RECOMMENDATIONS FOR "BRIGHT'S FAMILY PRACTICE. Recommendations from the Medical Faculty of the University of Louisville. Dear Sir ;—Having bestowed on an attentive examination of your "FAMILY PRACTICE," all the leisure I can command, I am of opinion that, with the addition of the word well, which I shall take the liberty of making, I cannot better characterize it than you have yourself done, in your very modest and appropriate title-page ;■—" A Plain System of Medical Practice, well adapted to the Use of Families. The work appears to me to be thus adapted, for the following reasons: 1. The matter it contains is sound and judicious, and sufficiently full and diversified for all the cases of disease, in which families should themselves attempt to employ it. When more is needed, recourse should be had to pro- fessional aid. 2. The descriptions of diseases are generally correct, and their changes and stages well marked ; and the style of the work is so simple a*id perspicuous, that no one, at all acquainted with English composition, can misapprehend its meaning. 3. The compass of the work, embracing as it does every form of disease which an American physician, in full business, can expect to encounter in the practice of a lifetime, is abundantly ample. Wishing it, therefore, the reception and circulation to which it appears to ve to be entitled, I am, very respectfully, your obedient servant, CH. CALDWELL, M.D., Professor of the Institute of Medicine and Medical Jurisprudence, Louisville, August, 1847. in the University of Louisville. P.S.—Were it not that comparisons are apt to be held exceptionable, I would not hesitate to say, that I consider your "Family Practice," the most valuable work of the sort, of which I have any knowledge. C. C. I have examined Dr. Bright's "FAMILY PRACTICE," and feel assured 'tat it :'e, on the whole, well adapted to the purposes for which it was written. .Link ths work is calculated to be eminently useful. August, 1847. S. D. GROSS, M.D., Prof. Surgery. concur in the estimate expressed above by Dr. Gross. H. MILLER, M.D., Professor of Obstetrics and Diseases of Women and Children. I have examined " BRIGHT'S FAMILY PRACTICE" with some care, and find that it is plainly written, and contains much that is valuable. I be lieve the work is calculated to do much good, J. COBB, M.D., Professor of Anatomy. I have examined Dr. Bright's "FAMILY PRACTICE," and find it what it purports to be, a plain system of Medical Practice, which I can conscien- tiously recommend to families. L. P. YANDELL, M.D., Professor of Chemistry and Pharmacy. FROM PRACTISING PHYSICIANS IN LOUISVILLE. From the Author of Gunn's Domestic Medicines. I have examined with care Dr. Bright's "FAMILY PRACTICE," and find it a valuable work, well suited to the use of Planters and Families. It is piain and comprehensive, and the treatment conformable to the latest and most approved practice, and it affords me much pleasure to recommend it to the uublic. J. C. GUNN, M.D. RECOMMENDATIONS. I have examined "BRIGHT'S FAMILY PRACTICE." The work is not only the result of long experience, but a very judicious selection of the latest and most approved Medical authors, and will no doubt be of great service to families. W. C. GALT, M.D. I have examined "BRIGHT'S FAMILY PRACTICE," and do most unhesitatingly recommend it as i plain, practical work—useful to families. C. PIRTLE, M.D. I have examined "BRIGHT'S FAMILY PRACTICE," and take great pleasure in recommending it as a valuable work, suitable to the use of Fami- lies. Having practised Medicine fifteen years in Mississ-ppi and Louisiana, I view this work as better adapted to the diseases of that region than any work of the kind I have ever seen. RICHARD ANGEL, M.D. We have examined with care Dr. Bright's "FAMILY PRACTICE," and feel no hesitation in recommending it to the public, as a book containing a variety of useful and valuable information. It is entirely practical in its de- sign, all technicalities are avoided, so as to render the Author's meaning clear and plain to the unprofessional reader, for whom it is more particularly intended than for the profession ; though the latter, and particularly the Medical stu- dent, might increase his store of practical knowledge by a careful perusal of its pages. Dr. Bright's instruments for the application of caustic to the mouth and neck of the uterus are ingenious, and no doubt, will save the practitionei much trouble, and the patient a great deal of unnecessary pain. U. E. EWING, M.D., Louisville, June 17, 1847. W. T. H. WINLOCK, M.D. I have examined "BRIGHT'S FAMILY PRACTICE," and find in it plain and important practical principles in medicine, well adapted to the use of Families. Louisville, June, 1847. WM. A. McDOWELL, M.D. 1 have examined " BRIGHT'S FAMILY PRACTICE," and take pleasure in recommending it to all persons as a valuable work—in particular to families in the country. Louisville, June, 1847. J. W. KNIGHT, M.D. We have examined the medical work written by Dr. J. WT. Bright, and take pleasure in recommending it to the public, as a work well calculated for the use of Families. JOHN M. TALBOT, M.D , Louisville, June, 17, 1847. H. M. WAKEFIELD, M.D. FROM PHYSICIANS IN MEMPHIS. After a careful examination of Dr. Bright's "FAMILY PRACTICE " 1 have no hesitation in saying, that the practical precepts, recommended by'the Author, are better adapted to the treatment of disease, as it prevails at the South-West, than are those of any other work, of a similar character with which I am acquainted. GEO. R. GRANT, M.D. Professor of Theory and Practice of Medicine, Memphis Medical College. From the cursory examination which I have been enabled to make of Dr Bright's Work on the Practice of Physic, I have no hesitation in sayino- thai it is the best production of the kind now published. Memphis, Sept. 2, 1847. E. F. WATKINS, M.D. We have examined Dr. Bright's " Plain System of Medical Practice," and are satisfied that it is better calculated for a safe guide to Families__and especially those remote from a scientific Physician—than any other work oa Domestic Practice. We can, therefore, cheerfully recommend it as a plain and valuable work; in the main, well adapted to the purposes designed. Memphis, Sept. 1, 1847. LEWIS SHANKS, M D JNO. R. FRAYSER, M.D RECOMMENDATIONS OF THE PRESS. BRIGHT'S FAMILY PRACTICE. This work embraces all the diseases of men, women, and children ; and a plain system of midwifery, and is the only work now before the public which contains all the new and approved remedies found in the standard works and medical periodicals of Europe and America, together with the experience and approved practice of the best authors, upon which the successful treatment of the present forms of disease so much depends. It is the only work now before the public containing a full description of all the new as well as the old diseases of the United States. The symptoms of each disease, in all its stages, are so minutely described, and the directions for giving and working off the medicines are so plain, that no one can fail to follow them ; the remedies all being put down in their appropriate place in plain English. It also contains a Family Materia Medica, with receipts for preparing all the family medicines in common use, with directions how to use them; and about thirty plates, mostly of medical plants, with their descriptions, medical properties, and uses. Recipes for preparing tooth powders, cologne water, and medicines for cleansing and beautifying the skin, and many other receipts, useful to farmers, and mechanics. Recipes for preparing and using the remedies for the cure of the poisons of Arsenie, Copper, Lead, Mercury, Opium, Morphine, Galicand, Prussic Acid; also, directions for preparing a variety of diet for the sick. The whole work is got up in the neatest and most fashionable style, and contained in 941 royal octavo pages. Every family should have a copy of this valuable work.—Nashville Christian Advocate, Tennessee, February, 1849. PLAIN SYSTEM OF MEDICAL PRACTICE ADAPTED TO THE USE OF FAMILIES; BY JOHN W. BRIGHT, M. D. The above is the title of a large octavo volume, of nearly a thousand pages, well bound and neatly executed. It treats of the theory and practice of Medicine, Physiology, Obstetrics, Materia Medica, and Botany, in a style easy of comprehension ; and may be of infinite value to those who cannot readily avail themselves of medical aid. The author is entitled to high distinction in his profession, and the work goes out to the world with the sanction of many distinguished names. Methodist Expositor and True Issue, Cincinnati, March, 1849. A Plain System of Medical Practice, adapted to the use of Families. By John W. Bright, M. 2)., Louisville. Published by Morton and Oris- wold, for the Author. It is not intended by its author to supersede the necessity of a medical adviser, but only to give such hints as will enable families to RECOMMENDATIONS OF THE PRESS. treat ordinary diseases with the usual remedies, and to have some guide when they are out of the reach of medical advice. All technical phrases are laid aside, and the prescriptions are so written as to be understood by the unlearned reader. The symptoms of the various diseases are so described as to be readily comprehended by all. We feel the greater confidence in recommending the work, from observing that it is commended to the public by some of the most eminent of the Medical Faculty in this and other cities. Among these commendations, we notice the names of Drs. Caldwell, Gross, Miller, Cobb, and Yandel, of the Louisville Medical Institute, and Drs. Ewing, Winlock, McDowell, Talbott, Knight, and others of this city ; together with those of Drs. Grant, Watkins, Shanks, and Frazer, of Memphis. We take it for granted, that these gentlemen would not suffer their names to go forth as sanctioning a medical work which is not every way worthy of public reliance.—The Presbyterian Herald, Louisville, Ky., March, 1849. BRIGHT'S FAMILY PRACTICE. The foregoing is the title of a large and substantially bound work, recently issued from the press of Messrs. Morton and Griswold, of this city. John W. Bright, M, D., of this city, is the author of the work. It is an octavo of 928 pages, in which the author has labored to describe all the diseases incident to the United States, and to prescribe the most approved remedies, in conformity with the latest discoveries and improvements of the profession. His definitions of diseases, and his prescriptions are given in plain and intelligent language divested of professional technicalities, suited to the capacities of the common reader ; and his prescriptions immediately follow the definition of each case of disease, and each change or variety of the various diseases of which he treats, so that the intelligent householder can in a short space, learn the distinguishing symptoms of any disease, and the appropriate remedies, adapted to each stage or variety in its progress. The work has a treatise on Materia Medica appended to it, which adds much to its value. The work is recommended by several of the Professors of the Medical College, and a number of the practising physicians of this city, and in other parts of the country. We doubt not that many of our readers would be glad to possess themselves of such an assistant in the treament of diseases, and especially where skillful physicians cannot be obtained. Baptist Banner, Louisville, Ky., February, 1849. A Plain System of Medical Practice, adapted to the Use of Families. By John W. Bright, M. D., Louisville, Ky. (Published by Morton ce Griswold for the Author.) This is the title of a large and beautifully printed and bound royal octavo volume of 941 pages. It is a sound, clear, and able production; a book, we may say the very book, needed for these times; and we are fully persuaded that it will be found eminently useful. The Author, in a manner highly creditable to himself, has per- formed his task, and redeemed his promise in the preface, to make it acceptable to the community at large, by carefully avoiding, as much as possible, the technicali- ties of his profession. It is destined, as a friendly visitor, to enter many a family and bring comfort to many who are suffering from the common calamities of life! This work is highly recommended by the very first physicians, and indorsed by them as every way worthy of universal confidence.—Quarterly Review, Methodist EoLt. copal Church South, April 1848, p. 323 v A PLAIN SYSTEM MEDICAL PKACTICE, ADAPTED TO THE USE OF FAMILIES. BY JOHN W. BRIGHT, M.D. LOUISVILLE, KY.: PUBLISHED BY MORTON & GRISWOLD, FOR THE AUTHOR \M B A IB $ -S 5 P United States of America, i District of Kentucky, ] ss Be it remembered, that on this 14th day of January 1847, John W Bright, x said Bistrict, deposited in this office the title of a Book, which is in the words and figures following, to wit: "A Plain System of Medical Practice, adapted to the use of Families. Bv .ohnW. Bright, M.D." The right whereof he claims as proprietor, m conformity with an Act entitled " An Act to amend the several Acts respecting Copy rights " A copy att. ; no. H. Hajtna, Clerk, District of Kentucky. MORTON & GRISWOLD, Btereotypers and Printers. Louisville PREFACE The author of this work, having been engaged in an extensive practice of medicine for more than thirty years, is fully apprized of the difficulties attendant upon so writing a work that the unprofessional reader may easily comprehend the description given of diseases, and the use of the remedies prescribed. In composing, compiling and arranging this work, he has consequently avoided the technicalities of the profession, and freely availed himself of the knowledge he has derived from the standard authors, both of Europe and America. New diseases are yearly presenting themselves, as new causes are developed ; therefore, new remedies are necessary for their cure. These new remedies, as given by the most approved practitioners, as well as those in former use, have been carefully selected, and applied to the cure of diseases, both new and old, to which the inhabitants of the United States are subject; thereby giving to this work advantages over any other now before the public. All the diseases incidental to the United States are carefully described. The work also contains a plain, practical treatise on midwifery ; and directions for nursing, and preparing diet for the sick. All speculation has been carefully avoided, while the remote and proximate symptoms of each disease have been described in the plainest manner, each stage properly defined, and the appropriate reme- dies given in plain English, with directions how to com- pound, prepare and administer them at the proper time and stage of the disease. The symptoms are then IV PREFACE. described according to the effect the medicine may have had, and further prescriptions made, so that the attentive reader cannot fail to administer the appropri- ate remedies throughout the process of the cure. This work is rendered still more valuable to families by the addition of a Family Materia Medica, which is illustrated by thirty-one engravings, twenty-two of them plates of medicinal plants, with their descriptions and uses. It contains, also, a formulary for preparing all the family medicines in common use, and a list of the antidotes, with directions how to prepare and use them, for the cure of the following poisons, namely — Arsenic, Prussic Acid, Lead, Copper, Mercury, Opium, Morphine, and Gallic Acid. In addition to this, will be found recipes for making Colognes, Tooth Powders and Cosmetics, with a number of others useful to fami- lies and farmers. Taking the whole work together, the author is fully satisfied that it is well adapted to the wants of the public, in a medical and practical point of view. Many of the new remedies contained therein have been col- lected from the most approved medical periodicals and journals of England, Ireland, Scotland, France, Ger- many and America, many of them not having as yet been introduced into systematic works written for the profession; but their virtues and properties having been satisfactorily established by physicians of the highest standing in the profession, they are herein given to the public. INDEX. DISEASES COMMON TO MEN AND WOMEN. PAGB Apoplexy,...............131 Asthma,...............164 Bienorrhoea, or Simple Urethral Running,........280 Blenorrhoea Luodes, or Clap,...........281 Cholera Morbus,.............187 Cholera, Asiatic,.............189 Colic,................199 Colic Spasmodic, or Iliac Passion,..........200 Colic, Painters',.............202 Colic, Wind,..............205 Costiveness,..... ........ 206 Crick in the Neck, cr Wry Neck,........ . 222 Cramp, . ........ .223 Consumption,............, . 241 Dysentery, or Flux,.............70 Dropsy,...............169 Dropsy of the Chest,............173 Diarrhosa, or Looseness,............176 Diarrhoea, Chylous,.............180 Diarrhoea, Mucous,.............179 Dyspepsia,...............259 Delirium Tremens,............. 307 Fever, Intermittent, or Ague and Fever,........1 Fever, Remittent or Bilious,...........10 Fever, Continued or Inflammatory,.........13 Fever, Bilious of the South,...........17 Fever, Simple Typhus,........... 23 Fever, Inflammatory Typhus, Red Tongue or Winter Fever, . . . . . 31 Fever, Congestive Typhus,...........42 Fever, Yellow,..............50 Fever, Treatment by Dr. Angel,..........812 Gout,...............96 Heart, Functional Diseases of,...........268 Heart, Palpitation of,......, .149 Hiccoughs, Morbid, .............147 Headache, Stupid,.............137 Headache, Chirmic,............139 A* VI INDEX. Headache, Throbbing, Headache, Sick, .... Headache, Treatment of all Species, Inflammation of the Lungs, . Inflammation of the Stomach. Inflammation of the Bowels, . Inflammation of the Liver. Inflammation of the Spleen, . Inflammation of the Kidneys, Inflammation of the Bladder, Inflammation of the Brain, Jaundice,...... Jaundice from Gall Stones, Jaundice, Spasmodic, Jaundice, Hepatic, .... Jaundice, Black, .... Looseness, Feculent, Looseness, Bilious, .... Looseness, Serous, .... Looseness, Chylous, Looseness, Tubular, Lientery, ..... Looseness, Gypseous, Lock Jaw, or Tetanus, Megrims, ..... Nerveache of the Foot, . Nerveache of the Breast, Pleurisy,...... Prostrate Gland, Disease of. Rheumatism, Acute, Rheumatism, Chronic, Sciatic, or Sciatica, .... Spitting of Blood, or Hemoptysis, . Sneezing, • . . . . Scybalum, ..... Syphilis, or Pox, .... Pseudo, Syphilis, or Bastard Pox, . Toothache, . ..... Tic Douloureux, .... Tic Douloureux from Anemia, V omiting of Blood, .... White Swelling..... DISEASES OF PREGNANCY. Antiversion ol the Uterus,....... Bleeding during Pregnancy....... Costiveness during Pregnancy,..... Displacement of the Uterus,...... Diseases of Pregnancy,....... Difficulty of .Making Water,...... Emetics, the Use of. . index. vii PAdl Edematose Swelling of the Labia,.......... 766 Exercise and Diet,............. 367 Fever during Pregnancy, .......... 361 Flooding during Pregnancy,...........356 Gestation, term of Utero,........... 334 General Condition of the System, ........ 345 Headache,......... .....369 Hernia, or Rupture,.............409 Obliquity of the Uterus,............333 Pregnancy,............... 326 Pregnancy, Extra Uterine,...........356 Purging during Pregnancy,...........351 Palpitation of the Heart, ........... 354 Piles,..... ..........352 Pains in the Hips, Thighs, and Legs,.........366 Retroversion of the Uterus,...........328 Signs of Pregnancy,.............321 Sickness at the Stomach,............347 Sleeplessness,..............364 Swelling of the Feet and Legs,..........367 Temper and Habit, Indulgence of,..........345 MIDWIFERY. After-pains,..............426 Deformities of the Pelvis,...........796 Different Actions of the Fibres, &c,.........419 Exhaustion during Labor,...........411 Fainting during Labor,............405 Falling down of the Cord, &c,..........410 Flooding after the Child is born, and before the placenta is delivered . . 421 Hemorrhage from other parts than the Uterus during Labor, . . . .412 Instruments, the Use of,............419 Labor, Causes of,.............373 Labor, Signs of approaching,..........375 Labor, Divisions of, . ............376 Labor, Positions of the Woman during,........378 Labor, the Management of,...........380 Labor, Complicated,............398 Labor, Tedious,.............405 Locked Head, Signs of,............418 Labor with Twins, &c,............425 Locheal Discharge,......«•....." 428 Midwifery, Philosophy and Physiology of, ........311 Parts concerned in Delivery, . ........312 Preparing the System for Delivery, ........370 Presentations of the Head, Different,.........387 Presentation of the Feet,............393 Presentation of the Head with the Hand,........390 vm INDEX. _ PAM Presentation of the Face,...........390 Presentation of the Breech,...........391 Presentation of the Hand, Arm, or Shoulder,.......393 Presentation of the Side, Back, or Abdomen,.......396 Partial Contraction of the Uterus,..........409 Rupture, or Hernia, . . .......409 508 Turning the Child, &c, . ......... 412 DISEASES OF CHILD-BED. Bloody Infiltration of the Labia,..........430 Inflammation and Adhesion of the Vagina,........438 Inversion and Prolapsus of the Uterus,........456 Inflammation of the Womb,...........452 Milk Fever, and Abscess in the Breast,........432 Milk Leg, or Phlegmasia Dolens,..........449 Madness, or Mania,.............459 Puerperal, or Child-bed Fever,..........439 Sore Nipples,..............430 CHILDREN, DISEASES AND MANAGEMENT OF. Abscess within the Ear,.......... j43 Adhesion of the Labium Pudendi,........ 544 Apoplexy of the Lungs, ... ........5gg BathinS>............' '. [ 526 Bronchitis, Acute, .... ..... gng Burns, .... cc- ' „ •••••.........565 Bites of Serpents,.......... 7g„ Bites of Insects, Musquitoes, Sec,....... 708 Bruises,............* 7QQ Constitution of Infants,........ 4o7 Costiveness,......... , „ CmuP»........*'.'.'. [ '. 567 Crying of Infants,........ _1fi coiic>..........'. '. '. ! ; ; 53o Convulsions,......... ~ Cholera Infantum,........ Carrying the Child, &c.......... Cow-pox, or Kine-pox,........ fi Chicken-pox,..... *•••■•• 657 Dressing the Child, &c, ........ Discharge from the Vagina,........ Diarrhoea, Feculent,......... Diarrhoea, Chronic,..... * *•••». 553 Diarrhoea, Lienteric,...... ••• 552 Diarrhoea, Chylous,......... Diarrhoea, Mucous........ * '..........^g INDEX. XI PAGE Diseii*s of the Vagina,.......... • 771 Deformities of the Pelvis,......... .796 Glandular Inflammation of the Cervix Uteri,.......783 Glandular Inflammation of the Mucous Membrane of the Vagina, . . 783 Menses, Cessation of, ........."G Pruritus, or Itching of the Parts of G Eneration, . . .... 768 Polypus of the Uterus,............786 Swelling of the Labia, Edematose,.........76f? Transparent Discharge of Mucus fr m the Vagina, &c,.....773 Transparent Discharge, &c,...........774 Tumor of the Labia, Oozing,...........76? Tumor of the Labia, Encysted,.........• 768 Tumors of the Vulva, Warty,..........761 Whites, or Leucorrhoea,............7^3 PROMISCUOUS. Hydrophobia,..............801 Explanation of Plate I.,............SI"7 Explanation of Plate II.,............819 Explanation of Plate III.,...........821 Explanation of Plate IV.,...........82» MATERIA MEDICA. Aloes, or Aloe,..............827 Arsenic, Poison by, ... .........836 Ammonia, Aromatic Spirits of,..........898 Ammoniated Tincture of Guaiacum,.........914 Antimonial Wine,.............898 Anti-Bilious Pills,.............919 Active Pills,..............9°9 Bone-Set,...............833 Bayberry, or Waxberry,............839 Balmony,...............840 Bitter-Root,..............841 Blood-Root,..............851 Blue Flag,...............853 Baldness, Remedy for,............857 Bitter Polygala,..............864 Blackberry, or Dewberry,..........• 8^ B.ack Alder,..............866 Black Pepper,..............867 Baldness, to Restore the Hair in,......... 88^ X INDEX. Scrofula,...............678 Strains,...............709 Sleep of Infants,.............476 Teething,...............519 Tooth-Rash,..............539 Thrush, or Apthea,.............530 Tongue-Tie,..............540 Tetter-Worm,....... ......674 Ulceration, and Imperfect Healing of the Navel,......464 Ulceration of the Mouth,............536 Vomiting,...............514 Varioloid,...............649 Whooping Cough,.............561 Weaning the Child,.............482 Water in the Scrotum, or Hydrocele,.........507 Walking,...............524 Wild Hairs in the Eyelids, ..........706 Wounds, Punctured,.............709 Wearing the Hair,.............711 Whitlow,...............668 Worms,.......... 57j DISEASES OF GIRLS. Chlorosis, or Green Sickness,...........740 Hermaphrodite, or Disease of the Clitoris,........743 Hysterics, or Hysteria,............743 Inflammation and too great Density of the Hymen,......744 Menstruation, Painful,.......... 732 Menstrual Functions Neglected,......... 720 Menstruation, Profuse,........... 72Q Menses, Suppression of,.......... 723 Menses, Retention of,......... 72i Menstruation, Time of its Visitation,....... 717 ^reservation of Health,..... .... 714 DISEASES OF WOMEN. Abscess of the Labia,.......... _g5 Chronic Inflammation of the Glandular Portion of the Os Uteri, . 778 Chronic Inflammation of the Mouth and Neck of the Womb, . . . 709 Corroding Ulcer of the Uterus,....... -oq Cancer of the Uterus, &c,........ -q1 Diseases of the External and Internal Pats of Generation, . . 7gg INDEX. IX PAH Diarrhoea, Bilious,.............548 Dropsy of the Abdomen,............617 Dropsy of the Brain,............608 External Signs of Internal Disease,.........491 Erysipelas, or St. Anthony's Fire,..........503 Epilepsy,...............628 Fashion, Exposure, &c, of Infants,......... 476 Food proper after Weaning, &c,..... .... 486 Frostbites, Chilblains, &c,...........664 Fever, Miliary, .............642 Fever, Catarrhal,......... ... 595 Fever, Scarlet,..............579 Fever, Remittent, before Weaning,.........587 Fever, Remittent, after Weaning,..........592 Fever, Simple Continued,...........640 Fresh Cuts,..............710 Fruils, the Use of,.............496 Glandular Pemphigus,............662 Goitre,................702 Horn-Pox,...............658 Hip Joint, Disease of,............ 541 Incontinence of Urine,............511 Infantile Pemphigus,...... .....663 Itch,........ .......677 Inflammation of the Tonsils,...........564 Jaundice,...............527 King's Evil,..............703 Language of Complaint during Pain,.........494 Measles,...............584 Milk Scald, or Crusta Lactea,..........537 Mumps,...............565 Nourishment,...............468 Nettle Rash,..............501 Nursery,...............473 Necessities of the Child,............517 Prickly Heat,..............46fi Pure Air,........ .... .517 Pleurisy,...... ...... .605 Pemphigus, or Vesicular Fever,.......... 659 Red, White, and Yellow Gum,..........465 Rose Rash, or False Measles,.......... . 499 Rickets,...............577 Rupture, or Inguinal Hernia,...........508 Rupture, or Umbilical Hernia,..........509 Ringworm Scald,.............673 Sweet Urine, or Diabetes,...........510 Sore Eyes,...............534 Sore Ears,...............539 Spasm of the Feet and Hands,..........637 Small-Pox,............... 544 Scurfiness of the Head,..........• . 670 Scald-Head,........ .....6H B Xll INDEX. PASI Bitter Sweet,..............902 Blood Purified by Diet,............933 Clinkers,...............834 Chalk Julep,..............838 Chaps in the Hands, Cure for,..........850 Cosmetic to Remove Pimples, &c,..........859 Cream Tartar,..............877 Corns, Cure for,..............881 Centaury, American,............882 Columbo, American,.............890 Cement for the Teeth, &c,...........891 Carminative Mixture, -............895 Cologne Water,.............895, 896 Cold Cream,..............896 Cough Mixture,..............912 Cerate, Simple,..............917 Cough Sirup, Domestic,............915 Chalybeate Water,.............847 Crumbacker's Pills,.............918 Cook's Pills,............ .919 Cooling Powders,.............919 Dittany, American,.............856 Dandelion, .... ..........862 Dewees' Tincture of Guaiacum,..........913 Diaphoretic Draught,............919 Diet Drinks,..............923 Dover's Powder,.............910 Diet and Drink for the Sick............924 Electuary of Senna,.............911 Essence of Camphor,............857 Essence Peppermint,............912 Epsom Salts,....... ......875 Elixir Vitriol,....... . .... 899 Eye Salve,...............917 Fever Root,..............885 Fowler's Solution,.............907 Flour of Sulphur,.............908 Gentian,...............860 Ginger, American,.............848 Gum Guaiacum, .............910 Glauber's Salts,..............876 Gamboge,...............872 Hair Oil,..............843, 855 Hellebore, American, ...........887 Hiera Picra,..............910 Hive Sirup, Cox's,.............90j Hair Cream,..............892 Indian Hemp,..............829 Iron, Precipitated Carbonate of,..........835 Iron, Citrated Aromatic Wine of,....... . g3g Indian Turnip/..............qqq Ink, Black,...............894 INDEX. Xlll rxat Ink. Indelible,............ .896 Iceland Moss,..............871 Judkins' Ointment,.............898 Jalap,................873 Lobelia,...............844 Lee's Anti-Bilious Pills;....... ... 838 Lee's Windham Pills,............897 Ladies' Slipper,.............849 Liverwort,...............856 Lactucarium, or Lettuce Juice,..........870 Lavender,...............870 Laudanum,...............899 Lime-Water,.............912> 913 Matico,...............830 Mustard,...............909 Myrrh,...............872. May Apple,..............863 Milk of Roses,....... ......895 Milk of Sulphur,.............903 Mustard Plasters,............. 921 Nux Vomica,..............904 Ointments to Remove Pimples, &c,.........861 Ointment for Leprosy,............892 Ointment for Gout and Rheumatism,.........894 Opium,...............869 Ointment for Milk Scald,............894 Ointment of Nutgalls,............915 Ointment, Basilicon,.............915 Ointment of Roses,.............916 Ointment, Green,.............91" Ointment, Kentish,.............916 Ointment for Tetter, 916 Ointment for Scrofulous Ulcers,..........917 Ointment, Tartar Emetic,...........917 Poison by Prussic Acid,............838 Poison by Arsenic,.............836 Poison by Copper,..............837 Poison by Opium or Morphine,..........837 Poison by Corrosive Sublimate, Copper or Lead,......837 Piles, Remedy for, .... T.........894 Pills of Balsam Copaiba,..... ......891 Pills, Mild,...............918 Pills, Active,..............919 Pills of Quinine,.............921 Pills, Tonic,.............. 920 Plaster of Horseradish,............921 Poultice for White Swelling,...........922 Poultice, Clay,..............922 qoi Plaster, Strengthening,.............L Pennyroyal,.............. 9Uo Persimmon,............<• 877 Pleurisy Ron................842 Pleurisy Root...............843 Drickly Ash,..... ........883 XIV INDEX. PAOl Poison, Antidote for Oxalic Acid...........895 Paregoric,...............899 Poppy Capsules,.............867 Poultice, Hop,..............922 Peppermint,..............907 Quinine, Solution of,............920 Rattle Weed,..............831 Rhubarb,.............. 869 Rochelle Salts,..............875 Rose, to make a Blue,............884 Sumach,...............864 Snakeroot, Virginia,.............846 Sirup of Green Persimmons,...........865 Saltpetre,...............876 Slippery Elm Bark,.............902 Seneca Snakeroot,...........•• 878 Spirits of Lavender, Compound,..........881 Sarsaparilla Broth,.............893 Scald Head, Remedy for,............893 Spreading Sores on the Legs and Arms, Remedy for,.....893 Sirup of Ipecac,.............897 Sirup of Rhubarb, Aromatic,...........900 Sirup of Rhubarb, Simple,...........901 Senna, American,............ . 853 Spirits Camphor,.............90] Squills, Vinegar of,........... . 912 Squills, Oxymel,........... . 912 Simple Sirup,..............904 Sirup of Garlic,..............904 Toothache Balsam,.............886 Tooth Powders,..............889 Tooth Cement,..............891 Tonsils, Remedy for Enlarged,...........892 Thompson's No. 6,.............897 Turlington's Balsam,............897 Tincture of Rhubarb and Aloes, ... •......901 Tincture of Lobelia,......... ... 914 Tincture of Peach-Kernels,...........914 Tincture of Guaiacum, Dewees', . . . %...... 913 Tincture of Gentian, Compound,..........913 Tincture of Cayenne Pepper and Myrrh,....... 915 Tincture of Myrrh..............g07 Tincture of Senna, Compound,........ ggg Tincture of Rhubarb, Simple,.......... 90q Tincture of Rhubarb, Compound.......... 900 Tincture of Digitalis,............gog Tincture of Hyoscyamus,.......... ggj Tincture of Aconite,........... 8^g Tincture of Asafoetida,........... ggg Tincture of Kino, .'.,........ g^l Tincture of Iodine,........... gQg Tonic in Jaundice,........... 921. INDEX. XV PAGE Tonic, Domestic,.............920 Varnish for Leather, Black,...........886 Wintergreen, or Pipsisseway, .........845 Wormseed, ..............854 WildPotatoe, ... ..........855 White Walnut, . . .........874 Wine of Ipecac., .. ... ..'... 899 Warts, Cure for, ... . • .... 894 Yellow Root, ... .... 858 APPENDIX. PAGE Falling of the Womb,..........929 St. Vitus' Dance,...........936 Spasmodic Cholera,...........940 Hygiene, - ..........941 Homcepathy,............956 Hydropathy, or the Water Cure,........966 The Use of Chloroform in Midwifery, &c. &c,.....1015 On the Use of Cod Liver Oil,.........1024 New Remedies in Materia Medica.........1027 MEDICAL PRACTICE. INTERMITTENT FEVER, OR AGUE AND FEVER. Diseases which are not complicated with any local affection that is essential to and belongs permanently to them, as those which belong to other diseases as of a febrile character, are, more strictly speaking, called fevers. Fevers are properly divided into genera and species. There are certain symptoms which are common to all the diseases comprehended under the class fevers ; but we shall here particularly confine ourselves to the descrip- tion of intermittent fever. The symptoms to be observed in intermittent fever are the following: The person is first attacked with languor or debility, sluggishness in motion, and some unea- siness in taking exercise, with a disposition to yawn and stretch; at the same time the face and extremities become pale, the nails turn blue, the features shrink, and the surface of the body becomes rough, hke the skin of a goose; — hence the term goose- skin. The surface of the body becomes contracted, as if it had; been exposed to cold. At the coming on of these symptoms, some coldness of the feet and hands may be detected by another person, though it may not be noticed by the one affected. The cold sensations are first felt in the back, from whence they pass over the whole body, increasing, with frequent rigors, until the person begins to shake, as if exposed to the chilling blast of a winter's day, though it may be in the heat of summer. Aftei these rigors or shivering sensations have lasted for an indefinite time, — from ten minutes to two hours, — they begin to abate* and are alternated with warm flushes, and by degrees yie.d entirely to an increase of heat, which augments till a fever has entirely taken the place of the cold stage. The heat now per- vades the whole system. The natural appearance of the skin returns, with an increased redness in the face. The surface 13 dry and smooth, and the featu 3s look a little more full than 2 NTERMITTENT FEVER, natural. The heat continues, with more or less pain in the back and head, and sometimes in the legs and thighs. After the fever has continued for several hours, more or less, with thirst and restlessness, a gentle perspiration begins to make its appearance; first on the forehead, from whence it gradually extends over the whole system more or less profusely. As the perspiration continues to flow, the heat, thirst and pain abate; after some time the perspiration gradually abates also, and the body assumes its natural temperature. Most of the functions of the body which were suspended during the cold and hot stages, are now restored to their natural state. The appearances pre- sented in the above description of intermittent fever, give us a natural division of the disease into three stages. In the course of the fulfilment of the above stages, several symptoms appear, which it is important to notice; and many changes take place in several of the important functions, which must also be observed. Upon the first approach of the attack, during the feeling of languor and lassitude, the pulse is always lower and weaker than in health. As the chill increases, the pulse con- tinues to become weaker till they are small, feeble, and very frequent, and sometimes irregular. At this stage of the disease, there is occasionally pain in the stomach, and sometimes nausea and vomiting of bilious matter. As the cold stage passes off and the fever rises, the sickness at the stomach abates, and the pulse becomes fuller and stronger, and gradually continues to increase in strength, till the fever begins to abate, and the sweat to break out. As the sweating becomes more general, the pulse grows softer and less frequent till the sweat ceases, by which time the fever has entirely subsided, and the pulse returned to its healthy standard. The breathing during the cold stage is short, frequent and anxious, and a tickling cough sometimes troubles the patient during the chill. As the hot stage comes on, the cough subsides, and the respiration becomes more free, full and easy, but still continues somewhat frequent and anxious till :the sweat breaks out, when it subsides. With the increase o" perspiration, the pain leaves the head, back and extremities, an& the breathing returns to a healthy state. Of the natural functions. Upon the appearance of the cold stage, the appetite fails, and does not return till the sweating stage is over, or at least till it continues for some time. Th( thirst that occurs during the cold stage is owing to the suspen- sion of the secretions in the fauces and palate, and the conse- OR AGUE AND FEVER. 3 quent dryness of those organs. But it is continued in the hot stage, in consequence of the increased heat in those parts, and is only relieved by the ushering in of the sweat, when a more com- fortable feeling of quietude to the whole body is experienced. In the course of the cold stage, the person generally voids a quantity of colorless urine, which deposites no sediment. In the hot stage, the urine is less in quantity and high-colored, but still deposites no sediment. But in the sweating stage, the urine deposites more or less sediment, which is white, yellow or reddish; and this sediment, continues to be deposited for some time after the paroxysm is over, unless there is a tendency to diarrhoea. No stools are voided till the sweating stage has progressed for some time; then they are inclined to laxity. If there are tumors or swellings in any part of the body, they are apt to shrink during the cold stage; but they return to their natural size, or larger, during the hot stage. Ulcers cease to dis- charge during the cold stage, but discharge again during the hot s:age. The mental organs are frequently affected during the cold stage, thought being confused, and sensation rather blunted and sometimes considerably impaired, for the time being. But when the hot stage comes on, all these return with considerably increased power, and delirium is frequently the consequence. There are some cases in which the cold is ushered in with a deep, heavy drowsiness and stupor, and becomes almost coma- tose approaching to apoplexy. The pain in the head, that attends the cold stage, does not always proceed so far as above described; but pain in the head rarely fails to attend the fever, and gener- ally continues till the sweat flows freely, when it gradually sub- sides, and the pain in the back and limbs subsides also. These are the principal symptoms, with the order of succession in which they ordinarily appear, in a paroxysm of intermittent fever, or ague and fever. But all those symptoms will not be found in every case, nor in every patient; at least, the violence of the paroxjrsms will vary in different persons according to age, consti- tution and habits. But there will always be a sufficient number of these symptoms in every case to characterize the disease, so that its true classification cannot be easily misunderstood. It is seldom that a fever of the above type ceases at the first parox- ysm ; that is, it seldom runs through all these stages without returning, unless arrested by medicine. It most frequently, after a certain length of time has elapsed, is again ushered in by a lecond paroxysm, passing through all the above stages, ofjteja 4 INTERMITTENT FEVER, continuing to alternate for several days, weeks or months, unesi broken by medical treatment. The intermission in fever is the Length of time which elapses from the time the sweating stage commences till the fever passes off and the next chill commences; and the interval in fever is the time between the end of the sweating stage and the commencement of the next chill. When the chill returns every day, the fever is said to be of the quotid- ian type ; when it returns once in forty-eight hours, it is called the tertian type ; when the chill returns once in three days, it is called the quartiner type of intermittent fever; in other words, we have the every day ague, the every other day ague, and the third day ague. Sometimes the chill returns at irregular periods, but they are only variations of the above types, produced by occasional circumstances. There is another thing to be observed in relation to the above forms of fever, and that is, the longer the chill lasts the shorter the paroxysm of fever will be. As a general rule, the every day ague, or the quotidian type, has the shortest chill and the longest fever. The tertian type, 01 every other day ague, has a longer chill and shorter fever than the every day ague. And the quartian type, or third day a^ue, has the longest chill and shortest fever of any other. As a general rule, if the chill lasts fifteen or twenty minutes, the fever will last six or eight hours, and the sweating stage two hours. If the chill lasts one hour, the fever will last from four to six hours; and if the chill lasts two or three hours, the fever will not exceed that length of time. We shall now speak of the treatment of the different types of intermittent fever. TREATMENT OF THE QUOTIDIAN TYPE. The cold stage is the first thing that attracts our attention in intermittent fever. The remedies to be used in this stage, are such as are calculated to remove the coldness and restore an equable warmth over the surface ; for during the chill, the blood recedes from the surface, and accumulates in the heart and large blood vessels internally. The remedies indicated in the chill are those that are calculated to establish a more uniform circulation throughout the system, such as warm teas of balm, hyssop sage, thyme, dittany, camomile, pennyroyal, <&c. Those teas that are not very stimulating are best, because stimulants raise the fever higher when the reaction takes place. Bottles of hot Water applied to the back and extremities, will aid in shortening OR AGUE AND FEVER. 5 the chill. When bottles cannot be obtained, hot rocks or bricks, dampened and wrapped in cloth, may be applied. The above remedies are proper where you have no medicine at hand ; and if the fever should be ushered in before you can get medicine, give an inema (injection) of salt and water, either warm or cold, to evacuate the bowels freely, which will lighten the fever. As soon as it can be procured, an emetic should be given Recipe: Ipecac, twenty grains. Tartar Emetic, three grains. Mix, and dissolve in nine table spoonfuls of warm water. Give three first, and one every fifteen minutes, till free puking Is induced. Then give a glass of warm water every time the patient pukes, till he has three or foir motions up; then give gruel to work it downwards. Give nothing cold till the opera- tion is over. But if the bowels should not be freely evacuated in two hours, give the following pills : Recipe: Calomel, twenty grains Rhubarb, ten grains. Aloes, ten grains. Form six pills. Give three first, and the other three in two hours. Work them off with gruel without salt. Toast water or herb tea may be taken during the operation. If the fever con tines after the operation of the pills, give Recipe: Cream Tartar, one drachm. Salts Nitre, twenty grains. Tartar Emetic, one grain. Mix, and divide into six powders. Give one powder every aour, in warm balm tea, till the fever subsides. Then, if you nave six hours before the chill should return, counting from the hour the chill came on the day before, give the following pills: Recipe: Aloes, twenty grains. Quinine, ten grains. Pipeline, two grains. Form ten pills. Give one every half hour till the time tNr the chill has past. But if the chill occurs before enough of the ^ills have been taken to keep it off, as soon as the nails become blue and a theatchy feeling is felt, repeat the emetic immediately, so that it shall commence operating just as the chill commences. This will break the chill, and but little fever will follow. As soon as the fever is off, commence the tonic pills again, and give them as above directed, as long as the intermission lasts. In a major- ity of cases, you will remove the chill and fever on the second day. But there are persons who cannot take an emetic of any 6 INTERMITTENT FEVEK, description, in consequence of its cramping them, or from extreme debility, or pregnancy, or bleeding lungs, &c. In such cases, the purgative course of treatment must be pursued; and in these cases it is generally most expedient to give the cathartic in broken doses, as the pills above prescribed, which may be taken two at a time, and repeated every two hours till they operate freely. During the administration of the pills, if the fever should be high, twenty drops of the sweet spirits of nitre may be given every hour, and a little herb tea, to mitigate the fever; and as soon as the fever is off, the tonic pills may be given as above directed. But there are cases where calomel should not be given; they are those where the patient has been salivated repeatedly and severely; in all such cases, emetics should be administered, followed with these pills: Recipe : Aloes, ten grains. Rhubarb, ten grains. Scammonia, ten grains. Ground Ginger, ten grains. Tartar Emetic, one grain. Form eight pills. Give one every hour till they operate freeiy. After the operation is over and the fever subsides, give the fol- lowing mixture: Make half a pint of strong senna tea, and dis- solve in it three grains of the sulphate of quinine; give a table spoonful every half hour till all is taken. This may be repeated every day in the intermission of fever, till the chill is broken. If the patient cannot take quinine, in consequence of its affecting the head, as it does with some patients, then use the following: Recipe : Salicine, thirty grains. Piperine, two grains. Dissolve them in two ounces of water, — (grind the piperine fine.)—and take two tea spoonfuls in sweetened water every hour during the intermission of the fever. In order to prevent the chills returning after they have been broken, take Recipe: Peruvian Bark, one ounce. Gentian Root, half ounce. Orange Peel, half ounce. Cloves, thirty or forty heads. Make all fine, and put them into a quart of spirits. Take a table spoonful every morning in water. When these articles cannot be obtained, take the following: Recipe : Yellow Poj lar Bark, one ounce. Dogwood Bark, one ounce. Wild Cherry Bark, one ounce. Cream Tartar, one ounce OR AGUE AND .'EVER. 7 Make all fine, prepare and use as above. In some cases, the chill will return every week or two, for months. In such case, a very popular remedy, and not a bad one, will be found as fol- lows : Take one gallon of hard cider, and boil it down to one pint; add to it a handful of horseradish root, cut fine. Take a table spoonful of this three or four times a day. This has often broken the chain of regular returns of the chill, and cured the patient. Another popular remedy is the juice of a large lemon squeezed into a cup of strong coffee, and taken warm just before the chill comes on. I have found the following to be an excellent remedy to prevent the return of chills : Recipe: Bark of the root of the Ptelea. one ounce Root of Yellow Gentian, one ounce. Root of the Spiraea, two drachms. Make all fine, and put into a pint of brandy or strong whisky. Take a table spoonful three times a day. In all cases, the pores of the skin must be kept open, by a bath of warm water, and soap freely applied once a week, and the bowels kept free and easy by some gentle purgative, such as castor-oil, rhubarb, extract of the white walnut bark, &c, till the cure is confirmed. Bathing the extremities in cool vinegar and water, when the fever is on, will always be admissible. The diet should be light and thin; no animal food should be taken; tea, soft toast, gruel or light soups, rice, roasted potatoes, &c. When there is neither calomel nor tartar in the system, the drink should be cold water. The chamber of the sick should in all cases be well ventilated. The discharges should be removed as soon as they are voided. There are various other modes of treating ague and fever. One is this: After the stomach has been cleansed properly, as soon as the fever comes on, strip the patient and wrap him in a wet sheet from head to foot, and cover him in bed; he will sweat profusely, and the fever will soon subside. Then give him the tonics above directed. Others plunge the patient into a cold bath while the chill is on, but I consider this a dangerous practice. Another mode is to bleed the patient in the chill. This never should be done but by a judicious practitioner—a physician of experience. The two last remedies have had their strong advocates in phy- sicians of great celebrity, but they can only be resorted to in the hands of such physicians, and not in the domestic practice, We now proceed to give the treatment of the tertian typo of ague. B INTERMITTENT FEVER, TREATMENT OF THE TERTIAN TYPE. The chill in this type of intermittent fever returns once in forty-eight hours. Here, if the fever is of short duration, you have double the time in which to perform the cure. It should be commenced exactly like the treatment of the quotidian type, by giving an emetic just as the chill comes on, and follow it with the purgative, and when free from fever, give the quinine and piperine pills; or you may give the senna tea and quinine, 01 the salicine and piperine, as directed in the quartian type. Only once in an hour will be often enough to give the tonic in this form of the disease. After the chill ceases to return, give the bitters, to secure him from a relapse. TREATMENT OF THE QUOTIDIAN TYPE. This type of the ague can be cured in the same way. But here you still have more time in.which to arrest the chill, and your remedies will be more certain to produce the desired effect. The course of treatment need not differ from that in the other types. All the above cases are supposed to be simple in their nature, and not of long standing. But ague may commence in the quotidian type, that is, the chill may return every day, and continue to do so for some time. Then it may recur every other day, for a time, and then only once in three days, thus passing through all the types of this form of fever, so that by the time it has assumed the type of the third day ague, the energies of the system have been so much reduced, and the resolution of the patient so broken down, that he has scarcely energy enough to escape from dangers seen, or take any exercise whatever. By this time, he looks pale and emaciated, his abdomen has become enlarged, and his spleen large and hard, — (this is called ague cake,)—his liver, has suffered in its functional powers, if it is not actually diseased. His stools are light clay-colored his feet and ankles swollen, his appetite precarious—sometimes voracious and sometimes he has none. The tongue is generally covered with a white coat, especially in the morning. If he can be per- mitted to lie down in the sunshine he is for the most part satis- fied. In such cases, we must pursue a different course of treat- ment The system is now more or less cachectic; none of the secreting organs perform their functions in a healthy manner. The first effort in such cases should be to restore a healthy action in the secreting organs—the liver, the pancreatic gland OR AGUE AND FEVER. 9 the mesenteric glands and the kidneys. We should commence the cure, in such cases, by giving an emetic of ipecac alone. Recipe : Pulv. ipecac, thirty grains. Dissolve in a tea cupful of warm water, and give it at three draughts, fifteen minutes apart; work it off in the usual way. It should be followed by the following pills : Recipe : Blue Mass, thirty grains. Rhubarb, thirty grains. Form twelve pills. Give two every two hours till they operate freely. They should be repeated every day for two or three days, or until healthy bile is discharged. As soon as this is effected, the following medicine should be given: Recipe : Nitric Acid, half an ounce. Muriatic Acid, half an ounce. Mix them together. Give ten drops three times a day, in cold water. At the same time apply the following ointment over the region of the spleen, by friction with the fingers. A portion as large as a hazle-nut may be rubbed in three times a day: Recipe : Hydriodate Potash, two drachms. Rancid Lard, two ounces. Pulverize the hydriodate potash, then add the lard. Mix them properly, and apply as above directed. If the liver should not act well, or the bowels be torpid under the use of these reme- dies, omit the drops for a day or two, and give the pills of blue mass and rhubarb, as above directed; continue the use of them again till the bile is freely secreted. You may then omit them and again resume the use of the acid. If the liver and spleen continue to be enlarged, and the stomach tender to the touch, omit the acid and give the following pill: Recipe : Calomel, twenty grains. Opium, two grains. Form twenty pills. Give one of these pills three times a day, till the gums become a little swollen and the saliva is secreted more freely than usual. These pills should then be omitted, and the following pills given to keep the bowels open: Recipe : Rhubarb, sixty grains. Aloes, thirty grains. Castile Soap, thirty grains. Form twenty-five pills; three or four of these, taken at bed- time, will operate once or twice in the morning. In order to give tone to the system the following bitters may be taken: 10 KEMITTENT OR BILIOUS FEVER. Recipe : Cherry Bark, one ounce. Dogwood Bark, one ounce. Macerate the bark in half a gallon of cold water. Take a wine- glass of this infusion three times a day. If the chills continue, even in a slight degree, give the following pill: Recipe . Aloes, ten grains. Quinine, ten grains. Piperine, two grains. Form ten pills. Give one three times a day; this course should be pursued for several days, or even weeks, till the chill and fever ceases to return, and the enlargement of the liver and spleen is removed. If the skin should continue to be dry, and the bowels inactive, use the following foot-bath : Recipe : Nitric Acid, four ounces. Muriatic Acid, four ounces. Mix. To two gallons of warm water add one table spoonful of the mixture. Place the feet and legs into the water, and let them remain till a tingling sensation is produced in the skin; this will be effected in fifteen or twenty minutes. The bath should be repeated every night for a week or two ; in the morn- ing the body should be sponged all over with cold water, or the shower-bath may be taken and the surface immediately rubbed dry with a coarse towel; and as soon as the apparel can be adjusted, the patient should exercise briskly till a free perspira- tion is induced. This should all be accomplished before break- fast. The practice may be continued till the health is restored. Exercise on horseback will be good for the convalescent. Expo- sure to rain or damp should be avoided. The diet should at all times be that which sits easy on the stomach, avoiding every- thing that acidulates, or is difficult of digestion. Spirituous liquors, either distilled or fermented, for the most part, do more harm than good, unless some bitter be infused in it, and then it may be taken as a tonic. REMITTENT OR BILIOUS FEVER. This is the common bilious fever of the Middle and Western States. The paroxysm of a simple intermittent fever is always completed in less than twenty-four hours. But in remittent fever though the sweating stage comes on before twenty-four hours have elapsed, ye* there remains some fever when the cold stage REMITTENT OR BILIOUS FEVER. H sets in again, when the paroxysm runs the same course as before. The pain in the head and back is increased on the recurrence or increase of the fever. When the remission is so distinct as to be clearly defined, and the return of a new parox- ysm is distinctly marked by the cold stage, though there be no shake, but only a chilly sensation in the extremities, and perhaps some cold creeping up the back, the type of the fever is strictly remittent. It is not an uncommon thing for intermittent, or ague and fever, in hot climates, to change its type to that of remittent or bilious fever. When this is about to take place, the hot stage is protracted a little every day, and the sweating stage corre- spondingly shortened, till at length the hot stage does not pass off entirely till the chilliness is felt again, which lasts but a short time, when the fever rises with more violence than before. In these cases, the tongue is covered with a white, yellow, or brownish coat. If the coat is white, the tongue is apt to be more or less swollen, and look pulpy, with indentations in its edge, made by the pressure against the teeth. There is an unpleasant taste in the mouth. The pulse is full and strong, and beats from ninety to a hundred strokes in a minute. The skin is dry and hot, with great thirst. There is frequently great pain in the head; the eyes are streaked with red. A quick motion of the head increases the pain. The back suffers with pain, and a general restless feeling pervades the lower extremities. The stomach sometimes loathes all food, but craves acid and cooling drinks. The bowels are apt to be constipated, and the urine scant and high-colored. TREATMENT. If the treatment of this fever is commenced when the fever is high, take a pint or more of blood from a large orifice, letting it run till a perspiration breaks out upon the face and arms. As soon as the blood is drawn, give an emetic, as prescribed in intermittent fever ; and follow it with a brisk purgative: Recipe : Calomel, twenty grains. Rhubarb, ten grains. Aloes, ten grains. Form six pills. Give three first, and the other three in two hours. At the same time, if the fever is nigh, give the following mixture: Recipe: Sweet Spirits of Nitre, one ounce Antimonial Wine, half an ounce. 12 REMITTENT OR BILIOUS FEVER. Mix them together, and give a tea spoonful every hour, in a little hot tea. Continue this till the pills operate freely. If the fever still continues, give the following powders: Recipe : Cream Tartar, one drachm. Salts Nitre, twenty grains. Tartar Emetic, one grain. Mix, and divide into six powders. Give one every hour, in warm balm tea, or some other herb tea. Continue them till the patient perspires freely. As soon as the fever is off, begin imme- diately and give the following pill: Recipe : Calomel, ten grains. Sulphate Quinine, ten grains. Tartar Emetic, one grain. Mix, and form ten pills. Give one every half hour, while free from fever. Should the fever rise, give the following draught: Recipe: Strong Senna Tea, half pint. Rochelle Salts, one ounce. Tartar Emetic, one grain. Dissolve the salts and tartar in the tea, and give it at four or five drinks, half an hour apart, till the bowels are freely acted upon, when the fever will abate; then you may give the last- mentioned pills again. If the bowels should become irritable at any time, as they sometimes do, and the dirxharges are frequent and watery, give: Recipe ; Calomel, twenty grains. Opium, two grains. Piperine, one grain. Form four pills. Give one every hour till the liquid purging is checked. In four or six hours after, give a dose of castor-oil. Any of the above medicines may be repeated in their proper places from day to day, till the fever is entirely broken. At any time when the fever is high, the face, hands, arms, legs and feet, may be repeatedly bathed in cold vinegar and water, or water alone. If there is much pain in the head, and the fever is high, a second bleeding may be used advantageously; or if there is much pain or soreness in the stomach or bowels, ten or fifteen leeches may be applied over the pained part, and the bites allowed to bleed for two or three hours. If leeches cannot be had, cups may be used, and in some cases a blister plaster may be applied with great benefit. After the fever is broken and does not return some vegetable tonic will be proper, such as Huxham's tincture — (see Materia Medica,) — a tea spoonful of which may be taken three times a day, in a wine-glass of water, or ten grains of INFLAMMATORY £R COMiNUED FEVER. 13 quinine, dissolved in an ounce of water, may be taken, a tea spoonful three times a day, or ten or fifteen drops of elixir vitriol, before each meal. It will make half a glass of water pleasantly sour. Any of the vegetable tonics will here be serviceable. In the whole course of the fever, the skin should be kept clean by frequent ablutions, or aspersions with a sponge and warm water. The diet, in all cases, during the cure, should be light and thin, and but little taken at a time. As soon as the patient is able to bear it, exercise on horseback should be taken every day, but not so as to fatigue or debilitate. All exposure should be avoided. INFLAMMATORY OR CONTINUED FEVER. It is somewhat difficult, at all times, to characterize this fever at first sight; for a simple continued fever from its commencement is of rare occurrence. Almost all fevers com- mence with a chill, and for the most part have one or two inter- missions, and these occur within twenty-four hours from the access or chill. This is perhaps owing to a general law of disease, which causes all diseases to assimilate more or less to the epidemic, if any prevail at the time; so that much may be gained by a correct knowledge of the diseases that prevail at the time in the neighborhood. If remittent fever prevails, you may be pretty sure that the fever you first take to be a continued bilious fever, has some remissions, though they may be lightly marked. If, upon a close examination of the symptoms, you fia: this to bo the case, it should be treated as a remittent fever; bu should there be no chill or coolness of the ends of the extremities, as the point of the nose, lobes of the ears, the fingers and toes, it is not of the remittent type. Yet if the coldness can be found in any of the above places, at any time in twenty-four or forty-eight hours, or at any intermediate time, it will govern the type of the fever, and call for its own appropriate treatment. Should the fever be ushered in by a chill, and after this no cold stage occur again, but the fever continue unremitted, then the type of the fever will be certain. This fever is attended with considerable heat on the surface, a dry skin, coated tongue, thirst, pain in the head and back, aching in the bones, loss of appetite, and watch fulness. The febrile paroxysm will last, without any abatement for forty-eight or fifty-six hours, when a slight abatement may 14 INFLAMMATORY OR CONTINUED FEVER. be discovered, but no sweat. The patient, however, in this slight respite, will sleep a little, but does not feel much refreshed by it. The fever is generally higher when he awakes than it was when he dropped to sleep. This form of fever, if let alone or badly treated, will run a course of four, six, or eight weeks, before it subsides entirely. It generally lasts till the flesh is waited from the frame, and the subject becomes a skeleton ; the skin is hot and dry all the time; that on the hands and feet becomes parched, and the lips seem to dry up and peel. The urine is high-colored and small in quantity. The patient often feels rectless, and tosses himself from side to side on the bed. He is apt to be more or less delirious, and talk incoherently at times, and, if the fever progresses, he becomes anxious to be removed, and talks of going home. His tongue is now dry; he breathes hard and quick; his pulse becomes frequent, and smaller than it was in the first stage of the fever. These are bad symptoms, and indicate great danger, especially if the bowels are too loose, and th". discharges thin, yellow or briny, and smell badly. If let alone, he presently feels disposed to lie on his back, with his mouth a little open; his eyes look sunken and rather red; he dozep, and when aroused if not conscious, for a moment, where he is. All such symptom? ndicate great danger. TREATMENT. This fever is essentially inflammatory in its type; hence the antiphlogistic treatment is demanded by all the symptoms that characterize it. If the pulse is full and strong, the treatment should be commenced by taking blood freely from the arm : if the blood is permitted to run till faintness comes on. a more decided impression will be made. The detraction of blood should be followed by an emetic, and that by an active cathartic in ten or twelve hours. Recipe: Calomel, ten grains. Jalap, twenty grains Mix, and give it for a dose; or, if the patient is strong and vigorous, give twenty grains of calomel with the jalap. Work this medicine off with gruel without salt in it. When the opera- tion is over, if the fever continues, the patient should be bathed or sponged all over with cool vinegar and water. If the vine- gar carmot be had, use the water alone. After the surface has been well sponged, wrap the patient up in bed, and give him a full draught of cold water, and he will be likely to sweat. If INFLAMMATORY OR CONTINUED FEVER. 15 he perspires freely, you have succeeded in breaking the chain of morbid action. He then should rest for six or eight hours, and take light nourishment. You may then give the following pur- gative : Recipe: Calomel, ten grains. Aloes, twenty grains. Rhubarb, twenty grains. Tartar Emetic, two grains. Opium, one grain. Form twelve pills; give one every hour till all are taken. They will first induce a perspiration, then act as a cathartic. Dur- ing the administration of the medicine, occasional draughts of balm or ditiny tea should be taken. Should the pills fail to act upon the bowels, they may be aided by a draught of senna tea, or v dose of castor-oil. If, after these medicines have been given and worked off, the fever still continues, the whole person should be sponged with cold vinegar and water, and be immediately wrapped in blankets, and a draught of cold water given; or he may take the following febrifuge medicine. Recipe: Cream Tartar, one drachm Salts Nitre, twenty grains. Tartar Emetic, two grains. Gum Camphor, four grains. Opium, one grain. Mix well. Divide into six powders. Give one every hour in a little warm herb tea, and let the patient drink freely of warm tea, till a free perspiration is induced, and kept up for three or four hours. The dolicus pruriens (pleurisy root) will make the best tea in this case, for it can be given while the fever is on, with safety. If the fever rises again, after this, and the bowels are in a good state, you may wrap the patient in a wet sheet, rolling it around him from his chin to his feet, and covering him in bed, and he will in twenty minutes sweat freely. After the perspira- tion ceases, take the wet clothes from about him, and rub the surface freely with a coarse towel, and put dry clothes on him, and cover him up in bed again. Some light nourishment may now be given. If he needs a purgative after this, the bowels may be kept open with the following pill: Recipe: Scammonia, twenty grains Aloes, twenty grains. Rhubarb, twenty grains. Castile Soap, twenty grains. Ground Ginger, twenty grains. Form twenty pills. From four to six will be a dose if taken at bed-time. If they should not operate by morning, two or lb INFLAMMATORY OR CONTINUED FEVER. three more may be taken. If this medicine cannot be had con- veniently, use rhubarb or castor-oil, or the extract of white walnut, which is equal to rhubarb in these cases. (See Materia Medica.) After the fever is broken, the patient will be weak, and the appe- tite not very good; to improve which, and strengthen the stom- ach, ten drops of elixir vitriol may be taken in half a glass of water/three times a day. Some mild tonic may also accompany it, such as an infusion of gentian root and orange peel; a small portion of each infused in a pint of hot water. Two or three table spoonfuls may be taken at a time, and repeated three or four times a day. Sometimes, in this form of fever, a diarrhoea comes on, which prostrates the patient very much; to check which, kino and opium are frequently given—which medicines never should be given combined tog-ether, as they invariably increase the purging. Before any medicine is given to check this diarrhcea, the region of the stomach and abdomen should be carefully examined, by pressing on them with the fingers, and if any pain, soreness or tenderness, be detected in any of these regions, if the patient's strength will bear it, apply leeches or cups over the pain- ful point. If they cannot be had, apply a blister plaster over the part, and as soon as it begins to draw give a grain of opium, or a quarter of a grain of morphine; or the dose may be divided, where the patient is weak,—say a quarter of a grain of opium every hour, or the eighth of a grain of morphine at the same intervals, till the purging is checked. Where no inflammation exists, and the purging is induced from extreme relaxation of the bowels, it can sometimes be checked by quinine and piperine. Recipe: Quinine, six grains. Piperine, one grain. Form six pills. Give one every hour till the purging is checked; but where any inflamation exists, this medicine should not be given. After the purging has been arrested for twenty- four hours, the bowels may be moved by an injection of molasses and water, or slippery-elm tea, or gruel and lard, &c. The patient, during this period, should drink freely of some muci- laginous tea, or rice-water. If the soreness of the bowels con- tinues after this treatment, and small brawny discharges are passed, give, Recipe: Nitrate of Silver, five grains. Gum Arabic, one hundred grains. Make all fine, and mix; divide into ten powders. Give one three times a day, in sugar, or, if the diarrhcea is troublesome, BILIOUS FEVER OF THE SOUTH. 17 you may repeat the powders every four hours, with eight or ten drops of laudanum in each dose, till the purging is checked. When the inflammation is removed from the bowels, the recovery will be slow. The principal remedies now consist in enemas, to keep the bowels open, and a light and nutritious diet. The diet, through the whole course of treatment, should be light and thin, and a little warm. The drink, except when tartar or calomel is given, should be cold. In convalescence, all exposure to the heat of the sun, or rain, or night air, should be avoided; also fatiguing exercise. Great care should be taken in returning to the use of strong diet, as relapses frequently occur from this source, and they are more dangerous than the first attack. A little good wine and water may now be serviceable, if carefully used. Moderate exercise on horseback and the use of wild meats will promote the recovery. BILIOUS FEVER OF THE SOUTH. Bilious fever is the prevailing form of fever in hot climates; and although nearly allied to some other forms of fever, espe- cially the marsh remittent fever, already described, it occurs in situations both by sea and land, where miasmata could not be suspected to give rise to it. The character of this fever is rarely ever mistaken by physicians of reading and observation, not- withstanding the symptoms are much diversified, owing to pecu- liarity of constitution, climate, season, and the modes of life of its subjects. This makes it more difficult to describe all the minutiae of its symptoms. There are always, however, some prominent symptoms, which so universally characterize this fever as to leave no doubt as to its true type. These symptoms are, pain and irritability of the stomach and around that region ; pain in the head, and especially over the eyeballs; pain in the back and loins; sickness at the stomach, and vomiting of bilious matter, and not unfrequently delirium, which sometimes proceeds to perfect madness. The pulse is not always altered in frequency even at this stage of the disease; at other times it rises to 130 or 140 strokes in a minute. In other cases, the symptoms vary; the attack commences with cold rigors; pain and sickness at the stomach; vomiting and headache; oppression at the upper orifice of the stomach, extending around under the ribs into the region of the liver, spleen, and diaphragm; with great dejection of BRIGHT. 3 18 BILIOUS FEVER OF THE SOUTH. spirits. Sometimes, without manifesting any previous indisposi- tion, the patient will fall down in a fainting fit, during the con- tinuance of which the countenance is pale and gloomy. As the subject recovers from this condition, he will express the pain he suffers by applying his hands to the stomach and head, and after vomiting a considerable quantity of bile, his senses are restored. Let the disease appear in whatever form it may, at first the pulse, if they vary from the healthy standard, are small, feeble and quick. The pain in the stomach is apt to increase and the vomiting continue. As the paroxysm advances, the countenance becomes flushed, the pulse quick and full, the eyes more or less red, tongue fired, the thirst intense, the pain in the head becomes severe, succeeded by delirium, and the patient becomes unman- ageable. This state of morbid action continues for twelve or fourteen hours, when a perspiration begins to make its appear- ance, and the violence of the symptoms to subside. In the remis- sion, the pulse falls to ninety, the delirium subsides, and the patient complains of great debility, nausea and bitter taste in the mouth This remission, which is only for a short time, is soon succeeded by another paroxysm, in which all the former symptoms are aggra- vated, particularly the thirst, delirium, pain in the stomach, and vomiting of bile. If the disease is not properly treated in the beginning, the remissions entirely disappear, and the skin be- comes moist and clammy; the pulse small and irregular; the tongue dark and crusted; the pain in the stomach becomes more severe, and the vomiting of bile increases till death ensues. The features of this fever are such as characterize all violent and fatal fevers. If it is not arrested in its progress, its duration will be from three to seven days, though it is in some cases pro- tracted to fifteen or twenty; but these cases are rare. When, however, they do occur, visceral obstructions are very apt to be the consequence, and the patient is liable, finally, to be carried eft' with dysentery or disease of the liver. The skin is apt to turn yellow, and sometimes matter is ejected from the stomach very much resembling that thrown up in yellow fever. When this form of fever generally prevails in a section of country, it is not uncommon for the acclimated inhabitants to present a yel- lowish tinge on the skin, as I have often seen in the south and especially in New Orleans. A torpid or irregular state of the bowels almost always precedes an attack of this form of fever unless it be suddenly developed by cold dews by night and the intense heat of the sun by day, or by some irregularity in eating BILIOUS fever of the south. 19 or drinking. In such cases, there are but few premonitory symptoms. In describing this fever, the symptoms are carried out in all their various manifestations. But it is not to be expected that every case will present all the symptoms here laid down; but that they may vary both in number and vio- lence. Nevertheless, every case will present enough of the leading symptoms to characterize the type of fever. In the most violent attacks of this fever, the symptoms very much resemble those of yellow fever; and if the physician is not acquainted with both forms of fever, he will be likely to con- found them, and, by so doing, produce among the friends a state of alarm altogether uncalled for. We may, however, truly say this is a fearful disease, and requires prompt and efficient treat- ment. The treatment may vary, and yet be successful. The general character of the epidemic and violence of the attack, varying under various circumstances, admit of variations in the mode of treatment. There are two modes of treating this form of bilious fever, which have been used by eminent medical men. One of them I have fully tested to my satisfaction, when I lived in New Orleans, in 1826. The other mode I have not tried, not having as much confidence in it as I have in the former. But [ shall give them both, because the milder forms of the disease may be treated successfully by either mode of practice. treatment. I shall first describe the mode of treatment that I esteem best and most safe. The first symptom that claims attention, in this disease, is the irritability of the stomach, accompanied by a dis- tressing vomiting. The relief of this symptom is the first step towards the cure, as it is developed in consequence of an exces- sive engorgement, and perhaps incipient inflammation of the stomach. The first remedy to be used for its relief, is the detraction of blood ; this should be taken from a large orifice in the arm. But the unskilful and trifling manner in which blood- letting is performed, often does more harm than good. If you bleed at all, bleed boldly and decisively from a large orifice. The blood should run till the pain in the head and stomach is relieved. The finger should be kept upon the pulse, and the blood permitted to run till they become soft, and the pain in the head and stomach subsides. Immediately after the detraction of blood, give the following medicine : 20 BILIOUS FEVER OF THE SOUTH. Recipe : Calomel, twenty grains. Opium, half a grain. Mix them in sugar, with a few drops of water, and let the patient take it immediately. This will tranquillize the stomach. It is well known to medical men that calomel, in large doses, acts as a sedative, tranquillizing the stomach and bowels, in many cases, as soon as it is taken. Should the irritability of the stomach, however, be so great that the first dose is. rejected, repeat it immediately. In a few hours, when the stomach is calmed, give the following purgative, to work off the calomel: Recipe : Scammonia, ten grains. Aloes, ten grains. Jalap, ten grains. Calomel, six grains. Form six pills. Give three at a time, two hours apart. If they should not operate freely in one hour after the last pills are taken, they should be elicited by an injection of strong salt and water, which may be repeated every hour till the desired effect is produced. Five or six free evacuations of dark bilious matter will greatly relieve the urgent symptoms. The more copious the purging, the less danger there will be of a return of vomiting ; an object greatly to be desired in the cure of this fever. But should the dangerous symptoms return, viz., the intense headache and pain in the stomach, especially if there be delirium, bleeding should be resorted to once more. Do not be alarmed at the false bugbear, debility, or putrefaction, which so often paralyzes the hands of medical men in warm climates; for the liver is exces- sively engorged with blood, and if it is not removed the liver will be broken down in its structure, and then your pstient will most inevitably die. Then bleed a second time, and immedi- ately repeat the calomel and opium as at first, and work it off with the pills; using the injections, if necessary, to promote a free catharses. These discharges will be dark and foetid, as the others were. The free action of this cathartic should be fol- lowed by the exhibition of five or six grains of calomel every five or six hours. If the stomach should be much sick, you may give half a grain of opium with every dose, or every other dose, of the calomel, so as to keep the stomach calm. Continue this practice till the gums become sore, and the patient begins to spit freely. The bowels should be kept open with the following pills, and the salivation gradually worked off: Recipe : Scammonia, twenty grains. Aloes, twenty grains. Jalap, twenty grains. BILIOUS FEVER OF THE SOUTH. 21 Form twenty pills. Give two or three every two hours, tih they operate two or three times. Omit the calomel while you are giving the pills. If the patient cannot take the pills well, you may give the following purgative: Recipe : Jalap, twenty grains. Cream Tartar, sixty grains. Mix. Give it in sweetened water. If it should not operate in four hours, repeat half the quantity. If the above medicine cannot be had. give a dose of castor-oil. While the stomach is sick, and the vomiting continues, but little fluid should be taken into the stomach. But if the stomach is not sick, small draughts of lemonade may be taken, or orangeade, which is better, if it is made of the pulp of the orange deprived of the rind; or water acidulated with cream of tartar. The great sheet-anchor in the cure of this formidable fever is mercury, which should be given till a slight salivation is produced. When this is effected, your patient is safe, under judicious management. I would, how- ever, remark that sometimes the pain in the stomach is so severe, and the vomiting so obstinate, that the remedies above prescribed will not remove them. In this case, if you press upon the region of the stomach with your fingers, you will find great soreness there; this being the case, there is inflammation, and immediately twelve or fifteen leeches should be applied over the tenderest part. If leeches cannot be procured, cups should be applied, and blood freely abstracted. After either leeches or cups, the wounds should be kept bleeding for an hour or two, by applying warm wet cloths, and frequently renewing them. If this should not relieve the pain, a blister plaster should be applied over the stomach, and permitted to draw fully. In weakly patients, leeches should be applied instead of a second bleeding from the arm. In the progress of the cure, when you have caused the patient to spit freely, your great care will be to keep the bowels open, which should be effected by the use of the most gentle medicine. By attending to the following directions, the teeth will not be injured by salivation. Remove the phlegm carefully from the teeth and gums three times a day; be sure that it does not become encrusted on the teeth. If the saliva does Dot act upon the bony part of the teeth below the enamel, caries will not be consequent on salivation. The following makes an excellent tooth-water: Recipe : Yellow Root, sixty grains. Borax Soda, sixty grains. Tincture Myrrh, one ounce. Warm Water, one pint. Good Vinegar, one gill. 22 BILIOUS FEVEK OF THE SOUTH. Simmer over a gentle fire fifteen minutes. Then strain, and add honey or loaf-sugar sufficient to sweeten it. Keep the mouth perfectly cleansed with this. After using this mouth- water, each time, rinse the mouth with common spirits of cam- phor ; this will smart a little, but will be found an excellent wash for salivated gums. At the same time, the following tonic should be used: Recipe: Sulphate Quinine, ten grains. Huxham's Tincture, two ounces. Dissolve the quinine in the tincture. Give a tea spoonful every four hours, in a little water. A little wine and water may be taken occasionally. The diet, during the cure and convales- cence, should be light and easy of digestion. The room, during the whole period of illness, should be well ventilated, cool and clean. The use of cold water cannot be resorted to in this fever as it can in continued fever. It may be applied to the head, in case of violent pain there, but the general application of cold water to the whole body, in this fever, is of very doubtful utility. After the second dose of medicine has been freely worked off, a hasty draught of cold water will sometimes bring on a free per- spiration; and for a crisis, I have now given what I believe to be the safest and best practice in this formidable fever of hot climates. But that you may not be left with this only, I will now give the other mode of treatment, as pursued by some eminent physicians. It is the following: On the commencement of the attack, give the following medi- cine : Recipe : Glauber Salts, one ounce. Tartar Emetic, three grains. Mix. Dissolve this potion in half a pint of warm water. Give one third every fifteen minutes, till the patient pukes freely, Work this off in the usual way of treating an emetic. As soon as it turns down on the bowels, give warm rice-water, or gruel freely; cream tartar should be dissolved in the gruel. When the operation is over, give the following medicine : Recipe: Tartar Emetic, one grain. Mint Water, two ounces. Laudanum, twenty drops. Mix. Give one fourth of this every hour. Still let him drink freely of the rice-water and cream tartar, till the next mornin°- when from five to ten grains of calomel should be given and repeated every five or six hours. One fourth of a grain of tartar emetic, with eight or ten drops of laudanum, should be given SIMPLE TYPHUS FEVER. 23 three or four times a day. The design of the tartar and laudanum is to keep up a moisture on the skin. If the calomel does not move the bowels in twenty-four hours, give a dose of Epsom or Rochelle salts. After the operation of the salts, commence with the calomel, tartar and laudanum, as before directed. If the pain continues in the stomach, apply a blister-plaster over it, and give the following medicine: Recipe: Vitriolated Ether, one ounce. Laudanum, one drachm. Mix. Give forty drops, in warm drink, every hour till the stomach is relieved. But the calomel and opium should be con- tinued till the patient is freely salivated. The diet and drinks may be used as in the first mode of treatment, and the sore mouth managed in the same way. The precise dose of medicine cannot always be given, in either mode of treatment, but must be varied according to the age and strength of the patient. I have already stated my preference to the first mode of treatment. SIMPLE TYPHUS FEVER. We mean by simple typhus fever the mildest form of that fever; for there are three modifications or grades of typhus fever. We shall treat of them separately, under their appropriate heads or titles. Like most other fevers, simple typhus has three stages. The first is that of oppression, which is marked by a variety of symptoms, among which the following are the most prominent: paleness of the face ; a peculiar look of dejection and weariness; some degree of darkness around the eyes; great weakness of muscular power, and of the energies of the mind also ; the sensi- bilities are dull; there are cold, creeping sensations over the body, alternated with hot flashes; a loathing of food and occa- sional vomiting; the tongue is white and clammy; there is a sense of weight in the stomach, and an anxiety of mind indicated by frequent sighing; and there is a sensation of aching, heaviness, and giddiness in the head; also, coldness in the back and pain in the loins; a quick, low, and struggling pulse, irregular in fre- quency and force. These symptoms are accompanied with a general uneasiness, like that produced by long and fatiguing exercise. Sometimes these symptoms are developed rapidly, but in other cases they come on more slowly, and two or three days naay elapse before the disease is fully developed. But, finally 24 SIMPLE TYPHUS FEVER. the second stage is ushered in by the development of fever. In strong, athletic persons, the strength and frequency of the pulse are now greatly increased. The pulse is fuller, thrilling, and rather hard under the finger; the cheeks are flushed with a dusky redness; the eyes are heavy, and the lips parched; the breathing is quick, and the skin almost always dry; the heat of the body is generally above the natural standard ; the tongue covered with a white or yellow coat; the thirst is great, and the pain or uneasiness in the head increased ; the brain is easily excited; every symptom denoting clearly an excess of excitement. This stage, in simple typhus, holds its even tenor for some time, probably six, eight, or ten hours. As the fever proceeds, the brain shows more signs of disease, by reveries or delirium, which is apt to come on in the evening when the fever is highest. Towards morning the fever abates, and these symp- toms also. After the first paroxysm, the debility is greatest dur- ing the fever. During the febrile paroxysm the bowels are con- stipated ; the faecal discharges, when they do appear, are darkei than natural, and very offensive; the breath and perspiration also are offensive. The urine is highly colored and smells strong; it is small in quantity. The second stage of this fever will last from five to seven days, according to the strength of the patient and the violence of the attack. The febrile excitement then subsides, and the third stage, or that of collapse, takes place. This stage is announced by signs of depression in the voluntary powers; the skin relaxes with a variable temperature, and the pulse evidently becomes weaker and softer, and is easily com- pressed under the finger. In the milder forms of this fever the first approach of collapse is apt to be taken for a favorable ter- mination of the disease; for, although the patient may complain of much general debility, and sometimes of soreness in the flesh with wandering pains and cramps in the extremities, yet the tongue will be found softer and cleaner, the pulse slower, and the breathing deeper and less frequent. But if this is really the stage of collapse, these favorable symptoms will not last long, but the fatal symptoms soon begin to develop themselves, viz. sudden prostration; quickened but weak pulse; the tongue becomes fouler, darker and drier; the voice becomes weak and faint; the articulation less distinct, and the breathing shorter, weaker, and more anxious; the delirium more constant- the countenance dejected, sunken and inanimate; the skin feels ooser and rather shrivelled, and the general heat of the surface SIMPLE TYPHUS FEVER. 25 diminished, though variable ; the patient becomes more restless, and a peculiarly unpleasant odor arises from the body, and fre- quently a short convulsive cough comes on by fits or paroxysms. The patient is now disposed to lie on his back; the fingers and toes often twitch and jerk; he often fancies he sees objects that are not apparent to others, and reaches out his hand to take or catch them; he mutters in a low delirium; he has some difficulty in swallowing; slides down in the bed, and draws up his feet frequently towards his body. These symptoms vary in different persons. Before the close of this fatal crisis, the stomach ejects whatever may be taken, and with it a thin, greenish fluid. Ere long, death closes the scene, either in slight convulsions or a deep stertorous breathing. In the treatment of typhus fever, we must carefully note the different stages through which it passes, and the remedies must be used accordingly; for it must be kept con- stantly in mind, that the remedies proper to be used in one stage will not be applicable in any other stage. If these facts are not kept in view, the treatment will be sure to fail. In the following plan of treatment, I shall prescribe the remedies proper to be used in each stage, under their appropriate heads. TREATMENT IN THE FIRST STAGE. As soon as a person is attacked with typhus fever, he should immediately cease to take exercise, and, if practicable, go to bed; for, no matter how mild the symptoms may be at the commence- ment, it is impossible to foresee to what they may finally lead, if they are neglected. The danger is always increased by attempt- ing to cast off the disease by exercise. It is in this stage of typhus fever that we are to expect the greatest good from a little medicine. We must not be deterred from the use of proper remedies at this period, through fear of debility, which has led thousands to the tomb. In the first stage of typhus fever, the stomach is generally sick, and apt to reject anything that is taken; for this reason, and because emetics always tend to equalize the circulation, when judiciously administered, we should commence the cure by the administration of an emetic: Recipe: Pulv. Ipecac, twenty grains. Tartar Emetic, three grains. Mix. Prepare and give in the usual way. When it is worked off, if it has not acted freely on the bowels, give an injection, so as to empty the lower bowels effectually. Wai+ a few hours, and give the following purgative: 26 SIMPLE TYPHUS FEVER. Recipe : Calomel, twenty grains. Rhubard, ten grains. Aloes, ten grains. Form six pills, and give three every two hours till they oper- ate freely. Should they all be taken, and free purging not ensue, (for the bowels are always torpid in typhus fever,) give an ounce of castor-oil. Three or four free evacuations from the bowels will strengthen rather than weaken the patient; for the bowels require to be unloaded of the feculent matter that has accumu- lated there during their torpid state. On this effect being pro- duced, the patient will feel stronger, and the blood will circulate more freely, and a more uniform warmth will succeed. But should the surface continue too cool, and the circulation be lan- guid, he should be put into a bath a little above blood heat, and remain there fifteen minutes, then be wrapped up in bed. The temperature of the room should be kept equal and comfortably warm. No stimulants should be given in this stage of the fever, excepting to very feeble persons; then a little wine may be taken in the form of warm sangaree; but use it cautiously, lest you change simple typhus into inflammatory typhus. A free use should be made of barley-water, rice-water, or thin, warm gruel; this will answer for food and drink. If this should not arrest the disease, the next day you should give the following purga- tive: Recipe: Blue Mass, ten grains. Aloes, ten grains. Rhubarb, ten grains. Castile Soap, ten grains. Mix. Form eight pills. Give two every two hours till they operate. Still use some of the above drinks. If this does not arrest the disease, it will make the febrile stage much shorter. TREATMENT IN THE SECOND STAGE. The second stage is that of excitement, and is far more fre- quently witnessed by physicians than the first or chilly one. A physician is seldom consulted till the fever has fully developed itself. He has, therefore, no opportunity to arrest the disease in its onset. In this stage of the fever the pulse is full, hard and strong, and the skin dry; the tongue is generally coated and dry; thirst great; the breathing hurried, and the patient more or less restless, with pain in the head and back. Examine him closely; inquire if he has any pain in any part of the chest stomach or bowels; examine them by pressing upon them with SIMPLE TYPHUS FEVER. 27 your fingers in every part. If you find no soreness anywhere, the first thing that you should do, if his room has not been kept too close so as to heat him, and he feels no chilliness on any part of his body or limbs, take him out of bed and place his feet in one tub of warm water while he sits over another, and suddenly pour about two gallons of water, less than blood-warm, over his body; wipe him dry immediately, and cover him lightly in bed between clean sheets. Be careful to notice all the above direc- tions strictly; for when this is properly conducted, it is a most powerful remedy in the second stage of mild typhus fever. As soon as you have wrapped him up in bed, if he has taken no medicine before, give the following : Recipe: Calomel, ten grains. Jalap, ten grains. Aloes, ten grains. Mix, and divide into two powders. Give one immediately, and the other in two hours. Give them in sugar, {never in honey.) If they do not operate in two hours more, give an active injection. Rice-water, or gruel a little warm, should be freely taken to work them off. Keep the room comfortably warm, and be careful not to exclude the pure air from the patient by sur- rounding the bed with curtains. A cold current of air should not, however, pass over the patient, as it may cause the fluids to recede from the external to the internal surface, thereby pio- ducing inflammation of the stomach, bowels, chest, liver or kid- neys. The cold-bath, however, when properly applied, has a very different effect, and, in the hands of a judicious person, and properly timed, is a powerful remedy in the cure of typhus fever. It should never be used except there is a uniform temperature over the whole surface, twelve or fifteen degrees above blood heat. The dash is the proper mode of using it, and after this manner: strip the patient in a close room, place him over a tub, and pour two or three gallons of water, of the temperature of eighty-five degrees, over his head and shoulders, and immedi- ately wipe him dry; cover him up in bed, and he will perspire freely. But should you be doubtful of your judgment in its use, then use water of the temperature of one hundred degrees, with some spirits in it. Apply this, with a sponge, over the whole surface. If he does not perspire by the use of this remedy, aid it by the following medicine : Recipe : Spirits Mindereri, two ounces. Sweet Spirits of Nitre, one ounce. Laudanum, two drachms. 28 SIMPLE TYPHUS FEVER. Mix. Give a tea spoonful every hour in half a teacupful of warm balm, hyssop or sage tea, till the perspiration is fully established. A free perspiration will reduce the fever, and the patient will sleep. The sleep generally takes place about eight or ten o'clock at night. If the fever should rise again the next day, repeat the purgative: or, if the one above has operated too freely, (recollect there should be from three to five operations in twenty-four hours,) give the following: Recipe: Blue Mass, twenty grains. Aloes, ten grains. Rhubarb, ten grains. Form six pills. Give two every hour till they operate, or all are taken, beginning the administration about twelve o'clock in the day, so that they may commence operating about the time the fever rises in the afternoon. When the fever begins to rise, com- mence and give the drops as you did the day before; and, as soon as the pills have operated freely two or three times, use the spirit-bath, as before, to allay the heat; this may he repeated every hour till the fever subsides. This course should be repeated every day till the fever is broken, and ceases to return. The purgative may be varied some days to castor-oil, instead of the pills. But if the discharges from the bowels should be very thin and smell badly, and mixed with curds of yellow or green matter, and the evacuations should be frequent and small, you must change the purgative, for there will be likely; under such circumstances, more or less sickness at the stomach: Recipe : Calomel, twenty grains. Dover's Powder, ten grains. Mix, and divide into four powders. Commence in the morn- ing and give one every two hours, in sugar and a few drops of water, till all are taken. If they should not operate in two hours from the time the last dose is taken, aid them by an enema of gruel or starch. The powders may be repeated the second day; but should the discharges be thin, examine the stomach and bowels carefully, as before directed, to see if any inflammation exists. This, indeed, should be done every day in typhus fever- and if any tenderness exists in these regions, apply ten or twelve leeches, or a dozen cups over the part, and draw blood freely. If the soreness continues after the abstraction of blood by leeches apply a blister, and let it draw fully. The diet should all this time be something thin and light. No animal food should be allowed in typhus fever, and no stimulants of any description, SIMPLE TYPHUS FEVER. 29 Giving strong diet and wine in typhus fever, for fear of sinking jnder debility, has sent thousands to the grave. If the appetite is not sufficient for the strength of the patient, when all fever is removed and the tongue clean, you may give ten drops of elixir vitriol, three times a day, in a small glass of cold water. This will be grateful to the palate, and strengthening to the stomach so that the patient can take enough food. TREATMENT IN THE THIRD STAGE. In the milder cases of typhus fever, if the treatment has been judiciously applied, but little medicine will be needed in the third stage. The powers of nature, assisted by light nourishment, will be sufficient to conduct the patient to a safe recovery. But in the more severe cases, where the first two stages have not been properly treated, there will be great necessity for medical aid in the third stage; but it must be very different from those used in the first and second stages. Evacuations must now be used cautiously, lest you prostrate the patient immediately. One or two moderate passages from the bowels in twenty-four hours will be sufficient. There are, however, some exceptions to this rule ; and they are these: Where the patient has not been freely purged in the first or second stage, an extraordinary accumula- tion of faeces will have taken place; this occasions an alarming oppression to take place upon the brain, accompanied with great prostration of all the natural powers of the system. The face will be flushed, with a suffused redness of the eyes, and delirium with some degree of stupor; the breathing will be quick, the tongue foul, and the pulse irregular. Notwithstanding all these symptoms, you cannot take blood in this stage of the disease. But something must be done to relieve these dangerous symp- toms, or the patient must die in a short time. The only remedy consists in unloading the bowels with a strong purgative. Then give the following: Recipe: Calomel, twenty grains. Jalap, ten grains. Mix, and give in simple sirup. In one hour give an active enema, and repeat it every hour till free evacuations are obtained. The strength of the patient must be supported during the opera- tion with moderate portions of good wine. In the last stage of typhus, where the bowels have been neglected in the former stages and the brain is affected from their loaded condition, 30 SIMPLE TYPHUS FFVER. much good may be done by cautious but gentle purging., while the strength is supported by wine or cordials, in moderate quan- tities. But great care must be taken in the administration of stimulants, lest fever be excited by them. In this stage of the fever, from previous neglect, sometimes small, frequent foetid stools, mixed with blood and mucus, are ejected. Such a state of things does not require astringents, but rather a purgative course for a time, though this must be cautiously directed. This kind of purging is caused by morbid offensive matter retained in the bowels, which must be removed; for which purpose give : Recipe : Calomel, twenty grains. Opium, one grain. Ipecac, two grains. Mix well, and divide into four powders. Give one every two hours in sirup, till all are taken. If they do not operate in two hours more, give an injection. Should this fail to bring down free stools, give a dose of castor-oil, (one ounce,) in a little warm sweetened water. If necessary, support the strength with cordials during the operation; and, if need be, after the operation is over, if the patient is much prostrated, give five or six drops of lauda- num in the wine and water, and repeat every hour till the patient is tranquillized. But there are other circumstances in which the above purgatives would be almost entirely prohibited. If the patient has been kept in a very close apartment, where the room has been but little ventilated, though the bowels may have been daily attended to in the first and second stages of the fever, yet it occasionally occurs, that on the approach of the third stage, copious black, bloody stools, without any bad smell, are passed by the patient. If you then examine the legs and arms, you will probably see petechia? making their appearance, which are at first few in number. (They look like a drop of black ink that has been allowed to dry on the skin.) They appear as if they could almost be rubbed off with the finger. This is a dan- gerous symptom. They soon become numerous, and spread over the body at different points. Presently they are accom- panied by discharges of blood from the gums, nostrils, bowels and bladder, or several of these parts. Under these circum- stances, you cannot use purgatives, for they will increase all these symptoms. Indeed, there is but very little, if any, possi- bility of success now. But to alleviate the sufferings of the patient, you must admit free air to his apartment. A liberal allowance of lemon-juice, mixed in small portions of good wine INFLAMMATORY TYPHUS FEVER. 31 with a few drops of laudanum, given occasionally, will be proper. If wine cannot be had, a decoction of Peruvian bark, with the lemon acid in it, and a few cloves, will be the best remedy. Such cases are generally hopeless. In all cases where the patient recovers from typhus fever, great care should be taken to avoid over-eating in convalescence. The diet should be light, and the bowels kept regular, with very gentle medicine, till their tone is restored. Gentle exercise on horse- back, or in an open carriage, in good weather, will be ser- viceable. INFLAMMATORY TYPHUS FEVER. The symptoms which were noted in the description of simple typhus, viz., languor and sluggishness of feeling, and cold sen- sations, though not a distinct chill, or shake, and a peculiar, wearied feeling in the limbs, a white tongue, and loss of appetite are the forerunners of an attack of inflammatory typhus fever. In a short time after these symptoms make their appearance, a fever rises, which does not, as in the simple typhus, remit in the morning, but continues, without abatement, for twenty-four hours. The continuance of the fever is an important symptom in this form of the fever, and is one of its characteristic symp- toms. Inflammation attacks different parts of the system, more or less. I shall show, in the progress of the delineation of symptoms, that the brain, the spinal marrow, the lungs, the pleura, the stomach, bowels, and liver, suffer more or less, by inflammation, at some stage of this form of typhus fever. Authors have divided these inflammatory states into acute and sub-acute. Now sub-acute inflammation only means, not so much inflammation as acute does; we therefore say that the disease is more or less violent, according to the amount and extent of inflammation that exists in any or all of these organs; for it must be borne in mind, that all of these organs are not inflamed in any one given case of the fever. The different degrees and amount of inflammation make a difference in the treatment, and a difference in the length of time the disease may last. The sub-acute may, and frequently does, change into acute inflammation during the progress of the disease; or the acute may be rendered sub-acute, by proper treatment, and so pass off. The acute form of inflammation generally rises or 32 INFLAMMATORY TYPHUS FEVER. the second or third day of the fever; but the sub-acute inflam- mation does not appear so early, and is not so easily detected when it does come on, for the symptoms are not so clearly defined. Therefore, in every attack of typhus fever, with a fixed pain in the head, chest, or abdomen, with a quick pulse, dryness of the tongue, and hurried and anxious breathing, and much general oppression of the strength, we may suspect acute inflammation to be seated there. If there be little or no pain, with a frequent pulse and hurried breathing, the tongue dry and parched, and covered with a yellow or brown coat, with great debility, we should suspect sub-acute inflammation to exist. But as these modifications of inflammation, coming on at different periods of the disease, require different modes of treat- ment, it is proper that they should be particularly noticed. When the acute form of inflammation exists in the brain, or within the head in any of the membranes of the brain, it is generally marked by various signs, such as, great irritability; an anxious, oppressed, or intoxicated appearance of the counte- nance; a dry, foul tongue; a quick and vibrating pulse; a flushed face, (though sometimes the face is pale;) a deep, pulsating pain in the head, with greatly increased heat there; the carotid arteries throb with a ringing sound in the ears; there is redness, with great sensibility of the eyes; there are generally transient pains in the bowels, and at the pit of the stomach, (called by physicians oppression at the pericardium;) costive bowels; uneasy respiration, attended with heavy sighing; nausea, and retching to vomit, without discharging much from the stomach. The patient feels fretful; is watchful; has visual delusions, with delirium, and these follow each other in quick succession. If the inflammation should uninterruptedly advance, these symp- toms are succeeded by indifference to surrounding objects • faltering of speech, and a gradually increasing stupor; paleness of the face; brown or black tongue, parched and contracted; low mutterings; tremors of the hands; stupid, suffused, watery eyes; squinting, or dilation of the pupils, and sometimes a palsied condition of one eyelid. Now the petechia? appear on the extremities; then an oozing of dark blood from the nostrils ■ a heavy, sterterous breathing; relaxation in the sphincter mus- cles ; the bowels are involuntarily evacuated; convulsions come on, more or less severe, and death soon closes the tragic scene. These symptoms are all marked in their highest colors- but they are not to be found, nor expected, except in those patients INFLAMMATORY TYPHUS FEVER. 33 that have been left without treatment. But sometimes the most prominent symptoms are in the beginning. A bloodshot eye; a contracted pupil; an agitated expression of the coun- tenance, and a peculiar species of moaning, which is almost constant. To these symptoms confusion of mind, tremors of the muscles, and stupor, often rapidly sueceed, and the patient expires at last with a bloated face and heavy, laborious breath- ing. The pulse in these cases is less disturbed than would be supposed from the symptoms above detailed. The pulse is often, in these cases, but little above the natural standard during the excitement; and it falls but little below it when the patient is dying. When the patient complains of pain in the head, in order to ascertain whether there is inflammation in the brain, require him to shake his head quickly. If inflammation exist, he will move it slowly, as it creates pain to move it quickly. But if he can shake his head stoutly, you need apprehend no danger of inflammation in the brain. When the brain is greatly inflamed, sometimes the disease runs its course rapidly, and the patient dies in twenty-four, or thirty-six hours. Generally, however, it proceeds less rapidly, and the patient may live to the seventh or ninth day. We now come to notice particularly the symptoms of the sub- acute inflammation in inflammatory typhus. They generally proceed much slower, and the patient lives longer, — sometimes fifteen or twenty days. For some days the sub-acute inflam- mation steals on imperceptibly. At first there is little more than the usual symptoms of lassitude, headache, and vertigo, with flying pains in the muscles or joints. There is an uneasy feeling in the stomach, with costive bowels, generally accomr panied with loathing of food, and nausea, especially if the patient changes his position suddenly. The pulse is small and: weak, but the carotid and temporal arteries beat with rather an increased force. The tongue, at first, is covered with a dirty white coat. The cheeks are alternately pale and flushed during the day. The countenance has a wearied, heavy expression, and the eyes feel as if there were particles of sand in them. The hearing is more or less affected, sometimes acute and some- times a little dull. The head cannot be shaken without an increase of pain. These symptoms generally continue, with but little alteration, for three or four days; but the patient becomes more restless, and sighs frequently: his breathing is quickened; the pain in the head increases, and the eyes are more painful BRIGHT. 4 34 INFLAMMATORY TYPHUS FEVEA. He now knits his eyebrows forcibly, and occasionally applies one or both hands to the forehead; and the pain continues to increase till it becomes very severe. The eyes are streaked with blood, and cannot bear the light. The anxiety and sick- ness at the stomach increases — ejecting fluids and other things taken into it. A yellowish-green water is thrown up with what is taken. The tongue now becomes very dry and stiff, and the coating that was on it a few days ago now slips off, and the tongue is red, or looks raw, and the teeth are covered with a brown sordes. The pain in the stomach increases, and also in the bowels, especially in the region of the colon, forming an arch over the stomach; but the whole abdominal region is more or less tender to the pressure of the points of the fingers. He sleeps with the eyes partially closed, and is apt to talk low in his sleep, and have frightful dreams. He starts up,- and his mind wanders. As the disease advances, the sickness at the stomach increases, and the pain in the bowels increases also. The mind becomes more unsettled. At length, signs of an oppressed brain increase, and the patient gradually sinks into a low delirium, with petechia?. Floating mucus is seen in the eye. These are the most common symptoms that present them- selves in sub-acute inflammation, in inflammatory typhus. In lax and irritable habits, particularly in weak and hysterical women, hypochondriacal men, and constitutions broken down by intemperance, typhus fever, in any of its forms, is now and then accompanied by furious delirium. Dissections show, in this form of typhus, that the brain and its membranes have been very much engorged, or inflamed; so, also, with the stomach, bowels, and liver, and sometimes the kidneys. When the mucous membrane of the bowels is much inflamed, the dis- charges are thin, yellow, fetid, and frequent, the patient is soon reduced to a skeleton, and dies at last in a comatose state, and insensible, with low delirium. TREATMENT OF INFLAMMATORY TYPHUS. The treatment of inflammatory typhus differs from that of simple typhus, though the first symptoms are, in many respects, very similar hi both forms of the disease. In inflammatory typhus, when the cold stage passes off, the fever rises, attended with more or less pain in the head. Sometimes it is very severe, with a sense of giddiness or vertigo. The eyes are more or less INFLAMMATORY TYPHUS FEVER. 35 red; the skin hot, generally with great thirst; the pulse full anu hard, and from 120 to 140 strokes in a minute. In the first reaction, or febrile stage, if you desire the patient to shake his head quickly, he will not be able to do it, in consequence of the pain which it produces. This is a strong symptom of incipient inflammation of the brain; and, as no remedy is equal to the lancet for the removal of engorgement of the blood-vessels, which ultimately will lead to inflammation, the patient should be bled freely from a large orifice in the arm. If he is able, let him sit up; if not, prop him up in bed. Take from eighteen to twenty- four ounces of blood, according to his age and strength. A strong, athletic man can always bear the loss of more blood than a weakly one, oi delicate female; and a man whose con- stitution has not been bruken down by hard labor, or intemper- ance, can bear a greater loss uf blood than one of the character last described. But blood must be taken according to the age, strength, and habits of the patient. As a general rule, keep your finger on the pulse, and let the blood run till it becomes soft under the finger, and the patient begins to look a little pale; then stop it, and if the patient becomes faint you will have gained a great point; you have produced a decided effect upon the heart and arteries, and a favorable impression upon the disease. But if you take only a few ounces of blood, and stop it, you only give the heart and arteries a good chance to increase the engorgement of blood in the veins, and have done more harm than good. After a full and free bleeding, if the patient has not been freely purged before, you should give him the following cathartic: Recipe: Calomel, twenty grains. Rhubarb, twenty grains. Mix and give the powder. If the patient is a delicate lady, or a weakly man, in either case give half the quantity. Elicit the operations by full injections of at least a pint or a quart of thin gruel, with salt and lard in it. Repeat it, if necessary, in two hours. Be sure to obtain at least four or five free evacua- tions in the course of ten or twelve hours. During the action of the medicme the patient's strength should be sustained by the free use of gruel, rice or barley-water. The room should be sufficiently ventilated, and at the same time strong light sh )uld be excluded. No more company should be admitted into the room than is necessary to afford the requisite nursing. The patient should not be allowed to talk much. If the heat of the 36 INFLAMMATORY TYPHUS FEVER. skin is great, and the extremities very hot, they may be bathed occasionally with water and spirits, a little warm. This will generally procure some remission of the fever towards morning, though it will not entirely remove it; it will rise again, early in the day: and if the pain in the head should return, with heat and burning of the skin, and a full, strong pulse, bleed again as much as he is able to bear without fainting. If he should become very weak after the bleeding, and not resuscitate in ten or fifteen minutes, give a little wine and water, which will revive him. After the second bleeding repeat a purgative. The same medicine as before may be repeated here, or the following may be given: Recipe: Blue Mass, twenty grains. Aloes, ten grains. Rhubarb, ten grains. Form eight pills. Give two every two hours till they operate. If the fever continues, and the pain in the head returns, there will also be more or less pain and soreness in the stomach. The stomach and bowels should be examined every day by pressing on them with the fingers. If any soreness is detected, and the strength of the patient will bear another bleeding from the arm, it should be immediately resorted to. But if the pulse is weak, bleeding by leeches will be preferable. Ten or fifteen should be applied, and as much blood taken as the patient can bear to lose. If leeches cannot be obtained, several cups should be applied over the sorest parts. It is true that six or eight ounces of blood taken by leeches will weaken the pulse more than double the quantity taken from the arm, at this stage of the fever. After the third day, as a general rule, it will be found better to bleed by leeches than the lancet. Therefore if, after the third day of the fever, the pain in the head should be severe, leeches should be applied behind the ears, and the mastoid process—(the large bone behind the ear immediately)—five or six on each side. The bites should be Kept bleeding by the application of warm wet cloths till the pain in the head is relieved. If there is much pain in the back, as is frequently the case in typhus fever which sometimes occupies nearly the whole length of the spine, it is pretty certain that there is inflammation in the coats of the spinal marrow, in which case leeches may be applied the whole length of the spine, at least as far as the pain extends. Cups may be used when leeches cannot be had. If the pain or sore- ness should continue in any of the above organs after the INFLAMMATORY TYPHUS ?EVER. 37 leeching, blister-plasters should be applied over all these points, except the head, to relieve which they should be applied to the neck: let them extend from the hair down between ttie shoul- ders. As a general rule, blisters should never be applied till the stomach and bowels have been freely evacuated. A blister will always be of service over the stomach when much sickness exists there. For the first three or four days the bowels should be freely evacuated three or four times every twenty-four hours. For this purpose, after the first three or four days, he may take small doses of calomel—say five grains every three or four hours. If there is much nausea or vomiting, a quarter of a grain of opium may be given with each dose of the calomel: Recipe: Calomel, twenty grains. Opium, one grain. Mix, and divide into four powders. Give them as above directed. If they should not operate, give an injection. Injec- tions are of great importance in typhus fever, and in almost all inflammatory fevers. If the head should continue to be affected, and delirium come on at night, the feet and legs should be bathed in warm water; this will be found-most serviceable when the fever is highest. When extensive inflammation exists in the mucous coat of the bowels, there will be frequent thin, yellow, watery stools, which exhaust the patient very much, in which case fre- quent injections of starch and laudanum will be found to be of great service — a gill of starch and forty drops of laudanum; but this is to be used only after the bowels have been freely evacuated. If they have not been freely evacuated, the patient should take a full dose of calomel, which will frequently stop this yellow, watery purging. If the stomach is disposed to reject the medi- cine, which is not unfrequently the case, opium should be com- bined with the calomel, in small and frequently repeated doses, till the mouth becomes sore, which is a desideratum in the cure of typhus in this stage. To facilitate this object, where the stomach is very irritable, blisters may be drawn upon the wrists and ankles, and the sores dressed with mercurial ointment. But where this is forbidden by the exhaustion of the patient, small portions of cordial may be given, and the ointment rubbed in on the inside of the thighs and arms, repeating the application every eight hours, till the gums become sore. When the patient begins to spit freely, the discharges from the bowels will become thicker and green or dark, and lose their fetor; then you will have gained a desirable ascendancy over the disease ; and the bowels should be kept open with a mild pill, as follows: 38 INFLAMMATORY TYPHUS FEVER. Recipe.- Rhubarb, twenty grains. Castile Soap, twenty grains. Form ten pills. Give two at bed-time; if they should not operate by morning, give one more. One or two operations in twenty-four hours will be sufficient. But this is not always the course typhus fever takes. The symptoms vary according to the attack,- and the seat and extent of the inflammation. It will be recollected that I spoke of and described sub-acute inflamma- tion. When sub-acute inflammation exists, it does not make its manifest appearance so early in the progress of the fever as acute inflammation does. The pain is less acute in the head, and comes on later in the stomach and bowels. These symptoms should be closely watched, for they may not appear before the third or fourth day of the fever. It is true, the pain in the head may be present, but not so violent; yet it may be detected by the patient shaking the head with some degree of violence. In this sub-acute form of inflammatory typhus, the fever is high, the skin hot, the tongue coated and dry, as in the active form, but the pains are not so severe either in the head, back, or limbs. The pulse will range from 120 to 130 strokes in a minute. Here you must also use the lancet as before. But in this form of the fever there is also a very deceptive condition of the circulation. which sometimes leads the practitioner astray, for the pulse may not be far from the healthy standard; it may not be, at most, over 95 or 100 strokes in a minute; but the breathing will be hurried more, in proportion to the frequency of the pulse, than in those cases where the pulse is higher. In these cases there are wandering pains in the legs and thighs, and sometimes in the arms, with a constant aching in the back and head, and occa- sionally, low delirium. When the patient sleeps, he is weaker in his bodily strength than he is when the inflammation is active. If you should be mistaken, and take these symptoms for those of positive debility, and stimulate your patient, you will do great harm, if you do not kill him. These symptoms are delusive. The debility is not real, from exhaustion, but negative, from oppression. The brain, spinal column, and the internal viscera of the chest and abdomen are engorged, and the influence of this engorgement upon the nerves has overcome the action of the heart and arteries, and produced these delusive symptoms, Now, if you will place your patient's feet and legs in warm water, with some mustard in it, and use active friction for ten or fifteen minutes, you will materially change his condition. INFLAMMATORY TYPHUS FEVER. 30 The pulse will rise. Then open a vein in the arm, and let the blood run freely: at first it will dribble from the orifice till it has run a few ounces; then the stream will enlarge and flow freely. After the blood has run for a few minutes, it is not uncommon fot all the pains to increase, and the patient request the blood to be stopped, believing that he is made worse by bleeding. You have, however, used the remedy which, by proper management, will cure him. You have partially delivered the nervous sys- tem from the pressure of the blood, and the circulating system of its load. Let the blood run till the skin becomes moist, ano the pain subsides, and the pulse, which rose and became full about the time the pain increased, becomes soft; then stop it. If the patient should become faint, the effect will be the more per- manent. Immediately follow this bleeding with an active purge: Recipe: Calomel, twenty grains. Jalap, ten grains. Mix, and give it for a dose. Then proceed as directed in the acute form of the fever; for you have now rendered the disease active, by rousing it from its latent, hidden, and mischievous lurk- ings. But it is too often that this form of the disease is neglected till the third, fourth, or fifth day, before any attention is paid to it. Then, in some cases, it might be fatal to use the lancet; still, blood must be taken. You then should place your patient in the warm bath, and keep him there ten or fifteen minutes, and as soon as he comes out, draw blood by leeches behind the ears, and down the spine. From ten to twenty leeches should be applied, and after they fall off the blood should be invited to run, by the application of cloths dipped in warm watei and applied to the bites; and if there is much pain or soreness of the stomach and bowels, leech these parts freely. The leech- ing may be repeated at any time if the inflammation demands it. If much inflammation exists in the stomach, the tongue, which is always more or less dry in typhus fever, now loses its brown or yellow coat, and becomes red and slick; hence the disease is called red-tongue fever by some. The teeth are covered with a brown, tough sordes. It proceeds from an excessively depraved state of the stomach, and its secretions. The tongue sometimes cracks and bleeds, and looks as slick and dry as if a hot iron had been passed over it quickly. After free operations have been procured from the bowels, and the fever continues, if the inflammation still exists, which you can ascertain by pressing on these organs, you have but little hope of a recovery except from 40 INFLAMMATORY TYPHUS FEVER. the use of small doses of calomel and opium, till a moderate spitting is produced. In the whole course of this fever, after the first free purging, you must, when the fever is on, give cooling medicines, such as the following: Recipe.- Spirits Mindereri, one ounce. Sweet Spirits Nitre, half an ounce. Elixir Paregoric, half an ounce. Mix. Give a tea spoonful in some warm herb tea every hour, This will promote perspiration and greatly abate the fever. Moderate portions of warm lemonade will be grateful to the patient, and aid in cooling the fever; or the following cooling powders may be given: Recipe: Cream Tartar, one drachm. Salts Nitre, twenty grains. Tartar Emetic, one grain. Opium, one grain. Mix properly and divide into six powders. Give one every hour, in warm herb tea, (balm,) till a perspiration is induced. If the warm bath be used in the evening, and followed by these powders, the patient will perspire freely, and a good night's rest will, likely, be obtained. Particular attention must be paid to the mouth and teeth, that they be kept clean. All the drinks in typhus fever should be a little warm, and slightly acidulated, or they may be mucilaginous. If there is much inflammation of the bcwels they must be so. Gum arabic water—an ounce of the gum to a pint of water—makes a good mucilage; a few slices of lemon may be cut into it; or barley-water, flax-seed, slippery- elm, or marsh-mallow tea will be found beneficial. If the dis- charges from the bowels are thin and fetid, charcoal water will be good to correct the fetor and strengthen the bowels. A large lump of clean charcoal may be put into a pitcher, and boiling water poured upon it, and, when nearly cold, drank freely. When the stomach is much sick, and a yellowish or greenish water is frequently thrown up, the case is extremely dangerous. It shows extensive inflammation of some of the viscera of the abdomen. But little drink should be taken in such cases, because it is imme- diately rejected. In the last stage of the fever, wine whey, with some spices in it, should be given; and small doses of calomel and opium, with a view to salivate. The room should always be well ventilated, and kept as nearly an equal temperature as possible. No curtains should be allowed around the bed as they confine the air, and help to keep up the fever. There should not be much light admitted into the room, as it always INFLAMMATORY TYPHUS FEVER. 41 aggravates the pain in the head; and, for the same reason, there should not be much talking to or near the patient, nor should he be allowed to talk much. But one patient should be in a room at a time. Favorable symptoms in this fever are, — a general abatement of pain, especially in the head and stomach, a correct exercise of the mind, reduction of fever, a moist skin, and uni- foimly warm sweat, refreshing sleep, a clean, natural-looking tongue, the fecal evacuations more natural, the bowels easily moved by medicine, and a return of appetite, which before was almost entirely lost. Great care should be taken, in convalescence, not to overload the stomach, either with light or heavy food, lest a relapse should ensue. It is an easy matter to relapse in typhus fever. If the patient should relapse before the strength is exhausted, it may be proper to bleed, if the pain and delirium return. But this should be done very cautiously, and all the remedies prescribed in the first attack may be used, but they must be regulated by the strength of the patient and the violence of the symptoms. The cold bath is always a doubtful remedy in typhus fever, but the warm bath is generally admissible. The author has had typhus fever four times, and knows from experience what he has written to be true, as well as from much observation. If this practice is properly applied, it will in gen- eral be found successful. Typhus fever may prevail at any season of the year, but it is most frequent in the fall and winter, when the weather is cool and damp, though I have known it to prevail in extremely cold weather, when all nature has been sealed up with ice and snow. I have also seen it in extremely hot weather. All ages and sexes are its subjects. It is not con- tagious, as far as my observation extends, except in very close and badly ventilated rooms. It may be communicated, where the pure air does not enter, and where the excretions are not speedily removed. This form of typhus fever is often called the winter fever, or the red-tongue fever, in the middle and western states. It is not apt to prevail in hot climates, yet it does sometimes very extensively. As before stated, the name of typhus fever is almost lost in the middle and western states ; it is called winter or red-tongue fever, — a name that is too vague to be adopted into any nosology. It is the genuine typhus of all writers on fevers. 42 CONGESTIVE TYPHUS FEVER. CONGESTIVE TYPHUS FEVER. There are three modifications of congestive typhus. We shall notice them separately, beginning with the mildest first, and so proceed. We shall give the treatment in the same order that we describe the symptoms. First. The mildest form of congestive typhus fever may be known by the following symptoms. The patient will be able to walk about for a few days after he is attacked, and complain but little, except a dull, obtuse pain in the head, loss of appetite, and languor. He will look paler than usual. If you watch him closely, you will observe a change in his whole demeanor. He cannot so steadily command his attention as before; he feels restless during the day, and cannot sleep well at night, and soon betrays a loss of memory. His gait becomes unsteady, like that of a person half drunk, and he talks inconsistently with his former views on the same subject. These mental variations in a day or two become obvious to all his friends; his gait now becomes more unsteady, and his countenance has an intoxicated appearance. If his tongue be examined, it will be covered with a white coat, and appear larger than natural; his breathing will be hurried and his bowels slow. His body will be rather hot, but his extremities cool and damp. If nothing be done for him in this situation, the hands shortly become tremulous, and the mind more confused, till delirium is manifested. Yet there is not a regular excitement throughout the system. The face is alternately flushed and pale, the pulse feeble, and there is evidently an unequal state of the circulation over the whole sys- tem. This is evident from the coldness of the extremities, and the partially concentrated heat in the chest and head. The skin is relaxed. A deceptive hearing and illusive visions succeed to these symptoms. He now begins to use violent exertions, or exercise, and every attempt to control him tends to increase the delirium and exhaust the strength. His tongue grows daily more foul, and his debility greater. He begins to pick at the bed-clothes, and shortly petechas and subsultin tendinum appear. About this time a general calm ensues, and the patient becomes so serene that the friends begin to think a favorable crisis has really arrived. Be not deceived! this is a delusive calm, only to be followed in a short time by a universal collapse, which will close in death probably, without much struggling. CONGESTIVE TYPHUS FEVER. 43 Second. The second variety of congestive typhus fever gen- erally comes on by a feeling of oppression and sickness at the stomach. The person is disposed to sleep, but if he should lie down and doze a little, it will not refresh him; he will awake with violent pain in the temples, heaviness, noise, and swimming in the head. The mind is not steady, the memory faulty, and he involuntarily sighs; his countenance soon acquires a look of extreme agitation; the skin is dry on the body, and damp on the extremities. The centre of the tongue is white, but moist; the pulse small and hurried; the heat about the pit of the stomach and around the region of the lower ribs great, but lower than natural in the hands, feet, end of the nose and lobes of the ears. These symptoms continue to increase, with raving delirium, till finally he becomes exhausted by exertion, when he suddenly becomes more quiet, but occasionally starts, and perhaps shrieks out, and is suddenly seized with violent convulsions and dies. Third. The third variety of congestive typhus may be distin- guished by the following symptoms: vertigo, or great giddiness in the head, chilliness, sickness at the stomach, and extreme weakness of the lower extremities, with great confusion of mind, talking and staggering like one in a state of intoxication. This state is soon changed for a profound stupor, with a pale, livid face. The breathing is deep and interrupted; the pulse small, frequent, and irregular; the tongue white, and generally cov- ered with a slimy saliva; the heat irregular over the body. He is nearly or quite insensible. The hands become tremulous; the tongue fouler. Petechae now begin to make their appear- ance on the limbs and trunk. The debility increases rapidly, and the patient sinks into a deep stupor, in which he expires, generally slightly convulsed. The whole period lasts only from twenty to sixty hours, and sometimes a much shorter time. There are other cases of congestive typhus, with still some additional symptoms, such as a violent congestion of the lungs. These cases generally attack with a chill, and have all the above symptoms, with the addition of such a heavy engorgement of the lungs, as to evince at once an apoplectic state of that organ. The breathing is heavy and quick, the face pale, the lips blue and thin; the pain most violent in the chest, sometimes more so in one side than the other; sometimes both sides are equally painful. The heart seems to drown in its own blood; the extremities become colder and colder, and the breathing more and more difficult. Stupor soon succeeds, and the patient dies 44 CONGESTIVE TYPHUS FEVER. in the first cold stage. This form of typhus pneumonia pre- vailed extensively in the United States in the years 1813, 1814, and a part of 1815, and we have occasionally met with it ever since that period. It was in those years called the cold plague, but in late years it has been called malignant pneumonia; but it is in every respect a violently congestive typhus, of a highly malignant character, more formidable than even yellow fever itself. Congestive typhus is evidently a disease in which there is not only venous congestion, but even arterial congestion, to an alarming degree. Dissection shows that the brain, the lungs, the liver, the stomach, bowels and kidneys, are all in an exces- sive state of engorgement and congestion; the balance of circu- lation is entirely interrupted and broken up, so that the vital organs must be inevitably broken down if they are not relieved by timely and appropriate remedies. TREATMENT OF THE FIRST VARIETY. It will be recollected that we divided congestive typhus into three modifications; this was for the purpose of making the treatment more plain and easy to be followed. In the milder forms of congestive typhus, the engorgement is not so great, and some reaction takes place in the beginning of the attack. In these cases, as soon as the reaction takes place, and the pulse becomes full, even if the extremities are cool, place the feet and legs into warm water; then take blood from the arm in moderate quantity. The bleeding should be followed by full doses of cal- omel and other cathartic medicine combined: Recipe : Calomel, twenty grains. Rhubarb, ten grains. Tartar Emetic, half a grain. Mix, and give it in sirup, and work off with warm gruel or rice-water. It is necessary that the bowels be freely evacuated • and if need be, to sustain the patient under the operation, some light cordial may be given; or the following medicine : Recipe : Carbonate of Ammonia, twenty grains. Divide into four powders, and give one every half hour, in sugar, washing them down with a little warm herb tea. After the operation is over, if the pain still continues in the head a blister should be applied to the back of the neck, and a warm bath to the body; after this, if the extremities are still too cool, a blister should be applied to each ankle, and to the wrists, if the CONGESTIVE TYPHUS FEVER. 45 nands are cool. If there is any soreness in the stomach, a blister should be applied over it, and while it is drawing, the follow- ing medicine should be given: Recipe : Spirits Mendereri, two ounces. Sweet Spirits Nitre, half an ounce. Mix. Give a tea spoonful every half hour, in warm herb tea. If the stomach is much sick, a few drops of laudanum should be added to each draught. At the same time, the bowels should be kept open with small doses of calomel and rhubarb: Recipe : Calomel, ten grains. Rhubarb, five grains. Mix. Give one powder every two or thre'e hours, in sirup. If the stomach should be sick, and much pain and soreness in it, or in the bowels, give: Recipe : Calomel, twenty grains. Opium, two grains. Tartar Emetic, one grain. Mix, and divide into four powders. Give one every two hours, and use injections to aid the operations. It may be thought that tartar emetic should not be given when the stomach is already sick. But it must be recollected that the sickness proceeds from the inflamed condition of that organ; and the calomel and opium are both sedatives to a certain extent,—while they prevent the tartar from vomiting the patient, they give it an opportunity to act as a counter stimulant, and tend to the surface, and so reduce the inflammation. The calomel, with or without the tar- tar and opium, must be continued till the mouth becomes sore, and even after that is effected ; the bowels must be kept moderately open with it for three or four days, to ensure success. As soon as the salivation commences, the skin will become warm and moist. The urine will be lighter colored and increased in quan- tity. The stools will become green, dark and thick, and lose their offensive odor. The diet, through the whole course of the treatment of typhus fever, should be light, and entirely vegeta- ble. The drinks should always be warm. The room should be kept of an equable temperature, neither too hot nor too cold. The air should circulate freely through the room, but should not blow directly upon the patient. 46 CONGESTIVE TYPHUS FEVER. TREATMENT OF THE SECOND VARIETY. In the second variety of congestive typhus, the balance of cir culation is greatly interrupted. The surface is cold, and the head affected with vertigo; the pulse is low and weak; there is great difficulty in breathing; the tongue is dry and red. These are the symptoms of this variety. It has already been shown, in the treatment of simple typhus, that bl^pd-letting is of great importance; if so in simple inflammatory Typhus, we may truly say that it becomes a desideratum in the worst forms of congestive typhus. But here, great caution is necessary. The lancet must be used, or the patient will die; and if it is used improperly, you may cut him off in half an hour. The first stage of reaction is so exceedingly short, that we often have but little time to use the lancet in, and yet it must not be used except in the reaction ; and as the first hours of the attack are the only period in which medical aid is likely to avail anything, we must be prompt and exact, when the attack is obvious, according to the symptoms laid down. While the state of depression, or cold stage, exists, place the patient into a warm bath and use brisk and hard friction upon the skin, having a quantity of ground mustard or salt in the bath. As soon, therefore, as the heat of the skin is restored, and the pulse rises, or even before the pulse rises full and hard, after it begins to react and the breathing is somewhat relieved, open a large orifice in the arm. You will sometimes find it difficult to get the blood to run for some time, as I have several times witnessed; but continue the friction on the surface, and presently the blood will flow freely. Let it run till the patient breathes freely and the pulse rises, which you will sensi- bly feel by keeping your finger on it. As the blood flows freely, the urgent symptoms will abate, the breathing will become more natural, the countenance will change, and a warm glow will be felt in the face. The congested organs are now partially relieved. If the patient bears the loss of blood well, let it run twenty-five or thirty ounces; that is, a pint and a half or a quart. If you have bled him while in the bath, you will now take him out, — (it should be remembered that, if the bath raises the pulse and warms the patient, he may be removed from the bath before he is bled,) —and place him in the bed ; and immediately give him: Recipe: Calomel, forty grains. Jalap, ten grains. CONGESTIVE TYPHUS FEVER. 47 Mix, and give it in sirup. As soon as the medicine is taken,, apply a large blister plaster over the stomach and abdomen ; in one hour give an active injection, to invite the operation of the purgative. If the strength should fail under the operation of the purgative, a little warm sangaree, or wine and water, may be given, to sustain the system. If the medicine operates well, anil brings away a large quantity of vitiated fseces, all the violent symptoms will abate more or less. But the fever may rise very high the next day, or even in eight or ten hours. If the patient is a strong, robust man, and the pain in the head is severe, you may bleed him again, letting the blood run till the pain subsides and his pulse becomes soft under the fingers; this will bring it down to ninety or one hundred beats in a minute. You should then give another dose of calomel, and if there is much sickness at the stomach, combine opium with it. Recipe : Calomel, ten grains. Opium, one grain. Mix in two powders. Give one every three hours, and repeat the calomel alone, after this, two or three times. Then, if it should not operate, give a dose of castor-oil. If the head should still be affected, apply a large blister to the back of the neck ; and if there is pain in the side or breast, apply another blister ovei it. In the interim of giving the calomel, give the spirits oj mendereri and spirits of nitre, as in the first variety. If the patient is faint, or very weak, under the operation of the medi- cine, he must be supported by wine or cordials, or the salts of hartshorn given in four or five grain doses, and repeated every half hour. This may be washed down with a little good Madeira wine and water, a little warm. The calomel must be repeated from six to eight times in twenty-four hours, till the mouth becomes sore; for, let us deprecate salivation as much as we please, we must salivate in this fever, or lose our patients very often. For, if the violence of the fever is not broken in the first twenty-four hours, he will die in all probability, if he is not salivated. The calomel and opium may be induced to act on the bowels by giving a small dose of castor-oil, or .Epsom salts, once a day, or a tea cupful of senna tea, or a little rhubarb. When the patient begins to spit, if you are careful to keep the bowels gently open, and regulate the diet properly, the patient will, in all probability, get well. All the symptoms in typhus fever should be vigilantly watched, and promptly attended to. As to the use of spirits or cordials in the treatment of typhus 43 CONGESTIVE TYPHUS FEVER. fever of a congestive character, they are, to say the least of them, doubtful remedies, insomuch that they cannot be relied on; they therefore should be used only as an auxiliary, to keep up the patient till the proper remedies can be used. The cold bath, in any shape, never should be used in congestive fever of any type. The warm bath, however, will often be found ser- viceable in all the stages of typhus fever. In the stage of collapse, or third stage of congestive typhus, the case is a hopeless one; but, while there is life, something ought to be done. In this case, as a dernier resort, we should give warm cordials, or wine and warm water, and opium; and, if you wish to salivate the patient, large doses of calomel, with small doses of opium, may be given; while you use mercurial fric- tions on the insides of the arms, legs, thighs, and groins, rubbing it in well and freely, three times a day. Before the renewed friction, every time, it should be washed off with soap and warm water. The drink in typhus fever should always be warm, and as plain as possible. The diet should never be more than what is contained in the drink; such as arrow-root, gum Arabic, rice, barley, sago, milk and water, gruel, bread-water and milk, apple-water, or thin, light soups, (as, a piece of chicken boiled all to pieces, with rice in the water.) Great care should be taken, in convalescence, that the patient does not relapse. Re- lapses are more dangerous than first attacks, and are more easily brought about in typhus than any other form of fever. The diet should be particularly attended to, and the bowels kept open with some gentle medicine. TREATMENT IN THE THIRD VARIETY, ETC. After what has been said on the treatment of the second variety, but little remains to be said on the treatment of the third variety. Indeed, all the varieties are only modifications of the same fever, and the treatment only differs according to the symptoms in the first attack and the subsequent reaction. It will be recollected, that, in the first variety, the reaction always comes on without forcing it by external stimulants, &c. In the second variety, it occasionally comes on fully by the energies of the system. In the third variety, it would, perhaps, never come on fully without the aid of those remedies that are calculated to develop it. It does, in some instances, come on partially, but the heat is never perfectly and uniformly CONGESTIVE TYPHUS FEVER. 49 developed. The chest and abdomen may be too hot, but the hands, arms, and legs will always be too cool, and the pulse below the febrile strength. The head will be hot, and a pro- found stupor, or wild delirium, be present. The bowels will always be costive, and the* urine, if passed at all, will'be in small quantities and highly colored. The tongue will be white, and soft. The remedies are first to be directed to bringing on reaction. For this purpose, the warm bath, with ground mustard, or salt in it, should never be neglected. Hard and continued frictions should be used while in the bath, and as soon as the pulse becomes fully perceptible or distinctly felt. If you cannot gain on that strength by the bath and friction, you must bleed, and you will find it to rise, generally, on the loss of a few ounces of blood. If, however, it should not, you will lose nothing, for the patient is sure to die if reaction does not take place. But be sure that it is the first reduction of the pulse that you are trying to raise. If it should be the second, it will, in all probability, be the stage of collapse. Then you cannot raise the pulse by bleeding, but your patient will die under the operation, or in a short time thereafter. After you have brought about a reaction, your next effort will be to evacuate the bowels freely, and nothing so effectually does that, in typhus fever, as calomel and jalap, or rhubarb, followed by castor-oil, senna, or Epsom salts. As soon as the bowels are freely evacuated, local bleeding, by leeches or cups, will be proper; succeed them with blisters; and calomel and opium should also be given, with a view to salivate. If you succeed in this, you will save your patient. Small doses of tartar emetic, where the lungs are much inflamed, will always be of service, if judiciously admin- istered. If a cough should succeed to the inflammation in the lungs, in a state of convalescence, equal quantities of balsam copaiba and paregoric will be found an excellent expectorant. Thirty or forty drops may be given, in mucilage, for a dose, and repeated every five or six h^urs. After what has been said heretofore in relation to diet and drink, nothing more need be added; nor in relation to the temperature of the room, nursing, &c. The mouth should be kept clean, and the teeth free from sordes, so that they may not suffer by the salivation. BRIGHT. 5 J 6 cf/3 50 YELLOW FEVER. YELLOW FEVER. This is a feve. of high grade and great malignity. It has prevailed in different parts of the world, from the earliest med- ical accounts of disease. Almost every territory in which it has committed its ravages, has given it a new name; it, therefore, is as gorgeously arrayed with titles as the mightiest monarch of the East. From the depredations it has committed in the West Indies and on the American coasts, it has been called the St. Domingo, Barbadoes, Jamaica, and American fever; and from its fatal visitations on the Guinea coast and its adjoining islands, the Bulam fever. In British India it is distinguished by the name of the Jungle fever, and still further to the east, by that of mal de Siam. Nearer England, in the lowlands of Hungary, and along the south of Spain, it is called the Hungarian or the Anda- lusian pestilence. From its rapid attack on ships' crews, that are fresh to its influence, the French denominate it fievre motellotte, and the Spanish and Portugese call it vomito prieto. cr bJa^k vomit, from the slaty or purplish and granular saburra thrown up from the stomach in the last stages of the disease. While its ordinary course is marsh lands, it has frequently been named peludal fever. Its more common name, however, at the present day, and for the reasons already assigned, is yellow fever. Though it may be greatly interesting to trace its origin and progress, and the treatment used by a great number of writers upon it in various parts of the world, yet we are more especially concerned in its character and treatment, as it has appeared in the United States. Our object is not to theorize and speculate on the origin or causes, remote or proximate, of any disease. This is designed entirely as a practical work. We, therefore, proceed to describe the yellow fever as it has prevailed, at different times and in different places, in our own country, according to the accounts given of it by Dr. Rush, as it prevailed in Philadelphia in 1793, 94, 95, and 97, and occasionally till 1805; and accord- ing to Dr. Cartwright, who has given us an able account of it as it prevailed in Natchez and Washington, Mississippi, in 1823 and 1825, as well as some account given by Dr. Monett. We shall also draw from Dr. Johnson on tropical c'imates, Jackson Lynd, and many others; so that we shall be able, from these sources, and from some small knowledge of it ourselves in 1826, when there were some sporadic cases in New Orleans. YELLOW FEVER. 51 J>. I having had an attack of it ourself, to give an account ol it that will comprise all the prominent facts belonging to th disease. We acknowledge that Dr. Cartwrighl's account of it. as it prevailed in Natchez, in 1823, is the fullest and most satisfactory of any we have seen, though Dr. Johnson is very plain and full. But Dr. Cartwright's post mortem examinations are more thorough than those of any man who has gone before him. We, therefore, shall extract largely from him. Yellow fever is like all other fevers in its manner of attack, as well as in the violence of its symptoms. In some cases, according to Dr. Rush, the attack varied but little from a common tertian fever; in others, it commenced with hiccough only; in a majority of cases, there was sickness at the stomach and vomiting, sometimes of bilious matter, and at others of a white glary fluid; and at other times, a dark substance was thrown up, resembling coffee with the grounds mixed with it. Sometimes the bowels were loose, and sometimes constipated, and so with all the secreting organs, the kidneys, liver, bowels, lungs, &c. The skin was generally dry and cool, but in some cases it was moist and cool. The eye for the most part was red and tinged with yellow, and presented a keen, piercing, anxious look,'though in other cases it was dull and listless. The cool- ness of the surface lasted an indefinite time, from six to twenty- four hours, before reaction or fever ensued. When that took place, the febrile heat was great, and the pain in the head, back and limbs, insupportable; this stage would last from six to twenty-four hours, and then a remission would take place, and most commonly a fatal one, which terminated in death. But either the fever differed in violence and characteristic symptoms from that which prevailed in Natchez, in 1823 and '25, or else Dr. Cartwright was more happy in his observations and descrip- tions of it in all its stages than Dr. Rush was ; for he has cer- tainly given us a more lucid and satisfactory description of the disease than Dr. Rush, or any other author that has written on yellow fever, either in the East or West Indies, or the United States, has done. I shall, therefore, follow Dr. Cartwright's description more closely than that of any other writer. Yellow fever, like all other fevers of a malignant character. presents three stages, which we shall notice in their proper order, describing and giving the treatment of each stage as we have done in all other forms of fever. 52 YELLOW FEVER. FIRST STAGE OF YELLOW FEVE.'.. The symptoms of the first stage of yellow fever, as it appeared in Natchez, in 1823, were manifested by an intoxicated appear- ance of the countenance, and a remarkable exhilaration 01 depression of spirits, and were soon ushered in by a contempora- neous sensation of heat and cold. The patient, though com- plaining of great internal heat, was often found under one or more blankets, which he would not permit to be removed ; and his skin, which to him felt excessively hot, was often actually cold to the touch. An inclination to yawn, a soreness of the flesh, an aching of the bones, and at length flatulency of the stomach, with great weight and oppression about the pericardium, take place, followed by pain in the head, stomach and back. But the pain in this stage is never so great as in that of reaction; indeed, it is sometimes entirely absent. It is remarked by a very intelligent and accurate observer of the disease, Dr. Gusline, that the most fatal cases are those which are attended with the least pain. A general reaction never takes place in these cases. The disease was always more fatal when the excitement did not become generally evolved, and hence pain, a consequence of increased sensibility which is necessarily associated with a dif- fused excitement, never occurred. A want of thirst also attended the disease in its first stage. The tongue is then seldom much furred, but its edges are often red; sometimes, in the most malig- nant cases, it presents no unusual appearance. The patient, in the first and second stages, is as anxious about living, as he is indifferent and careless of life in the third or last stage. As the first stage advances, a violent vomiting comes on, attended by spasms in the legs and arms. A slight perspiration, unequally diffused, bedews the skin, which will, however, dry up in a few minutes, and again appear, as if forced out by the violent exertions of vomiting. The broken reaction is now the most evident, as the head and breast are burning hot, and the extremities cold. The temporal arteries throb violently; the pulse at the wrist is small and feeble. By placing the hand on the abdomen, a strong pul- sation can be felt. The patient becomes more restless, and suffers more pain as the fever spreads itself over the system. At length a general reaction takes place. This is the beginning of the second stage of the fever. This stage, however, may no! take place, owing to improper medical treatment, or the extinc- tion of the apyrexial state, which constitutes the third or last YELLOW FEVER. 53 stage When n^ fever is about to make this unfortunate termi- nation, the excitement, which has spread itself only half over the system, gradually abates, and leaves the patient apparently „x«i no ievei. rphe o.«.,tioa of the first stage is from one tc twenty-four hours, —so say T>r. 3.hnsori) Lynd, Jackson, Rush, Cartwright and others. It can readily be ai&an5v.ioho n is the stomach, bowel*. ^1' y ' tnat tartar emetic is one most rririrallv and philosophically ^ . must ciiik j-i'y r * with"1 our possession in removing of the most efficient re.^j ^ ^ tQ ±ig all well.informed luiiaiinii rp, French physicians give tartar emetic in writers ag^o. xue / / ° rp large doses to remove pneumonic inflammation. 1 he author has very frequently witnessed its good effects in these and other cases of highly inflammatory action. Now, it matters not, in point of .n___ . i -a^r tartar emetic acts directly as a stimulant and so diffuses and equalizes the circulation, or whether it first acts as a counter-irritant and anti-inflammatory remedy, and, by so doing, causes the engorged vessels to throw out the blood into the general circulation. So it is, the effect is that of not only equalizing the excitement, but of permitting that excitement to rise to a height that calls for the remedies which are further calculated to over- come the deleterious effects of the primary mischief which would follow, if the tartar emetic had not been given. We forbear to theorize, for that is no part of our business in this work; facts are what we want, and facts are what we profess to state. Then, in the first stage of yellow fever, or in that which consists in an ataxic or crippled reaction, when the blood is unequally determined, the heat unequally diffused, sensation impaired, and secretion suspended, there is no other remedy, or combination of remedies, that will produce such decided effects as tartar emetic in full doses, Recipe: Tartar Emetic, twenty grains. Ipecac, five grains. Form four pills. - Give one of these every hour, till full vomit- ing is produced. Warm diluents should be freely taken to aid its operation. When the tartar is slow in its effects, it mayr be aided by the warm bath, with mustard or salt in it, and constant and hard friction with the hands, flesh-brush, or a piece of flan- nel. Ii must be borne in mind, that the effects of tartar emetic are not so soon apparent in this fever as in many others. Nor is the vomiting simply the only effect we expect to produce by it. It 58 YELLOW FEVER. is frequently an hour or more before the system begins to feel even the emetic effects of it. But this is not the permanently goo i effect of our remedy. The first salutary effect which is per- ceived is a sensation of heat which ensues; the temperature of the skin becomes more uniform, and, as the excitement is brought ensue, and the*sTi!i£el restless> tul at length §reat distress wil] regain, in some J'"^.., ^ ^puse from its torpor, and to more of the great?^^a^K.^^ Some one or action. The nausea, theluS^1 "Z^* °" * ^'^ * c n £ c i i etching, will soon give way to full vomiting; first of phlegm, ^ thfn u n f Ve to a spectator, will be an alarming period in the io in the first stage of cases of a less malignant nature. The earlier it is given in the first stage of the disease, the better. If given in sufficient doses, it shortens the first and fully develops the second stage, which is always a desideratum in yellow fever. But, in despite of all that can be done in some cases, the second stage never can be developed, but the disease rapidly passes from the first stage, or stage of broken excitement, over to the third or last stage, or that of collapse. It is hardly necessary to say that all such cases prove fatal. It must be kept in mind, that, in order to be successful, according to Dr. Cartwright, the puking must not be moderate or gentle, but must be effectual and powerful, and must continue till the broken balance of circulation is removed, and a reaction fully established. If the tartar fails to operate, let it be aided by ground mustard given in warm water. The mustard bath, with frictions and cataplasms, should he used as auxiliaries. I shall now give the treatment of some other physicians, in the first stage of yellow fever. Dr. Benj. Rush, as all physicians in America should know, after trying various modes of practice, and failing in them all, finally adopted the plan of active purging with calomel and jalap. He first gave ten grains of each, and repeated every four or six hours, till free purging was induced; and when he thought the pulse would bear it, he bled, and repeated it from day to day, till his patients recovered or died. Other physicians of Philadel- phia did not purge at all, neither did they bleed, but gave wine and bark, and strong aromatics, both by the mouth and by injec- tions. They used the cold bath in conjunction with their reme- dies. I will only say, the stimulating treatment did not succeed. All the medical world knows that Dr. Rush's plan of treatment was most successful. But yellow fever puts on so many faces in different countries, that the practice in one country and in one epidemic will not suit exactly in all others. This has been the prevailing opinion among physicians. Now, whether it is really because the epidemic differs so widely in one place, or at one YELLOW FEVER. 6] time, from that of another, is a question. I am disposed to believe that the greatest difference grows out of the opinion of physicians in relation to it. and not that there is so great a dif- ference actually in the specific disease, yellow fever ; some from ignorance, and in order to su>DOrt previously conceived opinions, and some from other causes. T however, talk more than those who can render a rea«Qn for what thev do1 nevertheless, they do much harm to the trofession and infi- nitely more to the community. From si*>h spots in the profession much of the difference of opinion and treatment in yellow fever, as well as many other diseases, ha* been sent abroad. I will now give the treatment of Dr. Johnson, wh* has written so ably and truly professionally on the diseases of trop- ical climates. His practice can be given in a few words. In the first stage of yellow fever he gave calomel and opium, — (twenty grains of calomel and one of opium,) — to allay the irritability of the stomach, then repeated the calomel every four hours, till the bowels were freely evacuated. He also used the warm bath occasionally, when the surface was very cold. After the reaction took place, he bled freely, and continued the calomel, with other purgatives, till a free salivation took place. He then gave other gentle purgatires, till convalescence com- menced. Then tonics were given, such as wine and bark; now it would be quinine, alone, perhaps. Some of these modes of practice, viz., the ptisan practice o£ the French, the stimulating practice of others, and the mercurial and bleeding practice of Dr. Johnson and Dr. Rush, and the tartar emetic practice of Dr. Cartwright, constitute the whole catalogue of practice of the medical world, (with here and there a modification,) in the first stage of yellow wer. TREATMENT IN THE &Tar;oNP STAGE. The treatment in the second stage is nearly the same as given by Drs. Johnson, Rush, and» Cartwrigrn; but the mode of prac- tice, as will be observed by a careful perusal of the previous pages, by which the second stage is made to develop itself, was very different. But, when it is developed, the symptoms are the same in all countries, and at all times, though they may rary in violence. This stage is manifestly the ataxic, or broken 62 YELLOW FEVER. state of excitement, giving way to a general glow over the whole surface. The skin is hot, and dry: the pain in the head, back, and limbs, and sometimes in uV chest and abdomen, is most excruciating and intense; the ftlirst is intolerable and in- satiable, and the pulse full and strong. In this stage of the fever and condition of the sys«m, Dr. Rush would bleed freely, Dr. Johnson more freely, ar-t Dr. Cartwright most freely. Each of these eminent physic^ns would be regulated by the strength and habits of the pa*'ent- But, m everY case> blood should be taken to the entire relief of the violent symptoms. In my own case 1 bled mj-^'f) hi the reaction, at least three quarts, to the relief of all tb*5 aggravated symptoms of the first reaction. The bleedin°- should be immediately followed by large doses of calomel/ twenty grains, every three or four hours, till three or four <£>ses are taken; to be followed by castor-oil and turpentine, Sfvina-tea, jalap, or rhubarb. These should be aided by injec- tions, till the bowels are freely evacuated. The balance of the cure may be accomplished by a dose of calomel once a day, worked off with some of the above medicines. I deem it unneces- sary to enumerate the practice of twenty, or more, physicians, and many of them of gnat eminence; for they all, more or less, who are worth quoting, follow the same mode of practice, with but little variation, exctpt where locality or topography of country make it necessary; and these things always did, and always will, modify the practice of medicine the world over. TREATMENT 1$ THE THIRD STAGE. The symptoms of this stage of yellow fever are, perhaps, the most delusive manifestation which appears in any form of fever that has ever appeared on earth, affording at least one of the evidences that it is a fever sui generis. When this stage conies on, the patient experiences a total r.alw> irom all his violent symptoms; he feels careless ^oout his condition. From just before feeling extremely l^eak and prostrate, he suddenly feels strong; his eyes either look dull, or, more commonly, have a keen, piercing look, and are streamed with red and yellow; he now spirts up the bla^k vomit, with a jerk; blood presently oozes from his mouth, nose, and, sometimes, from his eyes, and ears. The skin, which bscame yellow in the second stage, now frequently change? to an olive, or brownish green; he walks about the roon va a rag) or sits calmly on the side of the bed, INFLAMMATION OF THE LUNGS'. 63 and is cheerful; his bowels become constipated, and his pulse weak and compressible, and his skin cool. In some cases, he raves with madness, and uses violent exertions, till he falls dead. In other cases, he dies calmly. In one case, perhaps, in fifty, recovery has taken place from this state, so that it is not altogether a hopeless condition. Here purgatives may be con- tinued, especially when they have not been freely used in the second stage; and it is in these cases that hope, if any, is to be cherished. The purgative plan, then, with a little wine and water, constitutes all that we can do in this stage. But, such cases are generally considered hopeless; most certainly so, if the third stage is ushered in without reaction having been fully established. The diet in yellow fever should always be light and thin, and the drink, in all cases, a little warm, and, if lightly acidulated with lemon, will be more agreeable. The room should be kept well ventilated, and the ejections speedily removed. Good nursing is very important in this fever; with- out it but little may be expected. INFLAMMATION OF THE LUNGS. Inflammation of the lungs is known by the following symp- toms: an obtuse pain in the chest; a constant difficulty of breathing, which is alleviated by an erect position; the face and lips generally tumid, or purple; cough, with moist expectoration, mixed with blood; and the pulse is usually soft and quick. In- flammation of the lungs may be divided into simple inflam- mation, with a regular but violent fever. There is, in this form of the disease, but little expectoration in the beginning. The second form of this disease is more aggravated in its character, and resembles a typhus fever in many of its symptoms. The debility is extreme, from an early period of the disease. This form of the disease is often epidemic. The third variety differs from the two former, by the fever being more mild, and the expectoration more copious. This variety of inflammation of the lungs occurs most frequently in weakly constitutions; but the first variety is most frequent, and is often mistaken for pleurisy; but it may be distinguished from it by the followin§ symptoms: in pieurisy the faCe is, comparatively speaking, but little flushed, and not much swollen; the pulse is harder, and more resisting under the finger; the cough is less viohnt, and 64 INFLAMMATION OF THE LUNGS from the beginning to the end, there is but little, if any, expecto- ration. In pleurisy the pain is fixed in one place; but, in inflammation of the lungs, the pain shifts from place to place; from one side to the other, and from the breast to the back ; and when the lower point of the right lobe of the lung is affected, the inflammation is not unfrequently communicated through the diaphragm to the liver, occasioning pain under the edge of the ribs. Then the expectoration is yellow. The causes of inflam- mation of the lungs are those of inflammation in general, but particularly an excessive exertion of tlie lungs, or a sudden exposure to cold when the system is heated. The cold may be applied to the surface generally, or to any part of the system, as the skin, mouth, stomach, or feet. The robust and plethoric are more liable to. inflammation of the lungs than the feeble and delicate. It occurs more frequently in cold than hot weather, and when there are sudden changes from heat to cold, or the reverse. Sometimes it is induced by repelled eruptions, and a others by noxious inhalations. To the latter cause the frequency of this disease is ascribed in the vicinity of eruptive volcanos. The first symptom of inflammation of the lungs is, a cold, shiv- ering sensation, which may continue for an indefinite period of time, after which a fever rises, with more or less violence, ac- cording to the violence of the cold stage. With this fever there is great pain in the head; the urine is small in quantity, and highly colored; the pain in the chest occasionally comes on with the first fever, but more commonly it does not take place till the second or third day; the cough is a short, dry hack, and the pulse is variable. In some cases, it is hard and strong, and in others it is soft and compressible; but, as the disease progresses, in all cases the pulse becomes soft and compressible, and some- times fluttering. Delirium sometimes occurs, and is an unfa- vorable symptom, except where it alternates with the febrile paroxysms; then it is not so bad a symptom. In favorable terminations of this disease, the symptoms all begin to abate on or before the seventh day. But when none of the symptoms abate before the seventh day, the case is apt to terminate unfa- vorably. Inflammation of the lungs, like other local inflam- mations, terminates in various ways, as, by effusion, that is a free expectoration of mucus from the lungs, or by suppuration — the formation of an abscess, and discharge of matter; by gan- grene or mortification, or by hemorrhage, which is induced by mi increased determination of blood to the lungs. The most INFLAMMATION OF THE LUNGS. 65 favorable termination is by effusion and copious expectoration. Coagulable lymph is sometimes thrown out upon the surface of the lungs, and by it adhesions take place between the lungs and pleura of the ribs. Sometimes collections of matter take place in some parts of the chest. Sometimes the extremities of the blood-vessels give way, and more or less blood is discharged in the sputa. This is rather a favorable symptom, for by it the engorgement of the lungs is relieved, and a speedy recovery ensues. But a hemorrhage from the nose is equally salutary to the lungs, and greatly preferable, because the lungs suffer none of those lesions, (though they may be small,) that so often attend on hemorrhage from that organ. Shivering, or cold fits, with remission of pain, attended by perspiration and a low pulse, indi- cate the formation of an abscess in the lungs. If gangrene or mortification has taken place, the pulse sinks, the debility rapidly increases, and the eyes are fixed with a ghastly stare. These are fatal symptoms. TREATMENT Inflammation of the lungs is a formidable disease, and requires active treatment. No time should therefore be lost in the use of the lancet. The pulse may be depressed from an excessive engorgement, but we must not be deterred from the use of the lancet on that account. There is no condition in which the sys- tem can be placed, where the lancet is more admissible on a depressed pulse tha'h in inflammation of the lungs. A large orifice should be opened in the arm; keeping the finger on the pulse,. it will be found to rise as the blood flows, and it should run till the pulse not only rises, but again becomes soft under the finger, and a perspiration breaks out on the forehead and face ;. then stop it, and immediately give the following: Recipe: Calomel, ten grains. •!.-* Khubarb, ten grains. Tartar Emetic, one grain. Mix, and divide into four papers. Give one every hour, till all are taken. As soon as they have operated freely on the bow- els, if the pain and difficulty of breathing continue, bleed again, if the pulse will possibly bear it; then apply a large blister plaster over the most painful part, and repeat the above purga- tive, and in conjunction with it, give the following medicine: Recipe: Tartar Emetic, two grains. Salts Nitre, twenty grains. BRIGHT. 6 66 INFLAMMATION OF THE LUNGS. Mix, and dissolve in eight table spoonfuls of water. Give one spoonful every half hour. If the patient should vomit, protract the time a little; but if no nausea or vomiting should occur, then give the medicine oftener. Tartar emetic is our best medicine in inflammation of the lungs. I have given one grain every half hour, and repeated it for forty-eight hours in succession, without nauseating the stomach in the least. But as soon as the inflam- mation begins to subside, nausea will come on, and the dose must be lessened. If the bowels should not be kept in a suf- ficiently soluble state by the tartar, give a dose of Epsom or Rochelle salts. If the tartar should produce much sickness at the stomach, and the inflammation does not give way, give the following medicine: Recipe: Cream Tartar, one drachm. Salts Nitre, twenty grains, Tartar Emetic, two grains. Pulv. Opium, one grain. Mix well, and divide into six powders. Give one every hour in some warm tea, till a free perspiration is induced, and keep it up three or four hours. As soon as the patient begins to cough up phlegm, give the following expectorant: Recipe: Sirup of Squills, one ounce. Cox's Hive Sirup, half ounce. Wine of Ipecac, half ounce. Mix them together, and give a tea spoonful in warm barley- water, rice-water, or slippery-elm tea, and repeat every hour; this will promote the expectoration, and in proportion to the reduction of the inflammation, so will be the increase of discharges from the lungs, till they are entirely relieved. During the whole treatment, the bowels must be kept open with small doses of calomel and some mild aperient combined. Recipe: Calomel, sixteen grains. Aloes, sixteen grains. Rhubarb, sixteen grains. Tartar Emetic, two grains. Mix, and form sixteen pills, two of which may be given every three or four hours, to keep the bowels open. The drink in inflammation of the lungs, should always be a little warm, and of a mucilaginous quality, such as gum-Arabic water, flax-seed tea, slippery-elm tea, marsh-mallow tea, rice-water, barley- water, &c. The diet should be light: in general, little more will be required than some of the above drinks, or light soups or gruel, tea and soft toast, &c. Great care should be taken not to PLEURISY. 67 expose the patient in convalescence. During the llness, the room'should be well ventilated, but a current of air should not strike the patient. PLEURISY. Pleurisy is characterized by an acute pain in the chest. This pain may be seated in the breast, back, or either side, for the pleura lines the whole cavity of the chest. The pain is increased by a deep breath; there is a difficulty in lying on one side; the pulse is hard, sharp, and quick; the cough at first is dry, and is increased by the effort of coughing. Pleurisy is an inflammation in the membrane that lines the ribs, which membrane covers the outer surface of the lungs also. It is called pleura; hence the name, pleurisy. It matters not in what part of the pleura the inflammation is located,—in the lining of the ribs, or on the sur- face of the lungs, or the upper surface of the diaphragm, — in- flammation in any part of this membrane is pleurisy. Pleurisy, like inflammation of the lungs, is produced by exposure to cold, or a sudden check of perspiration. Like the most of febrile diseases, pleurisy commences with a chilliness, succeeded by- fever, heat, and restlessness. Let the pain be seated where it may, the expirations are less painful than the inspirations; the pulse is hard, strong, and frequent; the tongue is covered with a white coat; the cough is at first dry and suppressed; there is sometimes a bloody mucus spit up. showing that the inflammation has extended to the substance of the lungs. Like inflammation of the lungs, pleurisy«iay terminate in resolution, suppuration or gangrene. Resolution or expectoration is the most usual, as well as the most favorable termination. Gangrene rarely occurs, but suppuration is not uncommon, in which case, if the abscess should not point outwardly, the matter will collect internally, and constitute what is called an emphysema; the formation of pus is indicated by the cessation of pain, succeeded by a shiver- ing or chilly sensation. In some cases, a sense of fluctuation can be felt. This termination is far more frequent when pleurisy succeeds from external injuries, than when it proceeds from the ordinary causes, as above enumerated. TREATMENT. As pleurisy is a disease of active inflammation, we should not hesitate to use the lancet freely ; the blood should be taken from 68 PLEURISY. a large orifice in the arm, and the quantity taken should be regulated by the effect. The patient should become faint, and a perspiration break out, before the blood is stopped. The bleeding should be followed immediately by a brisk cathartic; and, in order that the liver may be excited into free action, the following may be given: Recipe : Calomel, twenty grains. Aloes, ten grains. Rhubarb, ten grains. Form six pills. Give three first, and the other three in two hours. Work them off with gruel, without salt in it. As soon as they are done operating, if the pain continues, apply a blister plaster large enough to cover the pain, and give the following powders: Recipe : Cream Tartar, one drachm. Salts Nitre, twenty grains. Tartar Emetic, one grain. Pulv. Opium, one grain. Mix, and divide into six powders. Give one every hour, in balm, or some other herb tea, warm. The patient should drink freely of- the warm tea while taking the powders, so that a free perspiration may be produced; he should be kept covered up closely during this time. When the blister has drawn freely, and he has taken all the powders, he should then repeat the pur- gative pills, as above prescribed. If they should not operate freely in three hours from the time the last is taken, a full dose of castor-oil should be given, or half a pint of strong senna tea, with half an ounce of Rochelle or Epsom salts dissolved in it. half a tea cupful of which may be given till free purging is pro- duced. If the pain and fever continue after this, and the pulse will bear it, bleed again, and give five grains of Dover's powder every hour, till the pain is relieved. If warm teas are taken during the exhibition of the Dover's powders, perspiration will be induced. This should be again followed by a dose of oil, or senna tea and salts. This course of treatment may be pursued from day to day, till the pain and fever are subdued, which will take place in three or four days, if not in less time. As soon as the inflammation is subdued, the patient will begin to cough and spit; then the drinks should be mucilaginous, and the following expectorant given. Recipe : Sirup of Squills, one ounce. Cox's Hive Sirup, half an ounce. Wine of Ipecac, half an ounce. Mix, and give a tea spoonful every two or three hours in some mucilaginous drink, so as to keep up a free expectoration, and PLEURISY. 69 continue it till the patient coughs and spits no more. During the treatment, the diet should be light and the drink warm; the skin should be kept clean and the pores open, by a warm bath, if necessary. Great care is necessary, in convalescence, lest the patient relapse. When the disease terminates by suppuration, and matter is collected in the chest, it must be discharged by making an incision between the ribs; the most dependent point should be chosen for the outlet of the matter; care should be taken that no air enter the orifice; the orifice should be tented and the matter drawn off from day to day, till it ceases to dis- charge. I have known matter to be discharged for several months, from such abscesses. The patient becomes extremely emaciated. The strength must be supported by a more nourish- ing diet, wine and vegetable tonics, such as Huxham's tinc- ture; a tea spoonful may be given, three times a day, in a little water; or the following bitters may be used, instead of the tincture: Recipe: Peruvian Bark, one ounce. Gentian Root, half an ounce. Orange Peel, half an ounce. Black Snake Root, half an ounce. Make all fine, and add to them one quart of good Madeira wino. Shake the bottle well, once or twice a day, for three or four days. A table spoonful may be taken three times a day in water, or the following may be used: Recipe: Sulphate Quinine, twenty grains. Sulphuric Acid, ten drops. Water, one ounce. Mix, and shake till the quinine is dissolved. A tea spoonful may be taken in a wine-glassful of water three times a day. None of these tonics should be given when the patient has fever. The bowels may be kept open with the following pills: Recipe : Rhubarb, twenty grains. Castile Soap, ten grains. Form six pills. One or two of these may be taken every night, so as to produce one motion in the morning. Sometimes the bowels are too loose; in this case, give a Dover's powder at bed-time; from three to six grains may be given for a dose. Some gentle expectorant should be given; for this purpose, the preparations of gum ammoniac are very good : Recipe: Gum Ammoniac, twenty grains. Acid N'ric, ten drops. 70 DYSENTERY, OR FLUX. Pulverize the gum fine, and dissolve in two ounces of water; then add the acid. A tea spoonful may be given from four to six times in twenty-four hours, in water; or the following ma"/ be given: Recipe : Gum Arabic, one ounce. Sirup of Squills, half an ounce. Water, half pint. Mix, and give a table spoonful every five hours; or the fol- lowing pill may be given as an expectorant: Recipe: Pulv. Squills, ten grains. Opium, one grain. Form ten pills. Give one, three or four times a day, as the urgency of the case may require. The patient should be allowed fresh, pure air, and a nourishing diet. As soon as the strength will admit of it, exercise on horseback, or in a carriage, should be taken. Great care should be taken to keep the skin clean and the pores open. A strengthening plaster worn upon the chest will be of service; by bracing the chest and supporting the muscles. DYSENTERY, OR FLUX. Dysentery is a miasmatic disease, and frequently prevails epidemically in summer and fall. Extremes of heat and mois- ture, or extreme drought, will produce the disease; also a sudden check of perspiration, with a determination of the fluids to the bowels, will often terminate in dysentery. In dysentery, the mucous membrane of the bowels is more or less inflamed, accom- panied with frequent stools, severe griping pains, tenesmus, and more or less fever. The stools are frequent and small in quan- tity, and but little, if any, natural fasces mixed with them. They consist mostly of mucus mixed with blood. When natural faeces do appear, they are generally a small, compact, hard sub- stance, in little lumps or balls. Besides the causes above enumerated, dysentery may be produced by unsound food, and by noxious exhalations; hence its frequent appearance in low, marshy situations, where it is apt to be malignant. When dys- entery makes its appearance where large numbers of people are collected or crowded together, it is apt to spread with crrcat rapidity. Dysentery frequently occurs about the same time&that autumnal fevers raake their appearance. It then partakes of the DYSENTERY, OR FLUX. 71 character of the epidemic, and even obtains the ascendancy; the other gradually slides into and partakes of the character of the epidemic. Dysentery is, under such circumstances, attended with regular chills, or a cold stage, which has given rise to the opinion advanced by some, that it is a misplaced form of intermittent or remittent, fever, just as the one or the other may prevail at the time. Dysentery may be readily distin- guished from diarrhcea, by the former being always attended with more or less fever, and the latter with none. In diarrhcea, there is no griping, no blood discharged in the stools, and but little straining or tenesmus. An attack of dysentery is generally preceded by a loss of appetite, costiveness, flatulence, with more or less sickness at the stomach, and occasional vomiting, or efforts to vomit. It always comes on with a chilliness, suc- ceeded by heat of the skin, and an increased frequency of the pulse. These symptoms generally precede the griping, when evacuations shortly succeed. When inflammation begins to occupy the lower part of the intestinal tube, the stools became more frequent, but smaller in quantity, with great pain, in the lower part of the bowels. The stools vary both in color and consistency; sometimes they are nothing more than frothy mucus mixed with blood, and at other times of an acrid, fetid fluid, which not unfrequently resembles the washing of fresh meat. Sometimes the evacuations are pure blood, and occasion- ally lumps of mucus resembling cheese, and sometimes pure matter, is discharged from the bowels. In some forms of the disease, the discharges consist almost entirely of whitish-looking mucus, constituting what is called by authors disenterea alba, or white dysentery. When the evacuations are of such various colors and consistency, it is seldom that any natural fasces are discharged with them; and if there is, it will be in hard balls or lumps. After passing them, the patient will experience more or less relief from pain and tenesmus. It frequently occurs, that from violent straining at stool, a portion of the intestine is forced down; this will increase the tenesmus. More or less fever always attends the symptoms above described, especially when it partakes of the putrescent character. The fever may disap- pear, and the dysenteric symptoms still continue, producing great prostration of strength, and if accompanied with a putrid ten- dency, and fetid and involuntary discharges, the disease is more apt to terminate fatally. But when the symptoms are more mild, the disease is apt to be protracted, and finally terminate ir 72 DYSENTERY, OR FLUX. a general perspiration. Now, the fever, nausea and griping. cease. The stools become natural in color and consistence, the appetite returns, and the patient recovers. When dysentery has not been taken in time, or when it has been badly treated in the outset, it is of difficult cure. If the subject of dysentery has previously labored under scrofula or consumption, or if his con- stitution has been previously injured by some other disease, his situation is very dangerous. A great degree of griping and tenesmus, with frequent desire to occupy the close stool, and but little discharged; great fetor of the evacuations, and much loss of strength; high fever and a swollen abdomen; cold, clammy sweats and cold extremities ; thrush in the mouth; dark or purple spots on the skin; hiccough, with a weak and irregular pulse, and belching up of a greenish or yellowish fluid; sunken eyes; tremulous hands and delirium ; are extremely dangerous symp- toms. Upon opening the bodies of those who die of dysentery, the internal coat of the large bowels, (the colon and rectum,) will be found inflamed, with the evident ravages of inflammation fully exhibited, such as ulceration, gangrene and contractions. Sometimes the peritoneum shows traces of inflammation. TREATMENT. In the progress of this disease, two distinct stages manifestly appear. In order, therefore, to treat it properly, proper attention must be paid to these different stages. In the first stage, if the patient is young and full of blood, with a high fever and a strong pulse, and there is pain and soreness in the stomach or bowels, on pressure, he should be bled from the arm. But if the fever is not high, and the pulse not very strong, then ten or twelve leeches should be applied over the region of the abdomen. Cups may be substituted where leeches cannot be had. Several ounces of blood should be taken. Let it be recollected that the inflammation which exists in the bowels is not produced by the disease, but is a part of the disease itself; therefore our remedies should be addressed to it as to the primary disease. After the free abstraction of blood, we may safely give an emetic: Recipe : Ipecac, twenty grains. Tartar Emetic, tnree grains. Mix, and give it in the usual way. If, after the puking is over, it should not act freely on the bowels, in three or foul hours, give the following purgative: DYSENTERY, OR FLUX. 73 Recipe : Calomel, ten grains. Rhubarb, ten grains. Form four pills. Give two; wait two hours, and give the others. • After the operation is over, if a tenesmus continues, and there is any straining, and frequent inclination to occupy the close stool, give: Recipe : Pulv. Ipecac, six grains. Pulv. Opium, two grains. Tartar Emetic, one grain. Mix. Form four pills. Give one every hour, till the patient is tranquillized. If a perspiration is induced, much good will result to the patient. After the effect of these pills is over, should the bloody discharges come on again with tenesmus, give the following medicine: Recipe : Calomel, twenty grains. Ipecac, four grains. Opium, one grain. Mix/ and divide into four papers. Give one every two hours, till all are taken. If they should not operate in a reasonable time, give a dose of castor-oil or Rochelle salts. The salts should be given in warm tea. ■ If, during the operation, the stomach should be sick, a tea spoonful of clove tea may be given occasionally. If great pain and soreness exist in the stomach, a blister should be applied over it; likewise over the bowels, if the soreness is great there. As long as the discharges from the bowels are mixed with blood and mucus, the calomel, ipecac, and opium, should be repeated once every twenty-four hours, and followed either with the salts, or oil, or rhubarb. If the gums become sore, the calomel should be omitted, but the ipecac, and opium continued. This dis- ease cannot be treated successfully without opium or laudanum. In all dangerous cases, a safeguard to returning health will be found in a light salivation. During the course of the disease, the warm bath will be found serviceable, either by fomentations with cloths wrung out of hot water and applied to the abdomen, or a general warm bath. The drink should, during the whole course of the disease, be mucilaginous, such as slippery-elm tea, rice-water, flax-seed tea, barley-water, &c. The diet should be light and thin, the room well aired, the bed-clothes frequently changed, and the discharges removed quickly from the room. In convalescence, great care should be taken that the patient does not eat too much, and relapse. 74 INFLAMMATION OF THE STOMACH. INFLAMMATION OF THE STOMACH. Inflammation of the stomach may be produced by swallowing acrid and poisonous substances, such as arsenic, corrosive sub- limate, or any other powerful poison; or by food of an unsound and improper quality; large portions of strong spirits; or by hearty draughts of very cold water, when the person is over- heated; or by repelled eruptions, such as small-pox, measles, or gout. Besides these causes, it may be communicated from some other contiguous organ, or by violent blows on the stomach. Inflammation of the stomach may be distinguished from any- other disease of that organ, by the tension, heat, and burning pain in that organ; by the aggravation of that pain when any- thing is swallowed, and the immediate ejection of it. There is always a great depression of strength in this disease. It may be precisely located by the seat of the pain, and by pressure with the ends of the fingers. The stomach is generally dis- tended with wind ; there is a constant rejection of what is swallowed; the thirst is most distressing, and great anxiety and restlessness pervade the whole system ; a continual tossing of the body, with watchfulness and debility; the pulse is quick, hard, and contracted. In some cases, a severe purging attends. If the disease increase in violence, the strength fails rapidly, and the patient becomes faint, the breathing short and hurried, and cold, clammy sweats break out on the face and extremities; hiccough and an intermitting weak pulse follow, and death soon closes the scene. TREATMENT. This is a disease of active inflammation, let the cause be what it may. I shall not give the remedies for inflammation of the stomach when produced by arsenic, or corrosive sublimate, &c.; for 1 shall notice them under the head of poisoning. The remedies necessary to the cure of inflammation of the stomach, produced from other causes than potent poisons: If the disease in question be produced by improper food of any kind,__un- wholesome or unsound, — the first thing to be done is to aid the vomiting by large draughts of warm water, that the stomach may be thoroughly washed out. Then take as much blood from the arm as the patient can bear. If fainting feelings should INFLAMMATION OF THE STOMACH. 75 come on, no danger need be apprehended. This should be followed by an active injection. Then give the following medi- cine : Recipe : Calomel, twenty grains. Opium, one grain. Mix, and divide into two powders. Give one, in a very small quantity of sugar, and repeat in two or three hours, The drink should be very light, plain mucilage, such as barley-water, or slippery-elm tea. If the pain and burning continue in the stomach, leeches or cups should be applied over it; and, after the blood is suffered to run till the pulse becomes weak, then apply a large blister plaster over the stomach. The calomel and opium should be continued every two or three hours, till the stomach is composed. Then they should be solicited by injec- tions. When the inflammation has been induced by a repelled eruption, the treatment should be different. There we cannot use the lancet, but it is a desideratum to bring the eruption again to the surface. Since I commenced writing this chapter, I have had a case in point, produced by a repelled eruption of scarletina. The patient is a man, fully grown. The eruption had been out about thirty hours, when, by exposure to the cc » air, it struck in, and he commenced vomiting; and the pu.p;:.n/ increased rapidly, — (he had taken a dose of some ncofiwaj — after he thought the medicine taken was done ope:?.ti-ig\ Tlv discharges became very liquid, and he vomited -^jry thing h-.* swallowed, fluid or solid. He became alarmed, rid sant for me. I found him prostrated; his pulse hard, (rj.ick, and resisting; his feet cold, and disposed to cramp: hi" thhdt intense; his tongue covered with a brownish crust; aud disposed to be dry. He was anxious and restless; the e, though in that time four or five grains of opium h-:f> been taken in various ways. I succeeded in producing z ^opio'is perspiration, but no abatement of pain, vomiting, rj ^v-ring. In my absence, the nurse gave him some French >.:<*:Jj, but it only aggravated the symptoms. I then apph:*s. t. large blister plaster over the stomach, and ordered ten gTdi .S. uf calomel, with half a grain of opium, — the dose to be -jpeated every two hours, till the stomach was quieted. By the r° INFLAMMATION OF THE BOWELS. lime the second dose was taken, (which he retained.,) the blister began to draw, and all the unfavorable symptoms left him In six hours, he was tranquil and cheerful, with the eruption returning on the surface, bowels calm, stomach easy and quiet, and the extremities warm. He then progressed, without any untoward symptoms. The drink in this disease should be some light mucilage, and as little as possible. The diet need be nothing more than the drink; for nothing oan be digested while active inflammation exists in the stomach. Some practitioners advise the free use of cold water in inflammation of the stomach, and even go so far as to give ice. Whatever good it may have done in the hands of others, I never saw it given and the patient live. The sudden chill produced in the coats of the stomach will be attended, by reaction, and all the symptoms aggravated thereby. The lips turn blue; the extremities become cold; the skin shrivels, and a fatal collapse always follows, as far as my observation goes, in the use of ice. The bad effects of ice, in such cases, are like those symptoms produced by large draughts of cold water taken when the person is over-heated. It never should be used. To sum up the whole treatment: when there has been no eruption struck in to prevent the use of the lancet, bleed from the arm; then leech, or cup, over the stomach; use injections, to keep the bowels open; give calomel and opium internally; blister the region of the stomach; let the drink be thin mucilage, a little warm; give but little at a time; this will be sufficient nourishment. If salivation ensues from the use of the calomel, let it come, rather than lose the patient. No other medicine will be retained on the stomach. Every physician knows that calomel is a counter-stimulant, and a sedative to a certain extent, and in no disease do we see the effects of it more fully manifested than in inflammation of the stomach and bowels. INFLAMMATION OF THE BOWELS. Elderly persons are more subject to inflammation of the bowels than youth. The causes of inflammation of the bowels are: long-continued and obstinate costiveness, loading the bowels with indurated faeces, or any acrid substance lodged there- spasmodic cholic; intussusception, or a folding of the bowels INFLAMMATION ;F THE BOWELS. 77 into themselves; the application of cold to the feet, or the abdomen; a sudden check of perspiration. The disease is manifested by an acute pain in some part of the abdomen, which may spread all through that regicn; this is generally most acute about the navel; the pain is always aggravated by pressure; there is more or less eructation of wind, and sickness at the stomach, with a vomiting of bilious matter; there is great heat and thirst, with restlessness, a quick and hard pulse, and obstinate costiveness; the pain gradually increases; the bowels are spasmodically drawn together in knots, and are extremely painful to the touch; the urine is secreted in small quantity, and voided with pain. If the inflammation is not arrested, it soon terminates in gangrene, and then the pain subsides; or it may terminate more favorably, by resolution, — then the symptoms .gradually abate. The only disease with which inflammation of the bowels can be confounded is chohc; but a little examina- tion into the symptoms will soon satisfy you whether the disease is cholic, or inflammation. There is no fever attending cholic, while there is fever, with a quick, small, hard pulse, and much increase of pain, in inflammation of the bowels. Inflammation of the bowels is a dangerous disease; it often terminates in gangrene, in a few hours from its commencement. When this takes place, there is a sudden remission of pain; the features shrink, and the pulse becomes soft and weak; there is generally a suppression of urine; the abdomen swells, and hiccough comes on; the abdomen seems to be inflated with wind, and, when struck with the fingers, sounds hollow. But this disease may prove fatal during the inflammatory stage. A favorable ter- mination of this disease is manifested by the abatement of pain, and the appearance of natural stools; a general perspiration over the whole system, with a firm, equal pulse, and a copious discharge of urine; or any two of these symptoms, fully mani- fested, indicate a favorable termination of the disease. When inflammation of the bowels terminates in ulceration, (which is not very common,) the fever abates, and the pain gradually sub- sides; but there are occasional rigors, or chilly sensations; there is also matter mixed with the fasces. Dissections show that inflam- mation may pervade the bowels to a very considerable extent; and cohesive inflammation frequently takes place between them and the contiguous parts; the blood-vessels supplying the fat of the bnwels have been found much engorged with blood. Ulcer- ation does not always make its way through the coats of the 78 INFLAMMATION OF THE BOWELS. bowels but is generally found in the inner or mucus coat Mortification is not a very uncommon occurrence; twistings and strictures of the bowels have also been met with. In this disease, the lining of the abdomen (the peritoneum) is frequently in- flamed, and covered with a layer of coagulable, lymph. The omentum, or call fat, is often inflamed. TREATMENT. In inflammation of the bowels, as in all other inflammations of vital organs, the remedies must be prompt and efficient. Depletion is imperiously demanded; bleeding from the arm should be promptly used, and the bowels should be opened by an active injection. If the pain is not relieved, leeches or cups should be applied over the painful part; then the warm bath, or fomentations of warm vinegar and water constantly applied by the use of several folds of cloth kept wet in it, and laid over the abdomen. If the pain still continues, a blister plaster should be applied all over the abdomen. As the stomach is always more or less sick, it is difficult for it to retain any medicine; calomel is the only article likely to be retained. Recipe: Calomel, twenty grains. Extract Colocynth, ten grains. Form four pills. Give one every hour, till all are taken. Then use injections to invite their operation. After a few operations have been procured, if the sickness of the stomach should con- tinue, give the following: Recipe : Calomel, twenty grains. Opium, two grains. Form four pills. Give one every two hours, till the stomach is composed. If the stomach will retain it, give a dose of castor- oil, or the following: Recipe: Manna, half an ounce. Rochelle Salts, half an ounce. Peppermint-Water, two ounces. Dissolve the medicine in the peppermint-water, and give it at two or three drinks, half an hour apart. After procuring free evac- uations from the bowels, they may be kept open by small doses of Rochelle salts, magnesia and cream tartar, or castor-oil, or senna and manna. But if the stomach continues irritable, your best medicine is calomel, in small and frequently repeated doses. If gangrene takes place, the patient will in all probability die. The strength in this case, however, should be supported by quinine and wine, or wine and the decoction of bark, and charcoal- INFLAMMATION OF THE BOWELS. 79 water. During the whole course of the disease, the drink should be mucilaginous and a little warm, such as rice or barley-water, slippery-elm tea, or water gruel well boiled and lightly salted. But little should be taken at a time, and not too frequently repeated. The drink will constitute the diet till the inflamma- tion is removed. Great care should be taken that the patient, in convalescence, does not eat too much and relapse; the bowels should be carefully attended to, and kept open for some weeks, and the diet should be light. Moderate exercise in the open air may be taken, but great care should be taken not to get wet, especially the feet. Cold water has been recommended to be dashed on the abdomen in inflammation of the bowels. To say the least of it, I think it a doubtful remedy. INFLAMMATION OF THE LIVER. Inflammation of the liver, as met with by physicians in their practice, may be divided into acute and chronic. In the acute form, all the symptoms of genuine inflammation are manifested The chronic form of this disease exhibits symptoms of less vio- lence as to fever, but presents an enlargement and hardness of the liver, with an obtuse pain in the right side, under the edge of the ribs. The causes are those which produce other inflammations, such as applications of cold to the body or feet, external injuries from falls, bruises, blows, &c, by violent exercises, intense sum- mer heat, by long-continued intermittent or remittent fevers, by an intemperate use of spirituous liquors, and by various solid concretions in the liver. In warm climates, the liver is more apt to be affected by inflammation than any other part of the body, probably because there is more bile secreted in hot than in cold climates. The cool, damp air acting upon the surface after an intense hot day. in tropical climates, causes the blood to recede from it, and accumulate in the liver, thereby producing engorge- ment, and, subsequently, inflammation. The bile being acrid in hot climates, an irritation is more readily excited by it, and inflammation ensues. These are probably the reasons why in- flammation of the liver is more frequent in hot than in cold cli- mates. The liver is the seat of disease in hot climates in about the same p-oportion that the lungs are in- cold climates. The acute form of inflammation of the liver comes on with a sense of chilliness, succeeded by a pain in the right side, under the 30 INFLAMMATION OF THE LIVER. ribs. The pain is sometimes sharp, and extends up to the collar- bone and shoulder, and pressure on the part increases it. There is a difficulty of lying on the left side; oppression in breathing, and more or less cough ; the patient can always lie best on the diseased side; there is not unfrequently nausea and vomiting of phlegm, mixed with bile; the bowels are generally costive, and the stools light or clay-colored. The urine is small in quantity, and highly colored. There is great thirst and loss of appetite; the pulse is strong, hard and frequent, and from 90 to 100 strokes in a minute. It sometimes intermits, beats a few strokes, then loses one. The skin is hot and dry, and the tongue covered with a white or yellow coat; after the disease has continued for some days, the eyes and skin may become tinged with a yellow hue. This is more particularly the case when the gall ducts are obstructed by biliary calculi. It is said by some writers, when great difficulty of breathing and cough attend, that the inflam- mation is on the upper surface of the liver, but when situated on the under surface, there is more sickness of the stomach and vomiting; the pain is not so violent, but there is more yellow- ness of the skin and eyes. I think that these signs are not always true. It is, however, quite probable that when the inflammation is situated on the under surface of the liver, it is more apt to become chronic than when situated on the upper surface of that organ. The chronic form of this disease is usually accompanied with a sallow, unhealthy complexion loss of appetite and flesh, indi- gestion, flatulence, pains in the stomach and yellow tinge in the skin and eyes ; the stools are light and clay-colored; the urine is highly colored, and deposits sediment and ropy mucus. There is always an obtuse pain in the liver, more or less pain in the shoulder, and sometimes a dull pain across the arm, between the wrist and elbow. The patient is frequently troubled with asthmatic symptoms, and is more or less dyspeptic. When there is much hardness in the liver, the pulse is apt to intermit. Some of these symptoms are occasionally so slight that they are not noticed unless they are particularly inquired for. After death, large abscesses have been found in the liver, which were the result of previous inflammation. There is no discharge in chronic inflammation of the liver, by the cough, unless the lungs become affected by sympathy, or the inflammation has extended to the lungs and caused suppuration. Inflammation of the liver may be distinguished from spasm in the gall ducts. In the INFLAMMATION OF THE LIVER. 81 spasm of the gall ducts, the patient always wishes to Dend the body forward on the knees; but, in inflammation of the liver, he wishes to keep as erect as possible. This disease is often carried off by hemorrhage from the nose or bleeding piles, a diarrhcea, sweating, or large evacuations of urine, which deposits a copi- ius sediment. It has been known to yield to the action of erysipelas in external parts of the body, or the extremities. The most favorable signs of recovery are a gradual abate- ment of the febrile symptoms, an improvement in the complex- ion and an improvement in the appetite, and an accession of strength. On the other hand, intensity of pain and fever, obsti- nate costiveness, severe rigors of cold, succeeded by flushings of heat and fever, denote that suppuration has taken place. Con- tinued hiccough, cold extremities and sinking pulse, denote gan- grene. Before suppuration takes place, adhesions generally take place between the surface of the liver and some neighboring parts. The matter is generally discharged by some of the outlets with v which this part is connected, either by coughing, vomiting or by stool, or by the abscess breaking outwardly, or by its being opened by art. In some cases, the pus is discharged into the cavity of the abdomen, and floats among the bowels either till it kills the patient or is taken up by the absorbents and thrown off by the bowels. On dissection, the liver is often found enlarged and hard to the touch. The color is more of a deep purple than natural, and there are more or less traces of inflammation to be seen on its membranes. Gall stones are now and then met with,. obstructing the gall ducts, or partially filling the gall bladder.. In a few instances, the liver of those dying in this state has been found putrid, and presenting somewhat the appearance of honey-comb. What constitutes the greatest difficulty, some- times, in successfully treating inflammation of the liver, especially in hot climates, is, that in many cases the primary symptoms Vhich indicate inflammation are so obscure that suppuration takes place before the disease is truly apprehended. The pain in the side may not be constant or acute; the patient may not take much notice of it; he seldom mentions it unless he is particularly questioned about it, and then he will reply that he has occasionally felt some slight pains in the side, but that they have not given him much uneasiness. He may complain of occasional pains in the pit of the stomach. The secondary symp- toms are then our only true explicators of the case. These are a diarrhcea, a dry. hacking cough, and pain in the top of the BRIGHT. 7 82 INFLAMMATION OF THE LIVER. shoulder. We shall generally be able to find some fulness and tenderness, by pressure on the liver with the fingers, and the eyes and skin will present some yellowness. By these symp- toms we may ascertain the true nature of the disease. TREATMENT. In the early stage of acute inflammation of the liver, the patient should be freely bled from the arm, proportioning the quantity taken, to the age, strength and habits of the patient, the violence of fever, and the acuteness of the pain. If the fever and pain continue, the bleeding may be repeated in twelve hours, and if the symptoms demand it, again the next day. By neglecting to bleed freely, there is great danger, especially in hot climates, of suppuration taking place. After the first free bleeding, the bowels should be freely acted upon by the following medicine: Recipe : Calomel, twenty grains. Jalap, twenty grains. Mix, and give it in sirup. Work it off with gruel, lightly seasoned. The operation will be free, and rather liquid than otherwise, which, in this case, will be right. If the fever con- tinues the next day, give the following: Recipe: Senna Tea, half pint. Rochelle Salts, half ounce. Tartar Emetic, one grain. Dissolve the salts and tartar in the tea. Give two table spoon- fuls every hour, till they operate freely. If the patient should puke a little, it will do him no harm. After the operation is over, if the pain continues, apply a large blister plaster over the region of the liver, and give the following cooling powders: Recipe: Cream Tartar, one drachm. Salts Nitre, twenty grains. Tartar Emetic, one grain. Mix, and divide into six powders. Give one every hour, in* warm balm, hyssop or sage tea. The patient should drink freely .of the tea, to aid the perspiration. If the fever continues, give the following: Recipe: Calomel, twenty grains. Divide into five powders. Give one every three hours in sirup, till all are taken. Follow these, in two or three hours with a dose of castor-oil. Nothing cold or salt should be given till the calomel is worked off. If any pain or soreness remains the following pill may be given : INFLAMMATION OF THE LIVER. 83 Recipe : Blue Mass, sixty grains. Aloes Socatt, twenty grains. Rhubarb, twenty grains. Mix well, and form twenty-four pills. Give four of these for a dose. If they should not operate in six hours, give two more. Continue these till the inflammation is overcome. An eruption on the lips, indicates favorably. During the whole course of treatment, the diet should be light, and the drink mild and diluent, such as rice-water, barley-water, slippery-elm, flax-seed, balm, hyssop or sage tea, &c. Bathing the feet and legs occa- sionally in warm water, will be found serviceable. When erup- tions take place on the lips, or erysipelas breaks out on the extremities, the cure may be completed by the use of quinine or salicine, as follows: Recipe : Sulphate Quinine, twenty grains. Elixir Vitriol, thirty drops. Pure Water, one ounce. Mix. Give a tea spoonful three or four times a day in water; or if quinine disagrees with the patient, give : Recipe : Salicine, forty grains. Acid Sulphuric, twenty drops. Pure Water, one ounce. Mix, and give as above directed. The diet may now be improved, and convalescence will take place. But this disease does not always terminate so favorably, for the proper remedies are not always used in time, and suppuration takes place, which may be known by the patient experiencing rigors or chills. The completion of the process may be promoted by very gentle pur- gatives, and the use of quinine or salicine, as above prescribed. The abscess should be invited outward, by the application of emollient poultices over the region of the liver. The part should always be fomented with warm water, or strong hop tea, before the poultice is applied. When the tumor points outwardly, and becomes soft, or fluctuation can be felt under the finger, it should be opened in the most dependent part. Great care should be taken that all the matter is discharged. In 1816, the author was called to a little girl, nine years old. She had received a bruise in the liver by a fall, and an abscess had formed. The tumor was prominent, and the fluctuation of the matter evident. He opened the abscess by dividing the skin and muscles immedi- ately under the point of the short ribs, till the surface of the liver was brought into view. Then an incision was made intc the liver with an abscess lancet, and the matter flowed out freely 84 INFLAMMATION OF THE LIVER. to the amount of two large saucers full. The edge of the sauces was held firmly against the side, to prevent any matter escaping into the cavity of the abdomen. The wound was then tented into the liver and a compress applied over the whole. The next day, on removing the tent, several ounces more of matter were drawn off; thus the quantity decreased every day, for several days, till the pus ceased to be discharged. The orifice was then suffered to heal. The little patient's strength was supported by wine and the decoction of bark, (we had no quinine in those days,) and a generous diet. The bowels were kept open with very gentle medicines. She recovered, grew up, married and raised a large family. In the same summer, I was called to see a little boy, whose parents lived some fifteen or eighteen mile? from me. He had, some weeks before, fallen from a height of ten or twelve feet and struck his side on a rail, and his livei swelled and finally suppurated. When I saw him, his liver, by inflammation and suppuration, occupied nearly the whole of the left, as well as the right side. The evidences of suppuration were apparent. The navel was very much protruded, and fluc- tuation could be distinctly felt in it. After a close examination of the whole case. I came to the conclusion that nearly the whole liver was a mass of matter, and that the cord, which was once the navel string, had been opened by the process of suppuration, and that it might be a suitable outlet for the matter. I, there- fore, by a free cut with a lancet, opened the end of the navel, and to my astonishment not less than three pints of matter were discharged by the incision, in a short time. I stopped the flow occasionally, to let the patient revive, for he became faint. The orifice was then tented. The tent was removed every day, and the matter allowed to discharge. His strength was supported with wine and bark, the mineral acids, and a generous diet. The bowels were kept open with blue mass and rhubarb, and other mild purgatives. This case discharged pus for nine months, and the patient finally recovered, and grew up to man- hood. But there are other ways by which the matter is dis- charged from the liver. I will relate another case. I once saw a young lady, eighteen years of age, who had labored under a long protracted intermittent fever, in Virginia, some seven 01 eight years before, since which time, her parents informed me, she had lost all color in her face, and had had a lump in her right side, under the ribs. She had been a long time afllicted with dyspepsia and indigestion, with clay-colored stools. When INFLAMMATION OF THE LIVER. 86 I saw nei, she had no coldr in her face; she was very much ema- ciated ; she had a dry, hard cough ; she had never menstruated; her feet frequently swelled; she had night sweats, and no appe- tite. After examining the case closely, I informed her parents that I believed there was an abscess in her liver. They thought not, but said she had consumption. My opinion, however, was unchanged, and I commenced the cure with calomel and blue mass, alternately, mixed with rhubarb, which I continued for sev- eral days. At one of my visits, I believed the swelling had so completely obstructed the gall-duct, that the mercurials could not bring bile. I, therefore, resolved to give an emetic, with a view to break the abscess; for, at this time, the patient was extremely prostrated, and gave every indication of sinking in a short time, unless she could obtain speedy relief. I apprized both herself and parents, that if the abscess broke into the cavity of the abdomen, she would probably die in a short time; but if it was discharged into the stomach, she might live; and if it was not discharged, she could not live. With this explanation of the case, they con- sented that she might take the emetic. I accordingly gave her an emetic of ipecac, and sat by her. At the second or third effort to vomit, the whole discharge was a whitish fluid pus, extremely fetid. She discharged, as nearly as I could judge, about one quart, under which operation she was very near sink- ing. It, however, turned down upon the bowels, and a large quantity was discharged by stool. Wine and laudanum sus- tained her then; and afterwards, wine, bark, and the mineral acids, and an improved diet. Gentle aperients were used to keep the bowels open. Her father removed to the Green river country some six or eight months afterwards, with his daughter's health greatly improved. She had menstruated two or three times*, regularly. Two or three years afterwards, I was in her father's neighborhood, and called to see the family. A more healthy, rosy young lady, I had not seen in her neighborhood, than was the subject of this narrative. I treated this case in 1818. In the winter of 1846, I was called to see a lady, in con- sequence of a slight discharge of matter from the umbilicus, which had taken place the day before. Her pulse was soft and compressible; the tongue white; the bowels constipated, and her voice feeble; the skin cool, and rather clammy, and she had no appetite. The history of the case, as she gave it, was this : About three weeks before, she had spent the day at a neighbor's- she had been in ♦he habit of wearing loose wrappers for a year 86 INFLAMMATION OF THE LIVER. or more, but on that day she put on a tight-bodied dress, and more under-clothes than usual. She felt that her dress pressed so hard that she was very uncomfortable all day, but she bore it till she returned home at night, by which time there was great soreness all around her waist, at the edge of her short ribs. The next morning the soreness had increased, accompanied with fever. She, however, neglected to use any remedies, and the fever continued, and the soreness, which had amounted to a pain, also continued for eight or ten days, when she began to feel frequent cold rigors, and some sickness at the stomach, with almost an entire loss of appetite. Thus these symptoms con- tinued for several days, when she took some aperient medicine which she had in the house. But the navel began to inflame and became very sore, and in twenty-four hours a small quantity of pus made its appearance there. This caused her to send for me. I was satisfied, on a close examination of the case, that suppura- tion had taken place to some extent in the liver. I so informed her, and gave her a dose of the following medicine : Recipe : Blue Mass, ten grains. Rhubarb, ten grains. Formed into five pills; given for a dose. Strict rest was enjoined. Next day, the symptoms about the same; prescribed a repetition of the pills, as the dose taken yesterday had brought but little bile. Third day the pills had operated better than the first dose; but little biLe, however, was discoverable in the evacu- ations. Her pulse was weaker and her skin cool and soft, tongue white. I then ordered, Recipe: Huxham's Tincture, two ounces. A tea spoonful to be taken, three or four times a day, in a little good wine and water. The discharge from the navel not abated a soreness generally diffused over the abdomen, with some swell- ing under the ribs in the right side; ordered an injection of molasses and water, and the drops and wine to be taken as above directed. On the fourth morning I found her very much debilitated- her voice weak, her features shrunken, her eyes hollow, her pulse weaker and more compressible than the day before, and she informed me that she had spent a sleepless night, having suf- fered much pain till four o'clock in the morning, when it left her side, and she dropped to sleep in a moment. She slept an hour or two, and awoke in a cool perspiration; felt very feeble • the discharge had ceased from the navel, and the swelling had sub- INFLAMMATION OF THE LIVER. 87 sided in that part as well as the side. I knew the abscess had discharged internally, of which fact I informed her husband privately, (as she was nervous and fearful.) I ordered the tinc- ture and wine to be given more frequently, and chicken broth occasionally, and the following pills to be taken with a view to the absorption of the matter. Recipe: Blue Mass, forty grains. Rhubarb, twenty grains. Castile Soap, twenty grains. Form twenty pills; two to be taken every four hours, till they operated. The first operation brought some matter, the second much more. The pills were continued every day, so as to pro- duce two or three evacuations in twenty-four hours. The tinc- ture and wine were continued; light broths, gruel, tea and soft toast were ordered for diet. The matter was discharged more or less every day for a week. Her appetite and strength im- proved ; the discharges ceased from the navel, and she gradu- ally improved, till her health was perfectly restored. Towards the close of her taking medicine, with a view of giving more per- manent strength, I ordered the citrated aromatic wine of iron, a tea spoonful three times a day, and the bowels to be kept open with the above pills. It has now been six months since I attended this case, and my patient is enjoying perfect health. I have related these four cases, in order to show the different manifesta- tions and terminations of abscess of the liver. I have witnessed various other cases, but the general symptoms of all of them may be found in some one or more of the cases above related. But there is another form of inflammation of the liver, — that is, chronic inflammation, strictly so called,—which is necessary to be described and treated. This is also the consequence of inflammation in peculiar constitutions. This inflammation ter- minates in an indurated and hardened condition of the liver. The organ swells, feels hard and sore; the stools are clay-colored; the urine is highly colored, and deposits a reddish or brown sedi- ment. The tongue is always coated towards the root in the morning; the stomach is dyspeptic; the eyes and skin have a yellow tinge; the skin sometimes becomes dark or brown, and is covered with livid spots; the appetite is poor, and the patient feeble. This is frequently the consequence of a scrofu- ous habit. Recipe: Iodine, twenty grains Alcohol, one ounce. 88 INFLAMMATION OF THE BOWELS. Dissolve the iodine in the spirit. Give from twenty to forty drops, three times a day, in sweetened water, according to the strength of the patient. At the same time, the bowels should b« kept open with the following pill: Recipe: Blue Mass, sixty grains. Rhubarb, sixty grains. Form twenty-four pills. Give two or three of these at bed-time; if they should not operate by morning, give two more, and repeat them every night. One or two operations should be procured every day. The mouth should not be allowed to become sore. If any signs of salivation appear, the blue mass must be discon- tinued, and the following medicine given: Recipe : Nitric Acid, half an ounce. Muriatic Acid, half an ounce. Give ten drops, three times a day, in a glass of sweetened water. At the same time, a tea spoonful of the acid may be poured into half a pint of water, and the side bathed with it freely; it should be rubbed in till the skin tingles freely. This should be repeated three times a day. The diet should be light, and consist of those articles that sit easiest on the stomach. A foot-bath of the acid and water has done great good in ray hands in this form of the chronic disease of the liver. The acid above named, called the nitro-muriatic acid, has been taken for months, before the liver has been restored. Repeated blisters, drawn over the region of the liver, have done much good in this form of the disease. The vegetable tonics will be found service- able. The following may be given : Recipe: Gentian Root, half ounce. Columbo Root, half ounce. Orange Peel, half ounce. Quassia, half ounce. Cut all fine, and add to them a quart of old whiskey. Shake the bottle every day for six days; then take a table spoonful in water three times a day. The bowels may be kept open with Rochelle salts or castor-oil, rhubarb, &c. Exercise, when the patient can bear it, in a carriage or on an easy travelling horse, will be serviceable. There is another.form of chronic disease of the liver very much resembling the former, but it is scirrhous. This disease is frequently brought on by a protracted habit of intoxication. The liver becomes indurated, scirrhous and destroyed in its functions. If mercury is occasionally service- able in the former species, it is poisonous here. The remedies INFLAMMATION OF THE SPLEEN. 89 are not many in scirrhous liver. They consist in the proper use of the taraxacum, or dandelion, either in extract, or the fresh, expressed juice. If the extract is used, twenty grains may be taken three times a day. If the fresh expressed juice be used, from one to two ounces may be taken twice or thrice a day. The pain is to be allayed by opium and cicuta, in the ordinary, or in increased doses: Recipe: Opium, five grains. Castile Soap, five grains. Form ten pills. One may be taken three times a day. The bowels should be kept open with salts, or castor-oil. The diet should be such as the stomach will bear comfortably. This form of diseased liver is almost sure to terminate in dropsy, and sooner or later, to prove fatal. In the event of convalescence, great care should be taken to avoid a relapse into former habits. The bowels should be kept open, and the diet be well regulated. Exposure of all kinds should be carefully avoided. In treating of this form of dropsy, I shall have occasion to say something more on this form of diseased liver. INFLAMMATION OF THE SPLEEN. Inflammation of the spleen comes" on, like inflammation of other internal organs, with rigors or chills, succeeded by heat, thirst, and other febrile symptoms; soon after which, an acute pain is felt in the left side, immediately under the short ribs; the pain is increased by pressing on the part. In many respects it resembles inflammation of the liver. Inflammation of the spleen must be carefully distinguished from a pain in the left side which is produced by an active exertion, such as running, jumping, wrestling, or a sudden gust of passion. This answers to the system the same purpose that a flood-gate does to a water- mill. When the large blood-vessels and the heart are likely to be engorged with blood from any violent exertion, to save the rupture of some important vessel, the spleen, which is a gland, receives the blood, by the expansion of its vessels, so as to hold a large quantity of that fluid. By this distension of its vessels with blood, a pain is often produced, which is very acute for a short time; but, after a few minutes' composure, the blood grad- ually returns into the general circulation, and the pain subsides. This pain, therefore, is not an indication of inflammation in the 90 INFLAMMATION OF THE SPLEEN. spleen, for it is not attended with fever. Like the liver, the spleen is often the seat of chronic inflammation. It then be- comes indurated and enlarged. The causes of inflammation of the spleen are those, generally, that produce inflammation in other organs; but an enlargement of the spleen is frequently produced by long-protracted intermittents, and then it assumes the name of ague-cake. No doubt but the cause of ague-cake is, the frequent and excessive engorgement of the spleen with blood during the protracted shakes in ague and fever. Inflam- mation of the spleen may terminate, like inflammation in any other large gland, in resolution, suppuration, or scirrhus. Some- times the disease is carried off by the discharge of a dark- colored matter, like coffee grounds; sometimes by diarrhcea, and sometimes by bleeding piles, (hemorrhoids.) When it ter- minates in suppuration, and the abscess bursts internally, and the contents are discharged into the cavity of the abdomen, it may prove fatal, sooner or later. A simple enlargement of the spleen may last for many years, and the patient experience but little inconvenience from it, more than being short of breath when taking exercise. TREATMENT. In the early stage of inflammation of the spleen, the pulse will be found to be quick and hard, and from 90 to 100 strokes in a minute; the tongue will be covered with a white coat; the skin hot and dry, and the thirst more or less increased. When these symptoms present themselves, the patient should be freely bled from the arm, and the following medicine given: Recipe: Epsom Salts, one ounce. Tartar Emetic, two grains. Mix, and dissolve in a glass of warm water, half of which should be taken; and if no vomiting is produced in half an hour, the balance should be taken. Two or three motions should be produced upwards, and then the action turned upon the bowels; three or four alvine evacuations are desirable. If the fever and pain continue, another bleeding should be used, after which a blister plaster should be applied over the painful part and the following medicine given: Recipe: Blue Mass, twenty grains. Rhubarb, fifteen grains INFLAMMATION OF THE SPLEEN. 91 Form six pills. Give three. Wait three hours, and give the other three. Work them off with gruel, or toast water. If the pain, soreness, and fever, are not entirely removed by these rem- edies, a dose of senna tea and salts may be given: Recipe: Strong Senna tea, half pint. Epsom Salts, one ounce. Dissolve the salts in the tea, sweeten it, and let it be taken at three drinks, half an hour apart. This and the above pills may be alternated with each other every other day, till the patient is cured. The diet should be light, and the drink cool, but not icy. But it frequently occurs that the spleen becomes enlarged, and perhaps scirrhous, before any medical aid is called. The only prospect then to obtain a cure is. to place the patient under an alterative course of mercury and acids. If mercury be used, the following will be found as convenient as any prescription: Recipe: Blue Mass, one hundred grains. Rhubarb, twenty grains. Form twenty pills. Take one three times a day, till the gums begin to get sore; then take two a day, for a week; then one a day, for another week. If necessary, keep the bowels open with castor-oil. If it is determined to use the acids, the following formula should be selected: Recipe: Nitric Acid, half an ounce. Muriatic Acid, half an ounce. Mix. One tea spoonful of this acid may be added to half a pint of water. The side should be bathed with it three times a day, till the hardness is removed, and fifteen drops of it may be taken, in water, three times a day; it should be sucked through a quill. If it should be necessary to take medicine to act on the bowels, the above pills will be proper. The disease will, likely, not be removed till the patient has spit for a month. Then use the following tonic: Recipe: Sulphate Quinine, twenty grains. Sulphuric Acid, twenty drops. Pure water, three ounces. Mix. Give a tea spoonful three times a day, in water. Or the following bitters may be taken: Recipe: Gentian Root, half an ounce. Orange Peel, half an ounce. Columbo Root, half an ounce. Rust of Iron, one ounce. Make all fine. Add to them a pint of wine and a pint of water, or good spirits in place of the wine. The bottle should 92 INFLAMMATION OF THE KIDNEYS. be shaken every day, for a few days. A table spoonful may be taken, in water, three times a day. The diet now should be generous. The bowels may be kept open, if necessary, by oil, or the following pill: Recipe; Scammonia, Aloes, Rhubarb, Castile Soap, of each twenty grains. Form twenty pills. From four to six of these, at bed-time, will operate once or twice the next morning. Exercise on horseback, or in a carriage, may be taken, in good weather. All exposure should be avoided. INFLAMMATION OF THE KIDNEYS. Inflammation of the kidneys may be produced by any of the causes that would occasion inflammation to take place in any other internal organ, such as, a sudden check of perspiration; suddenly becoming cool after being over-heated; wet feet; falls, bruises, or blows on the part, &c. It may be distinguished from cholic,—a disease to which it is closely allied, in some of its symptoms,—by the pain being seated near the backbone, and iust below the ribs. The urine is a deep red, nearly like blood; there is frequent inclination to pass it, when but little is voided at a time; the pain is not much increased by the motion of the body. It may be,distinguished from gravel, or calculus in the kidney, by fever accompanying or immediately following the attack of pain. The fever continues without any very visible intermission; whereas, in calculus, the fever does not come on for a considerable time after the pain is first felt. When calculus is lodged in the kidney, there will be a numbness in the thigh, and (if a man) a contraction in the testicle on the side affected, and a constant nausea, and frequent vomiting. Inflammation of the kidney may be distinguished from simple lumbago, or pain in the muscles of the back, by the seat of the pain, detected by pressure on the part; by the difficulty in making water; and by its being frequently attended with vomiting. The pain also extends along the ureter. In some habits, (as in those subject to gout,) irritation is frequently felt in the kidneys by acid mat- ter being thrown into them. This very much resembles inflam- mation of the kidneys. But inflammation in the kidneys is attended with a sharp pain in the side of the back, just below INFLAMMATION OF THE KIDNEYS. 93 the ribs, on the side affected, extending down towards the blad- der, in the course of the ureters; there is a frequent desire to make water, with much difficulty in passing it; the towels are costive; the skin dry, and hot; the patient cannot walk, or sit upright, without great pain; he lies with the most ease on the affected side, and when he lies down he bends his body a little forward; he has much nausea, and frequent vomiting. In forming our opinion as to the result of the case, wc are to judge principally from the age and strength of the patient; the severity of the symptoms; the quantity and quality of the urine voided. When the disease has been protracted to the seventh or eighth day, and the pain becomes less severe, if he feels chilly or shiv- ering sensations attend him, there is great reason to apprehend that suppuration has taken place in the kidney. But remission of pain, fever, and tenderness, followed by a copious discharge of highly-colored urine, a general perspiration, or a flow of blood from the hemorrhoidal vessels, are favorable symptoms. Dissections have not only shown the usual effect of inflam- mation in the kidneys, but likewise abscesses have been frequently found in them, which have destroyed the whole substance of the kidney. They have occasionally been found in a scirrhous state. TREATMENT. In the inflammatory stage of this disease the patient should be bled freely, at least once or twice. The quantity taken should be proportioned to the age and strength of the patient, and the severity of the pain. After general bleeding from the arm, if the pulse becomes weak, and the pain and swelling con- tinue, six or eight leeches should be applied over the part, and blood freely extracted. After the leeching, emollient applica- tions may be made by squeezing flannels out of a strong decoction of poppy-heads, or hops, and kept constantly applied to the parts. When these cannot be had, use a decoction of bitter herbs, or even warm water. An injection of some muci- laginous tea, as flax-seed, or slippery-elm, may be frequently thrown up, to act as a fomentation to the parts internally. The patient, at the same time, must drink freely of mucilaginous drinks, such as flax-seed, or quince-seed tea, slippery-elm tea, rice, or barley-water, &c. Nitre should never be given in inflammation of the kidneys, as it will aggravate the disease 94 INFLAMMATION OF THE KIDNEYS. The bowels are to be kept open with gentle purgatives; but, ia order to cause the liver to act freely, in the first instance give: Recipe : Calomel, ten grains. Jalap, ten grains. Gamboge, two grains. Mix, and give in pills or sirup. Work this off with gruel. Take nothing cold till the operation is over. After this you may keep the bowels open with senna tea; salts or castor-oil, or: Recipe : Jalap, twenty grains. Cream Tartar, one hundred grains. Mix, and divide into three papers. Give one in sweetened water every three or four hours, till they operate freely; and occasionally give the following purgative: Recipe: Castor Oil, one oup'"^. Tea of Fennel Seed, two ounces. Mix for a dose. At the same time, if the patient has fever, you may give the following cooling diaphoretic : Recipe: Spirits Mendereri, two ounces. Antimonial Wine, two drachms. Mix. Give a tea spoonful every hour, in some of the above teas. The patient should be bathed in warm water, once or twice a day, till the violence of the pain is subdued. Blisters should never be applied in inflammation of the kidneys, nor should any of the heating balsams nor diuretics be given. A decoction of the dried leaves of the peach-tree will be found serviceable, or a tea made of peach-kernels. A pint a day of either may be taken. When matter has been discharged by urine, showing that suppuration has taken place in the kidney, then some more stimulating diuretics may be given, such as: Recipe: Balsam Copaiba, half an ounce. Harlaem Oil, half an ounce. Mix them well together, and give twenty drops three times a day, in some mucilaginous drink. When this is proper, the preparations of iron will be found proper, such as, the citrated aromatic wine of iron. A tea spoonful may be taken, in sweet- ened water, three times a day ; or the citrate of iron; one drachm dissolved in two ounces of warm water. This may be taken as above. The uva ursi will be here admissible. A drachm may be taken, in substance, three times a day. The diet, from the beginning, should be light, thin, and nutritious, such as, gruel, barley, light soups, tea, calfs-foot jelly. The patient should take frequent drinks of such articles, though he INFLAMMATION OF THE BLADDER. 95 may throw them up again. They will aid in relieving the inflammation. Those who are liable to affections of the kidneys, should avoid getting wet in the feet, or exposing themselves tc cold in any way, especially after being over-heated; they should carefully avoid all kind of spirits, but live temperately in all things. INFLAMMATION OF THE BLADDER. Inflammation of the bladder is known by pain over the pubes, in the region of the bladder; a frequent desire to make water, and a difficulty in voiding it, — and sometimes there is a total suppression of urine; a frequent inclination to go to stool, and fever. Inflammation of the bladder is rarely a primary disease, but is generally the consequence of inflammation in some part con- tiguous to it. It may be brought on, however, by a suppression of urine, and distension of the bladder, or by stone in the blad- der. The treatment prescribed in inflammation of the kidneys will be proper here, only we should not give liquids in great quan- tities. The water should be frequently drawn off with a catheter. The warm bath, frequent injections, and cooling pur- gatives, are proper remedies to be used. If suppuration take place, matter will be discharged in the urine, giving it the appearance of whey mixed with it; and, occasionally, blood may be discharged. After the water is drawn off, some mild mucilage should be injected into the bladder, such as flax-seed, or slippery-elm tea, made in rain-water. Small doses of opium or laudanum should be given, to allay irritation, and procure rest. When the disease has been of long standing, cicuta 01 hyoscyamus should be given, in small doses, from half a grain to a grain at a time, and repeated at intervals of several hours The diet should be light, and the feet kept warm. 9b GOUT GOUT. The general definition of gout may be given as follows: Pain, inflammation and swelling about the smaller joints, returning after intervals; often produced by, or alternating with, usual affections of the stomach, or other internal organs. The swel- lings never suppurate. The resemblance between the gout and rheumatism is so close, that the one is often mistaken for the other, and they have been regarded by some writers as convertible the one into the other. Yet, while the gout fixes upon the small joints, rheumatism attacks the large ones. Both are, in the opinion of ;;ome writers, hereditary. Gout, in one of its aspects, is far more frequently connected with a dyspeptic^state of the stomach than rheumatism. The attacks of gout are more sud- den than those of rheumatism ; its nightly exacerbations less dis- tinct, but the intervals of attack further apart. Gout is a much more complicated disease than rheumatism. Perhaps there is no disease to which the human system is liable, that has led to such a variety of opinions, both in theory and practice. But as it is not our business in this work to theorize, but to describe disease and give the treatment, we shall avoid it here. We will, how- ever, just say that the diversity of theories on gout has led physicians, both of ancient and modern times, to differ widely in their practice. The old humoral pathology' governed the ancients; and, strange to tell, notwithstanding the moderns have discarded the humoral pathology in almost all diseases, yet in gout many of them practise as though that old theory was true. The following questions have arisen in the minds of the faculty on the subject of gout: Is the gout a local or constitu- tional disease 1 Is it a spasm or a poison ? Is its course benefi- cial or mischievous ? Should its inflammation be encouraged or counteracted ? Is it to be concentrated or repelled with cold or with heat; with a full diet, or Avith a spare diet 1 No set of questions can be more repugnant to each other than these are; and yet, there is not one but we may obtain a negative or an affirmative to, by applying to different authors for this purpose. We shall not enter into the labyrinth of disputation on this sub- ject, but proceed, in as few words as possible, to give as clear a description of it as possible ; and we profess to know something about it, from experience. In the first place, it is admitted by nearly all who have written on it, that gout is a disease of the system ; that is, it depends upon a peculiar state of the constitu- gout. 97 tion; and that this is, in some instances, hereditary, and in others acquired. It is acknowledged by all, that it may be trans- ferred from the parent to the child; but cases do occur in which such transfer cannot be traced. In such cases, it is acquired. The gouty diathesis is supposed to be produced by habits of indolence, luxury and indulgence, particularly in the pleasures of tlse table, from which habit the gouty diathesis is supposed to originate. There are others, however, though observing a life of great regularity and abstemiousness, who have been attacked by its paroxysms. Such persons are almost always capable of tracing it to a hereditary diathesis. When once established in the system, it is propagated from generation to generation. Whatever the manner of the life of the individual may be, unless the whole principle of it is removed from the system, and care be taken afterwards that it be not rekindled again, by the causes that might produce it in any one, it may be revived. A gouty disposition transferred from parent to child, may lie dor- mant in the child for many years, till some exciting cause is applied, which is calculated to develop it. It is declared, by some eminent physicians, that the gouty diathesis or disposition may pass over one or two generations, and then be developed in the grandchild or great-grandchild. Gout affects different per- sons very differently, according to their peculiarity of habit and# constitution. When the general health is sound, it fixes itself on one or more of the extremities, in the form of a particular, but very acute inflammation, that runs through a regular paroxysm, and gradually subsides; and when the health is infirm, and the general system debilitated, exciting great derangement in some internal organ or set of organs, particularly that of digestion, or shifting from one form to another, thus proving itself, under any form, to be the same disease; and, finally, laying the foundation for the three following varieties : Regular fit of gout; disguised, lurking gout; and retrograde, recedent, misplaced gout. The regular gout has pain, swelling and inflammation of the affected joint, as in the toe, considerable and acute, continuing for sev- eral days, often with remissions, and exacerbations; then grad- ually subsiding, it leaves the constitution in its usual, and sometimes in an improved state of health. The second, or dis- guised, lurking, debilitated gout, is disguised in the constitution, producing derangement of the digestive and other organs, with slight and fugitive affections of the joints. The third, is retro- grade, recedent, misplaced gout. This form fixes itself on some bright. 8 98 GOUT. internal organ, instead of the joints, or being suddenly transferred from the joints after having been fixed there, produces in the internal organs affected, great debility or inflammation, accoid- ing to the state and condition of the constitution. The predis- posing causes of a gouty diathesis, when first formed in an individual, are too great a fulness of the system, with a loaded condition of the blood-vessels; hence, in its origin, as well as the symptoms it evinces under a regular paroxysm, gout makes a near approach to various other inflammations of which we have already treated, and is more disposed to show itself where it has been transmitted hereditarily in men of robust and large bodies, of large heads, of full and corpulent, and especially gluttonous habits, covered with a thicker cuticle on the skin than is usual. Castration is said to act as a general preventive, but on what ground I know not. Such is a brief history of the origin, hered- itary transmission and effects of the gouty diathesis, which must be distinguished from the paroxysm to which it gives rise, and which constitutes the only manifest indications of its existence. The paroxysms of gout are excited by certain occasional causes, some of which are obvious, and some doubtful or altogether unknown; but without the cooperation of these, the gouty diathesis may remain quiescent in the body for years, or perhaps through the whole term of life; hence, individuals whose ances- tors have been notorious for the gout, have passed the whole of their days without betraying any marks of the disease. Nevertheless, some of their children may give evidences of its taint, even in their boyhood. The occasional causes of gout are very numerous; for where there is a strong predisposition in the system, anything that is capable of producing a disturbance there, and throwing it off its proper balance, will become the cause of an attack; hence, paroxysms in individuals are often produced by intoxication, or excess in eating ; violent emotions of the mind, particularly the depressing passions, as grief and fear ; or sudden exposure to cold, when the skin is moist by per- spiration ; or wet applied to the feet; great exertion of body; long and severe study; late hours, with fatigue; a sudden change from a spare to a fuller, or from a full to a very spare diet; excessive evacuations, of any kind; or the suppression of a periodical flux, as bleeding piles, or the cessation of the cata- menia, or the drying up of an issue that has long been discharg- ing. The more violent the attack, and the longer it continues the more confirmed the disease will be in the constitution and GOUT. 99 the oftener the attacks will be renewed; on which account, it will be of great importance to relieve and abridge the attacks as quick as possible, especially when they are not yet confirmed There has been much said about particular climates being favor- able to gout, in preference to others; whether this is true or not, one thing we know from all that has been written on the subject, that England is the hotbed and nursery of gout; if being, as yet, comparatively a rare disease in America. One of the marks by which a regular paroxysm of gout is said to be distinguished from that of rheumatism is, the suddenness of its onset. This is true with atonic gout, where the constitution is otherwise sound; but in other varieties, the fit is often preceded by pre- monitory symptoms, which those who have suffered from it before distinctly understand, and take as a warning of an approaching attack. Those symptoms are: a coldness and numbness of the lower extremities, attended with a sense of prickling along their entire length; there are frequent cramps 6f the legs; a sediment in-the urine; slight shiverings over the surface; languor, and flatulency of the stomach, and sometimes a pain over the eyelids, or in some other organ. Dr. Sydenham thinks that the attacks of gout are more frequent in January and February than in any other months. Dr. Goode has seen more cases in the summer and autumn than in any other season. The first attacks are usually in one of the feet, in the joint of the great toe, and most commonly commence in the night; there is generally a slight chill, succeeded by a fever; the local pain and swelling increase in violence; the joint assumes a fiery redness, and the whole body is in a state of great restlessness. The symptoms sometimes remit towards morning, yet they occasionally continue thirty-six hours. They will return during the night, but not with so much violence, for three or four days, or a week, when the inflammation subsides, as by resolution, and the foot soon recovers its strength, as though nothing had been the matter with it. If the patient had been previously indisposed, he now enjoys an alacrity of body and mind beyond what he had experienced for a long time before; the constitu- tional indisposition disappearing with the paroxysm. In the commencement of the disease, the paroxysms return only once a year, and perhaps only once in two or three years; but, if it be not eradicated, it is perpetually encroaching on the constitu-* tion, so that the intervals become shorter and shorter, and tha attacks become more frequent and of longer continuance 100 GOUT. whence, as Dr. Cidlin observes, "the patient is hardly ever tol- arably free from it, except, perhaps, for two or three months in the summer." Nothing can be more specific, more true to itself, or more distinct from every other kind of inflammation, than that of the gout, when thus exhibited in a regular fit. The inflammation certainly differs from every other kind of inflam- mation. It never suppurates, never ulcerates, when simple and genuine, however violent may be the attack, and though, to an inexperienced eye, the skin may seem to be on the point of bursting; while in the midst of the severest pain, there is a sense of numbness, weight, and want of energy, insomuch that, if the pain could for a moment be forgotten, the limb would fall paralytic; and although the muscles which move the limb bo not affected, they raise it, or drag it along, like a dead weight. If the inflammation run through its course where it first fixes, it subsides and leaves no external discoloration, or internal weak- ness or debility; and if it make a transfer from one extremity to another, it passes with inconceivable .rapidity. The limb to which it is transferred is loaded with all the vehemence of the inflammatory action, and that which was late the seat of pain is restored to perfect soundness. It is rarely the case that any metastasis takes place on its first appearance in a healthy con- stitution, until various organs have been weakened by its ravages. Frequent attacks of gout will weaken and break down the constitution, till the mind, as well as the body, becomes a prey to its tyrannical control; consequently, the paroxysms, though more frequent, are less painful than at first. There is no joint which will not alternately suffer by it; no organ in the system that will not be more or less weakened by it; so that, in the language of Dr. Sydenham, "the patient exists only to be wretched and miserable, and not at all to taste the happiness of life." It is a remarkable fact, which is but little dwelt upon by medical writers, and which we arc not able, perhaps, to account for, that as the system advances in years and debility, and every other secretion progressively fails, that of calcareous earth seems to increase; hence, the bones of aged persons are more fragile, and apt to break upon slight concussion, and the arteries and various other parts become ossified, or loaded with nodules of limestone; and where a powerful sympathy exists between the kidneys and stomach, and either of these is in ar inflamed state, we have a larger deposit of the same material GOUT. 101 in the kidneys or bladder. A similar deposit of calcareous* earth takes place in the weakness of chronic gout; every affected joint becomes loaded with its secretion, which collects and hardens into nodules in its cavities, or in the adjoining cellular membrane, which renders motion uneasy, or destroys it altogether. The limestone, moreover, as it hardens, acts as a foreign irritant to the distended integuments, and produces (what simple inflammation of the gout never does) ulcerations, and an offensive discharge. For the same reasons, calculi in the kidneys are often a sequel of the gout, when it has assumed a chronic form; and the children of gouty parents are said to be hereditarily disposed to both complaints, some of them exhib- iting a disposition to gout and to stone in the bladder. Thus far we have followed up a regular attack of gout, in a constitution otherwise healthy and vigorous; we now proceed to give the symptoms and attacks of the second variety, or disguised, or lurking gout. The same diathesis exists in systems of deli- cate and infirm health, and where there is a want of sufficient energy to work up a fit of inflammation, and throw it off' at its appropriate outlets. In such cases, where it becomes aroused into action by any of the causes of excitement above enumer- ated, it constitutes this second variety of gout. It assumes the guise of various other diseases, as, dyspepsia, hysteria, hypo- chondriasis, palpitation of the heart, vertigo, hemicraniaj with several modifications of palsy, or apoplexy. The stomach and bowels, however, form the chief seat of affection. There is nausea, eructations, and vomiting; and all the symptoms of indigestion follow, and are alternated with severe colic, or costiveness. In the mean time, the disease shows itself at times in some of the joints, by slight, wandering pains, as though it were making an effort to kindle up a paroxysm of gouty inflam- mation, but which there is not energy enough in the system to accomplish. Hence the pains in the joints cease almost as soon as they appear, and the derangement in the stomach, bowels, kidneys, bladder, &c, reappear and subside, and sometimes, wearing out the system, the disease terminates in cellular abdominal dropsy. Third variety. Retrograde or misplaced gout. It is some- times the case, that while the general constitution of a gouty subject is sound, one or more of the organs form an exception to the general rule, and are less healthy than the rest; and, as upon an excitement of gouty inflammation in a gouty habit, the *Q2 GOUT. inflammation seizes occasionally upon the weakest part of the body, it makes its assault upon such organs rather than upon the hands and feet; or if it commence in the latter, is readily transferred to them. This constitutes the third variety, or mis- placed gout. If the general system, at the same time, should be below the ordinary standard of health, when the paroxysm is thus excited, by the force of some exciting cause, the organ affected may evince great languor and painful inertness, as in the second variety, rather than acute inflammation, as in the first variety. The sensation in the stomach, instead of being that of a fiery coal, is that of a cold lump of lead. In the head, it changes from maddening pain to oppressive horror, in which the patient starts from sleep almost as soon as he falls into a doze, from the hideousness of the ideas that rush through the mind, and from distracting dreams. The fit is sometimes trans- ferred to the bladder, in which case there is acute pain in the neck of that organ; a difficulty in making water ensues, and a discharge of thin, acrid mucus from the bladder. The rectum has also been the seat of metastasis, and has evinced various species of affection, as, simple, vehement pain, spasmodic con- striction, or hemorrhoidal tumors. When thrown up«u \hz lung-- it resembles peripneumonia. TREATMENT. In applying the art of medicine to the cure of gout, our par- ticular attention must be directed to the state of the patient during the paroxysm and during the intervals, and particularly to his previous habits, which, according to their character, may demand a different, and even an entirely opposite, mode of treat- ment. Without giving this attention to the case, no wondei should be excited in our minds if a total failure attend oui practice. When a regular paroxysm of gout makes its attack, according to Dr. Sydenham, the more violent it is, the sooner il will be over. He also says: " The wisest plan will be to let il alone, and let it run its course without interruption." This is an easy prescription, but it argues but little for the profession. But we rest not here. The best writers say that the fit should be combated by the appropriate remedies for inflammation, such as bleeding from the arm, or, what is thought to be better by some, by leeching the inflamed part. After bleeding by leeches, GOUT. x03 a purgative should be given; and in order to put the secreting organs in. a good condition, the following: Recipe: Calomel, fifteen grains. Rhubarb, twenty grains. Mix, and give in sirup. Work it off with gruel without salt in it. When the operation is over, the parts should be bathed in cold water, by pouring it on for a few minutes at a time, and repeating it at short intervals for half an hour; then wrap the foot in flannel, and give the following medicine: Recipe : Cream Tartar, one drachm. Salts Nitre, one drachm. Tartar Emetic, two grains. Pulv. Gum Camphor, six grains. Mix, and divide into six papers. Give one every hour, in a cup of warm tea, till the patient perspires gently. The danger of repelling the disease, and throwing it upon some internal organ, has been proved, by experiment, not to be incurred by this treatment. The cold water should be applied every day, till the inflammation is removed. We have undoubted authority foi this. Hippocrates was in favor of it; Zacutus Lucitanus, in 1641; Kelhos and Keck, in 1783 and 1789. Bartholin speaks of the use of snow, as a common application, in 1661, and Peck- lin, both of snow and cold water, in the same country.— Goode. But this treatment should be properly regulated, and used in proper subjects, or the result may be hazardous. It should never be used, except where the constitution is decidedly sound and vigorous, the attack regular, and the patient young—say under fifty-five years old. It should not be used where the stomach is dyspeptic, or where any disease of the lungs or heart exists, or where the head is .subject to violent pain. Where any of the above organs are affected, previous to the attack of gout, instead of using cold water to the inflamed foot or hand, the following will be safer and better: Recipe: Vitaolated Ether, four ounces. P^oof Whiskey, one quart. Mix them, and apply cloths wet in it to the inflammation, and as soon as they become dry, wet, and reapply them. This may be continued till the inflammation subsides; and instead of giving the first-prescribed cathartic, the following will be bettei in this case: Recipe: Senna Tea, half pint. Epsom Salts, one ounce. 104 GOUT, Dissolve the salts in the tea, and take three ounces every hour, till the bowels are freely evacuated. Or the following medicine may be taken: Recipe: Epsom Salts, one ounce, Table Salt, half ounce. Mix them well, and give a large tea spoonful, dissolved m a glass of water, and repeat every hour, till free evacuations have been procured. Then the cooling powders above prescribed may be given, so as to produce a breathing perspiration. The diet should be light, inirritant, and always below the standard to which the patient has been accustomed; it is not, however, to be reduced as in a case of ordinary fever. If the patient has been accustomed to drink strong malt liquors, he may now have some good table beer. The room in which he lies should be well ven- tilated, and his dress light and easy. By strictly adhering to these directions, an attack of regular gout, in a healthy, souiiq constitution, may be arrested in three or four days. But we have yet two other varieties to treat; and however feaness we maybe of the disease fixing itself on some internal organ, in the first variety, here we have to guard against it with assiduity; for there is great danger of a transfer in its location, In the second species, our attempt should be to invite the fixing of the inflammation to one of the extremities, and so relieve the internal organ, or the head, as the case may be. To fill the first intention, the general system must be stimulated by warm tonics, and a generous diet; and, in order to relieve the internal organ, the feet may be placed in warm water, to weaken the tone of the vessels, and reduce them below that of the affected part. The suffering in this species is almost insupportable. If the head is the seat of pain, it is almost maddening, with great hor- ror, or it resembles apoplexy. If it fixes itself in the stomach, there is a faintness like that of death, or a gnawing and burning agony, or a spasmodic stricture, which feels like cutting the body in two, and renders breathing almost impossible, and is not unfrequently accompanied with a rapid and sinking palpitation of the heart. We must be certain, however, before we prescribe that these anomalous symptoms are gout. In order to decide mis important question, we have to judge by the general char- acter of the patient, his hereditary predisposition, habits of life, and the diseases to which he has been previously subject. In most cases where the stomach is affected during the paroxysm, the warmest cordials are necessary, such as brandy, the aromatic GOUT. 103 spirits of ammonia, the tincture of ginger, or of red pepper. If the bowels are costive, aloes or rhubarb, in the form of tincture, should be added to the above medicines. The man who is sub- ject to these attacks of gout, should always keep these medicines by him. as the attacks are sudden and violent in their character. But he should resolutely forbear taking anything of the kind, except in case of absolute necessity; for if taken when the sys- tem is free from an attack, they will certainly do him much harm, by debilitating the organ, inviting the attack, and render- ing the remedy less availing when it is necessary. Ether may be employed to advantage in this form of gout, and particu- larly in the icy coldness of the stomach, accompanied with numbness of the limbs and palpitation of the heart. Musk, in the hands of Sir James Pringle, has given great relief in this form of gout, especially where the lungs and head were the seat of the attack. But, to have the desired effect, ten or twelve grains should be given for a dose, and repeated in a short time, It sho'uld be dissolved in ether. But should this fail, large doses of opium or morphine should be given. Recipe : Opium, five grains. Tartar Emetic, five grains. Mix in five powders. Give one every half hour, till relief is obtained, and a gentle perspiration is induced and kept up for some time. The dose has been greatly augmented by some; indeed, if speedy relief is not obtained, four or five grains of opium, with one of tartar emetic, may be given at a dose, ana repeated from day to day, till the disease is removed, taking care to lessen the tartar every dose after the first, and as soon as pos- sible, to lessen the opium. When the inflammation begins in the foot, slightly, and will not leave the other part of the system to which it has been transferred, we should invite it to the foot more fully, by strong stimulating liniment, such as camphor and sweet oil, or a mustard plaster, or even by burning cotton or flax on the foot. More wine should be given than usual, and a more generous diet. The bowels should be kept open with the fol- lowing piL.s Recipe : Aloes, twenty grains. Comp. Extract Colocynth, twenty grains. Form eight pills. Give two every two lours, till they operate. It is recorded that Linnaeus effected a cure of gout in his own case by eating strawberries. The story is pleasantly told by M. Hedin: " Linnaeus having, in this pleasant and agreeable man- 106 GOUT. tier, driven away an attack of gout, by which he was then assaulted, he persevered in the same mode of relief through five fits, which attacked him annually, every attack being lighter than the preceding, till, by persevering in the use of the same fruit, the disease did not show itself for nearly twenty years." We are told, in some of the foreign journals, of like cures being effected by eating sour cherries. As astringent tonics are often as useful as bitter ones, it is possible the gouty diathe- sis has in some instances been checked by acids of various kinds. Alexander lire, Esq., of Europe, highly recommends the use of Epsom salts in gout. He prescribes a tea spoonful to be taken every morning in a glass of water; he says the quantity of water should be large, and the medicine taken early in the morning, before breakfast. If, however, it should fail to act when taken in water, it should be dissolved in a gill of senna tea. The wine of colchicum, once extolled so highly in gout, is now thought to be a doubtful remedy. In order to arrest the paroxysms and prevent their return, he recommends the use of acetic ether, and rectified coal naptha. The acetic ether was formerly introduced in nitre by M. Sedellot, in the transactions of the Medical Society of Paris. The acetic ether should be applied with gentle friction over the part, to the amount of half an ounce every twelve hours. After each application, the patient should be kept warm in bed. In sub-acute cases, the happiest effects have resulted from pencil- ing the parts over with a camefs-hair brush, dipped in naptha. Care must be taken that pure naptha is not confounded with that used by hatters for making varnish, and lately introduced as a medicine. The properties of the two are quite dissimilar. In some instances, the naptha has evinced a power of keeping off a paroxysm. Pure naptha is a pure hydro-carbon, almost identical in nature to the naptha which appears native on the shores of the Caspian Sea, in Persia, and other countries of Asia. Another valuable remedy is the tincture of arnica, and an ointment composed of one part of the extract of belladonna, well mixed with eight parts of simple cerate. This should be freely applied, three times a day, on the affected joint. These remedies must be aided by proper diet and drink. Abstemious living, compared with the previous habits of the patient, must be rigidly enjoined. In order to get rid of the swelling which succeeds to an attack of gout, the limbs should be supported at a considerable level above that of the body. The more effectually to accomplish this, a box may be made, long enough to embrace the limb from GOUT. 107 the hip down, and webbing pr a piece of canvass should be nailed in it, beginning low down in the box at the end next the hip, and gradually elevating it to the other end, leaving a small depression for the heel. The silicate of potash is an excellent remedy in gout. It may be given in ten grain doses, dissolved in water, twice a day. It exercises a powerful solvent action upon the urate of soda and phosphate of lime, which abound in gouty patients. The chalk stones, as they are called, are dis- solved by it, to a certain extent, say many late writers. The benzoic acid is another good remedy for the dissolving of the phosphate of lime in gouty patients. It may be taken in doses of five grains, twice a day, in sugar and water. In the interims between the paroxysms of gout, great care should be taken to keep the system in such a state that another paroxysm will not come on. To effect this, the patient should reduce his diet to one half his former allowance, and should positively abstain from spirituous liquors of all kinds, as well as wines and beers. I know that English authors advise the use of a little wine, such as pale Sherry or Madeira; some say Lisbon, and others say good Port, should be taken in moderation, in order to prevent the relaxation of the system, and, consequently, another paroxysm. With all due deference to the opinions of English writers on this subject, I do not believe one word of it. Many writers on gout have recommended these drinks because they love them them- selves; and every writer will recommend either the wine he likes best, or that which is the most fashionable in the circle of his acquaintance. Away with it. I know, from experience, that no such drinks are necessary. I had an attack of gout, from hered- itary predisposition, in 1827, when I was in my thirty-sixth year of age. I had always been a temperate man in eating and drinking, and had taken active exercise all my life. The attack came on in the joint of my great toe. I relieved it with cold water, and a few cathartics, and low diet. But, just as it was subsiding, so that I could walk imperfectly, I very imprudently walked one evening, with my brother-in-law and some friends, nearly half a mile, (I was in the country,) to see a lime kiln, made of large logs, in blast. I approached too near, and was suddenly thrown into a perspiration. I immediately withdrew from the sensible heat, and sat down on a log, when the perspi- ration quickly subsided, and I felt chilly, in fifteen minutes I felt no pain in the joint of my great toe, but walked home with as much ease as I ever did, but felt some anxiety about the con- 108 ACUTE RHEUMATISM. sequences. Before I reached my brother-in-law's house, I dis- covered that I was becoming very hoarse, and before morning I had a violent pain in my lungs, and great difficulty of breath- ing. I bled freely from the arm, and took some active cathartic medicine. I lived on a light diet, and in a week or ten days was relieved from all inflammatory symptoms in the lungs, but I was sorely afllicted with a cough, which lasted me four months. I expectorated freely, especially in the morning. I resolved tc eradicate the gout from my system; and, being fully satisfied that it was an inflammatory disease, I determined to pursue the antiphlogistic plan strictly. I, therefore, never partook of an ounce of animal food for twelve months. I took, for eight months of that time, every, or nearly every, night, Recipe: Scammonia, sixty grains. Aloes Socot., sixty grains. Rhubarb, sixty grains. Castile Soap, sixty grains. Tartar Emetic, three grains. Jamaica Ginger, thirty grains. Formed into sixty pills. Of these I took from three to six every night, so as to operate once or twice the next morning. I rode in all weathers, day and night. No doubt but I should have recovered much sooner, if I had taken better care of myself. My cough I cured by taking one egg, a tea spoonful of cogniac brandy,, a gill of new milk, and as much water, three times a day. I cut the egg fine in a glass with loaf sugar, then added the brandy, milk, and water, stirred and drank it. It is now 1S46. Nineteen years have elapsed, and I have not had another parox- ysm of gout. In my case it was hereditary. I have known several of my uncles to be confined with gout for weeks, and one of them for months. I have known my mother not to be able to feed herself for two weeks, with rheumatic gout in her hands and wrists; so that mine was a clear case of hereditary gout, and not acquired. ACUTE RHEUMATISM. This disease is characterized by pain, inflammation, and ful- ness, usually about the larger joints and surrounding muscles: often wandering, with fever; the urine deposits a lateritious sedi- ment. Rheumatism varies in respect to the violence of the fevei ACUTE RHEUMATISM. 109 and seat of the pain. The varieties mostly determined by the pain are as follows : First. In acute rheumatism, the pain is located chiefly in the joints and muscles. Second. The pain is located in the small of the back, and is called lumbago. Here the pain is seated chiefly in the loins, and mostly shooting upwards. Third. Sciatica. In this form, the pain is felt mostly in the hip joint, producing emaciation in the muscles on that side of the nates, and sometimes an elongation of the limb, in which case the head of the thigh-bone is thrown out of the socket. The common remote cause of acute rheumatism, as well as the other varieties, is cold or damp applied when the body is over- heated, though it may be produced by any of the causes which produce fever. Much exposure to cold, dew, or fog, is a fruitful source of rheumatism in this country. The greatest tendency to rheumatism is found in the most robust, healthy young men, though it may attack persons of every age and habit; yet the young are mostly its victims. The muscles are inflamed, as well as the joints, for motion produces extreme pain, and the muscles are sore to the touch; but the most acute pain is in the joints. How far the remark of Sir C. Wintringham is true, when he says that "those who have suffered amputation are most liable to rheumatism," we cannot say; but one thing we can say, he is a man of much experience and observation, and is not to be lightly accredited. As a general rule, it may be asserted that rheu- matic inflammation does not tend to suppuration ; but it has been known to take place in a few rare instances. The inflammation in rheumatism is of a peculiar kind. The limbs swell consider- ably, and generally the swelling is accompanied by an alleviation of the pain. Sometimes the pain is felt before any fever appears; but in other cases the fever appears first, and the pain and swell- ing follow in a few days. All the joints of the body are liable to its attacks, but the last joints of the fingers and toes are less hable to it than any others. It may attack a finger or toe, and be confined to it alone ; but this is not very common. It rather displays its fugitive character than its local disposition. It often wanders from the hands and wrists to the shoulders, hips, knees and feet. When this is the case, the pain is excruciating. The fever rarely has a clear intermission ; the pulse ranges from 95 to 100; the tongue is white, and the patient has considerable thirst; the urine is often pale at first, but soon becomes highly HO ACUTE RHEUMATISM. colored, and deposits a red sediment. There are frequent copi- ous and clammy sweats, but the skin still feels hard and harsh, The parts affected with pain, however, do not sweat much. The perspiration will not relieve the system as long as it is clammy, and the skin feels harsh, and a sense of chilliness creeps over the body, or any part of it, while the perspiration is going on. The fever, which regularly increases in the evening, rises higher in the night, and the pain becomes more severe, and fre- quently shifts from one joint to another. Lumbago, or rheuma- tism in the back, has been mistaken for an affection of the kid- neys, or ureters. But in affections of the kidneys, especially when a stone or gravel is lodged there, the pain shoots down the thighs, and one or both testicles contract very much, and are painful; and the urine does not flow freely and uniformly. What the ancients called ischiatica, the European writers call rheumatism of the hip joint, and the Americans call it sciatica. Where the sciatic nerve is the seat of the disease, I have treated it under the head Sciatica, and where the disease is seated in the joint of the hip, and is called, in strict medical language, morbus coxarius, I have treated it under the head, Disease of the Hip Joint. TREATMENT. As acute rheumatism is evidently an inflammatory disease, the cure should be commenced by taking fifteen or twenty ounces of blood from the arm, which should be succeeded by an active purgative. Recipe : Calomel, ten grains. Jalap, twenty grains. Mix, and give in sirup. As soon as the operation is over, if the fever still continues, give the following cooling powders: Recipe: Cream Tartar, sixty grains. Salts Nitre, forty grains. Tartar Emetic, two grains. Opium, one grain. Mix, and divide into twelve powders. Give one every hour, in balm, hyssop, or sage tea. If they produce a free and healthy perspiration, the patient will be better the next day. If they dc not produce this effect, and the fever returns, with a continua- tion of the pain, he should be bled again, and take the follow- ing medicine: Recipe: Senna Tea, half pint. Epsom Salts, one ounce ACUTE RHEUMATISM. Ill Dissolve the salts in the tea. Half a gill may be taken every half hour, till free purging is induced. After the operation is over the wine of colchicum may be given, commencing with thirty drops in water, three times a day, till free purging is pro- duced. If it should not purge freely the first day, the dose mus« be increased ten drops each time, till it has the desired effect. Where the wine of colchicum cannot be had, a saturated tinc- ture of the root of the racemosa (rattle root) may be given in the same manner in which you would give the wine of colchi- cum, till it produces the same effect. Some authors prefer the racemosa to the colchicum. My experience with it is favorable. There are various methods of treating acute rheumatism by dif- ferent authors. Dr. Corregan treats it with opium. He gives two grains every three hours, till ten or twelve grains are given. This he repeats daily, till the violence of the disease is conquered, open- ing the bowels every other day with castor-oil, salts, or s nna tea. He tells us that in three or four days he succeeds in per- forming a cure. A. L. Wigan treats it with the root of colchicum. If the fever is very high, he would take a small bleeding. Then com- mence with eight grains of the powdered root, (be sure you have a good article,) and repeat every hour. It may be taken in any way the patient chooses, till active vomiting, free purging, and free perspiration are produced. Some patients will take twelve or fourteen doses, others will take only five or six, before the effect is produced. The patient should, in all cases, be desired to keep it down as long as possible; the more he takes the better. By taking some aromatic in the mouth, he will be enabled to take a greater number of powders before he pukes. After the puking is over, the patient generally sleeps before the purging commences. He says that when the whole process is over, the pain, swelling and fever, generally leave the patient, and he soon recovers. The diet should be tea and bread for a day or two, and then he should gradually return to the ordinary diet. He, however, premises this treatment by an injection of aloes, if the patient is costive. M. Aran cures acute rheumatism with saltpetre alone. He gives twenty grains every hour, in some agreeable tea, till an ounce is taken in twenty-four hours; from eight to twelve days being required to effect a cure. The visible effects are, profuse perspiration, reduction of fever, gentle purging, and a copious 112 ACUTE RHEUMATISM. discharge of urine. Dr. Brockelsby gives the saltpetre in larger doses, and in some mucilaginous drink, but to the same effect with Dr. Aran* Dr. Hope gives a rational treatment of acute rheumatism of the joints. To a patient of a robust and full habit, after one or two free bleedings, give eight or ten grains of calomel, with a grain or a grain and a half of opium, according to the severity of the pain; to be repeated every night, and followed in the morning with an active cathartic, so as to ensure four or five free evacuations. With this treatment, he gives also three drachms of salts dissolved in water, with twenty drops of the wine of colchicum, and five grains of Dover's powder, every day. When the pain and swelling are greatly abated, if not almost entirely gone, (which Dr. Hope affirms will happen, often within two days, and almost always in four,) the calomel is to be omitted; or it is to be omitted sooner, if the gums become sore. The opium is, however, to be continued at bed- time, and in severe cases, to be repeated at noon, and the colchi- cum and cathartic are still given as at first. Dr. Hope considers it a case of exception if the patient is not well in a week. He states the following as the great advantages of his plan of treat- ment : " First. That the patient is generally sound, well, and fit fo» work, in a week or ten days after the pains cease. Second. That the gums are rarely affected, especially if you pre- viously ascertain that the patient has not a morbid susceptibility of mercury. Third. That it is rare to see inflammation of the heart, if the treatment is early begun,—not oftener than one in a dozen cases. Fourth. That if the slightest symptoms of inflam- mation of the heart should come on, a few extra doses of calomel and opium, given every four or six hours, will generally affect the constitution in twenty or thirty hours; which, with two or three cuppings or leechings on the region of the heart, almost always places the patient in a state of safety." The above course of treatment carries with it much good reason and scien- tific knowledge. * Another mode of using saltpetre is, to dip flannel drawers and shirt in a satu- rated solution of saltpetre, and dry them by the fire, before putting them on. They should not be worn more than twenty-four hours without thoroughly washin"- them and again saturating them with the saltpetre, as before, and drying them before putting them on. A perseverance in this remedy for a few weeks has cured obstinate cases of chronic rheumatism. Two suits are necessary, as the patient should not be without them for an hour. CHRONIC RHEUMATISM. 113 To sum up the whole treatment of inflammatory rheumatism : if the patient is a strong, plethoric subject, he should be bled from sixteen to twenty ounces; then take a purgative of calomel and jalap. If the next day finds him still with fever and acute pain, he may be bled again, and then give the calomel and opium, as prescribed by Dr, Hope; or the saltpetre, as prescribed by Dr. Aran; or the colchicum, by Dr. A. L. Wigan. lean safely say, that these modes of treatment may be safely relied on, if the proper precautions are taken, and the constitution well marked, in which they are given. In the treatment of rheumatic fever, the diet should always be light, and the drink not very cold. Great care is necessary, in convalescence, that the patient does not relapse, as, when the system is once predisposed to rheumatism, it scarcely ever loses that predisposition. CHRONIC RHEUMATISM. This form of rheumatism is characterized by pain, weakness and debility of the larger joints and surrounding capsular liga- ments and muscles. The pain is increased by motion, and relieved by warmth — the limbs spontaneously or easily growing cold—and the fever and swelling are slight, when compared to acute rheumatism. The fever is often almost imperceptible. Chronic rheumatism has, perhaps, as many or more varieties than inflammatory or acute rheumatism. It may be seated in the joints, large or small, or in the loins or hips; but seldom in the chest. There is, also, another form of chronic rheumatism, which attacks the periosteum of the bones, and raises nodes on the legs, arms and head. This form is the sequel of syphilis which has been badly treated. There is yet another form of chronic rheumatism, which is the sequel of the abuse of mercury, and exposure. This attacks the tendons and contracts the limbs. The symptoms of most of these varieties are pretty much like those of acute rheumatism, only there is less fever, and some- times none at all. The parts affected are less swollen, with less heat and throbbing, and seldom any night-sweats of a clammy nature. The tongue is generally a little white, and the pulse rarely over eighty strokes in a minute. This form of rheumatism rarely attacks the heart or chest. That form which is the result of badly treated syphilis, and the abuse of mercury, is mere BRIGHT. 9 114 CHRONIC RHEUMATISM. painful at night, than any other of those forms of the disease. Generally, the appetite is not much impaired. That form which produces nodes, and that which affects the tendons, are often complicated together, the causes being generally combined. This, as well as the other forms of the disease, will reduce the patient to skin and bones; and if it be not cured, the inflamma- tion which is seated in the periosteum, or covering of the bones, will communicate itself to the substance of the bones, and they will finally become rotten, and break or split to pieces, as I have several times seen. It is hardly necessary to say, when the dis- ease has progressed thus far, that death will be the result. The other forms of the disease, though they do not destroy the bones, destroy the elasticity of the articulations, and render the joints stiff, and cause the muscles to waste away; the patient becomes emaciated, and finally dies of marasmus, or general wasting of the system, rather than of acute pain, or fever. Cold, the com- mon cause of the acute, is also a common cause of chronic rheumatism, even when the chronic has not succeeded to the acute. But when chronic rheumatism occurs without having been first acute, it is when the system is peculiarly predisposed to rheumatic action. Chronic rheumatism is evidenly a disease of debility. TREATMENT. Debility from exposure, or a predisposition to the disease lying at the foundation, calls for a different course of treatment from that necessary to be used in the cure of acute lheumatisrn. Bleeding, therefore, will rarely be found necessary in the cure of this form of rheumatism, except occasionally we may find it necessary to use leeches on nodes, or on the large joints where effusions have not taken place. In the form of this disease where it has succeeded to acute rheumatism, the warm, active bal- sams and resins, as those of copaiba and guaiacum, will be found serviceable. The following formula may be given : Recipe: Pure Gum Guaiacum, forty grains. Hepatic Aloes, forty grains. Comp. Extract of Colocynth, forty grains. Form twenty pills. From four to six of these pills may be taken every night at bed-time, or as many as will operate two or three times the next day. During the day, the following preparation may be used: CHRONIC RHEUMATISM. 115 Recipe: Balsam Copaiba, one ounce. Oil Cajaput^half ounce. Oil of Turpentine, half ounce. Mix. Take a tea spoonful three times a day, on sugar, or in rome mucilaginous drink, as flax-seed or slippery-elm tea. Trie oil of amber has been given to advantage, in twenty or thirty drop doses, three times a day, in sugar; or the following may be used: Recipe : Oil Cajaput, half ounce. Spirits Camphor, half ounce. Laudanum, half ounce. Mix, and give forty drops three or four times in twenty-foui hours. If the pain is great, the volatile tincture of guaiacum, given in tea spoonful doses every six or eight hours, has, in some cases of cold chronic rheumatism, effected great things; others have succeeded best with the plain tincture. The following form may be used: Recipe : Pure Gum Guaiacum, one ounce. Proof Whiskey, one pint. Dissolve the gum in the whiskey, and take a table spoonful in sweet milk, three times a day. The bowels should be kept open with the following pill: Recipe : Scammonia, thirty grains. Aloes Socot., thirty grains. Pulv. Rhubarb, thirty grains. Castile Soap, thirty grains. Jamaica Ginger, fifteen grains Tartar Emetic, three grains. Form thirty pills. From three to five of these may be taken at bed-time, and repeated every night, so as to procure one oper- ation the next morning; while these are being used, the follow- ing liniment may be rubbed over the affected part: Recipe: Spirits Camphor, one ounce. Spirits Turpentine, one ounce. Sweet Oil, one ounce. Oil Juniper, one drachm. Oil Amber, one drachm. Carbonate Ammonia, one drachm. Mix these articles perfectly, and rub them into the part affected three times a day, at least fifteen minutes each time. The hand is the best to rub them in with. Before every fourth rubbing, the part should be well washed with soap, vinegar and water. Frequent friction with the hand on rheumatic swellings, will a.ways be found of service, both in allaying pain and reducing swelling. We now give one of the new remedies for chronic rheumatism, 116 CHRONIC RHEUMATISM. as used by Dr. Curtis, of England, in 1840. He ga>e several cases in detail, setting forth the beneficial effects of aconite, in chronic rheumatism. But this is a very powerful medicine, and should not be given internally, except by an experienced physi- cian. Where the pain is fixed in any particular part, and there is little or no swelling, and no fever, the bowels should be opened by a gentle laxative; then one drachm of the tincture of aconite may be rubbed in over the painful part. As the aconite pro- duces such a numbed state of feeling in the fingers, it should be rubbed in with a small mop tied on a stick. Dr. Curtis has given several cases where this remedy was applied by himself, and one application produced a cure in every instance. During the application, the patient feels alternate sensations of cold, heat and numbness. All that is necessary afterwards, is to reg- ulate the bowels, and the cure is completed. This, like all new remedies, is too highly extolled, but is certainly worthy of a trial. Where the rheumatism is fixed in the hip, in the form of sciatica, this remedy is very good. The author had an attack of this foim of rheumatism, a few months since, and two applications of the tincture of aconite, of one drachm each time, removed the disease entirely. We now subjoin a case, it being one of many, of chronic rheumatism, given by Dr. James Hay gale, of Scotland. Eliza- beth Holmes, aged forty-three. "Admitted into the hospital, Aug. 21st, 1846. Pain, with loss of power in the lower extrem- ities; knee joints much swollen, and have been so for many months, with inability to stand; pulse quick, tongue clean, bowels confined; she says various means have been used, but hitherto without any effect. The following recipe was given: Recipe : Hydriodate Potassa?, six grains. Compound Decoction Sarsaparilla, two ounces. Mix. To be taken three times a day, and a pill composed of; Recipe : Extract Rhubarb, twenty grains. Extract Conium, twenty grains. Blue Mass, twenty grains. Form ten pills. One pill must be taken every night. " 23d. Progress of the case. A vapor bath to be used every other day, and the following liniment to be applied to the limbs: Recipe .- Spirits Turpentine, one ounce. Sweet Oil, one ounce. f{ 28th. Improving; increase the hydriodate of potash to eight grains at a dose. 30th. The medicine agrees very well the CHRONIC RHEUMATISM. 117 joints not so stiff, less painful and less swollen ; to have crulchea, Sept. 6th. Limbs more pliable. Increase the hydriodate of potash to ten grains per dose, and substitute the camphor lini ment for the turpentine. 23d. Has continued improving since last report. Increase the hydriodate of potash to fifteen grains. 27th. Gums slightly turgid. Omit the pills. 30th. Joints reduced to almost their natural size ; can now walk about toler- ably well; to be made an out-patient, and gradually leave off the medicine." I have given this case in detail, that it may answer as a guide for others to go by. Several other virtues of this medicine are given by Dr. Haygate, in secondary syphilis, and some severe cases of affec- tions of the wrist joints, and nervous affections of the loins, with loss of power in the lower extremities. Dr. Graves, of England, confirms the statements of Dr. Haygate, on the great, utility of the above medicines in chronic rheumatism. Hydriodate of potash, in the syphilitic form of chronic rheumatism, is an inval- uable remedy. I have used it, in the following form, with great success: Recipe: Hydriodate Potassre, sixty grains. Pure Water, four ounces. A tea spoonful of this solution is to be taken three times a day, in the following infusion : Recipe : Spanish Sarsaparilla, two ounces. Dandelion Root, two ounces. ' Cut the roots fine. Mix them, and divide into eight papers. Put one of these papers into a pitcher at bed-time, and add to it a pint of boiling water; let it stand till morning. Take of the above solution, a large tea spoonful, in a half gill of this decoc- tion, three times a day, and drink the remainder at intervals through the day. One paper of the roots should be prepared every night, and taken with the drops, &c., the next day. It is important that the sarsaparilla be not boiled, for this process evaporates the most active and volatile parts, which contain its principal medical virtue. At the same time, it is important that the limb should be rubbed with some stimulating liniment, as the compound liniment of six articles above given, and the pills there prescribed, to keep the bowels open; or from twenty to sixty drops of the wine of colchicum may be given three times a day, in the above infusion, to keep the bowels open. The diet shoul 1 be light. In those cases where nodes appear on the 118 WHITE SWELLING. bones, the pill prescribed by Dr. Haygate 1 nave found to answer an admirable purpose. In all cases resulting from badly cured syphilis, and the abuse of mercury, and exposure, the warm bath will be found of great benefit. It may be taken in the form of vapor or hot water. If the pain is severe at night, opiates must be given with an auxiliary, as follows: Recipe: Pulverized Root of Colchicum, five grains Fulveiized Opium, one grain. ■ Mix for a dose, and give it in any convenient vehicle. The diet should be nourishing, but not gross; the drink, cold water. Perhaps no disease is more aggravated by spirits either distilled or fermented, than either chronic or inflammatory rheumatism It therefore should be avoided in all cases. Beer and porter should also be avoided. When the pain is acute, and there is not much fever, the aconite presents us with an important remedy. Where that cannot be obtained, mustard plasters, applied and kept on till they almost draw a blister, will do good. If the pain is seated in the knee joint, under the cap, a mustard blister is preferable to a fly blister. When the patient begins to walk about, great care must be taken to prevent a relapse. Moderate exercise on horseback, or in a carriage, in good weather, will be beneficial. WHITE SWELLING. This disease is characterized by a tense, colorless, permanent swelling, chiefly situated in the larger joints. The inflammation progresses slowly, and is deeply seated; the pain is fixed and severe; the swelling suppurates imperfectly, and the fever assumes the hectic form. As we have said before, this inflam- mation, like that of rheumatism, attacks the larger joints in preference to the smaller ones. It runs through its course with- out perfect suppuration. No matter how severe its symptoms and fatal its termination, it has a manifest relation to both acute and chronic rheumatism. The most common cause of white swelling is a strain or bruise of the part. But this cause does not operate equally in all persons to the production of the same result; for there is in some persons a predisposition to white swelling as there is a predisposition in some persons to gout, or rheumatism. And this disposition shows itself both in strong and woak consti- i WHITE SWELLING. 119 lutions. In the weak or lax fibre, we generally find the patien* disposed to a scrofulous taint, and here the disease manifests itself under two distincts forms, and seats itself on different parts of the joints or bones, and occasionally between the joints. We are required to use different modes of treatment for the cure of the two species. The first variety, to wit, that which is so accurately described by Dr. Bellonvlccrs, is the rheumatic white swelling. It mostly occurs in young, plethoric persons, in whom the rheumatic dis- position is predominant, or rather that firm elasticity of health and fibre, which, upon the application of casual causes, gives rise to rheumatism as well as white swelling. These causes I have stated to be strains and other external injuries to the large joints, as bruises, luxations, &c. But, like rheumatism, it may be excited by a current of damp air. The pain is diffused through the joint; the swelling is considerable from the first; and, on dissection, the inflammation is found to have originated, and to be especially seated, in the synovial membranes, and the sur- rounding ligaments of the joints ; though, according to Mr. Brodie, it sometimes commences in the cellular substance around the joint. The swelling feels tense and elastic, but the skin is but little discolored at any time. There is not much effusion of coagulable lymph, but a considerable surplus of synovial fluid, — that is, the fluid within the joint. Not less than four ounces were discharged in a case related by Dr. Simon. The cause of the disease in Dr. Simon's case was of a singular kind. It con- sisted of a small supernumerary bone, somewhat above the size of a kidney bean, which laid loose in the knee joint, and was covered with cartilage. At first it seemed to be attached, for the patient did not seem to have noticed it till about the commence- ment of the inflammation, when he frequently felt it as a hard body, of the nature of which he was ignorant. It was situated immediately under the cap of the knee — the patella. He could get no ease, till, by chafing the joint with his hand, he made it disappear. He was cured by removing it by incision. The inflammation in this disease, if not soon checked, runs into the cellular substance, and even the integuments of the joints ; but, in this variety, it rarely affects the bone ; yet it has as little ten- dency to the adhesive or suppurative character, and hence the parts by absorption become shining and glazy. It occasionally proceeds further, and the surrounding parts become affected. Finally, pus is secreted, and the covering of the bone ulcerates 120 WHITE SWELLING. * and the bone itself is rendered carious, so that, on an examination of the joint by dissection, its interior displays a confused union of different materials and substances, blended together in a com- mon mass. It is to be lamented that this variety of white swell- ing is not generally noticed as soon as it should be; for when a strain occurs in the knee or elbow of a robust and high-spirited schoolboy, he will generally rather suffer the pain it produces, as long as he can, than be deprived of his liberty. When, how- ever, the disease produced by such occurrences is treated at an early period, it readily yields in a few weeks. The application of a number of leeches, and a succession of blisters, to the' affected part, will soon remove the inflammation. If the joint be the knee or ankle, it should be placed in a reclining position; for per- fect quiet is of the utmost importance. The joint should be kept as much as possible free from motion. If the pain should con- tinue, and the swelling progress, a relaxing poultice should be applied, such as white swamp lilies, or Jamestown weed, or the leaves of the common buckeye. But should these fail to reduce the swelling, and the fever continue, then a seton should be deeply applied, which should give tree vent to the matter which is contained in different cells, now contained in and about the joint, and which so much endangers the loss of the joint, and produces enchaloses. As the bone, in this form of the disease, does not easily become affected, nor even the periosteum, the use of the joint may be saved by means of the seton. A very considerable degree of stiffness may remain for a long time after- wards, but will, in most cases, yield to the application of warm animal oil, if freely applied with the hand, and persevered in for a considerable time. The friction should be continued at least an hour each time, and repeated twice a day. The stiff- ness is generally the effect of quiescence of the joint, and not of inflammation in the tendons. An abrasion of the surrounding cartilages of the joint rarely ever causes a union of the ends of the bones; therefore perseverance in friction gives the more hope of success. When neither setous nor friction will produce any benefit, the only remaining hope is amputation; which must be performed by an experienced surgeon. It will be found, after amputation, and all the soft parts are removed, that the bones aie enlarged, and full of cancellated holes, like honey-comb. % WHITE SWELLING. 121 THE SECOND VARIETY OF WHITE SWELLING. This form commences, and for the most part is seated, in the bone itself; originating, as Mr. Brodie says, "in the cancelli, or spongy part of the bone." The pain, therefore, in this case, is more circumscribed, and appears to shoot almost from a point; and the swelling is inconsiderable, when compared with the other variety, or first described form of this disease. The pain, however, is very acute, and the least attempt at motion increases it; so that, in consequence of the pain on motion of the limb, it is kept quiet, and a stiffness of the joint is a very common result. The inflammation in this form of the disease proceeds more slowly than in the other, but it finally produces the same effect, and the tumor ultimately acquires the same elastic feeling; enlarged veins appear on the surface, and collections of matter take place in different parts of the swelling; these little abscesses break, one after another, and discharge an ichorous, or cheesy, purulent matter, and small scales of bone are occasionally thrown out at the openings. This is the scrofulous variety of Mr. Bell. And although it is not always confined to scrofulous subjects, it is, most commonly, to those who give proofs of this predisposition, or of an approach to it. Mr. Hunter says, he "considers that all such collections of matter give proof that the patient is of a scrofulous habit." They are most commonly in young subjects, and are seldom found in the full-grown, or old. The swelling is not proper inflammation, nor the suppuration pure pus. The author has seen this form of white swelling seated on the leg, and also on the thigh, without touching the joint. The causes are, occasionally, those which produce the other varieties. But the disease most generally commences without our being able to trace it to any occasional cause what- ever. It is far more disposed than the preceding to terminate in a fatal hectic fever. The treatment is disheartening, and the prognostic most melancholy; though I have seen many cases even of this form of the disease cured. Where the disease is evidently scrofulous, the treatment should be that for scrofula — which chapter s.ee. The removal of the limb rarely proves a cure, but only paves the way to the development of the disease in some other joint. I have, in several instances, where the disease has been seated in the long bones, as the leg or thigh bones, even near to the joint, laid the muscles open to the bone. 122 SCIATIC, OR SCIATICA. the whole length of the diseased part, and removed, with a strong instrument, all the semi-cartilaginous substance, and scraped and polished the bone; then, by the application of the tincture of myrrh, with the corrosive sublimate dissolved in it, destroyed the morbid action in the bone, and caused an exfolia- tion, or scaling of the bone, to take place, and then, by using the remedies prescribed in scrofula, cured the disease. In one instance, after exposing the ossio-fungoid substance, I reinovcd it with a firming chisel, it was so hard, and afterwards cured the patient. The substance removed was as large as three fingers laid together. The limb had been previously condemned to amputation by several physicians. The patient, however, who had not walked for years before, became an active servant, and could not have been purchased for six hundred dollars. In another instance, I removed the entire fibula, (the small bone of the leg,) and made a perfect cure. I scraped the large bone, and removed a number of scales from it. The instep had been so affected as to stand forward in more than a straight line from the great toe to the knee. But, by a splint made in the shape of the back half of a boot, and placed behind the heel and leg, and under the foot, with broad ribbons, I gradually brought the instep back, and restored the use of the joint. This required six months to effect a cure; but it was finally perfect, and the young lady afterwards walked as well as if she had not lost the bone from her leg, or had had an enchalosed instep. In the early stage of this disease, large and frequently applied blisters will be of great service. The tartar emetic plaster has done much good in those cases; but no plan of treatment has ever succeeded in my hands like that used for the cure of scrofula. It is too tedious to repeat here; see the chapter on that particular disease. SCIATIC, OR SCIATICA. This disease is very analogous to rheumatism. It is situated in the sciatic nerve, either in one or both hips. The pain extends from the small of the back, low down, outwards, and downwards, behind the trochanter major (what most people think is the hip joint.) When the sciatic nerve is much affected, the pain not unfrequently extends down the outer and back part of the thigh, and in some cases extends even to the ankle and heel. The inflammation in the sciatic nerve and its facia differs SCIATIC, OR SCIATICA. 123 from rheumatic inflammation in this, that very little or no swelling attends it. The parts rather shrink. Ii deed, if the disease continues for a length of time, as it will if not cured, the limb not only shrinks, but perishes away, and from elongation of the muscles from relaxation, becomes longer than the other. The pain sometimes is almost insupportable, when the inflam- mation runs high. The principal causes of this dircase are, injuries done to tho back, by falls, bruises, or strains; colds, exposure to damp air, or wearing wet clothes; fogs, &c. The fever is not high. The tongue is generally not altered in appearance; and when the disease becomes chronic, the appetite is not impaired, unless the disease is of a violent character. A man may sit at his table and partake of a hearty dinner, and not be able to rise from it without assisting himself by his hands upon the table; but, after he has straightened himself, he can walk off pretty well; his greatest difficulty is, in sitting down and rising up. After he getd warm in bed, if the disease is not violent, he sleeps well; but when the inflammation is active, he can neither sleep nor walk, but is an object of the most excruciating suffering. If the disease is suffered to progress, he finally becomes emaciated, and the symptoms and sufferings all become aggravated, and he dies a miserable victim of pain and suffering. TREATMENT. If this disease is treated early, and the patient bled freely, and a few active doses of medicine given, the disease will generally be cured in a few days. The medicine may be: Recipe : Calomel, twenty grains. Jalap, ten grains. Mix, and give in sirup. Or, if calomel is likely to salivate, as it will in some cases, give the following: Recipe: Senna Tea, half pint, (strong.) Epsom Salts, half ounce. Dissolve the salts in the tea. This should be taken at three draughts, half an hour apart. If these remedies have been repeated two or three days, and relief is not obtained, then use the following: oil of colocynth, one drachm. This should be carefully rubbed into the skin, over the painful part; the friction should be continued for at least half an hour. The end of the finger should be used. Be careful to wash the hand well before 124 SCIATIC, OR SCIATICA. it is appli d to the face. If the oil of colocynth cannot be had, crotor.-oil may be used in its place. This is Dr. GenelWs remedy. M. Martinet speaks in the highest terms of ike oil of turpentine in the cure of sciatica. His method of using it is, to give a largj tea spoonful three times a day, in some convenient vehicle, lie advises the following formula: Recip". • Oil Turpentine, three drachms. Sirup Peppermint, two ounces. Sirup Orange Flowers, one ounce. White of one Egg. The whole to be well mixed; of which one table spoonfu. should be taken morning, noon, and night. If the turpentine should sicken the stomach, or pain the bowels, a few drops of laudanum should be added to each dose. This medicine will sometimes produce a flush in the face, and some pain in the head, especially in weakly and delicate females; but these symptoms will subside without injury. Where there is no constitutional disease that produces the sciatica, such as syphilis, the chances of a cure are pretty cer- tain. If the bowels are affected with heat and pain, and they sometimes are, if the dose is increased before the desired effect is produced, the carbonate of magnesia will relieve it; three drachms of which may be taken in water, or eaten dry; or a table spoonful or two of honey may be taken — the magnesia is the best. The turpentine often produces a glow of heat in the throat, then in the stomach and bowels; a perspiration, more or less profuse, is apt to succeed. Martinet declares that three or four days' use of this article will cure almost any case, either acute or chronic. Dr. Robert J. Graves, of Europe, treats sci- atica in the following manner: First, bleed the patient freely from the arm, and then leech the affected part. Then he would give the following medicine : Recipe: Acetate Morphine, three grains. Calomel, six grains. James' Powder, two grains. Mix, and divide into eight portions. Give one every three hours, till the gums become affected. But in chronic cases, where the patient wishes to follow his occupation, he strongly recommends the hydriodate of potassa, which is to be given in the following manner: Recipe: Decoction of Sarsaparilla. one pint. Hydriodate Potassa, one drachm. HEMOPTYSIS, OR SPITTING OF BLOOD. 125 Dissolve the potassa in the sarsaparilla. One foui h of this ia to be taken daily. He does not restrict his patient to low diet or warm drinks. The tincture of aconite, applied with a small mop over the pain, using one drachm every day for a few days, has effected much good in some cases. But these remedies may all fail, and do fail occasionally. Then we must have recourse to a succession of blisters; the carbonate of iron, in large doses, twenty or thirty grains three times a day, in sugar. Fowler's solution has done good in some cases, —five drops three times a day, in sweetened water. If it should produce pain in the bow- els, a dose of castor-oil should be taken immediately, and the solution suspended for a few days. The blue pill and iodine, taken internally, is a good remedy. A slight salivation has cured in some cases. Dover's powder and the sulphate of quinine combined, have been given with good effect, when the patient suffers great pain, and is very much debilitated. Recipe : Sulphate Quinine, twenty grains. Dover's Powder, thirty grains. Mix, and divide into six powders. One may be given every six hours, in sirup. When the blue pill is used, ten grains should be given, three times a day, and ten grains of Dover's powder at bed-time; if this is not sufficient to procure rest, twenty grains may be given. If the quinine affects the head, salicine should be used in its stead, but double the quantity must be given. If the sciatica is the result of a badly cured syphilis, mercury to salivation must be used. (See Svphilis.) HEMOPTYSIS, OR SPITTING OF BLOOD. This disease is known by a discharge of red blood, by spitting, The blood, in every instance, comes from the lungs in hemop- tysis. It is always attended with more or less coughing. The discharge of blood is usually preceded by a discharge of saliva, which tastes more or less saltish. There is generally a sense of weight about the region of the skirts, and more or less pain in some part of the chest. Hemoptysis may be easily distinguished from hemorrhage from the stomach, as in this case the blood is thrown up by vomiting, is of a dark color, and at first mixed with the contents of the stomach. The blood from the lungs ia spit up, is of a florid color, and mixed with froth or mucus. A 126 HEMOPTYSIS, OR SPITTING OF BLOOD. spitting of blood is m^st apt to occur between the ages of sixteen and twenty-five years. It may be occasioned by any violent exertion, either in running, jumping, wrestling, speaking loud, or blowing wind instruments; likewise by wounds, weak blood- vessels, or plethora, hectic fever, a violent coughing, irregular living, excessive drinking, or the suppression of some accus- tomed discharge, such as the menstrual or hemorrhoidal. It may also be occasioned by breathing air which is too much rarefied to expand the lungs properly. Those who have a nar- row, or very flat chest, are most disposed to this discharge. In these cases, the proportions are not well developed. The shoul- ders are generally prominent; the make is delicate, and the tem- perament sanguine. Even in such persons, the discharge is frequently brought on by the causes above enumerated. Spitting of blood is not always to be considered a primary dis- ease ; it is frequently only a symptom; and in some diseases, such as pleurisy, and inflammation of the lungs, and many fevers, it often occurs, and is a favorable omen. Sometimes spitting of blood is ushered in by a hard, dry cough, and some- times by a cold, shivering fit, and cold extremities, with pains in the back and loins, flatulency, lassitude and costiveness. The blood, as before stated, is generally thin and clear red, and mixed with froth; but when it lies for some time in the air-cells of the lungs, it becomes dark and thick. If no symptom of consump- tion has preceded or accompanies the hemorrhage, or where it leaves behind no cough, or difficulty of breathing, or other affec- tion of the lungs, and where the person is otherwise of a healthy and strong constitution, unless the hemorrhage be very great, it will be attended with no danger. But if the person is of a lax fibre and delicate habit, it will be difficult to cure. It seldom takes place to such a degree as to prove fatal at once, unless there is a rupture of some large blood-vessel. The danger will, therefore, be in proportion as the discharge comes from a large or small blood-vessel. When it proves fatal, in consequence of the rupture of a large blood-vessel, there will be found, on dis- section, a considerable quantity of clotted blood between the lungs and pleura, and there is more or less inflammatory appear- ance in the ruptured part. If the hemorrhage returns frequently, it will be likely to terminate in consumption. HEMOPTYSIS, OR SPITTING OF BLOOD. 127 TREATMENT. In the treatment of this disease, the condition of the system must be taken into consideration. If the patient is robust and full of blood, and the bleeding is likely to be profuse, the patient should be freely bled from the arm; the most abstemious diet should be used, and strict tranquillity observed. The bowels should be kept open with cooling purgatives, such as Epsom salts or Rochelle salts, cream tartar and magnesia, &c. If the hemor- rhage is obstinate, the following medicine should be §l^cn: Recipe: Pulv. Ipecac, twenty grains. Pulv. Opium, two grains. Mix, and divide into ten powders. Give one ,v,ry hour, in sugar, till all are taken. If the hemorrhage shov./i continue, the following may be given : Recipe : Powdered Alum, two drachms Honey Strained, one gill. Mix them well. A tea spoonful may be taken every ten min- utes, till the bleeding stops. If this fails, the patient should cat as much table salt as the stomach will bear without puking. I have known each of the above remedies to have the desired effect in arresting hemorrhage from the lungs. The above rem- edies are generally at hand, and can be used at any time. The following mixture is very good : Recipe : Elixir Vitriol, twenty drops. Water, an ounce and a half. White Sugar, one drachm. Laudanum, twemy drops. Mix, and give it in three portions, fifteen minutes apart. The drink should be cold, and the patient keep quiet. Much benefit is derived sometimes, by placing the hands and feet in warm water for several minutes; this invites the action to the extremi- ties. Dr. Thomas says, " The immersing of the hands and feet in cold water should in no case be neglected in passive hemor- rhage from the lungs." The application of cold water to the genitals in such cases, has several times proved to be a good remedy in my hands. Lemonade is a good drink in such cases. Where the system is very much debilitated, so that blood cannot be taken from the arm, the following medicine should be given ■ Rr.voe: Pulv. Alum, twenty grains. Pulv. Gum kino, twelve grains Pulv. Opium, one grain. 128 HEMOPTYSIS, OK SPITTING OF BLOOD. Mix. and divide into four papers. Give one every hour, in sugar and a few drops of water, till the hemorrhage ceases Or you may give: Recipe : Tincture Kino, half ounce. Tincture Catnehu, half ounce. Laudanum, two drachms. Mix. Give thirty or forty drops for a dose, and repeat every half hour, till the bleeding ceases. Or you may give the follow- ing. Recipe : Sugar Lead, twenty grams. Pulv. Opium, two grains. Mix, and divide into four papers. Give one every half hour, in urgent cases, till all are taken, or the hemorrhage stops. They should be followed by a dose of castor-oil. Digitalis is a popular remedy, and is used by some of our best practitioners. The tincture is not so good as the leaves. The leaves, in a per- fect stale, should be used. Recipe : Leaves of Digitalis, ten grains. Blue Mass, twenty grains. Form ten pills. One may be taken, three times a day, till the pulse strikes only fifty or sixty beats in a minute. In all cases where the hemorrhage is protracted, and the discharge is likely to prove dangerous, a large blister plaster should be applied over the breast. The German physicians have used the hyoscyamus in hemoptysis, with good effect. The dose is half a grain, three times a day, in the form of a pill. After the bleeding is stopped, we should use every means to prevent its return. If it has arisen from a predisposition to hemorrhage, and an inflamma- tory disposition of the system prevails, it may be necessary to use ymall bleedings from the arm, and small blisters over any part of the chest where soreness is located. The bowels should be kept open with some gentle medicine, such as castor-oil, rhu- barb, salts, senna tea, or some of the gentle vegetable pills. A very safe and useful purgative in this disease is : Recipe : Epsom Salts, one ounce. Table Salt, half ounce. Mix them well. A tea spoonful of this may be taken in a full glass of water, before breakfast, dinner and supper, or as often as necessary, to keep the bowels open. At the same time, ■be diet should be light and cooling, mostly vegetable, with milk and bread, mush, rice, barley. All vigorous exertion, either of body or mind, should be avoided. Sailing on the ocean will be HEMOPTYSIS, OR SPITTING OF BLOOD. 129 beneficial; swinging, riding in an easy carriage, or on an easy travelling horse. If the patient is very weakly and delicate, some gentle tonic should be given; and perhaps nothing will be better than the following pill: Recipe: Copperas, burnt and ground, twenty grains. Salts Tartar, twenty grains. A small quantity of Flour. Mix, and form twenty pills. One may be taken before break- fast, dinner and supper; or the following may be taken in their place: Recipe: Citrate of Iron, one drachm. Water, one ounce. Dissolve the iron in the water. A tea spoonful may be taken three times a day ; or the following may be taken: Recipe: Citrated Aromatic Wine of Iron, two ounces. A tea spoonful may be taken three times a day. But if a chilly feeling come on at any time in the day or night, and return again, the following medicine will be better: Recipe : Salicine, forty grains. Water, two ounces. Dissolve the salicine in the water. A tea spoonful may be taken, once in four hours, in sweetened water. Where the lungs are likely to be involved by the spitting of blood, a seton should be introduced in the breast, over the sore part; this should be kept running for some time, and then removed, one thread at a time. An issue of some kind is necessary, and if the seton is objected to, the tartar emetic ointment should be used. (See Materia Medica for directions how to make it.) It should be worn for several days, till pustules are freely raised; or the fol- lowing ointment may be used : Recipe: Tartar Emetic, forty grains. Hog's Lard, half ounce. Mix them well, and apply a portion every day, by rubbing it in with the fingers, till the pustules are raised thick and full. When the pustules are full, they should be opened and dr?ssed with simple cerate. bright. 10 t3G VOMITING OF BLOOD OR HEMATAMESIS. VOMITING OF BLOOD, OR HEMATAMESIS. A bleeding from the stomach may be distinguished from thai of the lungs by its being usually preceded by a sense of weight, pain, or anxiety, in the region of the stomach. It is not accom- panied by a cough, and the blood is discharged in considerable quantities. It is of a dark color, and somewhat grumous. It, at first, is mixed with the contents of the stomach. This disease is caused by anything that will stimulate the stomach very highly, as blows, bruises, or wounds on this organ; in fact, anything that is calculated to cause too great a determination of blood to that organ. There are cases on record where a leech has been swallowed, and the bite caused profuse hemorrhage from the stomach. — Goode. It is frequently a symptom of some other disease; as a suppression of the menses, or of bleeding piles, or obstructions in the liver, spleen, and other viscera, or towards the close of malignant scarlet or typhus fever, and other forms of malignant disease where putrid symp- toms of a high degree prevail. This species of hemorrhage is seldom so profuse as to destroy the patient immediateljr. Dr. Thomas says: " The principal danger seems to arise from the great debility which repeated attacks bring on, or from the lodg- ment of blood in the bowels, which may become putrid, and bring on some other disease." TREATMENT. When hemorrhage takes place from the stomach, in healthy, robust persons, in consequence of suppressed menses or bleeding piles, if the pulse is full and strong, bleeding from the arm will be admissible. If the hemorrhage is induced by a suppression of the menses, in order to prevent a recurrence of it, the means prescribed under that head should be used. See chapter on Suppressed Menses. If the bleeding is profuse, active astrin- gents must be used: Recipe: Gum Kino, ten grains. Sugar of Lead, five grains. Opium, one grain. Make all fine, and give for a dose. This may be repeated every half hour, or hour, according to the urgency of the case; or a tea spoonful of alum may be dissolved in a gill of very cold water, and drank. This may be repeated every half hour, till APOPLEXY. 131 the hemorrhage ceases; or the sugar of lead and opium may be given, as prescribed for bleeding from the lungs. Dr. Thomas says he has seen the happiest effects from the use of the muri- ated tincture of iron. Thirty drops may be taken in a little water, and repeated every hour, till the bleeding stops. D) Hamilton says, he "has seen many cases of active hemorrhage from the stomach in healthy females, where every other course of treatment failed, readily yield to active purging." In all such cases, the bowels should be kept open with gentle purgatives such as castor-oil, Epsom salts, senna tea, form of the dis- ease that we meet with the sterterous, or snnring, breathing. The sterterous breathing depends upon the condition of the windpipe, larynx, and fauces; they being in the same condition, of those of the head, a larger portion of mucus is secreted by the exhalents than can be taken up by the absorbents; in con- sequence of which, it accumulates, and prevents a free flux and reflux of air in respiration; and hence a sterter. though not a 132 APOPLEXY. symptom of apoplexy, as a species, may be ranked as a pa- thognomonic character of the species before us. Drs. Cooke and Boerhaave measure the strength of the attack by the degree of stertor; and Dr. Portal agrees with them in opinion. In such a case, the breast heaves, and the eyes are glassy and the pupils are enlarged. In the beginning of the fit, the breathing is slow, 'aborious, and stertorous; and, in those cases that prove fatal, these symptoms remain to the end. There is not unfrequently i collection of froth or foam in the mouth, which is blown away from the lips with considerable force. The skin is about the ordinary temperature, and covered with a copious perspiration, or a clammy sweat. The pulse is full and hard, and the face is flushed; the eyes are bloodshot and prominent, and generally closed; the cornea, or black of the eye, is glassy and dull, and the pupil, for the most part, dilated; there is a spastic action of the muscles of the face, and this action extends to the limbs, and sometimes with great force; the teeth are frequently clenched; the pupil of the eye, in some cases, instead of being enlarged is contracted till it is not larger than a pin's head. This is a dan- gerous symptom. The paroxysm varies in duration from eight to eight-and-forty hours, and sometimes exceeds this period, Dr. Cooke, of Europe, relates a case of a woman, who lay three days, and then recovered. Where apoplexy does not prove fatal, it is apt to return on the patient, or terminate in palsy, more 01 less general; mostly, however, on one side, in the form of hemi- plegy, in the opposite side of the body from that of the brain affected. This proves that the nerves have their origin in the opposite side of the brain to that of the body which they supply. It is rarely that some of the blood-vessels of the brain are not ruptured in this form of apoplexy, and consequently produce an effusion of blood in some parts of the brain. The rupture is most apt to take place in the medullary substance of the brain, near the lateral ventricles, and a portion of the extravasatcd blood will often escape into these cavities. THE SECOND SPECIES OF APOPLEXY. Is the disease of a constitution infirm by nature, or enfeebled by age, intemperance, or over exertion of body or mind. It is more of a purely nervous character than the preceding variety, and more the result of vascular debility, and of vascular surcharge Mid consequently, where effusion of blood is found, as it often APOPLEXY. 33 is, in the present v jtriety, the vessels nave been ruptured, not from habitual distension, but from slight causes that have pro- duced a sudden determination of blood to the head, beyond which the blood-vessels are incapable of sustaining themselves; hence, a sudden fit of coughing or vomiting, a sudden fright or fit of joy, or an immoderate fit of laughter, or a jar occasioned by a stumble in walking, or a severe jolt, in riding, have brought on the present form of apoplexy; and with so much the more danger, as the system possesses less of a remedial or rally- mg power in itself. In most of these cases, the effusion detected after death has been as purely sanguineous as in the first- described species. Old persons are most liable to this form of me disease. It is not always the case that effusions of blood are found in the brain in apoplexy from debility; but large quantities of serum are sometimes found. Drs. Portal and Abercromby deny that serum is ever effused so as to produce apoplexy. But to rebut this, Boerhaave, Hoffman, Mead, Sav- ages, and Cullin, all say it can; and they cannot be cast off without more proof on the subject. Serous apoplexy, strictly so called, is the result of a debilitated constitution, and especially of debility existing in the excernant vessels of the brain, whether exhalents or absorbents. The extremities in the vessels of the brain, probably perform the office of absorbents. In these cases. a serous effusion, under these circumstances, may take place. From these causes, we frequently meet with apoplexy as the result of general dropsy. This variety of apoplexy rarely makes its attack so suddenly as the other variety. It is com- monly preceded by forewarning symptoms, as vertigo, head- ache, imaginary sounds in the ears, faltering in the speech, a failure in the memory, and at length a sense of drowsiness, and a tendency to spasms. But when the attacks come on, the patient is as completely prostrated as in the other variety, though the symptoms are less violent, but not on this account less alarming, in consequence of the greater debility of the system. The countenance is here pale, or sallow, instead of being flushed^ the pulse is weak and yielding, and sometimes scarcely percep- tible; and the breathing is always heavy and laborious, but not always sterterous. If spasms occur, they are uniformly of the convulsive kind. The duration of the fit varies as in the pre- ceding vaiiety; and if the patient recovers, he is more liable tc a relapse. There is greater danger of palsy after an attack of this variety than the former. *34 APOPLEXY. From these remarks on the two varieties of apoplexy, wb may readily see why this complaint and its ordinary associate, palsy, should be about equally common to the poor and the rich; for frequent exposure to cold and wet, severe and long protracted exercise, and a poor diet, will be often found to produce the same debilitating effects as ease, indolence, luxury, the indulgence in too sumptuous a table, and potations of wine and strong spirits. A::d hence, contrary to what many would evpeet. Sir Gilbert Blane has observed, from accurate tables, kept with minute attention, and derived from a practice of ten years in St. Thomas' Hospital, in Europe, and his private consultation, that " there is a. considerably greater proportion of apoplexies and palsies among the former than among the latter." That is, these diseases bear it greater proportion among the poor than among the rich, com- pared with other diseases. But cases of palsy of one side occur in both classes; in the poor, among the hard-laboring classes, and in the rich, among those who debilitate their systems by voluptuous and exhausting pleasures. In forming your opinion as to the probability of recovery, a special regard must be had Lo the peculiar character of the disease, the habits and the life of the patient, &c. Generally speaking, apoplexy in sanguine per- sons is not so dangerous as it is in weakened and debilitated per- sons; for in the latter, we have not so much to work upon, and the constitution has less power to resist it, and to assist us in the cure. As to the rest, in either modification, the degree of dan- ger will be generally measured by the violence of the symptoms. If the spasms are severe, and the pupil of the eye is much con- tracted, the patient will be almost sure to die. But if the pupil of the eye be very large, though the spasms be very severe, yet «ve have more hope of a recovery. TREATMENT. If we are consulted during the existence of the precursory signs, as noticed above as taking place, we shall often find it in our power to ward off a paroxysm by bleeding and purgatives, and the injunction of perfect quietude and a low diet. Any active purgative in a strong constitution will be proper; but in weak constitutions, the purgative must be more mild. If the patient is much debilitated, it would be better to bleed by leeches or cupping-glasses, applied to the back of the neck or under the mastoid process, than to bleed at the arm. Sometimes purga« APOPLEXY. na- tives alone will ward off the attack. Yet if there should bo much drowsiness, vertigo, swimming in the head, with a dull pain, bleeding will be indispensable; for. in persons subject to this disease, such symptoms will assuredly lead to a fit, if not timely 6ubdued. When the fit has taken place before any remedies have been used, which is almost always the case, the patient, if possible, should be immediately carried into a large, airy room; everything about the neck, ?vA. indeed, about the body, should be loosened, and free air admitted to him. He should be placed in a posture that least favors a determination of blood to the head; the legs and feet, if possible, should be placed in warm water, and stimulating applications be made to them, if he can be kept still enough to have them applied. These remedies are equally applicable to both forms of the disease. The othei remedies to be used must be adapted to the variety of the disease. They will be more easily understood if we give them separately. For the first variety, or sanguine apoplexy. Bleeding is our sheet-anchor; without it, we cannot expect a cure, notwithstanding the opinions of some ancients and moderns to the contrary. All correct observation and experience prove them to be wrong; for in those cases where copious bleeding has spontaneously taken place, from the nose, lungs, or hemorrhoidal vessels, recovery has frequently taken place. We have not only the sanction of all Arabia, as well as Europe generally, but America, for free bleeding in strong apoplexy. It has been made a question, from which arm the blood should be taken. I have not been particular about that circumstance. The great object is to reduce the gen- eral quantum of the blood ; therefore it should run till decided constitutional effects have been produced. 1 have taken from strong, athletic men, who were full of blood, at least three quarts. Indeed, a small bleeding will do more harm than good; for it only causes the arteries to contract upon themselves, and thereby increase the engorgement in the brain. Therefore, bleed till the fit ceases, let the quantity be much or little; and if symp- toms of a returning fit come on, bleed again, either from the arm or by twenty or thirty leeches applied all around the back of the neck and head, at the edge of the hair, from ear to ear. In sup- port of this practice, as well as my own experience, I might cite Sydenham, Wopfer, Boerhaave, Van Sweeten, Morgagni, Baglivi, Savages, Tissot, Mead, Friend, Pitcrain, Hoffman, Cullen, Portal, Cheyne, Cooke, Goode, and many others. The great object of 136 APOPLEXY. bleeding is to bring the whole system under its influence, and to afford time for an absorption of whatever fluid or blood may have been effused. If leeches cannot be conveniently obtained, cups should be freely applied on deep scarifications on the back ">f the neck. The next important means to be used is to open the bowels by an active enema; then follow it by an active cathartic. For the first dose, if the patient is stout and strong, give him Recipe: Calomel, thirty grains. Jalap, forty grains. Mix in sirup. Give it all for a dose. In three hours, follow this with a large dose of castor-oil, or a pint of strong senna tea with an ounce of Epsom salts dissolved in it. Elicit this, in two hours, by an injection of salt and warm water. Cold water or ice should be kept constantly applied to the head ; pouring the water on is better than wet cloths; or bladders filled with ice may be kept on the head. The bowels should be kept open after the first free evacuation by Recipe : Calomel, twenty grams. Aloes, twenty grains. Extract Colocynth, twenty grains. Form ten pills. Give three every four or six hours, so as to act from three to five times in the twenty-four hours. If the gums become a little sore, the cure will be the more certain. The patient should live on gruel, rice-water, or tea, and a little bread soaked in it; his drink may be cold water. The pills may be occasionally changed for castor-oil, senna tea, or E/tsom salts. Treatment of the second variety. Here our treatment must differ in many respects from that used in the first variety, or sanguine apoplexy; but even in this form of the disease, the lancet is often found necessary, though smaller bleedings will be sufficient. Cupping or leeching, however, in these cases, will generally be preferable to the lancet. In this way, we may suc- ceed in taking a sufficiency of blood; without it, we have but little hope of success. After the blood has been taken from the back of the neck and from the temples, dry cupping between the shoulders has been used with good effect. In this form of the disease we must use purgatives, but not in such large dosea The following formulary will be found proper: Recipe: Calomel, forty grains. Rhubarb, twenty grains. HEADACHE. 137 Foim twenty pills. Six may be given at first, and one every hour after, till free purging is produced. Injections should be used to meet them. The pills may be continued, from day to day, (ill the patient spits freely. This will ensure belter success than any other practice. Some persons say they had rather die than be salivated;—in this case they have a fair opportunity to test their faith, for, without a salivation, nine in ten will die. In this form of the disease, blisters should be applied to the wrists and ankles, and the head should be shaved, and a cap made of a blister plaster. If the patient is likely to sink, from debility, some mild stimulants should be given, such as the salts of harts- horn, in three or four grain doses, mixed in sugar, and a few drops of water, or a tea made of sweet marjoram, peppermint, or a few drops of the spirits of lavender, or the sweet spirits of nitre, may be given. It should be kept in mind, that a person once attacked with apoplexy is always liable to a return of it, and should be veiy cautious in his diet and drink; his body and mind should be kept tranquil, and his stomach never should be loaded. He should keep his bowels open, and if he has had an attack from debility, he should take some tonic; the prepara- tions of iron are the best. HEADACHE. STUPID HEADACHE. There are so many species of headache, all of them differing a little in their symptoms and remedies, that it is somewhat dif- ficult to describe every species precisely, without confounding the symptoms more or less. And the remote causes of headache are so numerous and so complicated, that it is difficult to arrange them satisfactorily. Many of the remote causes are so completely concealed from view, by being confined to the brain itself, that we labor in vain to discover and analyze them. Suppressed bleeding piles, repelled or retarded menstruation, or the drying up suddenly of a sore that has discharged a long time, are very frequent causes of some species of headache. A sluggish state of the bowels is another fruitful source of head- ache. Whatever retards the current of blood in the sinuses of the head, will produce headache. Of this kind are various tumors, particularly of the conglobate glands; polypus ; bony fragments 138 HEADACHE. separated by some violence from the internal table of the skull, which perhaps have not produced irritation till the occurrence has so long transpired that it has been forgotten ; hence, some part of the brain, on dissection, has been found in a state of sup- puration. In some cases, the disease has been cured by a dis- charge of pus from the eyes, nose or ears. It has often been produced by a decayed tooth, and has ceased on its removal; a profusion of hair will produce headache, — then it yields to clipping it close, or thinning it out. It has often followed on a neglected catarrh, or neglected rheumatism; and, still oftener, has resulted from some morbid irritation in the stomach, and especially from worms. Again, whatever prevents a free evac- uation of the right auricle and ventricle of the heart, and contrib- utes to retard a free circulation of the blood in the veins which discharge their contents on this side of the heart, has a tendency to lay a foundation for this complaint. From what has been said, it will be readily perceived that it is frequently very difficult to determine what is truly the cause of headache, and whether it be the true original disease, or a symptom of some other. Dr. Cullin regards it as a symptom in every instance, and not without some plausibility. But Dr. Goode says, "This is to suppose that the brain, which, from its magnitude and complexity, seems to open a theatre for more intrinsic disquietude than all other organs whatever, is exempt beyond any of them." The species immediately before us, especially distinguished by 'the name stupid headache, when original, seems to be strictly a nervous affection of the brain, originating from nervous debility, or exhaustion; or, in other words, for a want of a sufficient supply of sensorial fluid, on which the organic feeling of comfort and refreshment depends. It is hence peculiarly marked by dis- quiet and confusion, rather than by acute pain, which disquali- fies a person laboring under it for a continuance of mental labor, and in which the sight is dim, the hearing dull, and the memory vacant. Hard students are frequently the subjects of this species of headache; those who have set up all night in pursuit of some abstruse and difficult subject, or who have labored upon the same from week t:> week, with too small allowance of time for sleep or exercise. In such cases, it may be relieved by sur- rounding the temples with a towel wet in cold water, which gives energy to the enfeebled brain. Sudden and unexpected HEADACHE. ]39 grief will produce this species of. headache, during which the sufferer is incapable of sleeping, or thinking, or attending to any kjud of business. In fact, whatever has a tendency to produce debility of the brain, will produce this species of headache; as a profuse diarrhcea, repeated and immoderate bleeding, and partic- ularly any sudden faintness or debility of the stomach. This last cause acts in a double way : first, by withholding the neces- sary nourishment from the brain ; and, secondl}^ by uVcloro ?.nd direct sympathy that exists between the brain and stomach. Hence, when we meet with this species of headache, and are doubtful to what it is to be referred, we shall, by acting on the stomach, generally relieve it. But, as we have several species of headache to treat of, and the remedies are quite similar, for all that are remediable by medicine, we shall refer you to the treat- ment summed up at the close of the entire description of head- aches. CHRONIC HEADACHE. Perhaps this species of headache is always dependent upon some local irritation, and may be produced by many causes. Probably most of the irritants noticed at the opening of the pre- ceding species will be found to be the cause of this species; and when tins is the case, we need not expect to cure it, for pallia- tives are all that can be used; — the disease will only cease with life itself. It often, however, proceeds from chronic rheumatism, and that has a tendency to intermit. This form of headache will be often found to intermit. This species may be distin- guished by being rather limited to some particular part of the head; by its remissions or intermissions; by the acuteness of the pain on the return of the paroxysm; by an intolerance of all motion of the head, far more than of light or sound, both of which are, however, sometimes very irksome; and by a peculiai feeling of contraction of the brain, as if it was cramped in some- thing very tight. But this last symptom rarely takes place till the disease has been established for some time, and would seem to indicate a thickening of some of the membranes of the brain, from increased action and a long course of irritation ; a result which has been frequently discovered on dissection. When the headache is completely rheumatic, the pain ceases as soon as the rheumatism attacks some other part of the body, for the action becomes transferred. There are, however, intervals' of pain, when the cause is not rheumatic, but proceeds from some irri- 140 # HEALACHE. tating cause in the brain itself, as a tumor in the pcnial gland, or a spike of bone growing down into the brain, or an aneurism of the carotid artery, which has been discovered on dissection. Sir Gilbert Blane particularly describes this aneurism ; he saw two cases of this description made manifest by dissection. A caries of the bone in some of the sutures will produce this form of headache, as I have witnessed within the last four years, in a lady. The caries appeared to be absorbed after some months, and she recovered. We now proceed to the third species of headache. MEGRIMS. Generally speaking, this is a disease of far less importance than the two preceding species. It seems to be sealed chiefly in the externa I integuments of the head', and its principal symptoms are a tenderness on pressure, a slight redness of the skin, and a suffusion of the eyes, and with this there is frequently nausea and sickness at the stomach ; but whether this is a cause or a consequence of the disease, it is not always easy to determine. Indeed, it is most probable that in some instances it is the cause, and in others the effect of the disease. Persons in delicate health are most subject to megrims. They are generally of a relaxed habit and irritable temperament, and are apt to be dyspeptic, and hypochondriacal. In such persons, all the causes of catarrh and rheumatism are sufficient for this purpose, or anything else that will disturb the balance of circu- lation; hence, it is often the result of cold feet, or the chill that follows a badly digested dinner. The megrims often assumes a • periodical character, in which case the pain mostly fixes itself in the same side of the head. In some cases, it is limited to a small spot, with little or no affection of the brain ; but in other cases, it strikes deeply into the head, and reaches down towards the eyes. The eye then cannot endure the least glimmer of light. In many instances, the paroxysms are perfectly regular, return- ing at noon ; but more commonly the attacks are produced by some incidental circumstance, and then the paroxysms are not regular; yet it is more frequently found in the afternoon than in the morning. It is then more apt to occur soon after the diges- tion of the dinner. Sometimes, when it returns in the evening, it continues through the whole night, and the ensuing day, and subsides towards night — the paroxysm lasting about twenty- HEADACHE. 141 four hours. In some very active and robust men, otherwise healthy, it will commence in the morning and last about six hours, and go off, and not return perhaps for six weeks. The fourth species of headache is the THROBBING HEADACHE. Sometimes there is some particular artery, or some portion of an artery, that will not beat in regular time with the heart, and the rest of the arterial system. This anomaly for the most part, depends upon a peculiar nervous irritability of the muscular fibres of the arteries, and is mostly limited to that portion of the artery in which the palpitation occurs; but it may possibly take place in the whole arterial system. When any of the preceding species are grafted on a constitution of this kind, or where one or both of the temporal arteries are of this tendency, or are disposed to run into this anomalous contraction or relaxation, we shall have an instance of the species before us, which commonly origi- nates in this manner. Although it sometimes occurs that the morbid beat of the artery is in accordance with the action of the heart, it is no less a spasmodic action on that account. Thh- species of headache is, therefore, to be considered as of a mors compound character than the rest, in consequence of the pecu- liarity of the constitution in which it occurs, with the exception «f which, its causes and history, as we shall show presently and its mode of treatment, do not materially differ from those oi the other species. SICK HEADACHE. As the last species consists of almost any of the preceding, operating upon a constitution peculiarly predisposed to irregular arterial action, the present consists of the same, operating upon a constitution peculiarly predisposed to irregular action of the alimentary canal. In its general symptoms, it is nearly allied to the stupid headache, and the megrims, but mostly to the latter Sick headache usually shows itself in the morning; but it may vary its hour as well as its length of intermission. The patient awakes in the morning with a pain that rarely affects the whole head, but only some particular part of it, — most frequently the forehead, extending over one or both of the eyes. Sometimes it is fixed near the top of the head, a little to one side; sometimes the back part of the head is the seat of the 142 HEADACHE. pain. In other cases, it darts from one place to another, and varies in its degree of intensity. The person generally has some nausea, and occasionally vomiting. If the vomiting commences in the morning before breakfast, phlegm is mostly thrown up, unless the straining be very hard ; then bile may be mixed with it. After this, the pain soon begins to abate, leaving a soreness about the head, a squeamishness about the stomach, and a gen- eral feeling that causes the person to wish for repose. Perhaps, after a short sleep, he recovers perfectly, only a little weakened by his suffering. The duration of this species of headache differs in different persons. In some, it will subside in two or three hours; in others, it will last twenty-four hours, or longer, and with a violence scarcely to be endured — the least light or noise rendering the pain intolerable. In young persons, the paroxysm goes off soon; but the longer a person is subject to it, the longer the paroxysms will last; and the system becomes extremely debilitated. Its returns are very irregular; some per- sons suffer from it every two or three days, some every two 01 three weeks, and others have longer intervals. Those who take but little exercise, and are inattentive to their diet, suffer most severely. Costiveness, when habitual, is a frequent predisposing cause, and hence a protracted laxity of the bowels is frequently the only cure of the disease. TREATMENT OF ALL THE SPECIES. The connection of all these species of headache is so close, and several of them so apt to run into another, that we have reserved what we have to say on the treatment till we had fully described them all, as we wished to have an opportunity to conclude how far anything like a common plan of treatment would be advantageous, and upon what points they should vary. A very slight recurrence to the history of each species will show, that the causes of headache are local irritation, suddenly checked perspiration, or exposure to cold and damp; a peculiar irrita- bility of the nervous system, and a peculiar condition or idio- syncracy of the temporal arteries, and a morbid condition of the stomach, liver, and bowels. The last is, perhaps, the most common cause; and hence, where there is any doubt as to the specific cause or character of the disease, we cannot do better than to treat it as chiefly appertaining to the fifth species and implicated with the stomach and its coacting organs. It is on HEADACHE. 143 this account that an emetic, followed by an anodyne, will, in most cases, cure the disease in a few hours. Therefore, in the commencement of the attack, if it be in the morning, an emetic should be given: Recipe: Ipecac, twenty grains. Tartar Emetic, three grains. Mix, and give it in the usual way. When the operation is over, an anodyne should be given: Recipe: Opium, one grain. Camphor, two grains. Tartar Emetic, half a grain. Form a pill, which should be taken, and the patient left to rest and repose for two hours; after which, a cup of strong coffee, or tea, may be taken. But if the attack comes on at night, or in the evening, the following pill should be taken, and the patient should go to bed: Recipe: Scammony, twenty grains. Cape Aloes, twenty grains. Puiv. Rhubarb, twenty grains. Castile Soap, twenty grains. Jamaica Ginger, ten grains. Tartar Emetic, three grains. Form twenty-four pills. Three or four of these should be taken at bedtime. They will operate once or twice in the morn- ing, after which the patient will be able to take a light breakfast, and then attend to business. The author has been subject to sick headache for thirty years, and in no case has he failed to obtain relief, in an hour or two, when these pills have been taken in time; that is, before the pain has continued more than two or three hours. When the pain has continued for ten or twelve hours, it requires six or eight pills to operate. The pain will subside long before the pills operate. If due care be taken to take these pills as soon as the patient finds himself costive, he , never will have sick headache. If he is troubled with piles, the above pills will greatly relieve them, and in many instances will cure them entirely. Where the disease is complicated with rheumatism, some sudorific and anodyne should be combined with the purgative; such as a Dover's powder, six or eight grains, given with the purgative. This treatment will generally relieve the pulsatory headache, or the megrims, though in those forms of headache we may sometimes use the following to more advantage: Recipe: Extract of Belladonna, one grain. Extract of Liquorice, four grains. 144 HEADACHE. Mix, and divide into four pills. One of these pills may bo taken every half hour, till the pain is relieved. This medicine will enlarge the pupil of the eye. but that will soon return to its proper size. Or the following mixture may be used: Recipe: Spirits Camphor, half an ounce. Tincture of Valerian, half an ounce. Spirits of Ammonia, half an ounce. Mix them, and give thirty drops every half hour, in a little water, till reliet is obtained. But if you are sure the system is disposed to rheumatism, or if it has been affected by rheu- matism, then you may give the wine of colchicum, fifty drops, three times a day, for a few days, till free purging is produced. Snuffing black pepper, when the brain is debilitated, will give relief, for a time; or the strong acetate of ammonia, applied by wetting a cloth and binding it to the temples, will give relief; or cloths saturated with cold salt water, applied to the head. In all cases, the hair should be kept short and thin upon the head. Dr. Parr, however, thinks differently, and advises that the hair should be allowed to grow. But we must recollect, that in his day and country it was fashionable to shave the head and we?T a wig: he let his hair grow, and wore no wig, and his headache left him. Is it not plain that the head without a wig is cooler than with it? And is it not equally plain that short hair leaves the head cooler than long hair? If the relief was obtained by Keeping the head cool, then I am still right — keep the hair short. • In the intervals of the attacks, in chronic cases, the nitrate of silver is recommended by Dr. Goode; half a grain should be taken, three times a day. in the form of a pill. Blisters have been used to the back of the neck, and even moxa, or cotton, has been burnt on the painful part, where the pain has continued for 'years. By this remedy a cure has been obtained. Early rising, the shower-bath, and active exercise afterwards, and keeping the bowels open, will generally effect a permanent cure. It is said that Linnams cured himself of the megrims, by taking- a hearty draught of cold water every morning, and then walking himself into a perspiration. But we have yet another form of headache, which the above remedies, though palliatives, will not cure, and that is the chronic headache. Here the disease is often produced by a thickening of the membranes of the brain, or by a node or spike of bone on the inside of the skull. In these cases, leeching over TOOTHACHE 145 the painful part, and brisk purgatives are required; and in some cases, a salivation, properly conducted, is proper and necessary; but when all other measures have failed, and the point is clearly defined, the trephine may offer a chance for the patient yet to live. I need not say that an experienced surgeon will be required to perform this operation. By this means, if pus be collected, it will escape, or a spike of bone may be removed, or a thick por- tion of the skull be taken away. Cures have been performed in this way. If the disease be the sequel of gout, rheumatism, or syphilis, the remedies for those diseases must be used. It has been a long time a custom to take twenty drops of laudanum, in a cup of strong coffee, for the headache, and with a good effect; and although the patient does not sleep, he will be relieved for that time. In all cases, the bowels should be kept open, and a strict observance in diet should be attended to. I have frequently relieved headache from debility of the brain by quinine, or salicine, one grain every hour, for ten hours; or by the following: Recipe: Aloes, Socot., thirty grains. Sulph. Quinine, ten grains. Tartar Emetic, one grain. Opium, one grain. Form ten pills. Give one every hour, till all are taken. Early rising, and the cold bath, and active exercise immediately aftei it, so as to produce perspiration, will, in most cases, perform a permanent cure. TOOTHACHE. It may seem unnecessary that we should undertake to describe the toothache, as every one who has experienced it thinks he knows so well what it is. Thai, they certainly know that they have a pain in or about the tooth, no one will dispute; but that the tooth is really the seat of the pain, is very doubtful in many cases. Every tooth has an internal cavity, which commences at the point of its fang or root, and enlarges as it ascends into its body. This cavity is not cellular or rugged, but smooth on its surface; it contains no marrow, but appears to be filled with blood-vessels, a membrane, and nerve. In the interior of this cavity the teeth are peculiarly sensitive, and hence, direct o indirect exposure to the external air, (either through a caries, or BRIGHT. 11 146 TOOTHACHE. indeed in some instances it appears to act through the body of the tooth,) will produce acute pain, and is in part the cause of toothache. The pain thus produced will sometimes cease sud- denly, especially upon the application of an opiate, or some acrid essential oil; but the irritation is often communicated to the periosteum of the tooth, and from thence to the membrane that lines the socket of the tooth, which is only a duplicature of the tme membrane; and hence, the pain will often become per- manent, from the inflammation excited in this membrane, now thickened and tense, and at the same time incapable of relieving itself by stretching; and if a rheumatic or gouty disposition of the system prevail, the pain will become intermittent or peri- odical. In all these cases, wherever we can trace a hole or slit in the tooth, the most effectual way to cure the pain and save the tooth is, to plug it with fine gold; which, if well done, will not only relieve the pain, but save the tooth for years, and per- haps for the remainder of life. Where this cannot be done, the nerve may, as there is a sufficient opening, be destroyed by caustics, introduced through the hole of the tooth, so as to come in contact with the nerve; or the pain may be diminished by the application of opium, in substance, or by wetting a piece of cotton with laudanum, and filling the tooth, or by using the oil of cajeput, cinnamon, cloves, or creosote, in like manner. Indian turnip or smartwort, held in the mouth, will sometimes ease the toothache, especially if the pain is of a rheumatic character. Spirits of camphor, or spirits, held in the mouth, will have a similar effect. Sometimes warm water, and sometimes cold water, will give relief. Tobacco is of the same class of rem- edies. A little of the oil of ambeer, taken from the stem of a pipe, if carefully applied to the nerve, will always give relief; but it should not be swallowed, especially by those who are not in the habit of using tobacco. Electricity has been tried, with good effect, in some cases. A s\,all piece of India rubber may be pressed into the cavity, and then melted with the end of a knitting needle made red-hot, which will effectually fill the cavity and exclude the air, so giving entire relief as long as it lasts. Animal magnetism was, at one time, in Europe, used with considerable effect for toothache, as well as other nervous pains; "and," says Dr. Goode, "if we may credit the writers of a century or a century and a half ago, with instant and specific effect. The grand magnetizer of that day was the then celebrated Valentine Greatrake, who operated by stroking his hands over MORBID HICCOUGH. 147 the part affected; much in the same manner that Mr. Perkins of America, did his metallic tractors." We would add, that we have witnessed this operation for toothache, as well as other pains, and seen speedy relief given. The proper mode of applying animal magnetism for the tooth- ache, is as follows: wet the palm of one hand with spirits of camphor, or strong Cologne, or other spirits, and place it on the side of the face which is not affected, immediately opposite the painful tooth ; then, with the other hand, make quick, light, and rapid friction over the painful tooth, drawing the hand quickly from the angle of the jaw to the chin, making the pass only one way, and in from five to ten minutes, the pain will generally be entirely removed. If the pain be in an upper tooth, the friction should be made from the top of the cheek downwards. When all other remedies fail, and the tooth cannot be saved, then it should be carefully extracted. A tooth, however, never should be extracted till all other means have been tried, unless where much decay exists between the teeth, which will be likely to destroy the contiguous tooth; then, in order to save one, the other should be. extracted immediately. Sometimes the torn arteries bleed profusely after extracting a tooth. To remove this, some strong styptics should be applied, such as the sulphate of copper, (blue vitriol,) or burnt alum, or caustic, or the tinc- ture of catachu, or kino. MORBID HICCOUGH. In morbid hiccough, the spasmodic action exists cniefly m the diaphragm or skirts, but the principal seat of the disease may be the stomach, liver, or nervous system. Hippocrates, a long time ago, declared the principal seat of this disease " is the stomach ;" and Hoffman, in later times, corroborated his opinion. Debility is, perhaps, the ordinary reomte cause, and irritability, or some occasional stimulus, the exciting cause. Thus, an excess of food, especially in a Aveak stomach, is often a sufficient stimulus: and hence the frequency of this complaint among infants, and very old persons, from worms, acidity, or bile in the stomach. External pressure on the stomach is another exciting cause, as a curvature of one or more ribs, or the point of the breast bone, may produce it. The stomach is, however, not the only organ in which the morbid cause which produces hiccough is seated 148 MORBID HICCOUGH. The liver is frequently the seat of the disease. Dr. Percival says, he has frequently found an enlargement or inflammation of the liver to be the cause of morbid hiccough. When this is the case, the inflammation is seated on the upper surface of the liver, where the diaphragm is immediately contiguous to it. , Hiccough often follows upon strangulated hernia, and, accord- ing to Mr. John Hunter, "in numerous instances accompanies local irritation, after operations of various kinds." It has some- times attended the passage of a stone in one of the ureters, and has continued through its entire course. — Darwin. Where the exciting cause is in the stomach, the spasmodic action gener- ally removes it by vomiting If not, a draught of cold water will frequently relieve it, or a few drops of the spirits of camphor in water, or, which is better, the essence of camphor, or a dose of the volatile spirits of hartshorn, as well as the tincture of musk, or asafcetida. Sometimes, holding the breath, and producing a voluntary spasm, of a rigid and revulsive kind, will give relief; strong errhines, as snuff, or varatria, will produce this effect; if the varatria, very minute portions should be taken — gener- ally, smelling the bottle, with the cork out, will be sufficient. A sudden fright, or other strong emotions of the mind, will relieve it. If these remedies fail, we must use opium in large doses, or apply a blister plaster over the stomach. If the hic- cough is produced by inflammation of the liver, the remedies must be addressed to that organ ; first by bleeding, even to faint- ing, then give a brisk purgative of calomel and jalap, following it with opium and tartar emetic—two grains of the former, and four of the latter. Mix, and divide into four powders. One should be given every hour; warm tea should be freely taken, to promote perspiration. A blister applied over the region of the liver, and a low diet will be beneficial. In some cases, an emetic will be proper, and when there is much acid in thf stomach, the super carbonate of soda will give relief—a te? spoonful dissolved in a glass of cold water, uid repeated i' necessary. SNEEZING.—PALPITATION OF THE HEART. 149 SNEEZING. Sneezing is a convulsive motion of the respiratory muscles, commonly excited into action by some irritant applied to the inner membrane of the nose, in the course of which the air from the lungs is forced out, and the lower jaw is forced forward at the same time. It is a common, but rarely a dangerous affection ; although it occasionally becomes troublesome and sometimes dangerous. Some of the German Miscellanies give instances of its having been both permanent and violent, and sometimes peri- odical ; and. in a few cases, of its having proved fatal. There is one case related, where the sneezing, in one paroxysm, continued three hundred times, without intermission. The ordinary causes are, irritants applied to the inner membrane of the nose, a sharp, pungent atmosphere, hardened mucus, the acrimonious fluid secreted in catarrh or measles, or a morbid sensibility of the membrane of the nose itself; but the severest cases have been produced by sympathy with some other organ, as an irritable state of the lungs, stomach or bowels. For the same reason, sneezing often accompanies pregnancy. It may accompany injuries of the head, and sometimes the last stage of low fevers. It is said by some to be the sequel of repelled itch. As sneezing is a symptom of catarrh, it will sometimes call into action all the symptoms of a bad cold. Sneezing, in an ordinary way, is a health)'' action; but when it is morbid, it may be relieved by snuffing warm water up the nose, or ice-water, or laudanum, or spirits; rubbing the nose hard with the finger, or pressing hard upon the upper lip, a little on one side of the centre; bleeding the inside of the nose and snuffing cold water every morning, will prevent a recurrence of the disease. PALPITATION OF THE HEART. This is a subsultory vibration of the heart or arteries. The vibratory and irregular action which we denominate palpitation of the heart, is sometimes sharp and strong, in which case it is called a throbbing of the heart; sometimes the action is soft and feeble, when it is called a fluttering of the heart. It is possible for these to proceed from separate and distinct causes; one, a 150 PALPITATION OF THE HEART. morbid irritability of the muscular fibres of the heart, or some sudden stimulus applied to it, either externally or internally, by which its contraction becomes harsh and unpleasant, and gives 3vidence of spasmodic action. Another cause of these actions is, an irregular motion of the entire organ of the heart, by which it 'iterally strikes against the chest. The cause of this kind of action we do not always know, though we often see it produced by a violent and sudden emotion of the mind. When, however, the substance of the heart is thus irregularly acted upon, and jerked backwards and forwards, from a cause foreign to its healthy action, the palpitation is confined to the pericardium— the membrane that covers the heart. In this case, the pulse is not affected by it. The last is probably the most common cause of the palpitation of this organ. WTe are indebted to Dr. Wil- liam Hunter for having first pointed it out to us. The heart, in its natural state, lies loose and pendulous in the pericardium ; and when the jerk it receives is from an irritation of any kind, the blood is thrown with a peculiar jerk into the aorta, or large artery. The instant it reaches the curvature of this trunk, it encounters so strong a resistance that it produces a strong rebound, in consequence of the aorta being in close con- tact with the spine. The influence of the heart's own action is immediately thrown back against itself, and the heart, being loose, is tilted forward against the chest, between the fifth and sixth ribs, on the leftside. (See Hunter on the Blood.) The rebound of so strong a muscle as the heart against the inside of the chest must depend for its violence upon the violence of the jerk with which the blood is spasmodically thrown into the aorta ; and this has often been so violent as to be distinctly heard by the bystand- ers. The author has counted the pulse by the jerks of the cur- tains produced by every action of the heart. Harstic and Schenck both state, in their writings, that they have known the heart to beat so strongly as to dislocate and break the ribs; this is rather marvellous in our eyes. And Dr. Portal, of Paris, has said that the pulsation has been so strong as to rupture the muscles of the heart. The remote causes of these affections of the heart are rarely certainly known till after death, and, for the most part, seem to depend upon a diseased structure of the heait and pericardium, by which the muscular walls of the heart have either been obstrucied in their play, or have had too much liberty of action The heart has been found ossified, or turned into bone, in its PALPITATION OF THE HEART. 151 general substance, as in the case of Pope Urban VIII.—Goode— but more frequently in its valves, or in its connexions with the aorta. " It has sometimes been thickened, and grown to an enor- mous size—in one instance to a weight not less than fourteen pounds." In other cases, the heart has been peculiarly small and contracted; consequently there has not been a sufficient capacity for the influx of the venous blood. The size of the pericardium has been diminished by inflammation, or an undue growth of fat; this has impeded the heart in its action ; and in other cases it has been filled, or nearly so, with adipose fluid. To these causes may be added a morbid structure of the lungs, spleen, liver, stomach, or intestines. Palpitation of the heart is a frequent accompaniment of these affections, and in these cases the palpitation is always symptomatic. It is also an occasional symptom of dropsy of the chest. In these cases, it shows itself in a very violent manner, especially if the mind be much agitated by fright or anger. We should not, however, be hasty in deciding that the heart is diseased, since the sympathies of this organ are so numerous with so many others. All the above manifestations in action, or nearly all, may be only a functional derangement of that organ. and no actual disease of the heart itself exist; for it has not unfrequently occurred that a palpitation of the heart of long standing has gradually disappeared and left us in the dark as to its real nature. Dr. Cullen gives us a confirmation of the last remark in the following very instructive case: "A gentleman pretty well advanced in in life, Avas frequently attacked with palpitation of the heart, which, by degrees, increased both in frequency and violence, and thus continued for two or three years. As the patient was a member of the profession, he was visited by many of the faculty, who were very unanimously of the opinion that the disease depended upon an organic affection of the heart, and considered it absolutely incurable. This disease, however, after some years, abated, both in its frequency and violence, and, at length, ceased altogether; and since that time, for the space of seven or eight years, the gentleman has remained in perfect health, without the slightest, symptom of his former complaint." Dr. Goode says, "A case precisely similar, and in a professional gentleman, somewhat beyond the middle age of life, also occurred to him, with a spontaneous termination equally favorable." The same alternating spasmodic action into which the muscular sub- 152 FALPITATION OF THE HEART. stance of the heart is occasionally throAvn by some of the causes above stated, seems at times to take place in the larger arteries, and extends, to a greater or less extent, in proportion to the nature of the morbid cause and degree of irritability by which they are affected. That a morbid irritability may exist in one part of an artery, while the rest is free from any such condition, is proved by the observation of many eminent physicians, for it is to be found in organs where it can be traced in the most satis- factory manner; and in the arteries Ave can sometimes trace them to the entire satisfaction of our senses, as, for instance, in case of phlegmonous inflammation, where we find the throbbing sensation or spasm, and relaxation, Avhich constitutes Avhat is meant by palpitation. This action is rarely, and perhaps never, in unison Avith the action of the heart. This must depend upon a local excess of irritability in the arterial tube, and has for its manifestation an alternating spasm and*relaxation, as its effect. Yet inflammation is but one cause of such subsultory action, or of the irritability which gives rise to it; there are other and numerous causes, and wherever they exist, the artery acted upon will evince the same kind of vibratory throb, though the stroke may not be so hard as that found in inflammation. This action may change its seat from artery to artery; and Ave have some cases on record, where the whole arterial system has been so affected. J. J. Rousseau tells us, that after a paroxysm of high bodily excitement, he felt a palpitation throughout his whole system. Avhich he could not only feel, but actually hear, at times, and it lasted throughout his life. The temporal and carotid arteries ^re very apt to take on this action. In these cases, the heart is apt to form the first link in the chain of morbid'action. A vio- lent palpitation of the heart is not an uncommon occurrence in delicate females, in the first months of pregnancy. This action is frequently transferred to the temporal arteries, and lasts for an hour or two, when the patient has a flush of fever, which goes off with a gentle perspiration, and is followed witjft a ,*,ound sleep. The patient awakes in the morning, refreshed and tran- quil. Arterial action is to be found more frequently in the abdomen, immediately in the region of the stomach, than in the head. It depends upon an increased action in the arteries immediately in that region. Persons are frequently alarmed at this palpitation, and think that there is an aneurism in the aorta discendens. PALPITATION OF THE HEART. 153 This palpitation may be distinguished from an aneurism by there being no circumscribed tumor in the part; Avhich maybe known by pressure Avith the fingers. Dr. Baihj, who had much knowl- edge in morbid anatomy, says. '• I am enabled to say that the increased pulsation in the aorta, in the epigastric region, very rarely depends upon any disease of the aorta itself, or of its. 'T.gz branches in that place, and that this occurrence is almost t j\, stantly of very little consequence." TREATMENT. In a disease produced by so great a variety of causes, often obscure, and very generally complicated with other affections, it is impossible to lay down any one plan of treatment that will apply to every case. Our first endeavor should be, as far as we are able, to ascertain whether the palpitation is primary or symptomatic ; and if the last, Avhile we are palliating the present distress, our attention should be chiefly directed to the primary disease. If acrimony, or any other morbid state of the stomach or bowels be suspected, this, as far as possible, should be removed by gentle purgatives, such as ten grains of calomel, Avorked off with a dose of castor-oil; or the compound pill of rhubarb; (see Materia Medica :) and the bowels should be kept open Avith some gentle purgative. If the disease depends upon dropsy of the chest, the remedies for that disease should be used, (Avhich see.) If it is in consequence of pregnancy, use the remedies prescribed there. If it seem to be chiefly dependent upon a general irrita- bility of the circulating system, or of the Avhole constitution, then, opium in small doses, asafcetida, musk, &c, should be given. A light diet, regular rest, keeping the boAvels open, and a cheerful disposition, will be all important, and will sometimes effect a radical cure. Much of this plan will also be requisite when we have reason to believe some structural affection of the heart, or larger blood-vessels, exists; and when, from any unusual excitement, the irritation is more than ordinarily trouble- some, recourse must be had to opium, as by far the best remedy, where it agrees with the system. The black drop, in doses of fifteen or twenty drops, or the sulphate of morphine, in quarter or half grain doses, may be given. The. tincture of the hop, or the lupuline, in tea spoonful doses, or the extract of henbane, in from tAvo to five grain doses, from one to three times a day, or in twenty-four hours. In these cases, the extract of hemlock 154 JAUNDICE. has been used, in similar doses, Avith good effect. Sometimes one of these medicines will succeed after the rest have failed. Hen- bane, however, of all these remedies, has proved most beneficial; it has effected cures Avhen all other remedies have failed. The tincture of digitalis has been highly extolled, in these cases; but I must say, it has failed, in my hands, to give any relief. Musk, in some cases, has done good, in doses of ten grains each; it should be repeated according to the urgency of the case. This disease has been cured by the sudden attack of some other, as gout, or some disease of the skin, or a copious Aoav of urine, or the formation of an abscess. Hence, setons have been recom- mended and used; and no doubt, Avhere the disease is the sequel of the sudden healing of a long discharging sore, issues Avill be good. Gum camphor and other aromatics have been worn on the stomach, for this disease. In all cases, absolute quietude, open bowels, and a light diet, are all important. JAUNDICE. This is a disease of more importance than is generally sup- posed by superficial observers. There are four natural and proper divisions of jaundice. We, therefore, in order to make the subject plainer, shall describe them separately, and give the causes and treatment of each species, (if the term species is admissible here,) under its appropriate head. And first, OF BILIARY JAUNDICE. In this species, the course of the bile is obstructed by its OAvn viscidity; there is general languor, nausea, with dyspeptic symptoms, Avith occasional pain and uneasiness at the stomach. This species occurs most frequently in the fall of the year, after the finer parts of the animal fluids have been for some Aveeks carried off disproportionably, by continued perspiration. This disease, in many instances, commences slowly, and progresses insidiously. There is felt a general restlessness and loss of appetite, and disturbed sleep, Avith a disinclination for exertion if any kind. The urine is of a deep yellow color, and generally deposites a pitchy sediment. The bowels become sluggish, and the stools are light or clay colored. The whites of the eyes and JAUNDICE. 155 skin look yelloAver than usual; and there is not unfrequently an itching of the skin. In this sppcies, there is little or no pain in the right side, and little or no sickness at the stomach, though a frequent nausea. TREATMENT. In the early stages of this variety, free vomiting is of great benefit. Tartar emetic alone, is better than anything else; it should be given in the usual Avay. It is important that the patient puke freely. As soon as the operation is over, and the patient is suffered to rest for an hour or two, the folloAving pur- gative should be given : Recipe: Calomel, twenty grains. Rhubarb, ten grains. Mix, and give it for a dose. If this medicine produce yellow discharges towards the end of its operating, then the folloAving should be given: Recipe : Rhubarb, twenty grains. Aloes, twenty grains. Castile Soap, twenty grains. Tartar Emetic, two grains. Form tAventy pills. Three or four of these should be taken every night at bedtime, so as to produce one or tAvo free motions in the morning; and the folloAving tonic may be used: Recipe : Sulphate Quinine, ten grains. Sulphuric Acid, five drops. Pure Water, one ounce. Mix. Give a tea spoonful, three times a day, in Avater; or, n the patient cannot take quinine, the folloAving may be given : Recipe: Salicine, twenty grains. Pure Water, one ounce. Mix, and take as above directed. If neither can be conven- iently had, the following bitters may be taken : Recipe : Dogwood Bark, one ounce. Yellow Poplar Bark, one ounce. Camomile Tops, one ounce. Make all fine, and add to them one pint of good spirits and one of Avater. Shake the bottle every day, for three or four days. Take two table spoonfuls at a time, three times a day. The • infusion of wild cherry bark is a good tonic in this disease; one ounce of the bark, put into a quart of water at night and drank the next day, will be of much benefit. It should be continued from day to day, for some time Or you may take the following: 156 JAUNDICE. one tea spoonful of the sanguinaria, (percoon root,) dried and pulverized, put into a pint of warm Avater, at night; wliich should all be drank the next day. In a feAv days, the yellowness will all disappear. A strong bitter, made of the root of the silk- Aveed, and drank, so as to keep up a gentle action on the bowels, for several days or Aveeks, as the case may require, is a popular remedy, and by no means an inefficient one. JAUNDICE FROM GALL STONES. The free discharge of the bile, in this species, is obstructed by bilious concretions, lodged in the gall duct, Avhich occasionally escape, and are discharged with the fasces in small lumps. This disease is attended Avith frequent retching, and acute pain in the region of the stomach and liver, Avhich is increased upon eating. It is so closely connected Avith the following species, or variety, that we shall only give the prominent symptoms here, and leave the treatment to be given in the next variety. Yet it is neces- sary to give each variety its appropriate symptoms. There may be yellowness of the skin, and urine, and great pain in the region of the gall ducts, and yet the liver may be sound. But it is often functionally connected with a morbid condition of this organ, by which the bile becomes disposed to concrete. Dissections have shown that the seat of the obstruc- tion is most frequently in the systic duct; next in the ductus co- ledicus, and then in the hepatic duct. The remaining symptoms will be given in the next variety. SPASMODIC JAUNDICE. In this variety, the course of the bile is obstructed by a spas- modic contraction in the course of the bile ducts. The attack is commonly caused by the taking of acrimonious food, by hyster- ics, or some violent passion of the mind, and spontaneously sub- sides in a few days after the exciting cause is removed. The general symptoms of this affection are those of the preceding variety; but the causes of the disease are different, and the mode of treatment, in some respects, differs also. It is necessary, therefore, to attend to their specific signs, in order that they may be accurately distinguished the one from the other. Spasmodic jaundice, for the most part, occurs in persons of an irritable habit, or in those whose liver has become affected from a long residence in hot climates, or from an undue indulgence in JAUNDICE. .57 spirituous liquors and highly seasoned food, or frtm any other cause that will produce a state of chronic irritability. So far as 1 have observed, it occurs more frequently in delicate than robust constitutions, and in ladies Avho live a very sedentary life, and chiefly after the catamenia has ceased, and the general form has assumed a more corpulent shape. There is, also, in those who are subject to it, a salloAvness of the skin, indicate of irritability, and of a larger regurgitation of bile into the blood-vessels than is necessary for health. Notwithstanding all this, the liver may be perfectly sound; for the irritability may be confined to the gall ducts alone. But it may commence in the liver itself, and from thence extend to the gall ducts, which, from their structure, are far more irritable, as Avell as more sensitive, than the liver itself, and consequently susceptible of more pain and spasmodic action. We cannot always trace the primary cause of this disease; one thing, however, Ave do know: it is easily produced, in those Avho are subject to it, by flatulency, acrimonious and indigestible food, or by violent mental emotions. It may be reproduced or reex- cited by the application of cold to the feet, drinking cold Avater when the body is overheated, or by a transfer of atonic gout from the extremities to the stomach or the intestines. The disease is ushered in by a sense of great languor and ful- ness in the stomach, accompanied with nausea; a violent pain at the pit of the stomach soon succeeds, with almost an incessant sickness, and an utter inability of retaining either food or medi- cine on the stomach The pain grows more severe, and shoots towards the left shoulder, or spreads around the loins, and girds them as Avith a cord. The region of the stomach is greatly dis- tended, and cannot endure the pressure of the hand, Avhile the pulse exhibits but little variation from the standard of health. The boAvels are generally costive, and moved Avith difficulty. The urine soon evinces a deep saffron tint, and the sooner in pro- portion to the violence of the other symptoms. The Avhite of the eye, also, becomes yellow, and if the disease becomes chronic, the yellowness pervades the Avhole body, so that the organs inter- nally, as well as the surface externally, and all the fluids, partake of the yellow tinge. Perhaps the last fluid that becomes tinged is the milk. Whilst the bile ducts are firmly locked, the fasces are without bile, and are whitish or clay-colored. The whole mass of blood is so impregnated with bile, that the solids are filled with it; hence everything the patient tastes has a bitter 0.1 bilious taste. The deeply jaundiced generally see everything of 9 158 JAUNDICE. yelloAV hue, as they appear to us Avhen looking through a yellow object-glass. Though this is sometimes the case, it is not always so. This, as Avell as the other varieties of jaundice, may become chronic. When this is the case, the distressing symptoms of spasmodic pains, SAvellings, &c. subside, although the bile does not flow freely into the proper channels, but continues, in a greater or less degree, to be absorbed and carried into the circula- tion. The cause of this seems to be an insensibility in the bile ducts, almost approaching to palsy. Under these circumstances, the bile that finds its Avay into the duodenum must be grosser than it is in a healthy state, and hence another cause of retard- ation and a deficient supply. Consequently, there is a change in the color, as well as the consistency of the bile, in chronic jaundice. This, no doubt, is sometimes the result of a morbid secretion, and sometimes of a chemical decomposition, from the joint influence of delay and animal heat; it being out of the cir- culation, under these circumstances the bile has at different times, and in different persons, been found acid, saltish, insipid, Avhitish, blackish, greenish, and variegated in color. It has been found dense and dark, or as tenacious and limpid as the white of an egg, or as crowded and granular as the spaAvn of frogs.— Goode. In this chronic form, jaundice has run on for a long time, even for months or years. It has alternated itself Avith intermittents; proved a salutary crisis for fevers, or it has itself been carried off by some eruptive form of fever; especially by miliary or scarlet fever. When the constitution has been habit- uated to it, the general functions are but little disturbed, so that persons may go about and perform light Avork. TREATMENT. In the treatment of this variety of jaundice, emetics are profita- ble in the commencement of the cure; but they should be mild, such as ipecac, or seneca snake-root, made into a tea. This will relie\'e the stomach and bowels of any crude matter that may be lodged there; but avhere these are not suspected to exist, emetics should not be used. When the spasms are severe, and the patient is of a full habit, bleeding should be resorted to Avithout delay. The Avarm bath should be used, and opiates adminis- tered : opium, in a solid form, is preferable to laudanum. The opium should be given in one or tAvo grain pills, and repeated as often as the stomach rejects it, till it is retained. Flannels, wet JAUNDICE. 159 in laudanum or hot spirits, should be applied to the region of the stomach. Blisters over the stomach are a doubtful remedy in this disease; if they are used at all, they should be applied to prevent, and not to arrest, a paroxysm. The general soreness upon pressure, and the excitement of the absorbents of the liver, as already observed, very frequently continue for several Aveeks after the spasm has subsided ; consequently, there will be great languor and indisposition to exercise, and a taAvny skin. The bowels should be kept in a soluble condition, by gentle aperient medicines, such as the following pill: Recipe: Blue Mass, twenty grains. Aloes Cape, twenty grains. Pulv. Rhubarb, forty grains. Castile Soap, forty grains. Mix all well together, and form forty pills. From five to six of these may be given every night, or as often as it becomes necessary to keep the boAvels open. As soon as the patient is able, he should take exercise on horseback, go into cheerful com- pany, and use a generous but light diet. At the same time, a tonic composed of vegetable bitters should be used. Recipe: Gentian Root, one ounce. Orange Peel, one ounce. Columbo Root, one ounce. Quassia Wood, one ounce. Make all fine, and add to them half a gallon of old Avhiskey. Shake the bottle every day, for three or four days. Take a table spoonful three times a day, in Avater. The German Avriters have extolled the seed of the common hemp very highly. They recommend that it should be boiled in milk till the seeds burst — they are then to be eaten. The Germans say, that Avhen boiled to an emulsion, and taken, even during the spasmodic pain, they afford astonishing relief. Herlez says, •' This remedy Avas of eminent service in an epidemic jaundice that prevailed at Gottingen." The dandelion has been highly extolled by many Avriters of celebrity, in this disease. The roots or leaves may be used—an ounce of either to a pint of Avater, simmered till the strength is all out, and the tea drank in the space of tAventy-four hours; or the extract may be used in five grain pills. From four to tAvelve may be taken in twenty-four hours, as the stomach will bear them. The alkalies are useful in such cases; if they do not dissolve the bile in the gall ducts, they answer the pur- pose of the bile in the boAvels, and keep them lubricated. A piece of castile soap as large as a hazel-nut may be taken every 160 JAUNDICE. day, or hal-f a tea spoonful of the salts of tartar may be taken in Avater, three or four times a day. The acids are of eminent service in chronic cases of jaun- dice. The nitro-muriatic acid is made by mixing equal parts of the tAvo acids together. Ten drops of this may be taken in Avater, three times a day. It should be sucked through a quill. It is also very useful Avhen used as a bath. When it is to be used as a bath, a pint of the acid mixture is first to be added slowly to a pint of Avater; a tube to fit the feet and legs is then to be made; this should be half filled Avith warm Avater. Three ounces of this diluted mixture should be put into every gallon of the water. The feet and legs must be placed in this bath and kept there till the skin tingles as if it had been stung by nettles. This Avill require from tAventy to thirty minutes. The region of the liver and stomach may be bathed with the acid every day, of the same strength that the foot-bath is made. The foot-bath should be used tAvice a day. I have seen the happiest effects result from its use. It frequently, after a feAv days, Avill produce thick, green discharges from the boAvels. The author cured a chronic case of this disease, of more than a year's standing, Avith this bath. In all cases, the bath should be continued till a strong tingling sensation is felt in the skin. It has -been used as a general bath up to the neck, in some cases, with astonishing effect. Therefore, as a general application, the patient may be sponged all over the body, as well as the limbs. Dr. Scott had the Duke of Wellington plunged into this bath up to his chin, with decided benefit. The bath, when properly prepared, Avill taste about as strong as common vinegar. It should not be alloAved to touch the clothing, for it will very soon destroy it. HEPATIC JAUNDICE. This form of jaundice is different from the other three varieties, both in its origin, and in the remedies necessary for its cure. The causes are, derangement of the liver from scirrhus, or other indurations of the liver or its ducts, or from tumors or hard knots on the ducts, Avhich obstruct the free circulation of the bile. In the preceding variety, the gall bladder, or the gall ducts, are the chief seat of the disease; at least, in its commencement. In the variety before us, the seat of the disease is in the liver itself. Most generally, the preceding variety, when it becomes chronic, may lay the foundation for this variety. The course of the bile IAUNDICE. 161 is evidently obstructed, but rather in its secretion than in the ducts. After it has been secreted, Boerhaave, Savages, Culler^ Richter, Vogel, and Selle, all suppose it to depend upon some irritation in the liver itself, or in the whole hepatic system; but not an irritation dependent upon, or directly leading to, inflam- mation. — Goode. This irritation is of various kinds, and pro- duces different effects; but all become causes of obstruction to a free Aoav of the bile into its proper channels. One of the most common effects which operate in this manner, is scirrhus—an enlargement of the Avhole, or some part of the liver. Another is an accumulation of the calculous secretions in its substance. Another cause arises from tumors growing on the gall ducts, or even Avithin them; so that by their pressure the passage is entirely obstructed. This is the Avorst form in which jaundice can possibly make its appearance. Although there is little or no pain, it shows that there is disease in the structure of the liver. It is frequently an evidence of a broken-doAvn constitution. It is rarely found in the young and vigorous, but generally in those who have drank hard, or lived hard, and especially those who have been exposed to much labor in hot climates, or have suffered under repeated attacks of intermittent fever of various types. TREATMENT. It is a melancholy fact, that the art of medicine here often fails to perform a radical cure; but we must use those remedies that are best calculated to afford relief. If the remedies are used in time and properly administered, Ave have some prospect of doing good. The most efficient remedy here, is mercury; but this should not be given to salivation. The blue mass, if good, — (and here I Avould remark, that no blue mass under five years old, can be relied on, and as much older as you can get it, the better.) — may be given in a pill containing five grains, night and morning, as an alterative, till the gums are slightly SAVollen. It should then be Avithheld for several days, and a dose of rhubarb and Castile soap given, to work it off. Fifteen grains of each Avill form six pills for a dose. After tAvo operations per day have been procured in this Avay, for a feAv days, the blue mass may be again resumed, and continued for a time. Then, the iodide of potassium may be given. Recipe: Iodide Potassa, twenty (Trains Water, two ounces. BRIGHT. 12 162 JAUNDICE. Dissolve the medicine in the Avater, and take a tea spoonful three times a day; if a scirrhous state of the liver be suspected, the iodine may be used instead of the potassa. A large plaster of the blue ointment and ammonia should be Avorn over the region of the liver for a long time The nitro muriatic bath may be used, as before directed. A generous diet, and such exercise as the patient can bear, should be taken. Frequent friction over the region of the stomach and liver, Avith the hand, will be found serviceable. In some cases, small portions of Epsom salts have been serviceable; a tea spoonful taken every morning, dissolved in half a pint of water. It should be taken half an hour before breakfast. BLACK JAUNDICE, OR GREEN JAUNDICE. This variety of jaundice is characterized by occasional ejec- tions of dark or pitchy bile, intermixed Avith the faeces, am occasionally vomiting of yelloAvish-green and acrid matter from the stomach. Great languor attends these symptoms, which is often accompanied Avith vertigo. There is no pain in the stomach, but there is a tenderness on pressure there. In this form of jaundice, the liver is evidently diseased in its structure, and a morbid, deep colored bile, darkish or greenish, is secreted, instead of the natural, yelloAV, healthy bile. This bile seems to have lingered in the biliary passages ; the finer part of the fluid is first absorbed, and aftenvards the grosser, and Avhat remains becomes still more viscid, more stagnant, and of a deeper hue. Perhaps it may be truly said, in the AVOrds of Dr. Marcard, that "black jaundice means nothing more than yelloAV jaundice of a more than usually deep dye;" yet Avhen the real disease exists to Avhich this name should be limited, no practitioner, Avho examines the very peculiar dark hue of the skin and secretions, and reflects upon the danger that accompanies it, can avoid the conclusion that it has something peculiar in its nature, and cannot be merely an intense degree of yelloAV jaundice. It is highly probable, that a part of the dark hue may be OAving to some peculiar secretion combined Avith the bile in a state of morbid secretion. But along Avith this, there is a very great structural decay in the biliary organs, as Avell as the decay Avhich gives the chief character to the disease; Avhich so frequently prevents all beneficial effects from the best medical treatment, and, con- sequently, renders the disease so often fatal. The green jaundice is sometimes to be found in the young, but JAUNDICE. 163 more frequently, in the middle and advanced periods of life. It occurs more frequently in men than in Avomen, probably on account of the greater Avear and tear of their constitutions, and being exposed to all Aveathers, and all climates; and it appears to be less connected with intemperance than yellow jaundice, and less disposed to terminate in dropsy. The hardness and enlargement of the liver, in many instances, runs through the entire structure of the organ, but perhaps is more particularly confined to some particular part. Upon press- ing the region of the liver, the patient is generally sensible of some particular hardness, but, otherAvise, it is rare for him to feel any pain Avhatever. There is frequently a distressing itching of the skin, and sometimes a troublesome sensation of heat in the palms of the hands and soles of the feet. In some cases, the pulsations are natural, but in other cases they are slower than in health. They sometimes do not number more than forty or fifty beats in a minute. The stools are generally pale, but occasionally they are tinged Avith bile, of a peculiar dark or pitchy color, a part of Avhich sometimes rushes into the stomach and is vomited up. The urine is deeply loaded Avith the same, and tinges the linen of a dark, tawny hue; it Aoavs freely, and sometimes deposits a pinky sediment. The appetite varies, and the stomach is very capricious. Sometimes it will take any kind of food, and, at others, it will take none at all. The progress of the disease is ahvays slow, and it may continue for three, four, or even seven years. The person rarely recovers his color, if he survives the disease. If he recovers, it generally becomes a few shades lighter, but its traces are ahvays visible in the face. When the pulse is uncommonly sIoav, it is generally accom- panied Avith some disease of the head, and particularly apo- plectic or epileptic fits; evidently, from the sluggishness of the circulating poAvers, and the necessary predisposition to con- gestion. TREATMENT. As the causes of this disease have never been properly defined, its medical treatment is indecisive. Mercury rarely does much good here. Dr. Baily thinks he has found neutral salts of service. One tea spoonful of Epsom salts may be taken every morning, in a glass of Avater. But Dr. Goode says: " Calomel combined with antimony, is of great service." Then it may be used in the following form. 164 ASTHMA. Recipe: Calomel, ten grains. Tartar Emetic, two grains Form ten pills, and take one every four or six lours. Or, calomel, ten grains, and sulphur el of antimony, precipitated, ten grains. Form tAventy pills. Give one three times a day. The above pills may ha\re combined Avith each one of them one grain of gum myrrh or gum guaiacum. The tonic bitters, as advised in the preceding variety, may be used here Avith the hydriodate of potash, as directed in the other species, or the iodide of potas- sium, given in similar doses. The nitro muriatic bath should certainly be tried in this form of the disease; it should also be taken freely internally. An easily digested diet and proper exer- cise should be used in all cases of jaundice. ASTHMA. Asthma is defined in the following terms: The difficulty of breathing is temporary; it recurs in paroxysms, accompanied with a Avheezing sound, and sense of suffocation in the chest, with a cough and expectoration toAvards the close of the paroxysm. Asthma is a disease mostly of the latter periods of life, though the young are sometimes the subjects of it. Asthma soon becomes habitual, and in some cases no doubt, is hereditary. All tem- peraments are subject to it, but more particularly the melancholic, or that Avhich is a compound of the melancholic and sanguine. The paroxysms of asthma are universally preceded by languor, flatulency, headache, heaviness over the eyes, pale urine, dis- turbed rest, and a sense of straitness and anxiety about the diaphragm. At the approach of the attack, the Aveight over the eyes becomes oppressive, and the patient becomes sleepy. Fre- quently at this period, there is a tingling and heat in the ears, neck, and breast, Avith an inclination to expel the contents of the boAvels, Avith great uneasiness of the abdominal muscles. When an asthmatic feels these Avamings, he may be convinced that hia enemy is at hand. The attack generally comes on about the middle of the night, and during the first deep sleep. The cause of this has not been rendered satisfactory by any one Avho has written on the subject. For the most part, the patient Avakes suddenly, and feels a distressing tightness about the chest, as if he Avere bound with cords; his anxiety is inexpressible, and he .ahors for breath as though every one would be his last. He is asthma. 105 obliged to sit erect, almost breathless, and his distressful breathing has a Avheezing sound; he cannot bear the Aveight of the bed- clothes ; he expresses a great desire for cool, fresh air; at the same time the extremities are cold; the heart palpitates; the pulse is sometimes quickened, but usually Aveak, irregular, and often inter- mitting. The abdomen is distended with flatulence; the stomach is Aveak, and often ejects, Avith great violence, a slimy and frothy substance of a greenish or yelloAvish color. The eyes have a prom- inent stare, and the face is someAvhat bloated, and pale or livid. About this time, the patient, though costive before, is apt to pass a bose stool. There is a dry, hard cough, Avhich brings up nothing but a little frothy mucus. The fit may subside, or leave the patient entirely, in tAvo or three hours. But in other instances, the cough is far more violent and suffocative, though, in an hour or two, a tough, viscid mucus is secreted, which gradually becomes copious. and affords relief. From the severity of the struggle, the mucus is occasionally mixed with blood. But the larger the discharge of either, or both, the sooner the breathing will become easier. The paroxysm may, hoAvever. last for several hours, and the patient generally feels some degree of constriction during the Avhole of the preceding day. He is fortunate if the next night is passed without a return of the fit. The tendency to a return of the fit usually remains for several nights, and in some cases, for one or tAvo Aveeks. I have known cases Avhere they recurred every night for more than a month; during the whole of Avhich time the patient Avas obliged to sit up in an arm-chair. NotAvithstanding the violence of these paroxysms, the patient rarely dies in one of them. Asthmatic patients not unfrequently live to an old age, if they are not carried off by some other disease. In humid asthma, the paroxysm goes off by the discharge of a quantity of phlegm from the lungs; but in dry or nervous asthma the paroxysm may commence and end Avith but little expectoration, if any, of mucus from the lungs. The humid asthma is always worse in damp weather, and the spasmodic, or dry asthma, in dry weather, Avhen the air is dry and hot. Nervous, or dry asthma is most apt to occur under circumstances that try the nervous system; a sudden emotion of the mind will give rise to it; alter- ation of the wind to some other point of the compass; a change of residence, or a full meal that is not easily digested, may prove its exciter. But it frequently makes its attacks Avithout any KnoAvn cause; but suddenly repelled eruptions from the skin are \ frequent cause of asthma, and the restoring of such eruption will 106 AS HIM A. frequently remove the asthmatic disposition. The sudden disap- pearance of gout or rheumatism, in the hand or foot, or of piles, may become the source of asthma; and restoring the disease to the part from Avhich it Avas repelled, Avill cure that form of asthma. Asthma may be produced by the inhaling of the fumes of metals md other mineral substances, or by clouds of common smoke or dust. The fogs and mists Avhich are witnessed in large cities, are a fruitful source of asthma, and asthmatics are frequently obliged to leave them in October and November, for a drier and more wholesome atmosphere. These are patients Avho are laboring under humid asthma. But, on the contrary, those Avho are labor- ing under the dry or nervous asthma, long for, and seek after, such an atmosphere. Hence, Ave can readily see Avhy some patients can only live in high, dry, mountainous situations, while others can only live in moist valleys. It is related by some emi- nent Avriters, that the smell of aromatic flowers will produce a paroxysm of asthma; as the rose, or the dust of ipecac, &e. Tf young persons avIio are subject to asthma become very fat or round-shouldered, they are not apt to live long. TREATMENT. In the treatment of asthma, Ave must keep in vieAV the character of the species Ave haAre to treat; Avhether it is the dry spasmodic, or the humid species; also, the age and constitution of the patient, and the state of the system when the paroxysm is off. If the patient is young and plethoric, bleeding Avill be of service; but in old persons, bleeding must be resorted to Avith great care. The boAvels should be opened by gentle purgatives, and if the patient be bilious, a dose of calomel and rhubarb Avill be the best; but full purging, except in cases of a full habit, should not be resorted to. A more certain remedy will be found in emetics, of Avhich the ipecac, is certainly the best. This should not be carried to full and hard puking, but the stomach should be kept constantly nauseated, so as to puke occasionally. If the paroxysm be severe and the breathing excessively difficult, a dose of lobelia will often shorten the paroxysm. The ethereal tincture of valerian some- times affords immediate relief; a tea spoonful may be given every ten minutes, in water, till five or six portions are taken. If any acid be present on the stomach, the supercarbonate of soda, dis- solved in Avater, will give relief, by SAveetening the stomach. Wetting a piece of broAvn paper in a strong solution of saltpetre, ASTHMA. 167 drying it by the fire, and burning it in the room where the patien\ is, will, in some cases, give speedy relief. The patient should inhale the smoke. A blister on the chest, in some instances, will keep off the paroxysm the next night. I am acquainted with an old gentleman Avho keeps off the paroxysms for weeks, by eating a piece of rosin, as large as a hazel-nut, every day. Strong coffee is said by Sir John Floyer, not only to relieve the paroxysm, but to keep it off for a long time. The coffee should be the best Mocha, and made very strong, immediately after burning it; an ounce should be draAvn for one cup, and taken without milk or sugar. This may be repeated in an hour, if the first cup should not relieve the paroxysm. Opium should never be used in asthma; it invariably does harm, and the succeeding paroxysm comes on sooner than it otherwise would. Some Avriters recommend Dover's powder, but the opium in this medicine renders it of doubtful utility. When the disease is chiefly dependent on a morbid habit, the anti-spas- modics will be serviceable, such as musk, castor, valerian, cam- phor, or asafaetida; but even these will derive a great advantage by being combined Avith tartar emetic or ipecac. The hyoscyamus may be combined with ipecac, half a grain of the former with four grains of the latter, to be repeated every hour, till the lungs are relieved; then stop, as the effect will increase for several hou rs after. Where the feet and legs are disposed to swell, active diuretics are demanded, such as saltpetre, in eight or ten grain doses, dissolved in parsley tea, and repeated every half hour. The chinopodium, or Jerusalem oak, or Avormseed, as it is com- monly called, is said by some to be a good remedy. The leaves of the plant may be boiled in milk and water, and drank freely. or the dried leaves may be poAvdered, and a tea spoonful taken in molasses, and repeated every hour, till relief is obtained. The squill is, hoAvever, a better remedy. It may be given in the form of sirup, in doses of a tea spoonful, every hour. If it should puke the patient much, the dose may be lessened, or a small portion of paregoric may be added to each dose. Watch that it does not act too freely on the kidneys. This medicine is useful in both forms of asthma. The Seneca snake-root is a valuable remedy in asthma, after the operation of a dose of calomel. It may he given in the form of tea, as much and as often as the stomach Avill bear, Avithout puking freely; a slight nausea from it is desir- able. Dr. Bree recommends, after puking, in humid asthma, " that ar. ounce of good vinegar, with from one to three grains of 168 ASTHMA. ipecac, and a small quantity of Avater, be taken every tAvo 01 three hours, which will lighten the paroxysm, and tend to the surface." He also uses the following formula: Recipe : Henbane, three grains. Nitric Acid, five drops. Tincture Squills, ten drops. Mix all in a convenient quantity of water, and take it for a dose. He repeats it every three or four hours during the parox- ysm. He says this has given relief when all other remedies have failed. The Avarm bath should never be used in asthma, as it debili- tates too much. In weak and relaxed habits, the cold bath betAveen the paroxysms will be of great service. In such consti- tutions, tonics should be given in the inteiwals between the par- oxysms. Some physicians recommend the vegetable tonics; but the author has found the mineral tonics to have a better effect. The best preparation is the citrated aromatic wine of iron. A tea spoonful may be taken three times a day, in sweetened Avater. Smoking the dried leaves or root of the stramonium, (James- town Aveed,) is one of the best remedies to keep off an attack of asthma. The tobacco has been used for that purpose, but it is not equal to the stramonium. Issues placed in the arm, and kept running, are a favorite remedy Avith some authors; the French recommend them highly. If the patient has been the subject of bleeding piles, and they have ceased to discharge, they should be brought on again. If any long-standing eruption, suddenly cured, has been the cause of asthma, it should be brought b&.ck again ; as the itch, &c. The patient should live on a generous but easily digested diet, such as Mocha coffee and light mf \ts; little or no fruits, except oranges. Ginger tea and acidu! tied waters will be good. When asthma is dependent on indigc ;tion or dyspepsia, or an affection of the liver, stomach or bowel \ the primary disease should be cured, or no cure can be expect 3d of the asthma. Exercise on horseback is good. If it is a man Avho is laboring under this disease, ploughing in the spring and sum- mer, that he may smell the fresh earth, Avill be beneficial to him. The feet should always be comfortably clad, and kept dry. DROPSY. 159 DROPSY. Dropsy is susceptible of being divided into several differen* fonns, according to the parts principally affected ; but Ave design to treat all the various forms that are common to grown persons under this general head; dividing, however, the important modi- fications of the disease by sections, in Avhich the symptoms and treatment will be specially given, according to the form Avhich the disease assumes, and the particular place where it is found. We shall first notice that form of dropsy Avhich makes its appearance in the cellular substance. This variety of dropsy may extend through the cellular substance of the Avhole body. The second variety is limited to the cellular membrane of the limbs, and chiefly of the feet and ankles; it is most manifest in the evening. The third variety not only has SAvelling in the feet and ankles, but there is a stiffness and numbness of the joints; and the swelling rapidly extends to the belly, and from that to the chest, Avith difficult breathing, and great anxiety of counte- nance. General or local debility is a general cause of dropsy. It is frequently brought on by hard labor or intemperance, poor diet, fevers of various kinds, exhausting discharges, or some form of disease of some of the abdominal or thoracic viscera, which impedes the circulation of the blood, thereby producing distension or congestion. Dropsy is common to all ages, but is most fre- quently found in advanced life. The swelling of the feet and ankles, with Avhich symptom it generally opens, appears at first only in the evening, and disappears by morning; but by degrees it becomes more permanent and ascends higher up the limbs, till not only the thighs, but the hips and body are affected, and even the face and eyelids become SAVollen, and the complex- ion loses its healthy appearance, and looks pale and Avaxy. A general inactivity pervades all the organs, and consequently all their respective functions. The pulse is slow and often depressed, and always hard; the bowels are costive; the urine, for the most part, small in quantity, and highly colored ; the breathing is difficult and Avheezy, and is accompanied Avith a cough that brings up a little mucus. It gives no relief, hoAvever, to the sense of Aveight and oppression in the chest; the appetite fails, the muscles becomes Aveak and flaccid, and the general frame emaciated. The patient is not able to undergo any fatigue, or to 170 DROPSY. make any exertion of consequence, either of body or mind; a general languor and droAvsiness attends the case. The patient generally has great thirst, Avith fever and debility. The SAvelling pervades the whole body, more or less; but the abdomen, at this stage, generally becomes very much distended, and by placing one hand flat on one side of the abdomen, and striking the other side Avith the other hand open, you may feel a fluctuation of the Avater, and, in some cases, you can even hear it slush, if the ear be held close to the abdomen. The skin in some parts being more relaxed than in others, is apt to give Avay more, and the SAvelling to become more prominent there, so as sometimes to hang in bags. Sometimes the skin or cuticle cracks, and the Avater oozes out in a perpetual trickle. The difficulty of breathing proceeds partly from an overloaded state of the lungs, and partly from general debility. The pulse becomes weaker and more irregular; slight clonic spasms ensue, and death puts an end to the patient's suffering; and yet the progress is slow, and many mouths may elapse before the end comes. TREATMENT OF CELLULAR DROPSY. We must first endeavor to ascertain the cause of this form of dropsy, before our remedies can be properly directed. A simple SAvelling of the feet and legs may be caused by chlorosis or by pregnancy. When this is the case, it may be palliated by bleed- ing; but the exciting cause must be removed before anything permanent can be done for the dropsy. (See Chlorosis and Pregnancy, and the remedies there prescribed.) But, as we have said, general dropsy may be produced by intemperance or a sedentary life, or poor and mrwholesome food, or an obstinate fit of jaundice. These must all be corrected before any plan of treatment can succeed; for even if Ave succeed in removing the water before the exciting cause is removed, it will assuredly accumulate again. The occasional cause may, hoAvever, no longer exist, as when it is the sequel of fever or some eruptive disease, which has left the constitution an entire Avreck; or it may exist and be itself incurable, as Avhere it proceeds from a scirrhous state of the liver, or an incurable disease of some other internal organ. In this case, our object should be, if possible, to remove the original cause, and at the same time to palliate, as far as possible, Ihe dropsical condition of the system, Avhilst we arc endeavoring to accomplish this object. DROPSY. 171 Various means have been resorted to for the removal of the water from the cellular membrane. The medicines used for this purpose are those Avhich act upon the secretory poAvers of the system. They may act on the kidneys, skin or bowels. We shall therefore take notice of them under the heals of emetics, purgatives, diaphoretics, and diuretics. And, first, of emetics. Emetics can rarely be used, in the cure of dropsy, any further than to clear away the obstructing matter from the stomach and liver, so that other medicines may be advantageously given. Therefore, Avhen the tongue is white, and other evidences of a foul stomach exist, it may be Avell to commence the cure by the administration of a gentle emetic. This should be folloAved by a cathartic, and none, perhaps, is equal to a full dose of calomel. It will then be proper, in all cases where the strength will bear it, to take fifteen or tAventy ounces of blood from the arm, according to the age and strength of the patient. If there is a diseased state of the liver, calomel or blue mass should be used, to act as an alterative on the system. As an active cathartic, many medicines have been recommended to be used; but all are inefficient as a cathartic for discharging Avater, Avith the exception of a few. The following is an active formula, Avhich may be given after the secreting organs have been put in good order. Recipe: Cream Tartar, one ounce. Pulv. Jalap, half an ounce. * Mix them properly together. This may be given in parsley or horse-radish tea; a tea spoonful from three to six times a day, according to the activity of the operations. The tea should be freely drank at the same time. This medicine will generally carry off the Avater in large quantities. Or the folloAving may be given, Avhen the patient is depressed and very weak: Recipe: Glauber's Salts, one ounce. Refined Saltpetre, half an ounce. Pulv. Rhubarb, half an ounce. Pulv. Gum Camphor, two drachms. Mix them all Avell together. This medicine may be giA-en in the same Avay that the cream of tartar and jalap are directed to be given. I have known several gallons of Avater to be passed off by urine and stool, by the use of this medicine, in forty- eight hours, after it Avas once started, which generally requires ten or twelve hours. The illatcrium is another powerful hydra- gogue. It may be given in the following Avay: 172 DROPSY. Recipe : Illaterium, three grains. Castile Soap, twelve grains. Form twelve pills. From tAvo to four of these may be given in twenty-four hours, according to the effect; but in no case should more than four be given in tAventy-four hours. It would (in the hands of any but a physician) be better to give only two pills a day, and continue them longer, till the full effect is pro- duced; for sometimes this medicine acts very powerfully. The dwarf elder has been highly recommended by many writers on the subject of dropsy. It should be given in the form of a tea made of the bark, in such quantities as the stomach will most conveniently bear. 1 have known some good result from its use. The best mode of preparing it is to take the inner bark from the root and boil it pretty strong. From one to two table spoon- fuls will generally be sufficient for a dose. The dose may be repeated from three to six times in tAventy-four hours, according to the effect produced. Dropsy sometimes succeeds to scarlet fever, where the case has been badly treated, or the patient neglected, especially in keeping the skin clean after the eruption had died away. The swelling generally commences in the loins, and extends over the body and limbs; the face looks puffed, pale, and waxy; the pulse is quick and feeble; the urine is dingy and coagulable; the surface of the body is dry, smooth, and cold. The treat- ment is simple. The skin must be first cleansed with soap and water; then the patient must be dressed in flannel, kept in bed. and have a Avarm bath every night; and take the following medicine : Recipe: Acetate of Ammonia, three drachms. Antimonial Wine, ten drops. Sirup Poppies, ten drops. Mix for a dose. To be repeated every four hours; and the following poAvder every night, at bedtime: Recipe: Pulv. ipecac, three grains. Hydrargyri cum creta, five grains. Mix, and give in sirup, at bedtime. When the Avater and swelling are all removed, give: Recipe: Aromatic Wine of Iron. A tea spoonful, three times a day, in SAveetened Avater, till the strength is restored. The diet should be generous and free. M. Dcbrayne gives the folloAving medicine in dropsy; and he says it rarely ever fa;ls to cure, Avhen properly used : DROPSY. 173 Recipe: Pulv. Jalap, two drachms and a half. Pulv. Squills, two drachms and a half. Refined Saltpetre, six drachms and sixteen grains. Put all into three pints of white Avine. Shake the bottle well, and let it settle. Give a table spoonful three times a day. The quantity is to be gradually increased, till nine table spoonfuls are taken in twenty-four hours. But if the SAvelling is confined to the feet and legs, the doctor gives Avhat he calls his Aveak wine, in place of the above. It is prepared as follows: Recipe : Refined Saltpetre, half ounce. Bruised Juniper Berries, two and a half ounces. These medicines are to be macerated, as before, in three pints of white Avine, for twenty-four hours, and then give a common wine-glassful three times a day. These remedies, he says, are most efficient in passive dropsy. After the water is removed, the usual tonics are to be given, to prevent its return. They will be noticed presently. DROPSY OF THE CHEST. The causes of dropsy of the chest may be any of the causes enumerated for dropsy of the flesh and abdomen, Avith this additional one, a hepatized state of the lungs, or a diseased condition of the heart. When the lungs are hepatized, there are spots on their surface of the color and consistence of liver. When the chest is filled Avith water, the patient cannot lie down without a sense of suffocation. The breathing is difficult; the face, Avrists, and back of the hands are SAVollen; the lips are of a dark or purple color; the action of the heart is rapid and irregular; the pulse is soft, quick, compressible, and intermit- tent; on concussion of the chest, the sound of the Avater can frequently be heard, when dashed against the ribs on the opposite side; the heart is sometimes displaced, and beats on the right side, or in an unnatural place. It is not my business in this work to theorize on disease, but I shall be pardoned here, if I give a short theory of this form of dropsy. It will enable you to pursue the treatment Avith more courage, on which the life of the patient depends. I Avould say, first: that all the symptoms in this form of dropsy sIioav clearly that they are produced by, and kept up from, venous obstruction and its consequences; and venous obstruction is caused, either by a diminished capacity of the lungs, or by an increase of the circulation of the mass of venous blood; or by both of these combined. Secondly: that the 174 DROPSY. disease is not of an inflammatory nature. Thirdly: that the disease, with the exception of the early part of its course, is attended Avith more or less of general debility. From these facts before us, Avhat curative indications can be deduced from them? Common sense Avould say, and physiologists will bear me out in it, that we must first remove the venous obstruction, before Ave can remove the deposit of Avater; and this must be done, either by increasing the activity of the lungs, or by diminishing the circulating mass of venous blood. With respect to the first of these alterations: the capacity of the lungs is, in dropsy, either natural or diminished. When natural, as it is in cases arising from cold or plethora, it avouIcI be absurd to imagine that it Avould be increased by any means. And Avhen diminished, as in cases arising from hepatization, and a variety of other causes, it follows, as a matter of course, that Ave must adopt the other alternative, that of diminishing the circulating mass of the venous blood. This being the principal curative, indication, it can only be properly effected by the lancet. I hoav speak from experience; and I acknoAvledge that great caution is necessary to carry out the practice I am hoav about to give; but it has been done, and can be done again Avith safety. Let the patient be at as perfect rest as possible; bleed him from a small orifice in the arm, to ten or tAvelve ounces. If he becomes faint, give him a little hot broth, or Holland gin ; (one part of gin and four parts of Avater.) Here I will relate a case. The patient had had scarlet fever, and when Dr. ----saAV him, he Avas sitting up in bed, and doubled fonvards; that being the only posture, he said, that he could breathe in. He had now remained in that position for two days. His face, neck, trunk. k>Aver extremities, and hands, Avere greatly swollen; his lips Avere of a dark purple color, and the Avings of his nose Ave re in rapid motion; his pulse Avas full, soft, compressible, and inter- mitting, and the action of the heart tumultuous and irregular; his breathing Avas extremely difficult, and on concussion of the chest, the sound of a large quantity of Avater splashing in both cavities of the chest could be distinctly heard; the abdomen Avas much distended, and evidently contained a large quantity of fluid; he had not passed more than tAvo ounces of urine in the last forty-eight hours, and that was very highly colored. He Avas bled from the arm to the amount of ten ounces. When about five ounces had run, he exclaimed: " Doctor, you have saved my life!" And Avhen his arm was tied up, he was able DROPSY. 175 to lie down Avith comparative ease. The blood drawn was neither buffy nor cupcd. He Avas now ordered to have fifteen grains of the folloAving medicine, every hour, till his bowels were freely moved; and afterwards to take a cup of chicken broth: Recipe: Cream of Tartar, half an ounce. Jalap, two drachms. Mix, and divide into tAventy-four papers. To be given as above directed. Now eleven o'clock in the forenoon. At eight o'clock in the evening he was seen again. His boAvels had been freely moved, and he had passed more than a pint of highly colored, lateritious urine; his breathing was now greatly relieved; his pulse, though quick, Avas firmer, and no longer intermitting; the action of the heart Avas much less violent, and more regular, and the SAvelling Avas every way greatly dimin- ished. Finding him not complaining of Aveakncss, and his pulse firm, he Avas bled again, six ounces. The above poAvders were continued. He slept during the night, half an hour at a time; he had some Avatery discharges from the boAvels; he passed some urine of a clearer color. On the following morning he was still improving. The last-draAvn blood Avas neithei buffed nor cuped. His pulse being firmer, he Avas bled again, six ounces, and the same medicines continued. In a few hours after, he had several Avatery stools, Avhich seemed to distress him very much, and, for the first time, he complained of Aveakness, and asked for animal food, Avhich he AA'as al!oAAred to have, and some Aveak gin and water occasionally. The powders Avere hoav discontinued, and he Avas directed to keep as quiet as possible. He slept soundly nearly all that night, and frequently passed considerable quantities of clear urine. From this time all the dropsical symptoms rapidly left him. He only took his gin and water, and animal food. In ten days from the first bleeding, he was out, and rapidly convalescing. I acknowledge this to be a bold and daring practice; but it is founded upon the above theory, and the result Avas satisfactory. A number of cases of a like character have been cured by a sim- ilar course of treatment. But where the lungs are hepatized, Ave must not only use the lancet, but blue mass and squills should be given till the gums are swollen, and the patient spits freely, but moderately, for some time. The following prescrip- tion may be used: 176 DIARRHCE4, LAX, OR LOOSENESS. Recipe: Blue Mass, sixty grains. Powdered Squills, twenty grains. Gum Camphor, twenty grains. Form tAventy pills. One may be given three times a day, till the above effect is produced. In convalescence from dropsy, the tonic treatment must be used. Huxham's tincture may be given, a tea spoonful three times a day, or the aromatic wine of iron, as often, in similar doses. The diet should be generous, and a little Holland gin and Avater should be taken three or four times a day. Avoid exposure. DIARRHCEA, LAX, OR LOOSENESS. The general character of this disease is, that the discharges from the boAvels are crude, and too frequent; Avith little or no griping or straining. There are a variety of forms or species of this disease. The chief cause of them all is, an increased peris- taltic motion of the boAvels, in part, or throughout their Avhole course, and this action may be produced by various means, and under various circumstances. And these causes often stamp a peculiarity on the character of the disease; and this lays the foundation for various species. The increased action of the boAvels may be produced by irritating materials taken in by the mouth; secondly, by a morbid change in the fluids Avhich are naturally secreted in the intestinal canal; thirdly, by an irrita- ble state of the intestines themselves, or the membrane that lines their inner surface,—or the intestines may associate Avith the action of some one or more remote organs, and so manifest this disease in some one of its forms. Thus, sudden passions or emotions of the mind Avill frequently excite looseness. Sudden cold or heat applied to the surface of the skin, Avill do the same. A sudden check of profuse perspiration, may also excite this ar tion. The fluid of dropsies, the morbid matter of some eruptive fevers, as smallpox, varioloid, chickenpox, scarlatina, measles, etc., may be throAvn upon the boAvels, and produce a looseness. But as these last are not primary, but causes producing the disease by sympathetic action, Ave shall not treat of them here, but shall refer the reader to their appropriate places, under their proper heads. HoAvever numerous, therefore, the subdivisions of diarrhcea may be, those that really belong to it, as genuine and distinct species, may be found in the folioAving. And as DIARRHC3A, LAX, OR LOOSENESS. 177 there is some difference in the proper mode of treating each species, Ave shall enumerate and describe them, and then give to each its appropriate treatment. They stand in order as folloAvs: feculent looseness, bilious looseness, mucous looseness, chylous looseness, lientery, serous looseness, tubular looseness, gypseous looseness. We shall now take these up under their appropriate names; and first, of FECULENT LOOSENESS. The common cause of this species is food heated to excess, or intermixed Avith an undue proportion of irritating materials. —too* much salt, sweets or acids,—in consequence of which, it passes rapidly, not being thoroughly digested. The intestines are urged to an undue activity. Hence, it is often the case, that prior to an undue looseness, there is an unusual heaviness in the stomach, Avith acid, or more or less pain, in weak stomachs, or where the boAvels are sluggish. This mode of diarrhcea is also occasionally produced by a retardation of the aliment till it becomes acid, or more or less putrid,—or a superabundant accu- mulation in the bowels may produce it; and, where it is not checked in due time, and the exciting cause is kept up, it Avill run into a chronic form and become very troublesome. There are a variety of other causes that may produce this form of looseness, such as cold bathing, sudden fear or fright, or passion, where there is a peculiar irritability of habit. TREATMENT. When this disease is produced by an overloaded stomach, and acid eructations precede the purging, the better course is to drink a glass or tAvo of Avater, with half a tea spoonful of soda dis solved in each glass, to neutralize the acid. Then take some mild purgative, such as the compound rhubarb pill, or magnesia, or castor-oil, and be careful, afterwards, to avoid the exciting cause. BILIOUS LOOSENESS. In this species, the stools are loose, copious, and of a bright yellow. From the highly bilious color of the stools, there can be no doubt that the bile is secreted in a greater quantity than usual and probably has an unusual degree of pungency, which causes the increase of peristaltic action. This species of diarrhcea is more apt to occur in Avarm than in cold weather, and is of more fre- BRIGHT. 13 178 DIARRHCEA, LAX, OR LOOSENESS. quent occunence in hot than in cold climates. The diarrhtBa produced by a sudden change from a cold to a hot climate, or by being a long time exposed to a high temperature of the sun's heat, depends upon an increased action in the. liver, and an undue secretion of bile, with an increased acrimony. In inter-tropical climates, the bile secreted is sometimes more than the bile ducts can com>eniently carry off, amd some portion of it retrogrades, and is carried by absorption into the system, and becomes one of the causes of the darker hue of the skin, in those climates. In our own country, this species of diarrhcea is met with most com- *monly in the earlier parts of summer, when the heat suddenly and vehemently bursts upon us from a cool and backward spring, or in autumn, after the person has been exposed for many weeks to the effects of a vigorous sun, relaxing and debilitating the whole system. If the atmosphere be pure at this time, the disease is simple, and may be subdued without much difficulty; but if the air is charged with a strong miasmata, then the simple bilious diarrhcea will be converted into a remittent bilious fever. But this we have treated of in its proper place. TREATMENT. When bilious diarrhcea is simple and unconnected with fever, it is easily cured, if early attention be given to it. A few cathar- tics of the proper kind will generally be sufficient. Recipe: Calomel, ten grains. Aloes, ten grains. Rhubarb, ten grains. Form six pills. Give three first, and the other three in two hours. Work them off with gruel, rice, or barley-water, or some mucilaginous drink, to sheathe the boAvels from the acrimony of the bile. If the person cannot take calomel without affecting the mouth, the following pills may be used. Recipe: Aloes, twenty grains. Rhubarb, twenty grains. Tartar Emetic, one grain. Form six pills. One of these may be taken every hour, till they operate freely. In this case, the discharge of bile will be yellow and thin, but a repetition of the medicine will carry it all off. If the symptoms are aggravated, and any fever exists, before medicine is given, the cure may be commenced by giving an emetic. Recipe: Ipecac, twenty grains. Tartar Emetic, three grains. DIARRHCEA, LAX, OR LOOSENESS.. 179 Give, and work this off in the usual way. Then give the above pills. If the irritation of the bowels should continue aftei the operation of these medicines, then the following pill should be given: Recipe: Camphor, two grains. Opium, one grain. Ipecac, five grains. Form two pills. Give one at a time, an hour apart; drink freely of some of the above teas, warm, to aid in the determination to the skin. The subacid fruits will be found advantageous in this form of diarrhcea; such as the preserved fruit of the common dewberry, or blackberry. The diet should be light and easy of digestion; exposure to the heating rays of the sun should be avoided in convalescence. MUCOUS DIARRHCEA. This is characterized by a copious discharge of mucus from the boAA^els. The mucus discharged in this disease, bears a considerable resemblance to the mucus discharged from the nose m .a bad cold. The common cause of this form of diarrhcea is cold applied to the feet. The discharges are acrid, producing a heating, scalding sensation as they pass, often with but little bilious tinge. No doubt but the discharge of mucus in this disease, is increased by the secretions from the nostrils, and other parts, being swallowed, and commingling with the morbid secre- tions of the mucous coat of the bowels. As acrid substances, taken into the nose by those not accustomed to them, will produce an increased mucous discharge from the membrane of that organ, so may acrid substances, taken into the stomach, produce an acrid, mucous discharge from the intestines. It is also produced by the sudden action of cold air on the skin, after being for some time exposed to the hot and relaxing action of warm air upon it; hence, sudden transitions from heat to cold, or from a hot climate to a cold one, may expose the patient to attacks of this disease; or persons suddenly leaving a very warm room, and exposing themselves to the chilling blasts of a cold wind or heavy air, may bring on this form of diarrhoea. TREATMENT. Where the disease is brought on by sudden exposure to cold 90 as to throw the weight of secretion on the mucous surface of 180 DIARRHCEA, LAX, OR LOOSENESS. the bowe s, it will be proper to commence the cure by giving the following medicine: Recipe: Calomel, ten grains. Ipecac, five grains. Opium, one grain. Mix for a dose. After this has been taken two hours, a dose of castor-oil should be given, to work it off. If the disease is not arrested by this dose, it may be repeated, and then followed by some warm aromatic, such as clove tea, with three or four grains of ipecac, and the tenth of a grain of opium, every two hours, till eight or ten powders are taken. The following should then be giA^en: Recipe: Blue Mass, twenty grains. Rhubarb, ten grains. Scammony, ten grains. Form ten pills; give five first, and the other five in two or three hours. After the operation is over, if there is any pain in the bowels, ten grains of Dover's powder may be taken, and a portion of senna tea the next day. If the bowels are much weak- ened, the patient may take the folloAving bitters in convalescence • Recipe: Gentian Root, half ounce. Orange Peel, half ounce. Columbo Root, half ounce. Black Snake Root, half ounce. Make all fine, and add to them a pint of old spirits and a pint of water. Shake the bottle once a day, for three or four days. Then take a table spoonful, three times a day, in water. Tie diet should be nourishing and easily digested. CHYLOUS LOOSENESS. The characteristic sign of this disease is a milky discharge from the bowels. This depends upon a deficient admixture of bile with the faeces, either from a deficient secretion of the liver. or a locked state of the gall ducts, and the food, Avhen converted into chyle, is not taken up and carried into the system. This must proceed from some defect in the lacteal vessels, or in the mesenteric glands. There may be actual disease in these parts, or a torpor Avhich prevents the due and healthy functions of these organs; on the first examination of the patient, Ave cannot ahvays distinguish betAveen these two states. If the patient has hitherto been healthy and robust, and the disease has come on suddenly, then we may, with great propriety, refer the disease to a sudden DIARRH02A, LAX, OR LOOSENESS. 181 obstruction of the lacteal vessels, or of the mesenteric glands On the other hand, if the boAvels have for some time been becom- ing more and more loose, and the discharge more and more milky, and the patient is weakly, then we may suspect that there is disease in one or both of the above-named organs, or the gall ducts have been obstructed, or there is a deficiency of bilious secretion. TREATMENT. Where we suspect only a torpor of the organs, and not an obstruction, some warm stimulating medicine Avill be proper, such as the Avarm aromatic bitters, with gentle purgatives. Recipe : Rhubarb, twenty grains. Aloes, twenty grains. Myrrh, ten grains. Mace, five grains. Form tAvelve pills. Two of these may be given every two hours, till they operate freely, and,then the aromatic bitters may be given, three times a day, in small doses; such as Huxham's tinc- ture, a tea spoonful at a time. A little good French brandy and loaf sugar may also be taken tAvo or three times a day. The diet should be mostly light animal food. But Avhere there are evident signs of visceral obstruction, either in the liver or mesenteric glands, the above medicines Avill be injurious. Here we must resort to calomel in full doses, and repeat a few times; then the blue pill and aloes will be proper. While, in the former case, blisters and rubefacients Avill be useful, applied to the abdomen. here they should be applied, if at all, to the region of the liver. Great care is necessary in order to bring the secreting organs into a healthy condition, and to keep them so. After the mercurial action has been carried far enough to restore the secreting organs to a healthy action, this function must be maintained by proper tonics, till a healthy action is established. For this purpose, the metallic tonics are preferable. The aromatic wine of iron is one of the best. A tea spoonful may be given, three times a day, in Avater; or four or five grains of the sulphate of zinc may be taken. thrice a day, in sugar; or the citrate of iron may be used,—forty grains to the ounce of water,—and taken as directed for the aro- matic Avine of iron. The nitro-muriatic acid may be taken, in ten or fifteen drop doses, in water, three times a day. The diet should be light and easily digested ; exercise on horseback or in a carriage, will be beneficial; keep the surface of the body comfort- able, and the feet dry and Avarm. *82 DIARRHCEA, LAX, OR LOOSENESS. LIENTERY. Ih this disfase, the food passes rapidly through the bowels, undigested. The stomach, in these cases, is always in an unhealthy state, and the gastric juice is not secreted either in a proper state or in proper quantities; and the bile is not duly secreted, or is obstructed in its passage. The former is the most probable, from the absence of severe pain in the stomach and region of the gall ducts. If there be a free flow of bile, the faeces will be tinged with it, Avhether the food be well digested or not. It is most probable that the peristaltic action is increased by the stimulus of the crude, undigested food. The general treatment recommended in dyspepsia, will be found best adapted to the pure of this disease; for all the symptoms found here, are found there to a greater or less extent. In all cases where the gen- eral tone of the stomach is impaired, we find flatulence, nausea, and other dyspeptic symptoms, accompanying the looseness; we therefore refer the reader to the chapter on dyspepsia, for the remedies proper to be used in the cure of this disease. SEROUS LOOSENESS. In this form of disease, the stools are almost entirely liquid, and pretty clear. From the fluidity of the stools in this species, it is evidently dependent on a very irritable state of the excretory vessels of the intestines. The irritation here is much greater than in mucous diarrhcea. Mucous diarrhoea, or any of the pre- ceding species, may run into it, if long continued. The patient may have from ten to twelve of these liquid stools in tAventy-foui hours. Dr. Goode relates a case that lasted ten years, and the lady had passed more than ten liquid stools a day, for that period cf time. TREATMENT. In the early stage of this disease, a few large doses of calomel combined with opium, should be given. Recipe : Calomel, twenty grains. Camphor, five grains. Opium, two grains. Mix for a dose. This may be taken at bedtime, and if it should not operate well by morning, a dose of rhubarb may be given. If the first dose should not arrest the disease,—and it frequently will, if it is given in the first twenty-four hours of tH DIARRH03A, LAX, OR LOOSENESS. 183 attack,— it should be repeated, and again followed by the rhu- barb. Should the disease continue after the secreting organs have been properly corrected, then astringents should be used, such as : Recipe : Sugar of Lead, twenty grains. Powdered Opium, two grains. Mix properly, and divide into four papers. Give one every six hours, in a little sugar. It should always be followed, the next day, with a dose of castor-oil. A decoction of the bark of the pomegranate tree, combined with the leaves of the red rose, and cinnamon bark, was once a very popular remedy in this dis- ease, and it is still used in Europe in these cases. But a far bet- ter astringent will be found in the sirup of the diospyros virgin- iana, — the common persimmon fruit. (See Materia Medica for the mode of preparing this sirup.) A tea spoonful may be given every time the patient has a stool; and if there are any griping pains in the bowels, five drops of laudanum may be given in every dose. The native carbonate of zinc, or the lapis calami- naris, has been used by some of the most respectable physicians in Europe, in this disease. The dose is ten grains, three or four times in twenty-four hours. The camphor mixture is a valu- able remedy in this disease. It may be given in two table spoonful doses, and repeated every two or three hours. The bowels, under these circumstances, are to be kept open with the warm stimulating gums, such as aloes, asafoetida, and myrrh, in equal quantities, formed into pills. Two pills may be given every night, at bedtime. The warm aromatic bitters may be used also. The diet must be very particularly attended to, and nothing should be taken that produces any pain, or is at all indigestible. The food should be entirely lean meats and bread. and the drink plain water. Flannel should be worn next the skin, and the feet kept dry and warm. TUBULAR LOOSENESS. This disease is characterized, as the name imports, by the discharge of membranous tubes; rather whitish, viscous, and inodorous. This disease does not occur very frequently, but sufficiently so to require our attention. It depends upon a pecu- liar irritability of the mucous coat of the boAvels, especially the large bowels, which, in consequence of their irritability, secrete an effusion of coagulating fibrin, mixed with gluten, instead of 184 DIARRHCEA, LAX, OR LOOSENESS. secreting mucus; it is occasionally accompanied Avith some degree of inflammation. It has a striking resemblance to the fibrous exudation thrown from the trachea in croup, with this exception,—it is redder, and sometimes two or three feet long. The tube is sometimes perfect, so that it resembles the intestine, being hollow and entire. In other cases, it is broken, and has holes in it. Patients are frequently alarmed, thinking that they are discharging the Avhole of the inner coat of the bowels. There is generally a considerable sense of heat in the rectum or lower boAvels; and the stimulus is so great that the sphincter muscle is contracted so closely that it requires considerable straining to pass the fseces, and when discharged they are in a small, round form. This tube loses its form as soon as it is handled; it will not bear extension. This peculiar discharge may continue for Aveeks, if not properly treated. When the irritation extends to the duodenum, the liver may partake of the irritation by sympathy, and the gall ducts may contract, and pain and sickness at the stomach may be experienced by the patient. The tongue is generally lightly coated, and there is a slight fever, but no evidence of active inflammation of the bowels. The portions discharged vary in length and consist- ence; some not more than one or tAvo inches long, and others more than two feet. They may be discharged for several days in succession, till it Avould seem that the whole length of the alimentary canal had sent off its inner surface. In these cases, the pain in the smaller intestines is very acute, and also in the bile ducts, from the spasmodic constriction there; and the com- mon symptoms of jaundice, the passing of gall-stones, may be suspected, till the character of the discharge speaks for itself. From painful menstruation and a slight inflammatory action in the uterus, fibrin may be secreted, and a species of deciduous membrane may be discharged by those who never knew the other sex. TREATMENT. The milder preparations of mercury are here most certainly indicated. The form Avhich 1 have used with the most success is the blue mass. Ten grains may be taken, three times a day. Large injections of warm water and milk may be thrown into the bowels. Balsam copaiba, in ten or fifteen drop doses, may be taken, on sugar, three times a day, and Avih be found an excellent remedy. If the stomach reject it, it must be given in DIARRHCEA, LAX, OR LOOSENESS. 185 injections; three drachms at a time, three times a day. The milk of sulphur is an excellent purgative in this disease. The sulphur, mercury, and balsam, will cure the disease in a few days, in conjunction Avith rest, and a light, mild diet. The drink should be mucilaginous. GYPSEOUS LOOSENESS. This singular disease is characterized by liquid, gypseous, or darkish discharges, with a frothy scum on the surface. This, like the two preceding species, is produced by an irritable state of the intestines, occasioned by an increased secretion of morbid matter of this appearance; but in each of these species the secretions differ considerably. In the first, it is dilute and serous; in the second, it is viscid, and compounded of fibrin; but in this species it is serous, and compounded of earth and lime. Almost all animals are possessed of a power of forming this earth, or of separating it from the blood, (for we do not precisely know Avhich,) for various important purposes; as that of giving firmness to the bones, or hardness to the hoofs of animals, or to the shells of eggs, &c. This power certainly can be traced in all animals, and in all ages; and it shows itself in a state of health or disease, in almost all the organs. In mankind it com- mences and grows Avith the foetus; it accompanies us through mature life, and iu advanced years, it not only continues with- out failure, but occasionally increases with the failure of other secretions, so as in some cases to convert the blood-vessels into bony canals. It settles in the form of tartar around the teeth of aged persons, and is sometimes found in nodules or masses on the surface of the lungs; it therefore lays the foundation for many diseases; there is, therefore, no difficulty in tracing the source of the gypseous, limy material which forms the peculiar species of disease noAV before us. In general, when this is secreted in the bowels in more than ordinary quantities, it unites itself with some glutinous animal matter, assumes solidity, and increases by fresh concentric layers. But in gypseous diarrhcea no such tendency to combination exists; but the earthy particles are diffused loosely and separately through the fluids with Avhich they are discharged. When the disease is violent, the discharges are copious, and very numerous; of a pale color and sour smell, and the froth looks like yeast. When it changes to a milder *brm. the evacuations are still more or less oale, but of the con- 186 DIARRH03A, LAX, OR LOOSENESS. sistence of pudding, and do not occur more than two or three times in twenty-four hours. The appetite is not always impaired. The countenance is thin and sallow, but not much emaciated; the pulse varies but little from the standard of health; the tongue is generally covered with a light, Avhite fur; the urine is deeper colored than natural, generally clear, but occasionally turbid; the bowels are apt to be distended with wind, but there is no SAvelling, or sense of pain upon pressure. This disease" occurs most frequently in persons who have resided some time in a warm climate, or who have suffered from affections of the liver; but it is sometimes met with in persons who have never had any disease of the liver. It is more com- mon in men than in women. Perhaps this is because men endure the evils of hot climates more than Avomen. There are occasional appearances of recovery from this disease Avithout medical aid, but the disease generally returns again as bad as ever. This disease becomes worse under embarrassment in business, or any other cause that disturbs or depresses the mind. TREATMENT. The remedies for this disease are few, but simple. Small doses of calomel, or blue mass; small doses of laudanum, or Dover's powder; strengthening bitters, animal food, friction over the abdomen Avith nitro-muriatic acid, and a cheerful employ- ment, constitute the chief remedies for the cure of this disease. The calomel and Dover's powder may be given in the following formula: Recipe : Calomel, twenty grains. Dover's Powder, eighty grains. Mix, and divide into twenty powders. One of these may be taken at bedtime and another in the morning; or five grains of Dover's powder may be taken at bedtime, and ten grains of blue mass in the morning. An excellent bitter will be found in the salicine, in one or two grain doses, three or four times a day. Flannel, or silk, should be worn next the skin, and fatiguing exercise should at all times be avoided. Keep the feet dry and waim. CHOLERA MORBUS. 187 CHOLERA MORBUS. The characteristics of this disease are, vomiting and purging of bile, and other morbid matter, with great pain in the stomach, and severe griping in the bowels. This disease is both sporadic and epidemic. When it occurs only occasionally, it is called sporadic, and is not so violent as it is Avhen it prevails epidem- ically. Its common causes are, a superabundant and acrid bile; suppressed perspiration, particularly by damp or cold applied to the feet, as by standing on moist ground in damp and foggy Aveather; large draughts of cold Avater, especially when the body is overheated by violent exercise; green, indigestible fruits, as unripe apples,. pears, cherries, currants, gooseberries, melons, cucumbers, mushrooms and other indigestible articles; the heat of a vertical sun, and a sudden check of perspiration, are all occasionally the cause of cholera morbus. The causes are, therefore, the same, in many instances, that produce colic or diarrhcea. The discharge from the stomach is not ahvays bile, but frequently a whitish, glary fluid, like the white of an egg. This is evidently pancreatic liquor. The bowels generally act first, and, after a feAv painful, griping evacuations, the vomiting commences. The sickness and prostration are extreme. The stomach is all the time sick, and everything is ejected that is taken into it; the strength fails rapidly. The pulse becomes feeble and soft, and the extremities cold, and cramps take place in the hands and legs. Hiccough supervenes, and the patient, in the most extreme agony, dies in tAvelve or twenty-four hours. This is the worst form of the disease. Where the symptoms are not so violent, the patient, after two or three days' violent suffer- ing, recovers. The acrid bile that flowed so freely upwards and downwards, ceases to be discharged, and great prostration of strength is experienced by the patient, from which, by degrees, he finally recovers, and again enjoys health. TREATMENT. As there is an increased secretion of acrid bile in cholera mor- bus, and not only the stomach, but the bowels, in some cases, are almost literally filled with it, it becomes necessary to relieve them from it before anything else can be done, which will give permanent relief. All our first efforts, therefore, should tend to this end. The patient should take freely of some warm diluent 188 CHOLERA MORBUS. drinks, such as camomile or flax-seed tea, barley or rice-water, and as soon as the stomach is freely and fully washed out, an njection of starch, with a tea spoonful of laudanum, should be given, and the folloAving medicine taken : Recipe : Calomel, twenty grains. Camphor, five grains. Opium, one grain. Mix. and give in sugar and a few drops of water. The patient should now take as little fluid on the stomach as possible ; strong toast-water is best, and next to this mint tea, made of the green herb. If the medicine is thrown up, it should be repeated imme- diately ; or the following may be given : Recipe: Calomel, twenty grains. Morphine, one grain. Camphor, ten grains. Mace, five grains. Make all fine. Mix Avell, and divide into four papers. One of these, may be given every half hour, or hour, as the case may require, till the stomach is settled. An injection should be given occasionally, of starch, containing fifty or sixty drops of lauda- num, till the puking ceases and the griping subsides; at the same time, a mustard plaster should be applied over the stomach, and remain there till the skin becomes very red. If any cramp or coldness of the feet and hands takes place, mustard plasters should be applied to the Avrists, feet and legs. As soon as the vomiting ceases, and perfect tranquillity is restored to the stomach and bowels, the patient should be alloAved to remain quiet for several hours; then a full dose of calomel should be again given, and after remaining in the stomach tAvo or three hours, an injec- tion should be given of thin gruel, lard and salt; and if this does not produce copious operations, a full dose of castor-oil should be given, in hot coffee, or if the stomach will take it better, a tea cupful or tAvo of strong senna tea. All Ave have to do after the stomach is tranquillized and the first dose of calomel is worked off, is to keep up a gentle action on the boAvels till all the acrid bile is removed, and our patient is well again. If much debility remains, some mild tonic should be given, such as Huxham's tincture, or a bitter, of equal parts, of Colombo root and gentian, with a little orange peel in it. In convalescence, great care should be taken not to overload the stomach, and all exciting causes should be avoided. Those persons who are subject to cholera morbus should take great care not to use those articles of diet that are likeiy to produce this disease. SPASMODIC OR ASIATIC CHOLERA. 189 SPASMODIC OR ASIATIC CHOLERA. This disease derives its name from the country in which it started as an universal epidemic. It is, hoAvever, the diarrhcea serosa of the ancients. We are indebted to the publications in the European medical periodicals, — written by the British sur- geons who were in Asia at the time this epidemic broke out there, and their subsequent observations and remarks, and prac- tice upon and in the epidemic, for fifteen years before it reached the continent of America,—for what we have gathered in rela- tion to its history and progress, as Avell as the route which it took through the eastern world, before it reached Europe and Africa. Having had a full knoAvledge of their publications, regularly. every few months, for fifteen years, or from its commencement till we became eye-witnesses of it ourselves, as Avell as subse- quently, we are enabled to give a correct history of this dreadful scourge of the human race. We shall only, however, give a brief sketch of its origin and its tracks through the eastern world, as Avell as our OAvn country, and then a short but plain descrip- tion of its symptoms and the practical treatment of them, which we deem all that would be necessary in a work of this descrip- tion. This epidemic, as such, commenced at a little city called Jes- sore, on the Ganges, about one hundred miles northeast from Cal- cutta, in Asia, in August, 1817. From Jessore, it passed down the Ganges to the Coromandel Coast. From thence, it passed over to Siam, where an epidemic had never previously been knoAvn to prevail, it being one of the most healthy countries on the globe; and from thence, to the Spice Islands, where frost was never seen, slaying its thousands in its course. At the same time, it travelled up the Ganges, visiting all the towns and cities on its coast, to Delhi; from that city, it branched, and one line took the river Indus, and travelled down to its mouth, to the Arabian Sea; thence down the coast of Malabar, meeting the Coromandel line, and passed over to the little island of Ceylon. Here we leave it, and take up its line of march from the city of Delhi, north. From Delhi, it passed into Siberia, and crossing its high, snow-topped mountains, it slew its hundreds in a day and night, in some of the towns, in the dead of winter, when everything was sealed up with ice, and the traveller could scarcely live for the intensity of the cold. It passed into the interior of Russia, 19U SPASMODIC OR ASIATIC CHOLERA. and down the Irtva, to Tobolsk. It also passed up the Tobal RiA'er, to the Ural Mountains; from thence to Lake Aral, or the Sea of Aral, in Tartary, which is 220 miles long, and 150 miles wide. This is the lowest surface on the globe, when compared with the level of the sea, it being far below the sea's surface. This sea is surrounded by a large valley, Avhere the cholera raged for six or seven years, till it almost depopulated that whole country. From this place, it passed to the shores of the Caspian Sea, and, passing around its borders, made its way into Cau- casus, in Asia, and from thence to Turkey in Europe, and, passing through Independent Tartary, it entered Arabia and Africa, where Ave again lose its history and course. But Ave return to it in Europe. After spreading pretty generally over Europe, and occupying about fifteen years in the eastern world, it took its flight from Gibraltar ; and, as if upon the Avingsof the wind, it made its way to Canada, in North America, and the tOAvn of Montreal had first to announce this unwelcome visitor, on the shores of America. From thence, it spread doAvn the canal to Whitehall, and thence to New York. From thence it spread through all the eastern and northern states, more ?r less, and found its way down the Atlantic coast, through the southern states, to New Orleans. While it was making this tour, it also passed from Canada to our northwestern army, and from thence to the waters of the Mississippi, down to St. Louis, and from thence, down that stream, to the city of New Orleans, and from thence it passed into Texas and Mexico, and we lose its history in South America. It also passed up all the rivers contributory to the Mississippi, to their sources, and visited all the towns and cities, more or less, on their shores; spread out from various points into the countries contiguous thereto, and finally reached almost every state in the Union. It prevailed as an epidemic in Europe and Asia for fifteen years, and as an epidemic in the United States, about three years. Several mil- lions in the Avorld fell victims to it, during its ravages. It was far more fatal in Asia and Europe than it was in America. Two reasons may be assigned for this; first, the epidemic was more violent in its onset, and so continued for twelve or fourteen years; and, secondly, the physicians in America had the advantage of the published practice of the physicians of the eastern world, and were better prepared to meet it, than those were who had never seen or even heard of it till they were called to treat it, and Avar against it. SPASMODIC OR ASIATIC CHOLERA. 191 No epidemic, in the annals of medical history, ever travelled as did this epidemic, It would make its appearance in a town or city in one night, and rage with violence for a few days or weeks; then, like a flight of birds, it Avould escape, and passing .-jver from twenty to a hundred miles of thickly populated country, it would seem to light down on a neighborhood, city or town, and before the citizens Avere fairly apprized of it, would break out in every quarter and section. It was not an uncom- mon thing for it to kill from five hundred to a thousand, and, in some cities, ten or fifteen thousand, in less than that number of days; and then disappear suddenly, and not a neAV case appear. These facts are fully declared in our European periodi- cals. Its ravages Avere not so violent, hoAvever, in America; yet it was the most formidable epidemic that eArer visited our continent. It evidently paid no regard to climate or location, for while it Avas slaying its thousands in the sunny regions of the Spice Islands, it almost depopulated, in a few days, some of the towns in the cold regions of Siberia and Russia, in the dead of Avinter, when all nature Avas under the frigid seal of ice and snow. This short history of epidemic cholera is sufficient to show that no one common cause could have produced it in all these coun- tries. It could not have been a common miasmata, for those cold regions could not have produced it at that time. It could not have been produced by a small microscopic insect, as some have vainly supposed, for they could not have lived in these cold regions. It did not seem to be influenced by any of the known laws that govern epidemics of other descriptions and character. We shall not attempt to account for its origin and progress as an epidemic, but suppose it not improbable that it may have been one of the vials of God's wrath, spoken of in the Apocalypse, which was to be poured out upon the earth. Why may not these vials of wrath mean epidemics, as well as wars, etc. 1 Nor should this prevent the fearful indulgence of the idea that it may again appear; if not as a universal epidemic, as a sporadic disease, in which character it has often appeared since. Nor should this prevent us from using every means in our power to remove or cure it when it does appear. A great mystery lies at the bottom of the causes of these sweeping universal epidemics. With these remarks, we come to the description of the disease. Spasmodic cholera may be properly divided into four stages. The premonitory stage; the serous diarrhcea, or rice-water dis- 192 SPASMODIC OR ASIATIC CHOLERA. charges; the collapse, and the reaction. The premonitory stage, in most cases, in this country, was marked by a Avhite tongue, languor, or debility, and a looseness of the boAvels not amounting to a diarrhcea. The discharge from the boAvels, in this stage, may be of various colors. In some instances, this stage lasted tor several days. The appetite fails and the person feels Aveak. The stomach does not digest readily Avhat is taken. The second stage is marked by the discharges becoming more liquid, and of a soap-suds appearance first, then more milky, and then clear, or like water in Avhich rice had been boiled; hence, they Avere called rice-Avater discharges. These discharges are not accompanied with any griping pain ; the discharge is thrown off Avith a noise like that of Avater draAvn from a cask. The urine is diminished in quantity. The voice is IioIIoav and deep, but Aveak. The features shrink, the eyes look holloav, and the Avhole surface shrinks and feels cool. This form of discharges may last, in mild cases, for several days; but generally they lasted but a few hours, before the lips and all the extremities became blue, the hands shrivelled, and the whole surface cold. The hands looked as if they had been constantly immersed in Avarm soap-suds, till they Avere all shrivelled up, though cold as ice and clay. The third stage now comes in, with vomiting and cramps in the legs and thighs, hands and arms, the patient often crying out for some person to rub the extremities. The stomach is apt to reject everything that is taken in this stage of the disease. Noth- ing taken into the stomach becomes Avarm there, but is ejected as cold or colder than it was when swallowed; and injections are returned in like manner. But excessive vomiting does not occur m all cases. The cramp denotes the state of collapse to be in progress, Avhich is the third stage of the disease. The pulse, up to this time, is weak, and the skin cool; but iioav, the pulse fails, and is scarcely perceptible for a short time, and then is lost altogether. The skin, from being cool, now becomes icy cold, and the discharges run from the patient involuntarily. He noAV does not speak unless spoken to, and then he answers rationally. I never saAV a delirium in this stage of the disease. The tongue is Avhite and shrivelled, or contracted to less than half its natural size. The pulse, if felt at all, is as soft as a floss thread under the finger. In fact, every symptom shows clearly that all the fluids have been drawn off from the system. The strongest Btimulants app ied to the surface produce no effect Avhatever; SPASMODIC OR ASIATIC CHOLERA. 193 even fire will not make a red spot. The patient tosses from side to side, and does not wish to talk; but when he does speak he is rational. Perhaps forty-nine cases in fifty that reach the third stage, never exhibit the fourth. But the fourth stage does appear in some cases; and Avhen it does, it is marked by a ceasing of the cramp, a return of the pulse, a Avarmth of the surface, and a low, burning fever, with a rapid circulation, red eyes, and, frequently, Ioav delirium. The watery discharges noAv cease, and the boAvels become constipated. From this stage, the patient, if properly treated, may recover. Cholera often kills in a few hours, and according to the reports in our periodicals, has killed in a few minutes; but, generally speaking, it Avas not so severe in America. Here it generally lasted from twenty-four to forty-eight hours, and sometimes three days, but rarely so long without recovery. TREATMENT. The treatment of spasmodic cholera naturally divides itself into as many specifications as there are stages in the disease. The treatment for the premonitory or first stage, therefore, calls our* ; attention first. First. When the epidemic is known to be in the country, and especially in the neighborhood, and a person feels debilitated, with a white tongue, and the boAvels rather too loose, the first thing to be done is to take a tea spoonful of the strongest prepara- tion of the spirits of camphor, in a little water; — perhaps a better prescription is the strongest preparation of the essence of camphor, in Avater, as this article retains the camphor in solution when it is poured into Avater. Then take tAventy grains of calomel and one of opium, at bedtime; in the morning, take a dose of rhubarb to work it off. If this brings bilious stools, the disease is warded off; if not, repeat it every night, till bilious stools are produced. The diet should be light and the patient should keep calm; fear has killed its thousands. The super-carbonate of soda may be taken, in tea spoonful doses, in water, three or four times a day, with a tea spoonful of the essence of camphor in it. This will neutralize any acid that may be in the stomach or bowels. The camphor and soda Avill also tend towards the skin and kid- ueys. The diet should not be much altered from that Avhich the patient has been in the habit of taking, only it should be lessened in quantity, as the powers of digestion are weakened. All crude, imripe fruits, or even fruits of any kind, should be avoided, BBIQIIT. 14 194 SPASMODIC OR ASIATIC CHOLERA. Persons that have been in the habit of using spirits should not increase, but rather lessen, the quantity. The surface of the body should be kept uniformly warm, by wearing flannels or silk next to the skin. We now come to the second stage. The second stage is marked by a free discharge of liquid stools at first, like soap- suds ; then milky; then almost clear, or like rice-water, Avuh- out pain or griping. The features and surface shrink; the voice becomes hollow, and the stomach sick, and occasionally the patient pukes. But after the contents of the stomach are discharged, nothing is thrown up but clear Avater; no bile ever makes its appearance by such vomiting. The skin is still a little warm, and the pulse is tolerably full, but soft. Now the remedies must be prompt and powerful. If I were here to enumerate all the remedies that have been published by writers on this subject, for this stage of cholera, 1 might fill twenty pages Avith them and the directions and reasons therefor. Such a procedure Avould leave the reader in more difficulty to decide which he should take, than if I had given none at all; I there- fore shall only give those that I have found serviceable among them all. Having had nine Aveeks' experience with it, in 1S33, and having had it in my family, and had it myself, I feel that I can give those remedies that will present as fair a prospect for a cure as any others. Immediately on the appearance of the watery discharges, give an emetic of salt and ground mustard, in a glass of Avarm water; this will puke the patient immediately, and he will afterwards be enabled to retain the following medi- cine : Recipe: Calomel, sixty grains. Pulv. Camphor, fifteen grains. Pulv. Opium, six grains. Mix, and divide into three poAvders. Give one every thirty minutes, till all are taken; they should be taken in a little brown sugar and a few drops of Avater. At the same time, occa- sionally, a tea spoonful of the spirits of camphor should be taken in strong toast-Avater. Mustard-plasters should be applied all over the stomach and abdomen, and the legs and arms should be wrapped up in them. As little fluid as possible should be taken till the calomel operates. The toast-water will serve for drink and nourishment. Many have recommended piperine and cay- enne pepper internally. I have tried them often, but cannot say £ ever saw any marked benefit from their use, except when SPASMODIC OR ASIATIC CHOLERA. 195 given in injections. In this form, 1 have thought the article of some service. I have also seen ice given, in large and in small quantities; it gratifies the patient at the time, but I neA^er knew one recover who took much of it. The calomel, camphor and opium, should be repeated, again and again, till the Avatery stools are checked, and then, if they do not operate, a dose of castor-oil may be given to start it; but no cessation of the use of this medi- cine should be allowed, till bilious stools are procured. The best returning signs of success are a Avarm skin, the absence of cramps, a composed stomach, bilious stools, and a free flow of urine. Third stage, or that of collapse, is marked by a shrivelled skin, especially the hands, Avith a blue appearance of the fingers and lips, nose and ears, &c.; sometimes they are as blue as if they had been dyed Avith indigo. The discharges are frequent, and thin as water, and involuntary; the cramps are severe for a Avhile, but presently cease. The surface is as cold as ice and clay, and the pulse imperceptible; the thirst is great, and the vomiting frequent; everything thrown up is as cold as when it Avas swallowed. The great desire is for cold Avater, ice-water, or ice itself. The voice fails more and more, and the patient feels disposed to lie stiller, and not speak unless spoken to; he then answers rationally. The patient, in this state, looks like a skeleton; the skin loses its color, and, in some cases, turns brown, and seems as if it Avould cleave to the bone, especially on the face; the lips are contracted, and will not cover the teeth. The voice is perfectly sepulchral. The cramp now ceases, and it Avould seem as if the irritability of the nervous system Avas almost entirely destroyed. All the veins look flat and blue; the thinner fluids of the system have all been drained off. A multitude of remedies have been prescribed for this stage of the disease, by Avriters on cholera; and I have no doubt but many of them have been prescribed by men Avho never saw a case of cholera asphyxia. I have tried, and seen tried, a great many of them, and never saw one that I have seen published do any good. I shall here give but one remedy, Avhich I found by experimenting. I attended a lad, about nine years old, by the name of Buckley, in Newcastle, Kentucky; he was the son of a AvidoAv, a lady of good sense and strong nerve. Her son had been collapsed for several hours, when she said to me, "1 know he must die in a short time, and I Avish you to try some experiments on him." I immediately gave him a tea spoonful 196 SPASMODIC OR ASIATIC CHOLERA. of salt, and as much ground mustard, in a glass of warm water, he retained it. In a feAv minutes, I gave him another; he presently threw them up. The dose was repeated every few minutes, and as often rejected, till eight or ten glasses had been taken and puked up. The skin began to feel less cold, and the puking was continued to twelve or fifteen times, when the pulse began to be perceptible, the sweating ceased, the shrivelled con- dition of the skin disappeared, a glow came upon the surface, and the purging stopped. I now ceased to puke him any more. In a few hours the blood started from his gums, and he coughed up strings of dark blood from the lungs. The surface of the stomach and abdomen, and the whole length of the spine that had been freely rubbed with strong spirits of camphor, turpen- tine and mustard, without reddening it in the least, now became red and generally blistered. The febrile action ran so high that I bled him twice in twelve hours. I hoav gave him small doses of calomel and tartar emetic, till the fever Avas subdued, and he Avas slightly salivated; and by low diet and close attention he recovered. After this, several were recovered from a state of collapse in the same Avay. I have omitted to say, that in all stages of cholera, I have usee the warm bath. I have bled from the arm and from the feet, in the bath and out of it, but cannot say that I ever saw any bene- fit derived from these remedies. I have used all forms of cathar- tics and injections; but feAv of them seem to avail anything. I have given, in the above treatment, all the remedies that have been of any avail in my hands ; and Avith those remedies 1 have cured great numbers, as well as Avitnessed their good effect in the hands of my cotemporary practitioners. In conclusion, I Avould say, that in the course of my observa- tions in this epidemic, a great many persons have been frightened into this disease. I therefore would advise those who are fear- ful, when the cholera appears in the neighborhood, to make their escape to another section of the country, where it does not pre- vail. From all I have ever been able to observe, I do not believe the cholera is contagious; but after it has prevailed for some time in a small town, and the whole atmosphere becomes loaded with the effluvia of the discharges, persons not accustomed to it should keep away from its influence. SCYBALUM. 19T SCYBALUM. This disease is characterized by hard lumps in the bowels. They are unctuous or soapy concretions, mostly continuous, sometimes in layers, spheroidal or oblong, consisting chiefly of mucus, or oily matter, more or less mixed Avith hardened faeces. These lumps have often been mistaken for biliary calculi, an error which is apt to occur when they have not been particularly examined. The concretions are numerous, in many cases where the patient is liable to have these formations in the bowels. When, from a feeble peristaltic motion of the bowels, the faeces have remained a long time in them, they are found to undergo a considerable change; for they become harder as their more liquid parts are absorbed; and, in consequence of becoming harder, they stimulate the mucous glands, by which they are surrounded, to a more copious secretion of mucus, which inter- mixes with them, and as they break into fragments, gives them a less rough or more greasy feeling. These are the common scybala of medical writers. But we occasionally meet with balls, buttons, or globules, of a more fatty or oily substance, dis- charged, sometimes literally so, sometimes in groups, of very lifferent sizes, from the rectum ; and from the pain in the stomach, which often attends them, they are not unfrequently mistaken for gall stones. They are generally in size from that of a small pea to that of a grape, of a cream color, and slightly translucent, and of a sufficient consistence to bear being cut Avith a knife, like soft wax. We are seldom able to trace these concretions to any unctuous substance taken into the stomach; they, therefore, must be formed by some action in the larger intestines. Dr. Babington relates a case in a little girl of four years old, of whom he says, "At the age of three, her mother observed something come from her as she walked across the room, which, Avhen examined, was found to be fat in a liquid state, Avhich concreted when cold ; ever since that time, the patient has Avoided, at inter- vals often or fourteen days, the quantity of from one to three or four ounces, sometimes pure, at other times mixed with faeces. When voided, it has an unusually yellow tinge, and is quite fluid, like oil. Her appetite is good, as well as her spirits, and her flesh is arm; her belly is rather tumid, but not hard ; she is subject to occasional griping." Globules and balls of fat are noticed by various medical wri 198 SCYBALUM. ters, both in this country and in Europe. We nave an account, in the Edinburgh Medical Essays, of a substance, like tallow or hardened marroAV, in a congeries~of globules, passing with the faeces, in masses as large as a Avalnut, and subsequent pieces passing, the size of peas. The Paris Academy of Surgery have published similar accounts. These lumps are of various sizes and colors, from the size of a small nut to that of a hen's egg. Where they have remained for a long time in the bowels, they cause great pain, and colicy symptoms. Costiveness is always more or less an attendant on this disease. Those lumps are found in large masses in the Avhale, and are what is called ambergris. When found in a Avhale that has died of the disease, these lumps of ambergris sometimes weigh more than a hundred pounds. They bear a close resemblance to the faeces of the whale, but harden on being exposed to the air. It is probable that the largest lumps are never extracted from the Avhale, but are found after its death and putrefaction. Neumann gives an account of a mass found on the coast of the island of Tidor, that weighed not less than a hundred and eighty pounds. It Avas purchased of the king of Tidor, by the Dutch East India Com- pany, in 1693, for eleven thousand dollars. "It measured five feet eight inches in thickness." It was long exhibited at Amster- dam, and at length broken up and sold. Other masses, of many pounds' weight, have been found floating on the sea. The con- cretions thus detached, and of different bulks, are carried into every quarter of the world, by tides and currents, and have sometimes been found on the shores of the West Indies. The whale containing this substance lives in the southern seas. When recent, the smell of ambergris is very strong, and rather fetid; but by keeping, the offensiveness goes off, and it acquires a faint musky odor. It has scarcely any taste. Its color is ash- gray or brown, someAvhat mottled; its hardness is sufficient to render it somewhat brittle, but will not bear a polish; when broken down, it has a somewhat soapy feeling. TREATMENT. The treatment of this disease consists in mild purgatives of the vegetable kind. The following pills, if taken every night for some time will remove them : Recipe : Scammony, forty grains. Aloes, forty grains. Rhubarb, forty grains. Castile Soap, forty grains. Ta-tar Emetic, three grains colic. 199 Mix well, and form forty pills. From three to four of these pi .Is will, if taken at bedtime, operate two or three times in the morning. These pills should be repeated for some time; then they may be changed for a few doses of castor-oil. The patient should be careful not to suffer a costive habit to become estab- lished. Those means that are calculated to give general tone to the system, will also tend to remove this condition of'the boAvels, such as the cold bath by aspersion, or the shoAver-bath. Some warming vegetable tonics will also assist in the cure, such as: Recipe : Colombo Root, one ounce. Gentian Root, one ounce. Orange Peel, one ounce. Rhubarb Root, one ounce. Make all fine, and add to them one pint of old spirits and one pint of water. Shake every day for ten days. Then take a table spoonful in water, three times a day. The diet should be such as the stomach will readily and easily digest. Early rising and active exercise will be of great service, especially exercise on horseback. Kneading the abdomen every morning with the fists, for fifteen or twenty minutes, will go very far toAvards effecting a cure. Quick and active friction over the abdomen, with the open hand, Avill also be very good in aiding digestion. In this, as well as all other constipated habits of body, a large draught of cold water, taken in the morning immediately after washing, will be good. Also a glass of cool water should be drank every day while dining. COLIC. This disease is distinguished by griping pains in the bowels chiefly about the navel, Avith vomiting and costiveness. There are various diseases to which this definition will apply, but which, nevertheless, differ in character, in several important particulars, though they bear so close a resemblance to each other as to be properly classed in the same order or family. But for the sake of perspicuity, I shall treat of each member of this family under its appropriate head. The first species is called the 200 colic. ILIAC PASSION, OR SPASMODIC COLIC This species is properly defined by griping pain, vomiting, and costiveness, accompanied Avith retraction of the navel, and spasms of the muscles of the belly. It takes its name from the disease being seated in the ilium, or small intestines. The grip- ing pain, or belly-ache, in this species, is very acute; and the vomiting is accompanied not only Avith a discharge of bile from the duodenum, but actually of feculent matter from the large intestines, and, in some cases, of the injections that have been thrown into the rectum. So violent is the reverted action of the bowels, that the valve of the colon is forced, by which action the boAvels often become folded into themselves, like the finger of a glove folded into itself, Avhile the obstinate costiveness which exists at the same time, clearly indicates a spasmodic constric- tion; which, hoAvever, rarely produces an entire occlusion of that part of the canal Avhere the pain is most severe. The pain often extends to other parts, and even to the gall ducts. Even in this last case, Avhere the faeces are discharged by the mouth, they are rarely tinged Avith bile, while all the symptoms of jaun- dice supervene. It is not unfrequently the case that inflamma- tion is excited in that portion of the intestines where the pain is> most violent. This aggravates all the other symptoms. The dissection of persons who have died of this species of colic, has shown, in some cases, that one portion of the bowels, constringed and lessened in its diameter, has fallen into another portion below it, and thus produced what is called intussuscep- tion or involution of its coats; but we dare not say that this is the case in every instance of this disease. On the contrary, Ave have good reasons to believe that it is not, in the less violent forms of the disease. In every case in Avhich the coats of the intestines are Aveakened, there is a copious extraction of air, producing, in many cases, a great distension of the abdomen. In this species of colic, as Ave have already observed, there is, in conjunction with this extraction of wind, a strong, invertea peristaltic action operating from the rectum to the stomach, and forcing back every material that is contained in the bowels; these, by intermixing with the elastic vapor contained in the bowels, become very voluminous, and distend it to its utmost range, wherever distension can be accomplished. But there being in some portions of the bowels violent contractions, COLIC. 201 through which the distensive force cannot prevail, except by snatches, or during a lemission of the spasm, the two powers are hence brought into immediate contact, and while the intes- tine is rigidly contracted above, it is widened almost to bursting below; and during the struggle, which causes a part of the imprisoned contents of the expanded intestine to be forced upwards, the collapsed portion of the superior intestine slides downAvards at the point of the stricture. In the midst of this spasmodic commotion, there is also another very extraor- dinary change which has been found to take place in the relative position of some parts of the intestinal canal. From the urgency of the moving powers that work upwards, the natural effect of the gravitating poAver that Avorks doAvnAvards, and the looseness of the intestines themselves in many parts, and their tightness from adhesion in others, they have sometimes become twisted into nooses and knots, in Avhich, the portion forming an entire circling cord, a knot has been tied, and draAvn so tight as to pro- duce strangulation, and render gangrene or mortification inevi- table. In one instance, the strangulation Avas so complete, and the spasmodic action so extreme, that the bridle not only pro- duced strangulation and gangrene, but actually cut through all the coats of the intestines, on the opposite side to the mesentery, and made an opening about an inch in length. — Medical Obser- vations. The common causes of this disease are acrid, cold, or indi- gestible substances; cold beverages on a heated stomach ; catch- ing cold in the feet, or abdomen; unalimentary substances swallowed through bravado or by mistake, as pieces of glass or pieces of metal; plum, cherry, or other fruit stones; an excessive flow of acrid bile; worms; drastic purgatives in over doses, as of black hellebore or colocynth; calculus or other balls lodged in the intestines, and obstructing their passage, as scybala, be- zoars, or indurated or hardened faeces; violent passions or other emotions of the mind, as extreme rage or terror; a contraction of the intestinal canal from scirrhous or cancerous tumors. It is sometimes a consequence of transferred gout, or rheumatism. TREATMENT. If the patient is stout and full of blood, he should be bled from the arm, all his pulse will bear at the time; then place him in a warm bath, or he may be blod in the Avarm bath. If the first * 202 COLIC bleeding should not give some relief, he may oe bled a second, or even a third time, in tAventy-four hours. Immediately after the bath and first bleeding, an injection of some Avarm fluid should be given — say salt and Avater, or Epsom salts in Avarm water. This should be immediately followed by a large dose of oil, Avith a tea spoonful of laudanum in it. By this time, you will have obtained some quietus of the stomach, especially if a large mustard plaster has been applied there. Now you should give ten grains of calomel, with half a grain of opium, every two hours, till the stomach and boAvels are freely evacuated, always observing to omit the opium as soon as the vomiting stops. It would be scarcely necessary to say that every other medicine would be thrown up but calomel. A few drops of croton oil may be given with every other dose of the calomel, and a few drops may be rubbed on the stomach. If there are signs of inflammation of the boAvels, a large blister may be applied over the abdomen. If the calomel and opium fail to operate, then quicksilver may be ^iven. I once gave an ounce, in such a case, before arf operation could be procured ; the patient, however, had previously taken, in four days, an ounce and a half of calomel, and had had from twenty to thirty injections, and warm baths, bleedings, &c, all to no purpose. I gave the quicksilver and Availed the result. In ten hours it loosened all the knots in the bowels and passed off. The patient recovered, and Avas but slightly salivated. I have since used hyoscyamus — twenty grains of the extract to a quart of warm water. This relaxed the spasms, and the medicine operated well. This injec- tion should be throAvn into the bowels Avith great force. Some have used cold Avater, suddenly and forcibly thrown upon the abdomen, and also injected it freely into the bowels. Warm water has also been used in the like manner. The enema pump should be used, so as to fill the bowels completely. Emetics are of doubtful utility in this disease, though there is much vitiated bile discharged by vomiting. Yet Ave should always attempt to carry it doAvn. Great care should be taken in convalescence to avoid the exciting causes. painters' colic. The distinguishing marks of this species of colic are dull pains at first, which are remitting, but progressively growing more violent and continued; extending to the back and arms, COLIC 203 and at last producing paralysis. The pain in this species is generally seated at the pit of the stomach, and is apt to remain there; it gradually groAvs more severe, and as it increases, it extends upwards to the arms, and downwards to the navel, back, loins, rectum and bladder, and frequently to the thighs and legs. From the navel it frequently shoots Avith so much violence to each side, that the patient feels as if some person was cutting him in two. Almost all the muscles of the body are rendered sore by the violence of the pain, so that the weight of the bed-clothes, or the touch of the finger is not easily borne. Sometimes the pain alternates betAveen the stomach — Avhich it, however, never leaves entirely — and the external muscles. When the muscles and loAver bowels are most at ease, the pain is worst in the stomach. Sickness at the stomach, as Avell as costiveness, is an early symptom; and the sickness at the stom- ach increases with the pain; even on the second day from the attack, the straining and vomiting are violent. The discharges from the stomach consist of pancreatic liquor and bile, mixed. A momentary relief is generally obtained by vomiting; but as long as the pain continues the same morbid matter will be dis- charged. The secretions are increased, and the severity of the symptoms also. If the puking, however, should cease while the disease continues, its place is supplied Avith bitter eructations and hiccoughs. The pulse is generally but little affected at first, and for several days may continue as quiet as in health ; but in three or four days it becomes quicker. The urine varies Arery much in different individuals, so that no stress can be laid on that. Towards the close of the disease, there is generally a pain around the edges of the feet, and at the extremities of the toes, which are often red and swollen, and to appearance gouty. Sometimes sweats break forth, accompanied with an eruption on the skin; at the same time a griping, different from what had been felt before, and Avhich is not so violent, takes place, and now there is a disposition to go to stool, and after large dis- charges of different kinds of faeces, frequently in hard lumps, and not unlike sheep1s-dung, together with black and dirt-col- ored slime, occasionally mixed with blood, the patient is perfectly relieved. If the disease is mild and well treated, it may be removed in a few days; but if it be violent, neglected, or ill treated, it will continue for Aveeks, or even months, with now and then an abatement for a few days, and will terminate in a peculiar sort of palsy of the arms and hands, or in death, which 204 COLIC Avill be preceded by blindness, deafness, delirium, or epileptic fits. Lead is the remote cause of this species of colic, perhaps in almost every instance; being introduced into the system, either by the mouth, lungs or skin; hence, this disease is chiefly con- fined to those Avho Avork a great deal in lead, as among painters, or grinders, or smelters of this article. In the neighborhood of smelting furnaces, animals of vf.rious kinds are subject to this disease. Plumbers, potters, glaziers, workers in glass, gilders, and chemists, as Avell as miners and painters, are in like manner exposed to its attacks, from the large quantities of lead contained in the materials which they handle. Printers are not exempt from it, if they do not Avash their hands clean before they eat. Crude Avines and ciders are said occasionally to be the cause of this disease, but, in all probability, it is produced from the lead used in these articles to prevent fermentation, or they are made in materials Avhere lead is freely used. As far as I knoAV, the medical Avorld is indebted to Sir George Baker for his critical examination of this subject, and tracing it to its proper source, and exposing the iniquitous fraud of sAveetening sour Avine and cider Avith litharge or sugar of lead, and using vessels lined Avith lead for their manufacturing. Persons once attacked Avith this disease, are very liable to be attacked again on the application of the exciting cause. TREATMENT. If the pain be severe, the patient should be bled, and opium injections given, as in the preceding species. Then a large dose of purgative medicine should be administered, before the stomach becomes so sick as to reject it. Recipe: Calomel, thirty grains Scammony, twenty grains. Jalap, twenty grains. Form twelve pills. These may be given, four at a time, and repeated every hour, till all are taken. If they should not operate freely, tAvo ounces of castor-oil may be given, and the same quan- tity repeated every hour, till free evacuations from the boAvels are produced. Frequent injections may be used, to aid the medicine in operating. If the pain in the stomach should be severe, opium must be given to relieve it. If the stomach rejects the above medicine, smaller doses of calomel, combined Avith opium, must be given, till free operations are procured. If free purging is not COLIC 205 obtained before, it Avill take place when the patient begins to spit freely. After free operations have been procured, the boAvels may be kept open by some gentle purgative, as castor-oil, or salts and senna tea. I have been told by lead smelters, that on the first appearance of lead colic, if they can obtain half a pint of bear's oil and drink it off, it removes all the unfavorable symp- toms, and operates freely, and cures the disease. No doubt, if taken in time, any other oil that would act freely Avould do as well. Some men are so fearful of salivation that they cannot be persuaded to take calomel enough to salivate them. But in this disease, where it has become established, it is better to salivate than die. In convalescence, all the exciting causes should be removed from the patient, and he should quit working in lead. Tonics will be proper in convalescence. When the disease ter- minates in epilepsy, the nitrate of the silver should be given, in doses of from four to five grains, three times a day, for some time ; this rarely fails to affect a cure. The diet must be light and thin, and the drinks cool or mucilaginous. WIND COLIC This species of colic is characterized by acute pain extending to the pit of the stomach, often impeding respiration ; accom- panied A\rith great distension of the stomach and bowels, fulness and flatulency; Avhich is partially relieved by pressure or bending the body fonvard, or the expulsion of Avind. This species of colic is often produced by crude, flatulent fruits, and Avhatever lowers the tone of the stomach and boAvels; as too long fasting, fear, or grief, and all the causes of dyspepsia, Avith Avhich it is often complicated. Its seat seems to be in the small intestines, and, consequently, in the immediate neighborhood of the stomach. It is often accompanied Avith obstinate costiveness, which runs in a greater or less degree through the Avhole of the intestinal canal, adding considerably to the torture, and increasing the SAvelling and tenderness of the abdomen. The last symptom is peculiarly striking and distressing in persons who are hysterical. Such persons are attacked Avith this complaint from very slight causes : and Avith them it often produces fainting, or slight spasms of various kinds. 206 COSTIVENESS. TREATMENT. The first object to be attended to is the expulsion of the wind, and, Avith it, the pains and every other bad symptom Avill subside. The Avarm carminatives, such as pepper tea, ginger tea, spirits of camphor, and even hot brandy, have been given, and, in many cases, Avith immediate relief. These highly stimulating articles may be used the more freely, because there is no danger of inflammation in this form of colic. All the stimulating teas, such as peppermint, thyme, pennyroyal, etc., have been resorted to, but the folioAving is the most effect- ual. Recipe: Tincture Asafcetida, two drachms. Volatile Tinct. Valerian, two drachms. Laudanum, one drachm. Mix, and give a tea spoonful every ten minutes, in a little water, till the pain is relieved. Then give a full dose of castor- oil, or senna tea with salts dissolved in it. If the boAvels are greatly distended Avith Avind, an injection Avith Avarm Avater and salt Avill often giA^e speedy relief. If castor-oil is not at hand, any active purgative may be used, such as Recipe: Aloes, ten grains. Rhubarb, ten grains. Scammony, ten grains. Asafcetida, ten grains. Form eight pills. Give four ; wait an hour, and give the other four. After the boAvels are freely evacuated, the patient should be careful, for a feAv days, not to use heavy food; care in avoid- ing the exciting causes, will keep the patient free from another attack. Someimild tonics, Avhere the patient has become subject to colic, Avill be of great service. The best is the compound tincture of petelea. (See Materia Medica.) A tea spoonful may be taken, in Avater, three times a day, till the stomach and boAA^els have received their proper tone. COSTIVENESS. The characteristics of this disease are solid, compact faeces, large and hard. The habit of the subject is firm and rigid. In persons of a compact and robust habit, Avith hearty appetite and strong digestive poAvers, the intestinal absorbents occasionally evince an excess of action; and the faeces, Avhile they become COSTIVENESS. 207 hardened in consequence of such action, assume the figure of the large intestines through Avhich they pass. The action of the absorbents may be increased by violent exercise, that produces a copious perspiration, which diminishes the fluids that would' otherwise be thrown upon the inner surface of the intestines; or the aliment may be dried by such articles as act as astringents. These excite the sphincter muscles of the rectum, and so lay a double foundation for this form of the disease. Persons who are in the habit of eating heartily of solid food, and taking but little exercise, or fluids, may become costive thereby. In this case, the recrement, too inspissated from the first, gradu- ally becomes more so, by stimulating the absorbents to take up more of the fluids of the bowels, and thus increase the constipa- tion. Bakers' bread that contains alum Avill cause costiveness, by stimulating the mouths of the absorbents, causing them to take up more fluid, till finally they will become closed them- selves, with the secreting vessels. Then the costiveness is almost permanent; for exactly in proportion to the suspended action of the excreting vessels, will be the diminution of the peristaltic motion of the boAvels, and the aggravation of the constipated condition of the bowels. This condition of the bow- els, with a considerable, or even an inconsiderable, perspiration, will ahvays bring on costiveness. In this condition of the sys- tem, the secretion of bile is always diminished, and the bowels lose the natural stimulus of this fluid, and the costiveness is increased thereby. If all these circumstances are combined together, Avithout much diminution of appetite, the accumulation of faeces will be, in some instances, prodigious. The distension of the abdomen from this cause has been mistaken for pregnancy, especially if there be occasional sickness of the stomach, and suppression of the menses, Avhich is apt to attend on this condi- tion of the bowels; and a suppression of the menses will pro- duce a sympathetic enlargement of the breasts. Dr. Goode gives a case of this description, "which terminated fatally in about three years from its commencement. After death, the colon, the large intestine, measured more than twenty inches in circumfer- ence, and on dissection, Avas found to contain more than three gallons of faeces." A stricture in any part of the intestinal canal may produce this disease in the same manner that it Avill consti- pation in colic; but colic does not ahvays folloAV, for the bow- els are less irritable here than in colic. Intestinal strictures are more common in the large than small intestines, and Avhen they 208 COSTIVENESS. are in the colon, they exist sometimes without being suspected. Dr. Bailie gives the following case: " The patient was a shoe- maker, aged thirty years, and subject to habitual costiveness. ►He became, at length, much more so; and from having motions three or four times a week, he passed them not oftener than once or twice in a Aveek or fortnight; and this, moreover, Avith con- siderable pain in the lower part of the belly; and at length was incapable of passing a motion by any means. The real cause of the .disease not being very clearly understood, the strongest purgatives Avere given to him, both by the mouth and in the form of clysters, as five grains of calomel and ten of gamboge, and ten grains of calomel and thirty of jalap, and, at one time, four grains of illaterium, Avhich made him sick, but produced no other effect. Tavo drachms were given in the form of an injec- tion, and afterwards crude quicksilver by the mouth ; shocks of electricity through the abdomen, and the infusion of cold water on the feet. His appetite Avas but little interfered Avith, and he passed water freely. A scoop Avas introduced into the rectum, but this gut Avas found empty. Under this state of things, the belly SAvelled gradually, and at length arrived at an immense size, and the patient died in the fifteenth Aveek after the last evacuation. An examination after death showed the real nature of the case, for at the lower end of the sigmoid flexure of the colon, there Avas a narroAV stricture, which would hardly admit the passage of a goosequill, accompanied Avith an ulcer, which was partly in the situation of the stricture, and partly in the gut above it. This intestine Avas peculiarly loaded with faeces, and enormously distended, the mean of the transverse diameter being about six inches. All the large intestines, where the distension was considerable, had their muscular coats a good deal strength- ened, and the longitudinal bands had become twice as broad and thick as in their natural state. The system thus Avonderfully accommodated itself, for many weeks, to circumstances which seemed incompatible Avith the processes of life." The effects of constipation, when long continued, are pain in the head, nausea and sickness at the stomach, febrile irritation, general uneasiness in the abdominal region, congestion in the abdominal organs, and hence an impeded circulation of the blood, piles, varicous veins in the lower limbs, and, as we have already seen, colic. COSTIVENESS. 209 TREATMENT. Persons who are subject to costiveness are very culpable to allow such a state of things to continue. At first they should solicit a regular evacution, at a stated hour, every day. If that should not succeed, they should drink largely of cold Avater every morning, immediately after washing the hands and face; then use quick and active friction over the abdomen Avith the hand or a flesh-brush. Should these fail, a tea spoonful of Epsom salts should be drank, in a glass of cold water, before Dreakfast, or an injection of a pint of cold water may be taken, by a self-syringe, every morning. The bowels should be kneaded for fifteen minutes every morning, or take the following pill at bedtime: Recipe : Aloes, twenty grains. Rhubarb, twenty grains. Castile Soap, twenty grains. Ground Ginger, ten grains. Tartar Emetic, three grains. Form tAventy-four pills. Two or three of these may be taken at bedtime, every night, till the costive habit is overcome. Any diet or drink may be taken after these pills operate. I have known this pill to be taken for months, to overcome an estab- lished constipation, but I never knew it fail to perform a perfect cure. When a regular succession and action of the boAvels have been established, the pill may be omitted, by taking only one, or the half of one, at bedtime, and finally omit them altogether. Bitters of various kinds have been prescribed in these cases, but all to no purpose, unless they are strongly impregnated with aloes or rhubarb, and then they are not so good as the above pill. A draught of weak ley, every morning, has been of great service towards overcoming costiveness. A pill of castile soap alone, as large as a bean, taken every night, has effected a cure. Persons subject to costiveness should not sit a great deal. The pores of the skin should be kept open by a cold bath every morn- ing, either by aspersion or shower. The diet should be three fourths vegetable matter, but some fat meats or gravy must be taken; soups are good. All stimulants of every description should be avoided. Well-baked corn bread, light suppers and breakfasts, and active exercise both of body and mind, are the best securities of health. bright. 15 210 TIC DOULOUREUX, OR NERVEACHE OF THE FACE. TIC DOULOUREUX, OR NERVEACHE OF THE FACE This painful disease is characterized by lancinating pains, shooting from the region of the mouth to the orbit of the eye, often to the ear, and over the cheek, palate and teeth, and fauces; with convulsive tAvitchings of the adjoining muscles. As the French give the name of tic to lockjaAV, they distinguish this species of neuralgia, by the name of tic douloureux, by Avhich term the disease is noAv chiefly known, both in Europe and America. The name of tic, to this disease, is probably derived from the sound apparently communicated, or from the manner of attack. or shoots of pain, Avhich attend upon it, resembling the sud- den sting of some piercing insect. Some suppose that it derived its name from the sound that is produced by the horse biting the manger, Avhich he is constantly doing when he labors under this disease. Horses are very subject to this disease, and it is mani- fested in them by a constant nipping at the trough, and by sud- den starts, throwing up the head Avhile you are driving them, when there is no apparent cause for fright. By the symptoms by which this complaint is distinguished, it is not difficult to decide concerning both its seat and nature. The character of the pain is very peculiar, and its course corresponds exactly Avith that of the nerves. The second branch of the fifth pair is probably more frequently affected than those of the first or third, but the portia dura of the seventh pair, which is distrib- uted more extensively over the face, is more frequently the seat of affection than any of the branches of the fifth pair seem to be. When the disease is situated in the seventh pair, there can be no difficulty in deciding concerning it; for the pain commences in the fore part of the cheek, tOAvards the mouth and alia of the nose, sometimes spreading as high as the forehead, and branching off in the direction of the ears. At other times, the forehead, temples, and inner angle of the eye on the side affected, and even the ball of the eye itself, form the chief line of pungent agony, while, from the irritation of the lachrymal gland, the eye weeps involuntarily. In this case, we may reasonably expect the disease to be seated in some portion of the superior maxillary nerve, con- stituting the second branch of the fifth pair; hence Ave see that the radiation of the pain will be exactly in the direction of the branches of the nerve affected. This disease has been sometimes mistaken for rheumatism. TIC DOULOUREUX, OR NERVEACHE OF THE FACE. 211 hemicrany, and toothache; yet the brevity of the paroxysm and the pungency of the pang, the absence^ of inflammation or sAvell- ing, the comparative shalloAvness of its seat, and invariableness of its folloAving the course of the nerves affected, will be always sufficient to distinguish it from any other pain. This disease is found in the robust as well as in the weak, and in the middle-aged as well as in the old. Its cause would seem to be, in some instances, cold; in others passion, as anger, fear, grief; and in some others deranged menstruation, or a derange- ment of the digestive apparatus; and in some cases we are not able to trace its origin to any particular cause. It has been sup- posed, by some able writers on this disease, that it sometimes has its origin at the root of the nerves, rather than in their extremities. Avhich theory has some plausible grounds for its foundation, as we shall see Avhen treating of the neuralgia of the breast and feet. TREATMENT. The authors that have written on this disease during the last half century, until Avithin a feAv years past, knew of no remedy that Avould cure this distressing malady. They used mercury to salivation, arsenic and the various metallic preparations, and all to but little effect. The only remedy that they could apply Avith any kind of success, was the knife. They divided every branch of nerve that Avas the seat of pain, and after dividing ^. me times ten or a dozen, the patient Avas permanently relieved. Laudanum, musk, ether, valerian, iron, zinc, and mercury, have all been tried, in their various forms and preparations; and, generally speaking, with but little success. The true remedies and method of treating the disease, have been left to the discovery of the last ten years, and mostly, to the last five years. It will be advis- able, in every instance, to premise the use of the remedies noAv to be given, by cleansing the stomach by an emetic; and in some few instances, the disease has been cured by the use of emetics alone, (this is an old remedy.) They, however, to be successful, should be given every other morning for several weeks, and in some cases for months; and between the emetics, small doses of tartar emetic should be given every hour or tAvo, on the interme- diate days, so as to carry the patient effectually through an alter- ative course of tartar emetic By this means, a few cases have been cured permanently. But the science of medicine is on the march, and tic douloureux has not been left out of the list of diseases for which neAV reme- 212 TIC DOULOUREUX, OR NERVEACHE OF THE FACE. dies have been found. While writing this chapter, I was called upon by a lady, Avho had been laboring under, as she supposed, toothache, for several days, for a remedy, without extracting the tooth. After examining the case, I Avas satisfied it was tic douloureux. The pain was not confined to her teeth, but was situated in the cheek, and along the Avhole course of the gums, on the right side of the face. The parotid duct was highly stim- ulated by it, for large mouthfuls of water were constantly ejected. I prescribed an aperient dose of medicine, then followed it by the extract of belladonna, in half grain pills, to be repeated every three or four hours. She took four pills, and the pain ceased. Her vision became imperfect, and continued so for one day and night, so that she could not see how to thread her needle. By the use of another gentle dose of medicine, all the unpleasant symptoms left her. Her vision Avas as good as ever, and she was perfectly, cured of the pain. She had been subject to this pain, frequently, for some months, but has now been clear of it for nine months, (Avhile I hoav am revising my manuscript.) I have used the belladonna in several cases, with a similar result, but ahvays have to push it to the point of impairing the vision for the time being, before the pain is removed entirely. Mr. Norman has given a case, at the United Hospital, of a patient, aged fifty years. The patient, a female, of a leuco-phlegmatic temperament, much emaciated, had suffered from tic douloureux fourteen years, with a few intermissions. The paroxysms Avere so severe as to distort the features; they recurred every five or ten minutes, day and night, during the last four months, confin- ing her to bed, by Avhich her health was much impaired. The belladonna was administered internally, to the amount of one sixth of a grain every six hours, during two days, without any particular effect on the disease, but acting as a purgative. It was then combined with quinine as below. Recipe : Extract Belladonna, half grain. Sulphate Quinine, three grains. Form six pills. One was given every four hours. After the sixth dose, she became delirious at night. The pupil of the eye partially dilated, but the paroxysms were reduced to sixteen, and on the following day to three; after which time, she gradually • omitted the medicine, and was able to leave her bed, and take lull diet, having previously subsisted on fluids. She then Avholly omitted her medicine for a week, and having had no return of her distressing malady for ten days, she was dismissed from the TIC DOULOUREUX, OR NERVEACHE OF THE FACE. 213 hospital. Mr. Mortimer stated that in a case of tic douloureux well known to him, where tAvo grains of the extract of bella- donna had been given at once, through mistake, the patient was alarmingly ill for a Aveek, but never suffered from the disease again, though tAventy years had since elapsed. From these facts, Ave are in possession of undoubted evidence of the great utility of the extract of belladonna in tic douloureux. But it needs some modification of application. It should be given in larger portions than the smaller one here directed, — in the sixth part of a grain dose. The larger ones are too large. We have found from a third to half a grain, given in bad cases, once in four or five hours, is about the proper quantity to be given, Avatching the symptoms closely ; and as soon as any dim- ness of vision is manifested, the medicine should be omitted, and a gentle purgative given. The veratria is another neAV remedy, which has been known but a few years. Dr. Le Calve cites two cases of this painful disease, which were entirely cured by friction Avith the veratrine ointment. The first was a man employed as inspector of a tele- graph, Avho, having exposed himself for half an hour to a draught of very cold air, Avas, in a feAv minutes after, seized Avith violent pains. They proceeded from the ophthalmic branch, and radi- ated over the temple. The eye was injected, and there Avas considerable spasm of the eyelid, and dread of light. At the end of a few hours,after the first friction of the veratrine oint- ment, the pains ceased Avith exceeding rapidity, and the patient slept. The pain, however, returned at tAvo o'clock in the after- noon, but yielded in four minutes to the ointment. The oint- ment Avas applied, at every return of the pain, for several times, v/hen it finally yielded, and returned no more. The doctor cured another case, equally as bad, by the use of the ointment. The following is his formulary : Recipe : Veratria, ten grains. Rancid Lard, half ounce. Mix perfectly. The ointment should be applied with the end of the finger, Avhich should be carefully washed before it is put about the eyes; if any should get into the eye, it produces the most inveterate inflammation. It, however, may be applied even on the eyebroAv, with care, and do no harm to the eye. Dr. Berreyne uses the belladonna in the form of an ointment for neuralgia, as follows: 214 TIC DOULOUREUX, OR NERVEACHE OF THE FACE. Recipe : Extract Belladonna, half ounce. Pulv. Opium, forty grains. Hog's Lard, half ounce. Oil of Thyme, six drops. Mix them perfectly. A portion of this ointment, as large as a h'azlenut, is to be rubbed upon the affected part, tAvo or three times a day, or Avhenever the paroxysm of pain is severe. The rubbing should be continued for eight or ten minutes at each time, or until the ointment is quite absorbed by the skin; a little saliva may be added, now and then, to promote the absorption. If the sight become affected, the use of this ointment should be immediately suspended; or if the head should be affected by pain, it must be omitted. In every obstinate case, the doctor conjoins the internal administration of the extract of belladonna or opium, with the use of the above pomade. But, in the majority of instances, this is unnecessary, as the pain will very generally yield to the external application. He applies it espe- cially against facial neuralgia, and other local painful affections of a nervous character.—Med. Chir. Review. Dr. Hunt's treatment for tic douloureux, as found in the British and Foreign Medical Review, for 1844, is as follows: For many years, Dr. Hunt has made it a general practice in these cases, to begin with an emetic. If the paroxysms are regularly intermittent, the emetic should be given an hour before the fit comes on. After the emetic, he gives tAventy grains of rhubarb and twenty of the sulphate of potash, Avith thirty drops of sal volatile^ in mint-water. After this, a course of arsenic, combining it with a few grains of carbonate of potash, if there is an acid stomach. He begins with four drops, three times a day, of Fowler's solution, with eight drops of the compound tincture of camphor, gradually increasing the dose of the solution of arsenic, till there is some decided symptom of its action, which is commonly manifested by the time the dose is increased to ten drops — (this is known by sickness at the stomach.) When the pain has considerably decreased, he dis- continues the medicine for a feAv days, and then recommences with the original small dose. — four drops. He has rarely found it necessary to increase them, but continues that quantity for several weeks, if not months, after the pain is removed; for patients should be strictly cautioned against the error of thinking thems3lves cured, as soon as the pain is relieved. They must persist in the use of the medicine and diet, till the tone of the stomach is quite restored, or the pain will return TIC DOULOUREUX, OR NERVEACHE OF THE FACE. 215 The susceptibility of different stomachs tOAvards this remedy is various; in some cases, it must be given on a full stomach. If the pain at any time increases, the purgative must be repeated, and the quantity of the arsenic increased; during the Avhole treatment, an occasional purgative is useful. When the pain is relieved and the stomach improved, the substitution of a grain of quinine, three times a day, will be useful, although it would have disagreed at first. The arsenic may disagree Avith the patient, immediately producing an indescribable sensation of dis- tress in the stomach, dryness of the fauces, Avhite tongue, and other symptoms of gastritis. It should then be discontinued, and as this morbid sensibility is probably accompanied Avith slight inflammation of the mucous membrane, a rigidly farina- ceous diet should be enjoined. It should be in small quantities, and lukeAvarm, Avith small doses of saltpetre, combined with two or three drops of Scheele's prussic acid, three or four times a day; and three or four grains of James' powder, at bedtime. If aperients are needed, a little castor-oil may be given ; a mustard plaster to the stomach, or some stimulating liniment, or a blister, Avill be good. After a few weeks of this treatment, the arsenic may be borne. It should, at first, be given at or just after meals, and if it again disagree, it should be abandoned altogether. The attention to diet in all cases of neuralgia from dyspepsia, .s most important. In case of extreme sensitiveness of the stomach, the mildest food is sometimes necessary. Such patients should live entirely on a diet made of meal or flour, or some farinaceous roots, until the nerves of the stomach become less sensitive; Avhich is known by the tongue becoming cleaner, and the general feelings returning to those of health. When the stomach has become thus improved, some animal food should be added to the diet,—beef tea, or a chicken, — prepared thus: A chicken to be Avrapped in muslin and stewed for tAvelve or fourteen hours, with half an ounce of vermicelli, and a few whole peppercorns, until the Avhole has become a jelly. Some of this, diluted, if necessary, Avith a little toast, forms a very easily ligested meal. As the appetite improves, a slice of game, with soft toast, may be taken. In such stomachs, every kind of food has a tendency to become acid, which in some measure may be prevented by a slight stimulus, with or after meals; a little Aveak brandy and water, or a tea spoonful of sal volatile in a glass of water, or a cup of coffee, will often give temporary relief. For those less sensitive, or whose morbid sensibility has 416 TIC DOULOUREUX, OR NERVEACHE OF THE FACE. been quieted, a plain, nutritious diet of animal food, such as game, mutton, or venison, is best, or a good beef steak, Avith stale bread or toast, and pudding of rice, bread, or tapioca. All pastry, rich pudding, fruit, neAV vegetables, pickles, cheese, and various sauces, must be avoided. Errors in quantity may be prevented by tAvo rules : first, to live simply, and avoid too many dishes; second, to eat sloAvly, that the first indications that sufficient food has been taken may be felt and obeyed. Water, in all cases, is the best drink. Some, who have indulged in the pernicious practice of taking a little Avine every day, must still have a little, in order to digest at all; but. this must be gradually left off, till none be taken either at or before meals. Those Avho can eat bacon may use it, though it should be toasted after being boiled ; but no fresh pork or pig should be taken. TIC DOULOUREUX FROM ANEMIA. This name is applied to the disease Avhere there is no local cause of irritation to account for the pain, nor the neuralgic habit, but Avhere persons, naturally of a strong constitution, have a pallid skin, loss of strength, and symptoms indicating a defi- ciency both in the quantity and quality of the blood. It is in this class of cases that iron is so beneficial, continued unremittedly for months, till there is evidence that there is pure red blood in the system. But in those cases where the attacks are severe, half a grain of belladonna may be given, and will be found ser- viceable in allaying the general irritation of the system, as well as in checking the pain Sometimes tic douloureux has its seat in the spinal marrow. Dr. Hunt says he had three or four cases of obstinate tic, which resisted all the usual remedies; but some symptoms, such as loss of power in the legs, led to an examination of the spine, when much tenderness Avas discovered on pressing some of the ver- tebra (or joints.) Caustic issues Avere applied, and the recumbent posture enjoined, with complete relief to the tic, and restoration or general improvement to the system. The duration of this treat- ment will vary from a longer to a shorter time; and in these cases, the connection between the disease in the spine and the Dain in the face could not be doubted. I have seen such cases, and have cured them by repeated blistering and the use of the veratrine ointment to the spine, together with the continued use of the best preparations of iron. TIC DOULOUREUX, OR NERVEACHE OF THE FACE. 217 Tic douloureux, proceeding from depraved menstruation, will generally subside upon a regular and healthy established action of the uterus. (See Depraved Menstruation, &c) The state of the teeth should be carefully examined, in tic, at a time Avhen there is no pain. If there are any carious teeth that can be saved, they should be carefully plugged, and if there are any stumps or roots, they should be carefully removed. Great care should be taken to prevent a return of the disease. Aconite is another remedy, Avhich has been used Avith great success in the cure of tic douloureux. It is used in the form of a tincture. One drachm of the tincture must be applied Avith a small mop immediately over the painful part, care being taken to have it all absorbed by the process of slowly rubbing it on. The pain Avill generally subside by the time the drachm is absorbed. If the pain should return, the medicine should be reapplied. It is not an uncommon thing for the sight to be dimmed for several hours after the operation of the aconite, if it be applied near the eye, but it will disappear in a feAv hours, and the vision will be as perfect as ever, and in some cases more so, especially if the painful nerve has had any connection or influence with, or over, the retina. The tincture of aconite should be prepared from the root. A saturated tincture should always be used. If the oper- ator should use his finger in making the application of this tinc- ture, it Avould produce a numb sensation in the finger, that Avould last for some hours, so powerful is the narcotic effect of this medicine. The tincture of aconite is not only an excellent remedy in tic, but also in removing nervous pains of other descriptions, as sciatica. It should not be taken internally. Nervous patients should be careful to keep their bowels in a healthy condition. There is one more remedy that I will name before I leave this subject, and that is the extract of tobacco. One drachm may be dissolved in two ounces of water, and by friction, applied with a mop over the painful part. This is said to cure in a feAv moments, and the tic never to return again. I have not used it, but it is highly recommended in the last Retrospect, and, no doubt, is a valuable remedy. 218 NERVEACHE OF THE FOOT. NERVEACHE OF THE FOOT. This species of nervous disease is characterized by racking and lancinating pains ranging about the heel, and tremulously shooting in every direction-^toAvards the ankle, and down towards the toes, and even into the toes. This is the neuralgic plantaris of some authors. Dr. Marino, of Piedmont, was long subject to this disease. It often commences in early life, and in advanced years it becomes less severe. It is apt to alternate with other nervous affections. In the doctor's case, above cited, it ultimately terminated in asthma. It is by no means necessary that the constitution should be broken down, in order to the appearance of this disease, for it attacks the most healthy and robust constitutions sometimes. If let alone, it Avill continue for many years Avith unremitted violence. Dr. Goode relates a case of a clergyman, Avho suffered so severely with this disease that he was frequently obliged to stop short in the middle of a sermon, Avhen the pains would attack him. They would shoot up the leg, along the calf, to near the neck, and doAvn to the toes. He described it by comparing it "to scalding verjuice poured over a naked Avound." All the skill of that day was tried, Avithout giving relief, and he was obliged to abandon the pulpit for sev- eral years. Ultimately, the pain seemed to wear itself away, and he resumed his place in the ministry. TREATMENT. In every instance, the secreting organs of the system must be ^rtit in a good condition, and if the patient is of a full habit, he e*iould be bled from the arm. Then the belladonna should be g;'ven, as in tic douloureux, (Avhich see;) or the aconite may be rubbed in over the affected part, as in tic; or the extract of tobacco may be used, as there directed. The Avine of colchicum should be given, in forty or fifty drop doses, three times a day, till the bowels are freely purged by it; or the tincture of the racsmosa, or rattle-root, may be given instead of the colchicum, in similar doses. If the patient is of a leuco-pblegmatic habit, and, withal, inclined to be dyspeptic, the cure will most likely be effected by the use of arsenic, as recommended in the tic doulou- reux of the dyspeptics. By folloAving the treatment there pre- scribed, all the effects of that remedy will be obtained. In most NERVEACHE OF THE BREAST. 219 cases, a bandage tightly drawn around the leg, beginning at the toes, will alleviate the pain more or less. Amputation has been performed for the cure of this disease, but it never should be resorted to, for these plain reasons: First, the nerve may be affected above the point of amputation, and, secondly, the seat of the disease may be at the root of the nerve, and only manifested in its extremity; as the worm in the root of the tree is first shoAvn by a yellow leaf on the point of the twig. Amputation cannot present any prospect for a cure. The above remedies, Avith a proper diet, Avill cure the disease and restore the patient to perfect health. NERVEACHE OF THE BREAST. This disease of the nerves is characterized by sharp, lanci- nating pains, diverging from a fixed point in the breast, and shoot- ing equally down the course of the ribs and of the arm to the elbow,—the breast retaining its natural size, complexion, and softness. Young ladies are more subject to this disease than elderly ladies are ; but both may be affected with it. The pains in the commencement of this disease, come on once in a Aveek oi two. The attack is quick, like the incision of a small, sharp instrument. It may last but a feAv minutes, or it may last much longer; Avhen there is no pain present, the breast will bear pres- sure ; but Avhen the pain attacks it, the breast becomes acutely sensitive, and pressure cannot he borne, so sensitive is the whole organ. The paroxysms continue to return more fre- quently, till they come on every day, and finally every hour, or every few minutes, in some cases. They do not generally last long. As the disease progresses, the pain extends from the point of its first attack, doAvn the ribs, on the affected side, and up the arm-pit, and from thence down the arm to the elboAV. The pain is so acute, sometimes, that the patient becomes faint for a few minutes. The twitches or snatches of pain are so severe, some- times, as to induce the patient to think that something alive is gnaAving the parts internally. Though the pain may not reach lower than the elbow, yet a considerable trepidation of the uerves is felt, even doAvn to the fingers. This disease does not interrupt menstruation; all the functions of the uterus may be healthy. 220 NERVEACHE OF THE BREAST. All the authors that I have been able to see on this subject, regard this disease as a species of nondescript neuralgia, not being able to account for it. It has fallen to my lot to see a number of these cases. I have seen them in men as Avell as Avomen; but most commonly in females. I saAv a case of this disease in a young lady, nearly thirty years ago, Avhose breast had been liter- ally scared and skinned by blisters, Avithout affording any relief. On a close examination of the symptoms, and hearing a full history of the disease, and the treatment Avhich had been used, I came to the conclusion that the disease had not its seat Avhere the pain Avas felt, — that is, it Avas not in the extremities of the nerves. Reflecting on the subject, this analogical thought came into my mind, — that a Avorm at the root of a tree first showed its dele- terious effects in the leaves, on the extremities of the branches, which began to turn yellow first, then the tAvigs decayed, and finally the tree died. I immediately examined the spinous processes of the back, and found several tender joints betAveen the shoulders; and, on firm pressure there, the pain Avhich was produced could be traced through all the branches of the nerves that had their origin in that portion of the spinal cord, and the pain in the breast was very acute. I pronounced it as my opinion, that the disease Avas in the roots of the nerves, and not in the breast, and that it Avas curable. She said her case had often been pronounced curable, but that the remedies hitherto had failed to accomplish Avhat her physicians had anticipated, although her spine had never been thus examined before. The treatment proved my conjectures to be true. TREATMENT. When the pain manifests itself in the breast or mamma, and no SAvelling or tenderness or hardness is perceptible in the absence of the pain, we should immediately examine the joints of the back. The patient's clothes should all be loosened, and she should lie down on her face, and pressure should be made on every process of the back, Avith the thumb and finger, one on each side of the spine, and then immediately on it; and every joint must be examined in this Avay. As soon as you press upon the diseased part, the pain will be acute, and shoot to every branch of the nerve that has its origin from that portion of the spinal marroAV. The disease in the nerve is generally in the ganglion, that lies betAveen the layers of the spinal column. As soon as you have ascertained the number of tender joints on the NERVEACHE OF THE BREAST. 221 back, you may be satisfied that you are capable of covering all the ground affected. It is a great point gained to ascertain exactly where the enemy lies in ambush. Your first effort now should be to act gently, but efficiently, on the secreting organs, and put them all in good order; for Avhich purpose you may give the fol- lowing medicine: Recipe : Blue Mass, twenty grains. Rhubarb, ten grains. Aloes, ten grains. Form eight pills. Give four first, and the other four in two or three hours, Avhen they haA^e operated Avell. If the patient is fleshy, and of a full habit, ten or fifteen ounces of blood should be taken from the arm. A blister plaster, three inches wide and long enough to cover all the tender joints, should be applied over the spine. The blister should draAV deep and full, and Avhen it has ceased to run and healed up, it should be reapplied, even to the third or fourth time. After this, the veratria ointment should be applied freely, over the same surface; the ointment should be made in the following manner: Recipe: Veratria, fifteen grains. Rancid Lard, one ounce. Mix thoroughly. A portion of this ointment, as large as a hazlenut, should be rubbed in on the part, morning and evening, for two or three weeks. The ointment Avill produce a stinging sensation every time it is applied, but Avill produce no eruption on the skin. While these remedies are in use, the boAvels should be kept open, and the folloAving preparation of iron used. The citrated aromatic Avine of iron. A tea spoonful of this medicine should be taken, in SAveetened Avater, three times a day; or the folloAving pill may be given in its stead: Recipe : Prepared Copperas, two hundred and forty grains. Pulverized Borax, one hundred and twenty grains. Iodide of Potash, sixty grains. Make all fine, and, Avith a sufficient quantity of the conserve of roses, form one hundred and twenty pills. Commence Avith one three time's a day; and in tAvo or three days, take two at bed- time, and one morning and noon; and in a feAv days more, take tAvo at noon; and in a few days more, take tAvo, morning, noon, and night. Continue these internally, and the ointment to the back, till the disease disappears; or you may, after a week's application of the ointment, use the tincture of aconite on the spine, a tea spoonful at each rubbing, once a day, for a few day a 222 WRY-NECK — CRICK IN THE NECK. After the pain anc. tenderness has left the spine, the pills should be continued for a month, in order to confirm the cure. All the time, the boAvels should be kept open with the following pill: Recipe: Scammony, forty grains. Aloes, forty grains. Rhubarb, forty grains. Castile Soap, forty grains. Ground Ginger, twenty grains. Tartar Emetic, four grains. Mix, and form forty-eight pills. Two or more of these pills should be taken every night, at bedtime, so as to give one motion in the morning. The diet should be light, but nourishing,—light meats and vegetables. The cold bath should be taken for a few weeks, after you cease taking medicine. WRY NECK-CRICK IN THE NECK. This disease is characterized by the permanent contraction of the flexor muscles of the neck, on one side, drawing the head permanently in the same direction. It is generally caused by debility, or cold, affecting the mastoid muscles on one side of the neck. It may be produced by lying with the head too high, and the neck being on a tAvist with the shoulders. It is developed by an excess of muscular action. But Ave frequently meet Avith this affection from two other causes: one is where there is a disparity in the length of the muscles opposed to each other, and, conse- quently, a permanent contraction on the side on Avhich they are the shortest, producing the disease called the Avry neck; and the other, from a relaxation of the muscles on one side, permitting the opposite muscles to draAV the neck to that side. TREATMENT. Where this disease is produced by cold, or a strain, if the patient is full of blood, he should be bled from the arm, and a gentle purgative given. The parts should also be bathed with warm water, or some stimulating liniment should be applied by free, brisk friction. The folloAving liniment will be good: Recipe: Spirits Camphor, Spirits Turpentine, Olive Oil, Spirits Hartshorn, Laudanum, — of each equal parts. cramp. 223 Mix, and shake the vial well. This should be freely rubbed on the parts, and a silk handkerchief or a flannel Avarmed and applied over it. This may be repeated frequently, till the pain ceases. CRAMP. This disease manifests itself by a sudden and rigid contrac- tion of one or more of the muscles of the body or limbs, but mostly of the stomach and extremities, vehemently painful, but of short duration. The parts chiefly attacked Avith cramp are the calves of the legs, the neck, and the stomach; though the back and bowels are not exempt from it. The common causes are, sudden exposure to cold, drinking cold liquids Avhile the system is greatly heated, catching cold, eating indigestible fruits Avhen the stomach is Aveak and inca- pable of digesting them, and the excitement of transferred gout, or overstraining the muscles of the limbs,—in which last case it is au excess of reaction, produced by the stimulus of too great exertion. Persons of irritable habits are more subject to cramp than those of an opposite temperament. Cramp is apt to occur during the relaxation Avhich is produced by Avarmth in the bed, and particularly tOAvards morning, Avhen both the relaxation and the accumulation of the sensorial poAver of irritation are great- est, and the extensor muscles of the legs are strained to their utmost length, to balance the action Avhich the flexor muscles have gained over them during sleep. Cold night air is a com- mon cause of cramp, and it is a still more common attendant on swimming, in Avhich Ave have the tAvo causes united, of cold and great muscular exertion. An uneasy position of the muscles is also, in many cases, a sufficient cause of irritation, and hence we very frequently meet with painful cases of cramp in preg- nant women. Where the hollow or membraneous muscles are affected, they feel as though they Avere puckered and draAvn to a point; the pain is agonizing, and frequently produces profuse perspiration. If the stomach be the affected organ, the dia- phragm associates in the constriction, and the breathing is short and distressing. If the more fleshy muscles be the seat of the cramp, they seem to be Avithered, and twisted into a hard knot, which is perceptible to the touch, accompanied with great sore- ness, Avhich continues for a long time after the balance of power has been restored. 224 CRAMP. TREATMENT. I n common cases, where the calves of the legs are affected, an excitement of the distressed muscles into their usual action Avill be found sufficient; hence the relief which is suddenly obtained by rising into an erect posture, or by forcibly stretching out the leg, and maintaining that position for some time, till the appro- priate muscles haA^e obtained their counter influence. Sometimes seizing the muscle that is cramped, and holding it firmly in the hand for a few minutes, will remove the spasm; or rubbing the muscle forcibly Avith the hand, having some Avarm, stimulating substance in it, as spirits of camphor, or strong Cologne water; or taking hold of any solid substance, and griping it firmly for some time, Avill often relieve a cramp in some foreign muscle. Where the stomach is affected, Ave must use internal remedies, as the folioAving: Recipe : Vitriolated Ether, two drachms. Tincture of Castor, two drachms. Laudanum, one drachm. Mix. Give a tea spoonful in Avater, or some warm tea, every ten minutes, till relief is obtained. Stimulating draughts are frequently given, as strong ginger tea, pepper tea, hot brandy and Avater, &c. The tincture of asafcetida, in tea spoonful doses, is good. A mustard plaster applied to the region of the stomach will be found serviceable in protracted cases. The bowels should always be attended to, and some purgative given, as soon as the violence of the symptoms is over, after an attack of cramp in the stomach. If the stomach be affected with gout, opium and rhubarb, or some aromatic, should be taken at bed- time. The best preventives, in constitutional dispositions, to cramp, Avill be found in some Avarm tonic, such as those com- posed of gentian, orange peel, columbo, ginger, and cardamon seeds, of Avhich, Avhen properly prepared in spirits, a table spoonful should be taken three times a day. The bowels may be kept open Avith the folloAving pill: Recipe: Gum Fcetida, twenty grains. Aloes, twenty grains. Rhubarb, twenty grains. Gum Myrrh, twenty grains. Form twenty pills. Three or four of these, taken at bedtime, will remove costiveness, and afford a surety against future attacks. Cramp is also one of the severest symptoms in colic, and cholera spasmodica, under which heads the appropriate rem- LOCKJAW AND TETANUS. 225 edies will be found. Persons subject to cramp in the legs should not allow themselves to lie long in one position, but should change it frequently, so as to relieve the muscles and prevent too great an accumulation of excitability in the flexor muscles. The cold bath, which in itself is one of the greatest luxuries in life, if taken every morning, will effectually prevent cramp in the legs. LOCKJAW AND TETANUS. This aAvful disease is knoAvn by a permanent and rigid fixa- tion of the muscles of the lower jaAv; also a permanent and rigid fixation of many or all the muscles of voluntary motion, with incurvation of the body, and difficulty of breathing, and SAvallowing. Lock-jaAv and tetanus are found in almost all climates. All ages, sexes and temperaments are subject to it. It occurs, how- ever, far more frequently in hot than in cold climates. The middle aged are most subject to the disease, and men more so than women, and the robust and vigorous than the A\reakly; but all ages and both sexes are liable to be attacked by it, if the exciting cause be applied, and the system is in a proper state of susceptibility for it. Other animals are subject to the complaint as Avell as man; horses, particularly. Dr. Cullin says, "Parrots are subject to it." The causes are damp and chilliness oper- ating upon the body when heated; hence, sudden vicissitudes from heat to cold will produce it, as Avell as Avounds, punctures, lacerations, or other irritations of the nerves, in any part of the body. It has not unfrequently followed Arenesection, Avhen unskilfully performed, and still more frequently on amputation. It also results from Avorms, or other acrimony in the stomach, and especially in those of infants. We have, therefore, the three following varieties, which, how- ever, chiefly differ in symptoms peculiar to the period of life in which the disease is most disposed to show itself, or in the inter- val between the casual excitement and the manifestation of the disease. The first of these irritations is that Avhich attacks infants within the first fortnight after birth, and is generally produced by a portion of meconium being retained, or from irri- tation proceeding from the navel. This we have treated of in its proper place, and shall not repeat it again here. The second BRIGHT. 16 226 LOCKJAW AND TETANUS. variety is that which proceeds from cold and damp, especially the evening dew, the symptoms usually occurring Avithin tAvo or three days. All ages are liable to this variety. The third variety is produced, or is caused by, a Avound, puncture, strain, fracture, etc., chiefly in hot climates, and rarely appearing till a fortnight after the local affection has taken place. The physiology of tetanus and lockjaAV is extremely difficult and mysterious, and has been purposely avoided by most Avriters on the subject. There is one principle, hoAA'-ever, that I shall venture to lay doAvn, Avhich will, perhaps, throAV some light on this difficult question, and that is, the sympathy Avhich prevails throughout the whole nervous system, betAveen even the most remote organs of the body. And these sympathetic actions are always manifested at the extremities of the concentrated action; so that, if a morbid action is set up at one extremity of a nerve, the sensation Avill be first communicated to its centre, whether that centre be the brain or a ganglion; and from that centre to the extremity where spastic action is first set up, and from Avhich the dangerous action radiates. For example; if you irritate the fauces Avith a feather, the stomach and diaphragm will be aroused to a spasmodic action, and vomiting will be the conse- quence. Again; when the ilium is irritated, in what is called the iliac passion, the same effect is produced on the stomach, and oesophagus; and, at the same time, the other end of the extremity is affected Avith a violent spasm; Avhile, in cholera morbus and spasmodic cholera, both extremities are attacked in the same way, and, consequently, Ave here have both puking and purging. In one species of marasmus, the disease seems to commence in the digestive, and in another in the assimilating organs, consti- tuting the extreme ends of a very long and complicated train of action. It very generally happens, that, at Avhich end soever the decay commences, the other is very soon equally affected. If a long muscle be injured in any part of its fibrous belly, the extremity or tendinous portion is the seat of sufferin°-. So if a nerve be diseased in its ganglion, Avhere it passes through the lamina of the spine, the pain is felt at the extremity of that nerve. If you strike the elbow-joint against a hard substance, and bruise or press the ulnar nerve, at that condyle, the sensation of tingling, or pain, or numbness, is felt at the extremities of the fingers, and especially the little finger. Hence Ave see, that, in a continuous chain of nervous action, this principle of sympathy, Avhich induces remote parts, and particularly remote extremities, to associate in LOCKJAW AND TETANUS. 227 the same morbid action, is fully established. We might give many more examples to prove the truth of our position, but as we are not engaged in writing theories, but plain and practical facts, we shall not prosecute our inquiries in relation to this subject any further, but proceed to the TREATMENT. Of all the diseases to which the Human family are subject, lockjaAV and tetanus are the most difficult to cure. And perhaps I cannot do better than to cite a feAv cases from the late medical periodicals, on the treatment of this disease. To enu- merate the old remedies, or even any of those Avhich have been used longer ago than a few years, Avould be to occupy time and space to no purpose; for at least nineteen tAventieths who Avere treated under the old plan, died. It must be acknowledged. however, that some of the old Avriters have suggested the use of some of the neAV remedies, but had not the courage to carry them into practice sufficiently to knoAV what the results would be. Later practitioners, hoAvever, with more courage, have pushed them to the ultimatum, and ascertained all the results that could follOAV. The first case I shall give, is one cured by the use of tobacco^ by H. Bullock, Esq., of Uxbridge. George Clark, aged thirty- three years, a healthy laborer, of tolerably regular habits, was admitted as a patient to the Uxbridge Dispensary, laboring under the symptoms of tetanus, on Thursday, the 13th of May. " Upon entering his apartment," says Dr. Bullock, " I found him lying in a state of episthotonus, Avith his countenance peculiarly characteristic of the disease; the paroxysms occurring about once in three minutes, when the pain Avas most agonizing, Avhilst, during the interval even, the muscular rigidity Avas intense, the perspiration profuse, and the function of swalloAving Avas per- formed Avith the utmost difficulty, and never without producing a spasm. The history of the case, as obtained from the patient and his Avife, is, that six Aveeks ago he received a IjIoav on his left side, betAveen the lower ribs and the top of the hip, and that he has had pain in that part of the body ever since, though not sufficient to incapacitate him for his ordinary labor until two days before I saAV him; Avhen he complained of stiff neck and sore throat, Avith almost an entire inability to swallow; Avhich symptoms have increased up to the present time. His pulse .s eighty, and regular. Firm pressure over the seat of the injury 228 LOCKJAW AND TETANUS. creates no further pain than when applied to any otl tr portion of the abdominal muscles, Avhich always has the effect of excit- ing a spasm; nor is there any perceptible fulness there. The trismus, or lockjaAV, admits of the separation of the jaws to the extent of about the third of an inch; his respiration is hurried, and he describes a constant and severe pain in the site of the dia- phragm, extending from the ensiform cartilage to the sphx, I now prescribed: Recipe: Calomel, five grains. Comp. Ext. Colocynth, five grains. Croton Oil, one drop. "Form two pills; to be taken immediately. The following injection was immediately used : Recipe: Tobacco Leaves, half ounce. Boiling Water, nine ounces. " Macerate for a quarter of an hour, and strain. Then ordered it to be used immediately. Evening. The remedies have had the desired effect of removing from the boAvels large, black and scybalous evacuations. There had been no collapse peculiar to tobacco, and the man's suffering appeared to be rather increased than alleviated, since my last visit in the morning. I then ordered the tobacco injection to be repeated every six hours, an abortion may folloAV after the best operators; but is not even this better than that mother and child should both be lost Avhen labor comes on'? We have witnessed a few cases of labor supervening, with a retroverted uterus, at the full time; and the result was fatal both to mother and child. Doctor DeAvees says, "he never saAv a case Avhere the Avoman did not die." Nor do avc recollect a single author who has reported a case of the kind, that termi- nated favorably. And noAV, having decided upon the i:ec3s*ify of rectifying the womb in case of its retroversion, avc proceed to give directions for performing the operation. The first filing to be done is to draw off the water Avith a gum elastic ca*!icier. The catheter should be introduced sloAvly and cautiousv, till it reaches the bladder. If the water should not flow freely, it may be gently pressed above the pubis, till that fluid is all di?jharged. During this operation, the patient should lie on her br.ck, Avith her knees drawn up, and a covering, as a sheet or bed inroad, drawn over her, to prevent exposure. In this position, the Avater should be draAvn off slowly. Afterwards, the bowels should be evacuated by an injection of molasses and Avater, or gruel and lard. There is, hoAvever, some- times great difficulty in passing an injection, owing to the pelvis 332 RETROVERSION OF THE UTERUS. being filled by the retroverted uterus and its contents. After the boAvels have been freely evacuated, the patient should be placed on the side of the bed, on her back, Avith her feet resting on tAvo chairs, in the position for turning a child. Then, having oiled the forefinger of the left hand and two fingers of the right hand, pass that of the left hand into the rectum, and those of the right hand into the vagina. With the finger of the left hand press the fundus of the Avomb up; Avhile at the same time you take the os uteri or cervix between the tAvo fingers of the right hand, and by a simul- taneous, but gentle effort, pass the fundus up, Avhile the cervix is brought doAvn. This effort must be continued till the uterus is replaced in its proper position. We are aAvare that this cannot always be done; especially when the os uteri cannot be reached with the fingers. When this is the case, and the cervix cannot thus be reached, by the cautious use of the female sound, the os uteri may be brought doAvn. This is done by turning the curve to the pubis, and the point tOAvards the cervix; and, cautiously fixing the point a little Avay within the os uteri, by a gentle but steady effort, bring the os uteri to present fairly in the vagina. But in using this instrument, great care must be taken that it does not pass into the Avomb. If this be done, a rupture of the membranes of that organ, or an injury to the umbilical cord, will most probably be the result. And, in either case, the loss of the child must follow. There is a mode of operating, given in our medical periodicals, which is easy and safe, provided it succeeds. The operation consists in introducing an empty bladder into the vagina, inflat- ing it Avith air by the use of a belloAVs, and continuing the opera- tion till the distended bladder pushes the uterus up to its proper place. This method, to say the least of it, is Avell Avorthy of a trial. After the uterus is restored to its proper position, and the instruments employed in affecting its restoration are Avithdrawn, a piece of soft, fine sponge, Avell oiled, should be introduced into the vagina, and kept there for three or four days. All this time, the patient must be kept on her back; and, if necessary, the water should be drawn off with the catheter. The boAvels must also bo kept open, and the patient live on a light diet. After the sponge is removed, the vagina should be frequently washed Avith a strong solution of cold alum-Avater, till it so contracts as to prevent the Avomb from falling back again. The patient should avoid Avalking or fatigue for several days; or until the fourth month is completely passed. ANTIVERSION AND OBLIQUITY OF THE UTERUS. 333 ANTIVERSION OF THE UTERUS. In antiversion of the uterus, the fundus is thrown forwards and doAvnAvards, so as to press immediately against the posterioi and inferior portion of the bladder, while its neck is carried backAvards and tOAvards the projection of the sacrum. In .this displacement, the symptoms are less severe than in retroversion. This tumor being before, and the neck of the womb behind, will readily distinguish this from the former position. This displace- ment of the uterus has been mistaken for stone in the bladder. Doctor Lurette says: " The operation for stone has been abso- lutely performed, when there was nothing the matter but an antiversion of the womb." The remedy consists in emptying the bladder and boAvels as for retroversion ; and then pushing the womb up with the fingers, till the neck comes doAvnwards. The same treatment as in retroversion is also necessary. OBLIQUITY OF THE UTERUS. The inconveniences arising from this species of derangement are sufficient to demand attention. When Ave consider the globe- like form which the Avomb constantly presents during its develop- ment ; the feeble support it receives from the ligaments ; and also bear in mind the angle it has to pass through in ascending the superior strait; Ave should not be surprised to find it fail to maintain such a position in the abdomen as will enable the axis of its fundus, and that of the opening of the pelvis, to correspond exactly Avith each other. If Ave add to this the peculiarity of several parts of the pelvis, and of its more immediate depen- dencies, and the influence they exert over this organ during its ascent in the abdomen, we shall soon be convinced that it is well nigh impossible for its centre to correspond Avith that of the pelvis. Hence, the almost constant obliquity, in some form or other, in a majority of cases of pregnancy. The obliquity may be to the right or left, or fonvards. The remedy. hoAvever, is simple. It consists in wearing a pair of drawers, Avith a jacket laced behind attached to them. This dress should be put on before rising in the morning, and so adjusted as to keep the womb erect. In many cases, we have simply directed a jacket to be Avorn, reaching doAvn to the hips, and braced by some pieces of Avhalehone or tough wood. This should be laced so as to keep the abdomen in its round and natural shape. For 334 UTERO-GESTATION. should this be neglected, there may be come difficulty Avhen labor comes on. (See Labor.) OF THE TERM OF UTERO-GESTATION. This is a subject on Avhich much has been Avritten by physi- cian's, accoucheurs, and jurists. It is, in many respects, fraught Avith the most vital consequences. Peace, character, and fortune, are frequently involved in it. We shall, therefore, devote to it particular attention. Much light has been throAvn on this subject by what is called comparative gestation ; i. e., by accurately noting the time that the brute creation carry their young. This can be ascertained precisely. In Europe, Avhere stock raisers enter largely into this business, they do not suffer the connection of the sexes, except at a certain season of the year; and then only for a given length of time. This time is carefully registered in a book kept for that purpose, Avith the name of the animal. The day she brings forth is also recorded; so that there can be no mistake as to the time the dam carries her young. The experience of any one indi- vidual on this subject Avould not be satisfactory; but the experi- ence of numbers will give all the facts Ave require. Doctor Dewees has taken great pains to collect a fund of knowledge on this subject, both positive, negative and compara- tive. We shall be excused for copying largely from him in this chapter, lie says : " The time a foetus remains in utero has not been precisely determined by physiologists, even when the Avoman Avas placed under the most favorable circumstances for ascertain- ing it. It seems, hoAvever, from the best calculations that can be made, #iat nine calendar months, or forty Aveeks, approaches the truth so nearly, that Ave scarcely need desire more accuracy. We are certain, hoAvever, that it Avould be more accurate to specify the period of gestation by days, than by months or Aveeks. But there must always be a starting place, and the uncertainty of that period is always in our way, perhaps equally as much so as if we enumerated by Aveeks or months. There are, unquestionably, many causes that will provoke the uterus to action before the full period of utero-gestation is fuily accom- plished ; there may be some that procrastinate the usual period. The frequency of abortion, and the occasional occurrence of premature delivery, sufficiently prove the first; and much more rare, but, nevertheless, avcII authenticated cases of prolonged gestation, put the latter almost beyond dispute. Of the prcma- UTERO-GESTATION. 335 ture. hoAvever, avc nay remark, that Ave haA^e known seA'eral instances Avhere the labor habitually occurred before the full period. With one lady, it ahvays happened at the seventh month; and in tAvo others, it regularly took place at the eighth month of pregnancy. Of the protracted period, Ave have known still more instances Avhere every circumstance and calculation rendered it nearly certain that the Avoman carried her child ten months, and, perhaps, over that time. We ha\re no certain sign by Avhich to judge Avhen conception certainly does take place. There are many popular errors on this subject. All appeals by the woman to particular sensations felt at the time, should be very guardedly received, for avc are certain they cannot be relied on. Enjoyment and indifference are alike fallacious; nor are certain nervous sensations, tremblings, nausea, palpitation of the heart, Avith some other sensations, to be relied on. Conse- quently, AAre cannot ascertain Avith certainty the precise time of conception; therefore, Ave cannot make a minute calculation how long she may carry the child. The cessation of the menses and the sensation of quickening are, perhaps, as certain rules to be governed by as any others. Yet these are not absolutely certain; for a Avoman may conceive at any part of the menstrual inter- val, and she may quicken at various periods of gestation. It is generally supposed the most firvorable period for conception is, soon after the menstrual period has passed ; perhaps this is so as a general rule, but it certainly is liable to exceptions. A latitude of from tAvo to three weeks must be alloAA^cd, and this places the matter in uncertainty." But opportunities have occurred, where the most perfect accuracy must have prevailed. One of these cases Dr. Dewees records. He says: " Many years ago, the husband of a lady Avho A\ras obliged to absent himself for seA'eral months, in consequence of the embarrassment of diis affairs, returned one night, clandestinely, his visit being only knoAvn to his Avife, his mother,, and myself. The consequence of this visit was the impregnation of his wife. The lady Avas, at this time, within one week of her menstrual period ; and, as this took place, as usual, she was led to hope that she did not suffer by this visit of her husband. But the catamenia not appearing at its next regular time, gave rise to fears that she had not escaped; and the birth of a child, nine months and thirteen days from the time of this clandestine visit, proved her apprehensions to be well founded." This case is remarkable for two facts. Tho first of which is 336 UTERO-GESTATION that a Avoman, in perfect health, and pregnant Avith a healthy child, may exceed the period of nine months, by several days. The other is, that a Avoman may be impregnated just before her menstrual discharge takes place, and not have it interrupted. It therefore seems that a check is not immediately given to the catamenial Aoav, by an ovium being impregnated. This fact, perhaps, has frequently occurred; or, at least, more frequently than is supposed, and has thus created no inconsiderable error in the calculation. Desormeaux relates a case Avhere a lady had become insane, and was the mother of children. Her physician, considering that child-bearing might have a beneficial effect upon her mental disease, permitted her husband to pay her one visit; and then kept them apart for three months, in order that, if con- ception did take place, there should be no risk of abortion from further intercourse. The physician and the attendants made a note of the exact time the husband Avas permitted to visit his lady. When symptoms of pregnancy appeared, his visits were positively interdicted. The patient was closely Avatched by the female attendants required for her malady; and she Avas, more- over, a lady of the strictest morality. She Avas delivered at the expiration of nine calendar months and two weeks, of a small child. She was delivered by Desormeaux himself. (See Lon- don Medical Gazettee, Dec. 12, 1839, page 344.) Thus Ave see the term of utero-gestation is not definitely marked by an unalterable laAV of nature; and the condition of the uterus and child are not so clearly definable as Ave could wish. One thing Ave do know, that it is an established law. But it is also certain that this laAV arises from conditions that develop themselves, sometimes sooner and sometimes later. We have reason to believe the development of the foetus has something to do in bringing about this process; but this is hard to define, inasmuch as so many exceptions present themselves to the general rules Avhich are supposed to govern this subject. Many ingenious hypotheses have been proposed by Avriters on this subject, to explain this interesting phenomenon; but all have failed to be entirely satisfactory, from the existence of one fact, viz., that, in cases of extra-uterine pregnancy, the uterus is as certain to be thrown into painful contractions of shorter or longer continuance, as if the child had been contained Avithin the womb. To these we may add the few cases of extended gesta- tion. If those cases have been faithfully related—and, as far as we can judge, there does not appear to te any rational ground UTERO-GESTATION. 337 to suspect their fidelity—they must at once set aside the ingen- ious speculations of the theorists. Let the exact period be what it may, sufficient has been ascertained to fix the period at, or near, nine months. In making calculations, it is best to allow a little time over that which the mere stopping of the menses would indicate. For, as a general rule, it will be found that more Avomen conceive a few days after this evacution has ceased than at any other period. We are aAvare that much doubt has been entertained, and much wit expended upon the testimony Avhich accoucheurs have borne upon the absolute duration of human gestation ; especially since the discrepancy of the evidence given by seventeen profes- sional gentlemen in the celebrated Gardner Peerage Case, in England. But it should be borne in mind, that doubt is not proof, nor is Avit argument. Neither should be permitted to have ; an undue influence. Yet Ave are disposed to grant that all testi- mony opposed to the general laAvs of nature on this subject, should be admitted with great caution, and only after strict examination ; for were the plea of an unusual extension of the term of utero-gestation made a common one, or admitted with too much facility, the consequences Avould be both extensive and mischievous. But this cannot very well happen under its pres- ent limitations. Public opinion, as Avell as observations generally believed to be correct, are so unalterably fixed upon this point, that little danger can be apprehended from an occasional and well qualified admission of it. Nature is generally steady and uniform in her operations, and perhaps she is not more so in any than in her general scheme of impregnation. And yet it is noto- rious, that even in this, her favorite project, she is sometimes so whimsical, as not unfrequently to depart from absolute uni- formity. How much more uniform she may be in uncivilized life, Ave have no data from Avhich to judge. Nor is it essential to the investigation of the present question. It would, however, be a matter of curiosity, if not useful, information, to ascertain the degree of her uniformity, or the extent of her aberrations. As we cannot tell the cause, at all times, which brings about the contraction of the uterus, about the end of the ninth month, so we are ignorant of that which protracts it beyond that period. But that such departures take place, from time to time, we can- not doubt. We believe this Avith more readiness because it is not confined to the human species alone. If we are to believe Tepier, he found as great departures from the ordinary rule in the infe- bright. 23 338 UTERO-GESTATION. rior animals to which his experiments were directed, as are declared to occur with the human female. As the observations of the naturalist are highly curious, and not generally known, Ave will give them in detail. We regard them as furnishing an argument from analogy, in favor of the opinions Ave are endeav- oring to support. They are as folloAVS: " In five hundred and tAventy-five cows, twenty-one calved between two hundred and forty and two hundred and seventy- five days, — average, two hundred and fifty-nine days. Five hundred and forty-four between two hundred and seventy and two hundred and ninety-nine days,—average, two hundred and eighty-two days. Ten between tAvo hundred and ninety-nine and three hundred and twenty-one days,—average, three hun- dred and six days. Average of the whole, two hundred and eighty-two days. So that from the shortest to the longest period, there is a difference of eighty-one days,—i. e., more than one fourth of the average time. "In tAvo hundred and seventy-seven mares, with foal for the first time, tAventy-three foaled between the two hundred and eighty-seventh and three hundred and twenty-ninth days,— average, three hundred and twenty-two days. Two hundred and twenty-six betAveen the three hundred and twenty-ninth and three hundred and sixtieth days, — average, three hundred and forty-six days; and twenty-eight between three hundred and sixty and four hundred and nineteen days,—average, three hun- dred and seventy-two days. Average of the whole, three hun dred and forty-seven days. Difference between the extremes, one hundred and thirty-two days. " In one hundred and seventy mares, which had foaled before, twenty-eight foaled betAveen tAvo hundred and ninety and three hundred and twenty-nine days, — average, three hundred and twenty-one days; one hundred and tAventy-eight betAveen the three hundred and twenty-ninth and three hundred and sixtieth days, — average, three hundred and forty-one days; fourteen between three hundred and sixty and three hundred and seventy- seven days, — average, three hundred and seventy days. Average of the whole, three hundred and forty-one days ; so that betAveen the shortest and the longest periods, there was a period of ninety- geven days, —more than one fourth of the whole time. " In nine hundred and twelve sheep, the average time was about one hundred and fifty-one days, and the extreme difference about twelve days. UTERO-GESTATION. 339 " In tAventy swine, the extreme difference was from one hundred and nine to one hundred and thirty-three days. "In one hundred and sixty-one rabbits, the extreme in their terra of gestation Avas from twenty-seven to thirty-five days." Thus Ave see in the brutes a very considerable disparity prevails, with respect to the time of utero-gestation. And although no moral question can arise from aberrations in them, they neverthe- less furnish us with interesting facts, from which most important deductions may be made in favor of the occasional extension of the term of gestation in the human female. In my mind, the period of gestation has no precise and definite limits. By this I would be understood to mean that this process is not undeviat- ingly fixed to the lapse of an absolute number of days. The nearest Ave can approach to it, is within a few days,—one way or the other,—of nine months. It is quite probable that certain con- ditions must prevail before natural labor can take place. These may depend upon some physiological harmonies which cannot ahvays be exact. The functions of no one organ in the human body are so Avell regulated in themselves as to be unerringly exact in their performance. "I have," says Doctor Dewees, "every evidence on this side of absolute certainty, that the period of gestation has been prolonged ten calendar months, in an habitual arrangement, in at least four females that I have attended; that is, each one of those Avomen went one month longer than the calculations made, after allowing ten or twelve days after the last menstrual period, and from the quickening, which was fixed at four months." Other cases have occurred to the doctor, that convinced him that the woman had gone ten months. We have ourselves seen several cases in which the patients believed they had gone ten months; and from the manner of their calculations, we are induced to believe they did go that length of time. We, there- fore, cannot doubt but it is sometimes the case: and when it does occur, no unfavorable suspicion should be permitted to rest upon the person, on that account. There are also cases, and not a feAv, Avhere the Avoman does not go nine calendar months, but nine lunar months, or nine moons. Some, indeed, never exceed that time; and yet, their children appear healthy and full-groAvn. In illustration of these facts, we present a few cases, where the uterus lost its expulsive power, and the woman carried a dead child for many months. The first case is related by Mr. Parker, as given by Dr. Dewees. 34u UTERO-GESTATION. "A woman, aged twenty-seven years, though much emaciated, and very Aveak, in the month of October, 1820, had all the symp- toms of pregnancy. About the middle of the fifth month, she began to feel the motions of the child; and at the end of the ninth month, felt the precursory pains of labor. The surgeon who Avas called, found the pains weak, and the os uteri not much dilated, though sufficiently so for him to feel that the vertex presented. In consequence of the extreme weakness of the patient, she was treated Avith permanent and diffusible stimuli: and Avith so much advantage, that at the end of six weeks she had gained the appearance of health, and had returned to her ordinary occupa- tion. A feAv days after the coming on of the pains, the motion of the child became weaker, and eventually ceased. The size of the belly diminished, and the child appeared turned to the left side. The menses appeared in the tenth month, and returned regularly afterAvards. In December, 1821, Mr. Parker was called in consultation, and advised forcible delivery, which Avas not consented to. In October. 1822, he found the os uteri above the symphasis pubis, inclined a little to the right side, with the fundus to the left. The posterior surface of the uterus had descended st Ioav in the pelvis, as not to be more than an inch and a half from the orifice of the vagina. The back and feet of the child could be felt, through the integuments of the abdomen." Such Avas the state of the patient in March, 1823. It is to be much regretted that the termination of this case was not given. Many comments were made on it, Avhich it is not necessary to insert. "Case 2nd. Mrs. A. H., aged tAventy-nine years, became preg- nant about the first of April, 1822. She Avas much afflicted, at various periods of gestation, Avith vomiting and spasms of the stomach. She quickened about the fourth month. After this period, her spasms Avere less severe; but neAV evils supervened, such as pains in the hips, loins, and back. About two weeks before the expected period of labor, she Avas attacked Avith the usual symptoms of this process. These symptoms continued for ten hours, and then subsided. From this time no motion of the child was felt. "March 1st, 1823, she was attacked with what is familiarh known by the name of swelled leg, in one limb. The disease having left this, soon seized upon the other. During the first and second week of this attack, she had a discharge from the vagina, resembling the catamenia; at times this was fcetid. The os uteri was closed. No portion of the child could be felt; and the abdo- men was very tense. About the 12th of March, she began to DISEASES OF PREGNANCY. 341 recover, and was soon able to walk some distance without fatigue. From the first of April, her convalescence was rapid. The tume- faction of the abdomen began to subside. She appeared to be as large as at the seventh month. "June 10th. Catamenia healthy. Subsidence of the protrusion of the abdomen. November, 1823. Nothing remarkable has occurred up to this period. Abdomen nearly of its natural size. A small tumor of the shape and size of a child's head remains. Two Aveeks after the supposed death of the child, milk Avas secreted; and continued in small quantities till October. April 10th, 1824, she was attacked with pain, vomiting, cough, &c., and continued in this way until the 24th of May, when she died. " Dissection. Upon opening the abdomen, the uterus was dis- covered to be very much thickened, and presented an appearance of having been inflamed, and to have suppurated. It adhered closely to all the surrounding parts and organs. An incision Avas made through the anterior, or face of the uterus, and a full groAvn child Avas discoA^ered." (See Dr. DeAvees' Work on MidAvifery.) We leave these cases Avithout any further comment than to say, that they prove that the uterus may carry a foetus beyond the usual period, and yet the mother survive it for a long time. Our only apology for the length of this chapter is its importance. PART II. OF THE DISEASES OF PREGNANCY. First— Of the febrile state. It is true that the blood of «. pregnant Avoman differs from the blood of one that is not preg- nant. This difference consists in its inflammatory appearance; but Avhether it is produced by an inflamed state of the blood, is a question which we shall not noAV discuss. That there is a febrile condition of the system in pregnancy, is knoAvn to all experienced physicians; and that this inflammatory state of the blood is produced by an increase of arterial action, is, we think, very evident. But, notAvithstanding there is an excited state of the arterial system, it must not, from pregnancy alone, be locked upon as showing a morbid condition of the circulation. For were this ahvays to be rigorously inferred and acted upon, much mischief might be done. Even as it is, Avomen often suffer from the injudicious use of the lancet, as Avell as the too frequent use of act we cathartics. It should only be considered a disease, 342 DISEASES OF PREGNANCY. when it is accompanied by fever; or in local determinations giving rise to other symptoms, as headache, imperfect vision, difficulty of breathing, a full, bounding pulse, a hot, dry skin; more especially if they increase in strength, either in the morn- ing or evening. When either of these symptoms presents itself the patient requires medicine. Bleeding from the arm, a light diet, and some one of the medicines prescribed beloAV, would be beneficial. Recipe : Aloes Socotrine, twenty grains. Pulv. Rhubarb, twenty grains. Castile Soap, ten grains. Form twelve pills. Take four of them at once. Wait four hours; and then, if they should not operate, take two more, every two hours after, -until they do operate. Or, Recipe : Pulv. Scammony, ten grains. Pulv. Rhubarb, twenty grains. Castile Soap, twenty grains. Tartar Emetic, one grain. Form twelve pills. To be taken as above directed, till they operate well. Or, Recipe : Fol. Senna, one ounce. Rochelle Salts, half ounce. Boil the leaves in a pint of water, to strong tea. Strain it off, and dissolve the salts in it. Take half a tea cupful every half hour, till free purging is induced. Sweeten the tea if it is desirable. Or, Recipe : Castor Oil, one ounce. This may be taken in warm coffee, or in vinegar and water, Avarmed and sweetened. Some one of these medicines may be taken every day, till the fever and pain are removed. The diet should be light; the drink, cold water. Should the stomach be acid, the folloAving medicine may be taken : Recipe: Calcined Magnesia, two drachms for a dose. Mix the magnesia in sweetened vinegar and water, or add to it a few drops of lemon or orange juice. The folloAving medicines may be used, if preferred: Recipe: Pulv. Rhubarb, one drachm. Castile Soap, one drachm. 01. Sassafras, two drops. Form ten pills. Take two at bedtime, and one in the morn- ing, and repeat for a week. Or, DISEASES OF PREGNANCY. 343 Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap, — of each, twenty grains Tartar Emetic, one grain. Form tAventy pills. Take two or three every night at bed- time, till the acidity is removed. If the patient vomit much, from an accumulation of acid on the stomach, take the following medicine: Recipe: Super-Carbonate of Soda, one ounce. Tartaric Acid, three drachms. Mix, and inclose them in an air-tight vial. Take a tea spoonful in water, and repeat every half hour till the acidity is removed. After this, take the pills as above directed, till the secretions are corrected. All stimulating substances should be carefully avoided, as well as all fatiguing exercise. Errors in diet are often committed by pregnant Avomen. There is a false notion in the world, that females in that condition should eat heartily, in order to support the child. But, than this practice, nothing can be more injurious. During pregnancy, women are naturally inclined to become fleshy; and if they eat heartily, they lay themselves liable to fever, headache, and sometimes to convulsion, or apoplexy. In a feAv words, live light, keep cool, keep the bowels open, avoid fatigue, drink water only, and you need fear no evils. Secondly—Of vomiting during pregnancy. It will be recol- lected that this was considered one of the rational signs of preg- nancy. It would seem to be one of the efforts of nature to relieve plethora; and if this is the case, its advantages are con- fined to the early stage of pregnancy. When it continues after quickening, or renews itself towards the latter stage of gestation, it is sometimes attended with bad consequences. Vomiting in pregnancy is thought by some physicians to be an advantage both to mother and child. From those who think it advan- tageous to the child, we are compelled to differ. But so far as it has a tendency to throw off the superabundance of food — to which, perhaps, a morbid appetite may have tempted—and thereby prevent too great a formation of blood, and thus reduce the size and weight of the muscles, we grant it may be of ser- vice,—but no further. And this can only be necessary in those cases where the muscles are large and full. In the latter months of pregnancy, the increasing demands of the child generally keep doAvn the plethora of the mother, if she be prudent in her diet. 344 DISEASES OF PREGNANCY. If vomiting is suffered to continue to the latter end of gesta- tion, it Avill be more difficult to remove. The nausea commonly comes on soon after rising in the morning, and is succeeded by vomiting, Avhich may last for three or four hours. The matter thus thrown up is, generally, a sour, tenacious mucus. But it sometimes consists of a thin acid water, Avhich is at times so pungent, as almost to skin the throat, and put the teeth on edge. Bile is also occasionally discharged in considerable quantities. And when this symptom presents itself, the folloAving medicine should be given: Recipe : Pulv. Ipecac, twenty grains. Mix this poAvder in a tea cupful of Avarm water, and give tAvo large spoonfuls every fifteen minutes, till vomiting is produced. Drink freely of warm Avater, till three or four discharges have been effected. A little gruel, or a tea spoonful of magnesia in sweetened vinegar and Avater, may then be taken, to turn its effects on the bowels. The folloAving preparation may also be used. Recipe : Camomile Flowers, two drachms. Steep these in a pint of hot water, and drink the tea at four draughts, fifteen minutes apart. This will puke gently, and throw off the bile. If neither of the above articles can be had, a glass of warm water, with a tea spoonful of table salt, will ansAver the same purpose. The patient is sometimes harassed for weeks Avith a sick stomach, but does not vomit much. She frequently retches without being able to effect a discharge. In this case, a crust of corn bread and a little milk and Avater should be used as a diet. A pill, prepared from the following medicines, should be taken every night: Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap, — of each twenty grains. Pulv. Ginger, ten'grains. Form thirty pills. Or, if one should not be enough, as many as Avill operate once or twice the next morning. Recipe: Huxbam's Tincture, two ounces. A tea spoonful of this tincture, in a little sweetened water, should be taken before breakfast, dinner, and supper. Or: Recipe: Tinct. Nux Vomica, half ounce INDULGENCE OF TEMPER, ETC., DURING PREGNANCY. 345 Eight of these drops, in SAveetened Avater, three times a day, will bi sufficient for a dose; Avhich may be gradually incieased, one a lay, till the number amounts to sixteen drops at a time. We have never known this remedy to fail, where the bowels Avere kept open by the above pills, and the diet properly regu- lated. But Ave recommend the use of other remedies before this is tried, as the strength of this medicine is sometimes uncertain, and therefore the dose may not be exactly of the right strength. OF THE GENERAL CONDITION OF THE SYSTEM DURING PREGNANCY. Almost all Avriters on midwifery agree that pregnancy is not a disease. It is true that the state of the system is altered; but it is not in a diseased condition. The uterus should be, and gen- erally is, free from disease during pregnancy. But the healthy action of a pregnant uterus may produce disease in some other organ or organs of the system. This state of the uterus seems, indeed, to be necessary, in order that the rational signs of preg- nancy may be made manifest. It is generally found that those women Avho have a majority of these signs, in a mild degree, fare better through the whole course of gestation, and have more favorable labor, than those in whom they do not present them- selves. Yet have Ave known Avomen, having none of these signs, who nevertheless did well in labor, and had a speedy recovery. OF THE INDULGENCE OF TEMPER AND HABIT DURING PREGNANCY. The subject Avhich Ave propose to consider in this chapter is one to Avhich Ave invite the careful attention of the reader. Though parents, in general, may think that they have but little influence over the formation of the character of their unborn children, it is nevertheless true that they possess this influence to a great degree. In fact, character and temper are, to a cer- tain extent, as surely transmitted from the parent to the child, as form, features, and expression. Why should they not possess as much poAver over the one as the other? Assuredly no good reason can be given, because none exists. We do not, hoAvever, intend to enter into a physical or metaphysical discussion of this subject, for the design of this chapter does not require it. Many, and not the least, of the evils resulting from an indul- gence of temper in pregnant women, they bring upon them- selves. These are, "convulsions, nervous inquietude, uterine 346 INDULGENCE OF TEMPER, ETC., DURING PREGNANCY. hemorrhage, and perhaps abortion." Even if abortion should not take place, the child may receive such injury as will entail upon it a feeble constitution for life. It has long been a matter of observation by medical men, that Avomen of passionate and irritable dispositions are more liable to abortion than those of an opposite temper. This fact alone should be sufficient to guard the mother against indulging in outbreaks of passion, the result of which, as we have seen, may be of such serious character. Nothing contributes more to the safety and future good health of the child, than cheerfulness on the part of the mother during her period of gestation. This fact was well knoAvn to the ancient Greeks. Hence they Avere in the habit of providing for the chambers of their Avives the most beautiful specimens of art, as paintings of various kinds, from the best artists, representing the most illustrious personages in their mythology or history, as "Apollo, Bacchus, Castor, Pollux, Antinous, Narcissus, &c., that they might dwell upon their fine proportions with that com- placency of spirit which a beautiful object is sure to produce." We do not believe that these things had any influence on the formative process; but if any good was effected by them, it was done by producing tranquillity of mind and cheerfulness of dis- position. The truth of this is verified by every close observer of human nature. We will call the reader's attention to a few facts in support of it. The father and mother who have filled up the measure of their days principally in those pursuits of life of Avhich hard- ness of heart and recklessness of principle are the necessary results, bear, in the lineaments of their face, and in lines not to be misunderstood, a full index of their true character and dis- position. Again: The face of the bacchanalian discovers at once, and Avith unerring accuracy, the pursuits and habits in which he has engaged, and by Avhich he has been degraded beloAV the level of the brute. Let this character pass through one or two generations, and Ave have its results in the physical and intellectual development of the offspring. Such, indeed, is the universal law of nature; and it has become a matter of gen- eral observation, that a man wears in his face the index of his family. This is also true Avith respect to sects, tribes, and nations. The JeAV can be pointed out by his features and manners, wher- ever he is seen. So can the Greek, the Turk, the Hindoo, the Hottentot, and the American savage. The doctrine of Lavater, SICKNESS AT THE STOMACH IN PREGNANCY. 347 then, has more truth in it, than at first vieAv it would seem to possess; viz., that a man's disposition, character, and feelings are written in his face. And phrenology has shown that the true seat of a man's character is to be sought for in the developments of his brain. Let us carry out this idea. And to do this, we turn our attention to the mother Avhose mind has been well cul- tivated, in a moral and religious sense. There is an ease of manners, and a modesty of deportment, that give grace to all her expressions and actions. The very lineaments of her face speak a heavenly peace Avithin. There is none of that distrust, despair, or ferocity, that is seen in the fretful, desponding, ava- ricious, or bloodthirsty; but all is cheerful, lovely, and amiable. The character of the mother is reflected in her offspring; and we observe, even in the infant, an openness and fairness of counte- nance that attract the attention of all Avho are fond of the beau- tiful, noble, and good. Again: If we turn to the mother who has long been accustomed to eating opium, we shall see the heavy, somnolized, and vacant countenance, devoid of thought or expression; and in hei offspring, to a greater or less extent, the same vacuity of face will be observed. Nay, this resem- blance may be carried still further; for we have even seen the corners of its mouth habitually hanging down, and the saliva driveling from them. We have seen this in a distressing degree; and at the same time, all the features, taken together, indicated a state of despair — even before the child could speak the sim- plest words. Seeing, then, that these results may be entailed upon the child, mothers ought to be careful to avoid the practice which leads to them, and take such exercise of body and recrea- tion of mind as will produce in them pleasantness of feelings, and cheerfulness of disposition; for, assuredly, it is a duty which they OAve, not only to themselves but to their offspring. OF SICKNESS AT THE STOMACH AND VOMITING IN PREGNANCY. It Avill be remembered that vomiting, or what is called morn- ing sickness, is one of the rational signs of pregnancy. Perhaps there are but few Avomen Avho do not feel more or less disturbance of the stomach in the early stages of pregnancy; especially when they first rise in the morning. Dr. Denman is of the opinion that it is the change of position which brings on the sickness, and that it is not the necessary result of pregnancy. But, as he pursues this subject, he tells us that this peculiar sick- 348 SICKNESS AT THE STOMACH IN PREGNANCY. ness of the stomach " sometimes continues to, or returns tOAvards, the conclusion of pregnancy." He says, if it should only recur in the early part of the day, "so far from being detrimental, it is generally found to be serviceable;" and he argues this from the fact, that the "matter evacuated sometimes shows a very much disturbed, or a morbid secretion of such a kind as to be offensive to the stomach itself." It is thought, by many Avriters on midwifery, that vomiting in pregnancy is no detriment to woman or child; and some are of opinion that it gives energy both to the uterus and child. We must confess that Ave have never been able to fully comprehend this notion. Our conviction is, that no morbid action of the system, either local or general, sympathetic or primary, is neces- sary to the Avell-being of the patient. We are, however, ready to acknoAvledge, that an effort of the system, — no matter whether of the stomach or any other organ, — to relieve itself of offending matter, or an irritative action, may take place, and prove injurious or beneficial to the general health of the system; no doubt but this is often the case in the morning sickness of pregnant Avomen. In the first place, the sympathy of the stom- ach with the uterus is such, that a change of action takes place in the stomach commensurate Avith that in the uterus. Though the exciting cause of this action may be healthy, yet its effect may be morbid. Hence, Ave often see an unhealthy, vitiated, or acid fluid, thrown up in the morning. Sometimes the liver is excited into action, and bile is discharged in greater or less quantities. The heart and liver may form the third link in the chain of deranged action, and fever or headache may be the result. So. far as vomiting in the morning tends to relieve the stomach of crude or unhealthy matter, humors, or secretions; and so far as the arterial action and febrile symptoms are les- sened, and headache abated, so far vomiting may be considered beneficial. But as soon as it proceeds further than this, remedies are called for, in order to meliorate or remove it. Again—if the sickness of the stomach should continue aU day, or nearly so, the patient will become very much Aveakened by it: and in either case, Ave should use the proper remedies to remove it. In the first place, if the sickness comes on immediately after rising in the morning, and nothing but a white, glairy fluid is ihroAvn up, the best Avay to relieve it is, to take a cup of coffee or tea, Avith some dry toast, before rising from the bed. But should the effort to vomit bring up bile or acid, or an unpleasant tasted, SICKNESS AT THE STOMACH IN PREGNANCY. 349 half-digested substance, the patient should drink a cup of warm camomile tea, or take a tea spoonful of table salt in Avater, and' puke freely, so as to clear the stomach of all offensive matter. But should this not remove the bile, she may take the folloAving medicine: Recipe: Ipecac, fifteen grains. Tartar Emetic, one grain. Mix. Dissolve in nine table spoonfuls of warm water. Take three at first, and then one every fifteen minutes. When this has produced vomiting, let a glass of Avarm water be given every time the patient pukes, till she has three or four motions up. A little table salt in Avater will turn it down on the boAvels. If the patient is fearful of cramp being produced by the emetic, she may, instead of taking Avarm Avater, drink a tea made of wheat bran to Avork off the emetic. If she takes this she will not be cramped, but will puke Arery easily. Sometimes the fluid thrown up in the morning is very acid, and so affects the teeth as to make them sore. In this case, take Recipe: Sup. Carbonate Soda, one ounce. Take of this half a tea spoonful, dissolved in tAvo table spoon- fuls of cold water. This Avill neutralize the acid in a great measure; and should it be throAvn up, the dose should be repeated immediately. In half an hour afterwards, take the following: Recipe: Henries' Calcined Magnesia, thirty grains. Mix in a little Avater, and take it at one draught. If, after repeating these medicines a. few mornings, the sickness should continue, take the following pill at bedtime: Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap, — of each twenty grains. Best Ground Ginger, ten grains. Form twenty-four pills. Take from three to six of these pills at bedtime; or just as many as Avill operate once or tAvice the next morning. This dose should be repeated for a week. Should the sickness of stomach continue, and the patient have any pain in the head, Avith or without soreness in the stomach, she should be bled moderately from the arm. Sometimes the following drops will give relief: Recipe: Essence of Cinnamon, half ounce. Compound Spts. of Lavender, half ounce 350 BLEEDING DURING PREGNANCY. Mix, and take forty drops in a little water, in the morning. They may be repeated several times through the day. The practice of giving laudanum or paregoric at bedtime, or at any Jtber time, is a bad one, and should be avoided, as it never fails to Aveaken the stomach and aggravate the disease. When all other medicines have failed, if the stomach be first cleansed, we have knoAvn the folloAving to give prompt and lasting relief: Recipe: Tinct. of Extract of Nux-vomica, one drachm. From five to ten drops of this tincture may be given, two or three times a day, in water. But after all the remedies that can be prescribed are used, if the patient is not particular in her diet, she will not be relieved. She should take no heavy 01 indigestible food. A tea spoonful of Huxham's tincture, in a little sweetened water, may be taken just before meals. OF BLEEDING DURING PREGNANCY. The susceptibilities of the female system during pregnancy are peculiar. All experienced physicians knoAv that a pregnant woman not only bears, but requires, more active depletion with the lancet, in the treatment of inflammatory diseases, than those Avho are not in that situation. Tonics are also less admissible in the treatment of the diseases to Avhich pregnant women are liable, than in those of other females. In an especial manner, she can- not bear stimulants, either in health or sickness, Avithout more or less injury; while an unimpregnated woman may take them Avith impunity. This condition of the system continues till the fifth or sixtli month, when a change generally takes place, and stimu- lants and tonics may be beneficially used. This is probably OAving to the fact, that the uterus makes a greater demand upon the system for blood; and also that it may have become more accustomed to the stimulus of pregnancy. After the fifth month, the fundus of the womb loses, in a great measure, its resistance, and becomes less irritable, in consequence of its increased vascu- larity and the increased poAver of the child. Hence, all the early symptoms of pregnancy cease after the fifth month. There are often many objections urged against bleeding a pregnant Avoman; and these objections frequently prevent the young and inexperienced physician from doing his duty in this particular. Sometimes the omission of this duty proves fatal to the patient The reasons offered by the objectors to the use of 4 PURGING DURING PREGNANCY. v 351 the lancet, are, that it weakens the child and makes the mother liable to miscarry. But nothing can be more erroneous than this. When about the fourth month, or at any time after that period of pregnancy, a pain in the head, tightness of the joints, or stiff- ness of the limbs, are experienced, the loss of a pint or so of blood may be beneficial. A gentle purge—say the following pills — should be used. Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap, — of each twenty grains. Form twenty pills. Take four at bedtime, and repeat every night till these symptoms are removed. At the same time, the diet should be light and cooling. OF PURGING DURING PREGNANCY. The choice of purgative medicines for pregnant Avomen is of great importance. Choice should be made of those that do not gripe, operate very powerfully, or produce a difficulty in making water. When drastic medicines are necessary, they should be directed by a physician Avhile the patient is under his immediate care. For should those medicines produce straining, tenesmus, or stranguary, they may bring on abortion or miscarriage; espe- cially Avith those who have suffered any of these accidents before. In the selection of medicines, therefore, these things should ahvays be kept in vieAv. Some medicines, — such as jalap, aloes, scammony, gamboge, and colocynth,—when given alone, ahvays gripe. But when combined with others, they constitute the safest and most gentle purgatives. Should a gentle purgative be needed, one of the folloAving compounds may be used : Recipe: Scammony, Pulv. Aloes, Pulv. Rhubarb, Castile Soap,—of each twenty grains. Pulverized Ginger, ground, ten grains. Form twenty pills. Take three or four at bedtime The doses may be repeated as often as necessary. Recipe: Pulv. Aloes, Pulv. Rhubarb, Castile Soap, — of each twenty grains. Oil Sassafras, four drops. Form twelve pills. To be taken as above; or, Recipe: Ext. of White Walnut Bark, forty grains Grated Nutmeg, ten grains. 352 HEMORRHOIDS, OR PILES. Form ten pills. Take them as above directed. As a general rule, that should not be varied from, no purgative that will pro- duce griping should be taken by a pregnant Avoman; and almost any gentle medicine may be taken by her Avith safety. Mag- nesia or castor-oil may generally be taken with safety, if property prepared. Recipe : Calcined Magnesia, one drachm. This should be mixed in vinegar and water, or in lemon juice and Avater, and taken for a dose. Recipe: Castor-oil, one ounce. This should be Avarmed till it is thin, and then mixed in Avarm coffee, or, Avhat is better, vinegar and Avater. The acid separates the particles of oil, and makes it operate easier and better. Per- haps no case of abortion has ever been produced by free purging, if no griping attends the operation of the medicine. It is the specific effect produced by strong cathartics on the lower boAvels, that Avorks injuriously in pregnancy. To sum up all that may be necessary to be said on this subject, — let the boAvels be kept open with some mild purgative. And one of the most simple that can be used, is a glass of Avheat- bran tea, sAveetened Avith molasses, taken morning and evening. This generally keeps the bowels in a fine condition. • OF HEMORRHOID, OR PILES. Pregnant Avomen are more liable to become costive than those who are not so ; and costiveness is generally the cause of piles. When the piles have been formed, and suffered to remain exposed to the air, they are liable to inflame and become very sore. The torpid condition of the boAvels, the constant groAvth of the child, and the consequent pressure, preventing the free return of blood from the hemorrhoidal vessels, and the sedentary life of pregnant women, are generally the cause of this form of disease. Sitting on a sofa-cushioned chair is another fruitful cause of piles; or they may be brought on by long standing; so that too continued use of either position is not good. When piles are coining on, a sensation of pain or aching is felt in the lower bowels. This is followed by a throbbing sensation, Avhich causes the patient to press with the hand on the part affected. Swelling, in a greater or less degree, makes its appear- ance, accompanied by more or less pain. The tumor may not be larger than a filbert or bean; yet it is so painful that the patient HEMORRHOIDS, OR PILES. 353 cannot rest easy in any position. When this is the case, the sphincter muscles act so powerfully that the blood contained in the tumor cannot return into the general circulation. For the cure of this form of piles, bathe the parts Avith a strong tea made of hop-blossoms, and bleed from the arm. Take the following pill: Recipe: Pulv. Rhubarb, forty grains. Castile Soap, twenty grains. Scammony twenty grains. * Form tAventy pills. Take four or five every night at bedtime for four or five nights, and use the following ointment: Recipe : Extract Belladonna, one drachm. Hog's Lard, half an ounce. Mix these Avell into an ointment. Rub the piles frequently with it three times a day, or use the folloAving ointment: Recipe : Jamestown Leaves, four ounces. Hog's Lard, one ounce. Water, two ounces. Cut the leaves fine, add the lard to them, and simmer them down slowly to a salve. Anoint the piles Avith this, three times a day. Live on a light, cooling diet. Or take, Recipe : Poppy-Heads, two ounces. Hog's Lard, one ounce. Water one ounce. Cut the poppy-heads fine, and add the lard and water, as above directed, and simmer the mixture sloAvly to an ointment Strain the oil out, and Avhen cold, use it as above. There is another form of piles, which is not so painful, although the tumor is larger. In this case, the sphincter muscle is relaxed. Treatment. Use the cold bath to the parts, Avith leeches on and around them, to extract the blood. Then use an ointment of, Recipe: Pulv. Nut-galls, one drachm. Hog's Lard, one ounce. Mix Avell, and anoint the parts freely. Or a wash of red-oak bark ooze, made strong, may be used. If the patient is fleshy, she should be bled. The blue ointment is also a good remedy in these cases, and a plaster of fuller's earth will often give relief. Be sure to put them up as soon as possible. The b?,st position all this time will be upon the back, with the knees drawn up. Keep the boAvels open with the following pill: Recipe: Blue Mass, one drachm. Pulv. Rhubarb, one drachm. Castile Soap, half drachm. biugiit. 24 354 PALPITATION OF THE HEART. Form ten pills. Take five at bedtime, and repeat them every night, for several nights. But if the patient is feverish, anJ tho tongue coated, Avith or Avithout pain in the head, take. Recipe : Calomel, ten grains. Rhubarb, fifteen grains. Form six pills; to be taken at bedtime, and Avorked off the next morning Avith gruel. Then take the first pills till the • tongue is clean. If the piles still continue troublesome, take, Recipe : Cream Tartar, half ounce. Milk of Sulphur, or Flour of Sulphur, one ounce. Mix them together, and take a tea spoonful three or four times a day, or just as much as will keep the boAvels freely open. If any of the above medicines cannot be procured, take, Recipe : Epsom Salts, one ounce. Dissolve them at night in a glass of warm water, and let them stand till morning. Then take a table spoonful every hour till they operate; taking care, hoAvever, to leave the sediment in the glass, which sediment is the sulphate of iron, and should not be taken. If all these remedies fail to relieve the patient, and cure the disease, if the piles continue after she is delivered, or even if they should occur in a Avoman Avho is not pregnant, and refuse to yield to the above remedies, they should then be cut off. This operation is not very painful, and is a safe and sure cure. We have removed a great many, and ahvays Avith success. OF PALPITATION OF THE HEART. We do not design to treat of this disease as it occurs in organic affections of the heart; but only in its sympathetic form. Pregnant Avomen are more especially liable to this disease before the period of quickening, than at any other time. It fol- lows some nervous Avomen through the entire period of gestation. It is often the most prominent symptom in a paroxysm of hys- teria. Sometimes it is the consequence of too much blood ; and is then accompanied Avith pain in the head, flushing in the face, a full and irregular pulse, which beats Avith a flittering sensa- tion. When these symptoms exist, the patient should be Ued, and take the following medicine: Recipe: Scammony, twenty grams. Pulv. Rhubarb thirty grains. Aloes Socotrine, ten grains. aura Foetida, ten grains. THE LSE OF EMETICS AND BLISTERS IN PREGNANCY. 355 Form twelve pills. Take four at bedtime and two in the morning, and repeat the dose the following niglit. The diet should be light, and all stimulants should be avoided. In the hysterical form of the disease, after each paroxysm, there is a copious flow of pale-colored urine. For this form of the disease^ give the folloAving pill: Recipe : Rhubarb, twenty grains. Castile Soap, twenty grains. Russian Castor, ten grains. Form ten pills. Give five at bedtime, and repeat till the symptoms are removed. But should the paroxysms recur fre- quently through the day, give the following mixture : Recipe : Tincture Castor, two drachms. Tincture Foetida iwo drachms. Comp. Spts. Lavender, two drachms. Mix them together, and give a tea spoonful in water. Repeat every half hour, or oftener. till the symptoms are removed; or Recipe: Tincture Castor, one drachm. Vol. Tine. Valerian, half drachm. jEther Vitriol, two drachms. Elixir Paregoric, two drachms. Mix. Give as above directed till relief is afforded. None of these medicines should be used to the exclusion of the pills; but they may be taken at the same time. Sometimes a cup of orris tea will give relief. When nothing else can be had, give fifteen or twenty drops of laudanum in Avater, and repeat once in half an hour. A large draught of very cold water has been knoAvn to give immediate relief. In every case, keep the bowels open, and live on a light diet. Take all the exercise in the open air that strength will admit of, and cherish a cheerful and lively disposition. ON THE USE OF EMETICS AND BLISTERS IN PREGNANCY. In the advanced stage of pregnancy, the abdominal muscles are so much distended by the contents of the uterus, that they cannot, by their contraction, aid the stomach in ejecting its con- tents, but exert their contractile force upon the uterus. For this reason, strong emetics should not be given in an advanced stage of pregnancy. And another reason Avhy they should not be given is, that the stomach, once exceed into violent action, at this time, is more difficult to be allayed, than under any other circumstance or condition. But very mild emetics may be given when the urgency of the symptoms demands them, and no other 356 UTERINE HEMORRHAGE. medicine aviIi give the desired relief. When all the circum- stances of the patient are taken into consideration, we think emetics should be the last resort for the cure of diseases during pregnancy. Blisters are of doubtful utility when applied to pregnant women. They are more likely to produce abortion than to cure the disease for which they are intended as a remedy. If they are applied at all, the face of the plaster should be lightly sprinkled over with gum camphor finely pulverized, and a piece of fine gauze laid betAveen the surface of the skin and the plaster. In no case, however, should a blister be applied on the abdomen, or the back; as strangury is one of the dangerous symptoms produced by a blister when applied to a pregnant woman. The patient should drink freely of slippery-elm tea all the time the blister is draAving, to prevent strangury or a difficulty in making water. OF UTERINE HEMORRHAGE DURING PREGNANCY. That pregnant women are subject to hemorrhage, (or flood- ing,) is a fact so well known, as to require no cases to estab- lish it. This flooding is sometimes so profuse as to destroy both mother and child; and, on this account, women are justly alarmed Avhenever it occurs. In the first link of pregnancy, the ovum or foetus is enveloped in a membranous substance called the placenta or after birth. This substance is attached on one side to the womb, and to the child on the other, by the navel string. When the foetus, or child in embryo, first passes out of the fallopian tube into the uterus at one side of its fundus, one surface of the placenta attaches itself to the Avomb. This is called the maternal portion of the placenta. The other portion of it is attached to the child by the umbilical cord, or navel string; and this is called the foetal portion of the placenta. It must be recollected that the placenta is double, yet envel- oped in one membrane. The maternal portion of the placenta receives innumerable blood-vessels from the surface of the womb to Avhich it is attached, and sends back to that organ a like num- ber of those vessels. The foetal portion of the placenta receives its blood-vessels from the maternal portion of the placenta. Having received the blood from the mother, through this medium, tt conveys it to the child through the umbilical cord, or navel- UTERINE HEMORRHAGE. 357 string. The blood so received is conveyed and rcconveyed, from the mother to the child, and from the child to the mother. Having given this short explanation, we have only to say, that anything that will separate the placenta from the womb, will cause uterine hemorrhage, or flooding. Every discharge from the Avomb of blood that will clot, is hemorrhage; and a discharge of blood that will not clot, is not hemorrhage. Conse- quently, the latter is attended Avith no danger; but the former, when profuse, is attended Avith great danger. No considerable hemorrhage can take place, Avithout a detachment of the placenta from the uterus; and, moreover, it Avill always be in proportion to the extent of this detachment. There are various causes that may produce a separation of the placenta from the womb. First. The navel-string may be too short, and the motions of the child may tear the placenta loose from the womb. Secondly. Any mechanical violence, such as a sudden fall on the bottom, or blow on the abdomen, or small of the back; lifting heavy bodies; reaching too high; great exertion in running; leaping too far; running hastily up and down stairs; violent passions or emotions of the mind, as joy, grief, anger, or disappointment; plethora, or too full a state of the blood-vessels, may produce hemorrhage. It is not necessary to enter into detail, to show Iioav these causes produce a separation of the placenta from the womb, and so cause flooding, and consequently abortion or premature labor, if not arrested in time. There is, howeArer, one more cause of uterine hemorrhage which claims our special attention. This is found in those cases in Avhich the placenta is situated over the mouth of the womb. This is an unnatural position for that body; but, nevertheless, -it is sometimes found here. Be the cause of hemorrhage Avhat it may, when it takes place—if the bleeding is profuse — it lessens the bulk of the placenta ; and the womb, to close the space, ahvays contracts. This contraction, if not arrested, will sooner or later expel the contents of the womb. But should that organ not have sufficient strength to accomplish this expulsion, the flooding will still continue, and the danger will be increased. When the placenta is situated near the edge of the mouth of the Avomb, or over it, the contrac- tion of the womb, and consequent dilatation of its mouth, will always increase the hemorrhage. This will be the case Avhethei the labor is natural or preternatural. It is at all times difficult to arrest muscular contraction, when 358 UTERINE HEMORRHAGE. it is once established and marked by regular pains. But that such efforts are never attended Avith success, Ave are not Avilling to admit. On the contrary, Ave know it has been arrested ; and although Ave may fail in many instances, yet the attempt should be made in all cases where there is any probability of success; for if the life of one child in ten be saved by it, Ave have reason to be gratified Avith the result. Where the breasts have become tumid and tender, and have suddenly decreased in size, succeeded by uterine hemorrhage, it would be almost useless to administer remedies Avith a hope of saving the life of the child. For these are symptoms that strongly indicate its death, especially Avhen no motion can be felt, and the mother shoAvs a dark, circumscribed circle under her eyes, and experiences a feeling of faintness or languor. These signs were known to Hippocrates, and have stood the test of experi- ence ever since. So long, then, as this symptom is absent, Ave should try to save the child. The patient may not exhibit these signs, and yet the ovum may be cast off; in Avhich case it is to be ascribed to the contraction of the uterus. These signs may, however, be absent, and yet the child may be born dead ; but it will appear evident that it died a very short time before birth. These cases occur the most frequently Avith women that have miscarried before. The mouth of the womb may be dilated as large as a crown- piece, and still the child may be carried for Aveeks; but this is not common; and we are justifiable in saying the mother will probably lose her child Avhen the os uteri is thus dilated. Dr. Bums says, " Cases have occurred where Avomen, carrying twins, have lost one, and carried the other to its full time." And our own periodicals contain the reports of many such cases. Where the placenta is situated over the mouth of the Avomb, hemorrhage is sure to take place between the seventh and ninth month. The distension of the uterus by the groAvth of the child Avill naturally produce this effect, and it cannot be avoided. We have, therefore, no remedy but the delivery of the child; and this must be done to prevent the mother falling a sacrifice to the loss of blood. When avc are called to a pregnant Avoman laboring under uterine hemorrhage, if she has not been hurt, has no pain, and the bleeding is not profuse, Ave may calculate Avith more certainty on relieving her, than under a different state of facts. The placenta may be detached at different points. If the UTERINE HEMORRHAGE. 359 detachment be at, or near, the fundus of the womb, the prospect of success in arresting the hemorrhage will be very small; foi every contraction of the fundus will increase the separation of the placenta, and the passage of the blood doAvinvards Avill aid in that separation. By this means contraction will be increased, and, in all probability, the child will be lost. But should the detachment be at the loAver part of the placenta, and near the mouth or neck of the womb, the hemorrhage maybe much more profuse, and contraction exist; yet the child may be saved. The first appearance of flooding should be attended to immedi- ately, as a few drops may precede a serious hemorrhage; and the sooner it is undertaken, the more certain are Ave of success. On its first appearance, the patient should be placed on a mat- tress or straAV bed, or even on the floor, in preference to a feather bed. Cool drinks should be given; even ice-Avater in small quantities, or cold barley or tansey tea, or vinegar and Avater. The diet should be cold and thin, such as gruel, tea, sago, &c. No wine or spirits should be m>eJ under any pretext AvhateATer; unless, indeed, faintness should come on, in Avhich case, stimu- lants may be beneficial. While there is any probability of saving the child, the patient should not move hand or foot, except when absolutely necessary. Talk as little as possible. These things should be strictly observed, as the forfeiture of neglect may be the loss of the child, and perhaps that of the mother too. The friends of the patient, often through the best of motives, do her much harm. They Avish to be doing something to render her comfortable; and by fixing the pilloAvs or adjusting her in bed, giving first one thing and then another, they defeat the good effects of the best directed remedies that could be pre- scribed. It is too often the case that marvellous stories are told on such occasions; and every case of the kind, Avhich they ever heard or knew of, that terminated fatally either to the child or mother, must here be related—little thinking that by such con- versation hundreds have been sent to an untimely grave. Con- versations of this kind should never be alloAved in the sick room. Treatment.—The first thing to be done after arriving at the bedside of the patient, is to ascertain, if possible, the cause of the flooding. The condition of the os uteri should be next inquired into. If you find it much relaxed, the membranes protruding, or the child pressing down very low, Avith a relaxed state of the neck of the womb, the loss of the child is altogether probable. 360 UTERINE HEMORRHAGE. But if the os uteri be closed and the parts tolerably firm, Ihe pulse full, whether the patient be fleshy or not, bleeding from the arm should be tried. Apply cloths dipped in cold Avater, or even ice Avater, to the small of the back, and vulva, extending them over the pubis. Enjoin absolute rest. With these symptoms, there is some prospect of success. Should the means here recommended not prove sufficient to relieve the patient, give the following medicines: Recipe : Pulv. Opium, four grains. Sugar Lead, twenty grains. Mix. Divide in four poAvders, and give one every half hour, in sugar and cold water, till the pains are relieved. If the hem- orrhage should continue, fill the vagina with soft linen cloths, Avet in cold water; or a piece of fine sponge, Avell cleansed by being washed in vinegar, and dipped in cold water, may be carefully introduced into the vagina. Let it remain till the flooding is arrested. Continue the cold applications externally. Keep the patient still, and the boAvels open by the folloAving medicine: Recipe: Rochelle Salts; one ounce. Dissolved in cold water, and taken at tAvo or three draughts half an hour apart. If this cannot be had, use the following: Recipe ; Epsom Salts, one ounce. Dissolve these salts in cold water, and let them settle an hour or two. Then use them as above directed; or, Recipe : Castor-oil, one ounce. Take this in sweetened vinegar and water, cold; or, Recipe: Scammony, Aloes Pulv. Pulv. Rhubarb, Castile Soap, — of each twenty grains. Form twenty pills. Take four, and repeat two every tAvo hours till they operate. Use as little exertion as possible under the operation of the medicine; and if a bed-pan can be had, it should be used, in order that the patient need not be compelled to rise. If the sugar of lead and opium cannot be had, take the fc)Ww- ing medicine: Recipe: Pulv. Aium, ten grains Laudanum, forty drops. FEVER DURING PREGNANCY. 361 Mix them in sugar and water, and take the whole for a dose. Half the quantity may be repeated every half hour, till the pain and flooding are arrested,—using the external remedies at the same time. The patient should not be examined often, lest by so doing the womb should be excited to contract, and increase the flooding. But, above all, let especial care be taken that the membranes are not broken; for if this should occur, the foetus Avill escape and leave them behind; thereby causing more trouble to remove them than if all Avere suffered to come together. An unceasing dis- charge, moreover, will be the consequence. But should the efforts of the uterus rupture the membranes, and cause the child to escape,—Avhich is unfortunately too often the case, — some diffi- culty may be found in removing the after birth. Should it have partially escaped, and lodged in the os uteri, be careful not to puh at it, or to irritate the uterus, lest an increased hemorrhage be the result. Rather let it remain, and it will check the bleeding; after Avhich, the uterus Avill throAv it off by its own efforts, or it can be removed by the midwife Avith great ease. Should there be any difficulty in removing, give the ergot, or spurred rye. When the spurred rye is given, it should be boiled to a tea in the proportion of a tea spoonful, or one drachm to a pint oi Avater; and taken at three draughts, fifteen minutes apart. This Avill excite contraction of the uterus, and throAv off the after- birth. As soon as this is removed, the patient is safe. We have never knoAvn a fatal hemorrhage folloAV an abortion when the after-birth Avas removed. During the Avhole progress of this case, the feet of the patient should be kept warm; for just in proportion to the coldness of the feet and legs, will the uterine hemorrhage be increased. Let the feet, therefore, be kept Avarm by a dry heat. A moist one will not ansAver. Absolute rest and quietude of mind are indispen- sable to a recovery. OF FEVER DURING PREGNANCY. That there is a febrile disposition, or an increase of heat, during the state of pregnancy, no one can deny. But that this is a diseased condition of the circulation, or state of the system, is thought to be doubtful; for when it is properly conducted, it tends to the growth and perfection of the child. The blood oi pregnant, women, independent of disease, always presents a sizy appearance. But it is of its oavii peculiar kind; and is evidently 362 COSTIVENESS DURING PREGNANCY. very different from that Avhich appears in an inflammatory con- dition. It is. no doubt, in consequence of a neAV and specific action, produced in the system for the purpose of supplying the fcetus Avith that portion of blood Avhich is necessary to its groAvth and perfection. In justification of this opinion, if an inflammatory disease should occur during pregnancy, the blood loses the dis- tinctive marks which Avere given to it by pregnancy, and assumes thai inflammatory appearance which belongs to the peculiar form of disease which then pervades the system. This disposition to fever during pregnancy is greatly increased by the use of improper diet. It is a popular opinion among preg- nant women, that they should eat more than other Avomen; and * strong diet is chosen for them, which, they say, is to support the infant. But this is an erroneous idea; for the use of animal food ahvays increases the disposition to animal heat, headache, and costiveness. In accordance Avith the popular error just mentioned, cordials, beer, porter, ale, and wine, are recommended by ignorant mid- wives. But all this is injurious, and should be avoided. Let the patient herself speak on this subject, and she will tell you that she feels better when she abstains from these things; and that as often as she partakes of them, a feverish and. dull feeling, accompanied Avith a headache, is apt to follow. Common sense, indeed, should teach us that Avhat is improper for the mother, is also improper for the child. If a pregnant Avoman is permitted to choose for herself, she will invariably choose light vegetable, or acidulated food, acidulated fruits, cooling drinks; after the use of which, she is livery, cool, and cheerful. The bowels are kept in better order by the use of such diet, and a greater amount of exercise can be taken Avithout fatigue. Nature is the best guide to health, and she should be closely observed. Use a light diet; keep the boAvels gently open Avith mild pur- gatives ; and this febrile disposition Avill do no harm. OF COSTIVENESS DURING PREGNANCY. Costiveness is a common complaint of pregnant Avomen. It originates partly from the pressure of the child upon the rectum, or lower boAvels, and partly from neglect and improper conduct. It is too often the case that pregnant women indulge in the superstitious notion of Avhat is called longing. This leads them to the use of indigestible substances as a diet, or an absorbent, COSTIVENESS DURING PREGNANCY. 363 such as chalk, charcoal, cheese, clay, burnt coffee or coffee grounds, pencils, and other substances of a similar nature. By taking these things into the stomach, the boAvels become impacted and loaded, so that it is sometimes almost impossible to procure an operation through them. There is an acid on the stomach of females during pregnancy, that causes them to take these absorbent substances. But that acidity should be removed by the use of the proper remedies. Another cause of costiveness in pregnant Avomen is the use of too heavy and rich diet. Treatment. — All heavy, indigestible food should be avoided. The diet should be light, cooling, and acidulated rather than sweet. If there is much acid on the stomach, a gentle dose of ipecac, will remove it. Recipe: Pulv. Ipecac, twenty grains. Dissolve this in a gill of warm water, and take it at three draughts, twenty minutes apart, until vomiting is produced. When this is effected, the patient need not take any more. A glass of warm Avater should be given every time she attempts to vomit, till she has had three or four motions up. She may then take a little gruel, to turn it down. If it should not act on the bowels, take tAvo or three of these pills : Recipe: Scammony, Pulv. Rhubarb, Aloes Socotrine, Castile Soap, — of each twenty grains. Form twenty pills. Take two or three {every night, so as to keep the bowels open. Take such exercise as strength will allow; and let it be an invariable rule to go at a certain time every day and elicit an evacuation from the boAvels. The patient should never indulge in the use of any of those crude and pernicious substances Avhich too many are in the habit of taking. The boAvels sometimes become so impacted with hardened faeces, either from neglect or from the use of such substances, that medicine will fail to open them. In this case, they must be relieved by an injection, Avhich should be made of molasses and Avater, or thin gruel, lard, and salt, or a solution of Epsom salts, in Avarm water, or mild soap suds. Either of these, repeated till the hardened fasces Avhich lie in the rectum are softened and brought aAvay, will ansAver the purpose. 364 sleeplessness of pregnant women. of the sleeplessness of pregnant wcmen. It is not an uncommon thing for pregnant women, towarda the latter end of gestation, to feel feverish and restless during the night. These feelings are frequently attended Avitli slight pains, not unlike those in the commencement of labor, together with a disposition, Avithout the ability, to sleep. In this state, the patient often rises and exposes herself to the cool air, but cannot sleep till just before daylight, Avhen she falls into a sweet sleep, and aAvakes in the morning apparently as much refreshed as if she had slept all night. There are several causes for these restless feelings, some of which we can alleviate, others we can guard against, and some Ave cannot do anything for. These causes are, the too free use of strong food, especially at supper; keeping the room too warm; the constant demand of the child on the system of the mother; costiveness, and too full a state of the blood-vessels. Treatment. — The room should be kept cool and Avell venti- lated. The diet should be vegetable, and of a light, cooling character. The supper, if any at all be taken, should be very light. If the patient is full of blood, she should be bled. Let the boAvels be kept open with the folloAving pill: Recipe: Scammony, Pulv. Rhubarb, Aloes Socotrine, Castile Soap. — of each twenty grains. Form tAventy pills. Take three, tAvo, or one, every night, at bedtime; or just as many as will operate next morning. Rest has been often obtained *by placing a pitcher of Avater by the bedside, Avetting a towel, and holding one end in the hand, while the other lies in the Avater. This cools the Avhole system, by- passing the heat off from the hands through the wet towel. When the pains are so great as to prevent sleep, they may be relieved by rubbing the abdomen Avith the folloAving liniment: Recipe: Laudanum, half ounce. Spirits Camphor, half ounce. Sweet Oil, half ounce. Mix them together, and use it at bedtime. It is the practice of some to give laudanum, or some form of opium, to procure sleep. But Ave are opposed to this practice, because it produces costiveness. It often fails, moreover, to induce sWo, and leaves the patient Avith a sick stomach in the STRANGURY. 365 morning; nor are Ave free from serious doubts that its effects are injurious to the child, if long continued. Women who have fine large children, are apt to have these restless nights tOAvards the latter end of gestation; and some- times they are apprehensive for the child, fearing that it may be dead, or in a bad condition, when they are subject to these rest- less feelings. But such fears are Avithout solid foundation. The existence of those feelings is evidence that the child is healthy and vigorous; for they vanish immediately, if the child "be dead. OF DIFFICULTY IN MAKING AVATER, OR STRANGURY. It is not an unusual occurrence for Avomen to experience a difficulty in making water, while in a state of pregnancy. This occurs in the early stage of pregnancy, and is considered by some as one of its signs. When it takes place at this period, it is occasioned by the uterus pressing on the neck of the bladder which causes a frequent desire to urinate, though there is bin little water voided at a time. Sometimes it is produced b) remaining too long without ansAvering that call of nature. This. in the third month of pregnancy is dangerous; for it may produce a retroversion of the uterus, by throwing the fundus back, and the cervix fonvard. In a state of pregnancy, females should never hold their water Avhen they feel a disposition to void it. In the latter months of pregnancy, this difficulty is changed for an inability to retain the Avater. This is produced by the weight of the womb on the fundus or top of the bladder. If the woman should have a hard cough, slight jets of Avater will pass: and this is thought by all writers on midAvifery to be a favorable symptom, as the child is presenting right. Treatment. — In the first stage of pregnancy, this difficulty may be removed by keeping the boAvels open Avith neutral salts, such as, Recipe: Cream Tartar, half ounce. Rochelle Salts, half an ounce. Mix. Take a tea spoonful, two or three times a day. If the patient is fleshy, a little blood may be taken from the arm with benefit. Slippery-elm or marsh-mallow tea will be the best drink, and a light diet should be strictly maintained. Water- melon or pumpkin-seed tea is good; or, if it be in the season for melons the juice of that fruit may be used freely, as it is cooling and diuretic. As soon as the child has groAvn a little more, this difficulty Avill be removed. 366 PAINS, VARIC0US VEINS, ETC. In the latter stages of pregnancy, if there should be much inability to retain the urine, and the abdomen is large, it should be supported by a bandage round the waist, with two straps, like suspenders, fastened to it, and passed over the shoulders and buttoned behind. Let these so act as to raise the child a little, and take the pressure off the bladder. All other things being right, an easy labor and a speedy recovery may be expected. OF PAINS IN THE HIPS, THIGHS, LEGS, AND VARICOUS VEINS OF THE LOWER EXTREMITIES. Pains in the hips, thighs, and legs, happen ars often as any other complaint to Avhich pregnant Avomen are subject. These pains are produced by the pressure of the gravid uterus on the ischiatic nerves, and those Avhich pass through the perforations in the anterior part of the sacrum. In certain positions of the body, they are ahvays increased. When the patient is accus- tomed to sleep on one side, a change of position uniformly gives relief. Wandering pains in different parts, especially about the face, teeth, and ears, are common in pregnancy, and are consid- ered by some Avriters as a sign of that condition. All such pains are evidently produced by uterine irritation, and may be eased by ether, laudanum, camphor, castor, musk, oil of cajeput, or some other anti-spasmodic or stimulant. Yet they sometimes defy them all. In such a case, bleeding and gentle purgatives give relief. The hips, thighs, and legs may also be rubbed Avith laudanum and sAveet oil. The bowels should be kept open Avith some gentle purgative, and the diet should be light. Moderate exercise will be found beneficial. It is not an uncommon thing for the veins of the legs and thighs, and abdomen, to become varicous,— that is, very much enlarged, and crooked in their course, during the last stages of pregnancy. This condition of the veins is often attended with cramp, Avhich is, no doubt, produced by the pressure of the uterus on the internal veins, thus preventing the blood from returning to the body as freely as it should do. The remedy is to bleed, purge lightly, and live on a light diet. The limbs should be bandaged if the veins are much enlarged, and a recumbent posture frequently taken. Delivery cures all. EXERCISE AND DIET DURING PREGNANCY. 367 SWELLINGS OF THE FEET AND LEGS. SAA'cllings of the feet and legs are frequently to be met Avith in pregnant Avomen. The SAvelling sometimes extends to the thighs and abdomen, and frequently aflects the genital parts. We have seen cases Avhere the legs have burst and the water run out freely. This troublesome affection (for it cannot be called disease) is produced by the loaded uterus pressing upon the lymphatic ves- sels Avhich pass through the pelvis; thereby preventing the due return of the fluid they contain to the upper part of the body. In all such cases, the patient will be found to be of a costive habit. The swelling is generally less in the morning than in the evening, OAving to the recumbent position through the night. It is sometimes so great as to produce great pain, and almost entire helplessness. Treatment. When the patient is fleshy and full of blood, she should be bled, live on a very light diet, and take the folloAving medicine: Recipe : Cream Tartar, one ounce. Pulv. Rhubarb, half ounce. Saltpetre, one drachm. Mix them all together, and take a tea spoonful, three or four times a day, in parsley tea. The exercise of the patient may be such as she is able to bear without fatigue; and she should lie down frequently through the course of the day. The genital parts, at times, SAvell so much as to produce diffi- culty in making water. When this swelling cannot be reduced by the above remedies, the labia should be lightly/punctured on their inner edge, Avith the point of a lancet. This will do no harm in delivery; but, on the contrary, much good, by reducing the SAvelling and alloAving the parts to yield to the pressure of the child's head, and thereby save the patient from the dange of a laceration of them. OF EXERCISE AND DIET DURING PREGNANCY. There are many erroneous opinions in relation to the exercise and diet of pregnant women. A good lesson may be learned on this subject from the brute creation. They do not place them- selves under any restraint, in the early part of pregnancy, in relal.on to exercise; but indulge in it as freely as at any other time. This, hoAvever, is not ahvays the case Avith women. 368 EXERCISE AND DIET DURING PREGNANCY. They sometimes suffer from an enfeebled condition of the body at this time, to such an extont as to forbid their exercising freely and if they do, they are liable to a fainting sensation, Avhich would, in some cases, if the exercise be continued, produce syn- cope. Exercise leading to such results, should, of course, be avoided. These cases appear to be exceptions to the general rule; for usually the patient may take her accustomed exercise at this time. It must, however, be kept in mind, that Avhat would be ordinary exercise for one lady, Avould be more than another could bear; and, on the other hand, Avhat Avould be suf- ficient for one, Avould leave another in a state of almost entire inactivity. The healthy, active countrywoman can exercise much more freely than the delicate and enfeebled inhabitant of a city. Much depends on the location and general habits. The heal- thy and robust Avoman in the country, and the laboring, hardy female that lives in the city, often feel that if they could enjoy the indulgence of the Aveakly and fashionable lady, they Avould do much better; and the bitter cup of child-bearing Avould be greatly SAveetened by il. But this is a great mistake. We find universally, that the active, stirring woman, of robust constitu- tion, passes through this process better, and recovers more cer- tainly, than those of a different character and habit. As, there- fore, all observation and experience sIioav that the advantage is on the part of the active and robust, Ave have no hesitation in believing that this is the best condition at last, and draw the fol- loAving conclusion from the above observations. Let the preg- nant woman neither diminish nor increase the amount of her accustomed exercise, provided her strength and other things enable her to perform it. This Avill hold good till the period of confinement draAvs near; and Avhen she comes Avithin a feAv weeks of that period, she should gradually lessen the amount of exercise, move more sloAvly. take more rest, and observe as much quietude of mind and body as possible. In relation to diet. This need not be changed for the first six months, provided the appetite craves it, and there are no forbidding circumstances. But Avhen the latter.months come on, —from the sixth to the ninth month,—she should begin to lessen the quan- tity, especially of animal food. Her diet should then be more plain, simple and cooling, till she enters the ninth month, at which time she should refrain from meats oi all kinds, and high- HEADACHE. 369 seasoned food of every description. Her diet should be m the lightest vegetables, Avith milk and bread, tea, or coffee, Avith plain biscuit and butter, and soups that are not rich. She should take no more exercise than she is perfectly able to bear. Perhaps half or more of her time should be spent in lying down or mod- erate Avalking. No stimulants of any kind should be taken. There is a false notion in the Avorld, on this subject, that has laid the foundation of much injury. It is this. Women are per- suaded that in the latter months of pregnancy, they must eat heartily of rich food, in order to support the infant. We have often heard such language addressed to them: You must take another cup, or another piece of rich food, for the little one,— accompanied Avith a very Avise look. And thus the young and inexperienced are misled by the aged matron or midAvife, to whom they look for advice. A loaded stomach, and consequent indisposition, perhaps sickness, is the result. But the Avorst has not yet come. When labor comes on, the patient is doomed to suffer fourfold Avhat she would under other circumstances; and perhaps haAre an injury inflicted upon her from Avhich she may never recover, since convulsions, a laceration of the perineum, or the delivery of a dead-born child maybe its results. But should she escape these fearful consequences, it is impossible for her child to be as active, healthy and strong, as if she had lived lightly before her confinement. Besides, after such full living, she is always more liable to child-bed fever. In short, common sense, experience and observation alike forbid indulgence in such pernicious practices, more especially in the last tAvo or three months of pregnancy. OF HEADACHE. This is not an uncommon attendant on pregnancy; and is sometimes so severe as to become a dangerous symptom. For the most part, it is caused either by too much blood flow- ing to the head, or is a sympathetic pain, resulting from a deranged condition of the stomach and boAvels. It is a matter of common observation, that pregnant women have a flushing in the face, and are rather of a feverish disposition. This, how- ever, does not generally take place till after the fifth or sixth month, and is produced by the Aveight of the gravid uterus, pressing upon the descending blood-vessels, especially the great aorta. This pressure beloAV causes too much blood to Aoav to tha lead. The skull cannot yield to the pressure of the Mood; BRIGHT. 25 370 PREPARING THE SYSTEM FOR DELIVERY. the brain becomes too much compressed, and the consequence is a pain in the head. In this case, the patient should always be bled from the arm. Sometimes the boAvels become loaded with hard, heavy fgeces, and press upon the lower aorta, preventing the free circulation of the blood to the lower extremities, and consequently produce the same effect, or increase the effect of the gravid uterus, by confining too much blood in the head and chest. The patient suffers from shortness of breath, as well as headache. Bleeding, and some mild purgative medicine, such as the folloAving, will be found beneficial: Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap,—of each twenty grains. Form twenty pills. Take from four to six of these pills at bedtime, and repeat as many and as often as may be necessary to keep the bowels open ; or, Recipe: Senna Leaves, one ounce. Pulv. Jalap, half ounce. Rhubarb, half ounce. Anise, or Fennel Seed, two drachms. Boil all slowly in a quart of Avater, doAvn to a pint; SAveeten with brown sugar, and take a table spoonful night and morning. if less will not operate. Keep the bowels open. There are feAv pregnant Avomen, Avho are full of flesh and blood, who Avould not do better to be bled once or twice from the sixth month to the end of their pregnancy. In all cases Avhere there is a disposition to headache, a light diet should be strictly observed. These directions should be closely attended to by every lady, if she Avishes to enjoy health and escape the, dangei of convulsions. PART III. PREPARING THE SYSTEM FOR DELIVERY. We have not seen this subject treated of separately by any author on midAvifery, though it is one quite as important as many of which they have elaborately treated, and in many respects much more so. Much, in relation to the final issue, depends on the manner of living, and the mode of exercise of TKEPARING THE SYSTEM FOR DELIVERY. 371 women in a state of gestation. It is the common opinion, that a woman should, as the time of her delivery draws nigh, use more active exercise, and take more nourishing diet, in order to increase both her OA\m strength and that of her babe, z nd thus, as it is supposed, enable her more safely to bear the tria through Avhich she has to pass. It might appear, at the first view of this subject, that this opinion and practice are founded in reason; for, as the child approaches nearer to maturity, it certainly requires more nourishment than at an earlier date of its uterine existence. But Ave should not argue from this that the mother should take richer or more solid food, in order to supply the child with its due quantum of nourishment. The powers of digestion, if they are not weakened at this time, are certainly slower in the performance of their functions; yet they are no less certain. Hearty meals ahvays produce a desire to be still; and rest aids digestion. If no other consequence arise from the use of high-seasoned and rich food, it will produce corpulency and too much blood, and both of these are detrimental at the period of labor. From a rich diet, the muscles become hard and unyielding; the blood flows with too much rapidity to the head or lungs, and this creates, or increases, a liability to convulsions, or hemorrhage from the lungs. If, hoAvever, neither of these should follow, the patient will be sure to suffer from pains and cramps in the hips, thighs, legs or sides; and, from such causes, she must of necessity have a longer and harder labor, and also be more liable to have child-bed fever, or inflammation of the uterus. Laceration of the perineum, as Avell as inflammation of the breasts, is also much more apt to take place in a Avoman avIio is fleshy. To avoid all this, the patient should live on a light diet, and reduce her flesh before the time of delivery. A Avord or tAvo as to diet. It is true, as stated in the com- mencement of this chapter, that the child requires more nourish- ment in the last two months of utero-gestation than it did at any previous period. This nourishment must, of course, be draAvn entirely from the mother. Nevertheless, she should live light and sparingly, and her diet should be mostly vegetable. When the mother lives in this Avay, the child draws its full portion of nourishment from the mother's blood; and, by this means, the amount of that fluid being reduced, her flesh will become much softer j the space for the passage of the child Avill be larger in the 372 PREPARING THE SYSTEM FOR DELIVERY. pelvis, and there will be less pressure on the nerves of these parts, by the passage of the head of the child, and little or no cramp produced. The muscles concerned and the perineum yield kindly to the pressure of the child, and there is less pain suffered by the Avoman, and the danger of a laceration of these parts in giving birth to the child will be almost entirely removed. The mother Avill also be less liable to convulsions in delivery; her labor Avill be very much shortened, and she will be less likely to suffer from inflammation of the vagina, or uterus, or child- bed fever. The child Avill also be better, because it will undergo less pressure in the birth. With all these facts set before her, the mother will readily discover that, to prepare for delivery, she should, for tAvo months before her confinement, take care that she does not live so as to increase her flesh and blood. If the patient is full of blood, she should be bled once or tAvice, moderately. Keep the boAvels regularly open, and never suffer twenty-four hours to pass without an operation. The folloAving pills will serve for this purpose: Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap, — of each twenty grains. Form tAventy pills. Take three or four of these every night, or every other night, or just as many as will give one or tAvo motions in the morning. If these pills cannot be procured, take castor-oil, or rhubarb, or a pill made of the extract of Avhite walnut and rhubarb, or some other gentle purgative. It is also a very important item in the case to keep the spirits cheerful, by a kind and courteous treatment. The reprehensible practice of relating to the patient every accident that has ever been heard or known to occur to Avomen in her situation, should be avoided. There are some women in the Avorld that never can rest Avhen they hear of an accident happening to a Avoman in a slate of pregnancy, or in labor, till they go and tell it to some friend in a similar condition. After having related the case, and painted it in all the blackness of coloring it admits of, they will say, I hope this Avill not be your case. This is often done, even Avhile the Avoman is in labor. Such persons ought to have a patent right for killing their neighbors, through kindness, as they call it; for, in many cases, it amounts to little less than murder. All such conversation should be strictly forbidden. We are glad, however, to know it is becoming very unpopular amoDgst the CAUSE OF LABOR. 373 better part of society, and hope it will soon be done away every- where. It cannot be told hoAV much mischief such gossiping will do to a nervous, sensitive lady, and one who is full of apprehen- sions herself on this subject. She should rather be encouraged and comforted by all who are around her. CAUSE OF LABOR. Much has been said on this subject by writers on midAvifery. Some celebrated physicians suppose that the stirrings of the foetus contribute to the production of labor, and that the child has much agency in its OAvn delivery; others have declared that the desire of the child to have food, and to breathe, Avere the first causes of the contraction of the uterus; Avhile others say, the liquor amnia becomes acrid, tOAvards the latter period of gesta- tion, and, by its stimulus, forces the Avomb to labor. But as this fluid does not come in contact Avith the surface of the Avomb, this opinion must go for naught, even if it Avere a fact that the Avaters did become acrid, Avhich, hoAvever, has not beert proved. The explanation of Baudeloque is more plausible. He makes this process the result of a kind of mechanical necessity, and is of the opinion that the body and fundus of the Avomb, by their persevering alternate contractions, especially after the sixth month, oblige the neck of the uterus to unfold. The same agency, together with the Aveight of the child, constrains the os uteri to open, and labor takes place. This theory, hoAveArer ingenious, will not hold good in many cases; since labor comes on spontaneously in eome females at the seventh month of preg- nancy, whilst cthois suffer abortion, at a certain period, Avithout any known cause. Mr. PoAver looks upon the process of labor as mechanical. The contents of the Avomb, according to his doctrine, act like a wedge, by forcing the os uteri, and so bring on labor. This theory, at the first vieAV, has some plausibility; but, on exam- ination of the subject, cannot be sustained. Avicenna, centuries ago, declared that labor Avas a laAV of God, and that it came on at the appointed time; and Ave Avould ask, if any hypothesis, since that time, has enlightened us more on this subject? It is short, and full of meaning. But an explanation of the manner of Cod's acting in this case Avould be more satisfactory, if it could be gained. We Avill offer a few remarks on this subject. From the closest observation of anatomists it is satisfactorily ascertained, that the 374 CAUSE OF LABOR. uterus is composed of two sets of fibres, one of which runs Ion- gitudinally, and the other transversely. These fibres compose the principal part of the uterus, and are more abundant in some parts of it tnan in others. The longitudinal fibres, for example, are more abundant in the upper part of the Avomb than the trans- verse fibres are; and these, in turn, are more abundant in tne body and middle portion of the uterus than they are in the fundus. The neck of the womb is almost entirely made up of transverse fibres running around it. Now, as the child grows and ascends into the cavity of the abdomen, occupying, as it does, the upper part of the womb, in the first months of gesta- tion, it raises the fundus up. Hence, Ave find by examination, that, the os uteri, or neck of the Avomb, is loose, and more or less pointed within the vagina, because the child does not bear upon that part, and also because the fibres of the body and fundus are incapable of further distension. But as the foetus fills the cavity of the uterus to the extent of the capacity of its fibres, the fibres of the neck or cervix continuing to yield, by little and little, to the demand of the contents of the uterus, they become at last very thinly expanded, and the os uteri begins to open; not, how- ever, by a force like that of a Avedge, by a poAver applied above. but by a law of vital action, and, by this means, give the con- trol to the longitudinal fibres. By this contraction, the uterus becomes shorter; and, consequently, must widen itself at its opening, by draAving the circular fibres upwards. When this happens, the/fnouth of the uterus has a tendency to be drawn upAvards, also; and then the presenting part escapes from it, whether it be the membranes, the head of the child, a false con- ception, or any other body. Hence, after the complete expansion of the os uteri, its margin is often not to be found. But at other times it does not recede beyond the reach of the finger, OAving to the strong action of the transverse fibres in the mouth of the womb. In this case, the os uteri will always advance before the head of the child; and though every way disposed to dilate freely, or yield to the passing head, it often remains in that situation, so as to become the cause of tedious or difficult labor. The sympathies betAveen the transverse and longitudinal fibres are such, that any pressure from Avithin or without, upon the os uteri, if it be calculated to open it, Avill excite more or less con tn^tion of the longitudinal fibres, and so increase the pains of labor to a greater or less degree. We are satisfied as to the co?» SIGNS OF APPROACHING LABOR. 375 rectness of this conclusion; for much experience and close obser- vation have brought us to it. We would only say further, in case of false conception, it appears to be a laAV of nature, that Avhen the growth is com- plete, nature demands a release from the foreign body, and a suitable action takes place for throAving it off. The uterus yields, a detachment takes place, more or less hemorrhage succeeds it, and contraction follows, as in labor; and the decidua, or false conception, is throAvn off by a natural process, or it must be removed by art. OF THE SIGNS OF APPROACHING LABOR. Every change that takes place in the system, from conception to labor, may be called a separate process. Though it is inti- mately connected Avith the one Avhich has immediately preceded it, yet, Avhen properly considered, it Avill be found to be perfect in itself. Thus, previous to the act of parturition, many changes take place in the system, Avhich point out to us that the period of delivery is near at hand. These are called the signs of approaching labor. These signs may vary in the time of their appearance in dif- ferent women, and in the same Avoman at different times of ges- tation. Sometimes they make their appearance tAvo or three weeks before labor comes on; at other times they may appear only tAvo or three days before that period. They ahvays appear, hoAvever, sooner or later, before deliA^ery, except when labor is brought on by some accidental circumstance. The more perfect these changes are, and the longer they occur before labor, the better for the patient generally, because the labor, in these cases, is more natural. These signs are as follows: First. — The womb falls doAvn, more or less, from the region of the stomach, towards the pubis, and the Avoman will appear smaller at the middle of the ninth month than at the beginning of it. Her shape changes in appearance also. These are favorable signs; for when the child continues to lie high, even after labor commences, the patient may expect that process to be tedious; because the fundus or upper part of the womb does not act properly. Secondly. — The parts concerned in the act of parturition become enlarged, and appear to be SAVollen, yet they are soft and elastic, and not unfrequently a discharge takes place from them, 376 DIVISIONS OF LABOR. resembling the white of an egg, Avhich tends to lubricate the parts, and cause them to dilate. This is also a favorable sign. Thirdly. — The nearer the approach of labor, the more the breasts enlarge. There is either milk or a clear Avater in them. Sometimes this fluid is yellowish. Fourthly. — The Avoman does not walk exactly as she did before she Avas so far gone in pregnancy. She rather leans her body from side to side, as though she would fall. Hence the term, falling to pieces, Avhich is not an unapt expression, seeing it is indicated by the gait. This motion in walking is produced by the sacro-ischiatic ligaments relaxing; thereby causing the Avoman to move from side to side, rather than advance her feet directly forwards. A lightness and activity are frequently felt just before labor commences. These feelings have not been experienced for sev- eral days before, and arise from the fact of the child's falling doAvn a little, and relieving some of the blood-vessels and nerves from a pressure Avhich had been on them for Aveeks. The Avoman now feels a disposition to take exercise. When these signs appear, the time is near at hand; and they also indicate safety and ease in delivery. DIVISIONS OF LABOR. Labor is divided into natural and preternatural. Natural labor is performed by the healthy and natural energies of the uterus, aided by the functional powers of various muscles. It is begun, continued, and completed by the powers of living func- tionaries intimately connected therewith. Artificial labor is that Avhere the functionaries are too Aveak to complete the process Avithout the intervention of art; and hence it is called artificial labor. About the end of the fortieth Aveek, a painful effort is made by the uterus to expel its contents; and this effort is called labor. Sometimes this process commences by very slight movements, and can only be ascertained by placing the hand upon the abdo- men ; there being as yet no bearing doAvn pains, but a simple contraction and hardening of the uterus, by intervals. With the first child this may be perceived sometimes for tAvo or three days. In some cases, these slight contractions go off, and are not felt tgain for several days. They are called false pains. Labor rarely takes place so suddenly or so silently as not to present a DIVISIONS OF LABOR. 377 regular series of symptoms, Avhich, from their universality, must be considered a part of this process. These symptoms may be divided into rigors and nervous symptoms; a frequent inclination to make Avater, in some; but in others there is a suppression of urine, or a difficulty in passing the Avater. In some cases, there is a frequent desire to go to the close stool. There is generally a subsiding of the abdominal tumor, and a secretion of mucus tinged Avith blood, a dilatation of the os uteri, and regular pains. All of these symptoms are to be met Avith, more or less, in dif- ferent patients. Sometimes they make their appearance sooner, and sometimes later. Many Avomen are much troubled Avith sicknoss at the stomach, and vomiting; indeed, this is the first symptom of labor Avith some; Avhile in others it does not occur during the Avhole process. If a violent trembling takes place, whether it be early or late in labor, the os uteri will soon dilate; and generally the labor is soon terminated after this rigor sub- sides, provided no unnatural difficulty intervenes. With young Avomen we often see much restlessness, as tossing, and crying; but as soon as the expulsive efforts become strong, this irritable feeling subsides, and they become quiet. We should, in all cases, use soothing language, and do all that Ave can, by gentleness and tenderness of manner, to compose them. Those rigors which succeed or precede labor are not the access of fever; and they require no medicines for their relief. The patient should lie still, and they will soon pass off Avithout any bad effects. A frequent desire to use the close stool, or chamber is an evidence that the head of the child lies low m the pelvis, and presses on the rectum, or bladder, and is generally the sign of a quick labor. The patient may be indulged in these inclina- tions till the head of the child begins to engage in the bones of the pelvis; after Avhich she should not be alloAved to arise from her bed. The sinking of the uterus into the pelvis, or, as it is called, the falling of the child, has justly been considered a favorable cir- cumstance. It declares two important facts: first, a healthy condition of the uterus; secondly, a good conformation of the pelvis. The secretion of mucus is sometimes the first symptom of labor, even before any pain is felt. It is natural, and should be looked upon as favorable; and should not be removed by offi- cious examinations, any more than can be avoided. It is the substance Avhich nature supplies; to lubricate the parts, and! 378 POSITION IN LABOR. facilitate the passage of the head of the child thiough the vagina. It soothes those stinging pains that are felt in the os uteri, and aids the dilatation of these parts. A frequent touching of the glands that secrete it should be avoided, lest its secretions be, by this means, arrested; in Avhich case, a hot, dry state of the parts will succeed, and thus the difficulty of labor will be increased. Let the midwife be careful, then, "that she do not neglect or lose sight of this fact; and by all means abstain from a frequent handling of the parts. ON THE POSITION OF A WOMAN DURING LABOR. The position of a Avoman in labor is of more importance than many suppose it to be; and though authors on midAvifery have said much concerning it, something more may be said to advan- tage. Custom exercises great influence on this subject; and every author has advised that position Avhich is most common in his own country. The English advise the patient to lie on her left side; Avhile the prevailing custom in America. — Ave mean the common country practice,—is, to lay her on her back. The French use an arm-chair and a cushion seat; Avhile, in some countries, a stool with a hole cut through the bottom is preferred. In many parts of Germany, the patient is made to take a kneel- ing posture; but in others, she is delivered standing on her feet. Some prefer that the patient should sit on the lap of a friend; while others lay her on her back on the floor. A pallet,—made by placing three chairs with the rounds or posts tied together, to prevent them slipping apart, and laying a thin mattress or straw bed on them, for the patient to lie on,—is preferred by others. In this position, her feet are supported on tAvo stools or low chairs; and the midwife seats herself before her, Avith a sheet spread on her lap, for the purpose of receiving her child. These various positions have been recommended by different Avriters and midwives, and have been practised according to the celebrity and influence possessed by their different advocates. Some have recommended a bedstead made Avith joints in the rails, so that the patient could be raised or lowered, as the case might require. Several of these positions have their advantages in particular presentations of the child, and in peculiar forma- tions of the bones of the pelvis and sacrum, particularly the promontory of the sacrum. POSITION IN LABOR. 379 The side or the pailet-bed will embrace all the advantages that can be derived from position. When the promontory of the sacrum is very high, the pallet-bed will alloAv you to raise the woman up to an angle of forty-five degrees, or one half erect, Avhich will very much facilitate the passage of the child's head over this process. It will also be the best position Avhere there is great anterior obliquity of the uterus. But for every other case of natural labor, the side is certainly the position to be preferred. If the child presents in the natural Avay, the patient should lie on her left side, Avhich will give the accoucheur an opportunity to support the perineum Avith the left forefinger and thumb. But should the position of the child be such as to require it, the patient should be placed on the right side. In all cases of turn- ing the child, the patient should lie on her back. If the head of the child is in the left side of the mother, she should lie on her right side; but if the head is in the right side, she should lie on her left. There is no presentation of the child that will justify the midAvife in placing the patient on her feet, or on a stool, for delivery; nor is the lap preferable to either. These three positions will subject the patient to flooding, inver- sion, or prolapsus of the uterus; all of Avhich she might escape, if delivered either on her back or side. When she is placed in this last position, just before the child is born, a small pilloAV should be placed betAveen her knees, so as to keep them about two inches apart. For when they are thus separated, the perineum is not °o apt to suffer laceration as Avhen they are Avider apart. This is a safety to the mother that no other position can ensure. We have iioav Avritten all that is believed necessary on this part of our subject. It has been our object to embrace only those forms of labor and diseases Avhich we thought Avould be most profitable to the midwife or mother, and we have given as full an account of them as the limits Avithin Avhich we must confine this volume Avould permit. We have purposely omitted any mention of those forms of labor that the midwife could not man- age, as well as of those instruments Avhich a woman has not nerve enough to use properly. At the same time, we knoAV that there are many directions, in the management of the different forms of labor, that but few women can carry out. But we have given them in order that, when no physician is at hand, the midwife may be prepared to take advantage of them in her efforts to save the life of the mother or child, as it Avii! be found that fifteen minutes delay may prove fatal to one or both. 380 MANAGEMENT OF LABOR. Our constant effort has been to present the subject of which we Avere treating, in as clear and simple a manner as possible; and we Avish it distinctly understood, that the Avork Avas under- taken and prepared expressly for the use of midAvives and mothers. OF THE MANAGEMENT OF LABOR. On her arrival at the chamber of her patient, the first inquiries of the midwife should ke concerning the folloAving points: Have the pains yet come on? and if so, how long have they con- tinued? Have they been severe or not? Have the Avaters been discharged? and if so, Iioav long since? These inquiries being answered, if the pains are active, itNvill be necessary to examine the progress of the labor. This is done by first oiling the finger, and passing it gently into the vagina till it reaches the os uteri. The patient may lie either on her back or left side, during this examination, being covered to her head Avith a sheet or counter- pane. Having reached the os uteri Avith the finger, she should then feel gently hoAV much pressure the pain makes upon it. By this, the midwife may ascertain Avhether the contractions are strong or weak ; Avhether the os uteri is soft and yielding, or hard and thick; Avhether it is situated immediately in a line with the axis of the pelvis; Avhether the waters are gathering; and also determine Avhether the head presents properly. This can be easily ascertained, if the head has advanced far enough to enable her to feel either the anterior or posterior fontanel or mould of the head. Having done all this, — which may be accomplished in one or tAvo minutes,—if the parts and presenta- tion are found to be favorable, the patient should be apprised of the fact in a cheerful manner; and even if these parts are unyielding, and the labor is not likely to terminate speedily, she should receive all the encouragement that can be given con- sistently with the nature of the case. These directions should be attended to with the mqst scrupu- lous attention to modesty, decency and composure, on the part of the midwife, and with all due regard to the* feelings of the patient. If the boAvels are costive, and you think there will be time for medicine to operate, give a dose of one of the folloAving medi- cines : Recipe: Castor-oil, one ounce for a dose. Or, Recipe : Fol. Senna, one ounce. Manna Flake, half ounce. MANAGEMENT OF LABOR. 381 Boil to a strong tea, and give a tea cup half full, every half hour, till enough has been taken to produce operation. But should there not be time for medicine to operate, an injec- tion of Avarm Avater and molasses, or of thin gruel and hog's lard, may be given. A light, cool diet, should be used, and the patient kept still, if the labor is likely to prove tedious. It has been the practice of some midAvives to require the patient to Avalk about the room, to quicken the labor; but this should not be alloAved. The midwife should carefully avoid repeating her examina- tions unnecessarily, as this takes aAvay the natural secretions, makes the parts irritable, and causes the patient to suffer many pungent pains Avhich she might have escaped. When these preliminary steps have been taken, the patient should rest quietly, and be allowed to take any position she may like best. When, by the increase and activity of the pains, it is thought that another examination is necessary, the patient should be so informed; and if her labor is progressing, and all things are right, her bed should be arranged for delivery. This is done by placing one or tAvo blankets, —folded several times, — under the sheet, extending so Ioav as to permit the patient to place her feet against the foot-board. It is ahvays advisable to tie something to the opposite post, for her to hold in her hands Avhen the pain is on; and she should lie on her left side, if the presentation of the child does not require another position ; and thus the mid- Avife can use her right hand. Her hips should lie within one foot of the edge of the bed. Her knees should be drawn up, and separated by a small pillow placed betAveen them; her body bent fonvard, Avith her chin inclining tOAvards her bosom. The Avin- dows of the patient's room should all be curtained, or the shutters closed. Her clothing should all be loosened from around her Avaist, and her petticoat draAvn doAvn to her feet, so that she may be entirely covered by it. A sheet should be folded and placed next to her body, inside of her under clothes. During her labor, the patient's drink should be cold Avaler, Avhich she may have as often as she chooses. The midwife should noAV seat herself by the bedside, and care- fully attend to the progress of the labor. If the os uteri relax and spread easily, and the Avater has collected so as to protrude the membranes through it at every pain, you may predict a speedy delivery. But should the os uteri be thick in its edges, the waters collect sloAvly, the parts refuse to yield kindly, the \ 382 MANAGEMENT OF LABOR. perineum feel thick and firm, you may reasonably calculate that it Avill be sometime before delivery is accomplished. If the pulse be full, Avith or Avithout pain in the head, and a rigid condition of the parts exist, as above described, the patient should be bled. It Avill cause the parts to relax, increase the action of the longitu- dinal fibres of the uterus, and relieve those cutting pains Avhich so much harass the patient in this form of labor. When this is the case, she should be handled as little as possible; but she may be allowed to rise if she wishes to obey any of the calls of nature. • When the waters have gathered fully, if the parts yield kindly, the pains will be sufficient to discharge the waters. But if everything else is favorable, and the membranes are thick, and will not give Avay, they may be ruptured by the mkhvife, in order to let the Avaters escape; and if this is prudently done, the patient will be relieved of many severe pains. When the Avaters are discharged, either by the pains or the finger, and the head begins to engage in the bones of the pelvis, if the mouth of the womb continues to keep before the head of the child, and tht perineum is soft and yielding, the mouth of the womb should be gently passed over the head of the child, first behind, or in that portion next the sacrum, and then before, under the pelvis. This Avill facilitate the delivery very much. But if the mouth of the Avomb comes down before the head of the child, and the perineum is thick and hard, and will not yield kindly to the pres- sure of the finger, the following medicine should be used: Recipe: Extract Belladonna, one drachm. Dissolve this in a pint of Avarm Avater and dip cloths in it, and keep them constantly applied to the perineum, Avetting them fre- quently. This should be continued till the perineum becomes soft and yielding, Avhen the mouth of the Avomb should be put over the child's head, as above directed, and there will be no danger of a laceration of the perineum. If the extract of bella- donna cannot be had, take a handful of JamestoAvn or nightshade leaves, boil them in Avater, and Avet the cloths in it, as above directed. These remedies are only necessary, hoAvever, where the patient will not bear the lancet; but if her pulse will justify its use, bleeding will remedy these evils. By the timely use of the above-named remedies, the laceration of the perineum will be prevented, — a result most earnestly to be desired. If the lancet be used, the patirnt should be bled till she faints, in order to MANAGEMENT OF LABOR. 383 escape a laceration of the perineum. We have known a mid- wife to open a rigid perineum with a knife, and then boast of Avhat she had done, — an act which ought to be a penitentiary offence. Be careful, at all times, to preserve, as much as possible, the natural secretions of the parts. But should they become hot or dry, they must be kept moist with some kind of animal oil. When the pain is off, place the finger Avithin the vagina, and gently press the perineum tOAvards the back. The knees should be kept separated about two inches, as a Avider separation will subject the perineum to laceration. The patient should be directed to bring her chin tOAvards her bosom, at every pain: her eyes should be shut, and her loins and hips as perfectly relaxed as possible. She should make no effort, unless she has a pain that bears doAvn; but if she Avish it, some assistant may hold the back during the continuance of a pain. The perineum must be carefully supported as the head of the child passes over it. This is done by placing the palm of the hand on it, grasping one side with the forefinger, and the other side Avith the thumb, and squeezing the finger and thumb together, so as to relieve that portion of the perineum that joins the sphincter muscle of the rectum. The right hand should, all this time, be employed in relieving the croAvn of the head from the pressure above, by bringing it forwards, and turning it out- wards. During this operation, the patient should lie perfectly still, lest some injury be inflicted upon herself or child. The instant the child's head is born, a calm is felt by the patient; and the midAvife should Avait a short time for another pain, Avhen the shoulders will come doAvn; but if they are large, both should not be alloAved to come down at once. And here, again, great care is necessary to prevent the laceration of the perineum; since more accidents of this kind have happened from the pas- sage of the shoulder than the head. The midAvife must gently pass her finger up, hook it in the under armpit of the child, and bring doAvn the shoulder into the cavity of the pelvis, and then into the holloAv of the sacrum. She should then press the upper shoulder up a little, and return her finger to the under shoulder; and Avhile she again supports the perineum, as in the delivery of the head, bring the shoulder over the perineum; then bring down the other shoulder, and deliver the child by both. She must be careful not to use force, or pull by the child's neck, lest sne should slip a joint, and thus kill the child 384 MANAGEMENT OF LABOR. As soon as the child is freed from the mother, bring it forward towards her thighs, and draw the bedclothes betAveen it and the mother, that it may have a chance to breathe freely, and the mother be comp'.etely covered. Let the child breathe freely in this conditon, for some minutes, and the circulation nearly or entirely stop, before the cord is tied. This may be done with a thread or tape string ; apply it about an inch from the child, and tie it tight. Another may be placed tAvo or three inches above the first, to keep the placental blood from floAving out on the bed. After the navel string is divided, give the child to the nurse, Avho will receive it in a sheet or soft blanket. The midwife should now place her hand on the abdomen of the mother, and feel if the Avomb contracts firmly; if it does not, grasp the after-birth and womb, — through the abdominal muscles, — firmly in your hand, and gently move them till a permanent contraction is felt, and the patient experiences some pain. She may then let go her hold, and taking the cord in her hand, pass her finger gently along it, till she feels the after-birth, holding the c:rd moderately tight Avith the left hand. She may then hook th3 forefinger of her right hand into the after-birth, and gently bring it aAvay. After it is removed, she should apply the forefinger on one side and the thumb on the other of the vulva, and gently press upwards for a minute; and, by this means, relieve the birth of the child. A large, soft napkin should be applied to her, and the sheet that is next to her should be removed, and her clothes draAvn down to her feet. Let her then be straightened up in the bed, when the midwife should again apply her hand to the abdomen, and feel if the Avomb has con- tracted firmly. If it has not, grasp it as before, and move it a little, till it does contract. A bandage Avhich will reach from the hips to the stomach, and broad enough to cover tAvo or three inches of the upper portion of the hip bones, should then be applied, and be pinned or tied as tight as the patient can conven- iently bear it. All this should be done by the midwife before she leaves the patient for one moment; after Avhich, she may lay her on her right side, cover her comfortably, and leave her to rest. If she Avishes a drink of cold water, let her have it. It must be understood that Avhat Ave have said above relates to natural and uninterrupted labor, there being no difficulty either with the mother or child. But the child does not ahvays cry aloud when it is born; and Avhen this is the case, the midAvife should immediately feel the cord to ascertain if the circulation in MANAGEMENT OF LABOR. 385 it is strong. If so, it is probable that the child suffers from phlegm or mucus in the mouth or throat. To relieve it frorr this, she may wrap a piece of fine, soft linen round her finger, and introduce it into the mouth of the child, even doAvn to the root of the tongue, and clear aAvay the phlegm. If the child does not cry Avhen this is effected, she should raise its body up, turn its head doAvn, and shake the child gently. After this is done, if the child does not breathe freely, its breast and abdomen should be rubbed with a little spirits; after Avhich, if the circula- tion is still going on in the cord, the child will soon cry aloud; perhaps, at first, by convulsive sobs, and presently by a loud cry. But Ave are not ahvays so fortunate. The child may not cry at all Avhen it is first born ; and this may be OAving to hard and close pressure in the bones, or it may be naturally Aveak. In this case, if there be no circulation in the cord, if the child's face and lips are livid, and its belly flat or fallen in, the cord should be cut immediately, in order to let a little blood escape. This Avill relieve the brain and lungs from the apoplectic state into Avhich they had been thrown by the hard labor. The child should then be Avrapped in warm flannel, and the lungs cleared as above directed. If it does not yet breathe, its lungs should be inflated, by some one bloAving into them; but this must never be done by any one Avho uses tobacco in any form, as the breath of a smoker, snuffer, or cheAver, will kill the child. After the lungs have been inflated, gently press on the sides of the chest, to cause the air to escape; and let this be repeated several times. Let the child's head, breast and private parts be Avet occasionally Avith spirits; and do not soon be Avearied in this matter; for many children have been brought to breathe and live, that have remained silent for fifteen or tAventy minutes after they Avere born. Some recommend Avarm water, and the bath is resorted to immediately, and the child kept m it for fifteen or twenty minutes. But though the child may by possibility, live after being placed in the Avarm bath, Ave are fully persuaded it is not the best course to pursue. On the contrary, indeed, we are satisfied that the Avarm bath, in these cases, ahvays does harm, as Avell as in those Avhere the child is pale and flaccid Avhen born. If the child survives a long bathing, it is a triumph of nature over a bad remedy. Others use a dash of cold Avater over the breast of the child, and Avith more good reason and philosophy; for this is a stimulus of the tonic kind, and that is Avhat the child needs. Warm water is a stimulus, it is true, but of a uright. 26 386 MANAGEMENT OF LABOR. relaxing nature, and increases Avhat we Avish to remove. If either is used, cold Avater is decidedly the best; but if the cold is used, the child should be immediately Avrapped in a dry, Avarm blanket. The practice of turning the child's head doAvn to relieve the throat of mucus has been objected to by some, but Avithout any good reason. The objection is, that it causes too much blood to flow to the brain. Let us examine this reasoning. The child has not yet breathed; and its head has been down for three or four months. This is its natural position till it does breathe. Hoav, therefore, can it suffer from the head being turned doAvmvards ? To this it may be replied, that the action of the air upon the child's body makes a great difference. But let experience speak, instead of theory, and it will teach us that the child Avill not suffer from being placed in that position for a feAv minutes. Again. It will be found that warm, dry blankets are better than warm Avater, to resuscitate a child. The unskilful practice of giving ergot, to hasten labor, has caused hundreds of gallons of Avater to be heated for the resuscitation of the child, Avhere not one drop would have been needed, if nature had been alloAved to do her OAvn Avork. Some French Avriters have advised the lungs to be inflated, by bloAving through a tube passed into the wind- pipe. But these organs are too tender for such an operation as this, even if the midAvife should have a suitable tube at hand. When the cord is cut for the purpose of relieving the lungs or brain of the child by bleeding, it should be tied again as soon as the child begins to breathe. When it is sufficiently recovered, the nurse should Avash it in tepid Avater; and, if there is much white gum on the child, a little lard should be rubbed on it, till the gum is softened, after Avhich it may be washed in a little mild soap, or spirits and water. The navel string should be passed through a hole in a linen or cotton cloth, Avhich should be folded upAvards, then from each side, so that it may be completely covered, Avhile it is not alloAved to be in contact Avith the child. The Avaistband should next be applied. This may be of linen, cotton or flannel; but linen will not of course be used in cold weather. The band should be laid on smooth and tolerably tight, and may be fastened Avith tapes and pins; though tapes are the best. The balance of the dressing should be put on Loosely, and with as feAv pins as possible. Strings or tapes, in all cases, are better than pins. DIFFERENT PRESENTATIONS OF THE HEAD. 387 We noAV return to the mother. If she is weak, and feels no pain, the midAvife should place her hand on the abdomen; and if she feels the womb in a hard lump, Ioav doAvn near the pelvis, tonic contraction has taken place, and the after-birth will be found Avithin, or near the pelvis. She should then introduce the forefinger of the right hand along the cord, into the fold of the placenta, and take it gently aAvay. But if the uterus has not contracted, but lies flat in the abdomen, there is great danger of flooding. She should spread her hand and grasp as much of the abdominal muscles as she can; press, and at the same time, shake them gently, a little. If this should not cause contraction to take place, she should then rub her hand over the abdomen with a smart friction ; but should this fail to produce contraction, let her take some spirits of camphor, or whiskey, and rub the abdomen Avith it, Avith a quick motion. Should this also fail to have the desired effect, give the folloAving medicine: Recipe: Pulverized Ergot, twenty grains. Sugar, one tea spoonful. Mix, and give the patient. As soon as the uterus begins to draw- up in a hard knot, encourage it by friction, till it remains in a ball, near the pelvis, Avhen a broad bandage, firmly applied, Avill secure the patient from flooding. If she is faint at this time give her a little Avine and Avater, or spirits and Avater, or essence of peppermint in Avater. If none of these are at hand, give a little of any kind of stimulus that may be present. The patient should iioav be left to rest till she feels recovered, before her clothing is changed; but after she is rested, she may be comfortably fixed in bed. These directions may suffice for all kinds of labor, after the child is born; though each form of labor must be treated accord- ing to the demand of the particular case. OF THE DIFFERENT PRESENTATIONS OF THE HEAD. Besides the presentations described in natural labor, there are six more. These are called preternatural, or unnatural presenta- tions. The first is, Avhen the posterior fontanel presents itself behind the left acetabulum, while the anterior is placed before the right sacro-iliac-junction. The sagittal suture must, therefore, traverse the superior strait obliquely. The head of the child, in this presentation, offers itself in an oblique position, as it regards the superior strait. By the contractions of the uterus, the vertix is made to sink loAver in the pelvis than any other portion of the 388 DIFFERENT PRESENTATIONS OF THE HEAD. head, and, at the same time, to place the chin of the child on its own breast. The head always enters the pelvis at an angle of about thirty degrees, from a right line Avith the superior strait. It descends, in this Avay, till it is changed by the ischiatic liga- ments and perineum. When the head arrives at the first part, the fontanel is forced to offer itself to the arch of the pubis; and in doing this, the neck is slightly tAvisted, as it Avere, on a pivot, but the trunk does not perform a similar motion. In proportion as the head is urged fonvard, the sutures on the top of the head can be felt more distinctly beloAV the pubis. If the head be not unusually large, the pelvis a little contracted, or the sacrum too strait, the back of the head will be found to correspond with the centre of the pubis. But if either of these circumstances presents itself, it will be perceived to ansA\rer to the left leg of the pelvis, and ischium. At this moment, the chin of the child, Avhich had hitherto been placed on its breast, begins to depart from it; the vertex advances, and separates the external parts by engaging under the pubis, Avhence it rises up tOAvards the inons veneris. The inferior edge of the symphasis pubis answers as a kind of axis for the head to turn upon; in doing Avhich, it describes about a quarter of a circle backAvards. For the head, in issuing from the pelvis, obliges the chin to describe an excessive curve, passing successively over the Avhole line of the sacrum, coccyx, and per- ineum, Avhile the vertex itself passes through a small space. As soon as the head passes through the external parts, the face usually turns tOAvards the right thigh. You have then to deliver the shoulders and body, and the process is over. The second, presentation is exactly like the one just described, except that it is reversed in all its positions and movements. It requires exactly the same treatment. It is thought, by some, to be not quite so favorable a presentation: but Ave have found no difference. The third presentation is where the posterior fontanel pre- sents to the pubis. In this case, if the pelvis is well shaped, the labor Avill go on without difficulty. The precise little motions and turns attending this presentation, are unimportant to the common midAvife, and need not be described here. In ninety- nine cases out of a hundred, the labor Avill go on Avell; and unless the midAvife is very skilful, she will not know that the presenta- tion is Avrong. The fourth presentation is that of the forehead. This species of labor is necessarily more difficult and painful than those just DIFFERENT PRESENTATIONS OF THE HEAD. 389 described , and it sometimes becomes extremely so. If the head de relatively, or positively, large for the pelvis, it requires much more time to accomplish the labor; and the patient experiences much more suffering than she does when either of the former presentations takes place; especially if the soft parts give much resistance. We must, then, alter this presentation, and change it to the first or second. This is to be done in the following man- ner. If the waters are discharged, the parts well dilated, and the pains active, let the patient be placed in the most favorable position, according to the side to Avhich it is desired to turn the child. In the absence of pain, the midAvife should place her fore- finger on the child's head, and pass it to the right or left, as it may move most easily. AYhen she has gained all she can, she should hold it there during the next pain; and Avhen it has passed off, press the head further, and continue this action Avith the finger, till the head is brought either to the first or second pre- sentation. So absolutely necessary is a knoAvledge of these presen- tations, and skill in changing this into some other, that no one is qualified to practise midAvifery Avho does not understand them, or is unable to accomplish the necessary changes Avhen they are required. This duty, Avhich is easily accomplished by those Avho understand it, will relieve the patient of many hours of hard labor, and perhaps save the life of the child. We are aAvare that some object to alter the position of the child in this presentation. To say the least of it, the objection savors very little of humanity, tender feeling for the patient, or regard for the child. The fifth presentation is very much like the fourth, except that the anterior fontanel is placed to the right acetabulum. Now, if the midAvife recollect the mechanism of the fourth vertex presen- tation, she has this very nearly. In this presentation, a little more difficulty may be expected than in the fourth, OAving to the contingencies Avhich may make the second not so favorable as the first, as has been already stated. When the face escapes from the vulva, it will almost ahvays turn tOAvards the right groin. The efforts of the uterus sometimes reduce this case to a first presentation; Ave should then profit by this, and do likeAvise. The sixth presentation is of very rare occurrence, and is found, for the most part, in cases of tAvins. Fortunately, Avhen there are tAvins, the head is small, and the difficulty is thus decreased. In this presentation, the anterior fontanel is immediately behind the svmphasis pubis, and all the midAvife has to do. is to pass up the 390 PRESENTATION OF THE FACE. fingers, and turn the anterior fontanel toward sone of the acetab- ula. But the parts must be Avell relaxed before this is attempted. The natural poAvers of the uterus Avill soon complete the case. It Avill be perceived in a moment, that the character of this case is exactly the reverse of the third presentation; that is, the ante- rior fontanel is placed behind the symphasis pubis, and the pos- terior before the sacrum. PRESENTATION OF THE FACE. There are but two presentations of the face. First. — Where the forehead offers to the left, and the chin to the right side of the pelvis. The second is just the reverse of this. A presentation of the face may be easily known by the touch; by Avhich the eyes, mouth, nose, and forehead, may all be detected. We must either leave this case to nature, or deliver artificially, by turning or by instruments. Turning the head, or rectifying the position, is the safest, Avhen it can be done. To do this, the parts being prepared, and the patient properly placed, the midAvife should pass the palm of her hand over the forehead of the child, place her thumb on the forehead, and, seizing the vertex in her fingers, push the forehead up Avith the thumb, and bring down the croAvn Avith the fingers. This should be done when there is no pain, and the advantage gained should be firmly maintained. If Avith the next pain the crown comes down, she should take her hand out, and bring the croAvn as low doAvn with it as she can. But, if the first effort is not successful, it must be attempted again and again till it is. In this operation, the chin goes back upon the breast of the child, and the croAvn of the head engages in the superior strait. The labor should be alloAved to go on in the usual Avay. Delivering Avith the forceps is more severe to the mother, and more dangerous to the child. When the child is delivered by the natural process, with the face foremost, it Avill be found to be in a state of asphyxia, or suffocation, and perhaps may never come to; though this is not ahvays the case. This is a very painful labor, as Avell as a difficult one to manage, and is deservedly dreaded both by the patient and operator. PRESENTATION OF THE HEAD WITH THE HAND. The presentation of the head Avith the hand often happens. The hand may be felt, sometimes, through the membranes, before PRESENTATION OF THE BREECH. 39j the waters escape; and, Avhen this is the case, it is sure to come doAvn with the head, or before it. As soon as the head is found to be presenting, if the waters are gathering freely, and the os uteri be relaxed, the midAvife should break the membranes, and place her finger betAveen those of the child, and, at every pain, push its hand up, and tOAvards its face, so that the head may pass doAvn, and the hand up, till the head is fully engaged in the superior strait. The head Avill then pass into the pelvis, and the hand turn on the breast of the child Avith- out any further assistance. But should this be neglected, and the hands alloAved to come before the head, the patient must be delivered with forceps. In all cases she must avoid pulling at the hand. The hand may present with the knees, breech, or feet; but here it Avill be found an easy matter to keep it back, and let the other presentation,—be it which it may,—come forAvard, for the child may be safely delivered by either of them. PRESENTATION OF THE BREECH. Next to those of the head, the presentation of the breech is most frequent. It has its variations, also, as well as those of the head. It is sometimes difficult to distinguish a presentation of the bieech from that of the head. In some of its forms, a locked head resembles a breech presentation very much; so much so, that it has sometimes been mistaken for it. The signs of a breech presentation are, for the most part, these: a soft, roundish tumor. entering the pelvis, the presence of the foreshet, and sometimes a discharge of the meconium. This, hoAvever, is discharged in other presentations. We cannot decide with certainty on this presentation, till the Avaters are discharged; when, not only the foreshet, but the nates, and the genital organs, may be felt. A breech presentation, as it respects the mother, is as easy as those of the head; so far, at least, as the delivery of the body of the child is concerned. But in the delivery of the shoulders and head, the rules laid doAvn on this subject, in the operation of turning the child, must be strictly attended to; for then it becomes, to all intents and purposes, a case of that description, as far as the delivery of the several parts is concerned. We believe that breech presentations are safer for the child than those of the knees or feet, because the breech is nearly equal to the head of the child in size, and, consequently, when it passes first, there will be the 392 PRESENTATION OF TH£ BREECH. less difficulty attending the passage of the head. But Avhere the knees or feet present, they pass Avith less dilatation of the parts; and, consequently, there is greater risk in the passage of the head. Though the breech presentation may be a little harder for the mother, it is safer for the child. There are four presentations of the breech above the pelvis: First, Avhere the spine and sacrum offer to the left side. Second, Avhere this is reversed. Third, where the spine and sacrum are behind the pubis. Fourth, Avhere this is reversed, or where the back of the child is toAvard the back of the mother. But this is, fortunately, of rare occurrence. In either of the first tAvo, Avhichever hip presents, it may be suffered to come doAvn till it enters the pelvis; when the action of the uterus will press the child into the most favorable diam- eter of the pelvis. The midAvife may then proceed to deliver, giving attention to the caution in the chapter on turning; always using particular care not to let the longest diameter of the head engage in the shortest diameter of the pelvis. I.i the third presentation of the breech, the belly of the child lies tOAvards the back of the mother, and the back and spine pass out under the symphasis pubis. When the body is delivered, great care must be taken that the head does not become firmly fixed, by resting it on the pubis, and the ehin on the promontory of the sacrum. To prevent this, the head may be turned gently with the finger, so as to make the long diameter of the head cor- respond Avith that of the pelvis: that is, from right to left, or a little diagonally, as in the tAvo former presentations. Delivery is then accomplished as before directed. In the fourth presentation, if the time alloAvs, the midwife should bring down the feet and turn the child. If she cannot succeed in changing the position of its head, she will generally find that the case will prove fatal to the child; but the action of the uterus alone sometimes effects this change. All labors in breech presentations are sloAver and more fatiguing to the mother, and attended Avith greater danger to the child. Any of the causes that may occur in other presentations to make the labor preternatural, may also occur in this; such as. flooding, fainting, convulsions, bleeding from Avithin or Avithout the uterus, general prostration of the system, and entire loss of the contractile powers of the uterus, &c. In either of these cases, she must proceed according to the directions given in the chapter on com- plicated labor. PRESENTATION OF THE HAND, ARM, OR SHOULDER. 393 PRESENTATION OF THE FEET. After the feet have passed the internal parts of the mother, the labor must be conducted exactly as in the presentations of the breech, just described. It will, therefore, only be necessary to give some directions for the management of the case before the feet descend. ' If it is necessary to expedite the labor, and the feet are above the superior strait, the midwife should pass her fingers gently up, till she can grasp them; having done Avhich, she must draAV them doAvn slow\y. But s|iould this require much force, she must desist, and raise the hips of the patient upwards, as this will either cause the feet of the child to descend, or enable the midwife to bring them doAvn easily. If possible, both feet should be thus brought doAvn together; but should this prove impracti- cable, if the child is small, and the pelvis Avell formed, she may proceed to deliver by one foot. But if she cannot bring doAvn one foot easily, she must search for the other, and bring doAvn both together. In doing this, it is very important to use the hand, the palm of which will most easily touch the belly of the child. When she has found the feet, place one finger between the ankle-bones, grasp the legs firmly, and draw them doAvn sloAvly. After this, the case should be managed as in a presen- tation of the breech. In a case of tAvins, care must be taken to seize the feet of the same child; otherAvise, great difficulty will be experienced in correcting them afterwards. It is hardly necessary to give directions for distinguishing the foot from the hand, — the toes, bottom of the foot, and heel, are all so easily distinguished from the palm, thumb and fingers. Palm to palm, Avill always give the hand presenting; the thumb to the great toe, will always give the foot presenting. The right corresponds to the right, and the left to the left, both in the hand and foot. PRESENTATION OF THE HAND, ARM, OR SHOULDER. One hand or both may present; or one arm, as the elboAV, or one shoulder. If the hand present, the midAvife must learn the position of the shoulder from that of the hand. If the right hand present. Avith the palm upAvards, the shoulder and head of the child Avill be on the patient's right side or groin; as the patient is understood to be on her back, in these presentations, the child's 394 PRESENTATION OF THE HAND, ARM, OR SHOULDER. face will be towards the abdomen of the mother, and its back to her back. The feet will then be in the left groin, and betAveen the child and the abdomen of the mother. If the palm of the child's hand be doAvnwards, then the parts just described Avill occupy the same region; but their position Avill be exactly reversed in relation to the mother. If the left hand present, Avith the palm upAvards. the shoulder and the head Avill be in the left side of the mother, and the face of the child will be towards the mother's abdomen, and its back to her back. The feet of the child Avill be tOAvards the abdomen of the mother. If the palm of the hand be downwards, the shoulder and the head of the child Avill be in the left side; but their position in relation to the mother will be exactly reversed from that in Avhich the palm of the hand is upAvards. The hand presenting may be determined to be the right or left, by this rule: place the child's hand in your own, palm to palm, and if thumb ansAvers to thumb, you determine the hand presenting by the hand you use. A presentation of the elbow may be determined by the point of the elbow, it being sharper than the knee; or by ascertaining which Avay the bending of the elbow Avould carry the hand. If it go to the right of the mother, then the right elbow of the child is presented; if to the left, it is the left elboAV; for the hand always passes towards the head of the child, Avhether it goes to the right or left; and the palm of the hand always answers to the face of the child, Avhether it be up or down. The feet always correspond to the face, as it relates to the position of the child, in reference to the parts of the mother's back or abdomen. A thorough knowledge of these presentations is of" indispensable importance in turning the child. In the first and fourth presentations of the hand, the right hand of the operator must be used in turning the child; but in the second and third, she must use the left hand. Without pay- ing particular attention to these directions, she will not be able to turn the child, Avith safety to itself or the mother. There has been much said about spontaneous evolutions of the child, in hand or arm presentations, and it may all be true. We, however, have never seen it occur. Much has been said, also, about bringing down the head, in presentations of the arm, where that limb Avas fully delivered, and the shoulder impacted in the pelvis. But Ave never have been able to succeed in effect- ing this, nor have Ave ever seen any one that did. We often PRESENTATION Ol<* THE HAND, ARM, OR SHOULDER. 395 bring doAvn the head, when the hand presents Avith it; but this is a very different case from that Avhich we are considering; and it is one for Avhich Ave knoAV of but Iavo remedies, viz. : first, turn- ing; second, dismembering the child. The first may possibly be done Avith safety to both parties, though the condition of the child is a very dangerous one. If you can succeed in relaxing the system, so that the shoulder may be dislodged, and returned, with the arm, into the uterus, the child may then be turned. But should the remedies prescribed, such as opium, the lancet, anodyne injections, etc., prove ineffectual in relaxing the os uteri sufficiently, and in allaying pain, then try the following: Recipe : Extract Belladonna, one drachm. Dissolve it in one pint of hot water, and apply cloths wet in it to the vulva and vagina. If, by continuing this application for half an hour, the parts should not yield sufficiently, then soften one drachm of the belladonna, and Avith the finger apply it to the os uteri, inside and out. Let it remain on these parts; for we never kneAV this application to fail in arresting the pain, and relaxing the os and cervix uteri. When the relaxation is suffi- cient, and the pains suspended, the midwife may return the shoulder and arm into the uterus, and bring doAvn the feet into the vagina. But here she must stop, and let them remain till the pains return, which Avill be in from one to tAvo hours. In the mean time, she must be careful that the slight contractions of the uterus do not draw the feet back again into the cavity. The delivery of the child must not be attempted until the ener- gies of the uterus are fully restored, or the patient may be sub- jected to a dangerous hemorrhage. But should the efforts return, mough feebly, and the patient be likely to sink from exhaustion, the ergot should be given in the usual Avay. In this case, the child is in great danger; but it is better to save the mother than to sacrifice both mother and child. Belladonna is also believed to be a good remedy; Ave have tried it, and it has realized all our expectations. It is not to be denied that the operation of turning is frequently fatal to the child. Yet it is sometimes successful; Avhile the knife is always fatal, — at least to the child,—and, if unskilfully used, may be equally so to the mother. The operation of turning is a delicate one. and requires to be skilfully performed; for an aAvkAvard movement may prove fatal both to mother and child. The hand of the midwife should be 396 PRESENTATION OF THE SIDE, BACK, OR ABDOMEN. carelVly introduced into the uterus; and Avhen the parts are properly prepared, the patient will sustain no injury from the size of the hand. The second remedy resorted to for delivery in shoulder presen- tations, is cutting instruments. There are various methods pre- scribed for the operation for Avhich they are designed; and they Avho are curious to know them may read Dewees, Denman, Meriman, Smellie, Baudeloqne, Burns, and tAventy others, if they choose. As a surgeon must necessarily be called in, when any operation of this kind is demanded, Ave shall say nothing more on the subject, except to remark that if the instrument be in the hand of a skilful operator, the patient will not be conscious of pain occasioned by, or dreaded from, its use. PRESENTATION OF THE SIDE, BACK, OR ABDOMEN. If the side present, the position of the head may ahvays be ascertained by observing these rules: First. If the right side of The child present, the superior portion of the ilium will be felt in the left hip of the mother, (or to her left side;) the back of the child, in this presentation, being to the mother's back, its feet folded upon its abdomen, and its head in her right side, Avith its crown near the sacro-iliac symphasis. Secondly. If the left side of*the child present, the superior portion of its ilium will be found in the right side of the mother, its back to her back, its head in her left side, and its feet folded up, as in the other case, on its belly. Thirdly. If the child's back is in the abdomen of its mother, all the presentations and positions will be found reversed. so that the feet of the child, in every case of their presentation, Avill be to the mother's back. Fourthly. In the fourth presen- tation of the side, if the head of the child be turned to the other side of the mother, this presentation will be the result. All the positions correspond to this reversed condition of the superior portion of the ilium. In all these cases, the child must be turned; and it will be found easier to take the feet than the head, except that in the third and fourth presentations it will be difficult to get more than one foot at a lime. In the first and second presentations, the right hand must be used in turning, and the left in the third and fourth. Though the feet are easily reached in these cases, it is not the safest course for the child. The head can. sometimes, bo brought doAvn ; and Avhen this can be done, it should never be omitted. Turning by the head is not more painful to the mothei PRESENTATION DP THE SIDE, BACK, OR ABDOMEN. 39? than by the feet; and, therefore, Avhen practicable, it should ahvays be done. This may be effected, when the child lies in the first position, by passing the hand through the os uteri, and carrying it a little under the child's back and hips, gently press- ing them upwards, and, at the same time, turning the back of the child towards the back of the mother. This affords ar opportunity of bringing the croAvn of its head to the superioi strait of the pelvis. But care should be taken that its back be not strained too suddenly, or with too much force, lest an injury to the neck or spine be the result. A steady and gentle pressure will most surely effect it. When the head is placed in such a position that the efforts of the uterus will carry it doAvn, and every pain corrects it by little and little, the case may then be safely left to the efforts of the uterus, if the patient lie on the side that Avill leave the head uppermost. The labor will be a little tedious, but the head will presently come doAvn into the pelvis, and make its turns so as to adapt itself to the diameter of that organ. When the child is born, there will be a SAvelling of the skin on that portion of the head that first presented to the strait of the pelvis. This SAvelling should be bathed with spirits, two or three times a day, for a feAv days, after Avhich it will all subside. When the back presents, it mav be ascertained as soon as the waters break; for the joints of .oe back may be felt, or the edge of the shoulder-blade. The backbone may be a little above or beloAV the lateral axis of the pelvis; but this Avill make but little difference in the treatment to be pursued. In this case, the fingers of the child are all above and out of the reach of the oper- ator. Tluough the operation, in this case, is more simple than in the other, yet it requires great care in bringing down the head. The midwife must first press the back up as far as she can, till the head can be brought doAvn Avithout producing too great a curvature of the spine; otherwise a serious injury may be done to it. When the head is brought to a safe position, nature Avill complete the delivery, if she be not interrupted, and nothing else is the matter. When the abdomen is presented, the feet can be brought doAvn Avith great care, and Avithout any injury to the mother or child. Delivery is effected in this case as in all other cases of deliv- ery by the feet. The navel string must not be brought between the legs, but should ahvays be passed over one foot or the other, care being taken that it is not tied round both legs. 398 COMPLICATED LABOR. COMPLICATED LABOR. Labor is said to be complicated, Avhen it is attended with flooding, convulsion, and some other phenomena not common to labor. And first, of flooding. When this takes place during labor, it naturally and justly excites alarm. Avhether the labor be natural or preternatural. Flooding may lake place under two different circumstances of the uterus, after labor has commenced: First, when the os uteri has partially dilated and is rigid; and, second, Avhen the os uteri is dilated or dilatable. These tAvo conditions should never be overlooked. — Dewees. If flooding should take place in the first mentioned condition of the uterus, an attempt to hasten delh^ery Avould be very imprudent. The result will be defeat, and an increased loss of blood. Absolute rest should be enjoined ; and application made of cold cloths to the vulva and back. They may also be laid on the abdomen. The folloAving medicine should be given : Recipe: Pulv. Opium, four grains. Sugar Lead, twenty grains. Mix in four poAvders, and give one every half hour, in sugar, or sirup, till the flooding is checked. Should these remedies fail, soft cloths, dipped in cold Avater, must be placed in the vagina; and ice-Avater may be used, if necessary. As soon as the parts become sufficiently relaxed, the course prescribed in the second species of labor must be pursued. Secondly.— Flood- ing may take place Avhen the os uteri is dilated, or dilatable. When it occurs under either of these conditions of the uterus, if the Avaters are gathered, or gathering, the membranes must be ruptured, and contraction of the womb excited, by dilating the os uteri Avith the finger. If this fail, the ergot must be employed; and if it should also fail,— the head being in a suitable condi- tion,— delivery may be attempted Avith the forceps. But if the head is not in a position to alloAv this instrument to be used, the child must be turned, if it is possible to perform that operation. {See directions for turning.) The second cause of complicated labor is convulsions; to which the pregnant Avoman is liable at any period of gestation, as Avell as in labor. When they occur at any time before labor commences, and especially in the early stage of pregnancy, they are much more easily treated than Avhen they present themselves during the process of labor. We are told by Baudeloque, that COMPLICATED LABOR. 399 he knew a woman who suffered compulsions, every month, from the time her catamenia Avere arrested by pregnancy, till she Avas delivered at her full period. The paroxysms Avere of different periods of duration, lasting from half an hour to three hours, but Ave suppose they Avere of an hysterical character. Othei cases have occurred, in Avhich convulsions did not come on till the seventh month, or even later. The danger increases in pro- portion as they come on nearer to the full period of gestation. They give, generally, but little, if any, warning. Sometimes the patient feels a sensation of fulness in her head, or hears a ringing sound in her ears, with more or less of vertigo; the face is generally flushed, and the eyes look heavy and dull. The fit is extremely rapid in its approach. The whole system is thrown into a state of violent spasm ; the features are dis- torted; the saliva works out of the mouth, and, sometimes, the nose; the tongue is liable to be cheAved or cut by the teeth; the hands, arms, and feet, are violently agitated; the fingers are clenched; the body is strained and stiffened to a very great degree; the face becomes livid; the lips swell J the eyes are suf- fused, and red with blood, and the poAver of voluntary motion is lost. A state of entire unconsciousness pervades the body and mind ; and frequently both urine and stools are involuntarily voided during the fit. This convulsh^e action continues for a longer or shorter period, and may last from five minutes to three hours. When the spasm has passed off, the patient sinks into a coma- tose state; Avith deep, slow, heavy breathing, and sometimes'a loud snore. From this state, all attempts to rouse her Avill be vain ; but, if let alone, she will probably awake, after some time has elapsed, and speak feebly, but will not appear to be con scious of anything that has happened during the fit. Those women who are liable to convulsions generally have broad, high shoulders, a short, thick, neck, large head, short, thick body, and are disposed to plethora; are generally hearty eaters, and of a costive habit of body; but, occasionally, Avomen of all figures and states of health have been attacked Avith con- vulsions. Treatment. — There has been a great variety of remedies proposed for the cure of this disease. Some give anti-spasmodics, as opium, castor, asafcetida, &c, with loss of blood from the foot, and direct the boAvels to be kept open with gentle medicines. This is the treatment they adopt in those cases that occur before 400 COMPLICATED LABOR. the full period of gestation. But to us, this coirse of treatment appears entirely inadequate to the purpose of arresting the dis- ease. We have seen all these remedies used, Avithout any good effect; but, on the contrary, much harm, since the physician lost much time, Avhile the patient Avas suffering the violence of the disease. We Avould not be understood to say, that keeping the boAvels open is unnecessary; on the contrary, it is very important. But to rely on this, or opiates and anti-spasmodics, for a cure, is only to abandon the patient to her fate; in plain terms, to stand by and see her die. The lancet is the sheet-anchor of every suc- cessful practitioner in this disease; and Avithout it, the other remedies named above are entirely Avorthless. Immediately on an attack of this species of convulsions, the patient should be very freely bled; a vein in each arm may be opened, itneces- sary; but Avhether from one or both, the vein from Avhich it is draAvn must be opened by a large orifice, or it Avill do but little, if any, good. On the contrary, it may cause much harm; because the blood-vessels Avill contract,,and prevent the blood from floAving; the consequence of which Avill be, that the brain Avill suffer that species of violence from Avhich it may never recover. Hence, blood-letting has been condemned in this, and many other diseases, when the fault is not in the remedy, but in the manner of using if. But, as the object of bleeding is the relief of the patient, it should be continued, Avithout regard to the quantity taken, until that object is secured. After this end is attained, the boAvels must be kept freely open, and a Ioav diet and absolute rest must be strictly enjoined ; avoiding everything that is calculated to excite either mind or body. The folloAving medicines may be given first: Recipe : Calomel, thirty grains. Scammony, ten grains. Mix in sirup, and give it for a dose. If this should not operate in three hours, give: Recipe: Scammony, twenty grains. Aloes Pulv., twenty grains. Pulv. Rhubarb, twenty grains. Tartar Emetic, one g:ain. Form tAventy pills, and give tAvo every two hours, till the boAvels are freely moved. After this, they may be kept opon with some of the above pills, or with, COMPLICATED LABOR. 401 Recipe: Castor-Oil, one ounce, for a dose; or, Recipe : Fol. Senna, one ounce. Manna Flake, one ounce. Boiled to a strong tea, in a pint of water. A tea cupful, three or four times a day, Avill be sufficient. The diet should be gruel, rice, cool tea, soft toast, bread soup, etc. The following cases, out of a great number, will illustrate this mode of practice. The first case is one that occurred betAveen the sixth and seventh month of pregnancy. The patient was a yellow Avoman, belonging to a gentleman in the town of NeAvcastle, Ky. She was about seventeen or eighteen years old. Her body was short and thick; perhaps she did not weigh more than ninety or a hundred pounds. On being attacked in her first pregnancy with a convulsion, the family physician was sent for, who bled her from the arm, ten or tAvelve ounces. After some hours, she became rational. He then ordered a cathartic of senna tea and salts, which operated. In six or eight hours, she was again attacked with convulsion. The same physician was again summoned to her, but refused to bleed her again. We Avere then sent for; and, on our arrival, found her still laboring in the fit. We insisted on bleeding her again; to Avhich the physician reluctantly consented, remarking that we must bear the respon- sibility, to Avhich we readily consented. She was accordingly bled, and lost about thirty ounces. The convulsion soon sub- sided, and, after some time, she spoke. The attending physician wished to give an opiate, to Avhich Ave constantly objected, and proposed a large dose of calomel, to be folloAved by castor-oil and injections. With great reluctance he consented to this prescrip- tion, and it was accordingly given. In five or six hours, Ave were again called to see her, together with the family physician. She was in another fit, and we again proposed the use of the lancet; but he Avould not consent to its further use, and urged the propriety of giving anodyne injections, composed of lauda- num, tincture of asafcetida, etc. This we firmly opposed, believing it Avould be a pernicious practice, and proposed sending for another physician, to Avhich he assented, saying, "When he comes, you Avill have to yield." Dr. D. was sent for; and, on his arrival, the case, with the previous treatment, was briefly laid before him. The question, "What shall be done?" Avas asked. Dr. D. did not hesitate a moment, but immediately BRIGHT. 27 402 COMPLICATED LABOR. advised a repetition of the bleeding. With this, Dr. G., the family physician, relinquished the case, nor did he return to see his patient again. The mistress of the girl, overhearing our con- sultation, approached us, and said : " Doctors, my girl is in your hands, do what you please for her." Her arm was immediately tied, and about tAventy ounces of blood taken; and before the bleeding Avas over, she opened her eyes, and spoke. In half an hour, the calomel operated. The after treatment consisted in keeping her bowels open Avith gentle medicines, the use of a light diet, and absolute rest. She recovered, and bore a healthy child, at the full period. We will only add, that this woman, in tAvo subsequent pregnancies, and at or about the seventh month, each time, had a convulsion fit, for which about fifty or sixty ounces of blood Avere taken from her each time. She was purged gently, and put on a light diet; carried both children to the full time, and was safely delivered. In her fourth pregnancy, at the seventh month, she had another convulsion; but we had then left the tOAvn. and Dr. D. was absent. Her case Avas therefore submitted to another physician. We know not Avho he Avas, nor what treatment Avas used; but she died. The second case was one of a first labor, at the full time. This woman Avas Ioav in stature, had broad shoulders, a short, thick neck, large head, dark hair and eyes. This case occurred some fifteen or eighteen years ago ; yet, by the aid of notes taken at the time, Ave can give it correctly. Mrs.----, the patient. lived in the country, about eight miles from NeAVcastle, Henry county, Kentucky. From her own statement, she was in the latter part of gestation much troubled Avith headache, had a flushing of the face, and was habitually costive. She con- sulted Dr. G., the family physician in the foregoing case, and requested him to bleed her. He replied that she should not be bled while pregnant, and ordered her to take some light medi- cines. She passed on to the end of her gestation, but suffered very-much from pain in the head. When she was taken in labor, she sent for a neighboring midwife. Her labor com- menced Avith the ordinary symptoms; her pain continued to increase gradua.ly for two or three hours, during Avhich the pain in her head was not very severe. But she was suddenly attacked Avith a severe fit. We Avere immediately sent for; but before our arrival she had eight fits, and was then only partially rational. Her pulse Avas full, sIoav, and hard. We examined the state of the os uteri, and found it very rigid, though the dila- COMPLICATED LABOR. 41M tatior. was not larger than half a dollar. By this time, one of her eyes Avas spasmodically affected. A bandage Ava& called for, and preparations made for the purpose of bleeding her, This the midAvife instantly opposed, saying that, " Dr. G. had left word that she must not be bled." Without making a reply, we again called for a bandage, when it Avas brought, together Avith a half- pint cup, to receive the blood. We opened, at once, a large orifice in the arm, from which the blood floAved freely; perceiv- ing Avhich, Ave called for a suitable vessel to receive the blood. In an angry tone, the midAvife proposed a bucket, and immedi- ately produced a half bushel pail. A pint cup Avas handed to me at the same time. By this time, the fit had come on, and the blood flew around in every direction, over the bed and floor; the most of it, hoAvever, was caught in the cup, which Avas emptied three times before the fit subsided. We then untied the arm, and examined the os uteri, but found no change in it; when another fit came on. OAving to some interruption on the part of the midAvife, the patient Avas violently convulsed before she. could be bled the second time. We took from her about two pints more of blood, when the old midAvife and a friend of hers again interrupted us, exclaiming that Ave had killed her. Angered by continued interruptions, we sternly ordered them to attend to their OAvn business, and interrupt us no more. With this, the tAvo old ladies left the room. Her husband stood by all this time, and said not one Avord. We proceeded to draw blood, till, first and last, Ave poured five quarts into the pail, besides what Avas lost. We bled her till she was perfectly tranquil and relaxed, and her pulse very soft and gentle. She was not rational, though she spoke. She slept sweetly, to all appearance, for about two hours. When she aAvoke. we examined the state of the os uteri, and found it very soft and dilatable; but she had no pain. By some friction on the abdomen with the hand, and by moving the child a little, a slight contraction was excited. After Avaiting half an hour longer, and no more energy of the uterine fibres being manifested, the ergot Avas administered; pain was soon excited, and the child born, though it was dead, as Ave had before predicted. The patient was then put to bed, and a gentle aperient ordered, to act on the boAvels; with directions to give cold drinks and cold tea for a diet till the next morning. Fearful, howeA'-er, lest the nurse should not folloAV the directions given, Ave returned about four o'clock in the morning, and found the patient restless, with a pain in her head, and a flushed face. 404 COMPLICATED LABOR. Suspecting that the nurse had given her stimulants,—hot stews were the order of the day with her, for a Avoman in childbed, — we immediately took from the patient's arm a pint of blood; but a fit came on, just as the blood began to flow. The nurse denied that she had given anything but what we had ordered; but the patient afterwards told us that she had given her a hot stew that night. Gentle purgatives Avere ordered, with especial directions to the husband to allow of no variations from the course we pre- scribed. This was done; and in one month, she was as well as women generally are Avho have had hard labor; though, perhaps, a little more debilitated. She became pregnant again, and applied to us for advice. We treated her as before, directing her to keep her boAvels open with some gentle pills; to be bled again if she had pain in her head; to use a light dfet. etc. When Ave arrived, at the time of her labor, she had some twitching in her eyes, and her pulse was full; but, being bled two pounds, these symptoms subsided, and she had a speedy and safe delivery. Both mother and child did well. She became pregnant a third time; but, having moved to the neigh- borhood of the physician she had consulted in her first pregnancy, she concluded to take advice from him again, insisting, however, on being bled. When she was taken in labor, Dr. G. was sent for; but, notwithstanding she had strong symptoms of convul- sions, he refused to bleed. Presently, a strong convulsion came on; but he still refused to use the lancet. We were, therefore. sent for, although she noAV lived tAventy miles from our residence. But before Ave could reach the house, she died in a fit, undelhrered. We have been the more particular in detailing these cases, in order to shoAV the great necessity of blood-letting in convulsions occurring near or during labor. We have had many other cases of the same description, all of which Avere managed in the same way, that is, by bleeding, as the urgency of the symptoms required: and Ave have been successful in all. But, should convulsions occur during pregnancy, if the os uteri is well dikted, or is dilatable. and the Avaters are gathered, the membranes should be ruptured. and the child delivered with the hand or with the forceps. If the midAvife cannot deliver by the head, either with the hand or forceps, she should turn the child, and deliver by the feet. After a feAv bleedings, she will generally be enabled to succeed in one of these ways. But neither of them must be attempted while the patient is in a convulsion. The midwife should ahvays have a lancet in her pocket, and be able to use it in any case oi emergency. TEDIOUS LABOR. 405 SYNCOPE, OR FAINTING. Some women are of such a peculiar temperament, that almost any excitement, or pain, especially after it subsides, will cause them to faint; but Ave never kneAV a woman to faint during a labor pain, although she may as soon as it goes off. When this disposition is common Avith the patient, we need not be much alarmed; yet we should Avatch the symptoms. If blood should be floAving, or slightly oozing from the vagina; if the abdomen enlarge, or the patient becomes weak, we should suspect internal hemorrhage. In that event, if the head is within the pelvis, and can be reached by the forceps, the child should be delivered imme- diately ; but if the head is above the pelvis, and the os uteri is sufficiently dilated, it should be turned, and the delivery accom- plished. But should the os uteri be firm, and but little relaxed, it is better to rupture the membranes, if that can be done. The ergot should tljen be given, to force the contraction of the uterus. If the ergot fail,—Avhich is rarely the case,—use the following medicines: Recipe : Pulv. Opium, six grains. Sugar Lead, twenty grains. Mix in six poAvders. Give one in sirup, and repeat every half hour, till the flooding ceases. At the same time, give cool drinks, and apply cold cloths to the vulva, back, and abdomen; and, if necessary, fill the vagina Avith soft cloths, wet in cold water, and let them remain till they arrest the hemorrhage. By some of these remedies the patient may be saved; but the child will generally be lost, under these circumstances, no matter what course of treatment is pursued. When the child is born, particular attention should be paid to the mother, in order that she may not sink from exhaustion. Support her by Avine and cordials, till reaction takes place; when the case may be treated as in other deliveries. TEDIOUS LABOR. The causes of tedious labor are various, as, sudden emotions of the mind, anger, grief, fear, the arrival of a strange midAvife or doctor, or violent nervous excitement. Any of these causes may suspend the action of the uterus, at times, for an hour or tAvo, and again for two or three days. There are also other causes assigned, as a general reduction of muscular strength, from a long spell of fever, consumption, etc., or a general emaciation of body, fiom any cause. 406 TEDIOUS LAJOR. These conditions of the system are dreaded both by patient and friends; but without just foundation. We neA^er saAv a patient, reduced by any of the above causes, that did not have a safe and speedy delivery; at least, Avhen all other circumstances Avere equal. In this state of the system, the muscles are relaxed and diminished in bulk, and the resisting poAvers are diminishes clso; but this does not deprive the uterus of its energies; and, conse- quently , lauwi js generaby Gpccoy au such as, Recipe: Pulv. Rhubarb, twelve grains. Scammony, twenty grains. Castile Soap, ten grains. Form eight pills. Give tAvo every tAvo hours, till they operate freely. Should the discharge not be checked sufficiently, give the following medicine: Recipe: Sugar Lead, twenty grains. Pulv. Opium, two grains. Mix, and divide into four powders, of Avhich one may be taken every tAvo hours, in sugar and water. After the dischage is checked, the bowels must be opened Avith a dose of castor-oil. The locheal discharge sometimes continues to be too free, in consequence of debility; and, in this case, the patient should take some strengthening medicine, such as, Recipe: Huxham's Tincture, two ounces. Of Avhich a tea spoonful may be taken three or four times a day, in a little sweetened water; or, if she is in the country, where the above medicine cannot be obtained, she may take the following: Recipe: Yellow Poplar Bark, one ounce. Red Dogwood Bark, one ounce. Columbo Root, one ounce. Make them all fine, and add to them, in a bottle, a pint of good Avhiskey, and one pint of Avater; shake the bottle every day for three days, and take a table spoonful three times a day, in water. A more generous diet may noAV be taken, and the Sowels opened Avith a pill made of, Recipe : Rhubarb, twenty grains. Castile Soap, twenty grains. Form ten pills, of Avhich four or five must be taken every night, at bedtime. If the weather is Avarm, the patient should lie on a mattress: and if the discharge is offensive, she should use a Avash of char- coal Avater, prepared by putting a feAv lumps of charcoal into a pitcher, and pouring boiling Avater over them. When cool, the water may be used as a Avash for the vagina, Avith a Avomb syringe, repeating the application three times a day. If the patient is very weak, she may take the following medicine: Recipe: Tincture of Iron, half ounce. 430 BLOODY INFILTRATION. Ten or fifteen drops, three times a day, in water, Avill be suf- ficient; or take, Recipe : Sulj hate Quinine, ten grains. ElLxir Vitriol, thirty drops. Water, one ounce. Mix them, and take a tea spoonful three times a day, in Avater. If the above purgative medicine cannot be obtained, either rhu- barb, senna, Rochelle salts, magnesia, or castor-oil will answer. The AA'hole management of the mother may be summed up in a few Avords. Keep the boAvels open, and the person comfort- ably Avarm or cool, according to the season; use a light diet; let the room be sufficiently ventilated, that is, let the air pass freely through it, occasionally; talk but little; avoid taking exercise too soon; and Avear the bandage for a month; and you will rarely fail to have a safe recovery. PART IV. BLOODY INFILTRATION OF THE LABIA PUDENDI. Of all the accidents Avhich occur to the parts concerned in labor, none, perhaps, is more alarming, and of more difficult treatment, than the bloody infiltration of the labia pudendi. This is produced by the sudden bursting of a blood-vessel in the neighboring parts, most probably in the vagina. When it takes place, — which, fortunately, is very seldom,—it is just before, or immediately after, the birth of the child, or while the head is passing through the pelvis. In thirty years' practice, Ave have seen but one case; and in that,—the patient refusing to sub- mit to an examination of the parts, — Ave could only judge from feeling them; and seeing her but once, little or nothing could be done for her relief; so that Ave have nothing to say on this sub- ject from experience; and, therefore, can only give what others have said concerning it. It is said by authors on midwifery, that generally one side onl y is affected; but Baudeloque gives a case from Solayres, in which both labia were equally involved. Doctors Maitland and Perfeit say the SAvelling occurred, to their knowledge, before the child was born. This SAvelling is taken sometimes for the pro- truding meiibranes, and sometimes for the head of the child. BLOODY INFILTRATION. 431 According to a majority of authors, it comes on suddenly; but Dr. Burns says he kneAV a case in which tAvo days had passed before the swelling reached its height. The appearance of this SAvelling is a dark livid, or almost black color. When it is situ- ated on one side, which is generally the case, it presses so hard against the other, that it turns, as it were, inside out, and the passage of the urine is obstructed. This SAvelling gives great pain to the patient. Sometimes it bursts, as in Dr. Dewees' first case, Avhen large quantities of blood and coagula are discharged; and when the discharge takes place, the pain in a great measure subsides. Treatment. — As the parts are sure to slough, and a large cicatrix to be formed in consequence of it. it is best, according to good authority, to open the tumor immediately, by a free inci- sion. This should be done through the inner surface of the labia, whence large quantities of blood will Aoav out. The patient should be kept in a horizontal position. The urine will be likely to flow; but if it does not, it must be drawn with a catheter. The parts should then be dressed Avith a charcoal poultice, made of equal parts of Avheat bran and charcoal, and covered with a piece of thin muslin, so that no part of it may adhere to the Avound. The parts should be dressed frequently, and the coagu- lated blood removed by the finger. There is generally an intolerable fetor attending this dis- charge ; in consequence of Avhich, the sore should be carefully cleansed, frequently, Avith castile soap and water. The pyro- ligneous acid, or the chloride of soda, may be sprinkled over the poultice, to aid in removing the fetor. The patient should not be allowed to rise till all danger of bleeding is over, and a bed- pan should be used for the purpose of receiving the fasces and urine. If she cannot make Avater, by reason of the greatness of the tumor, it must be raised up, or turned to one side, and by this means the difficulty will be removed. There is ahvays great irritation of the system, and much fever, Avhich must be kept under by cooling purgatives, a low diet, and absolute rest: Recipe : Calomel, ten grains. Rhubarb, twenty grains. Tartar Emetic, one grain. Form six pills. Give tAvo, and repeat every tAvo hours, till they operate Avell. Or, 432 MILK FEVER, ETC. Recipe : Scammony, twenty grains. Rhubarb, twenty grains. Aloes Socot., twenty grains. Blue Mass, twenty grains. Form tAventy pills. Keep the boAvels open Avith these pills; at the same time, the patient may take: Recipe : Cream Tartar, one drachm. Salts Nitre, twenty grains. Tartar Emetic, one grain. Mix in six powders, one of which may be given every hour, in balm or hyssop tea, to keep down fever. If the patient cannot sleep, an anodyne may be given : Recipe : Pulv. Opii, two grains. Ipecac, four grains. Mix in six powders, and give one every hour, till she can rest. It generally takes from four to six Aveeks to cure this affection. When the patient is freed from fever, and the wound secretes a hfi^ur f.i it tv'oii. if it is not healthy, she may take some tonic to strengthen her, such as: Recipe : Pulv. Colombo, half ounce. Rad. Gentian, half ounce. Orange Peel, half ounce. Carbonate Iron, one ounce. Mix, and add to them a quart of good wine. A table spoonful maybe given three times a day; in addition to Avhich, a little good Avine and water may be taken occasionally, through the day. A more generous diet may be given, or the folloAving tonic may be used: Recipe: Sulphate Quinine, twenty grains. Sulphuric Acid, six drops. Water, one ounce. Mix, and give forty or fifty drops, three times a day, in water. As soon as she is able, the patient may take exercise in a car- riage, in the open air; but much care and attention are neces- sary to effect a perfect cure. MILK FEVER, AND* ABSCESS IN THE BREAST. Females are more disposed to fever, after parturition, than in any other condition. The various circumstances of gestation and labor, so Avell calculated to produce not only a predisposition to, but absolutely to excite fever, leave the patient but little chance to escape this evil, unless much care be taken to guard against all exciting causes. But, unfortunately, the common practice of MILK FEVER, ETC. 433 nursiu g is the very reverse of what is dictated by reason • and hence the frequent occurrence of fever in these cases. It is by no means necessary, as some suppose, for the patient to have fever, in order that the milk may be secreted ; and hence it is not necessary that she should have milk fever at all. Bad management before and after the child is born, is the only reason why that disease is experienced at all. And, by observ- ing the folloAving rules, both milk fever and sore breasts may be avoided. In the first place, let the rules laid down in a previous chapter, on preparing a woman for delivery, be observed for two months before confinement; and, during confinement, abstain from stim- ulating food, hot drinks, and anything that will heat the blood; but, on the contrary, take cool drinks, such as plain Avater, cool toast-water, or balm tea, cold; and, after delivery, take every night, for three or four nights, a gentle purge, so as to produce tAvo operations the next day. For this she may use the follow- ing pill: Recipe : Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap, — of each twenty grains. Tartar Emetic, two grains. Form twenty-four pills, and take three or four of them, every night, at bedtime, so as to produce tAvo or three operations the next day. The patient's room should be well ventilated, in warm Aveather; but she must not be exposed to the current of air. Let the child be early and frequently applied to the breasts, and thus milk fever may be avoided in almost every instance. But should these rules be neglected, the patient may have fever, and the breasts may be greatly distended and become very painful, and inflammation may be so excited as to terminate in suppuration. It must be acknowledged, however, that milk fever is not the only cause of inflammation in the breasts. There is a peculiar liability to it for fifteen or twenty days, and the causes may be obvious, or they may be obscure. Among the obvious causes are blows, bruises, colds, and bad nipples, produced by the reprehensible practice of wearing tight corsets. No girl, who has indulged in this habit for a long time. should ever be a mother,—for more reasons than that of spoiling her nipples. Neglecting to have the milk discharged in due time, may be BRIGHT 29 434 MILK FEVER, ETC. regarded as another obvious cause of sore breasts. But, at other times, the breasts SAvell and inflame, Avithout our being able to detect any cause, except that the system is not in a good state. Some females are more liable to this affection than others, and sometimes experience a repetition of it Avith almost every child. Sometimes this inflammation is announced by a chill, soon after Avhich, the breast begins to SAvell, and a lump is observed in it, Avhich is sore to the touch. At other limes, no lump can be felt, but still the breast is tender to the touch. The reason of this difference is, that sometimes the inflammation attacks the gland, and the lump is then produced. But at other times it attacks the cellular substance, and then there is only a general soreness through the breast. The fever is ahvays in proportion to the violence of the inflammation, and its seat. Inflammation of the breast, if not early arrested, will terminate in suppuration; so that much depends upon the early applica- tion of proper remedies. Time is often lost by the interference of the nurse, or other attendants, Avho try to put it back, in ordei to avoid the blame that must otherwise be attached to them The patient, also, through a false delicacy, will sometimes neg lect to inform the physician of her true situation, till the disease is fully formed. And in these cases Ave generally find thai some infallible remedy, prescribed by some old lady, has been resorted to, and the disease trifled Avith, until it has assumed a serious aspect. The patient must observe the folloAving directions : If she have fever, she must be bled. Warm vinegar, by means of a soft cloth, may be applied to the breasts, and repeated as often as the cloth becomes dry or heated. Let this be kept up, perseveringly, for tAventy-four or thirty-six hours, and let the breasts be Avell draAvn, by the aid either of an attendant or a breast-pump. A young puppy draAvs very easily. Leeches may be applied half an inch beloAV the rounded portion of the breast, and alloAved to draw freely. The bites may be kept bleeding, by applying Avarm Avater to them. They should be dressed Avith dry cotton and simple cerate, or hog's lard. Let these remedies be continued till the breast is relieved from deep- seated inflammation ; otherAvise, it Avill certainly rise and break Instead of the poultice, the folloAving liniment should be used : Recipe : Olive Oil, two ounces. Sugar Lead Water, one ounce. Ether Vitriol, two drachms. Laudanum, one drachm. MILK FEVER, ETC. 435 Mix them all Avell together, and anoint the breast with it frequently. The folloAving mixture will do as well: Recipe: Sugar Lead, one drachm- Vinegar, two ounces. Spirits Wine, one ounce. Boiled Water, five ounces. Mix them well, and apply the mixture frequently to the breasts by means of a piece of linen. The patient's bowels should be kept open by, Recipe: Rochelle Salts, one ounce, dissolved in cold water, and taken for a dose; or, Recipe: Senna Leaves, half ounce. Manna Flake, half ounce. Boil to a strong tea in a pint of water, and take a wineglassful every hour, till it operates freely. One or the other of these medicines should be taken daily. Her diet should be of the lightest kind; such as gruel, toast-Avater, Aveak coffee, tea, milk and Avater, dry toast, runnet whey, tapioca, thin sago, arrowroot, roasted apples, and ripe fruits of the season. Her drink must be toast-water, apple-water, molasses and Avater, &c. The patient should remain in bed, and lie on her back to prevent, as much as possible, a Aoav of blood to her breasts. Should they, hoAvever, rise, and require to be lanced, this opera- tion should not extend beyond the smallest puncture that can be made. If there be much matter, it should not all be alloAved to floAv out at once, but the orifice should be closed Avith lint, and, after four or five hours, this should be removed and the matter alloAved to Aoav again. If there is no pain after the operation, the puncture may be dressed Avith simple cerate, or a plaster of hog's lard and beesAvax. But should there be pain, a bread poultice should be applied over the breast. Sometimes a plug of cellular substance, like fat, stops the orifice and prevents the flow of pus. This must be pulled out with a piece of cloth betAveen the finger and thumb; but should this produce pain, it may be clipped off Avith a pair of sharp scissors, and the portion left in. be pushed back. This will afterwards be expelled by a natural process. Some lint should be kept in the hole till it heals from the bottom. A hard lump is sometimes left in the breast after the discharge ceases; and in this event, the breasts must be bathed with warm vinegar, or rubbed with opodeldoc. If the weather is cold, a piece of soft fur should be applied over the breast, and, in the summer, soft flannel or silk. This lump will 436 SORE NIPPLES. eventually disappear and though some females fear that it wiL turn to a cancer, there need be no apprehension of that, inasmuch as it is nothing but coagulable lymph, and will finally all be absorbed. The folloAving. ointment may, hoAvever, be applied to it: Recipe: Blue Ointment, one ounce. Pulv. Camphor, one drachm. Mix Avell. Rub the breast with this, night and morning. SORE NIPPLES. The nipples may become sore from various causes. With some Avomen this affection is just as certain as the approach of the period of suckling. It is often a species of thrush. The nipple first cracks, looks dry and feverish, and bleeds when the child sucks. The skin, at times, becomes so brittle betAveen these little cracks or fissures, that the child by sucking draAvs it off, and thus makes a large raw surface, when the act of nursing becomes almost insupportable to the mother. The child may communicate the thrush to the nipple, as Avell as the nipple to the child; but it is to be remarked that every sore nipple is not the thrush. Some of the worst kinds of this disease are produced by an unnatural and wrong application of the tongue to the nipple. Children and groAvn persons are made to draw the breasts when the milk first begins to flow, and before the child can be made to suck. The nurse, or any other person who may draw the breasts, should first produce a vacuum in the mouth, lay the tongue loosely and easily around the nipple, and suck it as she would an orange, or any other substance from Avhich she wished to extract the juice. By any other mode, the nipple will be made to crack near the breast; and if the same nurse is alloAved to continue, she will, in all probability, in a feAv days, take off one half or the whole of the nipple. But if this should not be done, it Avould seem that, in many instances, the saliva is poisonous to the patient's breast, and produces a condition in the sore that is hard to remove. The practice of wearing tight corsets, and pressing the nipples into the breasts, thereby preventing them from groAving out, is another fruitful cause of sore nipples. The ligaments which bind the nipple to the breast become hard and less elastic by this most unhealthy and suicidal practice. When the period of lactation comes on, and there is a demand by nature for the ripples to SORE NIPPLES. 437 spring out, m consequence of this injurious habit they cannot be brought out but at the expense of great suffering to the patient. The milk vessels fill, and distend the breasts over the little depressed nipple, till nothing but a flat surface can be seen. The patient must then submit to an abscess of the breast, or go through all the torments of scattering the inflammation, if, indeed, it can be done at all. She is, moreover, liable, Avith such nip- ples, to lose the use of the breast entirely; and, of course, when they are lost, she is no longer fit to be a mother. Treatment.—In the first instance, Avhere thrush is the cause of the sore on the nipples, the folloAving wash should be used : Recipe : Pulv. Borax, one drachm. Tincture Myrrh, half ounce. Honey, one spoonful. Strong Sage Tea, one gill. Mix all well together by simmering over the fire; and wash the nipple Avith it frequently through the day, especially after every time the child nurses. The child's mouth must also be washed Avith the same. When any portion of the nipple is gone, or the end is sore, «a cup of beesAvax should be made to cover it all over, and be con- stantly worn over the nipple. The dress should not touch the nipple. If this should fail, the following wash may be used : Recipe: White Vitriol, two grains. Rain AVater, one ounce. Dissolve the vitriol in the water, and Avash the sores with it, three or four times a day- When the cracks are around the base of the nipple, they will be found very hard to heal, but an excel- lent remedy in this case, when they have been of long standing, is an ointment made of Recipe: Red Precipitate, two grains ; Fresh Butter, two drachms, or a piece as large as a common thimble; mix them well together, and apply it to the sores. This, however, must be cleansed off before the child sucks, and reapplied as soon as it has done. We have knoAvn old leather, such as a shoe sole, burnt to a cinder, and powdered fine, and dusted in these cracks, to heal them, when other remedies have failed. In these cases, where the nipples are very sore and difficult to heal, the breasts may be drawn by a young puppy, as its tongue is broad and thin, and it draAvs easier than a child. It is more difficult to cure sore nipples than any other sore of 438 INFLAMMATION AND ADHESION OF THE VAC.V*. the same size, because there are so many applications of the mouth made to them, and thus they are Avet with the saliva, and exposed to the air. While on this subject, Ave will say a word on hardening the nipples. This should be done before the child is born, beginning a month beforehand, and using the folloAving Avash: Recipe : Tinct. Myrrh, one drachm. Rose Water, one cunce. Pulv. Borax, thirty grains. Mix them Avell together, and Avash the parts, tAvo or thres times a day, Avith it; or use brandy, Avith alum dissolved in it If these directions are carefully attended to, sore nipples may well be avoided. INFLAMMATION AND ADHESION OF THE VAGINA. Inflammation of the vagina is of more frequent occurrence than is generally supposed. But it seldom terminates in inflam mation of its Avails; though this docs sometimes occur. The most common causes of this disease are, neglect aftei child-bearing, and abortion, or erysipelas in these parts. Wher a female is neglected, after a severe labor, and the secretions suffered to remain in the vagina, if she should be attacked Avith fever, adhesive inflammation of these parts may take place. This adhesion maybe partial or complete; the patient herself being unconscious of the fact till she recovers; Avhen she per- ceiAres, for the first time, that the vagina is perfectly closed. Treatment.—Whether it occurs from violence done to the parts, by severe labor, abortion, erysipelas, or by neglect, or otherwise, it becomes A^ery necessary to give it prompt attention. On the first intimation of inflammation, Avhich may be knoAvn by great tenderness and soreness of the parts, they should be immediately examined, and Avashed and cleansed with warm milk and Avater. If there is fever, and the pulse will admit of the use of the lancet, the patient should be bled from the arm Cooling purgatives should be administered: Recipe: Scammony, Pulv. Rhubarb, Aloes Socot., — of each twenty grains. Tartar Emetic, three grains. Form tAventy-four pills. Give two, and repeat one every tAvo hcurs, till they operate freely. The same may be repeated the next day, or the folloAving medicine may be used instead: Recipe: Rochelle Salts, one ounce. PUERPERAL, OR CHILD-BED FEVER. 439 Dissolved in a glass of Avater; or, Recipe: Senna Leaves, half ounce. Epsom Salts, half ounce. Manna Flake, half ounce. Boil, in a pint of Avater, doAvn to half a pint; and give half a small tea cupful every hour, till it operates freely. During this time, the vagina should be Avashed out Avith Avarm milk nr\r\ v/r^er, ?»nd then Avith: Recipe : Sugar of. Lead, one drachm. Rain Water, one pint. Dissolve the lead in the water, and inject it into the vagina. This should be repeated three times a day. After the use of the lead Avater, an injection of thick, slippery-elm or marsh-mallow tea may be given. The diet of the patient should be of the lightest kind. Children are sometimes attacked Avith erysipelas in these parts; and even groAvn girls are not exempt from it. But, from neglect, or a false delicacy in net attending to the case, or not making it known, adhesion of the vagina may take place. When erysipelas attacks these parts, mothers should be very careful to keep them clean and cool, and see that adhesion does not take place. By neglecting this matter, the most serious consequences may ensue. The menses will be ever after retained, till an oper- ation is performed to open the passage and let them escape. The books give us many cases, in which life has been saved only by subjecting the patient to this operation; and many cases haAre terminated fatally, because the matter has been kept secret till all possibility of saving life, by an operation, or any other human agency, Avas passed. These things are the result of neglect in the nurse, in the first instance; and in the mother, or the girl, in the second; when timely attention would have removed all danger. Let all persons interested, then, take Avarn- ing, when they read this chapter, and see that these conse- quences are avoided, in all cases that may come under their care. PUERPERAL, OR CHILD-BED FEVER. Puerperal fever consists of an inflammation of the peritoneum, or lining of the abdomen, the outer surface of the intestines, the fat of the bowels, the ligaments of the uterus, &c. Any portion of this membrane, or all the contents of the abdomen, may be the seat of this inflammation; even the pleura and lungs have 440 PUERPERAL, OR CHILD-BED FEVER. been found inflamed; and M. Tonnelli says: " the Avhole uterine system may be involved, even the vessels of these parts." When this fever attacks the lying-in Avoman, it generally makes its appearance a few days after her confinement, and is usually ushered in by a chill. The pulse is quicker than in the onset of any other form of fever. The abdomen SAvells more or less in a short time, and is generally very sore. The milk is not secreted; or, if it is, it dries up. The locheal discharge either diminishes very much, or dries up altogether, and the bowels become constipated. The patient is not delirious, as in inflam- mation of the Avomb, though she forgets her child and pays no attention to it Avhatever. The fatal character of this fever is proverbial. Dr. Denman declares it is the cause of the death of much the greatest propor- tion of women that die in child-bed, and many other physicians bear testimony to this fact. Dr. Clark says that three out of four of those Avho have this fever die of its effects; and Dr Dewees makes a similar remark. But this is to be understood as comprehending all the diseases to Avhich lying-in Avomen are liable; for every disease that Avas attended with pain in this condition of the patient Avas called puerperal, or child-bed fever. But noAV, only that form of fever, in child-bed, which is attended Avith inflammation of the peritoneum, is called by this name. The history of this disease Avould be interesting to the young practitioner of medicine; but as this Avork is intended for mothers and midAvives only, Ave shall say no more concerning it, than that it has ahvays been more prevalent in Europe than in Amer- ica; it has prevailed, as an epidemic, in some parts of this country, though this is not often the case. Many writers have noticed it at great length; and among these are Drs. Leake, Key, Denman, Clark, Conquest, Tonnelli, Hume, Armstrong, Gordon, Kirkland, DeAvees, &c. Great diversity of opinion exists among them as to its cause; and many of them have not even con- cluded what the predisposing cause is. It has been attributed to cold, moisture, hard labor, &c. But it has prevailed in places Avhere neither cold nor moisture could have produced it; and it is agreed by the best writers that hard labor is not sufficient to produce it. To sum up the experience of the host of Avriters on puerperal fever,—it would appear that all that is required to excite this disease into action is the emptying of the uterus; and even this is not ahvays necessary, if we may believe some Avriters; for PUERPERAL, OR CHILD-BED FEVER. 44j cases are on record in Avhich this fever made its appearance before the child Avas born. Nor does it appear that any unusual difficulty in delivering the after-birth has anything to do Avith its production. Nor will the suppression of the lochea produce it, inasmuch as the disease is the cause of that suppression. Dr. Dewees says, "It has more frequently occurred, in his practice, after easy, than difficult, labors, or after preternatural labors." And Dr. Denman says, " Women are certainly not so liable to be attacked Avith this disease after difficult labors." If this Avere the case, it Avould be constantly prevailing ; for the ladies of our country have their share of children, and they are of full size, and have well proportioned heads. After all that can be collected together on this subject, from books and from observation, it would be difficult to say Avhat is the exciting cause of this disease. Perhaps we shall come as near the truth as it is possible for us to do, if we say, that any- thing that Avill tend to produce inflammation in the serous mem- branes may excite this disease into action; and exposure to damp or cold, a restless disposition, fretting, unsuitable and indi- gestible diet, a suppression of urine, &c., will certainly do this Inflammation of the uterus may be communicated to the perito- neum. We Avill noAV rehearse the symptoms and period of attack, and endeavor to make them so plain that they cannot be misun- derstood. The time of attack, after delivery, is uncertain. The disease may be formed before delivery, or at any intermediate period for several weeks afterAvards. The sooner after delivery the patient is attacked, the greater will be the danger. The most usual time of its approach is on the third or fourth day after delivery. The patient is seized with a fit of shivering, from the violence and duration of Avhich Ave may generally estimate the danger of the disease Avhich is to follow. In some cases, however, the chill is so slight,—if indeed there is any at all, — that it can scarcely be discovered. Nor is every chill that a female has in child-bed folloAved by puerperal fever. Before the shivering fit comes on, the patient is much debilitated, and suffers from pain in the abdomen. This pain soon becomes fixed in the hypogastric region, Avhere a swelling, with fulness and extreme tenderness, ensues. As the disease progresses, the whole abdomen enlarges; so much so, at times, as to attain nearly its size before delivery. The patient is generally sensible of this, and can describe its 442 PUERPERAL, OR CHILD-BED FEVER. progress. She feels great pain in the back and hips, and some- times in one or both legs, and other parts which are affected in uterine complaints. It is with difficulty that she lies in any other position than on her back, or on one side, Avith her body bent forward. If the disease be confined to the uterus, the seat of the pain seems to be changed Avhen she alters her position. She either vomits a green or yellow bitter matter, or has a loathing of everything that is presented to her in the form of food, and suf- fers much from an offensive taste in the mouth. A sudden change takes place in the quantity and quality of the lochea, and sometimes it is suppressed entirely. If the milk has not been secreted, that process will not iioav go on; and if it has, it Avill suddenly diminish, and its taste be perceptibly altered. The urine is voided with pain, in small quantities, and is thick. A frequent desire to stool is experienced ; the tongue becomes dry, is generally broAvn, and sometimes, but very rarely, it is moist, and coated Avith a thick, brown, fur-like substance. As the disease advances, its appearance changes. In some rare and slight cases, there is but little change on the tongue. The patient immediately apprehends the greatest danger, and expresses herself Avith great anxiety, Avhile her countenance bears strong marks both of bodily and mental suffering. The progress of this disease is sometimes very rapid, espe- cially in hot climates, and instances have occurred in Avhich the patient died in twenty-four hours after the first attack. She does not always groAV Avarm after the attack of the chill, and when this is the case, is apt to die in a convulsion. In some instances, death has taken place quite unexpectedly, either from inattention or from the insidious progress of the disease, the symptoms not having been — in appearance at least—at all in proportion to the danger. Most commonly, the shivering fit is succeeded by heat, thirst, etc., as in other forms of fever. But here Ave may draAV the dis- tinction betAveen them by the presence of the pain in the abdo- men. All the symptoms do not appear in every patient; but they may all be found accompanying the disease in its various forms. There is much variation in the subsequent stages. The signs of inflammation, joined Avith extreme irritability, continue for a feAv days, Avhen those of putridity appear,—sooner in this, per* PUERPERAL, OR CHILD-BED FEVER. 443 haps, than in any other disease Avhich is truly of an inflamma- tory character. A broAvn adhesive sordes collects about the teeth, and all kinds of food and drink are rejected, except those of a cool or acid character. Hiccough comes on, and distresses the patient very much, by agitating the abdomen; and small, livid specks often appear on the abdomen or privy parts. The bowels are now very much disturbed, and in some cases a loose- ness comes on immediately; nor can it be corrected but with the greatest difficulty, till the disease is overcome, if indeed it can be arrested at all. The stool presently comes aAvay involuntarily, and it is always preceded by an increase of pain, though after the evacuation a little relief is gained. The stools are uncom- monly fetid, of a dark green color, and Avork like yeast. In the last stages of the disease, though there has been much purging, hard lumps will sometimes pass aAvay, bearing the appearance of having been retained in the boAvels from before delivery. At times, a dusky tumor, about the size of a shilling, or larger, appears on the knuckles, wrists, elbows, knees or ankles. This may be regarded as an indication of great danger. When the disease runs its course Avithout medical aid. and sometimes Avith the best that can be procured, it ends in death, with all the symptoms of violent inflammation, terminating in gangrene, or suppuration. When the symptoms aboAre stated are of an aggravated character, Ave may generally look for a fatal termination of the disease. We are often asked Avhether this disease is contagious. What- ever it may be in other countries, Ave may ansAver promptly for our own, and say, it is not, under any circumstances whatever. No one, therefore, need fear it on this account. Treatment.—First. From Avhat Ave have said on the nature and symptoms of this disease, it will readily be perceived that we believe puerperal fever to be a disease of a highly inflamma- tory character; and as bleeding is one of the most efficient measures, —and, indeed, almost the only one, if one alone Avould be aifficient to remove the inflammation, — Ave should not hesi- tate to use the lancet freely, more especially Avhen the inflam- mation is located in the peritoneum. When Ave say Ave recommend the use of the lancet, we mean that it is indispensable; as, Avithout its free use, but feAv, if any, ever recover from this alarming and fearful disease. The patient, then, should be bled in its early stage. As soon as the chill ceases, and the skin becomes hot, the pulse quick and hard the 444 PUERPERAL, OR CHILD-BED FEVER. belly being tender to the touch, — though it is not ahvays equally tender over its entire surface, but sore and painful on pressure, — when this is the case, we say, bleed from a large orifice in the arm. The blood should be permitted to Aoav until the pulse becomes soft and beats less frequently, the heat abates, and the skin becomes moist. The operator must not be governed by the quantity of blood taken, but by the effect produced; and it gen- erally requires from a pint and a half to three pints to produce the desired result. If the patient becomes faint, the blood, of course, must be stopped; and it will be found that all the symp- toms abate Avith the faintness of the patient. But if the disease is not arrested in its progress, when the reaction takes place, the fever, pain, and soreness of the abdomen will return. In this event, the patient must be bled again; and, perhaps, the opera- tion may require to be several times repeated. But should the pulse not become strong enough to admit the use of the lancet again, cups, or leeches, should be applied to the most tender parts of the abdomen. The quantity of blood drawn here should ahvays be in proportion to the strength of the patient. Care must be taken by the midAvife, in this disease, that she is not alarmed by symptoms of debility, when they are only symptoms of the violence of the disease. If they require it, the bleeding may be repeated tAvo, three, or four times, in thirty-six hours, but not always Avith the lancet. As long as the abdomen does not SAvell much, and the pulse is under a hundred and thirty beats in a minute, blood may be draAvn, either from the arm, or by leeches, or cups. The great importance of the use of the lancet in the cure of this disease, is the reason why Ave insist so strongly upon it. Let it be remembered, that puerperal fever cannot be cured Avithout bleeding freely; and let the midwife be sure to take the blood from a large orifice. The next remedy to be used is purgatives. Very much has been said on this subject, and purgatives have been alternately advised and rejected, by those Avho have written on this disease. When we compare our experience Avith that of others, —it has been limited, to be sure, in comparison Avith that of those Avho have had the charge of large lying-in hospitals, Ave are candidly of the opinion that purging, in a proper Avay, is indispensably necessary in the cure of this disease. But Ave should be careful as to the medicines employed; and, as there is no article that will prove as beneficial for the patient as calomel, the fofoAving pills may be taken Avith advantage: PUERPERAL, OR CHILD-BED FEVER. 445 Recipe : Calomel, sixty grains. Rhubarb, ten grains. Water, a few drops. Form ten pills. Give five at first, and one every two hours, till they operate freely. When the operations are thick, and of a bottle-green color, it may be regarded as proof that the medi- cine is doing its office Avell; and if the patient is salivated a little, it will only aid in the cure. At the same time, the abdo- men may be rubbed with : Recipe: Mercurial Ointment, one ounce. Rub in one half of this, every tAvo hours, all over the abdomen. The drink should be, slippery-elm tea, or gum-Arabic Avater, or marsh-malloAv tea, &c. ArroAv-root, or rice boiled till it is dissolved, may constitute the diet. Should the calomel not oper- ate Avell, and the fever continue, the folloAving medicine should be given: Recipe: Spirits Nitre, half ounce. Venet. Terebinth., half ounce. Mix. Give a tea spoonful, every hour, in some of the above teas. The vial should be shaken well every time, before the mixture is poured out. The calomel pills should be continued, till they have brought all the secreting organs into proper action. The first dose of calomel should be given after the first bleeding. These are the remedies for the first stage. Second stage. This stage may come on, sooner or later, in the progress of the disease. The time of its appearance, and Avhether it Avill come at all, depend very much upon the violence of the attack, and the manner in Avhich it is treated. If the disease has been neglected, or the remedies used have been too feeble, or too sparingly applied, the second stage will shoAV itself as follows: The pulse is increased in number. In the first stage, the pulse-beats are one hundred, and from that to one hundred and tAventy, in a minute; while in the second, they rise to one hundred and thirty or forty. Their stroke is also softer and Aveaker. The breathing is more hurried; the abdomen SAvells more, and is less acutely tender; the pain abates; the patient forgets or neglects her child, and the milk entirely fails. Sometimes a delirium accompanies the above symptoms; the boAvels are still open, and the dis- charges are more fetid; the lochea is more diminished, if it is present at all, and has a very unpleasant smell; the urine is also diminished in quantity, is highly colored, and has a fetid smell. The tongue is generally dry — but not always so — and coated with a brown crust; the teeth are covered Avith a brown sordes, 446 PUERPERAL, OR CHILD-BED FEVER. and the gums are dark-colored. Hiccough now comes on, and the patient is much distressed by it; she is apt to throAv up every- thing she swalloAvs, and Avith it a broAvn or greenish-colored fluid, Avhich sometimes has a disagreeable smell. In her lucid moments, she is anxious and restless, and discovers signs of great prostration. This is called the typhoid stage of the disease. Here we are almost sure to miss the treatment. Judging from the symptoms, Ave are very apt to give cordials, and tonics, and wine, to support the patient; but, by so doing, Ave miss the true practice very far. She is not sinking under debility, but under the weight of disease. The only thing Ave can do, in this stage of the disease, that will be likely to profit her any, is to keep the boAvels open, apply the mercurial ointment all over the abdomen, and giA^e the sweet spirits of nitre and spirits of turpentine, alter- nately, every hour. For the purpose of keeping the boAvelsopen, use the folloAving pill: Recipe: Blue Mass, twenty grains. Pulverized Rhubarb, twenty grains. Form eight pills, and give one every hour. To remove the inflammation, the folloAving drops may be used: Recipe: Spirits Nitre, one ounce. and Recipe: Spirits Turpentine, one ounce. Give of these, alternately, every hour, thirty drops. They should be given in some mucilaginous drink; either of those prescribed in the first stage of the disease will ansAver. The fasces should be removed as soon as they are discharged. Some have recovered from this stage of the disease by this treatment; Avhile, perhaps, none would recover by means of stimulating treatment. Thirdly. The third stage is marked by a pulse that is flutter- ing, and scarcely to be numbered for its frequency; the abdomen is very much swollen, and sounds as if it were full of Avind. This is the state of effusion, in Avhich cold clammy sAveats break out over the Avhole body; but sometimes they are confined to the face and extremities. The hands at times appear shrivelled, as if they had been immersed in warm water for a long time. There is repeated chillness, Avithout reaction, and the patient frequently vomits and discharges a dark brown or coffee-colored fluid. The stools are passed involuntarily, and there is at times a profuse discharge of bloody Avater, or black grume, from the uterus. The tongue is frequently moist. At this stage, the PUERPERAL, OR CHILD-BED FEVER. 447 patient will most probably suffer from convulsions, when death will close the scene. Cordials, wines, and drinks of this descrip- tion, may yield a moment's relief, and therefore may be given. But it is in vain to expect aid from medical skill; at least, it is so in ninety-nine cases out of a hundred. There is so much importance attached to this disease, for several reasons, that Ave feel disposed, at the close of this chapter, to give some general directions for the management of the patient labor- ing under it. And perhaps this could not be more satisfactorily done than in the language of Dr. Dewees, Avhich Ave here present to our readers. He says : "It is of the utmost consequence to a woman laboring under puerperal fever, that her nurse or attend- ant should be faithful in the discharge of her duty; that she have sufficient understanding to comprehend the directions of the physician; enough good sense and fidelity to put them into prac- tice; resolution to Avithstand the AvayAvard resolutions of the patient, should they be made; and courage enough to bear up against the encroachment of friends, and the preposterous recom- mendations of visitors. Every direction of the physician should be promptly put into practice by the nurse; and that it may be done to the letter, it should be impressed again and again upon the minds of those Avho have the charge of the sick, by delivering them circumstantially, and Avithout ambiguity, or the possibility of misapprehension. Nothing should be left for the patient or the nurse to construe. The directions must be so clear as to prevent the possibility of subterfuge. To insure this, the physician should ascertain, at every visit. Avhether his directions haA'e been strictly complied Avith. If they have not, they should not be passed over Avith neglect, or it Avill surely be repeated. As this disease passes rapidly to a fatal termination when neglected, nothing can check it but the most prompt application of proper remedies, especially the proper quantity of blood draAvn. The physician should perforin this himself. The blood should be preserved, that its quality may serve as a guide to the extraction of more. As soon as the first blood is taken, the purgatives should be ordered, and everything folloAved up to the letter through every prescription. He should prescribe minutely the diet of his patient, Avhich must be of the very lightest kind. We would here state particularly Avhat Ave mean by a light or anti- phlogistic regimen. This refers to a variety of particulars. First, th» air of the room should be frequently changed by a well conducted ventilation. Its temperature must never exceed 148 PUERPERAL, OR CHILD-BED FEVER. sixty degrees if it could be helped; but it may sometimes bo ioAver, Avhen a loAver can be commanded. The purity of the air should be preserved by removing all the impurities from the room as quick as possible, when they are tangible. But Avhen they emanate from the patient herself, they must be alleviated as much as possible. The lochea are sometimes very offensive Avhen not obstructed, and when this is the case, the parts should be frequently washed with warm Avater, her clothes often changed and wet with chloride of soda, or pyroligneous acid should be kept constantly near her, but not so as to Avet her. If these cannot be had, poAvdered lime should be kept Avrapped near her, and placed under the bedclothes, and also in various parts of the room. No curtains, or anything that would obstruct the air, should be kept about the bed. If the air is not too cool, the doors and Avindows should be frequently opened a little, nor should the air be contaminated Avith unnecessary breaths. Noise and light should be excluded as much as possible. The air should not be loaded with unnecessary A^apors or smoke, under the idea of purifying it, for every kind of combustion is injurious. The diet should be made to conform most strictly to the indica- tions to be fulfilled; namely, the reduction of the quantity of blood, and the action of the blood-vessels. Food, therefore, con- taining much nourishment, or any stimulus, should be avoided. The diet should be toast-Avater, barley-Avater, molasses and Avater, thin runnet whey, balm tea, orange, or gum-Arabic Avater. Every shape and form of animal food should be avoided and for- bidden. No chicken-Avater, or beef tea, should approach the lips of the patient laboring under puerperal fever; much mischief has been done by a Avant of attention to this circumstance. Every article belonging to the bedclothes, body linen, or anything that may surround the patient, should be changed and Avashed as often as the circumstances of the case will alloAv, ahvays avoid- ing exposing or fatiguing the patient. Care should be taken to keep the bedclothes from pressing on the abdomen, by placing half hoops, crossing each other, under the bedclothes. The abdomen should be frequently wet with spirits of camphor, ether, or spirits of turpentine; it acts as an evaporator, and is grateful to the patient, carries off much of the accumulated heat, and iielps to reduce the inflammation. The patient should not be listurbed more than can be possibly helped in the giving of drinks, diet and medicines. A sick cup, therefore, should be used for the Iavo first, and a spoon for the third. She should not be MILK LEG, OR PHLEGMASIA DOLENS. 449 allowed to rise frequently for the purpose of attending to the calls of her medicine, but should use a bed-pan, as it is important to avoid the exertion, and, also, to keep the circulation as quiet as possible. The child should be carefully placed to the breast frequently, so as to keep up the secretion of milk; but this should' be done Avithout any exertion or fatigue. The sympathy between the uterus and the breast is obvious, and as long as the breast can be induced to secrete, the uterus will be in part relieved by it. No possible danger can arise to the child from it; but if any should be superstitious on this subject, let some one else draA/ the breasts." We have thus gone into all the particulars respecting this dis- ease, not only in the symptoms, but its treatment in every stage, as well as the diet and drink of the patient, and the minutiae of nursing; and we earnestly hope that our labor will not be in vain, but may yield important assistance to others concerned in the charge of the sick, and enable them the more intelligently and efficiently to contribute to the safety and comfort of the patient. MILK LEG, OR PHLEGMASIA DOLENS. Of all the diseases to which a lying-in woman is subject, per- haps this is the most painful. It has been noticed by a great number of writers, and the theories they have advanced, both of its remote and proximate cause, are various. But our object is not to indicate theories, but to treat of plain matters of fact; to describe symptoms, and point out the best mode of treatment of each disease of which we treat. This disease may manifest itself at any time within the month. Its approach is frequently announced by premonitory symptoms, such as irritability of feeling, with a sense of great weakness and depression of spirits, without any apparent cause, though there may be some transient pains in the uterus. By these symptoms, the approach of the disease has been sometimes foretold. When it is about to develop itself, a pain is suddenly felt, either in the calf of the leg or in the groin. When first felt in the groin, the pain is not so violent as when it first attacks the calf of the leg. In the last case, its approach is frequently as quick as the shot of a gun. It soon extends downwards to the inside of me ankle joint and the heel; thence, it stretches up to the ham and along the inside of the thigh to the groin and abdomen BRIGHT. 30 450 MILK LEG, OR PHLEGMASIA DOLENS. Sometimes the glands of the groin are affected, swell, and become more or less painful. The Avhole limb swells to a very great size, and is extremely tender to the touch, but there is no redness in the skin; on the contrary, it looks white and shining, and a general paleness is spread over the body, the veins seeming to be but partially supplied Avith blood. After the pain has lasted for some hours, the SAvelling begins to come on rapidly, Avhen the pain partially subsides, although it is still very severe. But from the moment of attack, all power of m otion in the limb is lost, Avhile, at the same time, it feels like a dead Aveight attached to the patient's body. Every attempt by the attendants to move the limb, gives great pain, and causes feelings of faintness to come over the patient. When the pain commences in the groin, it passes, Avith the swel- ling Avhich it has caused, doAvn the limb to the foot. We have seen cases in Avhich the swelling extended to the breast, and even to the top of the head, occupying one half of the body as exactly as if a thread had been drawn from the symphasis pubis to the crown of the head; and have known the disease to extend over the other side, after that first attacked had recovered from its influence. It is thought by some authors, that a female who has had this disease in one confinement, is not more liable to it in her next. Our own experience does not lead us to this conclusion. Two patients, whom Ave attended in the first attacks of this disease, were also its subjects in their next confinements; and we knew another lady who was attacked by it three successive times. Though one of the most painful forms of disease, if treated well, it rarely proves fatal. Of eighteen or tAventy cases of this kind, we have lost but one; and perhaps under different treatment, even this might have been saved. The lady alluded to Avas our first patient, and treated after Dr. Denman's plan. But, since that time, Ave have adopted another course of practice. Treatment. — This disease is one of highly inflammatory action, and consequently requires active anti-phlogistic treat- ment. The first thing to be done is, to take as much blood from the patient as the state of her pulse will bear. The bleeding may be repeated two or three times, according to circumstances. The patient should then be purged, and the following medi- cine may be used: Recipe: Calomel, twenty grains. Pulv. Rhubarb, twenty grains MILK LEG, OR PHLEGMASIA DOLENS. 451 Form eight pills. Give four at first, and the other four in tfiree hours. After they have operated Avell, the bowels should be kept open by: Recipe: Epsom Salts, one ounce. Calcined Magnesia, half ounce. Mix together, and give a tea spoonful every three hours, in sweetened vinegar and water, or lemonade, till she is again freely purged. After this, the medicine should be given so as to cause three or four stools every twenty-four hours. The patient's drink should be, balm tea or rice-water, barley-water, and gum- Arabic water; and her diet, gruel, sago, rice, arrow-root, toast- water, tea, and light bread. The limb must be guarded from the pressure of the bed- clothes by a hoop, cut in the middle, crossed and tied, and placed so as to act as a spider, and support the clothes. The leg and groin should be frequently bathed Avith warm vinegar, and a flannel should be wet with the same, and kept constantly applied to the holloav of the hip. Care, however, must be taken, that it does not wet the bed. After each Avashing Avith the vin- egar, the whole limb should be bathed with the following lini- ment : Recipe : Pulv. Opium, two drachms. Pulv. Camphor, half ounce. Castile Soap, two drachms. Dissolve the medicine in a pint of whiskey, and keep it Avarm, shaking it frequently, till it is perfectly mixed. The limb may be rubbed with this three times in twenty-four hours, and its use should be rigidly persevered in till the swelling goes down. The indication of the subsiding of the swelling will be noticed by rubbing the hand gently over the inside of the thigh and leg. Small lumps will be felt along the course of the lymphatic ves- sels, and by pressure of the finger, the limb will pit. A bandage may then be applied tightly around the limb, from the toes to the hip, and it may be drawn a little tighter every day, till it can be draAvn quite tight and smooth. It should be taken off and reapplied night and morning, every day, till the limb recovers its strength, which will be some weeks after the patient can walk about. When all fever is removed, as she will feel weak, she may take a more nourishing diet, together with some elixir of vitriol, with a little good wine. As soon as she is able to take exercise, a ride in a carriage will be of service to her; but she should 452 INFLAMMATION OF THE WOMB. avoid a fatiguing Avalk, or ride on horseback. A relapse is no common in the disease, so far as our observation has gone. Blisters have been recommended by many writers on this dis- ease, and used by many others; but we have never either used them ourselves, or knoAvn them to do good in the hands of others. We are satisfied that the irritation and troublesome sores which they produce do more harm than the blisters do good, and there- fore Ave never advise them. Nor, for the same reason, would we recommend leeches or cups. In a reasonable time, with the remedies above laid down, we have always succeeded in the treatment of this disease, and generally, indeed, cure our patients in about half the time that others take with different treatment. If the secretions from the vagina are fetid, a Avash of milk and water, or castile soap and water, or charcoal water, may be used as a corrective. INFLAMMATION OF THE AVOMB, OR HYSTERITES. The causes of inflammation of the womb are various; such as violent labor, harsh and improper treatment in delivery, and too sudden or violent efforts used to extract the placenta, indepen- dently of those which are natural to that process. These may be, First. The long and reiterated efforts which the uterus may be forced to make, to overcome the resistance which opposes the expulsion of the child; the construction of the pelvis; or the size or situation of the child. Second. The violence committed in the use of instruments of any kind; or to the ill-directed efforts to dilate the mouth of the womb; or by too frequent and rash handling. Third. By a rash delivery of the placenta, especially if it has adhered to the womb; or if the hour-glass contraction has been formed, and the hand has to be passed to take the placenta away. Fourth. It may arise from cold, checked perspiration, or improper diet, or the neglect to keep the boAvels in a proper con- dition. Symptoms. — Let the cause that produces inflammation of the uterus be what it may, it generally develops itself in four or five days after delivery. The patient complains of pain in the lower part of the belly, just above the pubis, which is increased by pressing on that region, or by anything that may disturb the quietude of the uterus, as turning in bed, making water, sitting INFLAMMATION OF THE WOMB. 453 tip, or going to stool. By feeling the region of the uterus, it will be found to be enlarged, and very sensitive to the touch. The pain which the woman feels is constant, but is increased when the after-pains come on. That which arises from inflammation of the uterus, however, may be distinguished from after-pains, inasmuch as it never ceases entirely, while they continue only with the contraction. The abdomen does not swell, in the commencement of this disease, there being no other enlargement than that from the SAvelling of the uterus; and this can only be known by applying the hand to the organ. The abdomen does not participate in simple inflammation of the womb, and hence there is none of that tenderness, or tightness, which is formed in inflammation of the peritoneum, in puerperal fever. If there has been mechanical aid in the delivery of the child, the patient usually feels pain in making water; and, in some instances, has a frequent desire to void it, though but little will pass, and sometimes none at all. Every effort of the kind gives pain, and the urine is high colored, and small in quantity. The heat of the body is soon increased; though sometimes the patient is chilly, yet in other cases she is not so. She also suffers from a violent pain in the head; and if the fever is not removed, delirium is apt to ensue. The tongue is white, and much loaded with coating; the mouth is drier than usual; the pulse is full, strong, and hard, though generally under a hundred beats in a minute. If it should rise to one hundred and twenty in a minute, we may be sure that the disease is complicated Avith peritoneal inflamma- tion ; or the patient is rapidly sinking, and will in all probability die. The patient is not liable to a sick stomach in this disease, especially in its commencement. As the disease progresses, the pain extends itself to the back, and down the thighs, and some- times there is a pain in the left side just below the ribs. The lochea is generally more or less interrupted, and sometimes entirely obstructed, in inflammation of the uterus. It is thought by some that the suppression of the lochea is the cause of inflam- mation of the womb; but the reverse,—that is, that the inflam- mation is the cause of the suppression of the discharge, — is no doubt the truth; and the diminished secretion of the uterus is. therefore, the consequence, and not the cause, of this disease. The less, hoAvever, that this discharge is affected, the less will be the danger from the disease. The return of the lochea in this 454 INFLAMMATION OF THE WOMB. disease is always a favorable symptom, and shoAvs that the cause which checked its Aoav is giving way, and the chances of a favorable recovery are returning. In pure or simple inflammation of the uterus, the breasts sym- pathize but little. They frequently secrete milk in their ordinary quantity, but as soon as the peritoneum, or the ovarium, is involved by the inflammation, the secretion of the milk is almost entirely arrested. Dr. Dewees says he has seen " the offices of the breast entirely undisturbed during the Avhole course of the inflammation of the uterus." If the disease should not continue too long, this may be the case. If the abdomen be enlarged, it is because the uterus or its ves- sels contain large quantities of blood, the expulsion of which is extremely painful. But the more freely it is expelled the better. In the first stage of this disease the boAvels are generally bound; but occasionally the disease is ushered in by a diarrhcea, though this is not often the case. If the disease end fatally, how- ever, a diarrhcea frequently attends the closing scene. When the disease runs to an unfavorable issue, suppuration takes place in the substance of the Avomb, and the matter may be safely dis- charged by the vagina. It may also be discharged into some of the cavities, as the pelvis or abdomen, or detained in the sub- stance, as Avell as the sinuses of the womb. When the disease is about to terminate in suppuration, the pulse becomes more irritated, and increases both in frequency and in quickness; the patient becomes chilly, alternately dry and moist; the cheeks flushed, and of a deep purple or crimson color, and the tongue dry and red. The lochea escapes in large quantities, and is very fetid; and the patient sinks rapidly from irritative fever. Treatment. — The remedies to be used for the cure of this disease are, First—Blood-letting. The lancet is almost our only hope. The patient should, therefore, be bled freely from the arm ; and if she become faint, it will do her the more good. She should, at all events, be bled till the pulse and skin become soft. If the disease continue after the use of other remedies, she should be bled again, if the pulse will justify the use of the lan- cet. But if it Avill not, she should be cupped or leeched over the uterus. Second—Purgatives. Recipe: Calomel, ten grains. Pulv. Rhubarb, ten grains.. INFLAMMATION OF THE WOMB. 455 Form eight pills. Give four at first, and the other four in two hours. If they should not operate, in two hours more a dose of castor-oil may be given, or injections may be administered. As soon as the bowels have been freely moved, the following mix ■ ture may be taken : Recipe ■ Sweet Spirits of Nitre, half ounce. Venice Turpentine, half ounce. Mix. Give a tea spoonful in slippery-elm or flax-seed tea, and repeat every hour. The above pill should be repeated every day, till the tongue begins to clean off. When the fever is high, the following cooling powders may be given: Recipe: Cream Tartar, one drachm. Salts Nitre, twenty grains. Tartar Emetic, one grain. Mix in six papers. Give one every hour in balm, hyssop, or sage tea, while the fever is on. If they produce a perspiration, their action will be the more beneficial. After the tongue begins to clean off, the bowels may be kept open with the following pill: Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap, —of each twenty grains. Tartar Emetic, two grains. Form twenty-four pills. Three or four of these may be taken at bedtime, every night, or just as many as will operate once or twice the next day. These should be continued till the patient gets Avell. The vagina should be opened and loosened by the finger every day, in a very gentle manner, so as to let out any fluid that may be there collected. Emetics should never be administered to a patient in this con- dition. Opiates are often spoken favorably of by various authors, but Ave have never known them to do good; but, on the other hand, much harm. Her diet should be light, composed principally of gruel, sago, rice, tea, toast-water, arrow-root, &c. Her drink should be, slippery-elm tea, flax-seed tea, hyssop, sage, balm, and dittany, or mallow tea. When she is recovering—as sne will be very weak, if the disease has been protracted—she may take a little good wine and water, and some gentle and mild tonic, such as, 456 INVERSION AND PROLAPSUS OF THE UTERUS. Recipe: Gentian Root, half ounce. Orange Peel, half ounce. Columbo Root, half ounce. Black Snake Root, half ounce. These should be put into a quart of good Madeira wine, and shaken every day for three or four days. A table spoonful may be taken, three times a day, in water; and, at the same time, ten drops of elixir of vitriol may be taken, before each meal. The symptoms of recovery are these: When the disease is about to yield, all the symptoms abate, the tumor begins to sub- side, the tongue becomes more clean, the mind is more settled, the fever abates, the skin becomes pleasantly cool, the lochea returns in its more natural character and color, the urine is secreted more freely, and is clearer, the breast secretes more milk, the patient rests better, and is more cheerful, and her appe- tite begins to return. All these are symptoms which indicate the recovery of the patient. OF INVERSION AND PROLAPSUS OF THE UTERUS. This subject is one of much importance, and should be well understood by all midwives and mothers. Inversion and prolapsus of the uterus may occur from several different causes. First, it may be produced by too hastily delivering the after-birth; and, second, it may be produced by the patient herself. In the first instance, by the midwife, by hastily pulling the after-birth away, when it has been attached to the fundus of the uterus. This can only happen when the child has been suddenly delivered, and the uterus has not contracted, and the midwife has neglected to make it contract before she removes the after-birth. If, in this uncontracted state of the uterus, with the after-birth attached to its fundus, a sudden pull be made at the cord, and it does not break, the fundus of the uterus must be brought down and folded into itself as you would fold the finger of a glove. In the second instance, the patient may produce this accident herself, several days after the child is born. This never happens unless the woman is, as it is called, very smart. The uterus not having contracted as it should have done, the patient, having either laid aside her bandage, or wearing it loosely. arises from her bed, and makes some exertion in lifting, or reaches up above her height, or suddenly rises or sits down, — the uterus being in a relaxed state, — and a falling in of the INVERSION AND PROLAPSUS OF THE UTERUS. 457 fundus of the Avomb is the result. If the cervix be well con- tracted, the fundus will rest upon it, and not come so low as to be easily felt; but if the cervix be relaxed, the fundus may fall through, so that it can be felt. When the cervix is contracted, and the prolapsed fundus lodges upon it, the patient may die, and the cause never be known, unless a physician should be immediately summoned, who is acquainted with the nature of such accidents. In every case, let the cause be what it may, we have but one remedy for each position of the inverted uterus. When it has lodged against the cervix, the midwife should, if possible, pass the hand so as to place three fingers against the uterus; and if, by steady and constant pressure, she can return the fundus to its proper position, the life of the patient may be saved. When the fundus has passed through a relaxed cervix, and forced its way through the os uteri, that body will be certain to contract upon it, being stimulated to this contraction by the pressure of the uterus itself. In this case, there is but one remedy, and that is, to grasp the uterus and bring it through the os uteri. The strongest effort that can be made to pass the uterus up, will fail; bringing it down, therefore, is the only hope of saving the patient's life. As Ave have now given the effects of this fatal catastrophe, Ave proceed to describe its visible symptoms. In those cases where the lady is able to walk over the floor in a few days after the birth of her child, after stooping, perhaps, tAvo or three times, Avith a quick motion, or making some muscular exertion, she feels an inward weakness; a sensation of faintness or sinking comes over her, and she either falls on the floor or lies down on her bed. She becomes pale; her pulse flutters, and becomes weak; a cold sweat may, or may not, appear on her skin; the faintness continues, and ere the friends can administer relief, in ten or fifteen minutes from the time she began to complain, her sufferings are at an end; she is dead. There is no discharge from the vagina, for the best of all reasons ; the uterus has filled the vagina so completely that nothing can pass out of it. Nei- ther the nurse nor the attendants can assign a reason for her death, Avhile the case is as plain as it is possible for a case to be. It is that of an inverted uterus. Is proof of this demanded 1 Let the inquirer pass her finger into the vagina, and she will find a tumor there resembling a child's head; and to prove that this is 458 INVERSION AND PROLAPSUS OF THE UTERUS. the uterus, let her place her hand on the abdomen, and she will find that the uterus is not there, but has escaped into the pelvis., Noav let us look a little further back, and see if this fatal acci- dent could not have been prevented. We assert, unhesitatingly, that it could. And if the doctor or midwife who delivered the patient had caused a firm contraction of the uterus to take place, applied a proper bandage, and had given instructions to the patient as to the mode of Avearing it, and why she should Avear it, all this evil might have been prevented. When this accident happens immediately after delivery, the symptoms are as folloAvs: A sudden gush of blood from the uterus, when it is partially inverted; sickness of the stomach, vomiting, fainting, a cold, clammy SAveat all over the body, great prostration of strength, and a pulse very feeble, or entirely arrested. The placenta may be discharged, or it may not. When the patient is in this situation, let the midAvife place her hand on the abdomen, and she will not feel the contracted uterus; but, by passing her finger into the vagina, she will find it folded Avithin itself, and protruded, more or less, through the os uteri. If the placenta is not yet removed, she will feel it dis- tinctly, separate from the tumor that the fundus makes by its side. And now is the moment to give relief, and save the life of the patient, if it can be saved at all. She must immediately remove the placenta, as gently as possible; not by pulling at the cord, but by passing up her fingers, or hand, as the case may admit, loosening the placenta, and taking it away. After this, she must pass her hand again into the vagina, place her fingers in the most favorable position, against the most depending part of the tumor, and steadily, but firmly, press it upwards, till it is loosened from the grasp of the neck of the uterus, Avhen the sffort must be continued, till it is placed in its proper position. Let her then withdraw her hand gently, and allow the uterus to -contract. This, however, can only be done when it is partially inverted, and then the remedy must be prompt, or no benefit will be derived from it. All this must be done very speedily, or the patient will die before the proper remedies can be applied. There have been cases of complete procidentia, Avhere the womb has turned inside out; and here the mouth of the Avomb projects upAvards into the abdomen, and the fundus lies between the thighs. In this situation, the os uteri contracts so firmly upon itself, that all attempts to reduce it Avill be unavailing. Dr. Dewees says: "I acknowledge there are cases Dn record, MANIA, OR MADNESS. 459 where the uterus was said to be inverted in procidentia; but I have not seen proof enough to satisfy me that it Avas truly a case of that kind, and reduced." When it could not be reduced, in order to save the patient's life, the uterus has been completely inverted- which operation will, at least, save from immediate death. Dr. Dewees once completely inverted a procidentia which he could not reduce; and we have no doubt but that he saved the life of the patient by so doing, as she finally recovered, and lived many years. Our object in saying so much on this subject is, to point out to the midwife the necessity of using the remedy for relief without a moment's delay, and also to warn her against a hasty delivery of the after-birth, and leaving her patient before the uterus has taken on a sufficient tonic contraction to prevent an inversion. The mother may also learn not to be anxious to be called "smart," lest, by so doing, she produce this dreadful accident; and we trust that all who are interested therein will give the subject that attention which its importance demands. MANIA, OR MADNESS. Puerperal mania is a disease of a very distressing character, but happily it is one of rare occurrence in this country. It does not confine itself to the lying-in Avoman at all times, but, in some cases, occurs in the earliest stage of pregnancy; in others, when the time of labor approaches; and in others, after the patient is delivered. This disease is apparently caused by some extraordinary dis- turbance in the uterus, but irritations in other parts may produce it, as when the breasts have been inflamed, or an abscess had been formed, and this at the time of first suckling or weaning the child. In many cases, the disorder has been occasioned by an uncommon irritation in these parts, extending its influence to the brain; and this may occur without any reference to former habits, either acquired or hereditary. If the nervous system be once disturbed so as to take on this result, the cause which in one patient Avould produce convulsions, and in another paralytic affections, may in a third produce mania. Some persons Avho have long suffered from intermittent fevers, are subject, on certain occasions, to melancholy, or mania. Sudden alarm in the female, either for herself or child, may excite this disease into action, even where there was no tendency to it before. Dr. Denman says he has seen more than one instance where this disease has 460 MANIA, OR MADNESS. been excited into action by a dismal story being told in the presence of the patient, Avhen she might have escaped if it had not been for those busy gossips. This disease is at times so gradual in its approach, that its character is not fully knoAvn for some time. Frequently, the first symptoms that are discovered are these: the patient begins to distrust her best friends, and especially her husband ; she begins to dislike her child; is not willing that any of her former friends should do anything for her; is irritable, restless and fretful; has more or less fever; her tongue is Avhite; her pulse quick; her eyes are inflamed or glistening; the heat of the body is increased, and she has the general symptoms of fever. The delirium is of its own kind; and even when the case becomes chronic, there is at all times a peculiar pulse that indicates fever. It is not unfre- quently the case, that, on the commencement of the attack, there is, Avith the peculiar appearance of the eye, a yelloAvness of the skin, and sometimes, indeed, it appears to be jaundice. Treatment.—When the skin is yellow, emetics may be given as the first item in the remedies to be administered. Recipe: Pulv. Ipecac, twenty grains. Tartar Emetic, three grains. Mix. Dissolve this poAvder in nine spoonfuls of warm water, and give three at first, and one every fifteen minutes aftenvards, till they operate freely. The operation may be aided by warm water. If the pulse be hard and sharp, blood should be taken, in proportion to the patient's strength. After the bleeding, use the following medicine: Recipe : Calomel, twenty grains. Pulv. Rhubarb, ten grains. Form six pills. Give three and Avait three hours, after Avhich give the other three. When a feAv doses of the above pills have been administered, the bowels may be kept open Avith, Recipe: Blue Mass, twenty grains. Scammony, twenty grains. Aloes Socot., twenty grains. Form fifteen pills, and give three or four of them every night. If the patient have much fever, give the folloAving mixture : Recipe : Cream Tartar, one drachm. Salts Nitre, one drachm. Tartar Emetic, one grain. Mix in six powders, and give one every tAvo hours, in balm sage or hyssop tea; or, DRESSING THE CHILD, ETC. 461 Recipe: Sweet Spirits Nitre, half an ou; ce. Wine of Ipecac, half ounce. Mix. Give thirty drops every hour, in one of the above teas. The patient's diet should be light, and altogether vegetable; not even chicken-water should be given. The room should be Avell ventilated, and the patient must be kept as tranquil as possible. Her various notions should be complied Avith as far as her own safety and welfare may alloAv. In a word, everything that may tend to keep her calm should be done. As the sight of her child or husband frequently excites and enrages her, they should be kept out of her sight till she calls for them. She is apt to Avish to be removed to a friend's house; as soon, therefore, as it can be safely done, let her be removed. She may also ride out in a carriage and take the air. When she begins to mend, great caution must be used in the increase of her diet; and stimulants or tonics must not be given, lest fever be thereby excited, and the disease brought back in all its violence. Let her system be well prepared for delivery before her next accouchement, and let all exciting causes be carefully avoided. PART V. OF DRESSING THE CHILD AND MANAGEMENT DURING THE MONTH. After the child is born, and is sufficiently strong to be dressed, if it has much white gum on it, the nurse should grease it all over with lard, Avhich must be Avashed off with mild soap and moderately Avarm rain-water. A little spirits added to the Avater will supply the place of soap. The skin should be made per- fectly clean, and wiped dry before the child is dressed. The umbilical cord should next be put up; and this is to be done in the following manner : Let the midwife take a piece of old, soft linen or cotton cloth, about five inches square, and cut a hole in the middle of it, large enough for the cord to pass through, and then fold the upper edge of the cloth down so as to touch the cord. On this she must lay the cord, pointing straight upAvards; fold the cloth from beloAV over it so as to cover the cord entirely; and then fold the cloth over from each side so as to make a square. She must then put on the waistband, which may be made of flannel in winter, and of linen in summer. It should be broad enough to cover the child from the hips to within an inch 462 DRESSING THE CHILD, ETC of the armpits, laid smoothly, and tied or pinned; though tying with tapes is the best. If, hoAvever, pins are used, care must be taken to let every point rest on the outside of the band, and so Avith all the pins that are used in dressing the child. After the Avaistband is put on smoothly and tolerably tight, the remain- der of the clothing may be arranged as the taste of the mother may direct; taking care, hoAvever, to have the sleeves long in cold Aveather. Caps should ahvays be used in Avinter, but never in Avarm Aveather. This will guard the child from cold in the head, sore ears, and perhaps deafness. If the child is oppressed Avith phlegm, Avhich is sometimes the case, half a tea spoonful of molasses, mixed in two tea spoonfuls of warm Avater, or a few grains of salt in Avater, should be given, and either of these will remove the phlegm and open the bowels. The molasses and water may be repeated three or four times a day, for three days, or until the mother has a flow of milk, Avhen the child should always be put to the breast. It there obtains the food Avhich nature has provided for it. and nothing which art can prepare is so well adapted to its necessities. If the first passages should not be thrown off freely, a little cat- nip tea, sAveetened with molasses or brown sugar, should be given two or three times a day, for a feAv days; or a tea spoonful of SAveet oil, or pure castor-oil. But no strong medicine should be given for this purpose. If the child should not make Avater freely, a tea, made of Avatermelon, pumpkin seeds, or parsley tops or roots, may be given. The warm bath, also, will assist in alleviating this symptom. If all these remedies fail, the parts should be examined, to ascertain Avhether the urethra or Avater- passage is not closed; and, if so, it should be opened by a person who understands the operation. As soon as the mother has milk, that alone should constitute the diet of the child. Nurses are too apt to give pap, toast-bread- water, and many other things that are only calculated to sicken; for the infant stomach cannot digest any of these things, and if not digested, they will create colic. It is too often the case, that whenever the child cries, it is considered hungry, and other potions must be prepared and administered. By this course, its stomach is soon filled with teas or pap, or other articles Avhich it ought never to have taken; and if nature is not able to relieve itself, by throAving up the offensive doses, the child will either have a fit, or be doomed to suffer the tortures and pain of this destructive course of feeding. From its cries and evident signs DRESSING THE CHILD, ETC. 463 of pain, the nurse concludes the child is suffering frcm the colic, and therefore gives it some soot tea, or a little weak toddy. If the last be given, it presently falls asleep from the effect of intoxi- cation, and as the necessary result, awakes with pain in the head. It cries aloud, since this is the only way in Avhich it can make knoAvn its pain, and it is again dosed, or pronounced natu- rally cross, and the nurse adds her testimony that it is ahvays crying. It Avould be strange, indeed, if it were not. But no child is cross in infancy, unless bad nursing, improper diet, or neglect, make it so. But crying is not the worst. Ninety-nine fits out of a hundred, Avhich children have before they are a year old, are produced by improper feeding. The eyes of an infant should never be alloAved to receive a strong light, for many have lost their sight from this cause alone. If the infant's eyes become sore, within the month, they should be washed Avith its mother's milk, or Avith a tea made of slip- pery-elm bark, strained. The eyelids should be opened fre- quently, to let the matter escape, otherAvise the eye may be destroyed. (See chapter on Sore Eye of Infants.) The navel-string Avill begin to suppurate a little in tAventy-four or thirty-six hours from the birth of the child; and Avhen this is the case the compress in which it is folded should be raised up gently, and a small feather, oiled, passed around the cord, and the compress replaced. This should be repeated every day till the cord comes off; after Avhich, the nurse should sprinkle the sore Avith pulverized nutmeg, and spread over it a plaster of tallow, burnt till it is black, and reneAV this process every day, till the navel is healed. If it should suppurate much, it must be Avashed Avith castile soap and warm Avater every time it is dressed. A firm compress should be kept over the navel till it has healed perfectly. In some instances the umbilical ring is very large, and the navel projects too far. In this case, after the sore has healed, a compress of sheet lead, as large as the palm of the hand, should be bound firmly over the part, and kept there by, or seAved fast to, the waistband, that it may not slip. It should be Avorn till the umbilical ring closes firmly around the cord, and the navel sinks down, and retains its position. Th? infant should be Avashed all over, in tepid water, every day; but no soap should be used, unless the skin cannot be cleansed Avithout it; in Avhich case, the child should be rinsed with water containing a small portion of oil. The soap removes 464 ULCERATION, ETC., OF THE NAVEL. all the natural oily secretion from the skin, and renders it more liable to chafe and chap. The infant's head should be kept free from dandruff or scruff; for the pores being closed by dandruff, is a fruitful source of dis- ease of the brain. Many diseases will be avoided by keeping the skin clean and soft and the pores open. ULCERATION, OR IMPERFECT HEALING OF THE NAVEL. The umbilical or navel string separates from the navel betAveen the fifth and tenth day. This is altogether a natural process of the system of the child; yet we occasionally have to aid nature in its performance. The cord, at times, remains attached by small filaments for several days after it should have been thrown off. In this case, it should be clipped off Avith a pair of sharp scissors. This is the simplest impediment to healing. The healing may also be prevented by fungous flesh springing up, and discharging purulent matter, of an offensive character. This condition of the navel generally alarms the mother, though there is no danger in it, if it be properly managed. This dis- charge will not cease unless means are used to arrest it, nor can the parts heal Avhile it continues. This fungus will ahvays be found in one of three conditions: first, the navel may exhibit an elevated ulceration of its whole surface; second, it may form a kind of button, with a narroAV neck, or pedicle; and, third, this button may have a broad base. The treatment in each of these conditions requires to be slightly varied. In the first case, it will be necessary to sprinkle it Avith powdered nutgalls, calomel, or an old shoe-sole burnt to a cinder and finely pulverized. Over this a plaster of burnt talloAV, made fine by working it in the hand with a knife, must be applied; and, after a few days, the parts will peel off. The application must be continued till the parts are entirely healed. But they should be cleansed with castile soap and water before each dressing. In the second case, a dark-red, round tumor may be seen within the cavity formed by the retiring of the navel; and, Avhen pressed out, it Avill have a footstalk, like a cherry, attached to its stem: except that the stem is larger and shorter than that of a cherry. All that is necessary in this case is, to pass a silk thread, Avaxed, around it, and tie it tight; after which the tumor will drop off, RED, WHITE, OR YELLOW GUM. 465 without causing any pain. Sometimes it will not heal imme- diately after the tumor drops off; in Avhich case, the remedies prescribed in the first instance should be used. In the third case, a ligature cannot be applied, as the base is too broad; but the remedies prescribed in the first case should be tried, and, if they fail, a Aveak solution of the nitrate of silver will be found of great service. This should be applied lightly, with a hair-pencil, or a small feather, and the application should be repeated every tAvo or three days, till the parts are taken off to a proper level. When this is accomplished, the plaster first directed should be applied. In using the solution, care must be taken to touch no part but the sore. It is prepared in the follow- ing manner: Recipe: Pulv. Lunar Caustic, four grains. Rain-Water, half ounce. Mix, and shake till it is properly dissolved. The vial should be well shaken before the solution is used. OF THE RED, WHITE, OR YELLOW GUM. Infants are subject, a feAv days after birth, to an eruption or. the skin, which is called gum, and may be either red, white, or yellow. It is named from the color it assumes, and is composed of small pimples, containing a little fluid. There is a saying, that the more copious this eruption is, the fairer will be the child's skin Avhen it is removed. The color of the eruption depends upon the first passages, or the state of the circulation. If the liver should be a little torpid, and the bowels constipated, the gum will be yelloAV; but should the liver act well, and the meconium, or first passages, not be sufficiently copious, the eruption will be red. If the liver and boAvels are both sufficiently active, the eruption will be white, because of the unusual activity of the lymphatic system. In the case of red gum, the arterial system is always active, and the skin always thin, as Avhen the child is born a little before its time. Neither of these eruptions is attended with danger, if properly treated. When the gum is red, and the bowels are not properly cleared of meconium, a dose of castor-oil — say one tea spoonful — should be given, to move the bowels freely. When the gum is white, and the bowels are in a good state, no medicine is neces- sary; but a little hair-powder should be dusted on the surface, and the child Avashed with warm, soft water, once a day, for a BRIGHT. 31 466 PRICKLY HEAT. few days. When the gum and the skin are yellow, the Avhites of the eyes are sometimes of the same color; which is also an evidence that the liver is torpid, especially if the urine be yelloAV. To remove this, a little tea, made of the root of rhubarb, and containing a small portion of calcined magnesia, may be given. If this should not prove effectual, after being repeated a few times, half a grain of calomel, mixed in the sirup of rhubarb, may be used, and repeated once in six hours, till the bowels are freely moved. This, however, must be folloAved up the next day with a dose of castor-oil. Some ladies are so much afraid of calomel that they would see an infant die before they Avould administer it; and in this case, if it be neglected, the infant may die. Although in the case of Avhich we are speaking, the liver is active, yet the gall- ducts are closed, and the bile is reabsorbed and carried into the circulation after the liver has secreted it, the absorbents having taken it up and deposited it in the skin. Nothing so certainly and effectually opens the gall-ducts as a dose of calomel; and in many cases nothing else will produce the desired effect. PRICKLY HEAT. Children of all ages, from a feAv weeks old up to manhood, are subject to prickly heat. It appears in children in the form of small, pearl-colored, or brownish, or pink-colored, and some- times innumerable red spots, with a very light, rose-colored base. This symptom commences Avith a sensation of tickling, or prick- ling, from which it takes its name. When these points are situated betAveen the fingers, especially if aggravated by scratching, it may be mistaken for itch. But its sudden appearance, the points being sharper and redder, attended by a sensation of smarting rather than itching, readily distinguishes it from that complaint. It may subside suddenly, and almost Avithout scaling; the Avater in the little points becom- ing thinner, and'being, therefore, more readily taken up by the absorbents. In other cases, a brownish scab Avill form, leaving the skin wrinkled, and producing fever and a deranged state of health, from irritation. When this eruption has spread over the hand, we have known the skin to peel off in large scales. In children this disease rarely assumes a chronic form, but is some- times of that character in adults. Treatment.—The treatment consists in gentle, cooling laxa- PRICKLY HEAT. 467 lives and sudorifics; and when the fever subsides, some gentle tonic should be given. Recipe: Pulv. Rhubarb, ten grains. Calcined Magnesia, twenty grains. Mix, and divide into four papers. To a child two years old, one of these may be given every three hours, in sirup, till they oper- ate freely. If the child be older or younger, the dose should be proportioned accordingly; or the following may be used instead: Recipe: Castor-Oil, half ounce. Spirits Nitre, one drachm. Mix them together; and, to a child one year old, give a tea spoonful every two hours, till a free operation is produced. As in the other case, the dose may be increased or diminished according to age. Or, if preferred, the folloAving may be given : Recipe: Fol. Senna, half ounce. Manna Flake, half ounce. Simmer them in a half pint of water, to a strong tea, of which a table spoonful, every two hours, may be given, till free purging is induced. Or you may give, Recipe: Rochelle Salts, half ounce. Dissolve in two table spoonfuls of water, and give one spoonful every hour, till they operate Avell. The water may be sweetened with white sugar. Or, if preferred, try, Recipe: Cream Tartar, two drachms. Milk of Sulphur, two drachms. Mix them together, and give a level tea spoonful, in sirup or honey, every tAvo hours, till the bowels are freely moved. If at any time the stools are of a light clay color, and smell badly, a few small doses of calomel should be given. Recipe: Calomel, ten grains. Salts Nitre, two grains. Mix. Divide into six powders, and, to a child two years old, give one powder, in sirup, and repeat every two hours, till they operate well. If the child should be older than this, a grain may be added for a year; but, for one of five years old or upward. only half a grain should be added for each year. Cold Avater should never be given till this medicine has done operating. The drink for children laboring under prickly heat should be, barley-water, rice-water, sweetened whey, orangeade, very weak lemonade, or cream of tartar in water. The diet should be light 468 NOURISHMENT OP tNFANTS. and cool, and the dress light. After the fever subsides, some strengthening medicine should be given, such as, Recipe: Huxham's Tincture, one drachm. For a child two years old, tAventy drops, in sweetened water, three times a day, will be sufficient. The dose maybe increased or diminished, according to age. Or, Recipe .• Muriated Tincture of Iron, half drachm. Give three drops, in sweetened water, three times a day. If the patient lives in the country, where these things cannot be had, a decoction of red dogwood and yelloAV poplar bark, with a little spirits added to it, may be given, three times a day; a table spoonful for a dose. The external remedies are, Avashing the body with tepid water; after which, the skin should be Avell dusted with starch or hair- poAvder. The child should ahvays sleep cool; but if the erup- tion irritates it, so that it cannot sleep, a few drops of paregoric, or a tea spoonful of tea made of poppy blossoms, sweetened, will be beneficial; and Avhen nothing else will quiet the child, the folloAving ointment will sometimes have that effect: Recipe: Simple Cerate, one ounce. Otto Roses, ten drops. Sugar Lead, twenty grains. Mix into an ointment, with which, after Avashing the child, it should be anointed lightly all over. The linen should be changed frequently, and as fine and as thin clothes as possible should be worn, and proper exercise taken in the open air. ON THE NOURISHMENT OF INFANTS. The infant needs a certain amount of nourishment, which should, if possible, be derived from the mother. She will be able in a few days to afford the requisite amount, and it would, there- fore, be wrong to substitute an artificial diet. It is sometimes feared that the mother will be weakened if she suffer the child to suck to its full satisfaction; but this is a mis- taken apprehension. The breasts are by nature adapted to the secretion of this fluid, and they will supply it, if the mother take proper care of herself. Is it not better for the child to take this milk away by the natural process of sucking, than to alloAv the absorbents to remove it by another process 1 On every princi- ple of good reason, this would be most certainly the better course NOURISHMENT OF INFANTS. 469 When the milk has flowed into the breasts, the system has suf- fered all it can suffer from this process, if, indeed, it has suffered at all. How, then, can it be said that taking it aAvay will be cal- culated to weaken the person? But, on the contrary, should the absorbents be compelled to take it up, as they must if it be not withdrawn by the child, a new process of secretion will neces- sarily be performed, which will probably create fever, and pro- duce unfavorable results, for some other organ must throAv it off. Another plea is urged by thousands, that the child should be early taught to eat; so that, in case the mother should be taken sick, it can be fed; or, if she should wish to go from home, she need not be hurried back to nurse it. The first reason is a very flimsy one; for if the mother should be taken sick, the child may then better be taught to eat, as it may be older, and consequently less likely to receive injury from the change. But the mother may not be taken sick at all; and then the necessity for feeding will not exist. And as for the argument drawn from the desire of the mother to visit, Ave have only to say, that she, who, for the pleasure derived from a party, can deprive her child of the food Avhich nature has ordained for its use, is unworthy of the endearing title of mother. A jhild should not be persuaded to nurse when it is not hun- gry, and once in tAvo hours is quite often enough to satisfy all the demands of its system. Time should be given the stomach to digest what it has taken in, before it receives more. After an infant is six months old, it should not nurse more frequently than once in three hours; and if the mother will accustom it to these rules, she will have but little difficulty in this particular; nor will she have need of pap, or bread-water, to satisfy its demand. The mother should learn, from observation and attention, how much the child should take at one nursing, and remove it from the breast when she is satisfied it has received this quantity. The breast should not be given every time the child frets, for the purpose of quieting it; for it may cry from too great a disten- sion of the stomach; and if the mother follow this course, under such circumstances, the pain will of course be increased. If a hurt be the cause of its crying, the breast will not cure it; if pain, an increase of food will only heighten it; if colic, the Avind Avill be likely to be confined more closely by surcharging the stomach ; and if acidity of that organ, the acid Avill clot the milk, and increase the pain. The mother should try at all times to ascer- tain what is the cause of the child's crying, and direct the remedy 470 NOURISHMENT OF INFANTS. accordingly. If it is the result of bad habits which have been taught it, let those habits be corrected as soon as possible. But more cries are extorted from children by the goad of a pin, the smarting produced by a wet diaper, the rolling up of the waist- band, or the pressure of tight clothes, than by hunger. It is an easy matter to accustom the stomach to take more food than is necessary for the support of the system; in Avhich case, more or less derangement will ensue. As it is with the adult, so it is Avith the child; if either take more than is sufficient to satisfy the demands of nature, he must certainly, and in a short time, feel its bad effects. Give to the child, in addition to its natural and Avholesome food, the various articles with which mothers and nurses are apt to load the stomachs of the little ones committed to their charge, and the most serious result may be expected. And the experience of every day confirms the expectation. The best method, therefore, is to give the child the breast only, and let it have it at regular periods, and as nearly as possible in the same quantity at each time ; and much trouble will be saved the parent, and much suffering to the child. After it has attained to the age of six months, some regular system should be observed in all its little supplies, whether of nursing, receiving food, rest, or exercise; and as life consists in a routine of habits, it is a matter of much moment that only such habits be established as will most effectually serve the best pur- poses of the system. There are but few circumstances that will justify the feeding of an infant at a very early age; and where the mother's milk is unhealthy in quality or insufficient in quan- tity, if the infant is very young, a wet nurse should be obtained. if it can be done. In the choice of a wet nurse, much care is necessary. She should be in good health, and not of a scrofulous, rheumatic, or consumptive habit. She should also be temperate and wakeful; free from any venereal taint in her system; nor should she have a child of her own to nurse. She should be cleanly in her person, and her milk should be as near the age of the child to be nursed as possible; but, if it vary, it should be younger rather than older. She should be willing to obey instructions as to the mode of dressing, attending, and nursing the child. The practice of employing a wet nurse when the mother haa sufficient nourishment for her child, is generally unwarrantable. But cases do occur in which the most tender-hearted mother must either employ a nurse, or feed her child; and when this NOURISHMENT OF INFANTS. 471 »atter plan is resorted to, the food should be of cow's milk, diluted with warm water and lightly SAveetened, so as to bring it as near as possible to the consistence and quality of breast milk. It should be prepared in the proportion of one third portion of water and two thirds of milk, for a young child; and to one five or six months old, the milk may be given without water; but in every case the milk should be sweetened a little, and the Avater Avarm. Home-made sugar is better than the imported brown, and this is better than the white. For several reasons, it is better to use the bottle than the spoon for feeding; because there is not so much danger of overloading the stomach, since the child will always stop when it has taken enough, and there is a better opportunity for the saliva to mix with its food. It is also better, because the nurse is thus pre- vented from putting the food into her OAvn mouth; which, if she uses tobacco in any form, Avould be injurious to the child. And, by this means, also, the child's clothes will be preserved dry and sweet. We have been forcibly struck with the eagerness of nurses to improve the diet of children, by adding a little flour, or boiled bread, or some other article to it. Every addition of the kind, at least till the child has arrived at the age of five or six months, will certainly injure it. The nearer we can approach to nature in preparing nourishment for our children, the better. She designed that they should live on milk till they arrived at a certain age; and that age she designates by giving them teeth, to cut or masti- cate more solid food. After these manifestations appear, a little bread boiled in milk, rice well boiled, sago or arrow-root, may be added, though the diet must still be simple. It is too often the practice to give an infant a little of anything which the mother may be taking at the time. But although some children may be treated thus without a fatal result, it is always a triumph of nature over a bad practice. The vast number of cases of rickets, scrofula, consumption, tabes mesentericus, and a variety of other diseases, prevailing amongst the children of those who are unable to procure for them the proper kind of food, warns us against a departure from that course which nature has made essential to the safety and well-being of our children. Hippocrates, the Father of Physic, saAv and urged the necessity of adapting the diet to the age of the child. And a departure from this rule must always produce serious, and, not unfrequently, fatal results. We may be asked, at what age a change in the diet may be 472 NOURISHMENT OF INFANTS. made? The question cannot be ansAvered by naming any num- ber of months or years; but the number of teeth the child may have will point out the period. If the first set of teeth be full, and the child is healthy, it may take some animal food; or even before they are all perfect, if its health be good. But the food should be easy of digestion, Avell cooked, but little given at a time, and that duly mixed Avith bread. And, Avhen all its teeth are perfect, it may take animal food, Avell boiled or roasted, once a day, but not oftener. But in no case must it have more than the stomach can readily digest. Beef, mutton, or foAvl, is better than veal, lamb, or pork; and the older animals, when properly fatted, are the easiest digested. " An excellent article of diet for children is made by cutting a'*piece of beef, or mutton, Avhen underdone, and catching the red liquor. Boil this with a little mace or nutmeg, and thicken it with grated cracker," sweet light bread, or the crumbs of corn bread,— the last being the easiest of digestion. When children take animal food, it should ahvays be on an empty stomach, that it may have all the advantage of the gastric fluid to aid in its digestion; and a sufficient time should be given for this to be digested, before it is allowed to take the breast, or other nourishment. After six months, regular rules for feeding or nursing should be observed; and thus a regular digestion will be established, the child will be more quiet, the breasts will fill regularly Avith milk, and the mother will preserve her strength. The child should be nursed the last, thing before retiring to rest, and then, as seldom as possible during the night, especially in warm Aveather. Bread, with sweet butter, and a little sugar spread on it, with SAveet milk, is a good article of diet for children that are old enough to take it, as a lunch betAveen meals. The potato is not a proper diet for children under a year old; and not even for those over that age, unless it be properly prepared. This should be done in the following manner: put it in cold water, which should be made to boil as quick as possible, and, as soon as the water boils, pour it all out, and cover the potatoes again Avith cold Avater. Let this boil three or four minutes, empty out all the Avater, and break the potatoes in your hands, between a towel; remove the rind, which is loose, and mash the pulp fine; add a little salt and new butter, and they are prepared for the child to eat. Potatoes, prepared in this Avay, may be given to children, in moderate portions, with impunity; and, for their NURSERY FOR CHILDREN. 473 use. it is the best way of preparing them. Strong gravy, of any kind, mixed with children's food, is objectionable, it being diffi- cult to digest. We said, in another part of this chapter, that a child raised by hand should be nursed from a bottle; and Ave will iioav give a little additional advice on that subject. The flat bottle is the best, as it can be kept in the bed all night, and warmed by the heat of the body. But as soon as the milk becomes the least sour, the bottle should be emptied, Avell cleansed, and laid in clear cold water, till it is again needed. When the child sucks the bottle, it will not be apt to take too much; unless, indeed, it has been spoiled, by being frequently urged to do so. Be regu- lar in the hours for feeding it, as Avell as in the quantities given and it will be likely to do well, as far as nursing is concerned. OF THE NURSERY FOR CHILDREN. It is a matter of no small importance, in towns and cities, to have a well-regulated nursery for children. And this, in a city, should be up stairs, in order to command a free circulation of air. Tavo rooms, with a communication between them, should be set apart for this purpose; and at least one of them should be large, having windows in such a situation that the air may circulate freely through both. The fireplace should be constructed to burn Avood or coal; for a stove should not be used, as it is liable to create too much dry- ness of the atmosphere; to obviate Avhich, the nurse will probably heat Avater upon it, and the children, heedless of the danger, Avill be liable to be scalded. There are instances on record of chil- dren being scalded to death in this way. The fireplace should be guarded by an iron fender, which is better than brass, because it will not canker. It should also be high enough to prevent the children from reaching over it and touching the fire. The arti- cles of furniture should be feAv and simple; the bedsteads Ioav, with side-boards; and mattresses, made of curled shucks, moss, or hair, should be used, instead of feather-beds, especially during Avarm weather; and a few folds of soft blankets, over a mat- tress, Avould be better, even in winter, than feathers. If possible, not more than tAvo children should sleep in one bed, and they should have room enough to roll over without interrupting e&ch other. A nursery should have but few chairs in it; some of which should be low and small, for the children to sit on, when they choose to rest. These, with a Avardrobe, or a bureau oi 474 NURSERY FOR CHILDREN. two, for their clothing, are all the furniture the room should contain. There should be a Avoollen carpet on the floor, o secure the head of the child from injury, in case of its falling; and the chil- dren should wear their shoes, lest injury be done by any needles and pins that may have been dropped on the floor and partly con- cealed in the carpet. All possible care should be taken to keep the floor clean and pure; and while one room is SAvept and dusted, the children should be kept in the other, free from inhaling the dust. There should be as many toys and playthings in the nursery as the children require for their amusement. Let them jump, run, and play, roll and tumble over the floor, at pleasure; for exercise gives strength to the muscles and activity to the mind. Let them sing and laugh; for this form of exercise strengthens the lungs, and improves greatly the general health. They should be put to bed early, and be accustomed to be left, for the night, in the dark. Nor will they, generally, be afraid of this, unless they have been frightened by foolish stories. They should not be allowed to form the habit of drinking after they are put to bed: and then, if they should call for Avater in the night, it will generally indicate that they are feverish. If they are allowed to drink freely, the bladder will be filled Avith urine, and they must be taken up frequently through the night, or they will con- tract the habit of wetting the bed. They should be taken up early, Avashed and dressed; and, if the Aveather is good, they should go into the open air, take free exercise, and have an early breakfast. The doors and Avindows of a nursery should be listed in cold weather, and the Avindows should have slats in them, placed five inches apart, and set up and down, so that the child cannot climb upon them, and thus be in danger of falling out. If any of the doors open immediately at the head of the stairs, they should be secured by a double door, made with slats in the same way, that the child cannot climb on or over it; and the catch should fasten by a spring on the opposite side. No sharp or pointed instruments should be allowed, under any circumstances, in the nursery. When the children are large enough to use them, give them slates and pencils with Avhich to amuse themselves by making marks and figures; and by this means, useful improvement may be connected with their hours of play. The principle of love and benevolence should always be cul- NURSERY FOR CHILDREN. 475 tivated in their minds. They should never be allowed to get angry, and fret, and pout, and cherish a grudge against each other. As soon as anything of this kind is discovered, the faulty one should be made sensible of its wrong, by mild means, and induced to acknowledge its fault to the other; Avho should be taught, in its turn, to forgive the offender. The endearing appel- lation of brother and sister should be early put into their mouths, and they should be taught to use it on all occasions. They should also be taught to speak to and of their parents with rev- erence, and to yield obedience to them at all times and in all places. And parents and nurses, on their part, should never fly into a passion Avith their children, as this betrays weakness which Avill always be remarked, and the effect of which must be injurious. A child should not, on any account, be punished till it is made sensible of its fault; and this should ahvays be done in a kind and gentle manner. Let it be first convinced that it deserves chastisement, and that the father or mother takes no pleasure in its infliction, but is rather pained thereby. NeA^er let a child be indulged in Avhat has been once forbidden; neither must it ever suppose that its parents can speak anything but the truth. In good Aveather, children should be sent out to take the air frequently, especially in the morning and evening; but they should not be kept out in the sunshine long enough to heat them. Many of these directions will not apply to the country, where children ahvays have the privilege of pure air; but so far as they do apply, parents will find it profitable, both to themselves and their children, to put them into practice. A few words on the subject of dress. Children should not be clothed in Avinter in such articles as will readily take fire; and for this purpose, Avoollen will be found to make the best dress. In summer, all their clothes should be made loose and short; and sufficiently so, in all seasons, to give them free play Avith their limbs and the power of expanding the chest freely. The stomach and abdomen should not be? bound tightly, lest the powers of digestion be impaired. Infants should not be carried out in the chilling Aveather of winter, spring, or fall, with naked arms and legs. They cannot remonstrate against this practice; but colds, pleurisies, bronchi- tis, and fever, will be the almost unavoidable result. As a father and friend, then, let us caution you against carrying your chit 476 FASHION, EXPOSURE, AND HARDENING OF INFANTS, ETC dren out in this situation, or alloAving the nurse to subject them to this unfeeling exposure. OF THE SLEEP OF INFANTS. In the early stage of life, the gastric, arterial, and absorbent powers are much employed for the purposes of digestion, of secre- tion, of deposition and groAvth. Consequently, much excitability is required, and a state of quiescence, or sleep, is most favorable to the development of the different functions above named; and, therefore, nature has Avisely ordered that an infant should sleep the greater part of its time. Indeed, it Avould seem that the waking moments of infants are only exceptions to a state of constant sleep; and the more an infant sleeps, naturally, the better. Though the excitability of the system is certainly accu- mulated in a greater degree in a sleeping than in a waking state, yet this superabundance of excitability had better be exhausted by crying, than to alloAv the system to lack anything in the important matter of developing its powers and functions. Sleep, therefore, is the natural and healthy state of infants. The organs of hearing are not acute in early infancy, and this is a Avise arrangement of nature, as children are, by means of it. not prevented from sleep by noise. Nor should this natural order of things ever be changed. The nursery should never be made entirely noiseless, but the child should rather be accustomed to fall asleep while surrounded by its usual noise, as it will then not be interrupted by it. The child will sleep better, longer, and sounder, and the mother or nurse will not be disturbed by its sudden shrieks when aAvaked by every little noise it may hear. If the habit of keeping still has been established in the nursery while the child sleeps, the sooner it is broken up the better. The child may resist it for a short time, but will soon yield, and sleep soundly, though there may be noise around it. OF FASHION, EXPOSURE, HARDENING, ETC., OF INFANTS. Fashion has ever exerted a baneful influence over the finest and best feelings of our nature, and even the mother has become willing to sacrifice the health and Avell-being of her offspring at its shrine. The child, in obedience to its dictates, must be dressed, even in winter, in short sleeves,—its arm naked above the elboAVs, its legs and head very lightly covered, if not entirely bare; and, in these habiliments, the child is exposed, till its skin FASHION, EXPOSURE, AND HARDENING OF INFANTS, ETC. 477 becomes blue, its lips tremulous, and its breathing slow and labored. And though the mother or nurse may deem it a matter of no importance, a feAv hours will generally serve to develop the injury which the child has thus received It is soon attacked with bronchitis, inflammation of the lungs, or some other form of inflammatory fever, which, in a feAv days, may prove fatal. And this is one of the fruits of fashion. We will shoAV the connection between the cause and effect here stated, and ana- tomical demonstration Avill, perhaps, throAv a light on this subject. Dr. Portal, in a dissertation on this subject, shows Avith much clearness the connection betAveen the arms and lungs, by means of the cellular membrane proceeding from the upper parts of these organs. He says: " After passing under the cellular mem- brane and accompanying the blood-vessels and nerves under the arms, they penetrate the glands in the armpits. The spaces betAveen the shoulder-blades and the ribs are occupied by this tissue; so are the spaces betAveen the muscles of the breast and backbone, under which it passes and extends itself to other muscles of the back and breast. This free and prompt commu- nication is found to exist by injecting the parts." If the anat- omist can inject into the air-cells of the lungs water which will pass from cell to cell, until it arrives at the external part of the breast, proceeding thence, under the armpit, and thence to the arms and sides of the chest, it may be reversed by making Avater pass from the armpit to the lungs. From these facts, the deduc- tion is clear, that Avhatever does an injury to the upper part of the arms or armpits, Avill be felt by the lungs, and hence the injury that will necessarily arise from exposing the arms to the action of cold. In every instance of the kind, we may certainly look for the lungs to be affected by inflammation or congestion. The only rule by Avhich parents can be safely governed in this matter is, to adapt the clothing of the children to the temperature of the air, no matter Avhat the season of the year. And surely a child may live in a pure air Avithout being exposed to the extremes of cold. The air in Avinter is as pure in a Avell-con- structed house as it is abroad, and is, moreover, as well adapted to health. Let us, however, admit that there might be an advantage in exposing a child to what such persons consider fresh air, in winter or cold weather,—will they not concede that such a process requires much care ? Will it not be necessary that the child's body should be carefully and sufficiently pro- tected ? Every sensible woman must admit that, if attention be 478 FASHION, EXPOSURE, AND HARDENING OT INFANTS, ETC. not paid to these things, great danger may be incurred. If, then, these points be yielded, as they certainly must, we ask if on« mother in a hundred has a confidential servant or nurse to take the child abroad and attend to these things as their importance demands ? We are sure that many will say, yes, because they believe they have. Yet, any one who traverses the streets of a tOAvn or city, will soon see that the mother's confidence in her nurse is often betrayed, as the exposure of the limbs of the httle sufferer until they are purple with cold will sufficiently attest. He will see that the nurse is attentive only to the gratification of her OAvn desires; and is sometimes engaged in holding a gossip Avith an acquaintance; at other times, standing and gazing into the windoAV of a paint-shop, or confectionary, apparently uncon- scious that the infant is shivering with cold, until she begins to feel a little chilly herself; when she returns home,—not, how- ever, until it is nearly benumbed with cold. The mother receives her child with rapture; and, because it has been breathing an atmosphere a little above zero, perhaps for two or three hours, she anticipates for it future health, from the very cause that must end in its suffering, and, perhaps, death; for a course more certainly destructive could scarcely be adopted. Will it be said that "the children of the poor are more hardy and healthy than those of the rich," while, at the same time, they are exposed to the inclemency of the seasons ? Let the bills of mortality decide this question. And they assure us, that a large majority of children that die in infancy are those of the poorer class; and every physician of experience will confirm this statement. Cold, Avhen combined Avith the unavoidable priva- tions of poverty, exerts a most destructive influence on the constitution of the infant, desolating without stint, and making more victims than any one disease in the whole catalogue of human maladies. Adam Smith confirms this representation Avhen he says, " It is not uncommon in the highlands of Scotland for a woman, who has borne twenty children, not to haA^e three alive at the same time." The British officers, instead of recruit- ing their regiments from the children born in the army, haA^e not been able even to supply them with drummers out of all the children born there. (See Wealth of Nations, vol. 1, page 105.) In thus attempting to point out the evils of improper exposure, we Avould not be understood to favor the opposite extreme ; we deprecate overweening caution as earnestly as we do imprudent exposure. Cold air is unquestionably a cold bath, with certain FASHION, EXPOSURE, AND HARDENING OF INFANTS, ETC. 479 modifications; but no mother would think of giving a child a cold bath in the nursery, at the temperature to which she exposes it by sending it out in the cold to take an airing. The same temperature does not suit every constitution, and not even the same constitution at all times. We agree that children may be brought up too tenderly; and this is equally as improper as to expose them too much, and has made its victims, too. But extremes, either way, should be avoided. On a subject of this kind it is impossible to lay down precise rules to suit every case. We can only give general directions, and must leave the rest to the good sense of the mother, Avho will not vary far from the proper course, if she permits that, instead of fashion, to guide her. Let her reflect on these things as seri- ously as their importance demands, remembering that the lungs of an infant cannot bear as cold a temperature as those of an older child or an adult. The bad effect of cold air on a child's lungs is not felt instantly on being exposed to it, but after it has been brought to the fire, and reaction has taken place. It should, therefore, never be taken out of the cold air, suddenly, into a heated room. But what is the practice in reference to this ? A child sent out on a cool evening, to take the fresh air, is brought back with its face and lips blue with cold. The mother takes it near the fire, where it presently falls asleep. It is then put to bed; and, in the morn- ing, awakes, hoarse, feverish, and fretful. The conclusion is, that it has taken cold, though no one can tell how; and the room is supposed to have been kept too warm. It is sent out again, however, to take the fresh air, and to make another trial of the strength of its lungs and constitution. They are now speedily inflamed; pneumonia, pleurisy, bronchitis, or catarrh, attacks the child, and the presence of the doctor is required. But no account can be given of the cause of this disease; and he, perhaps, through ignorance or timidity, refers it to the changes of the weather, and says the disease is epidemic. It Avould be strange if it were not; for the fashion is epidemic, and the disease is its result. But in such cases, the remedy comes too late and the death of the infant is regarded as a wonderful visitation of Providence, when it is only the result of parental imprudence, in what is called "hardening the child.''1 Let mothers, then, think of these things, and be more watchful over their nurfces, who frequently pretend twenty times as much love 480 FASHION, EXPOSURE, AND HARDENING OF INFANTS, ETC. and tenderness for the child committed to their care, as they really feel. The best Avay to " harden the child1" is, to dress it Avarmly, in cold weather. Let the skirts of the dress be long enough to cover its feet and legs in any position; the sleeves sufficiently long to cover the arms and hands, regardless of all "fashion," save that of keeping the child comfortable. A cap and stockings should also be Avorn in cold Aveather; nor should it ever be sent out for an airing Avhen sufficiently cold for frost. It should, indeed, never be exposed to a temperature below forty-five degrees. An infant should be washed every night with water nearly blood Avarm, and rubbed Avell with a tOAvel and the hand; it should be fed regularly, and with food proportioned to its age; put to bed early, taken up early, and alloAved to kick and play as much as it pleases. Let it breathe a pure, healthy atmos- phere, of a proper temperature, and keep its bowels in good order, and it will grow, keep Avell, have a good constitution, be lively, have better sense, and prove a greater blessing to its parents and society. And this is the true method of " hardening children." Try it, and see its results. In closing our remarks on this subject, Ave quote the following dialogue, from a celebrated author: " A lady, Avho Avas a great stickler for hardening her children, ,told the doctor, with an air of triumph, that the plan she had adopted in sending out her children, would, at once, be an ansAver to all his objections to the practice. Her plan was as folloAvs : ' When the Aveather is cold, — and that is the time you object to a child's being carried out, — I take care not only to clothe my child very well, but also, before the nurse sets out, to cover its little head completely with a good warm cloak, so that the cold air cannot get to its mouth. It will sleep, Avhen it is thus covered up, as soundly as if it were in its cradle in the nursery. So you see that no possible injury can happen to the child, since it is not made to breathe the cold air, which you appear so much to dread.' We admit this prevented the child from breathing the cold air. But it created an objection as strong as the one it Avas intended to remove; for it caused it to breathe a heated and impure air, generated by its own lungs, and, consequently, the design to be accomplished by sending it abroad Avas entirely defeated. We asked this lady how she would like to place a hild in the yard, after carefully wrapping FASHION, EXPOSURE, AND HARDENING OF INFANTS, ETC. 481 it up in the crib, that it might enjoy a nap in the open air 7 This, she declared, Avould be highly dangerous, and she could never think of running such a risk. We then asked her in what this plan differed from her own. She became much puzzled, and could only defend her plan by saying that, according to her method, the child had the advantage of exercise, which the other had not. We then appealed to her candor, and asked if the child Avas more passive in the cradle than it was in the nurse's arms? " At another time, we were speaking with a lady who had lost three or four children by croup. She informed us that she was convinced, from experiment, there was nothing like exposure to all kinds of Aveather, to protect and harden the system. By pursuing her first plan, in managing her children, she lost several with croup; but, since she had adopted the opposite scheme, her children had been perfectly healthy, and never had betrayed the slightest disposition to the disease which had robbed her of her other children. We observed to her, {Madam, perhaps, in making your first experiments, you attended to a number of details, which might be thought essential to the plan. You, perhaps, did not take the proper precaution when you sent them into the cold air, or failed to observe what was important when they returned from it.' 'Oh, yes,—I took every possible care. When they Avere going out, I always made them wear a great- coat, well lined with baize, and a fur cap, or collar. They always wore a comfortable, made of soft woollen yarn, around their necks; their feet were always protected by socks, or over- shoes, lined Avith fur or wool, as the weather might be wet or dry.' We then inquired of her: ' Do you believe they were kept at a proper degree of Avarmth by all these things?' 'Oh. certainly; rather too warm, for they would often be in a state of perspiration when in the open air, especially when they ran, slid, or skated.' ' And what was done when they Avere thus heated ?' 'Oh! they got cool enough, before they got home.' 'And would they receive no injury in passing from this state of per- spiration to that of chill?' 'Not at all; for, when this hap- pened, I* always made them take a little warm toddy, or wine and Avater, and made them toast their feet well by the fire.' : Did they sleep in a cold or warm room ?' ' In a warm room ; a good fire was always made in the stove before they went to bed, Avhich kept them quite warm all night.' ' Would they never complain of being cold, towards morning, when the stove BRIGHT. 32 482 PERIOD OF WEANING. had become cold?' 'Yes, constantly: but then there were always additional bedclothes at hand, with which they could cover themselves.' 'And did they always do so?' ' Oh, I sup- pose so.' Let mothers take notice, that, under this plan, this lady lost several children Avith croup. ' Well, madam, how did you carry your second plan into execution; which, you say, Avas attended with such happy results ?' ' I began by not letting them put. on their greatcoats, but when the weather Avas so cold as to require this additional clothing. I did not permit them to wear a comfortable or fur around their necks. I took away their overshoes ; and if their feet chanced to get wet, their shoes were immediately changed, if they were at home. If the weather was wet, or unusually cold, they were permitted to wear their great- coats; but not else. If they came home very cold, they were not allowed to approach the fire too soon. I gave them no warm, heating drinks, and accustomed them to sleep in rooms Avithout fire.' "—Dewees. Let mothers read this second plan over again, and they will see embodied in it a fund of good sense, and a plan for the enjoyment of air and exercise for their children, as judiciously arranged, as far as it goes, as any course of physical education can be. We trust they will profit by this lady's experience, and learn from her a lesson not soon to be forgotten. OF THE PERIOD OF WEANING THE CHILD. When the child arrives at a certain age, it is generally taken from the breast, and this is called weaning. This is a period of much anxiety to the mother, and shows plainly the pleasure she has had in suckling her child. Some mothers determine upon the period of weaning from the age of the child. It is, hoAvever, a bad rule, and has, for its confirmation as such, thousands of victims. The propriety of Aveaning a child depends upon a variety of circumstances, and no definite time can be named, at which that process should take place. It is dependent, altogether, on the circumstances of the case, and these circumstances are connected with the mother, the child, and the season of the year. Various causes may conspire on the part of the mother, which may render weaning necessary, both for her health and that of the child. First. Her general health may be so impaired, from some constitutional disease, —as consumption, king's evil, scrof- PERIOD OF WEANING. 483 ula, dyspepsia, &c,—as to make it important for her safety to wean the child. Secondly. She may be attacked with some active disease, as fever, local inflammation, especially in the breasts, the loss of her nipples, or any other cause that can seriously affect her milk; and this may continue long enough to injure the child materially. We Avould remark here, hoAvever, that the mother who labors under any form of fever whatever can suckle her child; and although she may receive an injury by so doing, the. child may remain unaffected. Thirdly. The mother may not be able to afford a sufficient quantity of milk; what she has may be deficient in quality, and thus even this small quantity may prove injurious both to mother and child. Under such circumstances, it should always be Aveaned. By these rules or remarks, we design to convey the idea that, when anything occurs on the part of the mother which would prove detrimental to her health or safety, in case of her suckling her child ; and when its condition is such as to insure as much safety for it as benefit to the mother, or even not so much, in such a case she should, by all means, wean it, even though the child be injured by it. For it is better that the child suffer than that the mother die, though we should save both if possible. Fourthly. The mother may become pregnant while she is 6uckling; and this, with some, is an unwavering call to wean the child; which, hoAvever, is not always right. We have known many ladies who have become pregnant, and continued to give suck to their children for months; and both mother and child did Avell. We have, indeed, known some ladies,—and other authors furnish many such cases,—who have continued to give suck till another child Avas born, and this without injury to mother or child. These cases are, however, comparatively rare. The only rule that should govern the mother as to the time of weaning, is furnished by the affirmative answer to thesle ques- tions : Is your milk healthy ? Do you furnish a sufficient quan- tity for your child? If so, the child may suck till it is at least a year old. But when the milk becomes thin and poor, and defi- cient in quantity, and the mother is failing in strength daily, the child should be weaned, if it be well, although it is only six months old. When the milk disagrees with the child, it will eject it from the stomach, when it will be curdled or very thin, 484 PERIOD OF WEANING. and smell badly; and, in this case, it will disorder the child's bowels. We have considered this subject in relation to the mother, and now continue it in reference to the child. Supposing the mother to be healthy, there is nothing on her part that makes it neces- sary to Avean the child. Different authors have decided on vari- ous periods for weaning children; some say at the age of siy months, and others nine or twelve months. Our own opinion is, that no age can be given. We consider it the best of all rules to folloAV nature, when she is not thwarted by art or disease. Let us, therefore, ascertain her language on this subject. At a certain period, earlier or later, she supplies the infant with teeth, the manifest design of which is to cut and masticate food. This tells us, in stronger language than any physiologist can command, that the stomach of the infant is prepared to digest stronger food than breast milk. Such food should, therefore, be selected, as will best suit its strengthened condition; of Avhich, however, the quantity should be small. If one child cut four, six, or eight teeth, at the age of six, eight, or ten months, and another child the same number at the age often, twelve, or four- teen months, the stomach of the first will digest animal or vege- table food that number of months earlier than the latter. If this fact be kept in view, the mother will not materially err as to the first rule. Again; we lay it down as an invariable rule, which observa- tion will attest, that a child should never be weaned Avhile it is sick. And we give the following reasons: First, because milk is more easily digested than any food that can be prepared for it. Secondly, it never disagrees with any medicine which a child may take. Thirdly, there is no plan that can be adopted by which nourishment can be so easily conveyed into the stomach as by sucking it from the breast. Fourthly, when children vol- untarily Avean themselves, while sick, they rarely do as well as when they continue to suck. Fifth, breast milk will frequently restore a child to health, Avhen all medicine and artificial feed- ing fail; and, therefore, Ave say, never wean a child when it is sick. Further, it is a matter of common observation, that the season of the year has more or less influence on children undergoing the process of weaning. And for this reason we should, all things else being equal, select the most temperate months, namely, Aprh, May, October, and November, as the most favorable. In these, PERIOD OF WEANING. 485 the nights are not so long as in some others; and a long night passed with a child undergoing the process of weaning, is extremely trying to the mother. In cold weather it is apt to suffer if it sleeps apart from its mother; but in the months just named, both these evils may be avoided. When the time for weaning is determined upon, it should be gradually prepared for the change by being allowed a little solid food, according to the rules laid down on feeding. A little bread and butter, with sugar on it, may be given once or twice a day for some days, and then increased in amount, adding, too, a small portion of animal food. Give it the breast less frequently, and allow it to take less at a time; and, by this course, it will soon be entirely weaned. As soon as they can reach out the hand, children are pleased with anything that is smooth or shining, and quickly carry it to their mouths; and, by taking advantage of this disposition, they may readily be taught to take water, milk, &c., out of a cup or spoon. Glass or china should not be given to them when cutting front teeth, as they will bite its edge, and thus produce an unpleasant sensation; for which reason, they will refuse it for a long time afterwards, thus making it troublesome to feed them. Metal will serve a much better purpose. When the child is accustomed to eat gradually, take the breast from it; and, by day and night, be careful to adhere strictly to the Avhole process of weaning, as here laid down, never varying from it, unless the child be taken suddenly sick. By exciting disgust in the child for the breast, by means of something bitter applied to the nipples, or something unsightly placed over them, but little trouble will be experienced in weaning it. A solution of aloes, soot-tea, or any bitter substance, will have this effect; or a piece of black court-plaster placed over the breast. Filling the bosom with wool, covering the breast Avith the skin of a small animal, as a squirrel, or rabbit, or anything else that it may dislike, will frequently cause the child to wean itself, and thus spare much trouble. Food should always be kept prepared for the child, Avhich should be given to it when it becomes disgusted Avith the taste or appearance of the breast; and by this means it will soon prefer the food to the breast. There is much benefit derived from this course, as it saves the child from crying or fretting, which sometimes produces fever. While the process of weaning is going on, the mother should not forget to attend to her breasts; and if the milk secretes freely, they should be drawn partially, once or twice a day, for a few 486 FOOD PROPER FOR CHILDREN, ETC. days. At the same time, she should live on dry food, and anoin the breasts with the following liniment three or four times a day: Recipe: Spirits Camphor, Laudanum, Sweet.Oil, — of each half an ounce. Mix in equal parts, and shake well together. Spirits of cam- phor alone will do much good; or horse-mint, stewed in vinegar, may be applied daily over the breast and under the arms, for a few days. If feverish, she should take a dose of salts, senna tea. or castor-oil, and be careful to avoid all fatiguing exercise. OF FOOD PROPER FOR CHILDREN AFTER WEANING AND UNTIL THEY CUT THEIR SECOND TEETH. We have in another chapter laid doAvn several rules for dieting children before and at the time of Aveaning; and we now proceed to speak of the diet proper for them from this period to that of their second dentition, or cutting a full set of teeth. This we may well consider a subject of sufficient importance for a distinct chapter, when Ave take into consideration the variety of diseases to which children are subject at this period, and are satisfied, at the same time, that many of these diseases are brought on by improper diet. Notwithstanding an important change has taken place in the process of the first dentition, yet there is one equally if not more important to follow. The digestive organs are yet weak, the system tender and irritable, and every deviation from the strict rules of propriety, in diet, is liable to derange the stomach and lay the foundation for disease. It therefore becomes our duty to inform ourselves on "this subject. A diet principally vegetable should be used till the child is two years old, though it may occasionally take a small portion of light meats, such as fresh beef, mutton, lamb, fresh fish, &c. Boiled fish is more easily digested than fried; veal, or pork, or the flesh of ducks and geese, is not easily digested, and should not be given to children. All salted and cured meats are objec- tionable, for the same reasons, and, therefore, should be given very sparingly. Fresh venison, and indeed all wild game, is easily digested. Children should not be allowed to take animal food oftener than once a day, and then it should be well cooked, made fine, and taken with a moderate quantity of vegetables, and never without bread. Much pastry is highly objectionable; and after THE CONSTITUTION OF INFANTS. 487 all that is or can be said on this subject, milk and bread, with a little SAveet butter, form the best diet for children. To this may be added, rice, sago, light soups, soft boiled eggs, custards, bread puddings, mush and molasses, well-cooked potatoes, cymlings, &c. The parent should ahvays judge of the quantity the child should eat; and nothing is more pernicious than to allow it tc have a little of anything it may see on the table. Highly seasoned meats, steAVs, cutlets, and fricassees, should be avoided, as Avell as rich dressings of every kind; for they are indigestible, and may produce cholera morbus or fever. Milk, or coffee well diluted with milk, lightly SAveetened, together with bread and butter, make the best breakfast and supper for children. As they grow older, they should be taught to eat anything that is com- mon, so that they may feed themselves easily at a table furnished with any article of diet in common use. Small children should not be indulged in eating candies, ice-creams, &c., nor in using ice in their milk or water, nor in eating confectionary, or unripe fruits of any kind, for they are all indigestible, and are apt to produce sickness. Nor should they ever be allowed to drink spirits of any kind, or in any form. If the parent never tastes a drop in the presence of a child, it will not wish to taste it. Thousands of drunkards have been made by giving the child a SAveetened dram in the morning, or a tansey dram to kill the worms. The motto of the parent should be: " Touch not—taste not—handle not" the poisonous drug; and the countless evils which it brings with it Avill thus certainly be avoided. OF THE CONSTITUTION OF INFANTS. Whether we regard the helplessness of the earliest spring-time of life, or reflect on the comparative mortality of childhood, the study of infantile pathology is replete Avith tender interest and instruction. When the physiologist begins to explain the phe- nomena of organic life, he should select the animal in which the organization is the most simple. For this reason, " the constitu- tions of young children are the most favorable for the study of disease," because usually marked by greater simplicity, and unmodified by alarm as to the result of their disease. They are not acted upon by sexual influence, by mental emotions, or disquietude; nor are their minds influenced by the changes resulting from the wear and tear of body. Children are also unaffected by the alterations of structure produced by repeated and complicated disease. Acute attacks in them, if not arrested 483 CONSTITUTION OF INFANTS. very soon, disorganize and change the normal condition of some important organs; thus forming Avhat is called a Aveak or deli- cate point, which becomes in after life the seat of disease. There is a greater uniformity in the diseases of children than in those of adults; their pathology being uncomplicated, the system of the child is capable of constant modification. It is often in our poAver to mould and modify the body; to impart to it that degree of perfection, at Avhich the standard of health, as Avell as the requisites of beauty, are to be found; and at this period of life there is a predisposition to disease, in an imminent degree, which arises from the peculiarity of infantile physiology and the sud- den changes of condition Avhich the vascular and nervous systems are undergoing. The heart is soft, possessing but little poAver, and is extremely irritable; its left or arterial side is, relatively, of large size, and the course of circulation is undergoing a meta- morphosis in the foramen ovale, the arterial and venous ducts, and the umbilical and portal veins. Corresponding with this, we notice the extreme celerity of the pulse and breathing,— the infant pulse varying from one hundred to one hundred and ten strokes, and the breathing about thirty-five times in a minute; Avhile, in the adult, the healthy pulse is about seventy-five strokes, and the breathing from eighteen to tAventy-four times in a minute. The bright pink hue or blush of the skin, in infants, is an evidence of their excitability. The brain and ganglionic masses are large in infancy, and the nervous system highly impressible,—a property constantly illustrated by the facility with which crying and laughing are excited, and the rapidity Avith which depression and exhaustion take place. As life advances, the cerebro-spinal system predominates, and diseases of irritation are more characterized by tetanic convulsions. From these pecu- liarities we may explain the very sudden'changes in infantile diseases; "the rapidity with which the tenacious mucus is formed into a substance so much resembling a membrane, in croup;" and the almost instantaneous effusions which take place in the serous cavities. The majority of infantile diseases bear an inflammatory character, in a certain degree. Children are seldom attacked with neuralgia, or pain in the nerves. The cause of their pains may, in a large proportion of cases, be traced to some offending matter in the stomach or bow- els ; for the mucous membranes are the first to take on an exces- sive action. There are, however, no membranes so vigilant in their own cure as these; for when diseased, they readily and CONSTITUTION OF INFANTS. 489 rapidly pour out an abundant secretion of mucus; so that in slight cases our interference is scarcely called for. The copious secretion of mucus from these surfaces would seem to tell us that nature is acting on the defensive, and that these discharges are salutary in keeping down inflammation. The liver, the pancreatic gland, the salivary glands, the mucous glands of the boAvels, all come to the aid of the system, in this important work. Some of the most severe infantile disorders arc those Avhich are symptomatic, or secondary, as affections of the head in hooping-cough; inflammation of the air-vessels of the lungs in bronchitis; pneumonia, or inflammation of the substance of the lungs; the various effects of scarlet fever, and diseases of the chest from measles. All diseases of infants are modified by hereditary taint, in cases Avhere any such taint exists. In addition to the natural causes of disease, the system is exposed to the influence of external agents, the vicissitudes of temperature, &c. There is suddenly imposed on the alimentary canal the duty of assimilating the food taken in for the nourish- ment of the system; and the tender infantile system cannot be acted on by these influences with impunity. Many, very many children, die in the first year of their lives, from exposure to cold air; for their power of generating heat is extremely limited. All establishments for the cure of infants,— such as hospitals, infirmaries, «fec,— as Avell as the daily observation of all phy- sicians, furnish evidence in proof of this fact. Thus Ave see, that the digestive functions are not ahvays adequate to the task they are called on to perform. Aliment does not always, on its introduction into the stomach, prove congenial to it; as the early process of digestion seems to be a struggle between the stomach and the aliment it receives. Another cause of disease in early infancy is, the retention of the meconium, or first passages. Nature, however, always true to her trust, Avhen not interrupted by art, has given to the first milk secreted a quality capable of carrying off the passages; but, if there be any interrupting cause, a portion of this matter may be retained, and, adhering to the coats of the bowels. become an irritant, and prevent the operation of the nutritious quality of the milk; thus causing griping pains, and, if not removed, eventually, perhaps, producing death. Hence, the interference of art is sometimes necessary; and some gentle med- icine must be given, to remove the offending cause. The process of teething is often accompanied with a variety 490 CONSTITUTION OF INFANTS. of morbid effects, sometimes causing death, particularly while cutting the first or milk teeth, as they are called. Teething may be considered detrimental in the ratio of integrity or derange- meat of the functions, especially of the stomach and boAvels; all of Avhich is natural to the peculiarity of the constitution of the infant. When the system is deranged, this process will appear under signs of an unhealthy aspect. When a strumous condition of the system is manifest by external signs, such as a deficiency of ossification of the bones of the head, or enlarged ends of the long bones, or disease of the spine, or chronic hydrocephalus, or water in the brain,— some general excitement is ahvays pro- duced, in a greater or less degree, by teething,— and where any of the above causes exist, the case will present symptoms more or less unfavorable. If the child be unhealthy, the fever will assume either an intermittent or a remittent form. It may fix on some particular organ, peculiarly disposed, and thus produce inflammation of some kind; the most frequent form of Avhich is that of the brain, or venous congestion, terminating in partial paralysis, convulsion, or dropsy of the brain. Nature is ahvays trying to relieve herself; and, in these cases, her remedy is a drivelling from the mouth, a diarrhcea, or an eruption on the skin. The two latter, when immoderate, constitute, of them- selves, disease; but Avhen they are moderate, they act as a preventive of fatal disease. An inquiry into the morbid influence of teething, especially as it regards the question of its primary action on the boAvels or brain, is a most interesting one. The functions of these organs are often simultaneously affected; they are, however, not always dependent on each other; for the brain may, in some cases be the seat of disease, and the boAvels remain but little affected. But, in severe affections of the bowels, the brain will always, sooner or later, participate. Convulsions, — so prominent a symptom in the disease of infants, and so frequently the pre- cursor of death, —point us forcibly to the study of cerebral pathol- ogy, in the diseases of children. The question of the original location or point of origin of these convulsions, is not easily answered. They may be produced by too much fulness, or by debility; and hence, Ave see them where the bowels are too loose, as well as where they are constipated. They may be pro- duced through the immediate influence of the nerves of the teeth, or some other nerves ; or inflammation may be occasioned by too great fulness of the veins leading from the sinuses, and / EXTERNAL SIGNS OF INTERNAL DISEASE. 491 terminating in effusion. Mesenteric tumors Avill soon produce a copious secretion of urine, from an obstruction of blood in the large venous trunks. We leave these questions as matters of reflection to the reader, and point to the pathology of the brain as the most important in regard to teething, as it is, indeed, in all the acute diseases of childhood. THE EXTERNAL SIGNS OF INTERNAL DISEASE. Fortunately, both for the parent and the physician, there are certain signs by which our remedies may be successfully directed in the cure of disease. The rallying poAver of infants is so great that we can, Avith no small degree of confidence, enter upon the treatment of their cases, hopefully expecting a cure. The healthy body of an infant is always in a state of renovation and increase; and the constitution itself often performs apparent miracles, even at the point of collapse, if the acute symptoms are removed. We should carefully Avatch the first buddings of infantine disease; and, although this important point is often overlooked or concealed, yet there is one,—if ourvisions were suf- ficiently acute to discern it, — at Avhich the disease might be arrested. The signs of incipient disease are not common to most observers, and are, therefore, often neglected; and sometimes they are so insidious that the most acute observer may fail to perceive them. We shall notice some of these external signs, because they point to internal disease. The saffron tinge of the skin, the white of the eye, or the urine, denote a derangement of the liver; anasarcus indicates a diseased function of the liver, or mesenteric glands; a livid com- plexion points out a cachectic, and glandular tumors show a strumous state of the system. A wasting of the flesh, with a tumid belly, shows that the child is in a state of marasmus, and also of venous congestion, from a pressure on the vascular trunks. By bearing these signs in mind, the mother will be able to know under Avhat form of disease the child is laboring. We now proceed to point out those symptoms which are more obscure. Grown persons can tell the seat of pain, and describe their feelings; but children cannot communicate to us in this way. Nature, however, is an unerring guide to truth, and she has a language which all can speak and understand. The moan or cry of pain, the expression of the features, the attitude and action of the body and limbs, will often be, if skilfully inter- \ 492 EXTERNAL SIGNS OF INTERNAL DISEASE. preted, a more certain guide to the true character of the disease than the doubtful meaning of words. As the expression of the features is the index of the mind, so does it present the earliest indications of unhealthy changes in the system. The pupil or sight of the eye, in a healthy infant, is usually dilated a little, and its alterations are very frequent; and when the dilatation or contraction is permanent, it becomes a matter of more impor- tance. If accompanied by a livid hue or flaccid condition of the face, it is often an indication of effusion in the brain. In the progress of hooping-cough, the eye should be attentively regarded. While the disease is confined to the organs of breath- ing, it will be little affected, except by redness produced by a paroxysm of coughing; and we may very certainly decide if the brain is about to participate, by the fixed contraction or dilatation of the pupil. A squinting suddenly taking place, in connection Avith other symptoms, though it may be produced by worms in the stomach, or the rays of light constantly falling on the eye from one direction; the contraction of the pupil of the eye to a small point, Avith the lid half closed, and the white of the eye streaked with red; a froAvning, or knitting of the brows, with spasms of the ball of the eye, mark the condition Avhich has ter- minated in inflammation of some of the membranes of the brain. or will soon do so. Spasms of the eyeballs generally indicate inflammation of the arachnoid membrane, in the base of the brain, Avhich is a dangerous symptom. It may be remarked, hoAvever, that, during the sleep of an infant in health, the pupil often becomes closely contracted, and rapidly dilates when the eye is opened. When the eyeball is fixed, and drawn up under the eyelid, the pupil widely dilating and contracting, the eye looking bright and glossy, we may expect convulsions or epilepsy, if these symptoms are not speedily removed. If, on exposure to light, the apparent effect is not produced on both eyes, one pupil being fixed and the other contracting, the child may be consid- ered in great danger. A sinking of the globe of the eye, its orbitar circle becoming dark, is the effect of rapid absorption, and is soon followed by extreme prostration. Any peculiar movement about the none.or lips indicates dis- order of the chest or abdomen; and if there be any impediment to the transmission of air through the lungs, the nose will be drawn in during respiration. If the mouth be kept open in an unusual manner, and the lips puckered and of a livid hue. when the nose and upper lip are tumefied, these are signs Avhich indicate EXTERNAL SIGNS OF INTERNAL DISEASE. 493 irritation of the bowels, as from Avorms, or a loaded condition of them, with a redundance of mucus, &c. If the inside of the nose be dry, and the lips pale and cracked, attention should be paid immediately to the condition of the head; and when Ave see frequent spasms of the loAver jaw, Ave may anticipate that the base of the brain is threatened, and the case should receive immediate attention. The motion of the limbs is an external sign of internal disease. Children in health move their limbs indiscriminately, seldom employing any exclusive action. They will spring, kick, roll, move the arms, craAvl and tumble about, in all the varieties of antic display ; and these motions are readily recognized, and gladly hailed by mothers as signs of health and vigor. But when we consider their movements as a series of symptoms, we must take a different view of the case. The part unusually active is rarely the seat of the disease; but such actions are, generally, the result of remote sympathy. If any particular movement be observed, it will be found, on close examination, to correspond with the extent of disease in some other, and perhaps remote, part of the system. In infancy, for instance, there is often a doubling up of the body, to relieve tension ; and Avhen inflamma- tion exists in the loAver boAvels, the legs are forcibly draAvn up tOAvards the belly. If, hoAvever, one limb be violently moved, it may be the seat of pain. There are two conditions of the limbs that indicate disease. First, an excess of action amounting to spasm; and, second, a loss of poAver; palsy depending on a peculiar irritation of the nervous system, from a variety of causes. The simplest form of spasm is manifested by starting in sleep; and as early as the fifth or sixth day, infants will be attacked Avith spasms of the muscles of the face, loAver jaAv, or neck, and, in severe cases, the lower jaAv becomes fixed. This form of spasms in infants is fre- quently produced by retained meconium, or extending ulceration of the umbilical cord. Convulsions may be produced by painful dentition, and, when this is the case, they are preceded by swell- ing of the backs of the hand and tops of the feet. There are other causes for convulsions, such as acidity of the stomach and the making of an effort by the system to throAv an eruption on the surface. In these cases, the lungs are often rigidly distended, but yield when the eruption appears. A contraction of the fpgers and toes is an evidence of severe convulsions. And there is a species of disease of the brain,;, marked by a draAving back of the head, and attended by a 494 LANGUAGE OF COMPLAINT DURING PAIN. croiving noise. Palsy, which is the reverse of this, and is most frequent in children of a lax and feeble frame, is usually accom- panied by wasting and coldness of the limbs; it may occur during teething from gastric irritation, or at the decline of fever; and pirtial palsy is not unusual during teething. The limb affected by this form of palsy -will ultimately regain its strength. Hemiplegia and paraplegia are dependent on more important causes in the brain and spinal marrow. In older children, an uplifted step or staggering gait, and a rocking of the legs, often indicate that species of dropsy of the brain which occurs without fever or acute disease ; and if the child moves much from side to side the spinal marrow is usually affected. THE LANGUAGE OF COMPLAINT DURING PAIN. The expression of complaint by mere simple sounds may be a voluntary, natural effort to relieve, or it may be involuntary, depending on morbid changes in the organs of respiration, as the Avhistling in croup. Weeping, though sometimes an indication of severe pain, is also an inArohmtary mode of relief. The first natural effort of an infant is crying, and by this means the air-cells of the lungs are distended and a free circulation ensues. In the system of the child, an excited condition, or an accumulated irritability, often occurs, for the dissipation of which, crying, laughing, or free exercise, is absolutely necessary. As, in the adult, the suppres- sion of grief and tears is often deleterious, so, in the infant, congestions would more frequently occur were it not for this mode of relief. An infant will never fret unless it be uneasy; and fretting may be the mere sensation of fatigue, as sleep is usually preceded by it, or it may arise from mechanical irritation, such as bandages, pins, or too great fulness of the stomach. Continual fretfulness often marks the beginning of disease, at which period there is time for the employment of a remedy. If fretfulness is combined with a disposition to doze, or take short naps, from which the child starts suddenly on the slightest motion or noise, there should be no delay in the administration of a remedy, for some important organ is invaded by disease. The same observation will apply to those conditions that are marked by rapid changes, such as becoming suddenly silent in the midst of a whining cry. Screaming. This expression of the existence of disease is a LANGUAGE OF COMPLAINT DURING PAIN. 495 violent effort, indicating vigor, and is usually heard in the early or acute stage of disease. The face is flushed and the veins turgid, in proportion to the difficulty caused by the effort in the return of blood from the head; and when it becomes shrill and keen, and the heat of the skin is increased, inflammatory action has probably commenced. In inflammation of the gums from teething, the screams will be more or less protracted; but in inflammation of the chest or belly, the effort of breathing pro- duces continual suffering, and increases the pain so much that the child controls, for some moments, the expression of those screams by fits and starts. Local symptoms. These will direct us to the seat of pain; as. intolerance of light and tossing of the head point our attention to the brain; quick breathing, a panting or coughing, directs our attention to the lungs; palpitation of the heart, to that organ; costiveness or diarrhcea, to the boAvels; nausea or vomiting, to the stomach: and a croaking sound points us to the larynx. Moaning is the most important and threatening language of com- plaint, as it is expressive of suffering, either from Aveakness or depression, Avhich makes inflammatory diseases so difficult to treat. In painful dentition, children moan and grind their teeth at intervals, and in acute disease the moaning is repeated at every respiration. Moaning is the peculiar characteristic of disease of the stomach and boAvels, especially if the body be bent and the legs drawn up. But if deep sighs precede the moaning, and the child speak Avith a nasal tone, leaving sentences half expressed, there is then, usually, a tending to effusion on the brain. Respiration. There are peculiarities in respiration that should be attended to, as they are closely allied to the language of com- plaint. They are discovered in the modifications of respiration. Difficulty of breathing is not uncommonly produced by a mechanical pressure of the large glands, that is, of those under the jaAvs, and sometimes the thymus gland, which lies immedi- ately under the breastbone; and to distinguish this from a real disease of the air-tubes of the lungs, is very important. The most formidable change from healthy breathing is that attending a disease bearing the name of croaking, chronic or cerebral croup, closely resembling the whistling sound in hooping-cough, but differing Avidely from it in its nature and cause. This disease consists in a spasm of the muscles of the glottis, and a secondary effort from a violent exertion* to open the laryngial constric- 496 USE OF FRUITS, ETC. tion, as mere coughing is to open the air-cells of the lungs. It is possible that pressure on the recurrent nerve, produced by a sudden rush of blood in the glands that press upon it, may produce this effect, but it is generally caused by cerebral irrita- tion. This croAving sound, though it may steal on insidiously, may be transient, and subside almost instantaneously, effecting the entire recovery of the child. "When it recurs frequently, and becomes more severe, it is attended Avith danger, and is often indicative of tubercular menengetis."—Dindy. We may also add, that when a cough assumes a spasmodic character, it usually indicates some affection of the brain; as cough, with mucous expectoration, is a pulmonary or bronchitic affection, and a dry and irritating cough, an affection from some disease or derangement of the stomach. We have noAV gone through most of the signs of internal disease of infants and children. Every mother Avould do well to treasure them up in her mind, that she may be able to ascertain the loca- tion of the disease of her child; then turn to it in the index, and, by tracing the symptoms of it, she will find the remedies laid doAvn for the different stages of each disease; when, by taking it in its incipient stage, she may be able to apply the proper reme- dies before it becomes dangerous, or difficult to remove. OF THE USE OF FRUITS, ETC. Questions concerning this subject are asked almost daily, and the answers are as various as the persons giving them. Experi- ence generally governs the opinion in this matter; if an article of diet agree Avith one child, the mother usually supposes that it will agree Avith all children; and, on the contrary, if it disagrees with her or her child, it is supposed to be unhealthy for all others. This mode of judging of the healthiness or unhealthiness of an article of diet, however, should not be depended upon; the old adage being true in general, that "what is one man's meat is another's poison." But the question of the propriety of a given article of food requires several considerations, and so many excep- tions, that no one should venture to ansAver it positively before giving to it an attentive consideration. There are a feAv plain reasons that should govern us in our judgmmt on this subject. First. It is obvious that the Author of our being never intended that those who have no teeth should live on the same food that those do who have teeth. The diet that would be proper for the one, would be decidedly improper for thi USE OF FRUITS, ETC. 497 other. From these considerations, Ave see that animal food, pas- try, fruits, confectionary, &c., would be improper for infants; tliough these articles are not umvholesome in themselves, Avhen taken in due quantities by an adult, or children that have teeth. Second. The food that would be proper for children after the teeth are perfect, would not be proper while they are forming. Third. The food for adult age, if employed before that period, Avould be often found highly injurious, though the general expe- rience of the Avorld shows that it is not hurtful in itself. Fourth. The food which universal experience declares wholesome, can only be so when taken in due quantities, at proper periods, and under proper circumstances; and, therefore, when we speak of food on which thousands have lived and done well, or from Avhich others have suffered, as being Avholesome or unwholesome, we certainly mean that it is either the one or the other, according to the age, constitution, circumstances, &c., under Avhich it is taken. We Avould not be understood to say, that any article which is common would.be hurtful to those Avho are in the habit of using it, but that circumstances make it so in many cases. We have declared that the meat of one animal is better than that of another; but this is very often a relative expression, as any of these articles may be pernicious under some circumstances, and the worst may not be so under others. Shall Ave again ask the question, Are any of these substances injurious to children before they get their first teeth ? And if so. What are they? These questions are fully answered in various parts of this Avork; but as indulgences in certain articles, at the period designated, may be too often granted, we shall say a few Avords under the heads of the different articles of diet used by children. And, first, of fruit in general: Fruit is ahvays in one of these states,—green, ripe, or dried; and of it, that is, of apples, pears, peaches, cherries, raspberries. strawberries, deAvberries, blackberries, whortleberries, grapes. oranges, plums, pineapples, apricots, melons, &c., various opin- ions are entertained; but all agree they are injurious when green. We Avish to be understood, when speaking of fruit as a diet, to speak of ripe fruit, unless otherAvise expressed; and in doing this we shall limit ourselves to children under two years of age. We do not think fruit of any description proper for them, as we find its effects on them uniformly injurious. But is it asked, How can it be injurious, since they are so fond of it, and nature has fur- nished it so abundantly? In ansAver to this question, we say, bright. 33 498 USE OF FRUITS, ETC. Children are no judges of the effects of fruit, nor of any other article of diet. They Avould eat the fruit of the Jerusalem cherry, the berries of the laurel, or the seeds of the stramonium, with as much avidity as they would the apple or the peach, though death would be the inevitable consequence. And to the second ques- tion we add, that nature has spread her poisons with as profuse a hand as her Avholesome fruits, and, consequently, the abun- dance of an article cannot prove it to be good for food. Children under tAvo years of age should take fruit very sparingly; though a little, perfectly ripe, and deprived of rind and seed, may be given occasionally. The fallacious notion that blackberries and deAvberries are good for children suffering from diarrhcea, should be laid aside; for the seeds of those fruits are numerous and small, and act as an irritant to the bowels, increasing the disease they are designed to cure. Fruit of almost every kind is less digestible than farinaceous matter. The stomach of the ostrich, for example, which is said to digest harder substances than that of any other animal in the Avorld, will not digest the pulp of a watermelon. When the stomach is incapable of assimilating what it takes into it, much disturbance is produced in the boAvels, and often fatal diarrhoea. Some suppose that it will .throw off all it does not digest, and therefore any quantity may be taken Avith- out injury. But this is a mistake; for food undigested acts as foreign matter. SwalloAving the skins and seeds of fruit is urged by some, because it is thought that they promote digestion; but this is an error, and should not be indulged in. Digestion is per- formed upon vital principles and is a vital process, not one of fermentation or trituration. Dried fruit is next in consideration. Of this there are various kinds, as raisins, cherries, apples, peaches, pears, figs, prunes, &e.; and of these it may be said, Avith safety, that they are more exceptionable than fresh fruits, but not all in. an equal degree. The most injurious are the first four just named. Raisins are very indigestible, unless deprived of their skins, and should never be eaten by children without this precaution being first taken. No stomach can digest the skin of a raisin. Dr. Deiifees says: " We knoAv, from experience, that the stomach of a hog cannot overcome the skin of this fruit." Yet they are given, by indulgent parents, in large quantities to their children, at an early age, regardless of the power of the stomach over them. Immediate or remote injury, and not unfrequently convulsions and death, are the consequences. Dried cherries, pears, peaches, ROSE-RASH, OR FALSE MEASLES. 499 and apples, are also unfit for children, especially when uncooked ; for, if taken in their dry state, they swell in the stomach, and are very apt to produce convulsions, and not unfrequently death. When they are Avell steAved, they are better suited for the pur- poses of food; but even then they should be taken in small quantities by children. The fig and prune are less objectionable, but they should be taken sparingly. The stomach, when healthy, will bear small quantities of them without injury. Adults often take steAved fruit to promote digestion or remove costiveness; but children should never take it for that purpose. OF THE ROSE-RASH, OR FALSE MEASLES. This is an efflorescence of a bright rose color, diffused, or in patches, on a fainter ground of pink color; sometimes assuming a serpentine form, resembling measles, and distinguished from it only by its bright color, and from mild scarlet fever, by the slight shading off from the principal spots. Very small watery pimples are sometimes seen in the eruption. In the hot months it is generally in the form of crimson or lake-colored patches, of an irregular shape, and at times there is a red circle formed around the patch. In grown persons this eruption sometimes appears during acute diseases. The patient generally has head- ache and feels Aveak before they make their appearance; but afterwards these symptoms usually subside in a short time. Treatment. — If there is much pain in the head, a child two years old should take: Recipe : Calomel, ten grains. Salts of Nitre, two grains. Mix, and divide into four powders. One of these may be given in sirup, and repeated every two hours till they operate freely. Increase or diminish the dose according to the age of the child. After the stomach is cleansed, keep the bowels open with: Recipe: Senna Leaves, half ounce. Manna Flake, half ounce. Mix. Boil to a strong tea, in half a pint of water. Give a table spoonful every hour, till they operate, and repeat this every day. Or, Recipe: Castor-Oil, half ounce. Spirits of Nitre, two drachms. Mix. Give a tea spoonful every two hours, till free purging is produced. Or you may give the following: 500 ROSE-RASH, OR FALSE MEASLES. Recipe : Pulv. Rhubarb, ten grains Calcined Magnesia, one drachm. Salts Nitre, two grains. Mix, and divide into four powders. Give one, in sirup 01 SAveetened Avater, every three or four hours, till an operation is produced. Repeat some one of these purgatives every day, till the rash subsides. The diet should be light and the clothing cool. There is another form of these eruptions, called erythema, which appear chiefly on the face and breast, in blotches of a dull crimson color, and disappear on pressure. They are usually transient, but sometimes are more severe, extending to and over a whole limb, and causing it to SAvell. This form of the eruption is often attended with distinct pimp'lesr and turns to a kind of purple color on its decline. It is attended by a quick pulse, and a considerable depression of strength. In some cases, it assumes the form of hard lumps, of a rose color, spreading out from the centre Avith a red blush, in which case there is more fever. In young females, it appears sometimes*on the fore part of the leg, spreads and becomes painful, but Avill gradually die away, in about a Aveek, leaving a dusky-looking spot. This is often an attendant on the sympathetic action of the uterine system; though it may be produced by external irrita- tion, and may also be the sign of deeper seated disease. It gen- erally, however, depends on some derangement of the stomach and bowels, or certain articles of diet. In children, it may be produced by unAvholesome breast milk; and certain medicines, such as arrowroot, balsam copaiba, or turpentine, will produce them in some children ; but in these cases they do not last long. In more slowly formed intestinal diseases, this complaint is more severe. We have seen, in very languid or unhealthy constitu- tions, the eruption of a very deep crimson color, or a dull, dark purple. In these cases the disease is marked by typhoid symp- toms, indicating a cachectic state of the system. The color of the eruption is very important in governing the treatment of the disease. The bright color requires a laxative and low diet; and the livid, in addition to the mild laxative plan, re- quires some mild tonics. It is needless to offer a long catalogue of remedies for all these forms of eruption ; but in the lighter forms a gentle puke, followed by some of the purgatives presented for rose- rash, will be proper. We should remember, of course, to remove the exciting cause, if possible. If the gums are swollen and hot, NETTLE-RASH. 5Q1 lance them, and change the articles of diet; regulate the temper- ature by changing the clothing, if necessary; and keep the patient quiet, and the bowels open, with gentle purgatives, such as castor-oil, rhubarb, or magnesia. If there is much fever, give the spirits of nitre, in water. Rice, tamarind, or barley-water, should be used as a diet and drink; and where the livid hue appears, a tonic, such as Huxham's tincture, should be given. The parts must be washed Avith»milk and water, and dusted Avith starch or hair-powder. In a Aveek or two the disease will be removed. OF THE NETTLE-RASH. The mild form of nettle-rash consists of white elevations, usually of a round, but sometimes of a long shape. The severer forms of the eruption are pale pink-colored elevations, on a deep rose-colored surface. The first form is unattended by fever; but the second is not unfrequently marked by the following symp- toms : pain in the head; sickness at the stomach; great Aveak- ness and faintness, accompanied Avith a sensation not unlike that of the sting of a nettle, from Avhich it takes its name. Scratch- ing or heat ahvays aggravates it. The eruption may last from six to ten days; after which time it will throw off the scales like fine bran. But if the spots become tubercular, and penetrate the skin and cellular substance beneath, all the symptoms are aggra- vated. The exciting causes are various; the emotions of the mind, excessive exertion, acetic diet, eating mushrooms, honey, the rind of cucumbers, strawberries, shell-fish, especially muscles, unhealthy breast milk, lemonade, and in some cases even boiled fowl or young cabbage, will produce nettle-rash. In cachectic habits, the eruption may assume a purple hue, appearing more like blood settled under the skin than anything else. The fre- quent occurrence of these varieties in the same patient is a suffi- cient proof of a peculiar susceptibility to the disease; and the frequent irritation of it will produce marasmus, remittent fever, and in some cases a heavy drowsiness approaching stupor. For these reasons, this disease requires attention. Treatment. — As there is more or less derangement of the stomach in nettle-rash, Ave should commence the cure by reliev- ing it of all offending matter ; and for this purpose, — to a child two years old, — the following medicine should be given : Recipe: Ipecac, ten grains 502 NETTLE-RASH. Dissolve this in three or four table spoonfuls of Avarm water, and give it at three draughts, fifteen or twenty minutes apart, until the child begins to vomit freely; and then it must drink plentifully of warm water, till it pukes three or four times. Tavo hours after the last motion upwards, give the following purgative: Recipe : Calomel, four grains. Calcined Magnesia, twenty grains. Mix, and divide into tAvo poAvders, and give one in sirup; and if it should not operate freely in two hours, give the other. The boAvels should be kept open with this medicine, unless there is much fever or drowsiness, after the first purge; in which case the patient should take the following: Recipe: Calomel, six grains. Rhubarb, four grains. Mix. Divide into tAvo papers, and give them in sirup, every two hours. When calomel is given, the child should drink toast-water; but when the other medicine is given, the drink may be cold. The dose must be increased or diminished accord- ing to the child's age. The skin may be rubbed Avith starch, sulphur, or hair-powder ; the diet should be light, and the drink cool, but on no occasion should it be acid. We knoAv that acid drinks are frequently recommended, but our observation leads us to forbid them. Children that are subject to this disease suffer very much by its frequent returns; and to prevent this, its cause should, if possible, be ascertained and removed. If it be improper diet, it should be avoided; if unhealthy milk, the nurse should be changed, or the mother take medicine, to purify her blood, and restore her milk to a healthy state ; and if irritation of the gums, they should be scarified. When the child is old enough to be fed, the diet should be light; the surface should be kept neither too hot nor too cold ; and scratching should be especially avoided. The bowels must be kept open, but no saline medicines should be given. Rhubarb or magnesia will be the best. The eruption is sometimes suddenly repelled by a drink of lemonade or a cool draught of air, and the patient becomes very sick, and perhaps faints, or vomits severely. Great prostration may take place; the feet and legs becoming cold, the pulse weak, the voice tremulous, and the lips pale or purple. Stupor may or may not ensue, and all the alarming symptoms of death hover around the patient. In this case, warm blankets must be ERYSIPELAS, OR ST. ANTHONY'S FIRE. 503 applied to the legs, a hot iron or brick to the feet, a mustard- plaster to the stomach, and some form of stimulant — as toddy essence of peppermint, mint tea, &c. — given internally; repeat- ing it frequently till the surface becomes Avarm, and then less frequently, till the eruption appears again. After this the stim- ulants should be omitted, and a dose of calomel administered; Avhich, when it operates freely, should be followed by rhubarb and magnesia, as above directed. Great care must be taken to avoid the causes that struck the rash in. If the child is very weak, the folloAving tonic may be given: Recipe: Compound Tincture Gentian, one ounce. Elixir Vitriol, one drachm. Mix. Give twenty drops, in sweetened water, three or four times a day, till the strength is restored. We would here remark, that, in all eruptive diseases, great care should be taken to keep the eruption on the surface till it disappears, and thus all these alarming symptoms will be pre- vented. OF ERYSIPELAS. OR ST. ANTHONY'S FIRE. A full history of this disease would require a treatise instead of a chapter; we shall therefore only say as much about it as the character of the present Avork requires. Erysipelas is divided into tAvo forms: first, that of debility; and, second, that of excess of action. The first is marked by a deficiency of poAver, from the commencement, often terminating in mortification; and is thought by some authors to be seated in the child, in some cases, before it is born. This may or it may not be true. It is certain, hoAvever, that, in some cases, it occurs in a few days after birth. This form of the disease shoAvs itself first in a dull crimson blush, changing to a purple or livid hue; often covered with blisters, or large lumps, which terminate in ulceration. It usually commences on the face, or about the private parts, the arms, legs, or belly; and occasionally, in new-born infants, in the navel. The symptoms are, a weak pulse, great debility, broAvn tongue, and at times delirium; the inflammation some. times penetrating so deep as to affect the peritoneum, or lining of the cavity of the belly. When the seat of the disease is in the navel, sinuses will sometimes form, and the parts slough off. The arrest of this disease is marked by a white line in the ear- 504 ERYSIPELAS, OR ST. ANTHONY'S FIRE. lier, and by pus in the latter, stages. Instead of bloody Avater, an ichorous discharge is seen, in the progress of the disease. Treatment.— For the cure of this disease, Ave must cause the secreting organs to do their duty, by commencing Avith the fol- lowing medicines, for a child six months old: Recipe : Calomel, four grains. Divide into six powders. Give one every two hours, in sirup or sugar and breast-milk, till they operate freely; after Avhich, give the following medicine : Recipe: Pulv. Rhubarb, four grains. Calcined Magnesia, twelve grains. Mix, and divide into six poAvders. Give one in sweetened water, and repeat every four hours, so as to keep the boAvels regular. A feAv drops of vinegar added to the Avater will be of service, to make the magnesia operate better. If the child is very feeble, give the folloAving mixture : Recipe : Carbonate of Ammonia, three grains. Elixir of Paregoric, one drachm, Pure Water, one ounce. Mix. Give tAventy drops, in a little sweetened water, every two hours, increasing or diminishing the dose according to age. But if the skin is hot and dry, the following medicine should be given in its stead : Recipe: Spirits Mendereri, one ounce. Give tAventy drops in orange-peel water, and repeat every hour, till the fever subsides. Or, Recipe : Spirits Nitre, two drachms. Water of Orange-peel, one ounce. Mix, and give forty drops, every hour, in sweetened water or balm tea. The inflamed parts should be bathed with the follow- ing solution: Recipe: Blue Vitriol, one drachm. Sugar of Lead, half a drachm. Mix. Make a strong tea of peach-tree leaves or twigs. Strain it, and to one pint of tea add one half of the above powder. Keep a cloth, Avet Avith this solution, constantly applied to the inflamed part. If the inflammation be situated near the eye or ear, and is likely to get into either organ, its progress must be arrested by a mark, drawn around the edge, with a piece of lunar caustic. The point of the caustic must be wet, and rubbed around on the sound skin, near to the edge of the inflammation. ERYSIPELAS, OR ST. ANTHONY'S FIRE. 505 This Avill cause a black mark, over Avhich the inflammation will not pass; shoAving plainly that the cuticle is its conductor. The part inflamed should be kept as still as possible, and the patient tolerably cool. If the mother's milk is not good, or she has not enough of it for the child, coav's milk, diluted Avith hot Avater, and slightly sweetened, should be used as a diet, in preference to anything else. Erysipelas sometimes terminates in sloughing; in which case, a poultice made of charcoal and hop-yeast should be applied. The grounds of stale beer also make a good poultice. Or you may take the inside bark of the common buck-eye, boil it to a strong ooze, and bathe the parts well with it; thicken it Avell with wheat bran, and apply the poultice over the parts affected. They may be touched, lightly, all over, Avith balsam Peru, before either of the above poultices are applied. The poultice should be removed every three or four hours; but before it is applied, if the sores smell badly, the surface may be lightly washed with the chloride of soda. Should there be deep-seated matter, it should be let out by an incision; Avhich, though a severe, is the only effectual mode of treatment. If the strength is likely to fail, some gentle tonic, such as the infusion of gentian or columbo root, must be given: Recipe : Pulv. Gentian Root, half ounce. Or, Recipe : Pulv. Columbo Root, half ounce. One tea spoonful of this root infused in half a tea cupful of boiling water, and a tea spoonful of the infusion may be given, in as much SAveetened water; repeating the dose every hour or two, according to circumstances. The second form of this disease shows itself in acute inflam mation,—the skin being of a bright scarlet color,—and is generally preceded, for one or two days, by slight chills, fever, and heat in the part, and a stinging or pricking sensation; the pulse not being very hard or full. This form of the disease Avill sometimes decline on the third or fourth day; in which case the skin becomes yelloAV and peels off. But if it should not termi- nate in this way, small blisters Avill form, and, bursting in two or three days, discharge an acrid, glutinous fluid. This is the lightest form of the disease. If the inflammation be more deeply seated, all the symptoms will be more severe; chills and acute fever, edematose swellings; and a deep burroAVing sanies Avill be Biaking its way among the muscles and tendons, and Avhen 506 ERYSIPELAS, OR ST. ANTHONY'S FIRE. discharged, it will be mixed with clots of dark grumous blood, entirely unlike the pus and circumscribed cells in common abscsss. If the disease is not properly treated in this stage, it is apt to assume the sphaceloid character, and will require a treatment adapted to this change. We sometimes observe, in the acute stage, that the cutaneous vessels are inflamed, and purulent depositions take place in the cerous cavities and lungs, when the disease is situated in the neighborhood of these parts. Treatment for the second form. — The first form of the second A^ariety of this disease should be treated Avith the follow- ing medicines: Recipe: Epsom Salts, half ounce. Tartar Emetic, half grain. Mix, and dissolve in half a pint of cold water. Give one table spoonful, for a child four years old, and repeat every hour, till it operates Avell. Use a light diet, and cooling drinks, which may be slightly acidulated Avith an orange or a few drops of vinegar. The folio Aving diaphoretic may be given: Recipe: Spirits Mendereri, half ounce. Give thirty drops every hour, in a little orange water; and let the inflamed part be sprinkled with flour. Should these remedies fail to perform the cure, more active medicines, such as the following, must be used: Recipe : Calomel, ten grains. Rhubarb, five grains. Mix, and divide into five papers, and give one every two hours, till a free operation is produced. If the pulse be strong and the fever high, the patient should be bled from the arm, and take the following: Recipe : Calomel, twelve grains. Scammony, six grains. Salts Nitre, two grains. Mix, and divide into six powders. Give one every tAvo hours, till a free operation is produced and the fever is cooled off. If the patient is old enough, Seidlitz poAvders may be taken; but if not give the following: Recipe: Rochelle Salts, two drachms. Tartaric Acid, one drachm. Mix in ten papers, and give one every two or three hours in cool water; and, at the same time, give: Recipe : Spirits of Nitre, half ounce. Wine of Ipecac, two drachms. Mix. Give ten drops, in water, every hour. HYDROCELE, OR WATER IN THE SCROTUM. 507 If tne brain or lungs be threatened, and the pulse will bear the tancet, bleed; but if not, apply cups or leeches over the chest, to the temples or back of the neck, as the case may require. They must be applied, hoAvever, on the sound skin. The blue oint- ment may be applied all over the inflamed part, and the pro- gress of the inflammation arrested by a line draAvn around it, with lunar caustic, about half an inch from the inflamed parts. Some authors recommend the application of a blister, over the inflamed parts, as an infallible remedy; and Ave have known it to do good. If the patient is fleshy and the inflammation deeply seated, it will be advisable to make several cuts with a lancet through the inflamed skin, to relieve the engorged blood-vessels: and soft poultices of flax-seed or light bread and milk may be applied, keeping them constantly at rest, and, if possible, elevated higher than the other parts. If the disease arise from a punc- tured Avound, as it very often does, it should be freely laid open, and made an incised Avound. The same solution of the sugar of lead, blue vitriol, and peach-leaf tea, should be used, as in the other forms of the disease. In convalescence, some tonic should be given, according to the state of debility, —the gentian or columbo, as in the other species; or a Aveak solution of quinine; as. Recipe: Sulphate Quinine, six grains. ' Elixir Vitriol, ten drops. Water, one ounce. Mix. Give the drops five or six times a day, in SAveetened water. In all cases, the patient should be alloAved a pure air; and. in convalescence, a generous diet, according to age and strength. OF HYDROCELE, OR WATER IN THE SCROTUM. The first appearance of this disease is manifested by an enlargement of the scrotum, and is generally perceptible in three or four days after the birth of the child, who in all probability was bom Avith it. The appearance of a SAvelling in these parts generally alarms the mother, who is ahvays certain to suppose it to be a rupture. The swelling feels hard, but is not pained by the touch. This SAvelling may always be distinguished from a rupture by the following rule: If a lighted candle be held, in the dark, below the tumor, and it presents the appearance of a slightly reddish transparent color, it may be regarded as certain proof chat the disease is not hernia, but only water in the scrotum. 508 INGUINAL HERNIA, OR RUPTURE. The Avater is generally confined to one side of the scrotum, but we have seen it in both sides. Children are liable to this disease up to the age of three or four years. In hydrocele, the tumor is smooth, and cannot be returned into the abdomen; nor is it at all painful, and it is ahvays of the same size. Treatment. — The remedies of this disease are feAV and simple. If the child is very young, the application of cold Avater, — say half a gallon each time,—poured, morning and evening, from the spout of a tea-kettle or coffee-pot, as high as the child can bear it, will, generally, in the course of a Aveek, cause the absorbents to take up the Avater. Bathing the parts with Aveak spirits of cam- phor Avill frequently cure it in a week or two. But should the child be three or four years old, the folloAving medicine should be given: Recipe : Cream Tartar, one drachm. Pulv. Jalap, half drachm. Mix, and divide in eight poAvders. Give one poAvder, morning and evening, in parsley tea, and continue this for ten or tAvelve days, at the same time bathing the parts, as above directed, with cold water, and a cure will generally be effected. No fear need be indulged of the return of the disease after the absorbents have taken up the Avater. Some surgeons advise a puncture to be made 'n the scrotum with a small trocar; but the above remedies should always be tried first. If, however, an operation must be performed, three or four silk threads should be passed through the scrotum, from above, doAvnAvards, with a small seton needle, great care being taken not to touch the testicle. Let the threads remain for six or eight days, and then draw them out, one each day, till all are remo\red. If much inflammation is induced, bathe the parts Avith sugar-of-lead Avater; though some inflam- mation is necessary, in order to effect a cure. OF INGUINAL HERNIA, OR RUPTURE. This disease is not of very frequent occurrence; but Ave occasionally meet with it in children, though more frequently in adults. It may exist before birth, or take place soon after: and may be suspected to exist Avhen the scrotum on one side is unusually large. It may be detected by the tumor being removed by pressure, and by the testicle not being discoverable. It may take place at any period, but generally occurs during the most active stage of life. If a candle be held beloAV it, no trans- parency will be discovered, on attempting to look through it. UMBILICAL HERNIA. 509 Treatment.—Dr. Underwood says, "It may be safely left without a bandage, and the cold bath used for its cure, when it happens to children before they walk." Dr. Physic advises " the application of a properly constructed bandage or truss to the part, as soon as the disease is discovered." We are of Dr. Physic's opinion. The use of the truss should not be delayed. If the truss be properly constructed, and applied when the hernia is first discovered, and Avorn constantly, the disease Avill be permanently cured. But, on the contrary, if this stage of the complaint be suffered to pass by, the abdominal ring Avill lose its disposition to contract, and the disease becomes permanent; or it may become strangulated in childhood, and cause death. We there fore advise the use of a proper truss immediately. In using a truss, much care is necessary, as it should be properly adapted to the part; and all the protruded parts should be properly and carefully placed within the abdomen before the truss is applied. It should then be Avorn, day and night, till the cure is completed. Stagner's truss is perhaps the best now in use. It should be applied by a physician Avho understands its use. OF UMBILICAL HERNIA. Umbilical hernia is a protrusion of the bowels through the umbilical, ring, or the hole through Avhich the navel-string passes. The true cause of it is a deficiency of abdominal muscles to fill the space through Avhich the umbilical cord passes. The existence of this disease is known by a protruding of that part Avhen the child cries, strains in having a hard stool, or strug- gles, in fretting, or otherAvise; the boAvels at times pushing through the hole to the size of a hen's egg. Occasionally, the boAvels are retained in the umbilical ring, and become strangulated, that is, they do not return, rendering the situation of the child dangerous; and, consequently, great care should be taken to aAroid this circum- stance, by keeping the child quiet, and the boAvels open. Treatment. — The cure is to be effected by preventing the boAvels from protruding through the ring, till the muscles grow and fill up the space. And to obtain this end, many means have been used, such as adhesive straps, and various forms of truss, of which, that made by Hall has been highly extolled. We, how- ever, have never found it necessary to use anything but a sxiootb silk pad, cohvex on one side and flat on the other, Avith a piece of sheet-lead, covered with silk, seAved on the flat side. This. must be fastened to the Avaistband; placing the convex part imme 510 DIABETIS, or sweet urine. diately over the umbilicus, and binding it sufficiently tight to keep the bowels Avithin the abdomen. This should be removed twice a day, and the parts bathed Avith cold Avater. It should be worn till the umbilical ring is completely closed, and the parts become firm; Avhich sometimes requires three or four, and in weakly children, or those born before the time, six or eight months. OF DIABETIS, OR SWEET URINE. Some of our best authors—of whom Dr. Dewees is one — con- sider diabetis a sympathetic affection. This may be true, or it may not. Nor is it very important that we should know, pro- vided we have the certain means of cure. It generally happens to children while teething; and this is the reason why it is considered a sympathetic disease. Dr. Horton believes it, in some instances, to be a family complaint. It is, hoAvever, a formidable disease, rapidly emaciating the little patient, and if not soon arrested, will certainly prove fatal. In some instances, large quantities of urine, of a sweetish taste, are discharged in a day. Treatment.—There is great thirst attending this disease; the kidneys secreting and throAving off the water almost as fast as it is taken into the stomach. The bowels should be kept open with the following medicines: Recipe: Pulv. Rhubarb, twenty grains. Magnesia, Calcined, one drachm. Mix in six papers. Give one every six hours, in a little sirup. In addition to this, give the following: Recipe: Tincture of Iron, half ounce. Four or five drops of this tincture, three times a day, will be sufficient. It may be given in SAveet milk. The drink and diet should be milk alone, and the under-clothes should be kept moist- ened with spirits of turpentine. If these remedies fail, give the following medicine: Recipe: Tinct. of Extract of Nux Vomica, three drachms. Give from five to ten drops, three times a day, in milk, and increase or diminish the quantity according to the age; ahvays beginning with the smallest quantity, and gradually increasing one drop a day, to the highest. INCONTINENCE OF URINE. 511 OF INCONTINENCE .OF URINE. Incontinence of urine is frequently brought on by habit, but is sometimes a symptom of stone in the bladder; it is also frequently caused by a weakness in the sphincter muscles, or neck of the bladder. When it proceeds from habit, it may be remedied by the child's urinating before it is put to bed, and repeating atten- tion tAvo or three times during the night, until the habit is formed of rising and urinating at stated times. But where it is the result of a weakness of the sphincter muscles, or an acid state of th< urine, we must resort to the folloAving: Treatment.—For a child one year old: Recipe: Tinct. of Rhubarb, one ounce'. One tea spoonful three times a day; or, Recipe: Magnesia, one drachm. Divide into three papers, and give one every day, in SAveetened vinegar and Avater, so as to keep the boAvels regular. Barley 01 rice-Avater, flax-seed or slippery-elm tea, should be the constanl drink; the diet should be light, and no drink taken after supper, If this fail, you may give to an infant one year old, four drops of the tincture of nux vomica, as for diabetis ; and tAvo drops of tincture of iron, in sweet milk or sweetened water. The dose must be increased or diminished according to the age of the child. It not unfrequently happens that much older children are affected Avith incontinence of urine; and when it occurs at the age of four or five years, you may give the following medicine: Recipe: Carbonate of Iron, forty-eight grains. Ext. Nux Vomica, three grains. Mix well, and divide into twenty-four papers. Give one, in sirup, morning, noon and night, till they are all taken. If this does not cure the disease, repeat the powder; but add half a grain more of the extract to the twenty-four powders, and give them in the same way; taking care that the quantity be proportioned to the age of the child. The bowels should be kept open Avith rhu- barb or castor-oil. The diet should be light, avoiding all very salt meats, as well as large draughts of any liquid. There are a great many other medicines prescribed by authors for the cure of this disease; such as stimulating diuretics, or bal- sams of various kinds; the tincture of cantharides; the alkalies; the acids and tonics; all of which we consider useless. The remedies we have prescribed above are safe, easily given, and we aave never known them fail. 512 costiveness, or constipation. of costiveness, or constipation. With some children this is constitutional, and Avith others acci- dental. When of the former kind, the child may go from four to Bight days Avithout a passage; indeed, it is remarkable hoAV long i child Avill sometimes go Avithout an evacuation, and yet suffer no inconvenience from it. Medical men are often consulted on this subject, and find, by strict inquiry, that the child has been habitually costive from its birth; Avhilst, perhaps, the mother has been habitually loose in her boAvels, though sometimes she is also habitually costive. Chil- dren frequently continue in this habit till they begin to cut teeth, when the boAvels gradually become more loose, but generally not sufficiently free and regular till the mouth is full of teeth and the child Aveaned. This state of things, hoAvever, does not ahvays go on so safely; for this rigid constipation will sometimes be suc- ceeded by feA'er and perhaps convulsions. Treatment.—When fever shoAvs itself under these circum- stances, immediate attention should be paid to it. An injection should be given, and folloAved, for a child six months old. by, Recipe: Castor-Oil, half ounce. Spirits Turpentine, one drachm. Mixed. This should be warmed, and tAvo tea spoonfuls given every tAvo hours, till it operates freely. If the fever continue, give the following: Recipe: Calomel, ten grains. Rhubarb, ten grains. Mixed. Divide into six poAvders, and give one every tAvo hours, in sirup, till they operate freely. If the fever should still continue give the folloAving: Recipe : Calomel, six grains. Ipecac, two grains. Salts Nitre, two grains. Mixed. Divide into six poAvders, and give one every tAvo hours, in sirup, till the fever is removed, repeating the dose as often as the fever recurs. After it is finally broken, if the bowels still incline to constipation, give. Recipe : Calcined Magnesia, one drachm. Tartaric Acid, six grains. Mixed. Divide into six papers, and give one, in sweetened w%tei; two or three times a day, so as to keep the bowels open. COSTIVENESS, OR CONSTIPATION. 513 But if the tartaric acid cannot be had, give the magnesia in sweetened vinegar and water; or you may give, Recipe : Rhubarb, two drachms. Bruised Fennel Seed, one drachm. Mix, and simmer them slowly, in half a tea cupful of water till reduced to one half the original quantity. Strain it well through a cloth; SAveeten the liquor, and give a tea spoonful or tAvo, two or three times a day. Children should never take med- icine in honey, because it may give them the colic, or so involve the medicine as to prevent its operating. Injections are of invaluable service to children; they should be made of molasses and water, Avith or Avithout a little table- salt. Suppositories, made of castile soap, will often answer the purpose. They should be passed entirely into the bowels; being made an inch long, and a quarter of an inch thick, tapered a little at one end; and alloAved to remain in the boAvels for fifteen or tAventy minutes, but no harm will be done by remaining longer. The bowels may be excited by an injection made of molasses and Avater, or gruel, sugar, and a little lard. Accidental Costiveness is more common, and may proceed from irregular nursing or feeding, or from the Avant of attention in teaching the child to elicit an evacuation at regular periods. It is astonishing what may be effected by holding a child over a vessel, and instructing it in this Avay; but when this is not suf- ficient, an injection may be given. Artificial Costiveness is often brought on by giving the child diet Avhich is hard of digestion, and, of course, improper for it to have. Some children, however, can use almost any kind of diet, without affecting their bowels in any way. But of all the repre- hensible Avays of producing costiveness in children, the practice of giving them laudanum or paregoric is the most blamable. These medicines should never be given by mothers or nurses, unless there is some disease requiring their use, since they are sure to produce costiveness. Their habitual use has been knoAvn to produce idiocy. To sum up the whole management of accidental and artificial costiveness, it consists, first, in regulating the diet,'—giving nothing that will be heavy on the stomach, or hard of digestion, —and teaching the child to elicit evacuations daily, at certain hours. If these means will not do, use injections, and give such diet as will aid in this matter, as molasses and mush, milk and mush, rice mush, and bread made of unbolted flour. But never BRIGHT. 34 514 VOMITING. give medicine for costiveness till all these remedies have been tried. Should they fail, give castor-oil, in small doses, or mag- nesia, or rhubarb tea, &c. If the infant has the colic, give it this mixture: Recipe: Calcined Magnesia, one drachm. Tincture Asafcetida, one drachm. Elixir of Paregoric, one drachm. Water, one ounce. Mix them well, and give a tea spoonful, in sweetened Avater, repeating half the quantity every half hour, if the first should not give relief; but an infant only two Aveeks old should take only five drops, and one tAvo months old ten drops, and so on, according to the age. A child of one year old should take a tea spoonful. The vial should always be well shaken before the medicine is poured out. Infants rarely cry from crossness alone; they are either spoiled, or have pain somewhere; for no child is naturally cross, let it be what it may when grown. OF VOMITING. The vomiting of infants is by no means at all times an evi- dence of disease. Young and inexperienced mothers should recollect, that, in many cases, it is only an evidence of perfect health; for when an infant has nursed too much, and the stom- ach is painfully distended, nature, always faithful to herself, will throw off at least so much as is requisite to give relief. It should, therefore, be considered as a sign that the stomach is in possession of its healthy powers. The milk, Avill be found to be perfectly SAveet when ejected, nor will the child be less playful than before. AH that is necessary in this case is to take it from the breast as soon as it ceases to nurse anxiously, for it should never be coaxed to nurse after it manifests an indifference for it. But sometimes an infant vomits from other causes; from the stomach sympathizing with some other organ in its derangement. Treatment.—When the vomiting proceeds from this cause,— that is, a disease in some vital organ, as the stomach, boAvels, kidneys, or liver, — it is only to be cured by removing the origi- nal disease, be that what it may. And this is to be ascertained by the symptoms. If it be inflammation of the stomach, the child will have an anxious look, fever, a quick pulse, and pain and constipation of the bowels. It instantly throws up every- thing it takes; has constant thirst, but throws up the water as soon as it is swallowed. Neither has it any desire to nurse. In VOMITING. 515 this case, blood should be taken from the arm, a plaster of ground mustard applied over the stomach, and the folloAving medicine given: Recipe: Calomel, six grains. Divide into six powders, and give one every hour, in clabour, or a drop or two of simple sirup, till they operate on the bowels. At the same time, injections should be used every hour, to pro mote the operation of the calomel, and cataplasms of mustard should be applied to the feet. The only diet given should be rice or barley-Avater, by the spoonful. When mustard is applied to infants, gauze or book-muslin should be laid between the plas- ter and the skin, and the plaster should be wet with vinegar. If the bowels are inflamed, the same remedies may be used for their relief, and calomel, as directed above, should be given, till it operates freely. If the kidneys are inflamed, the child will ma^e no water, but will scream, draw up its feet, and vomit, by paroxysms. In this case, Recipe : Magnesia, twenty grains, dissolved in sweetened watermelon-seed tea, may be given for a dose, and repeated every two hours, till it operates freely. Then give, Recipe : Carbonate of Soda, six grains. Water, one ounce. Dissolve, and give a tea spoonful every hour. The drink should be flax-seed or slippery-elm tea. The warm bath should be used, and the died should be very light, — rice or barley- water, sweetened with manna. If the liver is affected, and the vomiting is caused by this disease, you Avill find the skin yelloAV, or at least the white of the eyes. The urine, also, will be yellow, and the stools light or clay-colored; in which case, small doses of calomel and rhubarb should be given Aecipe: Calomel, six grains. Rhubarb, four grains. Mix, and divide into six powders. Give one every two hours, and repeat till the stools are thick and green, or dark. Let the diet be light, as before directed. In all these cases, we have supposed the child to be one yeai old. But the dose must be increased or diminished, according to the age and strength of the child. If the remedies for a stoppage of water produced by inflammation of £je Sidneys have been 516 CRYING OF INFANTS. used, hut without effect, let the child be put into a Avarm bath, and take an injection, Avith a feAv drops of laudanum in it. A small quantity of tea, made of Avatermelon or pumpkin seeds, parsley, or uva ursi, Avith eight or ten drops of the SAveet spirits of nitre in it, may be given every half hour; and, after the bow- els have been sufficiently opened, you may give a feAv drops of paregoric. When the kidneys act freely, the vomiting Avill cease. If the child vomits from acid on the stomach, a little magnesia, or Aveak ley made of wood ashes, Avill often correct it, and relieve the vomiting. (See the chapter in which all these diseases are treated of.) OF THE CRYING OF INFANTS. The cry of a new-born infant is listened to with delight by its mother and friends, being the evidence to them of life and health It is more than this to the infant, being not only of immediate, but mediate advantage to it—immediate, by facilitating the pas- sage of blood through the lungs, A\diere, until this moment, it had been unaccustomed to travel. It serves more effectually to expand the air-cells of the lungs, and thereby presents a larger surface for the action of atmospheric air, for the due oxygenation of the blood, on which the healthy functions of the system so much depend. Crying not only aids in clearing the lungs of phlegm and other things, but also strengthens and enables them better to perform their functions. When a child grows large enough to manifest the need of attention, it generally has recourse to crying in order to attract that of the mother or nurse, and thus have its necessities relieved. These may be, hunger, thirst, or some bodily requirement, change of position, &c. A long continuance in one position is not only painful to the child, but injurious to its health. If the infant express no uneasiness, it is often compelled to lie too long in one position, and thereby sustain injury, by preventing the full circulation of blood through the Avhole system. The limbs are unequally exercised Avhen the child is alloAved to remain on one side for a length of time; and it should never be alloAved so to remain longer than an hour or two. It will immediately express the pleasurable sensation produced by the change, stretch out its limbs, and again fall off into a SAveet sleep. By these changes, the blood circulates freely, and all the parts grow uni- formly. An infant should never be laid on its back; for if it should vomit, it might become strangled. Suffocation has been produced in this way. NECESSITIES of the CHILD.--PURE air. 517 In young children, the excitability of the system accumulates rapidly; and crying is the only means by which they can exhaust it, if they are not handled sufficiently for this purpose. Some children possess much more excitability than others; and, consequently, we see some cry more readily, and for trifles, as we suppose, Avhile others can scarcely be made to cry for any cause. Children that cry so easily should be allowed much more exercise than those that cry but little or not at all. The more you allow a crying child to exercise,— thereby exhausting the excitability of its system,— the less disposed will it be to cry. Parents should not forget this fact. Adults are often relieved from an accumulated excitability by crying; for who has not witnessed the relief ghen to the aching heart of an adult by a gush of tears'? Crying may, however, be indicative of disease; but this will be noticed in its proper place. OF THE NECESSITIES OF THE CHILD. " The necessities of the child are no less remarkably changed than its relations." It must noAV breathe a pure air, or it dies; it must receive and prepare food, by the operation of its own stomach, for the growth of its system, or it sinks; it must be protected against the variations of temperature, or it perishes. In a word, a neAV kind of life commences from its birth; and that this may be preserved in the best possible manner, is the end and object of physical education. It will now be noticed Avhy this species of education should be pursued at the period we have assigned to it in another part of this work, since it is certain that the more perfect is the health of the individuals who marry, the more perfect will be the foetal life of their offspring, and the animal life which is to follow. The new agents to which the body is to be subjected are, air, food, clothing, exercise, and cleanliness; each of which exerts a poAverful influence on the welfare of the being on whom it acts. The operation of these agents commences with the first motions of animal life, and is perpetuated, under some modifica- tion or other, to the last period of human existence. OF PURE AIR. It is not our purpose, in this chapter, to enter into an analysis of atmospheric air, nor to show how impure air is eliminated and pure air evolved. We will, however, say, that atmospheric 518 PURE AIR. air is composed of oxygen and nitrogen gas; of the former tAventy parts, and of the latter eighty parts. This comes very near the true quantity; but there are gases mixed Avith the air, Avhich render it impure and unfit for respiration, and in some proportions become poisonous and deadly in their effects upon the human system. Those gases which are most common are the carbonic acid and the azotic gas. The former is the product of decomposed vegetable matter, and the latter that of animal decomposition. It is proper, therefore, in order to preserve health, that we breathe as little of the above-named gases as possible. Oxygen gas is the supporter of animal life; without it, the blood Avould lose its vitality, animal heat Avould fail, and life become extinct. We see, then, hoAV pernicious the practice is of covering up an infant's head, and thereby preventing the due quantity of oxygen from being inhaled; for every inspiration exhausts all the oxygen taken into the lungs, and evolves, in its place, car- bonic gas. Hence, if the free access of atmospheric air be excluded from the child, you exclude the oxygen so necessary to its life; and therefore the practice cannot be too much repre- hended. When the child's head is covered it inhales, at every inspiration, a certain portion of the air Avhich is under the bed- clothes, and that portion of air is almost entirely deprived of its oxygen; the child must, therefore, at the next inspiration, inhale a portion of the carbonic gas which it has just thrown out, and Avhich is injurious to health, and should not be inhaled. This may be repeated till all the oxygen of the air under the bed- clothes is imbibed; when death must be the consequence, if oxy- gen, or pure air, be not immediately supplied. Another serious injury to children grows out of the practice of the mother of keeping the child to the breast all night, Avith its head under the bed-clothes; and here a double injury follows. The oxygen gas is destroyed, and the sensible or insensible per- spiration, that is constantly escaping from all living bodies, aids in rendering the air impure, and therefore unfit for respiration A candle placed under the bed-clothes Avill be extinguished immediately; and air that will not support combustion is not fit for respiration. Every article of clothing should be removed from the room as soon as it is taken off the child. Diapers, either wet, or rendered impure in any other way, should not be suffered to remain in the nursery. If possible, a diaper once wet should not be used again till it is washed. But should it be TEETHING. 519 used a second time without being washed, it should be dried in the open air, and not in the nursery; for the uric acid thrown off from the diaper by drying, renders the air impure. And everything that will have this effect should be removed from the nursery or room Avhere the child is kept, that every inhalation may afford a sufficient amount of pure air for invigorating and strengthening the system. Hence, washing and ironing clothes belonging to the children, in the room or nursery where they stay, should be avoided. Smoking tobacco in the room should not be allowed; indeed, no woman who uses tobacco in any way is fit to be a nurse for children. Nor should burning oil, with a long Avick, be allowed in the nursery. And, in addition to all the above precautions, the room should be frequently ven- tilated ; in doing which, however, care is necessary, in order to prevent a stream of cold or damp air from passing immediately over the child. OF TEETHING. We do not think it necessary to enter into a minute anatom- ical description of the first formation of the teeth, Avith all the changes which they undergo before they make their appearance through the gums. The order which nature observes in carry- ing out this important and sometimes hazardous process, is all that we think necessary for our present purpose. The teeth are formed, in part, in the foetus, and are developed, when in regular order, in the following manner. The first set consists of four incisors, or cutting teeth, in each jaw; two canine or dog teeth, commonly called stomach teeth and eye teeth; and four grinders; — making in all twenty; that is, 8 incisors or cutters, 4 canine or dog teeth, or stomach and eye teeth, 8 molars or grinders. It is the passage of the teeth through the periosteum and gums that creates the disorders of teething. The teeth groAv more rapidly than the absorbents take up the opposing mem- branes. The cutting of the first set of teeth generally com- mences about the sixth month, and ends between the second and third year of the child's age. All these teeth are smaller than the permanent ones, with the exception of the bicuspids, or small grinders; and this is a wise arrangement of Providence, to keep the jaws filled as they enlarge by the growth of the bones. 520 TEETHING. The order of teething is as follows: first, the two middle incisors of the loA\rer jaAv, and then, after an interval of three or four weeks, the corresponding teeth in the upper jaw. But this order is sometimes inverted, and all four of the teeth appear in the upper jaAv before the appearance of those in the loAver one. After this, the canine teeth beloAV appear; and these are followed by the corresponding teeth above. The first two grinders are those of the lower jaAv, and are soon followed by those above. After a lapse of from four to six years, two more grinders are added to those already in each jaAv; and these are permanent teeth. At times, from eighteen to tAventy-one years pass before the person cuts four more teeth, one in each jaw, above and beloAV; and these are called Avisdom teeth. This is the regular order of teething; but there are many variations from it. We have seen three or four children born with teeth. Such teeth seem to be loosely fixed in the gums, and are troublesome to the mother. It is said that Louis the Fourteenth of France Avas born Avith teeth, and Ptichard the Third of England. They do not appear to be of the least use to the child, but rather in the Avay. Neither do they argue vigor of the constitution, but rather debility; for, being out of the order of nature, they are of course imperfect. It has been a matter of observation by authors and physicians generally, that the teeth, in some instances, are very tardy in making their appearance. We have seen cases where the first teeth have not appeared till the twelfth and fifteenth month, and some later even than this. Vansweiten and Dewees mention such cases; and Ra.yer cites a case Avhere the canine teeth did not appear till the child was thirteen years old. Its health Avas bad, and before the teeth appeared it had sore eyes and convul- sions. No doubt this child was a subject of scrofula. Fourhard relates a case Avhere the child Avas six years old, and had none but the fore teeth. Brouzet gives a case where only half the proper number of teeth was present at the twelfth year; the gums had become as hard as those of an adult. And Professor Baumis gives the history of a man whose teeth never appeared. At the time of birth, the teeth are lodged in separate compart- ments; the deciduous ones having their respective stations within the cavity of the jaw-bone, and placed over one another. Each tooth is at first but a pulpy substance, and acquires hard- ness as the foetus becomes older. The croAvn r ardens first; the root then becomes bony, and is hollow, that it may have blood- TEETHING. 521 vessels and nerves admitted into its substance. The Avhole tooth is surrounded by a delicate, sensible, vascular membrane; and this membrane, Avhen put upon the stretch, gives great pain, which is immediately relieved by cutting the gums freely doAvn to the teeth. This knoAvledge of the phenomenon of teething or dentition is of much importance in the management of the child. The signs of dentition are, first, heat in the mouth, Avhich is first perceived by the mother, through the medium of her tender and delicate nipple. This heat produces thirst, and makes the child demand the breast more frequently than before. The gums itch, Avhich is evidenced by the child's stripping the nipple through them; it also rubs its mouth with its fingers, and bites hard substances which are placed between its gums. The older the child is before it teeths, the greater is the pain caused by this process; and the mother is often made to suffer from its severe bites upon the nipple. Second; a slavering in salivation is apt to attend this stage of dentition; and this is of service to the chrld. as it allays the inflammation and irritation of the gums, moderates the thirst, and supplies an additional quantity of saliva to assist digestion though if too much of it should be swallowed, the child will suffer Avith a boAvel complaint; but this, by diminishing the general vigor of the arterial system, keeps doAvn fever. Third; after these symptoms have continued for a longer or shorter time, a small Avhite speck is apt to make its appearance on the gums, over the tooth. When this breaks, or is cut, the tooth soon appears; and it is not unfrequently the case that a small quantity of serum is discharged Avhen this speck is opened. Fourth; the membrane of the nose is frequently affected by sympathy, and the child rubs and pulls at its nose; often deceiv- ing the mother, and sometimes the physician, causing them to believe the child is affected by Avorms. The irritation in this membrane sometimes causes sneezing. Fifth; fever is often provoked by teething. This shoAvs itself by heat in the palms of the hands; high-colored urine, Avhich is oftentimes offensive; a flush in one or both cheeks; great dry- ness of the lips, and heaviness of the eyes. Sixth; if several teeth are about to appear at the same time, the above symptoms will be increased in force; the gums will become someAvhat spongy, very red, and sore to the touch; the fever will be increased; the urine more copious and smell 522 TEETHING. strong: the child will become impatient, fretful, and have fright* ful dreams, starting, laughing, or whimpering, Avhile sleeping; diarrhcea, more or less violent; the glands under the jaAvs swell; the eyes become sore or tender; and if the teeth do not soon appear naturally, or are not relieved by scarifying the gums, convulsions may ensue. These symptoms rarely all appear in the same patient at the same time, but they occasionally occur. Some children cut all their teeth so easily, that none of the above symptoms make their appearance to any alarming degree. Teeth are not cut by forcing themselves through the gums, but by pressing every way on the incumbent membranes, causing the absorbents to take up the membranes, and so give place for the teeth to pass through. The belief that teeth force themselves through the gums has given rise to the practice of using coral, or some other hard substance, to aid their passage; but, although the theory is false, the practice is perhaps a good one. It is, at least, in imitation of nature; it causes the absorbents to take up the membrane, and let the tooth come through; it gives relief by promoting salivation, and thereby relieves the vessels of their redundant fulness. But softer substances than coral or ivory should be used. Gum elastic is perhaps the best, or a piece of thick, spongy leather. The article should be one that would not break and pass down the child's throat, or it might be choked by the detached pieces. Rubbing the gums Avith the finger is grateful to the child, and may be practised to advantage. Second dentition. — Before the period for the second cutting of teeth arrives, the child undergoes a considerable change in con- stitution and person. The jaAvs have spread out, and acquired considerable strength; the fontanels of the head are generally closed by bone; the limbs have become stronger, and the child is able to walk firmly. The abdomen loses the rotundity it possessed, and becomes flat; the eye becomes expressive, and all the features are fully formed, though not fully developed; the sense of discrimination becomes more accurate; it now has the power of expressing its Avants; and thus obviously improves till the seventh year. At this time, the first teeth generally drop out, to give place to a second set; and this operation is called shedding the teeth. The first teeth are twenty in number. The second set are at first tAventy-four; in six or seven years, four more are added; and at the age of eighteen or twenty, four more, called wisdom teeth, making in all thirty-tAvo, which com- pose a full set. CARRYING THE CHILD IN THE ARMS. 523 The second teeth do not push out the first, as is supposed by some, but arise from sockets of their own, and within the bone; Avhile the first teeth only rest on the bone. They, moreover, do not occupy exactly the place that the first did; they fill the enlarged mouth. And, Avere it not so, the adult Avould have to chew on the front part of his jaAvs, and have but little space on Avhich to grind his food. The first set of teeth, then, have but little control over the second, if, indeed, they have any at all. The decaying of the first teeth,—Avhich is a common thing, especially if the child has been sickly, — has no bad influence over the second set; but the stumps of the first set should always be removed if they become painful. The incisors or cutting teeth, and the cuspidati or first grind- ers, require from six to seven years to get their growth; the bicuspids about seA'en or eight; and the molars or large grinders about twelve years. From their increase in size and number, the second teeth sometimes do not find sufficient room in the jaAvs to arrange themselves in regular order; and when this is the case, some of the teeth should be extracted to give room for the balance. But this, of course, is the work, of a dentist. OF CARRYING THE CHILD IN THE ARMS. Young infants need exercise, but this should be given in a proper manner. Those Avho are a feAv days old. should, when they aAvake, be placed in a different position from that in Avhich they slept. They should be frequently laid on a level, smooth, soft place, that they may have the privilege of stretching their tender limbs. They soon express grateful feelings for this change of position, by throAving out their arms and stretching out their legs; appear relieved; and soon fall aAvay into a comfortable sleep again. This exercise gives strength to the muscles, and life and energy to the Avhole frame. Children, Avhen a little older, should be taken up frequently, held in a semi-horizontal position, with the head and shoulders well supported by the hand or arm of the nurse, and, in this position, be carried over the room several times, to let them enjoy fresh and pure air. The head should always be well supported. The practice of placing children on their feet at an early age, tc make them look smart, or setting them up erect before they are able to hold up their heads, is very wrong, and often gives a posi- tion to the head that is not easily overcome. The tender joints 524 AVALKING. of the backbone may be greatly injured by it, and a cur\Ted spine often folloAvs such a practice. After the child has acquired suffi- cient strength to sit up Avithout much support, it may be indulged in, if done in a proper manner ; that is, not too long at a time, nor too often repeated. A child should rarely ever be made to sit up before the third month; otherAvise, you may induce a curvature of the spine. After this age, it may be car- ried in the arms of the nurse, if properly handled, as daily exer- cise Avill be an advantage to it. We shall here lay doAvn a feAv rules for this practice. The child should never be so placed on the arm as to be obliged to support itself, or be in danger of falling backAvards; but the Avhole body should be supported by the hand and arm on Avhich the child does not rest. It should never be carried on the arm till the muscles of the neck are strong enough to support the head easily in an erect position. Nor should it be always carried on the same arm, but should be frequently changed to the other arm, to prevent a curvature of the spine. It should never be made to put an arm around the nurse's neck; for this Avill displace the shoulder-blade, and injure the side and back of the child. Nor should the nurse's arms grasp it too firmly; for, as all its bones are soft, they may, by this means, become bent, and groAv crooked. None but an experienced nurse should be alloAved to carry a young infant; otherwise, it will be more likely to be injured than benefited by nursing in the arms. OF WALKING. The child has to acquire several powers before it is able to Avalk. It must have the use of its limbs in all directions. It must move one foot before the other, without falling, and Ave have directed hoAV to acquire these poAvers in the previous chapter. This muscular poAver is too often interrupted by parents. They wish to see their children Avalk before they crawl. This is Avrong: for crawling is very beneficial to children. They never act in this manner Avithout having some object in view Avhich pleases them; and this is good for them, both for muscular and mental exercise. Children Avho craAvl are ahvays more robust than those who do not; for crawling exercises every muscle of the body, and gives vigor to the whole system. After children have craAvled a while, they Avish to do more; they climb up by a chair, and stand. They then try to balance themselves, Avhich exercise always pleases them. After a Avhile, they will try, from WALKING. 525 a perfect balance, to take a step; and presently, though they may get many falls, they learn to Avalk. All children are delighted when they can stand alone; and they Avill clearly manifest this delight by their countenance and actions. After repeated trials at this little adventure, they proceed to Avalk; and this they soon perfect, to a certain degree. We grant that children may be taught to walk without crawl- ing, but Ave insist that it is not the better plan. By forcing a child to stand on its feet before it feels a disposition to do so, you bend the long bones; and thus it becomes boAv-legged, the spine becomes crooked, and if there should be any disposition to rickets in the child, that disease will be certainly promoted thereby. Many plans have been devised to teach children to Avalk; but we, Avithout hesitation, condemn them. All go-carts and leading- strings should be destroyed; and mothers should remember that there is a God Avho has ordered the operations of nature, and they are only agents to carry them out. If it had been proper for children to walk at an earlier period than they do, their bones would have been formed hard and strong enough at the first. Look at the colt, the calf, and other four-footed animals, that have to depend upon themselves, Avhen born, to come to the mother for nourishment. They all have hard bones; but it is not so Avith the child. Pervert not, then, the order of nature; but let your babe craAvl, then stand, then walk, then run, and all its limbs will be perfectly developed, and groAV up in symmetry of form. Other modes of exercise for children. —After a child has learned to Avalk, it seems to desire to be almost constantly in motion. This desire is, perhaps, induced by the attraction of surrounding objects, and should ahvays be indulged. But children cannot ahvays perform on foot the journeys that are required to reach the places to Avhich they are destined; and then other modes of exercise become necessary. We have already spoken of carrying on the arm, and of walking ; and Ave iioav come to speak of exer- cise taken in a carriage, or on horseback. The baby-carriage is the better of the two. These carriages should be made Ioav, the Avheels placed Avide apart, and they should run steadily on a smooth axletree. The springs should be elastic, and the body of the carriage large enough for the child to lie down in if necessary. A covering should be added, for pro- tection from the sun; and the carriage should ahvays be drawn at a moderate pace, and never violently jerked, or rapidly put in motion. The place upon which it is drawn should be smooth 526 BATHING. the child should be placed in it in such a position as to be per fectly at ease. When young, it should be horizontal; when it groAvs older, it may be raised up a little; and when it can craAvl, Avalk, or run alone, it may sit upright in the carriage. Great care should ahvays be taken to prevent its falling out. The child should never be exercised in this Avay more than half an hour at a time, and should never be alloAved to sleep in the carriage; as sleeping in the open air is injurious to children, besides teaching them a bad habit, that will prove troublesome to the mother or nurse; for they will soon refuse to sleep Avithout the carriage. They should never be taken out in Aveather either too hot or too cold or damp, and Avhile in the carriage, should be kept all the time in motion. Riding on horseback. — As soon as they are able to hold the reins of a bridle, children should be taught to ride. This is the best exercise Avhich can be taken; it brings into action every muscle of the body, and is an agreeable amusement. Children are fearless of danger on horseback, and soon learn to keep their seats and ride Avell; they therefore should be allowed to practise early, but under the careful eye of a parent, nurse, or riding- master. Games. — There are but few games that do not, more or less, endanger the health of children, or lay the foundation of bad morals. Children are apt to become over-heated at most of the games practised in this country, and parents should be care- ful hoAV they allow their children to engage in them. None should be alloAved except those that are not absolutely injurious, and even then in a moderate degree; and of all this the parent should ahvays be the judge. Nothing is comparable to exercise on horseback, both for boys and girls; and this, under the pro- tection of suitable persons, should be practised freely. OF BATHING. Ail impure state of the skin will always bring its penalties; and t should, therefore, always be kept clean. Bathing is justly esteemed a luxury by all who have used it; and children should be bathed in tepid water, from the time they are born until they are two years old. After this age the Avater may be cool. The bath should be used with them, in the form of a wash of the whole body; and this should be repeated at least three times a Aveek, and as much oftener as may be required in order to preserve perfect cleanliness. JAUNDICE. 527 Some advise the cold bath for children. We shall not enter into an explanation of the many dangers that would attend its use in the case of infants; they are numerous, and in many cases fearfu*. But the bath of the temperature of eighty-four degrees, or a ittle less than blood heat, can never hurt, if properly applied. A little soap should be used, especially on the loAver extremities; but the head of an infant should ahvays be Avashed and dressed first. It is hardly necessary to advocate this practice in this country, where mothers are so well satisfied of its great utility. Health, vigor, activity, and complexion,—and may I not say good sense?—all, to a certain degree, depend upon it. Children should ahvays be bathed before going to bed, and not be awak- ened in the morning and placed in the bathing-tub. As before stated, Ave shall not enter into all the details why the cold bath should not be used for children; suffice it to say, that the experience of the medical Avorld is against it; and for good reasons. If there be any latent disease in the system, the cold bath, by its shocks, Avill invariably do an injury. The plea that it is a tonic, is founded in false theory, and Avill be, if it has not already been, exploded. It will do for robust, healthy male adults, but it never did, and never Avill, do for delicate females or males, or young children. By all means, keep the skin clean and the pores open, —but not Avith cold Avater, — and your children will be healthy and sprightly. OF JAUNDICE. The yelloAV color which is so common to new-born infants does not constitute the disease now under consideration. This yelloAV tinge may disappear in a feAv days, leaving no bad con- sequences to follow. The disease under consideration is distinguished from all others by the folloAving symptoms: A yellow tinge in the white of the eye; a yelloAV skin; urine quite yellow, and the stools of a light clay color. The child is more or less feverish, and not unfre- quently pukes. These symptoms may all be aggravated and much increased in violence, and we rarely see two cases presenting exactly the same symptoms to the same extent. The skin some- times assumes a dark or livid color; at other times it presents a motley or spotted appearance. The abdomen may be too hot or too cold to the touch; the extremities are sometimes cold; the child very languid, presenting great debility and symptoms of prostration. The danger of the case may be judged of by the 528 JAUNDICE violence of the symptoms, the age and strength of the child, and the length of time the disease has existed. Treatment.—Many remedies have been prescribed for the cure of this disease, as castor-oil, sirup of rhubarb, and decoc- tions and teas of various kinds, — all of Avhich have had their advocates in their day. But the only sure remedy is to be found in those medicines that act effectually upon the liver, and excite a healthy secretion from that organ. The cure may be com- menced by giving a child six months old, Recipe : Castor-Oil, two drachms. Mix in SAveetened Avater, and give it for a dose; which may be increased or diminished, according to the age of the child. If the stools are yelloAV or green, when the oil has operated, the point is gained, and, by keeping the boAvels open, the child will get well. But it too frequently happens that the stools continue to be light, or clay-colored, notAvithstanding the operation of the oil; and, in such a case, try, Recipe : Calomel, three grains. White Sugar, ten grains. Mix in six powders, and give one, every two hours, in sirup or molasses. This dose is for a child six months old, and it may be increased or diminished, according to age. If the child should puke, or the stomach be very irritable, the following mixture may be given: Recipe: Sup. Carbonate Soda, one drachm. Water, one ounce. Compound Spts, of Lavender, one drachm. Mix these together, and give a tea spoonful, sweetened lightly, every half hour. Flannels dipped in warm brandy or spirits may be applied to the region of the stomach. After the stools have become green or dark, and consistent, that is, thick, you may stop giving the powders, and give the folloAving: Recipe: Sirup of Rhubarb, one ounce. Give a tea spoonful every tAvo hours, till it operates freely. If the skin does not begin to clear, and the urine assumes its proper color, repeat the powders; or you may give, Recipe: Blue Mass, twelve grains. Pulv. Rhubarb, twelve grains. Mix in six powders. Give as above, till they operate freely: and folloAV them with these powders: JAUNDICE. 529 Recipe: Calcined Magnesia, twenty grains. Pulv. Rhubarb, four grains. Cream of Tartar, ten grains. Mix in six papers. Give one, in sweetened water, every three hDurs, till they operate freely. If symptoms of great prostration should take place, the skin Lecome brown or spotted, the eyes sunken, the urine very yellow, and the stools thin and light-colored, the stomach very sick, and hiccough troublesome, the case may be regarded as dangerous. But all dangers are not death; and we should, therefore, per- severe. Warm a gallon of water, and add to it, Recipe: Spirits of Nitre, one ounce. Bathe the child in this, every tAvo hours, and give the follow- ing medicine: Recipe: Calomel, ten grains. Pure Musk, one grain. Pulv. Mace, two grains. Mix in ten powders, and give one, every two hours, in sirup; or, you may use the folloAving: Recipe: Whiskey, one pint. Nitric Acid, one drachm. Mix. Add this to one gallon of warm water, for a bath, which should never be over milk warm. If the feet are cold, mustard plasters should be applied to the ankles, and one over the pit of the stomach. If the child puke much, the breast will be the most suitable diet. If it cannot suck, it should be fed with breast milk. If it is weaned, rice, or toast-water, arrow-root, gruel, or boiled milk and water, will be its best diet. In all cases, the room should be kept of an agreeable and uniform temperature. If excessive vomiting continue, a feAv drops of paregoric may be given, and repeated every fifteen or twenty minutes, till the puking is allayed; or Dewees' mixture, which is, Recipe: Calcined Magnesia, half drachm. Tincture Fcetida, one drachm. Laudanum, forty drops Water, one ounce. Mix well; from a half tea spoonful to a tea spoonful is a dose for a child, according to its age. After the obstructions are removed from the liver, and the stools are of a yellow color, a tea made of wild-cherry bark may be given, to clear the skin. If the child be a year old, a table spoonful, four or five times a day, will be sufficient. The infusion is made by adding an ounce of BRIGHT. 36 630 THRUSH, OR APTHEA. the bark to a pint of cold water, and letting it stand twenty-four hours before using. In convalescence, exercise in the open air will be good; and if the child be much debilitated, a gauze flannel should be worn next the skin. THRUSH, OR APTHEA. The thrush may attack persons of any age, under some pecu- liar conditions of the system, such as chronic diseases, where the patient has been a long time sick, and is reduced very low. But that is not the form of the disease of Avhich we are now about to treat. The thrush we now speak of is that of infants. Almost all infants are subject to thrush at some period of their infancy; but most commonly at the early age of a few weeks, at furthest; and some are attacked with the disease as early as the first week. The disease, in its first indications, is not unlike small specks of clotted milk, adhering close to the lip, cheek, tongue or gums, Avhere it first appears. The most common color is Avhite, though it is sometimes yellow, and sometimes very red, not unlike blood. The grades of color seem to depend upon the violence of the disease, the lightest color being of the mildest form. When the eruption first makes its appearance, it generally, in a few days, spreads so as to cover the inner surface of the mouth; but in some cases it is confined to the cheeks only, or to the top of the tongue, with a feAv specks in the roof of the mouth. The eruption is not ahvays confined to the mouth. It fre- quently, in bad cases, extends through the whole length of the oesophagus, or throat, down to the orifice of the stomach. Some authors suppose that the eruption passes through the whole length of the alimentary canal or boAvels; but this is doubtful. It is true that the discharges, which are very thin and acrid, excoriate the anus and nates of the child; but we do not think this sufficient proof that the eruption has passed through the child, as no dissections, hitherto, have shown any eruptions within the bowels. When laboring under this disease, the child frets and cries very much, partly from the heat and pain of the mouth, and partly because it cannot suck as it wishes to do. It is frequently sick at the stomach, and vomits more or less. If the nipples of the mother have any cracks or tender places on them, the thrush may be communicated to them by the child. THRUSH, OR APTHEA. 531 The child fans away rapidly while under the influence of thrush, because it cannot take nourishment enough to sustain itself. Treatment.—The common remedy for thrush is a preparation of borax, honey, and sage tea. Recipe: Pulv. Borax., one drachm. Strong Sage Tea, six ounces. Strained Honey, one ounce. Mix them together, by simmering them over a slow fire, till ihey are duly united. It is then used in the following manner : Wrap a piece of thin, soft rag around the finger; dip it in the mouth-water, and apply it to every part of the mouth; and this should be done every honr. We deprecate the practice of rub- bing off the crust in the mouth by friction with a piece of flannel, as the manner of some is. The boAvels should be kept open with some gentle purgative, a the same time, such as, Recipe: Simple Sirup of Rhubarb, one ounce. Give a tea spoonful, two or three times a day. Recipe: Calcined Magnesia, half drachm. Divide into three poAvders, and give one, in sweetened water, *very four or five hours, till they operate freely. But sometimes foe disease is more inveterate, and will not yield to this simple remedy. The following medicine should then be given: Kcapc: Calomel, three grains. Pulv. Mace, one grain. Mix in six powders. Give one, in sirup, every two hours, till .hey operate well. This medicine may be repeated, every other lay, till the disease yields; and the first wash should be used freely and frequently. The child must be fed with breast milk. if it cannot suck. The mother's nipples should be attended k. with the wash. If the above wash should not, by the aid of the internal rem- edies, cure in a few days, add, Recipe: Tincture of Myrrh, two drachms, .0 each portion of the mouth-water, and use it as above directed. In some cases, after the eruption is removed, the bowels are left in a state of debility and relaxation, and very much griped, and the stools are thin and gteen. In this case, use the follow- ing mixture: 532 COLIC Recipe: Calcined Magnesia, twelve grams. Elixir Paregoric, fifteen drops. White Sugar, one drachm. Boiled Water, one ounce. Mix. Give a tea spoonful of this mixture every two hours, till the boAvels are more tranquil, and the stools of a better color and consistence. But if the bowels still keep too loose, and the child is much Aveakened, give the following: Recipe: Calcined Magnesia, twelve grains. Laudanum, three drops. Prepared Chalk, half drachm. Boiled Water, one ounce. Mix properly, and give as above, till the boAvels are tranquil and the discharges are corrected. Sometimes Dewees' mixture will ansAver this purpose very well. Of this mixture from fifteen to thirty drops may be given to a child from two to six weeks old. It should be sweetened before it is given, and may be repeated every two, three, or four hours, as circumstances require. OF COLIC Infants are subject to colic from the time they are one or two weeks old till they have cut their first teeth. There are Iavo kinds of this disease. The first kind may seize the child at any time of the day, without any assignable cause, and generally attacks children of feeble constitutions. The child may have a full supply of milk, and yet not thrive. The second kind is produced by the use of unhealthy milk or improper diet. The boAvels are in some cases loose, and the stools may be green and frothy, or light-colored and yeasty. When the food is the cause of the pain, the child becomes uneasy almost as soon as it is swallowed; and if from unhealthy milk, the like result is observed. In either case, the bowels throw off their contents undigested. The symptoms of the colic are, a tension of the belly, wind, a drawing of the knees up towards the stomach, as if from pain, screaming, and a belching of wind from the stomach, from which some relief is gained, for a short time. If nothing be done to give relief, the child will exhaust itself by crying, fall asleep after a free eructation, and when it awakes will be free from pain. With some children, these paroxysms occur at stated periods—most commonly about bedtime, or immediately after eating. Treatment.—A variety of remedies have been used and pre- COLIC. 533 scribed for colic in children, such as soot tea, catnip tea, saffron tea, a tea made of the seeds of parsley, dill, fennel, caraway, coriander, and anise-seed; all of which frequently fail, and none of them remove the cause. Paregoric, laudanum, &c, have been used in their turn; these always give ease for the time being, but leave the sufferer liable to a return of the disease. Colic in children is generally produced by something which they have taken that is indigestible, or the souring of the milk on the stomach. In either case, it will be necessary to remove the offending cause; for which purpose, a purgative should be given, which, however, may be premised by an injection of SAveetened Avater, with a tea spoonful of the tincture of asafcetida in it. Then give a dose of castor-oil, or of the sirup of rhu- barb; or, in case of any fever having been produced by the colic, a few grains of calomel may be given, which may be fol- loAved by oil, or magnesia, till the bowels are freely evacuated. The warm bath will frequently relieve the child in a few minutes. When the system of the mother is out of health, it should be restored, and her diet properly regulated. Dr. Dewees relates a case where the mother had suffered from toothache for some time before her infant was born, and continued to suffer from it for six months after. The consequence was, that her infant became so emaciated from constant colic that it Avas at this age a skeleton, and all the remedies he could use availed nothing towards a cure, till he accidentally ascertained the condition of the mother, and learned the previous facts. He advised the immediate extraction of the tooth, Avhich was accordingly done; and from that day the child began to improve, and became fat and hearty. For the radical cure of colic, the diet of the mother and child should be strictly attended to, and the following medicines given when the child is oppressed Avith Avind: Recipe: Magnesia, twenty grains. Laudanum, twenty drops. Tincture of Foetida, one dracnm Water, one ounce. Mix. Twenty drops of this mixture may be given, in SAveet- ened water; and if the child is not relieved in fifteen minutes, ten drops more may be given. This is a dose for a child two weeks old; and it must be increased, according to the age of the child. The medicine should be given as soon as the first symptoms t>34 sore eyes. make their appearance. Once or tAvice a day, a tea spoonful of warm sweet oil may be given, which will keep the boAvels open. Children seldom have the colic after they are ten or twelve months old. Some mothers and nurses have adopted a practice of jolting and shaking their children on their knees, or thumping them on the back, with a vieAv to break the wind from the stomach. This is most brutal treatment, and cannot be too severely con- demned. The stomach and boAvels are distended Avith wind to such a degree as to cause great suffering from even the slightest movement. What torture, then, must result from this pounding. and jolting, and shaking, Avhich is resorted to so generally as a mode of relief! SORE EYES. There are various causes that will produce this disease. Exposing the eyes of a young infant to too strong light will, in almost every instance, have this effect. But there are other causes, of a more serious nature. They are gonorrhoea and leu- corrhcea; and the matter of either of these diseases will cause the most violent sore eyes. When the gonorrhoeal or leucorrhoeal matter has found its way into the eyes of an infant, we shall discover it in ten or tAvelve days after birth; the eyelids swell, and are partially glued up in the morning, and Avhen the lids are opened, some purulent matter will escape from them. The inflammation increases, till the ball of the eye is affected; and when the lids are opened, after softening them Avith water, the eye seems to swim in pus, and the ball can no longer be seen. The parts of the inner lids that can be seen are of a scarlet red, manifesting an intense degree of inflammation, which, if not speedily cured, will destroy the organ of vision, and total blind- ness Avill be the result. Treatment. — The first form of this disease, being produced by too strong a light, may be cured by keeping the child in a dark room, and washing the eyes with a mucilage made of the pith of sassafras sprouts, or slippery-elm tea, or breast milk. The second form of the disease is produced by the matter of gonorrhoea or leucorrhoea getting into the child's eyes as it passes the birth. It is not an uncommon occurrence for ladies of the first respectability to have leucorrhoea; but only those of a loose Jiaracter have gonorrhoea, except by the incontinence of their SORE EYES. 535 husbands. Let the matter be produced as it may, the remedy for the sore eyes caused by it is the same. When a child is born under these circustances, the eyes should be freely washed, for fifteen or twenty minutes, with warm water, and then kept from an exposure to a strong light, for fifteen days Some light inflammation may take place, but it will yield to the first remedies. But Avhen this precaution is neglected, and the eye inflames, and suppuration takes place, the treatment must be of the most active kind. After bathing the eyelids with warm water, and discharging as much of the matter as possible, three or four leeches should be applied on the lids of each eye, and allowed to draw freely. After the bleeding from the bites ceases, the child should be kept in a dark room, and the follow- ing wash may be used : Recipe: Sugar of Lead, two grains. Rose Water, one ounce. Mix, and bathe the eyes frequently with it. After the use of the eye-water, the mucilage of the sassafras should be used, and the eyes should be kept open and free from matter. The bowels must be kept open with the following medicines: Recipe: Calomel, four grains. Magnesia, ten grains. Mix, and divide in eight papers, and give one every four or ive hours, so as to keep the bowels freely open. If this does not greatly abate the inflammation in forty-eight aours, the leeches must be again applied to the temples; and as soon as the violence of the inflammation is overcome, blisters mould be applied to each temple, which may afterwards be Iressed with, Recipe: Basilicon Ointment, one ounce. Pulv. Savin Leaves, one drachm. Mixed. This may be used twice a day, and the sores kept running till the eyes are well. At this time, the following eye- water may be used: Recipe : White Vitriol, one grain. Rose Water, one ounce. Mix. The eyes should be washed with this, four or five times a day. If the matter cannot be conveniently removed from between the eyelids, a small syringe should be used, and warm water thrown in between them, three or four times a day; and this should be continued till the eyes are well. A word to mothers who know that they are laboring under 536 ULCERATION OF THE MOUTH. teucorrhea. When first taken in labor, you should wash the vagina out clean, with mild soap and water, and rinse the parts with clean warm water. A womb syringe should be used for this purpose. ULCERATION OF THE MOUTH. When this disease attacks an infant, it is first discovered by a free flow of saliva, which passes from its mouth; and, upon examination, small sores will be discovered under the tongue, and these gradually extend to the gums, but rarely reach the top of the tongue. The sores are deep in their base for the size of their surface. The child frequently refuses to suck, in conse- quence of the pain it suffers from them; it will lay hold of the nipple, but immediately let go and fret, and it ahvays has more or less fever. Treatment. — The first remedy to be used is that whieh removes the fever; after which, topical applications should be made. Recipe : Calomel, six grains. Magnesia, ten grains. Mix, and divide into six powders. Give one, in sirup, and repeat every three hours, till the bowels are freely purged. Then use the following wash: Recipe: Blue Vitriol, ten grains. Peruvian Bark, two drachms. Gum Arabic, one drachm. Honey, two drachms. Water, three ounces. Mix, and with a camel's hair pencil apply this to the sores twice a day. This generally heals them in a feAv days. There is another form of sore mouth to which children are subject at the age of teething, and especially when cutting their back teeth. The gums become very sore, especially if several teeth are about to make their appearance at the same time. They become purple, and the child drules constantly; its breath is offensive, and there is apt to be more or less difficulty in swal- lowing. The teeth that are cutting at the time soon decay, and those that were through before become injured. In this disease, purge the child gently with the following medicine: Recipe: Magnesia, half drachm. Rhubarb, ten grains. Mix, and divide into four powders. Give one, in sweetened water, and repeat every three hours, till they purge freely; aftei which, the following wash should be used: MILK SCALD, OR CRUSTA LACTEA. 537 Recipe: Oak Bark, one ounce. Boil to a strong decoction, and wash the mouth with it freely and frequently; or the following preparation will serve the same purpose: Recipe: Tincture Myrrh, half ounce. Chloride of Soda, two ounces. Rose-Water, two ounces. Mix, and wash the mouth freely Avith it. The child should live on a light diet; and in every instance the gums should be freely scarified, so as to let the teeth come out quickly. MILK SCALD, OR CRUSTA LACTEA. This disease never shoAVS itself before teething, and never continues after all the teeth have come through. Hence, it is properly classed among the diseases of dentition. It usually begins near the centre of the forehead, or on the cheek, and its first appearance is that of small Avhitish particles on a red sur- face. These pustules change to a red or brown, and break, and form a scab of greater or less density, from which proceeds a copious discharge. New pustules soon form, and spread, till, in some- cases, they cover the whole face, neck and shoulders, and sometimes the body, except the nose, on which, as AvelJ as on the eyelids, we have never known them to form. The surface which this disease will cover is very uncertain; sometimes it is confined to a small space, and again Ave see it cover the whole body, although it is not frequently so extensive. When the scab drops off, the surface is red and tender, and has the appearance of being marked with small fissures, Avhich, however, leave no scars. The itching caused by it is intolera- ble. The child frets day and night, loses its appetite, and Avastes away. But the disease is generally considered more alarming and troublesome to the mother, than dangerous. Yet it has proved fatal, and may, of course, be so again. When it is cured, or gets well spontaneously, it leaves no scars. Many varieties of this disease may be found, but these are the general symp- toms. Treatment.—The treatment of this disease should always be commenced with purgatives. Recipe: Milk of Sulphur, two drachms. Magnesia, two drachms. Mix in three powders. Give one, in sweetened water, night and morning. This should be continued for at least a week« 638 MILK SCALD, OR CRUSTA LACTEA. and, at the same time, the sores may be anointed Avith cold cream, or the following ointment: Recipe: Parsley Tops, one ounce. Sweet Cream, three ounces. SteAv them slowly together, till the strength is extracted from the parsley, and anoint the sores with the ointmen* two or three times a day. After using the above medicines a week, give the following powders: Recipe: Calomel, twelve grains. Prepared Chalk, twenty grains. Mix in twenty powders. Give one, morning and evening, in molasses or sirup; or, if necessary, vary them so as to operate two or three times each day. The use of the cream ointment should be continued till the inflammation is removed, when the folloAving preparation should be used : Recipe : White Precipitate, one drachm. Simple Cerate, one ounce. Otto of Roses, ten drops. Mix properly, and anoint the sores, three times a day, wash- ing them off, each time, with mild soap and Avater, before the ointment is reapplied. If this fail, try Dr. Dewees' preparation, which is, Recipe: Calomel, two drachms. Simple Cerate, one ounce. Essence Lemon, twenty drops. Form an ointment, to be used as above ; and when this fails, he uses the tar ointment. Recipe: Tar, two ounces. Fresh Butter, two ounces. Simmer them together, and apply to the sores, as above directed. Bathing, in every stage of this disease, is of great ser- vice. The best bath is made of flax-seed tea, and should be repeated every night. Diet. If the child be at the breast, it should take less than usual, and the mother should take medicine to cleanse her stomach well. She should then live on a mild or vegetable diet, or bread and milk. If the child be weaned, it should live on rice, sago, arrow-root, gruel, a little milk, &c, but not one mouthful of meat, butter, or gravy, in any form, should be used. It requires the strictest attention to cure this disease in one month; and if these rules be neglected, a cure need not be expected, till the child has cut all its teeth ; if, indeed, it should live so long. TOOTH-RASH.--SORE EARS. 539 TOOTH-RASH. This disease always makes its appearance when the teeth are coining through, and hence it is called tooth-rash. It attacks different parts of the body, in small pimples, which look not unlike the red gum of infants at a few days old, except that it is not so livid, and the pimples are smaller and more crowded together. It troubles the child by the itching which it creates, and at times there is a little fever attending it. Treatment. — If the bowels are disturbed, a full dose of mag- nesia, or a little rhubarb, may be given. The child should be bathed in lukeAvarm Avater, Aviped dry, and starched all over. It should Avear linen next the skin, if the weather be warm, live on a light diet, and in a few days the disease will disappear, by falling off in thin, branny scales. SORE EARS. During the period of teething, and sometimes before this takes place, children are subject to an eruption behind the ears, to Avhich those that are fleshy are more liable than those that are lean. The first appearance of this disease is not unfrequently like a chafe or scald, and there is, perhaps, no disease that is cherished Avith more care than this. It grows out of a false idea that a discharge from the ear relieves the child from the ill humors that are lurking in the system; and, consequently, the sores are irritated and made to discharge more freely, till presently they become foul, ill-conditioned, and secrete a large quantity of serum and unhealthy pus. But we lay it doAvn as a correct rule, that no sore anyAvhere on the body is conducive to health; and therefore they should be cured as quick as possible. Treatment. — When the abrasion is first discovered behind the ear, instead of being encouraged, it should be immediately washed Avith a little milk and water, or the mildest kind of soap, and then Aviped dry. This should be repeated as often as the serum is discharged, and the sores become wet, if it be half a dozen times a day. After being washed, the sores should be dressed Avith the following ointment: Recipe : Bees-Wax, half ounce. % Hog's Lard, half ounce. Melt them together, and apply a dressing, on soft linen, so as to cover the sore completely. If the child be disposed to scratch 540 TONGUE-TIE. the sores, its fingers should be muffled. The following medicine should be given : Recipe : Calomel, ten grains. Magnesia, thirty grains. Mix in ten papers, and give one, night and morning, in sirup, so as to procure tAvo or three operations from the boAvels every day. After the inflammation is removed, the folloAving oint- ment should be used: Recipe : Calomel, one drachm. Simple Cerate, one ounce. Mix them properly, and dress the sores Avith the compound, morning and evening, and let the plaster extend over the sore. and cover a part of the sound skin. The washing with the soap and water, before each dressing, should be continued, and the child must still live on a vegetable or milk diet. Diseases of the brain, often fatal in their result, are frequently produced by excessive and extensive inflammation, of which sore ears' is the cause. Let mothers, then, act rationally, and heal these sores in the outset, and thus prevent the long train of bad effects that so often results from this neglect. When the dressings are applied to the ears, if both be sore, the child should sleep on its back, and wear no cap, in order that the head may be kept cool. OF TONGUE-TIE. There are two distinct ways by which the tongue is tied; or. in other Avords, tAvp distinct membranes Avhich tie that organ down. One is the natural frenum, and the other is an unnat- ural, thin membrane, which extends beyond the continuance of the frenum, and fastens itself to the point of the tongue. This membrane is almost transparent, Avhile the unnatural continua- tion of the frenum is fleshy and much thicker. Both prevent the child from sucking with ease, and.their effect is to make it cluck and sAvallow wind, and, when grown, to lisp. Treatment. — The thin membrane is to be clipped Avith a pair of sharp scissors, or gum lancet; and the mode of operating is this: Place the child's face in a fair light; put the point of your little or fore finger under its tongue, and raise it up, and then, with a quick, but dexterous stroke, clip this membrane down to the frenum. It will not bleed more than one or tAvo drops. DISEASE OF THE HIP JOINT. 541 The cure of the other, or thickened frenum, is the same, but great care should be taken to prevent hemorrhage, for some important blood vessel may be divided. If this should be the case, the child may be strangled by the blood, or, by sucking it, may swalloAV the point of the tongue, and suffocate. The rem- edy is, to bring the tongue forward Avith the finger or a spoon- handle as soon as possible, and touch the bleeding vessel Avith caustic or burnt alum. This soon arrests the bleeding, and the wound quickly heals. DISEASE OF THE HIP JOINT. This disease is often suffered to progress for the want of a knoAvledge of its location. It is most frequent in children, and is generally caused by a strain, bruise, or anything that may give the joint a severe Avrench. The child firsffcomplains of pain in the knee or knees, and the parent supposes the joint to have been slightly strained, and that it Avill soon pass off, as there is no SAvelling to be perceived, and no pain is experienced when the limb is touched. Still, hoAvever, when it attempts to walk, the child cannot bear its Aveight on the affected limb, and is apt to set that foot a little before the other when it stands up. The reason of this is, that that limb is longer than the other, from a thickening of the membranes covering the head of the thighbone, and lining the cavity in Avhich it rests. The child may have general feArer, Avith a quick pulse and white tongue; or it may have but little fever, and the tongue may look healthy and natu- ral. The only certain method of finding out the location of this disease, is to lay the patient flat on his back, and flex the knee, by setting the foot up near the nates, and then, Avith the edge of your hand, to give the knee a sudden stroke, just at the lower end of the knee-cap; and the patient will complain of the hip joint Avhich lies nearest the surface, about the middle of the groin. When this disease progresses, inflammation extends to the surrounding muscles, and abscesses form; sinuses are produced; ill-conditioned pus is thrown out, with a briny bloody sanies; the bones become affected; the head of the thighbone ulcerates and is discharged, or it is throAvn out of its socket, and passes upwards and backwards. This shortens the leg, and turns the toes inwards. But the head of the thighbone may be thrown 542 DISEASE OF THE HIP JOINT. inwards, and lodge in the foramen of the pelvis; and this will make the leg too long, and turn the toes outAvards. The cavity for the lodgment of the head of the thighbone may be absorbed, and the head and neck of the bone slip through, and rest upon the trocanter of the thigh, and then the leg is too short, and the toes are only permitted to reach the ground. This is a formida- ble disease, and should be early and strictly attended to. Treatment.—It is almost ahvays the case that time is lost by parents addressing some remedies to the knee, supposing that it is a strain or rheumatism with which the child is afflicted. Indeed, there are many physicians who mistake this disease, and are not undeceived till it is too late to apply the proper remedies. When a child first begins to complain of pain in the knee, and no swelling or soreness is found there, it should be immediately tested in the way we have directed; and if there is the least pain produced in*the hip by this proceeding, it may be regarded as certain proof of the nature of the disease, and no time should be lost in using the proper remedies. If the pulse be full, hard, or quick, and the skin hot, the patient must be bled freely from the arm. He should then be placed on a mattress. or straw bed, —but on no account on feathers, — upon his back, and, in this position, his legs must be straightened, even if it should hurt. If he cannot keep them straight, the following treatment must be pursued: Let a hand- kerchief be passed around his chest, under his arms, and another through that, and around the head-board or rail of the bedstead; let a fillet be then passed around his ankle, and around the foot- board or rail, and draw the limb straight. This would seem to be a barbarous practice, but it is better that the child submit to it now than be a cripple for life; if, indeed, he does not lose his life. He must now take the folloAving medicine : Recipe : Cream Tartar, one drachm. Pulv. Jalap, half drachm. Mix, and divide into six papers, for a child six years old. One of these should be given, morning, noon and night, in SAveetened water, or just as many as will give him three free passages a day. When the medicine operates, he is to be again placed in his straight position. If the hip swells much, cups should be applied over it, or fif- teen or twenty leeches on the swelling, as near over the joint as possible; and this, as before stated, is nearest about the middle ABSCESS WITHIN THE EAR. 543 of the groin. This should be succeeded by a free bathing of the whole hip with vinegar and water, a little warm, which should be repeated three or four times in twenty-four hours. Some have recommended issues to be put on the hip, but Ave have never seen any good derived from them. The purging, bathing, leeching, position, and Ioav diet are the remedies. No article of diet should be taken that has the smallest portion of grease in it; no animal food, of fish, flesh or foAvl, nor soups of any descrip- tion, butter, nor sweet milk, should be allowed. On the con- trary, either gruel or rice, potatoes, tea, light bread, soft toast, made with warm water, arroAv-root, sago, mush and molasses, &c, should constitute the food, and the drink should be pure water only. Perseverance in this course will cure the disease in from ten days to tAvo months, if caries of the bone have not taken place before it is begun. If such be the case, six or twelve months may be required to effect a cure. As strong contractions must have taken place, splints and bandages must be used, and vari- ous remedies applied, Avhich require the aid of a skilful physi- cian, Such an one, therefore, must be called in. ABSCESS WITHIN THE EAR. Children from the age of six months and older are sometimes found to cry and toss themselves from side to side, giving to their head a variety of unnatural motions. They scream most violently for some minutes, fall into a sleep for a short time, and aAvake in a like paroxysm of pain. At times the child has a light fever, at other times it has none. This disease is generally thought to be colic by the mother or nurse, but is easily distinguished from it by the child's- not draAving its knees up tOAvards its abdomen; neither are the nands and feet cold. If pressure be made upon the loAver part of the ear, near the orifice, pain will quickly be produced; and by looking into the ear, Ave can very often discover the swelling, and too frequently see that matter has already formed. When the abscess breaks, the matter Aoavs out freely, and the child is relieved for a Avhile; it falls into a sleep, and aAvakes free from all pain; but is doomed to suffer a renewal of this process several times within a month, till at last inflammation seizes the bones of the ear, and exfoliation takes place, and if death is not pro- duced by the disease finding its way to the brain, deafness Avili be the final result. 544 ADHESION OF THE LABIUM PUDENDI. Treatment.—It is too often the case that the remedies proper for the removal of this disease are not used till it is too late to effect a cure. When, hoAvever, it is apprehended in time, the ear should be filled with a small plug of wool or cotton, Avet with laudanum; and this application should be frequently repeated. If the child has much fever, it should be bled, and the following medicines given, for a child six months old: Recipe : Calomel, six grains. Magnesia, twenty grains. Mix, and divide into six powders; give one, three times a day, in a little sirup, and repeat the next day. Three or four leeches should be applied under the ear. If the disease should not yield in tAvo days, a small blister may be applied under the ear, instead of re-leeching. Sometimes two or three drops of the juice of a roasted onion, squeezed into the ear, will give immediate relief; and the onion may also be roasted and mashed fine, and applied to the ear in the form of poultice. If this should not cure it in the first stage, and it breaks, or has broken before you are apprized of the nature of the disease, you must then cleanse it with the folloAving wash: Recipe: Lime Water, two drachms. New Milk, half ounce. Tincture Myrrh, half ounce. Mixed. This will be enough for one application, and shoula be thrown into the ear with a syringe, so freely as to wash it out perfectly. It should then be rinsed out Avith fine soap and water, and three drops of the folloAving mixture should be dropped into the ear after each Avashing: Recipe : Tinct. Myrrh, half drachm. Sweet Oil, half drachm. Mixed. Shake the vial Avell, and drop three drops into the ear, which must be stopped with wool or cotton. If the bones of the ear should become so diseased as to exfoli- ate, or loosen and come out, nothing can prevent a partial, if not an entire, loss of hearing. The boAvels should be kept open with gentle medicines, and the diet, if the child be weaned, should be entirely vegetable. ADHESION OF THE LABIUM PUDENDI OF CHILDREN. This misfortune is more frequent than we might suppose, from the first thought on the subject, seeing that nurses and mothers are both anxious about these parts, and are apt to inspect them FECULENT DIARRHC3A. 545 closely, to see if they are perfect. From this fact, we are led to believe that this disease is not often congenital, but is the result of accident or neglect after birth. This adhesion is produced as follows: the parts become chafed or galled Avith acrid fseces or urine, or both; by being neglected, they become raw, inflamma- tion takes place, and adhesion folloAvs. This may not be dis- covered for months, or years, if a careless mother or nurse have the management of the child. Indeed, it sometimes passes on till the girl has groAvn up, and, at a time, when she Avould wish above all others to be perfect in these parts, she is found to be in this condition. Consequently, notwithstanding the death-like mortifi- cation to which she must be subjected, she is compelled to be exposed, and suffer an operation to be performed for her relief. When this adhesion exists, the urine is ahvays passed with some difficulty, and the menstruous fluid has to find its way through the small external opening through which the urine passes; for the whole external meatus of the vagina is closed, and is perfectly smooth, Avith only a threadlike seam Avhere the labia have been closed together. Treatment.—There is but one remedy, and that is to divide the labia by an operation. Some advise this to be performed by tearing the labia apart, and others advise the use of the knife. There is no reason to hesitate between them, and the use of a sharp-edged instrument offers the remedy. The operation is performed by passing a probe-pointed bistoury down from the orifice of the urethra to the loAver part of the meatus of the vagina, and carefully and correctly dividing the labia. The parts should then be dressed with lint and sweet oil, to keep them from groAving together again; and, in a feAv days, the Avound heals, and all is well. Mothers should examine these parts of their daughters frequently, in order that no such accident may happen. FECULENT DIARRHQ5A. Children under two years and a half old are especially liable to this complaint. We shall cease to wonder at this, when we recol- lect the great length, sensibility, and irritability of the alimentary canal; the various parts with which it almost constantly sym- pathizes, as the liver, the skin, the lower extremities, the brain, and the gums during teething; and the immense surface it pre- sents to be acted upon by the variety of substances received into BRIGHT. 36 546 FECULENT DIARRH02A. it. (Deivees.) Whatever, therefore, is capable of increasing the peristaltic motion may contribute to the production and continua- tion of this disease. This form of diarrhcea may be created by agents acting directly and indirectly; and for the first cause, we enumerate improper diet of all kinds, or even too much of that which may be good when taken in proper quantities. Unhealthy milk or animal food may produce this disease, and anything that is disposed to fer- ment, and especially if that process be about to take place Avhen the diet is taken. When food of this description is taken into the stomach, the bowels act quickly, in order to throw off the offend- ing substance, and a diarrhcea is induced; the faeces are undi- gested, and of course feculent. The bowels are thus irritated, and prevented from performing their functions in a healthy manner. This form of diarrhcea is almost always attended with some nausea, and more or less pain. There is, generally, more or less acid on the stomach, Avith occasional accumulations of Avind; and, sometimes, there is fever to a greater or less degree. This disease sometimes continues till the flesh of the little patient is literally Avasted off its bones, and it becomes a mere skeleton. These dis- charges work at times like yeast, and again they are as thin as water, and in every instance are extremely offensive to the smelL They are sometimes so acid as to excoriate the skin. Treatment.—The kind of medicine we give in this form of diarrhcea is a matter of great importance. If the discharges are acid and acrid, we should give the following: Recipe : Magnesia, one drachm. Pulv. Mace, six grains. Mixed. Divide into six poAvders, for a child six months old, and give one every four hours, in a small quantity of sweetened water, till they have operated freely. This may be known by the color and smell of the discharges being changed. If these fail, give the following: Recipe : Magnesia, twenty grains. Pulv. Rhubarb, twelve grains. Pulv. Mace, three grains. Mix, and divide into six powders, and give them as above. Should they not check the discharge, they will destroy the acid. We must then give the following: Recipe: Calomel, twelve grains. FECULENT DIARRH03A. 547 Divide into six poAvders, and give one every tAvo hours, in a few drops of simple sirup, till they operate freely. They will produce a green or dark discharge, with but little or no smell. If the boAvels continue relaxed, and the passages too frequent, give the following drops : Recipe : Pulv. Mace, one drachm. Nutmeg, two drachms. * Cloves, two drachms. Cinnamon Bark, four drachms. Race Ginger, two drachms. Pulv. Rhubarb, one ounce, Boil all these in a pint of Avater, down to a half pint; strain them; add half a pound of loaf sugar; simmer till all are reduced to a perfect sirup, and then add half a pint of old rye whiskey. This is called the aromatic sirup ; of Avhich, when the bowels are relaxed and the passages are frequent, after the child has been sufficiently purged, to one six months old, give a tea spoonful in Avater, and repeat every tAvo, three, or four hours, as the case may require, till the bowels receive tone, and the discharges become natural. Occasionally, however, if much derangement exists, a dose or two of calomel must be given. Diet. — This is a matter of the greatest importance. If- the child be at the breast, no other diet should be given, and that not in too full portions. If it is a weaned child, all animal food must be taken from it. Scalded milk, with two table spoonfuls of lime- water to half a pint, and a small quantity of sugar, should com- pose its diet. Occasionally, a little Avell-boiled rice, arrow-root, gum-Arabic water, sago well boiled and sweetened lightly, or the crumbs of bread mashed very fine, and made soft Avith cream and a little sugar, will be good. The dress is important. The skin should be kept clean, and flannel should be put on next the skin ; shoes or socks should also be worn. The child should be carefully taken out into the pure air, but it should not be exposed to dampness. The bed-chamber should be ventilated, but a cold current of air should not strike the child while asleep, especially if it is in a perspiration. Great care should be taken to remove its diapers, or under-clothes, as soon as they are wet or soiled; and they should not be put on a second time, till they are washed and well aired. As soon as the child is able to bear it, exercise on horseback, or in the baby's carriage, cautiously and properly used, will be of service. It should never be allowed to take hearty drinks of cold water; and for a drink, water that has been boiled and cooled will be better 548 BILIOUS DIARRHCEA. for the child than common cold Avater. When the disease ia slight, and no fever or acid exists, a dose or two of castor-oil, without any other medicine, will cure it, if given in time. OF BILIOUS DIARRHCEA. The name of this disease in part describes it. The bowels are stimulated into inordinate action by an overcharge of bile; the faeces are loose, copious, and of a green or yellow appear- ance ; and this bile may be more or less vitiated. This form of diarrhcea makes its appearance only in warm Aveather, and has obtained the name of summer complaint. The influence of heat upon the skin is Avell known. It stim- ulates the liver into increased action, and consequently more bile is secreted, and, if the organ be sound, in order to relieve itself, it throAvs it off in greater or less quantities. Grown persons will observe this in their own case, especially after a hot season, suc- ceeded by a damp or moist atmosphere. In this form of diarrhcea, in children, the stimulus of the bile increases the action of the bowels, and they, in some cases, relieve themselves from the disease. On the other hand, fever ia sometimes provoked by the inordinate quantity of bile, and the child may be placed in a dangerous situation. Teething rarely produces this complaint, though it may be aggravated by it. This, as well as all the diseases of the bowels of children, is aggravated by improper diet, as well as by exposure of any description. Treatment. —The remedies for this disease are suggested by the disease itself. The boAvels must be evacuated, and that by such medicines as exercise a decided influence on the liver. The first thing, therefore, to be done, is to give the following powders, for a child six months old: Recipe : Calomel, twelve grains. White Sugar, twenty-four grains. Mix. Divide into six papers, and give one every two hours, wet Avith a few drops of Avater, till they operate freely three or four times. This must be repeated, every day, till the fever is overcome, and the discharges are of a consistent character. They may be so, and yet be green; and if they are of a pea- green color, the calomel must be continued till they are of a deep MUCUS DIARRHffiA. 549 or dark green, with some specks of mucus in them. The fol- lowing powders may then be given: Recipe: Calomel, three grains. Rhubarb, twelve grains. Mix, and divide into six powders, and give them as above directed, till the discharges are consistent and yellow. If the child is restless at night, and has a fever, a tea spoonful of the following mixture may be given, in sweetened water: Recipe : Magnesia, twenty grains. Tinct. Fcetida, one drachm. Laudanum, forty drops. Water, one ounce. Mix. Shake the vial well before you pour out the medicine. If the child has much fever at any time, Recipe: Spirits Nitre, half ounce. Give ten drops in a little lukewarm water, and repeat every hour till the fever is subdued; but if it should return, give them again, in like manner. The diet is very important in this disease. If the child is not Aveaned, it should live on the breast alone; if weaned, the diet should be light, and composed of such articles as rice, milk and water, light bread boiled in water and sweetened lightly, arrow- root, sago, rennet Avhey, rice-water, or Avell-boiled gruel. The clothing should be adapted to the season of the year and the temperature of the atmosphere. The room should be well ventilated, but a draught of damp air should not be suffered to pass over the child. Slippery-elm tea will be a good drink dur- ing convalescence. OF MUCUS DIARRH03A. This form of diarrhcea is produced by a sudden check of per- spiration, exposure to wet or dampness, too ?ight clothing in damp weather, the cold bath, or any other cause that Avill pro- duce a sudden check of perspiration. The discharges ahvays shoAV more or less mucus, before and after the true evacuation. They are sometimes colored a little green, and may be tinged with blood. There is rarely any pain with this disease, though there is pain, and more or less tenesmus, with a disposition to strain when at stool. Vomiting rarely presents itself in this disease; and it is, perhaps, the only form of diarrhcea to Avhich children 550 CHYLOUS DIARRHCEA. are subject, in the production of Avhich the teeth are not accused of having some active part. Treatment. —The cure of this disease should ahvays be com- menced by giving a gentle purgative. Recipe : Simple Sirup of Rhubarb, one ounce. Give a tea spoonful every two hours, to a child six months old, increasing or diminishing the dose, according to its age, till free evacuations are produced. If there is much straining after this, give an injection made of starch, containing ten drops of laudanum; and this maybe repeated as often as the straining returns. After the boAvels have been freely evacuated by the sirup of rhubarb, a dose of castor-oil may be given. Recipe: Castor-Oil, half ounce, A tea spoonful every tAvo hours, till a free operation is pro- duced, Avill be sufficient. If blood still appears with the evacu- ations, ghre: Recipe : Calomel, six grains. White Sugar, ten grains. Mix. Divide into six poAvders, and give one every two hours, till they operate well; after Avhich, the bowels should be kept open with rhubarb tea, SAveetened. The drink should be slippery-elm tea, or gum-Arabic water. The injections are important, and should be frequently used. Let the skin be kept comfortably warm, and avoid all exciting causes. OF CHYLOUS DIARRHCEA. It Avould seem that this disease has for its cause a different secretion from the liver, as the discharges are white or milky in their appearance. Thin Avhite fluid is chyle; and hence the name, chylous diarrhoea. The boAvels are always loose, the pas- sages frequent, though not generally smelling badly. The child laboring under this disease rapidly emaciates, because the chyle is not taken up by the lacteal vessels; and hence, there is a deficiency of nourishment for the maintenance and growth of the system, and the muscles, therefore, waste away. The skin becomes loose and flabby, the eyes sink in their sockets, the abdomen becomes flaccid, and the whole sys- tem seems to yield to the rapid influence of the disease, Avhich, if not speedily relieved, must inevitably prove fatal. But it does so because of the want of nourishment, since nothing which the child takes into the stomach is properly digested. CHYLOUS DIARRHCEA. 551 Treatment.—The liver seems to be the great defaulter in this disease, and our remedies must, therefore, be addressed tc that organ. In order to obtain what we desire, in this case, we must free the stomach from everything that would hinder its proper and healthy action; and, therefore, no kind of diet that can possibly offend, or require more of the digestive powers than it is able to afford' should, on any account, be given. Small quantities of rennet whey, or gum-Arabic water, will be the best diet for the first Aveek; or a small quantity of scalded milk, with one sixth its quantity of lime-water, which may be lightly sweetened, will serve as well. The medical treatment should be as follows: Recipe: Blue Mass, ten grains. Rhubarb, ten grains. Pulv. Opium, quarter of a grain. Mix, and divide into ten poAvders; give one, in a little sirup, every two hours, till yellow bile is discharged from the liver. Recipe: Calomel, six grains. Pulv. Mace, four grains. Mix, and divide into tAvelve powders; give one as in the pre- vious direction. If the child does not rest Avell at night, give the following iniection: n ,. Recipe: Starch, made thin, two ounces. Laudanum, ten drops. Mixed. This may be repeated every night. The above pow- ders may be repeated every day, so as to produce one or two evacuations daily; and, after the liver acts freely, Recipe : Sirup of Green Persimmons, two ounces. A tea spoonful should be given every time the child has a passage, till they are reduced to tAvo or three in twenty-four hours. Then, the following drops may be given as a tonic: Recipe: Huxham's Tincture, one ounce. Give fifteen drops, three times a day, in sweetened water; and, at the same time, the tepid bath, with salt in it, once a day will be profitable. Keep the child in the bath five minutes, and rub off with a dry towel. Flannel should be worn next the skin, and socks on the feet. The food is only to be increased as you find the stomach will properly digest it. Exercise in the open air, when the weather is warm and dry, will be serviceable. 552 LIENTERIC DIARRH02A. OF LIENTERIC DIARRH02A. "The rapid passage of the nearly unchanged aliment through the bowels constitutes this species of diarrhcea." It not unfre- quently follows the other species of that disease, but perhaps more frequently succeeds to dysentery. This complaint may exist in different degrees, and rarely comes on suddenly. The first indication of it is the passage out of the system, in a short time, and undigested, of the food just taken into the stomach. Small portions of apples, potatoes, or other articles of diet, may be seen, perfectly sound, in the diges- tions, in an hour or tAvo after they are SAvalloAved, and Avhen this is the case, Ave may regard the disease as fully formed. The child may vomit occasionally; is griped, and cries from pain; the urine becomes small in quantity, and smells badly; the hands and feet are apt to be cold, and the thirst is increased. The disease is generally brought on by improper feeding, or exposure, and perhaps both; but especially feeding. There is, occasionally, a mixture of bile in the stools, but generally there is rather a deficiency of it; evidently showing that the liver is someAvhat in fault. Treatment. — We commence the cure of this, as of chylous diarrhoea, that is, by letting the child have no more diet than Avill sustain it. If at the breast, it should take nothing but breast milk, and that in small quantities, and not oftener than once in three or four hours. Recipe: Calomel, twelve grains. Pulv. Mace, three grains. Mix, and divide into six powders; give one every four hours, in a drop or two of sirup, and repeat till the operations show that the medicine has acted on the liver. The stomach is evidently much in fault in this disease, and requires something to give it tone. As soon, therefore, as you have properly evacuated the bowels, if there is no fever, the aromatic tincture may be given, as prescribed in feculent diar- rhoea, and in the same quantities, according to the age and strength of the patient. If the recovery be slow, the abdomen may be rubbed with tartar emetic ointment. Recipe: Tartar Emetic, one drachm. Hog's Lard, one ounce. Mix them well together, and rub on the abdomen, morning and . CHRONIC DIARRHGEA. 553 night, a portion of this ointment as large as a hazle-nut, and con- tinue till the eruptions come out pretty freely. Dress the sores with simple corate. The child should be taken out in the open air, evening and morning. Yarn stockings and flannel should be worn next the skin, and, as the strength and digestion improve, the diet may be increased. CHRONIC DIARRHCEA. The several species of diarrhcea just treated of may run into this form, by neglect, bad treatment, or an improper diet. It is a most formidable species, and most commonly occurs after wean- ing, though it may, and does occasionally, occur before. It more usually attacks in the summer and fall months than at any other season of the year. The discharges are frequent, generally tinged with green, and sometimes fetid. The child is sick at the stomach, retches fre- quently, and sometimes vomits; is thirsty and feverish, peevish and fretful; though this is the effect, more or less, of pain, which constantly attends this disease. The faeces are mutable, being sometimes bilious, sometimes healthy in appearance, and some- times undigested. This disease may run on for six or eight Aveeks before it proves fatal; but in some cases, death may be produced in half the time, by a transition, by sympathy or otherwise, to the brain, when convulsions terminate the case. Excessive vomiting and purging, hoAvever, sometimes cause death before the disease runs its usual course. It occurs most frequently in children that have been weaned at the eighth or ninth month, —a fact of Avhich mothers are so well apprized that they never wean their children at this age except from necessity. It is most frequent in Avet, hot summers, and from July to October; and in very dry summers we rarely meet with it in children. Mothers are apt to neglect diarrhcea when children are teeth- ing, thinking that loose bowels will prove an advantage to them; than which, nothing is more erroneous and dangerous. This disease produces singular contractions in the Avhole length of the alimentary canal. The bowels are frequently folded one part into another, like the folding in of the finger of a glove, and this may be of the extent of from half an inch to tAvo or three inches. The liver is enlarged, and is of a bright-red color; the gall blad- 554 CHRONIC DIARRHCEA.. der is also enlarged, and contains dark green bile. Sometimes the mesenteric glands are inflamed and enlarged, and at others, they present no appearance of inflammation. These contractions and intussusceptions of the boAvels are altogether spasmodic, and present no adhesions by inflammation or otherwise, being easily overcome by a slight pressure Avith the finger. The evacuations in the advanced stage of this disease are not unlike pounded grass, or some green vegetable floating in a thin, green Avater; but when the mucous coat of the bowels begins to give Avay, the discharges are of a brown chocolate color, and extremely fetid. When the liver is much affected, the discharges are of a yellowish, pus-like appearance. Is it any Avonder, under these circumstances, that the child should be emaciated and weak ? Treatment.—After diarrhcea has become chronic, it is always more difficult to cure, because the liver is involved Avith the intes- tines in maintaining the complaint; because the stomach and bowels are seriously affected, independently of the condition of the liver; because the irritation is very often kept up by the presence of Avorms, which are sometimes difficult to remove; and because the influence of habit, added to diseased action, is hard to change. Let these causes be remembered, and the propriety of the treat- ment Avill easily be perceived. If the first stage of this chronic form of the disease alone exists, the discharges are green, slimy, or curdled; the child has loss of appetite, and occasionally vomits; the skin, under the clothes, is dry and hot; the urine is scanty and high-colored ; the thirst is great; the child is fretful, Avhimsical, and sluggish; the flesh shrinks and the child looks badly. In this stage, the boAvels must be freely purged with the following medicine, for a child one year old: Recipe : Calomel, ten grains. Rhubarb, twenty grains. Mix, and divide into ten poAvders. Give one, in a little sirup, every three hours, till they operate freely. After the operation is over if the discharges are green or slimy, give Recipe: Castor-Oil, one dose, a dessert spoonful, for a child one year old, which may be increased or diminished, according to age. Should this not bring natural passages, you should then give a tea spoonful of the sirup of rhubarb, every two hours, till the CHRONIC DIARRHCEA. 55S discharges are corrected and yellow; after which, the diet will generally perform the cure, if properly regulated. In the second stage, all the symptoms are aggravated; the dis- charges are of a light pea-green, very thin, and smell badly: there is evidence of much acid in the stomach and boAvels; griping pains are experienced, and the child pukes occasionally. The milk, if any be taken, is throAvn up in thick, hard curds; the tongue is coated with a thick, Avhite crust, perhaps mostly coagulated milk; the child has more or less fever; is very restless at night; the evacuations are frequent, and the bowels griped. The treatment for this stage of the disease differs a little from that of the first. The folloAving medicine should be given : Recipe: Calomel, ten grains. Magnesia, twenty grains. Pulv. Opium, one half grain. Mix, and divide into ten poAvders, for a child one year old; and give one, in sirup, every three hours, till they operate freely. After the operation is over, give the folloAving: Recipe : Blue Mass, sixteen grains. Pulv. Mace, two grains. Mix, and divide into eight powders, and give one, morning, noon, and night, in a feAv drops of sirup. If the child be restless, and griped much, give a starch injection, Avith ten drops of laud- anum in it. This may be repeated, every night, at bedtime. After the boAvels are corrected, but still Aveak, and the passages too frequent, give the folio Aving: Recipe: Prepared Chalk, three drachms. Laudanum, twenty-five drops. Oil Cinnamon, one drop. White Sugar, two drachms. Water, three ounces. Mix them well together, and give a tea spoonful every two, three, or four hours, as it may influence the operation. This medicine is designed to check the boAvels gradually; as soon, therefore, as this result is produced, the medicine must be omitted. If* the looseness should return, hoAvever, it must be given again, as above directed. If the evacuations are kept up from acrid bile, this medicine will not stop them, but they will become yel- Ioav, when the following medicine may be given: Recipe: Calomel, six grains. White Sugar, twelve grains. Mix, and divide into six powders; give one every two hours, till they operate freely. If the child should not rest at night, give 556 CHOLERA INFANTUM. the injection at bedtime; and should it go more than eight or ten hours Avithout a passage, an injection should be given, omitting the laudanum. During the Avhole process of the cure, the diet and drink of the patient should be strictly attended to. The drink should be slippery-elm, flax-seed, or marsh-mallow tea, rice-water, barley- water, &c, and these will constitute its principal diet. It may take a little milk and lime-Avater, in the proportion of tAvo table- spoonfuls of the lime-water to a pint of milk. This may be sweetened Avith a small quantity of Avhite sugar. Rennet Avhey, sago, and arroAv-root, may be given occasionally. No solid food, or stimulating drink of any description, can be alloAved; and if the child is at the breast, its mother's milk alone will be sufficient for it. As it gathers strength, the diet may be made more nour- ishing. Rice, boiled till it is dissolved, and milk added to it, or milk and thin mush, a little crumb of bread made perfectly fine, with some SAveet cream and a little maple sugar in it, may be given. The Avhole body and limbs should be covered Avith flannel, and socks put on the feet. The third indication may be ansAvered by vermifuge medicines. If, in spite of the above remedies, the bowels should continue too loose, we may suspect the presence of Avorms that have eluded the previous efforts to effect a cure, and Ave may then give, Recipe: 01. ofWormseed. Directions for its use are found around each vial; but it must never be given when the child has a fever. Or, the Carolina pink may be used instead, and taken in the folloAving manner: Give a quarter of an ounce, to a tea cupful of very Aveak coffee; boil the pink in the coffee, and add milk and sugar. Let the child make tAvo or three breakfasts of this, and then give a dose of castor-oil. OF CHOLERA INFANTUM. This disease is brought on children by a variety of causes, of Avhich the most frequent are improper diet and clothing, premature weaning, Avorms, and teething. It makes its appearance in different ways; and sometimes it comes on as a simple diarrhcea. In its more violent forms, it is attended by vomiting and purging, accompanied with spasmodic symptoms, not unlike those in the cholera morbus of adults. There is an irregular remittent fever, which is ahvays highest in CHOLERA INFANTUM. 557 the evening; the pulse is usually small, quick, and feeble, and sometimes corded, but rarely full and strong. There are strong symptoms of determination to the brain, even in the early stage of this disease. Stupor, and frenzy, or delir- ium, are manifested; the eyes are either fiery or languid in expression, and when the patient sleeps they are half open. The thirst is intense, and if cold Avater be drank, it is instantly throAvn up. The head, stomach, and boAvels, are hot, and the hands and feet are cold, or cool; the discharges from the bowels are generally thin and Avatery, Avith some lumps in them, occa- sionally tinged Avith blood and mucus. Their color varies from a green to a white, yelloAV, or brown; at times they have no smell, but at others they are very fetid, frequently having a sour or putrid smell. The motions are sometimes very frequent, in which case the food is undigested. The child falls aAvay rapidly, the surface is pale, and the skin soon becomes flabby and livid; and Avhere the weight of the body rests, the skin will frequently ulcerate, and become trouble- some with sores. The skin appears as if it were stretched across the#forehead, and the eyes are sunken in their sockets; the cheeks are sunken and IioIIoav, the nose is sharp, and the lips are shrivelled. But even under all these circumstances, life Avill sometimes linger for several weeks, and the patient may, possi- bly, recover at last. The belly, in this stage, becomes tumid from flatulency, or is pinched to the backbone; the feet and hands swell, but more especially the feet; an apthea or thrush appears in the mouth, and the child is so dull that scarcely anything can arouse it. About this time, if Ave examine the surface closely in a fair light, we shall see a great number of small watery points, like blisters, on the skin; and, if able, the child noAV shows a disposition to thrust its fingers, or whole hand, into the back part of the mouth; and sometimes a live worm will crawl aAvay from it. These last signs are all indicative of danger. The cerebral symptoms increase; the discharges become slimy and of a pink color, or thin and greasy; the skin cold; vomitings frequent; the eye becomes suffused Avith blood, and sinks; the pupil dilates; the pulse is frequent and feeble; and finally, convul- sions come on, and the child dies. This carries us through every stage of this disease, and shows its termination. But cholera infantum is not ahvays of this pro- 558 CHOLERA INFANTUM. traded character. It may, like cholera morbus, kill in a few hours or days, but it is not generally fatal in so short a time. Treatment. — The name of this disease explains in part its character; Ave, therefore, expect to find the patient laboring under a sick stomach, Avith more or less vomiting. The first step to be taken, then, to effect a cure, is to allay the irritability of the stomach; and the second, to clear the alimentary canal, and arrest the purging. There is great sympathy between the rectum and stomach; instead, therefore, of giving emetics or cathartics, in the first instance, as is too often the case, we should commence the cure by an injection. This should be made of thin gruel and salt, in the proportion of a tea spoonful of salt to a gill of thin gruel, and the injection should be thrown as high into the boAvels as possi- ble. If it bring aAvay a free discharge from the boAvels, the stomach will be partially relieved ; but if it does not, it must be repeated till it has that effect. Cathartic medicines must then be used. Recipe : Calomel, six grains. White Sugar, twelve grains. Mix, and divide into six powders, and give one every hour, till they operate freely; at the same time apply a mustard plaster over the stomach, and bathe the feet and legs in warm Avater. There is always great thirst; but the child should take as little fluid as possible. If it is at the breast, it should be alloAved to take very little at a time; and if it be Aveaned, it should have a tea spoonful of toast-Avater every few minutes. The mustard should be taken off before it draAvs a blister, and the surface anointed Avith sweet cream, or sweet lard. We have knoAvn a tea spoonful of strong coffee, without cream or sugar, settle the sick stomach very well; and this may be repeated frequently, if necessary. If the symptoms continue, the same remedies should be repeated, the next day, with the addition of a strong mustard bath to the feet and legs. And should this not give relief, and the extremities keep cold, let a blister be applied on the inside of each leg, to equalize the actk n on the surface. The Avarm bath will be found of great service; but it should contain salt or mustard, and the skin should be well rubbed, while in the bath, and, when taken out, wiped dry with a coarse towel. It will CHOLERA INFANTUM. 559 perhaps be necessary to repeat this, once or twice a day, for some days. If the irritability of the stomach should continue after the above remedies have been used, let a blister be applied over the region of the stomach, or over the Avhole abdomen;, a perspira- tion is apt to folloAV, and much good Avill be the result. The disease sometimes passes into that stage when a bloody mucus is discharged from the bowels, and then we shall find benefit from the following mixture : Recipe : Castor-Oil, two drachms. ---- Mucilage Gum-Arabic, two drachms. Laudanum, two drops. Mix them well together, and give a tea spoonful every hour, till they operate. After free evacuations have been obtained by this medicine, if the discharges continue to be tinged with blood, give the following: Recipe : Sugar of Lead, two grains. Pulv. Ipecac, two grains. Pulv. Opium, quarter of a grain. Mix, and divide into six poAvders; give one, in sirup, every two hours, till the discharges are changed. If any fever arise, and the passages do not become natural, in ten hours, give the foregoing preparation of castor-oil, etc., as above directed, till a free operation is produced. This disease frequently passes from this stage to the folloAving: The dis- charges become Avatery and green, the stomach is sick, and the child restless. There is an acid on the stomach, which has done this mischief, and the following preparation must be used: Recipe : Prepared Chalk, half drachm. Pulv. Gum-Arabic, one drachm. Laudanum, ten drops. White Sugar, one drachm. Water, three ounces. Of this mixture, give a small tea spoonful, once in two or three hours, till the green discharges are corrected; or, instead of the above, you may give the folloAving: Recipe : Salts Tartar, half drachm. Gum-Arabic, one drachm. Magnesia, half drachm. Oil Cinnamon, one drop. Paregoric, thirty drops. Pure Water, three ounces. Mix, and give as above directed. When thy. v.<;kness at the stomach is allayed, and these thin, green die or six times a day. Or the extract may be dissolved in Avater, of the strength of one drachm to the ounce of water, and applied twice a day, with a camel's-hair pencil. This will reduce the enlarged tonsils, after they have been enlarged for years. In the erysipelatous form of this disease, all the above rem- edies should be pushed Avith energy; in addition to which, a blister should be applied around the throat. If suppuration takes place, the tonsils should be lanced, when a gargle of sage tea. honeys and alum, will soon complete the cure. The diet must be light in both forms of the disease, and expos- ure carefully avoided, or the child will be subject, to frequent attacks. OF MUMPS. When this disease attacks the system, the first symptom is felt m the hinge of the lower jaw, immediately in front of the ear, where a stiffness is first felt; and if anything acid is taken into the mouth, a quick, pungent pain is experienced under the ear. The disease is seated in the parotid glands. After the above sensations are felt, the glands begin to swell, and fever arises. The patient sometimes feels a chilly sensation passing over the system, and suffers more or less pain in the 566 MUMPS. head. In some cases, only one side is affected, and when the disease has. nearly run its course there, the other side begins to swell, and its glands go through the same course. The inflammation sometimes extends itself to the submaxil- lary glands, and then the suffering is increased. The jaAvs swell and become painful, and there is more or less difficulty in swallowing, owing to the swelling and stiffness in the root of the tongue. If the patient be exposed to cold, or gets the feet wet, a me- tastasis, or falling of the mumps, may take place. If the patient be a male, the testicles may SAvell very much, and become extremely painful; and, if a female, the breasts will be affected in a similar manner. Sometimes these metastases present serious symptoms, such as great fever, restlessness, anxiety of mind, and, if the brain be implicated, there will be more or less delirium. When this disease progresses in its mild form, and runs its natural course, the swelling in the jaAvs and face begins to sub- side in four or five days, and in as many more, is entirely gone But if it should fall, and much fever supervene, the patient may suffer for a much longer time. Treatment.—It is thought by some that mumps require but little medical attention, especially in Avarm weather, but we have found it safest never to neglect any disease. If the fever should run high, the patient should be bled; after which, give, Recipe: Calomel, ten grains. Scammony, six grains. Mix in two papers. For a child five or six years old, give one, and repeat in three hours, and assist their operation with gruel or toast-water. After the operation is over, rub the swelling Avith, Recipe: Spirits Hartshorn, half ounce. Spirits Camphor, two drachms. Olive Oil, two drachms. Mix. Use this liniment three times a day, and keep the bow- els open with Epsom salts, dissolved in cold Avater, and given, in small portions, every two hours. But Avhere the metastasis takes place, if in a male, an emetic should be immediately given Recipe: Tartar, one grain. Ipecac, ten grains. Mix. Dissolve in nine spoonfuls of warm water, and give two at first, and one every fifteen minutes, till they operate CROUP. 567 freely. A glass of Avarm Avater should be given every time he pukes, till he has four or five motions up, when gruel should be taken, to turn its effects on the bowels. If, however, it does not act freely on the bowels, give, Recipe: Epsom Salts, half ounce, dissolved in half a gill of Avarm Avater; and, at the same time, rub the jaAvs and neck with the liniment above directed. If the testicles are much SAvelled, let the patient lie down, and keep the scrotum bathed in warm vinegar and water. If a female, and her breasts swell, she need not take the emetic,— for it will rather do her harm than good,—but, in its stead, the following: 'Recipe : Calomel, ten grains. Rhubarb, ten grains. Mix in two powders, and give them two or three hours apart. Rub her jaws with the liniment, as above directed; bathe her breasts Avith Avarm vinegar and Avater; and, after the operation of the calomel and rhubarb, keep her boAvels open with Epsom or Rochelle salts. In all cases, the neck and jaAvs should be covered with flannel, and the patient kept in the house. The diet should be of the lightest kind. Let it be remembered that this disease is contagious. OF CROUP. This disease takes its name from the sound produced by the breathing of the child. Half a volume might be written upon it, if we were to enter into a discussion of the various opinions expressed concerning it, and the remedies prescribed for its cure. But our object is to impart plain and practical truth, not to discuss theories. Croup evidently divides itself, by the course it pursues, into three different stages, each of which requires a different treat- ment. We shall, therefore, take them up in order. First stage. Children are generally the subjects of croup; of whom, perhaps, a majority have it between the age of nine months and three years, though no age is entirely exempt from it. It is said, by some authors, that grown persons occasionally suffer from it, but we have never seen a case of the kind. This disease, for the most part, comes on suddenly, and fat children are more subject to it man those of a different habit of 568 CROUP. body. Exposure to Avet, cold or dampness, either of the whole body, or of the feet, hands and arms, will produce it, and it pre- vails mostly in the fall, winter, and spring. Some families are more subject to croup than others. The first symptom of its approach, generally, is a peculiar dry hoarseness, observable only when the child coughs. This symptom may exist for a longer or a shorter time; and, in some instances, it has been present for several days, while, in other cases, the progress of the disease is very rapid. This hoarseness may, or may not, be accompanied by a secretion of mucus from the nose; and, in this stage, the child has little or no fever, and breathes easily. In general, the appetite is yet good, and the boAvels regular. All this may be the case, and yet. such is the rapid progress ff this disease, the child may die of croup in six hours from the first appearance of these symptoms. But, in these first symp- toms, the hands and feet will be found to be unusually cold, the face rather pale, and the skin will appear as in the first stage of an intermittent fever. Where the attack is quick, we do not observe these symptoms so distinctly. The nose is dry, and the breathing hoarse and sonorous; the cough dry and harsh; and, if anything is thrown up, it is thin and whitish, and in very small quantities. There is a little coating on the back part of the tongue. These are the symptoms of the first stage of croup. Treatment for this stage. — The treatment in the first stage consists in the immediate application of spirits of turpentine, or vinegar and mustard, externally to the throat. If this does not relieve the hoarseness, as soon as the stimulating effect is over, repeat it immediately; but a blister should not be raised. Give the following sirup immediately: Recipe: Oxymel Squills, half ounce. Cox's Hive Sirup, two drachms. Wine of Ipecac, two drachms. Mix, and of this preparation, give a child six months old fifteen drops, and repeat every ten minutes, till it pukes freely. Increase the dose, according to the age of the child, till the above effect is produced, when ten drops may tie given, every tAvo or three hours, till the hoarseness is all removed. If the bowels are not acted on by the sirup in three hours, give a dose of castor-oil. The child should be kept in the house, and flannel worn CROUP. 569 around the neck till the inflammation leaves the skin. The diet should be very light, for a day or two. If mothers Avould observe this part of the chapter on croup, and attend strictly to these directions, a case of confirmed croup would rarely occur in their families. But should they neglect the first stage, the second will soon come on. Second stage. In the second stage of croup, the hoarseness is evidently increased, and has a ringing sound; the cough is more frequent, lasts longer, and the child is more exhausted by it; the breathing becomes more difficult, and the face flushed during the cough. Perhaps one cheek will be redder than the other; the pulse becomes quick, hard, and sharp; the hands and feet rather cool; the child becomes drowsy, from Avhich feeling it is aroused by a hard cough, with an increased difficulty of breathing. It tries to raise itself up, as if it wanted a freer circulation of air. The brain is, also, affected. Treatment in the second stage. — If the first stage has been neglected, and the second stage is ushered in, we find two con- ditions of the patient. In the first, all the symptoms of breath- ing, croup, and hoarseness, are increased, but the extremities are , cool and the face pale, the pulse quick, but not strong. Stimu- lants must be applied to the throat, as in the first stage of the disease; and if the bowels are bound, an injection must be given. After this, give the folloAving medicine : Recipe : Calomel, fifteen grains. Ipecac, six grains. Mix, and divide into three poAvders, and give one every fifteen minutes, till they puke the child freely. This is sufficient for a child six months old, and the dose must be enlarged for an older child. After puking freely, give the medicine once in an hour or two, till the child is again puked; and keep up this action, according to the strength of the patient, till a moisture is pro- duced on the skin, and the extremities become warm. When this is effected, the patient is brought to the second condition of the second stage, and must then be bled from the arm, or cupped betAveen the shoulders. In order to do good, the bleeding must be continued till the patient is near fainting; the pulse must flutter under the finger before the bleeding be stopped. As soon as the child resuscitates, the purgative medicine must be repeated, but in smaller doses. 570 CROUP. Recipe : Calomel, six grains. Ipecac, three grains. Mix. Divide into tAvelve poAvders, and give one every hour, to keep up a purgative effect on the bowels. The sirup prescribed in the first stage should now be given, in doses of five or six drops every hour, to keep the phlegm loose. If the fever continue, the bleeding must be repeated again, and even again, till the inflammation is removed from the throat. But, to justify the repetition of the use of the lancet, the pulse must be hard, the skin hot, the face flushed, and the breathing difficult. The Avarm bath is often resorted to in croup; but it requires more judgment to use it, in this disease, than, perhaps, in any other. Two baths are never exactly of the same temperature; and therefore they are, in fact, tAvo different remedies; and, until it can be determined how Avarm the bath ought to be, it had better not be used. But if it is used, the feet and legs only should be put into it, and not the whole body. Laudanum should never be given in croup. If the disease does not yield pretty soon, under the above treat- ment, after the formation of the first stage, the third stage will soon be ushered in. Third stage of croup.-—This consists in the formation of a deciduous membrane, or lining of the windpipe, with tenacious mucus or purulent lymph, which does not coagulate, but Avill soon obstruct the air-vessels. This stage is one of great danger, since we can rarely get rid of the mucus or membrane in the throat; and even if we do, the parts soon form another. The brain noAV presents strong symptoms of congestion; the eyes are suffused, and the child gasps for breath; the hands and feet become cold, or cool. We have noAV but little hope of saving the patient's life. Treatment in the third stage.—In this stage of the disease, if we cannot dislodge the membrane or mucus from the Avindpipe, we cannot cure the child. But, for this purpose, many thing3 have been tried. In Europe, they use tartar emetic altogether, and puke the child freely and frequently. We must say, hoAvever, that Ave believe this practice Avill kill more than it will cure. Tartar is too strong and too prostrating for an infant. Dr. Chapman gives a strong decoction of snakeroot. WORMS. 571 Recipe: Seneca Snakeroot, half ounce. Boiling Water, half pint. Simmer the snakeroot in the Avater, till it is nearly half reduced, and of this decoction give a tea spoonful every fifteen minutes, till the child pukes freely. This quantity will answer for a child from one to three years old. At this time, the folloAving liniment should be used: Recipe: Spts. Turpentine, two drachms. Spts. Camphor, two drachms. Olive Oil, two drachms. Carbonate Ammonia, one drachm. Mix thoroughly, and rub the throat, and breast, and spine, from the hair to the waist, Avith this liniment. If the bowels are con- fined, give an injection, and folloAV it immediately with, Recipe : Calomel, ten grains. White Sugar, twenty grains. Mix, and divide into five powders. Give one every hour, till they operate freely. The poAvders may be repeated, every day, till all fever leaves the child; Avhen the bowels may be kept open with. Recipe : Sirup of Rhubarb, one ounce, of which give a tea spoonful two or three times a day. If the child recovers, it should be taken out to ride as soon as its strength v/ill admit. The diet must be gruel, rice-water, arrow-root, barley-water, slippery-elm tea, milk and Avater, or the mother's milk. OF WORMS. There is a great variety of opinions as to the cause which produces Avorms in the alimentary canal of children and groAvn persons. We shall not, however, enter into an elaborate discus- sion on causes remote and proximate on this subject; and Avould only say, that Aveakly children, that have been raised by feeding instead of the breast, from a very early age, are more liable to be afflicted with worms than those which are healthy, robust, and have lived entirely on the breast. Children that are fed indis- criminately on a little of everything, as mothers generally say, are most apt to be afllicted with worms. Indulgence in the use of unripe fruits is a fruitful cause of the generation of Avorms, and groAvn persons who are weakly aie liable to be afflicted with them. The symptoms of worms are an itching of the nose; sickness 572 WORMS. of the stomach, especially in the morning; raising a white, light, frothy phlegm from the stomach; sometimes a voracious appetite. and, at other times, loss of appetite; an enlarged abdomen; the boAvels either costive or too much relaxed, and the discharges fetid. The child is fretful, with flushes of fever at night, but the tongue is not coated. It is apt to start in its sleep, and spring up and appear to be scared, and cry out. It may puke up a worm, when it strains to vomit; and, at times, it has a dry, hacking cough; its face looks pale, and the upper lip is frequently savoI- len in the morning. It becomes sick, occasionally, and looks pale around the mouth and nose; and sometimes it complains of itch- ing about the bottom, and is disposed to scratch itself there. These are the most prominent symptoms of worms. There is a great variety of worms, some of which produce an additional set of symptoms to those already mentioned. But these embrace the most of the symptoms produced by such worms as those with Avhich children are afflicted. The different varieties and names of Avorms are these: FIRST SPECIES. 1. Long Round Worm, or Ascaris Lumbricoides. 2. Long Thread Worm, or Tricephalex. 3. Long Tape Worm, or Tenea Solium. 4. Broad Tape Worm, or Tenea Vidgaris. 5. Fluke Worm, or Fasciala. SECOND SPECIES. 1. Thread, or Maw Worm, or Ascaris Vermicularis. 2. Beetle Grub Worm, or Scarrabecus. 3. Bots, or kstrus. THIRl SPECIES. Erratic Worms, or Helminthea Erratica. The first of the first species, or long, round worm, has a body partly transparent, and a little yelloAvish, with a faint line doAvn the side, and is from six to fifteen inches long. It inhabits prin- cipally the ilium, but sometimes ascends into the stomach, and creeps out of the mouth or nostrils. It occasionally travels to the rectum, and escapes through the anus. The second of the first species is the long thread Avorm; it is about two inches long, and in color resembles the former. Its nead is thick, and its tail slender and sharp. It inhabits the BCflBcum, generally. WORMS. 573 The third of the first species is the long tape worm, in which the articulations are long and narrow, with marginal paws, by which it attaches itself to the intestines; one of these paws is situated on each joint generally, alternate with a terminal mouth, two rows of radicated hooks or holders, and a little beloAV, four suckers, two on each side. This Avorm is from thirty to one hundred feet in length, inhabits the upper part of the intestines, and lives upon the chyle and nutricious juices already animal- ized. Only one is sometimes found; but, more frequently, there are several in the same person. They adhere so closely to the intestines that they are with difficulty dislodged, and are said to have the power of reproducing parts that have been broken off. This Avorm is oviparous, and discharges its eggs from each joint; these are about one inch long, thin and Avhite, and flat on both sides, like tape. When discharged alive, they roll themselves into a knot that cannot be untied. We have seen thirty feet of this Avorm come from a man, and sixty feet taken out of the intestines of a sheep. The fourth of the first species is the broad tape Avorm. The articulations of this worm are broad and short, with a split in the end and centre of each joint. Its body is broader in the middle, and tapering towards each end, and its head resembles that of the third of this species. It inhabits the upper intestines, feeds on the chyle, is from three to fifteen feet long, and three or four are usually found together. The fifth of the first species is the fluke worm. Its body is rather flat, and it has a double mouth in the head,—one above and one below. It is oviparous. Of the second species.—The first of the second species is the thread or maw Avorm. This Avorm is wrinkled on the sides ; its tail is finely tapering, and terminates in a sharp point. It is about half an inch long; its color, Avhite; its head is divided into three points, in the middle of Avhich it receives its nourish- ment. Its location is in the rectum, but sometimes it wanders into the intestines, and even as high as the stomach. It pro- duces great itching sensations about the anus in the evening. I' is viviparous. The second of this species is the beetle grub. This Avorm is a gray larva, with yellowish legs, and a head resembling iron in its appearance; it is six feet in length, is hairy at the end of its abdomen, and its head is horny. The third of the second species is the bot. This worm is the 574 WORMS. product of the gadfly; it is of a round figure, pale-green color, tail obtusely truncated, head tapering, mouth horny Avith two lips, and two recurved black claws on each- side of the mouth. Third species. — These are Avorms of various kinds, not belonging to either of the above species, but produced by acci- dental introduction of larvae into the stomach, Avhich there brings forth an anomalous worm. It is impossible, in the present state of medical science, to givt the peculiar symptoms which attend each kind of worms we have described, and the precise appropriate remedy for their destruction or expulsion. We knoAV the general symptoms that are attendant on Avorms, and that is about the extent of our knowledge, till the Avorm is discovered. The symptoms, as stated before, are these: headache, vertigo, torpor, disturbed dreams, sleep broken off by fright and scream- ings, convulsions, feverishness, thirst, pallid complexion, bad taste in the mouth, offensive breath, cough, difficult breathing, itching of the nose, swelling of the lips and end of the nose pain in the stomach, nausea, squeamishness, voracity, leanness, tenesmus, itching about the anus towards night, ejections of films and mucus from the bowels, and a diarrhcea, with fetid discharges, &c. The broad tape worm produces the most mischief on the body, while the long red, or yellow worm, is not suspected till it appears in the faeces. NotAvithstanding the above symptoms accompany worms in the digestive organs, yet any other cause, as acid, bile, or other offensive substances, may produce all, or nearly all, these symp- toms. Worms injure the body they inhabit in one of these Avays: First, by irritation; second, by destroying the nourishment intended for the support of the child; and, thirdly, by their bulk, from accumulation. A small volume might be written on this subject; but Ave deem Avhat Ave have already said sufficient for all practical pur- poses, especially in a work of this description. We shall now proceed to give the treatment, but cannot designate the precise remedy for each sort of worm, as the symptoms do not always declare their species. Treatment. — There are so many remedies prescribed for worms, and Ave have used so great a variety, that Ave cannot say any one has the preference above every other, in all cases. But WORMS. 575 it is certain that some remedies are better for the removal of some kinds of Avorms than for others. For the removal of the long yelloAV, or red worm, which is the most common in this country, the following preparation has been found very effectual: Recipe : Pink Root, two drachms. Made fine. Boil it in a pint of weak coffee, down to half a pint; sweeten, and add cream to half this tea, and let the child take it for breakfast, Avith bread and butter. The remainder may be warmed, and given for supper, in the same way. This should be repeated tAvo or three days, Avhen a dose of senna tea, or castor-oil, should be given, to Avork off the dead Avorms, if any remain. Or the child may take : Recipe : Pink Root, two drachms. Senna Leaves, two drachms. Worm-Seed, one drachm. Make all fine, and mix; divide into three portions, and make a strong tea of each portion, say a large tea cupful; SAveeten it well, and add cream or milk. The child may take one of these portions. Avith bread and but- ter, every morning, for three mornings. We have known each of these remedies to bring aAvay large numbers of the large red worm, even after other good remedies had failed. The oil of turpentine is an excellent remedy in many cases. A child one year old may take ten drops on sugar, morning and evening, for three or four days; and this should be followed by a dose of castor-oil. Copperas has also removed many large worms. It should be given as follows: Recipe: Copperas, twelve grains. Pulverize, and divide into six powders; give one powder, morning and night, in sugar, or dissolved in sweet milk. When the child is feverish, and the bowels much loaded, small doses of calomel, in conjunction with pink tea, will be found good. To a child one year old, give: Recipe : Calomel, six grains. Rhubarb, three grains. Mix. Divide into three papers, and give one, night, morning, and noon, in sirup. Recipe: Pink Root, two drachms. 576 WORMS. Make a tea of the pink root, — the top is just as good; SAveeten it Avell, and let the child drink it freely, in the place of Avater, till the powders are worked off. Where there is no fever, the oil of Avorm-seed is a good rem- edy, but it should not be given Avhere there is fever. Three drops Avill be sufficient for an infant one year old, and the dose may be increased one drop for each year. It should be given on sugar, every morning, for three or four mornings, when a gentle purgative of senna, castor-oil, or rhubarb, should be given. When the child is costive, indigo-water has been found effica- cious in the removal of Avorms. It is given in two grain doses, dissolved in a spoonful of SAveetened water, to be taken every morning, for three or four mornings, to act on the bowels. When the worms ascend into the stomach, and cause vomit- ing, an emetic may be given, which will throw them out imme- diately. Recipe: Ipecac, ten grains. Dissolve in two spoonfuls of warm water. Give it at three draughts, ten minutes apart; or, if the ipecac, is not at hand, give a tea spoonful of table salt, dissolved in two table spoonfuls of warm Avater. This will cause the child to throw up the worms, or pass them off through the bowels. Ten grains of table salt, given every morning, in water, is a popular remedy, and not a bad one. The savin poAvders, coAvage, the bark of the cucumber-tree, and China-tree berries, are all frequently given for Avorms; but they are rather dangerous in the hands of any but an expe- rienced physician, and should be used by no one else. The male fern is a popular remedy for tape worm ; so is cas- tor-oil and spirits of turpentine mixed, and taken in the propor- tion of an ounce of each for a dose, twice a week, for groAvn per- sons. All these remedies have had their advocates and opposers, at different times; not because they are not all effectual, in some cases, but because one remedy will not destroy all kinds of worms, nor even the same Avorm at all times. But, as Ave do not know the exact kind of .worm from the symptoms, any of them may be given, and if one fail, another can be tried, till the worms are expelled. The ascarides are troublesome little white Avorms, that irritate the rectum, and produce much itching in these parts in the evening. They can only be discharged by injections. Many remedies, such as tincture of aloes, feetida, and all the bitter RICKETS. • 577 infusions, have been recommended, but the best we have used ia salt and Avater. This should be throAvn up the rectum, in the evening, about sunset, as this is the only time these worms come Ioav doAvn in the rectum. If, after being repeated three or four evenings, this should not carry them off, add two tea spoonfuls of spirits turpentine to each injection. Use the child's syringe of the largest size, and throAv the injection forcibly in. A dose of castor-oil may be given, two hours before the injection. OF RICKETS. This disease is not of so frequent occurence in this country as in some of the eastern countries. Children are rarely attacked Avith it before the ninth month, or after they are tAvo years old. It chiefly affects the limbs and body; the backbone becomes crooked, the ribs are depressed, the joints become enlarged and spongy, the belly is tumid; the mind, howeArer, is clear, and often prematurely active. " These symp- toms are preceded by a paleness and swelling of the countenance, and a yelloAV, sulphury hue in that part of the cheek Avhich should naturally be red. In some rare cases, it attacks later in life, that is, before the bones have acquired their full size and firmness, and it is said to have occurred even after this period." — Thomasin. u But in these late appearances, we are generally able to trace the attack to some local injury which acts as an exciting cause." Rickets, for the most part, come on slowly; the body becomes gradually emaciated, the flesh soft, the cheeks wan, or sallow, with a slight degree of tumefaction; as the flesh diminishes, the head increases in size; the sutures gape, and the forehead becomes prominent. The backbone becomes weakened and dis- torted, and incapable of supporting the weight of the body. The ribs and breastbone also partake of the distortion; the former become straighter, and the latter projects into a ridge, like the ^reast of a fowl. The bones suffer from a deficiency of earthy or x>ny matter; the process of breathing is slow and defective; all the cellular membranes seem to be deficient in oily matter, and the muscles have no strength, and but little irritability. The mental organs seem alone to be free from this extensive change ; and while the body is failing, the mind is rapidly developing. Many of our eminent poets, statesmen and generals, have, from being the subjects of the rickets when children, been hump. BRIGHT. 38 578 - RICKETS. backed and distorted in their persons, while their minds, like brilliant stars, have shone with resplendent lustre from the zenith of the mental heavens. Treatment.—In the treatment of rickets, the mind should be directed to the tAvo following objects: first, to strengthening the system generally, and, secondly, to giving a supply of the phos- phate of lime to the organs that constitute the chief seat of disease. For the accomplishment of the first, a pure, dry and temperate atmosphere, a wholesome and somewhat generous diet, regular exercise, of such kind as can be indulged in with the least incon- venience, clean linens and cold bathing, are of essential service, and have often performed a cure independently of other remedies. It is probably owing to a more particular attention to these things, that rickets are less frequent than they were half a cen- tury ago. A tonic plan of treatment is, hoAvever, necessary to accompany the above remedies, and the metallic tonics are to be preferred. Recipe: Carbonate of Iron, twenty grains. Sub. Carbonate of Soda, ten grains. Mix, and, for a child one year old, divide into twenty papers, and give one, morning, noon and night, in a little sugar. If the appetite fail, and the stomach becomes sour, an emetic should be given. Recipe: Ipecac, ten grains. Dissolve in tAvo ounces of water, and give a small spoonful every fifteen minutes, till the child pukes freely. The bowels must be kept open with rhubarb, given in small doses, so that it may not operate too freely. There is a great deficiency of action in the skin, especially in the lower extremities, and rubefacients will be found of service in this case. In the Western Isles the heating oil of the skate-fish is used for this purpose. It is rubbed in, on the wrists and ankles, every evening. This raises a fever of several hours' duration, when the unction on these parts loses its effect. It is then applied, in like manner, to the knees and elboAvs, and after- wards to the spine or backbone, so that a certain degree of fever may be maintained; and when friction on all these parts is found to fail, — as fail it will by degrees,—recourse is finally had to a flannel shirt, dipped in the oil; and this produces a higher degree of fever than has yet existed. It is continued to be Avorn, SCARLET FEVER. 579 after fresh illinitions, till the disease is removed; which is said to be pretty certain, and usually in a short time. When this oil cannot be had, the following will be found to be a good substi- tute: Recipe: Tincture Cantharides, Spts. Turpentine, Spts. Camphor, Olive Oil,—of each half an ounce. Carbonate of Ammonia, two drachms. Mix them well, and shake the vial each time before using it. It should be applied as above directed for the use of the skate-fish oil. Much has been said by instrument makers in relation to this disease, and many forms of apparatus have been invented for the support, strengthening, and cure of rickety limbs. But they are all worse than useless; and decidedly the best remedy for strengthening the joints and bones, is proper exercise, the tonic above prescribed, and a nourishing diet. While the child is in the house, let it lie down on a smooth floor or carpet, and roll and tumble over it for hours each day. Rub and straighten the limbs with your hands, but do not attempt to make the child stand on its feet too often, as its weight will produce a further curvature of the long bones and the spine. This exercise should be gradually given as the bones strengthen. SCARLET FEVER. Like most other fevers, this disease commences with chilliness, fulness of the head, and lassitude, to Avhich succeeds prostration Df strength, according to the violence of the attack. There is sometimes nausea and vomiting, and the surface soon becomes florid and hot. The throat is generally inflamed, and the same appearance extends to the tongue, Avhich is sometimes of a very deep scarlet, tinged with blue. There is often, at this time, more or less catarrhal affection, and severe pain in the head, particularly about the frontal sinuses. The intellectual faculties are sometimes disturbed; and the degree of these symptoms indicates with sufficient exactness the strength and character of the forming disease. If the symp- toms are slight, the disease will be mild; but when all these symptoms are increased, it is called scarlatina anginosa, or malignant scarlet fever. In the worst form of malignant scarlet fever, the symptoms are 580 SCARLET FEVER. alarmingly violent. The attack is generally sudden, and the patient becomes pale and faint, the heart palpitates, and the stomach is subjected to great uneasiness, though there may be no vomiting, as it may be prostrated beloAV the power of reaction. The face is pale or livid; the eye exhibits a glaring appearance; the lips sometimes present an appearance similar to that produced by intoxication; and sometimes a remarkable swelling of the fingers takes place, which, when connected with the peculiar inflammation, is sufficient to characterize the disease. The fever Continues to rise higher and higher, till the second or third day, and the skin becomes morbidly sensitive to the touch, when the eruption begins to make its appearance. The color of the skin is said to be " that of a boiled lobster." At the same time, a degree of redness and SAvelling appears in the fauces, and the surface becomes excessively hot,—more so, perhaps, than in any other form of fever. The pulse now rises to one hundred and fifteen or tAventy strokes in a minute, the reaction, at this stage, being complete. The pulse and the eruption will give the form and character of the disease. If the form be simple scarlet fever, the pulse will be frequent, but moderate; if it be an aggravated form of the disease, the pulse will be more frequent, irritated, and tense; and if it be the malignant form, it will be still more so, yet not so full, frequent, resisting and firm. The temperature of the body, the eruption on the skin, the scruff on the tongue, and swelling and color of the throat, will all be graduated in the same proportions with the action of the heart, and arteries, or pulse. In some cases, the eruption assumes the form of red points, but most generally that of red patches, which spread and unite, till they cover the whole body. The eruption appears first on the face and neck, then on the legs, and the redness is greatest about the loins, and bending of the joints, and on the hands and ends of the fingers. There is not, hoAvever, a perfect regularity in the eruption of scarlet fever, either in appearance or duration. In ordinary cases, the eruption remains out about four days, when the grain of the skin begins to peel off, and in a feAv days more it disappears. As the disease progresses, the tonsils become specked with ash-colored spots, and ulceration folloAvs. In favorable cases, these sloughs come off in eight or ten days; after which, the ulcers look fresh and red, and generally heal kindly the fever gradually abates, and the patient recovers rapidly. SCARLET FEVER. 581 But in more malignant cases, the termination is different. The sloughs in the throat grow fouler, and the discharge from them and the nostrils becomes very acrid; the inflammation in the mouth changes to a darker color, and the surface is generally incrusted Avith a dark or black fur; the breath becomes offensive, the fauces are lined with a tough mucus, an acrid serum is dis- charged from the eyes, and hemorrhage is also apt to take place from these parts. We have seen the blood ooze from every pore of the inner surface of the mouth, like sweat from the skin; and this condition appears to obtain throughout the stomach and bowels, for the blood is freely discharged by stool. This brings on an aggravated diarrhcea, when delirium or stupor follows, the glands under the ears become swollen and tender to the touch; those of the neck swell, also, and sometimes terminate in sup- puration, and ill-conditioned ulcers. It is thought by many that scarlet fever is contagious. The Aveight of evidence, however, is against this opinion, in this country. When the throat is putrid, if you breathe the hot breath immediately from it, you Avill very probably take the dis- ease. We once took it in this Avay, but are fully persuaded it cannot be taken at the distance of a few feet from the patient. The prognosis in this disease is favorable, or unfa Adorable, in proportion to the form of its attack, the violence of its progress, and the age and strength of the subject of it. Great prostration of strength, delirium, extreme restlessness, the discharge of an acrid sanies from the nose, a purple or livid appearance of the fauces, without tumefaction, interspersed with the white spots or dark sloughs, attended by a diarrhcea of acrid matter, and, above all, the change of the eruption to a mahogany color, are extremely dangerous symptoms. But in some cases where every hope is entertained of a recovery, death may take place suddenly. If the patient does not die by the ninth day, he will generally get Avell under proper management, though it may be three weeks, in some cases, before he recovers. When this disease terminates favorably, all the symptoms generally yield, begin- ning about the fourth day after the eruption appears. The patient is more liable to relapse in this than perhaps in any other form of fever. Take scarlet fever all together, in all its forms, and it is more alarming than any disease to which Ave are liable. It has slain its thousands where the monster of all diseases, cholera, has slain its hundreds. Parents Avould do well 582 SCARLET FEVER. to watch its first appearance, and keep their children from its influence as much as possible. GroAvn persons are not so liable to take it, for, as a general rule, it is one of the diseases of chil- dren. Treatment.— In the mild form of this disease, much medicine is not required. Emetics are prescribed, by most authors, in its incipient stage; but we have not found them to succeed well. The stomach is naturally inclined to be irritable; it ought, therefore, to be our endeavor to keep down the irritability. If the fever is A^ery high, the pulse full and strong, and the pain in the head great, the patient should be bled from the arm, and then take the following medicine. This is a dose for a child one year old, and must be increased or diminished, according to age: Recipe : Calomel, twelve grains. Pulv. Mace, two grains. Mix, and divide into six poAvders; give one every two hours, in a feAv drops of sirup, till they operate well. The drink should be balm tea, if it can be had; if not, sage, hyssop, saffron blossoms, or dittany, as this will bring out the eruption, and keep it out full; and if this can be accomplished, the danger of the disease Avill be very much lessened. This fact should be kept in view in all eruptive diseases. The above purgative should be repeated every day, till the eruption begins to fall off, when the folloAving one may be sub- stituted. Should the poAvders produce dark, heavy discharges, it is so much the better; follow them with the Recipe: Aromatic Sirup of Rhubarb, one ounce. Of which a tea spoonful may be given every two hours, or less frequently, so as to keep the bowels open. Castor-oil, or rhubarb, in powders, will do; or, Recipe: Calcined Magnesia, one drachrr. Cream Tartar, twenty grains. Mix, and divide into six powders, and give one every three or four hours, in sweetened water, so as to keep the bowels open. The throat should be washed or gargled with the following mouth- water, frequently: Recipe : Red Pepper, one drachm. Table Salt, one ounce. Vinegar, one pint SCARLET FEVER. 583 Boil all together for ten minutes; strain, and, when cool, wash or gargle the throat frequently. If Brites' Rheumatic Liniment can be obtained, apply it freely and frequently to the throat. externally; or you may use: Recipe: Spirits Camphor, two drachms. Spirits Turpentine, two drachms. Olive Oil, two drachms. Carbonate Ammonia, one drachm. Mix perfectly, and apply it freely; and wrap a piece of flannel or silk around the neck. The diet should be of the lightest kind, thin, and easy of digestion. In the second form of this disease, all the above remedies should be used, but promptly, losing no time; the doses should be double, and administered more frequently. In this form of the fever, the patient will find the juice of an orange very grateful to the taste; it also helps to keep the medicine doAvn, and to clean the tongue. The malignant form, of this disease requires a different mode of treatment in the beginning. The stomach is torpid, and the pulse Aveak, quick, and rather compressible ; the patient does rot vomit, the energies of the stomach being very much prostrated. The phlegm accumulates in the throat, and the swelling is great; and, consequently, Ave should commence the treatment of this form of the disease by an emetic. Recipe: Ipecac, ten grains. Tartar, two grains. Mix. Dissolve in nine spoonfuls of Avarm water, and give one spoonful every ten minutes, till the patient pukes freely. Then follow it with, Recipe: Calomel, twenty grains. Scammony, ten grains. Pulv. Mace, three grains. Mix. Divide into four powders, and give one, in sirup, every two hours, till they operate freely. The bowels are harder to act upon in this than in any other form of scarlet fever. In addition to the above remedies, antiseptics are necessary to counteract the putridity of the throat. These may be, Recipe: Muriatic Acid, half ounce. Give five drops, in thick rice-water, and repeat every three lours; and, if the fever is not too high, and the pulse soft and weak, make a tea of 584 MEASLES. R>ape: Peruvian Bark, half ounce. Cloves, one drachm. Water, one half pint. Boil all together for eight minutes, and strain ; when settled, give a tea spoonful every hour, Avith tAvo drops of the above acid init. Use the liniment externally, and the gargle internally. If the SAvelling is great, and putrefaction is likely to take place, the throat may be blistered, and then dressed Avith a poultice of charcoal and yeast, Avrapped in gauze. The Avarm drink must be persevered in; or a tea, made of charcoal by pouring boiling water on it, may be given to the child freely. In all cases Avhere the extremities are cool, mustard plasters must be applied to the wrists and ankles. If the eruption should strike in, in any form of the disease, the child should be put into a Avarm bath, Avith salt or mustard in the water, for eight or ten minutes, and its skin rubbed freely Avith the hand; after Avhich, it should be wiped dry, and covered up in the bed. Scrupulous attention must be paid to the diet, which should be vegetable entirely, in all cases of scarlet fever. In malignant cases, the skin, on recovery, will peel off the hands and feet, and subsequently off the whole body. If the patient be not very careful when he gets out, he will take cold, and the glands of the neck will swell and suppurate, and the ears Avill run, and if great attention be not paid, deafness will probably be the result. They must be kept clean, and laudanum and sweet oil put into them every day, till they get well. All these things must be attended to scrupulously. OF MEASLES. The measles are ushered in, like all other febrile diseases, by chilliness, languor, oppression, heat, and thirst; especially the first day, which terminates in a perfectly Avell-formed fever, with sick- ness at the stomach, and vomiting in some cases. The fever is generally pretty high, but not uniformly so. The patient has a cough of a peculiarly hard, dry, hoarse sound; the eyes run Avater, and sneezing invariably accompanies the fever, in the early stage of the disease. The tongue is coated; there is a bad taste in the mouth, —not unlike that of rotten wood,—of which every- thing taken partakes. Sickness sometimes occurs at the stomach, causing vomiting, but nothing is throAvn up except tough Avhite phlegm. MEASLES. 585 The dischai ges from the nostrils are abundant. About the third or fourth day the eruption begins to make its appearance, — first on the face and neck, and then on the loins and legs. It is not so scarlet-colored as the eruption in scarlet fever, but is a little ele- vated on the skin, and has a slight purple hue It is generally separate, but sometimes it is confluent, ultimately spreading all over the body. In some cases, it does not rise above the surface, and yet it may be genuine measles. It retains its color for three or four days, Avhen it becomes browner, and falls off in L ran-like scales. The cough may be very severe, and harass the patient very much; or it may be lighter, and not so troublesome; and this very much depends on the degree of inflammation in the lungs. There are different grades of measles, as Avell as of all other erup- tive fevers, and the treatment must necessarily depend upon the violence of the disease. This disease is universally believed to be contagious. But there are many physicians who deny it this character. We are satisfied, hoAvever, that it is contagious, though we acknoAvledge that some persons will have a second attack. Perhaps one in ten thousand, after the lapse of fifty years or more, when the susceptibility returns, may have a second attack of measles. Such is also the case Avith whooping cough and smallpox, and many other eruptive diseases. Treatment. — The treatment for measles is simple. If the fever is not very high, all that is necessary is to keep the boAvels open. Balm tea should be given, to drive them out. and care should be taken to keep them out, by avoiding the cold air. The patient must drink freely of flax-seed or slippery-elm tea, live on a light diet, and be careful not to take cold. For a purge, in light cases, give a potion of senna tea, sufficient to operate freely; or Rochelle salts may be taken in sufficient quantity to keep the boAvels open. Be careful to avoid taking cold; drink freely of flax-seed or slippery-elm tea, till the cough i.s removed, and nothing more Avill be necessary. Measles are not, hoAvever, ahvays to be found in as mild a form. The epidemical condition of the atmosphere, together with the peculiar character of the measles at the time, makes a vast differ- ence in the violence of the disease; and, owing to those reasons, measles sometimes become malignant, and of a highly inflamma- tory character, with a strong predisposition to congestion. When such is the case, the difficulty of breathing is great, the lungs swell, the eyes are suffused, the cough is violent, pain in the head 586 MEASLES. severe, and the pulse full, hard, and strong. The bowels appear to be engorged, and constipated, the urine is highly colored, the tongue is very Avhite or yellow, there is loss of appetite, and some- times sickness at the stomach; but the throat is rarely sore. In this condition of the system, the patient should be bled freely, and if the pulse is hard, and the difficulty of breathing great, an emetic should be given. Recipe: Ipecac, fifteen grains. Tartar, three grains. Mix. Dissolve in nine table spoonfuls of Avarm Avater; give three first, and one every ten minutes, till they operate freely, and then give a glass of warm Avater every time the patient pukes, till he has three or four operations up. It must then be turned doAvn with a little gruel, and nothing cold must be taken till the opera- tion is fairly over. If it should not operate well on the bowels, give the following poAvders: Recipe: Calomel, fifteen grains. Pulv. Rhubarb, ten grains. Mix. Divide into six poAvders, and give one every two hours, till they operate freely, when the patient should drink some Avarm herb tea, to assist their operation. If the symptoms continue severe, the same purgative should be repeated the next day; but if the child is better, the following may be given: Recipe: Rochelle Salts, one ounce. Dissolve this in a gill of warm Avater, and give a table spoon- ful every half hour, till they operate freely; after which, the boAvels may be kept open with castor-oil, senna tea, salts, or rhubarb. The cough Avhich ahvays accompanies measles must be attended to till entirely cured; and for this, Harris' Compound Cough Sirup, or the following mixture, may be given: Recipe : Oxymel Squills, half ounce. Wine of Ipecac, two drachms. Hive Sirup, two drachms. Give ten drops, in some Avarm tea, every two hours, to a child one year old; and so in proportion to age and strength. Recipe : Flax-Seed Tea, one gill. Honey, two ounces. Tartar Emetic, four grains. Mix, and give a small spoonful every hour or tAvo. The diet must be light, and the room kept comfortable, but not too hot. REMITTENT FEVER OF INFANTS. 587 OF REMITTENT FEVER OF INFANTS BEFORE WEANING. The form of remittent fever of which we design to treat in this chapter, occurs before the child is weaned, and during the first process of teething. The first indications of the approach of this disease are, a restlessness at night, and startings in the sleep, as if from sudden frights; or the child may remain awake and be fretful the greater part of the night. Its skin is hot and dry, until tOAvards morning, when a slight moisture breaks out on the face and chest. In the forenoon the child looks pale, with an expression of suffering and discontent; it evinces no disposition to play; the pulse is frequent, contracted, and feels hard under the fingers, and shows an evident increase of unpleasant feelings; as the evening comes on, a red spot arises on one cheek, or both. It is apt to be sick at the stomach, and sometimes vomits; the pulse increases in frequency and strength; the skin becomes hot; the urine is scanty and highly colored, and, in some instances, so acrid that the child will cry out from pain Avhen it is passed. After the disease has continued some days, a slight cough comes on, with a secretion of more or less mucus, or rattling in the throat or chest; the bowels are irregular and generally cos- tive. The discharges are, hoAvever, very offensive; they are apt to be of a muddy broAvn, or of a light green color, and sometimes they are curdled. Every paroxysm becomes more severe, and lasts longer than the former one. The child iioav lies in a drowsy state, with its eyes partially closed, and turned upwards, so as, in many cases, to hide the olack of the eye. If the disease be neglected, its progress will now become rapid, and all the symp- toms of irritation of the brain will come on; the eyes will look dull and heavy; the Avhite of the eye will begin to look a little inflamed, and the countenance of the child will either present the appearance of surprise or of stupor. By degrees, all the symptoms increase, till the brain is evidently oppressed; effusion takes place, and the child dies in a state of heavy stupor, or con- vulsions. This, hoAvever, is not ahvays the case. In some cases the fever continues Avithout any symptoms of an affection of the brain, but seems to exhaust the little patient by its continuance; or a rapid and obstinate diarrhcea may prostrate and kill it. If this fever be neglected in its early stage, it seldom terminates in less than tAvelve or fiff3en days, and longer in some cases. When 588 REMITTENT FEVER OF INFANTS. this is the case, the child is pale, weak, and extremely fretfrfi and restless; its boAvels are irregular; its pulse is frequent and small; the abdomen is usually very Avarm, the hands and feet cool, and sometimes the face swells. This form of fever may terminate by the efforts of the system, without the aid of medicine: and when this is the case, all the symptoms begin to abate on the third or fourth day. Every paroxysm becomes shorter and less severe, the child rests better at night, and the skin feels more pleasant, cool, and soft. When it terminates thus, it is generally brought about by a spontaneous purging, or a profuse secretion of saliva; and "in this case we shall find that one or more teeth have made their appearance." In this, as Avell as in all other forms of fever incident to children during the period of teething, the gums should be exam- ined first. If they are much SAVollen, they should be cut freely, doAvn to the teeth. If it be a jaw tooth, the gum should be divided from corner to corner of the tooth, the cuts crossing each other over the middle of the tooth. Every tooth should be examined, and every gum divided that is swollen. The condition of the boAvels must next be attended to. If they are bound, the first medicine should be such as Avould gently, but freely, purge off their contents. This may be castor- oil, a full dose. Or, Recipe : Rhubarb, ten grains. Magnesia, twenty grains. Mix. Divide into three poAvders. To be given every two hours, in a little sweetened water, till they operate freely. But if the boAvels, instead of being costive, are too loose, and the discharges either thin and green, or of a light color, and smell offensively, then, instead of the medicines prescribed above, the folio Aving must be given : Recipe: Calomel, six grains. Rhubarb, six grains. Mix. Divide into three powders, and give one every tAvo hours, in a few drops of plain sirup, till they operate freely. If the last operation is offensive, and of a pale green color, or if it be not offensive, but a pea-green, and the fever continues, give the fo'loAving medicine: Recipe: Calomel, eight grains. Salts Nitre, two grains. Pulv. Mace, one grain. REMITTENT FEVER OF INFANTS. 589 Mix. Divide into four poAvders, and give .as above, till they operate freely. If the discharges are now mixed with yellow, and the fever is lighter, use, Recipe: Sirup of Rhubarb, one ounce. Of Avhich, a tea spoonful may be given every two or three hours, till it acts on the bowels tAvo or three times. At the same time, if there be fever, give the following drops : Recipe • Spirits Nitre, two drachms. Mix. Give ten drops, in toast-Avater, and repeat every hour, till the fever is off; and if ten drops should puke the child, give less. The fever will probably go off Avith a gentle perspiration. This is the treatment for the first stage of remittent fever. But should the child have been neglected, or the character of the disease not apprehended till the second stage comes on, which is made knoAvn by symptoms of determination to the brain, such as heaviness or stupor, a disposition to roll the head from side to side, or throw it back,—the fever continuing longer at each paroxysm, with greater prostration of strength, and the bowels either obstinately costive, or more depraved in their secre- tions, — much greater energy must be used in the treatment of the case. If the fever is high, and the pulse quick and hard, you must bleed from the arm, aud let the blood run till the child becomes faint. If the child is very lean and feeble, bleeding should not be resorted to; but Avhether it is or is not, the follow- ing medicine must be given: Recipe.- Calomel, twelve grains. Ipecac, two grains. Mix. Divide into four poAvders, and give one every two or three hours, till they operate freely. At the same time, you will use, Recipe: Spirits Nitre, two drachms. Wine of Ipecac, one drachm. Mix. Give from six to ten drops every hour, in a little toast or plain water, slightly Avarm, till the fever subsides. If the feet are cold, or cool, mustard plasters, Avell guarded with gauze or thin muslin, should be applied to them; and if the hands be cold, apply the mustard to the Avrists. But the plas- ters should not remain longer than to redden the skin; and, when removed, the parts should be Avet Avith Avarm cream or sweet milk, to allay the smarting. These medicines should b« repeated e,rery day till the fever is broken; and then, if the dis 590 REMITTENT FEVER OF INFANTS. charges from the bowels are not healthy in appearance, or aro of a dark green color, in order to carry this off, and restore a healthy action in the secreting organs, give the following med- icine : Recipe : Rhubarb, ten grains. Magnesia, twenty grains. Pulv. Mace, two grains. Mix. Divide into five poAvders, and give one, in sirup, every three hours, till they carry off all the vitiated matter from the boAvels. If any fever should come on during this time, give the drops. as before directed, till it subsides. And if the aboA'e poAvders cannot be readily obtained, castor-oil, mixed in SAveetened vine- gar and Avater, will do as well. Third stage. If this disease should not be cured in the first or second stage, but passes into the third, the folloAving symp- toms will manifest themselves : The fever will be constant; the extremities more or less cold; the pulse quick, soft and flutter- ing; the child will be in a stupor, or heavy drowsiness, and will take but little notice of anything. The tongue is brown, instead of white, on the top, and is dry; the face is either pale or flushed on one or both cheeks; the eyes are rolled upAvards, so as to hide the most of the black part; the white of the eye is red and inflamed, and sometimes tinged with yellow, so as to give it rather the appearance of water tinged with yelloAV clay; the breathing is more hurried; swallowing is effected with some dif- ficulty ; the urine is high-colored and small in quantity; the ears look pale, and the forehead has more or less of a glossy appear ance, and the fingers and toes tAvitch occasionally. The bowels may be bound, or they may be loose, and the discharges thin and rather green. These are the symptoms of the third stage, and are very dangerous, as they present strong evidences of determi- nation to the brain. In this stage of the disease, the remedies are to be changed. Many physicians prescribe blisters to the back of the neck, but our OAvn observation and experience have not satisfied us of their utility. Opiates, in small doses, have also been prescribed, in combination with other remedies; but we have never realized any good effects from them, Avhere the brain is affected, or even implicated. In this stage of the disease, we have but little to hope for, yet Ave should make an effort to cure. We cannot use the lancet, but we should apply leeches to the temples, and not REMITTENT FEVER OF INFANTS. 591 less than five or six should be applied to each; and, at the same time, three or four should be placed behind each ear, just under the mastoid process, or lump beloAV the hair. When applied in this manner, we have seen all the comatose symptoms vanish before the leeches Avere full. The bites should, however, be encouraged to bleed as long as the child's strength will bear it. And this may be done by keeping them wet with Avarm Avater; and small pledgets of raAv cotton, or dry lint, held on with the finger, will soon arrest the bleeding. If the extremities are cold, apply mustard plasters to them, and place one over the Avhole region of the stomach and boAvels. At the same time, the folloAving embrocation should be applied to the spine: Recipe: Spts. Camphor, two drachms. Spts. Turpentine, two drachms. Ohve Oil, two drachms. Carbonate of Ammonia, one drachm. Mix them perfectly together, and rub the spine, from the hair of the head to the hips, Avith this liniment, every two hours. It should be Avell shaken, applied freely, and the application con- tinued for ten minutes each time. It will redden the skin very much, but will not blister. After the application of the mustard to the extremities and abdomen, you may give, Recipe : Calomel, five grains. Magnesia, ten grains. Mixed. Divide into five poAvders, and give one every two hours, in a little sirup ; and this medicine may be repeated every day, till the stupor or delirium is removed, and the surface is uniformly Avarm. The calomel may then be omitted, and the following medicine substituted, to keep the bowels open: Recipe: Magnesia, twenty grains. Cream Tartar, ten grains. Mixed. Divide into four powders, and give one once, tAvice, or three times a day, in sweetened water. Or, you may give of the simple sirup of rhubarb, a tea spoonful, as above directed. A small dose of castor-oil, every day, Avill answer the same pur- pose. Diet. If the child is at the breast, and the mother's milk is healthy, it should take no other diet; but if it cannot suck, it should be fed Avith the milk. If the breast milk is unhealthy, or the child weaned, its diet should be rice-water, barley-Avater, arroAv-root, or milk and water, equal quantities; slippery-elm, 01 t>92 REMITTENT FEVER OF CHILDREN, ETC. flax-seed tea, or thin gruel, boiled until the meal is all dissolved. This should be thin, and not SAveetened, but made perfectly plain. As soon as the child is able to be moved, it should be taken out in a carriage, but not exposed to damp air, or the heat of the sun. Some mild tonic may noAV be given, such as, Recipe: Huxham's Tincture, one ounce, of which, fifteen drops may be given, in SAveetened Avater, three times a day; or, Recipe: Tincture of Iron, half ounce. Give three or four drops of this, in a table spoonful of sweet- ened Avater. three times a day. Great care must be taken that it does not eat too much in its convalescence. OF REMITTENT FEVER OF CHILDREN, AFTER THEY HAVE CUT THEIR FIRST TEETH, AND UNTIL THEY ARE THIRTEEN OR FOURTEEN YEARS OLD. We have here a period of tAvelve or thirteen years, in which this form of fever may be justly said to be the remittent fever of children. It rarely occurs exactly in this form before the second year, but may occur at any period from that time up to the age mentioned above. This form of fever in children is evidently connected Avith some derangement of the stomach and bowels, some irritating cause haAring been brought to act there. It not unfrequently comes on suddenly, in consequence of overloading the stomach, even Avith proper diet, or Avith some indigestible substances, as nuts, candies, unripe or uiiAvholesome fruits, or high-seasoned diet, improper for children. But in older children, it may be brought on by exposure to wet, playing in the water, sleeping in damp clothes, or in a damp room; and evidently, in larger chil- dren, by exposure to miasmatic influence. The attack generally makes its appearance at night; "the child becomes pale or cold, and is seized with chilliness, which, in most cases, is followed by nausea and vomiting." This is soon succeeded by fever; the skin becomes warm and dry, the pulse is frequent and strong, the child is thirsty, and calls for water frequently; is restless, and generally complains of head- ache, and pain in the stomach. ToAvards morning, a light sweat breaks out on the face and neck, and the fever subsides. The uhild noAV looks pale, is Aveak, and has no appetite for breakfast; REMITTENT FEVER OF CHILDREN, ETC. 593 wishes to lie doAvn or keep still, and feels fretful. About ten or eleven o'clock, the face begins again to look pale, the hands and feet, become cold, and a chill, more or less severe, soon folloAvs. It now feels sick at the stomach, and perhaps vomits. The chilliness may last for a longer or shorter time, but is ahvays succeeded by fever, which lasts till the folloAving morning, when it goes off as at first. These paroxysms occur from day to day. In the .first outset, the tongue is not much coated; but on the second day, it is covered Avith a Avhite or yellowish coat, Avhich changes to a broAvn, and, in protracted cases, to a dark broAvn, or nearly black, and becomes dry. The tee''. are covered with a broAvn sordes, and the breath smells bauiy ; the pulse is frequent, full and quick, but not hard; the boAvels are generally bound, and the headache becomes constant. If the child vomits, the headache is relieved for a short time. After the fever has continued for a feAv days, the child is apt to be droAvsy all the time the fever lasts; and Avhen it is aroused, it is apt to pick at its lips, nose or eyes, or some part of its face or ears, and Avill continue to do this till the part becomes sore and raAV, if not prevented. If the boAvels are not bound, they are too loose; the stools are thin and very offensive, and sometimes of a greenish color, and the urine is generally highly colored, small in quantity, and has a strong smell. The child hoav loathes every article of diet that can be brought to it, and sometimes complains of severe pains in the boAvels, for a feAv minutes, Avhich not unfrequently induces the parents to believe that the disease is produced by worms. Treatment.—As this disease is frequently produced by an indulgence in improper diet, or by loading the stomach with diet otherwise proper for the child, the best way to commence the cure is by administering an emetic. Recipe: Ipecac, ten grains. Tartar, two grains. Mix. Dissolve in three or four spoonfuls of Avarm water; give one fourth at a time, and repeat every twenty minutes, till the child pukes freely, when warm water should be freely given, till it has three or four motions up. It should then take a little gruel to work it dowmvards; and, if it should not purge in two hours, give the folloAving purgative : Recipe : Calomel, six grains. Rhubarb, twelve grains. bright. 39 594 REMITTENT FEVER OF CHILDREN, ETC. Mix. Divide into six papers, for a child two years old, and increase or diminish the dose, according to age. Give one pow- der every hour, in a little sirup, till they operate freely. If, however, a free operation should not be produced,—Avhich may be the case if the child has eaten too much heavy food, or nuts, candy, or fruits, — give the following medicine: Recipe: Senna Leaves, half ounce. Manna Flake, half ounce. Mix. Boil to a strong tea, in half a pint of water, and give a table spoonful every hour, till it operates freely. Recipe: Castor-Oil, half ounce. Spirits Turpentine, one drachm. Mix, and give one half at first, and the balance in one hour, if the irst should not operate. It will frequently be found that the bow Is are loaded Avith hardened faeces, undigested food or fruits, and the above purgatives Avill have to be repeated several times, before the fever yields. The following drops should be given while the fever is on: Recipe : Spirits Nitre, half ounce. Antimonial Wine, one drachm. Mix, and give ten drops every hour, in balm, or some other herb tea. Or the folloAving poAvders will do as well: Recipe: Cream Tartar, twenty grains. Salts Nitre, six grains. Tartar Emetic, one fourth grain. Mix. Divide into six powders, and give one every hour, in a little balm tea, till the fever is cooled off. A favorite prescription with Dr. Eberle Avas the following: Recipe: Spirits Nitre, two scruples. Pulv. Extract Colocynth, two drachms Tartar Emetic, one grain. Water, four ounces. Mix well, and give a dessert spoonful every tAvo hours, till the fever is off. If the discharges from the boAvels should become thin and watery, of a light color, or green water, or should they become ol a muddy color, and have an offensive smell, give the folloAving: Recipe: Calomel, twelve grains. Pulv. Mace, two grains. Mix. Divide into four poAvders, and give one every two hours, till they operate freely. They may be given in sugar, molasses, or clabour. CATARRHAL FEVER. 595 But should the discharges be thick, green, or dark, give the fo lowing medicine: Recipe: Calomel, six grains. Scammony, twelve grains. Mix, and divide into six powders; give one every tAvo hours, till the discharges become yelloAV and consistent, and these may be repeated every day>till the fever yields. As soon as the fever is off, if the stomach and bowels have been properly cleansed, give the following: Recipe: Salicine, twenty grains. Water, one ounce. Dissolve the salicine in the water, and give half a tea spoonful, in sweetened Avater, every hour, Avhen the fever is off, to a child tAvo years old, and increase or diminish the dose, according to age. This is far preferable to quinine, for children, or very deli- cate persons. A general perspiration will accompany the action of the system when the fever is broken; after Avhich, the boAvels may be kept open with some one of the folloAving medicines: Castor-oil, rhubarb, or senna tea. Children rarely need tonics. The diet through all the sickness should be very light, such as rice, chicken-Avater Avith rice boiled in it, &e. The drink should be lukeAvarm toast-Avater, balm, hyssop, sage, or dittany tea. The room should ahvays be freely ventilated in summer, and the child should be covered lightly. When it is not taking calo- mel, it may occasionally take cold water. OF CATARRHAL FEVER. " Catarrhal affections, under various forms and grades of vio- lence, are among the most common diseases of infancy and childhood." This form of fever is most apt to occur in raAV, variable and damp weather; and hence it is most frequently met with in the winter and spring. It may also prevail in summer, when, after a long spell of damp weather, it suddenly becomes dry and hot. Catarrhal fever sometimes prevails as an epidemic, as it has frequently done in Kentucky, as well as the Eastern States. When this is the case, it is generally confined to children. This disease is characterized by fever, cough, slight hoarse- ness, some difficulty of breathing, running at the nose, sneezing, and a watery appearance of the eyes, not unlike that in measles. 59b CATARRHAL FEVER. Sometimes it is ushered in by a chill; at other times, only by a slight chilliness. The whole surface of the body is pale and con- tracted, and the child appears languid and droAvsy, at times, for eight or ten hours before the reaction is fully established; and, at other times, the reaction takes place much sooner. It is apt to complain of pain in the back, head, and legs; the pulse is fre- quent. someAAmat tense and full; the cheeks are flushed, and the skin is dry, but at first not much above the natural temperature; the boAvels are inactive, and the urine highly colored. In the early stage of the disease, the stools frequently shoAv a deficiency of bile, being of a light or clay color. In some cases, a cough and slight hoarseness are the first symptoms; more fre- quently, however, the cough does not come on till the fever is fully developed. In the first stage of the fever, the breathing is not much interrupted, tliough there may be a considerable rat- tling of phlegm in the Avindpipe; but in severe attacks, the breathing becomes difficult much earlier than in mild cases. And this is OAving to the abundant secretion of mucus in the air- cells of the lungs. This symptom is Avorse in infants that are not old enough to throw off the phlegm. Generally, the more violent the cough in the early part of the disease, the less mucus is thrown off; and when inflammation is about to take place in the lungs, the cough is perfectly dry. In the ordinary form of the disease, the phlegm is thrown off abundantly in three or four days, and, as the disease advances, the cough becomes more frequent. The liver is often torpid, in this form of fever; the regions of the stomach and right side frequently swell, giving rise to the popular notion that the child is " liver-grown." The truth is, the liver is torpid, and, consequently, has become engorged with blood. This, by distending the organ, produces soreness, which is manifested on the touch of the fingers. As the disease advances, the stools are changed from a clay color to a light or dark green. In severe cases, delirium appears in the afternoon or night. The febrile symptoms generally shoAv a distinct remission in the morning, but it is of short duration The appearance of bile in the stools, if accompanied by a moist skin and a more copious secretion of urine, generally brings an abatement of all the symptoms. On the contrary, when the stools are watery or muddy, or reddish and mixed Avith little flakes of mucus, like the washing of flesh, and a bloa ted state of the bowels ensues, CATARRHAL FEVER. 597 the skin becoming dry and harsh, the case has assumed an unfavorable aspect. If an engorgement of the lungs takes place, accompanied by a sudden effusion of mucus into the air-cells of the lungs, from an inflammation of these cells, or the substance of the lungs, the case is a very dangerous one, and convulsions, under these cir- cumstances, are very unfavorable. A great disposition to sleep is also unfavorable, as there is congestion either of the lungs or brain. When the disease is about to terminate favorably, a thick mucus is generally discharged from the nose and lungs; and this, with the cough, may continue for a week or two after the fever leaves the child. Treatment.— There are several indications to be attended to in the cure of this disease. We must restore the action of the liver and skin, moderate the excitement of the heart and arte- ries, allay the irritation of the mucous membraue of the air-ves- sels of the lungs, and prevent local congestion or inflammation. If the fever is high, the skin hot and dry, and the breathing difficult, the child should be bled from the arm till it looks pale. But if the fever is not high, and the breathing difficult, the bleeding may be omitted. The following medicine, for a child one year old, should be given, and the dose increased or dimin- ished, according to age: Recipe: Calomel, twelve grains. Ipecac, two grains. Salts Nitre, two grains. Mix. Divide into six powders, and give one, in a little sirup, every two hours, till they operate freely on the boAvels. If the discharges are green and thick, it has operated to a good pur- pose, and the dose should be repeated the next day. But if the operations are light-colored, green and thin, give this medicine: Recipe: Calomel, twelve grains. Pulv. Rhubarb, six grains. Mix. Divide into four poAvders, and give them as above directed. If this should not produce thick, green, or dark dis- charges, the following must be given: Recipe : Calomel, six grains. Divide into tAvo poAvders. and give these tAvo hours apart. This should be followed by a dessert spoonful of castor-oil, or. Recipe: Senna Tea, one ounce. Manna, half ounce. 598 CATARRHAL FEVER. Dissolve the manna in the tea, and give a dessert spoonful every half hour, till the dark discharges are removed, and yel- low discharges folloAV. The bowels may be kept open, after this, with the senna tea, or rhubarb ; or, Recipe : Magnesia, one drachm. Cream Tartar, one drachm. Mix. Divide into six powders, and give one every four or six hours, in SAveetened water, so as to keep up a regular action on the boAvels. There is always a cough attending this form of fever. It may come on early in the disease, or not till the second or third day; sometimes, indeed, not till the fourth day. But, let it come on Avhen it may, as soon as the phlegm begins to rattle, or a wheez- ing sound is heard in the throat or lungs, the following sirup must be given: Recipe: Oxymel Squills, half ounce. Hive Sirup, two drachms. Wine of Ipecac, two drachms. Mixed. Give ten drops every hour, in a little of the drink named below. "This sirup should be continued through the whole course of the disease, and after the feArer has abated, until the cough is entirely removed. But should you be situated in the country, where you cannot obtain the above sirup, you will find the following very good : Recipe: Flax-Seed Tea, two ounces, — made thick. Antimonial Wine, one drachm. Honey, Strained, half ounce. Simmer them together till they are properly mixed, and give a tea spoonful every hour. In all cases where the fever continues to be high, and the skin hot, in the interval between the doses of the powders above pre- scribed, the following drops may be given : Recipe: Spirits Nitre, three drachms. Antimonial Wine, one drachm. Mix, and give ten drops every hour or two, till the fever is removed. At the same time, if the feet and hands are' hot and dry, they should be bathed Avith tepid vinegar and water. The Avater should be heated and poured into the vinegar, which will reduce it to the proper temperature, and, at the same time, pre- serve the medical property of the vinegar. If the feet and hands become cold at any time, mustard plas- APOPLEXY OF THE LUNGS. 599 ters should be applied to them, covering the plaster with gauze or thin muslin, wet Avith warm vinegar. Some eminent authors recommend blister plasters to be applied to the breast of children laboring under this disease, when the lungs are inflamed. We have often tried them, but think they torture the child more than do it good, and consequently have not used them for many years. We think, moreover, that we have seen unfavorable effects pro- duced by them. The diet of children laboring under this disease, if they are not Aveaned, should be breast milk alone; but if weaned, it should be gruel, arrow-root, milk and Avater lightly sweetened, &c. The drink should be, slippery-elm, flax-seed, balm, hyssop or sage tea, rice-Avater, thin arrow-root, or some other muci- laginous drink. When the child begins to recover, great care should be taken not to increase the diet too soon; nor should it be exposed by exercise, lest, from some of these causes, it should be in danger of a relapse. OF APOPLEXY OF THE LUNGS. We have not seen this disease treated of under this name by any author. Infants, from the age of one month to the close of the period of cutting their first teeth, are liable to congestion of the lungs, with little or no febrile action, Avhich, Avhen properly examined into, and the symptoms closely traced, gives all the signs of a venous, engorged, congested or apoplectic condition of the lungs: and, for this reason, we have called it apoplexy of the lungs. The symptoms are these: the child is attacked Avith a cough; the breathing soon becomes laborious, attended with a wheezing sound; the face is very pale; the whole surface cold, and gen- erally soft or moist; the pulse frequent, but not hard or firm; and the child looks distressed and anxious. In severe cases, the cheeks become cold and the lips purple, Avhile the other parts of the body are of the natural temperature. The bowels are cos- tive, and the urine scanty, but generally natural and healthy in appearance. After a while, a cold perspiration breaks out upon the face. A dry cough attends the whole course of the disease, till, tOAvards the termination, if it be favorable, it becomes loose and rattling. In violent cases, the pulse becomes -small and quick, and the child sinks rapidly. The great difficulty of breathing resembles very much that in a violent attack of th« 600 APOPLEXY OF THE LUNGS. asthma; occasionally remissions occur, Avhen the pulse becomes fuller and sloAver, and the countenance will brighten up a little. When the disease is tending to a fatal termination, the child becomes drowsy, and breathes hard, and soon becomes insensi- ble, when the scene will soon be closed, either by suffocation or convulsions. This disease may continue for three or four days, but it more frequently proves fatal in eight or ten hours. It may be produced by any exposure to a sudden change of temperature, or check of perspiration. It is not uncommonly one of the fruits of hardening children, — or, as some mothers say, "teaching them to be hardy,"—a most ill-advised and unfeeling act. It may, hoAvever, occur Avhen the mother has taken all diligence to protect her child. The bedclothes may have been incautiously thrown off the child in the night, and thus cold may have been taken ; but it is often produced by changing long for short sleeve dresses, in damp, cool weather, and warm, for light, thin clothing. It is to be lamented that mothers, in making a display of a fine child, are often laying the foundation for that disease Avhich will soon take it to the grave. Treatment. — When the prominent symptoms of this disease are closely examined, the breathing will be found extremely difficult; the face pale and cool, with a hard, dry, convulsive cough; the lips purple, and the pulse frequent, but neither hard nor firm. The remedy is plain. The lungs must be relieved from this apoplectic condition, and inflammation prevented. In this stage of the disease, the pulse will rarely admit the use of the lancet; but where it Avill, bleeding from the arm should be the first thing resorted to. But should the pulse be too Aveak, and the surface too cold, to admit of bleeding, the child should be put into a warm bath in which salt or mustard has been streAved, the sur- face rubbed in this till it becomes Avarm all over, and the pulse fuller, and stronger. When the child is removed from the bath, it should be wiped dry Avith a rough towel, that the skin may be kept excited. Bleeding may hoav be attempted, as the pulse will be sufficiently full to authorize it; and cups should be applied between the shoulders. FoIIoav this treatment wi4h the following medicines: Recipe: Ipecac, ten grains. Tartar, one grain. APOPLEXY OF THE LUNGS. 601 Mix. Dissolve in three table spoonfuls of Avarm Avater, and give throe tea spoonfuls at first, and one every fifteen minutes, till the child pukes freely, Avhen it may take a tea spoonful or two of salt and Avater, to turn it doAvn. If it should not operate freely on the boAvels in tAvo hours, give: Recipe: Calomel, twelve grains. Salts Nitre, two grains. Mix. Divide into four poAvders, and give one every hour, in sirup, till they operate freely. If the extremities become cool, apply mustard plasters to them, and use the folloAving liniment: Recipe: Spirits Turpentine, two drachms. Spirits Camphor, two drachms. Tinct. Cantharides, two drachms. Olive Oil, two drachms. Carbonate Ammonia, one drachm. Mix well, and shake the vial Avell before using the liniment; rub it all over the breast, and doAvn the backbone, every tAvo or three hours. This will produce as much counter irritation as the child can bear. Recipe : Calomel, twelve grains. Rhubarb, six grains. Mix. Divide into three poAvders, and give one every tAvo hours; or, Recipe : Blue Mass, twelve grains. Scammony, six grains. Mix. Divide into three poAvders, and give them as above. When the fever has subsided, and the disease is conquered, the bowels should be kept ope*i with, Recipe: Calcined Magnesia, one drachm. Cream Tartar, twenty grains. Mix, and divide into four papers, and give one once in four or six hours, in SAveetened Avater, so as to keep the bowels open. As soon as the apoplectic condition of the lungs is removed, the phlegm will begin to secrete, or pour itself out into the ail- cells of the lungs; and then, the following mixture must be given: Recipe .- Oxymel Squills, half ounce. Hive Sirup, two drachms. Wine of Ipecac, two drachms. Mix, and give twelve or fifteen drops every hour, so as to keep the phlegm loose; but should the child not be able to raise the phlegm, so as to relieve the lungs, you must increase the quan- 602 ACUTE BRONCHITIS. tity of the sirup, till the child pukes freely, and thus throws of! the phlegm. In similar conditions of the lungs of children, a favorite medi- cine with Dr. Parris, of Philadelphia, is the following com. pound : Recipe : Tincture Asafcetida, three drachms. 01. Amber, one drachm. Mix, and give twenty drops every half hour, till the child breathes easy. The remedy of Dr. Eberle, in similar cases, was : Recipe : Gum Fcetida, one drachm. Mint Water, one ounce. Rub the gum Avith the Avater, till they are properly mixed, and give a tea spoonful every tAvo hours, or just as much as the strength of the child can bear. A tea, made of the Seneca snakeroot, and SAveetened, may be given Avith great benefit Avhen the phlegm is tough and hard to raise. It should be given in sufficient quantities to cause puking. Breathing the smoke of rosin is highly spoken of ty many eminent physicians, as a relief in case of difficult breath- ing. May it not do good here 1 The rosin may be burnt on a hot shovel in the room Avhere the child is lying. Great care should be taken, in these cases, that the child be not exposed too soon after it begins to recover. If it be not Aveaned, its diet must be breast milk; if Aveaned, the diet must be of the lightest kind, avoiding everything that has flesh of any description in its composition. OF ACUTE BRONCHITIS. This disease resembles, in many respects, apoplexy of the lungs. They are both produced by the same cause, and the great characteristic distinction is this: in acute bronchitis, there is, in addition to an engorged state of the lungs, more or less inflammation. This would argue that the existing cause had not been so poAverful in this case, and more time had been given for inflammation to take place. The symptoms of acute bronchitis are, a cold, contracted state of the surface, or chilliness ; a languid and pale appearance of the countenance; a slight cough, and some difficulty in breath- ing; and an increase in the strength and frequency of the pulse. The cough increases, and its sound is stifled and hoarse, and the ACUTE BRONCHITIS. 603 breathing becomes more and more labored. If the little patient can talk, it will make you sensible that it feels a Aveight on its breast, but rarely complains of pain. But when the cough is violent, " the child may cry out, as from pain." If the disease be at all complicated Avith pleurisy, there will be catches in the breathing, and the countenance will indicate pain. The cough is often dry at first; but in the course of tAvelve or tAventy-four hours, the mucus secretes freely, and there is a rattling sound in the lungs or throat. It is not uncommon for the child to vomit spontaneously sev- eral times in the course of tAventy-four hours. The stomach frequently swells, and sounds as though it were full of Avind. As the disease progresses, the child breathes harder, the rattling increases, and signs of great debility are manifested. It is always more or less painful to the child to be raised, or to sit up and lean forAvard. The cheeks are rarely flushed, but most com- monly pale, and the eye presents an expression of anxiety. Towards the close of the disease, the lips sometimes look pur- ple; the difficulty of breathing is not uniform, being sometimes comparatively slight. So also Avith the cough. Towards the close of the disease, it occurs in paroxysms. The progress of this disease is sometimes rapid, proving fatal in tAvo or three days; Avhile, in other cases, it may last for eight or ten days. Much drowsiness, and tAvitching of the fingers and toes, indicate great danger. In such cases, the child either strangles, or dies in a convulsion. Treatment. — In every form of inflammation of the lungs, — Avhether it be situated in the mucous membrane of the air-ves- sels, as in bronchitis, or in the substance of the lungs, as in pneumonia, or on the outer surface, as in pleurisy, — the use of the lancet is an all-important remedy. But for this, as Avell as all other remedies, there is a proper time; and if this be not attended to strictly, much harm may be the result. The proper time to use the lancet, in bronchitis, is in the early stage of the disease, Avhen the fever is high, the pulse hard, the breathing oppressed, and the cough dry and hard. The bleed- ing should then be continued, till a decided impression is made on the system. The pulse will then soften, and the skin become relaxed, and if a perspiration break out, the effect will be so much the better. If, hoAvever, the case has been neglected, till the lungs are rilled Avith phlegm, bleeding should not be resorted to, but 604 :ute BK WCHIT IS. leeches may be applied to the breast, or cups betAveen the shoul- ders. This should be folloAved by a dose of calomel, large enough both to puke and purge. Recipe : Calomel, ten grains. Give this at one dose. It will be likely to puke the child two or three times, and then turn down on the boAvels, and purge it once or twice. Should it not purge, however, in three hours. give the following: Recipe : Calomel, ten grains. Rhubarb, six grains. Mix, and divide into three poAvders ; give one every two hours, till they operate freely. If the inflammation does not abate, that is, if the breathing continues to be difficult, and the cough dry, you should give the following sirup: Recipe : Cox's Hive Sirup, two drachms. Wine of Ipecac, one drachm. Spirits Nitre, one drachm. Mix, and give half a tea spoonful every fifteen minutes, till the child vomits freely. Should the symptoms of inflammation continue, a blister plaster may be applied on the breast; but Avhen the skin becomes highly inflamed, it must be removed, and a flax-seed poultice applied over the inflamed part. The boAvels may be kept open Avith the folloAving powders: Recipe : Calomel, three grains. Rhubarb, six grains. Ipecac, three grains. Salts Nitre, three grains. Mix. Divide into six powders, and give one every three or four hours, so as to produce two or three motions from the bow- sis in tAventy-four hours. When the mucus begins to secrete in the lungs, and the phlegm to rattle, give the following sirup: Recipe : Oxymel Squills, half ounce. Hive Sirup, two drachms. Wine Ipecac, two drachms. Mix, and give ten or tAvelve drops every hour, in some of its drink ; or, you may give EberUs mixture. Recipe : Tartar Emetic, two grains. Salts Tartar, two drachms. Water, two and half ounces. Honey, one and half ounces. Mix properly, and give a tea spoonful every hour or tAvo. PLEURISY. 605 If the child be very much prostrated, and needs a stimulant, give the following: Recipe : Carbonate Ammonia, forty grains. Extract Liquorice, two drachms. Acid of Squills, two drachms. Pure Water, four ounces. Mix intimately, and give half a tea spoonful every hour or two, in its drink. In extreme cases, Avhere the child is likely to sink, Hoffman declares that nothing is so beneficial as the fol- lowing medicine: Recipe : Flowers of Benzoine, one grain. Pulv. Gum Camphor two grains. AVhite Sugar, twelve grains. Grind them fine together, and divide into four poAvders. Give one every tAvo hours. Two or three drops of Avater, in a spoon, will mix one of these poAvders. Opium should not be given, in any form, in this disease. In the latter stage of this disease, Avhere the child is so har- assed that it cannot sleep, much benefit may be derived from the use of the folloAving medicine: Recipe : Tincture Hyoscyamus, two drachms. Antimonial Wine, two drachms. Mix, and give from six to ten drops every four hours. This will tranquillize the system, and produce a gentle perspiration. The diet should be very light, and the drink mucilaginous. OF PLEURISY. Children are much more subject to pleurisy than is generally supposed. Exposure to the vicissitudes of Aveather, or any of the causes that produce inflammation of the viscera of the chest, may pro- duce pleurisy; but a very fruitful source of this disease is the exposure of the naked arms to the chilling blasts of frosty air, or the feet or legs to damp or cold. The symptoms are, a chilliness, Avith a pale, contracted sur- face, which is soon succeeded by a high fever; the skin becomes very dry and Avarm; the face flushed; the pulse frequent, full and strong; the breathing is hurried, short, and somewhat oppressed, particularly Avhen the child is lying doAvn. The cough is dry and short, and the child tries to stifle it as much as possible, as every cough produces pain This pain is ahvays 606 PLEURISY. increased by lying down, Avhich is evinced, by the crying of the child, as well as by the expression of the features. When only one side is affected, there is more pain produced by lying on that side; but when both sides are affected, the child lies easiest on its back, with its head raised. If the disease is not speedily relieved, these symptoms grow more and more severe, and if any mucus is thrown up, it is apt to be streaked with blood. Towards the end of the disease, the cough is attended Avith a rattling sound in the windpipe, the hands and°feet become cold, and the child finally sinks into a state of stupor. The pulse becomes irregular and intermittent, the feet swell, the breathing becomes short, and a frothy fluid oozes from the mouth. The muscles of the abdomen and diaphragm seem to perforin the office of respiration Avith difficulty; for the expan- sion of the chest increases the pain in the pleura, and therefore the child avoids it as much as possible. The skin becoming uniformly moist, the pulse soft and less frequent, Avith a free discharge of mucus from the lungs, and an ability to rest on either side, are favorable symptoms. But the occurrence of diarrhoea, stupor, or convulsions, or great distress, or anxiety, when placed in a recumbent posture, particularly if the breathing be attended by a wheezing sound in the windpipe, and the pulse small and irregular, are to be regarded as unfavor- able signs. Treatment.—Pleurisy cannot be safely and correctly treated Avithout the use, of the lancet. Bleeding, therefore, must be resorted to as soon as Ave are satisfied that the disease is pleurisy. The blood should run till the pulse becomes soft and compressible under the finger; after which, if it be necessary to take more blood, leeches should be applied over the seat of the pain. Br if leeches cannot be obtained, cups will do as well. The seat of the pain may easily be ascertained by pressing Avith the finger on the sides and breast, when signs of pain will be manifested by pressure on the part affected. As soon as the bleeding is over, the following medicine should be given: Recipe: Calomel, twelve grains. Salts Nitre, two grains. Pulv. Ipecac, four grains. Mix. Divide into four powders, and give one every two hours, till they operate freely. If the fever and inflammation do not sub- side after the operation of the medicine, a blister plaster may be PLEURISY. 607 applied over the seat of the pain, and alloAved to remain till it draws. It must then be dressed Avith an emollient poultice. If the fever and symptoms of inflammation still continue, give the folloAving cooling poAvders: Recipe : Salts Nitre, twelve grains. Tartar Emetic, half grain. Mix. Divide into twelve poAvders, and give one, in a little balm tea, every hour, till the fever is cooled off. Dr. Eberle prescribes the folloAving mixture: Recipe : Salts Nitre, forty grains. Extract Liquorice, two drachms. Tartar Emetic, two grains. White Sugar, half ounce. Pure Water, three ounces. Mix, and give from one to tAvo tea spoonfuls every hour or two, according to the age of the patient, till the feA^er is cooled off. If the fever return, and the skin is very dry and warm, and the bowels are not open, give the folloAving poAvder: Recipe : Calomel, three grains. Ipecac, three grains. Mix. Divide into three poAvders, and give one every hour, till all are taken. If they should not operate, in one hour more, give a dessert spoonful of castor-oil; and if the fever return, give some of the above medicines; or, Recipe : Tartar Emetic, one grain. Water, twenty-four tea spoonfuls. Mix, and give a tea spoonful every hour, till the fever is cooled off. The bowels must be kept open Avith some gentle purgative, such as sirup of rhubarb, castor-oil, or magnesia, till the child gets well. As soon as the inflammation begins to subside, the cough wih become loose, and the phlegm rattle in the throat. Sirup should then be given. Recipe: Oxymel Squills, half ounce. Hive Sirup, two drachms. Wine of Ipecac, two drachms. Mix. According to the age of the child, give from ten to tAventy drops every tAvo hours, in a little of its drink. If the above medicines cannot be procured, give the folloAving, Recipe: Flax-Seed Tea, two ounces. Tartar Emetic, half grain. Strained Honey, one table spoonful 608 DROPSY OF THE BRAIN. Mix. Give a tea spoonful every hour or Iavo, till the cough is removed, Avhich is often the last symptom of the disease. The drink should be slippery-elm, flax-seed, or marsh-mallow .ea, rice-Avater, or thin gruel. The diet must be of the lightest kind, such as rice-Avater, bar- tey-Avater, thin sago, arroAv-root. balm tea, &c. If the child be at the breast, breast milk will be its best nourishment. A general moisture on the surface, with, a clean tongue which has been Avhite before, an ability to lie on either side, and a cheer- ful countenance, are favorable signs of a recovery. OF DROPSY OF THE BRAIN. Dropsy of the brain is an insidious disease. It is frequently several weeks from the time the first and most remote symptoms appear before it shoAvs itself in its full character. In the first stage of this disease, manifestations of an unusually irritable condition of the brain occur, and continue for several weeks before it is fully developed. During this period, the patient manifests an irritable disposition, sleeps badly, grinds his teeth in his sleep, and is apt to aAvaken Avith starts and screams, as if frightened. If the child is very young, it will start and scream out, as if it had been stung with a pain. The boAvels are generally irregular, and the evacuations un- healthy. These symptoms, hoAvever, do not ahvays terminate in inflammation of the brain, but may pass off, and the child gradu- ally recover its health. But when they do exist, if an exciting cause be applied, such as painful teething, cold, or some derange- ment of the boAvels, from improper food, or crude, unripe fruits, candies, or nuts, this condition of the brain Avill be more or less aggravated, until actual inflammation takes place. New symptoms hoav appear, and characterize the inflamma- tory stage of the disease. The child begins to feel pains, which are very severe, in the head and abdomen, occasionally. They are not, however, of long continuance. The child becomes more and more irritable and restless; the countenance is pale, and expressive of suffering, marked by an occasional flush on one cheek. The eyebroAvs are, at times, contracted into a peculiar froAvn, and the eyelids are not fully spread; the eye becomes very sensitive to light; the appetite is variable, sometimes vora- ;ious, and sometimes quite the reverse. As the disease increases, the pain in the head becomes more intense. It is not, hoAvever, constant, and sometimes it goes off entirely for a short time. DROPSY OF THE BRAIN. 609 The pain is generally seated in the forehead, and passes back- wards, and through the temples; and when this is the case, the child Avill manifest it, by frequently putting its hand to the fore- head. Dr. Eberle says he "has seen instances Avhere the child kept its hand constantly to the forehead, and Avould not suffer it to be removed." The stomach is more irritable; the child throws up almost everything it takes. It cannot be raised up Avithout complaining very much, and it is frequently the case that the stomach will not retain anything, except in a recumbent position. In the early part of the disease, the patient Avishes to have its head raised a little when it sleeps, and is apt, Avhen aAvake, to turn from side to side of the bed, and moan. In some cases, the pain in the head subsides immediately on the occurrence of the vom- iting. The child sighs deeply and frequently, which is a symp- tom that effusion is taking place. In the latter part of the inflammatory stage, delirium is apt to occur; but, if the child is old enough to talk, it may generally be aroused sufficiently to give a rational answer. At this time, the skin is dry, and above the natural temperature. " The pulse is frequent, quick and tense, or sharp, but seldom full." The tongue may be clean, or coated Avith a thick, white fur, but gradually turns dark, dry and rough. After these symptoms continue for an indefinite period of time, a neAV series comes on, which characterizes the third stage of the disease, in which effusion takes place. The inflammation which before existed has noAV brought about a "disorganization," or deep functional derangement, of the brain. The delirium returns more frequently, and continues longer; the countenance exhibits a peculiar expression of surprise, and sometimes stupor, Avhich it is difficult to describe, but, Avhen once seen, is not easily forgotten; the white of the eye presents a suffused or reddish appearance; the pupils are either dilated, or very much contracted; the eye is, in some cases, very sensitive to the light, and, during sleep, it is turned up, so as to hide the black under the upper lid. There is a great disposition to sleep, with an inattention to surrounding objects; and if the child be aroused, the stupor soon returns again. It rarely speaks words of more than one syllable, and this condition continues to increase, till the stupor is complete. This symptom is more constant and certain than any other in the third stage of the disease, and is apt to be succeeded by a BRIGHT. 40 610 DROPSY OF THE BRAIN. paralysis of one hand and arm, or one foot and leg, sometimes extending over one entire side. It is a fact well authenticated, that inflammation may go on in the brain, Avithout manifesting itself by pain, or any other symptom indicative of its existence. In this case, paralysis may come on before either the physician or parent is aAvare that a serious disease has attacked the child. This paralysis in infants is first noticed by a tremulous motion of one arm, Avith the hand firmly bent inwards, and the thumb clenched in the hand, and this, in a short time, terminates in a complete paralysis of the arm. The upper eyelids show a paralytic fall, and cannot be raised but by a strong effort of the frontal muscles; a squinting of the eye is apt to precede the paralysis of the eyelid. Effusion has noAV taken place in the brain, and a fatal calm ensues, in Avhich the little patient appears to be much better. Both friends and physician are liable to be deceived by it, and think the child is about to recover. But, in less than tAventy- four hours, the delusive calm is interrupted by violent convul- sions, which at once decide the fate of the patient; and now all the symptoms become aggravated. The pulse becomes inter- mittent and irregular for a short time; again it changes, and becomes frequent, quick, small and corded; the poAver of hear- ing and seeing is lost, but the sense of feeling generally remains to the last. The unaffected arm is apt to be kept in motion. The causes Avhich produce inflammation and dropsy of the brain are various. Some authors are of the opinion that this disease is hereditary in some instances. Dr. Eberle says, he " knew several families, Avho had lost nearly all their children by this indomitable malady." Children that are subject to a strong determination of blood to the brain are, perhaps, more liable to this disease than others of a different temperament. The size of the head appears to exer- cise no peculiar influence in predisposing to this disease. There is more reason to believe that a scrofulous taint has this effect. In a large proportion of cases, Dr. Mills found, on examination after death, "unequivocal appearance of scrofula." In twenty- two cases which came under the observation of Dr. Percival, "eleven were decidedly scrofulous." It is said that the external causes which most commonly excite t lis disease into action in children are bloAvs, or faib, upon the head. But, unless the injury be sufficiently severe to DROPSY OF THE BRAIN. 611 produce conc.ission of the brain, Ave doubt the correctness of the remark. The drying up of any long-accustomed discharge, such as sores behind the ears, repelled itch, or any other humor, especially Avhen accompanied by painful teething, or a deranged state of the boAvels; a badly-treated remittent fever, or any of the forms of diarrhcea or cholera-infantum, may terminate in this disease, especially if the stomach and bowels are loaded with improper food, or any indigestible substance. Perhaps the remote cause of this disease has its seat in the stomach and boAvels fifteen times in tAventy. Parents are too careless of their children's digestive powers, and the articles they take into their stomachs. Worms may excite this disease. Whooping cough very often terminates in this Avay; and during the convalescence from measles and scarlet fever, children, if exposed, are liable to be attacked with it. We believe that, in cases of relapses from other diseases, it is not necessary for the system to go through all the inflammatory stages before effusion takes place in the brain; but it may take place without the inflammatory symptoms, and all the conse- quences of effusion folloAV. Treatment. — Let it not be forgotten that the most frequent cause of this disease is laid in the stomach and boAvels. Attend, therefore, to every derangement there, by using the appropriate remedies, as prescribed under their respective heads, and remove the remote cause in time. "There are three principal indications to be kept in view in the treatment of this disease," and they may, in a few Avords. be arranged as folloAvs. First. To moderate the general febrile excitement. Second. To prevent congestive inflammation and irritation of the brain. Third. To prevent an effusion from taking place in the brain. When Ave fail to fulfil these indica- tions, we fail to cure the disease. Unfortunately for the child, this disease is not often detected in its incipient stage, on account of the gradual and insidious manner in which it makes its approach. When we are aware of the derangement of the stomach and boAvels, Ave should, according to the character of that derangement, direct our reme- dies. Purgatives are the most valuable we possess for correcting the depraved condition of the digestive organs. 612 DROPSY OF THE BRAIN. When the discharges are thin, offensive, and light-colored, give the following medicine, for a child. tAvo years old : Recipe: Calomel, four grains. Rhubarb, four grains. / Mix, and divide into three powders; give one every two hours, till they operate freely. If the passages are natural and healthy at the last operation of this medicine, it is needless to give any more. But if they are green and unhealthy, it should be fol- lowed, the next day, with, Recipe: Simple Sirup Rhubarb, half ounce. Of which, a tea spoonful should be given every two hours, till they operate well; or you may give the folloAving medicine: Recipe: Calcined Magnesia, half drachm. Cream Tartar, ten grains. Mix. Divide into three powders, and give one every tAvo or three hours, in SAveetened Avater, till they operate freely. If this corrects the discharges, the disease may be arrested in its outset; but if the passages are not corrected by these medicines, the first prescription must be repeated. Should it be necessary, it may be given every day for three or four days, and then every other day for as long a time. Drs. Yates and Spurzheim admit that this disease has its origin in the stomach and bowels, and secondarily affects the brain; and this being so, the above practice will ahvays be found to be correct. The gums must be examined, and, if inflamed, must be cut freely to the teeth. The diet must be particularly attended to, for the appetite is sometimes very craving in the incipient stage of this disease. Improper food should not be taken, nor the stomach overloaded with proper food. If these things are not attended to, all reme- dies will fail to cure. Everything stimulating, either as a diet or drink, must be avoided. If sores have been discharging from behind the ears, and have been dried up, and irritation of the brain exists, with febrile symptoms, blisters should be applied to the seat of the sores, and kept running for several days. If these things be properly attended to in time, the disease may be arrested in the first stage. But should the case' be neglected, and the first stage pas* away, and the second stage be ushered in, it will be noted by an DROPSY OF THE BRAIN. 613 increase of fever, and pain in the head; a tense, quick pulse, resisting and active. The liver is engorged, and the bowels are either too loose or bound. An active course of treatment is now requisite, or, in all probability, all after remedies may fail to cure. We have said that the pulse is tense and quick. The child should be bled from the arm till it becomes faint, Avhen an effi- cient purgative should be given; and as this disease cannot be Avell managed Avithout calomel, you should immediately give, Recipe: Calomel, twelve grains. Ipecac, two grains. Mix. Divide into tAvo poAvders, and give them two hours apart. If they should not operate in two hours more, give a full dose of castor-oil. If the fever arises after the operation of the medicine, and the pulse is full and strong, bleed again from the arm; but if the pulse is not full, or of sufficient strength to admit of the use of the lancet, leeches should be applied to the temples, or behind the ears, and around the neck at the edge of the hair, which, per- haps, is better. The purging should be repeated every day, with sufficient activity to procure three or four evacuations. Calomel is our sheet-anchor in this disease. Recipe, Calomel, six grains. Magnesia, twelve grains. Cream Tartar, six grains. Mix. Divide into four poAvders, and give these every tAvo or three hours. If they should not operate well, give the follow- ing:- Recipe: Strong Senna Tea, two ounces. Manna, half ounce. Dissolve the manna in the tea, and give it at four doses, half an hour apart, till free evacuations are obtained ; and something of this kind should be given every day, so as to procure three or four evacuations. This is a disease of confessedly difficult treatment; and in order that the mother may be armed with all the knoAvledge that can be rendered available, we will here give the practice of sev- eral eminent physicians. Dr. Mills, in the stage in which Ave recommend the use of the lancet, says: " The temporal artery, or a vein in the arm, should be opened, and the blood allowed to Aoav, until an obvious 614 DROPSY OF THE BRAIN. impression is made on the system, or until the morbid actions of the vascular system of the brain are modified, or totally changed. That such an effect has taken place, may be known by a pale- ness of the countenance, a shrinking of the features, and a ten- dency to deliquium, (fainting,) or by a diminution of a reneAval of pain, heat, Aveight, or uneasiness of the head." Nearly all the French Avriters are great advocates of leeching and cupping in these cases; but physicians of other countries differ very widely from them. Mr. North says that he "never knew a well-marked symptom of determination to the head removed by leeches, hoAvever freely they Avere applied." We are bound to state a different result in our own practice, having seen the most violent spasmodic convulsions remedied by tAventy- four leeches applied to the temples and behind the ears of an infant that had been convulsed for six hours. The child Avas not more than eighteen months old, and recovered, after being freely purged with calomel. Dr. Eberle says: "After the impetus of the circulation has been moderated by the lancet, leeching the temples, and along the posterior parts of the ears, is a valuable auxiliary in the treatment of arachnites, or inflammation of the brain. All experienced physicians say that purgatives are essential in the cure of this disease. Dr. Schene says that, "The alimentary canal is torpid, and imperfectly performs its functions, admitting an accumulation of feculent matters; or that the secretions flowing into it are vitiated, or diminished in quantity; circumstances which are ascertained by the peculiarity in the appearance, or the pungent fetor, of the stools. We must, by steadily pursuing the purgative plan, endeavor to effect a change; for while this is produced in the appearance of the stools, we are effecting a most important change in the hepatic system, (in the liver,) alimentary canal, and all the parts included in every organ essential to life which is connected with them." Dr. Eberle says, "In symptomatic cases, depending on pri- mary irritation of the bowels, the milder purgatives, after the first thorough evacuation of the bowels, will, in general, be more bene- ficial than the repeated use of very active purgatives." It is not to be understood from the above remarks, that the doctor is not in favor of the repeated use of calomel in inflamma- tion of the brain. On the contrary, he says, "In idiopathic inflammation of the brain, the intestines are generally very torpid DROPSY OF THE BRAIN. 615 ard can seldom be sufficiently moved by the milder purgatives, In cases of this kind, it is often necessary to resort to the most active cathartics, in order to procure adequate evacuations from the bowels. The same difficulty sometimes occurs in cases attended with a great accumulation of fecal matter in the intes- tines ;" in Avhich case, he says, " calomel should always enter largely into the purgatives employed in this disease." In some cases of dropsy of the brain, unless you can bring the system to yield to the constitutional effort of calomel, the disease will never yield, but terminate in death. This truth has been tested by Doctors Percival, Dobson, Rush, Cheyene, Mills, Eberle, and many others of equal celebrity. After the fever has been subdued, all intestinal accumulations carried off, and the determination to the brain subdued, if irrita- tion of the bowels remain, some mild form of anodyne may be given, to procure rest at night. Drs. Brooke, Percival, Cheyene, Crampton, and some others, speak highly of Dover's powders for this purpose. They are composed of the following medicines: Recipe : Pulv. Opium, one grain. Pulv. Ipecac, one grain. Sulphate Potash, eight grains. Mix these perfectly in a mortar, and divide into eight poAvders, and, to a child two years old, give one in a little sweetened Avater, every hour, till rest is procured. A gentle perspiration will prob- ably ensue. If it does not, the poAvder should not be repeated. Dr. Monro says he has "cured several cases of this disease, by a plaster composed of tartar emetic and wax ointment, applied to the head, in conjunction Avith the internal use of calomel, com- bined Avith James' powder." The tartar emetic ointment is con- veniently made in the following manner: Recipe: Tartar Emetic, two drachms. Hog's Lard, one ounce. The lard to be used in the Avinter, and mutton talloAV in sum- mer. Mix them well together, and you have the ointment. Spread a plaster and apply it over the part, or rub it in with the finger, three times a day, till the pustules are full. The pustules should be opened Avhen full, and the sores dressed Avith tallow or SAveet oil. Mr. NeAvham directs the use of green tea for a child, when there is a strong tendency to inflammation of the brain. He says, " The efficacy of green tea has been strongly marked in my practice;" and he recommends its use in the folio Aving Ian 616 DROPSY OF THE BRAIN. guage: "Exhibited during the early symptoms, as soon as a sufficient, quantity of blood has been taken, and before effusion occurs, it has proved a more poAverful means than any other Ave possess, of controlling the morbid action; Avhich, if suffered to proceed to its second stage, is scarcely to be overtaken by any treatment." Nothing is more common in this disease than the application of a blister to the shaven scalp. We have often seen it tried, but have rarely known the good result from it that was expected, and have found nothing so eminently beneficial as ice applied to the top of the head. It should be broken fine, enclosed in a bladder, and kept constantly applied. The little patient is always composed, and the inflammation lessened by it. When ice cannot be had, the coldest Avater that can be procured should be applied, by keeping cloths constantly Avet in it, and laid on the head ; or, what would be better, by putting the Avater into a bladder, and laying it on the head, first wetting the hair well Avith the cold Avater, Avhich must be renewed as often as it becomes warm. The diet in this disease should be nothing more than a little rice-Avater, barley-Avater, or green tea, slippery-elm or flax-seed tea; and a little cold Avater may be given, occasionally, to Avet the mouth and throat. The room should be kept quiet, and but feAv persons allowed tc remain in it at a time, as their breath will render the air impure. It should be ventilated, but the light must not be alloAved to fall on the patient's eyes. If the medicine is sIoav in operating, injections should be used. If the feet become cold, mustard plasters should be applied to them, and Avhen the skin is dry and parched, the Avarm bath should be used; but if the patient is weak, the bath should be used by sponging the skin Avith warm water, mixed with an equal quantity of cold vinegar. The mouth should be well cleansed. When the patient begins to recover, the appetite will be vora- cious, and great care will be necessary to prevent a relapse ; the diet should be gradually and cautiously increased. The boAvels must be kept open; for which, nothing, perhaps, *rill be better than, Recipe: Calcined Magnesia, one drachm. Cream Tartar, one drachm. DROPSY OF THE ABDOMEN. 61? Mix. Divide into four poAvders, and give one or two a day, in sweetened Avater. As soon as the child is able to be taken out, a ride in a carriage, or on horseback, will be of great service to it; but care should be taken not to expose it to the heat of the sun, or too great fatigue. DROPSY OF THE ABDOMEN. Dropsy of the abdomen is not an uncommon disease among children, and is ahvays the sequel of inflammation of the perito- neum, or lining of the cavity of the abdomen. This inflamma- tion may be produced by various causes, such as improper substances taken into the stomach, and producing inflammation of the mucous membrane of the boAvels, which inflammation may be communicated to their outer or peritoneal coat, and thence to the peritoneum proper. On the subsidence of this inflammation, effusion may take place, and before the mother is aware of it, the child's abdomen is filled with water. This is. perhaps, the most frequent cause of dropsy in children. There are various other causes, however, that will produce this disease, such as blows or bruises on the abdomen; inflammation of the more solid parts of the abdominal viscera, as the liver, spleen, kidneys, &c.; repelled cutaneous eruptions, such as mea- sles, scarlet fever, itch, &e. A habit of protracted costiveness may also lay the foundation of dropsy. The first symptoms of this disease are sometimes so very obscure, that physicians, as Avell as mothers, may be mistaken in its true character. In many cases, nothing more than slight pains are felt in the region of the abdomen, and these are often referred to the presence of Avorms, or colic, Avhen some slight aperients are given, and the child gets better, for a short time. But the symptoms return. The abdomen should noAV be exam- ined ; and if, on pressure, a soreness is felt about the region of the navel, or a sore lump should be discovered on the right or left side, we should suspect inflammation. In the first instance, it Avill be seated in the peritoneum, or lining of the belly; in the second, it will be in the liver; and in the third, it will be in the spleen. In either of these cases, the child will have fever; the pulse will be small, quick, and hard; the tongue will be coated Avith a white fur, and the boAvels will be in a costive state. If these symptoms are neglected, a dropsy of the abdomen will probably ensue. The face will be pale, and the whole surface of 618 DROPSY OF THE ABDOMEN. the body salloAv; the countenance will be expressive of discon tent and suffering; the child will be Aveak and fretful; the appetite variable; the heat of the surface, hoAvever, not much above the natural temperature, except in the evening, when it Avill become warm and dry. Dropsy, hoAvever, does not ahvays commence and proceed so mildly. "In some cases, the pain in the abdomen is constant, severe, and much increased by external pressure; is attended Avith vomiting, a hot skin, a quick, firm, and contracted pulse, and great muscular debility." These symptoms may continue from five to tAventy days, before effusion begins to take place; but when it does take place, the abdomen enlarges, and, by placing one hand on the side of it, and striking the other side gently Avith the other hand, the fluctuation of the Avater may be plainly felt. The abdomen iioav enlarges more or less rapidly; the child falls off in flesh, and the extremities become very much emaciated ; the cheeks fall in; SAvelling takes place betAveen the eyes, producing great change in the features; the appetite may continue good, or it may fail; the child becomes so Aveak that it cannot bear its weight on its feet, and it frets all the time Avhen awake. The boAvels iioav become variable, being sometimes too loose and sometimes bound. There is, also, a constant Ioav fever. The child continues to lose flesh, and the abdomen to enlarge, till, unless proper remedies be applied, death closes the scene. Treatment.—In the inflammatory stage of this disease, our remedies are, bleeding, counter irritants, and Ioav diet. If the soreness should be great in any part of the abdomen, and the pulse quick, hard and resisting, bleeding from the arm should be resorted to, in such quantity as the strength of the patient will bear. This should be folloAved by, Recipe : Calomel, twelve grains. Ipecac, two grains. Mix. Divide into four poAvders, and give one every tAvo hours, till they operate well. Should they fail to operate, and the skin be hot and dry, use the Avarm bath, and give a dose of castor-oil. If the symptoms are not abated, but the pain and soreness con- tinue, after the operation of the medicine, cups or leeches should be applied to the abdomen, and as much blood draAvn as the child can bear to lose. The bowels must be kept open Avith the DROPSY OF THE ABDOMEN. 619 above poAvders and oil; in addition to which, the folloAving mix- ture may be ghren: Recipe: Venice Turpentine, two drachms. Spts. Nitre, two drachms. Mix, and gi\-e, to a child tAvo years old, fifteen drops every two hours, in slippery-elm or flax-seed tea. A feAv days' per- severance in the above remedies will generally perform a cure. Dr. Eberle recommends, after bleeding, the application of a large blister plaster over the abdomen, and that the blister should be dressed Avith mercurial ointment. We acknoAvledge the remedy to be a good one ; but Avhen the diseases of children can be cured Avithout blistering, Ave think it should be done. Should effusion take place, and the abdomen feel sore to the touch, " leeches may be applied to advantage." Drs. Laenec and Velpeau speak in the highest terms of mercurial ointment, rubbed on the abdomen. Dr. Eberle, also, speaks highly of its use, and says, " ^ly oavii experience has furnished me Avith unequivocal evidence of its usefulness." In this form of the disease, the bowels must be kept open with mild purgatives, such as : Recipe : Cream Tartar, one ounce. Salts Nitre, ten grains. Pulv. Rhubarb, twenty grains. Mix. Divide into five poAvders, and give one every four or six hours, in parsley lea, or a tea made of the roots of horse- radish. Wolff recommends small portions of calomel and digitalis to be given repeatedly: Recipe : Calomel, six grains. Pulv. Digitalis, two grains. Mix. Divide into tAvelve papers. One of these may be given three or four times a day; and, in the more advanced stage of the disease, he recommends that the digitalis be combined with the cream of tartar, in small doses. For many years Ave have not failed to cure the dropsy of infants, Avhere the liver or spleen is not affected, by the follow- ing simple remedy : keep the boAvels open with rhubarb, castor- oil, or Glauber's salts. For the purpose of removing the Avater, Ave give one honey-bee, three times a day. The bee must be dried, and pulverized as fine as possible, and given in a little SAveetened water. One bee is a dose for a child tAvo years old. This passes the water by urine, and not stool: and, after the 620 CONVULSIONS. second or third day, Ave have known the water to Aoav con- stantly, in a sIoav stream, till it had all passed off. We then give the folloAving tonic : Recipe : Tincture Iron, half ounce. Give five drops three times a day, in water, till the tone and strength of the system are restored. The diet, through every stage of this disease, should be light and easily digested. Pure air is important, and moderate exercise during convales- cence will be found very beneficial. OF CONVULSIONS. It maybe said that convulsions are almost peculiar to infancy, since so many more causes exist in infantile age than in any other. The brain and nervous system of infants are so excitable that we should not be surprised to find them frequently attacked with convulsions; indeed, this constitutes an alarming propor- tion of the diseases of infants, especially Avhen they are confined in large, badly-ventilated cities, croAvded hospitals, or close, unhealthy rooms. Dr. Clark, of Dublin, says that, "Of seven- teen thousand six hundred and fifty children born in the Dublin Lying-in Hospital annually, one sixth part die in the first year of their age; and of those Avho die, nineteen out of twenty perish of convulsions." In this number, more than tAvo thousand seven hundred die of convulsions, in that institution, every year. This is, however, a greater proportion than Ave find in this country, or than, Ave presume, could be found in Ireland, except in the Dublin Lying-in Hospital. Still, this disease presents a formidable aspect in all countries and in all places. The mind and body of an infant are not able to resist the various exciting causes to Avhich they are incessantly subjected. " All children, however, are not equally disposed to convul- sions." Mr. North observes, that "the children of parents Avho marry at too early, or too advanced an age, are more susceptible of convulsions than the progeny of those persons Avho marry in the prime of life ;" and we can underwrite this as a truth, as far as our observation, in thirty years' practice, extends. Boerhaave and Larrey believed that a disposition to convul- sions might be handed doAvn from parents to children. Dr. Eberle says : " We often meet Avith families in Avhich the recurrence of convulsions is almost a matter of course in all the CONVULSIONS. 621 chiliren, as they pass through the process of their first teething.' We have, hoAvever, on the other hand, seen families where con- vulsions never occurred, though all the usual exciting causes may, in their turn, visit them. Convulsions in children are evidently more common in cities than in the country, and there are three reasons for this. First. Imprudent and premature marriages : Second. The air is not so pure in a city as it is the country; and, Third. Children are more indulged in eating nuts, fruits, can- dies, and all kinds of sweetmeats, in cities, than they are in the country, since the facilities for obtaining them are much greater in the one place than the other. Again; their diet, in general, is not so plain and Avholesome as in the country. An eminent Avriter says: "The children of mothers endoAved Avith a very susceptible physical and moral constitution, Avith a quick and lively imagination, and great sensitiveness and mobil- ity of temper, are, in general, peculiarly apt to suffer convulsive affections during the period of dentition." Some persons think that children with large heads are very lia- ble to convulsions. This may be so, if the child is not healthy; otherAvise, Ave believe the size of its head will make no differ- ence, although, if it should be rickety, it will be more liable to them. But Mr. North says, "It not unfrequently happens, Avhere some children of the same parents are afflicted with rickets, that others, who are exempt from the disease, are, at a very early age, destroyed by convulsions." Children that are predisposed to convulsions are easily fright- ened. They start up in their sleep, and cry out; they are fever- ish and fretful; are not long amused Avith their playthings ; the pupil of the eye is Arariable, expanding and contracting Avithout the usual cause for such action being placed before them. In some cases, the pupil will dilate and contract in the same strength of light; in others, the light will not affect both pupils alike, and one may dilate and the other contract. This is, Iioav- ever, the case Avhen the brain is affected, and not Avh3n the cause of the convulsions is in the stomach and bcwels. Dr. Goode says : " Children Avho are strongly disposed to con- vulsions are apt, when asleep, to lie Avith their limbs almost rigidly extended, the thumbs and great toes turned inwards. A child's features, when predisposed to convulsions, change frequently, — a pale, languid appearance, being often changed for 622 CONVULSIONS. a flush, and an animated look. It frequently sighs, and breathes short and interruptedly; the fingers are apt to be either in quick motion, or firmly clenched in the hand; or the thumb maybe placed on the palm, Avhile the fingers are extended and spread apart. In convulsions, the countenance is always more or less dis- torted. "In some instances, the different parts of the body are successively affected." When the Avhole system is convulsed, there is a foaming at the mouth ; the tongue is protruded; the eyeballs are distorted and spasmodically affected; they twist and jerk; the breathing is difficult; the face and scalp are red, and, at times, flushed or purple; and at other times, they look pale. When this is the case, — that is, when the face is flushed, — the brain is apt to be deeply implicated, and the child may die in the fit. It is a remarkable fact, noticed by our best writers, that simple convulsions rarely occur at night, Avhile the child is sleeping; and herein they differ from epilepsy, which, almost ahvays, in the beginning, attacks the child while sleeping. The causes of convulsions are various. Anything that may cause a strong determination of blood to the head, or produce a nervous irritation of that organ, or anything that Avould produce apoplexy in an adult, will produce convulsions in a child. "In infants, the paroxysm of an ague is very often ushered in by a convulsion." This may occur from day to day, if the cause be not understood. In some cases, the cause may be local irritation, as teething, or crude, indigestible substances in the stomach. When the convulsion is attended Avith a flushed face, a quick, hard, full pulse, a dry, hot skin, folloAved by stupor, the cause is an excess of blood throAvn upon the brain. But when the face is pale, the pupils of the eyes contracted, the skin cool or of the natural temperature, the pulse small, frequent, quick, and irreg- ular, the cause is to be sought for in the boAvels or stomach. It may be worms. Errors in diet, both in quantity and quality, are by far the greatest sources of convulsions in children. So long as nurses and mothers believe that children ought to eat a little of anything the parents eat, and so long as they believe the child will thrive in proportion to the quantity it eats, so long will children be liable to convulsions. Hoav often are they brought on by induig- CONVULSIONS. 623 ing children in eating nuts and raisins, and other indigestible substances, in convalescence! AVe Avill give a plain symptom, that may warn parents, in this condition of the child, — that is, when it has been reduced by sickness of any kind, is recovering, and is indulged in eating too much, especially of indigestible food, its bowels being neglected, and costiveness ensuing; in a feAv days, the skin at the root of the nose will begin to SAvell, and the SAvellingAvill extend around the eyes, the child becoming fretful; it will shortly be attacked with stupor, Avhich will terminate in convulsions. Many cases of convulsions are referred to teething, when they owe their cause to improper diet and a neglect of the condition of the bowels. Dr. Eberle relates a case, Avhere a child who had been several Aveeks troubled by painful teething, Avhile amusing itself with its playthings, " was suddenly seized Avith a violent parox- ysm of convulsions. In a feAv minutes, it threw from its stomach a large quantity of fluid, containing a mixture of almonds, raisins, and sponge-cake." Where is the physician Avho has practised in a toAvn or city, for a feAV years, Avho has not witnessed many such cases? An emetic, in such cases, will generally dislodge the offending load. Repelled eruptions, such as the itch, measles, scarlet fever running sores behind the ears, &e., form another cause of con vulsions. Convulsions may be the result of moral causes, as sudden and violent alarm. Mr. North relates a case, where the nurse threat- ened to throAv the child out at the Avindow if it did not cease crying. This threat so frightened the child, that it Avas imme- diately convulsed in so violent a manner as to cause immediate death. Dr. Eberle relates a case Avhich he saw, Avhere the child Avas throAvn into convulsions by its sister suddenly appearing in a mask before it. Hufeland, in his journal, relates a case, Avhere a Avoman, immediately after a rage of passion, gave suck to her child, which was perfectly Avell at the time, but Avhich, in a few min- utes afterwards, was in convulsions. Mr. Gillibert relates a case of a child that died of convulsions, immediately after sucking its mother, Avho had been a long time exposed to hard labor under a very hot sun. Boerhaave gives two cases of convulsions in children, " Avhich were, in the first place, excited by being nursed immediately liter the nurse had been under the influence of violent passion." 624 CONVULSIONS. And Ave might collect, from authors, many more cases of a sim* ilar kind. Taking into consideration all the facts on this subject, we are decidedly of opinion, that it is dangerous for a Avoman of an impetuous and ungovernable disposition to suckle a child; for, should she be in a violent passion when she gives it the breast, its life may be endangered thereby. Our prospect for a cure, in this disease, depends very much on the exciting cause. If the primary irritation is located in the stomach and boAvels, or should arise from irritation of the gums from teething, the danger will be less, and the cure more certain, than if the primary cause or irritation be located in the brain or spinal marroAV. Though the danger is less Avhen the convul- sions are sympathetic, yet the case may terminate fatally by the shock and structural lesion Avhich the brain may receive from the violent determination of blood Avhich in some instances takes place "in that organ." This is more apt to be the result Avhen the child is fleshy and full of blood, especially if the convulsion continues a long time. If, however, it be light, and of short duration, and the child soon returns to its playful and cheerful attentions to surrounding objects, the danger is not so great. When strong symptoms of determination of blood to the brain exist, and the fit has lasted long, great danger may be appre- hended. Indeed, these are the fatal symptoms in convulsions. In such cases, the face becomes dark, a fulness of the veins of the neck and head, and a heaving and moving sound in the breathing is observed; and, "in such cases, the little patient dies in a state nearly allied to apoplexy in adults." Dissection has shown, in very many cases, that the brain Avas engorged Avith blood, in some instances blood-vessels having been ruptured, and blood effused; and in almost every instance, more or less serum has been found in the ventricles of the brain. " When palsy and squinting occur, the most serious cerebral lesion may be inferred." In this case, the hope of a recovery is greatly lessened. The longer the child has been sick or indisposed before the convulsion comes on, the greater is the danger to be appre- hended. If the child has manifested " great fretfulness, starting from sleep, grinding the teeth, occasional flushes on one cheek, a variable appetite, a deranged state of the bowels," &c. &c., we may expect the seat of the disease to be deeply laid. Treatment.—There are many who doubt the propriety of CONVULSIONS. 625 using any remedy when the convulsion is on; and, as a general rule, Ave can do but little at the moment. The use of external remedies may, hoAvever, lessen the violence of the paroxysms and shorten their duration, and in this way aid very much the curative process. If the child be suddenly attacked with con- vulsiDns, and the gums can be examined, this should be done, and every gum that is much sAvollen be freely cut down to the approaching teeth. The child may then be placed in a warm bath, and kept there for ten minutes; and, immediately on tak- ing it out, an injection of salt and Avater may be given. This Avill generally produce one or two free evacuations from the bowels, after which, the child will generally be enabled to swal- Ioav medicines. From all the information Avhich you can obtain as to the cause of the convulsion, you form your opinion, and prescribe accord- ingly. If it be from something the child has eaten, by Avhich the stomach or boAvels have become overloaded, you will imme- diately give it an active dose of medicine; and Ave have found that medicines which are calculated both to puke and purge have the best effect in these cases. Recipe : Calomel, twelve grains. Scammony, ten grains. Mix. Divide into tAvo powders, and give them half an hour apart. Should it not purge freely, in two hours, give, Recipe: Castor-Oil, three drachms. Mix in sweetened Avater and vinegar; give it all for a dose. Should the oil fail to operate, in due time, an injection of salt and gruel must be given. In the above cases, these medicines will generally perform the cure. But there are many cases Avhere the irritation is seated in the brain or spinal marrow, either directly or from sympathy; the child having received an injury on the head, or spine, or a disease of the stomach and bowels having existed for some days, till, by sympathy, the brain has become affected, and inflamma- tion taken place, with or Avithout effusion, in the ventricles. In this case, the child should be bled from the arm as freely as its strength will bear, and this should be followed by an injection of gruel, with spirits of turpentine, in the proportion of two table spoonfuls to half a pint of gruel. Should the turpentine not be at hand, a large quantity of salt, in warm water, should be used. BRIGHT. 41 626 CONVULSIONS. As soon as the convulsion subsides, the following medicine must be given: Recipe: Calomel, fifteen grains. Scammony, ten grains. Mix. Divide into three powders, and give one every two hours, in simple sirup, till they operate freely. The bowels should then be kept open with the following: Recipe: Calomel, twelve grains. Rhubarb, twelve grains. Mix. Divide into four powders, and give one every four hours. If they should not act freely, after each third dose, give a tea spoonful of castor-oil; or a portion of senna tea may be given occasionally, to Avork off the powders. Where the determination to the brain is strong, the face flushed or pale,—for these extremes are produced by the same cause, —there is engorgement or effusion of the brain, and exter- nal remedies should be used. If the pulse is full or hard, quick and resisting, and the pupil of the eye small, bleeding from the arm must be again resorted to. But if the pulse is soft, and the pupil of the eye large, leeches should be applied behind the ears, and to the temples, three or four in each place. Let them draAV freely, and continue the bleeding from the bites, by bathing them in warm water. When it is necessary to stop the bleeding, s little dry lint, or raw cotton, may be applied to the bites, or they may be greased with hog's lard. The feet and legs should be bathed in water as warm as can be borne without scalding; after which, mustard plasters should be applied to the wrists and ankles, and, at the same time, the cold- est water that can be had should be applied to the head, even while in the bath. Ice is better than water, if it can be obtained. These remedies will frequently moderate the symptoms immedi- ately, and bring the disease to a favorable issue. Should the face become pale, and the pulse intermittent, during the application of the ice to the head, it should be removed, and a dry cloth applied in its stead for half an hour; but as soon as signs of irritation return, the ice is to be reapplied, " even to the third or fourth time " till its good effects shall be decisive and manifest, in the suppression of all convulsions. The French and German physicians frequently immerse the whole body in warm water, and, at the same time, apply ice to the top of the head. Dr. Currie is a strong advocate of the application of cold CONVULSIONS. 627 water to the head, "in all forms of convulsions of children." And when the countenance is flushed, the surface warm, and the pulse full and active, there can be no doubt of the utility of this practice. We have witnessed its good effects so often, that we feel fully authorized to recommend it in the highest terms. If the patient's head be raised, and the water poured on it from a pitcher, so as not to run down over the body, the good effect will be sooner manifested. But if the face be pale, the extremities cold, and the pulse small, cold effusions should not be used. If convulsions have supervened, on the drying up of ulcerations behind the ears, small blisters should be laid on those parts, and alloAved to draw well; and, if there have been ulcerations on the back of the neck or head, the blisters should be applied to these parts. We have seen good results from shaving the scalp, and applying a blister thereon. Dr. Clark strongly advises " blistering the calves of the legs." Blisters should not be applied to the top of the head while any fulness of the vessels exists there, and this fulness Avill be mani- fested by a flush of the face. They should only be used when the face is pale and a little bloated. Mustard plasters are of equal, if not superior efficacy, to blis- ters, when applied to the bottoms of the feet and calves of the legs, and they may be advantageously applied to the Avhole length of the spine. The following stimulating embrocation may be advantageously used to the spine: Recipe : Spirits Turpentine, two drachms, Spirits Camphor, two drachms. Tinct. Cantharides, two drachms. Olive Oil, two drachms. Carbonate of Ammonia, one drachm. Mix perfectly, and apply it freely every two hours. It will not blister; but it exercises a powerful influence on the spinal mar- row, and so, by direct sympathy, produces a good effect upon the brain. When the convulsions assume the character of tetanus, and the head is drawn backwards, leeches should be applied along the spine; or, if they cannot be had, cups may be used instead. When Avorms are suspected to be the cause, or to bear any part in the production of convulsions, the following medicines may be given: Recipe: Senna Leaves, half ounce. Carolina Pink, half ounce. 628 EPILEPSY. Mix these together; boil to a strong tea, and give a small por tion, SAveetened, every hour, till it operates freely on the bowels. This may be repeated the next day. The bowels must be kept open with some of the above medicines. The diet for children laboring under this disease must be of the lightest kind, such as rice-water, toast-Avater, green tea, bar- ley-water, sago, arrow-root or gruel, — any of which may serve for diet and drink. The child, however, may take a little orange occasionally, or suck the juice of a SAveet orange, which will put an agreeable taste in the mouth; but lemon acid should not be alloAved under any circumstances, as it never fails to lock up the secretions of the liver, and thereby do much harm. This course of dieting should be rigidly persevered in, till the patient is able to sit up and take moderate exercise; otherwise, a relapse may be expected, and the second attack will be worse than the first. OF EPILEPSY. Epilepsy is a disease of frequent occurrence in children. It may be mistaken for convulsions, but the following symptoms will generally enable us to distinguish between them without much difficulty. In epilepsy, the child is deprived of its senses from the com- mencement to the termination of the fit; while, in simple convul- sions, the exercise of the senses is suspended only during the most violent part of the fit, and a degree of consciousness is to be observed long before the paroxysm is entirely off. Epileptic convulsions almost ahvays terminate in a deep stupor, from which the child cannot be aroused for some time. In many cases, it will sleep an hour or two before it awakes; and when it is aroused, or aAvakes from that stupor, it has a " fatuitous expression of countenance." A stupid surprise seems to rest upon it, and some time elapses before its features assume their natural appearance. But this expression of the countenance is never observable in simple convulsions, unless the brain is heavily congested. " The predisposition to epilepsy is sometimes hereditary;" and when this is the case, the disease is easily excited into action. Boerhaave mentions an instance, in which all the children of an epileptic father died of this disease. Stahl has related a similar EPILEPSY. 629 circumstance. Tessot says, he knew a remarkable instance of this kind. " An epileptic man had eight sons and three grandsons, all of Avhom became affected Avith this disease." The exciting causes of epilepsy do not differ from those given in simple convulsions. Indeed, many cases of epilepsy groAV out of simple convulsions, which by habit become confirmed, and so terminate in epilepsy. An epileptic attack may, however, come on without any previously known predisposing or exciting cause. Dr. Eberle has summed up the causes of epilepsy as folloAvs : First. The immediate cause of the epileptic paroxysms, Avhatever its essential character may be, is always seated in the brain. Second. In the majority of fatal cases, organic and other obvious affections of the brain, particularly of the back portion, or of the membranes, are found on dissection, and which, we may infer, contributed to the excitation of the epileptic paroxysms. Third. The affection of the brain is, in some instances, primary, and the result of causes that act directly upon the brain. In others, probably in a majority of cases, it is sec- ondary, depending on primary irritations located remotely from the brain. Fourth. Immediately before the accession of the epileptic attack, it would seem that vascular turgescence takes place in the back portion of the brain; and the pressure thus created, in cooperation with the general predisposition to the disease, and the organic affection of the brain, Avhere such disorder exists, is probably the exciting cause of the paroxysm. Epilepsy is like an enemy in ambush, frequently attacking suddenly and unex- pectedly. In many cases, hoAvever, it gives a previous warning. These are the most common premonitory symptoms: a dull, heavy pain, or a confused or distressed sensation in the head, Avith giddiness, and the appearance of sparks fluttering before the eyes; the veins of the head and neck become distended, and a buzzing noise is heard in the ears; palpitation of the heart, nervous tremors, an agitated and alarmed appearance of the countenance, starting during sleep, temporary spasmodic twitch- ings of some particular muscle, pains in ihe stomach, succeeded by nausea, and, at times, by vomiting, Avith a fretful or perverse feeling. A creeping sensation is sometimes felt in some part of the body; an epileptic aura, or tremor, beginning in some par- 630 EPILEPSY. ticular nerve, as the sciatic or femoral nerve, about the hip joint, or a rapid change of color and expression of countenance. All of these premonitory symptoms are not to be expected in any one case, but a sufficient number will exist to give character to the disease. Epilepsy, in its early stage, generally comes on Avhen the child is sleeping. When the paroxysm comes on while the child is awake, it is frequently preceded by a scream, or some peculiar noise; the child suddenly falls doAvn, and becomes violently convulsed. We have known cases Avhere the patient would not fall in every attack, but Avould show a sudden twitching of the face on one side, and in one foot, turn around, and partially lose its senses, and, in a minute or tAvo, vomit. We have known these symptoms to occur, in one boy, ten or twelve times in one day; and yet he had no fit that completely convulsed him, unless attacked while sleeping, in which case the convulsion Avould be violent. In this state, he lived to be middle-aged before he died. He described his symptoms by saying, that he felt a cold stream begin in his hip, run down to his foot, and then return. If it reached his head, he fell; but if it stopped before it reached his head, he did not fall, but whir.ed around like a top. We have, when a boy, seized and shaken him many times, to stop the fit; and this ahvays had the desired effect, if done in time, or before the aura epileptica reached the head. Perhaps there is nothing more frightfully violent than an epi- leptic fit. The convulsive action of the muscles, especially those of the face, is particularly alarming. They are drawn and dis- torted into every shape; the Avhole frame is violently agitated, and the eyelids are in constant motion; the eyes project, and are fixed, or turned upAvards, so as to hide the black; the face some- times looks pale, but most frequently " livid or red," and some- times almost black; the veins of the head and neck are very full; the tongue is often protruded beyond the teeth, and some- times badly bitten. The jaws contract, and the teeth grind with great power; "sometimes the mouth is clenched tightly;" the hands are clenched, with the thumbs tight upon the palms; the head is thrown about in various directions, but sometimes it becomes fixed in one position; and, while this is the case, every effort to move it will prove ineffectual. The body may also bo fixed firmly in one position, but it is mostly throAvn into various attitudes. Sometimes the stomach and abdomen are violently drawn back to the spine; at other times, they are raised upwards, EPILEPSY. 631 and the spine is bent accordingly. The breathing is always dif- ficult ; the saliva is frequently thrown from the mouth, but sometimes it only works out in lumps on the lips, which are contracted, and pale or blue. The spasms seem, at times, to yield for a moment, and then return with increased strength. If the spasms do abate a little, no return of consciousness is observ- able, but a vacant, unconscious stare of the eye, Avhich is soon interrupted by a returning spasm. One side of the body is generally more affected than the other. "In very violent cases, the urine and fasces are discharged involuntarily." The convul- sion ceases, sooner or later, sometimes suddenly, but more frequently gradually. The pulse, which, during the fit, was small, frequent, and irregular, now becomes full and regular; the countenance becomes more composed, and the child falls into a deep sleep, or stupor, from which he aAvakes in a state of confusion, or torpor of mind, " which generally continues for ten or twelve hours." The patient generally sAveats profusely while sleeping, espe- cially about the head and neck. The perspiration, in many cases, has a peculiar and offensive smell. All cases of epilepsy, however, are not as violent as in the description above given. After the attacks are confined to the sleeping state of the patient, for a longer or shorter time, they begin to make their appearance in the day time. In some cases, the paroxysms occur only once in a month; in others, more frequently, till they come on every day, or several times in twenty-four hours; and the younger the child, the lighter is the disease, generally. In some cases the fits appear at regular periods; but in a majority of cases this regularity does not obtain. "One of the most distressing circumstances connected with this disease is its tendency to impair the understanding, to pro- duce hebetude, and finally even total aberration of the mental faculties." The time at which this imbecility is effected, varies very much in different individuals, and this, perhaps, is owing to the peculiar part of the brain, or its membranes, affected, or the primary seat of the disease. But, in all cases, if the disease continues for a long time, the mind becomes more or less affected. " Epilepsy seldom proves fatal, except through the interven- tion of apoplexy." And though it may be suspended, and seem 632 EPILEPSY. to be cured, for months together, yet there is great danger of its returning. Dr. Eberle says, he "has seen instances where the disease returned, after a suspension of its attacks for several years." If the primary seat of the disease is in the brain, all attempts to effect a radical cure will be in vain. But where the epileptic fits are produced by a sympathetic effect on the nervous system, having their origin in the stomach or bowels, then the disease, by early and proper treatment, may be cured. But even in these cases, if the disease continue long enough to impair the mental faculties, a cure is rarely, if ever, performed. Richter observes, "that a long continuance of sleep or stupor, and confusion of mind, after the subsidence of the paroxysm, is a very unfavor- able sign." Epilepsy from moral causes, such as terror, is generally ex- tremely obstinate in its course.—Lahn. And it is said, also, "that those cases which come on at night, during sleep, are, in general, much more intractable than such as occur during the day, and are preceded by premonitory symptoms," — Richter. Men of great experience and observation have declared that "this disease occasionally occurs on a change of climate;" and this may be the case at the age of puberty, even where the disease has not been of protracted duration.—Lontin. Hereditary epilepsy is perhaps always incurable. Wensel, Roederer and Esquirol, all declare that, on dissection, the brain and spinal marrow have exhibited, more or less, une- quivocal signs of disease, and ever showed decidedly that epi- lepsy had its seat in these organs; that if its first and primary link was not seated there, the secondary effect had become so deep and lasting that the brain and spinal marrow ultimately became its seat. Treatment. — The causes of epilepsy are so various, and it is so difficult at all times to ascertain the exciting cause, that it becomes difficult to make a prescription to suit the case. Medi- cal treatment, in such cases, therefore, is not so precise and scien- tific as it is in many other forms of disease. The first thing to be done is, to inquire closely and particu- larly into all the previous symptoms; the time and manner of attack; how long the fits last; how long the patient has been subject to them; the age and habits of the patient; the hereditary predisposition, if any; whether the attacks are by day or by night; whether the patient sleeps long and sound after a fit; and EPILEPSY. 633 whether, when he awakes, he looks rational or wild, and is incoherent for a time; and Avhether he pukes before or after the fit. If he is old enough to tell, he should be asked Avhether he feels anything like an epileptic aura before the fit comes on ? If he does, in Avhat part of the body? Hoav long it lasts ? and if a fit always succeeds the aura? These things having been correctly ascertained, a prescription may be more certainly made Avith a hope of success. If the veins in the neck are full, the face flushed, and the head giddy, bleeding in time may prevent the fit. If the stomach has been overloaded, a brisk emetic may relieve the case for the present. Recipe: Ipecac, fifteen grains. Tartar, two grains. Mix. Dissolve in six table spoonfuls of warm water. To a child, give two tea spoonfuls; and to a groAvn person, give two table spoonfuls ; and repeat one spoonful, according to age, every fifteen minutes, till they operate freely. Richter says, "Where the attack runs regularly, at stated times, it may be kept off by administering an emetic every day, just before the expected attack." But many eminent physicians doubt the propriety of the practice; and Ave believe that Avhere there is a strong determination of blood to the brain, the emetic should be preceded by bleeding. Where the fit is preceded by the aura — that is, a warm, ting- ling sensation passing from some part of the limb up to the head, — a ligature should be tied above the aura, and alloAved to remain till it passes off. Dr. Cidlen observes, that "a ligature upon the limb above the part from which the aura arises should in these cases be applied, both because the prevention of a fit breaks the habit of the disease, and because the frequent com- pression renders the nerves less fit to propagate the aura." An instance is related in the London Medical and Physical Journal, in which pressure in this way prevented the recurrence of the paroxysm. Cooke, Brecktedt, and Michaelas, relate similar suc- cess by the application of a ligature above the aura. We once kneAV a boy that Avas subject to the aura epileptica, which would last for eight or ten minutes before it would go off. This boy was subject to the aura for years before he had a fit. It is, hoAvever, in the intervals of the attack that the most suc- cessful efforts are to be made for the cure of this disease. 634 EPILEPSY. The immediate danger attending an epileptic fit is from the rapid determination of blood to the brain, thereby injuring that organ, and terminating in apoplexy. It then becomes necessary, during the fit, to use such means as will prevent the brain receiving an injury by such rapid determinations of blood to it. And against this, bleeding is, perhaps, the best and only sure remedy. But should it not be convenient to draw blood, an injection of salt and water may be used, and the boAvels freely evacuated; and this will invite the action of the blood from the brain. Cold Avater may be applied, at the same time, to the head, and hot water or mustard plasters to the feet. Everything that would in the least press the blood-vessels of the neck, and pre- vent a free action of blood to the heart, should be removed. These remedies will not cure the disease, but they may pre- vent a fatal termination of the fit at the time. A radical cure is to.be sought for, hoAvever, in the use of remedies between the paroxysms of attack. If it be found, as before stated, that the bowels have been loaded Avith indigestible or unhealthy food, this should be removed as quickly as possible; and, for this purpose, a brisk cathartic should be given. Recipe: Calomel, twelve grains. Pulv. Jalap, fifteen grains. Mix. Divide into three powders, for a child three years old, and give one every two hours, till they operate freely; if the child should puke, it will do no harm. Everything cold or salt must be avoided, till this medicine is done operating. At times, the fit occurs once or twice a month; and, in such cases, Dr. Richter says he has succeeded in performing a com- plete cure by giving an emetic of ipecac, and calomel, which he repeated every third day, for six weeks. It may be given in the following manner: Recipe : Calomel, ten grains. Ipecac, five grains. Mix. Give in sirup; Avork it oft' with gruel without salt. This is a dose for a child five years old. When the disease is attended with acid on the stomach, it may be cured by adding an alkali to a tonic. The famous poAV- der of Margrave, the celebrated German remedy, is the following: Recipe: Powdered Mistletoe, one ounce. Carbonate Magnesia, half ounce. White Sugar, one ounce. EPILEPSY. 635 Mix them well together, and give a child five years old or under, a tea spoonful two or three times a day. When the child vomits after the fit, or the upper lip trembles much, it is thought by some eminent Avriters that the stomach is the seat of the disease; or, at least, that there is some offensive matter there. Van Swieton states, " that in a case of epilepsy in a child, in Avhich the paroxysms Avere invariably preceded by the tremulous motion of the under lip, he employed emetics and pur- gatives Avith entire success." Should there be any suspicion of the existence of Avorms in the boAvels, suitable remedies for their removal should be used.—■ {See chapter on ivorms.) Every physician of extensive prac- tice has seen a greater or less number of cases of epilepsy in chil- dren produced by worms, which A\rere cured by their removal. Of late years, the physicians of Europe have succeeded in curing epilepsy with the following medicine: Recipe : Pulv. Valerian Root, two drachms. Elutriated Oxide of Tin, half drachm. Mix into eight poAvders, for a child from three to six years old, and give one, in sirup, three times a day. The dose should be increased, according to age. When the elutriated oxide of tin cannot be had, the folloAving may be substituted for it: Recipe : Pulv. Valerian Ptoot, two drachms. Oxide of Zinc, twenty grains. Mix. Divide into eight poAvders, and give as above directed. When the disease succeeds to drying up of sores behind the ears, on the back of the neck, or any other part of the body, the obvious remedy is, to restore the discharge, by applying blisters, or setons, or tartar emetic ointment, to the old sores, and thus produce a fresh running sore. And, in thjs case, the following medicine should be used, in addition to the foregoing: Recipe: Pulv. Gum Camphor, ten grains. Pulv. Musk, five grains. Mix. Divide into five poAvders, and give one, in sirup, two or three times a day. The bowels should be kept open with some gentle purgative, such as castor-oil or rhubarb. The author has cured many cases of epilepsy in children, when the disease had its seat, apparently, in the stomach and bowels. Recipe : Cream Tartar, one drachm. Pulv. Jalap, half drachm. 636 EPILEPSY. Mix. Divide into ten poAvders, for a ~hild three year? old, and give one poAvder every night, at bedtime, in SAveetened water. This will operate tAvo or three times the next day. The following powders should be given in the daytime. Recipe: Pulv. Nitrate of Silver, six grains. Pulv. Russian Castor, twelve grains. White Sugar, one drachm. Mix in twenty-four powders. Give one three times a day, in sirup, and increase or diminish the dose, according to the age of the child. The oxide of zinc has been used successfully by many eminent physicians. This medicine should be given in small doses at first, and gradually increased, always keeping up to the quan- tity the stomach will bear without puking. Recipe: Oxide Zinc, ten grains. White Sugar, one drachm. Mix. Divide into ten poAvders, and give one three times a day, in a feAv drops of water. If the child pukes, give less. Lettoom, Cullen, Ideler and others, speak highly of this remedy. We have found this most beneficial Avhere the disease continued to return from habit, after the exciting cause had been removed. The ammoniated copper was a favorite remedy with Dr. Cul- len. It should be given in small doses. Recipe: Cruprum Ammoniac, five grains. White Sugar, thirty grains. Mix. Divide into tAventy poAvders, and give one three times a day, in thick sirup. Increase or diminish the dose, as the stomach will bear Avithout puking. We have no doubt that the disease has been cured by this remedy in some instances. Mercury given to salivation has also cured this disease; but any other remedy should be preferred to salivation in children. We have several times cured adults of epilepsy with Spanish Flote indigo. It is used in the folloAving manner : Recipe: Spanish Flote Indigo, one ounce. Pulv. Cloves, one drachm. Mix. Divide into tAvelve poAvders, one of which may be given, morning and evening, in sweetened Avater; if they purge too much, give only one a day. This remedy, hoAvever, will not cure every species of the disease. Whatever remedy is chosen for the cure of epilepsy should be SPASMS OF THE FEET AND HANDS. 637 steadily persevered in for a long time. It generally takes from three to nine months to cure the disease by medicine. When a portion of the skull has been beaten down on the brain, or a fracture produced on the interior table of the skull, from Avhich a spicula of bone has grown and penetrated the sub- stance of the brain, causing constant irritation, an operation by trepanning the skull, and removing the spicula, has cured the disease. Among the number of physicians and surgeons Avho have performed this operation successfully, are Boerhaave, Thenier, Stalport, Vanderweil, Tissot, Massie, Dudley, of Lex- ington, Ky., Roger, of New York, and Guild, of Alabama. We mention these names in justice to these gentlemen; and when all medical assistance fails, the patient may still have hope in surgi- cal aid. It would be next to impossible to name everything that has been and can be done for the cure of epilepsy, as our resources are almost inexhaustible; and yet, in some cases, all remedies fail; not, perhaps, for the want of a proper remedy, but because we have failed to adapt it suitably to the case. The peony or piony root, as it is generally called, has cured epilepsy. The iris, a species of flag, has also cured it, and many simple remedies have had their advocates, not because they were more powerful or more scientifically selected than others, but because they happened to suit the case, and the condition of the patient at the time they Avere given. Suffice it to say, in all cases, the most rigid adherence to a light and easily-digested diet is absolutely necessary in order to obtain a cure. Parents are too apt to become weary, and relax their attentions to the use of the medicines, as well as to the diet and exercise of the child. The dieting should be kept up for six months after the last fit occurs, and every facility for pure air and healthy exercise afforded. All exciting causes should be put as far out of the way as possible, and the patient placed where it cannot be brought under their influence. OF SPASMS OF THE FEET AND HANDS. This disease is denominated by Eberle and others, carpopedal spasms. The authors Avho have written most clearly on it are, John Clark, of Dublin, Kellie, Jas. Johnson, North, and Eberle. This disease usually makes its appearance in a gradual man- ner. From the third to the sixth month is the most usual age in 638 SPASMS OF THE FEET AND HANDS. which it appears, though it occurs as late as eighteen or twenty months after birth. At first, the symptoms are so slight as scarcely to attract attention; a hurried breathing, not unlike that in croup, is perceived at the moment the child awakes from sleep, Avhen it is apt to start as though it Avere frightened. From this time, its features undergo a perceptible change, and the counte- nance assumes an anxious appearance; "the sides of the nose are drawn in;" the child is apt to frown; and, when it takes the breast, it sucks greedily for a minute or two, then lets go, and throAvs back its head Avith great violence. In the progress of the disease, the bowels become constipated, and these symptoms continue to manifest themselves for a longer or shorter time, before the disease fully develops itself. The boAvels are more or less deranged; the faeces thin, light colored, and sometimes very fetid; presently the thumb will be clenched in the palm of the hand, and the toes drawn towards the bottom of the foot; the foot turned inwards; and sometimes the ankles and Avrists swell, and change their natural color for a purple hue. "The head is often throAvn backAvards;" and the neck is stiff- ened, Avhen the breathing becomes constantly difficult. " Each inspiration is iioav attended by a croupy sound;" "the heart palpitates violently ;" the child rarely cries in a natural manner, but sobs frequently. The breathing sometimes appears to be suspended, and the child looks pale or faint; but " sometimes the face is dark." The vessels of the head and face are filled, and the face is flushed as in apoplexy. The patient is iioav, every moment, liable to convulsions. These may be partial, as in the extremities; or they may be general, involving the whole body. In a child in whom the con- vulsions Avere very prominent and severe, the head and heels were the only parts that touched the bed for many days; and if with difficulty this painful position was altered by the mother, it was quickly resumed. — Eberle. In genera], but very little febrile action can be detected, " Sometimes the locked state of the thumb, the rigidly bent posi- tion of the head and feet, and croupy breathing, will continue several weeks, with but little intermission, except for a few minutes at a time." Sometimes the child will suddenly arouse from this state of spasmodic action, and present, for a few minutes, a cheerful countenance, and be disposed to" play, or take notice of surrounding objects; but this is soon changed for another convulsive action of the extremities and spine. SPASMS OF THE FEET AND HANDS. 639 These symptoms may, and do, vary, in many cases; but we nave given enough to show the mother the character of the disease. There are various opinions as to the cause and seat of this disease. Some physicians think it originates from a deranged state of the boAvels; others, that it has its seat, primarily, in the brain; and others, again, think that teething is the exciting cause. The bowels are, no doubt, deranged in the commence- ment of the disease, and teething may act as an irritant, and the brain may become affected secondarily. But we are of the opinion that this disease has its seat in the spinal marroAv. The peculiar spasmodic action of the hands and feet, and the curva- ture of the spine backAvards, all go to show that the spinal marrow, and the nerves having their origin from it, are the seat of this disease. Some authors speak lightly of it, and say it rarely proves fatal We are, however, of a different opinion. So far as our observa- tion, and the experience of the physicians of this country Avhom we have consulted on this subject, extend, it is a disease of great danger to the infant. Treatment.—In this, as well as all other diseases of infants, every irritating cause should be removed; the first thing, there- fore, to be attended to is, to examine the gums; and. if sAvollen, they should be freely cut doAvn to the teeth. If the teeth be large, cut from the corner of each tooth, till the gum lancet touches the tooth all the Avay; otherwise, no benefit will be gained from the lancing. If the pulse be full or hard, the child should be bled freely from the arm, and the bowels should be actively purged, — very light, mild purgatives will do little or no good in this disease. To a child six months old, give the following, and increase or diminish, according to age: Recipe : Calomel, twelve grains. Scammony, six grains. Mix. Divide into six poAvders, and give one every two hours, till they operate freely; or you may give the calomel alone, in the same proportion. If it should not operate Avell, in Iavo hours after the last is taken, give a dose of castor-oil. After you have evacuated the boAvels freely, if the pulse still keep full, leeches must be applied on the back, on each side of he processes of the spine, about an inch apart, nearly the Avhole ength of the spine. If the hands are cramped more than the 640 SIMPLE CONTINUED FEVER. feet, apply the leeches mostly betAveen the shoulders; and if the feet are cramped most, then apply them loAver doAvn the back, and between the hips. If leeches cannot be had, use cups of glass or little gourds; and if neither can be had, apply a blister plaster to the spine, nearly its whole length. But should there be strong prejudice against this practice, use the folloAving liniment: Recipe: Spts. Camphor, two drachms. Spts. Turpentine, two drachms. Tincture Cantharides, two drachms. Olive Oil, two drachms. Carbonate Ammonia, one drachm. Mix perfectly, and rub it in freely, the Avhole length of the spine, repeating it every tAvo hours. The boAvels should be kept open Avith, Recipe : Calomel, six grains. Ipecac, three grains. Mix. Divide into six powders, and give one every tAvo hours, so as to keep the boAvels freely open. Placing the feet in Avarm Avater, and bathing the head in cold water at the same time, will always moderate the spasms. Blisters behind the ears, and mustard to the feet, have done good. When the disease begins to yield, and the spasms have all left the child, the bowels may be kept open with, Recipe: Calcined Magnesia, half drachm. Cream Tartar, half drachm. Mix. Divide into four poAvders, and give one morning and evening, in SAveetened Avater. If the child is at the breast, its mother's milk will be its best diet; and if weaned, its food should be of the lightest kind. Proper exercise, as soon as the child is able to take it, will be profitable. OF SIMPLE CONTINUED FEVER. This form of fever sometimes attacks children, though not so frequently as it does grown persons. But, as it occasionally occurs, it is proper that it should be noticed here. Infants from the age of two to four years old are most apt to be attacked with this form of fever. It is rarely ushered in by a chill, but generally comes on after exposure, or active exercise in the heat of the sun; after which, the child is apt to fall asleep, and awakes with a fever. The face is generally flushed, the skin hot and dry. the tongue clean, and the pulse a little fuller SIMPLE CONTINUED FEVER. 641 and quicker than in health; the child is apt to complain of pain in the forehead; in some cases, a slight delirium supervenes for several hours, when the child will fall asleep, and a profuse per- spiration break out all over the body, and the fever subsides. The Avhole paroxysm may not last over twelve hours. The child will feel a little languid for a day or two, and all will be well again. This form of fever is called by some writers ephemeral fever. But the child is not always so fortunate as to have so short a paroxysm. It sometimes lasts several days, without any inter- mission ; the pain in the head becomes more intense, the tongue coated, the pulse full and strong, the abdomen hot, and the skin feels dry and burning; the bowels become constipated, and the delirium recurs. Stupor may come on, and the case present a dangerous aspect. When the child is aroused, it has great thirst, but no appetite. If neglected, the symptoms will increase in violence, and, in the course of from three to four days, death may ensue, and the child die with all the symptoms of cerebral irritation. Treatment. — If the fever is very high, and the pulse full, with much pain in the head, especially if the whites of the eyes are red, the child should be bled from the arm. If the above symptoms are not severe, the bleeding may be omitted; but whether it is bled or not, the following medicine, for a child two years old, should be given : Recipe: Senna Leaves, two- drachms. Pulv. Rhubarb, twenty grains. Simmer them in a gill of water fifteen minutes; strain and sweeten the tea, and give a table spoonful every half hour, till the bowels are freely purged; or, Recipe: Calomel, six grains. Rhubarb, six grains. Salts Nitre, two grains. Mix. Divide into three powders, and give one every two hours, till they operate freely. If the.discharges are green or dark Avhen the powders cease to operate, give the following: Recipe : Castor-Oil, two drachms. Spts. Nitre, twenty drops. Mix, and give in sweetened vinegar and water. If the fever continues after the operation of the oil, give the following cooling powders • bright 42 642 MILIARY fever. Recipe : Cream Tartar, half drachm. Salts Nitre, ten grains. Tartar Emetic, half grain. Mix. Divide into four poAvders, and give one every hour, in calm, hyssop, or sage tea, till the fever is cooled off; or, Recipe: Spirits Nitre, half ounce. Wine of Ipecac, one drachm. Mix. Give fifteen drops, in some one of the above teas, and repeat every hour, till the fever subsides. When the fever is entirely removed, if the tongue is coated, you must repeat a dose of castor-oil or rhubarb. If the fever return, repeat the above medicines, and continue, .ill it is entirely subdued. In every case, the diet should be light and thin. When calo- mel is given, everything cold, salt or greasy, should be avoided, till the medicine is Avorked off. When the child begins to recover, it should be kept in the shade for two or three days, or it will be liable to relapse. But in this, as in all other cases of fever of infants, as soon as the strength will admit of it, proper exercise on horseback, or in a carriage, will be beneficial. of miliary fever. This form of fever takes its name from the resemblance of its eruption to a millet-seed. The color is first a transparent red, and afterwards milky. It is preceded by a pricking sensation ; the patient sighs, feels great anxiety, and throAvs out a sour SAveat. This disease has been noticed by medical Avriters for at least one hundred and fifty years, during Avhich time it has not changed its character or type. This, however, is characteristic of all the eruptive diseases. Miliary fever is not contagious. It generally makes its appear- ance in hot weather, though Ave have seen it in the fall, winter, and spring. It is sometimes mistaken, by careless observers, for scarlet fever, and sometimes for measles; but a little attention will satisfy any one that it is neither. The eruption is small, round and distinct; sometimes elevated above the surface, so as to be observed by the eye, and at other times it can only be detected by feeling, when the surface will be found to be rough. The top or point of the vesicle is clear, and contains a little fluid miliary fever. 643 When it dries away, the cuticle or grain of the skin peels off, in thin flakes, like fine bran. The child is weak and fretful, sometimes showing signs of great debility. The boAvels are apt to be relaxed, and, in young children, the discharges are fetid. The tongue has a white coat on it, especially towards the root, and the appetite fails. The eruption remains out for five or six days, and then falls off, or is succeeded by a second eruption, Avhich runs its course as the former. When this is the case, the Avhole course of the disease Avill occupy about fifteen days. This disease is sometimes mis- taken for prickly heat. Miliary fever has prevailed in Europe, as an epid -x; but we have no such history of it in America, though every physi- cian in this country has seen more or less of it, especially in the large cities, Avhere the air is impure, in hot Aveather. The principal European authors who haA^e written on this disease are, Plouquit, Gerike, Jucks, Linnaeus, Parr, Boncroff, Stoll, Planchon, Triller and Goode. In America, Cullen, and many others. Various opinions are given by these authors relative to this disease; but let it have assumed what shape it may, at different times and at different places, in the old Avorld, in America it has been very uniform in its character, and the above description will so fully embrace its symptoms that it will not be easily mistaken. Treatment. — This is evidently a disease of more or less debility, especially in large cities, and, therefore, should be treated Avith a view to that fact. The bowels will generally be found, in Avarm Aveather, to be relaxed; the secretions are vitiated, and smell badly. The first thing, therefore, to be done, is to correct the secretions. This, for a child two years old, is most effectually done with, Recipe : Calomel, three grains. Rhubarb, two grains. Mix. Divide into three powders, and give one every three hours, in sirup, till they operate gently on the boAvels. The surface may be bathed with tepid water, two or three times a day. If the boAvels are not much deranged, as is generally the case in cool weather, the calomel may be omitted, and the following medicine given: 644 SMALLPOX. Recipe : Pulv. Rhubarb, six grains. Calcined Magnesia, ten grains. Mix. Divide into two papers, and give one every two hours, ji SAveetened water; or you may give the following: Recipe: Senna Tea, two ounces. Manna, half ounce. Dissolve the manna in the tea, and give a table spoonful every hour, till the bowels are freely opened; or, Recipe: Castor-Oil, half ounce; Avhich may be given at tAvo doses, tAvo hours apart. As soon as the boAvels are freely purged, and the discharges become healthy in appearance, the following tonic should be given: Recipe: Huxham's Tincture, one ounce; Give fifteen drops three times a day, in sweetened water, and increase or diminish, according to age. The bowels must be kept regular with some of the above gentle medicines. After the bowels are properly cleansed, if the child be six or eight years old, very small doses of tartar emetic will be found of service in correcting the sour sweats. It is most conveniently given in the following form ; Recipe : Cream Tartar, twenty grains. Salts Nitre, six grains. Tartar Emetic, half grain. Mix. Divide into six powders, and give one every tAvo hours, in some herb tea, and continue, till the SAveats are removed. In all cases, the diet should be light and nourishing, and the child should not be covered too warm in summer. All flannel should be removed from the skin, and cotton or linen substituted in its place. As soon as the child is able to bear it, riding out in the open air, in good weather, will be of great service. OF SMALLPOX. To give a full history of smallpox, its origin and progress in the world, would be to extend this chapter far beyond our pres ent limits. We will merely remark, that smallpox has been known in the world ever since the ninth century. It was, how- ever, first accurately described by the Jesuits. It prevailed, foi an incalculable period, in China, before it entered Europe. There are two forms of smallpox — the distinct and confluent. The distinct smallpox is characterized in its attack by the SMALLPOX. 645 following symptoms: A cold stage, Avhich is followed by fever, frequent vomiting, and some degree of soreness in the throat; the flesh is sore, and the bones ache. From the third to the fifth day, the eruption begins to appear on the face, neck, and breast, in small specks, which multiply for four days, when there is usually a pretty full crop of them over the whole body. They are more numerous on the face, neck, and arms, than any other part of the body; perhaps, in the proportion of "five to one." The head, face, and hands, and wherever else the eruption shows itself, gradually swell, the eyelids being fre- quently so swollen as to close the eyes entirely. The spaces between the pimples are reddish, "and continue to grow more so as the pimples become pustules," and matter forms in them. "The fever" does not intermit, but "is of the inflammatory kind." The pustules continue to increase in size, till the eighth or ninth day, when they become complete and full, and the matter found in them becomes yellow, and suppuration complete. But before the pustules fill, the formation of the vesicle is peculiar, and unlike every other vesicle in eruptive fevers. The pustules are flat on the top, and seem, in color, as if they con- tained milk and Avater, while they are filling and coming up to their full size. When they are full, there is, in almost every one, a small depression, as though the point of a dull pin had been pressed upon it. This depression remains to the last, and leaves a small puncture in the centre of the scar. This is a character- istic sign of this disease; and where it is wanting, the disease is not smallpox, but some other form of eruptive fever. The confluent smallpox. — This species commences with all the symptoms of the distinct smallpox, except that they are more violent, and the eruption begins to show itself sooner after the attack. As a general rule, the sooner the eruption appears, the more violent is the attack. In the confluent smallpox, the whole surface is raised, espec- ially on the face, neck, breast, arms and legs; the fev<>r runs very high, and sometimes delirium attends, to an alarming degree. Indeed, in all cases where there is much delirium, the danger is great. The patient sometimes vomits everything that is taken into the stomach, and suffers from great thirst. A day or two after the pustules have filled and become yellow, they begin to dry. The first appearance of this stage is the little dent in the middle of the pustules beginning to look broAvn, and this brownish appearance gradually spreads over the pustules, 646 SMALLPOX. when they begin to break, and emit a peculiar smell — the most loathsome, perhaps, of all others, and one that cannot be mis- taken by any one who has ever smelled it before. As the pustules begin to dry, the fever subsides a little, till it leaves the patient almost entirely for two or three days. At this time, the itch attending the pustules is most intolerable, and the patient, if not prevented, will scratch and tear the skin from the face, hands, and arms. Every mark of the nail leaves a deep scar, which heals in hard ridges or patches. Sometimes a pustule will make its appearance in the eye, when it is almost sure to destroy the sight. When the pustules have been drying for two or three days, a second fever arises, Avhich is probably produced by the absorp- tion of matter from the pustules. This fever is frequently more dangerous than the first. If the patient die of smallpox, it is from one of two causes: first, because the pustules do not fill well; or, after they have commenced filling, they cease to do so, and turn broAvn. In some cases, the pustules never begin to fill, but the spots that were first red turn black in three or four days, and remain flat; in the event of Avhich, delirium comes on, and the patient dies of all the symptoms of typhoid fever and congestion of the brain. In other cases, the fever runs so high that the patient is cut off in the first inflammatory stage, even though the pustules seem to be disposed to fill. Again; the patient often sinks under the secondary fever. This, however, is generally for the Avant of proper management. When this is the case, the tongue becomes dark on the top, and the teeth are covered Avith a dark sordes. The pustules that have come out on the tongue and roof of the mouth and throat change their color from a red to a purple. Symptoms of con- gestion, or pressure on the brain, now make their appearance; a heavy stupor follows, and the patient dies in a comatose con- dition. The length of time that smallpox runs, from the first symp- toms to a final recovery, is, in distinct smallpox, from twelve to fifteen days, and in the confluent form, from eighteen to twenty- four days, or sometimes twenty-eight days, before all the sores are healed. Smallpox is highly contagious, under all circumstances, from the time the fever first arises till the patient washes out. It may be kept for years in clothes, and then communicated to others SMALLPOX. 047 Treatment.-—The smallpox is at all times to be dreaded, and .ooked upon as a formidable disease; but if the patient be well treated, it may be shorn of many of its terrors. There is an almost insurmountable prejudice in the world against calomel; but we have noAV to combat a disease which cannot be successfully treated without it. That it has been cured, in a few instances, without calomel, we are ready to acknowledge; but those cases are rare, and are to be attributed more to the conservative poAvers of the system than the remedies used. If we have a specific in medicine, it is mercury in small- pox. We can say — what feAv physicians can, in the treatment of smallpox — that Ave have never lost a case, though we have treated a large number, counting all the varieties of distinct and confluent smallpox and varioloid. Our course of treatment has uniformly been, first, to give, for a child tAvo years old, an active cathartic of calomel. The dose may be increased or diminished, according to age. Recipe : Calomel, ten grains. Jalap, six grains. Mix, and divide into three powders; give one every three hours, till they operate freely, and work them off with gruel without salt. On the second day, give the folloAving medicine: Recipe: Calomel, twelve grains. Salts Nitre, six grains. Mix. Divide into six poAvders, and give one every two hours, in sirup. This should be repeated every day, till the eruption makes its appearance, when the calomel should be omitted, and the following purgative given : Recipe : Pulv. Rhubarb, twelve grains. Calcined Magnesia, twenty grains. Mix. Divide into four powders, and give one every four hours, in sirup or SAveetened water, or just as often as will pro- cure two operations daily. This should be repeated every day, till the pustules fill. The drink should be Avarm balm or dittany tea. When the pustules begin to dry, and the secondary fever comes on, the first or second prescription, according to the strength of the child, should be given. This should be repeated for two days, Avhen the secondary fever will abate. The rhubarb and magnesia should be resumed, to keep the bowels open. If, how- ever, any symptoms of stupor should come on, the rhubarb and magnesia should be omitted, and the calomel given again. €48 SMALLPOX On the appearance of the eruption in the mouth, the saliva will begin to Aoav, and the stomach become nauseated. This spitting is not salivation, but the effect of the pustules breaking out in the mouth and throat; and the freer the saliva flows, the better for the patient. In order to prevent the pustules from coming out in the eyes, they should be kept constantly wet with cold water, by means of a piece of fine linen. The diet should be thin water-gruel, made of plain corn meal, without salt; but tea, sago, or arrow-root, may be given, for a change. When the pustules are filling, a little Aveak chicken-water, with but little salt, and no grease on it, thickened by boiling rice in it, may be given once a day. If the patient is disposed to scratch, his hands should.be tied up in cotton; his face may be frequently wet with moderately cool water, to lessen the number of pustules. If the eruption is confluent, the sheets should be greased, to keep them from stick- ing to him, as the pustules break or fall off. The room should be well ventilated Avith pure air; and as soon as the pustules are full, the patient's drink should be cold water, with a little cream of tartar in it. His bedclothing should be light in warm weather, and comfortable in avinter. In bad cases, the thick skin on the palms of the hands and soles of the feet comes off. When the scabs begin to fall off, they should be removed from the sheets twice a day, and the rawest places should be lightly touched with sweet oil every day. When the scabs have all fallen off, and the surface is pretty well healed, the patient should be washed from head to foot in Avarm water and soap; the hair should be trimmed short, and the head Avashed with soap and water, and combed with a fine-tooth comb, to remove all the scabs from it. The nails frequently fall off the fingers and toes, in bad cases. The appetite becomes voracious in convalescence, and the patient, If permitted, will cause a relapse of the fever, by eating too strong food, or by eating too much of food that is proper. It sometimes happens that the patient becomes very weak; to relieve which, we have prescribed camphor mixture, or the gum alone, in a pill, or some of the more diffusible stimulants, such as ammonia, hartshorn, &c, all of which we have always seen VARIOLOID. 649 do more harm than good. If, hoAvever, great debility should occur, a little Avine and Avater may be given occasionally. If the pustules should fail to fill, and the spots turn black, or dark broAvn, and look flat, all the stimulants that can be given Avill not fill them. The patient will die. The pits are so deep, in many cases, especially on the free, that the features are very much disfigured. If the face has not been scratched, the pits may be taken off. This is done in the following manner: As soon as the scars are Avell, take the strong tincture of cantharides, and wet cotton Avith it; apply it on the face, bind it there, and let it remain till it draws a blister, when it must be removed and the skin clipped; let out the water, and dress the sore with simple cerate tAvice a day, till it heals. In this way, travel all over the face, till every pock has been raised. When the blisters have all healed, and the redness leaves the face, Avhich will be in six or eight Aveeks, there will be no pits of the smallpox observable. This is a severe remedy ; but those who prize their beauty very highly will bear the pain for the sake of the effect. OF THE VARIOLOID. This disease is so nearly allied to the smallpox that it has been considered by nearly if not all the writers who have treated of it, to be smallpox in a modified form, till Dr. Thompson, of Edinburgh, in 1818, wrote a letter to Sir James McGregor, Direc- tor General of the Army Medical Department, on the subject of the varioloid epidemic, which had, shortly before that time, prevailed in Edinburgh, and other parts of Scotland, with observations on the identity of chicken-pox with modified smallpox. In this work, he treats largely of the identity of these diseases, and brings some very striking cases to prove this position, — that where an epidemic disposition for these diseases prevailed at the same time, they often appeared in the same family, produced from the same cause, but, being in different subjects, assumed different characters, as in one child varioloid or modified small- pox, and in another child, in the same family, and at the same time, producing chicken-pox. He also gives some Avell-marked cases, in Avhbh measles and varioloid pervaded the system of the same person at the same time; and Avhich show that whichever began to act first ran its course till the febrile symptoms began to subside, when the febrilt tage of the other commenced; so 650 VARIOLOID. that before the eruption of the first had disappeared from the skin, the eruption of the second began to make its appearance, and each one continued to run its ordinary course, till it had passed through all its various stages. This fact has been proved by all Avriters on eruptive diseases since that time. Dr. Thompson is of the opinion that the contagion of small- pox may produce the varioloid in those who have been vacci- nated; and this the observation of all physicians will corroborate. But Ave Avould suggest this fact, —that all vaccinations are not gen- uine, any more than all cases of smallpox. If the vaccination be genuine, as we shall point out when we come to treat of that subject, the patient will never again be liable to take the genuine smallpox; and if he should take the varioloid, it will, in every instance, be in a very mild and modified form. With these remarks, we shall leave the subject of speculating on this disease, and proceed immediately to the characteristic symptoms and signs of varioloid. This disease is certainly contagious; perhaps equally so with the smallpox, and no one doubts the contagious nature of that disease. The varioloid commences, like smallpox, Avith a slight chill, soreness in the flesh and throat, headache, sickness at the stom- ach, and occasionally vomiting; the pulse is quickened, and the tongue is Avhite on the top; which symptoms continue till the third, and sometimes till the fifth day, when, on the face, arms, and breast, you will discover fine red points, like specks of blood in the skin, which will continue to enlarge and rise up, till the surface becomes elevated. The pustule noAV begins to form, the base of which is red, but the top is lighter colored. It is gener- ally circular, but, in some cases, some of them may be oblong or crescent-shaped, and occasionally, half-round, like a small pea when split. It does not rise up in a half-round, but is flattened on the top. A feAv of them may have a depression in the centre, but this mark is not characteristic of varioloid, as it is of small- pox, the varioloid pustules being generally flat on the top, with no depressed point in the centre. The color of the pustules is at first whitish, as though they contained milk and water. The fever continues for three or four days, till all the pustules are full; the first that come out filling first, &c. When all are full, the fever begins to subside, and the pustules become yellower as they ripen. In a day or two more, they begin to dry and break, and the matter discharges; a scab VARIOLOID. 651 forms on the top; and, in a few days, it becomes loose, and fahs off, leaving, at first, the appearance of a pit, which generally, however, entirely disappears in tAvo or three months, except a few that have been very deep, or were scratched off before they dried. A secondary fever arises when the pustules begin to dry, which Avill subside in about two days. If the case be neglected, or badly treated, and the pustules do not fill and come to maturity, the patient may die with this dis- ease ; but Avhere the case is well treated, comparatively little danger may be expected. There are well-attested cases of persons having the varioloid after having the smallpox, and after vaccination; but it occurs less frequently after vaccination than after smallpox. There is a certain susceptibility in the human system to all the eruptive forms of disease; and if this susceptibility be perfectly destroyed by having the disease once, it will most probably never be regen- erated in the system; and if not, it is of course impossible to take the same disease a second time. But should this suscepti- bility not be destroyed, it may in time, like a .latent spark, rekin- dle, and the person again be liable to the same disease. From this cause only can any person have the smallpox or varioloid the second time, or have either after being properly vaccinated. Treatment. — The varioloid, like all other eruptive fevers, requires to be thrown upon the surface, which is its natural place, Avhere it should be kept till it runs its natural course. The violence of the disease depends very much on the condition of the system at the time of the attack, and the management of the case during its progress. The first thing, therefore, to be done, is to cleanse the stomach and boAvels from all crude and unhealthy matter, and to put the secreting organs in a healthy condition. It is a fact always to be observed, that if all the internal secreting organs perform their functions in a healthy manner, the external organs will perform their duty in like man- ner; and in this fact lies the whole secret in the management of eruptive diseases. The skin is evidently a secreting organ; and if it is called upon to perform in the cure of disease, first make the internal and more vital secreting organs do their duty prop- erly, and the skin will always be found ready to sympathize and fulfil its duty. _ The first thing, then, to be done in varioloid, as well as in smallpox, is, to give the following medicine: 652 COW OR KINE-POX. Recipe : Calomel, twelve grains. Rhubarb, twelve grains. Mix; and, for a child tAvo years old, divide into six powders, and give one every two hours, in a little sirup, till they operate well. If the last operation is dark or green, give, Recipe: Calomel, six grains. Rhubarb, three grains. Salts Nitre, three grains. Mix. Divide ipto six poAvders, and give one every four hours, in sirup, till they operate tAvo or three times; and then follow with a dose of castor-oil. If the pustules seem not to fill Avell, give the following: Recipe: Spirits Lavender, compound, half ounce. Spirits Nitre, two drachms. Mix. Give ten drops every hour, in balm, hyssop, or sage tea, and continue this till the pustules fill. The bowels may be kept open with castor-oil, senna tea, or magnesia. The diet should be rice-water, arrow-root, sago, gruel, or milk and water. No salt or grease should be allowed till the secondary fever is all removed; and this comes on Avhen the scabs begin to dry and fall off. When it makes its appear- ance, a dose or two of the poAvders in the first prescription should be given. If the throat is sore, as it is generally, a mouth-wash should be used, made of sage, borax and honey, or yellow root and loaf sugar. The patient, in varioloid, as well as in smallpox, has a full flow of saliva from the mouth, produced by the pus- tules coming out in the mouth and throat. The room should be well ventilated, and the bed-clothing should be light, according to the season. When the scabs begin to fall off, the bed should be freed from them tAvice a day. The same care in washing out should be observed as in smallpox, and also in the diet in convalescence. (See c/iapter on Smallpox.) OF THE COW-POX, OR KINE-POX. The importance of this subject demands particular attention; and so much are the inhabitants of this country indebted to the cow-pox, for the preservation of beauty as Avell as life, that no one can feel uninterested in reading the account of its discovery, and the manner in which it was brought into use. It will be a subject of equal interest to know when the kine-pox is genuine COW OR KINE-POX. 653 and when it is not; and we shall, therefore, make no apology for the course we shall pursue in treating this subject. "This disease attracted attention in the county of Dorset, in England," about forty or fifty years since, as a pustular eruption derived from infection; "chiefly showing itself on the hands of milkers, Avho had milked cows similarly diseased." It was found to secure those who had thus taken it, from the smallpox. So extensive was the general opinion on this subject, that an inoculator who attempted to convey the smallpox to one who had been previously affected with the coAV-pox was treated with ridicule. The truth of this popular opinion was tested, how- ever, by proper persons, and it Avas found that "no smallpox ensued." About the same time, a farmer of sagacity, by the name of Nash, duly attending to these facts, had the courage to attempt inoculation on himself; and " the attempt succeeded completely." Similar facts Avere communicated to Sir George Baker, who, hoAvever, declined engaging in a controversy on this subject, having just gotten through one on the subject of the endemical colic of Devonshire; in which, however, he Avas successful; but he did not Avish to tread the thorny paths of controversy. Glou- cestershire, hoAvever, " another dairy county, had witnessed the same disease Avith similar consequences, and the same opinions generally prevailed in distant districts of both counties," and thus afforded proof that the power thus ascribed to cow-pox was not wholly visionary. (See Evidences delivered before the House of Commons.) Dr. Jenner, then resident at Berkley, in Glou- cestershire, took up this subject, and pursued it Avith great judg- ment and unabating ardor. He, however, Avas first foiled, by not distinguishing betAveen the genuine and the spurious cow- pox ; for it appears from the history given of the first discovery of cow-pox, that there was a genuine and a spurious kind. The cow is subject to both; but the spurious kind is not a preventive of smallpox, Avhile the genuine is a certain preventive, as we shall see before Ave are done Avith this subject. Dr. Jenner, having at length made himself master of the distinctive char- acter of the genuine vesicle, ventured to publish the discovery, in 1798, and to recommend inoculation Avith the virus of "vac cine, as a substitute for variola," or smallpox. This discovery was liberally remunerated by Parliament; and, since that time, vaccination has passed, with rapid progress, over every part of the world, from the Arctic circle to the extremes of Asia ard 654 COW OR KINE-POX. Africa, and has been adopted by civilized nations, by the black, as Avell as the white, "the JeAv, the Hottentot, and the Hindoo." The coAv-pox, as it presents itself in its present state, involves the four following varieties : First. Natural cow-pox. This is the genuine cow-pox, and ordinarily appears on those who receive it from the affected cow. Second, Spurious coAv-pox. This is an ineffective modifica- tion of coAv-pox, and resembles the genuine, but, nevertheless, is spurious. It is not a preventive of smallpox. Third. Inoculated coAv-pox. This is the genuine cow-pox, as it appears in inoculation. Fourth. Degenerated cow-pox. This is that form of the pox which has lost its specific poAver from unknoAvn causes. We shall take up these different heads as above named, and endeavor to make them so plain that those who read may tinder- stand, and be enabled to preserve themselves against smallpox, by using the genuine cow-pox, which, in every case, "will protect them. First. The natural coAv-pox is received on the hands of those who milk the coavs, the pustules being broken by the hand and the matter lodged on the fingers, into some small cracks, and thus affecting the dairyman. The vesicles are more on the hands, or such parts as have been in contact with the affected udder. The vesicle is, at first, "of a bluish tint;" the fluid, at first, limpid, afterAvards opaque and purulent; the glands under the arm fre- quently enlarge, and the person has more or less fever. The vesicles are apt to make their appearance about the joints or extremities of the fingers. The pustule is of a circular shape, with a slight depression in the centre. The fever comes on Avith the usual symptoms of a febrile attack,—pain in the head, lassitude, chilliness, pain in the limbs and loins, sometimes vomiting, and a quickened pulse. The headache frequently continues after the other symptoms disappear. In some cases there is delirium. As the vesicle fills, an areola is formed around it, from an inch to an inch and a half in diameter; and it frequently becomes so full, in three or four days, that it bursts, and discharges an almost transparent fluid. In some cases the sores are trouble- some to heal. The fever all disappears by the seventh day. The fluid discharged from this ulcer will cause an eruption on any part of the body it touches; consequen"ly, the eyelids, nos- trils, lips, and other parts of the face and body that may be COW OR KINE-POX. 655 touched with the fingers, having matter on them, are liable to become sore. In the affected cow, the tubercles are still larger; or rather, consist of vesicles surrounded by broad circular areola;. The cow becomes sick and drooping, and yields but little milk. " The ulcers on the udder are full, and often obstinate to heal." Second. The spurious pox to Avhich coavs are subject bears a close resemblance to the genuine, and is often confounded Avith it; yet it is destitute of any of the preventive qualities of the smallpox. The distinctive marks are these: " The vesicles are iess uniformly circular; purulent from the first; without the bluish tint" of the genuine; "Avith little or no central depres- sion." The use of matter from this vesicle, instead of the genuine one, has been the cause of the great number of failures with the coAv-pox, and Avill ever prove ineffectual as long as this is the case. Third. In the inoculated coAv-pox Avith genuine virus, the symptoms are these: the vesicle is single, and confined to the puncture; the pustule, when ripe, is of a bluish brown in the middle. The fluid is clear and colorless, till the scab begins to dry,; Avhich, after the tAvelfth day, becomes hard, of a mahogany color, and falls off, or may be taken off. About the third day from the time the matter is put into the arm, a small red speck appears Avhere it Avas inserted, Avhich spreads till the ninth day when the areola is from one to one and a half inches in diameter. By the tAvelfth day the redness is all gone, and the SAvelling sub- sides. If the fluid in the vaccinated pustule is not transparent, the pustule is spurious, and will not prevent smallpox. The manner and place of inserting the matter is of great importance, in order that it take in a genuine manner. The point for inserting the matter is on the outside of the arm, immediately over the insertion of the deltoid muscle. This point may be found by placing the finger on the outside of the arm, just beloAV the shoulder joint, and drawing it doAvnAvards, till you feel a small depression in the muscle; if you press hard on that point, it Avill feel tender. In grown persons, it is about five inches from the top of the shoulder; but in children the distance is much less, and the depression less distinct. The matter should be inserted here, because it will be more likely to be taken up by the absorbents, and carried into the circulation, thus making the effect constitutional instead of local. When the matter is inserted ever the body of a large muscle, a failure may be exacted. The matter, it is true, will produce a sore, insert it 656 COW OR KINE-FOX. where you may; but the effect may not be constitutional, and therefore, not a preventive of smallpox. These facts in relation to the cow-pox should be strictly remembered:—It is filled Avith clear fluid, is round externally. and fiat on the top, Avith an evident depression, slanting gradually from the edge to the centre; and when these appearances are wanting, the pustule is not genuine. The patient must have more or less fever, and the pustule must not dry before the tAvelfth day. The fever from vaccina- tion rarely requires medical treatment. If, however, it runs very high, a cooling purgative may be given. Fourth. There is variety of vaccina which is denominated degenerate coAv-pox by Sir Gilbert Blane, the manifestations and results of which are these: " The vesicle is uncertain, and anything but genuine in appearance; the fluid in the vesicle is often straw-colored, or mattery; the areolae are absent, or not perfect,—scab forms too soon.'"' Inoculation from this species will not prevent smallpox. Here is another source of failure, when it is for Avant of judg- ment, and not the fault of the cow-pox. Dr. Goode says that " vaccine virus seems to undergo a spontaneous alteration in a certain period of time, whatever be the caution with Avhich it is preserved." In passing through the human subject, it seems to be modified and rendered milder; for, "a person immediately inoculated from the affected coav uniformly suffers more than when one person is inoculated from another." It has been satis- factorily proved that the fluid loses none of its virtues by passing through hundreds of persons. This has been tested, by taking matter that has been passed through individual after individual, to an almost indefinite extent, and then "introducing it into the coav, and it still possessed all its original powers." But after all that has been said and done, there are some per- sons who will take the varioloid, even after they have had the cow-pox in its best form; but they will have it very lightly. It has been satisfactorily proved by the British surgeons, who have experimented by the thousands and tens of thousands, that the cow-pox, in its genuine form, will save nine hundred and ninety- nine in a thousand from smallpox, and perhaps not so many from the varioloid; but those who have either, will have it lightly. The cow-pox was first thought to be communicated to the cow's bag from the grease in the horse's heels, but this Avas ascer- tained to be a mistake. It is certainly an original disease in the CHICKEN-POX. 657 cow's udder; so say Drs. Goode and Jenner, and many others. Of late years, a long series of experiments, a full account of which may be seen in the different European medical periodi- cals, shoAV that the vaccina may be produced by inoculating the coav's udder Avith smallpox matter, and raising a vesicle, the matter of which will prevent the smallpox from taking in the human system. But this is a late discovery, and can, by no means, do aAvay with the idea that the vaccina is produced by an original disease in the cow. It is proved that the virus procured from the cow by inocula- tion with smallpox matter acts more poAverfully on the human species than the genuine vaccine matter as obtained by Dr. Jenner. It is no proof, either, that the coav was originally inoculated Avith smallpox matter, because the matter from her bag produced by the introduction of smallpox matter there Mali prevent the smallpox in man; for the grease in the horse's heels will also prevent the smallpox in man, and yet it is very differ- ent from the vaccina or variolous matter. Dr. Jenner has deservedly immortalized his name, by the able and unremitted attention he gave this subject, in bringing it before the world; and establishing its claims to the high virtues of arresting that most loathsome of all diseases, the smallpox. OF THE CHICKEN-POX. This is an eruptive disease. The vesicles are scattered over the body; they are transparent at first, and pea-sized. They are red at the base, and always pointed at the top; never flat. like varioloid, nor depressed in the centre, like smallpox; but roundish, and sometimes very slightly flattened on the top. The fluid they contain is at first clear, or nearly so; afterwards, it turns to a straw color, dries away, and falls off. It leaves no pit in the skin, except in a very few instances. The eruption is mostly confined to the face, neck and arms. with a feAv vesicles on the body and legs. It is a peculiar dis- ease, and depends on a specific contagion. The child is some- times feverish for a few days, but is rarely confined to the house from indisposition. Treatment.—The treatment is simple. Coding drinks, a light diet, and a dose of salts or castor-oil, are all that is required in most cases. < BRIGHT. 43 / \ i 658 HORN-POX. When the scab is thrown off, it leaves no pit, nor do any unfavorable constitutional symptoms follow it. The water-pox is so much like the chicken-pox that it scarcely needs a further description, except that the vesicles are generally more numerous, and are filled with clear water, which is dis- charged in a few days, and the pock dries aAvay, requiring no medicine for its cure. OF THE HORN-POX. This disease is called by Dr. Goode " the horn or crystalline pox." It is manifested by all the signs and symptoms of the smallpox, except that they exist in a milder degree than in the distinct smallpox. The patient is attacked Avith pain in the head, back and limbs; pain and sickness at the stomach, and sometimes vomiting; soreness in the flesh; the appetite fails; and the patient is generally sleepless for a few nights. This disease is evidently produced by the contagion of vario- loid having undergone some peculiar modification, or some pecu- liar state or condition of the system, which brings out a different result. The danger in horn-pox is even less than in varioloid; but more than in chicken-pox, or water-pox. We regard it as the medium action between varioloid and chicken-pox. We have seen a number of cases of horn-pox during the prevalence of varioloid. The eruption is not extensive, nor does it remain long on the surface. The pimples rise up suddenly, Avith a red base; they are semi-transparent and rise upright, and are almost pointed. They suppurate imperfectly, and soon form a dry, horny scab, which is of a light brown color in dark skin persons, and whitish in those of fair skin. The pock, in three or four days, looks more like the spur of a young rooster of three or four months old than anything else; and it is from this that it takes its name. It drops off in four or five days, and leaves no pit. We believe the disease to be contagious, as all other eruptive diseases are, but not unfrequently the product of varioloid con- tagion, peculiarly modified by the constitution it enters. But, like all other diseases, it loses part of its violence by passing through the modifying constitution, and therefore is not capable of reproducing the varioloid, but the horn-pox only. It does not seem to be very contagious, even under the most favorable cir- PEMPHIGUS. 659 cumstances for its communication. We have frequently seen it pass through all its stages, there being others in the room all the time, who had neither had it, varioloid nor smallpox, and they did not take it. It is true that they had been vaccinated; and vaccination, as far as our observation extends, is a perfect security against it, which is another proof that it is of smallpox or varioloid origin. We have seen, perhaps, twenty cases of it, in the course of thirty years' practice. Treatment. — The treatment is simple, if you can be sure it is the horn-pox; but as the symptoms are so nearly allied to those of varioloid, it would be well ahvays to commence the treatment as you would in the varioloid, and continue it till the eruption shoAVS itself and defines its character. Cooling drinks, and acidulated waters, such as lemonade, and cream of tartar in water, may then be given; and the boAvels kept open Avith some gentle purgative, such as senna tea or castor-oil, rhubarb, &e. The diet should be light and thin. When the pustules fall off, the patient should be carefully washed, and care must be taken not to cause a relapse by eating too much. OF PEMPHIGUS, OR VESICULAR FEVER. This disease attacks grown persons as well as children; but as children are subject to it in its three varieties, it is thought proper, in order to make this work complete, to notice them all. The first, which is the subject of this chapter, is the common vesicular fever. Many writers, such as Savage, Gulbrand, Cul- len, etc., think the different varieties of this disease only symp- tomatic manifestations of some other disease; but Avhen we find Home, Bontius, Seliger, Langhouse, Withers, Clarkson, Chris- tie, Ring, Browne, Stewart, of Aberdeen, and Goode, all of the opinion that this disease is, in many cases, idiopathic, we feel justified in giving it a place as such in the present work. Some slight degree of lassitude, sickness and headache, having existed for a day or tAvo, small blisters, about the size of a pea, make their appearance over different parts of the body, and not unfre- quently in the mouth, throat, stomach and bowels. These vesi- cles gradually increase, till they become as large as an almond : and, " now and then, they are to be met with as large as a Aval- nut." The vesicles are surrounded by an inflamed margin oi areola, and distended with a slightly yellowish fluid or serum. 660 PEMPHIGUS. The child not unfrequently has a difficulty in swallowing, with nausea, vomiting, and a sensation of soreness in the abdo- men, the vesicles being sometimes so numerous as to run into each other. The pulse, during this time, is small and frequent, and the patient feels very feeble. "If the vesicles are not broken, they fill with a yellowish serum, which is again absorbed into the system, in the course of three or four days." The absorption of the fluid from the vesicles is more favorable for the patient than breaking them and discharging the fluid, for troublesome sores are apt to follow the breaking of the vesicles. Pemphigus resembles the smallpox, in the particular of its frequently leav- ing pits in the skin, and the place Avhich the vesicle occupied remaining of a dark color for some time after the sore heals. In the third volume of Medical Facts and Observations, Dr. Winterbottom takes particular notice of this occurrence. We are to be influenced in our opinions of the favorable or unfavorable termination of the disease, by "the seat and appearance of the vesicles." " When they appear only on external parts, and are not numerous, they demand little attention."—Thomas. But when they are numerous, and attack the internal, as well as the external surface, and the pulse is hard and small, with great prostration of strength, the danger is great. Another unfavorable symptom is found in the appearance of the vesicles when they break; that is, if the sores turn livid, and are disposed to gangrene or mortification. These latter symp- toms rarely occur, except where the symptoms have been of the typhus character. From our own observation, and the opinion of reputable med- ical authors, we are fully authorized to say that this disease is not contagious. Treatment. — In order to treat this disease correctly, we must particularly observe the tAvo following facts: First. Whether the fever is of an inflammatory nature, and accompanied with a strong and increased action of the arterial system; or, Secondly. Whether the fever has a tendency to the typhoid type, and is marked by great debility, and other symptoms which denote a tendency of the fluids to putrefaction. In the first form of the disease, when the fever is high and the pulse full and strong, the patient should be bled. The following med- icine, for a child six years old, may then be given : PEMPHIGUS. 661 Recipe: Ipecac, twelve grains. Tartar, two grains. Mix. Dissolve the powder in six table spoonfuls of warm water ; give one every fifteen minutes, till he vomits freely, and then turn it doAvn with gruel. Nothing cold should be taken till the operation is over. This should be followed, in six hours, with the following purgative : Recipe : Calomel, six grains. Rhubarb, ten grains. Mix. Divide into three powders, and give one every three hours, till they operate freely; after which, give the following mixture: Recipe: Sulphate Quinine, ten grains. % Elixir Vitriol, thirty drops. Pure Water, one ounce. Mix. Shake the vial till the quinine is dissolved, and give twenty drops, in a little water, every four hours; keeping the bowels open with the folio Aving medicines: Recipe : Cream Tartar, half ounce. Milk of Sulphur, half ounce. Mix, and give a tea spoon level full, in sweetened water, every three or four hours; or just so much as will keep the bowels regular. The diet should be very light while the fever lasts; but as soon as it is removed, the diet should be more generous. If the vesicles break, dress the sores with simple cerate; or you may make the following salve : Recipe : Bees-Wax, half ounce. Mutton Tallow, half ounce. Hog's Lard, half ounce. Melt them all together, and dress the sores with the mixture. If mortification is likely to take place, a charcoal and yeast poultice should be applied; or the inside bark of the common buckeye may be boiled to a strong ooze, and the parts fre- quently bathed in it, and then dressed with the salve mei tioned above. If the mouth and throat are much ulcerated, a gargle of a strong decoction of oak bark, sweetened with honey, or yellow root, prepared in like manner, will be found of great service. Where the ulceration has extended to the bowels, slippery-elm tea should be given freely. As the patient recovers, exercise in the open air will be bene- ficial. 662 GLANDULAR PEMPHIGUS. OF GLANDULAR PEMPHIGUS. ' This form of the disease is but little known in the United States; but it may become a disease of greater frequency, and we therefore deem it proper to notice what authors have said concerning it. The information, therefore, Avhich we shall give in this chapter, will be taken from those who have Avritten on this disease. Dr. Langham, a Swiss physician, who observed it in the spring and summer of 1752, in the lowlands of his country, (see vol. 1st, 1787,) says of it: "It commenced Avith a sense of ten- sion in the fauces, and a slight pain spreading behind the ears," and extended " to the neck and breast, accompanied by the symptoms that mark the first stage of fever, but not succeeded by a hot fit." The pulse Avas feeble, and " greenish bilious mat- ter was thrown up from the stomach." " The neck swelled, externally and internally, about the fauces." "The blisters" which arose " were about the size of filberts," but they were not very painful; they contained a yellowish fluid, of an offensive smell. These were soon succeeded by a few vesicles, scattered over the body and limbs, Avhich, if not opened, "collapsed on the second, third, or fourth day," and Avere covered by a Avhitish crust. " During this period, the tumor of the neck often suppu- rated," or suppuration took place in some other glands, such as the parotid under the ears, or the axillary glands under the arms, or the inguinal glands in the groin. " The virus of the disease being thus discharged by different outlets on the surface of the body, the patient recovered." " But if, instead of the matter finding its way out of the sys- tem by some of these outlets," an abscess should form in the lungs and breast, " the patient died from suffocation ;" or if the matter lodged in any of the external vesicles was by accident repelled before any glandular suppuration took place, " the patient died almost as suddenly." Dr. Langham states that this form of glandular pemphigus is highly contagious, "affect- ing every member of the family where it appeared, and generally proving fatal." Treatment.—Dr. Langham!s treatment was, first, on the depleting plan. He bled once or twice, and then gave strong sudorifics, so as to excite a strong determination to the skin. These may be prepared in the following manner : INFANTILE PEMPHIGUS. 663 Recipe: Black Snakeroot, one drachm. Make one pint of strong tea, and add to it the following: Recipe : Pulv. Camphor, twenty grains. Tartar Emetic, three grains. Give a table spoonful every half hour, till the patient perspires freely. Then give a gentle purgative of, Recipe : Calomel, ten grains. Rhubarb, ten grains. Mix. Divide into three powders, and give one every two hours, till they operate freely. The strength is to be supported by cordials and wine, and the diet should be light. OF INFANTILE PEMPHIGUS. This form or variety of the disease generally appears a few days after birth. But Dr. Willan gives a case where it occurred in a child ten months old. When it appears on infants, it is attended with fever and lan- guor ; and, in a day or two, the eruption appears in vesicles on the neck, upper part of the breast, on the abdomen, in the groins, and on the scrotum and inner parts of the thighs. They arise in successive crops, break, and expose a surface that heals with difficulty, " and more generally enlarges its boundary." The little patient is apt to be worn out with pain, restlessness, and want of sleep. Treatment. — The bowels must be kept open with gentle aperients, such as, Recipe: Magnesia, one drachm. Rhubarb, six grains. Mix. Divide into six papers. Give one every three or four nours, in sweetened water, so as to keep the bowels open. The strength must be supported by cordials and wine whey, if the child be old enough to take it. If the pain demand it, a few drops of elixir of paregoric may be given occasionally. The sores, Avhen the blisters break, must be dressed with simple cerate; but, unfortunately, in very young infants, very little can be done in this case. 664 FROST-BITE, or chilblain. OF FROST-BITE, OR CHILBLAIN. When the fingers, toes or heels, have been exposed to intense cold for a sufficient length of time to destroy the vitality, or to stimulate the vessels into a high degree of action, the part savcIIs, and becomes painful, and purple, or a pallid color. The pain is not constant, but rather shooting, and pungent; at particular times attended by an insupportable itching. The skin, in some instances, remains entire; in others, it breaks, and discharges a thin fluid. When the degree of cold has been very great, and the applica- tion long continued, the parts affected are apt to mortify and slough off, leaving a foul and ill-conditioned ulcer behind. Children and old people are more liable to be frost-bitten than those of middle age, and children that are of a scrofulous habit are more apt to suffer by frost-bites. The best mode of prevent- ing this is to avoid with much care any exposure to extreme cold. Those Avho have been once frost-bitten are more easily affected again by being exposed to the exciting cause; and, on the approach of cold Aveather, they should be careful to have the parts well guarded by Avoollen gloves or socks, and not to expose the hands or feet, when very cold, too suddenly to a strong heat. Very old persons, whose circulation is languid, may be affected in the feet with frost while lying in bed, though their friends may have been careful on that subject; and, perhaps, the first thing they know, the parts begin to mortify. Treatment.—Young persons, whose hands and feet ache very much from the effects of cold, are apt to hasten to the fire, and hold the affected parts very near to it, in order to relieve the pain. This is wrong. They should first place the frost-bitten part in cold water, and hold it there till the pain is removed; after Avhich, it should be placed in water a little warmer, and kept there until the pain subsides again, and the parts feel supple. Then apply the following preparation: Recipe: Alum, half ounce. Water, one pint. Dissolve the alum in the Avater, and bathe the part Avith it freely and constantly, till the swelling is removed. If this cannot be had, and the use of the cold water has been neglected till the parts begin to inflame, or the skin breaks, a BURNS. 665 poultice made of roasted turnips will be very good; and this should be frequently reneAved. Should the parts be likely to slough or mortify, a poultice made of the ooze of the common buckeye bark, thickened Avith wheat bran will stop the mortification. The parts should be freely bathed Avith the ooze, and the poultice afterwards applied. This should be renewed three or four times a day. After the mortification has been arrested, a poultice of slippery- elm bark will remove the inflammation ; when the sores may be dressed Avith the following ointment: Recipe: Bees-Wax, Rosin, Mutton Tallow, Hog's Lard,—equal parts. Melt all together. Dress the sore tAvice a day, always washing it Avith Castile soap and warm water before the salve is applied. If proud flesh should spring up,—and it is apt to do so in frost- bites, — sprinkle a little burnt alum on the fungous granulations every day, till they are removed. After a sore caused by frost-bite is healed, the parts remain tender for several years, and are easily affected again by frost. When this is the case, it becomes very tender, and scales, or the skin comes off like chaff, leaving the part very sore, tender, and painful. The best remedy we ever kneAV for this is the thin membrane from the leaf-fat of a hog. This should be applied night and morning, for a few times; it will remove all the pain, fever, and soreness, and the part will heal kindly. Loose shoes should be worn aftenvards, or corns are apt to form on the frosted parts and become very troublesome. OF BURNS. There are so many accidents to which children are subject by fire, that we should ahvays be on our guard on this subject. We design, in this place, merely to state the mode of treatment for injuries of this kind. The degree of injury sustained by the parts to which the hot substances may be applied is owing to the quantity of heat con- tained in that substance, and the extent of the surface with which it comes in contact. When the heat has not been great, and the surface acted on is small, the danger is also compara- tively small; but when the degree of heat has been great, and the surface large, the danger is proportionately increased. But even 666 BURNS. when the surface is small, the degree of heat and depth of injury may be very dangerous. Again; the degree of heat may be comparatively small, but the surface so large that the danger from irritation may be great. Again; the surface acted upon may be small, and the degree of heat small, yet the part affected by it may be vital, and con- sequently the burn may prove fatal. We, therefore, see that the danger to be apprehended from burns will, in many cases, be owing more to the part burnt than to the degree of heat applied. The more vital the part, the greater will be the danger. To be burnt on the body is Avorse than to be burnt on the extremities; and to be burnt on the abdomen, or over the stomach, is worse than a similar injury on the back or shoulders. To be burnt on the face or head, though near the brain, is not so bad as to be burnt over the stomach or boAvels. As a general rule, the deeper the burn is,—that is, the more perfectly the flesh is killed, —the more danger may be appre- hended from it; unless it be produced by the quick and glancing passage of a red-hot substance, that only touches and sears the skin, Avithout killing the muscles. Treatment. — For slight burns, when the skin is not taken off. the most comfortable dressing is that which excludes the air entirely from the stimulated surface. The folloAving is very good : first wet the parts Avith spirits of turpentine, and then cover them Avith strained honey. This is an excellent remedy; or you may use the following: Recipe: Hog's Lard, Yolk of Egg, Flour. Mix in equal parts. Spread a plaster, and cover the burnt sur- face completely Avith it. The burn should be dressed as often as it becomes painful; afterwards, once in eight hours, till it heals. When the parts are burnt deeper, and severer pain is produced, and some of the flesh is killed, or turned Avhite, and the skin broken, the best application is spirits of turpentine, sufficient to wet the burnt surface. Raw cotton should be wet with the tur- pentine and linseed oil, and the burnt surface well covered with it, so as to exclude the air. When the pain entirely subsides, and reaction takes place, if there is much redness or inflamma- tion, apply a slippery-elm poultice, to remove that inflammation; when the wound should be dressed with simple cerate three time* .n tAventy-four hours till it is cured. BURNS. 667 When matter foims; it should be washed off with warm milk and Avater, or the mildest kind of soap and water; and, at all events, great care must be taken to keep the air from the sores as much as possible. When the burn is deep, and the flesh crisped, the following remedy is best for the first dressing : Recipe: Spirits Turpentine, Alcohol, or Whiskey, Olive Oil, — equal parts. Anoint the parts freely with this mixture, and then dress with the folio Aving salve: Recipe: Melted Bees-Wax, two ounces. Spirits Turpentine, two ounces. Lapis Calaminaris, half ounce. Yolk of Eggs, four. Mix these with the melted Avax, so as to form a completely- mixed salve; and, after anointing the parts with the above lini- ment, apply this salve so as to exclude the air. This will, in a few days, excite the living vessels to throw off the dead parts, when inflammation will take place. The slippery-elm poultice should then be used, till suppuration comes on freely, and the dead parts are thrown off; after which, the wound may be dressed with the folloAving ointment: Recipe: Bees-Wax, Hog's Lard, — equal parts. Mixed well together, and used twice a day. If much inflam- mation arises, apply the slippery-elm poultice, till it is removed, when the salve must be resorted to again, and laid over the whole sore every time it is used. If fungous or proud flesh spring up, apply burnt alum or lunar caustic to it once a day, till it is all removed. If any redness remains, use cooling poultices till the sore becomes white before it heals; otherwise a red scar will remain. All this time, the bowels must be kept open with cooling pur- gatives, such as salts, senna tea, cream tartar, gentle pills, cas- tor-oil, &c. The diet should be of the lightest kind, in all cases of severe burns; and exercise should be prohibited till the parts are entirely healed. When the tendons are injured by deep burns, they are apt to contract in healing; in which event splints should be used, and properly applied, so as gradually to extend the limb, and keep it o till the sore is perfectly healed. 668 WHITLOW. When the fingers or toes are burnt, at every dressing they should be separated Avith greasy rags, and kept so till they are entirely healed. And this treatment must be adopted Avith every part of the body that groAvs together, or touches an opposite sur- face. They should never be alloAved to come in contact while raAv. All inflammation should be removed from the tendons, by poulticing and Ioav diet; otherwise they will heal with knots on them. Perhaps no injury requires greater care in its treatment than those occasioned by burns. A slight burn may make a sore for life if it is not treated correctly at first. OF WHITLOW. This disease, of which there are four species, is situated in the extremities of the fingers. The first kind is nothing more than an inflammation, located immediately under the cuticle, near the edge of the nail. It suppurates, breaks and soon gets Avell. It sometimes travels nearly around the nail; and is then called, in common language, a run-round. A light bread poultice will soon cure this form of the disease. The second form is similarly situated, but lies deeper. This should be poulticed till matter forms, when it should be lanced, and dressed Avith simple cerate. The third form is called felon; it is situated much deeper, and is very painful. When it first makes its appearance, apply a plaster of, Recipe : Opium, one drachm. Asafcetida, one drachm. Moisten, and spread a plaster, wet with spirits, and keep it constantly bound over the end of the finger. If this does not scatter it in a day or tAvo, the best remedy will be to lay the finger open to the matter, with a lancet, razor or knife; after which, it must be dressed Avith simple cerate. The fourth species is seated still deeper, under the periosteum, and even in the bone; and when the bone is inflamed, it is called a bone felon. If this is not properly managed, the bone will soon become deeply diseased, and die, as will the periosteum and tendons; the matter will find its way up the tendon, and even into the arm, and much pain and SAvelling will be the conse- quence. The opium and asafcetida plaster may here be tried; but should it not prevent its progress, the finger should be laid open DISCHARGE FROM THE VAGINA OF INFANTS. 669 to the bone, and a poultice, made of the outside of rusty bacon and the leaves of rue, should be kept on it. We have frequently known the bone to be saved by this remedy. When the healing process begins, fungus is apt to shoot out. This must be taken off with burnt alum, or red precipitate, which should be sprinkled on it twice a day, till it is all removed. A dressing of simple cerate should be kept over the wound til' healed. The third and fourth species of this disease frequently destroy the first, and sometimes the second, joint of the finger. We have never seen a case in the toe. This disease is often produced by bruises or punctures. When a puncture is received in the end of the finger, beef's gall applied immediately Avill prevent this serious and painful termi- nation. OF THE DISCHARGE FROM THE VAGINA OF INFANTS. We occasionally meet with a case of this description in infants, in early age, from Avhom the discharge is thin, acrid, and some- times purulent. But there is another foim of this disease, more aggravated in its character, and more difficult to cure. This discharge is more like matter, and comes from the vagina or labia; and girls of five or six years old are afflicted Avith it. It may continue to womanhood, and lay the foundation for aggravated lucorrhcea or whites. If neglected, it destroys that healthy, rosy appearance of the cheeks, Avhich is so much admired. Treatment.—For the first form of this disease, in infants, nothing more is necessary than to cleanse the parts Iavo or three times a day Avith warm water. Keep the bowels regular, and in a week or tAvo the disease will yield. For the second form the same remedy should be used; but, should it fail, then, in conjunction with it, give these drops: Recipe: Balsam Copaiba, half drachm. Harlaem Oil, two drachms. Mix, and give, to a child five years old, five drops three times a day, on sugar. Keep the bowels open with rhubarb; or, if too loose, give a dose of magnesia two or three times a Aveek. If the child be Aveak, give thirty drops of Huxham's tincture, in sweetsntd Avater, three times a day, till cured. 670 SCURFINESS OF THE HEAD. OF SCURFINESS OF THE HEAD. If the child's head is not kept clean, there will, Avithin the month, a dark-colored scurf accumulate upon it, extending from the top to the back part. It generally commences near or over the front mould of the head, and extends back till it covers the Avh jle croAvn. A considerable itching takes place under it, and by rubbing or scratching, it is thrown off in thick scales. Tht itching is so severe, at times, as to cause the child to fret and cry. This scurf is occasionally very offensive, smelling like sour curd. When the surface is made bare, a great number of small pustules may be seen, Avhich throw out large quantities of acrid lymph, Avhich, becoming dry, forms a crust; and if this crust be removed, the skin beneath will be found inflamed. It will soon be replaced, however, by the drying of the lymph which the inflamed vessels throw out. This evil is OAving entirely to neglect, which grows out of an old superstitious notion, that to remove this dandruff (as they call it) will injure the child's senses. Treatment. — If the child be neglected till this crust forms, it should be removed in the following manner : Recipe : Pulv. Borax, one ounce. Dissolve one fourth of this poAvder in a pint of warm water, and Avash the child's head, applying it for a sufficient length of time to soften the crust. It may then be removed by the use of a soft cloth; but it should not be combed off, for that will create too much irritation. If the crust has been neglected, till it has become thick, and the surface beneath much inflamed, it would be better to apply the following mixture to it, freely, over night: Recipe: Olive Oil, half ounce. Whiskey, half ounce. Mix. Apply this freely to the head at bedtime, and cover the head Avith a suitable cap; and the next morning, use the borax and Avarm Avater. This remedy should be repeated every day, till the scurf is all removed; but the use of the borax and warm water should be continued, till all the inflammation is removed from the skin, when a suitable hair-brush for infants should be used daily, to prevent its reaccumulation. To prevent the crust from forming at first, the hair-brush SCALD-HEAD. 671 should be used after bathing the child's head in the morning. The daily use of the infant's hair-brush, from the birth of the child, will insure a clean skin and a fine head of hair. A fine- tooth comb should not be used on an infant's head till it is six or eight months old; and if proper care be taken, there will be nc need of it, even at that age. OF SCALD-HEAD. This disease is situated in the scalp, and first appears in cir- cular, flat scabs, Avith an irregular edge, attended Avith consid- erable itching. The eruption, if neglected, will extend all over the head, pass down the ears, and appear on the face and neck. The cuticle below the scabs is red, and dotted Avith points, from which oozes fresh matter. This disease destroys the hair, and is contagious. It is found chiefly in children, sometimes as early as the sixth or eighth month, and from that to ten years ; but adults are rarely affected Avith it. From the quantity of the discharge, the hair is matted together, the scabs become considerably thickened, the ulceration spreads into the substance of the skin, and even the muscle beneath, and the hard patches, in some cases, seem to be fixed upon a body of offensive matter beneath. The glands on the sides of the neck enlarge and harden ; first in a chain of small lumps, when they enlarge, some of them inflame, and a sIoav process of suppuration takes place. The ears not unfrequently become inflamed within and Avithout, and pour out a quantity of ichorous matter, which is so acrid that it produces a sore on any part of the body upon which it may fall. The arms and breasts of nurses are frequently affected in this way. The causes of this disease are, filth, bad nursing, unwhole- some diet, want of pure air, and whatever else has a tendency to weaken the system generally, and irritate the skin locally. Treatment. — As the fluids of the system, and especially the lymphatic system, become depraved in this disease, it is of much importance to correct them, in order to insure a cure. In all diseases of the lymphatic system, a general debility of the Avhole system is sure to prevail. We must, therefore, direct our reme- dies to this effect as Avell as the local disease. For the first indication, we should give the following drink: Recipe: Spanish Sarsaparilla, four ounces. 672 SCALD-HEAD. Cut this root fine, and to one tAvelfth part of it, in a pitcher, pour one pint of boiling water at night; let it stand till morning ; pout off the liquor, and add one ounce of Avhite sugar, and two or three thin slices of lemon, or twenty grains of the salts of lemon. This quantity should be drunk every day by a child seven years old, and more or less in proportion to age. If the Spanish sarsaparilla cannot be obtained,— as it cannot in many places, — take the following articles : Recipe : American Sarsaparilla, two drachms. Burdock Root, two drachms. Make fine, and mix them. Prepare them as above, and take in like manner. This quantity should be taken every day. The stomach should be first cleansed by an emetic. Recipe : Ipecac, ten grains. Tartar, half grain. Mix, and dissolve in four table spoonfuls of warm water. Give one at first, and repeat half as much every fifteen minutes. till the child pukes freely; after which, warm water must be given every time it pukes, till it has three or four operations up. It must then be turned doAvn Avith a little gruel, and nothing cold must be taken till the operation is over. If the bowels should not keep open, give the following medi- cine : Recipe : Sirup of Rhubarb, one ounce Give a tea spoonful two or three times a day; or, Recipe: Senna Leaves, two drachms. Make a tea cupful of strong tea, and give it, in small portions, every half hour, till it operates on the bowels. If the tongue should be coated, give: Recipe: Calomel, ten grains. Rhubarb, ten grains. Mix. Divide into six powders, and give one every three hours, till they operate. We noAV turn our attention to the head. The hair must first be clipped as short as possible, and then the scabs must be washed with mild soap and water, till they become soft. Wipe the head dry, and apply the following ointment: Recipe : Hog's Lard, two drachms. Flower Sulphur, one ounce. Mix them perfectly. Grease the head all over with this oint- ment, and put on a cap. This treatment should be continued RINGWORM SCALD. 673 twice a day, till the scabs become soft and begin to loosen, Avhen the following ointment must be used: Recipe : White Precipitate, two drachms. Venice Turpentine, half ounce. Mutton Tallow, two ounces. Mix these articles perfectly, and apply freely after each Avash- ing. Should this fail, use the following, in like manner, after each Avashing: Recipe : Calomel, three drachms. Simple Cerate, three ounces. Venice Turpentine, half ounce. Balsam Peru, two drachms. Mix them perfectly, and use as above directed. As often as the scabs become loose, they should be lightly removed with the teeth of a comb; and when they are all removed, if the skin is red, and a number of small points appear, which throAv out a serous fluid, Avipe the head dry, and dust the surface with the following powder, before the ointment is applied: Recipe: Lapis Calaminaris, half ounce. Calomel, two drachms. Mix well, and dust it carefully over the raw surface, before you apply the ointment. The child's bowels should be kept open all the time with some gentle purgative. It should live on a light diet, and avoid expo- sure to wet or cold. The child should sleep alone, or it will communicate the dis- ease to others. OF THE RINGWORM SCALD. This is a disease of children, and is situated on the head. It appears in clusters of very minute pimples, in circular spots of baldness, Avith a brown or reddish, and somewhat scaly, base. This disease has been known and described under different names, from the time of the Greek Avriters to the present day. There is sometimes only a single plat, and the pustules may be so small as to elude observation unless very closely examined: but there is a perceptible roughness attending them, and although the exudation is small, yet, in time, it forms a scab. This scab, on close examination, will sometimes present a shade of green on its edges. The spots extend in diameter, and in some cases cover a large surface on the head. The hair is iniured from the commencement of the attack, and BRIGHT. 44 674 TETTER-WORM. becomes thinner, and lighter in color, and breaks off short. Ie process of time the roots of the hair become diseased, and the spot bald; and if not arrested, the Avhole head will become bald, except a narroAv strip of hair forming the outline of the scalp. It sometimes spreads from the head, over the forehead and neck, and may be communicated from one child to another. This disease is most common in croAvded factories, that are illy ventilated, and full of filth. It is most generally induced by uncleanliness. Treatment.—The treatment of this disease should be com- menced like that of scald-head, to Avhich Ave refer the reader. The folloAving remedies should then be used, after the head has been Avell washed Avith soap and Avater: Recipe: White Precipitate, two drachms. Mutton Tallow, two ounces. Otto of Roses, twenty drops. Mix perfectly into an ointment; and, after the head has been well Avashed and dried, apply this ointment freely tAvice a day, and Avear a suitable cap, of oiled silk or linen. If this should fail to cure in iavo weeks, you may use the folloAving ointment: Recipe : Iodine, forty grains. Mutton Tallow, two ounces. Sulphuric Acid, six drops. Mix perfectly, and anoint the head tAvice a day. We have never known either of these remedies to fail. The bowels should be kept open Avith some light purgative. The diet should be generous, but not strong; and the child should be allowed a sufficiency of pure air and healthy exercise. of tetter-avorm. There are five varieties of this disease of the skin. First, the miliary teller; second, the erosive tetter; third, the ringworm tetter; fourth, the rainbow worm ; and fifth, the local ringworm or tetter. In the first variety, the vesicles are very small, clear, and in clusters. It may be situated on any part of the body, and pro- gressively spread over the whole surface, succeeded by a fresh supply of eruptions. The vesicles contain lymph, Avhich is some- times of a broAvnish color; and, in the space of tAvo or three days, other eruptions may arise near the former. These little points become of a milky color, and are perfected in ten or tAvelve days; but, about the fourth day, the inflammation around the eruption TETTER-WORM. 675 assumes a duller red hue. The minute vesicles break and dis- charge a thin fluid; or dry into scales, which fall off and leave an inflamed surface below ; and from this, fresh matter is thrown out, Avhich also falls into scales and is thrown off, like the first. The itching is very troublesome; the dressings are apt to stick fast, and are removed Avith trouble and uneasiness to the patient. In the second variety, or erosive tetter, the vesicles are hard, of small size, and croAvded together. They contain a yelloAvish or reddish fluid, Avhich is hot and acrid, corroding the surrounding skin, and spreading in crooked lines. This form of tetter is often connected with the state of the stomach, and sometimes the constitution generally. When this is the case, the eruption is attended with a sensation of burning or scalding, and becomes a source of great irritation to the patient. The third variety is ringworm of the skin, strictly speaking; this is designated by vesicles, Avith a reddish base, uniting in rings, the space within the ring being slightly discolored. This is still a slighter form of tetter than the tAvo preceding varieties. The vesicles never extend beyond the circumference of the spot affected, thus forming a regular outline. The central portion is, hoAvever, of a reddish color, and throAvs out some secretion, Avhich dries, and forms into dry, fine, light, scales, which, Avhen they fall off, leave a tender surface beneath. This is all completed in about one week; but another circle is soon formed; and this may be repeated, the location changing every time, till the Avhole body, sooner or later, becomes the seat of this disease. Yet no constitutional symptoms arise. There is nothing to incommode the patient, but an inquietude, produced by the itching and irritation of the parts, especially Avhen the skin is made moist by heat and perspiration. The fourth variety is the rainbow worm or tetter, Avhich is usually found on the hands or instep, and is peculiar in its appearance. It is designated by "vesicles uniting in small rings, surrounded Dy four concentric rings, of different colors, vesicular and promi- nent." This form is of rare occurrence; and, Avere it not for the sake of making this Avork as complete as possible, Ave should not have named this variety. The rings do not shoAV distinctly at first, but are formed by degrees. » It generally takes about nine days for the vesicles to become 676 TETTER-WORM. perfect; and in three days more they fall off, and in one week the surface is well. These rings vary in color. The central ring is of a yelloAvish white; the innermost of a dark or broAvnish red; the second, of near the central tint; the third, which is narroAver than the rest, is a dark red; the fourth, or outer ring, which does not appear till the eighth or tenth day, is of a light red color, and is gradually lost in the ordinary color of the skin. This species is only found in young persons, and is unconnected with any con- stitutional affection. The fifth variety is the local ringworm or tetter. This form of the disease is attended with a considerable sense of heat and itching, or tingling irritation, in the region in Avhich it originates. When it is situated in the lip, the adjoining part is hard and swollen, especially if it be in the angle of the mouth. The form of this species is usually semi-circular; it does not usually spread to any great distance. Yet it is found sometimes within the mouth, and on the tongue, tonsils, and uvula, pro- ducing herpetic sore throat. It is not unfrequently the result of some disease of the digestive organs. In ten or fifteen days, it terminates in a dark thick scab, leav- ing a tender cuticle beneath. It then commences again, and runs the same round. Treatment.—The treatment of all these varieties is so nearly the same that it may be placed under the same head. Generally, no internal medicines are necessary, any further than to keep the boAvels open, except in the last species, where the local ring- worm is situated in the mouth, and is symptomatic of some derangement of the bowels. A few doses of calomel, or some other light purgative, may then be given, to correct the digestive apparatus, and put the secreting organs in good order. The folloAving remedies may be applied to the parts externally: Recipe: Yellow Dock Root, sliced, one ounce. Apple Vinegar, four ounces. Add the root to the vinegar, and, after four days, touch the parts lightly with it twice a day; or use the following: Recipe: Citron Ointment, half ounce. Touch the parts lightly with this twice a day; or, Recipe: Corrosive Sublimate, two grains. Strong Whiskey, one ounce. ITCH. 677 Dissolve the medicine in the spirits, and touch the parts twice r day. If the disease be in the mouth, give the following tonic: Recipe: Huxham's Tincture, one ounce. Give twenty drops three times a day, in water, to a child one year old; and increase or diminish the dose, according to age. OF THE ITCH. There are varieties of itch, Avhich we shall describe before giving the remedies for any of them. The first variety is the rank itch. The pimples are small and numerous, with a slightly inflamed base, and Avatery point. The tops, Avhen made raAv by scratching, cover themselves with a broAvn scab. In the second variety, or watery itch, the eruptions are larger and more perfect, filled with a transparent fluid, Avith an inflamed base, intermixed Avith pustules, at times running to- gether and forming a scab. In the third variety, or pocky itch, the eruption is a distinct, prominent, yellow pustule, Avith a slightly inflamed base; occa- sionally running together, and forming irregular blotches, Avith a hard, dry, tough scab. The fourth variety, or complicated itch, partakes of all the above varieties. The eruption is complicated of vascular, pus- tular, and papular pimples, coexisting, spreading Avidely over the body, occasionally invading the face and neck, and some- times all running together in a blotch. The fifth variety, or mangy itch, has an eruption, chiefly of rank, numerous pustules, Avith a hard, inflamed base, rendering the skin rough and broAvnish. The itching is extreme, and the sores large from excessive scratching. This variety is produced by handling mangy animals, and, like all other varieties, is con- tagious. They are, however, not distinct species, but only a variety of the same disease. This is manifested from the fact, that, in different individuals, or under different conditions of the skin, even the mangy state itself will produce every other vari- ety ; Avhile all of them may exist at the same time in the same individual, and are cured by the same remedies. Treatment. — The first thing to be attended to in the cure of any form of itch is, to Avash the Avhole body, from head to foot, with soap and Avarm Avater, rubbing it well Avith a rough cloth, and drying it with another. 678 SCROFULA If the boAvels are not in a good condition, the following medi cine may be given: Recipe : Milk of Sulphur, one ounce. Rochelle Salts, one ounce. Mix. Give from half a tea spoonful to a tea spoonful twice or three times a day, in molasses, and repeat this three or four days, and then Avash again in soap and Avater as above. The following ointment should then be used: Recipe: White Precipitate, two drachms. Hog's Lard, two ounces. Elixir Vitriol, one drachm. Mix perfectly, and with it anoint all the sores lightly; repeat this for six nights, and then Avash out again. Or, you may cure by one night's anointing, as folloAvs: After the system is prepared as above, take of brimstone, made fine, two ounces; hog's lard, half pint; steAV them Avell together for half an hour, and apply the mixture freely for tAvo hours, before a Avarm fire. After this, wash out with soap and Avater, and put on neAvly-Avashed clothes before retiring. The above quantity of brimstone and lard is enough to cure half a dozen children. Instead of this, the folknving preparation may be used: Recipe : Red Precipitate, half ounce, Venice Turpentine, half ounce. Mutton Taliow, one ounce. Mix perfectly, and anoint Avith it three or four nights, and wash out. A popular remedy is prepared by boiling four ounces of sour dock-root in half a gallon of Avater, to one quart, Avashing Avith it, and repeating two or three nights. This has no smell, and is innocent. A strong ooze of poke-root is also a popular remedy; but it is very poisonous, and should not be used. We have known per- sons fatally poisoned by its use. There is a variety of remedies used for the cure of itch; but the preceding will never fail, if properly applied, according to the above directions. OF SCROFULA. Perhaps there is no disease to Avhich the infant is subject that is so full of deep and abiding interest to its parent, and to pos- terity generally, as the one under consideration. Scrofula is handed doAvn from generation to generation; and, instead of losing its character and formidable effects upon the SCROFULA. 679 future generations upon Avhich it is entailed, it only becomes more and more obscure in its latent character, but no less certain in its future development and effects. If, therefore, we should occupy a larger space on this subject than Ave have done on other diseases, the importance of the subject must be our apology; and it is hoped the mother Avho will take the lime to read and study this chapter carefully, will find an ample remu- neration in the lasting good she may do to her oaaoi children, and die incalculable benefit she may confer on posterity. We may safely say that scrofula is a disease, the seeds of which are laid exclusively in childhood; but, in many cases, it is not developed till maturity. In order to make this subject as clear as possible, without entering into a physiological discussion of it, Ave shall take a vieAV of its remote and proximate causes. The lymphatic system is evidently the seat of scrofula, and the lymphatic A^essels are those Avhich carry a light-colored or clear'fluid. It is generally called the absorbent system; but this, Ave believe, is not sufficiently full to convey the Avhole truth in relation to its functions and uses. " The lymphatic system is composed of three orders of organs." 1st. The absorbent vessels, so called, are an assemblage of small, delicate, transparent, uneven vessels, provided with valves, arising from innumerable roots or fibres, from the exter- nal and internal surface of the skin, from the membranes of the cellular tissue, &e. "These are distributed among all the organs, like the arterial vessels, of which they are the termina- tions, and terminate mostly in the thoracic duct;" but some communicate directly Avith the blood-vessels. " Some anatomists distinguish the lacteal from the lymphatic vessels:" but this is useless in practice. 2nd. " The thoracic duct, in which the major part of the lymphatic vessels terminate." 3rd. "The lymphatic or conglobate glands." These are small, oval, reddish bodies, composed of white vessels, blood- vessels and nerves, distributed here and there along the tract of the lymphatics, as the ganglions are "along the nerves." They are in greater abundance in the fat of the bowels, along the inside of the thighs, in the groin, about the neck, in the arm- pits, and generally in all parts of the body "where cellular tissue abounds." The lymphatic system exercises a powerful influence on the nervous system; and Ave cannot, therefore, appreciate its func- 680 SCROFULA. tions, Avithoat taking into consideration both its physical and vital forces; and by this, we become prepared to profit by our knowledge of the lesions to Avhich the vital poAver of other sys- tems is exposed. This Avould throw much light on those affec- tions to which the lymphatic system is susceptible. This system has tAvo principal functions, — absorption, and the preparation and assimilation of the nutritive fluids. Under the first head or function "is comprised everything that enters into the current of the circulation, to become identified with our structure." excepting those substances Avhich, being attracted from the air, mingle at once with the blood, in our res- piratory organs. "Absorption is effected,"first, on the digestive tubes, "on the materials designed to repair the constant Avaste of the body;" second, on the surface of the skin, and on the interior of the air- vessels of the lungs; third, in the interior of the cavities of the body. This mode of absorption is proved to exist by the mere fact of exhalation. If no absorption took place on the surface of the internal cavities, Ave should soon be filled Avith Avater. Fourth, in all the spaces between the folds of the cellular tissue, and " whereArer there are any absorbing vessels." The second function of the absorbent system is the preparation and assimilation of the nutritive fluids. In the process of forming blood, the lymphatic or absorbent system holds an important place. By the poAvers of this system, the homogeneous mass, which is chymified by the gastric juice and vital functions of the stomach, loses its inanimate character, and begins to become animalized, and makes approaches to vital matter. It is here the first step is taken from the physical to the vital Avorld; "a species of preparation which disposes them to be clothed Avith the properties of the blood Avhich they are destined to renew." This may suffice to shoAV hoAV great an influence is exercised by the lymphatic system on the material composition of the body. We see, therefore, that the formation of blood is essentially con- nected with the absorbent system; it folloAvs all its alterations, all its vicissitudes. Thus Ave see that upon the lymphatic system depends, to a certain extent, emaciation of the body, as Avell as the excessive development of many of its parts, or redundance of fat, serous infiltratives, enlargement of the glands of any and every part of the body, the removing of glandular swellings unnatural depositions of fat, &c. These things are, however SCROFULA. 681 al* performed by a vital process, and not by humoral processes or mere percolation. The remote causes of the sa'ofuloits diseases. These are three. First. " Everything that may effect a diminution of tone in the solids," and particularly those of the lymphatic system. Second. "Whatever may exalt the irritability of this system, or blunt its sensibility;" and, Third. "Everything that occasions chyle or lymph of a bad quality," such as unwholesome air: any derangement of the offices of nutrition, or the functions of the skin or lungs. We now come to the predisposing or principal causes of scrof- ula, the first of Avhich may be said to be hereditary tendency. It is a lamentable fact, that a majority of the children that are born of scrofulous parents bring into the Avorld with them this tendency, Avhich, Avhen it is hereditary, is apt to develop itself in early life. These facts are doubted by some; but there are too many instances by which this truth maybe attested. We are acquainted with whole families in Avhich the scrofulous taint has been perpetuated through tAvo or three generations, says Hufe- land. In countries where this disease is very common, as in England, the people are so well convinced of this truth, that one of the most important points in the choice of a Avife or husband, is, that she, or he, shall be free from the scrofulous taint. It is a fact in physiology, that constitutional diseases are he- reditary. They are transmitted from parent to offspring, as life is transmitted "from one to another." Children are often born of scrofulous parents Avith the disease fully formed; we see this manifested in scrofulous sore eyes; in other cases, in eruptions on the skin; ulcerations, and discharges from the ears, in very early life; and these are all symptoms of scrofula in the bud. Others have enlargements of the glands; and others, spina-bifida, or disease of the backbone. The cellular tissue is often indurated and swollen. These symptoms Avere first noticed in France, and then in England and Germany, as signs of scrofula. After all that has been said, it does not folloAV, invariably, that a child born of scrofulous parents should have scrofula, for "art sometimes contends successfully with nature," and the disease may be perfectly eradicated from the system, and thereby its train of procreation arrested. Of the age and sex most subject to scrofida. All experience and observation go to shoAV that children and Avomen are partic- ularly disposed to scrofula. This may not astonish us wnen 682 SCROFULA. we recolkct that weakness and nervous susceptibility are cir- cumstances most favorable to its development. This subject is of too much importance to keep back anything that will throw light upon it, and Ave, therefore, say that nothing is more apt to communicate to children the disposition Ave speak of, than weak- ness of the parents, and especially Aveakness of the organs of generation, " an ordinary consequence of onanism and venereal excesses. This fate is reserved for the children of those Avho have abused their youthful powers." It is probably not so much the venereal virus itself that produces this melancholy effect as l.he abuse of venereal pleasures, and "especially masturbation." Experience has so fully proved the truths here stated, that one must be uncandid to en" them in question. Is it not reasonable that exhausted pare ' •■ must communicate to their offspring a character of debili' /"which the lymphatic system, like other tissues, must partake? Children of aged and broken-doAvn parents bring into the Avorld a disposition of constitution Avhich is easily awakened into scrofulous action, and that at an early period of life. There is another fruitful source of scrofula, and that is, syphi- lis of parents. We shall, on this point, give an extract from Hufeland, which every physician of experience and observation will ratify. "It is certain that the scrofulous disease is often nothing but the consequences of syphilis. I have frequently seen syphilitic parents give birth to children, Avho, either at their birth or very soon afterwards, presented all the symptoms of the scrof- ulous taint; and it has been remarked that since the appearance of the pox, this taint has become much more common than it was before. At the present day, it is more frequent in those countries Avhere syphilis is very prevalent, than it is in others. The very symptoms, in many cases, have a striking resemblance to lues venerea." However close and strong these remarks of Dr. Huf eland may be, every physician of experience and observation will bear him out in their truth. UiiAvholesome food is another source of the scrofulous disease. Any kind of diet that the child's stomach will not properly assim- ilate into chyle, Avhether it be uiiAvholesome for others or not, will, in that child, aid in laying the foundation of scrofula. Of this kind of diet, we may mention improper artificial suckling; the child taking impure or badly-prepared milk; for, of all the fluids of the human body, none is more endoAved Avith vitality than milk, This is proved by the almost instantaneous influ- SCROFULA. 683 ence exercised by moral affections on the mixture and intimate combinations of its constituent principles. "Milk is vital while enclosed in its secreting organs; and the vital principle which animates it, Avhile it appropriates it to the infantile constitution, renders it, at the same time, more nutritious and more digesti- ble." Compare the children that are nourished at the maternal breast with those that are artificially brought up, and avc shall find, generally, that while the former are fresh-looking and healthy, the latter remain Aveak and languid, at least for the first one or tAvo years of their existence. See Iioav the consumptive invalid, avIio is ready to die with debility, bears a diet of milk sucked directly from the teat of the animal, or drunk Avhile still foaming Avith its natural heat. But let the same milk become cool, and lose the heat of vitality Avhich it brought from the ani- mal that afforded it, and it will become indigestible, and sicken the invalid who drinks it. Whence arises this difference, if it does not depend on the principle of life Avith Avhich the milk is animated while enclosed in the organs that prepare it, and which vanishes as soon as it ceases to be in contact with them 1 Sucking, then, is the order of nature, by which she supplies the infant with a portion of life from the mother, till its system becomes so perfected that it can vitalize its own food. Children, therefore, that are raised by hand, or artificially fed, are more liable to scrofulous affections than those that are properly nursed by the mother. We are apt to forget that animals which furnish us with milk feed entirely on vegetation, or are herbivorous, Avhile women derive their nourishment from each of the three kingdoms of nature. There is, therefore, a difference in the milk of animals and of women ; and this difference is produced by the different aliments on which they live. There is, in the milk of animals, something of a vegetable nature that does not exist in the milk of women. Hence the frequent acidity of the stomachs of chil- dren that are raised by hand. The child, by the motion of its lips in sucking, occasions a Aoav of saliva into its mouth, which mixes with the milk, and enters into combination with it, thus causing it to be more easily digested. It is a fact, that delicate stomachs bear solid better than liquid food; the only reason of Avhich is, that solids are mixed with the saliva before they are swallowed, while liquids enter the stom- ach just as they are taken into the mouth. "It is dipicult to portray all the difficulties that arise from artificial suckling." 684 SCROFULA. The milk is sometimes too hot, sometimes too cold, sometimes too old, and sometimes spoiled. Again ; the milk of different animals differs very much, —that of no two, perhaps, being exactly alike; and, therefore, a mix- ture renders the milk less healthy than it would be if it Avere all taken from one coav. It will be easily perceived that chyle pro- duced from a mixture of milk is not so healthy as that produced from the milk of an animal. If the child be put to the teat of the animal, or the milk be given Avhile warm, just taken from the udder, it will be more easily digested, and furnish better chyle. It is a little surprising, yet true, that ass's milk approaches nearer to that of Avomen than the milk of any other animal. All farinaceous substances that have not been fermented or well boiled, are difficult of digestion. The chyle they furnish is pasty, and of a week consistency; it circulates sloAvly in the lac- teal vessels, and clogs them up. Such is the effect of potatoes when they constitute the principal diet of children; and it is remaikable that scrofula is very common " Avhere children are nourished on this root." Vegetables that are very Avatery, and consequently contain but little nourishment, promote scrofula. The habit of feeding children on a little of every kind of food, and thereby Aveakening the poAvers of digestion, and making bad chyle, promotes the scrofulous disposition. Another fruitful source of scrofula is impure air. " This is one of the most frequent and poAverful causes of the disease in question." Cold, damp air is most favorable to its development. This is the reason Avhy scrofulous affections are almost endemi- cal in low places, "particularly Avith a northern aspect." " They are more common in the north than in the south;" are rarely seen under the tropics; but are frequently met with on the shores of the sea, "and particularly, in England, among children that live in low, damp places." Goitre, Avhich is a local affection, is endemical in mountainous countries. It has been remarked, that "the labor required in climbing up the mountains, the Avater of these places, and the cries of Avomen in labor, favor the development of this disease." Cretinism, a general affection, which Ave regard as the highest degree of the scrofulous diathesis, and Avhich is endemical in the deep valleys of the Tyrol, and the Pays de vaud, is visibly the effect of cold, humidity, privation of solar light, a highly carbo- nated atmosphere and perhaps, also, of a peculiar modification SCROFULA. 685 of the atmosphere, which chemistry has not yet been able to detect. — Dr. Huf eland on Scrofula. An inconstant and variable air is another fruitful source of scrofula, and this is the reason Avhy it is more common in high, mountainous countries than in those more level, or slightly undu- lating. An air highly charged Avith animal vapors or carbureted hydrogen gas, is very productive of scrofula. Hence, large manufactories and croAvded cities are less wholesome, and pro- duce more scrofulous cases, than the country. The higher the houses and the narrower the streets, the more unhealthy will be the city, and the more cases of scrofula Avill be found in it. " It is not possible to conceive of the Avhole influence of bad air in producing the strumous habit." This influence is naturally enough explained, on the supposi- tion of the suspended functions of the skin, the filthiness which folloAvs the debility which results from it, and the absorption of the deleterious principles of the atmospheric air. "Everything that will weaken the digestive poivers will promote scrofula;" such as acidity of the stomach, intestinal worms, the abuse of opium and other narcotics in childhood, want of exercise, want of cleanliness, abuse of heat or cold, precocious studies, too early exercise of the sexual organs, onanism, and great depression of spirits, &c.; all of Avhich, by Aveakening the powers of digestion, aid in causing an imperfect chyle to be formed, and thereby assist in laying the foundation for a scrofulous disposition in the consti- tution. Besides the remote causes, there are occasional exciting ones, such as a preternatural development of some parts of the body; " some particular seasons of the year, as the spring." —Huf eland. Mechanical causes, such as bruises, Avounds, blows, falls, &c., will sometimes bring on this disease. Hambleton and Weiber have both given cases that were excited by causes of this kind. It is also excited into action by diseases of irritation; and hence, we often see scrofula, follow smallpox, measles, or scarlet fever. These diseases, if badly treated, as well as many other diseases, will often develop scrofula when it would otherAvise have lain dormant. And here, perhaps, the physician or nurse should bear the blame. We now come to treat of the external appearances of scrofula; and, in doing so, we shall avail ourselves of the ample experience 686 SCROFULA. and clear elucidations of the physician to the king of Prussia, than whom no one has been more satisfactory on this subject. Of the external appearance of scrofula. There is a habit and an external appearance connected with the scrofulous diathesis, tha* is almost inseparable from it. Where this appearance of the body is presented, no doubt as to the scrofulous taint can exist The principal features of it are: 1. A short, thick neck. 2. Jaws rather broader and stronger than common. 3. The head rather large in proportion to the other parts of tho body, especially the back part of the head. 4. Light-colored hair. 5. The face slightly bloated; its" skin delicate, transparent, "mite, and someAvhat rosy. 6. Most commonly, the eyes are blue, and the pupils large. This appearance often indicates a scrofulous state of the mesen- tery. 7. The upper lip very thick. This is one among the symp- toms Avhich do not mislead. It is, hoAvever, sometimes periodi- cal. 8. The nose is often a little SAvelled, red and shining. 9. The Avhole body appears to be fat, and Avell nourished; but, on a close examination, the flesh is found to be flabby and soft It does not possess the resistance and elasticity Avhich indicate health and vigor. 10. The belly is somewhat larger than it ought to be, although it may not have become as hard as it will be in the future progress of the affection. Sometimes it becomes very large from the slightest cause. The folloAving developments of the organs are irregular; as, 11. The development of the teeth, bones, and muscles. Learning to Avalk and talk, also, are either difficult, baclavard, or very irregular. 12. The intellectual faculties and organs of generation are prematurely developed. Such children are apt to become addicted to masturbation, and should be attended to on that subject. Girls in whom these symptoms exist require more attention from their mothers than those who are not of a scrofu- lous habit. It is not an uncommon thing for a teacher or parent to be sL-uck Avith an unusual manifestation of intellect in such chil- dren • but in a few years they arrive at their acme, and all efforts to J ush them further are vain. SCROFULA. 687 The scrofulous taint shoAvs itself even in the development of puberty. " Retarded and irregular menstruation often depends on no other cause." Persons laboring under the scrofulous taint are apt to bleed at the nose frequently, and have frequent colds or coughs, with a wheezing respiration. "Small spontaneous ulcerations, peculiar to children, situated on the inside of the legs and thighs, and under the armpits, Avhich do not yield to the ordinary measures of cleanliness, and small pimples of various forms and sizes, and scabby," are signs of scrofula. The body may enlarge in some parts more than others, and appear to be SAvelled, " but does nol pit on pressure." This SAvelling is seen on the arms, legs, face, and scrotum, and this symptom should be particularly noted by the mother. Pains in the insides of the legs and thighs, subject to periodical returns, sometimes accompanied with more or less SAvelling for a feAv days, and a Avhite discharge from the vagina of infants, are further signs. There is also, in scrofulous habits, a manifest disposition to a sour stomach. The stools are variable; sometimes too solid, sometimes too liquid, and rarely of the right color and consis- tency. The appetite is irregular, Avith a particular fondness for dry bread: mucous disorders of the boAvels, flatulency, distension of the belly, Avind in the boAvels, spasms and colics, &c, also accompany the disease. These constitute a large majority, at least, of the second stage of symptoms of scrofula. We have, however, besides the above symptoms, at different times, a peculiar form of fever, Avhich, by some, has been called mesenteric fever, gastric fever, imvard fever. These different forms of fever shoAV nothing more nor less than that there is a scrofulous disposition in the system, though it may not yet be developed; and this peculiar form of fever, in its different varia- tions, might more properly be called scrofulous fever. It generally appears in children under tAvo years old, is very irregular, and its course and type are indefinite. It is various as to its duration, sometimes passing off in a feAV days, and, in other cases, continuing for several Aveeks, but in a mild form. The temperature of the body is not high, but the skin is sometimes manifestly too cold. There is sometimes attending it a slight cough, Avith Avheczing. The belly is ahvays a little SAvelled; and to these symptoms succeed glandular sAvellings, eruptions on the skin, scabs on the head, and emaciation of body. 688 SCROFULA. This form seems to be the line of transit from a scrofulous taint or disposition to the development of scrofula. Wc have iioav brought it to that point Avhere it falls, in some degree, under the inspection of our senses. "Not only are the vital forces changed, but the organization of the glandular system is altered; its functions are disturbed, and the disease manifests itself plainly by the swelling of the lymphatic glands." At first, they are small and movable under the fingers; they feel elastic, and there is no discoloration of the skin. The glands that first manifest this development of the disease are situated in the sides of the neck, under the loAver jaAv, and under the ears; and a particular examination of these glands will give the proper character of their affection. As above stated, they are at first small, loose, separate, and uninflamed; but, after a Avhile,—for their progress to suppuration is very sIoav,— they gradually enlarge, and the SAvelling is communicated from one to another. The cellular tissue and sacs containing the glands thicken, and the tumor enlarges, till finally it becomes hard and immovable. The glands under the veins and in the groins SAvell in their turn; and, in some instances, those of the whole body SAvell. It is uncommon for a single gland to be affected in scrofula. The virus will extend from gland to gland, in the same region, till several are affected by it; and they are often so connected together as to make an enormous tumor. At length the disease, in passing from gland to gland, affects the lymphatic vessels, which become thick and hard, and feel like hard cords passing from one gland to another. These tumors are variable; they sometimes rise and diminish alternately for a long time, Avhile in other cases they enlarge, and remain so for years, before they suppurate. " In proportion as the scrofulous taint increases, the tumors become hard and immovable;" yet they may feel cold and indolent; but, sooner or later, the gland inflames, and suppuration takes place slowly. When the pus is discharged, it is of an unhealthy character, mixed Avith curds, and, in some instances, with thin, hard, Avhite flakes, or concretions, not unlike small pieces of an egg-shell. "In other cases, the swelling passes into a schirrous and even an osseous state." In some cases, the lymphatic glands acquire an enormoua size; they have been seen to weigh "ten pounds and more." We suppose, in these cases, that the tumor had changed its scrofula. (539 scrofulous character, for that of a steotomatous tumor, though the scrofulous blemish or hue may still remain upon them. In some cases, the Avhole body is covered Avith scrofula; inat is, tumors and sores appear on every part of the body. The externa] surface is not the only part affected by scrofula; the fat and glands of the bowels become the seat of the disease, also. The fat of the boAvels, stomach, and chest, in these cases, is studded Avith tumors, from the size of a small pea to that of a walnut. This, Ave can readily see, obstructs the due process of chylification and mesenteric functional nutrition, and the patient becomes extremely emaciated, and dies from starvation. This is Avhat is called, by Avriters on the diseases of children, tabes meseutericus ; Avhich is nothing more nor less than scrofula. The heart, brain and liver, in their turn, become affected Avith this disease; but, in adults, the most common of all its determi- nations is the lungs. Here it shows itself in the form of tuber- cular consumption; Avhich, though it may be warded off for years, Avill ultimately prove fatal. Scrofulous children rarely have a clean head. They are liable to have small pustules and oozing sores on the back of the neck, Avhich emit an unpleasant smell. Sometimes these sores terminate in real scald-head. Thcse^ children are apt to have sore eyes, Avhich are difficult to cure. The glands of the eyelids pour out a viscous humor, denominated by Sca?-pa, "palpebral flux." The eyelids, in the morning, are glued together, and are separated Avith difficulty. The sight is frequently weakened, and, in some cases, the cornea, or black part of the eye, becomes diseased and turns Avhite; in Avhich case, vision is destroyed. Such children frequently have styes on their eyelids, and their ears are apt to discharge an ichorous, thin, fetid humor. In consequence of the disease of the mesenteric glands, the belly enlarges and becomes hard, while the legs and arms fall aAvay, till the skin may be wrapped around them like a piece of cloth. The skin shrivels, looks dead, and feels harsh. All scrofulous ulcers are not preceded by SAvelling of the glands, for some of them seem to be developed spontaneously, in consequence of a lesion of the lymphatic system. These sores present a foul appearance, the matter formed in them never being of the healthy kind; it is clear, watery, and very irritating. They heal in one place, and break out in another; they are not very painful, but are obstinate to heal, and tend to pcrpeluat© themselves almost Avithout end. mtiutiT. 45 690 SCROFULA. Goitre, as stated in the foregoing part of this chapter, is a form of scrofulous SAvelling of the strumous character. This swell- ing is situated exclusively in the thyroid gland, which lies across the neck, from side to side of the larynx, and enlarges, in some cases, to the weight of ten or fifteen pounds, when it may pro- duce death by suffocation, or, by obstructing the return of blood from the brain, cause an engorgement in that organ, terminating in apoplexy and death. We are ready, hoAvever, to acknowl- edge that goitre is not always of a scrofulous origin, but is fre- quently the product of situation, as in mountainous countries, where it is endemic ; depending, probably, on the qualities of the air and Avater, combined Avith other circumstances peculiar to such locations. To conclude these remarks, we will simply say, that scrofula terminates in disorganization, sooner or later, if not cured before it arrives at that point. The manifestations, then, of disorgani- zation are, First, a wasting away of the whole body and limbs, from mesenteric disease. Second, white swellings in the joints. Third, spontaneous dislocation of the joints. Fourth, suppura- tions of the glands in different parts of the body. Fifth, ulcera- tions on the surface, and about the eyes, head, and ears. Sixth, scrofulous dropsies. Seventh, tubercular consumption, and enlargements of the bones, caries, and spina-bifida. Eighth, scrofulous cancer. Ninth, tal^3 abdominalis, or abdominal con sumption. Tenth, rickets. Eleventh, a peculiar affection of the nervous system, such as spasms, cramps, paralysis, or palsy, supervening upon, and caused by, the retrocession of scrofulous matter from one part to another. Twelfth, cretinism, which, perhaps, is the highest grade of the strumous constitution. In this case, the whole body or system is scrofulous. We might write a volume on scrofula, but here we must con- clude ; the importance of the subject being our only apology for the length of this description of the disease, — a disease than which there is no other so full of importance to the human family. The fond father, the loving mother, the tender, inno- cent infant, who has had no part in bringing itself into the Avorld, and into this state of suffering, — the general and individual prosperity, happiness, and peace of society, — all call aloud upon parents to examine this subject closely, understand it Avell, and assiduously avoid the causes which produce it. We do not intend to carry this subject, in this chapter, into the open and ulcerative form of this disease, as we shall treat of it SCROFULA. 691 again, under the name of king's evil, after it has broken out, and become open, in an ulcerative form, in the glandular system We shall doav give the treatment of scrofula, following it through all the stages in which we have, in our previouc remarks, treated of it. Treatment. — From what we have said concerning the naturf and causes of scrofula, it will be readily observed, that som< particular arrangement must be adopted for the use of the reme • dies to be resorted to for its cure. The treatment rests, therefore, on the following indications : First. To withdraw the patient from under the influence of the scrofulous predisposition, or predisposing causes; for it is impossible to perform a cure while these causes continue to act. Second. To elevate the tone of the lymphatic system, which is evidently the seat of scrofula. This is certainly the funda- mental basis of the treatment; and whatever other remedies may be introduced, according to circumstances, this fact never should be lost sight of. The first is done by a pure air, light and sunshine, proper diet. suitable baths, &c. The second, by antimonials, mercurials, tonics, aperients, anti-spasmodics and stimulants, externally and internally applied. As the lymphatic system is the seat of scrofula, and that sys- tem of vessels, at least the thoracic part of it, is the medium through which the whole system is supported, it will be readily seen, that the diet from Avhich the lacteals are to separate the nourishment from the food, and carry it to the general circula- tion, should be pure, and properly adapted to the indications in question. If a proper diet is used, and a pure and wholesome chyle is formed, the scrofulous predisposition will often be entirely eradicated from the system. The food, then, should be light, easy of digestion, and incapable of producing acidities, or weakening the stomach. Vegetable ought to be combined with animal substances, as soon as the child has teeth to chew them. The vegetables should ahvays be fresh; roots should be Avell cooked; broths made of herbs, and lean meats, Avhich are easy of digestion; these being the most suitable aliments for scrofulous patients. For drink, plain water, pure and fresh, is the best. A pure air is essential; for "as long as scrofulous patients inhabit low and damp places, their state only grows Avorse and worse;" as, in such situations, the air is always impure. 692 SCROFULA. Exercise in the pure open air, on dry grass, is essential to the removing of the scrofulous taint in children ; they should sleep in a large, Avell-\rentilated room, that admits a full light, with but feAv beds in the same room. Parents and instructors should keep these things in view, and not lay the foundation of an incurable scrofula before the child can act for itself. Bodily exercise is also important in removing the predisposi- tion to scrofula. If a child, from the period at Avhich he learns to Avalk, spends the greatest part of his time in the open air, he is rarely affected Avith scrofula; and even if his parents have some of its taints in their system, its attack upon him is by the above means the more easily Avarded off. This exercise should be performed by the child itself, by running, walking, tumbling, &c. It should, however, be taken in dry, Avholesome places, and in the shade. Passive exercise, — that is, riding in little wagons, or being draAvn about on chairs,—is not of much avail in these cases. The child must use its OAvn strength when it is able to do it; for this gives tone to the system, and scatters any tumors that may be disposed to form in the glands of the lym- phatic system. Cleanliness is also important. The skin should be kept clean, as Avell as the body linen. The bedding should be kept clean, and frequently changed. Physicians often forget this important fact. Scrofulous children ought to sleep on mattresses, and not on feather-beds. The mattress should be refilled every spring and fall, or oftener. Bathing is of the greatest importance to children in the treat ment of scrofula. Baths have the happy effect of facilitating absorption and exhalation; they enliven the sensibilities of the skin, establish an equilibrium of action in the circulating system, soothe excessive irritation, regulate the functions of the lym- phatic system, and remove engorgements of the glands. Chil- dren Avho have been properly bathed rarely have glandular swellings. The bath is even proper Avhen scrofula is in full vigor. Baths also constitute a valuable means for the applica- tion of remedies in scrofula, as Ave shall see before Ave close this part of the chapter. Both parents and physicians are apt to become weary in the treatment of this disease; but let it be remembered that no disease requires more patient perseverance in its treatment than scrofula. There are many cases that require, not only Aveeks, SCROFULA. 693 but months, to effect a cure. The system itself, when it is kept in a proper condition, and the lymphatic system held, as it Avere, in the proper attitude, will, by a continued development of itself, at last lose all the scrofulous disposition, and, like a bird, having become full-fledged and strong-Avinged, rise above all its former defects and Aveaknesses, and health and vigor crown the untired efforts of a fond parent or a persevering physician. The spring of the year is, Avithout contradiction, the most favorable time for combating the scrofulous diathesis of the system. The lymphatic system, as Avell as the entire body, experiences, at this season, an increase of vitality; the diet can be better regulated, and vegetables are never so fresh and invigor- ating as in the spring, Avhen scrofulous persons can derive much benefit from their juices. We should never m stake the suppression of a glandular tumor for the cure of the scrofulous disease. Scrofula, Avhich has so many causes for its existence, cannot be cured by any one remedy. In all cases, the constitution must be revolutionized, in order to effect a cure. Nevertheless, there are certain remedies Avhich seem to possess specific virtues for certain symptoms and certain developments of the disease; but, in order to obtain success in scrofula, Ave must attend to its complications, and to the different temperaments of the subjects of it. If this be neglected, the cure will be retarded, or the disease not cured; and this will sIioav the necessity for varying the remedies according to circumstances. If we forget that the lymphatic system is the seat of scrofula, and lose sight of this fact in the treatment of the disease, Ave shall most assuredly fail to perform a cure. We have noAV given a sketch of the facts necessary to be knoAvn and folloAved, in order to the successful treatment of scrofula; Ave shall next speak of the particular remedies, in their order; and first, of emetics. Emetics deserve a distinguished place in the treatment of scrofula, ahvays exciting, as they do, an increased action in the lymphatic system. They, therefore, do good in this Avay, as Avell as in cleansing the stomach and large secreting organs, such as the liver, pancreatic gland, &c. Emetics, then, should be repeated frequently during the cure of scrofula. Recipe : Antimonial Wine, one ounce. To a child tAvo years old, give first a tea spoonful, and repeat half the quantity every fifteen minutes, till it pukes fieely, when 694 scrofula. warm water should be given every time the child pukes, till it has three or four motions up. It must then be turned doAvn, Avith a little gruel, or salt and Avater, but nothing cold must be taken till the operation is over. The bowels should then be acted on with the following medicines: Recipe : Calomel, six grains. Pulv. Rhubarb, twelve grains. Mix, and divide into six papers; give one every three hours, till the boAvels are freely evacuated. This purgative may be repeated in a few days. Where the belly is large and the bowels costive, the folloAving medicine may be given: Recipe: Scammony, Aloes Socot., Pulv. Rhubarb, Castile Soap, — of each thirty grains. Best Ground Ginger, five grains. Mix in ten papers. Give one of these every night at bedtime, so that they may operate in the morning; and, if they should fail to do so, a poAvder may then be given. In the morning, should vomiting come on in scrofula, Avhich is frequently the case, the following celebrated remedy of Hufeland will be found valuable: Recipe: Tincture of Orange Peel, half ounce. Tincture of Aloes, two drachms. Tincture of Castor, two drachms. Mix, and give fifty drops three or four times a day, in Avater. Sometimes the abdomen swells, and continues hard for a long time; the skin becomes of a bad color, the glands swell, and in these cases there is some cough. After these symptoms last for some time, a slow fever comes on, the cough increases, and the child is apt to vomit occasionally. For this state of things, Ave will also give Dr. Hufeland's remedy. Recipe : Klein Elixir, half ounce. Aperient Elixir, three drachms. Tincture Rhubarb, three drachms. Huxham's Antimonial Wine, two drachms. Extract of Cinta, one drachm. Extract of Dulcimara, one drachm. Essence of Orange Peel, one and a half drachms. Mix them all together, and give sixty drops four times a day, in an infusion of dandelion, yarrow, saponaria and bitter-sAveet This he gives to a child eight years old; and he states that the use of this remedy for three or four weeks, cured the scrofula, where the symptoms were dangerous. Indeed, this is the doc- tor's favorite remedy in scrofula of children. SCROFULA. 695 For the symptoms for which the celebrated Russian physician gave the above, we have generally succeeded with the following medicines: Recipe: Pulv. Rhubarb, Aloes Socot., Scammony, Aleppo, Castile Soap, — of each, twenty grains. Tartar Emetic, three grains. White East India Ginger, four grains. Mix all into twenty-four powders, and give one, night and mornir.^, in sirup. At the same time, let the little patient drink a Aveak tea, made of the bitter-sweet, or dandelion root, with a tea spoonful of the supercarbonate of soda dissolved in a pint of it. A half-pint should be drunk every twenty-four hours. Once in a week, the patient, should take the following pur- gative : Recipe : Calomel, six grains. Jalap, four grains. Mix in two papers, and give them three hours apart, in sirup. A tea spoonful of hyssop in powder may be given every mor- ning, when there is much pain in the head. A pinch of snuff occasionally will be of service. Where the scrofulous eruption is dry and scaly, resembling tenea, or scald-head, Avhether it be in the hair, or in the arms, legs, or body, the folio Aving will be found very profitable in its treatment, for a child six years old: Recipe : Antimony, in Powders, one drachm. Prepared Chalk, two drachms. Pulv. Can ilia Alba, two drachms. White Sugar, one ounce. Mix, and divide into ten papers; give one three times a day, in a little water. When these are all out, the same may be pre- pared, and given five times in tAventy-four hours, and continued for three weeks. During this time, the diet should be free from grease, and the drink should be a weak decoction of the bitter- sweet. The patient may also take a sulphur bath every other day. During the use of this remedy, great care should be taken to keep from taking cold; and if symptoms of much debility should come on, the following tonic should be given: Recipe: Huxham's Tincture, one ounce. Tincture Iron, two drachms. Mix, and give to a child two years old, forty drops three times a day, in the drink. 696 SCROFULA. Under this treatment, in five or six Aveeks, all the symptoms of ulceration and enlarged glands will generally give way. But there are still other forms of scrofulous affections; to wit, those that arise from a A'cnereal taint in one or both of t.ie parents. These manifest themselves by symptoms from different parts, as the ears, the vagina, indurations on the shallow bones, mesenteric derangements, &c; and here Ave are compelled to use a different course of treatment. In this form of scrofula, mer- cury, in some form or other, is our best remedy. The following may be given, for a child two years old: Recipe: Blue Mass, twenty grains. Pulv. Rhubarb, ten grains. Mix in four papers, and give one, night and morning, in sirup. These may be repeated for one week; then omitted for the same time, and the folloAving may be given: Recipe: Pulv. Rhubarb, ten grain. Castile Soap, ten grains. Mix in four papers, and give one every night at bedtime, in sirup. The child, during the time of taking this medicine, should take some tonic, such as Recipe: Huxham's Tincture, one ounce. Twenty drops of which may be taken three or four times a day. It should be recollected that mercury should never be carried so far in a child as to produce salivation. When the mercury is discontinued, the following should be given : Recipe: Hydriodate of Potash, half drachm. Distilled AArater, one ounce. Compound Spts. Lavender, one drachm. Mix, and give thirty drops, in SAveetened water, three times a day. It Avill be found, in many cases, that the tumors or enlarge- ment of the abdomen, will require a stimulating liniment, from the use of Avhich much benefit is derived. We have not met with a better article for this purpose than one prepared by my son, J. Milton Bright, Avhich he calls " Bright's Rheumatic Liniment." This liniment, rubbed on the glands that are SAvollen, tAvice a day, and then washed off with soap, vinegar and warm Avater, before applying it the third time, is superior to anything else of the kind Ave have ever seen. The abdomen may also be rubbed with it when there is much enlargement; but should this liniment not be convenient, you may use the following: SCROFULA. w Recipe: Basilicon Ointment, half ounce. Olive Oil, hall ounce. Beet's Gall, fresh, two drachms. Venice Soap, two drachms. Rock Oil, two drachms. Carbonate Ammonia, two drachms. Gum Camphor, one drachm. Mix these articles perfectly, and anoint the abdomen ond the tumors Avith the mixture, tAvice a day, Avashing it off clean, every time, with Avarm soap suds, before it is reapplied. Perse- verance Avill effect a great deal; therefore, use these remedies faithfully for several Aveeks, before you desist. Mercury, like all other medicines, loses its effect sometimes, by a long continuance in one form. It will then be necessary to change it occasionally, and give calomel instead of blue mass. Recipe : Calomel, sixteen grains. Pulv. Rhubarb, ten grains. Mix in eight papers, one of Avhich may be gh^en night and morning, or one at night and a tea spoonful of castor-oil in the morning. The sulphur bath, occasionally, Avhile these medicines are used, will be of service. Lime-water is a good remedy Avhere the bowels are apt to be costive. A tea spoonful may be given, in milk, three or four times a day, with great advantage. Scrofula cannot be cured Avithout tonics. There is. hoAA^ever. a proper time for their use in this, as in other diseases; and in scrofula this time is after the lymphatic system has been relieved from all its engorgements, and the passive or chronic inflamma- tion has been removed from the glands and facia that surround them. A state of debility always ensues to the removal of that state of the parts; and this is the time to introduce tonics. Even at this time, there must be some caution used, to prevent a second engorgement of the coats of the lymphatics, as Avell as the glands. The best form of a tonic, then, is that combined Avith such medicines as will prevent the above engorgements from taking place; and the folloAving is an excellent preparation. This, hoAvever, should not be given, till the fluids have been purified, and the glands begin to be reduced. Renpe: Peruvian Bark, one ounce. Biiter-Sweet, one ounce. Dandelion rioct, half ovjicc.. 69S SCROFULA. Boil the two last in a quart of «rater, for fifteen minutes; strain off, and add the bark to the decoction, and boil again for six minutes. Strain again; and add to the decoction, after straining the second time, Recipe: Hydriodate Potash, two drachms. Stir it till it is all dissolved, and add of good port wine, half a pint; let all cool, and bottle it close for use. Keep it in a cool place, and, to a child two years old, give a dessert spoonful, three times a day, and so in proportion to age, till you come to a grown person, who can take a small stem glassful three times a day. During the time this medicine is given, the folloAving may be used, to keep the boAvels regular, and take off any bad humors that may be set at liberty in the lymphatic system: Recipe: Scammony, Aloes Socot., Pulv. Rhubarb, Castile Soap, — of each twenty grains. Pulv. Ginger, ten grains. Tartar Emetic, two grains. Form tAventy-four pills, of Avhich, from one to four may be taken every night at bedtime, according to the age of the patient, and the effect they produce—one operation every morning being enough. It will be found necessary to continue this course for several weeks, and, perhaps, months; at the same time, if there are any glands that are enlarged, or any sores on the skin, they should be rubbed or dressed Avith the following liniment: Recipe : Basilicon Ointment, half ounce. Olive Oil, half ounce. Beef's Gall, two drachms. Venice Soap, two drachms. Rock Oil, two drachms. Carbonate Ammonia, one drachm Gum Camphor, one drachm. Mix them perfectly, and dress the sores, or rub the enlarged glands, with this ointment, tAvice a day. If the abdomen is much enlarged, it should be rubbed with the above liniment tAvice a day, also; and the skin should ahvays be well Avashed with soap and warm water, .before the liniment is reapplied. At this time, the diet should be more generous; that is, it should be composed not only of neAV, SAveet vegetables, but a little lamb, fresh beef, or some wild meat, Avhich, however, must be well cooked. SCROFULA. 699 We meet Avith cases where the debility becomes so extreme, that the ordinary tonics seem not to arouse the energies of the system; and Ave should then give the folloAving : Recipe : Huxham's Tincture, two ounces, Volatile Tincture Guaiacum, half ounce. Mix, and give a tea spoonful three or four times a day; or, Recipe: Compound Tincture Gentian, half ounce. Tincture of Iron, half ounce. Mix, and give thirty drops four or five times a day, in a stem glass of dandelion tea, or a tea made of the tops of camomile. Such are the varieties in Avhich scrofula presents itself, that it is difficult to set them all forth in one chapter. There is another form, however, Avhich Ave shall mention, in Avhich scrofula appears in small children from one to tAvo years old. They appear to be rickety; they cannot stand on their feet; the glands swell more or less; the belly becomes tumid, and great debility ensues; the joints, after a Avhile, SAvell; and the boAvels are irregular. For this form of the disease, the folloAving medicine will be found valuable: Recipe: Decoction of Bark, half pint. Orange Peel, two drachms. Mace, Pulv., two drachms. Madeira Wine, one pint. Add the materials to the Avine, and give a spoonful three times a day. The body should be kept very clean, by the use of the cool salt bath every day. By perseverance in this treatment, in a feAv months, the disease may be eradicated from the system; but Avhile continuing the use of the above medicines, the boAvels should be kept open with, Recipe: Rhubarb, twenty grains. Blue Mass, ten grains. Mix; divide into ten powders, and give one, morning and even- ing, in sirup. There is another form of scrofula, Avhich does not affect the glands much, but shoAvs itself on the skin, in dry, ill-conditioned sores, of a leprous appearance. The sores are apt to beal, and run a fetid and rather ichorous humor. The countenance of such persons is morose; and if the subject of it be a female, she is almost deaf Avhen she menstruates, if both ears should be affected. This is evidently a disease of a scrofulous character. For the cure of this form of the scrofulous disease, Dr. Huf& 700 SCROFULA. land prescribes " a draft of Seidlitz-Avater every morning; a scar- ification and cups to be applied to the back of the neck once a month; mercurial frictions applied behind the ears; a decoction of bark for her drink; and a blister on each arm." This, he says, will cure this form of scrofula in a feAv months. The scrofulous affection is not confined to any one part of the system, but may break out on the feet, legs, arms, hands, head, or backbone, as Avell as in the soft parts. Where the bones are aflected promiscuously, much good has been derived from the use of Piderifs celebrated remedy, Avhich is, Recipe: Corrosive Sublimate, six grains. Spirits of Wine, two ounces. Mix and dissolve. Then take, Recipe: White Sugar, four ounces. Pure AA'ater, six ounces. Dissolve the sugar in the Avater, by simmering till a perfect sirup is formed, and then add the previous prescription. Mix them Avell; and, of this preparation, give a tea spoonful three times a day. At the same time, the patient should take the fol- io aving decoction: Recipe : Guaiacum Wood, one ounce. Bitter-Sweet Twigs, one ounce. Pine Cores, one ounce. Make all fine, and boil in two quarts of water, down to one quart. A small Avine glassful three times a day is sufficient for a groAvn person. If the feet or other parts are ulcerated, a strong decoction of avIIIoav bark should be made, and the sores Avell bathed in it every day, and cloths wet in the decoction should be kept constantly applied to the sores. After a feAv Aveeks, a strong decoction of bark may be given, combined Avith an alkali. Recipe: Peruvian Bark, two ounces. Boil for eight minutes, in one quart of Avater; add a little cold water, and, Avhen settled, pour it off, and add, Recipe: Hydriodate Potash, two drachms. Mix well, and take a table spoonful every three hours, and the cure may be expected in a feAv Aveeks. There is a particular condition of the system in which iron is admissible in scrofula, as Avhere the system is very much relaxed, the scrofulous tumors soft, the skin flabby, &e. In such patients, great good may be effected by the judicious use of iron. The best form of administration is in substance : SCROFULA. 701 Recipe : Carbonate of Iron, forty grains. Ext. of Liquorice, twenty grains. Mix in tAventy poAvders, and give one, morning and evening, in sirup, for a child tAvo years old; the dose may be increased oi diminished, according to age. If any fever should exist, and, at the same time, great debility and relaxation should demand the use of iron, the following for- mula may be used: Recipe: Carbonate of Iron, forty grains. Salts Tartar, forty grains. Mix, and divide into twenty papers; give one tAvice a day, as above. The bitter-sAveet is an invaluable medicine in scrofula. When used as an alterative for the lymphatic system, it should be pre- pared in the folloAving way: Take of the tAvigs of the vine, half an ounce; of Avater, one pint; boil the tAvigs in the Avater for fifteen minutes; then pour it off, and SAveeten. This quantity should be taken, by a groAvn person, in a day. After it has been used of this strength for several days, the quantity of the herb should be increased, and taken daily, till it produces a vertigo, or giddiness in the head, Avhen it may be discontinued for a few days, and then resumed again, as at first. The dandelion may be used in the folloAving Avay: Take of the fresh root, half an ounce, and boil it in one quart of Avater; strain and SAveeten; this quantity may be taken daily by a groAvn per- son. The above decoctions should be used Avhen the sAvellings are hard, the belly tumid, and the joints enlarged. Anodynes are useful in scrofula, when there is much pain; and small doses of opium or hyoscyamus may be given at bedtime, to produce rest. The diet of scrofulous persons is of very great importance. Vegetables should compose four fifths of the food, especially in the spring of the year. Light fresh meats, and stale bread, with but very little butter, should be used; and, in the heat of summer, pure milk, —Avith lime-Avater, one ounce to the pint of milk, — and bread, and Avell-eooked farinaceous Aregetables. But, above every other diet, a coffee made of acorns is to be preferred. The kernel of the acorn should be broAvned like other coffee, ground, and pre- pared in the same Avay, and used with milk and sugar. It is a grateful article of diet, very nutritious, and of itself, in many cases, a sovereign remedy for scrofula. Patients living on acorn coffee 702 GOITRE. always become fat, and have a fine color, clear skin, and goof the system has been produced by the sprain, some cooling medicines may be necessary, such as salts, rhubarb, or some gentle pills. PUNCTURED WOUNDS. By punctured wounds we mean those that are made by small instruments, as penknives, splinters, pins, nails, or anything else that will make a small hole in the skin, but penetrate deep m 60 710 FRESH CUTS. the flesh. There is sometimes great danger produced by these wounds. If a nail should be thrust into the bottom of the foot or palm of the hand, so as to Avound the facia, there is much danger of lockjaw being produced. When the puncture is made by a needle or pin, or any small instrument, in the palm of the hand or bottom of the foot, and the instrument breaks, and leaves a part remaining in the flesh, the remaining portion should be taken out. It would be better to cut doAvn to and remove it by a pair of tweezers; after which, the wound should be dressed with a strong ley poultice. And this should be done, whether the foreign body be removed or not. The poultice should be reneAved every tAvo or three hours, till the wound suppurates, Avhen all danger of lockjaw is over, and not before. If the Avound is dry, and the pain great, the hole should be opened by a free incision Avith a sharp knife, and the wound filled with laudanum; when the strong ley poultice should be applied, as above directed, and continued till the wound suppu- rates. In this case, the boAvels should be freely evacuated by an active purge of calomel and rhubarb, or calomel and jalap, followed by oil. We have frequently draAvn out broken needles from the bottom of the foot, by poulticing as above directed. Beefs gall draAvs very hard, Avhen applied to such Avounds. It should be mixed with flour and the Avhite of an egg, and applied to the puncture. Thorns, splinters, &c., have often been drawn out by this appli- cation. If there be great irritation, and fever excited, which is some- times the case, the patient should be bled, and live on a Ioav diet. FRESH CUTS. Children are very apt to cut themselves; and it is a common practice to fill the cut with sugar, salt, soot, pepper, and such things; but they are all improper. They act as foreign matter, and, of course, will always retard the cure of the wound; for the suppurative stage mus! be brought on, either by art or nature, in order to throw out the matter thus introduced. A fresh wound, where there is no bruise connected with it, should ahvays be dressed in the simplest manner; and this ia WEARING THE HAIR. 711 done by bringing the edges of the Avound together, first removing any foreign matter that may be there, and binding it up in its own blood, Avarm and fresh, if possible. The bandage should be so adjusted as to make the wound fit a little tighter than the natural skin, but not much; and the dressing should not be removed for two or three days, unless the part becomes painful, in Avhich case, it should be removed the next day. If the wound is SAVollen or inflamed, it should be well washed Avith clean Avarm water, or milk and Avater, and a poultice of slippery- elm bark, or light bread and milk, applied. This should be reneAved frequently, till the fever and swelling are all removed, when the Avound will suppurate freely. It should then be washed with mild soap and Avarm Avater, and dressed Avith basilicon ointment, or simple cerate. If bad flesh spring up in the Avound, it may be removed by sprinkling red precipitate, or burnt alum, on it, till it becomes level Avith the other parts, when a bandage properly applied around the part will be of service. Sometimes cuts degenerate into old sores; in which case, a piece of sheet lead Avorn over the sore will be found of service. The sore, in this case, should be bathed in cold water, night and morning, and the lead cleansed with water, and fitted over the sore, and kept there by a bandage. In small Avounds on the hands and feet, an artery is sometimes cut, and the child is likely to bleed to death. In such cases, a firm compress should be applied just above, but embracing the whole of the wound. This is best done by a piece of money, a split bean, or a light roll of linen, laid on the part, binding it on tight Avith a ribbon or narrow bandage. OF WEARING THE HAIR. It may be thought that a chapter on the subject of children wearing their hair is uncalled for and unnecessary. But we are satisfied that a work which is designed to embrace everything that Avill benefit the child and the groAvn female, would not be complete Avithout including something on this subject. It is a fact that cannot be denied, that the inordinate growth of any one part of the system is so far an injury to some other part. And this is natural enough; for nature has only made provision for the supply of a certain portion of nourishment, and, consequently, a certain portion of animal life. This is wisely 712 WEARING THE HAIR. ordered and distributed, in compliance Avith the demand made by each separate organ of the system, according to their several functions. Now, if the vessels adapted to the supply of nourish- ment to the system should deposite double the quantity of this nutriment in the body and shoulders of a child or man, then it will be found that the extremities, as the arms and legs, of that individual will be meagre, small and Aveak. Hence, Ave see, where there is a disposition to gout in men or women, the body is apt to be large, but the legs very small in proportion. In this case, where does the disease manifest itself? Evidently in the feet, and the Aveaker part suffers. So it is Avith every part of the body. When one part calls upon the nutritious vessels to supply it with more than its ordi- nary or due quantity of nourishment, some other part must of necessity bear this loss. Now, if the mind depend upon a due, healthy secretion in the brain, — not that the mind is a secretion but a due quantity of healthy material must be maintained, in order to the development of a healthy and energetic mind,— then it follows, that any organ or part in the neighborhood of the brain, that will reduce the amount of healthy nourishment to the brain, will certainly weaken in the same proportion the active, healthy, and enduring intellect connected Avith that brain. We see how feeble the whole muscular system becomes, when dis- ease has deprived the solids of their due and accustomed quan- tity of food, by which strength is imparted to the solids; and just so it is Avith the brain. Though that organ may not be dis- eased, let it be deprived of its proper amount of nourishment, by some other organ or part taking that nourishment to itself, and the mind becomes enfeebled. Look at the little girl Avho has worn her hair very long and thick till she is twelve or fifteen years old, and you will see her manifest in her features the visi- ble phenomenon of a much younger child. Her mind is weak' her thoughts are much below her age, and she cannot prosecute any study Avith that rapidity and execution that other girls of her age and opportunities are capable of doing. To what is this to be referred ? Is it not the Avant of energy in the brain 1 or, in other Avords, a lack of mental activity, or development. Other parts of the system seem to be duly developed, according to age; and this Avant of mental balance is OAving to the great demand the hair makes upon the head for nourishment, thereby depriving the brain of a portion which it should receive. Hence the lean- ness of mental development or strength; and it will be found WEARING THE HAIR. 713 that such girls Aveary in studying more than those Avho Avear short hair. Of this the reason is obvious. The brain does not possess as much strength as if it received its due proportion of nourishment Avith the balance of the system. We are ready to admit, that the mind, the product of the brain, is as active, for a short time, as if it possessed more strength: and, perhaps, even more active. But it is not so dura- ble ; in other Avords, it cannot bear the same poAver of applica- tion, as the brain of those Avho never suffer it to be Aveakened by giving the support Avhich is natural to it to another organ. And hence, you see but few ladies, — if, indeed, you find any, — Avho always Avear a heavy suit of long hair, capable of performing that intense and protracted mental labor that men can. The reason of this is not to be sought for in the want of mind, or the organization of its organ, the brain; for it is acknoAvledged that many ladies have as Avell-formed and as fully-developed brains as men have. It is, then, to be accounted for by the fact that they Avear their hair too long, especially at an early age, when the brain is, by its natural groAvth, developing itself, and forming its fibrous structure, in Avhich consists its strength. After the brain has become fully formed, and its fibres devel- oped and strengthened, wearing the hair long Avill not have so much effect upon it; but, even then, a heavy suit of hair, Iavo or three feet long, cannot fail to prove detrimental. We would say, therefore, that children, girls or boys,— but the present fashions are more pernicious to girls than boys, — should not wear their hair more than six inches long, — less would be better,— till they are at least thirteen or fourteen years old. Let the brain obtain its growth, and become strong in fibrous development, before the hair is suffered to draw upon it for an over-balance of support. Even in adult age, you will ahvays see those females who wear their hair not more than a foot in length, and not a heavy suit at any time, possessed of more mental energy, and capable of enduring mental labor for a much longer time, than those Avho Avear very heavy suits of hair. In general, both males and females Avhose hair is disposed to curl, can bear more mental labor than those Avhose hair is ahvays straight, and is disposed to grow very long and heavy on the head. Keep, then, your children's hair short, if you would have them possessed of active and strong, enduring minds; for many years' observation has brought us to the above conclusions. 714 PRESERVATION OF HEALTH. PART VI. OF THE PRESERVATION OF HEALTH. As this work is designed exclusively for families, it is thought that a chapter, in the commencement of this part, on the preser- vation of the health of young girls, will not be out of place. What Ave design to say in this chapter will be applicable to the girl of ten years old and upwards. It is the duty of the mother or guardian so to direct the con- duct of the daughter that she may enjoy the blessings of life, and become a useful member of society. But, in order to lay the foundation of future usefulness, the health should be Avell guarded in early life. Much, of course, depends upon a good constitution, and strict attention should be paid to its develop- ment and preservation. The child, at an early age, should be guarded against all that Avould tend to weaken or derange this desirable attribute of the human system. Exposure is one of the fruitful sources of injury to the consti- tution ; and, therefore, the clothing should ahvays be adapted to the season of the year and the temperature of the air, Avhether children are at home or abroad. Girls are generally clothed sufficiently Avarm Avhile at home; but Avhen they are going abroad, they change their Avarm apparel for thinner and cooler garments. They are often allowed to expose themselves to the chilling blasts of Avinter, Avith their arms naked, their breasts and shoulders exposed, and their feet clad Avith thin stockings and shoes, in the place of those just laid aside, which Avere warm and comfortable. This is a practice that cannot be too much deprecated, being one of the great evils of dress and fashion, upon whose altar thousands have been sacrificed. How many girls do Ave find in these days, with enlarged tonsils, and broken, croaking voices, the fruits of exposure, and nothing else. The practice of tight-lacing is another fruitful cause of de- struction of health and broken-down constitutions. Young girls should not lace at all; an easy, smooth jacket, to make the dress fit smoothly, is all they should wear. Are Ave asked Avhy lacing is injurious? We answer, First: The ribs are soft and very elastic, and the cartilages that join them to the breastbone are softer than the ribs. If, then, a jacket or corset be laced around the ribs or chest so as to prevent a free and full play of the ribs at every inspiration, in the same proportion is the cavity of 'he PRESERVATION OF HEALTH, £ 715 chest diminished, and, consequently, the lungs are deprived of a certain amount of atmospheric air, in proportion to the contrac- tion of the ribs produced by the laced jacket or corset. Thus the order of nature is deranged, and the system is deprived of that due proportion of oxygen Avhich is necessary to health, the vitality of blood, and the vigor and proper proportions of the system. One of the consequences of tight-lacing, therefore, is, that the lungs are prevented from discharging a due portion of carbonic acid gas from the blood, and receiving, in lieu thereof, a due proportion of oxygen from the atmosphere. Hence, the person looks pale, the lips assume a blue or purplish color, the breathing is labored, the breast heaves, and the circulation is prevented from going on as freely as it should. The small air- vessels of the lungs are partially obliterated; they become dis- eased in their action, and tubercles form in them or the lungs, and these remain, to become in a feAv years the seeds of an incurable consumption. Again: The free action of the heart is prevented by tight- lacing; and the consequence is, it labors like a dying man, but in vain. — it cannot get relieved from its fetters. The blood is preArented from flowing Avith that freedom and ease which are essential to the Avell-being of the system, and the violent exer- tions Avhich the heart must make in order to carry on the circu- lation, become the cause of disease in that organ Avhich perhaps can never be cured. Another evil of lacing. The stomach is ahvays included in the deadly grasp of the corsets. The loAver floating ribs are forced to take the place the stomach should occupy in part; the skirts are compelled to groAv too narroAv; the liver is also pressed too closely, and the stomach is bound as Avith a cord. The gastric juice is partly prevented from secreting, and that Avhich is secreted is unhealthy; the ducts of the liver and pancreatic gland are prevented from performing their healthy functions; and, consequently, the food is not taken in due quantity to nourish the system, and Avhat is taken is not properly digested, for the want of a free and healthy action of the digestive func- tions. Dyspepsia is the result, —a feeble, and finally a destroyed constitution; for all the poAvers of nature must act freely and naturally, or a sound constitution and good health can ncA^er be enjoyed. Nothing is so fascinating, to an intellectual young man, as a well-cultivated mind, a rosy cheek, an intelligent eye, and a 716 % PRESERVATION OF HEALTH. corresponding expression of countenance; these you cannot have, if you suppress any of the healthy functions of the system. Exercise is another essential item to promote the health of girls, and this they should be allowed to take freely. At an early age, let them run and play, jump the rope, throAv the hoop, leap and skip; for free exercise gives freedom to the muscles and joints, and strengthens the nerves, all of Avhich are necessary for the building up of a good constitution. Girls should be allowed to sleep one third of their time, or eight hours in tAventy-four; and, Avhen younger, they should sleep more. The young of all the animal creation require more sleep than those that are fully grown. Girls, therefore, should retire early, that they may obtain sleep enough; rise early, and enjoy the benefit of the morning air, which is bracing to their systems. After children are ten years old, they should not sleep more than tAvo in a bed, and there should not be more than two beds in a room, unless the room be very large and Avell ventilated. Girls should rise early, and air and set their rooms in order; they should use a free ablution of cold Avater over their breasts and arms, especially as far as they are in the habit of exposing them to the air, as this will prevent their taking cold as easily as they otherwise Avould. The diet of children should be plain and simple, as their digestive powers are not as strong as those of grown persons. The quantity should ahvays be proportioned to the age and strength of the child. Much mischief is done by letting children eat too much. They should be allowed full time to eat, and be taught to cheAV their victuals Avell. They should be taught to eat anything that is common, so that they may appear easy at table at all times, and make their friends so likeAvise. Frequent bathing is of great service to youth. It invigorates the constitution, and gives a fine complexion. The bath may be changed according to the season; it may be cold, tepid, or salt. When the cold bath is used, either fresh or salt, the skin should be well rubbed Avith a coarse towel, as Avell before thev go into the bath as after they come out. When children are healthy, liquid food is, as a general rule, better for them than solid food, because it supplies more blood, and this is needed to form and build up the solids; but they should be alloAved some of both. Children should ahvays take light suppers and light breakfasts. Their dinner should be of more substantial food and taken more MENSTRUATION. 717 freely. But they should never be allowed to eat in haste, as nothing aids the powers of digestion more than the perfect mas- tication of food. THE TIME OF THE CATAMENIAL VISITATION, OR OF MENSTRUATION. The period of menstruation is an important one, and should be Avell understood by mothers, that they may be the better enabled to give the proper advice to their daughters, in the development of this process. Mothers too often neglect this important point of health, and thus, lasting, if not incurable disease, is brought upon the daughter. Great difference exists as to the period at which females men- struate, not only in different countries, but in our own. The catamenia, or menstruation, generally appears at or about the age of fifteen years; but it appears much earlier in some, and is delayed much longer in others. These variations will be found to correspond with the proportionate developments of the body and the genital system. In an essay on the Natural History of Menstruation, published in the Edinburgh Medical and Surgical Journal, Dr. Robcrton has given a fund of very valuable information on this subject. In the number of four hundred and fifty females, he found that 10 menstruated, for the first time, at 11 years. 19 " " " at 12 " 53 " " " at 13 " 85 " " " at 14 " 97 " " " at 15 " 76 " " " at 16 " 57 " " " at 17 " 26 " " u at 18 " 23 " " " at 19 " 4 " " " at 20 " There are instances of still earlier menstruation than these to be found on record. There is a case related by Dr. Martin Wall, in the Medical and Surgical Transactions, of a child that menstruated at nine months old, and continued regularly from that early age. There is another, in the American Journal of the Medical Sciences for November, 1832, in which the cata- menia appeared at three years of age, and were aftenvards regularly discharged. Many other cases may be found in the writings of Lobstein, Meyer, Plouquit, &c., &c. ri8 MENSTRUATION. All medical Avriters agree, that the warmer the climate, the earlier the catamenia will appear; and the colder the climate, the longer it will be deferred. It is said to make its appearance in the East Indies as early as at the eighth or tenth year, but in Greenland it does not appear before the twentieth or twenty- second year of age. Its duration is pretty equal in all climates. The Avomen in hot climates, Avho menstruate early in life, become old propor- tionably soon; and thus Ave see Avhy women bear children, and live to a much greater age in very cold than they do in hot climates. This is the sum of what is generally given by authors on this Bubject; and, as Avith many other doctrines, this account ia adopted to avoid the trouble of investigation. But there are still some men in the Avorld that are not satisfied Avith all they read and hear, and, consequently, this subject has been more closely examined and looked into; and it has been found, by Dr Roberton and others, that as far as testimony can be gathered, 1 is observed that the same variations as to the commencement of menstruation in this country exist everywhere; but, as a rule, it is neither so much earlier in hot climates as has been supposed, uor so much later in cold climates. The fact which has led to this error is, perhaps, the intercourse A\diich takes place between the sexes in hot climates at a scandalously early period. Hence the instances, but of rare occurrence, that girls sometimes become mothers at the age of ten years. In a perfectly healthy female, the catamenial discharge is thrown off without pain or suffering; but in the present state of society, this is not generally the case. Most commonly, for some days previous to its appearance, the girl has a pain in her head, with general languor and heaviness. She feels indisposed to use much exercise; has some pain in the back, loins, and down the thighs, and occasionally she experiences some uneasy sensations in the throat. There is a peculiar dark shade over the counte- nance, and especially under the eyes; the perspiration has a faint, sickly odor; the breasts enlarge a little, and are more or less painful; the digestion is apt to be somewhat impaired; the appe- tite is variable, and frequently not very good. After these symptoms have been present for a day or two, the catamenia appears, and the uneasiness diminishes. It occasionally happens that the first, and sometimes the second period, passes without any discharge, and the health is not impaired. MENSTRUATION. 719 The period of this discharge is from three to six days, and from three to six ounces of fluid are discharged during that time. The catamenia, to be regular, ought to return every tAventy-eight days in girls and unmarried ladies. Some persons suppose that every discharge from the vagina that is tinged with blood is a menstrual discharge, but this is not true. Every discharge from the vagina that clots is not men- strual ; all that portion that clots is hemorrhage, and that portion which does not clot is menstrual. Keeping this fact ahvays in your mind, you may be ready, in a moment, to decide whether the discharge is a secretion or hemorrhage. The menses are ahvays secreted in the same manner as the sweat is secreted from the skin, and they never come aAvay in lumps, but ahvays in a fluid state. The discharge is at times thicker and darker than it is at other times, OAving to the reten- tion of the fluid in the vagina after it is secreted and before it is discharged. Sometimes it appears in shreds and strings, Avhen it has laid longer, and is still darker. The cause of the dark and stringy appearance of the catamenia is that the fluid part of the blooi is absorbed before the discharge takes place. Menstrual blood has a peculiar smell, differing from the odor of any other blood. The menstrual function is of much importance to the female. By the healthy functions of the uterus it is prepared for the propa- gation of our species, and Avhen the uterus does not perform its proper functions, barrenness is ahvays the result. The healthy action of the system, and general good health and soundness of the constitution, depend very much upon the healthy functions of the uterus. Females, then, and especially young girls, should be extremely careful of themselves during this pro- cess ; and mothers should be particular Avith their daughters on this subject, and know that these things are all right Avith them. Neither girls nor married women should change their clothing, so as to be liable to take cold, or produce a check, during this process. They should, by no means, put on any garment that is wet or damp during this time, and should be careful to keep their feet warm and dry. Some girls are so imprudent that they will place their feet in cold Avater, or expose their feet and legs to the cool air, to check the menses, in order that they may be able to pay a visit, or attend a ball. This practice is but little better than suicide, often laying the foundation of disease, which terminates in death, after 720 NEGLECT OF THE MENSTRUAL FUNCTIONS. an incalculable amount of suffering, and a heavy bill of expense. An imprudent check of the menses by cold often lays the founda- tion of incurable consumption. Seeing, then, that much depends, in future life, upon the regular establishment of the menses, and a strict regard to their uninter- rupted and healthy functions, too much care cannot be taken on this subject. If, by accident or some unaA'-oidable cause, the menses should be checked, they should be restored as soon as possible. For this purpose, place the feet and legs in Avarm water, and, at the same time, sit over a vessel of Avarm Avater, with or Avithout some bitter herbs boiled in it, and remain there till you are in a free perspiration: then Avrap up in bed, and take a tea cupful of warm tea made of the root of vervine. This draught may be repeated every half hour, till the discharge returns; and this will generally bring it back, if it is used imme- diately. If this should fail, take the folloAving pills : Recipe: Aloes Socotrine, Pulv. Rhei, Scammony, —of each ten grains Gum Myrrh, six grains. Form six pills. Take three at first, Avait tnree nours, and take the other three. They may be worked off Avith Avarm gruel. But should not either of these medicines oe at nana, six oi eignt pills of the extract of Avhite Avalnut,—butternut,—or a dose of castor-oil, may be taken. Bleeding in the foot, if there is much pain in the back or uterus, will be of service at this time. OF THE CONSEQUENCES ARISING FROM THE NEGLECT OF THE MENSTRUAL FUNCTIONS. It is of the most vital importance that the functions of the sys- tem be established in a healthy manner, in order to the full and healthy development of the body and constitution, and there is no one function of the system that involves the general health more than that of the uterus. The order of nature is such that the functions of this organ must be performed in due time and in a healthy manner; otherAvise, the general system will, sooner or later, suffer from this defect. When the functions of the uterus should be developed, accord- ing to age and constitution, if they do not fulfil what nature demands of them, some other organ, of equal, and perhaps of superior, vital importance, will act vicariously or sympathetically. RETENTION OF THE MENSES. 721 and strive to supply the place of the natural and healthy func- tions of the organ that fails to do its duty. Hoav often do avc see the lungs taking on a sympathetic action to supply the func- tions of the uterus! But, by supplying this vicarious discharge, the lungs may suffer violence in their structure, and the result has often been pulmonary consumption. If the functions of the uterus are neglected, Ave may ahvays look for the lungs to bear a fearful part in sympathy with that organ. Should there be a scrofulous diathesis or taint in the system. and the functions of the uterus not be performed in a healthy manner, Ave may look for the speedy, and perhaps fatal, develop- ment of scrofula. The stomach and liver, also, bear a heavy portion of the mor- bid train of action arising from the Avant of a healthy develop- ment of the functions of the uterus. Liver complaint, dyspepsia, and all the concomitant train of symptoms, folloAV. The lym- phatic system is sure to suffer, and dropsy may be the result. When Ave take all these things into consideration, Iioav important is it that mothers should attend strictly to the healthy development of the menstrual functions! It is the duty of the mother to explain these things to her daughters, and have the first appearance of derangement attended to, before the foundation of more serious consequences is laid. A neglect of these things places too much at stake; and strict attention should, therefore, be given to this matter. OF RETENTION OF THE MENSES. This disease is often confounded Avith suppression of the menses; but there is an essential difference between them. Retention of the menses is where they have never appeared, though the time of life has arrived at which they should appear. A retention of the menses may be produced by various causes, such as a feeble state of the system, preventing a proper development of the differ- ent organs. There is sometimes a defect in one or both of the ovaries, and then the uterus is not developed, and no catamenia appear. At other times, the ovaries are entirely wanting, and then the catamenia never appear. The patient, in this case, may be robust, and her voice is rather on the masculine order, or deep and holloAV. She has no breasts, or they are very small. Other constitutional diseases, such as scrofula, consumption, diseases of the liver, &c., may prevent the appearance of the cata- menia. A thin membrane sometimes grows over the os uteri BRIGHT. 47 722 RETENTION OF THE MENSES. which prevents the flow of the menses. In this case, the regular menstrual feelings are present every month, but the fluid does not escape. In other cases, the vagina is closed, having adhered together from inflammation produced by erysipelas, or injuries of some kind, such as falls, &c. The hymen is, at times, imperfo- rate, and the escape of the fluid is prevented. In these latter named cases, the remedy consists in removing the defects or deformities. When the hymen is imperforate, the menses are secreted and retained in the vagina; and this can be known by examining the parts, Avhen no passage into the vagina will be found. The membrane is generally pressed out a little; and, by raising it gently by a tap Avith the end of the finger, a fluctuation can be felt above. Treatment.—The treatment of retention of the menses must necessarily vary, according to the nature of the disease, and the cause Avhich produced the retention. The remedy to be used Avhen the hymen is imperforate is, to divide it, by making tAvo incisions across it, and quite through the Avhole substance. This membrane varies in thickness from an eighth to a half an inch: and when it is divided, the long-retained menstrual blood Aoavs out as thick and black as tar. This membrane is sometimes so strong as,to retain the menses till they distend the Avomb, and. in this case, the girl presents the appearance of being pregnant; but, by dividing the hymen, and letting off a quart or tAvo of this fluid, the stigma is taken aAvay, after suffering all that the tongue of slander and the finger of scorn could place upon her. The same thing may occur by the adhesion of the Avails of tht vagina; and this difficulty can only be removed by the skilful operation of a good surgeon. When the mouth of the Avomb is closed by a membrane groAving over it, it must be divided by the use of a proper instrument; after Avhich, a very small bougie should be introduced into the Avomb through the cut made in the membrane, but great care is necessary in the performance of this operation. The bougie should be introduced every third day, till it has been repeated three or four times, in order to prevent the membrane from growing together again. After these obstructions are removed, the case must be treated as the constitutional symptoms demand. We have succeeded several times in curing this disease by this operation. When the retention is produced from the Avant of a sufficient development of the constitution, those remedies that are calculated to develop and perfect, the system must be used. A generous diet, such exer- SUPPRESSION OF THE MENSES, ETC 723 cise as the patient can bear, and lively company, wiil best accom- plish this end; but the patient must wait till nature is prepared to do her Avork. No forcing medicines should be used at this time. When the retention is produced by any constitutional disease, that disease must be removed by using the appropriate remedies. When retention is the result of a defect in the ovaries, the menses never can be brought on. When there is only a partial development of the ovaries, a partial secretion may be induced by bracing and strengthening the system; but it Avill always be imperfect. The patient will never bear children, and it would be better for her not to marry. OF SUPPRESSION OF THE MENSES FROM OTHER CAUSES THAN THAT OF PREGNANCY. There is a period in female life Avhen the menses cease to return; and this is the cessation, and not suppression, of the menses. A suppression of the menses is the ceasing of that secretion after it has been once established, and before the woman has arrived at that age Avhen this secretion should cease. Pregnancy is by no means the only cause of a suppression of the menses, and Ave propose to treat, in this chapter, of other causes than pregnancy for the suppression of this secretion. Any cause that will prevent this secretion, after it has been once established, is worthy of notice in this chapter. Girls are much more subject to suppression from unnatural causes than married Avomen. The most common causes of unnatural suppression of the menses are: anxiety of mind ; cold applied to the body, and especially to the feet; suddenly sup- pressed perspiration; falls, especially accompanied with terror; general debility, after protracted illness; a diseased state of the ovaria; diseased liver or lungs, &c. The digestive functions may be so impaired as to cause sup- pression ; or it may be the result of weakness alone, and, in this case, it is generally the precursor of some violent attack of sick- ness. There is no strength of constitution, or condition of the sys- tem, that may not, from some one or more of the above enumer- ated causes, become the subject of this form of disease. In order to produce a suppression, the causes must generally be applied at or near the time of the flow of the menses, f24 SUPPRESSION OF THE MENSES, ETC. Girls frequently ruin their health by putting on damp clothea at or near the time of menstruation; by going out in cold wea- ther, Avearing thin shoes and stockings; by sitting with damp feet in a cold room; or exposing themselves to an excess of heat, and then to a sudden check of perspiration. The consequence of this is, a check of the menstrual discharge. If they are of a full hnbit, they become feverish, and have pain in the head, back, and loins; the appetite is impaired; they are restless, and cannot sleep well. If this state of things continue, they become pale and lose flesh; the feet and ankles swell in the evening; some derange- ment of the stomach takes place; they become more or less dys- peptic; a cough may supervene, which may terminate in con- sumption if it be not early removed; the breasts shrink and become flat; the joints become weak; and, if the suppression continue long, the lips become pale, and some fine, downy-look- ing hair groAvs out upon the upper lip; the voice loses its former musical sweetness ; the eye becomes languid, and presents an anxious, inquiring look; the bowels generally become costive, and the appetite is deranged. When interrogated on the subject, from false delicacy, or some other cause, they are not apt to give the whole history of the case, and they answer questions reluc- tantly. A clear understanding of the case, Avith all its causes and symptoms, is very necessary to its correct treatment. Girls should immediately apprize their mothers, both of the suppres- sion as soon as it occurs, and of the cause, as far as they are acquainted with it, in order that the proper remedies may imme- diately be used. Treatment.—As soon as it is known that an obstruction exists, if it has been produced by the application of cold to the feet, or exposure to cold, which has acted upon the external sur- face in any Avay, — either as a sudden check of perspiration, cold or Avet feet, or putting on damp clothes, &c., — the feet and legs should be immediately placed in warm water. At the same time, the patient should sit over another vessel of Avarm Avater, in order that the steam may rise around her, till a free perspira- tion is produced. After remaining there for fifteen or twenty minutes, she should Avrap up in bed, take a cup of tea made of the root of vervine, half an ounce to the pint, or drink thyme, balm or sage tea, pennyroyal or mint, and continue the use of the tea ill she perspires freely for an hour or two. Bottles of hot water SUPPRESSION OF THE MENSES, ETC. 726 or bricks heated, wet, and wrapped up in cloths, may be applied to the feet and small of the back. By this course of treatment, the discharge will generally be reestablished; but should it fail, or be neglected so long as to fail to produce the desired effect at that time, when the next period arrives, about the time the discharge should come on, take an active purgative. Recipe : Scammony, ten grains. Aloes Socotrine, twenty grains. Gum Myrrh, ten grains. Form eight pills. Take four first, and the other four in two hours; or, Recipe : Calomel, ten grains. Aloes Socotrine, twenty grains. Race Ginger, ten grains. Form eight pills. To be taken as above; or. Recipe: Extract Butternut, thirty grains. Form six pills. Take them at one dose, and drink freely of warm teas, to work off the pills. If there is no other impediment, the above remedies will generally remoAre the difficulty. But it is too often the case, that girls keep their true situation con- cealed, till some other function of the system becomes deranged ; and then, the above remedies may not be sufficient to perform the cure. In all suppressions or obstructions of the menses, if they arise from any of the above enumerated causes of exposure to cold, a peculiar state of inflammation takes place in the neck of the womb. It is not that kind of inflammation that is consequent from a high degree of vascular action, but one that is peculiar to that organ under such circumstances, and is consequent upon a state of engorgement of the uterine vessels, Avhich always exists in a menstrual state of that organ, but is relieved by the natural flow of the menses. For the cure of the disease, under these cir- cumstances, Ave use a variety of medicines, such as, Recipe: Balsam Peru half ounce. Of which ten drops may be taken, on sugar, three times a day; ar, Recipe: Balsam Copaiba, half ounce. To be taken as above; or, Recipe: Balsam Fir, half ounce. 726 SUPPRESSION OF THE MENSES, ETC. Of which thirty drops may be taken three times a day, on sugar; or, Recipe: Turlington's Balsam, one ounce. TAventy drops of this may be taken three times a day, on sugar; or, Recipe: Spirits of Turpentine, half ounce. Comp. Spirits Lavender, half eunce. Mix, and take a tea spoonful three times a day, in sweetened water; or, Recipe .- Volatile Tinct. Guaiacum, one ounce. Of which, forty drops may be taken three times a day, in water; or, Recipe : Oil Savin, two drachms. Spirits of Ammonia, two drachms. Mix, and give twenty drops three times a day, on sugar. Keep the boAvels open with the following pill: Recipe : Aloes Socotrine, twenty grains. Fulv. Rhubarb, ten grains. Scammony, twenty grains. Castile Soap, ten grains. Race Ginger, ten grains. Form twenty pills-, and give three or four every night, at bed- time, or just as many as will operate once or twice the next morning. If these fail, the folloAving pill may be given : Recipe: Sulphate Iron, two drachms. Sub Carbonate Soda, two drachms. Flour, half a drachm. Mix, and form forty-eight pills. Take one of these pills, morn- ing, noon and night, for three days; and then take two at night, and one morning and noon. Keep the boAvels open with the above purgative pills ; or, Recipe : Sulph. Zinc, two drachms. Pulv. Liquorice Root, one drachm. Mix, and divide into twenty-four powders; take one, morning, inon and night, in sugar and water. All the above remedies have been used, and, in their turn, haAre done much good; but, in addition to these, the following remedies have been used, and have had their advocates: Chaly- beate waters, as Avell as teas, herbs, roots, &c, such as a tea made of sabina leaves, cedar, dittany, vervine root, valerian, Seneca snakeroot, broad-leaf sage, tansey, rue, thyme, gentian, columbo, black hellebore, silk weed—the root—bloodroot, and SUPPRESSION OF THE MENSES, ETC. 727 madder; all of which have had more or less reputation, at dif- ferent times, for removing obstructions of the catamenia. In using any of the above medicines, if the quantity taken should sicken the stomach, the dose should be lessened. It will require, as a general rule, the perseverance of three or four weeks to effect a cure; and, in some cases, where the obstruction has been of long standing, tAvo months. In using the teas made from the above herbs, from a small tea cupful to half a pint may be taken three or four times a day. The roots are stronger, and, therefore, less should be taken at a time. The gums are generally made into a tincture by pulverizing an ounce of the gum, and adding thereto, in a bottle, one pint of good spirits. Shake the bottle every day for fifteen days, and then take a tea spoonful three times a day, in water. For the removal of Avind or cramps from the stomach, the fol- lowing medicine may be given : Recipe : Tincture Fcetida. half ounce. Tincture Castor, half ounce. Mix. Give a tea spoonful, in water, and repeat every fifteen minutes, till the symptoms are relieved. It is not unfrequently the case, that the first return of the menses is almost a colorless fluid. At this time, the folloAving medicine may be given: Recipe: Aromatic Wine of Iron, four ounces. A tea spoonful should be taken, in SAveetened water, three times a day, and continued till the menses are fully established. At every month, when a pain in the back, together Avith a sensation of fulness in those parts, is experienced, the patient should place her feet and legs in hot water, and sit over a vessel of the same, for half an hour, before retiring to bed. This should be repeated every night for three or four nights. It is encouraging to obtain any discharge from the vagina at the regular time ; and by perseverance, a cure will be performed. A blister applied to the loins at this time will frequently aid in bringing on the discharge, and some have used blisters upon the breasts. We have not known them to do good; but, in obstinate cases, where other things fail, they are worthy of a trial. Free exercise should be taken, when the patient is able to perform it, by riding on horseback, jumping the rope, walking. &c. • 728 I PROFUSE MENSTRUATION. The diet, in all cases, should be regulated according to the digestive powers of the stomach, and nothing should be taken that cannot be easily and properly digested. More depends upon the quantity than the quality of the diet; and, therefore, the stomach should never be loaded Avith any kind of food. OF PROFUSE MENSTRUATION. Much has been said and Avritten on this subject, but Ave think that all that is necessary to be said may be contained in a short space. We should recollect that every undue discharge from the uterus is not a menstrual discharge, and, therefore, should not be called excessive menstruation. In order to place this ques- tion on certain and definite grounds, Ave will just say, as we have often said in this work, that pure menstrual blood never coagulates or clots. Any blood discharged from the uterus that will clot, is, therefore, not menstrual blood, although the dis- charge may occur at the regular period for menstruation. To be sure, then, that the discharge is menstrual, Ave must be sure that it does not clot. The discharge may be very thick, stringy, or ropy, and yet not clot. By observing these rules strictly, Ave shall find but feAv cases that are strictly cases of profuse menstruation. There is another fact to be borne in mind, and that is this : — that Avhich would be profuse menstruation in one person, Avould not be so in another. This arises from the fact that the consti- tutions of Avomen vary as much as their temperament. A lady of a weak or delicate constitution may menstruate one ounce per day, and that may be too much for her delicate frame, and, therefore, may by some be called profuse menstruation; and in such a case it might be true. But another lady, of a robust and vigorous constitution, rigid fibre of muscles, and sanguine temperament, Avould menstruate two ounces per day; Avhich, for her, Avould not be profuse. A full knoAvledge of this subject is necessary, in order to enable us to form a correct opinion, and adopt a correct practice. In all cases where the discharge clots, the case is to be cautiously treated as hemorrhage ; but, at the same time, we must keep in vieAV the fact that it is connected Avith menstruation. In those cases Avhere the discharge is profuse, and the evidence PROFUSE MENSTRUATION. 729 shows that it is entirely menstruous, the treatment sh uld be adapted to profuse menstruation only. Treatment.—When the discharge is truly menstruous, whether it is of a natural appearance or vitiated in character, the same remedies are required for its cure. The first thing to be observed is to keep the patient still, and in a cool, comfortable situation. If her boAA'-els are not sufficiently open, give the folloAving med- icine : Recipe : Rochelle Salts, one ounce. Dissolve in a glass of cool AArater, and take it at one or tAvo draughts, half an hour apart. The patient's drink may be of a cooling, acidulated kind, such as orangeade, or cream of tartar in Avater. After the boAvels are freely acted upon, if the dis- charge is still too profuse, give the following: Recipe: Sugar Lead, twenty grains. Pulv. Opium, two grains. Mix in six poAvders. Give one every tAvo hours, in sugar and water, and keep still. As soon as the discharge is checked, give a dose of castor-oil. The hips and abdomen may be lightly bathed Avith vinegar and water, moderately cool, Avhile she is taking the powders; and by all means let the mind be kept tranquil and cheerful. If the feet should be cold, as they are sometimes, they should be Avarmed by wrapping them in dry, warm cloths, and not by warm Avater, or anything that Avould afford steam, for that would relax the surface, and increase the discharge. If the sugar of lead and opium cannot be procured, a solution of alum-Avater may be taken. But the patient must be very cautious not to take too much of it. A lump as large as a hazel- nut, dissolved in a pint of Avater. will be enough to be takeu in one day. All the powerful vegetable astringents have been brought into use for the purpose of checking this secretion. ButfeAv of them. hoAvever, have been retained; and perhaps a tea made of the sycamore bark, or chips, is as good as any of them for this pur- pose, The following is a valuable remedy: Recipe : Prussiate of Iron, thirty grains. Powdered Liquorice Root, sixty grains. Mix, and divide into ten poAvders. One may be taken every iix hours, in sugar, till the discharge is checked 730 PROFUSE MENSTRUATION. Profuse menstruation rarely observes the regular periods for its return, but comes on every tAventy-two or three days, though some Avomen have a return every tAvo weeks; notAvithstanding which, they become pregnant; but cases of this kind are rare. The radical cure is to be performed by using proper remedies during the intervals. And these remedies are, a generous diet, and moderate but regular exercise, either on foot or on horse- back. The patient should take strengthening medicines, such as, Recipe: Rust of Iron, half ounce. Divide into tAventy-four poAvders, and take one three times a day, in sugar; or, Recipe: Sulphate Zinc, two drachms. Divide into twenty-four poAvders, and take one three times a day, in sugar; or, Recipe : Iron Scales, (from an anvil,) one ounce. Put these into a quart of good vinegar, and take from a tea to a table spoonful three times a day, as the patient's stomach will bear it. it should be mixed Avith Avater before it is taken. A good vegetable tonic may be made by taking: Recipe : Yellow Poplar Bark, one ounce. Columbo Root, one ounce. Orange Peel, half ounce. Make all fine, and add to them one pint of Avater. Shake the bottle every day for six days, and then take a table spoonful, in water, three times a day ; or, Recipe: Gentian Root, half ounce. Orange Peel, half ounce. Carbonate Iron, one ounce. Make all fine, and add to them one pint of whiskey and a pint of water. Prepare as above, and take in the same Avay. If the patient Avear corsets at all, she must Avear them very loosely, that the blood may have a fair chance to be equally dis- tributed through the system. Where the menses are profuse, and the patient full of blood, with a rigid fibre of muscle, the treatment should be different, both in the attack and in the interim. During the attack, she should be purged more freely, Avith the folloAving medicines: Recipe: Scammony, Rhubarb, Jalap, Castile Soap, — of each ten grains. PAINFUL MENSTRUATION. 731 Form eight pills. Give four first, and repeat two every three hours, till they operate freely. This medicine should be given two or three days before the expected return of the menses, and repeated every day till they do return. The patient should keep still. Her diet should be light, and her drink cool. All excitement should be avoided. The bed- chamber should be well ventilated, and if the patient be a married woman, she should keep apart from her husband for several days previous to her attack. When it comes on, the same reme- dies may be used as in the first species; but the case should be treated very differently in the intervals between the visitations of the catamenia, Avhen, instead of taking tonics, she should keep the bowels open Avith gentle, cooling medicines, such as, Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap, — of each twenty grains. Tartar Emetic, three grains. Form twenty-four pills, and take three or four of these pills every night, at bedtime. The patient should take free exercise in the open air, and live on a light diet. A self-possession of mind, in every instance, is absolutely necessary to the perform ance of a cure. OF PAINFUL MENSTRUATION. This form of disease has many varieties, all of which we shall treat in this chapter, in regular order, and give the symptoms and treatment for each in its regular place, immediately folloAV- ing the description and cause of the disease. The distinctive mark of this disease is not the quantity of menstrual fluid discharged, for this may be scanty, profuse, or in the proper quantity; it consists in the pain Avhich is experienced before the discharge appears, and during its continuance. The amount of pain varies very much in different individuals, and in the same individuals at different times. The pain may be moderate, and last only a few hours at each menstrual period, or it may be so severe as to cause fainting, and, by repeated shocks, break doAvn the constitution and entirely destroy the patient's health. The character of the pain, and its accompanying symptoms, vary, according to the constitution of the subject; and, on this ground, the disease may be divided into three forms: — the nervous, the inflammatory, and the mechanical. 732 PAINFUL MENSTRUATION. Difficult menstruation may occur at any menstrual period, and it is rarely confined, after it has occurred, to one or two periods only. In some cases, it may be traced back to the com- mencement of menstruation, and occasionally it continues through the Avhole of menstrual life. FVrsl. Nervous, painful menstruation may attack females at any age. but the attacks are more frequent after the thirtieth year than before that period. It is to be found in unmarried Avomen, and in married Avomen who have not borne children, more frequently than in those Avho have borne children. It is almost exclusively confined to those of a nervous temperament, and thin, delicate habit of body. The monthly paroxysms present all the peculiar characteristics of an irritable state of the nervous system. A day or tAvo before the paroxysms come on, there is a sensation of general uneasiness, and a deep-seated feeling of cold; some patients say their bones feel icy cold. A pain in the head may precede or succeed the discharge, and sometimes the pain in the back and head alternate, being first in one place and then in another. When the pain is in the back, it commences low doAvn, extends round to the abdomen, and goes doAvn the thighs. In some cases, the pain is constant; in others, it abates occa- sionally. The amount of suffering varies very much at different times and in different individuals. In some cases but a feAv hours elapse, after the pain attacks, till the menses appear; Avhile in other cases it will be a day or Iavo before they appear. These pains are generally attended Avith a sense of bearing down, Avhich adds very much to the suffering of the patient. Finally, the menses appear, sometimes slowly and sometimes in slight gushes. The quantity varies very much in different persons, and in the same person at different times. The discharge is sometimes dark, and at other times paler than usual, or mixed Avith small clots. There is sometimes a peculiar membrane discharged, first described by Morghani, and after- wards by Dinman. This membrane is composed of plastic lymph, such as Ave see throAvn up by children laboring under croup, and Avhich generally takes the shape of the inner surface of the uterus ; but it is sometimes discharged in shreds. When the figure of the uterine cavity is preserved, it may give rine to suspicions of pregnancy; and some ignorant persons have actually defamed the character of girls and AvidoAVS, on seeing this PAINFUL MENSTRUATION. 733 membrane. But such defamation arises from a want of knoAvl- edge on the subject, and the discharge of the membrane is no proof of a Avant of chastity in the suffering female from Avhom it has proceeded. If the little bag be slit open, a small quantity of fluid Avill be found in it; but it possesses neither the substance nor vascularity of after-birth, nor is there any point to Avhich a navel-string has been attached. The expulsion of this deciduous membrane is attended with pains like those of labor. Some patients discharge this bag at several successive menstru- ations, Avhile others only discharge it occasionally. Several of our best authors on midwifery suppose this mem- brane to be secreted at every difficult menstruation, and that it passes off unobserved. We are, hoAvever, of a different opinion. Although these membranes do occur occasionally, yet they do not occur at every menstrual flux. Conception is very rare under these circumstances, yet it may and does occur occasionally. At the menstrual period, the mouth of the Avomb is more open than at any other time. It is soft, and slightly SAvollen, Avith an increase of heat in it. The appearance of the menses is not, in this form of the disease, immediately folloAved Avith relief from pain, as it is in the next species to be described; but the pain sub- sides gradually, alternating with pain in other parts, as the teeth, face, &c. The pulse, during the attack, is rather loAvered than increased in strength; the patient has no fever, and is not appar- ently Aveakened by the attack. Each attack may last from tAventy- four hours to four or five days; after Avhich time, the patient generally resumes her ordinary employments. She may have a continuance of headache; the boAvels are regular, and the appe- tite is generally but little impaired. We have now described the symptoms and progress of this disease, as Ave have generally found it. But we should neither do the subject justice, nor act fairly, were Ave not to give another vieAv of it, which is too often presented to the close inquirer after truth. We have seen cases where the patient's health, during the interval, Avas much more seriously affected, being liable to returns of severe headache or pains in the back, so intense, and so much aggravated by Avalking, that they Avere obliged to lie on the sofa, or remain almost constantly in bed; and, as the natural conse- queuce of suffering and confinement, the functions of the stomach and boAvels became impaired, and the general health seriously injured. Causes of painful menstruation.—The causes of painful men- 731 PAINFUL MENSTRUATION. struation are various. A cold—especially if taken during men- struation, or after a miscarriage, or delivery—Avill often induce a severe attack. Sudden shocks, mental emotions, acting upon an irritable condition of the womb, may also give rise to an attack. especially if applied at or near the menstrual period; and any cause that will bring about an enfeebled condition of the system will be attended Avith similar results. The only mistake at all likely to be made is, the confounding of one of these attacks with abortion, or miscarriage. And this is made on account of the paroxysms of pain and bearing doAvn, and this error becomes more plausible when the membrane already described is discharged entire. But if the case is one of disordered menstruation, we shall find that the patient has been regular every month, and perhaps has had a similar attack a month or two before. And this, at once, decides that it is not pregnancy. But, in addition to this, the discharge Avhich accompanies abor- tion is decidedly blood; and this is a menstrual discharge. The quantity is greater, hoAvever, than in ordinary menstruation; but it Avill not clot, and it has the odor of menstrual blood. If a membrane should be discharged, it contains nothing but water, and of course no foetus is detected, since there is none there. The external surface differs more from an after-birth than the internal. On the after-birth, we find more or less of the corion; but on this membrane, we find none of it, hoAvever rough it may be. It differs very much from the other,—indeed, it bears no resemblance to it Avhatever, and a correct decision as to which of the tAvo it is, is speedily made. Treatment. — The indications of cure are two-fold: First, to mitigate the pain, and reduce the suffering during the attack; and, Second, to prevent a return of the disease, by appropriate rem- edies administered in the intervals. Our principal reliance, for the first part, is to be placed in seda- tives. When the pain in the back first commences, the following medicine should be given: Recipe : Calomel, ten grains. Aloes, Rhubarb, — of each twenty grains. Form ten pills. Give five of these pills at first; and, if they should not operate in three hours, give three more. If they do not operate Avell in three hours, give the remaining two. Work PAINFUL MENSTRUATION. 735 them oft with gruel or chicken-Avater, and take nothing cold till the operation is over. If the pain still continues, give the fol- 'owing: Recipe : Opium, four grains. Gum Camphor, ten grains. Castile Soap, four grains. Form eight pills. Give one every half hour, till the pain is removed, when they may be discontinued. Or, you may use the folloAving clyster: Recipe : Laudanum, two drachms. Tinct. Fcetida, half ounce. Mix. Give two tea spoonfuls, in half a pint of thin gruel, a little warm, in the form of an injection; after receiving Avhich, the patient should lie very still, as long as she can retain it. Should it pass off, and the pain still remain, it may be repeated every hour, till relief is obtained; or, Recipe: Pulv. Camphor, twelve grains. Carbonate Ammonia, six grains. Mix in six papers, and give one every hour, in sugar and water, till the pain is relieved; or, Recipe : Morphine, one grain. Scammony, twenty grains. Mix in four papers, and give one every tAvo hours, in sugar and water, till the pain is relieved; or, Recipe : Tincture Castor, two drachms, Laudanum, one drachm. Acetate Ammonia, one drachm. Mix; and give a tea spoonful, in Avarm tea, every half hour, till the pain is relieved. The ergot will sometimes do much good in these cases. Recipe: Pulv. Ergot, one drachm. Divide in twelve papers, and begin their use three days be- fore the expected attack; take one poAvder, morning, noon, and nigct, in a little sirup, being careful to keep the feet dry, and tc avoid over-heat. Bathing the feet in warm water every night. for a few nights before the attack, will be good, but especially so when it comes on. The bowels must be kept open, all this time, with, Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, — of each twenty grains. Gum Myrrh, ten grains. 736 PAINFUL MENSTRUATION. F->mi fifteen pills. Take three or four at bedtime, andj if they should not operate by morning, take tAvo or three more; or, Recipe : Fol. Senna, one ounce. Epsom Salts, one ounce. Make a strong tea of the senna; dissolve the salts in it, and take half a tea cupful every hour, till they operate Avell; or Recipe: Castor-Oil, one ounce. Vinegar, half ounce. Warm, and mix them for a dose. If none of these medicines can be obtained, take a purgative of any gentle medicine you may have. The second indication. — During the intervals, every means should be made use of to strengthen the patient and to lessen the general and local irritability. To this end, the diet should be generous and nourishing, and free exercise should be taken in the open air once or tAvice daily. If the patient is not able to walk, she should ride on horseback, or in an open carriage. Chalybeate water, or some of the preparations of iron, should be given: Recipe: Tinct. of Iron, one ounce. Vitriolated Ether, one ounce. Mix, and give tAventy drops, in Avater, just before breakfast, dinner and supper; or, Recipe : Sulphate Iron, one drachm. Sub Carbonate Soda, one drachm. Pulv. Gum Arabic, half drachm. Form thirty pills. Give one three times a day, for three days, and then give Iavo three times a day, for a month. The folloAving medicine has been used successfully by several eminent physicians: Recipe: Tinct. Cantharides, half ounce. Tinct. Cinnamon, two drachms. Mix, and give twenty drops three times a day, m water. If there is any difficulty produced in making water, the use of the drops must be discontinued, and slippery-elm or flax-seed tea must be taken freely, till that difficulty subsides, when the drops may be taken again. The difficulty in making Avater should be produced tAvo or three times, to have the full effect of the medicine. The following medicine is good: Recipe: Volatile Tinct. Guaiacum, one ounce PAINFUL MENSTRUATION. 737 Of Avhich a small tea spoonful may be taken three times a day, in water, and continued for a month. Dr. Dewees says the pain is sometimes increased the first visitation after taking this medicine, but, if persisted in, it will produce a cure. Dr. Chapman recommends very highly the use of Seneca snakeroot, which should be taken in the intervals of menstrua- tion. A day or two before the expected attack, a blister, applied on the sacrum, beloAV the small of the back, and allowed to stay till it draws Avell, will often do much good. Great benefit has also been experienced from the use of the cold or tepid Avater, throAvn into the vagina every day, during the intervals; but, on the approach of the attack, Avarm Avater must ahvays be used. The patient should take a hip bath every night, for tAvo or three nights previous to the eruption of the menses. This disease is sometimes very obstinate, resisting all remedies for months, and sometimes years. In most cases, however, we can, by the use of the above remedies, effect a cure in a few months. It rarely lays the foundation of any fatal disease ; and, should all our efforts proAre fruitless, the patient may look forAvard to the time of the cessation of the menses, knowing that she will then meet Avith a perfect cure. The second variety Avhich we propose to notice is the inflam- matory, painful menstruation. This species differs very materially from the one described above, not only in its symptoms, but also in its subjects. It occurs in females of a full habit, of the sanguine temperament, and at an earlier age than the kind previously described. Unmarried women are very liable to be afflicted in this Avay. It generally comes on suddenly, and is caused by cold, or some violent constitutional disturbance. Young girls of a plethoric habit are liable to suffer slight symptoms of it at every catamenial visitation; but marriage cures this form of the disease. In the milder form, there are but few precursory symptoms; DUt the more violent forms of the disease are preceded by restless- ness and rigors, with some fever, and flushing of the face, and general headache. For some time before the appearance of the catamenia, the patient suffers with pain across the back, and an aching sensation is felt in the limbs; a weariness of the Avhole system, and intolerance of light, are apt to supersede the Aoav of the menses. The face is flushed, the skin hot, the pulse full and strong, and upwards of one hundred beats in the minute. BRIGHT. 48 738 PAINFUL MENSTRUATION. Ill some cases, the fever rises so high that delirium comes on; Dut Avhen the Aoav takes place, all these symptoms subside. The time that elapses between the first appearance of the pain and the flow varies very much at different times and in different subjects; but less, perhaps, than in the preceding form of this disease. The discharge, in this form of the disease, is more abundant, and is also occasionally accompanied with a membrane similar to that discharged in the first species. During the intervals, the health of the patient is very little affected. She sometimes has a slight pain in her head or side, but this is not constant, and generally is not much noticed either by the patient or her friends. It is not uncommon for a patient laboring under this disease to be afflicted slightly with the whites between the periods of menstruation, and this is rarely the case in the former species. The severe symptoms may occur with every menstrual dis- charge, but they are not so regular in their intensity as they are in the nervous form of this disease, and occasionally a period will pass Avith but little suffering. If the neck of the uterus be examined during tliis time, it will be found more than usually full, Avith a considerable increase of heat in the parts; but no tenderness will be felt on external pres- sure above the pubis. The breasts not unfrequently SAvell and become painful at this time, OAving to the great sympathy betAveen them and the uterus. A severe attack of this disease will disqualify the uterus for im- pregnation for sometime afterAvards; but slight attacks will not prevent conception. Indeed, marriage is the best remedy for this disease; but, even then, discretion and judgment should be used. Treatment.—In the commencement of the attack, Avhen the patient is laboring under fever, pain in the head and back, and is restless, tAvelve or fourteen ounces of blood should be taken from the foot Avith the lancet, or six or eight leeches should be applied to the insides of the thighs. But if neither of these can be done, though we are not much in favor of bleeding from the arm in menstruation, yet, rather than fail to take blood, it must be taken from the arm. The bowels should then be freely acted upon with a cooling purgative; as, Recipe: Rochelle Salts, one ounce. Or, Recipe; Epsom Salts, one ounce. Or ' Recipe: Seidlitz Powders, one ounce. PAINFUL MENSTRUAT ON. 739 Either of which may be dissolved in a glass of cold water, and taken at one or tAvo draughts. Cooling drinks, a light diet, and absolute rest, should be enjoined ; and these remedies will often give speedy relief. The depletion must not go too far, or the flow will be prevented. If, after the operation of the medicine, the flow is not sufficient we may give, Recipe: Pulv. Camphor, six grains. Pulv. Opium, one grain. Mix in tAvo poAvders, and give them, in sugar and water, two hours apart. Take a cup of Avarm tea, and cover up in bed. During the intervals, active exercise should be taken on foot. The diet should be light, all stimulants avoided, and the bowels kept open by the folloAving medicine : Recipe: Aloes Socotrine, forty grains. Pulv. Rhubarb, twenty grains. Scammony, twenty grains. Caslile Soap, twenty grains. Tartar Emetic, three grains. Form thirty-six pills, and take three or four every night, at bedtime, or just as many as Avill operate once or twice the next morning. The drink may be cool Avater. These remedies must be varied to suit the constitutions of the different patients who have to use them, as some will require more, and some less, for a dose. But a little observation, and some judgment, will direct in this matter. I have found the folloAving remedy to be of great service in painful nervous menstruation. It should be taken for one or two days before the return of the menses, a tea spoonful three times a day, and, if that quantity should not keep the bowels open, a little more should be taken: Recipe : Tincture of Actea Racemosa, two ounces. To be taken as above directed, and continued till the flow is established; then stop. Third. The mechanical difficulty in menstruation consists simply in a narrowing of the vagina, which may be caused by inAammation, or it may be a natural defect. This variety has been met Avith by Drs. Chapuron, Mackintosh, of Edinburgh, Orailly and Churchill; but such cases are very rare. In short. the narroAving of the vagina constitutes but little of the com- plaint ; yet, Avhen it does exist, it certainly should be remedied. In order to ascertain the facts in this case, an examinatioi 740 CHLOROSIS. must be made; and when the sufferings of the patient are violent an examination should by all means be made. The finger should be passed gently into the vagina, and, if there be an obstruction, the finger must be withdrawn. Care must be taken not to rupture the hymen or vagina. If a closure of the vagina be met with before you reach the mouth of the Avomb, it may be safely regarded as the cause of the patient's suffering. In order to remove this obstruction, the folloAving medicine should be used: Recipe : Extract Belladonna, twenty grains. Warm Water, one pint. Dissolve the extract in the water, and inject it into the vagina with a Avomb syringe, keeping the hips raised so as to retain it as long as possible. It should be retained for ten or fifteen minutes. when a small-sized bougie must be passed very gently through the little passage already relaxed by the belladonna. Let the bougie remain for five or six minutes, and watch the patient. that she may not be left in a fainting condition. After this, give a cooling purgative, and in two or three days repeat the opera- tion. This treatment must be continued, till a number six bougie can be passed, without using the wash, when this remedy has been carried far enough. The case must then be treated as the other symptoms demand, according to the second form of this disease. The operation above described should always be performed with the patient's hip lying over the edge of the bed. {See chap- ter for turning a child in labor.) In passing the bougie, care must be taken not to turn the point up tOAvards the pelvis, or the vagina may be injured, and inflammation produced, and serious consequences folloAV. In such a case, bleeding and purging would be needed to reduce the inflammation; when, perhaps, these remedies would be contrary to the proper course of treat- ment which the original disease required. CHLOROSIS, OR GREEN SICKNESS. The characteristic symptoms of this disease are, a pale com- plexion, languor, listlessness, depraved appetite and digestion, and the menstrual secretions depraved or inert, especially at their commencement. The causes of this disease are numerous, of which one of the most frequent is retained or suppressed catamenia. Another is excessive menstruation; a third, an inability to obtain the object CHLOROSIS. 741 of desire, — 'n popular language, love-sickness; — and a fourth, dyspepsia, or some other cause of general debility about the age of puberty, by which the natural development of the sexual system, and the energies of its secretions, are at this time interfered with. A pining, eager, ungratified desire for any object whatever, in a particular state of constitution,— whether for an individual or for a particular circle of society, for home or for country,— is Avell knoAvn, in many cases, to break down the general health, and to lay a foundation for chlorosis, or a chlorotic condition of the system. Men are liable to become chlorotic, as well as women. Retained menses and dyspepsia in women, at the age of puberty, are, perhaps, the most common causes of chlorosis ; and hence the declaration of some writers on this disease, that chlo- rosis and dyspepsia are inseparably connected together. Chlo- rosis may, and does, occur in females Avho have an interruption of the menstrual Aoav. A derangement in quantity or quality is always an attendant on chlorosis; and, in many cases, the lead- ing symptoms of the disease. Chlorosis is characterized by a diseased state of the genital system operating on the system at large; and hence, it is most frequently met with at the age of womanhood. A certain state of the genitals is necessary to give tone and energy to the whole system; and, therefore, if this stimulus is wanting, the Avhole system may fall into a flaccid or torpid state, and from thence chlorosis may arise. There are evidently two statef of constitution in which this disease may occur. First. In those persons of a feeble habit, Avith a full and tense pulse, who are subject to severe pains in the head or bones. The ordinary cause, in this species, is taking cold in the feet at the time of the menstrual discharge. The pains in the back and loins, and often in other parts, evince a local debility, ar»d an increase of irritability, with more or less of spasms in the organs which form the seat of the disease. There is here a morbid accumulation of living poAver; the parts are satiated or over- loaded ; and hence, proper secretions are prevented from taking place. If the disease is neglected in this stage, it will terminate in the other species presently to be described. But Ave will here finish this part by giving the treatment. Treatment — The cure for the disease in this plethoric state 742 CHLOROSIS. of the patient calls aloud for depletion, and free bleeding aviII be found to be indispensible. Perhaps it may be necessary to be repeated. Cooling purgatives should be administered; such ?a, Recipe ■■ Epsom Salts, one ounce. Or, Recipe: Rochelle Salts, one ounce. Or, Recipe . Cream Tartar, half ounce. Milk of Sulphur, half ounce. Mix. Any of these may be given, in Avater or sweetened water. If the patient feels much pain in the back or hips, the hip bath must be used, and repeated, if necessary. When the fulness of the blood-vessels is subdued by this treatment, enjoin a low diet, regular hours, regular exercise, a sober, temperate mind, and she will soon enjoy good health. The second species, namely, that form of the disease which originates from debility, is characterized by a feeble state of body, great inactivity and love of indolence, and shortness of breath on much motion; the feet and ankles are cold, and savoI- len at night, the pulse quick and feeble, the mind becomes ener- vated, and the temper fickle, Avith great irritability. All these symptoms are to be met Avith in a much greater degree than in the first species, evidently showing a great disturbance of the general system. We rarely find these patients in the quiet and sober retreats of a country life, marked by simple meals, healthful activity, and early hours of retiring and rising. They are to be found in the gay and glittering retinue of toAvn and city life, where the young and old crowd into close parlors, and exercise till the midnight has long passed by, and then turn out into the chilling blast of winter, heated and lightly clad, bareheaded, and bare- necked. The havoc thus produced is to be seen in the pale and bleached face, the withered form, emaciated muscles, and departed symmetry, of those who were once the perfections of beauty and pictures of health. And thus, Avhen nature is per- verted, beauty becomes food for Avorms, at an untimely hour. Under the influence of such fashion, it is impossible for a growing girl to acquire a healthy maturity. Most happily for her, in folloAving up the fashions of the day, she must go into the country to spend a summer, and thereby obtain a respite from the privilege of self-murder. DISEASES OF THE CLITORIS, ETC. 743 Treatment. — In the treatment of this form of the disease, we can use neither the lancet nor active purgatives. The bowels, hoAvever, must be kept gently open with mild purgatives, such as Recipe : Pulv. Rhubarb, one drachm. Castile Soap, half drachm. Aloes Socotrine, twenty grains. Form twenty-four pills. Give three or four of these pills every night at bedtime, or just as many as will operate once or tAvice the next day. The blood must be recruited by tonics, such as, Recipe : Rust of Iron, two drachms. Gum-Arabic, twenty grains. Form twenty-four pills, and give one three times a day; or, Recipe : Steel Dust, one drachm. Vinegar, one pint. Put the steel dust into the vinegar, and shake the bottle every day for three days ; then take a tea spoonful three times a day, mixed in Avater; or, Recipe: Sulphate Iron, one drachm. Sub. Carb. Soda, one drachm. Form thirty pills, and give one three times a day. This will correct the menstrual discharge, which is always more or less depraved, in quality and quantity. All the bitter tonics are more or less admissible in this disease. A generous diet is necessary, and regular hours for rest and rising must be observed. Let these both be early; take exercise in the morning air, ride on horseback, keep cheerful company, lay off your tight corsets, dress warm and easy; do not let your mind be so weak as to love those who will not love you. Let the manner and matter of your life be such as will give you good health and an intelligent mind, and you will be more likely to obtain your desired objects, of rank, love and happiness. OF DISEASES OF THE CLITORIS, OR HERMAPHRODITE. The clitoris has been occasionally the seat of scirrhus and cancer; and when this is the case, the patient should immedi- ately send for a surgeon, and submit herself to an examination, so that the parts may, if possible, be removed, as no other rem- edy will hold out a prospect for a cure. The excessive enlargement of this organ has, by a 'tirgical 744 INFLAMMATION OF THE HYMEN. operation, resulted in the happiest effects, fortunately for the ladies of the United States, they are not much subject to this disease. The existence of hermaphrodites has gained the assent of many of the illiterate; nevertheless, the facts in the case will prove that no such being exists in the human family. Frequent appeals to the physician are made on this subject; and some, either from ignorance or from a desire to gratify the public mind, assent, or say that their existence may be possible. But when Ave come to examine these parts, and compare them with those of the male, we find that, both externally and internally, they differ very materially; and, therefore, the whole world has not produced one Avell-attested case of the kind. Nor do the in- stances of the other mammalia, purporting to be of this kind, bring any proof of the fact; for every case hitherto produced, and examined by judges of the anatomy of these parts, has proved to be that of a defect in the organization of the parts, and not of an hermaphrodite. It is contrary to the organization of animal nature that one person should possess both sets of the organs of generation. So fully satisfied of this fact are the judi- cial physiologists, that their decisions are, that it is impossible that both sexes should be combined in one individual of the same species. OF INFLAMMATION AND TOO GREAT DENSITY OF THE HYMEN. Some anatomists doubt whether there exists such a membrane as the hymen, nor is this subject yet decided by them. Indeed, it is not a matter of much consequence whether it ever is or can be settled, if the same mode of reasoning be folloAved by those who deny its existence; for, if we attempt to demonstrate its existence, they, like Ambrose Pare, declare it to be an unnatural production. Now, if the occasional absence of a production is to be assumed as the natural condition of the parts, in defiance of its frequent presence, it would confound all our philosophy, and set aside a thousand matters of fact. All that has been argued by philosophers amounts to this negative; see Fallopius, Visa- lius, Degraaff, Buffon, and many others, who say they did not ahvays find the hymen when they sought for it. But is this a reason that such a membrane does not exist in the properly organized parts 1 If the existence of the hymen be denied, it would be improper to talk of its imperforate state. INFLAMMATION OF THE HYMEN. 745 Of the imperforate state of the hymen Ave know but little from personal observation, having seen but one case in thirty years' practice. The most, therefore, that Ave can say on this subject, must be derived from others; and, as this'is, in many respects, an important subject, Ave shall avail ourselves largely of what they have seen and said. When the hymen is imperforate, the first inconvenience is experienced sbon after puberty. The menstruous fluid is duly secreted, but not finding an outlet, it accumulates from time to time, till the vagina is completely filled. Afterwards, the uterus becomes distended, and this distension may continue to increase till the abdomen presents the appearance of pregnancy before the true cause is discovered. Dr. Denman relates an interesting case of a young lady, who, after hearing the ill-natured suspicions of those around her, submitted to an examination, which eventuated in the discovery of the imperforation of the hymen. The doctor says: " The circumscribed tumor Avas found to reach as high as the navel, and the external parts were stretched, by the pressure of a round, soft substance at the orifice of the vagina, in such a manner as to resemble the appearance which they have when the head of a child is passing through them. But there Avas no entrance into the vagina. On the following morning, there was an incision carefully made through the hymen, Avhich had a fleshy appearance, and Avas thickened in proportion to its dis- tension. Not less than four pounds of blood, of the color and consistence of tar, Avas discharged. The tumefication of the abdomen was immediately removed. When the hymen is imperforate, the Avoman suffers pains at each return of catamenia, not unlike those of labor. They have, indeed, been mistaken for labor-pains. Dr. McCauly confesses that, in one case, he mistook the protruded hymen for the mem- branes forced down by labor. The patient Avas relieved by an incision being made through the dense hymen, and the discharge of the menstruous blood. Dr. Denman, Dr. Frank, Drs. Smellie and McFinny, and Mr. Coby, have all related cases in which the abdomen was more or less distended, and the Avoman suf- fered more or less at each menstrual period; and all Avere relieved by dividing the hymen; some, however, not submitting to the operation, till their characters Avere well-nigh ruined from a sup- position of pregnancy. The blood, in every case, Avas of a men- strual character; it did not coagulate, nor was it in the least fetid. It was, however, thick and dark, evidently showing that 746 INFLAMMATION OF THE HYMEN. it is a secretion of its own kind, and neither blood from a hemorrhage nor from a vein. The membrane, in these cases, ia sometimes half an inch thick or more. The operation consists in dividing the membrane with a sharp instrument, and after the blood is fully discharged, making three or four mytriform cuts, so as to insure a sufficient passage for the escape of the menses when they shall appear again. Care should be used to prevent the cuts from growing together, till the edges of the membrane heal. This may be done by keeping a small roll of silk, Avell oiled, and passed through the cuts into the vagina, and retained there for a feAv days by the T bandage, till the parts are perfectly healed. The menstruous blood is, to all intents and purposes, an extra- neous fluid to the womb, Avhen retained there. The greatest sur- prise is, that, the womb should not continue to contract, Avithout ceasing, as long as this fluid is retained; but this is not the case, for after they continue for a certain time, the Avoman enjoys a state of ease. Nor is this calm disturbed, until a hcav secretion produces an increased distension of the womb, when that organ is again provoked to contraction. The previous calm is most probably OAving to the absorption of the thinner parts of the fluid, or to the uterus accommodating itself to the distension. The discharge of urine, and the evacuation of the feces, are not unfrequently interrupted by the weight and pressure of this fluid. In Mr. Finny's case, convulsions were frequently pro- duced. He divided a hymen Avhich was more than an inch thick, and this is a most unusual thickness. Mr. Burns, on the contrary, has generally found the membrane thin ; and, by putting the experience of both gentlemen together, we may expect the membrane to be from one quarter to three quarters of an inch thick. In a case Avhich came under our own observation, it was about half an inch thick. The quantity of fluid discharged is sometimes very great, but the average quantity is from one to tAvo quarts. Benevolies' case, related by Mr. Burns, makes the quantity thirty-two quarts, but it is reasonable to suppose that some dropsical secre- tions Avere mixed with it. In all these cases the blood was fluid, and there was no coag- jltim present. The remedy, in all cases, is the same as above stated. Great care should be used, when the hymen is thick, and the patient old, lest the peritoneum be wounded, and inflamma- INFLAMMATION OF THE HYMEN. 747 lion ensue. Drs. Denman and W. C. Worthington both cite cases in Avhich inflammation of the peritoneum succeeded to the operation, and proved fatal to the patient. One of these Avas the case of a girl only fourteen years old; and there is a case related in the Medico Chirurgical Review, by Professor Langenbock, very analogous to those above, which also proved fatal. In order to avoid the cutting of this membrane, the case should be treated with palliatives, till the hymen becomes distended and protruded, before the operation is performed. The hymen is sometimes extremely dense, but sufficiently perforate to let the catamenia pass. Conception may take place, even under these circumstances; and a number of cases may be found on record of this descrip- tion, in which the birth of the child Avas obliged to be accom- plished by dividing the membrane Avhile the Avoman Avas in labor. Doctors Hildanus, Pare, Ruyseh, Meriman, and many others, mention such cases. The late Dr. C. Carie invited Doc- tors Dewees and Chapman to Avitness a case of this kind. The Avoman had been in labor with her first child for tAArelve hours when they saw her. The pains Avere strong and frequent; the perineum Avas very much distended, and alone supported the efforts of the uterus ; the os externum Avas entirely closed, with the exception of an opening about the size of a goose-quill; and this had been her situation for several hours before they were called in. As all chance of spontaneous delivery, or even one effected by the force of pain, was at an end, it was thought best to cut the rigid hymen, and give the vagina a chance to dilate, and the perineum to unfold. Doctor Dewees accordingly passed a probe-pointed bistoury betAveen the child's head and the perineum, and made a slight incision in the latter. This enabled him to introduce his forefinger, Avith Avhich he broke doAvn or dilated the Avhole of the existing membrane, in such a manner that there Avas nothing but the natural resistance of the parts to contend Avith; and, in about two hours more, the child Avas safely delivered, without injury either to it or to the mother. In performing this operation, great care should be taken to cut no more than the hymen. As soon as the finger can be intro- duced, the attachments of the hymen to the vagina maybe easily removed. The woman soon recovers if the operation is wel performed. 748 HYSTERIA. HYSTERIA, OR HYSTERICS. This disease is known by the familiar name of nervous. Tha subject of it is affected in so many different ways, at different times, that it is almost impossible to define it so clearly as to leave no doubt on the mind as to its real nature. But there is one thing we feel confident Ave can do: Ave can so far define it that it cannot be mistaken, at least in a great majority of cases. It is a notorious fact, that males are subject to this disease as well as females. The old authors almost constantly refer it, in females, to some disease of the uterus. Though this organ may be affected in many instances where hysteria is formed, yet it is often met Avith Avhere this organ is sound in itself, and in all its functions. Some authors think that the seat of hysteria is in the brain, Avhile others think it has its seat in the nerves, and a third class contend that its seat is to be sought for in the stomach, bowels and muscles. These various opinions groAv out of the fact, that all these organs are affected, more or less, in their turn, by this disease. But as it is not our business, in this place, to theorize, we shall proceed to lay down the symptoms as clearly as we can, and point out the remedies for them. Women are more liable to this disease during the menstrual periods than they are at any other time, yet many cases do occur before and after that time. According to the various shapes Avhich the disease assumes, so will be the symptoms in the attack. If the stomach be the seat of sympathy, Ave shall meet Avith such symptoms as eructations, sour belchings, pain in the stomach, water-brash, costiveness, and a sensation as if a ball were rising up into the throat and choking the patient. If the seat of the disease be in the bowels, they will be filled with wind, and spasms will folloAV, accompanied by a brisk purging or costiveness cramp in the abdominal muscles, &c. If the liver be the seat of attack, the consequence will be, either too great a flow of bile or none at all, biliary calculi, and pain in the right side, Avith a sense of fulness and distension, obstruc- tions, &c. If the seat of the disease be in the kidneys, an immoderate iIoav of pale-colored urine will take place. At times the quan- tity Avill be diminished; and then it is highly colored, and some times very offensive. There is also, at times, great pain in the HYSTERIA. 749 farts, resembling that produced by stone in the bladder, and the urine may be tinged with blood. If the bladder be the seat of attack, either the urine cannot be held, or it is suppressed entirely. This is owing to the seat of the spasm; if it be in the body of the bladder, the urine will flow; if in the neck of the bladder, it will be retained or suppressed. If the heart be the seat of attack, there will be violent palpita- tions of that organ; the pulse will be irregular, accompanied Avith faintness. If the attack be in the scalp, there Avill be a coldness in the top, or a sense of heat in the back part of the head; but there Avill be no appearance of inflammation, although it Avill be sore to the touch. It will be accompanied Avith irregular spasms. If the seat of the disease be in the muscular system, there will be most violent spasms or nervous twitchings. In hysteria, Ave see more or less of these symptoms, though they are not all found in any one case. Perhaps there is no disease to Avhich Ave are liable, in the treat- ment of which the skill and judgment of the physician are more fully tried than in this. Fortunately, however, it rarely proves fatal. The causes of this disease are various, and Ave shall not attempt to enumerate them all. Suffice it to say, anything that will tend to destroy the general tone of the system, if it is brought on grad- ually, may act as a remote cause; as too sedentary a life, over- stimulating diet, or medicine if too long continued, long Avatching, disappointed hope, abused affection, grief, terror, prolonged anxiety, &c. These, and many others, may act either as the remote or immediate causes of hysteria. In some Avomen, any of these causes, from the slightest indications, may produce par- oxysm ; while, in others, they must be strongly and repeatedly applied before the fit is produced. This is a very important subject, and we will, therefore, be excused for being a little particular, both in its description and treatment. When a predisposition to hysteria exists, or the disease has been once called into activity, a great variety of cases may excite a paroxysm of greater or less force. An hysterical paroxysm, so called, is Avhere the system is thrown into that violent spasm called a fit of hysterics; and a vast variety of symptoms, such as palpitation of the heart, globus hystericus, a large Aoav of limpid urine, rumbling of wind in the bowels, belch- ing, acid stomach, whimsical appetite, trembling, cold feet and 750 HYSTERIA. hands, &c, may manifest themselves from time to time; all of which are termed merely nervous symptoms. It is thought by Mr. Tale, and some others, that these symptoms, here called nervous, have for their cause some diseased condition in the lower portion of the spinal marroAV, which may be detected by pressing on these joints. A genuine fit of hysteria varies very much in the suddenness of the attack; sometimes coming on in an instant as it Avere, and at other times approaching more sloAvly. The approach of the fit is sometimes announced by a headache of a peculiar kind, oppression about the heart, heaving of the chest, difficulty of breathing, and alternate laughing and crying, Avhich are the most prominent symptoms of hysteria. They may alternate with each other, or they may exist separately. The patient sometimes talks very much in one of these fits; and again, Avhile in a paroxysm, sings melodiously and touch- ingly, so that the audience cannot restrain their tears. Dr. Dewees says he knew a lady Avho sung most sweetly at all times, but when under an hysterical paroxysm, her voice, manner, and the subjects of her songs, were so touching as to dissolve all those around her in tears. An hysterical fit, Avhen severe, is extremely awful; the violent and varied contortions of the body Avould seem to threaten the dislocation of every joint, while the sAvollen face, the protruded tongue, the starting eye, the gnashing teeth, the appalling scream, render the whole a scene of great horror. Sometimes the hair is torn out by handfuls, and the chest is beaten by the clenched fists with great violence, Avhile the whole muscular system, when throAvn into action, is endoAved with a strength that bids defiance to all efforts to arrest. The muscles are contorted, the abdomen feels as hard as wood, the frothy saliva is throAvn several feet from the mouth, the lips look livid or pale, the hands are clenched, and the breathing is excessively labored and difficult, till, finally, in some cases, it seems to cease altogether, and the patient falls aAvay as in the arms of death. Taking the Avhole together, nothing can be more alarming to the bystanders than a genuine fit of hysteria, and the physician is sometimes unstrung so far as to be at a loss to know what to do in the case. Treatment. — The pulse is to be especially attended to in the treatment of nervous diseases; for whoever expects to be success- ful in the treatment of these diseases, without paying particular attention to the pulse, will find himself disappointed. Who has HYSTERIA. 751 not witnessed the want of success of opium, asafcetida, and all other stimulating anodynes and anti-spasmodics, when the pulse was full and the patient plethoric ? If the pulse be full, a little blood must be taken, either from the arm or foot, when the folloAving pills may be administered: Recipe: Blue Mass, twenty grains. Aloes Socotrine, twenty grains Gum Fcetida, twenty grains. Form tAvelve pills, and give four first, and tAvo every tAvo hours, till they operate freely. If they should be sIoav in operating, it may be presumed that there is spasmodic action in the stomach or bowels; in which case, the folloAving medicine may be given : Recipe: Comp. Tinct. Castor, two drachms. Ether Sulphuric, two drachms. Laudanum, one drachm. Mix, and give a tea spoonful, in cold Avater, every tAventy or thirty minutes, till the spasms are removed; or, you may give the folloAving: Recipe : Compound Spts. Lavender, half ounce. Tinct. Castor, two drachms. Elixir Paregoric, two drachms. Mix ; and give them as above, till the spasms are removed. When the pills operate well, a temporary relief will be expe- rienced. If the pulse be disregarded, and stimulants be given Avhile it is excited, the disease will be aggravated; and then the dose must generally be increased, because the symptoms are also increased. In all cases where the symptoms are increased by stimulants, the dose should be lessened or discontinued, till the effects of the first have passed off. When laudanum disagrees Avith the patient. only half the usual quantity — say tAventy drops — should be given, and that in sweetened vinegar; this should be repeated every half hour, till the spasms are relieved; or the following may be given: Recipe: Tinct. Asafcetida, two drachms. Vol. Tinct. Valerian, two drachms. Spirits Camphor, one drachm. Tinct. Castor, one drachm. Mix them together, and give a tea spoonful every fifteen or twenty minutes, till the spasms are allayed. The practice of holding camphor or hartshorn to the nose is very wrong, and should never be encouraged. Trying to open the clenched hands should not be attempted. 752 HYSTERIA. Cold Avater, given in small portions, and frequently repeated, is a good remedy in hysteria. It may be applied to the fore and top part of the head, Avith a toAvel, or poured gently on the head. The boAvels should be kept gently open Avith the folio Aving pill; Recipe: Pulv. Rhubarb, Gum Fcelida, Pulv. Jalap, Castile Soap, — of each twenty grains. Form twenty pills. Give three or four every night, at bedtime, and continue them as long as necessary to keep the bowels regular. All exciting causes should be avoided; the patient should go into lively company, and take exercise in the open air. Her diet should be light; it would be better to take no supper, or a very light one. She should also rise early, and take the morning air. If the system is Aveak, and requires something to strengthen it, the folloAving tonic may be taken : . Recipe : Rust of Iron, two ounces. Gentian Root, one ounce. Orange. Peel, one ounce. Old Whiskey, one quart. Put the articles into the whiskey; shake the bottle tAvo or three times a day for six days, and then take a table spoonful, in water, three times a day, just before eating. The cold bath is of great service in many nervous affections, and maybe used to an advantage in hysteria; but judgment must be exercised in using it. It is best to use it in the morning, in the form of a shoAver bath. The Avater, in the first instance, should be only fifteen or twenty degrees below the heat of the body; but, after it has been used three or four times, it may be taken colder and colder, till it can be taken from the spring and showered upon the patient. The patient should be rubbed all over Avith a coarse toAvel just before the bath is used, and the same operation should be performed on leaving it; if a glow is felt after the bath, it will do her good. But if she experience a chill, Avhich lasts any length of time, it is an indication that she should desist from the use of the bath, especially if she feci weak afterwards. If the patient is very weak at the commencement, or scrofu- .ous, salt should be added to the water; but if there be any internal disease of importance, the bath should not be used. It is important in the management of all diseases, to give them that attention which their symptoms demand, either for the body or the mind. To this end, let the patient know that LEUCORRHCEA, OR WHITES. 753 yon are willing to do everything for her in your power; and, at the same time, it Avill be Avell candidly to inform her that her disease is not of that dangerous character she may have supposed. Respecting the diet of nervous persons, no one can tell exactly what will suit every case; but, in all the variations of symp- toms and circumstances, the diet should be light. This, how- ever, is a vague term, Avhen the patient is left to judge of Avhat is a light diet; for each one will call that article light which she likes best. Some general rules, therefore, should be laid down on this subject. No article of food that will be heavy on, or produce Avind in, the stomach, become acid, produce costiveness, create a diar- rhoea, or cause a belching, is a light or proper diet for that person. Much liquid food is not good for nervous persons. Of the meat kind, she may take beef, mutton, venison, rabbit, fowls that have no down, birds, partridges, pheasants, &c. Soft-boiled or poached eggs, potatoes, beets, turnips, rice, barley, simblins and pumpkins, are all easy of digestion Avhen well cooked; and every article of diet should be well cooked, but not dried till all the sAAreetness is exhausted from it. The bread should be cold, unless it be corn bread; and SAveet neAV butter may be taken in small quantities. Lard, Avhich has been well rendered, and sweetened by freezing, is easier digested than butter of any quality. The patient should always stop eating before the demands of her appetite are answered. PART VII. OF LEUCORRHOZA, OR WHITES. This disease is so common in the United States, that the term whiles is familiar to almost every lady. The lethargic and more indulging part of society are most liable to it. Those Avho keep late hours in crowded cities,, indulge freely in drinking hot tea and wine, turning night into day, and day into night, and, by sitting up late, receive all the impurities of the night air, and of heated and croAvded rooms, in large assemblies; spend the greater part of the morning in bed, and rise only to lounge away the most of the day on the sofa; and, when night comes on, again repair to croAvded rooms, urigut. 49 754 LEUCORRHCEA. where they take active exercise, dance and heat the blood, breathing an air that has been breathed several times before, and thus has been deprived of most of its vital principle; and then, at a late hour, Avhen midnight coldness has chilled the air, and all nature is sealed Avith ice, again expose themselves to the chil- ling blast; — these persons, Ave say, are more subject to ieucor- rhoea than the lady who lives in the country, and takes proper exercise in due time; retires early and rises early; breathes the pure morning air when every leaf and every AoAver is throAving out its fragrance, giving neAV life and vigor both to body and>> mind. Such ladies are rarely afflicted Avith leucorrhcea. They also live on plain and wholesome diet, and use but little of Avine or cordials. While the first-described lady is like the leafless tree, shorn of all her beauty, health and strength, the second is like the rose of Sharon, or the ever-blooming hyacinth, full of freshness and vigor; and will live many years longer, and enjoy the sAveets of life and social happiness. But there are other causes for the Avhites. Marriages, and premature labors in married women, are often the cause of this disease; and we may say, in a word, that anything that will tend to irritate the uterus, as well as the general system, may bring on the Avhites. Let the remote or exciting cause be Avhat it may, this disease, Avhen once confirmed, is of difficult treat- ment. Description of the Disease. — The Arst appearance of this disease is a thin and almost colorless fluid passing from the vagina, Avhich discharge afterwards becomes white like milk. It often comes on at intervals; and. Avhen it makes its first attack, perhaps will shoAV itself a few days before the catamenia appears, and cease until that discharge is over. The Avhite discharge, however, in its first onset, is not apt to be regular in its returns, immediately after the menses cease. In the first stage of the disease, there is some pain in the back, and, at times, a slight soreness in the vagina and neck of the Avomb. But this is not always the case, and is not detected by any except the married lady. The boAvels are also more or less costive. In this stage of the disease, the appetite is but little impaired. the spirit and complexion pretty good, and the mind is cheerful and lively. This stage may last for months, or years, './afore it changes and takes on the second stage, or it may run trough i» a feAv Aveeks or months. LEUC0RRHC3A. 756 Treatment in the first stage. — The success in the treat- ment of this disease depends very much on the strict adherence to the use of the remedies prescribed. If the disease has occurred in an unmarried woman, she should, if fleshy, be bled from the arm. The parts should be kept clean by Avashing Avith Castile soap and Avarm Avater; after which, a Avash of green tea or alum-water, not very strong, may be used. The boAvels must be freely purged Avith the folloAving medicine: Recipe: Pulv. Jalap, twenty grains. Pulv. Rhubarb, thirty grains. Aloes Socotrine, twenty grains. Tartar Emetic, three grains. Form tAventy-four pills, and take three every night at bed- time, or just as many as will operate once or tAvice the next morning. Or you may use the following: Recipe: Extract AArhite Walnut, forty grains. Aloes Socotrine, twenty grains. Tartar Emetic, two grains. Form twenty-four pills, and take them as above directed; or, if the other medicines are not convenient, use, Recipe: Senna Leaves, one ounce. Pulv. Rhubarb, half ounce. Cardamon Seeds, two drachms. Boil these, in a quart of water, doAvn to a pint; strain, and squeeze out the liquor; dissolve in it, of Rochelle salts, one ounce; SAveeten, and add three spoonfuls of spirits, to keep it from souring, and take a table spoonful tAvo or three times a day, so as to produce one or tAvo free operations daily. The drink should be cold hyssop tea, of Avhich a pint may be taken daily. The diet should be light, and mostly vegetable. All fatiguing exercise should be avoided; the feet should be kept warm, and the body clad comfortably. If the patient be a married Avoman, she must observe all the above directions, and, in addition to them, use a wash of the folloAving articles: Recipe: Pulv. Alum, one drachm. Sugar Lead, one drachm. White Vitriol, one drachm. By mixing these in a mortar, a paste will be formed, of which one third may be mixed in a quart of rain or river water. Shake it well in a bottle, and, after using the Castile soap and water, with the curved pointed womb-syringe, as much of the 75b LEUCORRHfEA. wash as the syringe will hold may be throAvn up the vagina tAvo or three times, and this should be repeated twice or thrice daily. She should also live apart from her husband for a feAv weeks, and use the same kind of diet and drink as that prescribed for the unmarried woman. Second stage of Leucorrhoza. — In the second stage of this disease, all the symptoms are aggravated. The white discharge becomes thicker and more profuse, being noAV of the consistence of cream that has stood for some hours on the milk. It fre- quently appears in lumps, and if the parts are not kept clean, the discharges become acrid. The pain in the back, Avhich before was troublesome, is now increased; the bowels are more deranged; the subject becomes lean and looks pale; her features are generally sharp, her appetite irregular, and she is liable to have attacks of colic and hysterics. Her spirits are variable,— sometimes she is very cheerful, and in a short time gloomy. If she should become fretted, Avhich she is most liable to do when afflicted with this disease, it is immediately increased on her, and the soreness in the neck of the Avomb and vagina increases. In a word, her general health is now suffering from the ravages of the disease. She has pain, —sometimes in one side, and then in the other; and, at times, this pain is felt low down in the groin, in one or both sides. Treatment in the second stage.—It will ahvays be found advisable to commence the cure, in this stage, by giving a dose of medicine that will cleanse the stomach and bowels Avell; and. where the strength will allow it, an emetic should be given first. Recipe: Pulv. Ipecac, twenty grains. Tartar Emetic, three grains. Mix. Dissolve this poAvder in nine table spoonfuls of warm water, and give three spoonfuls first, and repeat one every fifteen or twenty minutes, till she pukes freely; when a glass of Avarm water must be given every time she pukes, till she has three or four operations up. It may then be turned down, with gruel lightly seasoned. Nothing cold must be taken, till the operation is over. If the medicine should not operate freely on the bow- els, take the following pills : Recipe : Blue Mass, sixteen grains. Pulv. Rhubarb, twelve grains. Form six pills, and take three first; wait three hours, and take the other three. Take nothing cold, till the operation is OTer. 1.EUC0RRH02A. 757 If the blue mass cannot conveniently be obtained, you may use the following: Recipe : Calomel, ten grains. Rhubarb, sixteen grains. Form six pills; to be taken as above. If the patient is of a full habit, she should be bled; and a light bleeding may be repeated, if the womb continues to feel sore. The patient must not be frightened at the lancet because she feels a little weak. If the pulse be hard or full, bleeding must be resorted to, and the bowels kept open by the following medicine: Recipe: Scammony, twenty grains. Aloes Socotrine, twenty grains. Tartar Emetic, three grains. Form twenty-four pills, and take from two to four at bedtime, or just as many as will operate twice the next day. This pur- gative may be changed occasionally for the following: Recipe: Senna Leaves, one ounce. Manna Flake, one ounce. Make a strong tea, and take half a tea cupful every hour, till it operates Avell; or you may take, Recipe : Calcined Magnesia, one drachm. Cream Tartar, one drachm. Mix, and dissolve in a little SAveetened Avater, and take it for a dose in the morning, fasting; or you may take, occasionally, Recipe : Epsom Salts, one ounce for a dose. Dissolve in a glass of warm water over night, and when settled in the morning, drink the clear liquor. The parts must be particularly attended to, and kept clean all the time; otherAvise, all remedies will fail to cure. Frequent washing, therefore, Avith soap and water, will be necessary. The patient must live on a light diet. After this plan has been pursued till the discharge is altered, and becomes thin and free, the following wash may be used, with the syringe, in the same manner as you used the warm water, or soap and water: Recipe: Sugar Lead, one drachm. White Vitriol, one drachm. Mix, and divide into three powders; dissolve one in a quart of rain Avater, and inject three syringefuls three times a day, ahvays using the soap and water first. All the Avashes may be used cold in this stage of the disease, except in very cold weather 758 LEUCORRHtEA. The hyssop tea should also be cold, and be drunk freely all the time of the cure. It is supposed by some that leucorrhoea is a disease of debility, and requires tonics; but this is a mistake. It is a disease of increased action, and requires a Ioav diet and cooling purgatives. If the cure is not performed by this course of treatment, you must use the folio Aving wash: Recipe : Sugar Lead, Pulv. Alum, White Vitriol, — of each one drachm. Nitrate Silver, twenty grains. Make all fine, and mix. This preparation will absorb moist- ure from the atmosphere, and become a blue paste, one fourth of Avhich is enough to dissolve in one quart of rain water. It must be used as a Avash, as above directed. While using the above remedies, the patient must take all the exercise she can bear, either on horseback or on foot; retire early to bed, rise early, and take the morning air; always taking a feAv mouthfuls of some light diet before going out. The patient should not sleep on feathers in Avarm Aveather, but use a hair. moss, or shuck mattress. Sexual intercourse must be rarely indulged in. Third stage of Leucorrhoea.—Should the disease have been neglected till it passes into the third stage, all the symptoms will be aggravated. The discharge Avill have changed color from a yellow to a greenish hue; it Avill pass aAvay in lumps, as Avell as in thin fluid, and become so acrid as to excoriate the parts; and, if a strict adherence to cleanliness is not observed, the skin will be taken off. The vagina Avill become very sore, and the pain in the womb will increase; there will be great heat in the urine, which will also be more highly colored than in the second stage. There is pain and great Aveakness in the back and loins; sexual connection is painful, and there will be more or less pain in the sides, breast and stomach. The patient now becomes dyspeptic; her diet is apt to sour on her stomach ; the boAvels are irregular, and she may have a sympathetic cough, but expectorates very little, if at all. She sleeps badly, and does not feel refreshed in the morning; her appetite is depraved, and her spirits broken; she is altogether in a sunken condition, both in body and mind , has lost her flesh, is feeble, easily affrighted and irritated, and is apt to think that her feelings and condition are not appre- ciated, and that she is neglected. She is continuallv fearful of LEUC0RRH02A. 759 sinking doAvn under debility; is lean, pale, and almost totters in her steps. Treatment in the third stage.—In treating the third stage of leucorrhoea, all the remedies of the second stage, except bleed- ing, may be used; and, in addition to them, the lunar caustic may be applied to the vagina and neck of the Avomb, by using a solution of it as beloAV : Recipe : Puiv. Lunar Caustic, twenty grains. Rain Water, one pint. Dissolve the caustic in the Avater, and take a piece of fine sponge, as large as the first joint of the thumb, and tie it fast on the end of a small stick or Avhalebone; Avet the sponge thoroughly in the solution, and, after Avashing out the vagina with Avarm water and Castile soap, introduce the sponge, and pass it over every part of the vagina and neck of the Avomb. It must be repeatedly Avet, and this application continued, till you are sure every part of the vagina has been touched with it. As soon as a slight stinging sensation has been produced in every part of the vagina, its application may be discontinued for that time. The hands should be covered Avith gloves, to protect them from the medicine, as it will stain them black for a time. A suitable bandage should also be worn, to protect the clothes; for this medicine dyes an indelible black. At the same time, the following medicine may be taken inter- nally : Recipe : Balsam Copaiba, half ounce. Haarlaem Oil, half ounce. Mix, and take from ten to thirty drops three times a day, beginning Avith the loAvest, and gradually increasing, till you reach the highest number. Take it on sugar. . A little good port wine may be taken tAvo or three times a day, and a blister should be applied to the small of the back. The medicine applied Avith the sponge may be used every third day ; and, in the intermediate days, a wash of Castile soap and warm Avater should be tried; if much soreness be felt, flax- seed or slippery-elm tea must be used, instead of the soap and water. The Avashes should be applied with the syringe. The greatest attention to cleanliness must be observed, for without this, a cure cannot be performed. A mattress of hair, moss, or shucks, must be used, instead of one of feathers. The ' patient must be kept apart from her husband. The bowels must be kept open with : 760 LEUCORRK03A. Recipe: Scammony, Aloes Socotrine, Castile Soap, Pulv. Rhubarb,—of each twenty grains. Form tAventy pills, and take from tAvo to four every night at ledtime, so as to give one operation in the morning; or, Recipe: Pulv. Rhubarb, Aloes Socotrine, Castile Soap, Salts Tartar, — of each twenty grains. Balsam Fir,—enough to form a pill mass. Form tAventy-four pills, and take them as above. If the patient be bilious, she should take: Recipe: Blue Mass, twenty grains. Pulv. Rhubarb, twenty grains. Salts Tartar, ten grains. Form twelve pills, and take them as above directed. She must take exercise in the open air, either on foot, horseback, or in an open carriage. Her company should be cheerful, and especially should she be made as happy at home as possible. When the discharge has abated," and the color becomes white, she may take some tonic, such as the folio Aving: Recipe : Pulv. Gentian Root, half ounce. Pulv. Orange Peel, half ounce. Carbonate Iron, one ounce. Add to this medicine a pint of old whiskey; shake the bottle every day for three days; then add a pint of Avater, and shake the bottle again every day for three days, and take a table spoonful three times a day, mixed in Avater. Such diet only should be taken as the stomach will digest easily. Friction Avith a flesh-brush may hoav be used all over the abdomen, as Avell as over the body and limbs, every morning and evening. The surface may be sponged all over with salt and Avater, after using the flesh-brush. This disease sometimes makes its appearance in pregnant women, and may be very profuse. All that need be done in this situation is, to keep the parts clean, drink freely of hyssop tea, keep the boAvels open, and live on a light diet. If she is full of blood, she should be bled; and if there is much heat in the vagina, the sugar of lead Avash must be used. After delivery, the patient will probably suffer no more from it, especially if it 'comes on from some cause depending on it. If it does not sub- side, however, after delivery, the remedies prescribed ir this first Btage should be used. WARTY TUMORS OF THE VULVA. 761 The folloAving medicine has done much good in all the stages of leucorrhoea: Recipe: Pulv. Alum, one drachm. Saltpetre, twenty-four grains. Mix in twelve powders, and take one three times a day, in sugar and Avater. Let it be ever remembered, that, without cleanliness, all rem- edies Avill prove unavailing in the cure of this disease. AVARTY TUMORS OF THE VULArA. These tumors take their rise from the vulva, and vary in size from that of a hen's egg to that of a pea. The tumors are ahvays seated on some part of the external genitals; they are very apt to extend internally, and are generally not attended with pain or soreness. But this is not ahvays the case; Ave have seen them, when situated within the labia, and not larger than a bean, productive of great pain. In othei cases, they are not painful, the person experiencing inconvenience only from their size. The color of these tumors is that of the parts on which they groAV. Their internal structure is made up of small cysts, containing either serous fluid or purulent matter. They are surrounded by cellular tissue and fat, and occasionally they suppurate; and if they do not heal readily, they are apt to degenerate into troublesome sores. Churchill says, "On many occasions, they are undoubtedly of venereal origin, and arise from the seat of former chancres." We have seen them where there had been no venereal taint whatever. Treatment. — Relief is ahvays obtained by cutting them off; and the operation may be performed Avith the scalpel or the scis- sors. The wound should ahvays be touched Avith caustic, to prevent bleeding, as these little wounds bleed profusely, and thereby endanger the life of the patient. When the Avatery tumor is cut off, it is apt to spring up again, if it is not freely cauterized. When these tumors are suspected to be of venereal origin, a gentle mercurial course is the only certain remedy, and for this purpose the folloAving medicine may be given: Recipe: English Calomel, one drachm. Flour, forty grains. 762 OOZING TUMOR OF THE LABIA. Add a few drops of Avater, and form sixty pills. Take one, morning, noon and night, till the gums are slightly savoIIcu, and a copperish taste is produced in the mouth. Continue this course for fifteen or twenty days; and, at the same time, apply the blue ointment to the tumors tAvice a day, till they all drop off. During this course of treatment, the patient should live on a vegetable diet, and take but little exercise. OOZING TUMOR OF THE LABIA. This name has been given by Sir C. M. Clark to a peculiar kind of tumor, arising from, or groAving upon, the labia. This tumor sometimes extends over the mons veneris, and its texture is firm, and sometimes lobulated, or divided by fissures. Its color is nearly that of the part from which it groAVS. It is not edematose, although the neighboring parts are so sometimes. The tumor seldom rises much above the surrounding skin. A Avatery fiuid is distilled from its surface and interstices, and the quantity of the fluid discharged varies according to the constitution of the patient and the state of the atmosphere; it being much more profuse when the Aveather is damp and the Constitution of the Avoman debilitated. This disease most frequently attacks fat, middle-aged Avomen, who have borne children, or those whose constitutions have been impaired. The principal symptoms are, an itching of the part, Avith great heat, and a profuse discharge of Avatery fluid, but no blood. Occasionally the discharge is acrid, and excoriates the parts Avith Avhich it comes in contact. This complaint is not unlike that Avhich is denominated shin- gly—a species of erysipelas, — but upon a close inspection, it will be found that the projecting parts are solid, and that they do not, as in the case of shingles, contain a fluid. Care must be taken, also, not to mistake mere excrescences of the labia for this disease. Treatment. — Sir C. M. Clark says, " there is but little hope of curing this disease without complete excision of the labia, which he performed in one case." As palliatives, how- ever, astringent powders may be used. Recipe: Starch, one ounce. Sulph. Copper, one drachm. Mixed. Sprinkle these powders on the parts frequently; or they may be Avashed frequently with the following lotion: DISEASES OF THE PARTS OF GENERATION. 763 Recipe : Pulv. Oak Bark, one ounce. Pulv. Alum, two drachms. Water, one pint. Boil the ingredients in the Avater for fifteen minutes; then strain, and wash frequently Avith the liquor. Or^, Recipe: Green Tea, one ounce. Port Wine, one quart. Steep the tea in the Avine tAvelve hours; then Avash the tumor with it frequently. The bowels should be kept open Avith the following medicine: Recipe : Blue Mass, twenty grains. Pulv. Aloes, forty grains. Pulv. Rhubarb, forty grains. Form tAventy-four pills, and take three or four every night at bedtime. The patient should be in a recumbent posture as much as possible, and the room should be Avell aired. Her diet should be nourishing, and a little good port wine may be taken in her drink. Cushioned sofas, chairs, or ottomans, should not be used by her as seats, nor should the patient stand much on her feet, as the discharge is ahvays increased in that position. DISEASES OF THE EXTERNAL AND INTERNAL PARTS OF GENERATION. The structure of the external organs of generation is such as to render them liable to a variety of diseases. Any disease in these parts naturally excites alarm, however free it may be from danger. Nothing will satisfy a woman laboring under a disease of these parts but the knoAvledge that it is not one of a peculiar character, and that it will not be attended Avith danger. On this account, it is important, in a work of this description, to describe all the diseases minutely, that the mind may be at perfect rest on this subject; because the peace of the husband, as Avell as that of the Avife, depends upon it; and sometimes the character of both is involved, and not unfrequently the happiness of whole families. Not that the diseases themselves are so often of such character as to be cal- culated to produce these consequences, but because the diseases of these parts arc, not understood by the great mass of the people. OAving to their peculiar organization, inflammation runs rap- idly into gangrene, and, in spite of all that can be done, suppu- ration or mortification will take place In these cases, much pain is experienced. 764 DISEASES OF THE PARTS OF GENERATION. When inflammation of the labia terminates in suppuration, the discharge is generally fetid. Parts organized as these are generally granulate more sloAvly than other parts of the body. Sometimes they become very much enlarged from slight irrita- tion, and a neglect of proper cleanliness, the natural secretions becoming acrid, and producing the most intolerable itching; 01 at least this may be easily produced by scratching the part; and, if this be continued, they soon become swollen and inflamed. But frequent ablution with cold Avater will soon remove these symptoms. The external organs, especially the nympha and labia, are liable to tumors of various kinds. The former is more liable to these forms of disease than the latter, especially when it is pre- ternaturally large. When these bodies become enlarged by inflammation, they are of a purple color, and sometimes studded with a number of tumors resembling Avarts. From their posi- tion, they are constantly liable to irritation, especially in Avarm weather; and, at other times, a violent inflammation seizes on them, in consequence of their being exposed to cold. The remedy is, bleeding, a low diet, absolute rest, and the use of the following medicines : Recipe: Blue Mass, forty grains. Rhubarb, twenty grains. Aloes Pulv., twenty grains. Form twenty pills. Take four or five at bedtime, and repeat every night, till the inflammation is removed. At the same time, use this wash : Recipe .• Sugar of Lead, one drachm. Rain or River Water, one pint. Keep the parts constantly wet with this solution, by wetting soft cloths in it, and applying them frequently. Absolute rest must be enjoined. If this treatment should not remove the inflammation, and suppuration should take place, be careful that the lips of the vagina do not adhere or grow together. Suppuration will remove those little Avarts already described. The parts should then be kept clean Avith Castile soap and Avater, and they will soon heal. When these parts are covered with Avarts, — which is some- times the case,—exposing them to the air, by keeping the labia apart Avith adhesive straps, washing them daily with fine chalk and Avater, letting the chalk dry on them, and then rubbing it off dry, will generally remove them all in a few days. So ABSCESS OF THE LABIA. 765 essential is moisture to the existence of these warts, that they cannot live without it. Besides the excrescences just mentioned, these parts are liable to very great enlargements, Avhich sometimes require the knife for their removal; and Avhen this is the case, a surgeon must be called in. The Bosjesman women, the Persian, the Abyssinian, and Egyptian women, are very subject to this unnatural growth. In some parts of Egypt the operation is frequently performed. It resembles circumcision in the males. ABSCESS OF THE LABIA. When inflammation takes place in the labia, it is Avith diffi- culty arrested. The vascular and cellular construction of these parts contributes very much to hasten the suppurative stage; the progress of inflammation is frequently so rapid that it cannot be arrested by the most active means. Matter Avill form sometimes in a feAv hours. At furthest, the inflammatory stage rarely continues longer than three or four days. The first symptom of this disease is, a heat and burning in the parts, attended Avith pain in moving the loAver extremities, particularly in crossing the legs. When the SAvelling commences, it increases rapidly, and the parts appear of a livid color. The patient is feverish, and has loss of appetite and sleep. And, as other diseases of these parts produce great anxiety, so in this case, the patient is apt to apprehend something, and is not easily satisfied, till her fears are allayed by some one hi whom she has confidence, especially if she be a married woman. These abscesses in children, as Avell as in groAvn persons, are generally produced by bruises. They frequently occur by sitting doAvn on the knob of a chair, or upon a hard pincushion, or by a fall on a hard substance, &c. A bruise received in this way, or any cause that would excite inflammation in any other part of the body, will excite it in this. Treatment. — The treatment consists in bleeding, purging, a very Ioav diet, and absolute rest. Recipe : Epsom Salts, one ounce. Dissolve in a glass of water, and take it at a dose; 01, Recipe: Fol. Senna, one ounce. Rochelle Salts, half ounce. 766 EDEMA TOSE SWELLINGS OF THE LABIA. Boil the leaves to a strong tea, in Avhich dissolve the salts, and take it at three draughts, half an hour apart; or, Recipe: Rochelle Salts, one ounce. Cream Tartar, one ounce. Mix. Take a tea spoonful every hour, in a glass of cold water, till it operates freely; keep still, and bathe the paits freely with. Recipe: Sugar of Lead, one drachm. Dissolved in Water, one pint, Keep the parts constantly Avet with the solution Avhen cool. If you find that suppuration will take place, apply warm poultices: Recipe: Ground Flax-Seed, two ounces. Wheat Bran, two ounces. Avith water sufficient to make a poultice; and apply it Avarm; or a light bread and milk poultice, applied warm, will do. If the pain be great, give, Recipe : Opium, one grain. Camphor, two grains. Tartar Emetic, half grain. If this should fail to procure rest, or should the articles not be at hand, make a strong decoction of poppy-heads, or hop-blos- soms, thicken Avith Avheat bran, and apply this poultice, first anointing the parts with blue ointment, if it can be had. This will often relieve the pain. When the abscess points, and fluctuation is evident, it should be opened by a free incision Avith a lancet, so that all the matter may be discharged at once. After this, the parts soon heal without any danger of return, unless some exciting cause be applied. EDEMATOSE SWELLINGS OF THE LABIA. Women of lax muscular fibre, Avho have borne children especially if they stand much on their feet, are more liable tc edematose SAvellmgs of the labia than those women of a firm, muscular, and robust constitution. It is said by some Avriters on midwifery that those women who have an obliquity of the uterus are more liable to these sAvellings than those Avhose uterus is not thrown into a state of obliquity. It rarely happens that this SAvelling is confined to the labia; it generally extends to the lower extremities, also, distending them so much that they frequently burst. This produces great alarm EDEMATOSE SWELLINGS OF THE LABIA. 767 in the mind of the patient, and she is apt to think that she i» laboring under the dropsy. It has been said by some authors, that this condition of the parts indicates an easy delivery; but our OAvn observations on thh subject do not favor this opinion. We, hoAveA^er, never saAv the labia burst; but Doctor Dewees relates a case ':Avhere the labia was ruptured, and ulceration of the perineum ensued, attended, before recovery, with erysipelatous inflammation, and the discharge of a great quantity of ill-con- ditioned pus, or sanies." When this condition of the labia is a consequence of gestation, it Avill sometimes give Avay before labor comes on; but this is not to be relied on. Treatment.-—-When this disease is attended with fever, the patient should be bled from the arm; she should be confined to a horizontal position, and take the folloAving medicine : Recipe: Rochelle Salts, one ounce. Cream Tartar, one ounce. Mix. Take a tea spoonful every hour or tAvo, in parsley tea, and keep the boAvels freely open by the daily use of this medi- cine; or, Recipe: Glauber's Salts, one ounce. Salts Nitre, two drachms. Pulv. Rhubarb, half ounce. Mix. Take a tea spoonful, dissolved in a small glass of Avater, and repeat three or four times a day. The diet should be very light, and the patient should lie on a lounge, straAA^-bed or mattress, all the time, rising to her feet as seldom as possible. If these remedies should not remove the SAvelling, the labia should be punctured on the inner surface, in three or four places/ Avith a sharp lancet. This should be done three or four days before labor comes on, that the Avater may have time to drain out of the parts before L.. ' °^d of the child passes through them. No bad effects need be dreaded from these punctures; but, on the contrary, they will, by reducing the SAvelling, alloAv the parts to yield kindly, and thereby prevent their rupture, asAvell as a lacer- ation of the perineum. This disease is sometimes consequent on a true dropsical con- dition of the system; and, Avhen this is the case, no general remedies can be used for its cure, till after the delivery of the child. Nevertheless, if the labia should be much distended, several punctures may be made in it with a lancet, even after 768 ITCHING OF THE PARTS OF GENERATION .abor has commenced. Doctor Dewees says "he has often don« this, to the great relief and safety of his patient." ENCYSTED TUMOR OF THE LABIA. Encysted tumors of the labia are met with of various sizes. They are generally circumscribed and transparent, and they give rise to but feAv symptoms, except such as arise from their magni- tude. But they are very often symptomatic of more important diseases of the uterus. The color of the skin covering them is rarely changed; but, when opened, they are generally found to contain unhealthy sanies, or dark-colored matter. They occasionally ulcerate, and form an unpleasant sore. The sIoav progress of the disease, and the absence of inflamma- tion and of acute pain, will distinguish these tumors from phleg- mon of the labia. Bovin, and Duges, Sir Astley Cooper and Blundell, all speak of this disease. Treatment. — We have the choice of three modes of treat- ment. First. Simple incision of the tumor, which is sometimes sufficient. Second. The insertion of a seton, to produce suppuration, or obliteration of the sac. Third. The entire tumor may be cut out; and this is probably the best remedy that can be pursued, if anything at all is done. — Churchill. PRURITUS, OR ERUPTION, WITH ITCHING OF THE PARTS OF GENERATION. This is one of the most troublesome diseases to which females are subject. Ladies in a state of pregnancy are more subject to this disease than those Avho are not pregnant, but no state will exempt them from its attacks. It produces such an uncontrollable desire to scratch, that it is with difficulty refrained from. Dr. Dewees says, "he knew a case where the itching Avas so severe that the lady had to keep her chamber for three months;" and he goes on to remark that " every remedy that could be thought of by two eminent phy- sicians was tried in vain. No relief was obtained until aftei delivery; the parts Avere not examined; the child Avas born per- fectly healthy. The woman was much exhausted by the severe discipline to which she was subjected in order to obtain relief ITCHING OF THE PARTS OF GENERATION. 769 Pruritus is not confined to the vulva alone; the vagina also suffers from it occasionally. It has no particular time for making its attack, and may appear at any period of pregnancy, although its attacks are more frequent in the latter than in the early stage. But let it appear Avhen it may, if it is neglected for a Avhile, or if it is not Avell treated, it is apt to continue till the end of gestation, or till delivery takes place. This disease is very much aggravated by the want of cleanli- ness, though no attention of this kind is capable of preventing it, or of curing it after it has come on. A variety of causes, such as a Avant of cleanliness, an active secretion Avithin the labia, an inveterate eruption, varicose veins, an apthus efflorescence, &c, have been assigned for this disease. It is certain that in a great many cases a want of cleanliness can- not be its cause, though we are persuaded it is well calculated to increase it after it is once induced. There certainly is a secretion of acrid Auid in all cases of pruritus, be the remote cause what it may; and this secretion certainly renews the itching when it takes place. There is a discharge of thin limpid serum, of which the patient is perfectly conscious, which secretion always reneAvs the irri- tation. Dr. Dewees says, "he has not met with any case where vari- cose veins could be said to produce the disease." The eruption is very much like that of the thrush in a young child's mouth: and this covers the whole of the inner surface of the labia, and sometimes extends Avithin the vagina. When this eruption does not exist, the inner parts are inAamed ; the color of the inAamma- tion is that of a copper red, but sometimes inclining to a light purple, with a number of slight abrasions, which increase the irritability of the parts. Treatment.—The treatment of this disease depends very much on the habits of the patient. If she is of a full habit, she ought to be bled and purged, and take the following medicine: Recipe: Blue Mass, twenty grains. Pulv. Aloes, twenty grains. Pulv. Rhubarb, forty grains. Form mass, and divide into twenty pills. Take three or toui of these every night at bedtime; or, occasionally take, Recipe: Pulv. Rhubarb, two drachms. Epsom Salts, half ounce. BRIGHT 50 770 ITCHING OF THE PARTS OF GENERATION. Mix together, and take a tea spoonful three or four times a day in half a glass of water. Besides keeping the bowels open with these medicines, the folloAving wash must be used, Avhere the thrush-like eruption appears : Recipe: Pulv. Borax, one drachm. Tinct. Myrrh, one ounce. Rain or River Water, one pint. Mix the medicines in the water, and Avash the parts freely from three to six times a day; and, if the eruption has extended into the vagina, the Avash should be throAvn into the vagina with a womb syringe as often as the external parts are Avashed. At the same time, take the following drops: Recipe: Balsam Copaiba, one ounce. Take ten drops of this medicine three or four times a day, on sugar. The parts are not always covered Avith an eruption, but are sometimes of a red copper color; Avhen this is the case, the fol- lowing wash must be used : Recipe : Sulphate Zinc, one drachm. Rain or River Water, one pint. Dissolve the medicine in the water, and use it as above directed, externally and internally; or, you may use the following: Recipe : Sulphate of Copper, one drachm. Rain or River Water, one pint. Dissolve the medicine in the Avater, and use as above directed. There has been a variety of Avashes prescribed in this disease, such as brandy, or brandy and Avater, cold Avater, ice-water, spirits and Avater, soap and Avater, sugar of lead and water, &e.; and it must be acknoAvledged that all of these have done good in their turn; and again, all have failed to perform a cure. The remedies Arst given here are more to be relied on than any of those Avashes. The patient should live on a light diet, under any course of treatment, or a cure cannot be expected. There is a disease of these parts Avhich has been thought by some to be analogous to this, if not a species of the same disease, and some authors think the former may terminate in the latter. The disease which is supposed to resemble pruritus is called furor uterinus. But, according to our observation, no tAvo diseases are further apart in their true character. Pruritus is ahvays attended with an uncontrollable itching sen I DISEASES OF THE VAGINA 771 t sation, frequently with an apthous eruption, and ahvays with a diminished inclination for sexual intercourse. Furor uterinus is not attended with an itching sensation, but with an uncontrollably libidinous desire—marks of distinction which are as wide apart as they can be. The two diseases do not partake at all of the same nature. Pruritus may be communicated to the male from the female, and it is sometimes communicated to the female from the male, as both sexes are liable to this disease, and maidens are subject to it as well as married Avomen. Much importance is attached to a proper knowledge of this disease, and every female should be well acquainted Avith its symptoms, so that she may be able to distinguish it from other diseases. We have knoAvn both men and women to be under the strongest temptations to believe the other party incontinent, and think that one had contracted the venereal disease and communi- cated it to the other. An experienced physician will decide this question in a moment, when the symptoms are given. While writing this chapter, we Avere called on by a female, in great distress, because, as she thought, her husband had given her the venereal disease. But before she had ansAvered half a dozen questions, we Avere satisAed that she had not contracted a venereal disease, but was afflicted with pruritus. After fully explaining to her the nature of her disease, she went away per- fectly satisAed. By the use of the remedies given in the recipes above, she Avas soon cured. DISEASES OF THE VAGINA. The diseases of Avhich we are noAV about to treat are not com- mon ; but, as they occasionally occur,' it is proper that they be noticed in a work of this description. These diseases may be natural or accidental; and the natural may be more properly styled defects. These defects consist in abbreviations or contractions of the vagina, so as to render the parts unAt for the purposes for Avhich nature designed them. Morgani mentions a case, in Avhich the vagina Avas only one third the usual length, and terminated in a Arm, Aeshy substance. It is hardly necessary to say that this Avoman was barren. Columbus dissected the vagina of a woman Avho ahvays com- plained of great pain in coitu. The vagina was very short, and had no uterus at its termination. Dr. Dewees saAv a case, in which the parts were so small that it Avas with great difficulty the 772 DISEASES OF THE VAGINA. finger could be introduced, even after it was freely lubricated. This patient always experienced pain from connection with hei husband, and she had never menstruated. Upon examination, the doctor found the vagina to be not more than an inch and a half long, and, from all appearance, there was no uterus at the end of it. At least, if there was, it was very small and imperfect. We Avill describe the method of ascertaining whether there is a uterus attached to the vagina or not. Pass a bougie into the bladder, and one finger, Avell oiled, into the rectum, and bring the finger and bougie as nearly into contact as possible. If there is no uterus, the finger and bougie Avill nearly touch each other, being separated only by the coats of the bladder and of the rectum. But if there is a uterus, the substance of it will separate the finger and bougie to such a distance that the operator will be satisfied of its presence. \ny one acquainted with the anatomy of the parts cannot be mistaken, and any substance in the cavity of the pelvis may be in this way detected. If there is no uterus, the question is at once settled that the Avoman is not perfect. But if there is a uterus, although the parts may all be very small, and the vagina short and contracted, we have a remedy. And this consists in the use of tents, made of slippery-elm bark, oiled silk, or fine sponge, well wrapped and oiled. Any of these tents may be passed into the vagina, and retained there by a bandage in the form of the letter T, for ten or twelve hours each day. Let them be a little larger every day, till the parts are sufficiently expanded. Be careful to keep' down inflammation by bleeding, low diet, and gentle medicine; such as, Recipe : Rochelle Salts, one ounce, for a dose. Recipe: Fol. Senna, one ounce. Manna Flake, half ounce. Boil to a strong tea, and taken at three or four draughts, half an hour apart; or, Recipe: Castor-Oil, one ounce, for a dose. Recipe: Scammony, Pulv. Aloes, Pulv. Rhubarb,—of each twenty grains. Tartar Emetic, one grain. Form twelve pills. Take three or four for a dose, and repeat every day till the cure is performed. The smallness of the vagina does not always prevent concep- tion, nor does it argue that delivery will not be safe, though it TRANSPARENT DISCHARGE OF MUCUS. 773 may be tedious. The remedy for this state of things is given in the chapter on delivery. TRANSPARENT DISCHARGE OE MUCUS FROM THE VAGINA ARISING FROM AN INCREASED ACTION OF THE VESSELS. Women of naturally plethoric habits, Avho possess great strength of constitution, are more liable to profuse secretions from these parts than women of ordinary strength, and this dis- charge may become so profuse as to demand attention. Women Avho in the middle stage, of life indulge much in the luxuries of the table, particularly if they use wine or spirits, and Avhose habits of life are sedentary, taking very little exercise in the open air. are liable to become suddenly corpulent. They form a large quantity of blood; the pulse becomes full, and the blood-A'essels shoAV very plainly on the cheeks. Such women are generally weak, though they may have the appearance of strength. They can take very little exercise without fatigue, and are apt to lose their energies; the liver may enlarge; the stools become light-colored and fetid, and the patient now becomes of a costive habit. The transparent mucous discharge is increased in quantity; she menstruates more profusely, and the periods return too soon; she has fits of giddiness, sleeps badly, has pain in the head and indistinct vision at times, attended with the appearance of sparks flying before her eyes either Avhen they are shut or open. More or less of these symptoms may last for many years, till at last the patient is suddenly attacked with apoplexy, or some internal hemorrhage, which may quickly destroy her; or she may gradually become weaker and Aveaker, till finally she may take the dropsy. It is proper to notice here that these symptoms abate after each menstruation, and this is one cause why the Avoman puts off call- ing for adAuce. But there is danger in procrastination. The liver in these cases is ahvays enlarged, and wcretes badly. Treatment.—The first remedy in these cases, when the pulse will bear it, is to bleed freely from the arm. But if the lancet cannot be used, cups should be applied between the shoulders, or over the region of the liver, as well as on the loins or abdomen. according to the seat of the greatest distress. The patient should next take, Recipe: Epsom Salts, one ounce. 774 DISCHARGE FROM THE VAGINA. Divide into three doses, and take one every three hours, till it operates well. But if there is pain or uneasiness in the region of the liver, give, Recipe : Calomel, fifteen grains. Pulv. Rhubarb, ten grains. Form six pills, and give three first, and the other three in three hours; work them off with gruel or rice-water. Particular attention should be given to the boAvels, and they should be kept open; and, for a constancy, the following purgative will be good: Recipe: Scammony, Aloes Socotrine, Pulv. Rhei, Castile Soap, — of each thirty grains. Form thirty pills, and take three or four of these; or just as many, at bedtime every night, as Avill operate once or twice the next morning. The diet should be of the lightest kind, and entirely vegetable. If the discharge is very profuse, a wash should be used. Recipe: Sugar Lead, one drachm. Water, one pint. Dissolve the lead in the Avater, and inject two or three times a day. Sexual connection must cease till the cure is performed. As soon as the patient is able, she should take exercise in the open air, in a carriage, on horseback, or on foot. All stimulants should be avoided in all after life. TRANSPARENT MUCOUS DISCHARGE FROM THE VAGINA ARISING FROM DEBILITY OF THE VESSELS. The disease treated of in the preceding chapter is liable to ter- minate in this. There are, therefore, more cases of transparent mucous discharge from the vagina arising from debility than from increased action. Women who live in a moist atmosphere and breathe an impure air, who sit up and lie in bed late, and Avhose rooms are kept hot and badly ventilated, are most liable to this form of the disease. Allowing the child to suck too long is also one cause of this disease; and, when this is the case, it will generally subside when the child is Aveaned. The quantity, as well as the consistence, of this discharge, is various, being sometimes thin, and in other cases ropy. The woman experiences great pain in the back, attended w:th great DISCHARGE FROM THE VAGINA. 775 debility, she loses flesh, and becomes thin and pale; the skin assumes almost the appearance of a dead body, and, in many cases, becomes yelloAV, as if the patient were jaundiced, although the pearly white of the eye, and the clearness of the urine, assure us that she is not so. The muscles become soft and flabby ; the legs and feet SAvell towards night, but the swelling disappears by morning. The face also becomes sAvollen; the patient has a shortness of breathing, Avhich is increased by lying doAvn; she experiences much difficulty in Avalking up stairs, or up hill; and she cannot read aloud without rendering her breathing difficult. She is liable to have violent palpitations of the heart, and at times the strokes of the heart are so loud that they can be heard at the distance of several feet. In this stage of the disease, the patient is liable to faint, and is apt to think that she is dying; her hands and feet are generally cold, her pulse is feeble and quick, her appetite fails, she is costive, and her stomach and boAA'-els are filled with wind. Hectic fever now comes on, her breathing becomes more difficult, and she dies with all the symp- toms of dropsy of the chest. Treatment. — The first step towards the cure of this disease is, to place the patient in a healthy situation; otherwise, a cure cannot be expected. She should go abroad, and take the pure, healthy air; she should live and sleep in a large, Avell ventilated room; her habits of life must be regular; and she must retire and rise early. If she is too Aveak to sit up all day, she should recline on a sofa or lounge, and take excursions on horseback, in good weather, or ride out in an open carriage; but she should not travel much on foot. If she is not able to take exercise in either of the above Avays, she may take it on a chamber horse, made of a spring plank. Her diet must be of the lightest kind, and but little should be taken at a time. When the stomach will digest very light diet, she may begin to take a little light animal food: but the meats taken should be of full-grown, and not of young animals, the old being easier of digestion. All wines and spirits should be care- fully avoided. The bowels are to be kept open with the following medicines: Recipe: Pulv. Rhubarb, Castile Soap,— of each twenty grains. Form twelve pills; of which, from two to four may be taken every night, so as to give one operation the next morning. The following tonic may be given: 776 CESSATION OF THE MENSES. Recipe: Pulv. Gentian Root, half ounce. Pulv. Columbo Root, half ounce. Mix. Put these poAvders into a pint of hot water, and simmer t slowly for fifteen minutes; strain, and give a table spoonful of the decoction every hour, in cold water. Ten or twelve drops of elixir vitriol may be added to each portion just before eating. As soon as the stomach Avill bear it, she may take, Recipe: Carbonate Iron, one drachm. Sub. Carbonate Soda, one drachm. Mix, and divide into tAvelve poAvders; take one, morning, noon and night, in sugar and a feAv drops of water. After a few days, the portion may be increased to double the quantity at a dose, if the stomach Avill bear it. An excellent bitter may be made of the following: Recipe: Yellow Poplar Bark, one ounce. Red Dogwood Bark, one ounce. Wild Cherry Bark, one ounce. Take them all from the root; put them into a quart of water, and boil doAvn to a pint, leaving the cherry to be added to the tea after it is boiled and strained. When the cherry bark is added, a gill of spirits should also be poured into the tea, and old rye whiskey is the best. Of this mixture, a table spoonful may be taken three times a day. These remedies must be persevered in. The vagina should be washed three times a day, Avith sugar of lead and water, one drachm to the pint; or alum-water, one and a half drachms to the pint of rain water. As the patient gains strength, she should take exercise on horseback; but sexual intercourse should be avoided till the cure is complete. CESSATION OF THE MENSES. The cessation of the menses is very justly considered by all Avomen as an important period of life. In this country, the change generally takes place between the age of forty-three and forty-seven; but sometimes it takes place much earlier. We are, however, not without evidence, in some of our books, that the catamenia has continued to the protracted period of seventy years,—but this is very uncommon,—and that, too, Avithout any variation in quantity, quality, or regularity. It is a proverbial saying, that women who live in the country, and attend to the active duties of life, suckle their own children, CESSATION OF THE MENSES. 777 rise early, and lhre on a plain diet, pass through this stage safer and bettei than those Avho live in toAvns and cities, and indulge in the luxuries of life, lie in bed late, and retire late, and do not suckle their children. The approach of this change is often announced by a little irregularity in the returns of the catamenia; sometimes they come on every tAvo Aveeks, and then they may miss for six Aveeks or more. Sometimes they are deficient in quantity, but continue the full time; the next time they may be so profuse as to Aveaken the patient. But, most commonly, when the Avoman lives in the country and is governed by country habits, she passes through this period Avith the knoAvledge only that it is gone. She ceases to menstruate, and no bad consequences follow. But Avhen unnatu- ral indulgences are practised, she may be involved in many diffi- culties, such as being subject to profuse discharges, Avhich may weaken her very much, and even endanger life. When the uterus takes on a degree of infiammatory action, accompanied by heat, and the discharge is copious and lasts long, it is time to use remedies. Treatment. — The boAvels should be kept open Avith, Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap, — of each twenty grains. Tartar Emetic, three grains. Form twenty-four pills, and give two or three every night at bedtime, so as to keep the bowels always regular and purged a httle; or, Recipe : Rochelle Salts, one ounce. Calcined Magnesia, half ounce. Mix, and take a tea spoonful or two every night at bedtime. Keep the parts clean by frequent washings with a Avomb syringe; use cool or tepid Avater, and be careful not to take tonics, for fear of becoming too Aveak. It would be advisable to take a purge, to reduce arterial action, but no stimulants of any description must be taken. Rise early, and take exercise in the open air. The diet should be plain, and entirely vegetable. Use no meats, rich dressings, or gravies. Take no more at a time than the stomach Avill properly manage Avithout uneasiness; avoid everything that is calculated to excite or agitate either boay or mind, as grief, fear, joy, passion, &c. If the patient be fleshy, she should be bled occasionally iiom T8 CHRONIC INFLAMMATION OF THE OS UTERI. the arm. By attending to these directions, the period may bo passed over with all possible safety. OF CHRONIC INFLAMMATION OF THE GLANDULAR PORTION OF THE OS UTERI. All the diseases of the membrane covering the os uteri, or the cervix uteri, produce, in their active stage, a greater or less dis- charge. The discharge in this disease differs from that of leucorrhoea, and the suffering is more intense. The peculiarity of the dis- charge, and the state of the os uteri, Avill clearly distinguish this from the other diseases of these parts which we have described. The principal symptoms are, an aching sensation in the back and lower part of the abdomen. Avhich is rendered more severe by increasing the action of the abdominal muscles, or by pressure of any kind. Sexual intercourse is productive of more or less pain, and is often the first circumstance that excites the attention of the patient. The bladder and rectum are frequently irritable in this disease, and sometimes the functions of menstruation are disturbed; but most generally they are not. The discharge from the vagina is perfectly Avhite and opaque, resembling starch and Avater, Avhen mixed together, without heat. It is easily removed from the fin- ger after examination, and it renders the Avater in which the finger is washed turbid. In many instances the white discharge is thick. resembling glue in tenacity, and this is probably its natural state; but by remaining in the vagina for some time, and mixing with the natural mucus of that part, it changes its appearance. On examination, nothing unusual is found in the vagina; but when the finger reaches the os uteri and cervix, Avhich feel swol- len, the patient complains of severe pain on pressure. The dis- charge, as above described, may occur, and no puffiness of the cervix uteri be detected. "Judging from the local symptoms generally present, and from the resemblance Avhich this Avhite discharge has to the secretion from the glands in the mucous membrane of the neck of the womb under other circumstances, Sir C. Clark concludes that it is this glandular apparatus Avhich is the seat of infiammation in this case." Mitchell says, " There are seldom any constitutional symptoms present." The causes of this disease are not. at all times, easily ascer- tained ; generally, hoAvever, it proceeds from abortion, cold, exces- CHRONIC INFLAMMATION OF THE OS UTERI. 77S sive exercise, irregular habits of life, or a sudden suppression of the menses. If the discharge be copious, and the mouth or neck of the Avomb very tender, and menstruation painful or difficult, the case, if let alone, may ultimately become serious. All Avomen, while laboring under this disease, are barren. Treatment. — Depletion of the parts is the first thing to be attempted, and this is best performed by leeches to the part, cups to the loins, or leeches to the insides of the thighs; and this appli- cation should be repeated, if necessary. The hip bath should be used twice a day, and should immediately follow the loss of blood. Warm Avater should be throAvn into the vagina two or three times a day, Avith a Avomb syringe, and this remedy will ahvays give relief. After the use of Avarm water as an injection, the folloAving should be used: Recipe: Sugar Lead, one drachm. Dissolved in one pint of tepid Avater, of which two or three syringefuls should be used after each Avashing with warm Avater. The boAvels should be kept open with gentle purgatives, such as, Recipe: Scammony, one drachm. Aloes Socotrine, one drachm. Pulv. Rhubarb, one drachm. Castile Soap, one drachm. Form sixty pills, and give from Iavo to four every night at bed- time, so as to act gently on the boAvels every morning. The urine is sometimes obstructed; and, in that case, tAventy drops of laudanum, in Aax-seed or slippery-elm tea, should be given; and if this should not afford relief, the water should be draAvn off Avith a catheter. During the cure, the patient must keep still, lie on a mattress or sofa, and live on a very light and thin diet. All sexual intercourse must be interdicted till the cure is completed. When the inflammation is all removed, in order to establish the cure, and give tone to the parts, and regulate menstruation, the folio Aving medicine should be given: Recipe : Citrated Aromatic Wine of iron, four ounces. A tea spoonful should be taken three times a day, in sweetened water. At the same time the boAvels must be kept open with the above pills. r 7S0 HARDNESS OF THE NECK OF THE WOMB. OF CHRONIC INFLAMMATION OF THE MOUTH AND NECK OF THE AVOMB, AND HOW TO PREPARE AND USE THE INSTALMENTS REPRESENTED IN PLATE V. IN THIS DISEASE. There are to be seen, in the same plate, tAvo representations of the mouth and neck of the womb, figures 1 and 2. These plates show the neck and mouth of the Avomb in different states of disease, though produced from the same cause, namely, cold, or abortion. Figure 1 shows the mouth and neck of the womb in a state of chronic inflammation, which has taken place, first in the neck of the womb, and contracted the surface so as to act as a ligature upon the vessels, while the membrane covering the lips nas not contracted so much. Consequently, the lips have protruded, and, remaining in this situation for \ long time, the inflammation has become chronic. The parts are tender to the touch, and the woman menstruates Avith difficulty. Figure 2 shows the same condition of the parts, except that the contraction has covered the whole surface, both neck and mouth, of the womb, and reduced them both more than figure I. We have often met Avith both of these conditions of these organs. Some authors in our late periodicals have spoken of this disease, but so slightly that nothing satisfactory can be gathered from them. They, indeed, prescribe the use of caustic in many diseases of the os and cervex uteri, but the manner in Avhich they direct it to be applied we have found to do more harm than good. Some writers on the subject have directed it to be applied by making a solution of it in water, and applying it with a sponge, tied on a Avhalebone ; others direct it to be used as a wash, Avith a syringe; while others, again, direct it to be used as a pencil, through a speculum. All of these modes Ave have found to be very objectionable. To avoid this objection, we constructed these instruments, figures 3 and 4, and 5 and 6. To prepare these for use, they should be taken to pieces by loosening and taking off the screws, and be properly cleaned Avith a piece of buck-skin or soft flannel. The bowl of the spoon, figures 1 and 6, should then be filled Avith pulverized lunar caustic, and melted doAvn by a spirit lamp. The bowl should be filled again and again, and as often melted down, till it is full; when the instrument should be put together, and screwed up tight, Avith the caustic hid in the boAvl of the canula. The patient should then be placed in the position for turning a child,—which chapter see,—and the oper- HARDNESS OF THE NECK OF THE WOMB. 781 ator pass the forefinger of the left hand to the os uteri; and, aftei straightening the uterus, and bringing the mouth into a proper position to receive the instrument, —it being previously oiled, — he passes it up to the neck of the womb, placing the caustic in a position to rest upon the neck of the womb, while the vagina is guarded by the back of the bowl of the instrument. He then loosens the screw on the Avire at F, and shoves the wire upward, or draws the canula downward, till the port caustic is unsheathed; then, keeping the caustic close to the surface of the neck of the Avomb, passes the caustic entirely around the neck of the Avomb, touching every part of its surface, and nothing else. He then draAvs the port caustic or wire into the canula, and removes both from the vagina. If the lips of the womb are contracted or pouted,—and they are almost sure to be in one or the other condition,—having the instrument, figure 3, prepared, the operator introduces it as he did the other; and, placing the round knob of the port caustic, on the short end of the boAvl, in one corner of the mouth of the womb, he passes it completely over the Avhole surface of the lips of the Avomb; then, as before, sheathes the port caustic, and withdraws it from the vagina. In this operation, no part is, or should be, touched with the caustic, but the exact spot Avhich may be diseased. The surface of the parts touched will peel off in thin, dark-looking scales or flakes; but the parts are not left raAv, although a little tender, and, of course, slightly inflamed; but, as the opposite surface is not in that condition, they will not adhere together; and, even if they Avere so disposed, the mucilaginous Avash, directed after the operation, will prevent that occurrence. The operation may have to be performed several times before a cure can be effected; but it will succeed, if properly performed. The application of caustic by these instruments possesses an advantage over all the methods we have seen prescribed. First, no part is touched but the one diseased. Second, it touches every part that should be touched; and, Avithout this instru- ment, you can neither avoid the one nor effect the other; not even with the speculum, Avith all its boasted utility and exposure of the patient. In using these instruments she is not exposed in the least. As these instruments are not yet generally brought into use, and as the speculum is the only one that can be obtained till these are made, that instrument must therefore be used, and the 782 HARDNESS OF THE NECK OF THE WOMB. parts lightly touched all around Avith a strong solution of caustic, applied by a mop of cotton on a small stick. The parts should be carefully touched in this manner till the surface becomes Avhite and smooth; then the case should be treated as if Bright's •. instruments had been used. In the above cases, it. will always be prudent to prepare the system before performing the operation; and, in doing this, every secreting organ that is in health must be made to perform its healthy functions. The liver, pancreatic gland, kidneys, &c, should all be brought in as healthy a condition as possible. In order to obtain this point, if the patient is fleshy and full of blood, she should be bled from the arm, and then take the fol- loAving medicine: Recipe: Blue Mass, twenty grains. Aloes Socotrine, ten grains. Pulv. Rhubarb, ten grains. Form six pills. Give these at bedtime, and repeat them every night, till the liver acts freely and in a healthy manner, Avhen the folloAving pill should be given for a few nights before the operation: Recipe: Scammony, twenty grains. Pulv. Rhubarb, twenty grains. Aloes Socotrine, twenty grains. Castile Soap, twenty grains. Tartar Emetic, three'grains. Form twenty-four pills. Give three or four of these every night for three nights; the operation should then be performed, after Avhich the vagina must be washed out with slippery-elm tea tAvice a day, using the Avomb syringe. The bowels must also be kept open with the last-mentioned pills. The patient must live on a vegetable diet for six or eight weeks, and avoid all fatiguing exercise; her drink should be cold water. The operation should not be repeated oftener than once a month, and then eight or ten days after menstruating. After all the chronic inflammation has been removed, and the neck and mouth of the Avomb feel soft and healthy, if she does not menstruate sufficiently, give the following pills: Recipe : Burnt Copperas, two drachms. Borax, one drachm. Aloes Socotrine, one drachm. Flour, a small quantity. Form forty-eight pills, of Avhich she should take one, morn- ing, noon and night, for one Aveek; when she should take two INFLAMMATION OF THE NECR OF THE WOMB. 783 at each time, till the month is out; and if she does not then menstruate freely, she should continue another month. By using these instruments and these medicines, we have either cured, or greatly relieved, all the patients we have treated for this disease for the last five years; and these have not been a few, including some ladies who have been married for ten or fifteen years and remained barren, but who have, since the above operations, borne fine children, and thus proved the cure to be complete. We are persuaded the remedy will rarely fail, if the operation is properly performed, and the directions properly folloAved. We Avill here direct the use of the instrument in fig. 7. Press the thumb-nail upon the steel spring c,—the stiletto can be drawn back so as to hide the lancet point, — in Avhich condition it is passed to the membrane over the mouth of the womb; and, placing it on the dimple felt in that membrane, shove the stiletto fonvard till the spring rises. You then push the lancet point through the membrane, and move it a little to the right and left, till it makes an orifice of about one quarter of an inch Avide; you then AvithdraAV the instrument, and pass a small bougie half an inch into the neck of the uterus. This bougie must be passed every other day for three or four times, till the parts heal, and the difficulty as it respects the membrane is removed. Many females die from having the menses obstructed by this mem- brane, and the true cause of their death is never known. We have not as yet failed effectually to remove that difficulty Avith this instrument. All three of the above diseases may be, and are, very often, produced by cold, taken by imprudence in dress, or exposure to wet or cold, during menstruation. The injury thus done may not be detected for years, unless they should marry. Abortion may lay the foundation of it in married women, as also any of the causes that may produce it in girls. The closing of the membrane rarely takes place except in girls, and is then only made known by an obstinate obstruction of the menses, and its long train of symptoms, Avhich cannot be removed by other remedies. OF GRANULAR INFLAMMATION OF THE MUCOUS MEMBRANE OF THE CERVIX UTERI. This disease is not described by the older Avriters on diseases af the uterus, for the best of reasons. The speculum is but of 784 INFLAMMATION OF THE NECK OF THE WOMB. recent date, and, Avithout its use, this disease cannot be accu> rately ascertained or described. These granulations, Avhich may be seen on the labia of the oa uteri, and on the external surface of the neck of the womb, are the result of acute or chronic inflammation, Avhich two forms differ from each other very considerably. The granulations resulting from acute inflammation are few, and about the size of peas, firm and whitish; they are, however, more frequently small, resembling white mustard-seed, soft, and in great num- bers. They look like small blisters, but contain no fluid; but, when touched Avith the finger, they are apt to bleed a little. Hard straining at stool will also cause them to bleed. Those granulations produced by chronic inflammation are generally small, hard, and Avhitish, but sometimes red and soft. They grow from the cervix or neck of the Avomb. The causes of tlr/s disease are, in many cases, extremely obscure. In some cases, it may be referred to a derangement of the catamenial Aoav, or to cold taken during its continuance, or after abortion; Avhile, in other cases, it appears to follow syph- ilis, or some discharge of the skin. It not unfrequently coexists with a hardness of the neck of the Avomb. Avhich will be noticed in another chanter. Withoul il v. use of the speculum, it is almost impossible to ascertain riuc ;se*y the nature of this disease. The touch must be very acute and delicate to detect it fully, because the large granulations are soft, and the hard ones very small. It there- fore requires the greatest care to decide by the touch of the Anger. Treatment. — In the acute stage, bleeding by cups on the loins, warm baths, and injections of warm water into the vagina. are proper. Gentle, cooling purgatives should also be used, such as, Recipe: Senna Tea, half pint. Rochelle Salts, half ounce. Dissolve the salts in the tea, and give it at three draughts, one nour apart. Injections of flax-seed tea may be used three times a,day; but, in the chronic form of this disease, bleeding is rarely necessary. Astringent injections have been recommended by various emi- nent writers on this subject. These have been composed of all the astringent gums and mineral salts, alternately. Tonics of various kinds have also been recommended, and especially the mineral tonics, as well as counter irritation by blistering the INFLAMMATION OF THE NECK OF THE WOMB. 785 sacrum; all of which remedies we have used repeatedly for twenty-five years, but generally Avithout success. We therefore resolved, about five years ago, to apply the caustic directly to the part affected, but had no instrument by which to convey it thereto Avithout touching some other part. After being foiled in various attempts to make the application with a sponge, and by injections with a syringe, Ave constructed the instrument in plate 5, and by its use were enabled to apply the caustic immediately to the part without touching any other.— {See Directions for the use of the instrument.) The caustic should be applied by a light touch, and the port caustic returned into the sheath, and Avithdiawn from the vagina. The parts will feel a little sore for a day or two, and they should be Avashed, in six hours, with slippery-elm tea, which should be repeated three timess a day, for six days. In applying the instrument to the neck of the womb, the caustic should be turned tOAvards the neck, and the back of the instrument next to the cavity of the vagina ; then unsheathe the port caustic, by turning the screw at the outer end of the instru- ment, and withdraw the sheath. This leaves the port caustic naked at its curved end; you then direct it with the forefinger of the left hand all around the neck of the womb, making it fit closely: draAV it then into the sheath, and withdraw it from the vagina. If the os uteri be studded Avith tumors, you then introduce the instruments 3 and 4, and when it is conducted to the os uteri by the finger, you unsheathe it as you did the first, and placing one of the ends, or round knobs, in one corner of the mouth of the womb, you gently, but steadily, pass it round the mouth of the womb, embracing the lips completely, from corner to corner, till you reach the point from Avhence you started. You then sheathe it again, and withdraw it. The operation should be performed only from one to two weeks after menstruation. It may, however, be repeated as often as you find it necessary, but only once a month, till the cure is performed; ahvays using the slippery-elm or flax-seed tea Avash, afterwards. This will effectually prevent the adhe- sion of the vagina to the part touched; for the cuticle ahvays comes off, and if the wash be neglected, inflammation may take place, and adhesion follow. But where the wash is used as it should be, and the patient keeps her boAvels open, and lives on a light diet, no danger can occur from this source. BRIGHT. 51 786 POLYPUS OF THE UTERUS. This remedy effectually removes the tumors, prevents bleed- ing, and restores the healthy action and functions of the uterus Sexual intercourse must be interdicted for tAvo weeks after the operation, each time ; and the patient should keep still, live light, and keep the boAvels open. The following pill will answer very well: Recipe: Scammony, ten grains. Aloes Socotrine, ten grains. Pulv. Rhei, ten grains. Sapo Castile, ten grains. Ground Ginger, twenty grains. Tartar Emetic, three grains. Form thirty pills. Take from two to four every night, so as to keep the bowels open. OF POLYPUS OF THE UTERUS. Polypus of the uterus is an insensible tumor attached to the internal parts of this organ by a small neck, constituting a disease of a very important character. These tumors vary in appear- ance, shape, and degrees of hardness, being sometimes nearly white, and at other times of a broAvnish color. At times they are hard and resisting, and at others soft and yielding, not admit- ting of the application of a ligature without breaking to pieces. When they are hard, they partake more or less of the shape of the parts in which they lie. The os uteri always contracts the neck of the polypus, but the tumor spreads out beloAV, Avithin the vagina. The hard is of more frequent occurrence than the soft species of polypus. Dr. Clark says, " the soft polypus resembles a portion of brain more than anything else;" and it maybe removed with the finger. Both single and married women are subject to the polypus of the uterus. The tumor, Avhen removed and cut open, shows the same appearance internally that it does externally, and some- times groAvs so large as to fill the cavity of the pelvis. When the cavity of the uterus is filled with one of these, or the os uteri begins to dilate, to admit the descent of the tumor into the cavity of the pelvis below, great irritation and suffering are often felt by the patient, though the tumor is not large enough to All the cavity of the uterus. Nothing certain respecting the cause of these tumors is known. They arise in women otherwise healthy, and whose uterus has not suffered any violence. The symptoms which characterize the disease are, first, a POLYPUS OF THE UTERUS. 787 mucous discharge from the vagina, in considerable quantities. mixed with blood; in consequence of which, the patient becomes very much debilitated before the true nature of the disease is ascertained. Large lumps of clotted blood are discharged from the vagina, and the coagula are sometimes in a ring-like shape. At other times the blood discharged from the vessels remains in the uterus till it becomes putrid; and mixing with the secretions, tinges them brown, rendering them at the same time very offen- sive. The patient has sick spells occasionally. This disease has sometimes been mistaken for cancer of the uterus, but an examination by the vagina will decide this ques- tion. A sense of pain and bearing down attends this disease, and these symptoms are proportioned in degree to the size and weight of the tumors. The patient has pain in the back and groins. accompanied with a sensation of pressing down, like that of a dragging weight. The tumor sometimes grows so large and fills the vagina so entirely as to press hard upon the rectum and neck of the blad- der, and thus partially obstruct the passage both of stools and urine. The tumor, however, rarely groAvs thus large, before its true nature is ascertained and the proper remedy applied. A sympathy is sometimes created between the uterus and the stomach, and vomiting is excited. Here, then, from one cause, three or four symptoms are pro- duced ; as great weakness, an increased secretion of mucus, hemorrhage, and vomiting, Avith a derangement of the digestive powers; all of Avhich reduce the patient's strength. When enough of the above symptoms present themselves to satisfy the patient that something more than common is the matter, she should immediately submit herself to the examination of a skil- ful physician. He will discover an insensible tumor projecting through the os uteri, by Avhich its neck is entirely encircled, so that the finger can be completely passed round the tumor and within the mouth of the Avomb. The only diseases that can be mistaken for polypus of the uterus are prolapsus uteri and the cauliflower excrescence, both of which are described under their proper heads. A polypus is insensible to the touch, but an inverted uterus is sensible to the touch. The caulifloAver excrescence is irregular on its surface, and discharges a great quantity of watery substance 788 POLYPUS OF THE UTERUS. It does not grow Avithin the uterus, but is attached to the outer surface of the neck of the womb. If these symptoms and positions be compared together, there can be no difficulty in deciding on the existence of polypus. Treatment. — There is but one remedy in this disease, and that is to remove the polypus. When it is soft, it may be taken away by the finger; but Avhen it is hard, a ligature must be applied around it, in order to remove it. If the patient's situation be not examined, and the physician is content to treat symptoms only, she will inevitably die, as no medicines can cure this disease till the tumor is removed. Severe vomiting has, in a few instances, ruptured the neck of the poly- pus, and it has fallen away, and thus the patient has been cured; but this does not occur once in a hundred times. The operation for this disease is not dangerous; and, therefore, Ave may promise the patient a safe recovery. Previous to applying the ligature, the patient should keep the boAvels open for several days with the folloAving medicine: Recipe: Scammony, Aloes Socotrine, Pulv. Rhubarb, Castile Soap,— of each twenty grains. Form ten pills, and take three or four every night at bedtime, so as to operate twice the next day. The diet should be very light, and immediately before the operation, an injection of thin gruel, lard, and salt, or of molasses and warm water, should be used. After this is done operating, the patient should be kept in an upright posture for some minutes, and she may walk the floor, so as to bring the tumor as low down as possible. When the operation is to be performed, she should be placed on her left side on the bed, Avith her knees drawn up tOAvards her abdomen. The operator having tAvo or three long, strong, silk ligatures, well Avaxed, should pass one of them through a double canula; then pass, with one finger, the double over one side of the polypus, Avhile he carries the other part up Avith the canula, till he reaches the neck of the tumor. He should then tighten it a little, frequently asking the patient if she feels pain; and if she does, he should loosen the ligature a little, and then tighten it again, till she feels no pain from it. He should then gently remove the wire, and draAV the ligature tight, till it is firmly fixed; fasten the outer ends around the little knobs of the canula, CORRODING ULCER OF THE UTERUS. 789 gently pushing up the flat slide on the canula, till it reaches the top of the instrument, or the little round piece on the top. Let the canula remain in the vagina; keep the patient on the left side, and caution her, when she rises to make water, not to remove the canula. or press it in any way. Keep the bedclothes from touching the canula; tighten it a little every day, till it cuts through the neck of the polypus, when it may be withdrawn, and the polypus taken away, either Avith the fingers or the for- ceps ; wash the vagina out Avith Avarm water. Let the patient live on a light diet, and keep her boAvels open, and she will soon recover. It will take, according to the size of the neck of the polypus, from three to ten days to cut it off Avith the ligature; after which, she may use a more generous diet, and take exercise according to her strength. Some strengthening medicine may be given. CORRODING ULCER OF THE UTERUS. We have seen but one case of this formidable disease in thirty years' practice, and, therefore, must depend principally upon what others have said, in our remarks upon it. It is not unusual for Avomen to refer all extraordinary sensa- tions arising at the time of the cessation of the menses to Avhat they call the change of life, and to consider, when they have thus accounted for their diseases, that they have, at the same time, cured them. According to all the authorities Avhich Ave have seen on this subject, this disease never occurs till the menses cease. In the place of the menses, a yelloAvish discharge escapes; trifling. perhaps, in quantity at first, Avith now and then a streak of blood mixed Avith it. There is in the uterus a sense of Avarmth at this time, and by degrees this warmth increases into a gloAving heat, affecting the region of the uterus. Dr. Clark says, "It is not uncommon for the patients to state that they feel as if a fnt coal of fire was Avithin them;" and when this is the case, ulceration is in full force. The quantity of the discharge increases Avith the increase of this sensation, and these symptoms show that the ulceration is extending more rapidly. The countenance becomes pale, and the patient very weak. In corroding ulcers, keen lancinating pains constitute no part of the symptoms. Wc do not mean by this that the patient feels 790 CORROL.NG ULCER OF THE UTERUS. no pain; a sore on any part of the body Avill give more oir less pain. B it Ave would say, that the pain is nothing Avhen com- pared with that of cancer of the uterus. In this disease Avhen the ulcer is touched with the finger, the patient does not fed pain, but says she feels a soreness; and sometimes there is a profuse bleeding from the uterus, from the corrosion of a large blood- vessel. Should she not die from this cause, she will probably live much longer than she would with cancer of the uterus. Treatment.—This disease is produced by inflammation of tta neck of the uterus or membranes; and the proper time to use the efficient remedies for its cure is Avhen the inflammation is in the incipient stage. After ulceration takes place, a cure is rarely per- formed. When the menses have ceased, and a sense of heat succeeds in the Avomb, with a discharge of yelloAV matter attending this heat,—or if there is no discharge, but a continued sense of a gradually increased heat, — the patient may feel herself fully authorized to use the remedies prescribed below. The first thing to be done is, to apply several cups high up on the inside of the thigh, and draw as much blood as the patient feels able to lose; and this should be repeated every eight or ten days. The hip bath should be used, a little cooler than the blood; and, Avhile in the bath, some of its Avater should be throAvn into the vagina with a womb syringe. This should be repeated every day. The bowels should be kept open Avith some cooling purgative, such as, Recipe: Epsom Salts, one ounce. Dissolved over night in a glass of Avater, and allowed to stand till morning, when the clear fluid should be poured off, and taken at two or three draughts during the day; or, Recipe: Rochelle Salts, one ounce. Dissolved in a glass of water, and taken at tAvo draughts three or four hours apart; or, Recipe: Rochelle Salts, half ounce. Calcined Magnesia, two drachms. Mix them in two portions; take one in the morning, and the other in the evening. Or take, Recipe•• Tartar Emetic, one grain. Clear Water, half pint. Dissolve the tartar in the water, and take a taole spoonful CANCER OF THE UTERUS. 791 every two hours; and do this from day to day, as long as you. strength Avill allow, or until the heat of the uterus is removed. If the disease has been neglected, or not apprehended, till ulcer- ation has taken place, the same medicines may be used, with the addition of an opiate taken at bedtime occasionally, to pro- cure rest, and also an injection of slippery-elm tea daily. An injection of the folloAving medicine may also be used once a day: Recipe : Nitrate of Silver, twenty grains. Rain Water, one pint. Dissolve the medicine in the water, and use it once a day, with the syringe. After using the Avarm water as above, if hemorrhage should come on so as to reduce the strength, use this injection: Recipe: Pulv. Alum, two drachms. Blue Vitriol, half drachm. Mix. Dissolve in a pint of rain water, and inject it freely two or three times a day, till the bleeding is stopped. If the patient be very weak, ghre the folloAving tonic: Recipe : Gentian Root, half ounce. Columbo Root, half ounce. Make them fine, and simmer them slowly, in a pint of Avater,5 for fifteen minutes; strain the liquor off; keep it cool, and give a table spoonful every hour or tAvo. If there is no fever, a little good port Avine may be added; but the diet should, in every stage, be altogether vegetable. If the ulceration is extensive, no cure can be expected. This must always be attended to in the first stage, if you expect to effect a cure. CANCER OF THE UTERUS. Fortunately for the female, cancer of the uterus is of rare occurrence. It is, however, occasionally met Avith. There are many cases of disease of the uterus that are supposed to be cancerous which are not so, and it is a little difficult, at all times, to detect a cancer of the uterus in its early stages, espe- cially when it is situated in the neck of the womb. It so much resembles some other diseases that we cannot always decide on the first examination whether it be cancer or not. The neck of the Avomb is liable to a variety of diseases, many of which resem- ble cancer in some of their symptoms; and yet they are not cancer nor cancerous. The only way in which this disease can be decided on correctly 792 CANCER OF THE UTERUS. is, to look at it through a speculum, an instrument made for the purpose of examining the neck of the womb. The touch is not always certain in these cases; it is, hoAvever, very important in one respect, for by it the existence of those small irregularities on the surface of the neck of the womb, — standing, as it Avere, like small shot, or peas, embedded in the substance of the flesh, — is ascertained. These cannot always be felt distinctly; but, in all cases, the tumor Avhich is felt is hard, resembling a piece of gris- tle imbedded under the skin or outer membrane of the uterus. The lumps thus felt are not smooth on the surface, nor do they extend all round the neck of the womb, occupying the Avhole circle of the mouth of the Avomb. Generally, only one of these tumors can be felt distinctly. Women Avho are attacked Avith this disease while they men- struate are liable to have profuse discharges; at each menstrua- tion all the other symptoms are partially relieved for the time being. In the first stages of cancer, there is generally a profuse discharge of mucus from the vagina, resembling the white of an egg; and there is, also, some discharge of blood, but it is not profuse in the first stage. This discharge is more or less profuse, according to the exercise the Avoman takes, or the kind of food in Avhich she has indulged. She feels sharp, lancinating pains shoot through the neck of the Avomb more or less frequently; her stomach is liable to be disordered, and acid eructations to be thrown up. The bowels are more or less deranged, being sometimes costive and some- times too free. Her feet are liable to SAvell, and she feels a sense of weight in the back and uterus, accompanied with a bearing doAvn sensation, which increases in proportion to the increase of the size of the tumor. The general system differs more or less from the disease Avhich is preying upon it, and, as the disease progresses, all these symp- toms are aggravated. The pains increase, and the bleeding becomes more and more profuse; the general system is failing every day, and the patient becomes lean and pale; she sleeps but little, and her mind becomes apprehensive of serious danger from her situation. If the uterus be again examined with the speculum, the little sore seen on the first examination will be found to be enlarged. Its surface is irregular, and its edges uneven, and it looks as if it had been nibbled out by a small animal with fine teeth. When touched, it bleeds easily. This ulceration may progress more or less rapidly, till it has CANCER OF THE UTERUS. 793 destroyed all the neck of the womb; and it sometimes, according to authors on this subject, destroys a portion of the body of the womb before the patient dies. It is to be distinguished from the corroding ulcer of the uterus by the appearance presented by the surface. Avhich, in the cancer, seems as though it had been nib- bled out; Avhile the corroding ulcer looks as though it had been destroyed by strong lye, or something that had softened the parts and dissolved them, with soft edges and stringy fibres attached to them. The patient is not unfrequently much exhausted by large flows of blood. These are the general symptoms, filled up, hoAvever, with a thousand minor ones, Avhich grow out of the disease, and the manners, exercise, and habits of the patient Since the first edition of this Avork Avas Avritten, the author has seen a case of cancer of the uterus, Avith these additional symp- toms : There was constantly discharging more or less of a slightly Avheyish-looking fluid from Avithin the cavity of the uterus, that scalded the parts like hot lye. This fluid came aAvay more pro- fusely at some times than at others, and Avhen a half ounce Avas discharged, the burning pain Avas so severe that the patient would cry aloud. The odor Avas very offensive. There Avould settle in the vagina hard, grayish, granular lumps, like rough, irregular crystals of potash; and, upon applying the test of lytmus paper, and the nitric acid, it was ascertained to be the urate of ammonia; indeed, the ammoniacal smell of the Auid Avas very evident. This Auid, Avhen tested by heat, shoAved a large amount of albumen. The urine also contained a very large amount of albumen. The urate of ammonia would collect in the vagina in twenty-four hours to the amount of a drachm and a half, in lumps from the size of a millet-seed to that of a large bean. I never saAv or read of such an appearance in this disease before. Treatment.—A patient laboring under cancer of the uterus has always more or less fever; the pulse is Aviry and frequent, owing to the irritation produced by the disease. The patient, therefore, should be bled frequently, and but little blood taken at a time. This may be taken from the arm by the lancet, or from the inside of the thighs by leeches. The blood will be found in all cases to be sizy, showing the local inflammation under Avhich the system labors. It is the opinion of Dr. Dewees, that it is better to appiy eeches to the vulva than to the thighs, back, or abdomen. Dr. 794 CANCER OF THE UTERUS. Gilbert and Dr. Duparpque say, " they are of infinitely more service Avhen applied to the neck of the womb than Avhen applied anyAvhere else. But it is to be lamented, that, through a species of false delicacy, many females will suffer death before they Avill submit to this remedy; although it is not more indeli- cate, Avhen properly attended to, than many other things Avhich are done Avith impunity. In this case, life is often suspended upon the use of this remedy, putting out of the question the progress of a disease more loathsome in its character and certain in its consequences than almost any other to Avhich the human family is liable." It is to be hoped that the day Avill come Avhen it will not be thought indelicate to do anything in a proper man- ner that will save life. Let it not be forgotten, then, that bleed- ing is essential, and that too from the parts, or as near to them as possible, for the cure of cancer of the uterus. The boAvels must be kept open every day, and there is a very great choice in the medicines which should be used for this pur- pose. The best medicines are: Recipe : Epsom Salts, one ounce. Magnesia, half ounce. Mix them together, and take a tea spoonful tAvo or three times a day, dissolved in water; or, Recipe : Cream Tartar, one ounce. Milk of Sulphur, one ounce. Mix, and take them as above directed; or, Recipe .• Seidlitz Powders. Of Avhich, one or tAvo may be taken daily, while effervescing. Castor-oil may be occasionally given ; or, Recipe : Aloes Socotrine, thirty grains. Pulv. Rhubarb, one drachm. Castile Soap, eight grains. 01. Cloves, forty drops. Form thirty pills, and give one. tAvo, or three at bedtime, so as to procure one or tAvo operations the next day. The patient should not be purged at any time so as to reduce her strength. Great care should be taken to observe cleanliness, as the dis- charge in this disease is all the time increasing, and the frequent hemorrhages that take place from the corroded blood-vessels, lodging in the vagina, create a smell that is insupportable by the friends, and sometimes by the patient herself. This should be removed frequently, by using a wash, with a womb syringe. The Avash should always be mild, such as balm tea, slippery CANCER OF THE UTERUS. 795 elm, green tea, or milk and Avater, or chloride of sodt, in AAater, or a Aveak dilution of pyroligneous acid; all of which, Avhen used, should be a little warm. Lumps of Avell burnt lime, pounded and put into small bags, may be placed under the bed- clothes ; and small vessels filled with lime maybe set in different parts of the room, to absorb the bad air. But, as soon as the lime is slacked, it should be removed, and fresh lime put in its place. A cloth may be wet Avith the chloride of soda, and be kept all the time to the vulva; and the room should be kept well venti- lated, according to the season of the year. Rest is an important item in the management of this disease. We do not mean by the term rest that the patient should lie doAvn all the time, but that she should not, on any occasion, be fatigued. She may Avalk sloAvly over the floor, recline on a sofa, or lie on a bed, as she may choose. She should not, hoAvever, lie much on feathers. A shock mattress is preferable. Without proper dieting, medicine will avail but little in the cure of cancer of the uterus. The patient should use no animal food, fish, flesh, or foAvl, and no broths or soups. Her diet should be entirely vegetable, composed of such articles as gruel, rice, mush and milk, mush and molasses, rye mush made of unbolted flour, boiled turnips, boiled greens or salad, Irish pota- toes cooked properly, a soft egg, or any mild vegetable that agrees Avith the stomach. The quantity of diet taken is of as much importance as the quality, and but little should be taken at a time. We have treated of the cleansing Avashes to be used in this disease, and Ave hoav come to treat of the medical A\rashes. As the disease progresses, the discharges of blood will be increased; and, if they should threaten to weaken the patient from their profusion, they must be checked. But, if there is much pain, and the bleeding is not profuse, it should be checked very grad- ually. For this purpose, an ooze made of black oak bark, Avith a lump of alum as large as a hazel-nut dissolved in a pint of it, should be used as an injection, with a Avomb syringe. This, Avhen properly applied, will check the bleeding. But if the bleeding be profuse, and the patient is faint, the sulphate of zinc — tAvo drachms to the pint of ooze—should be used. The zinc will sometimes answer the purpose, if dissolved in clear Avater, "96 DEFORMITIES OF THE PELVIS. rain Avater should be chosen. When these fail, you may use the folloAving: Recipe : Nitrate Silver, half drachm. Rain or River Water, one pint. Dissolve the medicine in the water, and use it with the syringe; or, Recipe: Sulphate Copper, one drachm. Rain or River Water, one pint. Dissolve, and use as above. These Avashes may be repeated every hour, or two, till the bleeding is stopped. The painful nature of this disease demands of us some pallia- tives. We, therefore, must use anodynes; and Ave should begin Avith the weakest first. Let paregoric be first used; of Avhich, as much as the symptoms require may be given, till the pains are relieved. When this fails to procure ease in a reasonable time, by giving a reasonable quantity, tAvo or three syringefuls each time, we must then resort to laudanum, and use that till it fails, when opium must be given in a solid form; and should this become too feeble to give relief, Ave must resort to the more con- centrated form of the black drop. Any of these articles may be given in the Avay the patient can take them best. If the stomach or head be affected with any of these anodynes, they may be taken in strong coffee, or a little weak brandy toddy. DEFORMITIES OF THE PELVIS. Deformities of the pelvis may proceed from various causes. First, from rickets; second, fractures of the bones of the pelvis ; and third, disease of the bones, such as white SAvellings. Let the deformity proceed from what cause it may, if the dis- ability takes place before marriage, the girl should not marry; for if she docs, she can promise herself nothing but a repetition of disappointments in child-bearing. In all probability, she can never survive the birth of a child; and, if she does, it will only be to experience all the tortures of death in giving birth to a dead child. She therefore should be advised by the mother never to marry. Fortunately for the ladies of the United States, not one in twenty thousand is the subject of rickets, and but few suffer the misfortune of fractured pelvic bones. But should any be suf- ferers from any of the above causes, they should not marry. BITES OF SERPENTS. 797 OF THE BITES OF SERPENTS. Children are very liable to be stung by poisonous serpents, and if timely aid is not afforded, they die. It would be impossible, in many cases, to obtain a physician; and we shall, therefore, endeavor to give such directions as may enable the parents to afford immediately the requisite relief; for persons stung by some serpents die in tAventy or thirty minutes, if relief is not obtained. When a child is stung by a poisonous serpent, the danger depends in some measure on the part bitten. If the bite should be near the ankle, or on the foot, Avhere the veins are numerous, and lie near the skin, if a tooth of the serpent should enter a vein, the poison will be thrown immediately into the circulation; and in that case, the danger will be great. The first dangerous symptom that occurs is a tightness in the throat, prostration of strength, and vomiting, succeeded by coldness of the extremities — extending over the Avhole surface—faintness, and total loss of pulse; which symptoms, if not speedily re- moved, will terminate in death. The part bitten may or may not swell. If it SAvell, the danger is not so great; and if it does not SAvell, it is an evidence that the poison has passed into the circulation. The throat will then swell, and the tongue become stiff; and when this is the case, the condition of the patient is eminently critical. In all newly-settled countries, Avhere serpents are numerous, almost every family has a popular remedy for a snake-bite. We recollect, when a boy to have seen a man stung on the ankle- bone by a copperhead. He Avas about eighty rods from the house, and he immediately dropped his scythe and Avalked briskly to the house. The family kneAv not Avhat to do for him, but had heard that fresh earth would extract the poison of a serpent. Im- mediately there Avas a hole dug in the earth, and his foot and leg placed in it to his knee, and the earth returned into the hole. The man soon became very sick, and was likely to faint. Nothing else being at hand, a draught of the spirits of camphor was immediately given him, Avhen he revived a little, but soon became faint again, and the draught of camphor Avas repeated. He then vomited freely, and threAv up green fluid; but the camphor Avas given again and again, till he drank more than a pint. He became better; the pain in his foot, of which he had complained so greatly, together with the sensation of suffocation, subsided, and 798 BITES OF SERPENTS. he Avas removed into the house. Warm toddy Avas administered to him several times during the night; the next morning he Avalked tAvo miles home; and in a feAv days he returned and completed his work. No special good at that time Avas attrib- uted to the use of the spirits of camphor and Avarm toddy, except that they served to revive the man. But Ave have long since been satisfied that the stimulus of these articles saved his life. The following cases sustain this opinion ; they Avere related by William Mayrant, Esq., formerly a member of Congress, and Avere communicated by Professor Parsons, and published in the Medi- cal Recorder, 1823, vol. 6, page 619. We give them in the Avords of Mr. Mayrant: " In September, three years ago, one evening, at my residence on the hills of Santee, I heard a violent scream from a female at no great distance; in about from seven to ten minutes, I Avas called out, and informed that Essex, a male slave, Avas bitten by a rattle-snake, and Avas dead, or dying. They had brought him to the house ; and, on going out, I found him extended, motion- less and speechless, his jaAvs locked, Avith a very feeble, flutter- ing, and scarcely perceptible pulse. Humanity, as Avell as inter- est, directed me to every exertion to relieve him. I had heard of the successful use of spirits, both among the Avhites and Indians, in this affection. Calculating, from the rapid effects of the poison upon the system, that it must act on the nerves, and having seen a child about eight or nine years of age take, in typhus, near a bottle of wine in a short time, Avith benefit. I determined to try the effect of the strongest stimulus I could com- mand. I therefore mixed nearly a tea spoonful of red pepper, finely powdered, in a glass of whiskey, had his jaws opened, and poured it doAvn his throat. In a very short time it Avas ejected, as Avere three or four others, in succession. I still persevered, finding the pulse a little revived. After the fourth glass, it remained on the stomach; the pulse shortly after improved; and, after getting five or six glasses to remain, I ceased giving any more, until the pulse fell very fast—nay, almost ceased beating. I then commenced again pouring doAvn the spirits and pepper, till it revived. Apprehensive that the quantity of stimulus Avould destroy him, I soon discovered that, on increasing the stimulus. the pulse would increase. After taking more than a quart, he spoke in his native tongue to his countrymen; a copious stool soon followed ; the pulse still fluctuated. The spirits Avere again administered till the pulse became steady, the dose and frequency BITES OF SERPENTS. 799 of the article being regulated by its effects. In about two hours, the pulse Avas so strong that we left him in the care of his attend- ants, with strict injunctions to reneAV the stimulants Avhenever they found it necessary. In the morning the patient Avas pretty well recovered, but in a state of considerable debility. I con- tinued through the day giving hartshorn in moderate doses; also spirits and Avater. Avilh nourishing food. There Avere, during the course of the night, three quarts of spirits used, one quart of which may have been wasted in pouring it down his throat. On examining the wounds, Avhen first brought to me, I found the two marks of the teeth from an inch to an inch and a half apart, Avhich shows that the snake must have been of uncommon size. I observed no swelling about the part bitten. The parts under the jaAvs and about the throat were, hoAvever, so much tumefied that I Avas apprehensive that the passage to the stom- ach would be closed. 1 applied to the wound and SAvelling under the throat a poultice of slacked lime and soap, under the idea that the poison was an acid, and that the alkali might attract and neutralize it. Most of the fiesh under the jaAv Avhere the SAvelling Avas mortiAed fell out, and around the Avound larger than a dollar sloughed aAvay. They, hoAvever, in a short time, healed, by poultices and a decoction of red oak bark. The per- son that Avas bitten said, that as soon as he felt the wound, he took a rail from the fence near him to kill the snake, Avhich Avas a very large one; his strength, hoAvever, failed; he could not use the rail, nor make any exertion whatever. Being asked Avhy he did not call for assistance, he said that he felt that his tongue, and all around his throat, Avas so tied up that he could not speak. He Avas found in a feAv minutes by the overseer of the planta- tion, leaning on the fence and puking violently. In the morn- ing, he had no recollection of being brought to the house, or Avhat we had been doing for him." Case 2d. " The year after, I was called, late in the night, to relieve a negro that had been bitten by a rattle-snake. He Avas in great pain about the breast, and puking a green fluid. Spirits and green pepper Avere given him, in prepared doses of a wine glassful, until the pulse returned. The pains abated after the man had taken six glasses of spirits and pepper; he Avas much better, the puking ceased, and the pains abated ; he recovered by the use of a quart in ten or twelve hours." In the early settling of Kentucky, there Avas a popular remedy biought by Michael ShaAv into the neighborhood Avhere we were sou STINGS OF INSECTS. raised. The remedy is simply to chevv the herb called ladies' bleeding heart; apply it freely to the bite, and also swallow the juice of the herb till vomiting is induced; Avhen the draught must be repeated, till all the sickness at the stomach and un- pleasant feelings are removed from the system. The leaves of the herb may be chewed, and the juice SAvailoAved ; or they may be bruised, a little Avater added, and the juice squeezed out and SAvallowed. A pint of the juice Avas allowed to be a certain cure, while a large poultice of the fresh bruised or chewed leaves Avas applied to the bite. Mr. ShaAv Avas bitten by a rattle-snake, and also by a copperhead, the next year, and Avas cured by this remedy alone. Nor did he lose three hours' time from the effects of the bites. He said this remedy Avas so effectual Avith the tribe of Indians by whom he was taken prisoner, that they had no dread of the bite of the most poisonous snake. The herb groAvs in rich ground, from one to tAvo feet high, and has a rough leaf, lanceolate, single on the stalk; the taste of the leaf is pungent, and a little austere; the stalk is jointed, not unlike the smartAA^eed, or the hydra peppers; the flowering stem is also like the smartAveed, except that it is larger. If the herb groAvs in the sun, the floAvers are of a reddish hue; but entirely in the shade, they are rather of a dirty ash color. If the right plant be obtained, the remedy may be depended upon; but. as the stimulating remedy, with spirits, red pepper, opium, and ammonia, or hartshorn, can more certainly be ob- tained, it should ahvays be used freely. THE STINGS OF INSECTS. These may be treated upon the same principles as the sting of serpents. The sting of bees, Avasps, spiders, &c., may be suc- cessfully treated by the immediate application of hartshorn, spirits of turpentine, or alcohol, Avhich should be freely applied to the part affected; and, if any unpleasant symptoms super- vene, as vertigo, sickness at the stomach, faintness, coolness of the surface, loss of pulse, &c, the stimulants should be given internally. The juice of the above herb will relieve the pain from the sting of a bee or hornet in a feAv minutes. We have been relieved a great number of times by chewing and applying the leaves to the part stung. In aLl cases, Avhen the person has been stung by a serpent and sickness follows, as soon as the violence of the symptoms is relieved, the boAvels should be freely evacuated by castor-oil, oi some other quick and gentle purgative. HYDROPHOBIA 801 We Avould here remark, that the leaves of the ash-tree have been used very successfully in our OAvn and other countries, as a remedy for the bite of poisonous serpents. The juice is taken freely internally, and the bruised leaves applied to the bite. Numerous other remedies are in popular use, but those directed above are Avell authenticated by expe- rience, and Ave think them sufficient. We give none on conjecture. HYDROPHOBIA, OR CANINE MADNESS. Hydrophobia is defined to be the dread of water; but this symptom alone will not distinguish this disease from many others in which a dread of Avater also exists. In the disease called hydrophobia, the dread of Avater is only one symptom Avith many others, belonging to a specific disease, produced by a specific poison. It has been a matter of much research and diligent inquiry, Avhether this poison can be communicated by any animal except the dog; and it is now settled that it may >be by any of the canine or feline tribe; that is, any of the species of the dog or cat kind. And it has also been proved that the saliva of a man laboring under this disease, Avhen introduced into the dog. will communicate the disease, and the dog be thereby rendered capable of communicating it to other dogs.—See bth vol. Medical Recorder for 1823. This disease is of great antiquity. In the days of Homer it was Avell known, and by him Avas called Lyssia. He refers to it several times in the Iliad, Avhere he "is continually making his Grecian heroes compare Hector to a mad dog, which is the term used by Teucer; Avhile Ulysses, speaking of him to Achilles says, ' So Avith a furious Lyssia was he stung.''' The symptoms of rabies canina are these: spasmodic contrac- tions of the muscles of the chest, supervening to the bite of a rabid animal, preceded by a return of pain and inflammation in the bitten part; great restlessness, horror, and hurry of mind— (Goode)—and Ave might add, a peculiar Avildness in the expres- sion of the eye, and a fearful and ferocious expression of all the features, together Avith an attitude of the body which cannot be mistaken by those who have once seen it. It appears, from the best authorities on this subject, that it mat- ters not Avhether the bite be deep or shallow; if the disease be communicated by it, the characteristic symptoms will accompany it. BRIGHT. 52 802 HYDROPHOBIA. Hydrophobia is not, hoAvever, produced only by the bite of an animal. It is recorded by Goode, as taken from various authors, that the bite of an enraged man has produced hydrophobia, which terminated in death, Avithout the dread of Avater. Le Cat gives a case of death produced by an enraged duck, and in a German miscellany of repute Ave have another of the same kind. The bite of a goose, and also of a hen, has produced the same result, though neither of them Avas rabid.— Goode Marvellous as these things may appear, it is more reasonable to accredit them than to impugn the host of authorities to Avhich they appeal, as Theirmayer, Le Cat, Camerarious, &c.—Goode. That the specific poison of rabies is less active than many other kinds of morbid poison is clear, from the fact that it is never found diffused in the atmosphere so as produce an epidemic, and that it never operates on those Avho are the most susceptible of its influence, except when accompanied Avith a Avound, or inserted under the cuticle; and then it is sIoav in taking effect. It rarely happens that all the men or quadrupeds bitten by a mad dog are affected by hydrophobia. Mr. Hunter gives an instance, in which only one in tAventy persons bitten Avas afflicted with it. This virus is perhaps less volatile than any other; it is also, perhaps, less indecomposable; and hence, it is capable of remaining in a dormant state, in any part of the system into which it has been received, for a far longer period than any other known contagion Avhatever. It has been doubted Avhether the virus is capable of being propagated from the human subject to any animal, even by inoc- ulation ; but a bold experiment of M. Magendie and M. Breschet has completely settled this question. On the 19th of June, 1813, " having collected on a fine piece of linen a portion of the saliva of a rabid man in the last stage of the disease, they inserted it under the skin of tAvo dogs that Avere in waiting, both of them in good health; of Avhich, one became rabid on the 27th of July, and bit tAvo others, one of Avhich also fell a victim to this disease just a month afterwards." No one Avho has smelt the odor thrown out from the body and saliva of a mad dog can ever mistake it: it is so offensive, and so peculiar, that Ave once detected it at the distance of several rods, before we came up Avith the dog, which Avas lying still in a corner of a fence. Dr. Wolf states that the " blood of one of his patients stunk intolerably as it Avas draAvn from a vein.'' Dr. Vaughan s patient complained "of a most offensive smell Avhich HYDROPHOBIA. 803 issued from the original wound, but of which no one was sensi- ble but himself." We might go on to enumerate many facts, as related by authors on this subject; but they Avould be more curious than profitable. The length of time that the virus requires to become active, after having been introduced into the system, varies. Dr. Hamilton, volume 1, page 112, after a very laborious search, fixes the tenth day as the earliest period at which the disease has appeared, and nineteen months as the latest; and, between these periods, the time of attack varied very much. They were as folloAvs: Of 131 cases —17 Avere seized before the 30th day. 63 betAveen 30 and 59 ) , 23 9 from 60 to 90 to 90 \ aa^s i inclusive. 2 at 5 months. 1 n 5 & 11 days 1 u 6 (< 1 it 7 a 2 n 8 n 1 between 8&9 " 2 at 9 tt 1 c< 11 u 1 tt 14 tt 2 n 18 (( 1 it 19 a Dr. Mease has published a case, in which hydrophobia in a boy occurred three years and four months after the bite. It appears, from a labored collection of facts by Dr. Hamilton, that it matters not where the bite is received as to the early or late development of the disease. Of the remote or predisposing cause of this disease we knoAV nothing; for all the theories of dogs being exposed to over heat or cold, or living on putrid flesh, suffering from starvation, or being long kept from water, have been proved, by actual experi- ment, and attested cases by men of undoubted veracity, to be false. We, therefore, are kept in the dark as to the remote or exciting cause of the disease. But of one thing Ave are certain, that is, it is a disease of its OAvn kind, and possesses its OAvn spe- cific effects. The symptoms of attack are these: Before the poison becomes active in the system, the part which has been bitten becomes of a 804 HYDROPHOBIA. reddish or purple hue; sometimes the scar opens a little, and a fetid serum oozes out. Although the part SAvells and becomes painful at times, yet more frequently it does not swell. The development of the disease begins with " a painful constrictive sensation in the chest; the respiration is interrupted Avith fre- quent sighings; the spasmodic symptoms increase; and, at length, the Avhole system, and especially the lungs, become affected with violent convulsions; the breathing is very labori- ous; the paroxysms continue about two minutes; there is fre- quent sickness and vomiting. The convulsive spasms about the throat oblige the patients to gulp Avhat they SAvalloAv, and they are apt to shoAv a reluctance to a glass of water. The skin is apt to be cool, and the tongue moist, and the boAvels open; the thirst urgent, without any tendency to delirium. The patient, hoAvever, becomes worn out by sensorial exhaustion and distress. and sinks into a stupor not unlike that in typhus fever, and dies." This is a description of the mildest form of the disease, and such as Ave have met in practice; but Ave Avill noAV give the de- scription of this disease as related by Dr. Goode, in the third volume of his Study of Medicine, page 238: — "Whatever be the exciting cause, the wounded part almost ahvays takes the lead in the train of symptoms, and becomes uneasy, the cicatrix looking red and livid, often opening afresh, and oozing forth a little Colored serum, while the limb feels stiff and numb. The patient is next oppressed Avith anxiety and depression, and some- times sinks into a melancholy from Avhich nothing can arouse him. The pulse and general temperature of the skin do not, at the same time, vary much from their natural state. A stiffness and painful constriction are, hoAvever, felt about the chest and throat; the breathing becomes difficult, and is interrupted by sobs and deep sighs, as the sleep is — if any be obtained — by starts and frightful dreams. Bright colors, a strong light, acute sounds, particularly the sound of Avater poured from basin to basin, and even a simple agitation of the air moved by the bed- curtains, are sources of great disturbance, and will often bring on a paroxysm of general convulsions, or aggravate the tetanic constriction. The patient is tormented with thirst, but dares not drink, the sight, or even the idea of liquids, making him shud- der. His eye is haggard, fixed, and tinged with blood, from the violence of the struggle; his mouth filled Avith a tenacious saliva, in which, Ave have already shown, lurks the secreted and poisonous miasm, and he is perpetually endeavoring to hawk it HYDROPHOBIA. 805 up and spit it aAvay from him in every direction; often desiring those around to stand aside, as if conscious that he might thereby injure them. The sound he makes, in endeavoring to extricate this phlegm from the throat and mouth, is often of a singular kind, and has, occasionally, to a fruitful imagination, seemed to be a kind of barking or yelping. Hence the vulgar idea that barking like a dog is a common symptom of the disease. The restlessness is extreme; and, if the patient attempt to lie down and compose himself, he instantly starts up again, and looks wildly around him, in unutterable anguish." "On going into the room," says Dr. Munckley, describing the case of a patient to whom he had been called, " we found him sitting up in his bed, and one attendant on each side of him; he was in violent agitation of body, moving himself about Avith great vehemence, as he sat in the bed, and tossing his arms from side to side. On seeing us, he bared one of his arms, and, strik- ing it Avith all his force, he cried out to us, Avith the greatest eagerness, to order him to be let blood. His eyes were redder than the day before, and there Avas added to the Avhole look an appearance of horror and despair greatly beyond Avhat I had ever seen, either in madness or any other kind of delirium." The patient Avas, " neArertheless, perfectly in his senses at this time, and there Avas not the least danger of his biting any person near him; nor, among the variety of motions which he made, Avas there any Avhich looked like attempting to snap or bite at anything Avithin his reach; and they Avho Avere about him had no apprehension of his doing this." — Medical Transactions Vol. 2nd, Art. 5, p. 53. The patient had, at this time, reachec the third day of the disease, and expired about two hours after Dr. Munckley had left him. We have noAV given the mildest and most aggravated forms of the disease. All grades of symptoms may be found betAveen the tAvo just given. In some cases, the patient can drink water all the time; while in others, he cannot take water scarcely at any time. Treatment. — Our curative practice is unfortunately all afloat in this dreadful disease, and Ave have neither helm to steer by nor compass to direct our course. There is, indeed, no disease for Avhich so many remedies have been devised, and none in which the mortifying character of "vanity of vanities" has been so strikingly Avritten on them all. In the loose and hetero- geneous manner in Avhich they have descended to us, they seem. 806 HYDROPHOBIA. mdeed, to have folloAved upon one another without rational aim or intention of any kind. In examining them, hoAvever, closely, we shall find four priti ■ ciples by Avhich physicians appear to have been guided in their respective attentions to this disease. First. That of supporting the vital poAver by stimulants, so as to enable it to obtain a triumph in the severe conflict to which it is exposed. Scco?id. That of suddenly exhausting the system by severe bleeding and purgatives, as believing the disease to be of a highly inflammatory character. Third. That of opposing the poison by the usual antidotes and specifics to Avhich other animal poisons are supposed to yield; and Fourth. That of regarding the disease as a nervous or spas- modic, instead of an inflammatory affection; and, consequently, as most successfully to be attacked by an anti-spasmodic course of medicines and regimen. There was a class Avho endeavored to prevent the poison from entering the system by removing the part bitten. This was done either by burning the part out Avith a red hot iron or by caustic alkali, or by removing it by means of the knife. The advocates for these modes of practice Avere Dioscorides, Van Helmont, Morgagni, and Stahl; all of Avhom were for removing all the bitten part by a red hot iron. Schenck, Ponteau, and Mosby, used the caustic alkali. Hildanus advised excision first, then the application of the cautery, and after this, the removal with the knife of the parts killed by the cautery. Others recommend stimulating remedies — such as canthar- ides, camphor, turpentine, &c. — to be applied to the Avound made by the knife; and Celsus recommended table salt to be applied to the wound after the use of the knife, so as to keep up a free discharge. Sir Kenelm Digby and Haygarth advise the wound to be Avashed Avith warm Avater or wine before excision is commenced. Haquet, Percival, Vater, and Wedel, recommend first, a liga- ture to be tied tightly immediately above the bite, and then, as soon as possible, to excise the wound. Second. To give the volatile alkali, camphor, cordials, pepper, oil of cajeput, the different preparations of tin, copper, iron, and, in later periods, the Peruvian bark. Celsus recommended sub- mersion in cold Avater, as that the patient be thrown into '' a fish HYDROPHOBIA. 807 pond;" and this he Avould do repeatedly, till he drank himself full of Avater, or, in other Avords, Avas nearly drowned; Avhen he should be taken out and submersed "in warm oil, to prevent spasms." Some persevered in this practice, omitting the oil, till the patient Avas apparently dead; and one case is recorded of a recovery after this practice. To forAvard this vieAV of the case in the treatment of the disease, bleeding was carried to great length; even to the loss of six or eight pounds of blood, in a short time; and many Avere the advocates of this practice. But the remedy has been successful only in a feAv cases; and it has been doubted Avhether they Avere cases of genuine lyssia or hydrophobia. Those of the medical world who have been opposed to the depleting plan of treatment have adopted its opposite, and stimu- lated their patients, with a hope of counteracting the lyssiac virus. For this purpose, the strongest stimulants were used; reasoning from analogy, that strong stimulants cured the bite of the " cobra di capello, and the rattle-snake." Among these remedies, we find the ophiorrhiza mungos of Linnaeus, Avhich remedy is used to this day in India and Ceylon, as an antidote against the bite of a mad dog. " Kempfor highly extols it, and Gremmius, who practised Avith great reputation at Columbo, employed it very largely." . Acids and alkalies belong to the same class of anti-lyssiacs. Agricola preferred the muriatic acid, which he regarded as a specific, even Avhen restrained to a topical application. Poppius preferred the sulphuric acid; but by far the greater number of practitioners preferred the acetous acid. Many combined this last Avith butter, and used it externally and internally. Wodel, for the cure of the bite of a mad dog, directs the patient " to drink vinegar, therica, and rue." The greater number of practitioners, hoAvever, preferred the alkalies, and especially ammonia and the volatile alkalies. On the continent, and especially in France, the usual form in which ammonia Avas used, in cases of lyssia, was that of a strong caus- tic spirit; "prepared with quick lime, combined with rectified oil of amber, rendered more easily missible by being rubbed in half its weight of soap." They employed this externally and internally. In the French Journal of Medicine, we have several reports of its successful use, when given only internally. One case related by M. Hervet, and another by Rubiere. It was thought, at one time, that mercury,— from its specific 808 HYDROPHOBIA. effect upon the lymphatic system, Avhich is certainly the outlet of the poison of rabies,—Avould prove a specific in this disease; and although it has gained the reputation of curing many persons who have been bitten by the mad dog, especially after the imme- diate excision of the bite, yet it also, in many cases, has failed to perform a cure. Desault, of France, and James, of England, were strong advocates both of the external and internal use of mercury. They used it as a preventive of the disease, and as a remedy for it after it appeared. The turbeth mineral, in the shape of pills, was the favorite form in which they used the medicine. Dr. James cured a number of hounds belonging to Mr. Floyers, after every other favorite and fashionable remedy had been tried in vain. All the hounds that Avere salivated Avith mercury recovered, Avhile those treated otherAvise all died. — {See Philosophical Transactions, $*c.) But "his experiments on mankind are less complete;" for, only three have been reported as cured, and the medicine Avas given to them as soon as they Avere bitten; and these persons might not have gone mad, if the mercury had not been used. The patient must be salivated, and kept under the inAuence of the mercury, till all possible danger is past, in order to ensure a cure. But Desault and James have been strongly opposed by Frank, Girtanner, De Moneta, Ray- mond, Morse, and a host of others, Avho declare they have no conAdence in mercury. The efficacy of mercury in lyssia is, however, still strongly relied on by many; and to my OAvn knowledge, it proved a pre- ventive in one case,—that of Mr. Jonathan Jones, of Henry County, Ky. Cantharides have held a high reputation in the cure of hydro- phobia. " Bohadsch tells us gravely that the disease will ahvays yield to ten cantharides, poAvdered and introduced into the stomach." Monconys says, that " the powder should be con- tinued from the bite to the time in which we may reasonably expect the symptoms of hydrophobia;" and adds, that "this medicine, which Avas regarded as an arcanum in his day, was a remedy of publicity over all Greece." He might have extended his theatre; for Egypt was as Avell acquainted Avith the general principles of this practice as Greece or Hungary. Avicenna positively states, that, whatever diuretic was employed, it should be carried to its utmost acrimony, "even to the discharge of Dloody urine." With the same view, the ash-colored liverwort has been extcn- HYDROPHOBIA. 809 sively used in England, and has superseded the cantharides. It was given in powder, with an equal quantity of black pepper, "a drachm and a half of the two forming a dose for an adult, which Avas taken for four mornings, fasting, in half a pint of Avarm coavs' milk." The patient, however, was first to lose nine or ten ounces of blood, and aftenvards to be dipped in cold water every morning for a month. This remedy Avas highly extolled in the Philosophical Transactions, Avhen M. Dampier introduced it to public notice, at an early period of the history of the Royal Society; while, at the earnest solicitation of Dr. Mead, the powder was admitted, in the year 1721, into the Lon- don Pharmacopoeia, under the title of pulvis aniilyssns. Dr. Mead declares, " that when used Avith the previous venesection and subsequent cold bathing, he had never knoAvn it fail of a cure, though he had used it a thousand times in the course of thirty years' practice." — Goode, vol. hi., 249. In these days. however, we doubt such extravagant success in the treatment of so formidable a disease. Musk and opium have been highly extolled and extensively used, by a great number of physicians, both in Europe and America. Dr. Cullen gives us nothing deAnite on this disease. Opium and musk, however, have failed, in common Avith all other remedies, for the cure of hydrophobia. Musk Avas at one time combined with cinnabar in large doses, and for a time obtained some celebrity, but Anally Avas laid aside as ineffectual. The prussic acid has also been resorted to, but without effect. It has been injected into the veins of dogs, and of men, in a diluted state, but Avithout producing any good effect. The celebrated Ormskirk medicine, as given by Dr. Goode, is as folio avs : Recipe: Powder of Chalk, half ounce. Armenian Bole, three drachms. Alum Pulv., ten grains. Pulv. Elecampane Root, one drachm. 01. Anise-Seed, six drops. Mix all well together, and give it at a dose every morning for six mornings, in water, with a small proportion of fresh milk. It is said that this remedy has but seldom failed to perform a cure. It is also said that the planiago — madwort plantain—has for some ages been a popular remedy for the bite of a mad dog, in the north of Europe; and, "in a late communication to Sir Walter Farquhar, in the Russian tongue, translated and pub- 810 HYDROPHOBIA. lished in Mr. Brande's Journal of the Sciences and Arts, we are told, that it still retains its popular sway and reputation over a great part of the Russian empire, and that in the government of Isola, it has never failed of effecting a cure in a single instance for the last five-and-twenty years." The preparation is simple ; the root is reduced to a powder, and the powder is to be eaten by being spread over bread and butter. " Two or three doses are said to be sufficient in the worst cases, and will be found to cure mad dogs themselves." Dr. Goode says, " In the second number of the Hamburgh Medical Repository, Dr. W. Rilhmeister, of PowloAVsk, in Fin- land, has given an article, in Avhich he has collected a multi- plicity of striking cases, and various authorities, in proof that the blood of a rabid animal is a specific against the canine hydro- phobia, even Avhere the symptoms are most strongly marked. The mad dog, or other quadruped, is for this purpose killed, and its blood drawn off, and collected as an antidote against hydro- phobia. Dr. Stockman, of White Russia, confirms this account, and states the practice to be equally common and successful in his OAvn country." Chlorine has been used extensively by Professor Brugnatilli, of Pavia, with, as he declares, great success; but Professor Valetta, of Milan, denies that it possesses any curative poAvers in this disease. In conclusion, Ave Avould mention, that the chick-Aveed of our own country, and the hooded willoAv, have had some reputation in the cure of the bite of the mad dog. A pint of vinegar, drunk every day for a week or tAvo, is also said to be a remedy, and there are some declarations of its utility. It is said to have cured the hydrophobia. From all that has been said and Avritten on this subject, — for an abundance more than Ave have here related has been said and done, and many have been the advocates of the various reme- dies,— we may safely say Ave have no specific for the bite of a mad dog, though it is clear that the medical world has not been idle in the pursuit of one. We would say, hoAvever, as our deliberate opinion, from all we have seen of the disease, and all Ave have read about it, that the safest plan Avould be, to wash the wound immediately; after which, cut it clear out, leaving no trace of the bite behind; then fill it up, or cover it over, Avith red precipitate, and dress it Avith a strong stimulating plaster. Bleed the patient moderately, and HYDROPHOBIA. 811 salivate him as soon as it can be done; let him be kept on a light diet, his mind and body tranquil, and let the ptyalism be kept up moderately for one month, watching the under part of the tongue every day, and as soon as the small whitish points are discovered, cut them open Avith a sharp lancet, and burn them Avith a red hot knitting needle. Be very particular to open them all. If the disease should break out, the patient should be stimu- lated moderately, made to drink vinegar freely, and kept as tranquil as possible. This course of treatment, Ave believe,— from all that Ave have read and seen on this subject, — to be the best that can be adopted. \ 812 DR. ANGELL'S TREATMENT OF FEVER. The folloAving treatment of fever, from my friend, Doctoi Angell, Avas received too late to be inserted in the proper place,— on the treatment of fevers, — owing partly to his numerous en- gagements, and partly to absence from the city ; but the receipt of Avhich is iioav hereby acknoAvledged by his friend, J. W. Bright. Dr. Bright : Dear Sir, — The treatment of fever subjoined is substantially that Avhich I have pursued from the commencement of my prac- tice, at Cleveland, in 1826, modified, in 1831, by the exclusion of calomel and the addition of digitalis; and it has been tested on the shores of Lake Erie, the swamps of Louisiana, and the hills bordering the river in Mississippi. Of its success I will merely state, that but few cases of summer or autumnal fever required my attention more than three days,—generally no paroxysm, or but one, recurring after the commencement of the treatment, and not more than one in tAvo hundred, of all my cases of fever, termi- nating fatally. In bilious fever, emetics or purgatives are generally given before the attendance of the physician ; if not, I usually premised a mild purgative; occasionally substituting an emetic of ipecac, where the yelloAV, furred tongue, bitter taste, nausea, "and head- ache, indicated its use. My usual purgatives Avere castor-oil, senna, rhubarb, extract of Avhite Avalnut, or Seidlitz poAvders. I have cured many cases Avhere no purgatives Avere used, and vieAv their repetition as generally retarding the cure and increasing the subsequent debility. During the febrile paroxysm, I gave the folloAving mixture. Recipe : Tincture of Digitalis, one drachm. Sweet Spirits of Nitre, four drachms. Paregoric, three drachms. Tartar Emetic, one grain. Lessening or omitting the tartar, if it cause nausea or vomiting. Mix. One drachm, or a medium sized tea spoonful, to be given, in Avater, every tAvo hours, to an adult; eight or ten drops to a child six months old; and in proportion for intermediate DR. ANGELL's TREATMENT OF FEVER. 813 ages. I also direct cold water to be drank freely, and the skin to be freely and frequently Avashed with it, so long as its impres- sion is pleasant, and the surface remains heated. Immediately on the remission of the fever, I commence the use of quinine, two grains every two hours, discontinuing the febrifuge mixture Avhen the fever has entirely intermitted, but continuing the quinine through the intervals, and subsequent paroxysms, if any occur; resuming, during the fever, the use of the mixture and cold water as before. The quinine must be used till the fever fails to rise at its usual period, as above directed; it may then be given for tAventy-four hours longer, at intervals of four hours. The quinine, Avhen given Avith the fever mixture, Avill ameliorate and shorten the fever paroxysm, and, in most cases, prevent its recurrence. If fearful of using it in the fever, it will suffice to give it during the interval. Where quinine affects the head, the precipitated extract of bark, in three or four grain doses, may be substituted, unless the stomach be irritable, Avhen it will frequently be rejected. The extract, in rather larger doses, is equally efficient Avith the qui- nine ; and either it or quinine may be conjoined Avith the oil of black pepper — one drop to the dose. If the headache be severe, especially if attended with great heat or throbbing in the temples, the application of cold water to the head, by Avashing, pouring, or Avet cloths, is beneficial. If nausea, vomiting, or pain in the stomach be present, a fomentation of hops or a mustard plaster may be used, and Avarm instead of cold Avater drank, and if insufficient, especially Avhen there is great thirst, or a red tongue, cupping or leeching over the pit of the stomach. In nervous irritability of the stomach, the tongue not much furred nor red, but drinks and medicines inducing immediate vomiting, the matters ejected being unmixed with bile, a dose of morphine, — one eighth to one fourth of a grain, — will often immediately relieve. Other symptoms may occasionally indicate other remedies, but neither time nor space permits my noticing them. I have found the above treatment, in substance, sufficient in all the forms of southern fever where there Avas an entire remission of febrile excitement every twenty-four hours, however brief the inter- mission; constituting, in my experience, at least ninety-five pei cent, of the cases occurring in the summer and fall. Under the formerly prevalent ultra mercurial practice, conges- 814 DR. ANGELL's TREATMENT OF FEVER. tive fever raged extensively and fatally in my neighborhood, but fever rarely presented that type at the onset, and never assumed it in my practice; and, fully convinced that the repetition of irri- tating purgatives endangers the conversion of bilious into con- gestive fever, I Avill repeat the caution against their abuse, and recommend, in the cases Avhere evacuations are really required in the course of the treatment, the substitution of injections. In the form of fever commonly termed nervous or typhoid, characterized by a red and pointed tongue, great thirst, tender- ness on firm pressure in the stomach or some part of the boAvels, a small, frequent, and tense pulse, retaining that character through the partial remissions Avhich occur once or tAvice a day, frequently nausea or vomiting, and, in the progress of the disease, stupor and low delirium, the above practice will be useless. After gradually renouncing the use of active medicines, I relied upon cupping or leeching, and the affusion of cold Avater, Avith success. The application of half a dozen or more cups over the stomach and boAvels, especially where pressure caused pain, repeated till there Avas improvement, which generally required tAvo, three, or four applications, was usually my first remedy, aided by frequent spongings Avith cold Avater. If the abdominal inflammation Avas not subdued, and an intermission of fever obtained, I then had my patient placed on the floor, and a bucket of cold Avater poured Avith moderate quickness over his head and body, dashing some on the abdomen. He was then, without Aviping, enveloped in a dry blanket, and placed in bed. As soon as the improvement in the pulse and other symptoms passed away, which Avas often in half an hour, I repeated the process, and con- tinued the course till the delirium, stupor, heated skin, hard and quick pulse, &c., Avere permanently removed. Close attention to maintaining the impression, and patience, are requisite. But, by pursuing this course, I have succeeded in many cases where medicine had failed entirely. Injections of cold or warm Avater have appeared beneficial, and cold water Avas drank as freely as the patient desired. In complying Avith your desire that I should communicate my mode of treating southern fevers, I have endeavored to express myself so plainly that every reader compelled to depend upon his oaaii judgment in their treatment may understand me, and regret that your space and my time have not permitted my describing it with more minuteness and greater care. Richard Angell, M. D. « PLATE I. 817 EXPLANATION OF PLATE I. A A A A. The ossa ilia, properly so called. a a. The iliac fossa. b b b b. The angle which divides transversely and obliquely, from behind forward, the internal fossa of the os ilium into two parts, and makes part of the brim of the pelvis. c c c c. The crista of the ossa ilia. e e. The anterior superior spine of the ossa ilia. //. The angle formed by the internal lip of the crista of the ilium tOAvards the extremity of its anterior two-thirds; and to which is attached a ligament, inserted at the other end in the transverse apophysis.of the last lumbar vertebra. g g. The inferior angle of the os ilium, which makes part of the acetabulum. B B. The os ischium. h h. The tuberosity of the ischia. i i. The branches of the ischia. k k. The posterior parts of the ossa ischia, which make parts of the acetabula. C C. The bodies of the ossa pubis. 11. The angles of the ossa pubis. m m. The posterior extremities of the ossa pubis, which make part of the acetabulum. n n. The ascending branches of the ossa pubis, which unite with those of the ischia. D D D. The os sacrum. 12 3 4. The anterior sacral holes. ooo. The base of the sacrum. p p. The sides of the sacrum. E. The coccyx. F. The lumbar vertebra. r r. The transverse apophysis of the vertebra. s s. The ligaments which go from the transverse apophyses of the last vertebra to the angle of the internal lips of the crista of the ilia, indicated by the letters//. 11. Two other ligaments, which descend from the same apophyses to the superior edge of the sacro-iliac symphysis. G G. The femurs, or thigh bones. v v. The heads of the femurs, received into the acetabulum. u u. The foramen ovale. H. The symphysis of the ossa pubis. / I. The sacro-iliac symphysis. K. The sacro-vertebral symphysis. BRIGHT. 53 PLATE II. 819 TREATMENT. EXPLANATION OF PLATE II. This plate represents a deformed pelvis, through Avhich it would be almost impossible to deliver a living child of full growth. a a. The ossa ilia. b b. The ossa pubis. c c. The ossa ischia. d d d. The last lumbar vertebra. e. The projection of the sacrum. //. The sacro iliac symphysis. g. The symphysis of the pubis. h h. The foramen ovale. i i. The branches of the ossa pubis and ischia, which form the anterior arch of the pubis. k k. The acetabula. The lines indicate the diameters of the superior strait. A A. The anterior posterior diameter; its natural width educed to fourteen or fifteen lines, or so many portions, twelve naking an inch. B B. The transverse diameter; its length in this plate, four nches and ten lines. C C. The distance from the projection of the sacrum to that ff tho margin which ansAvers to the left acetabulum, thirteen ines. D D. The distance from the same point of the sacrum to that ff ihe margin which measures to the left acetabulum, twenty ■ints, PLATE III ng. Or, ©1 Crq ^1 a« >Cc- T expressed, would, I have no doubt, be adverse to false pretensions in any form; whether in the guise of Mormonism or Millerism, with Avhich their own profession is every noAV and then assailed, or homoeopathy, or Graefenburg company's wholesale manufactures, etc. But I am ready to meet my clerical brethren on middle ground, and in so doing, we Avould point out the subjects of study- on Avhich we shall be able to meet on this middle ground, and interchange views and suggestions, profitable alike to both parties, and profitable to the public at large. My reference is to HYGIENE. 94". physiology, or a knoAvledge of the healthy functions of the human body, and to hygiene, or an acquaintance with the nature and operation of agents by which, in succession or alternation, these functions are maintained and variously modified in their manifesta- tions. These studies involve a consideration of man's mixed nature — the physical, the moral, and the intellectual — and suggest important hints, even if they do not indicate absolute guides for an improved education, and a more fruitful didactic instruction, whether the teachers be professors in a college, or clergymen in the pulpit. The physician, whose views do not extend beyond the mere materialism of man and his functions; and the divine, or theologian, who directs his advice to a purely spiritual beino-; are equally wide of the mark, equally removed from an appreciation of human nature, and equally ignorant of the manner in which it has pleased the Creator to fashion man. For, while both the physician and the divine admit the compound nature of man, the former is perhaps too prone to lay undue stress on the purely physical causes modifying this nature, as the latter is most likely, too ready to attribute an undue share to spiritual control. If in place of being thrown, as they now and then are, into antagonistic positions, owing to a hasty assumption, by each, of the dogmatic ethics of the other, they were to start from common and mutually admitted postulates, the result would be more creditable to medical science on the one hand, and Christianity on the other; and both might harmonize in doing much good to man. The works of Hippocrates, Celsus, Galen, Holler, Zimmerman, the two Gheynes, Fuller, and Paries, in the medical, as Avell as those of Tcrtullian, Lactantius, St. Augustine, Jeremy Taylor, Paley, and Butler, in the theologian's library, might be selected as text books in common, for furnishing abundant apposite knowledge to both parties. This could be done without the clerical student deeming it necessary to learn the practice of physic, from the first class of these Avriters ; or the student of medicine puzzling himself with questions of controversial divinity, that he may meet with in the second class. All the great teachers of antiquity, especially those who legislated for their fellow-men, were well acquainted with the principles of hygiene, the practice of Avhich was made a religious duty. With the hygienic institutions of Moses, in Deuteronomy, and in Leviticus especially, all reading men are familiar. Those taught in the books of Solomon, though with lesa solemnity of inculcation than thoso of Moses, still indicate a nice 944 HYGIENE. appreciation of the influence of hygienic agents, as in the contrasted pictures of plain and simple living, and of the penalties incurred by luxurious and debasing indulgences. What admirable lessons of temperance and chastity are contained in the twenty-third and thirty-first chapters of Proverbs. Can there be more impressive images of the sorrow and ruin, and yet apathy, of the sufferer from the indulgence in wine, than in the last seven verses of the twenty-third chapter, beginning: "Who hath woe? who hath sorrow?" &c. More could not be said in favor of regular exercise procuring sound sleep, and of indolence being punished by wakefulness, than in this single verse: " The sleep of a laboring man is sweet, whether he eat little or much: but the abundance of the rich will not suffer him to sleep." Ecclesiastes v. 12. These few words are equal to a long homily, for inculcating contentedness Avith one's lot, be it ever so humble. The influence of the passions on the health is well pictured in the following verses: "A merry heart doeth good like a medicine: but a broken spirit drieth the bones." Proverbs xvii. 22. "A sound heart is the life of the flesh: but envy the rottenness of the bones." Proverbs xiv. 30. "As cold water to a thirsty soul, so is good news from a far country." Again: "A merry heart maketh a cheerful countenance: but by sorrow of the heart the spirit is broken." "All the days of the afflicted are evil: but he that is of a merry heart, hath a continual feast." The purifying influence of Christianity, in a' hygeinic point of view, merits not only the careful study of the physician, but more emphatic and frequent mention than it customarily receives in pulpit teachings and written sermons. How well does St. Paul describe man's double nature, the animal and the spiritual, and the struggle between the flesh and the spirit. He teaches, in a few words, how direct retribution, in their bodily suffering, is measured out to those who yield to sinful indulgences, when he describes the wrong-doer as one who sinneth against his own body. Much more instructive than any doctrine of abstract spiritualism, is that physiological and noble view which the Apostle takes of the human body, when he calls it "The Temple of the Holy Spirit, which is in us; and which is God's, and not our own;" we are left, clearly, not to infer, but to see, we have no right to abuse it. And by another figure, he speaks of the body as a vessel, to be possessed in sanctification and honor. Tertullian, in denouncing the vices of Paganism, and the vanities of personal decoration, the abuse HYGIENE. 945 of perfumes, &c, and visiting the theatre, showed, that not only the morals, but the health suffered by these practices. Still more celebrated for his knowledge of medicine, was the Platonic Clement, of Alexandria. He used to cite Hyppoerates, and Galen, in terms of great admiration, in the second part of his Pedagogue, which is purely hygienic. The best features in Islamism, are the hygienic precepts inculcated by Mohammed, in the Koran, and chiefly those relating to abstinence from intoxicating drinks, gross meats, and the regular use of personal ablutions. But, I must not forget, that I am only writing a chapter, and not a treatise on Hygiene. As no animal can five without water, in some form, we conclude, that it is the most important article in sustaining animal life. If we turn our attention to ancient authors, on the subject of beverage, we shall find them, Avithout a dissenting voice, all to agree on the one article—water—pure water—as the only safe and healthy beverage for man, or animals. If we trace the line of Hygienic descent, from the pens of all the philosophers, both ancient and modern, we shall find, without exception, that water is declared to be the only safe drink for man. It is one of the largest components of the blood. It is a universal febrifuge, it keeps the system cool, 'he brain clear, the mind unclouded, the intellect active ; and all the secreting organs, under its influence, perform their functions in a healthy manner. The advocates for alcoholic drinks, are Avont to say, mix a little wine, or spirits, Avith your water, to prevent it from hurting you. Let me say, to such, that there is not one particle of nourishment in alcohol. I care not in what form you may find it; it is a potent poison; and, although it may be slow in some instances, it is always sure to perform its work, if its use be persisted in. The importance of Avater to animal and vegetable life, must be manifest to all men. Water, considered in its physio- logical relations, is still, emphatically, one of the elements as described by the ancient philosophers. It makes up the chief bulk of all animal, and vegetable bodies; it gives the necessary fluidity to the former, and sap to the latter, without which neither coidd flow, nor be distributed to the several tissues and organs, of Avhico water is the largest constituent. Water is diffused through the atmosphere, in the form of vapour, and renders the air fit for respiration. Air, deprived of all humidity, would cause a rapid and exhausting evaporation from the skin and lungs, and reduce the being to an extreme state of exhaustion, if not to death As a proof of it, see the large proportion of water entering 61 946 HYGIENE. into the composition of the human body. I may mention a fact, stated by Bluminbach, namely, that " a perfectly dry mummy of an adult Guanche, (one of the original inhabitants of Tenerieffe,) with all the muscles and visera, did not exceed seven pounds and a half in weight." Not only does the blood contain four-fifths of its weight in water, but even the parts of the body termed solids, that is, the mass of flesh, of Avhich animals consist, contain, in reality, scarcely one-fourth of solid matter; the remainder being water. Bone itself, and cartilage, in still greater proportion, contain water as a necessary constituent. Again: water enters largely into the composition of all substances used for food. Take a familiar example, the potato ; this is composed of from seventy to eighty parts of water. That portion of animal matter used for food, will show an equal proportion of water. Water is indispensable to the process of nutrition, and digestion. Digestion cannot be carried on in any of its processes, Avithout a large proportion of it. Without water, the food we take could not be reduced to chyme; nor could the chyme furnish chyle; nor the chyle become blood. Water is indispensably necessary, in order that the balance of the living functions be preserved, and life sustained. Thirst can only be allayed by water, or those substances containing a sufficient amount of water for that purpose. When man is left to the dictates of the principle of his nature, to select the article best calculated to sustain his frame, he flies to water. Next to the nutritive fluid furnished by the maternal bosom, Avater is the one taken by the infant, with ' avidity; and if left to his unbiased taste, Avould ever be so taken by the adult. And even he who, in his midnight revel, drinks deep into the intoxicating bowl, will, on the following morning, intreat for, and grasp eagerly, the full pitcher of cold water, which only a few hours before he had go insolently derided. Both the principle of his animal nature, and his recovered reason, now suggest, and even demand, the only and proper beverage for them. And but for the blighting curse of imitation, and evil example, their joint influence would ever guide him right. When Ave say, water is the only suitable drink for man's daily use, we are fully sustained by the facts in the case. As a proof, that the God of nature designed Avater to be of universal use, it is found in all climates, and habitable regions of the earth; and providence has no Avhere offered, in fountain, river, stream, lake, or well, any liquid as a substitute for Avater. It is, therefore, designed as a universal beverage, as it is universally found HYGIENE. 947 where either man or beast can live on this globe. When disease lays hold of our mortal bodies, water is the only menstruum by Avhich medicinal substances are carried into the blood; and even Avhen they are refused an entrance, it readily finds its Avay, and not seldom accomplishes the cure, for which those drugs are lauded. How different is alcohol. If it is the menstruum of medicinal substances, it soon abandons them, and can neither obtain for them entrance, nor find its OAvn way into the blood; nor can it ever exercise its influence upon the nervous system, till, by repeated goadings and depraved influences, it finally finds its way into the blood vessels. But then, alas! it soon shows its mark; the face bloats, the limbs stiffen, carbuncles appear, the vital organs are diseased, and the fangs of the agent of hell soon tears the vital casket, and lets loose the spark of life, while it takes its subject to a disgraced, and untimely grave. Oh! spirit and agent of the power of darkness! thou shouldst be deprecated by all rational beings, and irrational brutes—the more rational cannot be deluded by it a second time. Alcohol does not form a constituent part of any tissue, or of any fluid in the healthy body: it retards, in place of aiding those series of changes which the aliment undergoes, before it is converted into blood. It prevents man, in all cases, from fulfilling the high destiny for Avhich he Avas created. On the contrary, pure Avater is ahvays exhilarating; it aids digestion, and is in itself nutritious. Perhaps Ave haAre said enough on water, simply as a beverage, though much more might be said on the subject, especially if Ave would take a full physiological view ef it. For A\That we have said, we can confidently appeal, for support, to all the scientific physicians, and philosophers, from Hyppocrates, down to the present day. Greek, Roman, German, French, English, and American—ail—all will sustain me. While Ave are on the subject of the Hygienic properties of Avater, we shall say some thing concerning its external use in baths, ablution, &c. Bathing may, with a great deal of propriety, be regarded as a practice; not less congenial Avith our feelings of bodily comfort, than conducive to vigorous health. We cannot doubt its antiquity, when we see it resorted to in every stage of society, from the Avandering savage of the woods, to the polished inhabitant of the city. The same instinctive impulse by Avhich, during the oppressive heats of summer, man and animals are led to Reek the shade, and inhale with eagerness the cool air, Avould also prompt them to plunge into the nearest stream, as an additional 948 HYGIENE. means of refreshment and invigoration. Of the antiquity of bathing, no one who has any pretensions to a knowledge of the manners and customs of the ancients, will presume to deny. In the best description of ancient manners, we meet with accounts of bathing in rivers; as when the daughter of Pharaoh, and her attendant maidens, went down to the Nile ; and Nausicao, and her companions indulged in similar enjoyments, in the stream near her royal father's residence. Domestic baths, suggested by the wants and conveniences of life, were also of remote antiquity; as we learn from Homer, who represented Diomeda and Ulysses, to have made use of such after washing in the sea. So also, the poet tells of Andromache, preparing warm water for Hector, on his return from battle; and of Penelope calling in the aid of unctions, and baths, to mitigate her melancholy, at the prolonged absence of her husband. It is from the hands of Helen herself, that the disguised Odysseus received these services. Minerva is feigned to have imparted renewed vigor to the wearied limbs of Hercules, at the warm springs of Tfiermopylce; and Vacca, in place of other gifts, offered him warm baths. Numerous are the passages in Homer, which describe the custom of females attending male guests, and assisting them in their ablutions. On this point the following observations of Athenozus are worthy of remembrance. " Homer makes virgins and women wash strangers, which they did without exciting desire, or being exposed to intemperate passions ; being well regulated themselves. Such was the custom of antiquity; according to which the daughters of Cocalus washed Minos, who had passed over into Sicily." The importance of bathing, as a means of cure of loathsome disease, is well illustrated in the directions given to Naaman the leper, (by the Prophet Elisha,') to wash seven times in the river Jordan: and still more in the command of our Saviour, for the blind man to wash in the pool of Siloam. The pool of Bethesda was also resorted to by the sick and infirm. It seems to have been a uniform part of eastern hospitality, to furnish water to the wearied traveller, for bathin" his feet, as we find Laban to have done for the messenger of Abraham, and his attendants; and as Abraham did for the three angels in disguise, who tarried with him during the night. Bathing was strictly observed by the Jews, as a religious right, and with them was typical of moral purity. This was practised throughout central Asia, and the East, even before the time of Moses, during the patriarchal ages. Job speaks of purifiea- HYGIENE. 949 fcion by snow water. It Avould seem, that the great Jewish law- giver and prophet was not merely influenced by his enactments, in this respect, by the necessity of preserving the health of the twelve tribes, during their long journeying through the wilderness, and their subsequent residence in the land of Canaan; but he was also swayed by the remote example of the Patriarchs, and perhaps by the more recent one of the Egyptians, whose priests washed their bodies three times a day, on the occasion of extraordinary sacrifices. So intimate was the emblem with the Jews, of bodily cleanliness, and moral purity, that their priests always washed their whole bodies, before they undertook to officiate in the temple. Mohammed required his followers to consider themselves bound to wash their face, head, neck, hands, and arms, severally before they repeated each one of their five daily prayers ; and besides the ordinary lavations, there were others peculiar to each sex. The Greeks, it would seem, borrowed their practice of bathing as a religious rite, as well as a prophylactic remedy and Hygiene, from the Egyptians. Baths were sometimes called sacred by the ancients, and the reason of this designation is one of the problems proposed for solution by Aristotle. Sea bathing was held sacred by the ancients to Neptune; fountains and springs to the Naiads, and other nymphs, &c. At Syracuse, in Sicily, Apollo Thermistes, was worshipped; and in Thessaly, the hot springs of Thermopylae, were dedicated to Hercules. In Italy, medical springs were sacred, to respectively, Juno, Esculapius, &c, as Lake Avernus was to Pluto, and that of Cuma, to the Sybil—who was designated by it. We will not follow these superstitions any farther; they go to show how near, that, in all time past, in ancient days, baths and ablutions were deemed right and necessary for the purification of the body, and stood as emblems of moral purity; both of which were, as they now are, and ever will be, necessary to the perfect health of the body and mind. Socrates, Plato, and Aristotle, talk of baths as in common use. Hyppocrates, about the time of the Peloponnesian war, recommends them in a variety of circumstances,both as hygiene, and as remedial agents in the cure of diseases. In the primitive houses of the Greeks, the bathing room is described as being included in the division of the first court; and the bath-room appro- priated to the women and children, was, according to Homer, situated in the interior of the house. Sea bathing, as a strengthening remedy, was generally followed by the ancients; by a cleansing bath in a tub. " Noble women thus bathed and perfumed." 950 HYGIENE. (See H. Hase, on the public and private lives of the ancient Greeks.) Historically considered, bathing assumed the most importance, Avhen it became a part of their hygiene, or that art by which all the agents of life and well-being are systematized. The practice of bathing, however, became a mania at times, and the Spartans adopted the practice of plunging their new-born babes into cold water; by which practice many of the delicate and feeble ones were killed, as some of ours are in this day. The ancient Germans were much addicted to bathing, as Tacitus tells us. We might say much more on the subject of ancient bathing; but we come down to England. She had her sacred springs also, as that at Rye, in Sussex, into which some Avonderful virtues were infused by the prayers of a certain Norman Monk. While Rome had her thousands of baths, and bathing places, England had her hundreds. Water of all temperatures has been, and is still used for baths, some from a superstitious notion of divine virtue, and others purely for Hygienic purposes. Who can read of the magnificence of the baths of Agrippa, and the manner in which he bequeathed them to the Roman people for their health, and not feel that those people set a high estimation on the Hygienic properties of bathing. The baths of Etroiscus, made free by the Emperor Claudius, gave him great renown. The baths of Oaracalla were ornamented with two hundred pillars, and furnished with sixteen hundred seats of marble; three thousand persons could be seated on them, at one time. But those of Dioclesian surpassed all the others in size and sumptuousness of decoration; they were enriched with the precious collection of the Ulpian Library. All this goes to show how much the ancients esteemed the Hygienic properties of bathing. It may be said, that bathing, as a means of preserving health, is of modern origin. We should rather say, to our shame, that it is too much neglected in many parts of our beloved country, even for common decency and cleanliness, but we refrain ; and, in order to shorten our remarks on this part of our subject, we will give some directions for the use of the bath. Under all circumstances it is important, both to health and comfort, that the skin be kept clean, and the pores open. If a person be weak, and easily chilled, let him, or her, take a tepid bath. If this debilitates i^o much, take it at the temperature of the blood 98° of Farenheit. Weakly children should not be bathed oftener than three times a week; but in all cases, if the skin becomes soiled, it should be cleansed, either HYGIENE. 951 with water, or soap and water. Adults should also use a bath, from two to four times a week, in the spring and fall; every day in hot weather, and twice a week in the winter. The best time to take a bath is in the morning, before breakfast. The manner of taking the bath, is much practiced by a shower on the head ; but it is much more preferable, as a hygienic remedy, to use it by aspersion. Let those who use the bath, as a hygienic remedy, turn out of their bed in the morning, and step into a tub of cold Avater, and with a towel, or sponge, begin at the feet, and wash themselves quickly, to the arm pits; then step out of the water, wipe dry, and put on the lower garments ; then throw off the shirt, and begin at the wrists, and bathe to the neck, then the face, neck, head, breast, and shoulders, wipe dry, and dress as quick as possible ; the quicker all this is done the better. The reason for applying the water to the parts as above named, first, is this: where you first apply the water, the first reaction will take place, hence you see, that all the vital organs are protected from a sudden rush of blood into them, as the brain, the lungs, stomach, &c. After bathing, some exercise should be taken in the room before breakfast. As a positive rule, the bath should never be taken on a full stomach, either by aspersion, ablution, shower, or dipping, either tepid, warm, or cold. If for the comfort, or for the refreshing and cooling effect, we take a bath in hot weather, it should always be after some active exercise, when the surface is heated, and an hour before, or four hours after dinner. Those baths may be taken in a suitable tub for this purpose, where a person can lie down, at the degree of 80°, and be enjoyed for half an hour, or more. Plunging into rivers, or pools, when the water is cold, should be done on an empty stomach, and not remain in the water, but two or three minutes ; unless active exertion is made by swimming. Let me repeat, again, weakly children should never be plunged into cold water, as a hygienic remedy, but their baths should be tepid, or warm, and used quickly. Where the shower, or aspersion cold bath, produces a chill in adults, that does not speedily go off, and a warm glow succeed, it should be changed for the tepid, or Avarm. bath. (I mean, by the warm bath, one equal to, if not a little above blood heat.) As a man, or woman advances in age, the bath should become one of their regular practices, at least twice a week ; it Bhould be tepid, it keeps the pores of the skin open, and moist, and aids digestion. If there is a dry harshness on the skin, stron"- friction should be used, till a full glow is produced all 952 HYGIENE. over the surface, before taking the bath: this may be done by an assistant, Avith a pair of tight gloves on, or hair mits for that purpose. When great insensibility exists in the skin, salt is frequently dissolved in the bath, for the purpose of stimulating the skin; and when the person is apt to be chilled, this is proper, or where it is desirable to make the absorbents act more freely. Sea bathing is rarely used as a hygienic remedy; but as a medicinal course of treatment for disease. (For the reputation of that bath see Hydropathy.) No man is prepared to go into society genteely, unless his skin is thoroughly clean, and the secretions SAveetened and natural. Diet. The natural diet of all the mammalia is milk. This article is prepared by the living organs which secrete it from the blood, and deposit it in suitable receptacles, from which it is abstracted by sucking, or that action of the mouth, and tongue of the young, which is called by that name ; though, philosophically speaking, the term sucking is not appropriate to this process, aa it is abstracted by art, called milking, and fed to the young. Milk is, of all other diet, the easiest of digestion, when taken in its natural and warm state. Every process through which it is taken, preparatory to digestion, only impairs it, and makes it less digestible. Next to milk, vegetables, when properly prepared, are next easily digested. These require an artificial preparation, in as much as they never were designed as food for man, till he had teeth to masticate them, the Ghahamite theory to the contrary, notwithstanding. It is true, that some vegetables are more palla- table in their raw state, than they are after being cooked; but the number is comparatively few. As a general rule, children should not use vegetables as a diet, without being well cooked. Vegeta- bles being the most appropriate diet for man, should constitute three-fourths of his diet. Those vegetables that require a large dilution with water, such as tea, coffee, chocolate, cocoa, &c, should always be sweetened, as the sugar adds greatly to the nutritive quality of those articles. As a general rule, children should not use any of those articles as a diet, without diluting them largely with milk, and having them well sweetened. There has been much said about the use of tea, and coffee as a diet. Some tell us they are not proper articles of diet for man: they judge of their effects on others, by the effect they have on themselves. The only rule that I find Avorthy of our judgment, in relation to those articles of diet, is this : do they agree with you, if they do, you can use HYGIENE. 953 them; if they do not, you should not use them. And so we might say of almost every article of diet. So diversified are the conditions of various stomachs, either from abuse, habit, idiosyn- crasy, and age, condition, &c, that no positive, or even o-eneral rule can be laid down by any man on dietetics. There is one general remark that may be made, which Avill govern every case, and that is, the proper exercise of the judgment; and also, that all meals should be taken regularly, and uniformly, and with as little variation from the same articles of diet as circumstances will permit. I know it is much desired, by many, to have a great variety of dishes on the table at once, and this variety must be changed very often. All this is wrong. The human stomach is neither a mill, or a fermenting vat. It is a living organ, and it performs its offices by a vital, and not a mechanical, or chemical process ; therefore, Ave should not require it to do more than it can perform with ease and certainty. Then let it not be engorged with any article of diet; and especially, with a great variety .at once of beef, pork, mutton, bacon, fowl, &c. with a half dozen different vegetables, and to top off with a rich dessert, and an abundance of sauce. What stomach could receive all these, and not be burthened even to positive oppression ? Every article taken into the stomach must be rendered homogeneous: that is, perfectly assimilated Avith each other, before one drop of healthy chyle can be formed, of which the fluids and solids are made. If the stomach be so far over charged with those varieties, as to render it unable to assimilate them, then a chemical process commences, and acid is formed; the stomach is what you call sour. and vomiting or purging must be the consequence, in order to get rid of this chemical process; for, be it remembered, that chemistry and vital action are the opposites to each other. It is the province of vital action to build up, supply, and sustain the system ; and it is the province of chemistry to pull down, and separate, dissolve. and analyze—to render heterogeneous, instead of homogeneous. From what we have said, it will be readily seen, that the more simple and plain our diet is, the more healthy it is ; and, as a result, the longer will those live who observe it closely. I am ready to admit, that the different seasons of the year bring their varieties of food ; but this does not change my principle. I would only say, Ave should gradually slide into the change, and not rush into it precipitately. We can, Avith impunity, use more animal food in cold than in warm weather. Except the taste has been depraved, as are the heathens, we all prefer meats well cooked; but depravity, 954 HYGIENE. by habit, has made some men prefer meat raw, to well done. Such persons are, generally, short lived; the more they partake of the animal, in their diet, the nearer their lives approach to the longevity of the animal. In all miasmatic countries, and situations, it will be found very conducive to health, to take breakfast before exposing yourself to the unhealthy influence of a miasmatic atmosphere, or heavy fog. Instead of taking a potation of stimulants, take a cup of coffee, or a full meal. The dress should be varied according to the temperature of the air; and we should never sleep in wet clothes, if it is possible to avoid it. We should always sleep up stairs, in a city, in prefer- ence to the lower story; the bed room should be well ventilated, without a draft of air passing immediately over the bed. In all damp weather, it will be found conducive to health to have a little fire in the house, morning and evening, to expel the damp air. As a general rule, we should not take active exercise immediately after eating, as the process of digestion is retarded by it. Half an hour's sleep, after dinner, for those who are weakly, will do more for their digestive powers, than pounds of medicine. Keep your head cool, and your feet warm; if you would keep well. A slight indisposition may be often relieved, and a spell of sickness warded off, by drinking freely of cold water alone, and abstinence from food, or taking it very sparingly for a few days. This is the way to aid nature to perform her own cures, take away all her hinderances, and give her a chance to do her own work in her own way. Never eat while you are in health, unless you are hungry; nor take a drink of water, unless you are thirsty; but should you have taken very active exercise, or been deprived of water, till your throat and mouth seem to be dried, and you feel almost famished, be careful, then, how you take water; first gargle your throat two or three times, till you get the tongue, palate, and fauces well moistened, and cool, before you swallow any water. This will so allay your thirst, that you will not be liable to take too much. Always swallow a little at a time and swallow it slowly. Thirst is situated at the root of the tongue and not in the stomach. When a person feels like dyin«-, for the want of water, if the region about the root of the ton one be freely gargled with vinegar and water, the thirst will be entirely allayed, and a few small swalloAvs of water will suffice. No person should use ardent spirits as a beverage; it should only be taken as a medicine, and then in small quantities. It is poison, and will sooner or later, kill if persisted in. I know it is said, by good men HYGIENE. 955 take a little, and it will do you no harm. I do not know, if I put my hand into a bear's mouth, that he will bite lightly; he may tear my flesh and bones to pieces. Keep away from danger, and you will be sure not to get bitten. The better way is to taste it not at all ^ in health; then, if it becomes necessary as a stimulous, when you are sick, a little will have the desired effect; but, if you are in the habit of using it freely, your system becomes so habituated to its action, that when you really need it, it will do you no good. Temperance in all things is the only guarantee that any man lias, for a long, useful, and happy life. Gluttony, wine bibbing, and laziness, lays the foundation of a host of diseases, and is a sure prelude to a short life. A man should not sleep more than eight hours in twenty-four: many men sleep not more than six, and enjoy good health for three-fourths of a century. Keep the body unincumbered with food, drink, or drowsiness, and your mind will be active and useful. No man, whose mind is sluggish, can enjoy life or yet be useful, either to himself or to society. On the contrary, every man owes a duty to society, as well as to himself; Avhich is, to let the Avorld be something better by his having had a place in it. This duty may be fulfilled in many ways. Every man is not a philosopher, or a business man; nor is he a mechanic or farmer: but every man has a talent for some one of those pursuits ; or else he is only a machine, to labor as he is put in motion. Every man should strive to leave some- thing behind him, by which his memory may be perpetuated. Hence, it is the duty of all men to marry, and raise a family: this he should not do, however, without the means of supporting them; and the industry that enables him to do this, will make him a useful member of society. " The proper study of mankind is man." Take this motto in all its moral, hygienic, sanitive, philosophical, mechanical, pharmaceutical, horticultural, and business aspects, and you will live long and usefully, both to yourself and the world. If you are attacked by disease, take care to use the proper remedies early, while the disease is in its forming stage: a little medicine will then remove it; but, if you let disease become deep seated, and the system overcome by it, you are in danger of losing your life, or having your constitution broken before you are cured. 956 HOMEOrATHY. HOMEOPATHY. It is by special request, I write a short chapter on this subject In doing so, I shall avail myself of the researches of others into the merits of this system of practice, as well as the knowledge I possess of its merits, or demerits; and what I say, shall be as strictly as possible guarded by the principles of the great founder of homeo- pathy, and my conclusions as open to the criticism of others as the principles of Hahneman, are to myself. I hold, that every system of medical practice should be subjected to the most searching scrutiny—of truly scientific investigation. Let us lay aside all mysticisms, witchcraft, and transcendentalism, when human life is at stake; and let us, if possible, find and adhere to the truth. If we are not able to find the truth, let us confess it; but cease not to search after it, till happily we may find it. This, I conceive, to be the only safe course. If we are dissatisfied with the researches of the regular schools of medicine, we certainly gain nothing by catching at a new-fangled theory, and notions that are the results of a disappointed success in the practice. According to the established method of the science, we have, at least, the right to examine the foundation on which such new systems are founded. and all the grounds which it claims for the change. When the mind is awakened to the investigation of any system, whether it be governmental, educational, medicinal, or religious, in which all have an interest, a set of system mongers will be sure to spring up, and put forth something that will produce more or less confusion. This, for a time, may delay, yet it will not ultimately prevent the triumph of truth. The popular inquiry on the subject of medicine has fostered a number of conflicting systems of medical practice, which have been pressed into public notice. Added to the Allopathic, we have the Steam, the Botanic, the Hydropathic, and the Homeopathic systems, each maintained by hundreds of disci]ilea and patrons. So general is the interest felt in these different methods of practice, that, in some sections of country, almost every person feels competent to pronounce judgment, much more decided than a man who has devoted a whole life time, to the study of diseases and their remedies. Public confidence in the medical treatment of disease can never be restored, till the popular systems have been subjected to the test HOMEOPATHY. 957 of thorough, candid, scientific scrutiny. Scientific and common sense principles, may be applied to a system of therapeutics, as well as to a mode of agriculture, or mechanics. The means for restoring a diseased human body to health, lie as properly within the province of scientific research, as the means for restoring the fruitfulness of a field, or the repairing of a dilapidated machine; and any system of medicine, that will not stand this test, will soon be laid aside, as among the things that were. I shall now examine some of the principles of Homeopathy, as laid down by Hahneman, its author. I am aware, however, that many who profess to be his followers, are not, in all cases, guided by his rules; but, if they profess to be Homeopathists, and yet transcend the theory laid down by Hahneman, they are to be considered ignorant of his principles, or hypocritical in their profession and practice. Homeopathy pro- fesses to cure all curable diseases. The founder of this system has woven into it a great share of German transcendentalism. Hahne- man, in common with all physicians who have studied the functions of the human system, in their healthy and diseased manifestations, know, that it is possible for these functions to be diseased in their manifestations, as well as the possibility of a farther organic de- rangement of the different organisms. And this action, or condition of the system, must be, if possible, remedied by the use of medicine. The peculiarity of the homeopathic system is found in the use of the means necessary to restore these functional, or organic derangements, to a healthy state. We shall endeavor to state Hahneman's doctrine, and not those doctrines taught by a school, or individual, who may have embraced his system, either in whole, or in part. Doctor Kerby says, " When we attempt to defend Homeopathy, those principles announced in Hahnemann's Organnon, and received by all acknowledged Homeopathists throughout the world, are the standard by which we reason, and by which we judge ourselves, and others." And Doctor J. Baseom says, " It is mainly from this same Organnon, that I have drawn the following statement of principles." Hahneman declares, in his Organnon, " That any disease is to be cured by the administration of a medicine, which, if administered in proper doses, to a healthy person, will produce a similar disease." Or, in the phrase so much hackneyed by his disciples, " Similia similibus curanter." Let us hear what Hahneman h;is to say, himself, on this point. On page eighty-seven of the Organnon, he says, " We ought to rely, solely, on the morbid appearances which medicines excite in a healthy person—the only 958 HOMEOPATHY. possible manifestation of the curative virtues which they possess, in order to learn what malady each one of them produces in- dividually, and, at the same time, what disease they are capable of curing." Again, on page eighty-eight, "There remains, accord- ingly, no other method of applying medicines profitably, in diseases, than the Homeopathic; by means of which, we select from all others that medicine (in order to direct it against the entire symptoms of the individual morbid case,) whose manner of acting upon persons in health is known, and Avhich has the power of producing an artificial malady, the nearest in resemblance to the natural disease before our eyes." Again: " Plain experience, an infallible oracle in the art of healing, proves to us, in every careful experiment, that the particular medicine, Avhose action upon persons in health produces the greatest number of symptoms resembling those of the disease which it is intended to cure, possesses, in reality, (when adminis- tered in convenient doses,) the power of suppressing, in a radical, prompt, and permanent manner, the totality of these morbid symp- toms ; that is to say, the whole of the existing disease. It also teaches us, that all medicines cure the disease, whose symptoms approach nearest to their own; and that, among the latter, none admit of exceptions." This is Hahneman's OAvn statement of the doctrine which constitutes one of the leading peculiarities of his system. If this doctrine be true, we cannot, according to Homeopathic doctrine, either by the appearance, taste, or chemical properties of any medicine, say what its effect may be on the living system, either in health or disease. The question is to be settled wholly by experiment; " and to experiment the Homeopathi-st appeals." But, it would seem, that Hahneman's method of experi- menting is unphilosophical; for, whatever may be the nature of disease, all must admit, that there is a difference between the healthy and physiological, and the diseased and pathological state of the system. If Hahneman wishes to know Avhat agents will counteract a certain diseased or pathological condition of the system, instead of making the experiment on the system, while in that state, he makes it on the system in a healthy and quite different physiological state; and, what is still objectionable, the doses of the same medicine are so Avidely different, that no safe inference can be drawn from the action in one case, in respect to the action in the other. From the fact, that a grain of tartar emetic will nausiate a man in health, and perhaps, vomit him ; it ia bv no means a nhilosonhical inference, that the millionth of a grain HOMEOPATHY. 959 will cure nausia in a sick man. Dr. Kerby, in speaking of the effects of medicine, " supposes that a person will not believe that tartar emetic, in a dose of three grains, will cause vomiting." And he further supposes the physician to give this answer: " What I assert is true. Tartar emetic, in that dose, and even less, has been administered in tens of thousands of cases, and, perhaps, by as many physicians, within two hundred years ; and they all concur. that it will vomit: but, if any one doubts the testimony, let him try to swalloAV a dose himself and he will personally experience the truth of it." Dr. Kerby adds, "All must admit this would be sound reasoning." Yes, certainly, this should be admitted by all; but it is the very thing that the Homeopathist will not admit. The Homeopathist declares, that a certain dose of certain medicine, will produce a certain effect on the system. We deny it, and offer to swallow the dose. " Oh, no !" says he, " you must take a dose a million times larger." But, sir, this materially alters the case. Stick to your text, Mr. Homeopathist, " Similia similibus curanter." This is the great truth you claim to have discovered, and the world holds you to your position. But, we ask, has this position been proved to be true ? Certainly not, by the great mass of scientific physicians, either of Germany or any other part of the world. Some minds, that are like kites, flying with every breeze, and never settled, only Avhere there is nothing to unsettle them, may profess to be satisfied with this system. Let any well balanced mind examine the results of Hahnemann provings of medicines, on the system in a healthy state, and then judge for himself, in respect to the reliance that is to be placed on them in the cure of disease. He gives us no account of how the medicines are prepared; the mode of administration; or the doses required. But he occupies thirty-eight pages with the symptoms produced by charcoal; and fifty pages Avith symptoms produced by sulphur. Here are some of his symptoms, detailed as produced by these medicines in chronic diseases : Yol. iii. p. 46. Here he details the symptoms produced in persons in health, by the use of charcoal. " Painful straining in the left ear; straining in the right ear in the evening ; straining coming out at both ears ; pinching in the left ear ; tearing in the interior of the right ear; tearing pains in the groove in the right ear; tearing and burning pain in the left lobule; tearing jerks, or single stitches in the right meatus audito- rious internus ; stitches in the left meatus auditorious from without inwards; (p. 48.) itching of the upper part of the ear, Avhich 960 HOMEOPATHY. afterwards became hot." These are only a part of the symptoms referred to the ears. Then follows a few of the symptoms developed in the head, by the same articles. " Obtusion of the head, aggra- vating thought; considerable obtusion in the head, in the morning after rising; obtusion in the head for several days, without any pain; obtusion of the occiput, as in intoxication," &c. This obtusion of the head is a favorite symptom in Hahneman's pipings. Almost every article in his Materia Medica produce obtusion of the head. What man would acquire confidence in the homeopathic remedies, by examining these provings ? But let us return to his principles, Similia similibus curanter. That which will produce the disease, will cure it—if homeopathically applied. If burning a burn will cure it; if opium will cure an appoplexy ; if cutting and gashing a fresh wound will cure it; if bleeding and starving a starved man will restore his strength; or to transfuse more blood into the veins of the already plethoric, will make him lean; or feeding him on roast beef will reduce his flesh and blood; or to throw a drowned man into the river to restore life, be a rational practice ; then we should receive the doctrine, and practice upon it. But, till such can be satisfactorily shown to be true, Ave ask to be excused from believing in it. Dr. Post quotes the old ditty, (and none can be more appropriate,) and the editor of the Ameri- can Journal of Homeopathy declares it to be a strong point against Homeopathy, or Hahneman's system; and although it may seem a little low, we venture to repeat it here : " There was a man of Thessaly, He was so wondrous wise, He jumped into a bramble bush, And scratched out both his eyes. And when he found his eyes were out, With all his might and main He jumped into another bush, And scratched them in again." Yes, but says the homeopathist, you have gone too far with this matter; I appeal to Hahneman's principles, "Similia similibus curanter." I shall not allow you to deny the basis on which your master stands. The next great and fundamental principle in Hahneman's system, is this: " Where medicines are administered homeopathi- cally to the sick, they do actually produce a new disease in the system, similar to the original one, but more intense in ita HOMEOPATHY. 961 character ; hence, he directs you to give the homeopathic medicine, till they produce a sensible but slight aggravation of the disease. Here let him speak for himself. Organnon, p. 90. " The curative powers of medicines are, therefore, grounded upon the faculty which thoy possess, of creating symptoms similar to those of the dis- ease itself, but which are of a more intense nature. It necessarily follows, that disease cannot be cured in a certain, radical, prompt, and permanent manner, but by the aid of a medicine which ia capable of exciting the entire group of symptoms which bear the closest resemblance to those of the disease, but which possesses a still greater degree of energy." Again : Hahneman says, " This law is founded on the natural law of Homeopathy; a law unknown till the present time, although it has, on all occasions, formed the basis of every visible cure; that is to say, a dynamic disease in the living economy of man, is extinguished in a permanent manner, by another that is more powerful; when the latter, without being of the same species, bears a strong resemblance to it, in its mode of manifesting itself." If this were true, vaccination that prevents small-pox, should be a more powerful disease than small-pox; and the remedy that cures all diseases, being more powerful than the disease itself, it would seem reasonable that we should choose the least evil, and let the disease alone. Again: p. 153, "A remedy, which has the power and tendency to produce an artificial disease, closely resembling the natural one, against which it is employed, and which is administered in appropriate doses, affects, in its action on the organism, precisely those parts which had, till then, been a prey to the natural disease, and excites in them the artificial disease which it is naturally capable of producing: the latter, by reason of its similitude, and greater intensity, now substitutes itself for the natural disease." The idea, that medicines being introduced into the system, to produce a disease different from the one existing, is by no means to be attributed to Hahneman, it is much older than his grand-father, or great grand-father. But, that it produces a similar disease, much stronger than the one it cures, is not true, either in Allopathy, or Homeopathy. Mercury certainly produces a disease, where it is introduced into the system so as to salivate ; but it is different from the fever, or syphilis it cures by the mercurial fever. But, suppose Hahneman is right; what have we gained ? We have removed one stage of disease, but we have produced a still higher grade of the same disease. But, forsooth, by it the patient is cured. Away with such philosophy. BKIGHT {VI 962 HOMEOPATHY. It is a poor subterfuge to say, the second disease will disappear of itself. I should certainly risk the original, being a milder disease ; to disappear of itself. There is another doctrine found in Hahneman's works, Avhich, perhaps, is not so fully believed by all his followers ; it is this: that most chronic diseases are dependent on a miasm, which has come down to us, through successive generations, from remote antiquity. This he calls the "psoric or itch miasm." He tells us, it cost him " twelve years' research to discover this great truth." Happy would it be for truth, if he did discover it in that length of time. Men have labored twice that length of time, to establish what, in the chimera of their brain, they suppose to be true ; but, when it is scrutinized, it proves to be false. He refers, "Hysteria, dropsy, cataract, pains of all kinds, and the itch, to common causes." We cannot have respect to such unreasonable doctrines. But, let us say something about his medicines, and the manner of their preparation. The homeopathic doctrine is, that, by trituration, agitation, and friction, the power of medicines, over morbid condi- tions of the system, is either developed de novo, or greatly exalted; and that they thus become capable of exerting a spiritual dynamic agency. It is fully admitted by Hahneman, that some of the im- portant articles of his Materia Medica possess no medical properties in their crude state. Vegetable carbon, for example, in its crude state, possesses no medical properties. But, says he, " by tritura- tion, they are spiritualized, or dynamized, so as to become very powerful." But as the class of physicians to which I belong, ac- cording to Hahneman, " feed on no other ideas, but what are gross and material," it becomes necessary that we quote the language of Hahneman himself. Hear him: " The homeopathic healing art develops for its purposes, the immaterial (dynamic) virtues of the medical substances, and to a degree, previously unheard of, by means of a peculiar, and hitherto untried process. By this process it is, that they become penetrating, operative, and remedial, even those that, in a natural, or crude state, betrayed not the least medicinal power upon the human system." After detailing this peculiar process, which Ave shall presently give, Hahneman adds, in a note: " In order to have a determinate rule for the moderate development of the power of the fluid medicines, multiplied experi- ence and observation have led me to retain two shakes for each vial, in preference to a greater number which had been previously used, but Avhich developed the energy in too great a degree.'" HOMEOPATHY. 963 On the contrary, there are homeopathists who, in their visits to the sick, carry about their person the medicine in a fluid state, which they nevertheless affirm, do not in time become increased in energy by the frequent agitation to which it is thus subjected. This declaration, however, betrays, on their part, the want of a talent for accurate observation. " I dissolved a grain of nitre, in half an ounce of a mixture of water and a little alcohol; poured the solution into a vial, which was thereby filled two-thirds, and shook it un- interruptedly for half an hour: by this agitation, the fluid attained an energy equal to that of the thirtieth dilution." Organnon, p. 200. In a preface, dated at Paris, in 1839, Hahneman says: " Homeopathic dymasolution, are processes by means of which the medical properties of drugs, which are in a latent state, in the crude substance, are excited, and enabled to act spiritually (dynamically) upon the vital forces; that is, upon the sensibility and irritability of the fiber, by employing proper care in the preparation of our potencies, even the fiftieth potency becomes exceedingly powerful; so powerful that a pellet of that potency has frequently to be dissolved in a large quantity of water, and has to be taken in very small doses by susceptible patients, lest the effect should be overwhelming." Can any man, in his sober senses, believe there is a word of truth in the statements made above ? No one, but a lunatic, could believe it. Another principle in Homeopathy is, the administration of infinitisimal doses of their medicine to the sick. This is very naturally connected with the idea of spiritual agency; and to this peculiarity of the system we would now call the attention of the reader. It is generally understood, that this class of doctors deal in very diminutive doses of medicine, that they carry very small bottles with very small pills. There are but very few persons, who have paid sufficient attention to this matter to understand any thing about it. It is only due to this class of doctors to say, they disagree among themselves in relation to the strength of the medicine they use. There are the high dilutionists, and the low dilutionists. Some give a dose, thai contains a thousandth million times as much medicine as that of others, and for the same class of symptoms. Hahneman, the father of'the system, however, should be the standard by which his system should be tried. He says, " vegetable medicines are to be prepared by expressing the juice, and mixing it with an equal quantity of alcohol." This he calls the mother tincture. Organ- non, p. 200. " If ^o drops of a mixture of equal parts *f 964 HOMEOPATHY. alcohol, and the recent juice of any medicinal plant, be diluted with ninety-eight drops of alcohol,'in a vial capable of containing one hundred and thirty drops, and the whole twice shaken together, the medicine becomes exalted in energy to the first development of power, or, as.it may be denominated, the first potency; the process is to be continued through twenty-nine additional vials, each of equal capacity with the first, and each containing ninety- nine drops of spirits of wine; so that every successive vial after the first, being furnished Avith one drop from the vial, or dilution im- mediately preceding it, Avhich had been twice shaken, is itself, in turn, to be shaken twice, always remembering to number the dilution on the cork as the operation proceeds. These manipulations are to be thus conducted through all the vials, from the first up to the thirtieth dilution, or dicillinoth development of power, which is the one in most general use." All other medical substances, as the metals and other minerals, petroleum, phosphorous, the parta of plants obtainable only in the dry state, neutral salts, &c. ; one and all are, in the first place, exalted in energy by attenuation in the form of powder, by means of three hours trituration in a mortar. To the millionth degree of this, one grain is to be dissolved, and brought through twenty-seven vials, by a process similar to that employed in the case of vegetable juices, up to the thirtieth development of power. When these preparations are to be given, little globules, made of starch and gum water, are prepared, two hundred of which will only weigh a grain, these globules are moistened with the thirtieth dilution; five or six of these globules are mixed with a small portion of the sugar of milk, (if that cannot be had, a little finely pulverized loaf sugar,) and dissolved in a glass of water, from which the patient must take from one to two tea-spoonsful, once in an hour or Wo, according to the violence of the disease. Here we have before us, essentially, the whole pharmacy of the homeopathist. The principle medicines they use are of the most potent poisons; such as aconite, arsenic, strychnine, belladonna, morphine, prusic acid, quinine, and other medicines of less power. If they give calomel, the thousandth part of a grain is a large dose, (but I was told, by a popular homeopathist, if he ever gave more than the ten thousandth part of a grain, he gave more than he intended.) We are hard of belief, however, that they follow Hahneman's system in this country. As these dilutions arc con- ducted in these little vials, it Avould seem to be by no means a HOMEOPATHY. 965 formidable one; but try a few figures on the subject, and you will find, that the dilution must be carried to an inconceivable extent. The proper measure of the degree of dilution is the quantity of alcohol, (or water) required to carry a grain, or a given portion, or a drop of this juice of the medicinal plant, to the thirtieth dilution. And how much water would be required for this purpose ? We cannot measure it by gallons, or barrels, or hogsheads ; all our measures of capacity do but mock us. Lakes and even oceans of water do not begin to supply the requisite amount. Do not be startled, Doctor Bascom says, " Were the whole space appropriated to our solar system, from the central sun to the distant orb of Herschel, filled with Avater, even this would not suffice. Nay, it would require more than a quintillion of such masses. If the quantity of water necessary to carry one drop, to the thirtieth dilution, was in one solid cubical mass, it would exceed nine quin- tillions of miles in diameter; and light, moving at the rate of two hundred thousand miles per second, Avould be more than fourteen hundred years in passing through it, from side to side; even the thirtieth dilution, the one Hahneman says, is " most commonly used,'1 leads us Avhere our conceptions become dizzy, and we begin to stagger. What shall we think, then, of the fiftieth dilution, which is said, by Hahneman, (in the passage quoted above,) to be so powerful, that a pellet containing one two-hundredth part of a grain of the liquid, must be dissolved in a large quantity of water, and given in very small doses, to every susceptible patient, lest the effect should be overwhelming. Stretch your imagination, if ycu choose, to conceive of the quantity of water necessary to carry out this dilution, for I am not willing to try it. I would as soon expect to take a tea-spoonful of the water of Lake Superior, after one drop of this solution had been thoroughly mixed in it, for an emetic, and expect to be vomited thereby, as to believe, that any medicinal effect Avhatever can be produced by any such preparations of medi- cine. It is surprising, that Hahneman's transcendentalism ever should have taken hold of the minds of sensible men: but it has done so, and here is the system, and the practice : judge for your- selves. I have never known a man, whose mind was Avell balanced, follow the practice. Men, in this country, may sail under Hahne- man's flag, but they do not follow his system in their practice. 966 HYDROPATHY, OR THE WATER CURE. HYDROPATHY, OR THE WATER CURE. It is not our intention, in this chapter, to lay down a complete systematic mode of the water cure, but simply to show that the use of water, not only as a hygienic remedy, but as a remedial agent, in the cure of disease, has been customary almost from time im- memorial. We shall also lay down some general rules for the use of water, as in the warm, tepid, and cold baths, as well as a febrifuge; with some notice of the use of water in its various external applications. The antiquity of bathing is too well under- stood, and acknowledged by the historical reader, to require proof. In the best description of ancient manners, we meet with accounts of bathing in rivers; as when the daughter of Pharaoh, and her attendant maidens, went doAvn to the Nile; and Nausicao, and her companions indulged in similar enjoyments, in the stream near her royal father's residence. Domestic baths, suggested by the wants and conveniences of life, were also of remote antiquity; as we learn from Homer, who represented Diomeda and Ulysses, to have made use of such after washing in the sea. So also, the poet tells of Andromache, preparing warm water for Hector, on his return from battle; and of Penelope calling in the aid of unctions, and baths, to mitigate her melancholy, at the prolonged absence of her husband. It is from the hands of Helen herself, that the disguised Odysseus receives these services. 3Iinerva is feigned to have imparted new vigor to the wearied limbs of Hercules, at the warm springs of Thermopylae; and Vacca, in place of other gifts, offered him Avarm baths. Alhenceus remarks, that females often attended male guests, and assisted them in their ablutions. Homer makes virgins and women Avash strangers, without being exposed to intemperate passions; "being well regulated themselves." Such Avas the custom of antiquity; according to which the daughters of Cocalus washed Minos, who had passed over into Sicily. The importance attached to bathing, as a means of cure of loathsome disease, is well illustrated in the directions given to Naaman the leper, (by the Prophet Elisha,') to go and wash seven times in the river Jordan: and still more so, by our Saviour, when he com- manded the blind man to go and wash in the pool of Siloam. The pool of Bethesda Avas also resorted to by the sick and infirm. Although these commands certamly carry with them the idea, that HYDROPATHY, OR THE WATER CURE. 967 they were designed for more than simply the cleansing the skin; yet, they show that, if nothing more, they were types of that which was capable of cleansing the soul. It seems to have been a uniform custom with the ancients, to furnish water to a traveller to bathe bis feet; as in the instance of Laban, for the messenger of Abraham; and Abraham himself, Avho furnished water to Avash. the two angels' feet, Avho tarried with him in disguise. Bathing by the ancients was considered typical of moral purity; consequently, ablution and immersion was made to perform part of the religious rights of the inhabitants of central Asia and the East. In the patriarchal age, these ablutions were strictly attended to, as Avhen Jacob commanded his family to purify themselves, and change their garments, before they went to Bethel to sacrifice. Job speaks of a like purification with snow Avater. It would seem that Moses, the great Jewish lawgiver and prophet, Avas not merely influenced, in his enactments in this respect, by the necessity of preserving the health of the twelve tribes, during their long journeyings in the wilderness, and their subsequent residence in the land of Canaan; but he Avas also gwayed by the remote examples of the Patriarchs. The Greeks, though familiar with the practice of bathing, for the purpose of health and recreation, were indebted to the Egyptians for a well regulated system — " That's the best physic which doth cure our ills, Without the charge of apothecaries bills." The sentiment, all will agree, is better than the poetry. Mr. Smith says, " He had an experience of forty-four years in the use of the cold water remedy ;" and that " water, in some cases, may be styled an universal remedy, since the diseases it either prevents or cures may have this remedy applied to all persons, and in all places where men do inhabit." Mr. Smith, to strengthen his asseverations, enlists the opinions of a host of learned doctors: among whom I may mention Dr. Manwaring, in his Method and Means of Enjoying Health; Keill, Pratt, Duncan, Sir Thomas Elliott, Allen, Sennertus, Harris, and Van Hayden. Mr. Smith adds his testimony to that of Mr. Hancock, in favor of the curative effects of cold water, freely drank in the cure of small-pox. The cases were two of his own children. He refers to the opinion of Dr. Betts, who being consulted in a case where the eruption did not come out kindly, " ordered two quarts of cold water to be drank as soon as could be, upon which they came out according to expectation, and the patient did well." Water is styled by Sennertus, the balsam of children. " The drinking of it by the mother, being one of those things whereby children may be strengthened in the womb, and will prevent the PRIGMT. 64 994 HYDROPATHY, OR THE WATER CURE. injuries that are done by drinking strong liquors ; which Samson's mother was not allowed to do; for she was commanded "not to drink wine or strong drink." Judges xii. 4. Mr. Smith lays down a pathological doctrine, which has been the basis of more than one popular system since his day, viz : "The stomach being the place where distempers do first begin;" and from it he deduces his favorite mode of treatment, for all surfeits, or disorders that follow after much eating, under which he includes appoplexy. It is " to bring on vomiting by large and repeated drafts of warm water, aided by tickling the throat with a feather, or the end of a small stick covered with the folds of a linen or muslin rag." He adds a piece of advice, similar to that given by Galen, and practiced by Baynard, namely, to dilute the peccant matters, and carry them off along the first passages, " by the suffuces from indigestion, and taking a pint of water when they find themselves ill from eating, and do so every three or four hours, eating no more till they are hungry." Cheyne says, " Gouty persons, after excess, either in meat or drinks, should swill down as much fair water as their stomachs will bear, before they go to bed, Avhereby they will reap these advan- tages—either the contents of the stomach will be thrown up, or both meat and drink will be much diluted, and the labor and expense of spirits in digestion much saved." Mr. Smith is an advocate for large potations of cold water, in fevers of a low grade, in which diffusible stimulants are usually administered. The first sensible effect of these draughts, he says, " is a profuse sweat, which is soon followed by a remission, and afterwards, a complete solution of the fever." We may add our testimony to,the truth of this assertion. Grief and melancholy, so great as to suggest self-destruction, were entirely dispelled in Mr. Smith's own case, by drinking a pint or more of cold ivater. This leads him to advance another well founded piece of gastric pathology : " That the stomach sympathizes Avith the mind." (I would say, the mind with the stomach.) Though the like success may not follow this practice in others ; yet, certainly it is, that their prospect of restoration will be much more favorable bv the use of water, than by that of vinous or distilled liquors. Tlioden also gives his testimony in favor of water drinking, for the cure of melancholy. Doctor Brown, the author of a treatise on the cures performed by the cold bath, shows that madness and melancholy, with all their HYDROPATHY, OR THE WATER CURE. 995 retinue, may find better effects from bathing in cold Avater, than from other violent methods, with which people so afflicted are now treated. (We treat such cases now, in America, by the mildest means with success.) He says: " That which will make a man sober in a minute, will certainly go a great way towards the cure of a mad man in a month." " Now, it is most certain to my own knowledge, that, if a drunken man be plunged over head and ears in cold Avater, he will come out of it perfectly sober." He relates a case of a man " raving mad," who was bound in a cart, stripped, and blind-folded, that the surprise might be the greater, who received from the height of twenty feet, a great fall of water on his naked body, and continued under this, as long as his strength would permit; and after he returned home he fell into a sleep, and slept twenty-nine hours, then aAvakened in as quiet a state of mind as ever, and so continued for twelve months." I cannot, in a single chapter, follow Mr. Smith in his enumera- tion of all the forms of disease in which the external use of cold water, either by a general bath, or topically applied, has been found serviceable. He terminates his treatise, however, by this whole- some piece of advice : " That fasting, rest, and drinking water, will cure most diseases." If the first feelings of uneasiness, precursory to an attack of any of the forms of fever, that com- monly prevail in our country, were made a signal for obeying the above precept, there is no doubt, that the disease would be often prevented; or, if it were to come on it would be comparatively, mild and easily treated. Water is the only true drink; it is the one which dilutes and qualifies all that we eat; which cleanses out the stomach, and excites the appetite; it is the drink which preserves the fluidity of the humors of the body, and while giving flexibility and pliancy to the vessels, also preserves the health. In order to make this chapter as complete as the limits of our space will alloAv, we shall now give some account of the topical application of water in the cure of wounds, bruises, sprains, &c. And, for authority, we may go as far back as Hyppocrates, the father of physic. Hyppocrates, in his Aphorism, recommends an abundant flow of cold Avater, on painful and swelled joints, Avhen they are not ulcerated; also in gout and rheumatism, and convulsions, as a means of relieving pain. He advises a similiar application in cases of spasms, luxations, and fractures, in order to prevent the swelling 996 HYDROPATHY, OR THE AVATER CURE. consequent on these accidents. Pare tells us of a victim of gout, who used to fill his b( ots with cold Avater after he had put them on, which enabled him to walk to his library, and select such books as he wanted to examine in the prosecution of his studies. Cocehi, Sanctorino, Marziano, and Berthy, all give their approval to the utility of applying cold water to a gouty limb, during the paroxism of pain and swelling. Lauret, the celebrated Harvey, and a great many others, have practiced it on themselves. Mr. Smith found that sprains were entirely freed from all swelling and pain, by putting the part into a vessel of cold water for about two hours. If it should be a joint that _ could not be placed in the water, cloths were kept constantly wet with cold water, and applied over the joint. When inflammation of the joints were produced by external violence, cold ablution, according to the intensity of the injury, or the facility of applying the water, have been at all times freely used. The recency of the accident, and the heat and pain of the part, are the chief indications for our applying cold water in a full stream. More stiffness and tumefac- tion, constituting the second, or more advanced stage of the affection, will demand a recourse to the warm, or even hot bath. After a violent exertion, a person is seized with acute pain in the back, soon followed by heat of the corresponding region; frequent sponging of the parts with cold water is a very soothing and salutary application; frequent ablutions of the loins and groins with cold water is good in flour albus. It is also good to relieve the irritation produced by the piles. In the various forms of sore eyes, a con- tinued application of cold, or tepid water to the eyes is very serviceable; it allays pain, and removes inflammation. Warm water, topically applied, frequently relieves pain of the joints when swollen. Ice water has often relieved neuralgic pains. It is also a good application to the head, in inflammation of the brain. In every variety of hemorrhage, from the mucus surface, as from the nose, throat, lungs, stomach, bowels, uterus, and urinary passages, cold, by means of ice and cold water, applied both externally and internally, have given the most prompt relief. In cases of uterine hemorrhage, bleeding from the bowels, and bleeding piles, cold effu- sions, as a sheet wet with cold vinegar and water wrapped round the patient, and frequently renewed, is eminently serviceable; though, in such cases, we are generally satisfied to make a local application of cold water. But in doing so, this precaution must always be observed, the skin must be hot, and the pulse full. The anciento HYDROPATHY, OR THE AVATER CURE. 997 placed the feet in cold water to relieve hemorrhage from the womb; and they applied cold wet cloths over the stomach, to relieve vomiting of blood, and gave injections of cold water. Injections of cold water has been used time immemorial, for the removal of costiveness. Should cold injections chill the patient, the water should be luke warm. When the sick man is burning with fever, tossing and turning from side to side, nothing calms and relieves him so quick as sponging him with cold water, and a cold water injection. When, on the other hand, the system is depressed, and the indications are to raise the heat, injections of warm, or even hot water, will often arouse him, and equalize the heat on the surface. In irritable bladder, injections of cool water into this organ gives marked relief. The present improved injection pump is the best apparatus now known for the cure of these remedies; they are portable, and can be conveniently carried in a travelling bag, or even in the pocket. The teachings of John Hunter, by his pointing out the imperative processes pursued by nature in the healing of wounds, contributed not a little to simplify their treatment. An improvement in this respect had been, it is true, begun by his predecessor, Pott; but still, surgeons were, till late years, indeed, we may say, many of them are even now, backward in having recourse to simple water dressing in place of poultices, unguents, and plasters, in the treats ment of wounds. A brief outline of the history of water dressing in surgery, it is hoped, will not be deemed unacceptable by my readers in this place. The lovers of classical lore will at once refer to the example of Patroculus, at the seige of Troy, who, on the occasion of the wound received by his friend Eurypilus, dressed it with water, after he had withdraAvn the javelin. In modern times, the use of water as a vulnerary, first obtained some vogue in Italy; but it was first freely adopted by the French military surgeons, Avho formally acknow- ledged the great utility of this remedy, and showed its superiority over the farago of applications with which vain learning had at different times tortured the wounded soldier. Ambrose Pare thought himself abundantly rich, when he became possessed of a secret for preparing Italian balsam, (oleum catelorum,) which was to heal all kinds of wounds. But when, afterwards, he saw simple water in the hands of a quack, named Doublet, at the seige of Mentz, in 1553, produce equally wonderful cures, with those he obtained with the use of his balsam, he could neither conceal his disappoint- 998 HYDROPATHY, OR THE AArATER CURE. ment, nor his mortification. He thought there must be something supernatural in such surgery as this, which he first refrained from adopting on account of religious scruples. But in an age of superstition, such prejudices need not surprise us, more especially, when we learn it Avas common to attribute the success of the water practice to peculiar sympathies, or magical incantations, which could only be wrought by a privileged few. Pares good sense soon enabled him, however, to discover and declare, that the true vulnerary was the water, and not the mummery. The Latin essay of Michael Angelo Blondi, on water, as a newly-discovered remedy in gun shot wounds (1542,) served only to fix attention as it Avere, but for a moment on the subject. The view taken of it by this author was natural—he spoke merely of simple water, which could not be supposed to interest the people, nor produce in them the same confidence in its curative powers, as conjured, or magical waters. In this respect, we do not find that mankind are much altered in this day, in their credulity, and love of the marvellous. Tell them of the curative effects of pure water, and they smile incredulously, or perhaps scornfully. But render it impure by some impregnation, either mineral, vegetable, or alcoholic ; then call it aqua mirabilis, or Balm of Gilead, or any unmeaning, but, yet sounding title, and it is eagerly sought after, purchased with much silver, or fine gold, and swallowed with a faith which works prodigies in the way of cures. Gabriel Fallopius, of Venice, and Felix Pallatius, endeavored to do away with quacks and conjurers, and exhibit simple water as a remedy, meriting the attention of the regular surgeon, and to be employed by varying the temperature according to the nature of the wound. Joubert and Martee, of France, exerted themselves in the same spirit, and with such success as to obtain for the practice the formal title of the university of Montpelier. But nature and common sense were not long allowed to bear sway. Van Helmont, with his sympathetic dress- ings— Gliclenius, with his magic cures—the devotees, with their plasters, from the hand of God, gradually cast the water practice into oblivion; or, if it were had recourse to, some wonderful mixture was introduced into the water; such as the powders of Sir Kenelin Digby, which had all the credit of success, but which, in fact, was due alone to the simple fluid. In Italy, owing to the warmth of the climate, and the necessity of frequent recourse to water, for the purpose of ablution and HYDROPATHY, OR THE WATER CURE. 999 drink, the Avater regimen, in diseases and wounds, was less corrupted by the jargon of schools, arid the tricks of mountebanks. In 1752, Lamorier, in France, attempted once more to direct the attention of his countrymen to the subject, in an essay on the use of common water in surgery. By a fortunate co-incidence this publication appeared at the time when all France, and even Europe, was made acquainted with the wonderful success of the practice in the case of the Duke of Orleans, who was cured of a Avound in one of his hands, which at first seemed to threaten the most serious consequences, and even to require the amputation of the arm; but was cured by the free use of water alone, by immer- sion, and fusion on the part affected. Were the remedy less simple and natural, and to be obtained with less facility, I should not think it necessary thus to show the revolutions which it has under- gone in the professional world, nor to write in its support the names of Sancassani, in 1753—Caldani, in 1767—and Bonneken, whose sage efforts were, however, insufficient to preserve it a place in clinical surgery. It fell into neglect, if not into disrepute, for a period of nearly thirty years. Danter, in 1780, published a valuable essay on this subject, which abounds in sound precepts and erudition. But it is doubtful whether his labors would not have been as unsuccessful as his predecessors, had not a fortuitous circumstance restored water to its former high rank among surgical remedies. Percy, the distinguished military surgeon, from whom I have borrowed the preceding details, (See Dictionary of the Science of Medicine,) tells the story, as follows : "On the 4th of June, 1785, whilst trials were being made of the comparative merits of the cannon of two rival founderies, several artillery men, among whom was Pichogree, then a common soldier, were wounded in different parts of the body. The chief surgeon, Lombard, a man of o-reat merit, dressed the contused and lacerated Avounds in the usual manner. A miller of Alsace, having heard of the accident, went to the governor of the province, and succeeded so well in pursuading him of his ability to render water an infallible cure for all sorts of wounds, that the worthy magistrate gave orders to have the wounded soldiers placed under the charge of the miller, and to be dressed exclusively by him. This surgeon immediately, by intuition, set about washing those wounds with river water, to which he added a pinch of powder, at the same time making divers signs, sometimes with one hand, and sometimes with the other, and muttering some unintelligible words. The powder was nothing but 1000 HYDROPATHY, OR THE WATER CURE. common alum; and the additional virtues imparted to the water by his mummery may be readily appreciated. After the wounds had been well washed and bathed, the miller covered them with lint and linen, which were readily furnished by the ladies of the city, and which he dipped in the water, still gesticulating and uttering the magical words. We, says Percy, (who was one of the surgeons of the garrison at the time,) were not allowed to be present at the dressing, except at the twelfth, twentieth, and thirty-first days, in order to assure ourselves of the state of the wounds. Those with- out much pain, or any other dressing, except the prepared water, all cicatrized in six weeks; although immediately after the accident, the surgeons hesitated about amputating the hands of six of the artillery men, which were much lacerated. The wounds were only exposed once a day; but every three hours they were wet with the water, moderately cold, which the miller called his holy water." Percy makes a remark, which is a very natural one, and also instructive, that there was some deformity of the hands and fingers of the wounded, for want of suitable support by splints, and graduated bandages. This lesson was not lost on the French surgeons, who found simple water as successful in their hands, as in those of the miller, with all his charms and secret powder; while their entire treatment was more successful than his, on account of their using water, either cold or tepid, according to the condition of the wound, and of their calling in the aid of posture and splints, to prevent pain and deformity. It is in this way, that true science ever shows itself superior to empiricism. Percy, thus early acquainted with the curative properties of water, did not fail to make liberal use of the remedy in the campaigns of the French armies, during the war of the revolution. The waters of the chief rivers of Europe, from the Moselle, to the Guadal- quiver, have often alone formed the dressing of the numerous wounded soldiers of these armies. In Egypt itself, Larry found the river Nile to furnish a vulnerary to the most terrible wounds. Professor Kern, of Austria, while praising the use of water in the treatment of wounds, has erred in claiming for himself the honor of the discovery. Percy regards water as especially efficacious in lacerated wounds of the membraneous and eponeoratic expansions, and also of the tendons. He tells us, that he has often succeeded by the external use of this fluid in saving limbs which were so dreadfully lacerated, that it seemed imprudent to defer their imme- diate amputation. Immersion of the part in cold, or tepid water. HYDROPATHY, OR THE WATER CURE. 1001 according to the season, and present convenience ; or tfie applica- tion of sponges, or linen dipped in water: in fact, this fluid, used in every fashion, prevented or moderated when they occurred, sinister symptoms; restrained, within proper limits, irritation and inflammation, and promoted as good a suppuration as the nature of the parts would allow. By such means he obtained cures with water only. Since it was the only application to which he had recourse, he thinks that we obtain, by the use of water, all the best effects, without the use of poultices, and save large sums to the public treasury. THE MODE OP APPLYING WATER TO A WOUND. Apply on, or around the limb, as the case may be, pieces of sponge, moistened from time to time, with water. Since it is sufficient to pour the water on the sponge without removing it, thereby preventing both disturbance and pain, a sponge is preferable to linen, because the water does not evaporate so rapidly from it. If sponge cannot be obtained, cotton, flannel, or swan's down, should be selected in place of linen. If the parts are sensitive, Ave may apply soft linen immediately next the wound, and let it remain there, and apply the other above it. In tropical climates, a favor- able remedy is plantain leaves applied next to the wound, and frequently wet with cold water. Percy is of the opinion, that lockjaw would be a much less frequent occurrence from wounds, if water dressing were used, and to keep the cloths all the time moist. Where the edges of wounds become spongy, it may be well to add to the water a little salt, or alcohol. This remark will better apply to contused than simple smooth wounds. In gun-shot wounds, the addition of salt, or alcohol, is well adapted. Percy cites the success attending the employment of water, with the chill barely taken off, in several cases of gun-shot wounds in the feet; in which there was a terrible laceration of the tendons and ligaments, and fracture of the bone. Were it possible, says the French surgeon, for a person wounded by a bullet, or by any other violent means, in the elboAV, knee, or foot, to keep the part immersed in water, during the first ten or fifteen days, we should have much fewer amputations to perform, and a greater saving of lives. Sanson thinks that the water dressings are best adapted to lacerated wounds, in relieving the tendons and aponeu- rosis. M. Josse, of Amiens, says the forms of inflammation, in which water is best adapted, and may be employed with success, 1002 HYDROPATHY, OR THE WATER CURE. are, in addition to contused wounds, erysipelas, phlegmon, burns, and mortification. He recommends cold water to be applied directly after the injury, before inflammation takes place ; and where it can be applied with energy, proportional to the occasion, the phenomena of reaction will (he assures us,) be prevented, the heat, pain, and swelling will be subdued, and, consequently, the sympathetic fever will not take place. He goes still farther, and asserts, that even after the inflammatory symptoms have been developed, they may be conquered, by its efficient use, and that re-organization takes place more favorably under its application. (See British and Foreign Medical Review.) A more modified view is probably the correct one ; that is, that cold Avater is beneficial in the forming, and, probably, in the first stage of inflammation ; but that, after this, tepid, or warm applications, as recommended by Dr. Macartney, of Dublin, are preferable. To Dr. Macartney, more than to any other, is British surgery indebted for the free and methodical use of the water dressing in wounds. In his work on inflammation, he points out the important fact, of the reparation of parts, after wounds, being brought about by processes more approaching to physiological growth, than to the pathological state of inflammation; which last, so far from being necessary to such reparation, retards, and may prevent it entirely. Dr. Macartney says of water dressing, "It assists the reparative process by producing a moderate degree of cold in the affected parts, which dimimshes, but does not extinguish sensibility and vascular action: it, in fact, allows the reparative process to be carried out, as we see in the inferior tribes of animals." The cold is a direct sedative to all vital action; it should, therefore, be in such moderate degree, as to prevent inflammation, without suspending the process of reparation. For this purpose, the mode by irrigation is preferable. In case of severe injury alone, where the inflammation cannot be otherwise restrained, intense cold is admissible. A very simple rule may be adopted in this respect, as to the temperature of the water, which is, to consult the feelings of the patient; when they alleviate pain they do good; but when they fail to have this effect, they are improper. The most easy and manageable way of employing irrigation, is to place the wounded limb in a trough, and having laid some lint on the inflamed part, to let the water be conducted by means of a strip of woollen cloth, from a vessel holding the water, or other fluid, which may be placed on a chair, or table, standing beside the bed: one end of the strip is to be inserted into the vessel; the other, which should be HYDROPATHY, OR THE WATER CURE. 1003 cut into a pointed shape, laid on the lint: the water will then proceed in the manner of a siphon, continually from the vessel, not by drops falling from a height, the sensation of Avhich is dis- agreeable ; and is carried off by a tube proceeding from the end of the trough into a vessel placed at the head or foot of the bed, as the case may be. Dr. Macartney says, " I have found that a strip of cloth, of some breadth, Avhere it is inserted into the water, and ending in a point, where it touches the lint, answers the purpose of a siphon much better than the filaments of candle-wick, which some surgeons have employed." The patient is able to vary his position with this apparatus. It is obvious, that irrigation can only be used Avith convenience to the extremities. The water may have any degree of temperature that is desired. The prime con- ditions for aiding the reparative process of nature, by preventing, or subduing inflammation, so liable to occur in wounds, consist, principally, in the careful regulation of temperature, and the con- stant application of moisture. It is advisable, if the water-cure be adopted, that the parts should be kept all the time moist; and, if the mode of irrigation be not used, some one, as a careful nurse, should sit by the bed side, and, by squeezing a moist sponge over the clothes,, let the Avater drop on them gently, but constantly. If a change be thought necessary in the temperature of the water, or for other dressings, it should be made gradually, so that too great a shock be not given to the circulation. Dr. Tiller, of Lancaster, Pennsylvania, has written an interest- ino1 paper on this subject. It is chiefly illustrations of the beneficial effects of cold Avater in violent inflammations of the extremities, following fractures, wounds, and other injuries. He directs that, in the more violent grades of inflammation, that the coldest spring water should be procured ; or, if necessary, it may be artificially cooled, and the limb be kept constantly bathed in it, until the morbid excitement be reduced. Dr. Tiller thinks, that copious effusions of cold water would be preferable to the common practice, in lacerated wounds. Dr. Bell says, he has frequently used cold water dressings with marked benefit to old ulcers. It is a sound axiom in surgery, that all wounds, without the loss of substance, will heal of themselves, if inflammation be prevented, and the lips of the wound be kept together. With regard to the healing of ulcers, we all know, that by standing a long time in the water, ulcers' of the legs readily heal, especially, if the feet and le^s be bare. Hence, fishermen rarely have sore legs, though 1004 HYDROPATHY, OR THE AVATER CURE. they have them frequently wounded, and that, too, by poisonous substances. We leave the subject of the surgical use of water, and return to its use in the cure of diseases. Hitherto, we have said but little about water as a remedy taken internally in the form of a diluent. By a judicious continuance in the use of cold water, as a drink, we have it in our power to relieve the stomach and bowels of their crude contents, to dilute the excess of fibrin, and sometimes of saline matters in the blood, to wash away morbid formations, lithic acid and its combinations, and to replenish the blood vessels where they have been suddenly deprived of a large part of then serous, or watery contents. After pursuing the directions of the free use of water, as a drink, and a remedy in so many diseases, by successive writers, from Galen, down to TJieden, and Hufeland, we must have anticipated the views and suggestions contained in the paper written by Dr. Holland, on the use of diluents. It is pleasant, however, to obtani confirmation of a truth, yet doubted by many, from a gentleman, Avho, like Dr. Holland, unites habits of study and reading, with the opportunities furnished by a large practice. He has often known the action of the bowels to be main- tained with regularity, for a long period, simply by a tumbler of water, Avarm or cold, on an empty stomach, in cases where medicine had almost lost its effect, or become a source only of distressing irritation. The advantages of this practice are still more obvious, where the intestinal secretions, or the products of digestion are vitiated in kind. Singular relief is often procured from this morbid sensation, by the dyspeptic patient taking, before breakfast, a pint or more of water, warm or cold. Properly regarding the alimentary canal, as—a surface, with similar functions to the skin, it is capable of being acted on in a similar manner. The abstrac- tion of heat from an inflamed, or irritable membrane within, is often, indeed, quite as salutary as the cold directly applied to the hot skin. The extent of use is, from obvious causes, much more limited : but I have seen enough of the benefits of cold liquids freely given, in the acute stages of gastric disorders, inflammatory, and febrile, with express reference to this temperature, to qualify the recommendation of the more frequent use of it in practice. This is a point where the feelings and desires of the patient may be taken as a guide, and we can rarely go wrong in following them. The test depends on sensations which cannot readily be mistaken and the changes which iniicate the extent, as well as suggest the HYDROPATHY, OR THE AVATER CURE. 1005 use of the remedy. The second condition is one of more difficulty, and connected with questions in physiology and pathology, which we do not intend to discuss here. It is conceded, that the blood can appropriate, by absorption, medicines largely diluted. Under these circumstances, liquids may be freely and largely given, in those cases where there is a demand for them. The effect of diluents upon the various functions of secretion and excretion, have been fully advocated by many valuable writers on this subject. It must be acceded, that the use of water scarcely receives enough attention by the English and American practitioners. This is a point wholly distinct from»the question regarding the fit proportion of liquids as a part of diet. The process of digestion often suffers from any excess in quantity of these ; and though the natural appetite may be unduly controlled; yet, some rule is often required, in dyspeptic cases especially, to obviate such excess, even where the most simple and inoxious liquids are concerned; for in these cases a morbid craving is often created, partly by the vitiated sensations of the patient, and partly by the actual state of the membrane lining the palate, oesophagus, and stomach, and from the disordered secretions and products of digestion acting on this surface. This subject is so copious, that we scarcely know when to stop. But we are compelled to bring this chapter to a close. We shall now describe the different processes through which the patient is to pass, in the course of the hydropathic treatment, for the cure of disease ; and we cannot do better than quote from the celebrated Priessneitz, of Graefenberg, as he is, at the present day, the only man who seems to have reduced the practice to any thing like a system. He has, however, many followers, and many who know nothing on the subject as a science, not allowing, by any means, that Priessneitz knows any thing about the practice scientifically. We conceive we have given what is properly the first stage of the hygienic treatment of disease, as well as the general plan of cure by water. We now give the second stage, or different modes of local application of water, as used by Priessneitz. THE SEVERAL STAGES OF HYDROPATHIC TREATMENT. There are four in number, and they are gone through in the following order : 1st. Sweating.—The patient is awoke at dawn of day, and, after being divested of his night clothes, is carefully inveloped in a 1006 HYDROPATHY, OR THE WATER CURE. blanket, or woollen wrapper, leaving his face and head alone uncovered ; the head is afterwards covered with a napkin, and he lies down on a mattress, when more clothes are put over him, and sometimes a feather bed, in German fashion ; the air of the room being of a reduced temperature. Thus situated, the patient soon manifests increase of animal heat, redness of the face, &c, followed by sweat. On the appearance of this secretion, the windows of the room are opened to purify the air; an attendant holds cold water to the patient to drink, and does the same at intervals afterwards. At first the third of a glass, and afterwards a full glass is taken every quarter of an hour. The sweat is greatly increased by this means, and becomes so copious as not only to bathe the entire surface, but also to pass through the bed clothes, and flow in small streams on the floor. It is allowed to continue from one to six hours, according to the nature of the case, and the strength or vital force of the patient. Wet sheet packing.—If there be difficulty in procuring perspira- tion by the dry envelops, the patient is wrapped carefully in a wet sheet, which has just before been dipped in cold water, and then wrung out Avith some force: over this comes the woollen covering, and then the feather bed. Few skins, however dry and harsh they may be, resist the sweating operation of the wet sheet and its assistant coverings. 2nd. The cold bath.—After the sweating period has been gone through, the feet are freed from the bed clothes and wrappings, and stockings and shoes, or boots, are put on by an attendant: the coverings are somewhat loosened, but are still kept round the body, like a cloak. Thus equipped, the patient walks down to the bath, which is supplied by a cold spring, and immerses himself in it. The bath is from twenty to thirty feet in circumference, large enough to admit the patient to move his limbs about freely, and turning himself with ease in the water, which is of a temperature from 45° to 52° of Farenheit. The mode of entering the bath is by prompt immersion, first wetting the head and chest with the water. The bather then either swims or makes equivalent movements, so as to give himself as much exercise as possible : he also washes thoroughly by rubbing his body and limbs. At the expiration of ten minutes he leaves the bath, and is invested, by an attendant with a sheet and coverlid, and conducted to his chamber, where, on being dried, he dresses himself quickly, and then sallies out. The object now is to take exercise in the open air, to produce reaction, HYDROPATHY, OR THE WATER CURE. 1007 and also to drink the water. In an hour afterwards the patient returns to the house and takes his breakfast. The half, or shallow bath.—Feeble, delicate, and irritable persons, are not subjected, at once, to the cold bath; they take what is called the half bath, that is, they are placed in a bathing tub, the Avater in which is only six inches deep, and of a temperature raised by the addition of warm water to 56° or 60° Farenheit, and sometimes to 63°. The patient, as in the former case, wets his head and chest with the water, and then enters the bath; in which he remains seated, and rubs his body well with a cloth. He continues in it five or six minutes, during which time an attendant pours over his shoulders, and sometimes his head, tepid or cold water. The temperate bath.—The tepid bath, as it is called by some, by way of courtesy, (for to the feeling of most men it would, unequivocally, be called cold,) is used by Priessneitz preparatory to the cold bath—to which last patients are subjected at the end of a few days. Some pass at once, from the temperate to the cold bath, and return again from this to the former. Others, in whom it is deemed either useless, or impracticable, to produce sweating, take the tempered bath in rising from their bed, so as to become accus- tomed, gradually, to a lower temperature. Priessneitz has recourse to it in some subjects, who are slow to reaction, as a means of creating fever, and thus bringing about what he believes to be symptoms of crisis. In these cases the patient remains an hour or more in the bath tub, which has a lid, with an opening, to allow the head to appear above it. Cold ablutions.—Those whose constitutional powers are so weak as to disable them from the use of the bath by immersion, are obliged to content themselves with ablutions of cold water. These should be regarded as an excellent preparative for the treatment, especially in the cases of young children, and persons Avhose skins have been Aveakened by the use of too warm clothing. We do not require any hydropathic illumination to make us aware of the utility of the practice of ablution. To persons in common health, with a view to the keeping up suitable acti\aty of the cutaneous functions, it may be performed with a sponge, towel, or the hand, and its efficacy will be greatly increased by strong friction. 3rd. Drinking cold water.—The quantity of water drank during the day by those under the care of Priessneitz, is represented to be on an average, from six to tAvelve pints, of a temperature ranging from 46° to 53° Farenheit. It is drank by the patient 1008 HYDROPATHY, OR THE WATER CURE. when he is yet in his bed sweating; after the bath, when he is walking about, between breakfast and dinner, during Iris meals, and in the afternoon, two or three hours after dinner, and again in the evening. The times preferred are before breakfast, and during exercise. The appetite of the sick is the best guide, as to the quantity and frequency of their drink. Taken beyond measure, it has produced aqueous indigestion. Douching.—The fourth act of the hydropathic drama—sweat- ing, cold bathing, and drinking cold water, being the other three —is the use of the douche. This is applied an hour after break- fast, and three hours after dinner. The water, brought directly from the spring in troughs, falls through tubes, at heights of from ten to twenty feet, and with a diameter of between three and four inches. The place for receiving the douche, at Graefenberg, is in the open air, surrounded by a wooden palisade, and traversed by horizontal bars of wood, of which the weaker patients take hold, in order to prevent being thrown down by the impetus of the fall of water. The bather, having been previously undressed in an adjoin- ing apartment, is wrapped in a sheet, and enters the enclosure, where he throws aside the sheet, and puts on slippers. Before receiving the douche, he wets his head and whole body with water, received into the hollow of his two hands with Iris fingers inter- twined. For the first few seconds the douche is received on the nape of the neck, and along the back, and afterwards on all parts ■ of the body ; the bather, in the mean time, rubbing his skin, at all accessible points, with his hands; and, in this way, we are told, he removes the unpleasant sensation of cold produced by the douche. After the body has received these watery favors, the water, during the remainder of the douching period, is to be directed, especially, on the diseased organ, or affected part. The duration of the douche will vary from five to fifteen minutes; the last period is not to be exceeded. After it is completed, the body is to be thoroughly rubbed; the person dresses quickly, and returns to the house; but the aqueous labours of the day are not yet over, for, if time is allowed, the remaining hours before dinner are to be deAroted to the local application of the water, in some of the fusions described beloAV. No inclemency of weather is to prevent the use of the douche; some have taken it when the thermometer in the open air was as low as 12° below the freezing point, (but, in general, trials of this kind are neither necessary nor Avise.) The douche is forbidden in cases of great irritability, febrile excitement, HYDROPATHY, OR THE WATER CURE. 1009 or extreme langor. Its effects in gout and rheumatism are prompt and pleasing. The seat, or sit bath.—No application of water figures more prominently than this in Priessneitz' treatment. It is so constructed as to allow the patient to sit in it, nearly up to the naval; it rises at one end so as to support the head, and back, while the lower extremities are outside, and in a state of demi-flexion. The part of the body not immersed, is to be well covered. The duration of the seat bath varies according to the indication to be fulfilled. If it is intended to strengthen, or even stimulate the organs in the region exposed to the water, as in weakness of the organs of gene- ration, nocturnal polutions, impotency, flour albus, &c, the patient need not remain longer than from ten to fifteen minutes in the water: but if it is desired to produce a revulsive effect, as in cases of inflammation of the head and chest, in fevers, or to cause powerful impressions in chronic affections of the abdomen, as for instance in congestion of the liver and spleen, chronic diarrhoea, or obstinate piles, the patient may remain in the bath for a full hour. Chronic determination to the head sometimes requires two hours duration. Inflammation of the brain and organs of the chest, and in nervous fevers, a few mouthfuls of water are swallowed from time to time. The time for using the seat bath, at Graefenberg, is two hours before dinner; but, sometimes, it replaces the douche; then it is taken after dinner. In certain cases, again, where there is great irritation, its use follows immediately after the sweating stage: it is then preceded by general ablution. During the whole period of the bath, the skin of that part of the body, and particu- larly to the lower part of the abdomen, immersed in water, is subjected to continued and active friction. The water is to be renewed as soon as it has acquired the temperature of the body. On quitting the bath, the hips, thighs, and lower part of the sacrum, which are almost benumb by cold, are to be well rubbed; and, if exercise can be taken soon afterwards, the natural heat is not long in being restored. The cold foot bath.—It is used as a revulsive in pains of the upper part of the body. This is to be a very shallow bath, not more than an inch deep, except when used as a tonic, then it is to cover the ancle. This is continued from ten minutes to an hour. The cold head bath.—This mode of bathing is used for head- aches, sore eyes, &c. It is practiced by the patient reclining on a table, at one end of which is a vase of Avater, of a suitable size and BRIGHT 65 1010 HYDROPATHY, OR THE WATER CURE. depth to allow of his immersing first one side, then the other, and finally the back part of his head, giving about five minutes to each of these regions. Embrocation, or fomentation.—This is done by the wet sheet, or napkin, which is applied to any given part, and covered by dry cloths, so as to cause that part to sweat freely. Reducing process.—This is done in fevers, where the sheet is frequently reapplied, that is, every fifteen or thirty minutes. Local applications are also to be made to any particular suffering organ. Exciting process—When heating or stimulating effects are derived from local applications, linen, in numerous folds, resting one on the other, like a compress, is wet, and afterwards Avrung out with some force, and applied closely to the prescribed part. Over this are put dry compresses, in order to prevent the access of air, and consequent evaporation. Great pains must be taken to make the wet compress fit closely to the skin, so as not to allow the introduction of the least portion of air between the skin and the wet compress. The heat which is soon generated under this com- press, is much greater than the natural heat. The compress is to be renewed when it becomes dry, which is nearly every hour. The exciting effects of this remedy are manifested in what may be called a depurative sweat, which is at first clear and difficult to bo procured ; but as the treatment advances, it becomes more profuse, is viced and glutinous, of a dark yellow, or brown color ; sour, and impregnated with the most disagreeable odors. This stage of the sweating is often followed by an eruption, which is called the critical stage. When this application is made round the body, it is called " The Belt of Neptune." Injection.—Liniments and blisters are not omitted in the hydropathic treatment. They first use them of tepid Avater, afterwards cold water. Frequently rinsing the mouth with cold water, is more salutary than might at first appear: it acts beneficially on the mucous membrane of the mouth and throat and stimulates the salivary glands to partial salivation. In some cases of gout of the head, it diminishes the pain. The nose is Avashed by snuffing up water. This process is serviceable in scrofulous affections of this part, as also in bad colds and headache. In these cases fomentations to the forehead are employed at the same time. Crisis.—The process towards a cure at Graefenburg, appears, to the patient, to be interrupted all at once by the feeling of great langor HYDROPATHY, OR THE WATER CURE. 1011 and prostration, accompanied by febrile movements, and increase of secretions, which are deemed critical. Vomiting, diarrhcea, increased flow of urine, are among these signs ; but more than all the appearance of what is hailed with joy by the patients of Priessneitz, are certain eruptions on the skin; sometimes papular, but more generally pustular, and amounting to furunculous abscesses. The term crisis, is applied to these out-breaks; but, under the same name, are ranked also, the reappearance of old venereal ulcers, and scrofulous and mercurial syphilitic sores, and of gonorrhoea; all appears in the progress of the hydropathic treatment. Dr. Bigel tells us how he was gratified by the appearance of forty-five ab- scesses, one of which was a whitlow, that deprived him of sleep for ten nights. The only ease he could procure from his torment, was by immersing the part in cold water. The abscess opened of itself; and the pus, on its being collected on linen and dried, exhibited a portion of calcarious matter, which we find in the articulations of gouty persons after death, or in their urine when they are living. Whatever may be the nature of these eruptions, they are all treated alike, namely, by cloths dipped in cold water, and renewed as often as they become dry. They are allowed to open without any surgical aid. The general treatment of the primary disease is still to be continued, but in a somewhat milder manner. Thus, for example, the general bath and douche are to be omitted; but the packing in sheets and blankets, and the drinking of cold water are to be continued. If, from the severity of the symptoms, fear should be felt that an important organ may become the seat of crisis, revulsive applications must be put in requisition. The papular eruption is represented to be the most common form of crisis in nervous fevers, and the furunculi and abscesses in those affecting nutrition. The abdomen is said, also, to be the most frequent seat of critical eruptions in old mercurio-syphilitic diseases; and the limbs in gout and rheumatism. Great is the variety of disorders brought up from their long-concealed depths by the water treat- ment. " Gonorrhoea, which had been suppressed two years before, cicatrices, and dried up ulcers, re-opened." Viceral diseases, we learn, are also susceptible of being renewed in this way. Priessneitz relates the case of a lady, who had been salivated for inflammation of the liver, and in whom, after she had begun the water cure, there supervened hepatitis and ptyalism as before. (We are not told how long a time elapsed, between the first and second attacks in the case of this lady.) With the re-appearance- 1012 HYDROPATHY, OR THE WATER CURE. of the crisis, there is generally an amendment of the health, and gradual restoration of strength, and vivacity of thought and move- ment. Dr. Johnson avers, " That he has neither seen, or heare* of a single case, in which these eruptions did not entirely vanish away, leaving the skin perfectly healthy and clear as before." We have, perhaps, said enough upon the use of cold and warn water, as a remedy. We will now say something relative to the diet used at Graefenburg. The food there is served in the Germar fashion, of an abundance of greasy cookery. " The patients are allowed, and even encouraged to eat abundantly of roast meats, fish, green vegetables, cheese, and other preparations of milk, and fruits. The want of variety, and bad cookery, arose in part from the parsimony of the superintendent, (Priessneitz,) says Dr. Johnson, and in part from the circumstances connected with the place itself. All the food used at Graefenberg is taken cold. The most recent writers on hydropathy are silent on this subject; at any rate, the restriction is not enforced in any of the hydro- pathic establishments in France. Priessneitz prohibits all stimulous pepper, mustard, and all other condiments, except salt. He is equally strict in withholding all kinds of acids, tea, and coffee. But then, as Augustus told the Romans, when they complained of his taxing their wine, he offers them an abundance of pure water. M. Fleury, with a great deal of good sense, protests against so irrational a generalization as Priessneitz sets up. Fleury admits, "that the watery regimen may be advantageously prescribed to plethoric persons; to those invalids who' have committed excesses at table, or who are afflicted with chronic gastritis, (inflammation of the bowels or stomach,) or an affection of the liver, gout, or gravel; but he alleges it is often hurtful to chlorotic, frenic, scrofulous, and nervous subjects." I have no hesitation in saying, that if the diet of the patient be properly regulated according to his case, that a cure Avould be much more readily and speedily obtained, than where no restrictions are used in this respect. One thing is very remarkable, both in relation to the subject of change of diet, and still more to that brought up by the class of half-way reformers. That the sudden and entire abstinence from all alcoholic liquors, by those inmates of Graefenberg, who had been the most free in drinking them, was not productive of the least inconvenience to the parties. This being the fact, away with the practice and advice often given to drinkers, to taper off. Quit it at once, and take to the free use of cold water. HYDROPATHY, OR THE WATER CURE. 1013 This subject, namely, the hydropathic practice, is full of interest, and requires a few words of explanation and caution, before it is submitted to the public, as a curative process, or prophylactic remedy. The only difference between the ordinary practitioner, and the hydropathist is, that the latter thinks he has discovered a new remedy, and obviously, it is as necessary to know how, when, and in what dose, to apply this new remedy, as the old one. And the same kind and amount of knowledge is necessary: for an over dose, or misapplication of the new remedy, is as deadly, as an over dose, or misapplication of the old remedy. And this must be distinctly, and permanently remembered. First, that the well-informed hydropathist does not pretend that his remedy is applicable to all diseases, nor to all states of the same disease. Therefore, a thorough knowledge of the nature of the several diseases, to which the human body is liable, is necessary, that he may distinguish one from the other, to know when the same disease is produced by this cause, or by that; which is the same thing as to know, when the same disease is curable, and when it is not curable. To know in Avhat particular stage the disease is, when the patient applies for advice ; to know whether the symptoms of which he complains are produced by disorganizatiqn of parts, or whether they are merely functional, and only depending on morbid sensibilities of nervous centers. All this, and much more, is clearly a necessary part of the hydropathist's education. For, if he does not possess this knowledge, he will not only do much mischief, but will be continually receiving patients, and vainly submitting them to a long, tedious, and expensive process, when he ought to have known at first, that the case was one which could not be benefitted by the hydro- pathic treatment. I will cite a few instances. In the cure of dropsy, if the disorder has arisen in consequence of general debility, arising simply from functional derangement, the case is one that may be cured by the water treatment. But if it has arisen in consequence of chronic adhesions, as between the pericardium and pleura, or in consequence of tubercles in the liver, or from the pressure of any internal tumor resting upon any of the large veins, so as to prevent the return of blood to the heart; to submit such a case to the water cure would be a cuhpable injustice, and, to say the least of it, a most gross cruelty. So again, in epilepsy, and palsy. If these affections have arisen in conse- quence of some irrenioveable mechanical agent, as the growth of a spicula of bone, goading the brain, or spinal marrow, or some 1014 HYDROPATHY, OR THE WATER CURE. large nerve; nothing can cure them, but the removing of the exciting cause. But, if they have been produced by a clot of blood, which has oozed from some small ruptured vessel, then, I say, such cases are curable by the water treatment, united to a severe course of abridged diet. Again, it must be distinctly and permanently remembered, that the hydropathic remedy, so seemingly simple, is not unique and one, but several, and thus effects, diametrically opposite to each other, may and are produced by it. I would again repeat, that a knowledge of sound physiology and pathology, are never more required than in the practice of the water cure ; and in no system of treatment will the great truths of these sciences find more ample and beautiful confirmation. Priessneitz was lamentably deficient in physiological and pathio- logical knowledge; but he made up for his deficiency before the uninformed, by his bold and dogmatical assertions. On the death of a lady patient, at Graefenberg, supposed to be from an internal abscess, the body was examined, but no abscess was found. What, then, was the explanation offered by the man whom his admirers profess to venerate as a second Hyppocrates ? Neither more nor less than this, " that the deceased had too short a neck for a long life." Where could another man be»found, who would dare to express himself in this style ? Where could Ave find a people, but those inveloped in gross ignorance, and beclouded by superstition, that would esteem such an answer the evidence of profound wisdom. We would give some rules for sea bathing, but we presume this work will not be consulted on that subject; and those who resort to the sea shore for the purpose of using the sea bath, will find, at those places, prepared for the accommodation of such patients, all the necessary directions for its use. Also a full description of the character and nature of those diseases which are likely to be benefitted by sea bathing, as well as the manner and time, or times of taking the bath. It is abundantly evident, that every form of disease should not be submitted to sea bathing, any more than to cold fresh water bathing; and the same knowledge is requisite to conduct the one as the other. Let no man suffer himself to be treated by any one who is not qualified to conduct such an estab- lishment. CHLOROFORM. 1015 THE USE OF CHLOROFORM IN MIDWIFERY, AND AS A SEDATIVE OF UTERINE PAIN GENERALLY, WITH THE MODE OF APPLY- ING IT: ALSO, THE MODE OF APPLYING • IT IN SURGICAL CASES. Chloroform has now had time to be amply tested in obstetric practice. The opinions of eminent men, however, still clash respecting its utility and safety. Doctor Bennet has used it very extensively in labor, as well as in uterine pain generally. He thinks the amount of danger incurred is so small, as not to forbid its use when the case demands it, or the patient shrinks from pain. The greatest care, however, ought to be observed; and I cannot too decidedly urge the precaution of seeing that the chloroform vapor is mixed with a sufficient quantity of atmospheric air, for the purpose of respiration; so that, on the one hand, asphyxia may not be produced ; and, on the other, that the sedative effect of the chloro- form on the nervous system may take place gradually, so that the latter may not instantaneously be paralyzed by the sudden presence of a large quantity of chloroform in the system. It is, for this reason, I generally prefer for inhaling, a thin cambric handkerchief, to any of the inhalers now in use. The handkerchief certainly does admit of a more easy and gradually chloroformization. Extreme caution in the first stage of inhalation is necessary; as most of the cases of death from its use, that have been recorded, have taken place after a few inhalations only, and from a quantity of chloroform which appears incredibly small, (half a drachm, or a drachm.) Those who are in the habit of using it continually, find it necessary to give four or five times that amount, in order to produce complete anesthesia, or insensibility. But we shall explain this at the close of the chapter, when we speak of those persons in whom there is an inadmissibility to chloroform. There are four classes of cases in which chloroform may be safely administered; and, when judiciously applied, suspends suffering, and is heaven's blessing to the afflicted. It may be administered, First, in irregular, but unnatural labor: Second, in operative labor: Third, to facilitate operations in the uterus: Fourth, to subdue uterine pain, in difficult and painful menstruation. In natural labor, the use of chloroform may be dispensed with, till 1016 CHLOROFORM. the last stage is ushered in; then it may be given to allay the severity of those pams, and promote relaxation of the parts: or it may be given Avhen there are some morbid conditions of the nervous system, which may be interfering with the progress of labor. We must not omit to say, that the pains of labor are sometimes partially arrested, or interfered with; or, are rendered irregular, or insufficient by fear, impatience, want of self-control, or by long continued suffering. When this is the case, chloroform generally exercises an almost magical effect; under its influence, all nervous excitement is soothed, the pain gradually becomes more regular and efficient, and the labor once more progresses regularly. This return of the labor pains, and their regularity under the calming influence exercised by chloroform on the brain, probably explains the increase in their intensity, noticed by some writers, on its first administration; and thus is explained the apparent discrepancy of different observers, on which so much stress has been laid by the opposers of chloroform. If the pains are arrested, or modified by nervous reaction, they return: if, on the contrary, they are too violent and prolonged, as is sometimes the case in the latter stage of labor, when the soft parts are rigid and irritable, the intensity of the pains diminish on the withdrawal of the excess of stimula- tion : this the chloroform does, by relieving nervous sensibility, and therefore, does great good. It gives time for the soft parts to yield, before they are endangered by the birth of the child. The dis- ordered state of the circulation, and the congested condition of the extremities of the vessels, which are often observed in many cases of irritable labor, give way, in a most remarkable manner, to the action produced by the inhalation of chloroform. This is so much the case, that the use of the lancet may be almost entirely dispensed with in such cases, where once we thought it not safe to do so. Although I never hesitate to give chloroform in natural labor, when I think it may be of use, I do not urge my patients to take it merely as a remedy for pain. If they wish to avoid the pangs of labor, and wish to inhale chloroform, I do not object to its administration. Firmly believing that a judicious use of it can do no harm, I do not see how I could object to its use* but I never press my patients to resort to the use of chloroform when the labor is progressing well, and they are able and willing to bear it. In operative midwifery, we may, with great benefit, resort to the use of chloroform. The cases which most demand its use are in CHLOROFORM. 1017 turning the child. Where the placenta has been retained for some hours, the use of the chloroform, to allay the irritability of the sensitive parts, is invaluable. It also relaxes the rigidly contracted uterus. As I am one of those accoucheurs who very seldom find the application of the forcepts necessary, or even warranted, I have scarcely had an opportunity of judging, as to the advisability of placing the patient under the influence of chloroform, prior to their use. I should, however, be inclined to give a negative opinion, as either the maternal parts are sufficiently roomy to admit of their application without pain, or they are not; and, in the latter case, the danger of injury to the mother would only be increased by her unconsciousness. When I administer chloroform in simple mid- wifery, I never give it to such an extent as to annihilate pain, but merely to allay, or deaden it: in a word, I do not attempt to render the patient totally unconscious of her sufferings, but merely to render them bearable. In operative midwifery, the full effect of the chloroform must be obtained, as the intention is then, both to render the patient unconscious of what is done, and to obtain the muscular relaxation, which is produced by a full dose of the chloroform. In uterine examinations and operations, chloroform is occasionally very useful; though, as a general rule, no instrumental examination of the uterus need be painful, if an instrument proportioned to the degree of dilatability of the vaginal orifice be used, and proper gentleness be observed. There are cases, however, in which the fears of the patient are so great, that the use of chloroform may be desirable. There are also cases in which the uterus, its neck, and even the vagina, are the seat of such intense neuralgic sensibility, that interference of any kind is almost impossible ; unless the patient be under the influence of chloroform. There are some cases where the patient cannot bear the slightest touch of these parts; the cervix uteri being ulcerated, no remedy could be used without the use of chloroform ; consequently, the patient would die, (and many have died, before this remedy was discovered,) without its use. No detrimental effects have resulted from a repetition of the remedy in those cases, so far as I am made acquainted. It occasionally gives rise to a little sickness at the stomach, and that is all. The quantity required varies very much at different times, even in the same patient, to produce the same effect. It generally requires from half a drachm to a drachm, at each inhalation. The sickness that follows the use of chloroform does not depend on the 1018 CHLOROFORM. quantity taken, but upon a certain condition of the nervous system, which, perhaps, could not be ascertained before its administration. In uterine pain, or painful menstruation, or from cauterisation of the mouth, or neck of the womb, or from any other cause, chloro- form is a valuable medicinal agent, either when given internally, or by inhalation: the latter is- preferable. But when it is given internally, from three to four drops should be mixed with mucilage, in the yelk of an egg, to hold it in solution, before the water is added. If a little camphor be added to the chloroform, which soon dissolves it, the solution will more readily mingle with water. The dose may be repeated every fifteen minutes. Mr. Nunneley's experiment points out its local action. When applied to the skin, or any of the tissues, its immediate effect is, " to induce redness, some tumefaction and paralysis, with loss of feeling of the part which has been exposed to its influence." Bearing in mind these three facts, its action may be understood. The vapors of chloro- form, diluted with atmospheric air, according to the strength of the dose, when drawn into the lungs, is rapidly diffused over an immense extent of mucous surface, surrounded on all sides by innumerable blood vessels, and nervous fibrilla. It first acts as a stimulant, exciting cough, hurried breathing, a sense of choaking, excitement of the brain, and, if pushed too far, produces convulsions; but this effect is almost instantly followed by the sedative influence of the vapor. When chloroform is perfectly pure, the stage of stimulation is scarcely noticed, being so rapidly succeeded by insensibility; but, if it is impure, it is exactly the reverse, which proves the im- portance of attending to the quality of the article used, if Ave would wish to measure accurately its effects. In the lungs, it i3 brought into immediate contact with the ultimate ramifications of the nerves and blood vessels that surround the vesicles, and passing through these it is taken into the pulmonary circulation. Mr. Nunneley is inclined to think, " the action is primarily, in all cases, and principally, if not entirely upon the nerves." If this be the fact, the sedative effect is instantly communicated to the cerebro- spinal axis, and from thence reflected over the whole of the sentient ' nerves. Such, however, is not the effect when locally applied elsewhere: the loss of sensation seems quite confined to the part or to progress but slowly over the body. The extent of nervous surface exposed in the lungs, as compared with other parts, may however, account for this influence. Doctor Snoiu has shown, bv experiments very carefully conducted, that the vapor of chloroform CHLOROFORM. 1019 is absorbed into the blood, and the quantity absorbed bears a fixed proprotion to that inhaled. Chloroform is very volatile, and there- fore rapidly diffused through the system ; it is only slightly soluble in the serum of the blood, and, consequently, the blood parts with much less than it absorbs. This will explain the rapidity of its action; because a certain portion being free, is immediately con- veyed from the lungs to the heart, and from thence throughout the whole circulation. It will also account for the slight change produced in the blood, in proportion to the effects produced on the nervous system. If we assume, that a free 'undissolved portion of chloroform passes rapidly from the lungs to the heart, and thence throughout all the vessels of the body, its effects on the constitution may be understood. First, on its arrival at the heart, a safe dose will only act as a stimulant, or perhaps not at all. In some cases, Avhere the patient is previously excited by apprehension, and the heart, in consequence, pulsates rapidly, chloroform may reduce these pul- sations, by controlling the mental excitement; but this is very different from the slower and feebler beat, which is the result of its sedative effects. This symptom is important to attend to, because sudden death is the consequence, if the heart's action be suspended. The syncope of chloroform is fatal; and, if too concentrated a dose be inhaled, the excess of free chloroform may be so great, as at once to paralyse it. The brain gives evidence of its effects, by loss of consciousness; the medulla oblongata, in a slow deep ster- torous respiration, and in the dying activity of reflex action. The different degrees of its influence, on the vital functions, have been fully pointed out by Dr. Snow ; but that effect which has the most important relation to our present subject, is the independence of sensation and consciousness. Mr. Nunneley observes, as the result of several experiments, that " the animal, after recovering from the effects of soporific, is often conscious long before there is any muscular power, or even mere sensation ; indeed, after a moderate dose, or when the dose is not sufficient to induce a complete state of insensibility, consciousness remains where there is no power of motion, and but little sensation, as every body who has inhaled any of those substances knows." This effect has been frequently noticed by Dr. Bennet, and also by the writer, and seems to him to be one of its most valuable actions in obstetric practice. A moderate dose will diminish, if not remove sensation, Avithout destroying consciousness. The patient is afforded relief from the intensity of her sufferings, without being 1020 CHLOROFORM. put to sleep; and also by a suitable dose of chloroform, without producing the slightest risk. The reverse of this sometimes happens under the use of more full doses; consciousness is lost, but sensation remains; a metaphysical difficulty, certainly, but which, nevertheless, seems to be true. The patient may place her hand to the back, or some other part, and she will give evidence of sensibility. Yet, after the child is born, she will declare she felt no pain. In a recent conversation with a surgeon dentist, on the use of chloroform, he informed me that he had witnessed, but a few days previous, a patient to whom he had administered the chloroform, while a surgeon applied the actual cautery, so severely, that he burnt a hole an inch in diameter, and one inch deep in the thigh, during which time the patient complained severely ; but when the operation was over, and the patient restored to his rational feelings and senses, he declared that he did not know when the cautery was applied, nor did he feel any pain. This is still another confirmation of the above facts, that although the patient may complain, during the pain, of its acuteness, when fully under the influence of chloroform, yet, when restored, has no recollection, of having suffered pain. When chloroform is administered injudiciously, and death is produced thereby, we do not see that this takes place in a uniform manner. But the influence of the chloroform on the vital functions may be progressive, or simultaneous. Loss of sensa- tion, motion, and consciousness, may be followed by stertorous, labored, feeble respiration, and this by the gradual cessation of the heart's action; or they may occur all at the same moment, the pulse, respiration, and consciousness ceasing together. Hence, the appearances after death, in man and beast vary, and are influenced very much by the rapidity of the effect. After the most powerful doses, the lungs are collapsed, the heart florid and empty, or the right side moderately distended from the vena cava, and the left ventricle contracted by the vigor mortis; the brain is natural. But when death is less instantaneous, the lungs are congested ecchymosis, emphysematous; the right side of the heart, and cava distended, sometimes enormously, and the sinuses and membranes of the brain filled with blood. Dr. Murphy recommends, " that, in ordinary cases of labor, the dose of chloroform should be very small; and herein consists the safety of the practice." In natural labor, the full influence of chloroform may certainly be safely induced, but it does not CHLOROFORM. 1021 appear to the writer necessary to go so far. It seems, to him, to be sufficient to dimmish the intensity of the pain. This may be accomplished without putting the patient to sleep; without even disturbing, in the least degree, her self-possession; perfect con- sciousness may remain, and yet the urgency of suffering completely subdued. When chloroform is given for this purpose, the quantity is sc small, that no interruption to the action of the uterus could be produced. Whenever this has happened, the dose has been sufficient to put the patient to sleep; but even here, the effect was only temporary, and passed away with the chloroform, when the uterine contractions returned with more power and efficacy than before it was inhaled. In order to subdue the pains of natural labor, I generally pour half a drachm of chloroform on a clean cambric handkerchief, and this is held to the mouth of the patient, by an assistant, so that she can breathe it without touching the handker- chief with her lips, and yet so as to inhale it through the mouth. Three deep inspirations are all that I allow a patient to take at once. This may be repeated when the pain is felt to be approaching ; but it should never be used, except in the last stages of labor. By applying the chloroform in this way, the quantity really admitted into the lungs is very small, and that well diluted Avith atmospheric air so that no harm can result from its use. If this quantity, however, produce no effect, it should be gradually increased, till it becomes sufficiently pungent to render the inhalation rather difficult. Its strength should always be tested before giving it to the patient: a single inspiration will be sufficient to prove this. If the very moderate dose first used should act with a power disproportioned to the dose; if it excite the patient, produce incoherency, or interfere with the action of the uterus, it should be at once with- drawn, and not reapplied. The proper time to be selected for its use is in the second stage of labor, (as above stated,) when the pains are increasing to their highest degree of intensity. The importance of using pure chloroform is alluded to by every writer, who has paid any attention to the subject. Pure chloro- form should contain no oxygen, and the more it approaches to chloric ether, and to the properties of alcohol, the more exciting it becomes. Hence, it is probable, that in those cases where most excitement Avas manifested, the effect might be attributed to the impurity of the chloroform employed. On the other hand, it should be remembered, that perfectly pure chloroform is most prompt in 1022 CHLOROFORM. producing its sedative effect; and, therefore, it should not be recklessly administered. Wrfen the quantity of chloroform sufficient for the purpose is inhaled, it may be known by the pulse, the respiration, the voluntary muscles, and the eyes. The pulse—that may have been increased—becomes slower and fuller ; the respira- tion also is slower and deeper, as in sleep ; the voluntary muscles have lost their power; the arm drops; the eyes are inclined upwards; the pupil is sometimes dilated, but always contracts sluggishly. If the quantity is more than enough, the pulse may not only be slower, but feebler; a symptom that never should be passed over. The respiration becomes stertorous. In surgical operations, this degree of narcotism is generally required, but it is not so in obstetric practice. Spasmodic con- tractions of the voluntary muscles may occur. As soon as the respiration becomes slow, deep, and regular, chloroform may be withdrawn, because its action will increase for sometime afterwards. If it should not do so, it can easily be renewed. By allowing the chloroform sufficient time to develop itself, and by ordinary attention to its effects, the practitioner can scarcely err in its administration. Dr. Murphy says, " He feels perfectly assured, that chloroform neither impaires the contracting powers of the uterus, nor injures in any way either the mother, or the child ; and that if ordinary caution be used, and if the administrator be conversant Avith the properties and effects of the agent he uses, there is no risk whatever in the administration of chloroform. But, at the same time, it must be understood, that these conditions are absolutely essential. The closest attention should be paid to the manner in which chloroform is developing itself; and equal care should be given to the quality of the article used." (See Monthly Journal for 1849.) It is acknowledged, by the best writers on the use of chloroform in midwifery, that it weakens the action of the spinal nerves ; hence, a very valuable hint may be taken in the management of hemorr- hage, after or before delivery, where chloroform is, or has been used; that is, that neither ergot, nor cold applications Avill be effectual in arresting the hemorrhage; but galvanism, or direct stimulants, such as firm pressure over the uterus, and stimulants given internally—brandy, &c. It may be proper to give some exact rule, by which we should be governed in the administration of chloroform, to the extent in which surgical operations are to be performed. In all these cases, it is necessary to produce a certain amount of insensibility; and, on the other hand, it is dangerous to CHLOROFORM. 1023 push this insensibility too far. By what sign, then, are we to know that the insensibility has been carried to the proper extent ? Mr. Dudart " thinks we may find this sign in the species of trismus, or stiffness that affects the muscles of the lower jaw. When the jaws and teeth are pretty firmly pressed against each other, and some force is required to separate them, we should suspend the inhalation, and may perform the most painful operation in full security, for the patient has ceased to feel." (Med. Times, 1850.) We must not omit to state, that Dr. J. B. Brown is a strong advocate for the use of chloroform in abortion. In those cases where the placenta is held by the spasmodic action of the osuteri, he says, " That the chloroform readily relaxes the osuteri, and admits the placenta to pass, or to be easily removed by the finger." (See the report of the Westminster Society.) After all that has been said of the great utility of chloroform—and I would be dis- tinctly understood to say, I think it heaven's best blessing to the parturient woman—we have to acknowledge, that, by the injudi- cious use of it, and before the proper mode of using it was fully known, that insanity, and also death has been produced by it. But since its use has been better understood, and the cases in which it is inadmissible are known, we feel that, in the hands of a cautious and judicious administrator, it is a safe article. I will now give those cases in which it should not be used. Any patient that has been afflicted with insanity, or is of that diathesis ; persons laboring under disease of the heart, brain, or lungs, or any of the important organs of life, should not take chloroform. An anemic state of the blood is unfavorable for its use, yet not always dangerous. Lock- jaw, or tetanus, has been cured by the use of chloroform; but the cases are very rare, and it should not be relied on as a remedy.. Calomel and opium, and clysters of tobacco juice, will do much more in these cases. But we have treated this subject in another part of this work. We might say a great deal more on the use of chloro- form, in painful menstruation, hickup, lockjaw, spasms, histerea, delirium tremens, toothache, &c, but it would transcend the limits of this chapter, and come within the province of a treatise on chloroform. We think, however, that we have said as much as the unprofessional reader can render useful; and we again repeat, that it should be used cautiously by those who do not well under- stand its power and effects upon the system. 1024 COD-LIVER OIL. ON THE USE OF COD-LIVER OIL. The medical world has been called to give their attention to the use and effect of cod-liver oil, in the last six or eight years, more abundantly than before. Various have been the treatises published on this subject; and, in looking over them, and weighing the opinions and statements which have been expressed in them, it is, indeed, abundantly evident, that cod-liver oil is an agent of no inconsidera- ble power. It is also evident, that its action is chiefly in one direction, and is exerted almost entirely in modifying, restoring, and improving the several processes, partly of primary, but chiefly of secondary assimilation, the derangement of which constitutes the basis and origin of certain symptoms which we are accustomed to treat under various names as special diseases. There are many diseases, however, of the above character, in which the effects of the sod-liver oil has not been very accurately studied—as dyspepsia— chiefly, perhaps, from the difficulty of finding pure and uncomplicated cases of this affection. It appears, however, to be most useful in those cases where the stomach and duodenum are involved; but here only after the active symptoms have been subdued by other remedies, and where the digestive powers of the stomach and duodenum recover themselves with difficulty. In those cases where the dyspeptic symptoms are dependent on some lesion, or ulceration of the stomach, or an incipient organic disease of the walls of the stomach, the cod-liver oil appears to be unsuited; and even if retained in the stomach, to be inefficacious, if not hurtful. It is chiefly in cases Avhere the stomach does not properly assimilate the food, that the oil seems to do the most good. Such as in chronic rheumatism, in rickets, in the various affections which are the local manifestations of the scrofulous diathesis, scrofulous affections of the bones, sore eyes, diseases of the messenteric glands, tubercles of the peritoneum, &c, and in consumption, especially in the early stages, and in various chronic eruptions of the skin. It appears to be more beneficial in those diseases of the skin where they can be traced back to a defective nutrition, and more especially, if this is laid in a scrofulous habit. The cod-liver oil has been used in a great number of other forms of disease ; but the benefit has been less marked and determinate. In true gout, also in itch, porrigo, osteo-malacia, atonia amenorrhcea, worms, and in the various sequela of measles, small-pox, and typhus fever, COD-LIVER OIL. 1025 the opmrong df its utility are very contradictory. Cod-liver oil has been found useful in cases where tonics are indicated ; as in convalescence after influenza, bronchitis, pneumonia, plurisy, and other cases where the disease has been partially, or entirely removed. The constitution requires to have cautiously supplied to it, from which its impaired tissue may be supplied with more force. Two diseases, upon which cod-liver oil appears to exert a consider- able influence, are chronic rheumatism, and scrofulous consumption. It would seem, in some of these cases, there appears to be some- thing almost specific; while, in most other cases, the benefit resulting from the use of the cod-liver oil appears to be owing simply to its tonic and nutricious powers. Indeed, the cod-liver oil does not appear, in many of the above diseases, to be superior to the ordinary fish oil. But of the virtues of cod-liver oil there can be no question, when we look upon it in a nutritive point of view. It is certainly capable of doing two things. In the first place it fattens, and adds to the bulk of the body; it also gives nutrition a better turn, making the fluids and solids more healthy, and enabling them to throw off a variety of cachectic derangements. These useful qualities have been partially accounted for, on the supposition, that they are due to a minute quantity of some biliary principle contained in the oil. This hypothesis has been fully proved to be false, by Robert Duritt, Esq., who has tried a great variety of experiments with the common fish oil, and the oil of the seal, both of which proved to be equally nutritious, and beneficial in restoring the tone of the system, and the weight of the muscles, as well as the ruddy appearance of the cheeks, and are, therefore, equal to the cod-liver oil. But the great value of the cod-liver oil, is to be found in the treatment of consumption, in its various stages. At the Brompton hospital for consumption, cod-liver oil has been given very extensively, and in five hundred and forty-two cases its effects have been noted; of these two hundred and ninety-three were in the first stage of the disease, and two hundred and forty- nine, in the second and third, or those stages subsequent to softening. Of those in the first stage, one hundred and ninety were males, and one hundred and three were females; seventy-two per cent, of the males, and sixty-two per cent, of the females had their symptoms materially improved; in nearly eighteen per cent, of the males, and in twenty-eight per cent, of the females, the disease was arrested, that is, all or nearly all of the symptoms of the disease had disappeared, the patients felt themselves well, and able to BRIGHT 66 1026 COD-LIVER OIL. pursue their ordinary occupations. In ten per cent, of the males, and in nearly ten per cent, of the females, the disease progressed unchecked. Of the two hundred and forty-nine patients in the second stage of the disease, one hundred and thirty-nine were males, and one hundred and ten females ; in fifty-three per cent. of the males, and nearly sixty-one per cent, of the females, the symptoms were materially improved; and in a little more than fourteen per cent, of the males, and in nearly fourteen per cent, of the females, the disease was arrested. In a little more than thirty-two per cent, of the females, and in twenty-five and a half per cent, of the males, the disease was not arrested. Viewing these results collectively, we find, in about sixty-three per cent., the symptoms improved; in eighteen per cent., the disease was arrested; and in nineteen per cent,, it went on unchecked. When it is recollected that, of the whole number at this hospital, the disease was arrested in eighteen per cent, of the cases, the value of this remedy must be considered very great. Different qualities of oil were tried there, without exhibiting any marked difference in their remedial effects; but the offensiveness of some of the darker kinds rendered their general use impractica ble. The oil now used is straw colored, transparent, and free from offensive smell. Patients in general take it without repugnance. The dose, at first, is one drachm, or a large tea-spoonful, three times a day, for an adult; but it should be gradually increased to one oi two table spoonsful for a dose. It is usually given in camphor water, or any aromatic water, or bitter infusion, or in milk. When the stomach is very irritable, it may be given in mucilage of gum, or slippery elm tea, with a few drops of hydrocyanic acid. In cases where there exists great anemia and debility, and in those where the effects of the oil seems slight, preparation of quinine, iron, or manganese, which is better, may be conjoined with ad- vantage. When nausia and feverishness occur, the remedy should be omitted for a few days. In some cases the use of the oil may be continued, where there is slight spitting of blood, without producing any injurious effects. One of the most striking effects of the use of cod-liver oil, is an increase of the patient's weight. But an amelioration of the symptoms does not always follow the increase of weight; but these exceptions are rare. An aggravation of the symptoms, and a decrease of Aveight, are almost ahvays coincidences. In some few cases, the symptoms may improve though the Aveight be not increased. But in most cases where the NEW REMEDIES IN MATERIA MEDICA. 1027 symptoms abate, and the weight does not increase, or even diminish, the patient is apt to relapse, and progress rapidly to a fatal termi- nation. Such cases do occur, and they should be noted, in order that a good remedy should not be hastily thrown aside, after sanguine hopes have been disappointed. On the other hand, with- out entering into the successive steps of improvement, in the patient, it will suffice to say, that " many of the cases included in the eighteen per cent., in whom the diseases were marked arrested," in the above account, " felt themselves as well as they had been before the attack of the disease." From these facts, no other conclusion can be drawn, than that cod-fiver oil possesses the property of controlling the symptoms of pulmonary consumption, if not arresting the disease, to a greater extent than any other agent hitherto tried, and bids fair to become the fashionable remedy for that as well as other diseases. We give the following as the best remedy, to disguise its nauseous taste. Chew a piece of dried orange peel, before and after taking the oil. NEW REMEDIES IN MATERIA MEDICA. COD-LIVER OIL. Cod-liver oil has been used by Dr. Brefield, as a topical application in strumous diseases with great benefit. The German physicians award to it great merit. The diseases in which it is most beneficial are scrofulous affections of the neck, as in glandular tumors, or enlargements, ulcerations, &c. The following is the preparation found to be most beneficial. Recipe: Cod-Liver Oil, fifteen parts. Yelk of Eggs, twelve parts. Extract of Lead, eight parts. Form an ointment. This ointment is applied to the ulcers thinly spread upon lint. In scrofulous sore eyes, the eye lids are to be anointed several times a day with pure oil. In mesenteric diseases, the abdomen may be rubbed with the oil either warm or cold, as is most agreeable to the patient, three or four times a day, and continued till the enlargement of the abdomen subsides. 1028 NEW REMEDIES IN MATERIA MEDICA. A NEW REMEDY FOR SCALD HEAD. This remedy removes the roots of the hair without pain, when the remedies prescribed in this book may be applied. This remedy is called the sulpho-hydrate, of the sulphuret of calcium. It is made in the following manner: by passing sulphuretted hydrogen to saturation, through a mixture of two parts of slaked lime, and three parts of water. The result is a jelly-like substance, of a blueish- green color. It is sufficient to apply a layer of this, of a line in thickness, to the parts to be denuded, when in the course of three minutes the hair will be entirely removed, without the least injury to the skin, and without causing the slightest pain. Then the usual remedies prescribed under the topic of scald head, may be success- fully applied. ON PURGATIVES APPLIED TO THE SURFACE. The endemic use of purgatives has been found very useful in those cases where long constipation has existed, and the stomach has become so irritated that medicines cannot be retained by the patient. The mode of applying it is this: draw a blister over the stomach, or on the inside of each thigh, and when the skin is loosened, remove it, and sprinkle the raw surface with colocynth finely powdered. In from four to six hours, the bowels will be freely evacuated. This remedy should not be persisted in for any length of time, as it is apt to irritate the bowels too much. A NEW REMEDY FOR ULCERATED PILES. Chromic Acid. This is to be applied freely to the ulcerated piles. In about two days, a considerable slough will be thrown off, and the tumor will subside. This remedy gives but little pain. TER CHLORIDE OF GOLD IN RHEUMATIC AND GOUTY AFFECTIONS. This substance, made into an ointment with lard, has been found to relieve rheumatic and gouty pains, with great facility. It tinges the skin purple, but this stain is readily removed by washing with urine. A NEW REMEDY FOR BALDNESS. Take leaves of the Cherry laurel, sixty grains. Cloves, eight grains. Tincture of Lavender, one hundred and eighty grains. Mix, and digest for six days. Then filter, and add fifteen grains of sulphuric acid. The bottle should be kept hermetically NEW REMEDIES IN MATERIA MEDICA. 1020 sealed. The bald parts are to be rubbed daily. The effect will be perceptible in six or seven days. A German Remedy. FOR THE STING OF A BEE. The oil of tobacco, as found in the heel of a pipe, or the mouth end of a segar, applied, will relieve pain immediately, and prevent swelling; it removes poison in a few minutes. OIL OF ANDA. This is the product of the seeds of a plant, which is a native of Brazil. This remedy has been used very successfully by Dr. Ure. The average dose is twenty drops. Taken on a little sugar, it has no unpleasant taste. It operates mildly, but efficiently, in from one to two hours. It is one of our best remedies for habitual costive- ness. It is gentle and safe. " Braithwaite." NITRATE OF SILVER. To remove nitrate of silver stains from linen, wet the stain with. the bi chloride of mercury, then wash it in cold water. This will remove the stain entirely. CARBONATE OF MANGANESE. This is a valuable tonic. In many cases it is preferable to iron, especially i» those anemic conditions of the blood in chlorosis, and diseases of the lungs. The dose is from two to three pills a day, of two grains each. SULPHATE OF MANGANESE. The dose of this preparation is two grains three times a day. prepared after the following— Recipe: Phosphate Manganese, one and a half drachms. Peruvian Bark, half a drachm. Syrup of Tulu, three ounces. Syrup of Peruvian Bark, five ounces. Essence of Lemon, one and a half drachms. Powder of Tragacanth, ten grains. This preparation must be made quickly, and preserved in a well stopped bottle. This may be divided into lozenges, each containing two grains of the manganese. Take one, three or four times a day COLLODION. For bed sores, apply a piece of soft linen over the sore, and apply the collodion over it and its edges. This preserves and shields the sore from the friction of the bed. 1030 NEAV REMEDIES IN MATERIA MEDICA. ANTIDOTE TO ARSENIC. Calcined Magnesia. This should be given in drachm doses, in milk and water, and repeated every hour, till all the violent symptoms are removed; then once in three or four hours, for the next twenty-four hours. Light nourishment should be given, after the bowels are gently moved. This remedy has saved the patient, after sixty grains of arsenic had been taken through a mistake. First, give a puke, then the calcined magnesia as above directed. ANOTHER ANTIDOTE TO POISON. Animal charcoal, prepared from the ivory black, or from blood, or old leather. This is chemically prepared by chloro-hydric acid. Remove all earthly and impure matters, by washing; then heat to redness in a covered crucible. It is said, by Dr. B. H. Rand, of Philadelphia, that this preparation is an antidote to opium, morphine, belladonna, aconite, nux vomica, delphinium, straversacre, white - hellebore, digitalis, hemlock, tobacco, ilaterium, ipecacuanha, hydro- cyanic acid, cantharides, and arsenic. The dose is from a drachm to half an ounce. It should be given immediately after the poison is SAvallowed, and repeated in a few minutes. The animal charcoal is innocent in itself, and easily taken in a Httle sweetened water, or milk and water. It is also an antidote to the poison of copper and lead. This, however, should not be given to the exclusion of the susqui peroxide of iron—in mineral poisons, especially arsenic—which is so easily prepared, and kept by all families. See Article, Antidote to Poisons, in this work. TREATMENT OF ULCERS. The treatment of ulcers has been so simplified by the profession, that all that is necessary on this subject, may be said in a few lines. It was formerly the case that every variety of sores was treated in a different way, and it not unfrequently required months to effect a cure. The profession has reduced the treatment to a few simple remedies, which any one can apply with ease and certainty. It has been found that the great secret in curing old sores is to exclude the atmospheric air from the surface. Dr. Newman has happily given us a remedy, that is at once safe and simple, which answers this purpose. It is to cleanse the surface well with warm water, then sprinkle it over completely with very finely powdered charcoal. The matter insinuates itself between the fine grains of the charcoal, and forms a complete covering to the surface; it also NEW REMEDIES IN MATERIA MEDICA. 1031 prevents gangrene or mortification. Over this a pledget of soft lint or old linen should be placed, which should be moistened occasion- ally with warm or cold water, as there may be too much heat or fever. If the sore has been of long standing, and the edges have spread out, they may be drawn together with adhesive straps, after the charcoal has been freely applied over the surface. If the edges of the sore are soft and pale, or flabby, half a grain of opium should be given to the patient—night and morning. This exercises a happy effect in restoring a healthy condition of the sore, and causes healthy granulations to spring up. The charcoal should be washed off, once in two days, or so much of it as can be easily removed, and fresh charcoal applied. The diet should be light, and the bowels kept open. This treatment will apply to almost all kinds of old sores and ulcerations, as well as recent ones. Scarcely any other remedies are used in Europe, for the treatment of old sores. Some have used water dressing entirely: keep the sore constantly covered with a wet cloth, till the granulations spring up, then draw it together with adhesive straps, and apply simple cerate over the surface to exclude the air; or the charcoal will answer well in this case. If the sore is in the form of a deep fissure or crack, be sure to insinuate the charcoal to the bottom, and once in a day or two, bathe it well with warm water; and whether the charcoal is all removed or not, cover it again with fresh powder. More can be done in as many days by this treatment, than can be effected in as many weeks, by the old mode of treating sores by poulticing and plastering, with so great a variety of ointments and detergents. Pure charcoal, and pure water with bandages, will give satisfaction to all who will give them a fair and candid trial, in any case of sores or ulcerations. We except burns; they should be painted com- pletely over with white lead and linseed oil when first burnt, and kept completely covered till they heal. And this cure is upon the principle of complete exclusion of the atmospheric air. I have, in a few years past, seen the most astonishing cures performed by this remedy, in the most alarming cases of burns and scalds. A NEW REMEDY TO PREVENT SMALL-POX FROM PITTING THE FACE. As soon as the pocks begin to appear, take mercurial ointment, six parts, and flour or starch, two parts: mix them well, and cover the face completely, and keep it covered, till the pocks all fall off the body, elsewhere; then wash it off, and but few pits will be seen. The remedy gives ease and comfort to the patient, and no danger 1032 NEW REMEDIES IN MATERIA MEDICA. accrues from it. This is a very valuable discovery for the preserva- tion of the beauty of the ladies. Another—Keep the face well oiled with sweet oil, so as to exclude the air from the surface, or cover the face with collodion, and keep it so till the pocks fall off, then wash it off. ERGOTINE—A NEW REMEDY FOR HEMORRHAGE. Doctor Bonjean, of Chambery, has furnished the medical world with his experience of the use of this new remedy, in arresting bleeding from wounds, and also from the uterus. The substance of his remarks is as follows : Ergotine, when applied to Avounds, has the property of facilitating their cicatrization, and moderating inflammation of the wounded tissues. Under its influence, union takes place by the first intention, and cicatrization occurs without further assistance. In certain cases, ergotine may perform all the offices of the ligature. As—first—when, in order to arrest a hem- orrhage, it would be necessary to disturb the lips of a wound in which cicatrization is commencing. Second: when the wound manifests a tendency to gangrene of the cut surface. Third: when the source of the hemorrhage is from vessels imbedded in the inflamed and swollen tissues. Fourth: when the blood flows from many small arteries, of which the orifices cannot be perceived. Fifth: when hemorrhage occurs from the sloughing of an eschar, as in gun-shot wounds, &c. In these difficulties, the use of ergotine is as often useful, as pressure is ineffectual. The application of ergotine supersedes ligature of the arteries, and effects cicatriza- tion, without interfering with the permeability of the artery. The mode of applying ergotine, is to dissolve it in five or six times its weight of water, for ordinary wounds ; and in three or four parts, or even in a concentrated form, for more serious hemorrhage. A portion of tow or lint, is to be moistened with the fluid, and applied with gentle pressure to the surface, previously wiped. When the hemorrhage does not return, on the pressure being removed. another pledget, moistened with the solution, is to be laid over the former, and the limb bandaged as usual. Perfect rest must be observed by the patient. KOUSSO.—A NEW REMEDY FOR TAPE WORMS. The flowers are given in a strong tea, till they purge freely; they are taken on an empty stomach. Happy effects have been produced by this remedy, both in France and England. NEW REMEDIES IN MATERIA MEDICA. 1Q33 A NEW MODE OF STOPPING HEMORRHAGE. When a tooth is extracted, and the blood flows freely, and is not arrested by the usual remedies, apply the Mowing. Take of Recipe: Gutta Percha, one ounce. Stockholm Tar, one and a half ounces. Creosote, one drachm. Gum Shellac, one ounce. Boil these articles together in a small crucible, or some suitable vessel, and constantly stir or beat them till the ingredients are perfectly blended into a stiff homogeneous mass. This mass can be rendered quite soft by working it with the fingers; you then can mould it into any shape you choose, so as to fit the wound, or holes made by the fangs of the teeth; press it firmly into the hole in the jaw bone, and let it remain there for twenty-four hours, when it may be removed. It will stop the hemorrhage. The mass will be hard, and show the shape of the cavity. Leech bites, or small wounds of any kind, may have their bleeding arrested in this way. TO REMOVE NEVUS. These are tumors that sometimes exist at birth, and sometimes arise after the child is born. They are mostly situated on the head, face, or neck; but may make their appearance on any part of the body. They are generally red, or of the color of a ripe cherry. To remove them apply collodion, or gun cotton dissolved in ether, over the surface, till it is completely covered, so as to exclude the air. Reapply it once a week, till the tumor disappears. From one to six or eight weeks will in most cases remove the tumor entirely. No danger in it. NEW CURE FOR THE ITCH, OR SCABIES. Cover the eruption completely with lard, and then cover the part with oiled silk. Reapply the lard twice a day. In a few days the disease will be cured. TO PREVENT THE SPREADING OF SCARLATINA. Dr. Webster says, " Patients affected with scarlet fever should be__in the early, and inflammatory stage of the disease—sponged freely Avith tepid vinegar and water." He states, that he has great confidence in the efficacy of this means, in preventing the spread of the disease ; he gives several cases in illustration of this opinion. __London Journal for 1849. 1034 NEW REMEDIES IN MATERIA MEDICA. NEW MODE OF TREATING HEMORRHAGE FROM THE STOMACH. Give the oil of turpentine in small doses ; say, thirty drops every fifteen minutes, and gallic acid in half grain doses every half hour. The former stimulates the coats of the stomach, and the latter contracts the mouths of the blood vessels, and shuts them up. The diet, in all cases of hemorrhage from the stomach and bowels, must be absolute. All nourishment should be .given in a concentrated, and liquid form ; perfectly cold, and in very small quantities at a time; and a return to the ordinary diet should be permitted with the utmost caution.—Dublin Journal, 1850. NEW REMEDY FOR CONSUMPTION AND SCROFULA, COMBINED WITH DYSPEPSY. This remedy has been published by an eminent physician in the South. It consists in the combined use of phosphate of lime and cod-liver oil. For a child of ten or twelve years old, give twelve grains of the phosphate of lime, three times a day, and so increase or diminish the dose according to age. For a grown person, from twenty to twenty-five grains may be taken three times a day, and the cod-liver oil, at the intermediate times, between the doses of the lime. The oil is taken in the usual doses. (See chapter on Cod-liver Oil.) The phosphate of lime should be used ten or tAvelve days, then omitted five or six days before it is taken again. The diet should be generous, ana easily digested. TETANUS, OR LOCKJAW, CURED BY THE DESTRUCTION OF THE CICATRIX, OR SCAR, BY A RED HOT IRON. A robust youth, aged twenty-two years, was seized with trismus, or lockjaw, on the ninth day after the receipt of a wound on the temple, when it had almost healed. He experienced a painful constriction of the chest, followed by reiterated convulsions, and suppression of urine, delirium, and unconsciousness followed. All other tried means had failed to abate the severity of the disease. M. Remy, on the seventh day of the attack, apolied Larrey's treatment, namely, cauterizing the scar in its whole extent with an iron heated to a white heat. The symptoms immediately underwent a great improvement: the convulsive movements became less frequent, and soon ceased entirely ; consciousness returned and the urinary excretion reappeared; but the muscular rigidity continued, the slightest movement, or attempt at swallowing of NEW REMEDIES IN MATERIA MEDICA. 1035 fluids, produced a sense of suffocation ; the recumbent posture had become impossible, and the patient exclaimed against a breath of air. This condition, Avhich lasted from four to five days, dis- appeared under the use of digitalis, in large doses. In fifteen days more convalescence was complete.—Medical Gazette, Sep- tember, 1849. A NEW METHOD OF MAKING ISSUES. This is performed by galvanism, in the following manner : Take a piece of perforated zinc, fasten or rivet it to a sixpence, shilling, or half crown, according to the size you want the issue. Place this on the spot where the issue is to be made, with the zinc surface next to the skin, and cover it with a piece of spongio-piline moistened with salt and water. Moisten the spongio-piline with salt and water every twelve hours. An eschar will be thus formed in about twelve days. Or, if the cuticle be removed before apply ing the little battery, the slough will be formed, in from four to six days; but this is more painful than when the cuticle is not previously removed. VOMITING REGARDED AS ANTAGONISTIC TO SYNCOPE. Any cause capable of so lowering the force of the circulation as to determine fainting, can also produce vomiting. If a strong man lose blood to such an extent as to induce fainting, he will in all probability have a seizure of vomiting. Should this occur during incipient fainting, he will not swoon; if he have completely swooned, we may calculate on reaction on the occurrence of vomit ing. Thus, then, from so direct a source of enfeebled circulation as the sudden abstraction of blood from a healthy man, whose stomach or system contains nothing deleterious, we may confidently rely upon the production of vomiting. The phenomena of sea sickness probably consists of a series of attacks of syncope, followed by a series of reactions. The fact, that fainting is "pro duced by a swinging motion, on the generality of persons, is undoubted, and the relief afforded to that condition, by the full and active effects of retching, is equally certain; but as the agitation of the ship continues, these phenomena continue to hold their alternate course, until the rocking of the vessel is discontinued, or the system ceases to be affected by it, as the author has experienced in his own case. It is highly probable, that the action of many of khe class of emetics, and also of some poisons, owe their emetic 1036 NEW REMEDIES IN MATERIA MEDICA. effects simply to their influence in depressing the heart's action, and not to any direct effect upon the stomach itself, as tobacco, lobelia, and many others. When any severe shock has been sus- tained by mechanical injury, if vomiting occurs, it is to be regarded as evidence of reaction from a state of more or less syncope which has resulted from it. If we study the countenance of a person in a state of syncope, and also during vomiting, we shall find that the two conditions are exactly opposite. In fainting, the countenance is completely blanched; while in vomiting, the capillaries are intensely injected, even to those of the white of the eye. What- ever may be the powerful effects of medicines in curing insidious diseases, in syncope they are peculiarly inert, compared with the influence of measures suggested by the physical laws. Thus, the horizontal posture is by far more restorative, than any of the articles of the Materia Medica. In examining the mechanism of energetic vomiting, we have only to regard the powerful contractions of the diaphragm and abdominal muscles, in order to understand its effect on the circulation ; direct pressure on elastic tubes con- taining a fluid being obviously the most immediate way of emptying them. Nor should it be forgotten that the blood varies in its fluidity, in proportion to the force of the circulation; thus rendering mechanical action the more important. If, then, in severe injuries there be no vomiting, the danger is the greater; but, if free vomiting follow, you may expect a favorable reaction to succeed it, and, if the appropriate remedies be applied, the patient will recover. NEW caustic. M. Velpeau says, that sulphuric acid with saffron forms an additional caustic. The powerful cauterizing effects of the acid are not destroyed, but by the combination a black paste is formed, which hardens into a crust, shortly after exposure to the air. The peculiar properties of this caustic are its combining great power with facility of circumscribing its action, and it is stated, also, that the eschar thus formed, though deep, is quickly thrown off. In cancerous affections, the peculiar and distinguishing fetid odor is quickly destroyed, nor does any bad effect indicating its absorption arise during its use. It may be spread on a piece of soft linen, just large enough to cover the sore, and applied till it kills the surface then remove it, and dress with simple cerate. NEW REMEDIES IN MATERIA MEDICA. 1037 THE REUNION OF FINGERS OR TOES, OR PIECES OF MUSCLE SMOOTHLY CUT FROM THEIR POSITION. In all such cases, if the part cut off be a finger or toe, or any piece of fle'sh, if it is rendered foul or dirty, wash it clean with warm water, and reapply it to its position, exactly—if it is not soiled, apply it to its position without washing. After it is exactly adjusted, cover the edges freely and fully with collodion, and then with adhesive straps, so as to exclude the air completely from the wound—let this dressing remain till the wound heals, then remove it. If any portion of the collodion should be removed by any means, immediately reapply it over the whole denuded surface. THE PRESERVATION OF SIGHT. The minuteness and inconceivable velocity of the rays of light, the facility with which they penetrate bodies of the greatest density, and closest texture, without a change of their original properties, make them the sour go of the most wonderful and astonishing phenomena, in the physical world. The smallest conceivable stream of light is called a ray. The sun is, perhaps, the original and great source of light. But light is produced by chemical preparations and decompositions. Light is not uniform in respect to color. Every part of a ray is not capable of exciting the idea of whiteness. White light is composed of different kinds of rays, which, individually, give the sensation, of red, orange, yellow, green, blue, Indigo, and violet, or purple. Besides these, there are invisible rays giving heat—but no, light. These are less refractable than the colored rays. It is by the judicious use of the rays of light and heat that we preserve the eye-sight. When we recollect that the eye is a very tender and irritable organ, composed of so many sensitive coats, it is a matter of surprise, that it should remain perfect so long- seeing that it is used on all occasions, in all degrees of light and shade, exposed to every variety of stimulus. Any thing that will act as a violent stimulus upon the eye, either light, heat, or too great fullness of the blood vessels of that organ, will, if long continued, injure the power of vision. Hence, looking directly at the sun, or on red-hot molten metal, or receiving the reflected rays from the surface of a white body, will injure the sight. It is important, that the humors of the eye be preserved in their due 1038 NEW remedies in materia medica. proportions. Hence, the eye should not be rubbed with the finger immediately on its front; but should be pressed from each angle towards the centre. By pressing he ball of the eye in this way, the aqueous humor is preserved perfect, and in due quantity, and the globular shape of the eye is also preserved ; so that the focus is formed at the proper distance from the eye. The manner in which the eye is used, tends greatly to preserve the sight. We shonld accustom ourselves to look at objects at a great distance ; this causes the muscles of the eye to contract, and press the ball forward, and preserve the globular form of the eye. When reading or writing by a strong light, we should always sit ai a position to throw the rays obliquely from the eye, and not directly into the eye. It is proper to soften the rays of light, by using a blue shade over the blaze. Blue is greatly preferable to green, or any other color. We have said, too great fullness of the blood vessels of the eye injures it; and as study invites an increased action of blood to the brain, if you read or study much after night, the supper should be light, and the digestion kept free and easy. We have said, that there are rays of heat that emit no light: by long watching, or reading, these rays cause great stimulus to the eyes. Mr. W. B. Payne, of London, has invented what he calls an eye fountain; it is in shape like a small vase, with a small air-pump attached to it; so that a very small jet of cold water may be constantly applied against the eyes, for some time. The German oculists have, for a long time, used a similar instrument for the application of cold water to the eyes; it strengthens them very much. , In a conversation with a gentleman, on this subject, of much sound philosophical knowledge, he informed me, that, after long watching, or reading, when his eyes pained him, and the vision became weakened, he would lie down on his back, place a wet cloth over his eye-lids, and then cover the eyes with pounded ice, or with snow, and retain it there for an hour. It would, at first, for some minutes, produce pain; but, after this was over, a pleasant sensation ensued. By this means he has preserved his eye-sight, so that he has not required the use of glasses; when, if he had not used this remedy, he no doubt would have been obliged to use them years ago. This proves the truth of the declaration, that the rays of heat accumulate in the eye by long watching, or reading; and if the heat be not abstracted, they, by NEW REMEDIES IN MATERIA MEDICA. 1039 their stimulus, cause the vessels of the eye to absorb the humors, and thereby alter or change the axis of vision, and make the demand for glasses necessary, in order to restore the proper focus. All foreign bodies that may become insinuated under the eye-lids, should be carefully removed as quick as possible. To avoid dust falling into the eyes, we should not sleep on the back. Frequently applying cold water to the head strengthens the eyes. Light suppers and healthy digestion is important to the healthy functions of the eyes. HUMAN SYSTEM. A perfect human system is composed of two hundred and sixty bones, more than four hundred muscles, and thirty-two teeth. The bones are supplied with periosteum, tendons, ligaments, synovial membranes, arteries, veins, and absorbents. The principal com- ponents of the bones are phosphate of lime and gelatin. The muscles are composed of muscular fibre, and fibrils, facia, and tendons. To every muscle belongs arteries, veins, and absorbents, sentient and motary nerves ; there is not a fibre that is not supplied with them all. The skin is mostly composed of the extremities of the nervous system. The brain and spinal marrow are the great sensorium, and origin of the nervous system; all sensation is conveyed through the nerves to the brain ; and the mind takes cognizance of the action or injury, and the man experiences pleasure or pain. The eye is composed of six coats, and three humors—First, the tunica albuginea, cornea, sclerotica, pigmentum nigrum, retina, and arachnoidea. Second, the aqueous and vitreous humors, and the christaline lens: the expansion of the optic nerve, makes the retina, then we have the iris, and celiary bands and procroses. Besides these, there are the vicera, heart, lungs, stomach, liver, spleen, pancreatic gland, bowels, kidneys, bladder, and all their secreting and excreting glands, ducts and vessels. Strange that a machine so complicated should keep in tune so long. Take good care of it, if you would live long. « BRIGHT'S FAMILY PRACTICE.! A PLAIN SYSTEM OF fok lie. By J. W. BRIGHT, M.D. This work embraces all the diseases of Men, Women, and Childrku, and a plain system of MIDWIFERY; and contains the experience of the Author, in | more than thirty years extensive practice of Medicine, and is the only work bow i before the public which contains all the New and Approved Remedies, found in I the standard works an! medical periodicals in Europe-and America, together ( with the experience and approved practice of the best anthors, upon which the ' successful treatment of the present forms of disease so much depends. It is the ' only work now before the public, containing a full description of the new, as well \ as the old diseases of the United States. The Symptoms of each disease, in all J its stages, are so minutely described, and the directions for giving and working ( ofl' the medicines are so plain, that no one can fail to follow them; the remedies , all being put down in plain English, in their appropriate places, it also contains / a Family Materia Medica, with Receipts for preparing all the Family Medicines ) in common use, with directions how to use them, and about thirty plates, mostly ' ' of medicinal plants, with their description, medical properties, and uses.' Recipes for preparing Tooth Powders, Cologne Waters, and Medicines foi( eieansing and Beautifying the Skin, and many other recipes, useful to Farmers ( and Mechanics : recipes for preparing and using the remedies for the cure of the ( Poisons of Arsenic, Copper, Lead. Mercury, Opium., Morphine, Gallic and Prussic Acids ; also, directions for preparing a variety of Diet for the Sick. The ( work is got tip in the most fashionable style, with marble edges, and bound In fine , leather, with spring back, especially1 for the use of families. The whole is , contained in 941 royal octavo pages, and will be delivered to subscribers at Five | Dollars per copy. Recommendations from the Medical Faculty of the University J of Louisville. Locisvhjjs, Anjrust, 1847. Dear Sir—Having bestowed on an attentive examination of your " FAMILY PRAC- ' TICK" all th« leisure I can command, I am of tho opinion that, with the addition of the ' word well, which I shall take the liberty of making, I cannot better characterize it than ( jrou yourself have done, in your very modest and appropriate title-page, "A Plain System < of Medical Practice, well adapted to the use of Families." M The work appears to me to be thus adapted, for the following reasons s— 1. The matter it contains is sound and judiokius, and sufficiently full and diversified tor I all the cases of disease in which families themselves should attempt to employ It. When i more is needed, recourse should be had to professional aid. 2. The descriptions of diseases are generally correct, and their changes and stages well i marked; and the style ot the work is so simple and perspicuous, that no one at all i acquainted with the English composition ean misapprehend its meaning. i 3. The compass of the work, embracing as it does every form of disease which an i American Physician, in full practice, can expect to encounter in a lifetime, is sufficiently ample. i Wishing it, therefore, the receptlen and circulation, to which it appears to me to b* ( tntitled, lam, very re»pe«tfully, your obedient servant, CH. CALDW-KLflb, M. D., Prefessor of the Institutes of Medicine and Medical Jurisprudence. P 8 Were it not that comparisons are apt to be held exceptionable, I would nftt, hesitate to say, that I consider your "Family P^astice" the most valuable work of tha ( sort of which I have any knowledge. • C. C. I have examined Dr. Bright's " FAMILY PRACTICE," and feel assured that it is, on the ' I whom, well adapted to the purpo.«e for which it is written. I think the work is calculated t i to be amiaently useful. S. B GROSS, M. D., Professor of Surgery. ) August, Wit. ( I ooucui in the estimate expressed above by Dr. Gross. 1 It. MILLER, At. D., Professor of Obstetrics and Diseases of Women and Children. I hav* examined ;'MIGHTS FAMILY PRACTICE" with some care, and find that it j is plainly wri'ten, mui contains much that is valuable. I believe the work is ralou'.^'ed tc ( do uiucli good. •'• COBB, >1. IX, Professor of Anatomy. ( I have examined Dr. Bright^ -FAMILY PRACTICE," and find it what it purports < to >»t-—a pl.iin system of Meditxii Practice-- which I run conscientiously recommend to < families. L. P. YA.NDKLL, M. D., Prol'uswir of Physiology ( From Practising Physicians in Loiusville. I hare examined with care Dr. Bright's " FAMILY PRACTICE," and find it a valuable ] 1 work, well suited to the use of Planter* and Families. It i« plain and comprehensive, and ( the treatment conformable to the latest and most approved practice, and it affords me much pleasure to recommend it to the public. J C. GUNN, M.D. I have examined " BRIGHT'S FAMILY PRACTICE." The work is not only the result J of long experience, but a very judicious selection of the latest a.«d most approved Medical ) Authors, and will, no doubt, be of great »er Vv to families. W. C. GALT, M. D. I have examined "BR'GIFTS FAMILY PRACTICE," and do most unhesitatingly recommend it as a plain, practical work—useful to families. 0 PIRTLE, M. D. I have examined "BRIGHT'S FAMILY PRACTICE." ar.d take great pleasure in ' recommending it as a valuible work, suitable to the use of Families. Having prax.-t.ised ( Medicine fifteen years in Mississippi and Louisiana, I view this work as better adapted to ' the diseases of that regiou than any work of the kind I have ever seen. RICHARD ANGEL, M. D. We have examined Dr. Bright's "FAMILY PRACTICE," and feel no hesitation in recommending it to the public, as a book containing a variety of useful and valuable information. It is entirely practical in its designs; all technicalities are avoided, so as to render the author's meaning clear and plain to the unprofessional reader, for whom it 1 is more particularly intended than for the profession, though the latter, and particularly ) the medical student, might increase his atoru of practical knowledge by a careful perusal ) of iUs pages. Dr. Bright's instruments for the application of caustic to the mouth of the ) uterus are ingenious, and no doubt will save the praeti'ionor much trouble, and the patient a great deaJ of unuecesssry pain. U. E. EWLN'G. M. I). Louisville, June, 1S47. W. T. H. W1NLOCK, M. D. I have examined " BRIGHT'S FAMILY PRACTICE." and And in It plain and imporant practical principles m medicine, well adapted to the use of families. wm a. Mcdowell, m. d. I have examined " BRIGHT'S FAMILY PRACTICE," and take pleasure in recommeEa- ing it to all persons as a valuable work—in particular to families in the country. Louisville, June, DMT. J. W. KNIGHT, M. D. Wa have examined the medical work written by .1 W. Bright, and recommending it to the public, as a work welt calculated for the use of families JOHN M. TALBOT Louisville, June 13, 1847 W. U. WAKEFIELD, M. D. i take pleasure In / lilies ) ,BOT,.M. D. ) Dr. Briokt : Dear Sir—I have looked into your work at such moments as my urgent labors for the season would afford me. It appears to be a work of great research, and il doubtless one of high merit. It is my wish that the reading public may be most th»- roughly satisfied of the high appreciation put upon it. B. W. DUDLEY, M. D., Lexington, Ky., Feb. 5. 1SH». Prof, of Surgery ki Transylvania University. From Physicians in Memphis. After a careful examination of Dr. Bright's " FAMILY PRACTICE," I have no hesita- | tion in saying, that the practical precepts recommended by the Author are better adapted 1 to the treatment of disease, as it prevails at the Southwest, than any other work of a sim- ilar character, with which I am acquainted. GEO. R. GRANT, M. D., < Professor of Theory and Practice of Medicine in the Memphis Medical College. From the cursory examination which I have been enabled to make of Dr. Bright's work < i on the Practice of Physic, I have no hesitation in saying, that it is the best production of < its kind now published. B. V. WATKLNS, M. D. j Memphis, Sept. 1,1847. . We have examined Dr. Bright's " PLAIN SYSTEM OF MEDICAL PRACTICE," and < are satisfied that it is better calculated for a safe guide to Families—especially those remote < from a scientific physician—than any other work on Domestic Practice. We can therefore < cheerfully recommend it as a plain and valuable werk; in the main, well adapted to the < purposes designed. LEWIS SHANKS, M. D. ( Memphis, Sept. 1,1847. JNO. B. 7BAYSBB, M. D. { From Physicians in Illinois. Having been requested to examine " BRIGHT'S FAMILY PRACTICE," I have satisfied \ myself that it is superior to any work of the kind which has met my notice, both in its ( description of diseases and principles of treatment. HENRY WING, M. D., March 6,1848. Prof, of Mat. Med., in Jacksonville Med. Coll., 111. TO THE PUBLIC—Having examined Dr. Bright's " FAMILY PRACTICE OF MEDI- CINE" attentively, I have no hesitation in stating, that it is the best work of the kind now extant, to the English language, and is admirably adapted to the wants of western people. Lexington, Morgan Co., HI., March 8,1848. C. H. KNIGHT, M. D. iMT9! tpm©iro©[ IS EMPHATICALLY THE BOOK FOR EVERY FAMILY IN THE UNITED STATES. n^AGENTS WANTED in every county of each State. Very large ! profit* are allowed, and energetic men have made from $500 to $2,000 per annum by Belling BRIGHT'S PRACTICES. A Cash Capital of Eighty or One Hundred Dollars is requisite, as the Publishers sell exclusively for cash, to avoid charging an extra profit on < those who pay, to make up for losses from those who do not pay. Consequently. \ iin ne case will booka be forwarded without the money ih hand. Persons > wishing to have an agency, will address the Publishers. ; B^- Akt person remitting Five DcOars to the subscribers shall reccire; a copy by mail, postage paid, to any part of the United States. MORTON & GRISWOLD, Publishers, LOUISVILLE, KY. REVISED AND ENLARGED EDITION OF GOODRIC H'S SCHOOL. READE Tha following are supposed to be some of the peculiar excsUonciee of this SERIES, as a whole. I. Completeness, embracing all that is required by the pupil from the Alphabet to the highest degree of ac- complishment in the art of reading. 2. Comprehensiveness,—Includ- ing all the approved helps and facilities both for teacher and learner. 3. Progression, step by step in an easy path, without confusion, breaks, »r other impediments. *• Simplicity and manliness of sentiment, which constitute the charm of Mr. Goodrich's style, acknowledged wherever the English language is read. 5. Originality, net a line having been borrowed from any other series ; while every other reader of late date has taken more or less, and generally without acknowledgment, from them or other compositions by the same author. S. Tho Illustrations, of the most beautiful character, introduced with profusion, in order to interest and excite ' the young mind, and develop its per ceptive faculties. 7. Mechanical Execution—the \ paper being white and thick, the type i large and clear, and tha binding neat j and substantial. i 8. Cheapness—being sold at lewer prices than works of inlerior authors. and less merit 9. Rhetorical Ezcrciscs—afford- ing most cvpious practical lessons in < enunciation, articulation, inflection, em- < phasis, and accent. 10. Moral Tendency—inculcating J by familiar precepts and pleasing illus- ( trations, a sense of justice, a feeling of < kindly charity, a reverence for religion, i a regard for the rights, feelings, inter- ests and characters of others, a love of < the works of nature, and a reverent I affection for their beneficent Author. GOODRICH S FIRST SCHOOL READER 72 pages, 18mo. 1. It has sixty-nine beautiful engrav- ings of simple but very interesting subjects. 2. It begins with very short words, in very short sentences, accompanying an appropriate engraving. In this respect the author has pursued the plain originally used by him many years since in " Peter Parley's Primer," and subsequently limited and copied by other books. 3. It contains eighteen lessons in articulation, comprising all the vowel sounds, based on the principle of teach- ing one thing only at a time, and making the pupil perfect in that one thing, by frequent repetition. 4. Preceding each reading lesson is a spelling exercise, containing the more difficult words. 5. In the lessons, Polysyllables are j neither accented nor divided, for several < reasons. 1. Words cannot be divided I without often misleading. 2. The pupil < should learn to read words as he will < afterwards meet with them in other( books. This last reason applies to' the marks sometimes used to dis-' tinguish the various sounds of the' vowels. 6. It is entirely original, being writ-' ten with the racy, genial and manly' simplicity peculiar to the author. 7. _ A knowledge of points and stops ( is given in the course of the book in( familiar language. 8. The type is beautifully clear and < distinct. \ GOODRICHS SECOND SCHOOL READER 144 pages, \%mo. 1. This work, formerly published as Cbe Tint Reader, having been revised, enlarged and improved, and being now preceded by a new introductory volume, is called the Second Reader. 2. It contains about fifty beautiful engravings. 3. The lessons are progressive, rather harder than in the First Reader, leas so than in the Third. 4. It contains 28 lessons on articula- tion, comprising all the consonant sounds of the language—with a view to produce by repetition ef one thing at ,' a time, the attainments of a fulL clear, : distinct enunciation, 5. Preceding each lesson is a Spell- ing Exercise, containing the most diffi- cult words. 6. Questions follow each lesson, de- signed to ensure a thorough understand- ing of the subject. These may be i multiplied by the judicieus teacher. 7. A familiar explanation is given of j punctuation, arciculaiion, emphasis, fyc. 8. Its lessons cannot be surpassed' by any in the language, in point of adaptation to the wants of young ( learners. 9. The type is large and very clear, while by a compact arrangement, many , new lessons have been inserted. GOODRICH'S THIRD SCHOOL READER, 218 pages, 18ww. 1. Tbis work, eriginally published as 1 die Second Reader, having been revised ' and enlarged, is now called the "Third Reader." . 2. It contains a great variety of i beautiful engravings. ( 3. The lessons are progressive, carry- i ing the learner onward, step by step. 4. It contains lessons on articulation, arranged upon the principle of teaching 1 one thing mt a time, and of continual 1 repetition. 5. Preceding each lesson is a spelling exercise, with the words properly divided. 6. Following each lesson are ques- tions to excite and interest the pupil. 7. Much useful information is given , respecting the different kinds of type, used in printing, with lessons in italic i letters, script, SfC. ' 8. To ensure greater interest in the i lessons, there is a continuity of narra-' tive between many of the lessons, while they are also complete in them- selves, so as to be read separately. 9. Prefixed to each lesson is a list ( of the most common and vulgar errors ( of pronunciation. GOODRICHS FOURTH SCHOOL READER. 240 pages, 12mo. 1. This work, originally published as the Third, having been revised, im- proved and enlarged to nearly double its former contents, is now the Fourth S. In this, as in all the others, while many facilities are offered to the pro- gress of the pupil, it is not by takmg away the necessity of exertion, but by bringing his faculties into play, and inducing him cheerfully and efficiently to help himself. J. An exercise in definitions precedes nob. lesson, explaining the meaning of the words as used in the context 4 Rules for Reading are prefixed to , the'book. These rules are simple, in- ) •eilieibla, and practical, and their effi- ciency ensured by a peculiar system of questions attached to the lessons. 5. It is abundantly illustrated with beautiful engravings. «. Errors of pronunciation are pointed out, and questions asked in connexion with each lesson. 7 Appended to many of the lessons are remarks of an explanatory or critical sharacter. 8. It contains exercises in Elocution of a most useful and practical kind. 9. For simplicity, interest, animation, pure moral tendency, and beauty of style and sentiment, a more delightful body of reading lessons was never before brought together. Goodrich's Fifth School Reader, 381 pages, 12mo. 1. This work, formerly the Fourth Reader, having been revised, improved, and enlarged to nearly double its forme' contents, is now the Fifth Reader. 2. By means of a large page, as large, in fact, as an ordinary octavo page with clear,, compact type, and a neat arrangement, nearly twice the matter is given of ordinary works, at same price. 3. An exercise in Spelling and Defi- ning precedes each lesson. Tnis exer- cise contains the words that the learner is losst likely to know. The definition? of upwards of three thousand words, ic the sense in which they are used in the context, are found in this and die pre- J ceding book. j 4. The lessons afford a selection of J the very best extracts in the English j language, and comprise more than usual J of the highest efforts of modern and { living masters. 5. It contains an ample number of pages devoted to rules an/J exorcises hi i Elocution 6. By a new arrangement, the se quence of the lessons has been made more uniformly progressive. 7. The interests of religion, morality, and good manners, have always beeu ' carefully considered in the selection. ____________________________________________________________< S, G. Goodrich's Primary Historical Series. FIVE VOLS., EACH 216 pp., 18mo, Parley's Primary History of North America, comprising the United States, with notices of Mexico, Canada, &c. Parley's Primary History of South America. Parley's Primary History of Europe. Parley s Primary History of Africa, in preparation. Parley's Primary History of Asia, including BIBLE HISTORY, in prep. These handsome little books form a series of primary histories. The mechan- ical execution is very creditable to the publishers. The following peculiarities , render them especially suitable far beginners, for whose use they are intended. The remarkable abundance and beauty of the pictorial illustrations. The use of maps in the text, thus uniting geography with history. The striking simplicity and force of the style, which is also chaste and finished. The freshness with which all the topics are invested. The introduction of new material, wanting not only in ordinary school books, but even in elaborate historical works. NEW AND ENLARGED EDITION »F THE A COLLECTION OF TUNES AND HYMNS For the use of Worshipping Assemblies and Sunday Schools. NUMERAL EDITION.—Compiled from many Authors, by SILAS \V. LEONARD and A. D. FILLMORE. Revised by Rev. WM. GUNN, of Ky., Rev. THOS. HARRISON, of Ohio, and by the AUTHORS. It is therefore both a Hymn Book aad Tune Book in one. Bound in Sheep, or Extra Cloth, 75 cts. I Bound in Super Gilt Cloth Morocco, gilt, $1 00 I " Turkey Gilt Cloth SCHOOL GRAMMARS. The Series consists of Two Parts, , BTJTLEB'S INTEODUCTOEY LESSONS i: ENGLISH GEAMMAE.—For Beginners. II. BUTLEE'S PEACTICAL GEAMMAE Instead of oifering to the public their own commendations of these books, the publishers have the pleasure of inviting attention to the following communications: 1. From Rev. J. M'Clintock, D.D., who is well known throughout the United States as one of the most accomplished scholars and skilful educators. As a' professor in the highest institutions of learning, as the author of a moat successful : series of classical text books, and as editor of the Quarterly Review, published by the Northern Methodist Episcopal Church, in the city ot" New York, his reputation is as wido as the country. " Bittlbr's ' Practical Grammar of the Bsuiish Lassijage,' is an exceedingly xrett- coneeived and well-executed book. It is scientific, not only in its groundwork (which every elementary book ought to be), but also in its practical methods and device*, wh«r« empiricism is too often substituted for science. As every lesson can be put to u connected with education. ) v Dear Sir—I have hardly had an hour since I received your note accompanying this t ( Grammar, which was not absolutely bespoken for some other purpose. On looking over ( ' Hie book rapidly, I see many thing* in it which are excellent. Tho definitions are remark- ( ? ably simple and clear ; the rules are short and comprehensive ; and the arrangement is so t { ?ood, and the exercises so well selected, that a tolerable teacher might, bo very successful ( ) in teaching the principles of English Grammar by the aid of it. It forms, moreover, in I ) the way it is intended to be used, what every Grammar for beginners ought to form—an / ! introduction to the art and practice of composition. The names of the tenses are far more sensible and philosophical than those found in ( most Grammars, which indeed are often quite wrong xnrt absurd; and tho principles of ) Syntax and of Prosody are singularly well condensed, without becoming too abstract, and ) obscure. In a future edition, I hope ho will give the same condensation t» the rules for ) > Punctuation. I am, dear sir, very truly youss, ) Oct. 27,1345. GKO. B. EMERSON. ) ) To J. G. Palfrey, LL.D., D.D., Secretary of State. ) 3. The following are extracts from the opinions of distinguished scholars:— { From E. D. North, Prof, of Rketoric in Yale College. <* It is th« most scholarly and philosophic Grammar that I know." A. D. Is>rd, of Ohio. " I consider it one of tne best works wo have on the subject." Rev. B. P Aydelote, of Cincinnati. " An improvement; in every respect, upon preceding works." Rich. IT. Lee, Prof. Wanb.iriz/.on. Coll. " I heartily recommend it as the best now to be got." John Leiris, of Llangollen. " Tt is really what Its title indicate*—A Practical Grammar." Jno. B. L. Soitle, Torre Haute. u Far in advance of any now ia use." E. A. Smith, S'lf/t of Common Schools, SlaUtovyH, N. Y. "I prefer it before Brown's and Bul- lions'.'' Muses Souk, North Brtdsrlpn. "My beau idwal of an English Gram- ^^-^-vJ BRONSON'S > (m'Mz OR, Mental and Vocal Philosophy, for the Development of the Mind and Eody. COMPRISING 1. Tuxi or Three Hundred of the Choicest Anecdotes in onr TjU'.(fu«cj€. 2. Three Thouxihd Oratorical and Poetical Headings and 1'(citations. 3. Fice Thousand Proverbs, Maxims, Sii/ingi, Themes, and Ixiconirs. 4. And Several Hundred Elegant Engravings, to Illustrate tlte Work ' L All the Principles of Elocution, in ) accordance with Physiological and Men- i Ul Science: II. SIX FULL LENGTH ) VIEWS of the Nerves of Organic Life, | >)f Respiration, of the Nerves of Sense and Motion, and of all the Muscles and Hones of the whole Body, clothed and unclothed: III. Natural and Deformed Chests, Positions of Ladies and Gentle- men, of their Bodies, Hands, Arms, and Feet, and ONK HUNDRED Full Length Oratorical and Poetical Por- traits: IV. FORTY-FOURMOUTHS, showing every position to produce the FORTY-FOUR sounds of our Lan- guage : V. The Common, and New Modo of Learning the Letters, of Spell- ing, and of Teaching Children to Read, S involving the Science of Phonology: VI. Several Hundred Jaw or Muscle- Breakers, for Training the Voice, while } ■' Laughter holds both of his sides." )VU. FIFTY ENGRAVINGS, exhib- > i*i»g all the Phases of Passion, with appropriate examples to illustrate them: VIII. An immense number of Q.ues- t tions and Subjects suggested for Ly- ' Bourns, Debating Societies, and Social Parties: IX. The largest and best col- lection of READINGS, RECITA- TIONS, and DECLAMATIONS, in- cluding those interspersed with his Popular Lectures, involving every va- riety of Thought and Feeling, and IT CONTAINS. will Feel and Think he must have, and cannot do without it. ITS COMPARATIVE MERITS. I. An examination of its C nt.MU« and their Arrangement, will enable one to institute a comparison between this work, ami all others on the same subject II. It is in perfect harmony wiifc what is known of ell that is NATURA L, HUMAN, and DIVINE. III. Its foundations are deeply laid in the Philosophy of Mind and Voice— Spirit and Matter; and the principles ( are of a far-reaching and comprehensive ' nature, tending to produce a great rev- olution in the Art of Reading and Speaking with Science and Effect, and the development of the WHOLE MAN, Soul, Mind, and Body. IV. Its method is that of ANALYSIS and SYNTHESIS, and is altogether < Progressive and Practical in its ebarac- teristics. V. Although but ONE Elocutionary Principle is presented, specifically, on any page, yet each Elementary page ' contains, incidentally, ALL the Princi-' pies of Elocution. VI. These Principles have never < been known to fail, when faithfully ap-1 plied, to enable one to Read, Speak and Blow on Wind Instruments, fori hours in succession, without Hoarse- / ranging from the deepest Tragedy to ness, or injurious Exhaustion; and they ■ ' tha highest Comedy; with something I tend to the Preservation from, and Cure ' } on every page, calculated to make one j of Diseases of the Throat and Lungs f serious and gay: X. By being printed Dyspepsia, and other Complaints inci- ( m double columns, and certain kinds of | dental to Public Speaking, and a ISed- ( type, it is designed, on philosophical entary Life. ( principles, to facilitate the arts of Read i ing, Memorizing, and the Preservation ) of the Eyesight—three important points ) of attainmep*: XI. It is expressly pre- \ pared for use m all SCHOOLS, ACAD- ) HMJBS, and COLLEGES, Male and (Female; and also with particular ref- erence to Private Readers and Learn- (ers : XII. In a word, it is just such a book, as every one, having heard of it. VII. It is BEAUTIFULLY and SUBSTANTIALLY got up in the oc- tavo form, of between three and four hundred pages, and includes a greater variety of Prose and Poetry than any other system of Elocution, and contains DOUBLE the amount of reading mat- ter found in any similar work in the United States, and yet—THE PRICE IS ONLY ONE DOLLAR. m NATIONAL LIBRARY OF MEDICINE NLM 0327Mblfi 7 ■,,,.f •,-, • V^fi-tfBft-..v ■mMmim ■y-^wm^ •'; < ,l'i";1'«Vi,;4ig.,f' 'y^m 1 ¥■ 4, 1 ll ;':;-;:yl--^ ■ ■;i:'.'-'.V>i. .v/-A.;i)Lt M* !W1v .'■•.i'.-.-'iV '.'.'/ NLM032746187