are
from time to time forced up,  or  pass off downward; gene-
rally not dangerous  unless it terminates in  inflammation,
which sometimes, though not often,  occurs.
   Treatment.—In slight attacks, carminatives and anodynes
are often sufficient to procure relief.  Remedies  of this kind
generally answer well, when the stomach  does not contain
irritating substances.   When  it does contain irritating sub-
8 grains.
6  do.
1  do. 
COLIC.
67
stances, an ipecacuanha emetic must be given;  purgatives to
be used when  the  pain is below the  stomach.  They may
be advantageously  combined with aromatics.  I prefer cas-
tor oil and spirits of turpentine  in union.  Injections are
always useful when the pain is  excessive.   Opium, in very
large doses, with calomel, is  a valuable remedy.

   Bilious Colic—This colic  is so called from the bilious
vomiting, and  other symptoms, manifesting functional  de-
rangement of  the  liver.   The  most  urgent  and peculiar
symptoms of this variety of colic, are  generally preceded by
headache, want of  appetite, bitter taste in the  mouth, thirst,
and bilious vomiting.  The colic pains are excessively acute;
pressure at first gives relief;  but the abdomen  becomes ten-
der to the touch, as the disease advances.  Immediately after
vomiting, the pain  undergoes  a temporary  abatement;  the
bowels are  generally immovably torpid.  About the second
or third day, the eyes and skin become yellow.  It is gene-
rally believed that the liver is in a state of morbid activity,
secreting  a superabundance of bile.
   Treatment.—In this variety of colic the principal measures
are, first, to free  the bowels  from their • irritating contents;
second, to allay the irritability of the stomach  and bowels;
and third, to restore the healthy action  of the liver.   Emetics
are very useful  in the beginning, when  there is  not full spon-
taneous vomiting.   Purgatives are of  primary importance.
They  can seldom  be  given,  however,  with effect,  until  the
gastric irritability is allayed.   Small doses of calomel, say one
and a  half grains, given every half hour, answer well to pre-
pare the stomach for the reception of purgatives.  Our princi-
pal reliance must be placed on the full operation  of purgatives.
Opium, given in two grain  doses, affords much relief after
free purging.   It should always be given in combination with
calomel.   Then  mild  aperients should be used for several
days after the bowels have been  once  freely evacuated.   A
mustard plaster to the stomach, and warm fomentations, are
valuable  auxiliaries.  Bleeding must be  fully  employed  in
robust and plethoric subjects, with  a  view of  obviating in-
flammation.  The  warm bath  is a very useful  auxiliary.
The utmost caution is to be used in relation to diet and ex-
posure during the period of convalescence.  Flannel should
be worn  round the abdomen.   Very  cold  drinks  must be
avoided. 
68
COLIC.
      Painter's Colic—This variety of colic generally comes
    on gradually, and is, in  most cases, preceded by symptoms
    of gastric derangement:  such as irregular appetite; constipa-
    tion; foul stomach;  pains in the belly; languor;  pale coun-
    tenance, &c.   This kind of colic is attended with constant
    and extremely severe pain  about  the  umbilical  region;  the
    belly is hard  and forcibly contracted, and the bowels very
    costive.   The pain suffers occasional remissions, but no per-
    fect intermissions, as in other varieties of colic.  It sometimes
    assumes a chronic form,  producing wasting and palsy of  the
    fore-arms.  The predisposition to it is greatly increased by
    having once suffered an attack;  by sudden change  in  the
    atmosphere, unripe fruit,  &c.  It is called painter's colic,  be-
    cause it mostly attacks painters, glaziers, and workers in lead
    factories.
      Treatment.—Bleeding should be freely employed in robust
    and plethoric subjects; or, when the pulse is hard and quick,
    opium, with calomel, is  a  remedy of primary  importance.
,    Both these articles should be given in very large doses, with
    the view of relieving the intestinal  spasm, and  bringing on
    an early action.  Two  grains of the former, with the same
    quantity of the latter; may be given every two hours until the
    pain  is relieved.  Purgatives ought to be given immediately;
    they should be given in  a liquid form.  Cold water dashed
    on the belly and thighs, has been found useful.  Alum, in
    fifteen grain doses every  three hours, is  much recommended.
    Stimulating enemata are highly  beneficial.

      Colic in Infants.—Infants  are  extremely liable to suffer
    from colic, as may be seen by their becoming suddenly fret-
    ful, drawing up their legs, and crying violently for a few mo-
    ments, then becoming apparently easy again for a short time.
    Some children will suffer greatly in this way, with occasional
    intervals  for some weeks; yet they will thrive, and become
    quite fat.
      Colic, in many cases,  depends upon some ill quality,  and
    quantity of  food taken.   The milk of the mother, from  im-
    proper diet on her part, may give the child colic.  Children
    often suffer from colic, induced  by inattention to the speedy
    removal of the diapers  of the  child, after evacuation either
    from the bowels or bladder.
      Treatment.—The mild forms of colic can generally be re-
    moved by wrapping the child  warmly, briskly  rubbing its 
CANCER.
69
back and belly with a warm, dry hand, and laying it with its
abdomen upon the nurse's  lap, while  gently  agitating its
whole body upon the knee.   Should it continue to evince
pain, a teaspoonful of warm infusion of fennel seed, or anni-
seed, may be given at intervals of five or ten minutes, till five
or six doses are taken.  Paregoric, laudanum, and various
carminatives and colic tinctures, are all hazardous remedies.
Two or three drops of sweet spirits of nitre, in a teaspoon-
ful  of water, will often  relieve  obstinate colic.   I  have al-
ways found the following prescription to relieve colic:—

    Take Magnesia,                              \ drachm.
      "  Tincture of assafoetida,      -      -     -  40 drops.
      "   "      opium,                       20 drops.
      "  White sugar,      -            -    -    1 drachm.
      "  Warm water,   -                         1 ounce.
  Mix them well together, and give twenty-five drops to  an infant two to
four years old.

  The above will be found a good and safe remedy for colic.
The quantity may be increased in proportion to age.

                        CANCER.
  Cancer generally commences in  a hard, knotty tumour,
beginning in the secreting  glands, but often propagated to
other parts, and terminating in an ulcer, with thick margins
and  a fetid discharge.
  A predisposition  to cancer is unquestionably hereditary;
the experiment of communicating the disease by inoculation,
proves it is not contagious.   In women, the attack is  most
generally in the breast.   Unmarried  women, after the age of
forty, are most liable to  cancer; and next to these, are mo-
thers who have not suckled.   Next in the order of frequency,
comes married women who  have reached the period of life
above referred to.   When cancer occurs in men, it is chiefly
in the lip or on the face, where it  is commonly caused by
the irritation of a peculiar kind  of wart.   The  causes which
produce  cancers are numerous.   Among them  may be men-
tioned various kinds of external injury ; pre-existing tumours,
accidentally irritated; severe eruptive  diseases, and the time
of change of life.  Cancer in the breast usually commences
with  a small indolent  tumour, which for  some weeks or
months attracts but little attention.   After a short period this
tumour begins with itching, which  is soon followed  by a 
70
CANCER.
pricking or lancinating pain, often very intense, and generally
shooting in the direction  of neighbouring glands.  A sense
of burning, and  a livid discolouration of  the skin, appears
still later in the case.   When these symptoms are united, the
disease  may be considered  as manifest.   At this period the
tumour  approaches the skin, and  feels  knotty to the finger.
Sooner  or later the integuments  give way in places, and  a
small quantity of fluid,  mixed  with blood, is  discharged.
The ulcer rapidly enlarges till a  considerable cavity is ex-
posed, from which issues a most offensive discharge.  What-
ever appearances there may be of the ulcer healing from time
to time, no real progress is made; its ravages extend  until
the whole gland  is involved; and the weight, pain, and fetor
of the  tumour render life  a burden.  When cancer attacks
the uterus, it is known by lancinating pains in this organ,
shooting through  the region of the pelvis; and there is, after
a time,  a  mixed, unhealthy discharge,  having the peculiar
odour which belongs to the disease.   Cancer in the stomach
is obscure, and during life  is seldom more than suspected.
There are acute and burning pains at the pit of the stomach,
and  tenderness on pressure, nausea, and  rejection of food;
but these symptoms do not  enable us certainly to discrimi-
nate between this disease  and many others.  Cancer of the
lip usually commences with a slight fissure or crack, which
being irritated by injudicious applications,  takes on a malig-
nant form.   On the tongue, the  disease  first manifests itself
in a small wart near the tip.   Both this  and the  latter form
are easily removed by an  operation, and  they rarely return.
When on the  cheek or nose, cancer is  usually preceded by
a wart,  which, when  not  subject  to  irritation, may remain
harmless for life.
   Treatment.—In the treatment of this disease, our chief re-
liance must be on extirpating the part affected.  Some have
attempted to dispel the tumour by leeches, caustics, and nar-
cotics, but without much success.   The plan of destroying
the parts by caustic, is very painful and  tedious.   Cancer of
the breast, in its  early stage, may be  relieved by lead  water
washes, and the  constant application of sheet  lead to the
surface  of the tumour.  At a late period, when the ulcer  is
fully developed, the application of arsenic has been success-
fully resorted  to;  and this  forms the basis of most of the
cancer plasters in common use.   It is a violent and  danger-
ous caustic, and requires caution in its use.   If there is much 
CATARRH.
71
pain, I would  use a drachm of the extract  of belladonna,
rubbed down with an  ounce of soap.   Evaporating lotions
and warm applications should never be used;  they do more
harm  than  good;  but the remedy just  recommended di-
minishes the nervous irritability of  the  parts, and excites  a
gentle perspiration without any undue heat   With  respect
to diet, it must  not be too low; but let  your patient take
those things which she  finds will agree with her own feelings,
and which  do not derange the general health.  Wine or
spirits must not be taken, or,  if wine is allowed, it should be
mixed  with water.   Never hurry the constitution, nor give
her any thing so as to  disorder the  constitution, but support
her strength  by animal  food.   Do not  debilitate it, on
the one hand, nor stimulate it on the other; for if you do,  it
will be a  sure way to hasten the  progress of the disease.
Cancer of the skin rarely returns after operations; but those
of other parts are extremely prone to do so.

                       CATARRH.

   Catarrh,  in itself, is very rarely a  dangerous affection.
The symptoms of a common cold are too well known to re-
quire  any description.   Its causes  are  a  sudden  change of
temperature, to a  cold and damp atmosphere; but it often
makes its attack without obvious reason.   In its nature  it  is
a  mild  inflammation, generally commencing in the mucous
membrane of the nose, and gradually extending through the
fauces, to the  larynx, and often to  the whole  length of the
air passages.  In one  form, catarrh becomes epidemic,  and
takes the name of influenza.   The history of the rise  and
progress of  the several  great influenzas, (for they have been
somewhat numerous,)  is a matter of great interest,  but our
limits compel  us to omit it.  Suffice it  to  say, that the pro-
gress  of the disease is infinitely too rapid to be  caused by
contagion, and both its universality, and the impossibility of
certainly avoiding an  attack  by extreme care, disprove its
dependence directly upon any  atmospheric  vicissitudes of
temperature or moisture.   Although the ordinary causes of
catarrh may hasten the attack, and  heighten its violence, the
source of influenza lies buried among the  mysterious agents
which probably produce all the varieties of epidemic disease.
Influenza probably  destroys more  lives  than the  plague, 
72
CHICKEN-POX.
though secretly; for it calls into action all lurking tendencies
to consumption, scrofula, and other chronic  diseases.
   There is a peculiar form of chronic catarrh, the obstinacy
of which depends upon a dyspeptic condition of the stomach.
This  kind only yields to remedies  appropriate in that com-
plaint.  There is  also another, peculiar to elderly people:
being an habitual cough, accompanied with loose expectora-
tion, occasional  hoarseness, and increased secretion  in  the
nose and fauces.  This it is considered dangerous to  cure;
but it is much relieved by a course  of stimulating treatment,
the reverse of that which is employed in a common cold.
   Treatment.—In common catarrh, active or severe reme-
dies are seldom needed.  On the outset of a cold, take a  hot
beverage of lemonade, or mint tea,  of some  simple infusion;
this, aided by rest in a warm bed, will bring on perspiration,
and cure the cold.  One of the best and most powerful reme-
dies, after fever has supervened, in bad  cold, is a weak,  hot
infusion  of boneset,  (eupatorium perfoliatmn.)   A full pint
should be drank at bed-time,  and as hot as possible.  It is
necessary to take a mild cathartic,  senna  and salts, rhubarb
and magnesia, or a seidlitz powder.  If the fever run high,
bleeding must be resorted to;  and as a febrifuge,  ten  drops
of antimonial wine, with forty drops of sweet spirits of nitre,
may be given every two  hours.  If the throat is sore,  rub it
with a liniment of spirits of camphor, hartshorn, and  sweet
oil in equal parts.

                    CHICKEN-POX.

   Chicken-pox is a disease resembling small-pox, in its  es-
sential particulars.   That  which is  now known to  us as
chicken-pox, has existed for many  years; yet it is still dis-
puted whether the affection be distinct, or merely a variety
of small-pox, modified either by the constitution of the indi-
vidual, or by the circumstance of a  previous infection.  The
latter opinion has been ably maintained by two eminent pro-
fessors; but the former view is adopted by the great majority
of medical men of the present day, and the  arguments in its
favour seem to predominate.
   Chicken-pox has often prevailed epidemically over exten-
sive portions of this country, without any material variation
from a standard form, and without  ever assuming any pecu-
liar symptoms.   When observed side by side with small-pox, 
SMALL-POX.
73
in cities, there is seldom any difficulty in distinguishing them.
The following description of the course of the disease, and
the remarks which follow, will, we hope, place this important
distinction in a clear light:—
   Chicken-pox is  sometimes, but not  always, preceded by
distinct fever.  On the third day, the eruption appears in  a
form of small, inflamed spots; commonly showing themselves,
first, on the back and breast.   These spots have little promi-
nence, are of a pale red hue, and exhibit smooth and shining
surfaces.   In a few hours, a small vesicle may be seen rising
up in their centre, with a whitish, transparent, and extremely
thin covering.  On the second day of the eruption, the vesi-
cles  increase, and  occupy nearly the whole of the inflamed
spots, so as to  resemble little  bladders of fluid situated on
narrow inflamed  bases.  Their form  is  irregular.   They
easily  give way under  pressure,  and communicate  to  the
finger  a  soft, elastic sensation.   On the third day, the fluid
becomes turbid,  and  by the  fourth,  many of  the  vesicles
break,  and form crusts; the contents of the others, condensing
and hardening within them.   On the fifth day, most of  the
vesicles are broken, and their little pellicles collapsing, adhere
to the  skin beneath, so as to confine a little fluid in the tubu-
lar ring which remains.   The drying process goes on rapid-
ly, and by the sixth day all  the vesicles are converted into
small,  soft, brownish crusts, which gradually contract into
scales.   From the seventh to the tenth  day, the scales sepa-
rate and fall  off, not in a single piece, but in small fragments,
leaving some traces in the skin.   The febrile  symptoms, if
any have been developed, decline  on the  second day of  the
eruption, and do not again  recur.  Chicken-pox, therefore,
is easily distinguished from small-pox and varioloid.

                      SMALL-POX.

   The universality of small-pox, and the severity of its symp-
toms, rendered it formerly an object of extreme interest, espe-
cially to parents; and  although from the discovery of cow-
pox, its ravages on life  and beauty have been less  general
and fatal, it must still remain a matter  of importance accu-
rately to distinguish and successfully to  treat it.
   There are two forms  assumed by small-pox, termed  by
physicians distinct and confluent, and popularly, though with
less accuracy, a good and bad kind; which  are so varied in
       10                    G 
74
SMALL-POX.
their symptoms and general termination, as to require a sepa-
rate description.

   Distinct Small-Pox.—The patient is seized with cold-
ness, or shiverings, which soon abate, and are followed by a
hot stage, which  lasts  for two or  three days, during which,
children  are  liable to  sickness and vomiting, to  starting in
their sleep, or to  epileptic fits; and adults  are disposed to
sweating.  Towards the end  of the third day, the eruption
appears,  and  increases  during the fourth day.  It  commonly
appears first  on the face, then on the lower parts, and is
completed over the whole body on  the  fifth day.   The fever
commonly abates upon the coming out of the eruption;  the
sickness, vomiting, fits,  and other  oppressive symptoms, go
off;  and the  patient is, for the time, free of uneasiness.   The
eruption  appears in small red spots, hardly  rising above the
skin, but which, by degrees,  form pimples.   On the  fifth or
sixth day, a  small vesicle, containing a colourless fluid, ap-
pears on the  top of each pimple.   These get broader on the
seventh day; and about the eighth, are raised into round
pustules.   These pustules are surrounded with a circular in-
flamed border;  and as they increase in  size,  about the eighth
day, the  face is  considerably swelled,  and the eyelids  are
sometimes completely  closed.   The matter  in the pustules
now becomes thick  and white, or  yellowish, exactly resem-
bling the matter  of an abscess.   On the  eleventh  day, the
swelling of the face subsides, and  the pustules appear quite
full.  On the top  of each, a darker spot appears; and at this
place, the pustule, on the eleventh day,  or soon after, is spon-
taneously broken, and a portion of the matter oozes  out; in
consequence  of which the pustule is shrivelled and subsides;
while the matter  oozing out, dries, and forms a crust  upon
its surface.   Sometimes a little only of the matter oozes out;
and what remains in  the pustule  becomes  thick, and  even
hard.  After  some days, both the  crusts and the hardened
pustules fall  off, leaving the skin  which they covered of a
brown, red color; and  it is only after many days, that the
skin in these places resumes  its natural colour.   In some
cases, the parts covered suffer a scaling off of the skin  and
a small pit or hollow is left   This is the course of things on
the face, and successively, the pustules on  the rest of the
body take the  same  course.  On the  tenth and eleventh
days, a swelling arises  in the hands and feet, but this  goes 
SMALL-POX.                    75
off as the matter ripens.  When the pustules on the face are
numerous, there is some degree of fever about the tenth and
eleventh days;  but in distinct small-pox, it soon abates.  An
uneasiness  in the throat, with a  hoarseness  of the  voice,
comes on about the sixth or seventh  day, and much  saliva
flows from  the mouth.   This soon becomes thick and  tough,
and being with difficulty spit out, is productive of  great un-
easiness.  The inside of the mouth and throat has numerous
pustules; and in all probability, the whole internal surface of
the bowels is affected in the same manner.   In the  apart-
ment of those affected with small-pox, there is in many cases
a strong, peculiar, and nauseous  smell, which remains even
for  months  after  the  disease has entirely subsided.   When
the pustules blacken, the whole appearance is very loathsome,
and presents a  striking contrast to the blooming health and
beauty which existed but a few days before;

  Confluent  Small-Pox.—This kind of  the  disease  is
marked by the  greater violence of the feverish symptoms in
the first attack, by the strength  of the convulsions,  which
sometimes destroy the patient even before the eruption ap-
pears; and by the very great number and clustering together
of the pustules, especially on the face.  After the eruption,
the fever abates a little, but never goes off entirely;  and soon
after returns with severity, and continues through the whole
course of the disease.  The vesicles  appear sooner on the
tops of the pimples;  they are not of a round  figure, but irre-
gular; and  numbers  of them  run together,  forming large
patches.  The matter does not become thick and yellow, as
in the distinct small-pox, but  the vesicles  appear flat and
shrivelled;  and where the skin is to< be seen, it is pale and
flaccid.  The secondary fever, about the eleventh day, is re-
newed with considerable violence.
  It is not any difference in the  contagion, or in the  matter
inserted, if the  disease be communicated by inoculation, that
causes the difference in the  malignity of the disease; as  it
not unfrequently  happens, that a child with  small-pox of a
very bad kind, imparts the disease to another, who takes it in
a very mild and favourable way;  and the reverse of this also
very often  happens.   The cause seems to be  in the state of
the constitution receiving the infection.
  After the small-pox has gone off, there is great tendency to
boils  and inflammatory symptoms in  different parts  of the 
76                     small-pox.

body; and, like the measles, it often calls into energy various
unhealthy actions, producing swelling of the glands ot the
neck, ophthalmia, and  the like.   Many lose their sight by
injuries done to the eyes, during the inflammatory period of
the disease.   Another unpleasant consequence is the  pittings
which occur after small-pox, totally disfiguring the  counte-
nance, and altogether altering its expression.
  In the treatment of  small-pox, we are not to  expect the
sickness,  vomiting, heat, thirst and fever, which occur before
the eruption  appears, to be totally escaped  by any class of
remedies; but they may certainly be very  much alleviated,
and their influence on the subsequent disease much dimin-
ished.  One very alarming symptom, especially in children,
is the occurrence of convulsions.  This symptom, as well as
the very severe feverish ones, used to be much aggravated by
the hot regimen formerly in vogue;  and they are materially
alleviated, or even prevented, by the free admission  of  cold
air, and of tepid or even cold bathing.  The same  heating
plan was undoubtedly  the cause of the  abundant confluent
small-pox, so  general  under that practice;  by which such
numbers  lost their lives, or their eye-sight, and were other-
wise so much pitted and scarred.  It is found that a cooling
plan of treatment is b}r far the best, in the early stages of the
disease; that it renders the eruptive fever moderate, and pre-
vents many of the inflammatory  and putrid symptoms which
would otherwise occur afterwards.   So confirmed  is it by
experiment, that the confluent nature of the small-pox is very
much occasioned by heat, that on any particular portion of
the body we  can, by covering it with plasters, bring out a
more plentiful crop of pustules than on others; and since the
more rational and cooling plan has been in use, fewer persons
appear with the numerous pits that formerly were left  both
on the face  and other  parts of the body.  In an adult per-
son, if the fever be very violent, it will  be  proper to admit
cold air very freely;  to give purgative medicines and cooling
drinks;  and in those of a full and plethoric  habit, blood-let-
ting will be necessary.   The giving of an emetic at the com-
mencement of small-pox is a good  practice, both as deter-
mining to the skin* and freeing the stomach and first passages
from undigested aliment,  which  would  aggravate future
symptoms.   The irritation during the  ripening of the pus-
tules is so great, that we are compelled to allow anodyne
medicines, taking care to prevent costiveness by  laxative 
DYSPEPSIA.
77
medicines and clysters.   For the swelling of the throat and
the salivation, we apply blisters externally, and employ clean-
sing  gargles  of various acids, and preserved fruits.   When
secondary fever occurs in small-pox, it is to  be  treated by
purgatives, cool regimen, and prudent blood-letting.  The
convalescence is sometimes very tedious; and, like measles,
small-pox excites scrofula and other disorders of  the consti-
tution.  Sometimes large boils form  in different parts of the
body;  these are to be treated with poultices and the usual
dressings; and  in many cases these boils, even when large
and  painful,  may be  considered as  salutary,  and having a
tendency to diminish  unhealthy action in the other parts of
the body.   No  means have yet been devised to prevent the
pitting left by small-pox.

                      DYSPEPSIA.

   That state of the stomach in which it is incapable of per-
forming its  appropriate function,  of changing the received
food into chyle, is termed dyspepsia.   Whether the  imme-
diate cause of dyspepsia is to be sought in the debility of the
muscular fibre of the  organ, or in the defect or bad character
of its  secretions, is a question not easily determined in all
cases.   Other symptoms of dyspepsia are  oppression at the
stomach after food is  taken;  a sense of weight and dragging
about the limbs while the digestive  process is going on; a
sensation  of gnawing rather than hunger is felt whenever the
stomach is empty; a  disposition to sleep, which, when a full
repast has been taken, is almost irresistible; and frequently
a heavy dull  pain about the head.   The modes in which in-
digestion  is  induced  are nearly innumerable;  but one very
universal cause demands the especial attention of Americans,
namely, the habit of  too  rapidly swallowing food, by which
sufficient time is not  allowed for the process of mastication,
and for the secretions of the fluid which aid digestion. The
general means  by which dyspepsia  may be avoided, are to
be inferred  from the nature of the  causes by which it has
been produced.   It is not always that even a bad habit can
be wholly omitted with impunity, nor will its discontinuance
always repair the mischief which it has occasioned.  But
the change from  sedentary to active habits is  one of more
difficulty.  The  sedentary student may be  fully persuaded
gf the  advantages of exercise, and may, with all earnestness,
                           g2 
78
DYSPEPSIA.
attempt a reform ;  but if the exercise be tedious or distaste-
ful; if he walk without an object or interest, merely to ac-
complish a task, and with his mind still occupied by his pre-
vious studies, he will gain  little benefit.  Exercise  must be
an actual relaxation  and  amusement, or it will fail in  pro-
ducing its effect.   It is on  this ground that travelling, which
combines bodily motion with a change of scene and pursuit,
is so often recommended.   Exercise should produce fatigue,
but not exhaustion.   Indigestion arising from ardent spirits
can be cured only by abandoning their use, and substituting
therefor  some of the bitter tonics.   That from coffee  can
generally be obviated by the substitution  of tea;  and that
from the use  of green tea  by the  use of black, which pro-
duces, usually, little disturbance either of the  stomach or the
nervous  system.   Opium in every form must be totally ab-
stained from.   To obviate the cravings  occasioned by its
disuse, the bitter tinctures which contain a narcotic principle,
such as those of valerian, hops, &c, may be employed.  The
remedial measures for giving tone  to the stomach, and for
improving the  character of the secretions,  are  in general
those which are termed tonics.  They are supposed to exert
their action on the muscular fibre.   They are generally bit-
ter substances, and are employed either in  their simple state,
or in  the form of tincture.  Among the most popular of these
preparations  may be  mentioned  Huxham's, or compound
tincture of bark, which, in addition to its principal ingredient,
contains  snake root, saffron,  orange peel, &c.  Whatever
virtue the above  articles may possess in  their character of
tonics, they are still to be regarded as subordinate to those
more general means which  communicate vigor to the stomach
by strengthening the whole system.   Such are the breathing
of fresh, pure air; the due exercise of the muscular system;
cold and warm bathing; and the maintenance of  a well re-
gulated  mind and a cheerful temper.  Dr. Chapman recom-
mends the following pills, three of which to be taken at night
when going to bed..

    Take Pulv. Rhubarb,   -      -     -     _   15 „„;„,
     "    «  Aloes,  '-      -     -      -       \lgTS-
     "    "   Gamboge,   -      -     -          3   u
     "    «  Gum Myrrh,    ...        3   u
     «■    «   Charcoal,   -      -     -      -    2   «
     «   Oil Anniseed,  -                          4 dropg
   Mix, and make three pills to be taken for a dose, to be continued until
 the disease is removed. 
ERYSIPELAS.
79
                     ERYSIPELAS.

  Erysipelas is an eruptive fever of a typhoid character, oc-
curring more frequently in persons in advanced life, or those
of debilitated constitutions, but confined to no age or condi-
tion.   It often breaks out as a limited epidemic, in hospitals,
&c.   Its  approach is insidious,  the preceding fever  being
often very slight.  Sometimes  there  is chill, succeeded by
heat, and accompanied by  drowsiness, and even delirium.
On the third and fourth day a redness shows itself in some
part of the person.  At first this is  not very distinct, and the
line  which separates it from the surrounding parts not very
well marked; but it gradually  spreads  in all directions, and
as it advances,  becomes  more prominent,  and its outline
more perfectly defined.   When it  attacks the face, the nos-
trils become  swollen, tense and painful, and the eyelids  so
much enlarged as often entirely to obstruct the sight.   In
the majority of cases, perhaps only one side is affected ; and
then the boundary may be traced along the ridge of the nose,
bisecting  the lips, the chin and the  scalp.   The distortion
of the features,  especially of the mouth, is among the most
striking appearances.  On examination with the hand, the
morbid action is found to involve  at  least  the whole  thick-
ness of the true skin,  to which it imparts an unnatural hard-
ness and a peculiar fleshy feel.  At first, slight pressure causes
this colour to disappear, which returns when this is removed.
The parts first attacked, and the others in succession, begin
to form blisters in irregular  patches on the  second or third
day.   The fluid effused is yellowish or livid, and oozes out
through small crevices.   On parts where blisters do not ap-
pear, the  skin  usually dries  into fine scales, like  those  of
measles.   The inflammation and accompanying fever usually
continue from eight to ten days.  During this time,, however,
the eruption trails along gradually and successively over dif-
ferent parts, so that the process in a given part is completed
in  somewhat less time;  at length  the disposition to spread
ceases, and the disease subsides.   The signs which indicate
danger in this disease are the continuance or renewal  of the
delirium,  and  the occurrence of  coma  or torpidity, from
which the patient is with difficulty aroused.  These how-
ever, do not necessarily indicate a fatal termination; for per-
sons in advanced life often exhibit both delirium and coma
for many days and yet recover. 
80
ITCH.
   The treatment  must vary with  the  condition of  the  pa-
 tient   If he be accustomed to drinking or improper food, if
 nausea and dyspeptic headache  be present,  particularly if
 accompanied with a bad taste in  flie  mouth, an  emetic is
 proper, and should not be withheld by any fear of tendency
 to the head.   One or two  cooling and  moderate purgatives
 are sometimes needed; but in general, all very active evacu-
 ations are improper.   When there  is much prostration,  the
 decoction of Peruvian bark, or a solution of quinine,  may be
 given in such quantities as the stomach will bear.  As exter-
 nal applications, great relief is  often given by dusting  the
 part with dry rye  meal, and rags wet  with lead water fre-
 quently have a happy effect.  The watery solution  of opium,
 so useful in erysipelas of other parts, is inadmissible in that
 of the face.  The mucilaginous washes are seldom beneficial,
 and we have always found  the much lauded unctuous pre-
 parations  decidedly injurious..  In  erysipelas  which is  ad-
 vancing with rapidity along an arm or leg, its.progress may
 often be checked by a narrow blister, applied  so as  to sur-
 round the  limb  over  the  line where the  inflammation  ter-
 minates.
   The erysipelas of infants is a peculiar disease, which
 usually shows itself within a few days, sometimes hours, after
 birth;  in  fact it  is sometimes  congenital.   It  commences
 ordinarily about the navel, and its progress involves the lower
 part of the abdomen, the hip, thigh, &c., of one side.   Vesi-
 cation follows, and sometimes even ulceration of the parts;
but in  infants at the period just alluded to, the disease may
prove fatal without reaching either of these stages.
  Local erysipelas from wounds, may occur on  any  part of
the body, but most frequently follows on wounds of the scalp,
and then assumes much of  the character of general erysipe-
las, as already given.

                        ITCH.

   The itch has been described as a cutaneous inflammation
without fever, consisting of  vesicles  containing  a  serous or
limpid fluid, which may appear on any part of the surface,
but are found principally  in the flexures  of the joints, and
between the fingers and toes.* In the severer cases, and later
 stages of the affection, the vesicles  degenerate into pustules,
 containing a yellow matter, and these sometimes coalescing' 
NERVOUS  diseases.
81
form irregular  and unsightly blotches.  Itch may  sponta-
neously arise from filthy and negligent habits; but it is usually
received by contagion.  Adults take the disease less readily,
and when they do receive it, it remains dormant for a  long
time.   Itch, at its first appearance, is  sometimes difficult to
be distinguished from other eruptions; but when it  has be-
come confirmed, the co-existence of the pimple, the vesicle,
the pustule, and  the scab,  the absence of fever,  the  close
aggregation of the eruption in the  particular parts already
mentioned,  and  the circumstances  under  which it shows
itself, are sufficient to determine its nature.   When itch has
continued  for long time, and extended itself to the  surface,
generally, its sudden removal by treatment has been said to
produce internal disease, and even mental derangement; but
as a general rule, no hesitation should be felt in curing  it by
the speediest possible  method;  for it is  never known to
cease spontaneously.
   In the treatment of itch, various  applications have  been
employed with nearly equal success;  since it seems sufficient
to induce a new action in the parts by some active stimulus.
Thus sulphur, zinc, mercury, arsenic, alum, tobacco,  and tar,
can each boast of its cures.  The common mode of employ-
ing sulphur, is to prepare an ointment of  this  article  with
lard, and rub it well into the affected parts, for three or four
successive  nights, before  a warm  fire; after which the  skin
must be thoroughly washed.  It is usual to administer the
sulphur internally,  in  slightly laxative doses—an innocent
treatment,  and one which  may prevent a  repulsion of the
disease from the skin.   Other ointments and lotions for the
itch are in common use;  but it is  needless to describe them.
   The following will be found a good application;—

    Take Red precipitate,    -     -      -     -   20 grains.
      " Flour sulphur,        ...        1 drachm.
      « Hogs lard,  -----   2 ounces.
  Mix—and rub once a day until cured.

                 NERVOUS DISEASES.

   Of all diseases incident to mankind, those of the nervous
kind  are the most complicated  and  difficult  to cure.  A
volume would not be sufficient to  point out their various ap-
pearances.  They imitate almost every disease;   and are
seldom alike in two different persons, or even the same per-
        il 
82
NERVOUS  DISEASES.
son at different times.  Proteus-like, they are continually
changing shape; and upon  every  fresh attack, the patient
thinks he feels symptoms which he never experienced before.
Nor do they only affect the body; the mind likewise suffers,
and is often thereby rendered extremely weak and  peevish.
The low spirits, timorousness, melancholy, and fickleness of
temper,  which  generally attend nervous  disorders, induce
many to believe that they are entirely diseases of the mind;
but this change of temper is  rather a consequence, than the
cause of nervous diseases.
   Causes.—Every thing that tends to  relax or weaken the
body, disposes it to nervous diseases, as indolence, excessive
venery, drinking too much tea, or other weak watery liquors
warm, frequent bleeding, purging, vomiting, &c.  Whatever
hurts  the digestion, or prevents the proper assimilation of the
food,  has likewise this effect: as long fasting, excess in eat-
ing or drinking, or  unwholesome aliments,, an unfavourable
posture of the body, &c.
   Nervous  disorders often proceed from intense application
to study.   Indeed,, few studious persons  are  entirely free
from  them.   Nor is. this at all  to  be wondered at; intense
thinking not only preys upon the spirits, but prevents the
person from taking proper exercise, by which means the di-
gestion is impaired, the nourishment prevented, the  solids
relaxed, and the whole mass  of humours vitiated.   Grief and
disappointment likewise produce the same effects.  I have
known more nervous patients who dated the commencement
of their disorders from the loss of  a  husband, a  favourite
child, or from some  disappointment in life, than from any
other cause,   In a  word, whatever weakens  the  body,  or
depresses the spirits, may occasion nervous disorders; as un-
wholesome air, want of sleep, great fatigue, disagreeable ap-
prehensions, anxiety, vexation, &c.
   Symptoms.—We  shall only mention some  of the  most
general symptoms  of these disorders, as  it would be both a
useless and impracticable task  to enumerate the whole.
There is a great tightness  of the breast, with difficulty of
breathing; violent palpitations of the heart; sudden flushings
of heat in various parts of the body;  at other times a sense
of cold, as if water was poured on  them; flying pains in the
arms  and limbs; pains  in  the back and belly, resembling
those occasioned by gravel; the pulse very variable, some-
times uncommonly  slow,  and at  other times  very quick- 
NERVOUS  DISEASES.
83
yawning, the hiccup, frequent sighing, and a sense of suffo-
cation, as if from a ball or lump  in the throat;  alternate fits
of crying and convulsive laughing; the sleep is unsound, and
seldom refreshing; and the patient is often troubled with the
nightmare.
   As the disease increases, the patient is molested with ver-
tigo, syncope, headaches, cramps, and fixed pains in various
parts of the body; the eyes are  clouded, and often affected
with pain and dryness; there is a noise in the ears, and often
a  dulness of hearing; in short,  the whole animal functions
are impaired.   The mind is disturbed on the most trivial oc-
casions, and  is hurried into the most perverse  commotions,
inquietudes, terror, sadness, anger, diffidence, &c.  The pa-
tient is  apt to entertain wild  imaginations, and extravagant
fancies;  the memory  becomes weak, and the judgment fails.
   Nothing is more characteristic of this disease than a con-
stant dread of death.   This  renders those unhappy persons
who labour under it peevish, fickle, impatient, and apt to run
from  one physician to another; which  is one reason why
they seldom  reap any benefit from  medicine,  as they have
not  sufficient resolution to persist in any one  course till it
has time to produce  its proper  effects.   They are likewise
apt to imagine that they labour under diseases from which
they are quite free; and are angry if any one attempts to set
them right, or laugh them out of their ridiculous notions.
   Regimen.—Persons afflicted with nervous diseases ought
never to fast long.  Their food  should be solid and nourish-
ing, but of easy digestion.   Fat meats and heavy sauces  are
hurtful.  All  excess  should  be carefully  avoided.  They
ought never to eat more at a time than  they can easily di-
gest; and  heavy suppers are to be  avoided.   If they feel
themselves weak and faint between meals, they ought to  eat
a  bit of bread, and drink a glass of wine.   Though wine in
excess enfeebles the  body, and impairs the faculties of  the
mind, yet taken  in moderation, it strengthens  the  stomach,
and promotes digestion.  Wine and water is  a very proper
drink at meals;  but if wine sours on the stomach, or the  pa-
tient is  much  troubled  with wind,  brandy and water will
answer better.   All weak and warm liquids are hurtful;  as
tea, coffee, &c.   People  may find a temporary relief in  the
use of these, but they always increase the malady, as they
weaken the stomach, and hurt digestion.   Whatever imme-
diate ease the patient may feel from the use of  ardent spirits, 
84
NERVOUS  DISEASES.
they are sure  to  aggravate the malady,  and prove certain
poisons at last.   These cautions are the more necessary, as
most nervous people  are peculiarly fond of tea and ardent
spirits; to the use of which many of them fall victims.
  Exercise in nervous disorders is superior to all medicines.
Riding  on horseback is  generally esteemed  the best, as it
gives motion to the whole body, without fatiguing it.  I have
known some patients, however, with whom walking agreed
better,  and others who were most benefitted by riding in a
carriage.  Every one ought to use that which he finds most
beneficial.  Long sea voyages have an excellent effect; and
to those who  have  sufficient resolution, we  would by all
means  recommend this course.  Even change of place, and
the sight of new objects, by diverting the  mind, have a great
tendency  to remove these  complaints.   For this  reason a
long journey, or a voyage, is  of much more advantage than
riding short journeys near home.
  A cool, dry air is proper, as it braces and invigorates the
whole body.  Few things tend more to relax  and  enervate
than hot air, especially that which is rendered so by great
fires, or stoves in small apartments.   But when the stomach
or bowels  are  weak, the body ought to be  well  guarded
against cold, especially in winter, by wearing a thin flannel
waistcoat next the skin.   This will keep up  an equal per-
spiration, and  defend the  alimentary canal  from many im-
pressions to which it would otherwise be  subject upon every
sudden  change from warm to cold  weather.  Rubbing the
body frequently with a flesh-brush, or a coarse linen cloth, is
likewise beneficial, as it promotes the circulation, perspira-
tion, &c.   Persons  who have weak nerves ought to  rise
early, and  take exercise  before breakfast, as lying too long
a-bed cannot fail to relax the  solids.  They ought  likewise
to be diverted, and to be kept as easy and cheerful as possi-
ble.  There is not any thing which hurts the nervous sys-
tem, or weakens the  digestive powers, more than fear, grief,
or anxiety.
   Treatment.—Though nervous diseases are seldom radically
cured,  yet their symptoms may sometimes be alleviated, and
the patient's life rendered at least more comfortable by proper
medicines.
   When the patient is costive, he ought to take a little rhu-
barb, or some other mild  purgative,  and should never suffer
his body to be long  bound.   All strong and violent purga- 
RHEUMATISM.
85
tives are, however, to be avoided, as aloes, jalap, &c.  I have
generally seen an infusion of senna and rhubarb answer very
well.   This may be made of any strength, and taken in such
quantity as the patient finds necessary.   When the digestion
is bad, or the stomach relaxed and weak, the following infu-
sion may be used with advantage:—         v
   Take of Peruvian bark, an ounce; gentian root, orange
peel, and  coriander seed, of each  half an  ounce; let  these
ingredients be all bruised in a  mortar, and infused in a bottle
of brandy or rum, for the space of five or six days.   A table-
spoonful of the strained liquor may be taken in half a glass
of water, an hour before breakfast, dinner, and supper.
   Few things tend more to strengthen the nervous system
than cold bathing.   This practice, if duly persisted in, will
produce very extraordinary effects; but when the liver, or
other viscera, are obstructed, or otherwise unsound, the cold
bath is improper.  It is therefore to be used with very great
caution.  The most proper seasons for it  are summer and
autumn.  It will  be sufficient, especially  for persons of a
spare  habit, to go into the cold bath three or four times a
week.  If the patient be weakened by it, or feels chilly for
a long time after coming out,  it is improper.
   Opiates are generally extolled in these maladies; but as
they  only  palliate the  symptoms, and generally  afterwards
increase the disease, we would advise people to be extremely
sparing in the use of them, lest habit should render them at
last absolutely necessary.
   It would be an easy matter to enumerate many medicines
which  have  been extolled  for relieving nervous disorders;
but whoever wishes for a thorough cure, must expect it from
regimen alone;  we  shall therefore omit  mentioning  more
medicines, and again recommend the  strictest attention to
diet, air, exercise, and amusements.

                     RHEUMATISM.

   This disease has  often  a  resemblance to the gout   It
generally attacks the joints with exquisite  pain, and is some-
times attended with inflammation and swelling.  It is most
common in the spring, and  towards the end of autumn.  It
is usually distinguished into acute and chronic: or the rheu-
matism with and without a  fever.
   Causes.__The causes  of  a  rheumatism are frequently the
• 
86
RHEUMATISM.
same as those of an inflammatory fever, viz., obstructed per-
spiration.   Sudden  changes of the  weather, and all  quick
transitions  from  heat to cold,  are very apt  to  occasion the
rheumatism.  The most extraordinary case  of a rheumatism
that I  ever saw, where almost every joint of the body was
distorted, was a man who used to work one part of  the day
by the fire,  and the other part of it in the water.   Very obsti-
nate rheumatisms have likewise been brought on by persons
not accustomed to it, allowing their feet to continue long wet.
The  same  effects are  often produced by wet clothes, damp
beds, sitting or lying on the damp ground, travelling in the
night, &c.
  The rheumatism may likewise be  occasioned by excessive
evacuations, or the stoppage of customary discharges.   It is
often the effect  of  chronic  diseases, which vitiate  the hu-
mours;  as  the scurvy,  the lues  venera,  obstinate autumnal
ague, &c.
  Symptoms.—The acute rheumatism commonly begins with
weariness,  shivering, a quick  pulse,  restlessness, thirst, and
other symptoms of fever.   Afterwards the patient complains
of flying pains, which  are increased by the least  motion.
These at length fix in the joints, which are often  affected
with swelling and  inflammation.  If blood be let in this
disease, it  has  generally the  same   appearance as in  the
pleurisy.
  Medical  Treatment.—In this kind  of rheumatism the treat-
ment of the patient is nearly the same as in an  acute  or in-
flammatory fever.   If he be young  and  strong, bleeding is
necessary,  which may be repeated  according to the exigen-
cies of the  case.   The body ought likewise to be kept open
by emollient clysters, or cool, opening liquors ; as decoctions
of tamarinds, cream of tartar, senna tea, and the like.   The
diet should be light, and in small quantity.   After the fever-
ish symptoms have abated, if the pain still continues, the
patient must keep his bed, and take  such things as promote
perspiration;  as  wine whey, with solution  of the acetated
ammonia, &c.   He may likewise take, for  a few nights, at
bed time, in a cup of wine  whey, a drachm  of the cream' of
tartar, and half a drachm of gum guaiacum in powder.
   The chronic rheumatism is seldom attended with any con-
siderable degree of fever, and  is generally confined  to some
particular part of the body, as  the shoulders, the back or the
loins.   There is seldom any inflammation or swelling'in this 
RHEUMATISM.                    87
case.   Persons in the decline of life are  most subject to the
chronic rheumatism.  In such patients,  it often proves ex-
tremely obstinate, and sometimes incurable.
  In this  kind of rheumatism, the regimen should be  nearly
the same  as in the acute: cool and diluting diet, consisting
chiefly of vegetable substances.
  Blisters are sometimes  employed in this  complaint; but
they appear to be most serviceable in  those  cases where the
disease partakes of the nature of acute rheumatism, or where
the pain is fixed  in any particular joint;  and a repetition of
fresh blisters will be preferable to keeping up a constant sore
by stimulating the part with savine or other ointments; and
produce a greater effect upon the disease.
  Whatever liniment is applied to the  affected parts, it should
be rubbed in frequently, and with active  friction, by the pa-
tient himself.   The friction can hardly be too long continued
at one  time, or  too frequently resorted to;  for it  has  done
wonders in curing desperate cases.   I have seen bad eases
of chronic rheumatism cured by the steady use of friction, in
the following  manner:—Take of spirits  of camphor, spirits
of hartshorn, and sweet oil, equal parts; mix—make  a lini-
ment.  Take of this mixture about four or five tablespoonsful.
and rub  it on the  parts  affected,  one hour by the clock.
every day for ten days or  two weeks.  I will guarantee it
will effect a perfect  cure.  Let the  patient at the same time
take a teaspoonful of the tincture of  gum guaiacum in mo-
lasses, daily.
   The internal  remedies  most  generally recommended  in
chronic rheumatism are sudorifics, and medicines of a stimu-
lating nature,  which abound in essential oils and resins; and
therefore  volatile alkaline salts, guaiacum, turpentine  com-
bined  with Cinchona bark, and  the  like, may be  given in
any of the undermentioned forms.*
   Cold bathing,  especially in saltwater, often cures the rheu-
matism.   We would also recommend exercise, and wearing
flannel next the skin.

  * Take Guaiacum, in powder,     _     -     -     -   6 grains.
     "  Antimonial powder,   -     -      -     -   ,  3 ■     ^
     "  Syrup of ginger, enough to form a bolus, to be taken three times a day.
                           Or—
  Take Ammoniated tincture of guaiacum,                 2 drachms.
    "  Spirit of cinnamon,.....£ ounce.
    "  Decoction of bark,       -     -           -     1A
    "  Solution of tartarized antimony,      -     -     -  24 drops.
  Make a draught, to  be taken two or three times a day. 
88
PILES.
   Persons afflicted with the scurvy are very subject to rheu-
matic complaints.  The best medicines in this  case are bit-
ters and mild purgatives.   These may  either be taken sepa-
rately or  together, as the patient inclines.  An ounce of
Peruvian bark, and half an ounce of rhubarb, in powder, may
be infused in a bottle of wine, and one, two, or three wine
glasses  of  it taken daily, as shall be  found necessary  for
keeping the body gently  open.   In cases where  the  bark
itself  proves sufficiently  purgative,  the  rhubarb   may  be
omitted.
   Chronic rheumatism sometimes affects the lumbar region,
with an acute  pain  shooting down  into the os sacrum, so
that the patient cannot stand upright without suffering con-
siderable pain and inconvenience;  nor  does he feel  any ease
when in bed.   This affection is  known  by  the  name of
lumbago, and, as it frequently does, when it fixes itself in the
hip-joint, it is called sciatica.  Both of these  affections are
to be treated in the same  manner as  chronic  rheumatism.
In sciatica and  local pains of the  hip  and loins, turpentine
is often given with relief, as is also, guaiacum combined with
the essential oil of sassafras.

                        PILES.

  Hemorrhoides, or piles, consist in a  diseased state of the
blood vessels of  the rectum and anus, attended with tumors,
and generally with a flow of  blood, which often takes place
at stated  intervals.   The  tumors, forming the piles,  are
either seated within the anus, or at its verge ; and occasion-
ally one tumid ring surrounds it completely. When no blood
is discharged from these tumors,  they are popularly  denomi-
nated blind piles.  These are, in fact, portions of the exter-
nal edge of the gut, strongly injected with blood,  and in a.
state of chronic inflammation.   This state of engorgement
and inflammation causes  the hemorrhage with which piles
are so generally  attended, and thus gives temporary  relief by
evacuating the overloaded vessels.  Piles are sometimes pre-
ceded by a sense of weight in the back, loins, and lower part
of the abdomen, together  with uneasiness  of  the  stomach,
flatulency of the bowels, and other symptoms of indigestion.
On going to stool, a pungent pain is felt in the fundament,
and small tumors are found to project beyond its verge.   If
a quantity of blood is discharged from them, considerable re- 
PILES-                       89
lief from the pain and uneasiness is obtained.   If, however,
no hemorrhage occurs, the  patient experiences great torture
every time he goes to stool,  and feels an inconvenience when
sitting down  on any hard  seat.   Frequently, however, the
symptoms  are less severe, but nevertheless very troublesome,
as the patient is, from time to time, annoyed by their becom-
ing engaged within the sphincter of the gut, and causing in-
tense pain; considerable uneasiness is, also, frequently sud-
denly experienced when the patient is walking,  or has  been
standing long.  Piles  may  sometimes continue  for  a  long
time without the general health of the patient  being much
affected; while in other cases, particularly in weak and irri-
table constitutions, the  health suffers considerably; the face
becomes pale, the eyes appear sunk,  from the  dark circle
which surrounds them;  the functions of the stomach are
impaired; the feet swell, and there is a sensation of coldness,
with shivering, experienced  by the patient, with a hard, quick
pulse, dryness of the mouth, thirst,  &c.  The piles, also, oc-
casionally cause abscesses to form  in the vicinity of the anus,
terminating in fistula.   Piles  are not unfrequently met with
in persons  predisposed to, or labouring under consumption;
they are a  frequent accompaniment also of chronic diseases
of the liver, indigestion, &c.
   The general causes of piles are long continued sedentary
habits; food of  a stimulating or indigestible  kind; habitual
costiveness; hard riding on horseback; the abuse of purga-
tives, especially  those  containing  aloes,&c.
   The blood  discharged by piles is most generally of a bril-
liant red, excepting  in  a few rare  cases, in which the veins
about the anus are dilated, and accidentally burst, when the
blood is dark, and often mixed up  with the feces.
   Those individuals who have been for a long time subject
to piles, especially those attended with a discharge of blood,
should be extremely cautious not rashly to suspend the evac-
uation,  as  this  may be  productive of dangerous, or  even
fatal consequences; apoplexy, spitting  or vomiting of blood,
violent fevers, inflammations of the abdominal viscera, or,  in
the predisposed, consumption of the lungs, have been known
to result almost immediately upon  an imprudent suppression
of the hemorrhoidal flux. When,  however, they are strictly
a local disease, unattended with other  affections of the  sys-
tem, or any predisposition to disease  of the  head, or chest,
and especially when they are  of recent origin,  by a proper
       12                    h 2 
90                       PILES.
treatment they may be  removed  without any injury, but
much benefit to the patient.
  In the commencement, the symptoms attendant upon piles,
are of an inflammatory nature/and in the young and pletho-
ric, require bleeding from the arm,  or by cups, from the lum-
bar region, a low spare diet, and perfect rest upon a settee
or sofa.  The  bowels should be  kept  regularly open,  by
means of equal parts of sulphur  and cream of tartar, in the
dose of a teaspoonful, three or four times a day, or by a diet
of rye mush and molasses. In regard to  the local treatment;
in some cases, a judicious application  of leeches to the  in-
flamed tumors about the anus, will be advisable, followed by
cold applications; as compresses wet with cold water or lead
water, and injections of cold water into the rectum.   Even
when leeches are not considered advisable, the application
of cold water will be found beneficial.  When the discharge
of blood is very considerable, which, however, is seldom the
case, it  may require for  its  suppression  a  compress to the
bleeding pile, if it  be external;  or  if internal, the insertion
into the anus of a portion of a wax candle, or of the gut of
some animal, subsequently injected with  cold water and tied.
When  the  disease has  been recent, and the constitution
sound, by these means, with a careful avoidance on the part
of the patient, of the exciting causes by which it was pro-
duced, and a well regulated  diet and regimen, the return of
the piles may, in general, be prevented.   But when the dis-
ease has been of long standing, the general system debilitated,
and the extremity of the rectum  is found to be surrounded
with several firm, indolent, but painful  tumors, it is impor-
tant for the surgeon to  attempt their removal by local means.
These consist of certain astringent applications, compression,
or a surgical operation.   Astringent applications have been
often found highly beneficial; one of the  very best is, per-
haps, the  gall ointment; but  a strong solution  of sugar of
lead, or  of white vitriol, or  a decoction of oak bark, as a
wash, may  likewise be used.   In some cases, puncturing
each pile with  a lancet  will  occasionally cause the entire
removal of the disease.   Compression is chiefly resorted to
when the  piles are seated within  the anus; an instrument
called a rectum bougie, is employed to produce the necessary
compression.  When a surgical  operation is decided upon
for the removal of piles, they may  be cut off by the knife or
scissors, or strangulated by a ligature passed around them at 
HERNIA, OR RUPTURE.
91
their base.  The comparative advantages of these two modes
of operating, and the particular cases to which one or  the
other is especially adapted, must be left entirely to the judg-
ment of the surgeon.
  When a sudden or imprudent suppression of  the hemor-
rhoidal flux is followed by violent headache, pain of the chest,
or abdomen, the premonitory symptoms  of apoplexy, or a
discharge of blood from the lungs or stomach, the remedies
are bleeding from the arm; active purgatives by the mouth,
as aloes, soap and gamboge combined; purgative injections
into the rectum;  warm  fomentations  to the anus, either by
poultices or by  the  patient sitting over  the  steam of  hot
water.  If these means fail, leeches should  be applied around
the anus, and the patient's feet and legs immersed in a  hot
bath, to which a teacupful of mustard has been added.  The
utmost attention must for some time be paid by the patient
to his diet and regimen.  His food should be light and spare;
his drink water; and he  should use daily exercise  in  the
open air.

                HERNIA, OR RUPTURE.

   This dangerous and very common  disease  deserves espe-
cial notice in a popular  work; because, even in this country,
where it  is supposed to be much less  common than in some
parts of  Europe, it  probably affects  every eighth  or tenth
individual.
   The pressure of the abdominal muscles upon the  bowels,
in jumping, lifting, sudden falls,  and all violent  exertions of
the body, sometimes  forces a portion of some bowel outward
through the passages.  This  accident constitutes hernia, or
rupture.   The bowel always thrusts before it the peritoneal
lining of the abdomen, in the form of a sac, within which the
bowel lies.  The sac tears away the loose cellular tissue of
the passage, and stretches the tendinous fibres which surround
its outlet.   The whole  hernia then enlarges into a  soft or
doughy tumor, according to the nature of its contents, lying
beneath  the skin and superficial  fascia.  As every hernial
patient  is  constantly in some danger of  strangulation,  and
every one who labours under strangulated hernia is in con-
siderable  danger of  death, the symptoms, and, to a certain
extent, the treatment, should  be  known to all.   On its  first
occurrence, strangulation is generally mistaken for colic; and, 
92
HERNIA, OR RUPTURE.
 except in the severity of the pain at the ring, the pains and
 symptoms, for some time, scarcely differ from those of a very
 bad colic.   Almost invariably there is one loose discharge
 from the bowels near the moment of strangulation; it is even
 violent and copious in some instances; and occasionally, but
 very rarely, a second follows very soon  after.   This seems
 astonishing;  as, in most  cases  of  strangulated  hernia, the
 whole calibre  of some part of the intestine is so tightly
 grasped by the ring, that nothing can possibly pass; but in
 fact, these evacuations come  exclusively from the part of the
 alimentary canal below the stricture; and  this portion  once
 evacuated, all farther passages are impossible until the strangu-
 lation is relieved.  Soon after the strangulation  occurs, the
 hernial tumor becomes tender to the touch, and  commences
 to swell;  severe  pains are usually felt both  at  the  seat  of
 stricture  and about  the  umbilicus;  the  latter being  often
 more distinctly paroxysmal.   As the ease advances, if left to
 run its course, the tumor increases  in size, appears  succes-
 sively  red,  purple, and livid, while  its tenderness becomes
 continually more  marked, and is extended to the abdomen,
 so that the patient can scarcely bear to be touched  on any
part of its surface.   Cotemporaneously with  these   local
changes, the  countenance assumes  first  an anxious, then a
haggard expression;  the  pulse rises and becomes very fre-
quent,  then diminishes in  volume, and  becomes gradually
more and  more feeble  and fluttering;  while the stomach is
affected in succession with nausea, vomiting, hiccough, and
finally  the discharge by the mouth of fecal  matter.
  In protracted cases.—'those, for instance,  which have  con-
tinued  from four to eight days—it is usual for the symptoms,
when at their point of greatest severity, to cease suddenly
 and  entirely without any  return  of  the  bowel,  leaving the
patient entirely calm and  free from pain.   This  apparently
flattering condition of  things is the immediate precursor of
 death.  It marks  the moment when the  mass of intestines,
inflamed by the accident, sink into a state of mortification.
   Treatment.—The  moment strangulation occurs,  a  good
 surgeon should be sent for, if possible; but as this is not al-
 ways the case,  not a moment should be  lost by the  patient
 and his friends, in attempting reduction before the arrival of
 the surgeon.   The patient  should  undress, and  lie  on his
 back in bed; the  affected part should be thoroughly  shaved.
 If the  hernia be not extremely large, and  old, or irreducible 
'HERNIA, OR RUPTURE.
93
in its character, the following course should be pursued:—
The  head and shoulders, as  well as the pelvis, should be
properly raised by pillows, the thighs should be completely
bent,  and the heels  drawn up high in bed.  If the  hernia
should be located in the groin, the thigh on the affected side
should be  most elevated,  and  should also be carried  a little
across its fellow.  The  patient should now steadily  endea-
vour to return the bowel by pressing it back with the hand.
These efforts may be continued for half an hour;  when, if
ineffectual, and no surgeon has been procured, other measures
may be pursued by an intelligent assistant.   The patient, if
vigorous, may be  freely bled  from the arm, and the coldest
local applications may be made; when ice cannot be procured,
the powder of  muriate of ammonia thrown into water, may
be used,  to produce intense cold.  Whatever article  is  em-
ployed, it should  be  done faithfully.   The only precaution
necessary is  to avoid the  actual freezing of the  tumor.
While this cold  is being  applied, it is sometimes  useful to
place one or two heavy smoothing  irons upon the hernia;
for we have  repeatedly seen the reduction happily effected
under the steady pressure of such instruments without the aid
of hands.  After continuing the cold for full half an hour, the
patient or assistant should again attempt the reduction.   If
still unsuccessful,  the cold should be continued;  and if there
be much disposition to inflammation  about the part, leeches
may be applied over  or  around the neck of  the  sac.   A
powerful injection of senna and salts will sometimes do es-
sential service by calling strongly into play the peristatic  ac-
tion of the lower part of the alimentary canal; and the small-
est escape of feces from the strictured bowels will often pave
the way for the reduction of large and obstinately  strictured
hernia.   The taxis, or application of the  hands, should be
renewed every half hour; and great care must be taken to act
steadily, regularly, and patiently, covering as much  as possi-
ble of the  tumor with the hands, and avoiding any  severe
pressure upon one spot.   The direction of the pressure may
be changed a little from side to side with advantage, and re-
quires to be varied with the kind of hernia, and its route of es-
cape.   Details  on this subject cannot be given here, but we
would earnestly advise every director of a large plantation, or
manufactory, as well as every  principal of a boarding school,
to make himself  somewhat acquainted with the anatomy of
the inquinal  and femoral canal, in  order to become more 
94
GRAVEL.
  capable of usefulness to those under his charge.   We might
  continue the subject of reduction through much greater space,
  were we to mention the very numerous remedies recommend-
  ed, and occasionally employed,  by various practitioners;  but
  it is believed that the directions  already given, are  all  that
  can be at once safely and usefully followed by the domestic
  practitioner.

                         GRAVEL.

    The urine, in its healthy state, always contains more or less
  alkaline matter, held in solution by its peculiar acid,  the uric
  or lithic.   This alkali, which is for the most part  of  a calca-
  reous character, is immediately  secreted by the kidney itself.
  If either of these principles be in  excess in proportion to the
  other, a deposite will take place, either acid or alkaline.  In
  the former case, it sometimes concretes in the kidney, where
  it forms masses of considerable size, and sometimes is carried
  on to the bladder, where it shows itself in the form of red
  sand.   In the latter case, the alkali, then set free, immediate-
  ly unites with the phosphoric or oxalic acid, most commonly
  the former, which is always present, and forms a phosphate
  or oxalate of lime;   Another form of calculous disease,  and
  by far the most painful and formidable, is that of a solid con-
  cretion in the bladder  itself,  constituting what  is  usually
- termed stone.  These concretions are formed  in the bladder
  by a gradual deposite from  the urine itself,  around a central
  nucleus, which may be  either a calculus which has made its
  way from the kidney, or some foreign  substance  introduced
  accidentally into the cavity.  The most painful circumstance
  connected with this disease, is the passage of the calculous
  concretion,  when already large,  from  the  kidney into  the
  bladder.  During this process there is  fixed pain  in the re-
  gion of the affected kidney, with a numbness of the thigh on
  the same side, the pain  alternating with a sense of weight in
  the part.  The pain is  acute, and accompanied with nausea
  and faintness from the time when the  calculus has  entered
  the ureter, until it enters the bladder;  after which there  is a
  remission.   If the stone should  become engaged  in the ure-
  thra,  after reposing for a time in the  bladder, its farther pas-
  sage is attended with some  pain;  but the nausea that accom-
  panied its previous course  is absent;  and the pain, instead
  of being deep-seated, is referred to the  opening of the canal, 
DIABETES.
95
and  the  actual  seat of the  concretion.  While the stone is
passing from the kidney to the bladder, the urine  is usually
high coloured, and deposites a reddish  sediment, not unlike
coffee grounds, the effect, probably, of altered blood flowing
from laceration of the mucous membrane of the ureter.
   The presence of stone in  the bladder can only be certainly
determined by actual examination by a surgeon; but if after
the passage of one or more  calculi from the kidney, there is
experienced a permanent difficulty in the evacuation of urine,
with a frequent desire to discharge it, and this  accompanied
with acute pain at the termination of the urethra,  the pre-
sence of stone in the bladder may well be suspected.  When
no passage of calculus or discharges of sand have been  no-
ticed, the existence of  the disease is less readily recognized;
but that some cause  of irritation is present, will be perfectly
evident;  since, in  addition  to the pain, it  will soon be  ob-
served  that the stream of water once commenced, is suddenly
interrupted before its  completion.  As the stone  enlarges,
there will be  a dull pain about the neck of the bladder, while
the irritation, extending itself to the rectum, will produce a
straining and frequent desire to evacuate the bowels.   These
latter symptoms do not absolutely determine the actual pre-
sence of calculus, but point out the  propriety of  a strict
examination.
   Treatment.—In the treatment of gravel, the domestic prac-
titioner can do but little.  Bleeding is very necessary in the
beginning.   Cloths dipped  in hot water, and  applied to the
affected part, and renewed  as they grow cool.   Besides the
fomentations, rub the part  with  sweet oil, and take gentle
diuretics : such as uva ursi, sub-carbonate of soda, turpentine,
parsley, &c.

                      DIABETES-

   The  diabetes is  a  frequent and excessive  discharge of
urine.  It is seldom to be met with among young people:  but
often attacks persons in the decline of life, especially those
who follow the more violent employments.
   Causes.—A diabetes  is often the consequence of acute  dis-
eases, as fevers, fluxes, &c, where the patient has suffered by
excessive evacuations.   It may also be  occasioned by great
fatigue, as riding long  journeys upon a hard trotting horse,
carrying heavy burdens, running, &c.   It may be brought on 
96
DIABETES.
by the use of strong, stimulating, diuretic medicines, as tinc-
ture of cantharides, spirits of turpentine, and such like.   In
a word, this  disease may either  proceed from  too  great a
laxity of the organs which secrete the urine, from something
that  stimulates the kidneys too  much, or from a thin, dis-
solved state of the blood, which makes too  great a quantity
of it run off by the urinary passages.
  Symptoms.—In a diabetes, the urine generally exceeds in
quantity all the  liquid food which  the patient takes.  It is
thin  and pale, of a  sweetish taste,  and an  agreeable smell.
The patient has a continual thirst, with some degree of fever;
his mouth is  dry, and  he spits frequently  a frothy spittle.
The strength fails, the appetite decays, and the  flesh wastes
away till the  patient is reduced to skin and bone.   There is
a heat of the bowels; and frequently the loins, testicles, and
feet, are swelled.
  Regimen.—Every thing  that stimulates the  urinary  pas-
sages, or tends to relax the habit, must be avoided.   For this
reason, the patient should live chiefly on solid food.  His thirst
may  be quenched  with acids: juice of lemon, or  vinegar.
The mucilaginous vegetables—as rice, sago, and salop, with
milk, are the  most proper food.   Of animal substances, shell-
fish are to be preferred: as oysters, crabs, &c.
  The patient ought daily to take  exercise, but it should be
so gentle as not to fatigue him.   He should lie  upon a hard
bed or mattress.  Nothing hurts the kidneys more than lying
too soft.  A  warm, dry air, the use of the flesh-brush, and
every thing that  promotes perspiration, is of service.  For
this reason, the  patient ought to wear  flannel next his skin.
A large strengthening plaster may  be  applied to the back;
or, what will answer better, a great part of the body  may be
wrapped in plaster.
   Treatment.—Gentle purges, if the patient be not too much
weakened by the disease, have a  good effect.  They may
consist of rhubarb, with cardamom  seeds, or any other spice-
ries,  infused in wine, and may be taken in such  quantities as
to keep the body gently open.
   Opiates are of service in this disease, even though the pa-
tient rests well.   They take off spasm and irritation, and at
the same time lessen the force of the  circulation.   Ten or
twelve drops of laudanum may be  taken in a cup of the pa-
tient's drink, three or four times a day.
   The nitric acid is a medicine of great importance, as it is 
DISLOCATIONS.
97
both tonic and  astringent, and  it has,  in  several cases of
diabetes, been found to succeed alone.   It may be taken in
the following way:—Nitric  acid, one drachm and a  half;
barley water, nine ounces; simple syrup, one  ounce.—Mix,
and take two tablespoonsful in a like quantity of water,  three
times  a  day,  gradually increasing the  dose to four  table-
spoonsful.  Whatever medium is resorted to, daily friction
over the region of the kidneys, with camphorated liniment,
should be persevered in at the same time.   Blood-letting has
been strongly recommended in this disease.

                   DISLOCATIONS.

   When a bone is moved out of its place or articulation, so
as to impede its proper functions, it is said  to  be  luxated, or
dislocated.  As this often happens to persons in  situations
where no  medical assistance can be obtained,  by which
means, limbs, and  even lives,  are frequently lost, we shall en-
deavour to point out the method of reducing the most  com-
mon luxations, and those which require immediate assistance.
Any person of common sense and resolution, who  is present
when a dislocation happens, may often be of more  service to
the patient than the most expert surgeon can after the swell-
ing and inflammation have come on.  When these are pre-
sent, it is difficult to know the state of the joint, and danger-
ous to attempt a reduction; and by waiting till they are gone
off, the muscles become so relaxed,  and the cavity filled up,
that the bone can  never afterwards be retained in its place.
   A recent dislocation may generally be reduced by extension
alone, which  must always be greater or less, according to the
strength  of the  muscles which move the joint, the age, ro-
bustness, and other circumstances of the patient.  When the
bone has been out of its place for any considerable time, and
a swelling or inflammation has come on, it  will be necessary
to bleed the patient, and, after fomenting the part, to apply
soft poultices with vinegar to it for some time  before the re-
duction is attempted.
   All that is  necessary after the reduction, is to apply cloths
dipped in vinegar,  or camphorated spirits of wine, to the part,
and to keep it perfectly easy.  Many bad consequences pro-
ceed from the neglect of this  rule.   A  dislocation seldom
happens without the tendons and ligaments of the joint being
stretched, and sometimes torn.   When these are kept easy
       13                   I 
98
DISLOCATIONS.
till  they  recover their strength and tone, all goes  on very
well;  but if the injury be increased by too frequent  an exer-
tion of the parts, no wonder if they be found weak  and  dis-
eased ever after.

  Dislocation of the Jaw.—The lower jaw maybe luxat-
ed by vawning, blows, falls, chewing hard  substances, or the
like.  It  is easily known from the patient's  being unable to
shut his mouth, or to eat any thing, as the  teeth of the under
jaw do not correspond with those of the upper;  besides, the
chin either hangs down, or is  thrown towards one side, and
the patient is neither able to speak distinctly, nor to swallow
without considerable difficulty.
   The usual method of reducing a  dislocated jaw, is to set
the patient upon a low stool, so as an assistant may hold the
head firm by pressing it against his breast.   The operator is
then to thrust his two thumbs, being  first wrapped up with
linen  cloths that they may not slip,  as far  back  into the pa-
tient's mouth as he can, while his fingers  are applied to the
jaw externally.  After he has got firm hold of the jaw, he is
to  press  it strongly downwards  and backwards, by  which
means the elapsed  heads of the jaw may be easily pushed
into their former cavities.

   Dislocation of the Neck.—The neck may be dislocated
by falls, violent blows, or the like.   In this case, if the patient
receives  no  assistance, he  soon  dies, which makes  people
imagine  the  neck was  broken; it is, however, for  the most
part, only partially dislocated, and may be reduced by almost
any person who has resolution enought  to attempt it.  A
complete dislocation of the neck is instantaneous death.
   When the neck  is dislocated, the  patient is  immediately
deprived of all sense and motion; his neck swells, his coun-
tenance  appears bloated, his chin lies upon his breast, and his
face is generally turned towards one side.
   To reduce this dislocation, the  unhappy person  should
immediately  be laid  upon his back on the  ground, and the
operator must place  himself behind  him,  so as to be  able to
lay hold of his head with both hands, while he makes a re-
sistance  by placing his  knees against the  patient's  shoulder.
In this posture he must pull the head with considerable force,
gently twisting it at the same time, if the face  be  turned to
one side, till he perceives  that the  joint  is replaced, which 
DISLOCATIONS.
99
may be known from  the noise which the bones generally
make  when going in, the patient's beginning to breathe, and
the head continuing in its. natural posture.
   This is one  of those operations which it is more easy to
perform than describe,  I have known instances of its being
happily performed even by women, and  often by men of no
medical education.   After the neck is reduced, the patient
ought to be bled, and should be suffered to rest for some days,
till the parts recover their proper tone.

   Dislocation of the Ribs.—As the articulation of the ribs
with the back-bone is very strong, they  are  not often dislo-
cated.   It does, however, sometimes happen, which is a suf-
ficient reason for our taking  notice  of it.  When a rib is
dislocated, either upwards or downwards, in  order to replace
it, the patient should  be laid upon his belly on a table, and
the operator must endeavour to push  the head  of the  bone
into its proper place.   Should this method not succeed, the
arm of the disordered side may be suspended over a  gate or
ladder,  and while  the ribs are thus  stretched asunder, the
heads  of such  as are out of place may be thrust into  their
former situation.
   Those dislocations wherein the heads  of the ribs are forced
inwards, are  both more  dangerous and the  most difficult to
reduce, as  neither the hand  nor any  instrument can be ap-
plied  internally to direct the luxated heads of the ribs.   Al-
most  the only thing that can  be  done, is to lay the  patient
upon his belly over a  cask, or  some gibbous body, and to
move the fore part of the rib inward towards the back, some-
times shaking it; by this means the heads of the luxated ribs
may slip into their former place.
   In  a modern work may be read the particulars  of  a  case,
where all the ribs are said to have been dislocated from the
cartilages.   The accident arose from  the chest being violent-
ly compressed between the beam of a mill and the wall.  In
such  a case, there is no means of reduction,  except the  effect
produced by forcible inspiration; nor are there  any modes
of relief but  bleeding, and the application of a roller round
the chest

   Dislocation of  the Shoulder.—The humerus, or upper
bone of the  arm, may be dislocated in various directions; it
happens, however, most frequently downwards, but very sel- 
100
DISLOCATIONS.
dom directly upwards.   From the nature of its articulation,
as well as from its exposure to external injuries, this bone is
the most subject to dislocation of any in the body.   A  dis-
location of the humerus may be known by a  depression or
cavity on the top of the shoulder, and an inability  to move
the arm.   When the dislocation  is downward or  forward,
the arm is elongated, and a ball or lump is perceived  under
the arm-pit; but when it is backward, there appears a pro-
tuberance behind  the shoulder, and the arm is thrown for-
wards towards the breast.
   The usual method of reducing dislocations of the  shoulder
is to seat the patient upon a  low  stool, and to cause an  as-
sistant to hold his body so that it may not give way to the
extension, while another lays  hold of  the arm  a  little  above
the elbow, and gradually extends it.  The operator then puts
a napkin under the patient's arm, and causes it to be  tied
behind his own neck: by this, while a sufficient extension is
made, he lifts up the head  of  the  bone, and with  his hands
directs it into its proper place.  There are various machines
invented  for  facilitating this  operation, but the hand  of an
expert surgeon is always  more safe.   In young and  deli-
cate patients, I have generally found it a very easy matter to
reduce the shoulder, by extending the arm with  one  hand,
and thrusting in  the head of the  bone with the other.   In
making the  extension, the  arm ought always  to be a little
bent.

  Dislocation of the Elbow.—The bones of the  fore-arm
may ba dislocated in any direction.  When this  is the case,
a protuberance may be observed on that side of the arm to-
wards which the bone is pushed, from which, and  the pa-
tient's inability to bend his arm, a dislocation of this joint
may easily be known.
  Two assistants are generally necessary for reducing a dis-
location of the elbow;  one of them must lay hold of the arm
above, and  the other below  the joint, and make  a pretty
strong extension, while the operator returns the  bones  into
their proper place.  Afterwards the  arm  must be bent, and
suspended for some time with a sling about the neck.
  Luxations of the wrist and fingers  are to be  reduced in
the same manner as those of  the  elbow, viz., by making an
extension in different directions, and  thrusting the  head of
the bone into its place. 
DISLOCATIONS.
101
  Dislocation of the  Clavicle, or Collar-Bone.—The
clavicle may be luxated at its  sternal extremity, forwards,
backwards, and upwards, but never downwards, on account
of the situation of the cartilage of the first rib.   The luxation
forward is most frequent, and almost the only one ever met
with.
  In reducing these dislocations of the sternal  end of  the
clavicle, a lever is to be  made of the arm, by means of which
the shoulder is  to  be  brought outwards;  and  when thus
brought outwards, it is to be pushed forwards, if the disloca-
tion be in that direction; backward, if the dislocation be  be-
hind; and upward, if it be  above.  It is as difficult to keep
the bone  reduced, as it  is  easy to  reduce it, so smooth and
oblique are the articular surfaces.   Dislocations of the cap-
sular end  of the clavicle, or that  nearest the  shoulder-joint,
are much  less common.   The luxation  upwards is the only
one that ever occurs; and this is reduced by carrying  the
shoulder outwards, putting  a cushion in the  axilla, and  ap-
plying a proper bandage, as in fractures of this bone, making
the turns  ascend from the elbow to the shoulder, so as to
press the  luxated end of the bone downward, and  keep it
in its due  situation,  at the  same time that the  elbow is con-
fined close to the side,  and supported  in  a  sling, by which
means  the shoulder will  be kept raised and inclined outwards.

   Dislocation of the  Patella,  or Knee-pan.—This bone
may be luxated  outwards,  or even inwards, when violently
pushed in this direction.   The dislocation outwards  is the
most frequent.
   The generality of cases  of this description, are easily re-
duced by  pressure, when the extensor muscles  of the leg have
been completely  relaxed; but owing to a lax state  of  the
ligament of the patella, or other predisposing causes, the bone
is sometimes with difficulty retained in its proper position,
unless a roller be applied.
   The inflammatory affection of  the joint is to be opposed
by topical bleeding, purging, and  the use of evaporating lo-
tions.   The joint must be  kept quiet a few days, and then
gently moved, to prevent stiffness.

   Dislocation of the Thigh.—The head of the thigh-bone
may be dislocated  upwards,  (on  the dorsum  of the  ilium;)
upwards and forwards, (on the body of the os pubis;)  down-
                           i 2 
10$
DISLOCATIONS.
 wards and forwards, (on the foramen ovale;) and backwards,
 (on the ischiatic notch.)   The dislocation upward and back-
 ward, and that downward and forward, are the most frequent.
   When the thigh-bone is dislocated forward and downward,
 the knee and foot are turned out, and the leg is longer than
 the other; but when it is displaced backward, it is usually
 pushed upwards at the same time, by which means the limb
 is shortened, and the foot is turned  inwards.
   When the thigh-bone is displaced forward and downward,
 the patient, in order to have  it  reduced, must be laid upon
 his back, and  made  fast by bandages, or held  by assistants,
 while by others a gradual and unremitting extension is made
 by means of slings, or a pulley fixed about the bottom of the
 thigh a little above the knee;  a  sheet, folded longitudinally,
 being first placed under the  perinseum or fork, and one end
 carried behind the patient, the other before him: they are to
 be fastened to one of the legs or posts  of the bed, or other
 more secure part.  While the extension is making, the ope-
 rator must push the head of the  bone outward,  or as the cir-
 cumstances of the case may require,  till it gets into the socket
 If the dislocation be outward, the patient must be laid upon
 his face, and during the extension the head of the bone must
 be pushed inward.
   Dislocations of the  knees,  ancles, and toes, are reduced
 much in the same manner as those  of the upper extremities,
 viz., by making an,  extension in opposite directions, while
 the operator replaces the bones.   In many cases, however,
 the extension  alone  is sufficient, and the bone will  slip  into
 its place merely by pulling the limb with sufficient force.  It
"is not hereby meant, that force alone is sufficient for the  re-
 duction of dislocation.  Skill and address will often succeed
 better than force.  I have known a dislocation of the thigh
 reduced by one man, after all the force that could be used by-
 six had proved ineffectual.
   When the force of the muscles in very robust persons re-
 sists every effort to reduce a dislocated  limb, a grain or two
 of emetic  tartar, dissolved in water, may be  administered,
 and taking advantage  of the general languor and  debility
 that precedes the act of vomiting, the limb may be reduced
 with facility.  I have known this plan successfully practised;
 to which may be added bleeding and the warm bath. 
broken bones.                   103
                   BROKEN  BONES.

  There is, in most country villages, some person who pre-
tends to the art of reducing fractures.   Though  in general
such  persons are very ignorant, yet some of them  are very
successful; which  evidently proves that a small degree of
learning, with a sufficient share of common sense and a me-
chanical head, will enable a man to be  useful in this way.
We  would, however,  advise people never to employ such
operators, when an expert and  skilful surgeon can be had;
but when that is impracticable, they must be employed:  we
shall therefore recommend the following  hints to their con-
sideration:.—
  When  a large  bone is broken,  the patient's diet ought in
all respects to be the same as in an inflammatory fever.   He
should likewise be kept quiet and cool, and  his body open
by emollient clysters; or, if these cannot be conveniently
administered, by food that is of an opening quality; as stewed
prunes, apples boiled  in milk, boiled  spinage, and  the like.
It ought,  however, to  be here remarked, that persons who
have  been accustomed to live high are not all of a sudden to
be reduced to a very low diet.   This might have fatal effects.
There is often  a  necessity for indulging even bad  habits in
some measure, where the nature of the disease might require
a different treatment.
  It will  generally be necessary to bleed the  patient imme-
diately after  a fracture, especially if he  be  young, of  a  full
habit, or has at the same time received  any bruise or contu-
sion.   This  operation  should  not only  be performed soon
after  the accident  happens, but, if  the  patient be very  fever-
ish, it may be repeated next day.  WThen several of the  ribs
are broken, bleeding is peculiarly necessary.
   The most  unequivocal symptoms  of fractures are,  the
crepitus, or grating noise distinguished on moving the limb,
occasioned by the fractured  ends; the  separation and in-
equalities of the ends of the fracture, when the bone is super-
ficial; the change in the form  of the limb, and the shortening
of it.
   The treatment  of fractures in general embraces three prin-
cipal indications.   1.  To reduce the pieces of the bones into
their natural situation.  2. To secure and keep them in their
place by proper bandages and splints.   3.  To  prevent  un- 
104                  BROKEN BONES.
pleasant symptoms, and  to  relieve them, when, in spite  of
every effort to the contrary, they do arise.
   If any of the large bones which support the body are
broken, the patient  must keep  his  bed  for several  weeks.
It is by no means necessary, however, that he should lie all
that time, as is  customary, upon his back.   This situation
sinks the spirits, galls and frets the patient's skin, and renders
him very uneasy.  After the second  week, he may be gently
raised  up, and  may  sit several  hours, supported by  a bed-
chair, or the like, which will greatly relieve  him.   Great
care, however, must be taken in  raising him up  and laying
him down, that he make no exertions  himself, otherwise the
action  of the muscles may pull the bone out of its place.
   It is of great importance to keep the patient dry and clean
while in this situation.   By neglecting this, he is often  so
galled  and  excoriated,  that he  is forced to keep shifting
places for ease.   I have known a fractured thigh-bofte, after
it had been  kept straight for  above a fortnight, displaced by
this  means, and continue bent  for life, in spite  of all that
could be done.
   It has been customaiy, when a bone was  broken, to keep
the limb for five  or six weeks continually upon  the stretch.
But this is  a bad posture.   It is  both uneasy to  the  patient,
and unfavourable to the cure.  The best situation  is to keep
the joint a little bent.  This is the posture into which every
animal puts its limbs when it goes to rest, and in which few-
est muscles are  upon the stretch.   It is easily effected, by
either laying the patient upon his side, or  making the bed so
as to favour this position of  the limb.
   Bone-setters ought carefully to examine whether the bone
be not  shattered or broken into several pieces.   In this case
it will sometimes be necessary to have the limb immediately
taken off, otherwise a gangrene  pr mortification may ensue.
The horror which attends the very idea  of an  amputation,   «
often occasions its being delayed in such cases  till too late!
I have known this principle operate  so strongly, that  a limb
where  the  bones were  shattered into  more than twenty
pieces, was  not amputated before the third day  after the ac-
cident, when the gangrene had proceeded so far as to render
the operation useless.
   When a fracture is accompanied with a wound, it must be
dressed  in all respects as  a wound.
   All that art can do towards the cure of a broken bone  is 
BURNS AND SCALDS.                105
to lay it perfectly straight, and  to  keep it quite easy.   All
tight bandages do hurt.   They  had much better be  omitted
altogether.  A  great many of the  bad consequences which
succeed to  fractured bones  are owing to tight bandages.
This is one of the ways in which the excess of art, or rather
the abuse  of it, does more mischief than would be occasioned
by the want of it.  Some of the most sudden cures of broken
bones which were ever known, happened where no bandages
were applied at all.   Some method, however, must be taken
to keep the member steady; but this may be done many
ways, without bracing it with a tight bandage.
   The  best method of retention is by two or  more splints
made of leather or whalebone.   These, if moistened before
they are  applied, soon assume the shape of the included
member, and are sufficient, by the  assistance of a very slight
bandage, for all the purposes of  retention.   The bandage
which  we would recommend is that made with twelve or
eighteen tails.  It is much easier applied and taken  off than
rollers, and answers all  the  purposes  of retention equally
well.   The splints  should always be  as long  as the limb,
with holes cut for the ancles  when the fracture is in the leg.
   In  fractures  of the  ribs,  where  a bandage cannot be
properly used, an adhesive plaster may be applied over the
part.   The patient in this case ought to be bled,  to keep
himself quite easy, avoiding  every thing that may occasion
sneezing,  laughing, coughing, or the like.   He ought to keep
his body in a straight posture, and should take  care that his
stomach be constantly distended, by taking frequently some
light food, and drinking freely of weak, watery liquors.
   When  the ribs are fractured  on  both sides, bandages are
not admissible, as the patient would be in extreme danger of
being suffocated, from impeded  action of the chest.
   The  most proper external application for a fracture is
lead water, or a mixture of vinegar  and water, to which some
spirits of wine may be  added.  The bandages should be  wet
with this  at every dressing, if the inflammation runs high.

                BURNS AND SCALDS.

   In all large burns or scalds, unattended with collapse, the
first question is, has the cuticle  or skin been  extensively
broken 1  If not, then let the part be instantly enveloped in
carded cotton, which should be  kept at hand in every family,
       14 
106
MORTIFICATION.
for cases of accident.   If there be a delay of more than half
an hour, it will prove decidedly injurious.  When the article
cannot be procured in time, let the parts  be well oiled, and
put in cold water.  When the situation of the burn precludes
the use of this remedy, it should be dressed with the ointment
of lime water and sweet oil.  In burns or  scalds with exten-
sive rupture of the skin, we cannot with any propriety apply
the cotton in the first instance; but after a complete  oiling
of the parts, if the time elapsed after the accident be not too
considerable, it may be employed to much advantage.   The
benefit derived from the cotton appears to be limited to about
a day;  it may then be removed carefully, and  a dressing
applied, consisting of patent lint, linen, or muslin, well coated
with lime water and sweet oil.  These ingredients may be
mixed  in equal  parts;  by shaking them well  together in a
wide mouth vial, they form a kind of white paste, very soft,
and very agreeable in its effects.  This dressing should be
renewed two  or three  times a day, until a new skin  begins
to form.  If the  burn  be deep and severe, so as to harden
and render crisp any part of the skin, this must mortify and
slough away.  In such cases, it  is best to  omit  the ointment
in about forty-eight hours, and then to use poultices until the
sloughs separate; after which  the case may be  treated as an
ulcer.   Spirits of turpentine and oil are very good applica-
tions, also chalk and lard have been successfully applied.
  Give opium and wine as long  as the chilly state continues,
but as soon as the heat is  developed, and the pulse has re-
covered its powers, do  not  continue it any longer.

                  MORTIFICATION.

  When any part of the body loses all motion, sensibility, and
natural  heat, and becomes of a brown, livid, or black colour,
it is said to be affected with sphacelus, that is, complete mor-
tification.  As long as any sensibility, motion, and  warmth
continue, the state of the disorder is termed gangrene.
   Mortification is the sequel of  diseases both of excitement
and of debility. In inflammations of the external parts, which
terminate in mortification, the process observed is as follows:
the pain ceases, the purulent matter becomes acrid and sa-
nious; air-bubbles are set at liberty, collecting in small vesi-
cations under the  skin, or distending the whole organ by an
emphysematous swelling.   The blood is coagulated  in the 
MORTIFICATION.
107
vessels of the gangrened part, and the circulation cannot be
restored.  A slight delirium comes  on, followed  either by
dejection of spirits or calmness of mind;  but in each case
attended with a peculiarly wild expression of countenance;
though sometimes with a very peculiar expression of serenity,
with a blackness under the eyes.  The pulse is usually quick,
low, and often intermitting.   In the  earliest stages, deep in-
cisions  are  attended with  a discharge of  blood, still florid,
but the  skin, the  muscles, and the cellular membrane, soon
melt down into a  brownish offensive mass.   We conclude
that similar processes take place in  the internal parts when
they become mortified.   When this occurs in strangulated
hernia, or in inflammation of the bowels, a amission of the
violent pain takes  place, and the  patient and his friends are
deluded with the hope of complete relief; but the experienced
physician knows  the treacherous symptom, and  must not
deceive them with false hopes.   There is a peculiar kind
of mortification called dry gangrene, where  the disease be-
gins in one  of the toes, and very often after a person has
been paring a corn or toe-nail.  It sometimes  stops sponta-
neously, and deprives the patient of some of his toes, or even
of his foot and leg, as cleanly as if it had been amputated by
a surgical operation:  at other times it has  been successfully
treated by giving large doses of opium.
   The  causes of  mortification are general or local.  Those
which affect the general system are the violent inflammatory
fevers, or the jail and hospital  fever; as also scurvy and
dropsy,  long  continued  or intense cold, and some  internal
changes, which we cannot trace or explain.  The  local
causes of mortification  are numerous.  Some of  them are,
burns, excessive cold, the application of caustics, the stran-
gulation of a part,  as in  hernia, or the tying of tumors; severe
contusions, as gun-shot wounds, bad  fractures, violent inflam-
mation, urine effused in the cellular substance, pressure on
large blood-vessels, by  a ligature  or by tumors, wounds of
large vessels.  Long continuance in one posture, as when  a
person is  confined to bed, gives occasion to gangrene of the
parts where the bones have least flesh upon them, and which
are  therefore much exposed  to  pressure; as  the shoulder-
blades,  the haunch-bones, and the lower  part of  the spine.
The hospital gangrene is  produced by some indescribable
state of the air in  hospitals, jails, and ships.  During its pre-
valence the smallest scratch or ulcer is apt to turn to a fatal 
108
MORTIFICATION.
gangrene.  In dropsy,  which  occurs  in  broken down  and
debilitated  constitutions, if a few punctures be made to let
out the effused fluid, these are  too apt to run into gangrene,
and a prudent surgeon will therefore not risk the experiment;
although it is not unusual for spontaneous vesications to form
and break on such dropsical limbs, and to go on to gangrene.
The local  mortifications which  happen  in  old people, are
generally owing to ossification of the arteries.
  Internal  mortifications are generally beyond  the reach of
medicine; but as very threatening symptoms have sometimes
disappeared, we must attempt all that art can suggest.
  When inflammation is  so violent and strong as to give
reason to fear jjjjtat it will end in mortification, it is a call for
us to use with  great diligence bleeding, purging,  low diet,
cold applications, and the other means for abating it; taking
care that we do not continue them  too  long, lest we add to
the debility and exhaustion which are to follow.
  When the mortification  has  fairly begun, our  remedies
must be very different from those which  counteract inflam-
mation.   We are now to prevent debility by giving a nour-
ishing diet and tonics.   Of the class of tonics, the most effi-
cacious is the bark; and in a great variety of cases, the good
effects of the Peruvian bark  are very  remarkable.   Small
quantities of opium and calomel combined, may be given at
frequent  intervals.  When the weakness is  very great, the
use of wine may occasionally be required, as also ammonia
and  other diffusible stimulants.  We must be careful not to
give these remedies when there is any strength  of pulse and
inflammatory symptoms remaining.  When our  remedies are
successful, and the  mortification is about to cease, a separa-
tion takes place at the  verge of the  sound part,  by means of
a slight  degree of  inflammation.  But, on  the contrary, it
very often  happens that  the  disease  spreads, and  death
ensues.
  Local Applications.—Some have advised cold lotions near
the verge of the mortified part, to check the further progress
of inflammation;  but fomentions and emollient  poultices are
commonly  preferred.   To  the common poultices,  in  some
cases, are added powdered charcoal, or yeast, to correct  the
fetor, and to counteract putrefaction.   Stale beer  grounds,
or  port  wine,  with linseed meal,  make a  good  poultice!
Stimulating balsams, hot oils, and the actual cautery, are now
disused in the dressing of mortified parts.   It is necessary to 
MEASLES.
109
give vent to putrid matter, and for this purpose pretty deep
incisions are required.   With a view of allowing  dressings
to reach the sound part, and to excite inflammation, which
commonly  takes  place  at the verge of  the  mortified part
when it terminates favourably, and separates from the sound,
scarifications have been recommended;  but they are always
attended with risk of increased inflammation, and we never
can be sure how much the disease extends below the surface.
We may, therefore,  be  cutting a superficial part, while the
evil is extending close to the bone.
   When a part is frost-bitten, it is a very dangerous practice
to bring it  suddenly into a higher temperature; and in Win-
ter campaigns of armies, it has been found, that soldiers who
have been  exposed to intense cold, have not complained of
being frost-bitten till a thaw came on.  The proper treatment
is by  frictions with camphorated spirits of wine.

                       MEASLES.

   An eruptive disease arising from  contagion, attended with
catarrhal and pneumonic symptoms,  from which few indi-
viduals  of  the human  race are exempt, but  which  attacks
them  only  once in the course of their life.   As it is generally
children who are affected with measles, and as it is a disease
accompanied with very dangerous symptoms  in many cases,
we shall, therefore, give a pretty full description of its synn>
toms  and treatment.
   When the contagion of measles has been received into the
body, the patient, for some time, feels indisposed at intervals,
and then appears well again.  At last, a shivering and cold-
ness  come on, soon followed by increased heat,  thirst, and
other feverish  symptoms,  with sickness,  loss of appetite,
vomiting, and in  some  rare cases, with  convulsion  fits; but
these are far  less common than in the  commencement  of
small-pox.   Sometimes the  fever is sharp  and violent from
the first; sometimes  it is more obscure and mild, but it gene-
rally is  very violent before the measles show themselves  on
the skin, which generally happens  on the fourth  day from
the attack  of shivering or cold stage of the fever.  From the
very commencement, there are  all the symptoms of catarrh,
hoarseness, a very frequent rough cough, difficulty of breath-
ing, swelling and redness of the eyes and eyelids, and a run-
ning of sharp, acrid  matter from the eyes  and nose.   With 
110
MEASLES.
all this, there is often severe headache, throbbing of the tem-
ples, and great drowsiness.   The eruption generally appears
on the fourth  dav, first about the  face  and under the  chin,
and  then  on  other parts of the body.  It first appears m
small red points, but a number of  these  come  together, and
form themselves into  semi-circular patches, in the intervals
of which the skin is not very much different from its natural
appearance.  It is by this that the eruption is distinguished
from that of scarlet fever, where the skin  is uniformly of a
bright red colour.   The eruption is very slightly prominent,
and appears a  little  rough to the touch.  The eruption con-
tinues pretty bright  for two days, but about the third it fades
a little, and becomes of a brownish hue; and in a short time,
about two  days more, it totally disappears, and a powdery
scaling off of the outer skin takes place,   A looseness of the
bowels occasionally comes on when the eruption is subsiding.
The fever is sometimes of alarming violence, and it does not,
in general, subside  when the eruption  comes  out; on the
contrary, its violence  is  occasionally increased  till  after the
fading of the eruption.  Whether the  fever subsides or not,
the cough commonly continues with great severity for a con-
siderable time; and the  difficulty of breathing increases, and
is accompanied with pain  and other symptoms, marking a
degree of inflammation of the chest.  This tendency to in-
flammation of the chest and  disorder of  the lungs, is what
renders the measles so troublesome and dangerous a disease;
and in  too many  cases brings on a protracted illness, or
causes sudden death,  when the disease appears to be going
entirely off.
   The  danger in measles is  owing to the  tendency  they
have to end in acute  catarrh, or inflammation  of  the  lungs;
but in some rare  epidemics, they have been known to assume
a putrid or malignant form.   The time when  measles gene-
rally make their appearance  as  an epidemic, is about the
month of January, and they continue till some time in May;
though, from particular  circumstances, there may be cases at
any time; and, from  the numbers that  generally take them
in  one epidemic, the measles are not very  prevalent  each
successive year, but  intermit  for  a year or two, till  a new
succession of subjects for the disease comes into existence.
   It is  a matter of high importance to regulate the  tempera-
ture in  which patients should be kept during measles.  Hap-
 pily the absurd and destructive practice of loading the patient 
MEASLES.
Ill
with bed clothes, and heating his system by hot rooms  and
large fires, and by giving strong aromatics and stimulants, is
now almost universally exploded;  and in no class of  dis-
eases has a return  to  a better  plan  been more beneficial,
than in eruptive diseases.  The safe and rational plan is
to keep the patient in measles in an equal moderate tempera-
ture, avoiding all unnecessary, artificial, and external heat,
and taking care  that the  patient, on  the other hand, be not
exposed to cold.  In the early stages  of measles, the fever is
sometimes of the most  alarming appearance, and requires the
abstraction of blood from  the arm;  but in general, the symp-
toms are light, and  it is not necessary to do any thing more
than to  supply  the patient  plentifully  with mild, diluent
drinks, to administer a gentle laxative, and to sponge the
head  and temples with tepid vinegar and water; or if the
eyes be  much affected, to  apply tepid milk and water to
them.   If the oppression  and  difficulty of breathing be great,
before  the eruption comes out, it is of great service to put the
patient into the warm bath, and to repeat this once or twice,
if the urgency of the symptoms continues; in general, this
helps out the  eruption, and relieves the patient.
   Some physicians of great ability  recommend an emetic as
always useful  at the commencement  of the disease, and the
practice is worthy of attention.  After it has operated, a pur-
gative  medicine  may be given and repeated, so as to preserve
the bowels in  a lax state:  as Epsom salts, one ounce; tartar
emetic, two grains; water, eight ounces; dose, a tablespoon-
ful every two  hours.  The diluting drinks recommended in
inflammatory  diseases—such  as barley water, tamarind  tea,
and  the like—should  be taken  freely;, and all  animal  food
and stimulating liquors  must be  avoided.
   But when  the symptoms are  severe, and there  is a  good
deal of pain the chest, with difficulty  of breathing, blood-let-
ting must be  resorted to; as, in  addition to the  object to be
fulfilled in mild cases, we have here to prevent or remove in-
flammation in the chest.   It  is  seldom, however, that these
symptoms come on till the eruption is going off, and the ab-
straction  of blood  should never be  resorted to early in the
disease, unless it be clearly necessary.   Under  the circum-
stances just  stated, of great difficulty of breathing, and an
unusually hard pulse, from six to eight ounces of blood should
be taken from the arm; and if these symptoms continue  little
or not at all relieved by  the  first evacuation, the operation 
112
MEASLES.
should be repeated to the same extent.   The  application of
leeches to the  chest is often  advisable, in  addition  to the
general bleeding.   After the loss of blood, a blister should be
applied over the chest;  the  purgative solution with  diluting
drinks, and a low diet, being resorted to, as just advised.  In
the severer forms, the diet, of course, must be very spare and
low, and  the purgative medicine may be administered a little
more freely than is necessary under the milder attacks.
  With regard to exercise, if the patient find himself inclined,
from the commencement, to remain in bed, he should not be
prevented; at the same time, there is no occasion to confine
him to it against his inclination.   In all cases, towards the
period of the eruption, he feels fatigued, and averse to mo-
tion.   Whether he be in bed  or not, extremes of heat  and
cold are  equally to be avoided.  If cough be  troublesome, it
will be useful to breathe the steam of warm water, not through
an  inhaler, but over  a large  basin, with the head  covered
with a flannel large enough to hang over its  edges;  by this
means the inflamed eyes will also have the benefit of the re-
laxing vapour.
  If the  oppression of the chest, pain, and hard pulse, should
return, as they are apt  to do  on the disappearance of the
eruption,  blood-letting  or cupping  must again be  had  re-
course to, however  freely  they may have been employed
before.
  Opium should never be given to relieve the cough, as it
generally fails in effecting this object, and always increases
the fever and restlessness.  One of the best medicines for this
purpose,  after  the use of the lancet has been carried to a
proper extent, is the following:—Extract of hemlock, extract
of henbane, of each, half a drachm ;  ipecacuanha, in  powder,
twelve grains.—Mix,  and divide into twelve pills; one to be
taken three times a day.  From half a pill to a pill may be
given to children above a year old, and below ten years.
   In  measles a spontaneous  looseness  proves the most fa-
vourable crisis.  When moderate, it should not be interfered
with, and even when  it appears excessive, only the  mildest
astringents should be given in small doses, so as to lessen,
but not altogether to  remove it.
   In case the measles should suddenly disappear, endeavours
should be immediately resorted to  in  order  to  restore  the
eruption to the skin.   The  patient must be placed in a warm
bath, blisters be applied to  the inside of the  thighs or  legs, 
HOOPING-COUGH.
113
and to the chest, and a little warm lemonade be given fre-
quently, with ten drops of antimonial wine every hour, which
may be taken either by itself, or in warm balm tea.
  Some of the  most troublesome  consequences of measles
are, a hoarseness, cough, shortness of the breath, and inflam-
mation  of  the eyes.   The hoarseness  is often best removed
by astringent gargles, when there is no fever nor difficulty of
breathing.   For the  cough,  we would recommend the pills
above prescribed.  A gentle  purgative  frequently relieves  the
shortness and difficulty of breathing; and, if that fail, a blis-
ter to the  breast, frequently  repeated, or the  tartar  emetic
lotion, rubbed freely into the same  part,  are the best means.
To moderate and remove the inflamed state of the eyes,  ex-
posure to  the light should  be avoided, and the  eyes be fre-
quently washed  with a lotion,  composed  of ten grains of
sugar of lead, one ounce of water, and half an ounce of rose
water.  After the inflammation has been subdued by means
of quietude, low diet, and exclusion from the light, and  the
complaint  assumes an indolent character, one of the most
efficacious  remedies is the diluted ointment of nitrated quick-
silver, or citrine ointment.
  It is, however,, to be remarked, that blood-letting sometimes
removes, most   promptly,  the symptoms  remaining  after
measles.  Thus it will remove cough,  although  unaccompa-
nied by fever, or the  other symptoms denoting inflammation.
It may, therefore, be  tried  to a small extent, when the pre-
vious means fail to remove the cough,  difficulty of breathing,
and other symptoms  above mentioned.
  It will be necessary cautiously to avoid  exposure to cold,
for some time after the patient has recovered.

                  HOOPING-COUGH.

  Hooping-cough or  pertussis, is  most commonly a disease
of childhood; adults,  however, are by no  means exempt from
it.  It seldom attacks the  same individual more than once.
It usually commences with  a dry cough, hoarseness, slight
fever, and the other symptoms of ordinary catarrh, with which
the  disease is  generally confounded  in its  forming  stage.
The cough becomes  by degrees more harsh, and assumes  the
peculiar sound and paroxysmal character by which hooping-
cough is characterized.  The above symptoms may continue
several days, before  the cough acquires the hooping  sound.
       15                  k2 
114
HOOPING-COUGH.
Its peculiar characteristics, after the disease is fully formed,
consist in the act of expiration being  repeatedly interrupted
at short  intervals, each  interruption  being succeeded by a
long effort at inspiration, accompanied with a sharp, hissing
or wheezing sound.  The fit  of coughing continues in the
same manner, until at length a copious expectoration of glairy
mucus, or vomiting takes place, by which the fit is terminated.
The fits  of coughing occur irregularly, and are often numer-
ous throughout the day and night   The violence of the dis-
ease is proportionate to  the  duration and intensity  of the
paroxysm, previously to  expectoration  or vomiting  taking
place. Sometimes the fit does not continue but a few minutes,
while at  others it endures a much longer period.   The pa-
tient is made aware of the approach of a paroxysm of cough-
ing, by a slight irritation  felt in the throat, in  consequence
of which he throws  himself upon  his knees, seizes hold  on
some object near him, or desires his head to be held fast by
his  parents or nurse.  The  paroxysms follow each other
more frequently, and are  more  severe during the  night than
in the day.  The ordinary interval between  them  varies in
almost every case; every sudden emotion or rapid movement
of the body; a fit of crying or  anger;  the inhalation of irri-
tating substances, &c, are so many  causes capable of exciting
a paroxysm.  When the  paroxysm of coughing commences,
the  patient  is affected with great  anxiety; the face  swells,
and becomes flushed; the eyes protrude and are filled with
tears; and  if the disease  be violent, the face  becomes of a
dark red  or purple hue; the eyelids swell; the eyes appear
starting from their sockets; the neck is tumid, and at every
accession of the  cough the child  appears to  be threatened
with apoplexy, suffocation or strangulation.  The general
health of children labouring under this disease is seldom much
impaired, and the little patient will rise from his knees, upon
which he had thrown himself  at the  commencement of the
fit, and return with  unimpaired spirits to his play.   After a
violent fit, also, has terminated by vomiting, he will call for
food, and eat  greedily and voraciously.  In the intervals of
the paroxysms, indeed, we would scarcely suspect that he
was labouring under disease.   After hooping-cough  has con-
tinued some time, it is attended with expectoration, frequently
tinged with blood, which infants often  swallow, and which
even those  who  are older do not readily discharge.  The
disease is not always accompanied  with fever, excepting 
HOOPING-COUGH.
115
in its early stages; when present, the fever  resembles that
which accompanies catarrhal complaints, and has a paroxysm
every evening.  Hooping-cough  is a  disease of uncertain
continuance; after an indefinite time, the symptoms gradually
abate, until at length nothing remains excepting a harassing
and frequent cough,  unaccompanied, however, with the pe-
culiar marks by which it was characterized in the height of
the disease.   This ordinarily ceases  after a few days, and
the patient returns very quickly to a state of health. In some
cases, however, it is kept up apparently by the force of habit,
and continues for months, or even longer.
   The  hooping-cough,  under ordinary  circumstances,   is
rather a troublesome than a dangerous disease.  It is, how-
ever, dangerous in proportion to  its violence and duration;
to the weakness of the constitution  of  those it attacks; it is
also a much more  serious disease  in young infants than dur-
ing childhood or adult age.  In warm climates or in warm
seasons of the year, it attacks with less violence and is of
shorter duration, than under opposite circumstances.
   In infants,  particularly those of  a delicate or unhealthy
constitution,  it is  apt to produce  convulsions,  suffocation,
apoplexy, inflammation or  dropsy of the brain, or ruptures;
a moist skin, warm extremities, open bowels, and free  vomit-
ing, are favourable symptoms. When hooping-cough is very
violent or long  continued, it is  apt, in the  predisposed, to
produce  a diseased  condition of the  lungs, attended with
hectic fever, and other symptoms  of consumption; or a state
of extreme emaciation may be induced, finally terminating
in death.   When  the  paroxysms are violent, it is said that
death may be produced  by the rupture of a blood vessel in
the brain, or by suffocation;  we believe, however, this to be
a rare occurrence.
   With respect to the treatment of hooping-cough, this dif-
fers considerably, according to the violence and nature of the
symptoms, and the stage of the  disease.   In the very com-
mencement, the remedies  are the  same as in the forming
stage of  catarrh; and  we have reason to believe, that at its
very onset, by an  emetic, followed  by a warm  bath, and an
opiate  combined with some diaphoretic, adapted to the age
of the patient, we should in most instances be enabled greatly
to diminish the violence and  curtail the duration of its sub-
sequent symptoms.   When the disease is fully formed, if the
patient be of a robust or full habit; if there be much difficulty 
116                  HOOPING-COUGH.
 of breathing, or if the other symptoms of the paroxysm be
 of considerable  violence, particularly if there  be fever, and
 an evident determination to the head, bleeding from the arm.
 or locally from the  head and chest,  by cups or leeches, will
 be demanded; and a quantity of blood should be thus drawn
 off, graduated by the urgency of the  symptoms, and the age
 and strength of the patient; although, in every case of hoop-
 ing-cough, bleeding will not be demanded; yet, under cir-
 cumstances similar to those we  have enumerated, its neglect
 would be attended with serious  consequences.
  Emetics are the  remedy from which the most advantage
 will be derived in  this  disease.   To do good, however, the
 operation of the emetic should be frequently repeated; at
 least once in the twenty-four hours during the first stages of
 the disease, or as long as the paroxysms recur with violence.
 In  cases attended, however, by the symptoms  indicating
 blood-letting, the use of the emetic  should be preceded by
 the lancet, cups  or leeches,  according as circumstances may
 require.   During the intervals of vomiting, the exhibition of
 nauseating doses, either  of tartar emetic or ipecacuanha, will
 generally produce decided relief.  Subsequent to the opera-
 tion of the emetic,  Dr.  Pearson has  recommended a combi-
nation of opium, ipecacuanha, and carbonate of soda, accord-
ing to the following formula: tincture  of opium, one  drop;
wine  of  ipecacuanha, five drops; carbonate of  soda, three
grains; water, one drachm; which is the dose for a child a
year old,  to be repeated every three hours.
  Blisters to the chest or to the back, between the shoulders,
 are in many cases productive of the best effects.  There are
few cases marked with any degree of violence in which they
should not be applied; but  in milder cases, a warm plaster,
or embrocations  to the spine, with some stimulating liniment,
may in general supersede the use of blisters. The most com-
mon stimulants employed for this  purpose are  garlic, cam-
phor, ammonia, and the spirits of turpentine and oil of am-
 ber.   As  the local  stimulating  effects  of the remedies are
those from which the benefit is to be  derived,  any of the
 class may be made use of.
  The bowels in hooping-cough are to be kept freely open
 during the whole continuance of the disease, though we are
 not convinced that any advantage will be derived from active
 purging.   The castor oil, senna tea, or in  older  children
 calomel, followed by castor oil, will in  most cases fully answer 
CROUP.
117
 our purpose.  These articles  are to be repeated as occasion
 may require.
   After the disease  has passed through its first  stages, and
 appears to  consist almost entirely in a spasmodic affection
 of the respiratory organs, unattended with  inflammation  or
 febrile excitement, the  treatment  consists almost entirely in
 the exhibition of antispasmodics, narcotics and tonics, certain
 articles of each of which classes have been supposed more
 particularly adapted to  the disease before us.
   The best article at  the stage  referred to, is, perhaps, a
 watery solution of assafcetida; when properly timed, it will
 seldom be found to fail in very speedily removing the cough
 and other remaining  symptoms.   The only difficulty is that
 some children cannot be  prevailed  on to take it, in conse-
 quence of its nauseating smell and taste.  The dose must  of
 course be adapted to the  age of the patient
   Besides the above, various  other remedies have been pro-
 posed ; we believe, however, that  the above are  those upon
 which our dependence  should be chiefly placed.
   The diet in hooping-cough should be light, easy of diges-
 tion, and  moderate in quantity.  The patient should breathe
 a pure air, and be carefully guarded, by appropriate clothing,
 against cold and damp.   In the chronic form of the disease,
 warm bathing, change of air, and regular gentle exercise, will
 be found  of great advantage.

                         CROUP.

   Croup  is principally, though not solely,  an affection of
 the throat; a quantity of  lymph being thrown out upon the
 inner or mucous membrane of this passage, which hardening,
 forms a false membrane, and  rendering the  passage  narrow,
 obstructs the breathing.   Croup is most frequent  in children
 from the first to the fourth year; and plump, fat subjects are
 more likely to be affected than those of  spare habit.  The
 disease occurs  at  all seasons, but especially at times when
 changes of weather are frequent.  A decisive symptom  is
 the shrill sound  produced by the  passage  of the air  through
 the windpipe, which once heard, can  never be mistaken:  it
 is observed in a few hours after the first  embarrassment  in
breathing  is perceived.  If this sign be absent,  the case can
hardly be  regarded as croup, though the term is often misap^
nlied.   Other  marks  of the disease  are a hoarse, sonorous 
118
CROUP.
breathing, and a husky cough, sometimes wholly dry; but at
others, attended with expectoration of a purulent matter, in
which may be detected fragments of the membranous forma-
tion above named.  The voice is sometimes, but not alwa}s,
altered.  On examining the throat it will be found ot a deep
red colour,  and in the struggles of  the child a large quantity
of pus will often be thrown up on the tongue.   1 he disease,
whether  it terminates  favourably  or otherwise, is ot  short
duration; often only a few hours elapsing before relief is ob-
tained, or death terminates the case.
   In the most dangerous stage or degree of the disease, there
is  often to be  remarked a mottled  complexion, or a circum-
scribed flush in the cheeks.   The  pulse is  small  and quick;
the eyes  prominent and blood-shot; the pupils dilated;  vio-
lent  tossing, with difficulty of breathing.   The immediate
cause of  death is either actual suffocation or the exhaustion
incident  to the rapid  breathing,  the  laborious action of the
heart,  and the imperfect supply of  air.   Frequently, some
hours  before  a fatal  termination, the  little  sufferer  falls
into a state of torpidity, and death is met with surprising tran-
quillity.
   Treatment.—In treating croup, the remedies  principally
relied  on are, bleeding,  emetics, and calomel.   Bleeding is
employed early, not only with the view of relieving inflam-
mation,  but likewise  to diminish the  engorgement  of the
lungs.  Emetics, also,  apart  from their  general  effect, tend
powerfully to produce a dislodgement of the secretion within
the throat.   Calomel has enjoyed a large share of confidence
in croup.   Let the little patient  be bled  very freely at the
commencement of the case.   Then give to a child of three
years old or upwards, a teaspoonful of antimonial wine,  and
repeat it, if necessary, in half an hour.   If the  second dose
do not cause vomiting, double its quantity, unless the case
be very mild.
   Vomiting must be  induced.   If  it  appear not in three
hours, the warm bath must be employed to promote it.  The
vomiting should  be encouraged by warm  drinks; and the
nausea should be continued  for  a few hours by giving a few
drops of antimonial wine occasionally.  The dose for a child
of eighteen months old,  half  a teaspoonful; and  for younger
children, in proportion.  All exposures should be most care-
fully avoided for several days.  When the symptoms  seem
to linger long after the emetic, a blister  to the throat will 
MUMPS.
119
often  give  great  relief.  The hive  syrup, known as Cox's
hive syrup, is a very good and safe emetic for young children.
A single dose of  three or four grains of calomel at the com-
mencement is both safe and advisable.
  The  croup of  adults, though resembling in many respects
that above described, is of much rarer occurrence,  and shows
itself principally in those advanced in life, and of decayed or
broken  constitutions.  It usually involves the epiglottis, and
the other parts concerned in forming  the voice.   There is
more  or less  soreness of the  throat  at  the very commence-
ment  of the attack, accompanied with heat,  and difficulty in
swallowing, but with little or no cough.  The inflamed ton-
sils and pharynx soon become covered with  lymph, and then
pain begins to be experienced in the larynx, and change of
voice occurs, but seldom with those violent paroxysms which
mark croup  in children.   The expectoration, therefore, is
seldom mixed with any solid matter, but consists  principally
of mucus or phlegm, and sometimes of pus.   The disease is
commonly fatal under any mode of treatment.  It was prob-
ably this disease that terminated the career of Washington.
   The  following prescription for children  one  year  old, I
have  generally found to give relief in a short time.
      Take Calomel,                            4  grains.
        *'  Tartar emetic,    -      -     -      -  |  grain.
      In molasses or jelly.
  Then  rub its throat and breast with liniment made of spirits of camphor,
spirits of hartshorn, and goose grease or sweet oil, equal parts.  Half a tea-
spoonful of antimonial wine is also to be given.   The warm bath is good.

                         MUMPS.

   The mumps is a swelling of the  glands about the throat,
which  is  occasionally observed to  be epidemic in certain
districts of this  country.   This disease generally makes its
appearance in spring, and  young  persons of both sexes are
much more liable to be  attacked by it  than  those farther ad-
vanced in life.   It is preceded by  heaviness, lassitude, and a
general sensation of uneasiness, which continue for several
days.  Stiffness,  pain, and difficulty of motion, is then per-
 ceived about the articulation of the lower jaw.   A swelling
 of the glands situated under the jaws, and  diffused over the
 neck,  next  takes place, which sometimes   increases  to so
 enormous a magnitude as greatly to disfigure  the countenance.
 There is a good deal of fever, as indicated  by the increased 
120
MUMPS.
frequency of the pulse. About the fourth day from the com-
mencement of the tumefaction, the disease is at the height
A gentle moisture then begins to exude from the surface of
the swelling, accompanied with a general perspiration of the
whole body, which, if it be encouraged by keeping warm in
bed, and drinking diluent fluids, appears to form the natural
crisis  of the  disease,  and the whole terminates  favourably
about the sixth day.
  But if, from  exposure  to  cold, or improper management,
this natural  process of the disease be interrupted, a singular
translation of the morbid action takes place.  The tumors
about the throat suddenly subside, and are followed by swell-
ings of the testicles in the male sex, and of the breasts in
the female, accompanied with  a fresh exacerbation  of the
fever.    If the  swellings of  these  parts  be imprudently-
checked  by exposure to cold,  or if they suddenly subside,
the brain is apt to become affected, occasioning convulsions,
delirium, and other dreadful symptoms, which finally termi-
nate in death.
  In the treatment of this disease, evacuations of  all  kinds
are not only improper, but  dangerous.  If the bowels are
much constipated, they may occasionally be  relieved by a
clyster;  but active purgatives, and blood-letting, must on no
account be employed.  The patient ought to  keep warm in
bed, and encourage perspiration, by drinking plentifully of
diluting liquors: such as mint whey, or balm  tea, with  a few
drops  of spirits of hartshorn.   The effort of nature to resolve
the tumors by exudation, should be promoted by covering the
parts with soft flannel.  If the swellings  show a  disposition
to subside too early, they should be  covered  with blistering
plasters, or rubbed with the volatile liniment.
  Should the tumor, when seated in the testicles,  suddenly
subside, and any tendency  to  delirium  manifest  itself, the
whole scrotum ought, without  delay, to  be enveloped  in a
blistering cataplasm, which is made by sprinkling a little of
the powder of Spanish flies over the surface of the common
poultice.  By this means the disease may be  arrested in the
part occupied  by it, and the dangerous consequences  of its
falling on the brain prevented.
  It is not an uncommon sequel of this complaint, to find
sometimes one and sometimes both testicles, after the inflam-
mation has ceased, gradually shrink in size, and finally wither
wholly away. 
WORMS.
121
                        WORMS.

  There are several kinds of worms which infest the intes-
tinal canal of man, but the chief are the ascarides, or small
white thread worms, mostly found in the rectum, or last gut;
the lumbrici, or long round worms, usually found in the small
intestines; and the taenia, or tape-worm, which occupies the
upper part of the intestinal tube, and is occasionally found in
every part of it.
  Worms can hardly exist  in so sensible and highly organ-
ized a part as the intestines, without producing some degree
of irritation there; and we are certain that irritation cannot
take place in that canal without producing, sooner or later,
and in a greater or less degree, disagreeable effects in various
parts of the system, and especially in the stomach and head.
Hence these animals frequently occasion a variable appetite,
which is sometimes deficient, at other times voracious;  pains
in the stomach; fetid breath;  nausea; headache; vertigo
and giddiness; cough;  irritation about the nose and  anus;
disturbed sleep;  and a disordered  state of the  bowels.   In
children, hardness and fulness of the belly frequently occur,
with frequent slimy stools, and  sometimes  convulsion  fits.
In adults, as well as in children, worms not unfrequently give
rise to  severe epileptic fits, and sometimes occasion great
emaciation.
   Worms most frequently appear  in persons of a relaxed
habit, especially in those whose digestive  organs  are  disor-
dered.   An excessive use of vegetable food, of fruits, of sugar,
or any other saccharine substance, very strongly favours their
generation.   The reason  why  children  are  more  infested
with them than  adults, appears  to be chiefly because they
are allowed to indulge to  excess in  eating sweet things, to
the partial or total neglect of salt.
   Simple irritation of the stomach and bowels will often pro-
duce all the symptoms above  described, and, in  some cases,
it is difficult to ascertain whether worms do or do  not exist
in the bowels, when none  have  ever been discharged.   In
such instances, we can determine the real nature of the case
only by an attentive consideration  of all the symptoms,  and
the patient's habits, more  particularly with respect to the use
of food.                           ■*
   The fundamental principle in the  treatment of worms is,
to restore health to the system  generally, and the stomach
       16                   L 
122                      WORMS.
and intestines in particular, and thus not only to dislodge the
worms, but to render them incapable of reproduction.   On
this principle, it will be found, almost  invariably, that those
medicines and plans of treatment are the most eligible, which
tend directly to invigorate the whole constitution, at the same
time that they expel the worms.
  A great deal has, at different times, been said about the
efficacy of certain medicines in the cure of worms, but many
of these are unnecessary, or even injurious.  There are few
cases which will resist the proper use of salt, more especially
if the usual means of invigorating a weakly constitution be
resorted to, and rich food, flatulent and crude vegetables, and
saccharine substances, be avoided as much as possible.  Salt
is a natural and necessary stimulant to the digestive organs;
it excites them to a healthy and vigorous  action, and is par-
ticularly obnoxious to all kinds of worms.   Persons troubled
with these animals  should, therefore, increase their quantity
of salt at each meal; lessen that of every kind of sweet food;
avoid partaking much of vegetables; regulate the bowels by
the occasional employment  of a purgative:  as castor oil,
magnesia  and rhubarb, or a pill of three grains of soap, two
of aloes,  and  one of gamboge, and  avail themselves of the
usual means of strengthening the general habit, by having
recourse to active exercise daily, early  rising, the use of the
tepid bath, frictions of the skin, &c.   These  measures are
highly advisable and  useful, whatever  kind of medicine be
employed.   At the same time, a dose of salt and water—for
example, an ounce or two of common salt, dissolved in nearly
half a pint of water, should be taken in the morning, fasting,
and  repeated  at the  end of three  or four days.   This will
generally act as a purgative, and will  certainly bring away
almost every  kind  of worm.  If necessary, the  repetition
may be extended to a third or fourth time, and in very severe
cases, the  quantity of salt used at each dose may be increased
to three or four ounces.
  This plan is applicable to the cases of children, as well as
to those of adults.   As a purging potion for young  children,
half  an ounce of salt, dissolved  in  a  quarter  of  a pint of
water, will usually be sufficient.
  For tape-worm, the oil of turpentine is an effectual remedy
An ounce may be given to an adult, or half an ounce to a
child, and  may be repeated the second or third time in the
course  of a fortnight.  It may be swallowed simply suspended 
EAR-ACHE.                    123
in water.  It is seldom advisable to repeat it more than three
times, unless under the direction of a medical practitioner.
  In the small white thread worm, so often infesting the last
gut in children, half a pint or a pint of lime water should be
injected once a day, and calomel and jalap, or a dose of cas-
tor  oil, be given  once a week, for three  or four weeks.   Or,
instead of the lime water, a strong  decoction of wormseed,
or a solution of salt and water, may be injected after the same
manner.   This plan is generally successful.
  The bristly down of the pods of cowhage is also a power-
ful  remedy for worms.
  A great number of other medicines have been recommend-
ed : as pink root, tin filings, male fern, tansey, rue.  Several
of them are very useful; but the preceding remedies are the
most  powerful  and the best,  and will very rarely fail in  af-
fording satisfactory relief.
  Worm lozenges, and other patent medicines sold for the
cure of  worms, are composed chiefly of calomel, or  some
other active purgative.  They  are, no  doubt, sometimes
beneficial, but the foregoing measures are by far more eligi-
ble, and those who adopt them will find no need of resorting
to any secret preparation.

                       EAR-ACHE.

   This disorder chiefly affects the membrane which lines the
inner cavity of  the ear, called the  meatus auditorius.  It is
often so violent as to  occasion  great  restlessness, anxiety,
and even delirium.  Sometimes epileptic fits, and other con-
vulsive disorders, have been brought on by extreme  pain in
the ear.
   The  ear-ache may proceed from any of the causes which
produce inflammation.  It often  proceeds from  a  sudden
suppression of the perspiration, or from the head  being  ex-
posed to cold when covered with sweat.  It may also be oc-
casioned  by worms or  other insects getting into the  ear, or
being bred there; or from any hard body sticking in the ear.
Sometimes it proceeds from the translation of morbific mat-
ter to the ear.   This often happens in the decline of malig-
nant  fevers, and  occasions  deafness, which  is generally
reckoned a favourable symptom.
   When the ear-ache proceeds  from insects, or any hard
body sticking in the ear, every method must be taken to re- 
124
EAR-ACHE.
move them  as soon  as  possible.   The  membranes may be
relaxed  by dropping  into the ear oil  of sweet almonds, or
olive oil.  Afterwards the patient should be made to sneeze,
by taking snuff, or some strong sternutatory.   If this should
not force out the body, it must be  extracted by art.   I have
seen insects, which had got into the ear, come out of their
own accord  upon pouring in oil.
  When the pain of the ear proceeds  from inflammation, it
must be treated like other  topical  inflammations, by a cool-
ing regimen, and  opening  medicines.  Bleeding at the  be-
ginning, either in the arm or jugular vein, or cupping in the
neck, will be proper.  The ear may  likewise be fomented
with steams of warm water;  or flannel bags filled with boiled
camomile  flowers, may be applied to  it warm; or bladders
filled  with warm milk  and water.  An exceedingly good
method  of fomenting the ear is to apply it close to the mouth
of a jug filled with warm water,  or a strong decoction of
camomile flowers.
  The patient's feet should be frequently bathed in lukewarm
water, and he ought to take small doses of nitre and rhubarb,
viz., a scruple of the former, and ten grains  of the latter,
three times a day.  His drink may be  a  decoction of barley
and liquorice, with figs or raisins.  The parts behind the ear
ought frequently  to  be  rubbed  with camphorated oil, or a
little  of the volatile  liniment, and a few drops of the cam-
phorated spirits of wine may be  put into the ear with wool or
cotton.  A  blister behind the ear, applied early,, will some-
times remove the complaint.
  When the inflammation cannot be discussed, a poultice of
bread and milk, or roasted onions, may be applied to the  ear,
and  frequently  renewed, till the abscess breaks, or can be
opened.  Afterwards the humours may be diverted from the
part by  gentle laxatives, blisters, or issues; but the discharge
must not be suddenly dried up by  any external application.
  Ear-ache sometimes continues for some time without  any
apparent inflammation,  and is  then frequently removed by
filling the ear with cotton  or wrool, moistened with tincture
of opium or ether, or even with  warm  oil or water.   Pain in
the ear is also sometimes the consequence of a diseased tooth,
in which case the ether should  be applied to the cheek over
the  suspected tooth, or a grain  of opium with a little cam-
phor, or half a grain of the extract of belladonna may be ap-
plied to the tooth itself. 
FLUOR ALBUS.
125
             FLUOR ALBUS, OR  WHITES.

  Some women are subject to a discharge of a fluid, usually
light coloured, but occasionally green or yellow;  sometimes
it is  thin, at others, thick and adhesive.  The  quantity va-
ries in different persons, and  at  different times in the  same
person.  In some individuals it gives no uneasiness, while in
others it  occasions much constitutional disturbance, breaking
down the health of the strongest female by slow degrees.
  This discharge is a symptom  in various  affections of the
uterus and vagina.  Great mental emotions, severe labours,
chronic inflammation, or organic disease of the vagina, or
uterus; a displacement of the latter organ, or unsuitable in-
struments  introduced into the  vagina, to  support it,  often
produce  irritation and discharge.  To relieve this complaint,
when there is no organic disease of the uterus, let the patient
pay  strict attention to the cleanliness of her person in gene-
ral, and of the parts whence the fluid escapes.   If she have
pain in the back, quick pulse, and headache, with fever, let her
lose  a few ounces of blood from the arm;  let her bowels be
purged with Epsom salts or magnesia, alone, or with rhubarb.
Keep her quiet for several days, in  a horizontal position, till
the pain in the  head and  back, and the fever, are relieved;
after this, she may use a solution of a drachm of alum,  in six
ounces of water, cold or warm, at  option,  or half a drachm
of sulphate of zinc, dissolved in six ounces of rose water;  a
part of this to be thrown into the vagina, by a proper female
syringe,  two or three times a day.   A tea made  of the black
oak  bark, or a weak infusion of nut-galls, sometimes answers
a very good  purpose as an injection, as also does  lead water.
All the vegetable injections, however,  should be  avoided  as
long as there is heat in the parts.   Cold water alone, several
times  a  day, will be very useful till  the  inflammation has
passed away, or has  been much reduced.  Warm clothing
should be  worn about the waist and lower extremities of all
women  subject to this  affection.   Flannel drawers  should
always be used in cold weather.

           SUPPRESSION  OF THE  MENSES.

   The woman may have been "right," or "regular," for a longer
or shorter period, yet owing to some  such  cause as getting
her  feet wet, or being in other respects out of health, the dis-
                            l 2 
126
SUPPRESSION OF THE MENSES.
 charge may not recur, though she may have the premonitory
 symptoms  in a greater degree than usual.   There  may be
 headache, pain  in the bones, and especially in the back, with
 fullness;  bearing  down, and a distressing irritation  of the
 bowels, but no  discharge from the uterus.  Now the  condi-
 tions of the system under  which  this  occurs, are various.
 The patient may be either in a state of vascular excitement,
 or she may have spasms of the uterus.   If she have  fever,
 headache, a rapid and  full pulse, a  hot  skin,  thirst, and ten-
 derness over the uterus, her case is to be treated by bleeding
 from the arm till she becomes pale; free purgation by salts;
 confinement to bed; low diet, and  leeches to  the vulva, or
 cups to the inner side of the thighs.  When the inflammatory
 action is reduced by these means, the discharges will  prob-
 ably return, and continue, unless interrupted by some new
 cause.
  If the patient be  thin and delicate, and of a nervous con-
 stitution, the same causes which excited inflammation under
 the circumstances just described, may occasion the spasmodic
 contraction of the uterine vessels, and thus give rise to sup-
 pression of the  menses.   The patient, instead of being fever-
 ish, will then be chilly, with cold extremities; and although
 she will suffer  some pain, there will  not be any particular
tenderness  on pressure  over the region of the uterus.  In this
 condition, the  patient  should be treated  by means  of the
 warm hip  bath; warm  drinks—such as barley water, rice
water, infusion  of catnip, or very weak  pennyroyal tea, and
 a Dover's powder, in doses—of each, five grains every three
 or four hours, till the pain abates.  Two  drachms of assa-
 fcetida, dissolved in six ounces of hot water, used as an injec-
 tion, often  acts with great promptitude.   If it  do not give
 relief in  a short time,  half the quantities  may be repeated
 with the addition  of fifty drops  of laudanum.   If now no
 menstrual action takes place, we consider the  case  as one
 of obstructed menstruation.

  Obstructed  Menstruation.—By this term  we mean a
 suppression of some standing.  In this form of the complaint,
there are generally some symptoms which resemble those of
 prolapsis.   The appetite  fails,  or  becomes deranged; the
 patient is often afflicted with headache, dropsical swellings,
 and  many  other disturbances, which sometimes  involve the
 mind itself, causing even insanity.   In some women the 
PAINFUL MENSTRUATION.
127
digestion alone  is affected.   If we know that conception
and  pregnancy  are not  the  cause of the suppression, the
remedies recommended under the head of prolapsus, will be
proper;  but it may be  added  that the patient who has once
menstruated freely, is generally capable of bearing the loss of
more blood than the chlorotic female.  An excellent prepa-
ration for the purpose of keeping up the regular action of the
bowels, and exciting a  disposition to menstruation, is the fol-
lowing combination:—

    Take Powdered rhubarb,      -     -      -     1 drachm.
     "      "   aloes,    -      -      -      -   l  do.
     "  Castile soap,    -      -     -      -     8  do.
     "  Oil pennyroyal,    -      -      -      -   2 drops.
  Mix them, and divide the mass into forty pills.  Let two pills be taken
every morning and  evening, till they operate; then, one  or two  daily to
keep the bowels open.

   For that obstruction which accompanies consumption, two
grains of aloes, with two grains of the dried sulphate of iron,
and  Venice turpentine, enough  to  make them adhere, may
be given two or three times a day for some time.

           OF PAINFUL MENSTRUATION.

   Some  females are regular enough as to the  periods of their
monthly  "visitation;" but are  annoyed greatly,  at  these
times, by the pains they  experience in the lower part of the
abdomen, resembling  colic or diarrhoea, obliging them to
make frequent efforts  to relieve the bowels.    This distress
commonly  lasts  only for a few hours;  and  when the dis-
charge is established, it passes away; but,  in other  cases,
there are severe  pains, darting through the  loins and  pubes,
attended with an excessive  tightness about the  head, and
weakness of the knees,  for some time previous  to the dis-
charge.   The flow now occurs, not in the thin, fluid form
which it usually presents, but in flakes or little masses, some-
times resembling a false  membrane which has  lined the  in-
side of the uterus.  The whole  amount  of the discharge is
generally less than when the secretions are healthy, though
sometimes, after the membranous matter is  thrown off, the
thinner discharge is so abundant as to enfeeble the patient
very much; indeed, she  always feels more exhausted after
painful  menstruation, even though the  secretion be   small.
While this state of things exists, the woman  has  but a slen- 
128          FINAL  CESSATION OF THE MENSES.

der chance of becoming a mother.  In the treatment of this
distressing  affection, two things are to be  done.   V irst, to
relieve the paroxysm.  If the patient have a flushed face, a hot
skin, full, active pulse, and  tenderness  on pressure upon the
uterus, she  should be bled, and purged, and  should pass half
an hour in  the hip bath, the temperature of which should be
raised  gradually, from ninety to  one hundred and  ten de-
grees, and  then gradually lowered before she leaves it; she
must abstain from  strong food or heating  drinks.   If, how-
ever, the  woman  have a  feeble, nervous constitution, the
above directions will not apply;  but in their stead, we should
order mild  laxatives; such as a Seidlitz powder or two, or a
teaspoonful of sulphur  and molasses, or a  tablespoonful of
spiced syrup of rhubarb,  combined with  a teaspoonful of
calcined magnesia.  After the operation of this purgative, five
grains  of camphor may be given every two or three hours,
in a little ginger syrup, until  the pain is abated.  We  have
also known  much  good to  result  from the following pre-
scription:—

    Take Prussiate of iron,   -      -      -     -   4 grains.
      " Powdered ipecacuanha,  -      -      -     - \ grain.
     " Powdered opium,   -     -      -      -    1  do.
  To be taken at once in a little syrup or molasses.

   This has afforded instant  relief in several cases in which
there was no inflammation.  The warm hip bath is extreme-
ly useful to delicate and nervous females, at the time of pain-
ful menstruation.
   In the second place, an effort is to be made to prevent the
return  of the pain, &c,  at the next menstrual period.  Upon
very high authority, the volatile tincture of guaiacum is  re-
commended  as the best medicine  for  effecting this object.
If the  patient be free from  any inflammatory disposition, she
is to take  a  teaspoonful of this  preparation, each morning,
noon,  and  evening, in a wine glassful of sweetened  milk, or
a little Sherry, Madeira, or Teneriffe wine.  It is often ne-
cessary to  continue this medicine for a long time.


        FINAL CESSATION OF THE MENSES.

   About the age of forty-five, women, in temperate  climates,
approach the "time of life."  The monthly periods  then be-
come  irregular, the discharge sometimes diminishing very 
FALLING OF THE WOMB.
129
much in quantity, or remaining absent for several months,
and  then  returning so  profusely as to prostrate the patient
very much.   In other cases, the quantity is so small, and
gives so little relief, that the woman  is subject to  giddiness,
dimness of vision, vertigo, pain in the head, or other distress-
ing sensations.   In some instances,  the change takes place
without any disturbance.   Women, in general, look forward
to this period with much anxiety;  for there is a popular be-
lief, not without too  much foundation in truth, that at, or
shortly after, this period, diseases  of the  breast and uterus
exhibit themselves.
   Those who are subject to much pain or inconvenience on
account of this irregularity, should  carefully attend to their
condition.  If  they feel much fulness about the head, with
pain or giddiness, they  should reduce the quantity of food,
and  abstain  from  meat, and all  other  animal substances.
They should keep their bowels free by frequent and  small
doses of Epsom or Rochelle salts, or cream of tartar and sul-
phur; and, if not  manifestly relieved by this course, they
should lose six  or eight  ounces of blood from the arm occa-
sionally ; making the  intervals between the bleedings longer
and longer.   Regular, but not violent, exercise in  the open
air is of the highest importance.

     FALLING OR PROLAPSUS  OF THE WOMB.

   The uterus is so  situated in  the human  female as to be
subject to a variety of displacements, some of which excite
so much  influence on  the health of the individuals who
have  incurred  such accidents, that  a few  observations on
the subject appear peculiarly necessary in a work like the
present.
   The most  common displacement is, perhaps, the descent,
falling, or prolapsus of  the womb.  In this case the uterus
becomes too much  depressed towards the  bottom of the
vagina, so that  its mouth lies upon the lower surface of the
passage, producing  a slight bearing-down sensation in the
part, and  some dull or acute pain  in the back,  especially
when the patient is long upon her feet.   This pain disap-
pears soon after lying  down, and the patient rises in the
morning apparently well; soon after the business of the day
commences, her pain and  distress return.  A discharge of
       17 
130
FALLING OF THE WOMB.
 whites now presents itself, if indeed it have not preceded, or
 caused the accident.   The inconvenience goes on increasing
 under common exercise, till the patient becomes feeble, ner-
 vous  and dyspeptic;  the local suffering may now become
 worse, or it may be lost in the impression of pains low down
 on the  left side of the abdomen, and under  the  short rib;
 dragging and distressing soreness about the loins, tenderness;
 dragging and colic; pains about the umbilicus, and perhaps
 costiveness, and painful or difficult urination.   The causes
 are a sudden fall, lifting a heavy weight, and tight lacing.  A
 walk, or ride, over a rough road may also sometimes pro-
 duce  sudden  displacement.
   Symptoms.—When in an erect position, the patient com-
 plains of an  aching  in the  back, or a dragging  sensation
 about the loins; a sense of weight upon the  lower part of
 the vagina, as if something were falling through; a bearing-
 down sensation; pains in the  hips and thighs,  and frequently
 a sense of weight about the anus;  and if much standing, or
 long walks, aggravate all these symptoms, and a few hours
 in the recumbent  posture, either mitigate or cause them to
 subside, she has good reasons to suspect that  she is afflicted
 with  Prolapsus Uteri.
   It  often happens that  the  uterus has been suddenly de-
 pressed almost to the  orifice of the vagina, pressing upon the
 rectum  and neck of the  bladder, so much as to cause the
 inclination to evacuate them.  If this state of things be long
 neglected, the bladder  may  almost  assume  the  position
 of the uterus, and the latter  may  slip  entirely out of the
 body.  In such case the whole organ is suspended  between
 the thighs of the wretched  patient, and her sufferings com-
 monly exhaust her physical and mental energies.   Yet  such
 is the vigour  of constitution in some women, that they move
 about, and attend to  laborious business without evincing, to
 a mere spectator, the existence of any special disorder.  This
 sudden  affection is to be treated by rest on the back in bed,
 with  the hips raised, when the displacement  is in the first
 stage, and of recent  occurrence.   The same  remedies are
 proper when  the disorder has reached the second stage, (the
 mouth of the womb presenting at the  external orifice,) ex-
 cept that it is then often necessary to restore the  womb to
its natural situation by pressing it  upwards and backward
by a finger or two  passed into the vagina.  If there be any
pain in this operation, the vagina should be well washed by 
FALLING OF THE  WOMB.
131
injections of thick flaxseed or slippery elm bark tea, for  a
day or two before the astringent washes are used.
  When the womb has passed completely out of the vagina,
which is always drawn down  and inverted, the parts some-
times become suddenly so swelled that it would be impossible,
as well as improper, to return them at once.   The inflamma-
tion is to be reduced by leeches, ice water, or warm foment-
ing  poultices  of bread  and  milk, or  hops and flaxseed,
continually  applied until the  swelling and pain subside;
then, with  the  hand well oiled, and the patients hips well
elevated upon a cushion or pillow, at  the edge of the bed,
the organ is to be passed carefully within  the vagina, and
restored to its natural situation.  The uterine  supporter  is
then to be applied.   The bowels and bladder must be regu-
larly evacuated; but the patient should not be allowed to
rise for several days, and should even then assume the upright
position very  gradually  and  cautiously, after  having  used
anodyne and  astringent injections.   The  injections to  be
used should be made of the following ingredients.
   Take one  drachm of alum and dissolve  it in half a pint
of clear water;  or, half an ounce of the inner bark of the
black oak, with three gills of water, boil down to  a half pint
and strain.   Two  ounces of either  of  these  preparations
should  be  injected into the vagina, by means  of a syringe,
the  extremity of which should be perforated with a number
of  orifices, to convey the fluid to the different points of the
surface on which it is to act.
   This operation should be repeated twice a day  for  a week
or more, the syringe being always well lubricated with lard
or oil, that it  may be introduced without difficulty or pain.
From thirty drops to a teaspoonful of laudanum may be
used in the  injection, when  there is much sensibility; and
this  may be repeated every day or two till the sensibility
disappears.   The patient may now be allowed to move about
her room, and if she  discovers no  return of the  symptoms,
she may gradually resume her domestic duties, avoiding for
a long time any efforts at lifting, long walks, &c.
   In all cases where  the above symptoms are  manifest, the
uterine supporters, such as are now made  and used in the
city and county of Philadelphia, should be  immediately ap-
plied; they are decidedly* the  best instrument  that has yet
been made, and in most cases they have effected an entire
cure in a very short time. 
132                   ABORTION, &C.
                    ABORTION, &c.

   Every pregnant woman is more or less in danger of abor-
tion.   This should be guarded against with the greatest care,
as it not only weakens  the constitution, but renders the
woman liable to the same misfortune afterwards.*   Abortion
may happen at any period of pregnancy, but it is  most com-
mon in the  second or third month.  Sometimes, however, it
happens in the fourth or fifth.  If it happens within the first
month,  it is  usually called a false conception; if after the
seventh month, the child may often  be kept alive by proper
care.
   The  common  causes of abortion  are,  the  death of the
child; weakness or relaxation of the mother; great evacua-
tions; violent exercise;  raising great weights; reaching too
high; jumping, or stepping  from an eminence; vomiting;
coughing; convulsion fits;  blows on the belly; falls; fevers;
disagreeable  smells;  excess of  blood; indolence;  violent
passions or affections of the  mind, as fear, grief, &c.
   The  signs of approaching abortion are, pain in the  loins,
or about the bottom of the  belly; a dull heavy pain in the
inside of the thighs; a slight degree of coldness, or shivering;
sickness; palpitation of the  heart;  the  breasts become flat
and soft; the belly falls, and there is a discharge of blood or
watery humours from the womb.
   To prevent abortion, we would advise women  of weak or
relaxed  habit to use solid  food,  avoiding great quantities of
tea, and other weak and watery liquors; to rise early and go
soon to bed; to shun damp houses; to take frequent exercise
in the open air, but to avoid fatigue; and never to go abroad
in damp foggy weather, if  they can help it.  Women of full
habit ought to use a spare  diet, avoiding strong liquors, and
every thing  that may tend to heat the body, or increase the
quantity of  blood.  Their diet should be of an opening na-
ture, consisting principally of vegetable substances.  Every
woman with child ought to be kept  cheerful and easy in her
mind.   Her  appetites, even  though depraved, ought to be
indulged as  far as prudence would permit.
  * Every mother who procures an abortion does it at the hazard of her life • vet
there are not a few who run this risk merely to prevent the trouble of bearing
and bringing up children.  It is surely a most unnatural crime, and cannot, even
in the most abandoned, be viewed without horror; but in the decent matron it
is still more unpardonable.                                     ' 
ABORTION, &C.
133
  When any signs of abortion appear, the woman ought to
be laid in bed on a matrass, with her head low.   She should
be kept  quiet, and her  mind  soothed and comforted.  She
ought  not to be  kept  too hot, nor to  take any thing of a
heating nature.  Her food should consist of broths, rice and
milk, jellies, gruels made of oat meal, and the  like,  all  of
which  ought to be taken cold.
  If she be able  to bear it, she should lose at  least  half a
pound  of blood from the arm.  Her drink ought to be  barley
water,  sharpened with the  juice of lemon; or, she may take
half a  drachm of powdered nitre,  in  a  cup of water gruel,
every five or six hours.  If the woman be seized with a violent
looseness, she  ought to drink the decoction of calcined
hartshorn prepared.  If she  be affected with vomiting,  let
her take frequently two  tablespoonsful of the saline mixture.
In general, opiates are of service;  but they should always be
given with caution.
  Sanguine robust women, who are  liable to miscarry at a
certain time of pregnancy, ought  always  to be  bled  a few
days before that period  arrives.  By this means,  and observ-
ing .the regimen  above prescribed, they might often escape
that misfortune.
   Though we recommend due care for preventing abortion*
we would not be understood  as restraining pregnant women
from their usual exercise.  This   would  generally operate
the quite contrary way.  Want of exercise not only relaxes
the body, but induces  a plethora, or too  great a fulness  of
the vessels, which are  the two  principal  causes of abor-
tion.   There  are, however, some  women  of  so delicate a
texture, that it is necessary for them to  avoid almost every
kind of exercise during the whole period of pregnancy.
  Where abortion  cannot be prevented, the next  indica-
tion is to conduct the patient  safely through the process,  by
directing  our  immediate  attention to the  hemorrhage;  to
check  which, bleeding is  resorted to  by some practitioners;
but,  unless  the  vessels be above  their  natural force and
strength  of action, it  is  not  likely  to be of any service.
Astringent injections, composed of alum, oak bark, or sul-
phate of zinc, and cold applications to  the loins, &c, are
often employed in  floodings;  and  where the hemorrhage  is
slight,  these immediately will  prove beneficial"; but in flood-
ings without any remission, they do not appear calculated to
afford  much relief.  In such cases it will be better to trust to
                           M 
134
ABORTION, &C.
the formation of a coagulum:  enjoining rest, giving an ano-
dyne  at bed time, and keeping the  bowels open by some
gentle aperient.  But, where these means have been pursued
without effect, and the woman becomes exposed to imminent
danger from great loss of strength, the most powerful astrin-
gents  must be employed; such as the sulphate of zinc* and
superacetate of lcad;f of the  last, one, two, or three grains
may be given, repeating the dose every three or four hours
according to the urgency of the case.  As soon, however, as
the hemorrhage has  stopped, give a dose of castor  oil in
order to prevent any bad effects from the action of these re-
medies on the coats of the stomach and intestines.   The
application of cloths  dipped in  cold  water to the back  and
external parts will have a much better effect than internal
astringents, consequently ought never to be neglected.   The
introduction of a piece of smooth ice  into  the vagina has
often  a very speedy effect  in arresting  the hemorrhage.  A
snow ball wrapt in a piece of  soft linen will have the same
effect; but neither of these should be continued so long as
to cause pain.
   The most effectual means, then, to be resorted to for re-
lieving the  hemorrhage  attendant on abortions are:  if the
pulse be full, hard, and frequent, bleeding is to be resorted
to; if not, the foxglove is to be trusted to, either in the form
of pill, tincture, or infusion:  the application of cold to the
thighs and pubes;  admitting a free circulation of cool air in
the patient's bed chamber; keeping  the heat of the body at
a low temperature; absolute rest in a  horizontal position, and
which must be continued during the whole process, however
long  it may be; cold acidulated liquors for  ordinary drink;
light  food taken in small quantities at a time;  carefully ab-
staining  from  every thing stimulant, and plugging up the
vagina, &c, &c.
   Sometimes the hemorrhage is kept up by  some portion of
the  ovum remaining  partly within  and  partly without the
uterus; when,  should circumstances  demand it, this  should
 * Take Sulphate of zinc,   -     -     -     -     -  2 to 5 grains.
     "  Confect. of roses,      -     -    -     ,     j scruple.
     "  Opium,    ------  igiain.
            Make a bolus, to be taken every fourth hour.
 t Take Superacetate of lead,     -                    2 grains.
     "  Opium,     -     -     -     -     .     . 1 grain.'
Make a pill, to be given every hour, should it be required, until six pills are given. 
            MANAGEMENT OF CHILDBED-WOMEN.          135

be removed by careful  manual interference with a pair  of
armed forceps.
  For some days  after  abortion the patient should be con-
fined to  bed, as getting up  too  soon is apt to produce  a
debilitating discharge.   Women disposed to abort should the
more  sedulously avoid  the exciting  causes of  abortion at
those dates of utero-gestation when  it is most  apt to take
place.


      MANAGEMENT OF  CHILDBED-WOMEN.

  Many diseases proceed from the want of due care in child-
bed; and  the  more  hardy part of the sex  are  most apt to
despise the necessary precautions in this state.   This is pe-
culiarly the case with young wives.   They think, when the
labour-pains are ended  the danger is over; but in truth  it
may only  then  be  said  to be begun.  Nature, if left to her-
self, will seldom fail to expel the foetus; but proper care and
management are certainly necessary for the recovery of the
mother.  No doubt mischief may be done by too much as well
as by too  little care.  Hence females who have  the greatest
number of attendants  in  childbed, generally  recover  the
worst.   But it is not peculiar to the state of childbed.  Ex-
cessive care always  defeats its  own intention, and is gene-
rally more dangerous than none at all.
  During actual labour, nothing  of  a heating nature ought
to be given.  Spirits, wines, cordial waters, and other things
which are given with a  view to strengthen the  mother, and
promote the birth,  for the most part tend only to increase the
fever, inflame  the  womb, and retard the  labour.   Besides,
they endanger the  woman  afterwards, as they  occasion
violent and mortal hemorrhages,  or dispose her to eruptive
and other fevers.

  Parturition.—Is that natural  process which, at the expi-
ration of  forty weeks from conception, is  matured, and by
which the womb detaches and expels its contents, and returns
nearly to the same condition in which it was previous to its
impregnation.

  Classification  of Labours, &c.—The  divisions of la-
bours, originally made into natural and preternatural, is suffi- 
 136          MANAGEMENT OF CHILDBED-WOMEN.

 ciently  comprehensive, whilst it forcibly recommends  itself
 by its simplicity and perspicuity.
   Natural labour, of which we shall only treat here, supposes
 four things: 1. That the vertex presents.   2. That there be
 sufficient room in the pelvis  to admit of the  ready descent
 of the child in that direction which permits the occupit or
 back part of the head to emerge under the arch of the pubis.
 3. That there be parturient energy adequate to the expulsion
 of the contents of the uterus, without manual interference,
 and  without  danger either to the mother or child: and, 4.
 That the process of parturition be completed within a mod-
 erate time,

   Stages  of  Labour.—Certain  occurrences  take  place
 during  the progress of parturition, which may be  managed
 under  three  divisions  or stages;  the first  comprehends all
 that  may occur before the complete dilatation of the os uteri;
 the second includes all that takes place between the  develop-
 ment of the os uteri and  the expulsion of the child; the third
 embraces  every7 thing connected  with the  detachment and
 extension  of the placenta and its  adherent  membranes.
   Symptoms preceding Labour.—For several days before the
 actual  existence  of labour  arrives, there are often certain
 promonitory  symptoms, which, by women  who have borne
 children, are viewed as precursors of that eventful hour which
 many of them so much dread.  Among these  are:
   1.  Restlessness, particularly at night, very frequently  pre-
 cedes parturition for days and weeks, and is rarely to be
 considered as  bearing unfavourably in labour.
  2.  Subsidence of the womb and  abdomen is not an unusual
 monitor of the approach of suffering.  It may be viewed in
 a favourable light, inasmuch as it indicates room in the pelvis.
  3.  Glairy mucus  secretion  from the os uteri and vagina,
popularly termed shew, sometimes  occurs for days before the
more active symptoms of labour.   It is often  streaked with
blood, and tends to lubricate the parts concerned  in  par-
turition.
  4.  Irritability of the bladder and rectum, demanding their
frequent relief, is another occasional precursor  of labour.
  Symptoms accompanying Labour.—Owing  to the resist-
 ance which  the womb  encounters during its  contractile
 efforts, pain follows every such  contraction;  but  the pain
 attendant on parturition  differs very materially in its nature 
management of  childbed-women.         137
and in its influence in the uterus.   These paroxysms of pain
are either intestinal or uterine.
   Paroxysms of intestinal pain, or such as are termed false
or spurious, may.be distinguished from genuine labour-pains
by being unconnected with uterine contraction; by attacking
different parts of the abdomen; and by recurring irregularly.
These pains usually originate  in  some source of intestinal
irritation, and may almost always be removed by emptying
the bowels, and subsequently exhibiting an opiate.  By the
observant practitioner, should one be present, they cannot be
confounded with pain in the bowels.
   The true uterine pains are either dilating or expulsive.
   Dilating pains, or, as they are popularly termed, grinding
pains,  result from contraction of the womb.  They are prin-
cipally confined to the back, and occur in the earliest stage
of labour, and are often peculiarly distressing to the patient,
who  expresses  herself by  restlessness,  despondency,  and
moaning.  They often continue for a long time without the
intermissions being free from uneasiness, and  appear almost
exclusively to dilate  the  mouth of the womb, having little
influence over the fundus of the uterus.   It  is during the
existence of  these  dilating  pains that cold shiverings most
commonly come on, and may be  relieved by avoiding spiced
or fermented  fluid, and by  administering, any simple  warm
diluents.
   When the mouth of"the womb is. considerably dilated, ex-
pulsive pains, sometimes  termed forcing or  bearing-down
pains,  commence in the loins, and gradually proceed  round
the abdomen, till they meet at the region of  the pubes, and
dart down  the labia pudendi and thighs. If the accoucheur's
hand be placed on the flaccid sides of the abdomen, previous
to the accession of a paroxysm of expulsive pain, before the
woman is aware of it, the womb may be felt contracting to
a  hard, tense, incompressible tumor.   These  pains observe
regular intervals of ease, which become shorter, whilst the
pains,  in an inverse ratio, increase in their duration and se-
verity; and now it is that the abdominal muscles and dia-
phragm afford their assistance.
   During each propulsive effort a larger portion of the mem-
branes, distended with  the  liquor of the  amnion, is  forced
through the mouth of the womb, performing to it, and  all the
parts through which the child is to pass, the office of an easy
but powerful wedge.  With these pains there  is often a fre-
       18                   m2 
138         management of childbed-women.
 quent disposition to empty the  rectum; and sometimes this
 inclination is so harassing  as  to justify the administration
 of a small injection, with half  a drachm of the tincture of
 opium.
   Vomiting is a common attendant on uterine pain, and  is
 beneficial by rejecting food,  which, from its quality or quan-
 tity, may be a source of irritation to the stomach.   It  prin-
 cipally occurs during the  dilating pains, and unquestionably
 assists in the relaxation and dilatation of the mouth of the
 womb.
   In a protracted labour, when vomiting continues or returns,
 after the mouth of the womb is fully dilated, with abdominal
 tension  and  pain, without  uterine contractions, and  with
 ejection from the stomach of fluid like dark coffee grounds,
 with foul tongue, and rapid and hard pulse, it generally must
 be taken as indicative of inflammatory action, and as requir-
 ing immediate and most efficient interference.  Besides these
 attendants on parturition, the pulse usually becomes quick-
 ened and full; the countenance florid; the whole surface of
 the body covered with  profuse  perspiration; and the  lower
 extremities cramped.
   The Process of Natural Labour.—The process of natural
 labour, to use the words of  a modern writer, is  at once so
 simple and beautiful, that it cannot fail to excite the admira-
 tion of those who look beneath  the surface of the operations
 of nature.  Without repeating what has already been ad-
 vanced respecting the precursory and accompanying symp-
 toms of delivery, we shall merely recall to the mind  those
 statements, as constituting a part of the history of  this pro-
 cess.  The symptoms which announce the commencement
 of natural labour have continued for an indefinite time;  pains
 in the loins, darting through  the pelvis, with an  appearance
 of shew, indicate the approach of unequivocal evidences of
 this stage of parturition.   From time to time these pains are
 of the dilatimg kind, and  on an examination per vaHnam,
will be found to  be diminishing the thickness of the^cervix
uteri more than  to be  opening the  mouth of  the womb.
 When the neck of the womb becomes reduced to the thick-
ness of th(* other parts of that organ, it begins to open, and
 as soon  as it can admit the extension of any part of the
 membranes distended  with  the liquor of the amnion, the
pains rather  assume the expulsive character, and there will
be a sensible  bearing down of the whole uterine tumor. 
management  of childbed-women.
139
Successive paroxysms of pain dilate the mouth of the womb
more and more, whilst the protruded membranes, distended
like a  tense  bladder, fill up  the  opening, and  perform the
office of an inimitable wedge, till the womb and the entrance
to it form one continuous passage.   Soon after this the mem-
branes  generally burst during a strong pain, having previously
contributed to the dilatation of the vagina; and with the es-
cape of the waters, or liquor of the amnion, there is some-
times a temporary suspension of pain,  and  the  head of the
child falls into the superior aperture or brim of the pelvis,
or descends into the cavity; but more frequently this advance
is not made until several pains have followed this occurrence.
   The contractions of the womb recurring with augmented
frequency and force,  gradually propel  the foetus along the
passages, until the  head presses on the perinseum  or fork,
which  is  put on the full stretch; and  also  against the soft
parts which it protrudes.  These by degrees dilate, and per-
mit the back part of the head to  emerge under the  arch of
the pubes, and with the complete extrusion of the head, the
other parts of the body are expelled, sometimes by the same
pain, but more frequently by one which speedily follows.
   The same paroxysm of pain that  expels the child, now and
then detaches and expels the  placenta, or after-birth, com-
monly so called; but more frequently  the womb remains  at
rest for about a quarter of an hour,  when it resumes its con-
tractions, and throws it off with the  adherent  membranes.
This constitutes the interesting process of natural labour,  in
which the uterus requires no officious interference.
   All  that it becomes necessary for the  accoucheur  to do
during this interesting process of natural labour, is to support
the perineum by his  hand,  covered  smoothly  with a soft
napkin, and so applied as to give equable support, without in
the slightest  degree resisting the exit of the head.  No other
interference,  in natural labour, is justifiable,  and too strong
terms cannot be employed to reprobate the practice of hasten-
ing the birth of the body, dragging it forcibly  by the head
into the world.   It should be left to be expelled by the un-
aided  contraction of the uterus.
   As  soon as the child  is thus brought into the world, and
manifests unequivocal signs of life,  the navel string  must  be
tied by passing a  ligature, consisting  of a few threads, or a
thin piece  of tape, round it, at  about the  distance of two
inches from  the navel.   The funis  may then be divided by a 
140         management of childbed-women.

round-pointed pair  of scissors, at  a point equidistant from
each ligature, taking care to cut nothing but the funis   All
this should be done in the most delicate manner under the
bed clothes, without exposing either the mother or child.
   The navel string  being thus secured, and the child sepa-
rated  from the mother, it is to be transferred to the nurse,
whilst the bandage,  previously passed round the body of the
mother, should be moderately tightened, or the womb  sup-
ported by gentle  pressure made by an assistant, which will
be found very materially to  aid its efforts to detach and expel
the placenta.

   Management of the After-burden.—The management  of
the placenta  constitutes  a  very important part of natural
labour;  and if the  womb be not permitted to  empty  itself
gradually, some untoward  and  alarming  circumstance  may
occur in this  stage of parturition.   Generally from twenty to
thirty minutes elapse between the birth and the  expulsion of
the placenta.   The woman then complains of a slight pain
in her back, or abdomen, and this  secondary contraction of
the uterus  detaches the placenta, although it but rarely ex-
pels it from the passages;  whence, however,  it may usually
be easily7 removed  by coiling the  funis round two of the
fingers  of  the  right hand, whilst guided by the  cord, the
thumb and index  finger of the left hand should be passed up
to its insertion into  the placenta, which, if it can be felt, is a
pretty certain  indication of the  detachment of the whole
mass  from  the sides of the  womb.   By this means,  also, the
navel string is prevented from breaking off, and a firmer hold
of the placenta is obtained.
   To prevent the possibility of inverting the  womb, or from
its occurrence without knowing  it, the placenta should be
permitted to  slip by the fingers of the left hand into the va-
gina; and  the withdrawing of the placental mass should al-
ways be in  the  axis  of  the brim, cavity, and  outlet of the
pelvis, as it passes those parts.  The hand of the accoucheur
should afterwards be laid on the abdomen, to ascertain that
the uterus  is  well contracted: and the pulse  should be felt,
lest  internal hemorrhage,  re-distending the uterus, may be
going on, to  the endangering of the patient's life.
   It  is  of great importance that a bandage be passed over
the region of the womb: this being done, and a well-aired
napkin applied to the labia pudendi, or external parts, some 
management of  childbed-women.         141
mild and cool nourishment  may be given to the woman,
who, after having been suffered  to remain quiet for about
half an hour, should have her soiled linen withdrawn, and,
without being raised from her horizontal posture on any pre-
tence, may be drawn up to the head of the bed, whilst she
herself remains perfectly passive,  without taking any part in
this operation, lest  hemorrhage or prolapsus  of the womb
should follow.

   Treatment after  Delivery.—After  delivery, the woman
ought to be  kept as quiet and easy as possible.  Her food
should be light  and thin—as gruel, panada, &c.—and  her
drink weak  and diluting.
   Sometimes an  excessive hemorrhage, or flooding, happens
after delivery.  In this  case the patient should be  laid with
her head low, kept cool, and be in all respects treated as for
an excessive flow of the menses.    If the flooding prove  vio-
lent, linen cloths, which have been wrung  out of a mixture
of equal parts of vinegar and  cold water, should be applied
to the belly, the loins, and the thigh:  these must be changed
as they grow dry, and  may be discontinued as soon as the
flooding abates.
   In a violent flooding after delivery, I have seen very good
effects from the following mixture:—-Take of pennyroyal
water, simple cinnamon water, and syrup of poppies, each two
ounces;  elixir of vitriol, a drachm.   Mix,  and take two ta-
blespoonsful every two hours,  or oftener, if  necessary.

   After-pains.—In the childbed state, women are not un-
frequently distressed with sharp pains in the belly, back,  and
loins, recurring at  intervals for several  days  after delivery.
These resemble the pains of labour;  being, however, some-
what slighter in  degree.   They continue about two or three
days,  and are not  attended with any danger.  One great
matter is, to be sure that the pains, complained of are after-
pains,  and  not  the effect of some more  serious disease.
After-pains  are distinguished  by being alternated with inter-
vals of  ease, and by being generally attended with the  dis-
charge  of some  coagulated blood from the womb; pain is
not excited  by pressure on the belly.
   After-pains are alleviated by giving an opiate, &c, shortly
after delivery, and  repeating the  medicine  in smaller doses 
142         MANAGEMENT OF CHILDBED-WOMEN.

every six or eight hours, taking care not to injure the nervous
system by taking too much opium.
    Take Spirits of camphor,  -      -      -    1 tablespoonful.
     «  Laudanum,     -     -      -      - l teaspoonful.
     "  Powdered gum arabic,      -     _    2 drachms.
     «  White sugar,    -     -      -      - 1  °»nce-
     «  Water, pure,       _      -      -     6 ounces.
  Mix, and of this take a tablespoonful every hour or two until the pain
ceases.

  Costiveness.—Costiveness is apt to prevail after delivery,
and should always be removed by a laxative clyster, or some
gentle purgative, such as neutral salts and manna, or about an
ounce of castor oil.          •

  Inflammation  of the Womb.—An  inflammation of the
womb  is a dangerous and not unfrequent disease  after de-
livery.   It  is known by pains  in the lower part of the belly,
which  are  greatly increased upon  touching; by the tension
or tightness of the parts;"great weakness; change  of  coun-
tenance, a  constant  fever, with  a weak and hard  pulse ;  a
slight delirium;  sometimes incessant vomiting; a hiccup;  a
discharge  of reddish, stinking, sharp water from the womb;
an inclination to go frequently to stool; and heat, and some-
times total  suppression of urine.
   This must be treated like other inflammatory disorders, by
bleeding and  plentiful  dilution.   The drink  may be  thin
gruel or barley water; in a cup of which  half a drachm of
nitre may be dissolved and taken three  or four times a  day.
Clysters of warm milk and water must be frequently adminis-
tered :  and the belly should be fomented by cloths wrung out
of warm water, or by applying bladders, filled with  warm
milk and water, to it.

   Suppression of the Lochia.—A suppression of the lochia,
or usual discharges  after delivery, and  the  milk fever, must
be treated  nearly in the same  manner as an inflammation of
the womb.  In all these cases, the safest course is plentiful
dilution, gentle  evacuations, and fomentations  of  the  parts
affected.   In  the milk fever the breast may be embrocated
with a little warm linseed  oil.   The child should be often
put to the  breast, or it should be drawn by some other person.
   Nothing would tend more  to prevent the milk fever than
putting the child early  to the breast.  The custom of not 
MANAGEMENT OF CHILDBED-WOMEN.
143
allowing children  to suck for the  first two or three days, is
contrary to nature and common sense, and is very  hurtful
both to the mother and child.   Every mother who has milk
in her breasts, ought either to suckle  her own child, or to
have her breasts frequently drawn, at least for the first month.
This would prevent many of the diseases which prove fatal
to women in childbed.

   Inflammation of the  Breast.—When an inflammation
happens in the breast, attended with redness, hardness, and
other symptoms of suppuration, the safest application  is a
poultice of yeast or bread and milk, softened with oil or fresh
butter.  This may be renewed twice a day, till the tumor be
either discussed or brought to suppuration.  The use of re-
pellents, in this case, is very dangerous; they often occasion
fevers, and sometimes cancers; whereas a suppuration is sel-
dom attended with any danger, and has often the most salutary
effects.

   Fretted or  Chapped Nipples.—When the nipples  are
fretted or chapped, they  may be anointed with a mixture of
oil and beeswax,  or  a little powdered gum arabic may be
sprinkled on them.  An  application of borax to the nipples
has  a very good  effect.   Should  the  complaint prove  ob-
stinate, a cooling  purge  may be given, which generally re-
moves it.

   Puerperal Fever.—The most fatal disorder consequent
upon delivery, is the puerperal, or childbed fever.   It gene-
rally makes its attack upon the second or third day after de-
livery.  Sometimes, indeed, it comes on sooner, and at other
times,  though rarely, it does  not appear before the  fifth or
sixth day.
   It begins, like most other fevers, with  a cold  or shivering
fit, which is succeeded by restlessness, pain of the head, great
sickness at the stomach,  and bilious vomiting.   The pulse is
generally  quick, the  tongue  dry, and there  is a remarkable
depression of spirits  and loss of  strength.   A great  pain is
usually felt in the back, hips,  and region of the  womb; a
sudden change in the quantity or  quality of  the lochia also
takes  place, and the patient is frequently  troubled  with a
tenesmus,  or constant inclination to go to stool.  The urine,
which is very high coloured, is discharged in small quantity, 
144         MANAGEMENT OF CHILDBED-WOMEN.
and generally with pain.  The belly sometimes swells to a
considerable bulk, and becomes susceptible of pain from the
slightest  touch.  When the fever has continued for a few
days, the symptoms of inflammation usually subside, and the
disease acquires a more  putrid form.   At this period, if not
sooner, a bilious or putrid looseness, of an obstinate and dan-
gerous nature, comes on, and accompanies the disease through
all its future progress.
  There is not any disease that requires to be  treated with
more skill and attention than this: consequently the best as-
sistance ought always to be obtained as soon as possible.
In women of plethoric constitutions, bleeding will  generally
be proper at the  beginning;  it ought, however, to  be used
with caution, and not to be repeated, unless where the signs
of inflammation rise high; in which  case it will also be ne-
cessary to apply a  blistering plaster  to  the  region of the
womb.

  Swelled  Leg.—This is a peculiar swelling of the leg,
which occurs in women after child-birth.  It is a tense, clear
swelling of one of the limbs, generally beginning at the upper
part, and increasing pretty quickly; the pain is considerable,
and accompanied with fever.   It occurs a few days after de-
livery, and commonly begins at the groin, the hip, or top of
the thigh, being  preceded by shiverings, and some feverish
symptoms.   There  is pain, weight,  and stiffness, and diffi-
culty of moving either the  body or lower limbs.   The part
complained of is generally hotter than natural; a little swell-
ed, but not discoloured;  at length the pain and  swelling in-
crease, and extend  to the  leg and foot; at which time the
pain diminishes, except on motion.   The whole extremity is
now swelled;  but  it does not,  like a  dropsical swelling,
change  its bulk by posture, nor  does it pit upon pressure,
being tense,  elastic, and very  painful  when  touched.  When
the acute symptoms are over, the  patient feels much weaken-
ed, and the limb is stiff,  heavy, and weak.
   Treatment.—If  the inflammatory symptoms are  high, a
general bleeding will be proper, as also purging and antimo-
nials.  For the swelling of the leg, the  best applications  at
the beginning, is to foment the parts with flannel, wrung out
of hot vinegar; continue this for some hours, and if it does
not seem to give  relief, then rub it with liniment made  of
spirits of camphor, hartshorn, and sweet oil, equal parts, three 
SORE MOUTH OF INFANTS.
145
or four times a  day.   As  a purgative, take calomel,  five
grains; jalap, ten grains;  rhubarb, ten grains;  gamboge, three
grains; make a pill, to be taken  once a day for three days;
then one dose of senna and  salts.

             SORE MOUTH OF  INFANTS.

  Sore mouth is a disease veiy common to infants within the
first month, though it may occur later.  It consists of small
white specks on the  tongue, and' inside of the cheeks, with
more or less derangement of the stomach  and bowels.
  There are two forms of this disease, a milder one, in which
the affection of the  mouth  is - slight,  and the constitutional
symptoms not severe;  and another form, in which both the
local and constitutional symptoms are  rather violent.   In the
milder form a few scattered  spots appear  on the tongue, or
within the lips, like little bits of curds; these soon become
yellowish, and fall off, leaving the parts  below  of a red or
pink colour.   The bowels are somewhat deranged, griping
or purging  occurs, the stools are greenish, ill-smelled, and
containing portions of undigested milk.  The child is fretful,
and the mouth is rather warmer than  usual.
  The other  variety of the disease begins with great op-
pression  and  feverishness;  sometimes with fits  and  violent
screaming.  When the  spots begin to appear, the feverish
symptoms are  mitigated a little, but do not go off entirely;
and it  would appear that the ulcerations are not confined to
the mouth, but go  through the whole alimentary  canal, caus-
ing severe pain,  vomiting,  griping and purging; and the
matter discharged is so acridj as even  to produce excoriation
of the parts about the anus.   The mouth is very tender, and
the child sucks with  pain and difficulty.
  Cause of the disease appears  to depend upon  an irritation
of the stomach and bowels.    It may be caused by improper,
or too  much food, or a bad state of the  mother's milk.  The
stomach  and  bowels of  infants  are peculiarly delicate, and
the mouth sympathizes very readily with  the derangements
of those parts.  Bad  air, or want of due attention to the
cleanliness of the child's person,  or their clothing. Exposure
to cold and damp  has  also a tendency to bring it on.
   Treatment,—As the disease is frequently connected with
considerable acidity of the stomach, a little magnesia should
be given as a corrective,  or  the chalk  mixture, in doses of a
       19                   N 
146
GOUT.
teaspoonful  every two hours, to infants within the year, or
larger doses to those who are farther advanced.  Mild cooling
substances may be applied to the mouth, as powdered borax
mixed with a little honey, or a weak solution of alum, weaker
than what a sound mouth could bear.  The greatest attention
must be paid to the food of the child.  If not weaned, it should
be confined to the breast milk of a healthy nurse.  If the
child be beyond one year of age, its sole diet should consist of
rice, or guni water sweetened with loaf sugar; to which may
be added, as the disease gets  better, an equal quantity of
fresh cow's milk boiled.   The  child should be immersed in a
warm bath daily, and breathe constantly a pure dry air.   In
severe cases, particularly if  the belly be sore, or the child be
affected with much  griping, two or  three leeches should be
applied over the stomach,

                        GOUT.

  Gout is divided into the acute and chronic forms.
  Symptoms of the  Acute  Form.—Violent inflammation of
the ball of the great toe of one foot, attended with excruciat-
ing pain, redness of the skin,  and distension of the neigh-
bouring veins.  The cause of its occurrence, however,  in a
large proportion of cases, is known to be  a certain morbid
state of the stomach, and ol the digestive system generally.
  The subjects in whom it most usually shows itself, are those
of sanguine temperament, of full habit, florid complexion, and
rather  coarse skin;  persons of rather sedentary,  indolent
mode of life, and who perhaps indulge freely in the pleasures
of the table;  depressed  spirits, and  protracted study.  It  is
more common in cities than in the country; in men than in
women; in those using principally animal food, than in those
restricted to vegetable diet.   Gout commonly makes its at-
tack with pain in the ball of the great toe, and with a feeling
of general chill.  As the pain increases, this chill gives place
to heat, and the usual symptoms  of fever.   The joint soon
becomes more swollen, red,  and tense; the redness disappear-
ing when  the surface is touched, and returns when the pres-
sure is removed.  The paroxysm of pain and inflammation
continues,  perhaps,  with little abatement, for twenty-four
hours.   At length, probably on the  night following that of
the attack, it begins to subside, and terminating with a gentle
sweat, leaves the patient to  the enjoyment of repose.   For 
GOUT.
147
several days the symptoms recur in the evening, though per-
haps in a more tolerable form, and then subside, leaving the
foot apparently sound, and the system in a state of increased
health and vigour.  After the first fit, especially if the alarm
of the patient induce  him to  reform his mode of life, the dis-
ease often absents itself for three or four years; then, gene-
rally on the occasion of some excess or imprudence; such  as
exposure, cold, severe bodily labour, mental  application, or,
in a word, any disturbance of the system, the  attack is re-
newed.   At  each return, the interval is usually shortened,
while, on the contrary, the duration of  the fit is augmented,
and instead of subsiding in three or four days, it will at length
continue, with occasional remissions, for many weeks.  From
the prolongation  of the fits, and  the contraction of the inter-
vals,  the  affection sometimes becomes  almost constant,  so
that the patient scarcely ever enjoys good health.
   As the disease advances, the symptoms are  modified.  At
first the paroxysm appears without warning; afterward, it is
preceded by a sense  of coldness of the lower limbs; occa-
sional pricking, alternating with numbness;  slight shivering;
disturbance of the stomach, &c.   At first, only a single joint
is affected; then the two feet are attacked in succession; the
pain commencing in one as it subsides in the other.  Then,
perhaps, both are affected at once,  or  alternately.  At last,
the other joints  become involved, and  the disease becomes
universal, or nearly so;  but the  intensity of the pain dimin-
ishes, so that, although there be no  freedom from  it at any
time, the patient is able to give some attention to his ordinary
occupations,  even during the paroxysms.  Some permanent
traces of the attacks are soon visible in the  principal joints,
which become swollen, stiff, and weakened, so that walking
is performed with more and more difficulty.  Meanwhile, the
small  joints  of the toes and fingers are embarrassed by a
whitish deposite, once  supposed to be actually chalk, and
still so called in popular language; but, in fact, consisting of
the acids of  the urine in  combination  with  soda.   Such
quantities of this  deposite sometimes accumulate, that an in-
dividual  is mentioned who used, in playing  cards, to score
the points of the  game on the table with his knuckles.
   It is a general  impression  that gout, when it becomes ha-
bitual, absorbs all the  morbid tendencies of the system, and
keeps all  other diseases at a distance.   However this may
be, it  is worthy of remark, that  individuals severely affected 
148
ST. VITUS'S DANCE.
 with it continue to live  to  an advanced  age.   When gout
 proves fatal, it is generally by receding, as it is termed; that
 is, by suddenly quitting the extremities, while  the stomach,
 the brain, or some other important organ, becomes the seat
i of inflammation.  It would be wrong to conclude that  an
 attack of gout is always a certificate of luxury, wealth, or in-
 dulgence.   We have repeatedly met with it among the poor
 and the abstemious,  both by choice and  necessity; in old
 soldiers, sailors, shoeblacks, washerwomen,  and  temperate
 farmers.
   Treatment.—'.Cathartics and diuretics are decidedly bene-
 ficial in gout.  Two or three evacuations should be procured
 daily.   Take extract of  colacynth, half a drachm; calomel,
 fifteen  grains; tartar  emetic, one grain; rhubarb, five grains.
 Make into a mass, and divide into sixteen pills.  Dose, two or
 three every evening.   As a  diuretic, take tincture of  colchi-
 cum, two drachms; antimonial wine, one drachm; tincture of
 digitalis, two drachms.  Dose, twenty drops on a lump of loaf
 sugar, once a  day.   Opium is a valuable palliative in cases
 attended with extreme pain; taken in one grain doses, every
 two hours until the pain remits.   As an outward application,
 take  spirits of camphor, hartshorn, equal parts, with  sweet
 oil.   Make a liniment.

                 ST. VITUS'S DANCE.

   This disease, so  called, is marked by the  convulsive mo-
 tion of the limbs, as if the person was dancing.   These con-
 vulsive motions, most generally, are confined to one side, and
 affects principally the arm  and leg.  When any motion is
 attempted  to be made, various  fibres of other  muscles act
 which  ought not;  and thus a contrary effect  is produced
 from what  the patient intended.   It is chiefly incident  to
 young persons of both sexes, and makes its  attack between
 the age of ten and twenty, occurring but seldom after that
 of puberty.
   By some practitioners it  has been considered rather as  a
 paralytic affection  than  as a  convulsive disorder, and has
 been thought to arise  from a relaxation of the muscles, which,
 being  unable to perform their functions in moving the limbs,
 shake them irregularly by jerks.
   The disease is  occasioned by various irritations, such as
 teething, worms, offensive  smells.   It also arises in  conse- 
ST.  VITUS'.S DANCE.
149
quence of violent affections of the mind, as horror, fear, and
anger.  In many cases it is produced by general weakness;
and, in a few, it  takes  place from  sympathy, at seeing the
disease in others.
   The fits are sometimes preceded by a coldness of the feet
and limbs, or a kind of tingling sensation,  that ascends like
cold air up the spine, with obstinate  costiveness.  At other
times, the accession begins with yawning, stretching, anxiety
about the heart, palpitations, nausea, difficulty of swallowing,
noise in the ears, giddiness, and pain  in the head and teeth;
and then comes on the convulsive motions.   These discover
themselves at first by a kind of lameness, or instability of
one of the legs, which the person draws after him in an odd
and ridiculous manner; nor can they hold the arm  of the
same side still for a moment; for if they lay it on their breast,
or  any  other  part  of their body, it is  forced quickly from
thence by an  involuntary motion.  If they are  desirous of
drinking, they use  many singular motions before they can
carry the cup  to the head,  and it is forced  in various direc-
tions, till at length they get it to  their  mouth, when they pour
the drink down their throat in  great haste, as if they meant
to afford amusement to  the by-standers.  Sometimes various
attempts at running and leaping take place; and at  others,
the head and trunk of the body are affected with convulsive
motions.  In many instances, the mind is affected with some
degree of fatuity, and often shows the same  causeless emo-
tions (such as  weeping  and  laughing)  which  occur in
hysteria.
   Treatment.—In the treatment of this  complaint are, first,
to obviate the several exciting causes; second, to correct any
faulty state of the constitution, which may appear to give a
pre-disposition;  and third, to use those means  to allay irre-
gular muscular action.  Among the sources of irritation, the
most common is the state of the bowels; and the steady, but
moderate, use  of active cathartics  has often a  great  effect
upon the disease, improving the appetite and strength at the
same time; and the best  cathartic  is, senna  and salts, rhu-
barb,  and jalap.   Calomel, in conjunction with the rhubarb
and jalap, would be advantageous where the liver is  torpid.
   The general debility usually attending, indicates  the em-
ployment of tonics; for this purpose the sulphate of quinine,
in one grain doses, three times a day.   Sometimes, in violent
cases, and in irritable constitutions, the occasional exhibition
                           n2 
150
CARBUNCLE.
of opium  or  other  sedatives, may be required, taking care,
however, that the bowels are not confined thereby.   Occa-
sionally too, where the above means are not successful, the
antispasmodics may be  tried, as ether, camphor, musk, &c.
Electricity also has  been by some recommended.

                     CARBUNCLE.

  Carbuncle  is  an  inflammatory tumor, resembling a very
small bile in a  state  of intense irritation,  and very painful.
It is not seated beneath the true skin, but  in  its very sub-
stance, and consists in an inflammation of all the soft parts,
contained in  one or more of the minute, tendinous, or fibrous
rings which form the  outer substance of the true skin, each
of which gives passage to the delicate extremity of a nerve
of sensation,  and its accompanying blood vessels.  After se-
veral days of intense  agony, an imperfect suppuration  comes
on,  and, flowing into  the few unclosed cells of the cellular
tissue, renders the  tumor  peculiarly quaggy or doughy.  In
the meantime,  the  centre of  the tumor mortifies, and nu-
merous little  ulcerations on the skin give partial exit  to the
ill-conditioned pus.
  During this process, unfortunately, the pain and irritation
are not abated, for new parts around the circumference of
the dead skin are continually taking on the same kind of in-
flammation, and propagating the disease.  The complaint is
peculiar  to persons whose  constitutions are  weakened by
disease, luxurious habits of living,  or intemperance.
   Treatment.—The best and least  painful  mode of treating
this affection, is to  divide the  tumor at once, with a sharp
knife, and then to dress it with poultices of bread and milk;
when mortification  is at its height, the  charcoal poultice  is
advisable.  The late  Dr. Physick recommends the destruc-
tion of  the entire thickness of the skin over a wide space in
the  center of the tumor with the  vegetable caustic,  which
requires to be wet at  the end of the stick,  and to be rubbed
for some time over the surface.  This destroys all the stran-
gulated parts at once.

                         CORNS.

   Corns are  nothing else than unusual growths of the cuticle,
caused by habitual  pressure upon the prominent  portions  of 
CORNS.
151
the body.  They are chiefly confined to the joints of the
toes, where they are consequent to the use of tight boots or
shoes; but they do  not  differ from the callosities not unfre-
quently noticed on the instep, heel, hip, elbow or knee, when
either of these parts is subjected to long continued pressure.
Their consistence seems to be intermediate between that of
ordinary cuticle and that of the nails; though, after a time,
it becomes analogous to the latter.
   These excrescences are themselves incapable of inflam-
mation ; but they often occasion great suffering when they
inflame the parts around  them by their pressure.   They
sometimes become  surrounded by a little abscess, and are
then cast off or cured.
   The  proper treatment of corns is very  simple,—and, if
faithfully  attended to,—almost certainly successful.   Let the
part be well soaked in warm water; then with a sharp pen-
knife, pare  away the summit of the excresence until it  is
level with the sound skin, or a little depressed below it  In
the next place, provide some buckskin well coated  with good
adhesive plaster.   Take a circular piece of this, about three
times as great as  the diameter of the corn, and cut a hole in
its centre, a little  larger than the base of the corn.  The
plaster is now applied around the  excresence, which occu-
pies the  central  space, so that nothing can press upon it.
The cause being thus removed, the  disease soon disappears.
If the corn should grow rapidly for a time, let it be  frequently
retrimmed and the  plaster reapplied.
   When corns occur between the toes, it is often impossible
to  surround  them,  and it  is then best to place one or two
layers of the buckskin between the  points of the toes, so as
to keep them permanently apart;—but, let it  be steadily re-
membered that the application of a dressing, directly over
the excresence, tends to increase, rather than diminish it.
   Under  the foregoing treatment,  perseveringly  and judi-
ciously applied, w7e believe that a cure will invariably take
place in  a reasonable time.
   Soft  Corns.—Near the junction of two toes,—where the
skin  is perpetually folded  in  contact with  itself,—it is not
uncommon  to observe  a  thickening and  softening of the
cuticle, with a thin and red portion  of surface in the middle,
which bears no slight resemblance to a corn which has been
thoroughly soaked, and then cut to the quick in the centre.
This affection has  been called "soft corn," but although fre- 
152                      TETTER.
quently associated or complicated with true corns, it is totally
different in its nature.   The thickening of the cuticle in this
case, results  from the simple imbibition of  the  moisture of
the part, and the thin, red surface is a portion of skin, trans-
formed by moisture, and the exclusion of air, into a tissue
resembling the mucuous membrane, and  secreting a vitiated
and strangely fetid mucoid discharge.  The affection is often
intensely painful: it is sometimes seen surrounding the base
of a true corn in the fold of the toes.
   In the treatment of soft corns, the separation of the parts
is as necessary as in true corns; but there is little disadvan-
tage here, in applying  our dressings directly to the part;  for
pressure is not among the  causes of the disease.   The most
effectual mode of cure is to keep the toes apart;  to wash the
sore thoroughly  with  Castile soap  and  water, twice every
day;  then to dust the part well with the powder of  carbo-
nate of zinc, and to place a piece of soft patent lint on the
diseased surface.  Cleanliness, and some drying or separating
material occasionally applied are necessary,  permanently, to
prevent the recurrence of  the disease;—an accident always
likely to occur, from the constancy of the cause.

                        TETTER.

   Tetter is distinguished by an assemblage of numerous little
creeping ulcers, in clusters, itching  very much, and difficult
to heal.   It appears indiscriminately in different  parts of the
body, but most commonly the  face, neck, arms, wrists and
hands, in pretty broad spots and small  pimples.   These are
generally very itchy, and after continuing a certain time, they
at last fall off in the form of a white powder, similar to fine-
bran, leaving the  skin below apparently sound; but again re-
turns in the form of red  pustules, which originally are sepa-
rate and distinct,  but which afterwards run together in clus-
ters.  At first they  seemed  to  contain nothing but  a thin
watery serum, which afterwards turns yellow, and extends
over the whole surface of the  part  affected; it at last dries
into a thick crust or scab.   These ulcers do not, in general,
proceed further down than the cellular tissues, yet sometimes
the discharge is so very penetrating  and corrosive as to de-
stroy the skin, and even the muscles themselves.
   Treatment.—In the  treatment of this disease the remedies
are few and simple.  In the first place it is best to prepare 
SCURVY.
153
the system for the cure, by commencing the taking of cream
of tartar and flour of sulphur, a small teaspoonful of each,
in molasses, once a day for  a week.   Then take a quarter,
or a half a pound of the green sullentine, bruise it, then put
it into a pint of whiskey,  wash the parts three or four times
a day, for a month, or until a cure is effected.  Another very
good  remedy is to take, corrosive sublimate one drachm, put
it into a pint of whiskey,  wash the parts frequently.  I have
succeeded  in curing some yery bad  cases of tetter  by this
mode of treatment,

                       SCURVY.

   Scurvy is characterized by extreme debility;  complexion
pale  and  bloated;  spongy  gums; the teeth become loose;
livid  spots on  the skin;  breath offensive; swellings in the
legs;   fetid urine; and  extremely  offensive stools.  The
scurvy  comes on gradually, with  heaviness, weariness, and
unwillingness to move about,  together with  dejection of
spirits,  considerable loss of strength, and  debility.  The
scurvy is a disease of a putrid  nature, much more prevalent
in cold climates than in warm ones, and which chiefly affects
those shut up  in confined  places, owing, it is supposed, to
being deprived of fresh air, and the prevalence  of cold and
moisture, and by such  other causes  as depress  the nervous
energy: as indolence, confinement, want of exercise, neglect
of cleanliness, sadness,  despondency,  &c.
   Treatment.-^In the  cure as well  as the  prevention of
scurvy, much more is to be done by regimen than by medi-
cines, obviating, as far as possible, the several remote causes
of  the disease, but  particularly providing the patient with
wholesome diet;  it has been found  that those articles are
especially useful which  contain a native acid, such as lemons,
oranges, &c.  Vinegar and sourcrout,  have  likewise been
used  with much advantage; also brisk fermenting liquors,  as
spruce beer, cider,  and  the like.  Mustard, garlic, horse-
radish, and others of a  stimulating  quality, promoting the
secretions, were much relied upon, and no doubt proved use-
ful to a certain extent.   The spongy state of the gums may
be remedied, by washing the mouth with acids, such  as vine-
gar, lemon, &c.
        20 
154
SCROFULA.
                      SCROFULA.

  Scrofula may be properly divided into two periods, or
states: the one  called the scrofulous habit; the other, the
disease  in its  state  of  development and activity.  The
scrofulous habit or predisposition may be acquired from acci-
dental causes, or from hereditary transmission.   The scrofu-
lous habit is characterized by the  following circumstances:
a particular delicacy and languor  of countenance; smooth,
soft, and flaccid  cheeks;  a dull lead-coloured  circle around
the mouth, with fine red lips; swollen upper lip;  inflamma-
tion of  the eyelids; weak  digestive powers;  scabby  erup-
tions about the head;  irregular state of the alvine discharges;
slow growth of the body; aptitude to take cold, &c.   This
dormant state of the disease may continue for years, or pass
off, under favourable circumstances.   More generally, how-
ever,  it  becomes gradually  developed, under the influence
of various  exciting causes; the glands along the neck, and
other parts, become enlarged, and by degrees pass  into a
state of slow inflammation, terminating in suppuration.  The
ulcers thus formed discharge  a thin, milky fluid; the eyelids
become  inflamed, as well as  the mucous  membrane  of the
nose and bronchia.  In a more advanced stage of the disease,
the extremities of the bones  enlarge; ulceration occurs, par-
ticularly in the cartilaginous  and glandular structures; some
of the bones become carious;  the large joints inflame and
suppurate; the spine becomes diseased; the nose and palate
are destroyed  by ulceration; in short, there is scarcely any
part of the body, which is not sometimes affected.   Scrofula
occurs  more frequently  in  children  than in adults.  The
scrofulous habit is rarely formed after the period of manhood.
The most common causes which produce this morbid habit,
are: cold and  atmospheric vicissitude ; excessive  indulgence
in  eating;  confinement and want of exercise; mental dis-
quietude ; chronic irritation in the  stomach and bowels, from
worms and other causes; exposed  to cold  and  humidity, dur-
ing convalescence from various diseases; particularly measles,
scarlatina, and hooping-cough;  in  short, whatever debilitates
the system, more especially during childhood.
   Treatment.—In order to  counteract the scrofulous  habit,
great care is  required to avoid the exciting  causes.  The
digestive functions are to be  maintained, and the tone  of the
system  supported.  This is to be done by the occasional use 
POISONS.
155
of mild aperients; such as Seidlitz powders, senna and salts,
&c; warm clothing; mild vegetable tonics: such as sulphate
of quinine, in one grain doses; or Virginia snake root, made
into an infusion.   When the disease exists in the lymphatic
glandular tumors, leeches, and  emollient poultices, are often
beneficial; also  the tincture iodine, and bathing with salt
water.   The compound extract of sarsaparilla is worthy  of
a trial.

                        POISONS.

   Poisons are  those substances which in small quantities,
produce deleterious effects on the human body.  Poisons are
derived from three sources, viz., those from the animal, vege-
table, and mineral kingdoms.  There is a material difference
in the action of poisons.  Some  affect the vascular system;
others the nervous; while many poison both the nervous and
vascular systems at the same time.
   In looking at poisons  from many animals, for example, we
find the first action in the arterial system, while the influence
of others evidently begins in the nerves.   The poisons com-
municated by the viper  and rattle-snake, attacks  the arterial
system first;  that from the bite of a  rabid animal influences
the nervous system first; but ultimately, in these  cases, both
become affected.
   Vegetable  poisons operate solely on the nerves.   Their
effects are in proportion to the quantity taken;  whereas, with
morbid poisons, the quantity makes no difference in its par-
ticular specific  action; but this is regulated by the peculiar
condition of the patient.
   The poisons which wTe shall  notice, will be  merely the
animal and morbid.   Under the head  of  animal  poison, we
shall speak of hydrophobia, and the bite of vipers.

   Hydrophobia.—This disease is the  result of poison from
rabid animals; and is so different in its character, so different
from those arising from  any of the other poisons, so marked
in its nature, so horrid in its effects, that, upon seeing  it, you
could not hesitate to form a correct opinion as to the  nature
of the malady.
   The first symptoms of those who have been  bitten by a
rabid animal, are, pain in the injured part, and this is usually
felt from the third to the fifth week.  The. next  symptom  is 
156                     poisons.
a sense of chilliness, succeeded by rigour and heat; then a
difficulty of swallowing  is felt; not of liquids in particular,
but of any substance, thus arising from the construction  of
the muscles of the throat; and  so violent are the spasms of
the throat, that upon offering the patient any thing to swal-
low, you would think it  would directly occasion suffocation.
He will desist from the attempt, and tell you  he will try by-
and-by.   Upon again applying the cup to his lips, he will
be seized with the most horrid shuddering, turn  away  to
avoid the sight of what he was about to take, and  sit down
in a state of exhaustion.  In hydrophobia, there is  evidently
a great excitement of the nervous system, and it is quite erro-
neous to suppose that all the  symptoms of the disease are
produced by inflammation.
   On the dissection of those who have died of hydrophobia,
there has been found inflammation of the internal surface of
the mucous and  muscular coats of the stomach.   Although
the appearances, after death, confirm the previous  existence
of inflammation, yet they are  not sufficient  to account for
the symptoms, and the cause certainly resides in the nervous
system.
   Treatment.—The best mode that can be adopted, is, im-
mediately after the part has  been bitten, to cut it out.  You
should at first ascertain  at what depth the teeth have entered
by means of a probe, and then take care to  cut a  sufficient
quantity, and allow no part of the injured integuments to  re-
main.   If persons should foolishly object to having the poi-
soned  part cut away, I  would advise you,  in such  cases,  to
let sink into  the wound a small piece of the potassa fusa;
this will readily dissolve, and, becoming liquid, will  soon be
communicated to each  part of the wound, and thus destroy
the influence of the poison.   As for medical remedies,  when
the symptoms of hydrophobia  have once appeared, I am not
acquainted with any that much reliance can be placed  upon.

   Bite  of the Viper.—The bite of a viper is quickly fol-
lowed by severe effects, some  of which are local, and others
general; but it is with the former that the disorder  invariably
 commences.   At the instant  of the bite, the bitten part is
 seized  with  an acute pain, which rapidly shoots over  the
 whole limb, and even affects the viscera and  internal organs.
 Soon afterwards, the wounded  part swells and  reddens;
 sometimes the tumefaction is  confined to the circumference 
MILK SICKNESS.
157
of the injury;  but most  frequently it  spreads  extensively,
quickly affecting every part of the limb, and even the body
itself.
   Treatment.—The treatment of the bite of a viper should
be both local and  general; for the  influence of the virus is
both nervous and  arterial.  The local  treatment has for its
principal object the destruction of the venom, the prevention
of its entrance  into the vessels,  or the removal of it from the
wound.  You  then  have to soothe the local inflammation
when it is  severe,  by bathing and poultices, and anoint the
part with sweet oil.   If the case require it,  I should advise
you to cut out the  part that has been bitten,  and apply a
ligature above  the wound, if the situation will  admit of it,
with a view of preventing absorption.

   Stings of the  Wasp and Hornet.—The stings of the
wasp and hornet give rise, in many cases, to very great pain
and severe inflammation.
   The best  application, to mitigate the effects, is  to  take
one drachm of opium, rubbed down in an ounce of olive oil;
put some  of this on lint, and lay it over the wound, occa-
sionally changing it; at the same time keep  the bowels open
by some mild cathartic.

                    MILK SICKNESS.

   Occurring, as the milk sickness does in the frontier settle-
ments, where medicine as a science is in its infancy, and its
practice too much in the hands of the ignorant, we have had
very imperfect  accounts of the affection, either as regards its
history, symptoms, or means of cure.
   It is a disease peculiar to the Western States, and as far
south as Tennessee, and  extends north to the  lakes.   The
states of Indiana and Illinois are more  subject to its occur-
rence; its prevalence is not confined to any season or de-
scription of weather, existing in a like degree, in the heat of
summer, or cold of winter, and  with like virulence and fre-
quency, during a dry or wet season.
   The animals in which it has been  observed are, cattle,
horses, sheep and  goats, which  seem to  acquire it with their
food or drink.   The cattle  may be affected with it to such
a degree, as that their flesh and milk will produce the disease
in  man, and  yet  they themselves  manifest no unhealthy 
158
MILK SICKNESS.
symptoms whatever.   The disease  may be discovered by
subjecting the suspected animal to a  violent degree of exer-
cise by running them, and  when  the disease is  present the
animal will  be  seized  with tremor,  spasms, convulsions, or
even death.   This is the precaution practised by butchers in
that  country, always before killing a beef in any wise sus-
pected of the poisonous contamination.   The animal usually
dies after repeated convulsions, never lingering beyond a few
hours; often it falls suddenly, as if it received a blow from a
heavy body  on the head.
   Cause.—The  cause  of this disease  in  animals is  yet a
mystery and uncertainty.   No satisfactory account of its na-
ture has ever yet been given, and it has been in turn supposed
to be a vegetable, or mineral.  The  locality which seems to
produce the disease, most  commonly extends  as a vein of
variable breadth,  traversing the  country for a  considerable
distance.  It can be traced in  one instance for nearly a hun-
dred  miles,  running  parallel to  the  course  of the Wabash
river, in the state of Indiana.  Again,  it will  be found to
occupy an isolated spot, comprised  of  one hundred  acres,
whilst for a  considerable distance around, it is not produced.
Thus having the locality perfectly circumscribed, much labour
has been expended in order to discover  some production pe-
culiar to the locality.  The search has been uniformly un-
successful in the attainment of its object.
   The general appearance of these infected districts is some-
what peculiar.  It has been always  observed that the situa-
tion of the  ground is elevated above that of the  surrounding
country, occupying what is denominated a ridge, and that
the quality of the soil  is in general of an inferior quality.
The  growth is  not. so luxuriant as in other places, but is
scrubby and stunted in many instances; what  in the West
is called " barrens."  Butter and cheese, made from the milk
of an infected cow, are supposed to be the most concentrated
forms of this poison.  They  possess no distinguishing ap-
pearance  in odour or taste  from  the healthy article.
   A very minute quantity of the milk, butter, or cheese, will
soon develope the disease in man.  The cream used in coffee
drunk at a single meal, is said to have  produced  an  attack.
The  butter  or cheese eaten at one meal has frequently been
known  to prove fatal.   Hundreds of persons throughout the
west, and south  west, are  annually  dying from  its attacks.
Owing  to  the want of  success which has so uniformly 
MILK SICKNESS.
159
attended the practice of their  physicians, many  of the in-
habitants depend entirely on their domestic remedies.
   Treatment.—General bleeding is the first, and of the most
importance.  The  extent to which it should properly be
carried, can only be regulated by the pulse, and, so long as it
will  bear  it, we  should have  no hesitation to continue the
abstraction, being guided neither by the weight or measure.
To insure its  advantageous operation it must be practised
early, as after  the  lapse  of a  few days, it cannot be  car-
ried to any extent from the sinking induced.   If it can be
avoided, we should never at any one time push  it so far  as
to produce syncope, for reaction is  always slow.  Next  in
importance to blood-letting, is local abstractions by cups ap-
plied over  the epigastrium region,  but more particularly they
are of  service to the temples and back of the neck.
   We should direct the head to be shaved  in the beginning,
cold applications being made and continued for  some days.
This, conjoined with the liberal  abstraction of blood gene-
rally, and  locally from  the head, with cups,  will be found the
most certain means of allaying the excessive  irritability  of
the stomach.   Blisters may be applied early over the liver,
and also to the back of the neck or to the scalp  itself; their
benefits will be increased by dressing them with some irri-
tating  ointment.  No  remedy given internally has  ever yet
been found to allay the irritability of the stomach.
   Calomel given in  five  grain  doses every two  or three
hours,  combined with  olive  oil, has  been found to  be more
readily retained in the stomach than other cathartics.   Soon
after the commencement of the use of cathartics, we  should
have recourse  to stimulating enemata every few hours, as
they frequently exert a powerful influence in hastening their
operation.  Even when we have  succeeded in opening the
bowels, and established the flow of bile, the cure of the case
is not  yet  accomplished.  The secondary fever will always
follow, with a  different degree  of obstinacy, varying as much
in duration as  in the different  types it assumes.  Of  course
the treatment of this must be varied according to the symp-
toms which arise.  Not even general directions can be given;
there  is now no specific action, and the intelligent  practi-
tioner will treat the symptoms  as they present themselves. 
160
to destroy rats.
                 TO DESTROY RATS.

   Melt hogs lard in a bottle, put it  in  hot water, introduce
into it half an ounce of phosphorus,  for every pound of lard,
then add a pint of proof-spirit  or whiskey; cork the  bottle
firmly after its contents have been heated to 150 degrees,
taking it  at the same  time out of the water, and agitate
smartly till the phosphorus becomes uniformly diffused, form-
ing a milky looking  liquid.   This liquid being cooled, will
afford a white compound of phosphorus and lard, from which
the spirit spontaneously separates, and may be poured  off to
be used again, for none of it enters into  the combination, but
it merely serves to communicate the phosphorus, and to  dif-
fuse it in very fine particles through the lard.   This com-
pound, on being warmed very gently, may be poured out into
a mixture of wheat flour and sugar,  incorporated therewith,
and then either flavored with oil of rhodium or rosemary, or
not, at pleasure.   The flavour may be varied with oil of any
kind to suit the fancy.  This dough  being  made into pellets,
is to be laid about near the  rat holes.   By its luminousness
in the dark, it attracts their notice,  and being agreeable to
their palates, and noses, it is  readily taken, and  proves cer-
tainly fatal.   They soon are seen issuing from their lurking
places to seek for water to quench their burning thirst and
bowels, and they commonly die near the water.   They con-
tinue to eat it  as long as it is offered to them, without  being
deterred by the  fate  of their fellows.  It may be an easy
guide for those who are  desirous of  following the prescrip-
tion, and may  not have a thermometer at hand, to know that
a temperature  of 150 degrees of Fahrenheit is equivalent to
a degree of  heat midway between that at  which the  white
of an egg coagulates, and that at which white wax melts.

              CHLORINE  FUMIGATION.

     Take Common salt,    -----  2 pounds.
       "  Carbonate magnesia,                    5 ounces.
       "  Cold water,  ------   i pound.
       "  Sulphuric acid, -----     1   «
Mix the salt and magnesia, and add at proper  intervals the acid and water.
  Used in wards of hospitals or other  infected  apartments,
to purify the atmosphere of filthy places.   The  chloride  of
lime is also good. 
ANATOMY.
  Anatomy is the art of exhibiting the structure of organized
bodies, either by dissection, injection, boiling, or other modes
of preparation; or the  knowledge acquired by any of these
means.
  The importance of human anatomy as the basis of all  true
physiology, and of the rational exercise of physic and surgery,
is now universally acknowledged.   The ancients having had
few opportunities of examining the structure of the human
body, made  comparatively little progress in the  knowledge
of its functions;  and a few facts obtained by casual inspec-
tion  of wounded patients, with some analogies gathered from
the internal parts of brutes which had been killed in sacrifice
or for food,  constituted the sum of their anatomical know-
ledge.   Their opinions of  the functions of living animals
were still more contemptible.   Of the uses of the heart and
arteries, the lungs, and the liver, they were totally ignorant;
the grand discoveries of the circulation of the blood, the ab-
sorption  of the chyle  and lymph, the  functions  of the sto-
mach, the liver, and the other viscera employed in digestion
or nutrition, are  entirely due to the skilful and patient anato-
mists of modern times.  Of the  absolute, the indispensable
necessity of the most minute knowledge of anatomy to the
operating surgeon, it is superfluous to speak.   By the exact
acquaintance which surgeons have now acquired of the rela-
tive-position of the various organs, whether  muscles, nerves,
or blood-vessels, they  are enabled successfully to perform
operations,  which formerly would have  been regarded as
utterly impracticable;  and to cure diseases which in ancient
times were  allowed  to wear out the patient  in torture  and
putrefaction.
  It is greatly to be  regretted, that any obstacles  or discour-
agements to the acquisition of anatomical knowledge should
exist in  any quarter.  There is  undoubtedly an  instinctive
horror at mutilating the erect form, which was  so lately the
residence of an intelligent and immortal spirit: and  few con-
       2i                   o2               161 
162
ANATOMY.
template, without the deepest anguish, the possibility of this
being done to the person of those who had  nourished their
infancy and protected their childhood, or in whose  counte-
nance they were accustomed to discern the benevolent feel-
ings of their heart  Yet the instincts of nature must give
way to the calls of duty and necessity.   They who, for the
acquisition of a useful and necessary profession, devote them-
selves for a time to the disgusting exercise of dissection,
should meet with no obstruction from those who are to bene-
fit by their skill and attainments.   If persons in the  better
ranks of life are  afflicted with diseases  which require  the
knife of the surgeon, they very properly demand the assistance
of the best that can be procured; but they should remember
that they cannot have a skilful surgeon who has not dissect-
ed  many bodies.   This should not be forgotten  by judges,
magistrates, and  other persons in power, who, by the influ-
ence of their character and attainments, should temper and
remove the prejudices of the people,  instead of inflaming
them.  Every year there are numerous judicial investigations,
on the result of which many lives depend.  In trials for sus-
pected murder, and in coroners' inquests, almost the whole
affair depends on the evidence of medical  men, who  are
called upon to state their opinion as to the cause of death,
and who  can never, with  the  slightest  accuracy, describe
what is the consequence of violence, poison, or disease in
anyr part of the body, unless, by the  frequent practice of dis-
section, they have been familiar with the appearance of the
same part in its usual unaltered state.  Some knowledge of
the human body, and  some  information  on the importance
of anatomy, should be  communicated in all Mechanics' Insti-
tutions, and the labouring classes should be impressed with
a proper sense of the importance of good surgeons  to them
in particular.  A rich  man, when sick or disabled, can com-
mand many alleviations;  but to those who must  live by the
strength of their limbs, and the dexterity of their hands, health
and vigour are equivalent to a fortune.   Sensible and well-
informed masters should take proper  opportunities  of  im-
pressing on their workmen the utility and necessity of human
dissections.   When the fall of a scaffold precipitates a num-
ber of masons to the ground; when the  bursting of  a steam
engine throws down the walls of a manufactory, and  mangles
many of the workmen, or scatters the destructive fragments
of a vessel among the passengers and crew;  when the car- 
ANATOMY.
163
penter or ship builder cuts  an artery with his tools, nothing
but the assistance of a skilful surgeon can give a chance of
recovery, and preserve the life and limbs of the wounded, for
the support of themselves and their dependant  families.  No
plates, no models, no descriptions, can convey the knowledge
necessary to entitle a man to make the  smallest pretensions
to operate on the diseased  living body.  There are means
of supplying the materials  for a surgical education, without
imparting a shock  to the  feelings of any, and without de-
moralizing the character of those who are employed; and
we confidently trust that the liberality and good sense of the
legislature will take out of the way those obstructions to the
attainment of surgical knowledge, which have been long pro-
ductive, not only  of inconvenience, but of profligacy and
crime.
   By  Comparative Anatomy, is meant the knowledge  of
the structure of the bodies,  or of the functions of other living
creatures  besides  man.  The great functions,  which  are
common to all living and organized beings, can  be known
only by the diligent cultivation of comparative anatomy.  By
this we see what powers or operations of nature are necessary
to the existence  of animal life;  how respiration is performed,
and how digestion;  how some  senses are perfect  in some
animals, and  in  others defective, but all conducive to the
comfort of the  animal  in  whom they are  found.   We are
thus enabled to  distinguish what is essential to  animal  life,
and what is extrinsic or accidental;  and in  many cases, we
apply  to the  use of man, for  the  cure  of diseases, and the
improvement  of his powers, the knowledge we acquire, by
observations and experiments made on the lower animals.

                   THE SKELETON.

   The skeleton, by which  is understood all the bones of the
body connected  together in their proper situations, is divided
into the head, trunk,  and extremities.
   When the bones are  put into a natural situation, scarcely
any one of them will be found to have a perpendicular bear-
ing on another;  though the fabric composed by them is so
contrived, that in an erect  posture, a perpendicular line from
the common  centre of gravity, falls in the middle of their
common base.   On this account, we can support ourselves
as firmly as if the axis  of  all the bones had been a straight 
164
ANATOMY.
line, perpendicular to the horizon: and we have much greater
quickness, ease and strength, in several of the necessary mo-
tions, as well as other advantages in  the situation and  pro-
tection of the viscera.   It is true, indeed, that wherever the
bones, on which any part of the body is sustained, decline
from  a straight line, the force of the muscles required to
counteract  the gravity is greater than would be otherwise
necessary; but this is more than compensated, by the advan-
tages above mentioned.

                   OF THE  BONES.

   The bones compose the  solid frame-work of the animal
body, determining its shape, containing or defending various
internal organs, and forming levers, by acting upon which,
the muscles effect some of the most important motions of
our bodies, particularly those in which the feet, hands, arms,
and legs are concerned.  Bones vary in their shape, size, and
texture, according  to their  situation  and uses.   They are
composed chiefly of phosphate of lime, or earthy matter, and
gelatine, or animal matter.   The outer surface of bones is, in
general, firm and compact; while inwardly they are spongy
and  porous, with numerous blood-vessels running  through
them.   The most general division of bones  is into  the long
and cylindrical, and the flat and broad.  The bones of the
arms, thighs and legs, belong to the  first  class, and  those of
the skull, shoulders and hips, to the latter.
   The large round bones, as those of the arms and legs, have
a cavity in their centre, to admit of greater lightness being
combined with sufficient compactness and strength.   In this
cavity are contained the marrow  and blood-vessels which
nourish the bone.  There are in the human body altogether,
two hundred and forty-eight distinct bones.
   At the time of birth, the bones are  very imperfect, partic-
ularly those of the head; so that by being moveable in this
part, and folding over each other during the time of delivery,
an easier passage is procured for the infant.  There are many
projections from the bones, which  in infancy are  soft, but
which in the adult state are  bony; and the same tendency to
the formation of bone increasing with our years, bones which
were separate in the prime of life, concrete in old age.   In
the decay of the body, however, the  bones  are  diminished 
ANATOMY.
165
with the other parts, so as in extreme  old age to weigh a
third less than in the middle periods of life.
  To far the greater number of bones, whose ends are not
joined to  other bones by immoveable articulation, are an-
nexed, by the intervention of cartilage, smaller bones, called
epiphyses or appendages.   In young subjects these are easily
separable, but  in  adults the points of conjunction are not
very perceptible.
  The bones  are  furnished with a tough membrane, called
the periosteum, which is  spread on their surface, and the
principal use of which seems to be to convey blood-vessels
for their nourishment;  these blood-vessels are very numerous
and remarkable in the bones of the infant state, but become
gradually less so in the progress of life.
  The ends of the long bones, where they are united to each
other, are larger than their  middle part,  and several advan-
tages attend this  structure.  By this means the surface of
contact between the two  bones at the  joint, is  increased;
their conjunction consequently becomes firmer; there is more
space for the connection of the muscles, which also act more
powerfully, from their  axis being further removed from the
middle of the joint, or the centre of motion.
   The marrow, which fills the cavities of the bones, is a fat
oily  substance, contained in a  fine transparent membrane,
which receives numerous blood-vessels, and is supported by
the filaments of the reticular substance of the bones.  If the
different parts of a bone are observed, it  is found  that where
the  diameter  of the bone is the least,  there the sides are
thickest and most compact; where the diameter is the greatest,
which is in general towards the ends of the long bones, their
structure is very cavernous  throughout.   The  marrow per-
vades  the whole substance  of the bones, but it is most re-
markable in the middle part of the cavities of the long bones.
Its appearance and nature also differ in different bones, or in
the same bone in the progress of life.  Thus, the marrow is
bloody in  children, oily in  adults, and thinner  and more
watery in aged people.
   Besides  dislocations and fractures, bones are liable to in-
flammation, to caries or rottenness, to necrosis,  in which the
bone dies  and is replaced by a new one; to rickets, and to
distortion and softening of their substance. 
166
ANATOMY.
                  THE MEMBRANES.

   A  membrane is  an expanded thin substance, lining and
covering the  different parts  of the body.   The membranes
are of different kinds, varying in structure, appearance, and
functions.  They are named from the fluids which lubricate
their free surfaces, serous, mucous, &c.   The membranes are
extremely liable to  inflammation, which alters, if it be not
speedily  removed, their structure, and changes the nature of
the fluids which they secrete.   Most of the inflammations
which occur wTithin the body are seated in membranes.
   Serous Membrane.—The serous membrane forms the en- •
velopes of the brain,  lines  the  thorax and abdomen, and
covers nearly all the organs  contained in these two cavities.
It is  a thin  transparent membrane,  its free surface being
smooth and shining, of a silvery white appearance;  it is con-
stantly lubricated by a thin  serous fluid, in  consequence of
which, it receives its name.   In  a state of health, it is insen-
sible,  or nearly so, and presents no trace  of  vessels carrying
blood; but when inflamed, it becomes very  sensible, and of
a bright red colour.   Under certain states of disease, the se-
rous membrane pours out an increased amount of fluid from
its surface, which collects  in the cavities, constituting the
different  dropsies.   Pus is also  sometimes  exhaled from its
surface, when  inflamed; it becomes  likewise covered with a
false membrane, which, uniting with a similar  morbid pro-
duction, from an adjoining portion of serous membrane, glues
the two surfaces together.   In this manner, the cavity of the
thorax, or abdomen, has been completely obliterated, or or-
gans are  made to adhere together, which, in a healthy state,
have no connection with each other.
  Mucous Membrane.—The  mucous membrane lines the nos-
trils, mouth, windpipe, and  bronchia,  the alimentary canal,
bladder, and various other cavities. It is called mucous, from
the circumstance of its being constantly covered on its free
surface, during health, with a mucous, or a slimy fluid.  The
structure  and  general  character of this  membrane are the
same wherever it is  situated.  Its free surface has a velvety
or spongy appearance; every where it is covered with small
eminences  or  depression, from  which  exudes  the  mucus
which lubricates  it.  It is  plentifully supplied with blood-
vessels, nerves and lymphatics, which are so intimately com-
bined  with the membrane, that they seem to form the greater 
ANATOMY.
167
part of its substance.   During health, the mucous membrane
has more or less of a rose colour; when inflamed, it becomes
entirely red, and  secretes, according to  the  degree or  stage
of the inflammation, a thin watery fluid, a thick yellow mu-
cus, or  pus.   Sometimes it  pours  out large quantities  of
blood, or its surface becomes covered with a false membrane.
This  membrane  is thickened by inflammation, but its sur-
faces, which are in contact with each other, never adhere.


                    THE MUSCLES.

   The  muscles are the  organs which change,  regulate, and
fix the  positions  and attitudes of the body, and which  are
directly or indirectly concerned in all the  more conspicuous
motions of the solids and  fluids.   In these numerous and
important  operations,  they  exhibit  phenomena peculiar to
themselves, and which  cannot be traced to gravity or im-
pulse, to elasticity or to chemical attraction.  They produce
their  effect, whether it be a  state of  motion or rest, by con-
tracting their fibres in consequence of stimulants; while  the
stimulants, whether chemical, mechanical,  or vital, seem to
act through the medium  of a nervous energy.
   They are not  restricted to any length, breadth, or  thick-
ness;  to any form, magnitude, or colour;  though every one
belonging  to  a pair  resembles  its  fellow.   They  are not
formed  of any one homogeneous substance, but composed of
carneous and tendinous fibres, interspersed every where with
cellular membrane, and the ramications of arteries, veins,  ab-
sorbents,  and  nerves,  all of them  alive,  and  all  of them
irritable.
   The  carneous  fibres  constitute  flesh.   They seldom or
never appear single, but  are  collected into small fasciculi, or
bundles, that unite to form larger ones; which larger fasciculi
beino- united, form the collections which, with their tendinous
fibres, &c, we call muscles, and which we distinguish  by
proper  names.
   The  carneous  fibres are all sensible to  stimulants of one
kind  or another;  and being the  only parts that contract in
obedience to the  will, or in  consequence of stimulants ope-
rating regularly, they constitute the  distinguishing character
of muscles.  As  they derive their  principal power from a
vital  source, the  change  produced upon  them by  death, is
sudden  and obvious.   Hence the muscles,  that, when living, 
168
ANATOMY.
could have  ruptured  their tendons, luxated the bones, or
broken them to  pieces, can  scarcely, when  dead, if it were
not for their tendons, their cellular membrane, and the rami-
fications  of  the  blood  and absorbent vessels, support their
own weight.   In the living state, it is obvious, however, that
their strength must vary, and in a  great measure depend on
the nature and degree of the energy communicated.  In the
voluntary muscles, that energy, to a certain  extent, is varied
at pleasure.   Yet the influence of  the will is nothing,  com-
pared to  the influence of instinct, emotion, and passion, to
which the will is frequently subservient.  These often affect
the whole of the muscles, and, through their medium, alter
the secretions.  It is this connexion between muscular action
and the vital powers, that explains how our muscular strength
is varied  by  the states of sickness and  health; and how our
exertions are more or less vigorous and extensive, continued
for a longer  or a shorter period, and attended with greater or
with less fatigue, in  proportion  as the mind happens  to be
influenced by the exhilirating or depressing passions.
   Of the ultimate fibres composing a muscle, of their con-
nexion with contiguous fibres, of their form, their structure,
and that series  of processes  occasioning their contraction,
much has been said, conjectured, and reasoned; but nothing
of importance has been added to our stock of authentic in-
formation.

                   THE STOMACH.

   The stomach is  a membranous sac, in form, when dis-
tended, not unlike a bagpipe.  The stomach is much larger
towards  the  left side than towards  the right.   It has two
orifices, one  towards  the  left side, where the esophagus or
gullet enters, called the cardia, and another towards the right
called the pylorus, which opens into  the intestines.   The
great extremity of the stomach is situated in the left side of
the abdomen, and for the most  part immediately under the
diaphragm;  the  left  orifice is  almost opposite  to, and  very
near the  middle  of the bodies of the lowest  vertebrae of the
back.  The small extremity of the stomach does not reach
fully to the  right side of the  abdomen; it  bends obliquely
backward towards the other orifice; so that the pylorus lies
about two fingers' breadth  from the  body  of the vertebrae,
immediately under a  small portion of  the liver, and conse- 
ANATOMY.
169
quently lower down and more forward than the cardia.  The
stomach is connected to the omentum, and by means of the
omentum, on the left side, to the spleen.
   The orifices of the stomach are placed in the recesses on
each side of the spine, to which the body of the stomach is
close applied so as in a manner to  be  bent round it.   The
orifices of the stomach are therefore placed further back than
its body, and  also a little higher, though when the  stomach
is distended, its body rises  nearly to a  level with its orifices.
The body of the  stomach is  distinguished into two curva-
tures;  the  concave surface, which is applied  around the
spine, is called the lesser curvature, and that which is con-
vex, and is turned forwards and downwards, the greater.
   The stomach is formed of three  coats.  The external of
these is the  peritoneal; the second is muscular, and is formed
of fibres, variously distributed around the stomach; some run
down each side of the stomach longitudinally, other circular
fibres surround the stomach, and refuse egress to such mat-
ters as are not fitted to undergo the next changes in the process
of digestion.   Thus, ill masticated and indigestible  food,
coins, stones of fruit, and the like, are not suffered at  once
to pass from the stomach into the intestines.
   The pylorus is  subject to alteration of structure, ending in
cancer, and giving rise to very painful  and distressing symp-
toms.
   Gastric Juice.—The fluid  secreted by the exhalant arte-
ries  of the  stomach.  Until a very late period, the gastric
juice was supposed to  act upon the aliment taken into the
stomach, as  a powerful solvent, and in  this manner to effect
its digestion.  To prove this, attempts have been made to
cause the digestion of various articles of food, by submitting
them to the  action of the gastric juice out of the stomach;
and, in these experiments, it has been found that the food does
undergo a certain  degree of softening; but the  product of
these artificial digestions, has never been proved by chemical
analysis  to  be chyme.   Nor  is it  probable,  that a process
which is so  intimately dependant upon the health and vigour
of the stomach, as digestion, and which causes  the food to
undergo  an  actual change in its  chemical properties, can be
effected  by  the action merely  of a solvent fluid.  All the
office we are permitted to ascribe to the latter, is that of pre-
paring the aliment for the  action of the  stomach  itself;  an
office which it shares with the teeth  and saliva.  The gastric
       22                  P 
170
ANATOMY.
juice, when obtained after a long fast, is a clear, ropy, faintly
opaque fluid, entirely destitute of acidity; but when food, or
any stimulus, even the simplest kind, is applied  to the inner
coat of the stomach,  the gastric juice  then becomes uni-
formly acid, and the degree of acidity is in proportion to the
amount of the stimulus applied.   The acidity is derived from
the presence of free acetic, and probably hydrocloric  (mu-
riatic)  acids.

                      THE HEART.

   The heart  of man, and of the more  perfect animals, is
composed of two parts, one of  which is destined to propel
the blood into the lungs, and the other to distribute it to the
system at large.   The heart is contained within the pericar-
dium, a strong membranous  bag, smooth, and lubricated by
fluid on the inside, having its inner lamina reflected over the
heart itself.   The heart is situated  obliquely in the middle
of the breast,  its posterior surface is flat, and lies upon the
diaphragm:  its apex is turned  forwards, and towards the left
side, so that, in the living body, it is felt striking between the
fifth and sixth ribs, a little towards the left side of the breast
bone.   The pulmonic  part of the heart  is composed of an
auricle and a ventricle.   The auricle is a muscular bag, very
thin, and having a dark appearance, from the blood shining
through  its  coats.   Into  this cavity, the two  large veins,
which  have collected  the blood from the upper and lower
parts of the body, empty themselves; the auricle contracting
sends the blood into  the right ventricle, which propels it
through the pulmonary artery into the lungs.   There circu-
lating in innumerable vessels, and exposed to the influence
of the  air we breathe,  the dark purple blood  is changed to a
bright  scarlet colour, loses the noxious properties it acquires
by flowing through the system, and becomes again fitted to
circulate as before.   The  blood proceeds from the lungs by
four vessels into  the left auricle, which, like  its fellow, is  a
muscular bag that contracts and sends the blood into the left
ventricle, by which it is sent  into  the aorta,  and by its
branches throughout the body.   To  prevent  the blood  from
regurgitating, and to keep it flowing  in the proper direction,
both the auricles are furnished with valves, or little membra-
nous folds, which allow the blood to pass one way, but are
accurately closed when any of it attempts to  pass in the op- 
ANATOMY.
171
posite.  At the mouths of the  pulmonary artery and of the
aorta, there are also valves, for the same purpose.  The
valves of the right  auricle are called  he tricuspid valves,
those of the  left the  mitral; those at the beginning of the
arteries are called semilunar valves, which forces the blood
into  the auricles, and the returning blood, they throw into
the ventricles; which, when they are filled, throw the blood
into  their respective  arteries.   The  contractions  are called
the  systole, and  the dilatations, the diastole of the heart.
The  beating of the  pulse corresponds with the force and
frequency of  the movements of the heart.   This astonishing
organ contracts and  dilates upwards of  a hundred thousand
times in a day, and can continue its action unimpaired and
unwearied for seventy or eighty years.

                     THE BLOOD.

  A red fluid, of  a  saltish taste,  and urinous  smell, which
circulates in the heart, arteries, and  veins.   The  blood is a
most important fluid  in the animal  body.   It furnishes the
materials  from which.the various parts  of the body are fur-
nished with nourishment;  it is the fluid from which the se-
cretions are  formed; it is the source  of animal  heat;  it
stimulates  the heart  to contraction, and  by its presence  in
the blood-vessels, it distends them, and gives plumpness to the
body;  and by shining through the transparent skin, causes
the fine complexion, and the shades of colour, which impart
so much beauty and interest to the  healthy human  counte-
nance.
  Many calculations have been formed  of the total quantity
of blood in the body; but as the data upon which they have
proceeded are extremely uncertain, so the conclusions have
been widely  different, and, of  course, the greatest  part  of
them remote  from the truth.  Perhaps,  upon the whole, the
estimate, which would  seem the  nearest approximation,  is
that  of Haller, who supposes that the blood may constitute
about one-fifth of the weight of the adult body, the propor-
tion  of the fluids being  greater  in youth, and diminishing  as
age  advances.   A body  weighing one hundred  and fifty
pounds, would,  therefore, contain about thirty pounds   of
blood, and of this, it is  supposed,  that three-fourths or more
are in the veins, and one-fourth only in the arteries.
  The blood in one portion  of the heart  is of a bright, 
172
ANATOMY.
red colour, and is driven by the contraction of this powerful
organ into the  arteries.   When the red blood  has  reached
the extremities  of the arteries, it is conveyed into veins, by
which it  is brought back  to  the  heart  The blood in the
veins differs in colour from that in  the arteries; it is now
dark  coloured,  and  incapable  of furnishing  materials for
nourishment or secretion, with the remarkable exception of
the venous blood from the intestines, which,  circulating
through the liver, is employed in the secretion of bile.  The
blood which has circulated through the body, and been em-
ployed in  secretion, is unfit for performing a second time the
same functions;  and  in  order to  repair its salutary powers,
and  be again rendered fit for the  purposes of the animal
economy,  it passes through the lungs; in  which  organs, by
the action of the air, it loses its dark venous colour and in-
jurious properties, and again is fitted, in the  state of florid
arterial blood, to impart  life and vigour  to the animal system.
   Blood, when it  is first  drawn  from the body, appears a
"uniform fluid; but by being allowed to  rest, it spontaneously
separates into two parts, viz., the crassamentum, or cake, and
the serum, or watery part, besides a vapour which  exhales
when the  blood is warm at its first drawing off.   The cras-
samentum is thick, and like jelly; it soon becomes putrid;  it
is  insoluble in water.   The surface of the crassamentum, ex-
posed to the air, is of a more florid colour than that which
is  deeper in the dish, and not exposed  to the air.  The red
globules may be washed away, and they leave what  is called
the fibrine of the blood.   The other part of the blood is the
serum, a lymphatic, or watery fluid, with little  smell, saltish
to the taste, of a yellowish  green colour.   When blood  is
drawn from the body, while under the influence of inflamma-
tory disease, the crassamentum is covered with  a tough, lea-
ther-looking surface, of various depths, from the thickness of
a shilling  to a quarter of an inch,  known by the name of the
buffy coat.   The appearance of this buffy  coat, in conjunc-
tion with  other circumstances, gives a  very good  indication
of the inflammatory state of the system.   Sometimes this
appears cupped in the middle, drawing the upper part of the
crassamentum from the sides towards the centre.   The blood
frequently puts on a similar crust in the state of pregnancy. 
ANATOMY.
173
                     THE BRAIN.

  The important organ contained within the skull constitut-
ing the material instrument by which the mind acts, and is
acted upon.  It is, in other words, the exclusive seat of the
powers  of perception and volition,  and of the intellectual
faculties.   The human  brain is  divided  into  cerebrum, or
brain proper; the cerebellum, or lesser brain, and the medulla
oblongata, or commencement of the spinal marrow.  Besides
the bones of the scull, the brain has  a covering composed of
three membranes, an external one which is very firm, and of
a bright silvery appearance, termed the dura mater; an in-
ternal thinner and very  vascular one, named  pia mater, and
between these is interposed the fine  delicate membrane, de-
nominated tunica arachnoides.  The brain consists of a large
pulpy mass, externally formed into numerous waved or con-
voluted furrows, being  of a light reddish colour near the
surface, but internally of a whitish or cream colour.  It con-
tains several  cavities, and its  substance  is  amply supplied
with numerous small blood-vessels.    The internal structure
of the brain has been accurately studied, and  minutely de-
scribed by anatomists;  but still these descriptions throw but
little light upon the nature of its functions.  The cerebrum
constitutes the uppermost and anterior portion  of the brain,
beneath which, posteriorly, is situated the cerebellum; from
the former it is separated by a strong transverse membrane,
called the tentorium.   In man, the cerebrum is much larger
than in  any other animal, in proportion to the cerebellum,
which, in the lower animals, has  always the preponderance.
The cerebrum is now very generally conceded to  be the
organ of  the intellectual and moral  faculties..   It is divided
into  two hemispheres or lateral portions, by a doubling of the
dura mater, which, from  its  resemblance to a scythe, has
been called the falciform process.   Both hemispheres are
identical in their structure and functions.   The cerebellum
is the organ of the passions, appetites and propensities; it is
also  composed of two parts,  or lateral lobes.  On the infe-
rior  part of the brain, commencing near its centre, and pro-
jecting backwards, between  the  lobes of the cerebellum, is
situated the medulla oblongata.  Both the cerebrum and ce-
rebellum  are  connected  with the  medulla oblongata, and
through it with each other.   The connection  between the
                           p 2 
174                     ANATOMY.
brain and the organs of sense, and the  other  parts of the
system, is maintained through the medium of the nerves and
the  spinal marrow.  The nerves  of  the organs  of sight,
smell, hearing and taste, together with the great sympathetic,
which gives branches to the stomach, heart, lungs, and other
important viscera, are the nerves which proceed directly from
the brain.
   The  principal  disorders to which the brain and  its mem-
branes are liable,  are concussion, compression from external
injury, inflammation and suppuration, accumulation of water
in the ventricles,  constituting dropsy, apoplexy,  and various
morbid  growths.

                     THE NERVES.

   Nerves are whitish cords, of various thickness, which are
found distributed  to every part  of the system.   Every nerve
that has yet been  discovered  in an animal body  regularly
formed, has  proceeded directly or indirectly from a brain, a
little brain, or a spinal marrow.   The  nerves  distributed to
the organs of  sense and voluntary motion are, compared to
the parts on which they ramify, proportionally the largest in
the whole system.  Any of the trunks of the nerves of  the
arm, are larger than the middle or great  sympathetics, that
supply  the  viscera of the thorax  and  abdomen;  and  the
branches, at the points of  the  fingers, are larger than those
which are seen entering the basis of the  heart.   All nerves
have been divided into those which are sensible or insensi-
ble, voluntary  or involuntary; the sensible being those which
obviously and  suddenly communicate intelligence to the vital
principle, of the  injuries or changes that take place  in  the
system,  or of the  impressions  that  are made from  without;
the insensible, those which perform their observations  ob-
scurely  and  secretly, unknown  to the senses, and without in
general  awakening  our consciousness; the  voluntary, those
which are either subservient, or at least partly subservient, to
the will; the involuntary, those, whose functions are obvious
to the senses, but on which the will has no direct or imme-
diate influence.   The sensible nerves grow often insensible
and the voluntary nerves often involuntary, in consequence
of palsy; while insensible nerves,  on the  other hand,  are
often observed to become sensible from the diseased state of
the parts on which they ramify.   Voluntary nerves, though 
ANATOMY.                     175
 enerally sensible, do not appear to  be necessarily so.  In-
 oluntary nerves, although exempted from  any direct influ-
ence of the will, are  seldom exempted from the effects of
fear, of anger, or any of the violent  mental emotions which
affect  indiscriminately both the  voluntary and  involuntary
nerves.  We see the nerves  not immediately subjected to the
influence of the will, distinguished not only by a proportion-
ally smaller size, but  likewise by certain swellings or knots
that are named ganglions; and as all  these nerves are sub-
servient to functions  that are constant and uniform, it has
been supposed that these  ganglions  are both reservoirs  and
sources of  the nervous energy; and  that by affording a reg-
ular supply, and resisting those occasional commotions ex-
cited by volition, they are calculated to preserve  that uni-
formity in point of function,  by which the involuntary nerves
are distinguished.
  Nerves also form plexuses or net-works, whose use is less
obscure than that of the  ganglions.   In the large plexuses
formed by the nerves of the  superior and  inferior  extremi-
ties, we see a number of communicating branches  passing
between one trunk and another; and which, like the inoscu-
lating branches of blood-vessels, contribute to secure a more
regular supply of that sort of energy which  nerves convey
to the different parts on which they are  ramified.  Physi-
ologists are accustomed to trace particular connexions among
the organs  that, distant  or  near, derive  their  nerves, not
merely from the  same ganglions  or  plexuses, but  the  same
trunks, or the contiguous corresponding parts of  the brain
and its prolongation.   It is thus they explain the sympathy
between the eyes and the nose, when a strong light impinges
on the one, or a pungent odour is applied to the other.
  The accurate researches of modern anatomists have made
considerable additions to our knowlege of the  nerves.  It
has been discovered,  that what is commonly called a nerve,
may contain in one  sheath nervous filaments  possessed of
very different properties, some conveying sensations from the
external world, or the surface of  the body, to the brain;
others transmitting museular motion by volition, to  the ex-
ternal  organs.  Thus, in a part of the  body, as the face, the
sensation may be entire, while the muscles  are paralyzed, or
the reverse may take place, the  motions  being  perfect, but
the sensibility gone.  Hence many anomalous symptoms are
explained;   and  paralytic affections which  were  formerly 
176
ANATOMY.
thought to indicate great derangement of the brain, are now
easily traced  to a tumor pressing upon  a  particular nervef
and very bad  symptoms disappear from the spontaneous cure
of the tumor, or by an easy surgical operation.

                  THE INTESTINES.

   By the  intestines is meant  the whole of the alimentary
canal below the stomach.  They are  divided into the small
and  large.   The  small intestines are subdivided  into the
duodenum, the jejunum, and the ileum.  The large  into the
ccecum, the colon, and the rectum.  All the intestines, ex-
cept some part  of the duodenum, are surrounded and sup-
ported by the mesentery.  In  man, the length of the intes-
tines is about six times that of the body, but in graminivorous
quadrupeds, their length, in proportion to  that of the body,
is  much greater.
   The small  intestines fill the middle and fore  parts of the
abdomen, while the large  fill the upper and under parts, as
well as the sides of that cavity.
   Small Intestines.—The  small intestines, in general, are of
a cylindrical  form.  They are  composed  of four coats, the
structure of which is similar, and which bear the same names
as those of the stomach.   The mucous coat of the small in-
testines is very extensive, and forms, together with the cellu-
lar substance  beneath  it, a vast number of red semilunar folds
or wrinkles, which serve to increase remarkably the internal
surface of the intestines, and of course to expose the aliment
more fully to  the mouths of the lacteals.
   The small  intestines assist in the preparation of the chyle,
and propel their contents towards the great intestines.
   With respect to the small intestines in  particular, several
circumstances are to be noticed.  The duodenum, so named
from its being about twelve inches in length, differs from the
others in  not being entirely surrounded by the  peritoneal
coat.  The  duodenum, beginning  from the stomach,  first
runs  towards the  right side  downwards, and rather back-
wards;  then  it  bends towards the right kidney, to which it
is slightly connected, and thence passes  obliquely across the
abdomen, ascending gradually from right  to left, till it gets
before the last vertebras of the  back.   It continues its course
obliquely forwards, by a gentle turn, and then terminates in
the jejunum.   Through this whole course the duodenum  is 
ANATOMY.
177
firmly bound down and concealed by folds of the peritoneum.
About six inches from the pylorus,  the common bile  duct,
and the duct from the pancreas, pour their contents together
into the duodenum.
  Of the remaining part of the small intestines, two-fifths are
called the jejunum,m empty gut, and the remaining three-fifths
the ileum; between them no striking line of distinction can be
pointed out.  The jejunum is placed more about the umbili-
cal region; the ileum more in the hypogastric.  The  small
intestines at length terminate in the  large, in the hollow of
the right iliac, or haunch  bone, below the kidney.   At this
place there is a valve, which exhibits the appearance of a
slit or chink.   This  valve permits a free passage from the
small intestines  into the  large, but prevents any thing from
passing readily from  the large into the small.
  Large Intestines.—The caecum, which forms the beginning
of the great intestines, may be considered as  a production of
the colon  expanded  into  a bag.  It is about four fingers in
length, and as many in breadth.   It is situated in the right
iliac region, and rests on the  broad part of the haunch bone.
At its lower part, it has a long small  projection, called vermi-
form, from its resemblance to an earth worm.  Under the
name of colon, is comprehended almost the whole of the great
intestines.  The colon begins in the right iliac region, and
is attached to the kidney; thence it  rises as  high as the sto-
mach and the liver.   It  now runs  transversely  before the
stomach to the left side, is connected to the  spleen  and kid-
ney, descends into the left iliac region, and being there bent
in the form of the letter S, it  terminates in the rectum.  The
structure of the colon is similar that  of the small intestines.
   Along the whole course of the  colon are a number of cells
formed  by circular contractions of the intestine, which serve
to retard the progress of its contents.
   Along the whole course of the  large intestines we also ob-
serve small projections of a fatty substance,  contained in
elongations of the common coat.
   The rectum, which is a continuation of the colon, begins
at the lowest vertebra of the loins.   It is bent  along the in-
ternal surface of the sacrum and coccygis, to which it  is
closely  applied, and terminates at the anus.
23 
178
ANATOMY.
                    PHRENOLOGY.

   The word phrenology signifies a discourse on  the  brain;
it is applied to designate the doctrines advanced by Gall and
Spurzheim in relation  to the structure and functions  of the
brain.  According  to  these gentlemen, the brain is not a
single organ, but a collection of organs, each  one destined
to perform a particular function.   The mental faculties they
divide into those of the feelings, and those of the intellect.
The first are subdivided into propensities and sentiments. The
second, or intellectual  faculties, they divide into the knowing
and reflecting.   The propensities do not give origin to ideas,
they merely produce sensations of a kind peculiar to each.
They are common to man  and other animals.   They are
amativeness—the propensity to physical love; philo-progeni-
tiveness—the instinctive love of offspring;  concentrativeness,
the function by which  the mind maintains  two or more
powers in simultaneous action, and determines the individual
to fixedness  of  location and purpose; adhesiveness, the in-
stinctive attachment for surrounding objects, whether animate
or not—it disposes to  friendship and society; combativeness,
instinctive desire to combat; it manifests itself by anger and
rage; constructiveness,  instinctive tendency to  construct; in
man, directed, by the predominance of other faculties  in dif-
ferent individuals, to various objects;  in the lower animals,
to form their burrows,  dens, or nests; acquisitiveness, instinc-
tive tendency to acquire and possess; the love of property
and wealth is founded  on it; its predominance causes ava-
rice;  secretiveness,  instinctive  tendency   to  conceal  the
thoughts, desires and emotions of the  mind, until  the under-
standing  has decided upon their fitness and probable  conse-
quences;  when  properly balanced by  other organs,  it pro-
duces prudence; when it predominates, it causes slyness and
cunning.    The sentiments  are mere emotions,  or  tendencies
to emotion, they produce no ideas, many  of them are pos-
sessed by other animals as  well as man, some are  peculiar to
the latter.   The first are self-esteem—love of approbation__
cautiousness,  and benevolence, which  are  fully indicated by
their names.  Those peculiar to man, are veneration—hope__
ideality, or the faculty of the mind which causes in indivi-
duals a desire for something more perfect than what ordina-
rily presents itself, which inspires them with enthusiasm and 
ANATOMY.
179
exaggeration, and promptsto embellishment and splendour of
conception—wonder,  the  sentiment of  the marvellous, or
marvellousness, proneness  to belief in  mysterious  incidents,
ghosts, sorcery and  witchcraft; conscientiousness and firm-
ness.  The organs upon whose functions the sentiments and
propensities just enumerated depend, are situated in the pos-
terior and inferior portion of the  brain; the organs  of  the
intellectual faculties now to be enumerated, are seated in the
anterior and upper part of the brain.   They are eventuality,
or the desire and ability to know facts and things; form,  the
faculty of judging of form; size,  the  faculty of judging of
magnitude—weight—colouring—locality, the  faculty of re-
membering and recognizing places; order—time—number—
tune — language — comparison — casualty—wit—imitation.
The greater the development  of  the individual organs,  the
more powerful the propensity, sentiment, or intellectual fa-
culty, to  which they are destined, becomes.  The  develop-
ment of the organs is caused by their frequent exercise. The
predominance of one or more of  the mental organs,  stamps
the peculiar moral or intellectual character of the individual.
Of course, the foregoing is a very superficial sketch of  the
leading propositions;  the  explanation and application of
which constitute  the doctrines of phrenology;  sufficient,
however, has been  said to give the reader a general idea of
that science. 
 
MATERIA  MEDICA.
THE  USE OF  MEDICINES.
  Medicines are those substances introduced into the  sto-
mach, with the intention of producing certain effects, for the
cure of disease, or the preservation of health.   Substances
applied externally are more generally termed  applications, or
remedies.   Medicines are obtained from all the various king-
doms of nature, and  are used either simply or combined to-
gether.  Their doses are to be regulated  according to the
circumstances of each individual, with respect  to  age, sex,
temperament, strength, peculiarity of constitution, &c.   The
doses of medicine for children under twelve, are to be di-
minished to one-seventh, one-fifth,  one-fourth, and one-half;
at two years, four, six, eight, and upwards; from sixteen, in
general, the full  dose may be  given.  Some medicines—as
calomel—do not make the same  impression on children as
on adults, and therefore are  not to be diminished so much.
Women in general require smaller doses  than men; but of
purgative medicines,  many require a good deal more. When
a person has been accustomed to a medicine, he in general
loses his susceptibility of being moved by it;  but some medi-
cines appear to  have their action more  easily excited by-
habit   When a person has been weakened  by  the long du-
ration  of a disease,  medicines must be ordered in smaller
doses than at the commencement of it  Some medicines
only act more certainly when given in large doses, but not
more violently; this  is the  case with ipecacuanha.  Medi-
cines vary  in their activity, and this must  be taken  into the
account when a fresh parcel of such medicines is commenced
with; thus, if we are giving foxglove, it will be right to begin
with a diminished dose of the new portion.  The effects ot
some medicines  seem to accumulate in the system.   This is
remarkable of foxglove, and sometimes of mercury; we must
not  therefore, always continue to  give the medicine till we
have some proof of its entering the constitution.  Some per-
                           Q                 181 
182                 MATERIA MEDICA.
 sons  have very remarkable peculiarities with  respect  to the
 operation  of certain  medicines.   W7hen this  can be known
 beforehand, we of course avoid the  use  of these medicines
 with such patients.

   Times of Administering Medicines.—There  are certain
 times of the day more convenient than others for giving some
 medicines.  Purgative  medicines should be  given late  at
 night, or early in  the morning.  The bowels are not so easily
 acted upon during the time  of sleep; and  hence pills, and
 other medicines which do not act speedily, have time to dis-
 solve  fully, and to  produce their due  effect on the bowels.
 Saline purgatives are best given  in  the  day time, that the
 cooler state of the surface may determine their action to the
 kidneys.  Emetics, in slight feverish disorders, are best given
 in the evening, as they produce tendency to sleep and per-
 spiration,  which  are  best encouraged by  retiring  to bed.
 Medicine  for  perspiration should not be given  during the
 process  of digestion.

                      ANODYNES.

   Anodynes  are  medicines .which relieve  pain.  Another
 name by which they are known is narcotics, from  a Greek
 word, which signifies stupor, which may be  considered  as
the general term; and the various narcotics have  received
specific  names  according to the effects most strikingly pro-
duced by them.   If they induce sleep, they are called hyp-
notics, or  soporifics.  If they diminish the rapidity of the
circulation, or the activity of the general system, they are
 called sedatives;  and from the circumstance of  their being
used to  diminish the sensibility of pain, they are  called ano-
dynes.  The substances possessed of narcotic, and, therefore,
of anodyne properties, are very numerous.  The following
are some of them:—opium, henbane, hemlock, camphor, fox-
glove, tobacco,  and  stramonium.  Of these,  one of the most
useful is opium, in some of its various shapes.
   Great care  must be taken  not to give  anodynes from the
mere  circumstance  of pains  being felt.   A person has an
acute  pain  of the  side, from inflammation of the lungs, or of
the bowels.  In such  cases, the true anodyne is a large bleed-
ing; and a dose of opium given  on such occasions, would
be destructive of life. 
MATERIA MEDICA.                 183
                    ANTIEMETICS.

  Antiemetics  are medicines which have the effect of sus-
pending  vomiting, or  removing  sickness of  the  stomach.
The irritability of the stomach, by which nausea and vomit-
ing are produced, in  very many cases, can only be removed
by  such  remedies as are  adapted to restore  the  organ to
health.   Hence bleeding, leeches to the stomach, perfect rest,
and small portions of iced water, or even ice itself, are often
the only antiemetics which  can be employed or depended
upon.  When,  however, inflammation of the  stomach is not
present, vomiting will often be suspended by small doses of
magnesia—by the effervescing mixture;  tablespoonful doses
of lime water and milk;  a weak infusion of serpentaria, taken
cold:  cold toast water, or  by a mustard poultice, or blister to
the pit of the stomach.  When vomiting  depends upon the
presence of some  irritating substance in the stomach, as bile,
indigested  food, or the like, drinking plentifully  of warm
water, or of a weak infusion of camomile flowers, will aid in
removing the cause, and in that manner suspend the vomiting.

                 ANTIPHLOGISTICS.

  All remedies which  have the power  of reducing the in-
creased action of the heart, and morbid heat of the skin in
fevers, and of curing local inflammations, are termed anti-
phlogistic regimen, under  which are included all the ■ rules,
prohibitions,  and observances, which are prescribed  in cases
of fever,  inflammation, and diseases of excitement.   These
directions, viewed by themselves, may appear minute, trifling,
and beneath the dignity of science; but  taken together, they
form a plan of  acting, of which the best recommendation is
the safety attending its observance,  and the fatal results which
ensue when it is rashly, obstinately, or secretly disregarded.
The  enlightened  and upright practitioner does not perplex
his  patient with the volubility of medical phrases which he
cannot understand, nor does he needlessly pour in quantities
of nauseous drugs.   He knows that in many things the pa-
tient must administer to himself, and in many, the good sense
of his attendants must ward off the mischief arising from sur-
rounding circumstances of incessant occurrence.   The anti-
phlogistic regimen consists in the removal or non-application
of  whatever  would  greatly or  unnecessarily employ  the 
184
MATERIA  MEDICA.
 powers of either the body or  mind.  To illustrate what is
 meant, let us take the case of  a patient in fever, or in pleu-
 risy.   The  medical  attendant will,  of  course, when first
 called,  use the proper remedies; as  blood-letting,  purging,
 and determining to the  skin; but he will  do comparatively
 little for his patient's  recovery, if his directions for his  after-
 management are not precise,  and  accurately attended to.
 The air of the apartment  must be kept pure and temperate;
 there ought to be  no unnecessary attendants in the  room;
 fresh  air should be admitted from time to time, by  cautious
 opening of the doors  and windows;  and all evacuation from
 the body should be  quickly removed from  the  apartment;
 there should be no glare  of light from the sun, or fire, or
 candles; the room  should be darkened, and the curtains, or
 at least those next the windows, should generally be closed.
 No talking or whispering should be kept up in the room; the
 noise of carts or carriages in the street should be  diminished
 by straw or  oak bark; or, where this is impracticable, the
 ears should be  slightly stopped with  cotton or wool.   The
 regulation  of the diet, and of  the drink, is of primary im-
 portance; and  it is here that physicians have the  greatest
 difficulties to encounter.  The friends of the patient tell with
 real concern that he has taken  no food for many  days; that
 he  must be very weak,  and that  he  surely  can never get
 through if he be kept  so  low; they do  not consider the  salu-
 tary instinct  of nature in loathing the food which the sto-
 mach cannot digest;  and  they  venture  to give what  they
 think  very nourishing, in the shape of beef tea or chicken
 broth.   The physician, at his next visit,  finds the fever still
 high, the pulse  full and strong, the thirst urgent, and the face
 flushed;  he suspects, or  obtains a confession of, the impru-
 dence which has been committed, and is  obliged again  to
bleed  largely, to counteract or repair the mischief.   When
nourishment  is allowed  at  all, it should be  of the  mildest
kind, and such as does  not heat or stimulate the body:  as
thin gruel,  or panada, sago, rice,  or arrow root.   Equally
alarming and destructive events follow from too strong drinks.
However general among the ignorant, may be  the hateful
practice of using spirits on  all  occasions, and their  faith in
the mysterious virtues of wine, it is to be hoped that few
among the well-informed and educated classes would venture
on strong drink in any illness, without the  express order of
the physician; but even here, injury is sometimes done, espe- 
MATERIA  MEDICA.
185
cially in the inflammatory diseases of childbed, by the igno-
rance or  officiousness of nurses and servants.  The drink
should be of the mildest sort—neither too hot nor too cold;
though it  is, in many cases, very proper to allow the patient
cold water, for which he often has instinctively a strong and
not unsafe desire.  The drinks proper in  inflammatory dis-
eases, are  toast water, barley water, water gruel, various pre-
serves of  fruit, dissolved  in water: as strawberry jam, rasp-
berry jam, &c;  whey of milk, vinegar and water, sulphuric
acid,  largely diluted with water, water from cream of tartar,
lemonade, and the like.   Much irritation will  be prevented
by frequent changes of linen and bed clothes.  Much of the
antiphlogistic  regimen is to be directed to the mind.  Every
source of uneasiness and anxiety must be  avoided; there
must be no talking of business, no hasty or unguarded narra-
tives introduced, no exhibition of distress and hurry, of alarm,
or mystery, in the faces of  friends  or attendants.  Every
thing should be  done for the patient's comfort, with calmness
and good  sense; and while we  cannot sanction any deceiv-
ing of his mind  with regard  to his situation when there is
real danger, we  consider it of great importance to give him
no unnecessary agitation, by the imprudence  of those around
him, or by representing tilings as worse than they really are.

                  ANTISCORBUTICS,

  Are medicines which prevent or cure the scurvy.  The chief
of these are fresh vegetables,  and nourishing food generally,
as acid fruits,  vinegar, lime and lemon juice;  sorrel, pure dry
air, proper clothing, daily active exercise, and  such pursuits
as have a tendency to  promote  a cheerful  disposition  of
mind.

                   ANTISPAMODICS,

  Are medicines generally to relieve  spasm, or irregular and
painful  action of muscles, or muscular fibre.  Antispasmo-
dics, properly so called, are given rather to put an end  to a
fit, or sudden  attack of painful convulsions, than to cure the
disease itself.  A patient is  seized with a fit,  and to put a
stop to the fit, we administer  to him hartshorn or camphor;
but this will not cure the disease, or prevent its return; we
must  try  to  discover its cause, whether  it proceeds from
       24                   o2 
186
MATERIA MEDICA.
worms, from dentition, or from a wound; and we must direct
our after practice accordingly.  Antispasmodics are  useful
in cramp  of the  stomach, in  griping pains of the bowels,
asthma, hysterics, and some other sudden and  violent affec-
tions  not connected with  inflammation.   In griping of the
bowels, it is the practice among the ignorant, to  trust to the
antispasmodic  powers of ardent  spirits,  either alone or in a
toddy; but the possibility of the pain being the symptom of
inflammation, should, in every instance, deter  from this  ex-
pedient.  If the pain arise merely from  spasm or flatulence,
a cup full of warm water will be a far better remedy.  Fre-
quently, cold water suddenly applied to some part of  the
body, relieve the spasm there, or even in distant parts.  Thus
the cramp in the leg is stopped by cold applied  to the foot.
Sometimes the warm bath relieves spasm, sometimes blood-
letting does it  It  appears then, that whatever makes a
strong or sudden impression on the nervous system, is to be
regarded as an antispasmodic;  but the medicines which com-
monly go under that name, and produce a sudden relaxation
of the spasms  are, musk, castor oil, ammonia,  assafcetida,
valerian, opium, ether, and camphor.                       i

                    ASTRINGENTS.

  Astringents  are those remedies which, when applied to the
body, under the solids, dense, and firmer, by contracting the
fibres, independently of their  nervous  or muscular  power.
They thus  serve  to  diminish  excessive discharges; and by
causing greater compression  of  the nervous fibrillae, may
probably lessen morbid sensibility or  irratibility.   Hence,
they may tend  indirectly to  restore the strength when  im-
paired by these causes.  Most astringents impart a peculiar
harshness  and roughness  to the tongue  and palate  when
tasted.  The chief astringents are alum, sugar of lead, cate-
chu, oak bark, galls,  kino, lime water, logwood, uva-ursi,  and
the mineral acid  diluted.  Cold, also, appears to act as an
astringent  Astringents are principally employed to  arrest
profuse discharges of blood and mucus, and to  check the in-
ordinate action of the bowels.   In certain cases  of local in-
flammation, externally seated,  astringent washes are also
beneficial.  Their internal use requires a very great degree
of judgment;  improperly resorted to, they very often are  the
cause of no little  mischief. 
MATERIA  MEDICA.
187
                   BLOOD-LETTING.

   Blood-letting signifies the taking away of blood by artifi-
cial means, and is  either general or local.   General blood-
letting is performed by the opening of veins or  arteries by
the lancet;  and  local blood-letting  by the application of
leeches or cupping-glasses.   The great power  of  blood-
letting in the cure of diseases cannot be quite satisfactorily
explained.  Even in pretty large bleedings, the quantity taken
away does not  bear a great proportion to  the whole of the
circulation or mass; and blood-letting seems to do good prin-
cipally by somehow altering that excited state of the system
which occurs in robust  constitutions, and which  is marked
by a full, strong pulse, and a florid look, with  firmness and
activity of the  muscular  system.   This excited state, pushed
a  little farther, passes into inflammation, general or local.
When the fulness of the vessels is taken off by blood-letting,
their coats contract less  strongly, and the  excited  action is
lowered.  Blood-letting  seems  to have great effect by its ac-
tion on the nervous system, as  we see in the fainting which
is  brought on in many cases by a very small bleeding.  The
taking away  of blood, in whatever way it acts, is ascertained
by long and universal  experience to  be  one of our most
powerful remedies.   The particular  cases to which  blood-
letting is applicable, may be considered as ranking under the
heads of diseases of excitement, of fulness,  and those which
arise from tension and irritation.  Blood-letting is useful in
the following diseases:—1. Fever.—As there are fevers of
various kinds,  and as the same disease in  different stages
presents various symptoms, the  remedies  which  would be
useful at one period, and in one kind of fever, would be de-
structive when  circumstances are altered.   To no remedy is
this remark more applicable than to blood-letting.   At one
time it may be  the means of a perfect cure;  at others it may
occasion a waste of the  vital  powers which cannot  be re-
paired.   It therefore requires much discrimination to deter-
mine the kinds of fever,  and the periods of disease in which
it is proper, and to guard lest bad consequences  follow the
loss of blood.   In inflammatory fever, where there is a strong,
quick,  and full  pulse, much flushing of the face, throbbing at
the temples, delirium, thirst, and heat  of the skin, we should
not hesitate to  bleed largely.  There is a disease well known 
188
MATERIA MEDICA.
to the people by the name of Typhus  Fever, where the
pulse is small, weak, and fluttering, the tongue black, the skin
dry,  the patient delirious  and insensible; in this fever, or to
speak more correctly, at this stage of the fever, it would be
insanity to bleed largely.   But whatever may be the danger
of bleeding at that stage of the disease, or  however the phy-
sicians of  forty  years ago would have  shuddered at the
thought of bleeding a patient in Typhus, it is well known
that  this disease often begins with symptoms of high excite-
ment;  and there is reason to believe that the blood is irregu-
larly distributed and accumulated in certain organs.   At this
early period, blood-letting is one of the most effectual reme-
dies  we can  employ; and when prudently  and moderately
employed, it  prevents the sinking  strength which frequently
succeeds to high excitement when too long continued.  Much
caution is  requisite  not  to bleed too often, nor when the
disease has continued for several days; as this would have a
tendency to bring on a dangerous and fatal sinking of the
strength, or the true typhoid state.   Against inflammation of
every organ, blood-letting is the chief, and  almost infallible
remedy.   Other auxiliaries have  been found, but our  main
reliance is upon blood-letting.  In acute rheumatism, or what
is properly called a rheumatic fever, it  is generally proper to
begin our  treatment by a pretty free discharge of blood; and
it is vain to expect success from the sweating practice, unless
the high  action of the vascular  system be  first reduced by
this or other means.   There are certain states of the system
in which, after a period of what is called high health, feverish
synmptoms come  on;  and then a  discharge of blood, gene-
rally clear and  florid, spontaneously takes place from  some
part  of the body.  Thus we  have bleeding  at the  nose,
spitting of blood, or a discharge of blood  by stool,  or urine.
Such discharges of blood are called active hemorrhages; and,
however paradoxical  it may appear to cure a  discharge of
blood by taking away more, yet  by this operation the physi-
cian has it in his power to relieve the  system, and to dimin-
ish the danger which might  occur in organs liable  to be
injured by the too great activity of the circulation, or likely
to become the  seat of diseases which  may  ultimately  prove
fatal.  Instances  of active hemorrhages are  seen in bleeding
from the nose,-and from the lungs.  There are bleedings again
where the system is in a state quite the  reverse of activity
and  excitement, and where artificial blood-letting would be 
MATERIA  MEDICA.
189
 improper.   These hemorrhages  are  termed passive.  Such
 are  the true  sea scurvy, and  the  too  copious flow of the
 monthly discharge, when  accompanied by sickness and  a
 broken state of health.  In apoplexy, blood-letting is abso-
 lutely necessary also.  In  convulsive diseases, especially if
 there is an appearance of any tendency to the head;  and in
 certain kinds of dropsy, and occasionally in asthma; in short,
 in any disease, by whatever name it may be  called, where
 there is a necessity for quickly reducing feverish action, or
 diminishing the quantity of blood circulating in  the system,
 or reducing the local inflammation.
   The quantity of blood to be  taken.—With respect to the
 quantity of blood to be taken  away,  no general  rule can be
 given;  different  diseases  are  to  be  treated  with different
 quantities, and in two persons  labouring under what might
 appear to be the same disease,  the quantity that would have
 little effect in  the one case, would cure the other.  In an
 adult of good strength, a pound of blood, or sixteen ounces
 is a  moderate bleeding; twenty-four  ounces a full bleeding,
 and  from thirty to forty ounces a large  one.   Some inflam-
 mations are so violent, and demand  such active treatment,
 that in one day the bleeding may require to be repeated from
 three to six times, the quantity taken away in a day varying
 from sixty to eighty or ninety, and at one bleeding from thirty
 to fifty ounces.   In general, we are not to be regulated by
 measurement, but by  the effect produced by the disease, and
 on the  general system.
  Mode of Bleeding.—The veins from  which the blood is
 most commonly  taken, are those at  the bend of the arm;
 there the veins are in general pretty numerous and easily got
 at, and a ligature  is  easily put around  the limb to fill  the
 veins.   In diseases of the head, we may consider it advisable
 to take blood from the external  jugular vein, or from the tem-
 poral artery.  In some cases we find it difficult to get enough
 of blood from  the arms, and we try  it from the superficial
 vein of the foot.   In  bleeding at the bend of the arm, when
 the blood appears to  run less freely, its flow is increased by
 the patient squeezing the hand, or grasping something in it,
 by which the blood in forced from  the  deep to the superfi-
 cial  veins.   Sometimes we are prevented from getting the
proper quantity by the patient  fainting; in this case we are
to lower the head and shoulders, to stop the orifice a little,
and then to let the blood flow when the patient is in the ho- 
190
MATERIA MEDICA.
rizontal posture.  Sometimes the patient, from  mental mo-
tion, faints  almost immediately on the arm being tied up;
and  sometimes we must  be content with the  diminished
action  of the  system, of  which this fainting is the proof.
Sometimes the veins are so small, or so imbedded in fat, that
it is impossible to get the quantity of blood we wish.  This
is often the case with children.   We are  obliged, therefore,
to resort to other methods, opening the  temporal artery,  or
leeches, or cupping.

  Accidents that sometimes follow Blood-letting.—A dark livid
swelling sometimes takes place at the wound made in blood-
letting.   It looks alarming  to  those who  are  not  familiar
with it; but is not in general a circumstance of much conse-
quence, as it arises merely from the blood getting under the
cellular substance and skin.  It sometimes swells so fast, that
the  proper  quantity of blood cannot be obtained.  In this
case we  must  take off the bandage, and apply  compresses
wet with a  cooling lotion—as vinegar, or cold water—to the
swelling, retaining them by a slack bandage.  The effused
blood will in time disappear; and if we have not got enough
of blood, it  must be taken from the  other arm.   Sometimes
there is an inflammation of the skin in the neighbourhood  of
the  wound.  This is to be treated with cooling applications
and rest, and by a poultice;  if there is a tendency to suppu-
ration,  red lines  are  sometimes seen  extending from the
wound; these  are inflamed  absorbents, and are painful  on
pressure; sometimes the inflammation reaching to the arm
pit,  causing the swelling of a gland there,  and perhaps sup-
puration.  Inflammation may spread along the course of the
veins, and produce symptoms of the most alarming and even
fatal nature.   The fascia,  or membranous expansion on the
fore-arm, may  become inflamed, and give rise to great pain,
tension, and febrile symptoms.  Poultices are to be  applied,
and an extensive incision  made through the fascia, to relieve
the tension, and to give vent to this  matter.  A nerve may
be wounded, and this may give rise to  convulsions, violent
pain, and other symptoms of nervous irritation.   In  every
puncture of the skin, a nerve of some size or other must be
wounded; and it is thought to be in consequence of the par-
tial wound of  a nerve of some considerable size, that violent
accidents occur after blood-letting.   The  artery of the arm 
MATERIA MEDICA.
191
may be wounded, giving rise either to a dangerous bleeding,
or to aneurism.
   After enumerating so many accidents that may arise from
blood-letting, we  may  surely be allowed to blame the rash-
ness of those numerous dabblers in surgery, who pretend to
be competent to the performance of this operation, but who
are ignorant of the precautions they ought to  observe, and
stand  aghast when the dangerous or painful  consequences
follow.  It should be remembered, that as  bleeding is one of
the most salutary remedies when timely and properly applied,
so it is one of the most deadly and destructive when exhibit-
ed in wrong circumstances; and though, from its frequency,
it must be performed by those whose skill and experience is
but small, yet it may be attended with  accidents which  re-
quire the utmost boldness, address, and promptitude, to coun-
teract their fatal  tendency.
   Blood-letting should not be employed but for the cure of
disease, or for the prevention of it when manifestly impending.
Many persons  who have no particular illness, apply to a sur-
geon  to  have blood  drawn  from  them.  In  Europe,  and
among country people, blood-letting is habitually employed
at certain seasons, with the view of preserving their health;
but it is a practice that should not be followed, as it is apt to
induce a dangerous habit: and instead of diminishing  the
 quantity of blood, it ultimately increases it.   Fulness  of  the
 system may be prevented by safe  means, such as purging;
 but even this preventive would be wisely superseded by tem-
 perance in eating and drinking, and avoiding the provocative
 of modern luxury.  When apoplexy appears to be likely to
 make an attack, as indicated by the throbbing of the temples,
 ringing in the ears, flushing of the face, and headache, then
 a precautionary bleeding will be very  proper.  Also, when
 feverish symptoms occur  in those who are known to be sub-
 ject  to spitting of blood.

                    CARMINATIVES.

    Carminatives are those medicines which dispel flatulency
 of the stomach and bowels, by stimulating the  inner coat of
 the organs.   They produce only temporary relief; for if the
 diseased condition  of the alimentary canal be not removed
 by appropriate remedies,  it will very speedily become again
 distended with flatus.  The  articles generally employed as 
192                 MATERIA MEDICA.
carminatives, are infusions or tinctures of the aromatic seeds
and vegetables.   The use of these articles is decidedly inju-
rious in every instance in which the stomach or intestines
are in the least degree inflamed, or when their sensibility is
morbidly increased.   They are very favourite prescriptions
with nurses and mothers, to allay  the griping  with which
young  children  are so frequently afflicted, and, under these
circumstances, a great deal of mischief is caused by their in-
discreet  administration.  Wholesome food, cleanliness of
person, protection from cold and damp, and sufficient exer-
cise, will most  generally prevent  a flatulent  state of  the
bowels of infants; when, however,  it depends upon the dis-
ease of those parts, carminatives will seldom do good, but
will often increase the sufferings of  the little patient.

                    CATHARTICS.

  All medicines which accelerate the action of  the bowels,
or increase  the  discharges by  stool, are termed cathartics.
These remedies, from a general difference in their modes of
operation, have  been classed  under two  divisions,  namely,
laxatives and purgatives.   The former operate so mildly, that
they merely evacuate the contents of the intestines without
occasioning any  general excitement of  the body,  or even
stimulating the  exhalant vessels  of the canal,  and extend
their effects to the system in general; and when these effects
are very violent, the purgative is further distinguished by the
name of drastic.   Laxatives may then be said simply to open
the bowels, and to carry off extraneous matter, which is al-
ready present in the cavity; but purgatives, as they Occasion
more  extensive  effects, may be made subservient  to  many
important purposes in the cure of diseases.  Many medicines
which in their usual doses act as purges, may in diminished
doses be made  to  act as gentle aperients.  An  ounce of
Epsom or of Glauber salts, dissolved in about four ounces of
water, and  taken pretty warm,  will  purge strongly;  but half
an ounce in the same, or  even a  larger quantity of water,
will  operate as an aperient or laxative.  Castor oil, in the
dose of from half an ounce to an ounce, is a good  aperient,
or a dessert-spoonful  of sulphur  and cream of tartar, with
molasses; or an  infusion  of senna, with or without a small
spoonful of  tamarinds; or a teaspoonful of cream of tartar;
or diminished doses of any of  the  purging  salts; it may be 
MATERIA  MEDICA.
193
taken as an  aperient.  The cases in which it is desirable
or necessary to use aperients, and not purges, are in persons
of a sedentary life, women  in  the  state of pregnancy, and
those who  are  subject to piles, or where we do not wish to
reduce the  strength of the patient, or produce increased irri-
tation of the intestines.  Purgative medicines, as distinguish-
ed from  laxative, in their effects, may be said to  produce a
considerable influx of fluids from the exhalant vessels which
open into the intestine canal, and hence to extend the action
to the system in general.  The effects of purgatives depend
either on their stimulating the muscular fibres of the  intes-
tines to  a  quicker motion,  by  which the  contents  of the
bowels are  more speedily and completely discharged;  or on
their stimulating the exhalant vessels and the mouths of the
mucous glands, which open  into the bowels, by which  there
is an increased discharge both of serous and mucus fluids;
or purgatives may so stimulate the neighbouring viscera, as to
occasion a  more copious discharge of the bile and pancreatic
liquor.   Different purgatives have  different powers of pro-
ducing several effects.   Sulphur, magnesia, and manna, eva-
cuate the bowels without any great increase of serous dis-
charge; while others,  as the  neutral  salts, and some vegetable
purgatives—as gamboge and elaterium—"-produce large watery
evacuations, and are thence denominated hydragogues.   The
mercurial purgatives—as calomel—seem to act  chiefly by
promoting  an increased flow of the  bile, and hence are called
cholagogues.
   The use of purgative medicines is of great importance in
the preservation of health, and the cure of disease.   They
can be so managed and selected as  either simply to promote
the discharge of the feculent matter, or to cool the system by
abstracting watery fluid, and withdrawing the action from
the upper parts of the body, or to promote the flow of  drop-
sical water by  stimulating the absorbents and  exhalants,
which  open in  such prodigious numbers on the inner surface
of the intestines.
   The neutral  salts furnish many useful purgative medicines:
as the sulphate of soda, the tartarate of soda, and salts;  these
are commonly  given  to purge  and to cool  the system, and
are useful  in inflammatory  disorders.  The usual dose of
them is  an ounce, dissolved in about four ounces of tepid
water.   They should be taken in the morning, and not too
warm • as in  that case they will either be thrown  up, or pass
       25                   R 
194
MATERIA  MEDICA.
 off too quickly for  the  bowels.   The purgatives from the
 vegetable kingdom  are very numerous:  as  aloes, jalap, rhu-
 barb, gamboge, scammony, colocynth, and  others;  and in
 addition to these, we have calomel, and perhaps a few more,
 from the mineral  kingdom.   Castor oil  is a  mild and safe
 purgative, more commonly ranked as a laxative; and there
 is another oil, (the  croton,) famous  for its activity in doses
 so small as a single drop or two.   Purgatives are  combined
 together with great and manifest  utility; not with the result
 of adding the powers of one  to  another, but of making the
 desired  effect  more  complete,  certain, and  advantageous.
 Thus five grains of calomel will purge, and twenty grains of
 jalap will purge separately; but by giving in  one dose, five
 grains of calomel, and twenty grains of jalap, we do not pro-
 duce a double evacuation, but one  modifies the other, and
 produces the effect intended, with certainty and expedition.
 It is unnecessary, in this general  article, to speak of the dif-
 ferent kinds of purgatives, as we shall  detail  under each of
 them their properties, and the reason  of preferring  any of
 them in particular cases.   We may say here, that it is not a
 good habit to take frequent purgatives; they relax the intes-
 tines, and debilitate the digestive  system, as well as the whole
 body;  but in  some  constitutions, the bowels  are so  torpid,
 that it is absolutely necessary for the preservation of  health,
 to take some medicine or other pretty constantly; directed,
 not so as to produce copious thin stools, but gently to stimulate
 the intestines, and excite them to evacuate the proper feces.

                    DIAPHORETICS.

   These consist of medicines which, from being taken inter-
 nally, increase the perspirable discharge by the skin.  When
 this  is  carried so  far as to be condensed on the surface, it
 forms sweat; and the medicines producing it are termed su-
 dorifics.   The operation in both  cases is the same, differing
 only in degree, from increase of dose, from the  employment
of more active articles, or from the use  of auxiliary  means.
 This class of remedies may be  divided into—1. Antiphlo-
gistic diaphoretics, or those which reduce the  action  of the
heart and arteries.   These are principally the  antimonials,
small doses of ipecacuanha, nitre,  and the saline mixture.
2. Stimulating diaphoretics: as  the volatile salts, essential
 oils,  serpentaria, gum guaiacum, opium, and camphor; these 
MATERIA  MEDICA.
195
are proper only in cases where the circulation is languid, the
skin  below the natural temperature, and the general  sensi-
bility of the system is reduced.   3. Dilutent diaphoretics, as
a weak infusion of  balm, camomile,  or  common tea, toast
water, whey, and the like.  These are best adapted to cases
of fever, after depletion, towards the decline of the hot stage;
they are likewise useful in increasing the action of the other
diaphoretics.  4. External diaphoretics:  as the warm  or va-
pour bath, or the application of cold water to the skin when
the latter  is very hot and dry.  Frictions  may likewise, in
many cases, be ranked under this head.
   The proper employment of diaphoretics, as well as in re-
gard to the diseases in which they are demanded, the period
of the  case when they are  resorted  to,  and the particular
kind of diaphoretic to be resorted  to, demands a great deal
of judgment.  By many persons they are considered  to  be
remedies adapted to all cases of disease,  whenever  the skin
is dry and hot; this  mistake, causing them  to be resorted to
under improper circumstances, has caused  not a little mis-
chief.  In those affections, attended with a dry and burning
skin, and violent  action of the heart and arteries, the only
diaphoretics to be depended upon, are the lancet, cold  drinks
internally, the application of cold to the surface of the body;
and, after the violence of the disease has been broken in this
manner, small doses of the antimonials, combined with nitre,
or some other neutral salt.  In diarrhoea and dysentery, as
well as in rheumatism and catarrh, accompanied with a dry,
harsh skin, the temperature which  is not much above that
of health, the warm bath, and  combinations of opium and
ipecacuanha should be preferred.
   When diaphoretics are resorted to,  the patient should  be
confined to  bed, the  temperature of the room should be kept
at a  medium point, and sudden transitions from a warm room
to a  cold air carefully avoided  after the  sweating has sub-
sided.

                      DIURETICS,

   Are  medicines which increase the  secretion by  the kid-
neys, and  by consequence, the  flow of urine.  This is  an
effect which, in many cases  of disease, we  are  very anxious
to accomplish, and which has a very salutary tendency.   In
dropsy, it  is always very desirable to increase the flow of 
196
MATERIA  MEDICA.
 urine, and in severaj species of that complaint, it is the chief
 indication of cure.   The principal diuretic medicines  are
 the  following: cream  of tartar,  squill, foxglove,  acetate of
 potash, carbonate of soda, spirit  of nitrous ether,  turpentine,
 juniper, tobacco  and mercury.
   These various diuretics have their peculiar modes of ope-
 rating.   Some, as potash and  its  combinations, nitre and
 cream of tartar, squill, juniper, and  turpentine, seem to  act
 by directly stimulating the kidneys, being  carried, more or
 less  decomposed, to  these organs.  Others, as mercury,  stim-
 ulate the absorbents primarily, and secondarily the kidneys;
 others appear to act first on the stomach and digestive organs,
 or the bowels, and afterwards on the  absorbents; such  are
 tobacco, jalap, gamboge, elaterium; while others, by reducing
 the action of the heart, and  emptying  the blood-vessels,  in-
 crease the action first of the absorbents, and secondarily that
 of the kidneys.   Their  effect is to be aided by moderate
 cold  to  the surface of the  body, and we therefore prefer
 giving them  during the  day time.   It  is to be  remarked,
 however, that we  are by no means certain of always procuring
 a  diuretic effect  by  any medicine whatever, and  that those
 which, in general, have the highest character, frequently fail.

                       EMETICS,

   Are substances capable of exciting vomiting,  independ-
 ently of  any effect arising from the mere quantity of matter
 introduced into  the  stomach, or of  any nauseous taste  or
 flavour.   The susceptibility of vomiting is very  differently
 modified in different individuals, and is often considerably
 varied by disease.  Emetics are employed in many diseases.
 When any morbid affection depends upon, or is immediately
 connected with, over distension of the  stomach, or the pre-
 sence of acrid or indigestible  matter, vomiting gives  speedy
relief.  Hence their  utility, when  too much or improper food
has  been taken,  in cases of intoxication  and  poisoning.
 They are serviceable, also, in jaundice, arising from calculi,
 obstructing the course of the bile in the gall ducts;  in the
 early stages of catarrh, consumption, diarrhoea and dysentery,
and  in the forming  stage of  various febrile affections.   In
nauseating doses,  they  are  useful  in  arresting discharges  of
blood from the lungs, bowels, and uterus, in dropsies, swelled
 testicles, buboes, &c. 
MATERIA MEDICA.
197
  Their administration is injurious and  dangerous in every
case in which there is a determination of blood to the head,
especially in full  habits;  in  inflammation of  the  brain,
stomach, and bowels;  in the advanced stages of pregnancy;
in persons affected with  hernia; in prolapsus of  the womb,
and wherever extreme debility is present.   The frequent use
of emetics produces irritation of the stomach, and impairs
digestion.  An emetic should, in general, be administered in
a fluid form, arid its operation may be promoted by drinking
any tepid diluent, or weak bitter infusion,  as  that of camo-
mile flowers,  &c.   The principal emetics are tartarized an-
timony,  ipecacuanha,  sulphate of copper,  sulphate of zinc,
mustard seed, muriate of soda, and squill.

                   ENMENAGOGLES,

  Are medicines supposed to have the  power of acting on
the womb, and promoting  the  menstrual  discharge.  It is
now  acknowledged by  all  judicious physicians, that we
know of no substance which has a direct and specific action
on  the womb; and that whatever  success any means may
appear to have had, in producing the monthly  discharge,
was owing to some action on the whole system, or on the
neighbouring parts, from which that action has been commu-
nicated, by sympathy, to the womb.  The non-appearance
of the menses in young women, or their obstruction in those
who have had them established  for some  time, is generally
owing to some disorder of the system; and whatever removes
this, and produces  the wished for  discharge, may be styled
an enmenagogue.    Sometimes tonics, sometimes  purgatives,
have  this effect; or if the system be too plethoric, bleeding
may contribute to bring on the discharge.   Electricity, aloes,
cantharides, turpentine, cupping on the loins, or warm fo-
mentation, may all be  useful, when  directed by a practitioner
of skill, who knows the proper time and manner of their
exhibition.  Sometimes good air, exercise, and a regulation
of the diets, are all that is required to establish the monthly
discharge.  Women are very apt to lay a great stress on the
importance of this  function, and to be very uneasy if it be
too long in becoming regular; but there is no fixed period for
its beginning, and while the  health is uninjured, they should
not take strong  medicines with the view of forcing on the
discharge. 
198
MATERIA  MEDICA.
                   EXPECTORANTS.

  Medicines which are supposed capable of facilitating the
excretion of mucus from the chest; that is, from the wind-
pipe, air cells, and passages of the lungs.   They are chiefly
employed in  croup,  asthma, consumption,  and  hooping-
cough.   The greater  number of expectorant medicines, are
those which, in larger doses, prove emetic,  namely, squills,
ipecacuanha, antimony, and ammoniacum.  Besides  those
medicines which are more  commonly called expectorants,
there are various other  remedies which indirectly have the
same effect.   Thus, bleeding, blistering, the warm bath, and
nauseating  doses of  emetics, mucilaginous  and demulcent
fluids, slowly swallowed, as gum water, liquorice, linseed tea,
barley water, and oily emulsion, and the inhalation of the
steam of hot water, have the effect of promoting expectora-
tion, by relieving the irritation of the lining membrane of the
fauces, wind-pipe, and lungs, and restoring its healthy secre-
tions.  Opiates, also,  by removing  any remaining irritation
of the respiratory organs, after depletion has  been carried to
a sufficient extent, may be  considered as, in  some measure,
an  expectorant.  Other substances  promote expectoration,
by directly stimulating the mucous membrane of the trachea
and lungs.   These can  only be resorted to in the absence of
inflammation, or in those cases where there is habitually an
excessive secretion of fluid in the lungs, which,  by its accu-
mulation, impedes respiration,  and  causes a constant and
troublesome  cough; this is particularly the  case in chronic
catarrhs, in certain cases of  asthma, and in the catarrhal af-
fections, occurring in old persons.   The principal stimulating
expectorants, are the  fumes  of burning  tar, the vapour of
vinegar, the balsams of copaiba and tolu, seneca snake root,
garlic, Indian turnip, assafcetida, &c.

                     NARCOTICS.

  Narcotic medicines are those which have the property of
diminishing the action of the nervous and vascular system,
and of inducing sleep.  These medicines are also called se-
datives,  anodynes, and soporifics.   They  appear to act by
first exciting the energy of the nervous and vascular systems,
and this excitement is followed by a degree of collapse alto- 
MATERIA  MEDICA.
199
gether disproportioned to the excitement.  This depression
is so rapid, that the previous excitement is not perceived, and
hence many physicians regard certain substances as direct
sedatives.  The principal  substances possessed of narcotic
properties,  are  opium, hyosoyamus, (henbane,) belladonna,
camphor, hemlock, foxglove, strammonium.. Each of these
substances  seem to have some peculiar manner of operation;
and when one narcotic fails, another will often induce sleep.

                   RUBEFACIENTS,

   Are remedies which excite the vessels of the skin, and in-
crease its heat and redness.  They act precisely in the same
manner as blisters, excepting that they produce no vesication,
hence they are employed like them to relieve  internal irrita-
tions, inflammations and congestions; or to  excite the absorb-
ents of some external part.  The principal rubefacients are,
dry frictions, or friction with  some volatile liniment, as  the
liniment of ammonia, soap liniment, decoction of turpentine
and  cantharides, friction with  salt, or dry mustard, mustard
poultices, &c.

                     SIALAGOGUES,

   Are  medicines which  increase the flow  of the  saliva.
 This may be produced by chewing various acrid substances,
 as tobacco, ginger, &c, which, by stimulating the termina-
 tion  of the ducts, excite  the  glands  to  the secretion of an
 augmented amount  of saliva.   The principal sialagogue,
 however, is mercury; which,  taken into the stomach, or in-
 troduced  into  the system by injection,  act on the salivary
 glands with peculiar energy, and causes  the discharge of an
 immense quantity of saliva, producing at the same time violent
 inflammation of the  gums, tongue, and cheeks.   There are
 few,  if any diseases, in which the production of salivation
 is useful.

                      STIMULANTS,

    Are medicines, or other circumstances, capable of exciting
 the vital energy, whether  as exerted in sensation or motion.
 These are of various kinds.   1. They are such  as  are ap-
 plied to the stomach: as alcohol, tinctures, wine, &c.  In 
200
MATERIA MEDICA.
certain cases of debility and disease, a very small portion of
the mildest food will act as a stimulant.   2. Diffusible stimu-
lants, or such as are easily extended  over the whole frame;
as hartshorn, heat, electricity, and  galvanism.   3. Tonics,
mustard,  cantharides.
   It will be seen from the above slight enumeration, that in
speaking of substances of the first class, we  use the term
stimulants, to denote nearly the  same thing as cordials; and
and that  the other classes are arranged along with them on
account  of  the similarity of their  action.   The  cases in
which general stimulants are useful,  are those of torpor and
debility;  but the power of some  stimulants is  so great, and
the constitution is  at times so easily affected by them, that
much skill and caution is required in their exhibition.   Sup-
pose a person  debilitated and torpid, after a long  fever, or
other illness; it w7ould be desirable,  no doubt, to restore his
strength as quickly as possible.  But this is not to be effect-
ed by strong stimulants;  to  him, the  use of such in any
considerable  quantity would probably be  fatal.  In all dis-
eases of excitement—as  inflammation and  fevers, stimu-
lants are to be  avoided, as well as in all cases in which the
stomach  is labouring under irritation, or any affection of the
brain is present.

                       TONICS,

   Are medicines which are supposed to increase the tone or
healthy action, or strength of the living system.  Under this
head might, in  fact, be included nearly  all the  remedies em-
ployed for the  cure of disease.  The  term, however,  is re-
stricted to a certain class of remedies, the action of which is
not properly understood, but the  ultimate  effect  of  which is
to increase  the energy of the muscles, and to promote the
functions of digestion,  assimilation, and nutrition ; and in
this manner, the general exercise of the system.   Tonics are
chiefly useful in that state of debility which remains after the
removal of irritation or inflammation of internal organs, and
are hence  chiefly prescribed  in  the intervals between the
paroxysms of intermittent fever, and in the stage  of convales-
cence, subsequent to long continued and debilitating diseases.
The  principal tonics are the vegetable  bitters, bark, and
various preparations of iron. 
MATERIA  MEDICA.
201
                         ALOES,
   Is  a well known and very useful purgative medicine.  It
is a gum resin, or substance soluble in  diluted spirits, and is
obtained from a  plant which  grows in Barbadoes,  at  the
Cape of Good Hope, and in  the  Island of Socotra, in the
Indian Ocean.   It is prepared  by pulling off the leaves, from
which the juice is squeezed out, and afterwards  boiled  and
skimmed.   Its  taste  is  intensely  bitter  and  disagreeable,
though it has an aromatic flavour.   Aloes is a  warm, stimu-
lating purgative; and it acts chiefly on the large intestines,
seldom  producing any watery or fluid stools, but merely pro-
moting  the easy  evacuation   of the  bowels.   It  generally
agrees well with the stomach,  and  by its bitterness promotes
appetite and digestion;  and it is remarkable with  regard to
it, that  it operates as beneficially  in a small as in  a  large
dose; one  or two grains will often  produce one considerable
stool, and twenty grains may  do no more; excepting in the
last dose, the operation will be attended with griping.  Aloes
is one of the best remedies against  habitual costiveness;  it is
extensively employed by  those of studious, sedentary habits,
and by females of all classes  of society;  and from  its  very
general use, and from its  certainly acting chiefly on the great
intestines, it is not wonderful that many instances are known
 of its seeming to produce piles, and other irritations of the
 lower belly and neighbouring  parts.  It will have  this effect
 when frequently used; and therefore, however  useful aloes
 may be as a  mild and certain evacuant,  it will be right for
 those whose constitutions require  frequent purgatives, to in-
 terpose occasionally  a dose  of neutral salts,  or compound
 powder of jalap, or  infusion  of tamarinds, with senna.   In
 indolent habits, where costiveness  is accompanied by languid
 circulation, loss of  appetite,  disinclination to  exertion  of
 mind or body, fretfulness of temper, and those  symptoms
 which the unlearned understand so well by the term nervous,
 aloes in some of its various combinations, is one of the  most
 valuable medicines we possess.   The cases in  which  aloes
 should be avoided, are those of persons  subject to piles, to
 discharges of blood, and where  inflammation  or  irritation
 exists in the bowels.   From  their action on the uterine sys-
 tem they are used  in cases where the monthly discharge is
 obstructed;  and  for a similar reason, should be  used with
 caution in a state of pregnancy.   The dose of  aloes is from
        26 
202
MATERIA  MEDICA.
three to fifteen  grains, but from  its disagreeable and bitter
flavour, it is never given alone, but combined with aromatics
or bitters, or made into pills.   The  following are some of the
most useful forms in which aloes may be taken, with the par-
ticular purposes, and times of the day proper for each.   They
are kept in the  shops of apothecaries, under the name pre-
fixed to each of them :—
  Aloetic Pills.—Aloes and Castile  soap, equal parts.  For
costiveness, without any peculiarity of symptoms,  two pills
for  a dose at bed-time.
  Aloetic Pills with Assafcetida.—Aloes, assafcetida and soap,
equal parts.  For hysterical affections, with costiveness and
flatulence, two pills every second night at bed-time.
  Aloetic Pills,  with Colocynth—commonly called  Colocynth
Pills.—When the  simple aloetic pills are found too weak,
two or three pills at bed-time.
  Pills of Aloes with Myrrh, or Pilula  Rusi.—In  female
constitutions, in  the full complexion and sluggish habits at-
tendant on the suppression or non-appearance of the monthly
discharges, two or three pills may be taken twice or thrice a
day.
  Rhubarb or Stomach Pills.—These contain a small por-
tion of aloes; they are useful for strengthening the stomach
and opening the bowels, and may be taken to the extent of
two pills every forenoon, and two in the evening.
  The far-famed Anderson's Pills consists of Barbadoes aloes,
with a proportion of jalap and oil of aniseed, one or two for
a dose.
  There is another kind of pills  which seem a slight varia-
tion of the pills called Dinner Pills, or Lady Webster's, or
Lady Crespigny's pills, made of equal parts of rhubarb, aloes,
and mastick.  This last ingredient  is not of much virtue in
itself, but  makes the  solution of the  others  in the  bowels
gradual and equal.  The dose of these pills, which have not
received any particular name, is two or three, and the time
for  taking them is immediately before dinner;  they  then mix
the food, prevent flatulency, and are usually found to operate
next morning after breakfast.

                    ASSAFCETIDA,

  Is a gum resin from a plant growing in Persia—the ferula
assafcetida—procured by cutting  the top of the root  across; 
MATERIA  MEDICA.
203
and when the juice is exuded, it is scraped off, and a second
cut made across.  This operation is repeated till the root is
entirely  exhausted of juice.  This drug has a  strong, dis-
agreeable smell, somewhat like garlic, with a bitter acrid taste.
It is one of the most common  remedies for spasms, in hys-
terical complaints, and  in irregularities  of the monthly dis-
charge.  In asthma, and  other kinds of difficulty of breath-
ing, in hysterical  cases, attended  with much flatulence and
costiveness, assafcetida  is  usefully given;  in  this last case,
joined with aloes, in the pills, called the pills of aloes, with
assafcetida, of which two may be given every night, or every
second night   In the fit of hysterics, a draught of the solu-
tion of assafcetida will sometimes put a stop to it immediate-
ly.   When there  is a costiveness, with  much  distension of
the bowels from wind,  or colic pains, a drachm or two of
assafcetida  may be added to a  clyster, consisting of about a
pint of gruel or infusion of senna, with very good effect.  In
spasmodic  cough,  the administration of a mixture, composed
of thirty grains  of assafcetida, two  ounces of.the water of
acetate of ammonia, and  two ounces of  peppermint, may be
given  in doses of one  or two spoonsful, and the same also
has been found of service in hooping-cough.

                  CREAM OF TARTAR.

   Supertartrate of potash—a most useful medicine, obtained
from the matter called  tartar, incrusted  on the bottom and
sides of  casks in which wine has  been kept.  This incrus-
tation is purified by dissolving it in boiling water, and  filter-
ing it while hot;  on cooling, the  salt is deposited in irregular
crystals, and is called  crystals of tartar, or cream of tartar.
This substance is a very effectual diuretic.   When given  as
such in dropsy, it may  be taken in doses of a drachm  twice
a day, dissolved in a large quantity of water.   It is also used
as a purgative; in doses of an half an ounce,  made up into
an electuary,  with an  equal proportion of sulphur, it  is an
excellent laxative in case of piles; and added to jalap, in the
proportion of two parts of cream of tartar to one of jalap, it
furnishes one  of  the best purgative powders we possess.   It
operates mildly and speedily, and besides its purgative effect,
it is also diuretic.  The  dose  of the compound powder of
jalap is  from forty to  sixty grains, and it may  be  given  in
water, tea, beer, or any other fluid vehicle, taking care that 
204
MATERIA  MEDICA.
the cream of tartar be suspended in it, stirring it well imme-
diately before taking it.   Cream of tartar is not very soluble
in water.   The drink called imperial, is a solution of cream
of tartar, flavoured with  lemon  peel, and is very useful in
feverish disorders,  and other cases where a refrigerant drink
is wanted.   It is improper to use it, however, as an ordinary
beverage, as it has a tendency to retard digestion.

                 DOVER'S  POWDERS.

   The ingredients of this medicine are, in ten grains of the
powder, one grain of opium, one grain of ipecacuanha, and
eight of the sulphate of potash; the use of this last substance
being chiefly mechanical, to effect the more complete tritura-
tion and mixture of the other.  It is a most valuable sudorific,
and affords a good example of one medicine so altering the
properties of another, as to produce a third substance  pos-
sessed of new powers.   It is  much used in rheumatism, in
dropsy, in catarrh, and in many7 other diseases where perspi-
ration is required.  The soothing effects of opium seem to be
greatly increased by its combination  with ipecacuanha.   In
inflammation of the bowels, after the free use of blood-letting,
and in perpueral fever, where there is much restlessness and
irritability, Dover's powders is an excellent medicine.   When
we wish to promote perspiration by means  of  it, it is proper
to abstain from drinking  much till after the sweat begins to
flow.

                  DYSPEPTIC  LET.

  A ley made  by infusing a quart of hickory ashes and six
ounces of clean soot in  one gallon of boiling  water, for
twenty-four hours, the clear liquor to be then poured off, has
been highly recommended, in the dose of a tea cup full three
times a day, as a remedy in  chronic  cases  of  dyspepsia, at-
tended with much acidity and flatulence.

                    EPSOM  SALTS,

  Are one of the  most useful of the purgative salts.  It  is
composed of sulphuric acid, combined with magnesia, and is
procured by the evaporation of mineral waters, in which it is
the chief ingredient, as those of Epsom in Surrey; and like- 
MATERIA MEDICA.
205
wise by the evaporation of the bittern  remaining after the
extraction of salt from sea water.  It is one of those purges
which are almost universally proper, and it has nearly super-
seded the use of Glauber's  salts, as being less coarse and
disagreeable.  The dose for a grown up person is from one
ounce to one ounce and a half, dissolved  in  half a pint  of
warm water, and drank lukewarm.  The morning is the best
time for taking saline purges.  Epsom salts may also be given
in the infusion of senna leaves, a quarter of an ounce being
dissolved in four or six  ounces of the infusion.   The same
mixture, of  increased strength, may be  given as a purgative
clyster.

                    IPECACUANHA.

   The root of a plant found in Brazil, which furnishes us with
one of the best and safest of our emetics.  The introduction
of this celebrated root  into medical practice was  chiefly
owing to Helvitius, grandfather of the celebrated author of
the work Der Esprit, who went from  Holland to  Paris very
young, to practise medicine.  He attended and cured a drug
merchant, who  paid him with a packet  of the  root  from
Brazil, called ipecacuanha.  After some experiments in the
hospitals, Helvitius found it possessed the virtue of curing
dysentery.   Before the end of thirty-two years he had made
100,000 crowns by the  cure of that  disease.   Louis XIV.
gave him a thousand crowns for his secret.  So famous was
the success  of the root, that it obtained the  name of radix
anti-dysentarica.  It does good in pure dysentery, by main-
taining a steady  motion of the intestines downwards, and by
determining to the skin;  but in modern practice,  we do not
trust the cure of that very distressing, and in warm climates,
dangerous disease, alone to ipecacuanha, or any one remedy.
For any purpose for which an  emetic is advisable, no better
than ipecacuanha can be desired.  Even  an  over dose has
merely the  effect of producing too hasty  an  evacuation  of
the stomach, but without any bad effects.   It may be given
as an emetic to very young children, and is not followed  by
the debilitating  exhaustion induced by metallic  and other
emetics.  The root is reduced to powder, and the dose for a
grown up person is from fifteen to twenty  grains;  for a child
above a few weeks old, from six to twelve grains, according
to the age.  White wine extracts the emetic properties  of 
206                 MATERIA MEDICA.
ipecacuanha, and the ipecacuanha wine is a very good form
of administering it, providing there be no  degree of fever
present.  To  a  child  a teaspoonful of the wine may be
given every ten minutes till it operates.
  Like other emetics, or perhaps with virtues superior in this
respect, it proves an excellent expectorant; and may be taken
for this purpose, in doses of three or four grains three times a
day; or be made up into lozenges, with some sweet or aromatic
substance; the ipecacuanha lozenges, containing half a grain
each.  In nauseating doses, ipecacuanha is very useful in
hemorrhages from the lungs and uterus.  In dysentery it may
be used as an auxiliary to other means;  combined with
opium it forms the celebrated Dover's powders, now called
the powder of ipecacuanha  and opium, a very effectual su-
dorific; and for its soothing effects in colds, rheumatism, and
various instances of disordered bowels, one of the  most sa-
lutary compositions of the pharmacopoeia.

                        JALAP,

  Is a plant growing at Xalopa, in Mexico, the  powdered
root of which is  very useful, and much employed as1 a purga-
tive.   The dose is from ten to  twenty grains;  but it is not
often used  by itself, but commonly conjoined with calomel,
in the proportion of one part of calomel to two of jalap; the
dose of such  a purge for an adult, of good  strength, is five
grains of calomel  to sixteen of jalap, to be taken in jelly,
honey, or any viscid substance, to prevent the calomel falling
down by its great weight.   To  form a very drastic or active
purge, as may be desirable in some affections of the head, or
with  the view of bringing off a large quantity of water in
dropsies, a purge  may be  formed by joining together six
grains of aloes, ten of jalap, and five of ascammon, or gam-
boge;  the watery stools produced by such a dose are some-
times of a surprising quantity, and give  a  great relief.
   Compound Powder of Jalap.—Another most useful form of
employing jalap, is by combining  it with cream of tartar;
constituting the compound powder of jalap, one of the most
manageable of purgatives,  which,  with most  persons, acts
very speedily and safely, and not only evacuates the bowels,
but for the  time  increases the flow of urine.   The propor-
tions are one part of jalap to two of cream of tartar; and the
dose of the compound powder is from forty to sixty grains. 
MATERIA MEDICA.
207
It may be  taken in plain  water, gruel, syrup, or any mild
liquid most convenient for the patient

                      MAGNESIA,

   Is a species of earth, of great benefit in correcting acidity
of the stomach.  It is of the class of what are called alka-
line earths;  and having an affinity for acids, it attracts what-
ever acids it finds in the stomach, and  forming with it a
purgative salt, it produces several easy motions of the bowels,
and so removes the acidity, heartburn, and other unpleasant
symptoms.   Magnesia may be taken to the extent of a tea-
spoonful twice or thrice  a day, according  to the urgency of
the symptoms;  and it  may be mixed with  water,  pepper-
mint water, or any  similar fluid, to diminish its insipidity.
Magnesia may be safely and  usefully given to children, even
when very young, mixed with their panada or thin gruel. The
best magnesia is what is called burnt,  or calcined magnesia.
Magnesia is either found in nature, combined with the car-
bonic acid, or it is obtained in that combination in the pro-
cess of preparing it from Epsom salts, which are  magnesia
combined with sulphuric acid.   This carbonate of magnesia
answers the  purpose of correcting acidity, and is  cheaper;
but in some  cases  may be disadvantageous, on account of
there  being an escape of carbonic acid, which  gives rise to
flatulency in the stomach  and bowels; by exposing the car-
bonate of magnesia to  a strong heat for  a proper length of
time,  the carbonic acid is driven off, and  the pure magnesia
remains, which is then  termed pure  calcined, or burnt mag-
nesia.   Double the quantity of the carbonate is required to
produce the same effect as the calcined magnesia.

                       MORPHIA,

   Is  a chemical principal contained in  opium, and which
possesses nearly all the properties of the  latter, without  the
nauseous taste and other objectionable qualities.  It is spa-
ringly soluble;  it unites with  acetic,  sulphuric, and  hydro-
chloric acids.   It is the sulphate of morphia which is prin-
cipally employed as a medicine: dose from a fourth to a third
of a grain.   To induce sleep or abate pain, in cases where
anodynes are  proper, either of the following  prescriptions
may be used. 
208
MATERIA MEDICA.
   Syrup of Morphia.-^Acetic syrup of morphia, four grains,
and clarified syrup, one pint, well mixed  together.  Dose, a
dessert spoonful for an adult.
   Syrup of Sulphate of Morphia.—Sulphate of morphia, four
grains, clarified syrup, one pint, well mixed together.   Dose,
two teaspoonfuls for an adult
   Anodyne Drops.—Take acetate of morphia, sixteen grains,
distilled water, one ounce, acetic acid, three or four drops, and
alcohol, one drachm. Dose, thirty or forty drops for an adult.

                        OPIUM,

   Is a medicine of  inestimable value, and indispensable for
the successful practice of physic.  Speaking  generally, we
may say it is a narcotic medicine, but may be so managed as
to procure various other salutary effects in a great variety of
diseases.   Opium is obtained from the white poppy, papara
somniferum, and  is  chiefly prepared in Turkey,  Persia, and
India.  The plant grows also in many parts of Europe, but
the opium obtained in the places  first mentioned, is what is
chiefly valued in medicine.  Opium  is procured in the fol-
lowing manner:  when  the  seed capsules are  about half
grown, two or three longitudinal incisions are made at sunset
in each capsule, but so as not to reach the internal cavity;
a juice exudes, which is removed  as fast as it concretes; this
is  put into  earthen  pots, and afterwards dried  in  the sun.
Opium should be of a rich  brown colour, a tough consis-
tency, and rather smooth and  uniform in its texture.  Its
heavy narcotic smell should be strong and free from all mus-
tiness, and there should be no burnt odour;  its taste is bitter
and a little acrid.   Opium has been produced in England of
a very good quality, but the moist and changeable nature of
the climate, renders it impossible to procure it good and
abundant  enough to supply the  demand for it.
   Uses of Opium.—nit is employed in the practice of physic,
and I will enumerate a few of the diseases, or other states of
the system, in which it may be given.   In combination, says
Dr. Paris, the medical powers of  opium are wonderfully ex-
tended, so that there is scarcely  a disease in which it may
not, during some of its stages, be rendered  useful.  Opium
is very generally given when we wish to  produce sleep. Its
dose for this  purpose is, from  twenty-five to  fifty drops  of
laudanum, or ten drops of black drop, or one grain of crude 
MATERIA  MEDICA.
209
opium.   It is frequently prescribed  to  procure rest in fever,
in agues, in burns, in small pox, in dyspepsia, and in a great
variety of cases of watchfulness and irritation, taking care
that it is not  administered, or at least very cautiously, when
there  is fulness of the  system, an inflammatory state of the
body, costiveness, or a tendency of the blood to particular
organs.   Opium  is  much  employed to mitigate  pain,  and
there  is  no substance whatever, which has such extensive
and seldom-failing powers as this.
   As  an anodyne, it is employed in griping of the  bowels,
in cramps, in gall-stones, jaundice, dysentery, burns, and poi-
sons,  and even  in  some inflammations,  provided we  have
premised proper blood-letting.   Opium is used to allay inor-
dinate action, and so to act as an antispasmodic in  convul-
sions, in tetanus, in asthma, in  colic and hysterics.   Opium
can be absorbed from the surfaces, and  so  exert its peculiar
powers on the system.
   Effects of an overdose of Opium.—By mistake, or  design,
opium is sometimes swallowed in such a quantity as  to pro-
duce very alarming effects.   The principal of these are, gid-
diness, a bloated and flushed appearance of the face, a slow
full pulse, and oppressive  breathing, as in apoplexy.  There
are also troublesome dreams, startling  or  convulsions, cold
sweats, vomiting, hiccup, and fainting.   As soon as the acci-
dent has been discovered^  the stomach should be emptied, by
the stomach pump, or by a speedy emetic, as thirty grains of
the sulphate of zinc, or eight of the sulphate of copper, dis-
solved in three or four ounces of warm water; and   its ope-
ration is to be assisted by the drinking of warm water.
   When the  stomach is evacuated,  drowsiness must  be pre-
vented by keeping the patient in continued motion; strong
coffee has been found to diminish the headache and stupor;
and bleeding, especially from the jugular vein, should be re-
sorted to, for  the purpose of relieving the  apopleptic symp-
toms.   Afterwards, ammonia and other stimulants are to be
tried.    If the  patient cannot  swallow, or if the   emetics
do not empty the  stomach, if the pupils  are dilated, the
breathing difficult, and the system in a state of torpor, from
which it cannot be roused, there is  every reason to fear that
death will be the consequence of the poison.  In  all cases
of poisoning with opium, dashing cold water over the face,
head  and shoulders, is a powerful remedy.
   The  ordinary duration of a fatal case of poisoning with
       27                   s2 
210
MATERIA MEDICA.
 opium, is from seven to twelve hours.  Most people recover
 who outlive twelve hours.   The dose of opium requisite to
 cause death has not been determined; it is very much altered
 by habit.   Those who have been accustomed to eat opium,
 are obliged gradually to increase the dose, otherwise its usual
 effects are not produced.

               THE  USE OF CALOMEL.

   Calomel is the preparation of mercury, and one of  the
 very best products of that remarkable and useful mineral.   It
 is a compound of the black oxide of mercury with muriatic
 acid, the acid  being in less quantity than is sufficient to neu-
 tralize the base;  or, according to the more modern yiew, it
 is a chloride of mercury.
   Calomel is  one of the most useful mercurial preparations
 we have.   It is principally used as a purgative, and there  are
 few purgatives more convenient.   It may be administered to
 patients of every age, and in a great variety of complaints.   It
 is a medicine which, on account of its efficacy in a very small
 bulk, and its having no nauseous taste, is excellently adapted
 for children.   To infants from a few weeks to a year old, it
 may be given  in doses  of  from  half a grain  to two grains,
 according to their age; we must  never forget that it is a
 preparation of mercury; and  as this active  mineral, if not
 carefully administered, may prove a poison instead of a  re-
 medy, it ought to be alternated with some purgative of quite
 a different character, and given only occasionally, and at  in-
 tervals.   As mercury is apt to exert its peculiar action  on
 the mouth, we must be careful  not to  order it in cases of
 thrush and ulceration of the mouth, to which  children  are
subject.   In disorders  of the digestive  organs in children,
 accompanied with wasting, pale colour, picking of the  nose,
 and the  symptoms commonly supposed  to indicate worms,
 very small doses  of calomel, combined  with magnesia,  or
 prepared chalk and ipecacuanha, will often produce very ben-
 eficial  effects,  when aided  by a proper  diet, and the warm
 bath.   When  the child is really  troubled with worms, espe-
 cially the long round worm, or the small white ones, three
 grains  of calomel, with  six or eight of jalap, form  a  good
 vermifuge.
   In croup, it was at one time thought to be a very efficient
 practice, to give calomel to the amount of five  grains every 
MATERIA MEDICA.
211
hour, even till eighty grains  were taken in a day, but this
practice does not seem to have kept its ground; as croup re-
quires very active treatment for  its inflammatory and spas-
modic symptoms, and cannot wait for the mercurial action
of calomel, nor does there  seem any specific power  in calo-
mel against croup.  In inflammation of the  bowels, it has
been recommended  to  give  doses of calomel so large  as
twenty or thirty grains; but there seems no peculiar advan-
tage in this  plan; indeed, many practitioners have doubts
whether any effect whatever, results from such doses.  When
we wish the purgative effects of calomel in an adult, the best
way is to  combine it with jalap, rhubarb, scammony, or  the
extract of colocynth; five  grains  of calomel  to  fifteen  of
jalap or rhubarb, or eight of scammony or aloes, (increasing
the quantity of both  ingredients if necessary,) form a very
valuable purge.   Calomel  is  frequently employed with  the
intention  of introducing mercury into  the  system;  and for
this purpose, the  dose is one  grain to two, taken night and
morning, and it is administered very conveniently in the form
of a pill.   It would  be  difficult  to enumerate the great va-
riety of diseases in which calomel is used.

                       QUININE,

   Is a vegetable alkaloid body, discovered by modern chem-
ists, in the  yellow Peruvian bark.  It is a white powdery
substance, sparingly soluble in water, but dissolved by warm
alcohol.   Gluinine is now much employed in medicine, being
found to answer all the  purpose of bark;  and as small doses
only is necessary, it does not produce the unpleasant effects
of the  bark in powder, or infusion.  Eight grains are con-
sidered equal to an ounce of  the powdered bark.

                       RHUBARB,

   Is a plant, the  root of which  is much used in medicine.
All the rhubarb of commerce grows on the mountains  of
Chinese  Tartary.  It is imported into  Russia, and what
comes to us from thence is always good, as much attention,
both in purchasing and  transporting it, is paid by order of
the government.   It  is  improperly called Turkey rhubarb.
Rhubarb is a mild cathartic, which operates without violence
or irritation, and may be given with safety even to pregnant 
212
MATERIA MEDICA.
women, and children.  In some people, however,it occasions
severe griping.   Besides its purgative quality, it is celebrated
as an astringent, by which it increases the tone of the  sto-
mach and intestines, and proves useful in diarrhoea.
   Rhubarb  is  exhibited, 1. In substance, in the  form of
powder;  it operates  more powerfully as a purgative in  this
form, than in any other.  The dose for an adult is a scruple;
its laxative effects are often increased by the addition of neu-
tral salts, or other more  active purgatives.  2. In infusion,
rhubarb yields more of its purgative property to water, than
alcohol.   The infusion  is,  however,  considerably weaker
than the  powder, and requires double the dose to produce the
same effect.  The virtues of rhubarb are destroyed by roast-
ing or boiling.
   Rhubarb is one of the medicines most usefully given to
children.  As a laxative, it may either be given to them alone,
in doses of from six to ten grains, in water gruel or jelly; or
two grains of calomel,  with six of  rhubarb, may be given at
once; or it may be combined with magnesia, four grains of
rhubarb, to fifteen of magnesia.
   The compound rhubarb pills are composed of rhubarb,
aloes, and myrrh, each five grains; two pills to be taken once
a day for an adult, while there  is weakness of the digestive
powers.
         i
                    SARSAPARILLA,

   Is a plant  growing in South America, the root of which
had great celebrity many years  ago, for their power of curing
syphilis.   It  is now agreed, that sarsaparilla has no power
whatever, in the cure of true  syphilis, though it has some
good effects in certain cutaneous disorders.  It is of service
to those dull pains in the bones and joints,  the sore throat,
and other symptoms, which appear to  be owing to the com-
bined effects of  mercury and syphilis.   In spreading sores,
in some forms of scrofula, and in debilitated constitutions, it
has done good.  The best way of using it is  in  decoction,
or compound syrup, of which half a pint is to be taken daily,
or an ounce of the powder.

                       SULPHUR

   Sulphur, or brimstone, as it is  sometimes called, is  pro-
cured in the form of cylinders,  and in fine powder.  It  has 
MATERIA  MEDICA.
213
 neither taste or smell, but when rubbed  has a faint peculiar
 odour.   It is of a yellowish colour; it is purified by sublima-
 tion, and when thus purified, it is called flour of sulphur, in
 which form it is used  as a mild purgative, which purpose it
 completely answers.   The dose is from one to two drachms,
 it may be given with syrup or molasses; and when combined
 with an equal portion of cream of tartar, forms one of the
 best and  mildest laxatives for  those who are troubled  with
 piles.   Sulphur has long been famous for its powers of curing
 diseases of the skin,  and  for  being a specific  in the  itch.
 For this purpose it is applied  in the  form of ointment, the
 sulphur being mixed with lard or butter, and rubbed over the
 parts affected, or as much of them at a time as may be judged
 proper.  At the same time, the patient may take a little sul-
 phur internally. The  rubbing for the itch may be continued
 for four or five days, when the  disease  is commonly removed.
 There are great popular apprehensions about exposure to the
 air when using sulphur;  it no doubt pervades the pores of the
 body, this is evident by the smell it exhales, and by blacken-
 ing silver in the pocket.   But while under its influence there
 is no more need than of the usual precautions against taking
 cold.   Sulphur is a  favourite remedy with the  people  in
 measles, and other eruptive diseases.   It  is very harmless,
 and may, by acting gently on the bowels, be of some service
 in the commencement of these diseases.   Sulphur counter-
 acts the activity of mercury.

                     SNAKE   ROOT,

   Is Virginia snake root, or Polygala Senega.   This plant
 is almost entirely destitute  of smell, with, at first, a sweetish
 taste, but afterwards hot and pungent.  It is used either  in
 substance,  or  infusion of the  powdered  root;  the dose  is
 twenty to thirty grains; of  the  infusion, one to two drachms.
 In  its effects  upon  the  system,  it  is reputed  a  stimulant,
 tonic, and diaphoretic.   The diseases in which  it has been
 found most beneficial,  are the lower grades of fever.

                         IRON.

   This metal, so widely  diffused through nature,  so essential
in its metallic  form, and its large aggregations to  the comfort,
and even to the existence of civilized  society, is capable of 
214
MATERIA MEDICA.
 entering into various  chemical combinations, which render
 it fit to be  taken into the body, and capable of producing
 various salutary effects.  These are principally of a tonic or
 strengthening nature.  The preparations of iron most in use
 are the carbonate, the  sulphate, and the tincture of muriate
 of iron; steel filings are also used, in the view of their being
 oxidated in the stomach and intestines.  The  dose of the
 various preparations of iron,  when used as tonics, are the
 following: of the carbonate, from ten to  fifteen  grains may
 be taken in molasses,  jelly, honey, or the like; of  the sul-
 phate,  one or  two grains may be rubbed  together with aro-
 matic powder, and taken, at first, once, then twice a day;  of
 the tincture  of muriate of  iron, ten drops may be given  in
 water,  twice a day, increasing  them to twenty or thirty a day.
 The carbonate of iron has of late been celebrated  for other
virtues than  those of  a mere tonic,  and has been  thought
serviceable in  painful affections of the face, called the nerve
pang, and also in cancer.   The dose for this  purpose is ten
grains, four times a day. 
APPENDIX.
      THE USES  AND  DOSES OF  MEDICINE.

  In giving an account of diseases and their remedies, we
have endeavoured to be as  distinct and intelligible as possible,
and to put  it in the power  of any sensible person to know
generally what should be done in most cases.  The following
is a list of preparations mentioned, of which many of them
may be prepared at the residence of the patient
  The doses of medicine mentioned  in this work  are for
grown up persons;  for young persons under fifteen years of
age they  must be diminished in nearly the following propor-
tions, for example:—if the dose  for a person of twenty-one
years of  age, be twenty grains,  then  for one of fourteen
years, it will be fourteen to sixteen grains; seven years old,
ten grains; five years old,  seven  grains; one year old, three
grains; six  months old, two grains.
  Sixty drops are considered equal to a common sized tea-
spoonful, and a tablespoonful to half an ounce.

                       Brown Mixture,
  Take of liquorice ball, three drachms, dissolve it in four ounces
of boiling water, rubbing it in a mortar, and adding the water gra-
dually, then add powered  gum arabic, two drachms, let the mix-
ture cool,  and add :—
    Antimonial  wine,     -             -     2 drachms.
    Tincture of opium,      -      -      -  1
    Spirits  nitre dulce,    -      -      -     2   "
  This is a  valuable  expectorant.  Paregoric may be substituted
for the laudanum, by taking three times the quantity.  Dose for
an adult,  a tablespoonful every two or three hours.

                   Mixture of Camphor.
Take of Camphor,       -      -      -      "2 drachms.
   «   Alcohol,                               35 drops.
   «   Calcined magnesia,      -      -       -  1 drachm.
  Rub up the camphor and  alcohol in a mortar, then add the 
216
APPENDIX.
magnesia, and rub them well together, then add gradually one
and a half pints of pure water; then filter  the mixture through
paper.  If alcohol  cannot be got, whiskey will answer tolerably
well.  Dose  for an adult, one or two tablespoonsfuls every hour
or two.  This is an antispasmodic, anodyne, and diffusible stimu-
lant.
                       EMETICS.

   In using  emetics a few simple  rules are worthy of atten-
tion.   Whatever may be the apparent necessity for  empty-
ing  the  stomach, all  the  circumstances of the case  must
be taken into  consideration, particularly if there  be much
arterial excitement,  and a determination  of  blood  to the
head.   When these  symptoms  are present, blood-letting
should be done.
   Where poisons have been taken, the first object is to evac-
uate the stomach as  soon as possible, and for this purpose
we should select  an emetic which is prompt in its action.
   When free vomiting is wanted, plentiful draughts of tepid
water would be useful.  Sometimes  the tickling of the throat
with a point of a feather, or  finger, will induce vomiting.
   When excessive vomiting occurs, it may be checked by
some one or more of the following  remedies:
  Ice, broken into small pieces, and allowed to  dissolve in the
mouth.  Lime water and milk; a tablespoonful  of each mixed
cold, and given at  intervals of fifteen or twenty minutes.  Brandy
and water, and cloves, or green tea, will check the vomiting.
  When these means fail, an  anodyne injection  will  sometimes
do.  As an  external application, mustard to the stomach;  also
spice plasters, and hot fomentations of brandy and  cloves to the
stomach.

                 Powder of Ipecacuanha.
  Take powder of ipecacuanha,  two  scruples, divide it  in two
doses; one to be taken in a little molasses, or sugar and water, and
followed by a draught of tepid water.   If one  powder does not
produce the desired effect, the second to be taken in like manner.
       Powder of Ipecacuanha with  Tartar Emetic.
Take Powdered ipecacuanha,    -       -      -1 scruple.
  "  Tartar emetic,  -                             j grain# '
     Mix—to be taken in the same manner as the former. 
APPENDIX.
217
      Powder of  White  Vitriol, or Sulphate of Zinc.
Take of White vitriol                              5 grains.
         Mix—to be taken in a little molasses or jelly.
  This medicine  is very prompt in its operation, and is mostly
employed in cases of poisoning.

                     Antimonial  Wine.
Take of Antimonial wine,                            1 ounce.
  A teaspoonful to be taken every ten or fifteen minutes until free
vomiting is effected.

                    Infusion of Lobelia.
Take of Lobelia leaves,                             1 ounce.
    "  Boiling water,  -                             1 pint.
  Mix.—A small wine glassful may be taken every half hour
until vomiting succeeds;
  This plant,  called Indian tobacco, is frequently made in  the
form of a saturated tincture.  The  dose of the latter is a table-
spoonful every half hour until vomiting is excited.   It has gained
considerable celebrity in the treatment of asthma, and is now em-
ployed by the steam  doctors as a part of their treatment of all
diseases.   It should be used with great caution.


                      CATHARTICS.
   It may be observed as a general rule, that cathartics  are
capable of fulfilling three different indications:—1st, simply
to evacuate the bowels; 2d, to excite an increased discharge
from the bowels;  and 3d, to stimulate the viscera, and cause
them to pour out a greater quantity of their fluids.
   It seldom happens that the  same article will produce those
three different effects;  in order to do this we must  combine
different cathartics.   It  is  better to give cathartics on an
empty stomach.   If  given after a full  meal, it  is apt to
produce  nausea, and sometimes vomiting, and does not open
the bowels with the same certainty or  effect.  The opera-
tion of cathartics may be very much assisted by free exhibi-
tion of diluting drinks, such as oatmeal gruel, barley water,
&c.  Finally, the operation of a  cathartic may often be pro-
moted by blood-letting.
              Powder, with  Calomel and Jalap.
Take of  Calomel, -       -      -       -       -    12 grains.
        Jalap,       -             -      -       12  «
           Mix in molasses—to be given at one dos6.
       28                    T 
218                     APPENDIX.

         Powder, with Calomel, Jalap, and Rhubarb.

Take of Calomel,       -                            8 grains.
  «     Jalap,.....10   "
        Rhubarb,      -      -      -      "       f   "
  «     Oil of peppermint, -       -     '  -           1 droP-
          Mix with molasses—to be taken at once.


           Powder, with Magnesia and Rhubarb.

Take of Magnesia,      -      -      -           h scruple.
        Rhubarb,    -      -       -       -       -1    "
  "     Oil of cinnamon, -      -      -       -    1 drop.
         Mix in sugar and water—to be taken at once.


              Powder of Calomel and Rhubarb.
Take of Calomel, -	10 grains.
" Rhubarb, -	- 10 «
" Tartar emetic, -	1 «
<l Oil of cinnamon, -	1 drop.
Mix'—to be taken at once.	
                          PILLS.

           Pills of Calomel, Jalap, and Rhubarb.

Take of Calomel,       -
  "     Extract of Jalap,   -
  "        do. of Rhubarb,   -
            Mix into a mass—to be taken at once.
8 grains.
8   «
5   "
                Pills of Abes and Rhubarb.

Take of Aloes,   -       -       -       -       -     ^ drachm.
  "     Rhubarb,   -      -      -      -      - £    «
  "     Soap, sufficient to make a mass.
  Mix, and make into twenty-five pills.  These pills to be taken
three a day in habitual costiveness, and dyspepsia.

                   Pills of Croton  Oil.

Take of Oil of Croton,                               \ drop.
Make into four pills—one to be taken every hour until they operate.
  This is a powerful remedy, and must be used with  caution.__
One drop is a full  dose, and sometimes less  will  answer  every
purpose. 
                         APPENDIX.                     219

       Pills of Rhubarb, Aloes, Gamboge, and Myrrh.
 Take of Rhubarb,     -                            30 grains.
         Pulv. Aloes,     -       -      .          20   "
          "   Gamboge,      -       -       -      10   "
          "   Gum myrrh,       -      -           5   «
          "   Charcoal,      -       -       -       5   «
         Oil of anniseed,  -                        25 drops.
 Mix into a mass, and make into nine pills—three to betaken daily
                        for dyspepsia.

         Pills  with Aloes and Mercurial Blue Mass.
 Take of Blue mass,     -      -       -      -      1 scruple.
   "     Aloes, powdered,  -       -      -       - 30 grains.
 Mix, and make fifteen pills—one to be taken every two hours until
                        they operate.


                     Saline Purgatives.
   Saline purgatives are, Glauber salts, Epsom salts, and Rochelle
 salts.  Dose  of each-—an ounce  dissolved in three ounces of
 tepid water, and taken once a day.

                    Simple Senna Tea.
   Take three drachms of senna leaves, infused in half a pint of
 hot water;  a spoonful of manna, or tamarinds, adds to its efficacy,
 and makes it more pleasant to take.

                   Compound Senna Tea.
 Take of Senna leaves,    -      -       -       -  1 ounce.
   "     Manna,       -       -       -             \   "
   "     Cream of tartar,         -                 4 drachms.
   "     Cinnamon bark,                          \ ounce.
   "     Boiling water,   -      -       -      -   1 pint.
   Infuse for one hour.  Dose, a wine glassful  every two hours.—
 This is a very valuable and effectual purgative for all acute dis-
 eases.
   Castor Oil.—From an ounce  to a half ounce is an ordinary dose.
   Gamboge, in powder, from two to five grains.
   Rhubarb, in powder, from fifteen to twenty grains.  The above
 medicine may be usefully combined with from five to fifteen grains
 of calomel.   Two of them may be also combined together, as jalap
 and scammony, or gamboge and rhubarb.
  Aloes.—An excellent purgative.   Dose, six grains;  may be
taken in pills, with various combinations.
   Calomel is seldom used alone as  a  purgative; but in some per-
sons, a few grains (from eight to twelve) move the bowels freely. 
220                      APPENDIX.

            Mixture of Magnesia and Rhubarb.

Take of Magnesia,                                 h drachm.
  "     Pulv. rhubarb,    -      -      -      -   8 grains.
  "     Sugar,       -       -       -      -   a teaspoonful.
  "     Essence of peppermint,   -                 6 drops.
  "     Water,      -       -       -      -       1£ ounce.
  Mix.  A teaspoonful to be given every two hours to  children,
until it operates.


                    Decoction of Prunes,

Take of Prunes,    -
  "     Water, -       -       -       -
                  Used as a mild laxative.
                    EXPECTORANTS.

  During the  administration  of  expectorants,  the patient
should be kept warm; and if the  complaint be violent, they
should be in bed.   The  dose of all expectorants should  be
repeated sufficiently often to allay the irritation  as  much as
possible; for it is obvious that the act of  coughing  increases
the inflammation.

                Pills of Squills, Calomel, fyc.

Take of Calomel,            A       '-      -      3 grains.
  "     Powdered squills,       -      -       -   1 scruple.
  "     Dover's powders,                         1 drachm.
  Make into a mass, and divide into thirty pills.   Take one three
or four times a  day.  Very good in troublesome cough,  for an
adult.

                         Tar Pills,

  Take of  Tar, 1 drachm ; Pulv. liquorice root, a sufficient quan-
tity to make twenty-five pills.
  One to be taken every three hours.

                     Dover's Powders*

Take of Powdered  opium,    -       *           15 grains,
  "     Ipecacuanha,     -      -      -      - 15   "
        Sulphate of potassa,       -       -       2 drachms.
  Mix them in a mortar, and divide any quantity of this mixture
into  powders containing ten grains each*  Dose, from five to ten
grains, for an adult.
3 ounces.
3 pounds. 
APPEXDIX.
221
                     Infusion of Boneset.

Take of the dried leaves of boneset,      -       -      i ounce.
  "     Boiling water,       -      -       .       .  i pint.
  Let  the  tea draw  by a fire in a covered vessel, for twenty
minutes.  The best mode of giving this highly valuable herb, are
various.  In severe colds, when the object "is a powerful perspira-
tion, it should  be taken as hot as possible, the patient to be cover-
ed warm in bed.  An adult should take half the above quantity as
rapidly as  its  heat  permit.   The remainder, again heated, may
be taken in two doses, at intervals of half an hour.  When used
as a tonic,  it should be taken quite cold, in doses of a wine glass-
ful every two hours.   When taken moderately warm, it often pro-
duces vomiting.


                        Simple Cerate.

Take of Beeswax,                                    1 pound.
        Lard,.....4  do.
         Mix  them with a gentle heat, and stir  till cool.

                   Ointment ofBasilicon.

Take of Rosin,     -----    5 ounces.
  "     Lard,        ....       g   »
  "     Yellow wax,      -       -       -       -    2   "
       Mix them  together, and stir the mixture until cool.


               Ointment of Red Precipitate.

Take of Red precipitate, finely powdered,       -    1 drachm.
   "   Simple cerate,       -                      1 ounce.
  Warm the cerate, then add the precipitate, gradually rubbing
it well with a knife.

                        Tar Ointment.

Take of Tar,       -       -      -      -      -    1 ounce.
   "   Suet,  or simple cerate,  -      -      -       1   "
     Melt the cerate with a gentle heat, and stir until cool.
                    Fermenting Poultice.

Take of Yeast,.....I gill.
   «    Flour,      -       -       -               h pound.
  Mix, and set the mixture in a warm place to rise; when it
begins to rise it is ready for use.
                             t2 
222                      APPENDIX.
                        Lime Water.

   For domestic use lime water is best prepared thus:—
Take of unslacked lime, about     -       -      -   \ pound.
    "    Pure water,   -,.-,.        2 quarts.
   Put the lime in a wide mouth earthen vessel, and pour the water
upon it.  Let the mixture stand a short time, then stir it well, and
pour it into elean porter bottles, before the lime subsides.  Cork
the bottles tightly.   When used, the  lime water is to be poured
off without agitation, and only that which is perfectly clear should
be used.

                     Flaxseed Poultice.

  Boil flaxseed meal in just sufficient water to make a poultice
of proper consistency.

                     Charcoal Poultice.

  Take a sufficient quantity of fresh  charcoal,  reduce it to a fine
powder, and mix with flaxseed poultice, or simple corn mush.

                      Volatile Liniment.

Take of Spirits of hartshorn,        -       -           1 part.
    "    Sweet oil,       -       -       -       -       4 parts.
    "    Spirits of camphor, -       -       -           2  "
             Shake them well together in a vial.
                         TONICS.

   Those medicines which  are  considered  tonics,  impart
strength to the system, without subjecting it  to any  preter-
natural excitement during their operation.   They stimulate
in a secondary manner, by gradually increasing the force of
the circulation,  and by restoring the digestive functions to a
more healthy state.

              Pills of Sulphate of  Quinine, Sfc.
  Take of sulphate of quinine, ten grains, and conserve of roses
sufficient to make a mass.  Mix, and make  ten  pills; one to be
taken every hour in intermittent fever.

                   Pills of Steel Filings.

  Take of steel filings, fifteen grains,  extract  of gentian, sufficient
to make a mass, and divide in six pills.   Dose—one  three times
a day, followed by some bitter infusion, is very good. 
APPENDIX.
223
             Mixture of Sulphate of Quinine.
Take of Sulphate of quinine,    -      -      -   15 grains.
        Sulphuric acid,      -                      5 drops.
   "   White sugar,                              1 drachm.
  Mix—take a teaspoonful for a dose, every hour during the
paroxysm of intermittent fever.

           Decoction of Wild Cherry Tree Bark.
Take of Wild cherry tree bark,   -       -       -   1 ounce.
   "    Orange peel,        -      -      -      2 drachms.
   "    Water,  ■>       -       -       -       -   1 pint.
  Boil the bark alone for half an hour, and then add the orange
peel.   A wine glassful  may be taken  every two hours, in con-
sumptive cases and asthma.

             Infusion of Virginia Snake Root.

Take Virginia snake root,  -       -      -       -   1  ouncfe.
  "   Boiling water,                                1 pint.
  Put  them into a covered vessel for  one  hour.   Dose, a wine
glassful every two or three hours.
  Powdered Gentian Root.—Fifteen  to  twenty-five grains for a
dose.
  Colombo.—Fifteen grains twice a day, is an ordinary dose.
  Infusion of Camomile.—Take a pint  in the course of the day.
             DIETETIC PREPARATIONS.

  It is important that the diet of the patient, during disease
and convalescence, should be observed with a great, deal of
correctness.  It was remarked by an eminent professor in
one  of his lectures, that a physician  should spend some
months in a kitchen before he commenced practising;  as it is
the duty of the doctor to  give  directions and rules for pre-
paring the diet for the sick, we have inserted a few formulas,
for those  articles which are in daily use.  The rules to  be
observed  in  giving  nourishment  to  the  sick, will  generally
present themselves, but  there  is one in particular,  which
should not be overlooked.  In all  low diseases, the nurse
should be  directed not  to give too  much at once but  fre-
auently to repeat a small  proportion.  The  lapse of a very
short time without food, will frequently, in  cases of great
prostration, reduce the patient very low, and may endanger
his life. 
224
APPENDIX.
                        Rice Gruel.

Take of Rice, ground,     -                      -    1 ounce-
   "    Cinnamon bark,     -       -      -       1 drachm.
   "    Water,.....1 quart.
  Boil for forty minutes, adding  the  cinnamon near the conclu-
sion ;  strain and sweeten it.  Wine may be added, if necessary.

                        Water  Gruel.

Take of Oatmeal, -      -      -       -          2 ounces.
   "    Water,        ....        1 quart.
  Boil for fifteen minutes and strain, adding sugar and salt to
make it agreeable.

                        Rice Water.

Take of Rice, washed clean,     -       -      -     3 ounces.
  "     Water,     -       -       -      -      -  3 quarts.
  Boil it for an hour and a half;  then add sugar and nutmeg, as
much as may make it palateable.

                       Barley  Water.

Take of Barley,     -       -       -      -      -   1 ounce.
  "     Boiling water,                               1 quart.
  Let the barley be well washed ; then boil down to one half, and
strain the liquor.  A little lemon juice  and sugar may be added.
To be taken occasionally in inflammatory diseases.

                         Lemonade.

Take of Lemon juice, fresh,     -
  "     Lemon peel,       -
  "     Sugar, -      -      -      -      -
  "■     Boiling water,      -
  Let them stand until  cool; then strain off for use.
ployed in fevers, a little sweet spirits of nitre may be

                          Panada.
Take of Wheat bread,     -      -       -       -    1 ounce.
        Cinnamon,    -                             1 drachm.
        Water,   -       -       -       -           1 pint.
  Boil them until well mixed; then add a little nutmeg and sugar.
Wine or bitters may  also be added, if desirable.

                           Sago.
Take of Sago,                                    2 spoonsful.
  "     Water......1 pint.
  Boil gently until  it thickens,   frequently  stirring.   Add wine,
sugar,  and nutmeg.
  4 ounces.
  i   u
  4   "
  3 pints.
 When em-
added. 
APPENDIX.
225
                        Arrow Root.
Take of Arrow root,                           1 tablespoonful.
  "      Sweet milk,        -       -           \ pint.
         Boiling water,                        \ pint.
  Boil them  a* few moments  over the  fire; then sweeten with
sugar.

                        Boiled Flour.
Take of fine  flour,                                    1 pound.
  Tie it up in a linen cloth as tight as possible; and after fre-
quently dipping it in cold water, dust the outside with flour till a
crust is formed round it, which will prevent the water soaking into
it, while boiling.  It is then boiled until it becomes a hard, dry
mass.   Two tablespoonsful of this  may be grated, and  prepared
in the same manner as arrow root; for which it forms an excel-
lent substitute, and can be obtained in the  country when perhaps
the other cannot.

                       Vegetable Soup.
   Take one  turnip, one potato, and one onion; let them be sliced
and boiled in one quart of water for an hour.   Add as much salt
as is agreeable, and pour the whole upon a piece of dry toast.

                          Beef Tea.
Take of lean beef, cut in small pieces,     -       -     1  pound.
   "     Water,      -       -      -       -      - 1  quart.
   Boil it for twenty  minutes, taking off  the scum as it rises.—
After  it grows cold, strain  the liquor.   This preparation  is very
nourishing and palateable.
                        Spice Plaster.
Take of Powdered cloves,                      1£ teaspoonful.
   "     Ground cinnamon,    -       -       - li
   "     Ground allspice,   -      -      -     1£
   "     Ground black pepper, -       -       -  1
         Flour,                                4
   Mix them into a  paste, with  vinegar,  and spread them upon
muslin.
   If a powerful local stimulation be required, Cayenne may be
substituted for black  pepper.
                     Turpentine Mixture.
Take of Spirits of turpentine,     -       -       "    1 drachm.
   "     Laudanum,  -                             *
   «     Loaf sugar,      -                          *
   «     Water,     -                              6 ounces.
   «     Whites of two  eggs.
   Let the whites of the eggs be  placed in a five ounce bottle;
         29 
226
APPENDIX.
then pour over it the spirits of turpentine, the laudanum, and a
little water.   Shake the bottle well.   Dissolve the sugar in a little
water ;  add  to it the mixture, and again  shake the bottle; then
fill the bottle with water, by little and little, agitating it at each
addition.
  Dose for an adult:—One tablespoonful every two hours.  If the
mixture be designed for a purgative,  the turpentine may be dou-
bled in quantity, but the laudanum must be omitted.
                     CATALOGUE
     Of some of the Principal Drugs used in this Work.

   It is deemed advisable to add a list of a few of the princi-
pal drugs and implements mentioned in this book, which are
suited for occasional use in families.

                    LIST  OF DRUGS.
 Alcohol,
 Antimony, powdered,
 Anniseed,
 Arrow root,
 Assafcetida,
 Alum,
 Acetate of lead, (sugar of lead,)
 Antimonial wine,
 Allspice,
 Blue vitriol,
 Burgundy pitch,
 Balsam copaiva,
 Beeswax,
 Boneset, the herb, (Eupatorium
  Perforatum,)
 Borax, refined,
 Calomel,
 Camomile flowers,
 Camphor,
 Cloves,
 Cantharides, (Spanish flies,)
 Cantharides, tincture,
 Caroline pink root,
 Castor oil,
Chloride of lime,
 Castile soap,
Chincona, (Peruvian bark,)
Cinnamon,
Columbo root,
  "       "  powdered,
Coxe's hive syrup,
Croton oil,
Court plaster,
Cream of tartar,
Caustic potassa,
Carbonate of iron,
Carbonate of lime, (prepared
  chalk,)
Dover's powders,
Dragons' blood,,
Epsom salts,
Elder flowers,
Ergot, (spurred rye, powdered,)
Elixir of vitriol,
Extract of cicuta,
Extract of liquorice,
Flour of sulphur,
Flaxseed,
Fol. senna Alexandria,
 "  digitalis,
 "  lobelia inflata,
 u  uva ursi, 
APPENDIX.
227
Gentian root,
Ginger, ground,
Gum arabic,
Gum ammoniac,
Gum assafcetida,
Gum guaiacum,
Hive syrup,
Hoffman's anodyne,
Honey,
Hiera picra,
Horsemint, the herb,
Iodyne,
Ipecacuanha, powdered.
Itch ointment,
Jalap,
Juniper oil,
Lemon peel,
Lime water,
Liquorice root,
Liquorice ball,
Lint, patent,
Laudanum, (tincture of opium,)
Lavender, compound,
Manna,
Magnesia, lump,
Magnesia, calcined,
Mercurial ointment,
Morphine, sulphate.
Musk,
Mustard,
Nutmegs,
Nitric acid,
Nitrate of silver, (lunar caustic,)
Nitrate of potassa, (salt petre,)
Opium,
Opodeldoc,
Oak bark,
Paregoric elixir,
Peppermint oil,
Peppermint, essence,
Pepper, Cayenne,
Pepper, black,
Pith of sassafras,
 Rhubarb root,
 Rhubarb, powdered,
 Rosin,
 Rose water,
 Senna,
 Seidlitz powders,
 Soda powders,
 Soap liniment,
 Slippery elm bark,
 Spiced syrup of rhubarb,
 Spirits of camphor,
 Spirits of hartshorn, (aqua am-
   monia,)
 Syrup of squills,
 Sulphate of copper,
    "    " magnesia,  (Epsom
             salts,)
    "    " quinine,
    "    " iron,
    "    " potassa,
    "    " zinc,
 Sulphur, flour of
 Sulphuric ether,
 Super-carbonate of soda,
 Super-tartrate  of potassa,
   (cream of tartar,)
 Sweet spirits of nitre,
 Sweet oil,
 Starch,
 Saltpetre,
 Sponge,
 Tapioca,
 Tooth brushes,
 Tartaric acid,
 Turpentine,
Tartar emetic,
Tamarinds,
Valerian root, powdered,
Wax, white,
Wax, yellow,
White vitriol,
Wine bitters. 
228
APPENDIX.
                LIST OF INSTRUMENTS,
Necessary to be  had in large establishments, and which ought
           always to be kept immediately at hand.

  A pair of Apothecaries' Scales and Weights.
  A Surgeon's Pocket Case, containing :—
1 pair of Scissors,               1 Spatula,
2 Scalpels,                      1 Thumb Lancet,
1 Straight Bistoury, 1 Curved Bistoury,	2 Curved Surgeon's Needles, 1 Silver Female Catheter,
1 Dressing Forceps, 1 Silver Probe, 1 Abscess Needle,	1 Cupping Syringe and Glasses, 1 Pint Injecting Syringe, 1 Gill do. do.
1 Gum Lancet,	1 Female Syringe,
  Half a dozen of Gum Elastic Catheters, assorted.
  One Spring Lancet, with one Thumb Lancet, in the same case.
  Muslin, Linen, Buckskin, and Sheepskin.
  Some good Sewing Silk, for Ligatures.
  Two or three  yards  of Coarse Muslin for fractures, and two
pieces of Tape, an inch wide.
  Five yards of Domestic Muslin, torn into bandages from two to
three fingers breadths in width, and rolled.
  A piece of Cotton Wadding; some Patent Lint; one Mortar and
Pestle; one Apothecaries'  Spatulas; several  Cedar  Shingles,
planed thin ; a piece of half inch Pine Board, six feet long by two
wide, or two pieces of half the width,  smoothly planed.
  These articles  should be kept in a convenient place, that they
may be always ready at hand when accidents happen. 
INDEX.
                                Page.
Anatomy,......................161
   "      Comparative,..........163
Apoplexy,.......................54
Abdomen, Dropsy of the,.........60
    "     Prescription for,........61
Asthma,........................36
Abscesses,......................58
    "     Prescription for acute, ... 59
    "     Treatment of,..........—
    "     Chronic, treatment of, . .. —
Abortion,.......................132
    "     Danger of procuring,....  —
Absorbents,....................  208
Astringents,....................186
Anodynes,..................... 182
Antiemetics,.................... 183
Antiphlogistics,.................  —
Antiscorbutics,.................185
Antispasmodics,.................  —
Assafcetida,.....................202
    "      mixture,.............203
Aloes,.........................201
Aloetic Pills,...................202
Antimonial Wine,............... 217
Appendix,......................215

Brain,.........................173
  "   Dropsy of the,.............61
Bronchitis,......................45
Bones, Of the,..................164
  "   Broken,..................103
Blood, Of the,...................171
Blood-letting,...................187
Bleeding from the Nose,..........31
Burns and Scalds,...............105
Bite of the Viper,...............156
Brown Mixture,.................215
Boneset, Infusion of,.............221
Blister Ointment,.......•........  —
Bilious Fever,...................16
Bilious Colic,....................67
Basilicon, Ointment ot,...........-«J

Colds and Coughs,...............  37
Cough, Hooping,................*"
  "    Common,.................  *"
  «    Prescriptions for,. 40, 41, 42, 43
Consumption,..escr;ptlon^r-;;::; «
                                 Page.
  Catarrh,........................71
  Catarrhal Fever,.................26
  Croup,.........................117
    "   Prescription for,........... 119
  Childbed Fever,.................27
  Childbed Women, Management of, 135.
        136, 138, 140,  141, 142, 143, 144
  Chicken Pox,....................72
  Colic,..........................66
    "   Flatulent,.................' —
    "   Bilious,...................67
    "   Painters',.................68
    "   in Infants,.................—
    "   Prescription for,............69
  Cancer,.........................—
  Confluent Small Pox,..............75
  Croup, .................,..........117
  Carbuncle,........................150
  Corns,............................ —
    "   Soft,.....................151
  Costiveness,.....................10
      "      Diet in,.............. 11
  Chlorine Fumigation,............160
  Cathartics, ,....................192
      «     .....................217
      "    Varieties of,......217,218
  Carminatives,...................191
  Charcoal Poultice,...............222
  Camphor Mixture,...............215
  Cerate, Simple,.................221
  Cream of Tartar,............... .203
  Catalogue of Drugs,.............226
  Calomel, Use of,................210
  Chest, Dropsy of the,.............59
  Collar Bone, Dislocation of the, ... 101
  Comparative Anatomy,..........163
  Camomile, Infusion of,...........223
  Charcoal Poultice,...............222

  Dysentery,......................64
      <■'•     Prescription for,.......66
  Danger of procuring Abortion, . ... 132
  Dyspepsia,..................... 77
      "     Prescription for,.......78
  Dropsy,......................... 59
    «    Of the Brain,.............61
    «    Of the Chest,.............59
    «    Of the Abdomen,.........60
    «    Prescription for,..........61

TJ                      229 
230                         INDEX.
	Page.		Page.
	95		..52
	..74		.53
	..81		I hi)
	..97	Hornet and Wasp, Stings of, .	157
" Of the Jaw,........	. 98		
" Of the Neck,.......	—rr		17b
" Of the Ribs,........	..99		145
" Of the Shoulder,---	. .—	" Colic in,................	68
" Of the Elbow,...... " Of the Collar-bone, ..	.100		69
	.101	Itch,..........................	80
Of the Thigh,......	. —		81
" Of the Knee-pan, . ,.	. —		30
	...8		213
Dietetic Preparations, ... 223, 224	225		205
	.194		216
	195 220		221
			217
	.223		,219
" Of Wild Cherry Bark,..			223
	.204		228
	226	" " Prescriptions fo	. ,11
			r, 15
	79	Influenza, (see Catarrh,)........	71
	54		
	..30		33
	123 .196		206
			98
	217		
	.198		101
	.220		
	.197		. 62
	.204	Labour, or Women in Childbed,...	.136
	.100		9.9.9.
			99.9.
	..11		217
" " Prescriptions			217
	15		226
	..16		228
" Yellow,..................	..19		
'• Typhus,................	..21		207
" Scarlet,.................	24	Management of Childbed Women,	.135
	26	Parturition, Classification of La-	
" Puerperal, or Childbed, . ..	..27	bours, &c..................	
	.129		136
Flooding, or Excessive Menstruation,..		Process of Natural Labour, ....	138
	.141	Management of the After-burden-140	
	.125	Treatment after Delivery,.....	141
Final Cessation of the Menses, ..,	.128		141
	.215	" Prescription for alle	
	..66		142
		Costiveness, Inflammation of the	
	.221	Womb, Suppression- of the Lo-	
	222	Inflammation of the Breast, Fret-	,142
	94	ted or Chapped Nipples, Puer-	
	.146	peral Fever,...............	143
			.144
	,170 ..54	Milk Sickness, ..,..............	. 157
			
	. .91		109
	113		.119
 
INDEX.
231
Menses, Suppression of the,.......125
  "     Prescription for,.........126
  "     Final Cessation of the, ... 128
Menstruation, Obstructed, ..       126
              Painful,...........127
    "         Prescriptions for,.... 128
Muscles, the,...................167
Mixture of Magnesia and Rhubarb, 220
   "    of Quinine,............. 223
   "    of Turpentine,.........225
   "    of Camphor.  ............215
Medicines, Use of,  .'___..........181
Membranes, the,................166
            Mucous,............  —
Morphia,.......................207
   "     Prescriptions of,  ........208
Materia Medica,................181

Nerves, of the,..................174
Nervous Diseases,...............  81
Narcotics,......................198
Nose, Bleeding from the,..........  31
Neck, Dislocation of the,.........  98

Opium, Uses of,................208
   "     Effects of an over dose, .  .. 209
Ointment of Basilicon,...........221
     "    of Red Precipitate,......221
Obstructed Menstruation,.........126
     "     Prescription for,.......127
Of Painful Menstruation,.........127
      "      «  "        Prescrip-
         tion for,................128
Of a Common Cough,............  40
        "       a   Prescriptions
     for,...............40,41, 42,43

Pulse,.....................'. .. .   7
Palsy, or Paralysis,.............. 56
   «         "     111 Effects  of tea
                    in promoting,. 56
   "         "     Prescription for, 57
Puerperal Fever,................ 27
Piles,...........■...............  88
Pleurisy, True,  ................. 46
    "     Spurious,.............. 51
    <■'•    Prescriptions for,. .49,  50, 51
Procuring Abortion. Danger of,.. .. 132
Poisons, Hydrophobia,...........155
    "    Bite of the Viper.........156
    "    Stings of the Wasp or
           Hornet,..............157
 Pills, Aloetic,.............  .....102
   "   Calomel, Jalap and Rhubarb,. —
   "   Rhubarb, Aloes, Gamboge,
        and Myrrh,..............219
   «   With Mercury,............. —
   «   of Croton Oil,..............^»

 Poultices' o'f Charcoal; Flaxseed
   and Yeast, ...............li\,iu
                               Page.
Phrenology, ....................178
Painters' Colic,..................  68
Prolapsus, or Falling of the Womb,. 129
Powders,..............216, 217, 218
Prunes, Decoction of,............220

Quinine,.......................211
   "    Mixture of,.............223
   "    Pills of,................222

Ribs, Dislocation of the,..........  99
Rupture, or Hernia,..............  91
Rules of Diet,...................   8
Rheumatism,...................  85
             Prescriptions for, ....  87
Rubefacients,  ..................199
Rhubarb,.......................211
   "     Mixture of,  ............220
   "     Powders,..............218
   "     Pills,..............218,219

Simple Cerate,..................221
Skeleton, of the,.................163
Scurvy,........................153
Scrofula,.......................154
St. Vitus.' Dance,................148
Shoulder, Dislocation of the,...... 99
Summer Complaint, (see Dysentery,)
Scarlet Fever,.................. 24
Suppression of the Menses,  ......125
Small Pox,..................... 73
   "     "  Distinct,............. 74
   "     "  Confluent,............ 75
Stomach,.......................168
Sulphur,.......................212
Scalds and Burns,...............105
Stings of the Wasp and Hornet, .. .157
Sore Mouth of Infants,...........145
Saline Purgatives,...............219
Senna Tea, Simple and Compound, .219
Sarsaparilla,....................212
Snake Root,.................213,223
Sialogogues,....................199
Stimulants,.....................199
Spice  Plaster,...................225
Spurious Pleurisy,............... 51

The Pulse,.....................  7
The Skeleton,  ..................163
 The Membranes,................166
 The Muscles,...................167
 The Stomach,...................168
 The Heart,.....................170
 Times of Administering Medicines, 182
 Thigh, Dislocation of the,........101
 The Itch,....................... 80
     "    Prescription for,  ....... 81
 Tetter,.............             152
 Turpentine Mixture,.............225
 To check  Vomiting, .............216
 Tar Pills,  ......................220 
232
INDEX.
                               Page.
Tonics, Varieties of,.........200, 222
  Pills of Sulphate of Quinine,....
   "   of Steel filings,...........
  Mixture of Sulphate of Quinine,.
  Infusion of Virginia Snake Root,.
  Decoction of Wild Cherry Bark, . 222
Typhus Fever,.................. 21
To Destroy Rats,................160
Tar Ointment,  ..................221

Uses and Doses of Medicines,.....215

Vomiting Stopped,  ..............216
                               Page.
Viper? Bite of the,...............156
Volatile Liniment,...............222
Virginia Snake Root,.........213,  223

Worms,........................121
Women in Childbed, Management
    of,  ....................135-141
Whites, (see Fluor Albus,)  .......125
Womb, Prolapsus or Falling of the,  129
Wasp and Hornet, Sting of,.......157

Yellow Fever,..................  19
 
*
I 
NLM032746179