SMMs m ARMY MEDICAL LIBR WASHINGTON rh} s Founded 1836 ANNEX Section.. Number "=?._2.£/__£jL_ Fobm 113o, W. D., S. G. O. in 3—10543 (Revised June 13, 1936) i \ v^- DOMESTIC MEDICINE; OR, MEDICAL VADE MECUM: a SAFE COMPANION AND GUIDE FOB FAMILIES, PLANTERS, COMMANDERS OF SHIPS OR STEAMERS, OR ANT ONE WHO MAT REQUIRE A TRUE FRIEND IN TIME OF NEED. THIS COMPANION EMBRACES, ALPHABETICALLY ARRANGED, THE MEDICINES IN GENERAL USE ; THE DISEASES AND ACCIDENTS OP USUAL OCCURRENCE; THE MOST USEFUL ARTICLES OF DIET OR DRINK FOR THE SICK OR CONVALESCENT, WITH THE BEST MODE OF PREPARING THEM; AND NU- MEROUS REMARKS IN REFERENCE TO BATH- ING, EXERCISE, AND OTHER HYGIENIC MEASURES TO PRESERVE HEALTH, TO REPAIR AND STRENGTHEN AN ENERVATED CONSTI- TUTION, AND TO CURE DISEASE. BY EDWARD JENNER £OXE, M.D., NEW ORLEANS. PRINTED FOR THE AUTHOR, AND FOR SALE BY ALL BOOKSELLERS THROUGHOUT THE UNITED STATES. "est restoratives in most diseases. In cases of dysen- tery of long standing, a few grains of hydrarg. cum creta, 182 DOMESTIC MEDICINE. six to ten, combined with an equal quantity of Dover's powder, repeated for several successive nights, bathing the abdomen with a stimulating liniment, and confinement to a farinaceous diet, as rice gruel, will often effect a cure. In cases of dysentery, attended by functional derangement of the liver, one of the following pills, repeated once or twice a day, for two or three days, with a diet of rice gruel, gum- water, and elm-bark infusion, in small quantities, as the sole drink, will frequently remove the disease. Pulv. opii, gr. vj.; pulv. ipecac, gr. viij.; mass, hydrargyri, 9j.; to be made into ten pills. As long as the symptoms continue severe, the patient must be confined to rice or barley water, flaxseed tea, gum Arabic water, or elm-bark infusion; but these having been removed, or much relieved, rice gruel, arrow-root, sago, or tapioca, may be allowed. Calves-foot jelly, or that made with isinglass, is easily digested, and given as mild nourish- ment in convalescence from this and other diseases of the bowels in preference to the farinaceous articles. Beef tea and chicken broth may be given when convalescence has been established. Warm clothing is always indispensable after recovery from dysentery, and exposure to raw, damp, or night air, should be avoided for some time. The oil of butter, first recommended by Dr. Dewees for dysentery in children, will be found equally beneficial when given to adults! In many cases, a full dose of opium at bedtime will prove of the greatest value. In chronic dysentery, strict attention to diet is all-important, in default of which a cure will almost invariably be impossible. The following pills will frequently prove successful: sugar of lead, twelve grains; ipecac, four grains; opium, four grains; to be made into eight pills, and one given two or three times a day. The following are often equally suc- cessful : sulphate of copper, four grains; opium, six grains; ipecac, four grains; made into fifteen pills. Dose, one, two or three times a day. Injections of sugar of lead, or sul- phate of zinc, six to ten grains of either, in four ounces of water, and twenty or thirty drops of laudanum, repeated three or four times a day, or in some cases after each evacu- ation, are strongly recommended. The sugar of lead to be EARACHE. 183 preferred for the acute stage, and the zinc when of a chronic character. Warm salt-water baths, are often useful in cases of dysentery, whether of children or adults, and as a sub- stitute, where not procurable or desired, a warm poultice, made of chamomile flowers or hops, will prove useful. EARACHE. This generally depends upon a greater or less degree of inflammation of some part of the organ of hearing. When of a mild character, there is pain in the ear, at times in the head, with occasionally dulness of hearing. When of a severe character, the pain is intense, sharp, deep-seated, and affects the whole head. The parts feel as if they would burst, delirium is often present, there is great, anxiety and distress manifested in the face, with excessive restlessness, the pulse is frequent, full, and hard, the tongue furred, and the appetite impaired or lost. It is important that it be understood that most of the discharges from the ear, as well as a great proportion of cases of deaf- ness, proceed from chronic inflammation of the membrane lining the internal ear. Treatment.—When the earache is mild, rubbing the back of the ear with spirits of turpentine, or spirits of hartshorn, alone, or mixed with an equal portion of sweet oil, bathing the ear at bedtime with tepid milk and water, or flaxseed tea, then pouring a few drops of warm sweet oil and laudanum into the ear, with a dose of salts or castor oil, will generally be found sufficient. When the pain and other symptoms are severe, and the head much affected, general bleeding, and the application of leeches behind the ear, to produce a copious local discharge of blood, which should be encouraged by warm fomentations, are necessary. The bowels should be freely acted upon by a dose of calo- mel (six to twelve grains), followed in two or three hours by salts and magnesia, or senna and salts. The violence of the inflammation having been subdued, a blister behind the ear to the back of the neck, will be of essential ser- vice. Should an abscess form and break, the ear must be frequently syringed with tepid milk and water, flaxseed tea, or other mild fluids, and a few drops of almond or 184 DOMESTIC MEDICINE. sweet oil afterwards dropped into it. In chronic discharges from the ear it is necessary to keep the parts clean, by frequent syringing with the above, or old white Castile soap and water, and dropping into the ear a few drops of any of the following washes: chlor. sodae one part, water two to four parts; nit. silver two to four grains, water ten ounces; pyroligneous acid, two teaspoonfuls, in half a pint of water. The application of a few leeches, followed by a blister behind the ear, every few days, is of advantage in chronic discharges from the ears. Foreign substances, as beads, cherry-stones, &c, often get into the ear, produce great pain, and are with difficulty removed. A pair of forceps, or a scoop, may be used to lay hold of or scoop out any hard substance. The following plan is recommended by the eminent Abernethy, who succeeded by it in removing a large bead, after other means had failed. Lay the ear affected on a soft cushion, placing another upon the other; strike frequently the upper cushion, and the foreign sub- stance will frequently be forced out. When insects creep into the ear, fill it with warm sweet oil; the insect will be forced to come to the surface, when it can be laid hold of with the fingers, or a pair of forceps. When wax collects in the ear, and becomes hardened, it frequently gives rise to uneasiness, and may produce in- flammation. The best mode of removing it, is to wash the ear frequently with soap-suds, its best solvent, allowing it to remain in ten or fifteen minutes, and then endeavor to extract the hardened wax with the finger, a pledget of linen rolled like a quill, or a small scoop. ECCHYMOSIS. By this term is understood an effusion of blood under the skin, or in the interstices of any part of the body. It is generally caused by a blow or puncture, rupturing a small bloodvessel. It is of frequent occurrence during or after the operation of bleeding, and a familiar example is a black eye. The blood in an ecchymosis generally coagu- lates, though occasionally it remains fluid, in which case inflammation may supervene, and terminate in suppuration. To prevent this, a small puncture may be made with a ERYSIPELAS, ROSE, ST. ANTHONY'S FIRE. 185 lancet into the sac containing the fluid, and gentle pressure applied to force it out, after which a pledget of lint or old linen, soaked in cold salt and water, or lead water, will be sufficient. The appropriate treatment is rest, cold applica- tions, as lead water, salt and water, vinegar and water, the sedative solution of Raspail, diluted chloride of soda, a piece of raw beef, or scraped potato, with, occasionally, moderate pressure. ERYSIPELAS, ROSE, ST. ANTHONY'S FIRE. This is a constitutional affection, characterized by a peculiar, spreading, circumscribed inflammation of the skin, accompanied or preceded by fever, or, as sometimes occurs, following the local inflammation. This disease is generally ushered in with languor, general uneasiness, soreness of the limbs, chills, or rigors, alternated with flushes of heat. Soreness of the throat is often early observed. Nausea and vomiting, or diarrhoea, frequently exist. The pulse is commonly full, frequent, and hard, and the tongue furred. The face and legs are the parts most frequently affected. When the head or face is attacked, one side of the nose, one cheek, or the tip of one ear, begins to feel hot, stiff, and tingling, swollen, hard, and is of a deep red color, rapidly extending, and denned by a distinct elevated margin. The lips swell, the . cheeks enlarge, and the eyes are closed by the cedematous lids. The inflamed surface is often covered with small blisters. The inflamma- tion occasionally extends to the subcutaneous tissue, and is followed by suppuration and sloughing. In the majority of cases, at the end of three or four days, the redness begins to fade, the swelling subsides, and desquamation ensues; while this is occurring in one part of the body, other parts may, in their turn, be attacked. In severe cases, delirium, with coma, often occurs, and after death an effusion into the brain is not unfrequently discovered. Death sometimes occurs in this disease, from an affection of the throat, the submucous tissue of the glottis becomes filled with serum, which, closing the chink of the larynx, impedes or prevents inspiration; and causes suffocation. Some individuals are 16* 186 DOMESTIC MEDICINE. subject to repeated attacks of erysipelas, for which no other cause than general derangement of the digestive organs can be assigned. Treatment.—As a general rule, the loss of blood is not required in erysipelas, and in large cities less frequently than in the country, but should there be headache and fever, with a full, strong pulse, and a moderate tendency to delirium, bleeding from the arm is necessary. The appli- cation of leeches in the neighborhood of the disease, is, by some, strongly commended. If nausea, and a disposition to vomit, be present, an emetic will be proper. Eight or ten grains of blue pill, with one of ipecacuanha, followed, in a few hours, by one or more doses of oil, senna tea, rhu- barb and magnesia, or salts and magnesia, to operate on the bowels, will generally be demanded in the commencement of ordinary attacks of this disease. A solution of four grains of tartar emetic in a pint of water, given in table- spoonful doses every hour, is of service. To this solution is sometimes added, with advantage, from forty to one hun- dred gains of saltpetre. In those cases attended with pros- tration of the system, evinced by a feeble and frequent pulse, tremors, and a dry, brown tongue, covered with sordes, the carbonate of ammonia, four to ten grains, every two or three hours, quinine, bark tea, wine, or brandy, and a more nourishing diet, as beef tea, should be had recourse to. A strip of blistering plaster, applied around the edges of the inflamed surface, is praised by some eminent physi- cians to arrest its further progress, and for the same pur- pose, a strong solution of lunar caustic, or the stick dipped in water, applied around the inflamed surface, has been equally lauded by others. The tincture of iodine applied around the border of the inflamed surface, extending about one inch over the sound skin, and repeated daily, if necessary, will often arrest the further progress of the disease. The ordinary external applications in cases of erysipelas, are wheat or rye-flour, or any other unirritating powder dusted over the part, raw cotton, a weak solution of chloride of lime, half a drachm to a pint of water, fomentations of flannel, wrung out of a decoction of poppy heads, lard, mercurial ointment, a weak FAINTING. 187 solution of corrosive sublimate, one or two grains to the ounce of water. Dr. Meigs speaks highly of the application of Kentish's ointment in the erysipelas of new-born infants. He softens the basilicon ointment with spirits of turpentine, and rubs it on the diseased part with the finger. Velpeau praises as a local application for this disease, a solution of sulphate of iron, one ounce to a pint of water, or an ointment of the same, two drachms to an ounce of lard. Cold water, if agreeable to the patient, and not pro- ductive of chilliness, is often useful. During the existence of this disease in its ordinary form, the diet should consist of mucilaginous and farinaceous articles, gradually changed to one of a more nutritious character, when the violence of the disease has passed by, and convalescence has become established. FAINTING. .This consists in a diminution or temporary suspension of the action of the heart and lungs, with loss of conscious- ness. Though often occurring suddenly, and without pre- monition, it is generally preceded by sickness or sinking at the stomach, dimness of vision, shrunk and pallid features, with a weak, rapid pulse. When fainting is complete, the features are pale and shrunken, the surface cool, and the pulse scarcely perceptible. A fainting fit may be of short duration, or continue several hours, in which last it is often difficult to determine whether life is or is not extinct. Treatment.—In all cases, commence by freeing the throat, breast, and abdomen of all pressure, allow a free circulation of air, lay the person on the back, the head rather lower than the body, and sprinkle cold water on the face. If swallowing can be performed, give cold water, or a few drops of essence of ginger, peppermint, cayenne pep- per, or other diffusible stimulants in cold water; apply to the nostrils the fumes of burning feathers, hartshorn, cam- phor, or cologne. Should the fainting continue, place the feet in a hot mustard-bath, and apply a mustard-poultice, Granville's lotion, or strong ammonia to the calves of the legs, the abdomen, or spine. In some cases of long con- tinuance, where swallowing cannot be performed, injections 188 DOMESTIC MEDICINE. of brandy, or any diffusible stimulant in water, as hot aa may be considered prudent, become necessary. FEVER. In its general acceptation, by fever is understood that state or condition of the system, in which the natural func- tions of one or more of the organs of the body are deranged. The most common and striking effects produced by fever are, a hot, dry skin, an increased frequency of pulse, with variation as to strength or fulness, with a disinclination for food as a general rule. FEVER, INTERMITTENT, AGUE AND FEVER. A regular paroxysm of this disease, composed of a cold, a hot, and a sweating stage, generally commences with pain in the head and loins, weariness, coldness of the extremi- ties, and along the spine, frequent yawning and gaping, or sighing. The tongue is furred, there is a bitter taste in the mouth, with at times nausea, or vomiting. This is fol- lowed by shivering or shaking of the whole body, the teeth chatter, the face, lips, and nails become blue, the features shrink, the respiration is hurried, and the pulse frequent and oppressed. After this, the skin becomes dry and hot, the face flushed, with more or less pain in the head, great thirst and throbbing of the temples; the pulse becomes full, strong, and frequent. After some time, a moisture breaks out upon the skin, followed by a profuse perspiration. The above symptoms gradually subside, and the paroxysm is over, the patient in a short time feeling as well as ever. Intermittent fever usually returns at stated periods, gene- rally with marked regularity, and is therefore called quoti- dian, tertian, or quartan, depending upon the time inter- vening between the attack. Treatment.—As a general rule, it is better to commence the treatment of this disease with an emetic of ipecacuanha, or tartar emetic, the last generally preferable, especially if there be nausea, a furred tongue, offensive breath, and a bad taste in the mouth. A few hours after the emetic has been given, give a dose of calomel, or blue mass, combined FEVER, INTERMITTENT, AGUE AND FEVER. 189 with rhubarb and ipecacuanha. If time will allow, it is best to administer the above dose at bedtime, and follow it up the following morning with salts and magnesia, or strong senna tea, in one large dose, or smaller ones repeated every one or two hours, until the bowels have been freely acted on. Occasionally, it becomes necessary to administer quinine with the purgatives, the severity of the case not allowing any delay. The condition of the stomach being improved, as shown by a clean tongue, absence of bad taste in the mouth, or nausea, quinine should be given in doses of two to six grains every one or two hours, until from twenty to forty grains have been taken, when it may be discontinued until the next day, and then resumed in simi- lar doses, at similar intervals. Attention being paid to preserve the secretions of the liver, stomach, and bowels in a healthy condition, by the daily administration of some mild medicine, the above plan will rarely fail to prevent a return of the paroxysm. A good substitute for quinine, where it cannot be procured, and a most excellent vehicle in which to give it, is the bark and snake-root tea, in the dose of a wineglassful every one or two hours. In obstinate cases, Fowler's solution of arsenic is a valu- able remedy, frequently succeeding after the failure of other articles, even quinine. Dose, ten to fifteen drops, two or three times a day. Piperine, the active principle of black pepper, is highly esteemed by some, and may be advanta- geously combined with quinine, opium, oil of black pepper, and occasionally small doses of blue mass. A strong decoction of the bark of the willow, drank freely, has been used successfully in intermittents. Common charcoal, two or three teaspoonfuls, several times a day, is advantageously combined with quinine, in cases attended with slight derangement of the stomach, and bowels. The prussiate of iron, in doses of five to ten grains, four or five times a day, has proved successful in this disease. Larger doses may be given, but are apt to produce unplea- sant sensations in the head. It may be given in pills, wjth ext. of liquorice, or made into a mixture with powdered gum Arabic, liquorice, and water. In obstinate cases, which 190 DOMESTIC MEDICINE. have resisted all the usual remedies, small doses of strychnia, one-twentieth of a grain, very gradually increased, have been found successful. When symptoms of a return of a paroxysm of intermit- tent fever show themselves, they may frequently be arrested by giving a large dose of laudanum, forty to sixty drops, covering the patient warmly in bed, and making him drink freely of hot lemonade, flaxseed, chamomile, or bone- set tea. During the existence of this disease, it is important to keep the stomach and bowels in a healthy condition, with moderate doses of rhubarb and magnesia, or a pill of blue mass, rhubarb, and ipecacuanha, which last is especially useful, where the functions of the liver are not performed in a healthy manner. Between the paroxysms of this disease, the stomach and bowels being in a healthy state, and no determination to the head, or other important organ, existing, a generous diet, with a moderate allowance of porter, ale, or wine, may be permitted. It is proper to continue the quinine, bark, and snake-root tea, or whatever other medicine has been given, for at least a week or ten days after the disappearance of the disease, so great is the tendency to its recurrence; for the same reason, every effort should be made to avoid those causes likely to produce it, as over fatigue, exhaustion of all kinds, exposure to sudden changes of the atmosphere, remaining in wet clothes, avoiding the night air, and above all not to go to work early in the morning without having partaken of a warm and wholesome meal. Persons liable to an attack of ague, and requiring pur- gatives, should select those of a warming and stomachic character, the preparations of rhubarb being preferable. Very singular cases sometimes occur, of this disease at- tacking one-half, or one particular part of the body, recur- ring with great regularity; the remedies should be the same as in ordinary cases. • FEVER, REMITTENT, OR BILIOUS. Preceding an attack of this disease, the patient usually FEVER, REMITTENT OR BILIOUS 191 feels heavy and languid, with headache, frequent yawning, and alternate fits of heat and cold. On its accession, there are pains in the head, back, and limbs, a flushed face, the eyes are injected and watery, the skin hot and dry, great thirst, and tenderness at the pit of the stomach, increased on pressure, are generally present, the tongue is furred, there is a bitter taste in the mouth, which is clammy, or dry. The eyes and skin are generally of a yellow tinge, the urine high-colored, and the bowels torpid. Nausea, and vomiting of bilious matter occur, the pulse, at times, hard and full, often frequent, small, and irregular. These symptoms continue for some time, when a remission takes place accompanied with moisture on the skin, a partial or total disappearance of fever, and the patient feels much relieved, but in a few hours the same symptoms recur, although the chills may not be so well marked. These remissions occur at irregular periods, and are variable in their duration. Treatment.—The fever being high, the pulse hard and full, with considerable pain in the head, general bleeding is of importance, and often requires to be followed by cup- ping or leeching the forehead, temples, or back of the neck. If general bleeding is not considered admissible, cupping or leeching maybe resorted to with the happiest effects, and the general strength not be affected by the local loss of blood. The tongue being furred, with nausea or vomiting, an emetic should then be given of tartar emetic alone, or of ipecac, with a grain of tartar emetic At the expiration of a few hours, a dose of calomel or blue-pill, eight to ten grains, with half a grain of ipecac should be given, followed in four to six hours by a moderate dose of salts and mag- nesia, or senna tea, every two hours, until the bowels shall have been freely opened. Frequently a copious injection of salt and water will answer equally well, and in some cases better. As long as the discharges continue dark and offen- sive, it will be proper to give an occasional purgative in small doses. Cutting the hair close, and applying to the head cloths wrung out of cold water, or bladders filled with pounded ice will be found of service where much pain or uneasiness 192 DOMESTIC MEDICINE. exists in the head. At the same time, the feet may be placed frequently during the day in a hot mustard bath, mustard poultices applied to the calves of the legs, and, when the skin is hot and dry, sponging the whole body with cold water, will be found grateful and beneficial. Where there is great heat and dryness of the skin, one grain of tartar emetic, and one tablespoonful of Epsom salts, dissolved in four tablespoonfuls of water, and given in .the dose of a teaspoonful every hour, will be found serviceable. Or the following may be used: tartar emetic, one grain; saltpetre, forty to sixty grains, dissolved in six^ tablespoon- fuls of water. Dose, one teaspoonful every hour. An oc- casional Seidlitz or soda powder may also be given advan- tageously. In the latter stages of this disease, blisters applied to the calves of the legs, or inside of the forearms, or both, are of benefit; and when in the low stages of this and other fevers, the tongue becomes dry, of a brown or black color, and, as well as the teeth and gums, covered with a dark sordes, we may give, with benefit, three or four grains of the ioduret of potash, in one or two table- spoonfuls of water, or camphor-water, every three or four hours. The diet, during the first stage of this disease, should consist of diluents, as barley or rice-water, toast- water, flaxseed tea, and weak lemonade; but when the vio- lence of the symptoms has passed by, and debility, with nervous symptoms ensue, sago, arrow-root, chicken, or beef broth become proper, and should be given in small quan- tities, repeated frequently. As soon as the fever has sub- sided, quinine alone, or in an infusion of bark, should be given every one or two hours. The room should be kept cool and well-aired, and the body _ and bed linen daily changed. Convalescence being fairly established, a gradual return to animal food should be allowed, and when to be procured, the soft part of oysters is both nourishing and easily digested. Exercise in the open air should be cau- tiously engaged in for fear of a relapse, which is frequently more severe than the primary attack. FEVER, SCARLET, SCARLATINA. A highly contagious febrile disease, attended by a rash FEVER, SCARLET, SCARLATINA. 193 and sore throat, rarely occurring twice in the same person. Scarlet fever is generally divided into three varieties, scarlatina simplex, where there is a rash or eruption, with little or no affection of the throat; scarlatina anginosa, where the throat and skin are both affected; scarlatina maligna, where the throat is principally and violently affected, attended often with great irregularity, or a sudden disappearance of the eruption. In proportion to the violence of the disease in the throat, is the danger of fatal consequences to be appre- hended. Symptoms.—The first thing complained of in the majority of cases, is a soreness of the throat, stiffness of the neck, with weariness, chilliness or shivering, languor, headache, bloodshot eyes, at times nausea and vomiting, succeeded by fever, and occasionally delirium. The pulse is frequent and excited, and the skin dry and hot. The back part of the mouth is red, or at times of a dark claret color, fre- quently covered with whitish specks, gray aphthous crusts, or a sloughy kind of ulceration, caused by the falling off of the crusts. In scarlatina simplex, and anginosa, the tongue is at times covered from the commencement, with a thick, white, cream-like fur, with projecting red papillae, the edges being of a bright red color; the red points gradually increase, the fur or coating cleans away, and the whole surface of the tongue becomes red, and raw, like a piece of beef; fre- quently, when the disease is of an unpromising appearance, •it will become dry, brown, and hard. In scarlatina maligna, the rash is apt to come out late and imperfectly, fading or receding, frequently not appearing at all; instead of a bright red color, it presents a bluish, or livid tint, the pulse is feeble, the skin cold, the tongue dry, brown, and tremulous, debility extreme, the throat ulcerated, at times gangrenous, the respiration impeded by the tough viscid mucus which collects about the fauces, and a typhoid depression of the whole system, occasionally ending fatally with rapidity. . The difference between scarlet fever and measles, is, 1st. The presence in measles, at the onset, of catarrhal 194 DOMESTIC MEDICINE. symptoms; the sneezing, cough, and running of the eyes and nose, preceding the rash, while rather later in scarla- tina, and subsequent to the eruption, there is occasionally only running from the eyes. 2d. By the absence in measles, of severe inflammation of the throat, which is almost always present in scarlatina, and invariably so in severe cases. 3d. By the character of the eruption, that of measles being more elevated above the surface than in scarlatina, and of a darker color, that of measles being similar to the color of a raspberry, while that of scarlatina is strictly of a scarlet color. 4th. In measles, the eruption is collected in semilunar clusters, with interstices of healthy skin, while in scarla- tina, it commences in minute points, quickly becoming so numerous and crowded together, that the surface appears universally red, which is deeper about the groins and flexures of the joints. Lastly, the rash of measles, in its most regular form, ap- pears on the fourth day, and that of scarlatina on the second or third. Treatment.—In mild cases, with little or no affection of the throat, keeping the bowels gently open by some mild medicine, confinement to bed, or the chamber, a strict fari- naceous diet, and mucilaginous drinks, slightly acidulated, bathing the feet in hot water at bedtime, and avoiding ex- posure to draughts of cold air, will generally succeed in effecting a cure. Should the tongue be furred, and the head painful, three or four grains of calomel or blue mass, with half to one grain of ipecac, may be given at bedtime, followed the next morning by a dose of castor oil, senna tea, rhubarb and magnesia, or salts and magnesia. Upon exa- mining the throat, always to be carefully done, if soreness, red- ness, and difficulty of swallowing exist, a few leeches should be applied to the angle of the jaws, or, if that be not consi- dered necessary, the throat must be frequently bathed with a stimulating liniment, as soap liniment, spirits of camphor and hartshorn, spirits of turpentine, or the volatile liniment, to either of which, a portion of laudanum may be added, the throat being afterwards covered with a strip of flannel. FEVER, YELLOW. 195 FEVER, YELLOW This disease is ushered in by languor, loss of strength, chilliness or rigors, flushed face, intense pain in the head and back, soreness, and great weakness of the lower extremi- ties, followed by a violent fever; the eyes are dull, heavy, injected, and intolerant of light, the tongue furred and moist, becomes dry, black, and at times deep red; the pulse varies considerably, sometimes quick, full, and strong, at others, quick, weak, and irregular. The skin is hot and dry, the thirst excessive, and the stomach irritable, at times to such a degree, that the smallest quantity of the blandest fluid will be thrown up, and constant retching is often present. This is a prominent feature of the disease, frequently aug- menting its danger, and the difficulty of treatment. The vomiting, which often occurs early in the disease, is obsti- nate, at times of bilious matter, at others of a glairy fluid, which adheres in small flakes to the sides of the vessel. As the disease advances, the symptoms become still more serious, the skin, at times more or less yellow, assumes a livid or leaden hue, an oozing of blood occurs fromtbe nos- trils, mouth, and bowels; delirium occurs, the urine be- comes high-colored, small in quantity, or totally Suppressed; the discharges from the bowels- have a tarry appearance, vomiting occurs still more frequently, the matter ejected presenting often the appearance of coffee-grounds, or a dark grumous mass, and this constitutes black vomit. These last symptoms occurring together, the case may be regarded as almost hopeless, and death not far distant. Treatment.—The violent headache in the commencement, which I believe is of a purely nervous character, suggests the propriety of free bleeding; experience, however, has proved, that except in those cases where there is an evident and powerful determination of blood to the brain, or other important organ, with a hard, full, or oppressed pulse, when it may prove serviceable, it should not be resorted to. The local abstraction of blood by cupping or leeching the tem- ples, back of the neck, or region of the stomach, though not often absolutely demanded, is more generally to be de- pended upon, and while relieving the local engorgement, 196 DOMESTIC MEDICINE. will not so materially affect the strength of the system, and various organs, which the disease itself is found to depress almost beyond the power of recuperation. Hot mustard foot-baths, frequently repeated, should be resorted to as soon after the attack as possible, and these should be followed by large emollient poultices to the calves of the legs and soles of the feet, to endeaver to "produce perspi- ration, and equalize the nervous and circulatory systems. Soon after this, a few grains of blue mass, six to ten, are given in pills, although some prefer an equal quantity of calomel. Oleaginous, or salt and water injections to pro- duce free discharges from the bowels, is an admirable remedy, and, while some rely principally upon them, others are partial to a full dose of castor oil, taken a few hours after the pills, to produce the same effect, and frequently with it conjoin the use of injections. By some, the saline cathartics, as salts and magnesia, or one or more Seidlitz powders, are preferred to the oil, at the same time giving freely iced flaxseed tea, gum-water, or elm-bark infusion, sweetened, and made more agreeable and palatable by the addition- of lemon-juice, or slices of fresh lemon.^ Irritabi- lity of the stomach will often be relieved by applying a large mustard poultice to the abdomen, and when removed, sup- ply its place by a spice plaster. The pain in the head is generally relieved by soaking the feet in hot mustard water, applying afterwards mustard or garlic poultices to the soles of the feet, and also to the back of the neck, extending down the spine, eight or ten inches. Sponging the head with ice-water, applying bladders of pounded ice to it, giving a warm bath, or sponging the body with tepid vinegar, or cologne and water, will often prove comfortable to the patient. To assuage the thirst, which is excessive and dis- tressing, small pieces of ice held in the mouth, and allowed to dissolve and trickle down the throat, will be found of service, and may be used with freedom. Should the patient desire an occasional drink, small quantities at a time, of iced gum- water, or flaxseed tea, may be allowed, and, during the vio- lence of the disease, should alone be taken. It is a matter of absolute necessity to prevent or overcome that irritability of the stomach, so constant and dangerous HEADACHE. 197 a symptom of this disease, and for this purpose, too much care cannot be observed in regard to the quantity of the simplest fluid taken at any one time, and how much more im- portant to abstain from over medication. Should the powers of life begin to fail, more nourishing food, as beef tea, or essence of beef, cordials, stimulants, and tonics, with qui- nine, become necessary. To allay vomiting, blisters to the stomach and calves of the legs, with teaspoonful doses of powdered charcoal, will sometimes prove successful. Where hemorrhage, or oozing of blood occurs, with depression of the vital powers, small quantities of tannin, in brandy, fre- quently repeated, by the mouth, as also by injection, will sometimes produce good results. Creasote, in small quanti- ties, has been successfully given to check obstinate vomiting, and also to remove hiccough. HEADACHE. This common complaint, frequently sudden in its ap- proach, is produced by various causes, the most usual being indigestible food, an excess in quantity, or sedentary occu- pations, with want of exercise. Treatment.—For mild cases, the following remedies will generally prove successful:—Bathing the head or temples and forehead with cold water, cologne water, spirits of camphor, or the eau sedative of Raspail. One teaspoonful of supercarbonate of soda or calcined magnesia, in a little water, will generally afford relief, more especially if acidity be present. A mild cathartic, as rhubarb, magnesia, senna and salts, or one or more Seidlitz powders will frequently suc- ceed. A small quantity of aromatic spirit of ammonia, or spi- rit of hartshorn often affords immediate relief. If bilious de- rangement exists, five to eight grains of blue mass, followed by a dose of rhubarb and magnesia, or magnesia and milk of sulphur, will prove serviceable. In severe cases, if nausea or a disposition to vomit exists, an emetic should be given, and one of ipecac, or mustard and salt, is to be preferred, and should be followed by a mild laxative. A cup of strong tea, or coffee, are household remedies of no trifling value in some severe cases. When symptomatic of other diseases, bleeding from the general system, or locally, by cups or 198 DOMESTIC MEDICINE. leeches, will be required. A mustard poultice between the shoulder-blades, and a mustard foot-bath will always be of service. In obstinate and long-continued cases, or in those accus- tomed to repeated attacks, ^he following will frequently succeed. The nitro-muriatic acid foot-bath at bedtime for weeks. Due attention bevng paid to the digestive organs, Fowler's solution in doses of ten drops, three or four times a day, has often.cured after other remedies had failed. A quarter of a grain of sulphate, or acetate of morphia, in a little sugar and water, will sometimes immediately relieve the most intense headache. A combination of bitters, purgatives, and narcotics, will cure chronic cases. In all cases, it is highly important to attend to keeping the bowels regular, and for this purpose, chewing a small piece of rhubarb root, every night or morning, will fre- quently cure a headache of long standing. In nervous headache, from ten to thirty drops of tincture of nux vomica, three times a day, will often effect a cure. HEARTBURN. This is most frequently attendant upon, or symptomatic of indigestion or dyspepsia, and other diseases of the stomach, though it may and does proceed from improper food, or an over indulgence in that which is otherwise healthy. There is a burning sensation in the stomach, throat, and mouth, and frequently a discharge of fluid from the stomach, so acrid and sour as to set the teeth on an edge, and make the throat and mouth burn and feel sore. Treatment.—One or two teaspoonfuls of calcined mag- nesia, or a teaspoonful of supercarbonate of soda, in a tumbler half full of cold water, or two or three tablespoon- fuls of lime water, in an equal quantity of milk or water, or a few drops, five to ten,*of liquor potassae, in a wineglass- ful of water, may be given with a certainty of producing temporary though immediate relief, by neutralizing the acid. A few drops of elixir of vitriol, or of sulphuric acid, in a wineglassful of water, will often succeed. In persons subject to heartburn, eating eight or ten blanched almonds HEMORRHAGE. 199 after each meal, will often prevent its occurrence. In cases depending upon dyspepsia, or debility of the stomach and general system, great attention to diet, the use of mild tonics, as bark and snake-root tea, extract of gentian, or chamomile, quassia, or chamomile tea, keeping the bowels regular by a daily injection of cold water, regular exercise, and friction with a coarse towel or flesh brush, after spon- ging the body every morning with cold salt and water, are necessary to remove the cause upon which this may depend. HEMORRHAGE. By hemorrhage is understood the loss of blood from the system, whether resulting from an injury, or caused by morbid action in any part, eventuating in the rupture of a bloodvessel, or the oozing of blood through one of the tissues of the body. When the blood is of a bright scarlet color, escaping by jets, it is from an artery, and when it flows in an even, unbroken stream, of a dark red or purple color, it is from a vein. Pressure, properly applied, is the surest mode of arresting hemorrhage, and unless the artery from which the blood flows be so large as to require being tied, will generally succeed. The simplest mode of making pressure is to place a compress of linen, or muslin, six or eight thicknesses, of the proper size, upon the part, and apply a roller or bandage over it sufficiently tight. The tourniquet is an instrument made for that purpose, and is especially useful in cases of profuse hemorrhage from the arteries of the extremities, as it completely arrests the circulation in 'the part, and thus enables the surgeon to procure the requisite instruments for tying the artery. When the regular tourniquet is not at hand, a very ex- cellent temporary one is made as follows : Pass a handker- chief around the limb, tie the two ends together in a hard knot, place a thick compress over the mam artery, and with a penknife, key, or piece of stick, passed under _the knot, continue turning the ends of the handkerdhief around, until the bleeding has been arrested, when the stick must be firmly secured in its position. 200 DOMESTIC MEDICINE. HEMORRHAGE FROM LEECH-BITES. Although of rare occurrence, great difficulty is at times experienced in arresting the discharge of blood after the falling off of leeches, and as in very young children, or those of infirm and debilitated habits, such an event may and has proved fatal, the following local applications are to be used:— A fine powder of gum Arabic, starch, charcoal, sugar of lead, alum, catechu, kino, or nitrate of silver. A few drops of muriated tincture of iron. A portion of felt from a hat, with gentle and permanent pressure, or applied as follows, as recommended by Dr. Houston. Apply the felt over the bites, and then spread over it a piece of thin muslin, drawing this tightly, in order that the blood exuding must pass through both. With a sponge remove the blood, as it oozes through the muslin, and, in a short time, the muslin and felt will become dry by the coagulation of the blood, and the bleed- ing will be permanently arrested. The muslin may in a few hours be cut off around the adhering part, which, in a few days, will drop off, and the wound or bite be*perfectly healed. The glazed surface of a visiting card, cut round, and firmly applied for a few minutes, has succeeded after the failure of other means. A piece of cotton, saturated with a hot solution of alum, firmly applied to the bites, may be employed. A stick of lunar caustic, cut into a fine point, and intro- duced into the bites, is very effectual. Collodion is an excellent application. HEMORRHAGE FROM THE LUNGS. This hemorrhage, though at times appearing very sud- denly, without premonition, is most frequently preceded by one or more of the following symptoms : A tickling, uneasy sensation in the trachea, larynx, or windpipe, causing a slight hacking cough, followed by more or less blood; a sensation of fulness, weight, tightness, heat, and oppression in the breast. The pulse is most frequently hard and full, HEMORRHAGE FROM THE LUNGS. 201 with headache, flushed cheeks, and general febrile symp- toms. Frequent returns of slight hemorrhage from the lungs arc often the precursory signs of consumption, and, in all cases, its first appearance should be attended to, and such a course of proceeding, as regards diet, exercise, and remedial measures, adopted, and rigidly persevered in, as may be calculated to prevent its recurrence, and remove any local or constitutional effects. To use the language of Dr. Howard, " It is the duty of the physician to act in every case of hemorrhage from the lungs, as if danger was to be apprehended." It is acknowledged, that occasional bleedings from the lungs may occur in robust individuals, without leaving any injurious impression, and many cases have been known of periodical hemorrhages from the lungs and other parts of the body, continued through a long life without manifest injury to the constitution. These, how- ever, should be regarded as exceptions. It is certain that, as a general rule, they should be looked upon as the symp- tom of a dangerous disease, showing clearly such a morbid condition of the lungs and general system, that but little is required to set in action those hidden causes of a regular, though sldVly progressive decrease of strength, change of complexion, inability to endure accustomed exercise, fol- lowed by tubercles, confirmed consumption, and death, unless early opposed by proper remedial measures. Treatment.—It is important in hemorrhage from the lungs of a severe character, first, to elevate the head and shoulders, loosen the clothes, and allow the free entrance of fresh air, the body being sufficiently protected. Let the patient keep quiet, avoid speaking, and, as much as possi- ble, restrain the disposition to cough. He should swallow one or two teaspoonfuls of common salt dissolved in a little water, or, taking the salt in his mouth, allow it gradually to dissolve, and slowly trickle down the throat. This popular remedy in hemorrhage from the lungs, deservedly highly esteemed, should be frequently given, and will rarely fail to check the bleeding, for a time at least. Place the feet in a hot mustard footbath, and allow no other nourishment than water, gum-water, rice-water, or flaxseed tea, as cold as possible. Small pieces of ice may be frequently held in 202 DOMESTIC MEDICINE. the mouth. In those cases where the pulse is full and strong, particularly in robust individuals, bleeding from the arm, or locally by cups, is necessary, and where the loss of blood is not considered necessary or advisable, or has been carried as far as the symptoms will admit, the free applica- tion of dry cups to the breast, by their powerfully-revulsive effect, will be of service. A combination of sugar of lead, three to five grains; powdered opium, half to one grain; and ipecac, one grain, repeated every one or two hours, will prove serviceable in this disease. Large doses of salt- petre, one to two drachms, dissolved in water, three or four times a day, is strongly recommended. As a cooling laxa- tive, the saline draught, combined with saltpetre and digi- talis, is much used, the violence of the symptoms having been subdued. In those predisposed to bleeding from the lungs, it is advisable, upon the first appearance of symptoms indicating an attack, to lose blood, either generally or locally, to keep the bowels open by saline laxatives, or injections, and to take small doses of saltpetre, or the powder of sugar of lead, opium, and ipecac, above noticed. Mustard poultices, or blisters to the lower extremities, are useful auxiliaries. Powdered ergot, in ten-grain doses, every two or three hours, will sometimes succeed after the failure of other remedies, and may be continued for one or two days, or until the bleeding shall have ceased. The oil of turpentine will often act promptly and efficiently in cases unattended by great excitement, or febrile symptoms, which should be previously removed. From ten to twenty drops, or, in cases of feebleness and paleness of the sur- face larger doses may be given, and repeated every hour or two. Mere frequency of pulse does not contraindicate the use of turpentine. • In passive hemorrhages from the lungs, the different astringents, the mineral acids, oil of turpentine, the pre- parations of Peruvian bark, and iron, with an unirritating but nutritious diet, will be found of great service, and, in many cases, the only means of cure. In hemorrhage from the lungs the diet must be varied according to the character and stage of the disease, and con- dition of the system. When active and in the early stage, HEMORRHAGE FROM THE NOSE. 203 the mildest mucilaginous and farinaceous drinks should alone be allowed. When convalescence has commenced, or the system is much debilitated, food of a more nutritious character, with at times a cold infusion of a mild tonic, will be required. To prevent a return of the hemorrhage, the greatest attention must be paid to clothing, diet, and exer- cise in the fresh air in the proper weather, and at proper hours, on foot, horseback, or in a carriage, while an entire avoidance of stimulating or heating food or drink, and sudden or violent exercise must be guarded against. A long sea voyage will occasionally be productive of perma- nent benefit, as well from the salt atmosphere as from the perfect state of repose which may be enjoyed without a deprivation of pure fresh air. HEMORRHAGE FROM THE NOSE. This often occurs as an effort of nature, to i*lieve or pre- vent the injurious consequences apt to follow a determina- tion of blood to the head, or as a substitute for some natural periodical discharge which has been suppressed. In febrile diseases, with a determination to the brain, it occasionally occurs, and unless excessive in quantity, producing great debility, should not be arrested. When of an active character, it is generally preceded by local heat, fulness in the head, itching in the nostrils, ten- sion and pain in the forehead, giddiness, headache, buzzing in the ears, cold hands and feet, though occasionally it occurs without these premonitions. The hemorrhage may issue by drops, or in a full stream, from one or both nostrils. When unattended by constitutional symptoms which it may relieve, as fulness or pain in the head, or when not vica- rious to some more dangerous disease, efforts may properly be made to arrest it. Treatment.—Frequently little is required to be done; cases, however, do occur where the loss of blood is very great, much difficulty is experienced in arresting it, and death may result from it. , Bathing the face and head in cold water, snuffing it up the nostriTs, the sudden contact of any cold body, as a key, a piece of ice, or cold water, to the back of the neck, lower 204 DOMESTIC MEDICINE. down the spine, or to the genitals, dashing cold water over the abdomen, keeping the head elevated, and the breast and neck exposed to the cold air, will prove sufficient in mild cases. When the loss of blood is more profuse, and the above fail, the feet should be put into a hot mustard bath, mustard poultices applied to the calves of the legs, soles of the feet, or between the shoulder-blades. Give a dose of salts and magnesia, and injections of salt and water, to operate quickly on the bowels. In some cases, with a hard, full pulse, and much pain in the head, it is necessary to bleed from the arm, or by cups to the back of the neck. The quantity necessary to be drawn must depend upon the con- dition of the individual; a decided impression should, how- ever, be made. Astringent remedies are at times demanded internally, and one of the following powders may be given every hour or two, or more frequently if required. Sugar of lead, twenty grains; powdered opium, two grains; pow- dered ipecac, five grains, made into six powders. In some cases, before a cure can be accomplished, it will be necessary to administer mercury with or without opium, in frequently-repeated doses, in order to affect the system. At times the application of a blister to the back of the neck will produce an immediate good effect. The mechanical remedy of plugging the nostril from which the bleeding proceeds, has often to be resorted to, and when the loss of blood is excessive, should not be de- layed too long. A dossil of lint or cotton, rolled loosely in the shape of a quill, saturated with a solution of alum, salt- petre, or sugar of lead, then covered with powdered gum Arabic, bark, charcoal, or other fine powder, should be gently introduced up the nostril. Abernethy adopted the following plan for the same pur- pose. He used a probe with lint moistened and covered with a fine powder, which was passed gently along the floor of the nose for its entire length, and then carefully with- drawing the probe, allowing the lint to remain in three or four days. A quill will answer as well as the probe. HEMORRHAGE FROM THE STOMACH. 205 HEMORRHAGE FROM THE STOMACH, . VOMITING OF BLOOD. An attack of this disease is often preceded by loss of appetite, and a feeling of depression or fulness of the stomach, attended by pain on pressure, general uneasiness or chilliness, and subsequent heat of surface. These are followed by dizziness, paleness of the face, faintness, nausea, depression of the pulse, and vomiting of blood, generally mixed with particles of undigested food. The system is sometimes greatly depressed by the sickness and loss of blood, evinced by the cold and bloodless condition of the skin, and smallness of the pulse, at times scarcely percep- tible. When the hemorrhage is copious, it may be red and fluid, though in general it is thrown up more or less coagu- lated, in irregular lumps, mixed with the contents of the stomach, and of a blackish color. The mouth and fauces should be carefully examined, to ascertain whether the bleeding does not proceed from those parts, and being swal- lowed, is subsequently vomited up. Treatment.—In hemorrhage from the stomach, or vomit- ing of blood, placing the patient in bed, keeping him com- posed in mind and body, allowing a free circulation of air, swallowing small quantities of ice-water, or pieces of ice, and at the same time a few teaspoonfuls of a strong solu- tion of common salt, or a teaspoonful of dry salt put into the mouth occasionally, and allowed slowly to dissolve, and pass into the stomach, will, in mild cases, generally prove suc- cessful. If the pulse be full and hard, bleeding from the arm becomes necessary, and if much tenderness or pain exist in the region of the stomach, cups or leeches should be applied to the abdomen, followed by a mustard poultice or blister. Give a mustard foot-bath, and apply poultices of mustard to the calves of the legs, or soles of the feet. Small portions of sugar of lead conjoined with opium and ipecac, two to five grains of lead, one-half to one of opium and ipecac, repeated every fifteen or twenty minutes, or hour, according to the violence of the symptoms, are always useful. Alum, kino, catechu, three to five grains of either, or a few drops, five to ten, of elixir of vitriol, or the muri- 206 DOMESTIC MEDICINE. ated tincture of iron, frequently prove of service in severe cases. From ten to thirty grains of saltpetre, dissolved in a small quantity of water, may be given every half hour, or hour, for four or five times. In many cases, particularly if much nausea, or frequent efforts to vomit exist, an emetic of ipecac, may be advantageously given. A few drops of oil of turpentine and laudanum, suspended in mucilage, is an excellent remedy, as is also one or two drops of creasote, given in the same manner. In many cases, with evident signs of biliary derangement, one or more small doses of calomel, or blue mass, will prove advantageous, and may be followed by a Seidlitz powder, or one or two teaspoonfuls of Epsom salts, unless the stomach is very irritable, when in- jections will be more proper. These will most generally be required after the cessation of the hemorrhage. Cold mu- cilaginous or farinaceous drinks should alone be allowed during the severity of the disease, unless great debility attends, when more nutritious articles may be cautiously given in small quantities at a time, and even wine-whey, milk-punch, or jellies, may be required. In convalescence from this disease, great attention should be paid to the diet, both as regards quality and quantity, as well as to the im- portance of keeping the bowels regularly open by some mild saline aperient, if necessary. Attention to proper clothing, erring on the safe side of being rather too warm than to suffer chilliness, and an avoidance of exposure in raw, damp weather, should be rigorously observed. HEMORRHAGE FROM THE URINARY ORGANS. This hemorrhage, manifested by a discharge of blood from the urethra, pure, or mixed with urine and mucus, generally depends upon inflammation of some portion of the mucous membrane lining the urinary organs, though it may proceed from the kidneys, ureters, bladder, or urethra. The discharge of blood is often preceded by uneasy sensa- tions of irritation, or inflammation of the part affected, at times without pain, at others great and frequent efforts to urinate, with a bearing down, and great heat and pain at the neck of the bladder and along the urethra. A feeling of distension and weight above the pubis, and other symptoms HEMORRHOIDS, PILES. 207 of retention of urine, may proceed from a coagulum of blood in the bladder. Treatment.—When the symptoms are severe, bleeding from the arm, cups to the loins or abdomen, or leeches to the perineum, or over the region of the bladder, with abso- lute rest, cold mucilaginous drinks and emollient poultices, or stupes of flannel wrung out of hot water, are to be resorted to. If the bleeding is profuse, ice, or ice-water, to the pubis, and injections of cold water with laudanum are proper, and will generally afford relief. In some cases, small and repeated doses of sugar of lead and opium, or Dover's pow- der, and injections of laudanum, will be required to relieve the distress and pain. A saline laxative, or injection, is often of service, espe- cially if the bowels are constipated. In chronic cases, a few drops of oil of turpentine, or balsam copaiva, with lau- danum in mucilage, often prove of great service. An in- fusion of buchu, or uva ursi, is often advantageously used as a common drink. Injections into the bladder several times a day of mild astringent infusions, have been strongly recommended. HEMORRHOIDS, PILES. By hemorrhoids is meant one or more tumors, inside or outside of the rectum, with or without hemorrhage; or there may be hemorrhage without a tumor. The disease consists in a morbid enlargement of the hemorrhoidal veins. The most frequent causes of this painful complaint are free living, a sedentary mode of life, the frequent use of aloetic purgatives, and, above all, habitual constipation. Hemorrhoidal tumors are generally supposed to arise from a varicose state of the hemorrhoidal veins, first formed within the intestine, and afterwards protruded by various causes, most frequently straining at stool. Bleeding piles are those attended with a discharge of blood, and blind piles, those where hemorrhage does not occur. Treatment.—Regulating the bowels, so as to remove the constipation usually existing, is of primary importance in the treatment of piles. For this purpose, the mildest laxatives should be selected, as castor-oil, cream of tartar 208 DOMESTIC MEDICINE. and sulphur, magnesia and sulphur, and especially the con- fection of senna, with or without magnesia and sulphur, which may be regarded as one of the best. A diet of rye- mush and molasses formed the principal part of the treat- ment of piles by the late Dr. Physick; and there can be no doubt of its value. The frequent use, at times daily, of an injection of half a pint of cold water often proves of service. Sir B. Brodie thought highly of the confection of black pepper as a remedy in piles, given internally, and applied externally to the parts. The free use of cold salt- and-water, as a wash, after every evacuation, should never be neglected. Thirty or forty grains of balsam copaiva, or spirits of turpentine, three or four times a day, will some- times effect a cure. Twenty or thirty grains of powdered cubebs given three times a day is often successful. Among the numerous local applications, the following are the best. Placing some rosin on live coals in a shovel, and sitting over the fumes. Tar-water, or tarred rope soaked in water. Five to ten grains of nitrate of silver, finely powdered, and intimately mixed with one ounce of lard. An ointment made by mixing two or three drachms of powdered galls, ten or fifteen grains of powdered opium, and one ounce of stramonium ointment, is very good. For old cases of piles, Lisfranc orders a mild diet, gentle exercise, shower-baths, and cold-water injections. He also passes over the surface the nitrate of silver, to excite, and not to cauterize.. In those cases where profuse bleeding occurs, the mineral and vegetable astringents should be used locally, taking care not to have them too strong. The iodide of iron, and creasote, are of great value, as also powdered alum. A plug of old linen is often successfully introduced up the rectum. Should the hemorrhage, as is sometimes the case, be excessive, injections of cold water, or lead-water, must be used; and at times small doses of sugar of lead, and opium, become necessary. HICCOUGH. A convulsive inspiration caused by a spasmodic affection HYDROPHOBIA. 209 of the diaphragm, which most generally depends upon ner- vous or other irritation of the stomach. Occasionally, it proves distressing from its long continuance, and, when occurring at the latter stages of severe diseases, may be regarded as a dangerous, and frequently a fatal, symptom. Treatment.—A glass of cold water, holding the breath while swallowing it, will often remove it, as will also taking a full inspiration, retaining the lungs distended as long as possible. In severe cases, the application of dry cups, a mustard poultice, flannel steeped in spirits of turpentine or strong aqua ammonia, to the region of the stomach and the middle of the spine, will generally succeed. Bathing the feet in a hot mustard-bath is an efficient remedy. Lauda- num, paregoric, tincture of assafoetida, and sulphuric ether, alone, or combined, are used internally with success. In some protracted cases, it will be found necessary to apply a blister to the abdomen, after having made use of dry cups to that part. A copious injection, to operate upon the bowels, followed by one of an anodyne or antispasmodic character, is at times successful. The oil of amber is at times used advantageously. HYDROPHOBIA. This disease, produced by the bite of a rabid animal, generally of the canine species, evidently exerting its prin- cipal force upon the nervous system, may be said, after the development of the characteristic symptoms, to bid defiance to the best-directed efforts of physicians. It is sufficiently proved that, of those bitten by rabid animals, scarcely one- half will become affected with hydrophobia, in consequence of the saliva of the animal having been wiped off the teeth in passing through the clothes, before coming in contact with the skin, which must be abraded or torn before the poisonous influence can be communicated. It is stated by Mr. Hunter that, of twenty persons bitten by the same rabid dog, but one suffered from the disease. A wound inflicted by a rabid animal gradually heals, as if from other causes; and after an interval of from six weeks to twelve months, or, according to some apparently well-authenticated cases, even longer, there is experienced 18* 210 DOMESTIC MEDICINE. a pain or uneasy sensation, with inflammation in the situa- tion of the bite or scar, which tingles, aches, or feels cold, stiff, or numb, or becomes livid or swollen, at times opening anew, and discharging a little colored serum. The pain extends from the sore or scar towards the central parte of the body, generally thought to follow the course of the nerves, though cases have been noticed where the absorb- ents and glands were red and inflamed at the forming stage of the true symptoms. The symptoms of hydrophobia are an excessive nervous irritability, anxiety and depression, fear, constant sighing and great melancholy, a spasmodic constriction of the muscles of the fauces, throat, and chest, excited by different external influences, especially by the sight of liquids, or the sound ■produced by pouring them from one vessel to another, or by attempting to swallow them, which is frequently attended by great difficulty, and is often absolutely impossible. A paroxysm will often be produced by a sudden agitation of the air. At the expiration of a few days, the patient becomes hurried in manner, and irritable in disposition; the eyes are haggard, glassy, fixed, and suffused with blood; there is great restlessness, starting up in a fright, almost immediately after lying down, &c.; he complains of pain and stiffness about the throat, is unable to swallow liquids, every effort to do so bringing on a paroxysm of choking and sobbing, which will continue to be repeated more se- verely each time for several days, when death comes to his relief. The pulse is at first not much affected, though soon becoming hard and strong, then weak and frequent, accom- panied by a rapid prostration of strength. It is supposed that the morbific virus is not immediately absorbed, but remains in a dormant condition in the origi- nal wound, until morbid phenomena develope themselves in the part, to be quickly followed by the general symptoms. Too much stress cannot be laid on the necessity of a thorough excision of the wound, and other local treatment, as soon3 after the bite as possible, or whenever any symptom, local, or general, may manifest itself, and this, irrespective of the time elapsed since the wound or first cause. ' It may not be useless to remark, that, in no case, should HYDROPHOBIA. 211 the dog be killed, but rather should he be carefully secured; for, if he should die, the bitten person is no better off; and should the disease not occur nor the dog die, what an in- conceivable amount of anxiety and terror will be spared to the individual and family. No good can result from killing the dog (except what can be obtained by his strict confine- ment), and yet that unnecessary act, as far as the bitten person is concerned, is the first thing done. The rabid dog is said, by Mr. Youatt, never to have fits or dread of water, which last he will seek with avidity, and lap for some time, while there exists an inability to swallow, from a paralysis of the muscles of the jaw and throat. ' The earliest symptoms of madness in a dog, says Mr. Youatt, whose experience in this disease has been most ex- tensive, are, sullenness, fidgetiness, constant change of pos- ture ; a steadfast gaze, expressive of suspicion; a constant licking of some part of his body, on which, most frequently, will be found a scar, where previously bitten; occasional vomiting; a depraved appetite, soon noticed by picking up and swallowing pieces, of thread, hair, straw, and often lap- ping his urine and devouring his excrement. He flies fiercely at strangers, becomes impatient of correction, is quarrelsome with his companions, when chained will make evident efforts to escape, and, if at large, will attack those only who come in his way. The expression of countenance is early remarkably changed; the eyes glisten; about the second day a consi- derable discharge of saliva comes on, which continues for ten or twelve hours, and is followed by insatiable thirst. As soon as this flow of saliva has ceased, he appears to be trou- bled with a viscid matter in the fauces, working hard with his paws to get rid of it. A loss of power in the voluntary muscles next occurs; the lower jaw hangs down, though frequently the paralysis is not complete. The animal staggers, falling frequently, whereas previously he had been in constant motion. His howl is short and peculiar, and his bark hoarse and unnatu- ral. The respiration is laborious; the inspiration is at- tended with a singular grating, choking noise. Death gene- rally occurs on the fourth or fifth day. 212 DOMESTIC MEDICINE. Treatment.—A great number of articles of the materia medica have been resorted to for the cure of hydrophobia; but many, if not all heretofore used, are useless, as time and failures have conclusively proved. The injection into the veins of different active substances has been proposed and tried by Magendie and others, without any positive cures, though the excessive nervous irritability has been calmed by injections into the veins of a solution of morphia. Were it not for the discovery of chloroform, that powerful controller of nervous action, and which judiciously though heroically used, it is reasonable to believe may prove cura- tive, this injection into the veins would deserve further ' trials. Although, when alluding to the curability of hydropho- bia, we touch upon debatable ground, there can be no ques- tion of the real efficacy of a preventive plan, which it is necessary to enforce rigidly, as soon after the wound as possible. By adopting such a course, and the free use of chloroform, it is more than probable a large number of cures will be reported. The first and most important remedy with which to com- mence the treatment, in case the preventive excision has been neglected, is a complete excision of the wound; for, although many persons, bitten by dogs proved to have been mad, do. escape an attack, it is never allowable to act upon that presumption. Even in cases where a reasonable doubt may exist, it is important to resort immediately to such an apparently severe remedy, it being preferable to enjoy the absolute immunity afforded by the operation early per- formed, rather than suffer the torture of the imagination dwelling upon the possible and inconceivable horrors of the disease. Should the bite have been inflicted in a joint, where no positive certainty can exist that all of the poison has been removed by excision, washed out, or the parts thoroughly touched with caustic, amputation alone can be depended upon; and, if no doubt should exist of the rabid- ness of the animal, this should be resorted to. After having thoroughly excised the wound or wounds, cupping-glasses should be continuously applied for one or more hours, it having been proved, by experiments, that HYDROPHOBIA. 213 the absorption of the most deadly poisons not only cannot proceed, as long as the application of glasses or suction is made, but, that, if continued sufficiently long, the poison will be entirely removed. The experiments of Dr. Barry, and others show— 1st. That the application of cupping-glasses to a poison- ous wound will prevent the absorption of the poison, and consequent injurious effects. 2d. That the application of a cupping-glass to a poisoned wound, even after a portion of the poison has been absorbed, and begun to manifest its effects upon the system, will arrest its further progress, and prevent their recurrence, as long as the cup or cups are permitted to remain on the part; and, 3d. That after a cupping-glass has been applied for some time, the parts may be thoroughly washed with soap and water, and all unpleasant consequences avoided. The bitten part having been completely removed by ex- cision, and the cupping-glasses having been applied for a considerable time, it is necessary to touch every part of the wound with a strong solution of lunar caustic, or pure nitric acid, and then to introduce into the wound a soft ointment of Spanish flies, basilicon, and turpentine, and over all apply a warm bread and milk, or flaxseed-meal poultice, every hour, to produce and keep up free discharges. The propriety of adopting this prescribed course derives additional value from the fact that, in two individuals bit- ten by the same dog, no inconveniences resulted in the case where the wound remained open, or would not heal for months; while, in the other, where the wound healed in a short time, the usual symptoms manifested themselves at a future period, eventuating in death. In cutting out the wound, generally made by one or more teeth, the following directions were given by the celebrated Abernethy—" Cut out effectually the cell into which the tooth has gone, by introducing a wooden skewer, cut in the shape of a tooth, into the cavity formed by it, and then remove the whole by an ellipticaMncision, cutting all around and beyond the skewer of wood." # The pain resulting from an effectual application of the 214 DOMESTIC MEDICINE. remedies above noticed, is very great, to allay which, it is necessary to administer large and frequently-repeated doses of laudanum, or a solution of morphia, by the mouth as well as by injection, the quantity and frequency of repetition necessarily depending upon the effects produced. The use of laudanum in large doses throughout the whole course of the disease, is alone calculated to alleviate the sufferings of the patient, and by many is considered, in a curative point of view, the only remedy worthy of confidence. An occasional powerful operation on the bowels is strong- ly recommended by some practitioners; while others insist upon the importance of maintaining a constant free dis- ' charge from the bowels, for which purpose a large dose of calomel, followed by one or more drops of croton oil, in sweet or castor oil, or mucilage, and an active cathartic injection of senna and salts, will generally be most likely to succeed. The continued use of nauseants, as repeated doses of a solution of tartar emetic by the mouth, and tobacco injec- tions, with the view of their relaxing effects upon the sys- tem, has appeared in some cases to have proved useful. The use of mercurial preparations to produce profuse salivation, has received the sanction of many medical men, and a few cases are recorded of cures following such a course. The frequent employment of a hot water or vapor bath, continued for a considerable time, is asserted to have proved serviceable in hydrophobia, both as a palliative and a cura- tive agent. In the commencement, as well as in the more advanced stage of hydrophobia, the repeated application of cups to the breast and spine, followed by blisters and counter-irri- tants, are powerful remedial agents, well calculated to counteract the cause upon which the spasmodic constriction of the muscles of the fauces, throat, and chest depend. Mr. Youatt strongly recommends large and repeated doses of belladonna, as a palliative and curative, to be used in conjunction with the above means. There having been observed, in some cases of hydropho- bia, a decided intermission of the paroxysm, during which INFLAMMATION OF THE BLADDER. 215 the patient was free from any unpleasant symptoms, it seems a just inference that the administration of one or more large doses of quinine in quick succession might prove permanently beneficial. In conclusion, it may be remarked, that, from the re- corded cases of hydrophobia, the excision of the wound, the application of cupping-glasses to the wound, as well as to the spine and breast, followed by the most active and per- manent counter-irritants, active purgation by drastic cathar- tics, copious injections, nauseants by the mouth and rectum, large doses of laudanum, and, in the latter stages, stimulants and cordials, are, when the disease has fairly commenced, the principal means upon which reliance can be placed to conduct the case to a successful termination. INFLAMMATION OF THE BLADDER. This is indicated by a burning pain in the region of the bladder, pain in the end of the urethra, a frequent desire to make water, the quantity passed being small, with severe spasms, more or less shivering at the commencement, with subsequent hot skin, a hard pulse, the bowels constipated, and great restlessness. As the disease advances, the pain shoots from the bladder to the anus, loins, and down the thighs, there is tenderness of the whole abdomen, with vomiting, hiccough, delirium, and frequently death. The urine is at first high-colored, then mingled with flakes of albumen or blood, and towards the last acquires a very offensive odor. Treatment.—Bleeding, both general and local, is of importance. A warm bath, an emollient injection, and warm poultices or fomentations to the region of the bladder, being simultaneously resorted to. A full dose of calomel, with one or two grains of opium, must now be given, and followed, in a few hours, by one of oil or salts, with one or more emollient injections, to act freely on the bowels. Iced mucilaginous drinks are alone to be allowed as drink or nourishment, and should complete retention of urine exist, some caution must be observed in the quantity allowed. The use of diaphoretics to determine to the surface, often proves useful; Dover's powder, acetate of ammonia, with 216 DOMESTIC MEDICINE. saltpetre, spirits of nitre, and a minute quantity of tartar emetic, being the most certain. During their use, the drinks will act more beneficially if taken warm. A blister, properly timed, after the violence and pain of the disease have been relieved, will frequently be found necessary. For fear of strangury, the blister should be left on only a few hours, or until the skin becomes red, when a warm poultice should be applied, which will succeed in com- pleting the drawing of the blister. Anodyne injections may be used every few hours, or more frequently, if the pain or spasm is severe and persistent. It is frequently necessary to draw off the urine with a catheter, in passing which, great care must be observed, excessive and excru- ciating pain being caused by it. It has been proposed in certain stages of this disease, to inject into the bladder mucilaginous fluids, and but for the difficulty of accom- plishing it, in consequence of the pain, there can be no question of its advantageous results. INFLAMMATION OF THE BRAIN. The more severe and characteristic symptoms of this dangerous, though rare disease, are generally preceded by the following sensations or symptoms, which may be re- garded as premonitory. They are, general uneasiness.and restlessness, a sensation of fulness and weight, or conges- tion in the head, frequent headache, flushing of the face, an increased heat in the head, intolerance of light, unusual noises in the ears, an impaired memory, and derangement of the digestive organs. These are followed by an intense burning pain in the head, red, shining, and rolling eyes, pupils contracted, throbbing of the temporal arteries, res- piration quick, sighing, and irregular, the tongue red and dry, the pulse frequent, hard, and full, sometimes oppressed. In acute inflammatory affections of the ear, the brain is at times secondarily affected, and Sir A. Cooper gives cases of inflammation of the brain resulting from a sudden suppres- sion of long-continued discharges from the ear. In rheu- matism, and rheumatic inflammation of the heart, the func- tions of the brain are, at times, so deranged, as to give rise to the belief of the existence of acute inflammation. INFLAMMATION OF THE EYE. 217 Treatment.—Bleeding is of the utmost importance, and the quantity of blood taken should be sufficiently large to produce a decided impression upon the symptoms, and this should be repeated, as soon as they increase in violence. The hair should be shaved off, to allow the continued use of pounded ice in a,bladder, or cloths wrung out of ice- water. The frequent application of leeches to the temples, or cupping the back of the neck and temples, are important remedies. The head should be kept elevated, and the room cool, the feet placed in a hot mustard-bath, followed by mustard-poultices to the soles of the feet, or calves of the legs. A dose of calomel, fifteen to twenty grains, must be given, followed, in two or three hours, by a dose of senna and salts, or salts and magnesia, and repeated every hour or two, until copious discharges from the bowels take place. Frequent large injections of senna tea and salts, or salts alone, in water, are here of importance, to accelerate the operation of the medicine, and produce evacuations as quickly as possible. In the early stage of this disease blisters will prove injurious, but after the violence of the symptoms has been subdued, they may be used advanta- geously. In general, the blister should be applied to the back of the neck, extending several inches down the back, although it is at times applied to the whole head. Great judgment is required to properly time its application, upon which its proving beneficial or injurious will entirely depend. Throughout the course of this disease, ice-water, gum-water, or flaxseed tea, should alone be allowed for drink or nou- rishment. INFLAMMATION OF THE EYE, OPHTHALMIA. This consists of pain, heat, and redness of the eye or lids, intolerance of light, a flow of tears, at times so acrid as to irritate or excoriate the parts over which it runs, and, when severe, to produce swelling of the lids. ^ Treatment.—When caused by the introduction of foreign bodies, the eye must be bathed, to wash them out, and should that not succeed, they may be removed with the point of a paint-brush, or a piece of linen rolled and moist- ened At times the particles adhere so strongly, that it 218 DOMESTIC MEDICINE. becomes necessary to remove them with the end of a lancet or sharp probe. Bleeding is often required, though the local abstraction of blood by leeches, or cups, will be found preferable. The bowels should be freely acted on, by a dose of calomel, followed by repeated doses of salts and magnesia; after which, I have found the following mixture extremely serviceable : Tartar emetic, five grains; saltpetre, one drachm; Epsom salts, and powdered gum Arabic, of each four drachms; orange-flower-water, four ounces. Dose, one tablespoonful every hour, until nausea or vomiting is produced, when it may be given in smaller quantities. Many lotions are made use of in ophthalmia; those generally found to answer best, are the following: Five grains of sulphate of zinc, two drachms of wine of opium, and five ounces of a cold infusion .of the pith of sassafras in rose-water, or fifteen grains of the acetate of zinc, mixed in the same manner. The proper mode of using these collyria, is, after having well bathed the eye in flaxseed tea, or infusion of pith of sassafras, to envelope a piece of the soft part of stale bread, in a piece of fine linen; soak this in the flaxseed tea, and pour two or three teaspoonfuls of the eye-water upon it. Lay this pledget or poultice, upon the eye, and retain it there, by passing a small handkerchief, or band, around the head. Instead of removing this poultice to renew the eye-water, let a small quantity be poured upon it from the top, every half-hour, or hour. By means of this simple proceeding, I have suc- ceeded in perfectly curing severe cases of ophthalmia, with- out being obliged to resort to such active depleting measures as are generally required. The following washes are much used: Rose-water, a cold infusion of the pith of sassafras or elm-bark, flaxseed tea, weak lead-water, a teaspoonful of laudanum or brandy, in a gill of water. When the pain and heat are great, warm or tepid applications frequently prove more agreeable and soothing than cold ones. Should the disease prove obsti- nate, or become chronic, small blisters must be applied frequently to the back of the neck, or behind the ears, and kept discharging by basilicon, or savin ointment, or a mix- lure of Spanish flies and basilicon. In chronic ophthalmia, INFLAMMATION OF THE LARYNX. 219 one grain of corrosive sublimate, dissolved.in ten tablespoon- fuls'of water, forms a useful application. In the treatment of this complaint, the diet is all-important, and should con- sist of farinaceous preparations, and vegetables, with a free use of mild diluent drinks. It is important to confine the patient to a moderately dark room, or, if that be not possi- ble, to have the eye covered with a shade. INFLAMMATION OF THE KIDNEYS. This disease is characterized by a high fever, a frequent, hard pulse, a furred tongue, great heat and dryness of skin, a frequent desire to urinate, the urine being deep red, or limpid and colorless. There are mostly present nausea or vomiting, numbness of the leg, and often acute pain in the region of the kidney, with retraction and pain of the testicle in%he male. Suppression of urine occasionally occurs, adding to the danger. # . Treatment.—Bleeding, both general and local, is ot pri- mary importance; it should be early and freely employed, and repeated according to the violence of the symptoms, and not upon the amount of blood drawn. The warm bath, and fomentations or poultices to the back, are of great value. Mild laxatives, as oil or magnesia, with, at times, if costive- ness be obstinate, a dose of calomel, followed by emollient injections, are to be used for the purpose of acting on the bowels Frequently, from the constant nausea, injections only can be used. If the pain cease suddenly, and hiccough, clammy perspiration, a weak, intermitting pulse, great pros- tration of strength, suppression of urine, or discharges ot dark, flaky, offensive urine occur, the case may be regarded as almost hopeless. . During the acute stage of this disease, diluent drinks should alone be taken. INFLAMMATION OF THE LARYNX. This is an inflammation of the mucous membrane cover- ing the laryngeal cartilages, at times confined to that alone, thougu generally extending upwards and downwards Al- though cases of a mild character frequently occur, and yield readily to treatment, it being impossible to foresee to what 220 DOMESTIC MEDICINE. extent it may proceed, this disease should always be re- garded as one of a dangerous character, requiring at the onset prompt and vigorous treatment. At times its pro- gress is so rapid that the delay of a few hours may render ineffectual all the efforts of medicine. Symptoms.—These are more or less inflammation at the back part of the mouth; a feeling of soreness, a degree of restlessness and anxiety disproportionate to the apparent in- flammation, hoarseness of voice, difficulty of respiration and swallowing, inspiration being protracted and wheezing, as if the air was passing through a dry, narrow reed; the patient points to the pomum Adami, or protuberance in the centre of the throat, as the seat of the pain and distress, mani- festly increased by the least pressure. The cheeks are red, the skin more or less hot and dry, the pulse full and hard, or corded and oppressed. The cough, when present, is stridulous, harsh, and husky. As the disease advances, all the symptoms increase in severity, the countenance is pale, livid, and ghastly, the eyes protrude, the voice becomes wheezing, whispering, or entirely lost, the cough often convulsive and very painful, respiration difficult and painful, with great restlessness. If relief is not speedily afforded, the patient becomes drowsy and delirious, arterialization of the blood is not perfected, and suffocation closes the scene. By this disease the immortal, the great and good Washington perished. Treatment.—In mild cases, a dose of Epsom salts and magnesia, repeated small doses of tartar emetic, confinement to the chamber, and a stimulating liniment or mustard poultice to the throat, will often succeed; but, as a general rule, bleeding, general and local, will be required, and may be considered of primary importance. The bleeding from the arm must in severe cases be continued until a decided impression be made upon the symptoms, and this should shortly be followed by leeches or cups to the front or sides of the throat, back of the neck, or upper part of the breast. A brisk purgative of fifteen or twenty grains of calomel, followed by oil, or salts, will prove highly serviceable, and in some cases, small doses of calomel, with or without a minute portion of ipecacuanha and opium, to produce its INFLAMMATION OF THE LARYNX. 221 effect upon the general system, have been strongly recom- mended. Upon the first appearance of an accession of the symp- toms, the general and local bleedings should be unhesitat- ingly repeated. Immediately after the bleeding, or indeed at the same time, the use of a mild gargle, or the inhalation of air passing through warm water, will frequently produce the best effects. Tartar emetic, given in large doses, as eight or ten grains dissolved in eight tablespoonfuls of water, and one tablespoonful given every hour or two, will fre- quently act favorably. Hot mustard foot-baths, cataplasms of mustard or tobacco to the throat or back of the neck, will occasionally prove serviceable. Always in mild, and frequently in chronic cases, the hydropathic application of a handkerchief soaked in cold water, eau sedative, or spirits of camphor and hartshorn, to be kept on all night, will prove very beneficial. If the powers of the system begin to sink, the skin be- coming cold, the face pale, or of a leaden hue, the lips blue, and the pulse small and wavering, the time for deple- tion has passed, and no benefit can be expected from it. In that case, the system must be supported by a more nutri- tious diet, and our only hope and resource in this stage is the operation of tracheotomy, which may enable respiration and its attendant effects to be carried on, and thus gain time for the operation of other remedies. Although this operation has not been generally successful, most probably from having been too long deferred, there are on record a sufficient number of cases to provelts importance. In chronic inflammation of the larynx, the most decided benefit, in many cases the only remedies to be depended upon, are an issue or seton in the breast or throat, a repe- tition of blisters, the tartar emetic ointment or solution, or croton oil, to the throat, the local application of a strong solution of nitrate of silver to the inner part of the larynx, or merely to the back part of the fauces, and above all, the proper and long-continued use of many medicines by in- halation. Among those found principally beneficial by in- halation in this disease, may be named tar, naphtha, creasote, 222 DOMESTIC MEDICINE. turpentine, the various narcotic extracte in solution, iodide of iron, iodine, and hydriodate of potash. In acute cases of this disease, the diet should be restricted to the mildest farinaceous and mucilaginous articles, while in those of a chronic character, with the strength depressed, a more nutritious diet should be allowed, and will often be absolutely necessary. In severe cases, whether acute or chronic, it is important to use the voice as little as possible. INFLAMMATION OF THE LIVER. A disease mosl. frequently met with in hot climates. It commences with constant tenderness, or dull pain, in the right side, increased by pressure, or taking a full inspira- tion ; there is more or less fever, with a hot and dry skin, the pulse is frequent, strong, and full, the tongue gene- rally furred, the urine high-colored, and small in quantity, the bowels irregular or costive, vomiting of a bilious or dark-colored matter frequently occurs, and there is a dry cough, with difficulty of breathing, or lying on the left side. There is often present a constant pain under the right shoulder-blade. In cases of long standing, the liver fre- quently becomes so much enlarged, as to be distinctly felt below the ribs. Treatment.—Much fever and pain being present, bleed- ing largely from the arm is necessary, and should be fol- lowed by cupping or leeching, which often require to be repeated, and the application of warm bread and milk, or flaxseed-meal poultices, sufficiently large to cover the right side. A dose of calomel, fifteen to twenty grains, with one of ipecacuanha, should now be given, and in three or four hours, one or more doses of salts and magnesia, or senna tea, to operate freely on the bowels. After this, two or three grains of calomel or blue mass, and one of ipecacu- anha, made into a pill, should be given two or three times a day, until the gums become tender; should these pills operate on the bowels, one quarter of a grain of opium may be added to each one. The more prominent and violent symptoms having been subdued by these means, a large blister over the right side is of great value, and when re- INFLAMMATION OF THE LIVER. 223 moved, the blistered surface should be dressed two or three times a day with a stimulating ointment, as basilicon or savin. When the blistered surface has almost healed, un- less all the symptoms have disappeared, the blister should be repeated. In the latter stages, the inflammation and pain having passed by, as well as in chronic cases, the iodide of potash dissolved in water, or still better, in the tonic ex- tract of sarsaparilla, and may be used as follows : Iod. potass. 5ii to 3iv; syr. ipecac. 3vj, in eight ounces of extract of sarsaparilla. Dose, two or three teaspoonfuls, three or four times a day. The extract of taraxacum has long enjoyed a high reputation in affections of the liver, more especially of a chronic character. It may be given freely, mixed with the extract of sarsaparilla. R.—Ext. Taraxaci giss;ext. sarsaparilla § x. Dose, two teaspoonfuls three or four times a day. The iodide of potash may be usefully added to this mixture. In chronic cases, the nitro-muriatic acid, both internally and externally, is of value ; with it, cases of long standing have been cured, after other means had failed. In functional derangement, as well as in chronic inflammation of this organ, the muriate of ammonia is highly praised by the German physicians, and is said to produce the same good effects as are known to follow the use of mercury. It may be given dissolved in water, with powdered gum Arabic or extract of liquorice, or mixed with the extract of sarsa- parilla, in the dose of five to ten grains, two or three times a day. . ... . During the existence of the disease, it is important to have the* bowels daily opened by some mild aperient, and the diet should consist of diluent, mucilaginous, or farina- ceous articles; when convalescence has been established,- sao-o, arrow-root, rice, or mush, may be given, followed by chicken soup, or beef tea, and a gradual return to ordinary food The strength being sufficiently re-established, and nothing to prevent being present, regular exercise in the fresh ah-, sponging the body with cold salt and water, fol- lowed by friction with a flesh brush, or horse-hair glove, or strap, will essentially contribute to a perfect restoration to 1GIn chronic diseases of the liver, the benefit resulting from 224 DOMESTIC MEDICINE. the free use of taraxacum, has been acknowledged by many, and by Emberton in particular, who employed it largely in chronic derangements of the stomach and liver. INFLAMMATION OF THE LUNGS. This frequently commences with the ordinary symptoms of catarrh, which may continue several days before positive signs of inflammation appear. The prominent symptoms are, a sensation of chilliness, followed by heat of skin, more or less cough, and pain, or soreness in the side, or back of the chest, increased by coughing, taking a full inspiration, or pressing on the part, a sense of oppression, and a diffi- culty or quickness of breathing. The cough is at first dry, soon attended with expectoration of a viscid character, generally mixed with blood assuming a rusty color, which is probably the most characteristic sign of inflammation of the lungs. The pulse is quick and hard, or corded and oppressed at times. When fully developed, the fever is usually severe. When the sputa become less tenacious, and lighter colored, more resembling those of ordinary catarrh, the inflammation is known to be on the decline. Treatment.—Bleeding is decidedly the most efficient re- medy in the treatment of a well-marked case of inflamma- tion of the lungs. In no disease is the loss of blood better borne than in this; and the earlier it is had recourse to, the more decided and manifest will be the effects. As a general rule, the blood should be allowed to flow until a decided impression has been produced on the symptoms. Local bleeding, by cupping or leeching, soon after the general bleeding, will frequently be demanded, and, should the symptoms reappear at the expiration of a few hours, the bleeding must be repeated. After leeching or cupping, the front part of the chest should be covered with a warm flaxseed meal, or other poultice, or several thicknesses of flannel, wrung out of hot water. Tartar emetic is a power- ful aid to bleeding, in this disease. The best mode of giving it is to dissolve five to ten grains in three table- spoonfuls of water, and thirty or forty drops of laudanum. Doso, one teaspoonful, every hour, gradually increasing the quantity until the symptoms have become manifestly im- INFLAMMATION OF THE LUNGS. 225 proved, when the amount of tartar emetic, which had been previously well borne, without producing nausea or vomit- ing, will now produce its usual effects, and be no longer tolerated by the system. In the more advanced stage of the disease, small doses of calomel, every hour or two, to slightly affect the gums, will often produce decided benefit. After the removal of the more violent symptoms, by the above remedies, there still continuing difficulty of respira- tion, dull pain, or tightness of the breast, with a trouble- some hacking cough, the application of a large blister over the front part of the chest, will frequently produce the most surprising effects. Applied too early, in this, as well as in other inflammatory diseases, or when the skin is hot and dry, the pulse quick, hard, or oppressed, positive injury will result. When the cough is troublesome and constant, the use of nauseating expectorants will prove beneficial, and for this purpose hive syrup, alone, or combined with mucilage, and syrup of ipecac, may be given every hour or two. Although, in this disease, purging is not generally much resorted to, still will it be found important to unload the bowels, in the first stage, by a dose of calomel and ipecac, followed by senna tea, or salts and magnesia, espe- cially if the tongue be coated. The only nutriment proper, in the early stage of this disease, is flaxseed tea, gum-water, or other drink of a mucilaginous character. The feelings of the patient may, to a certain extent, be consulted as to the temperature of the drinks, still, as a general rule, they are more beneficial if drank warm. The symptoms having been removed, and convalescence established, farinaceous jellies, as. sago, tapioca, arrow-root, or rice, may be allowed for a few days, when, should nothing interfere, small quantities of beef, mutton, or chicken broth may be ventured upon. In recovering from this disease it should be remembered, that too much caution cannot be observed in respect to diet, clothing, and exercise in the open air, as apparently slight deviations have been followed by relapses of the most serious character, often more dan- gerous than the first attack. 226 DOMESTIC MEDICINE. INFLAMMATION OF THE PERITONEUM. This consists in an inflammation of the membrane cover- ing the large viscera, the bowels, and the inner surface of the walls of the abdomen. The symptoms are, excessive pain, swelling, and tender- ness on pressure of the abdomen, mostly preceded by shiver- ing, and a feeling of general indisposition and weariness. These are followed by a high fever, a frequent, hard, and small pulse, and a sensation of heat and pain in the abdo- men, which last soon becomes the most prominent symp- tom, being of a very acute cutting character. At times this pain is constant, and fixed in one spot, while at others it is paroxysmal and shifting, appearing to depend upon flatus. The least motion increases it, and the patient lies on his back, with the knees slightly elevated. The respira- tion is small, frequent, and interrupted. Hiccough, nausea, and vomiting are frequently present, the bowels generally obstinately costive, the tongue coated with a white fur, the urine scanty and high-colored, and the thirst excessive. This disease is, in general, rapid in its progress. Treatment. — The most important remedy is bleeding froilr the arm, and locally by leeches, carried quickly to the point of producing a decided impression upon the system, the quantity to be drawn to be determined by the condi- tion of the patient's constitution. A repetition of the bleeding and leeching has often to be resorted to in a few hours, in order to keep up the impression, and prevent a renewal of the symptoms in all their force. Light warm fomentations should be applied to the abdomen, or, if pos- sible, a warm bath given. After the bleeding, a dose of calomel and opium is to be given, and repeated in a few hours, after which the mildest aperients and injections should be given to act on the bowels, provided it be consi- dered necessary to effect that, and the pain be not too severe to contraindicate it from the difficulty of the slightest movement. Calomel and opium, in small doses, to affect the system, are now to be given. Flannel, dipped in warm turpentine, is a good local ap- INFLAMMATION OF THE PLEURA. 227 plication. Oil of turpentine, internally given, is a remedy of much value in the latter stages of this disease. The mildest mucilaginous drinks, iced, are alone to be allowed, during the violence of the disease. In some cases, small pieces of ice can alone be tolerated by the stomach. INFLAMMATION OF THE PLEURA, PLEURISY, PLEURITIS. This is an inflammation of the membrane lining the inner part of the thorax, and is one of the most frequent of in- flammatory diseases. It commences with chilliness and shivering. The characteristic symptoms are, a sharp, pricking pain, or stitch, in the side, increased by coughing, sneezing, pressure, or drawing a full breath. This pain is commonly confined to one spot about the mammary region. The respiration is more or less embarrassed or difficult, the inspirations being short, hurried, and imperfect, to avoid increasing the pain. The cough is at first short and dry, or with a slight mucous expectoration, which, when pre- sent, is like that of an ordinary catarrh, and if consisting of frothy mucus, the bronchi are affected, while, when of a rust color, a complication with inflammation of the lungs is evinced. The face is flushed, and the pulse generally hard, frequent, and full, though at times small and oppressed. The tongue is generally furred, the appetite impaired, and the secretion of urine scanty. Treatment.—In this disease, bleeding is justly consi- dered of absolute necessity, and there are few diseases which bear the loss better, or more strongly call for it, pro- portioning the quantity drawn, and frequency of repetition, to the severity of the symptoms. It is important that a decided impression be made upon the system and disease, as manifested by the pulse becoming softer, and less fre- quent, the pain, or stitch, in the side relieved, or removed, a full breath being taken with little pain, or until faint- ing supervene. In the course of a few hours, should a re- newal of the above symptoms occur, bleeding must again be had recourse to. It may be well to repeat what has been said previously, that in violent inflammatory diseases, one large bleeding in the beginning, to completely over- 228 DOMESTIC MEDICINE. come the disease, is far better than drawing smaller quan- tities at a time, and repeating it more frequently, as in the end, the aggregate amount is much greater, and the system more debilitated, by pursuing the latter course. The seve- rity of the symptoms having been removed, if pain or un- easiness continues, cupping, or leeching, becomes necessary, and will materially assist the cure. The blood drawn in this disease presents a buffed or cupped appearance. After general and local bleeding, benefit will result from the ap- plication of a warm bread and milk, or flaxseed-meal poul- tice, or one made by steeping hops, or chamomile flowers, in boiling water and vinegar, and enclosing them in flannel. Much difference of opinion exists as to the propriety of purging in this and other inflammatory diseases of the re- spiratory organs, and unless great care be taken to protect the patient when getting out of bed, or a bed-pan be used, no doubt, inconvenience may result, but there can be no question of the propriety of thoroughly unloading the primae viae, by administering ten or fifteen grains of blue mass, and one or two of ipecacuanha, after the bleeding, followed, in four or five hours, by one large, or repeated smaller doses of senna tea, salts and magnesia, or oil, until the bowels are freely moved. During the violence of this disease, or until convalescence has been established, nauseating doses of tartar emetic, dissolved in water, or the hive syrup, may be given every hour or two, with advantage. Two or three grains of calomel, or blue mass, ipecacuanha half a grain, and opium one-eighth of a grain, every two or three hours, until the gums become tender, often prove serviceable, after the removal of the more violent symptoms by the above means. After the subsidence of the more active symp- toms, the system having been sufficiently reduced, should there remain soreness, or pain in the side, it will be proper to apply cups, scarified, or not, as may appear advisable, and afterwards a large blister, immediately over the painful part, will rarely fail to act beneficially. If effusion has taken place, shown by great and increased difficulty of breathing, or in lying down, the gums must be kept sore by administering two, three, or four times a day, one of the following pills. Calomel, or blue mass, twenty grains; INFLAMMATION OF THE STOMACH. 229 powdered squill, ten grains; powdered digitalis, five grains; to be made into fifteen pills. During the existence of this disease, the patient should only be allowed mild mucilaginous and farinaceous drinks, and when convalescence has begun, rice, or oatmeal gruel, sago, or arrow-root, may be given in moderation. All symptoms of the disease having disappeared, the food may be more nutritious, and plain unstimulating meat-broths, or the soft part of a few oysters, may be safely given. In chronic pleurisy, the necessity for general bleeding does not always exist, and the local application of leeches, or cups, will prove sufficient in a majority of cases. The repeated application of blisters, croton oil, or tartar emetic ointment, or plaster, will prove of great benefit, at the same time giving, several times a day, small doses of calomel, digitalis, and squills, as above, in order to mercurialize the system and promote the absorption of the fluid which is often effused. INFLAMMATION OF THE STOMACH. This disease, not of very frequent occurrence in its most acute form, is, however, of a chronic character, constantly met with. It is accompanied by the following symptoms, varying.in intensity according to the violence of the attack. A sensation of distress in the stomach, with more or less pain, increased by the least pressure, or the weight of the bed-clothes, excessive thirst, with desire for cold drinks, nausea, and vomiting; sunk countenance and extreme pros- tration. Respiration is quick and difficult, cough sometimes frequent, constipation severe; the pulse is small, frequent, contracted, and corded; hiccough supervenes, adding greatly to the suffering. The tongue at times presents a natural appearance; at others is coated or red. In some cases of severe disease of the stomach, the more prominent symp- toms are those of cerebral affections. Treatment.—If the patient be robust, with the pulse hard and corded, there will be no doubt of the benefit from general bleeding; but under opposite circumstances, blood must be sparingly abstracted. Local bleeding by leeches is more to be depended upon, with less risk of excessive pros- 230 DOMESTIC MEDICINE. tration. They should be freely applied, and the bleeding encouraged by warm fomentations, which should be light. Cool, saline enemata are to be used to open the bowels; for if the stomach could retain purgatives, the propriety of their use is generally doubted. At the latter stage of the disease, after having arrested the violence of the symptoms, a large blister to the abdomen will prove beneficial. Large doses of opium by the mouth, or injection, have been advised, as well as mercury carried to salivation, if easily induced. The producing salivation by friction with mercurial ointment is the preferable mode of using it, for the purpose of avoiding increased irritability of the stomach. Small pieces of ice, and iced mucilaginous drinks, should be the only articles permitted to be taken during the height of the disease. INFLAMMATION OF THE THROAT, INFLAMMA- TORY SORE THROAT, QUINSY. In quinsy, properly speaking, the tonsils are principally affected; but as those glands cannot be much inflamed with- out implicating the neighboring parts, we shall, under this head, treat of the more common inflammation of the fauces, or sore throat. Symptoms.—The first evidence of quinsy, or sore throat, is pain in swallowing solids or liquids, the tonsils are swollen, and, as well as the adjoining parts, red or inflamed. There is a sensation of heat and dryness, with soreness and difficulty of swallowing. The voice is generally hoarse. In a short time there is a secretion of viscid mucus, re- quiring painful hawking efforts to remove it. The ear at times becomes affected, and hearing is impaired, which may be temporary, or become permanent. Unless in the act of swallowing, or in severe cases, little pain is generally expe- rienced, though there exists constant uneasy sensations of distension and discomfort. When both tonsils are affected, they often project into the arch of the fauces, leaving but a small space for deglutition, and fluids are apt to run out of the nostrils in endeavoring to drink. The pain in swal- lowing, and difficulty of breathing increase as the disease advances. In severe cases, the pain shoots from the throat to the ear, and a tingling in the ears, with partial deafness, INFLAMMATION OF THE THROAT. 231 are often present. The mouth can at times be opened with difficulty, scarcely sufficient to allow an examination to be made, and the patient is frequently unable to lie down. The eyes are generally inflamed, and the pulse is full, quick, and hard. An increase of the mucous secretion, with less viscidity, and more ease of swallowing and breathing, and a decrease of the inflammatory symptoms, indicate that the disease will terminate by resolution; while an increased difficulty of breathing, swallowing, or opening the mouth, the ex- ternal swelling considerable, with a pulsation internally, extending to the ear, indicate the commencement of sup- puration, and the probable bursting of the abscess; when- ever this occurs, whether naturally, or by opening with a lancet, an immediate relief to all the unpleasant symptoms results. Treatment.—In mild cases a dose of calomel, or blue pill, and ipecacuanha, followed by cooling saline purgatives, or senna tea, the frequent application to the throat of a stimu- lating liniment, confinement to the chamber and the use of a mild gargle, repeated every ten or fifteen minutes, will often prove sufficient. The use of emetics, in anginose af- fections, is peculiarly beneficial, and we may strongly recom- mend one of tartar emetic, to be followed, in a few hours, by a dose of calomel, or blue pill, and after this, free purging, with castor oil, senna tea, or salts and magnesia. When the inflammation, and other symptoms, are severe from the commencement, bleeding from the arm, and locally, by leeching or cupping, or scarifying the tonsils, followed by gargling with warm"water, are of great importance. Mild gargles should be freely used, and that of cayenne pepper will, at times, produce the most beneficial effects. Black or red currant jelly, as a gargle and drink, may be freely used. Inhaling the vapor of warm water and vinegar, or laudanum, to effect a resolution or hasten suppuration, is a remedy of value. The application of a blister towards the latter stages of the disease, after the free employment of the antiphlogistic regimen, has been strongly recommended, and there can be no question of the great advantage result- ing when properly timed. The throat, however, being that 232 DOMESTIC MEDICINE. part of the body where a blister produces the most pain and uneasiness, respiration and every effort to swallow being attended by an increase of pain and irritation, it is prefer- able to allow the blister to remain on only a few hours, or until considerable redness and uneasiness result, when it should be removed, and a warm bread-and-milk or flaxseed- meal poultice applied, which will prove soothing and cause a large blister to be raised. When suppuration has resulted in one or both tonsils, unless demanded by the difficulty of breathing, it is gene- rally considered preferable to allow the abscess to open spontaneously. In cases of enlarged tonsils of a chronic character, should inconvenience result in speaking or swallowing, they must be removed by an operation, previous to which incisions may be made in them every two or three days, as such a course has often succeeded in effecting a cure. The following gargle is used advantageously in chronic enlargement of the tonsils. One or two tablespoonfuls of oround oak bark, boiled in a pint of water for one hour, strain, and add four or five tablespoonfuls of brandy, and two teaspoonfuls of alum. Tannin, dissolved in water or brandy, forms an excellent gargle for those subjected to frequent attacks of sore throat^attended with a relaxation of the parte. The extract of catechu, made as a gargle with vinegar, water, and honey, is an excellent application. At the commencement of this disease, many strenuously advise the free application of cold water to the throat, or a handkerchief or small towel, soaked in cold water, applied to the throat, with a dry towel over it. This I have tried with success. INFLAMMATION OF THE TONGUE. This disease of the substance of the tongue, often sudden in its attack, and rapid in progress, results from the usual causes of inflammation, though more frequently from direct injury by corrosive or irritating articles, as scalding drinks, wounds, bruises, or bites of venomous insects. At times it occurs during the progress of eruptive fevers, and from sali- INFLAMMATION OF THE TONGUE. 233 vation caused by mercury. It commences generally by the anterior part becoming painful and swollen, at times, in a few hours, embracing the whole organ, which may become so large as to fill the mouth, force open the jaws, and pro- ject beyond the teeth and lips. Deglutition, always diffi- cult, is sometimes impossible, and the patient is unable to articulate. The tongue, generally dry and red, is at times moist and covered with a thick, white, or yellow fur. The pulse is quick and strong, and the skin hot and dry, in the commencement; but as the disease advances, and respira- tion becomes embarrassed, the pulse loses its strength, and cold sweats occur. If not removed by appropriate treat- ment, suppuration, or gangrene will ensue, unless the patient shall have previously died from suffocation or apoplexy. Treatment.—This must be prompt and efficient. Bleed- ing from the arm should be carried to as great an extent as the system will allow, and repeated as often as may be necessary to arrest the inflammation. If the patient can swallow, active purgatives are very necessary; among the best are salts and magnesia, senna tea with salts, or croton oil in a small quantity of castor or sweet oil. Copious in- jections are also to be used simultaneously with or in place of cathartics when deglutition is impossible. Shortly after the bleeiing, the application of a large number of leeches to the upper anterior part of the throat will be necessary, and should be repeated according to the urgency of the symptoms. If leeches are not to be pro- cured, cups may be applied to the back of the neck, or side of the throat. After the leeching, a large emollient poultice should be applied, except in those cases where a blister becomes indispensable. If no impression on the disease be made by the treatment vigorously pursued, and danger of suffocation be imminent, it will be necessary to make free incisions into the substance of the tongue, one on each side of the median line, extending from the base to the tip, ob- serving the precaution not to make them too deep, for fear of wounding the ranular arteries. Should, all of these means fail, and the patient be in danger of suffocation, the operation of laryngotomy or tracheotomy will be the last and onlv resource; allowing respiration to be carried on, and 234 DOMESTIC MEDICINE. giving time for the subsidence of the swelling, and inflam- mation. When an abscess forms in the tongue, it should be opened with a lancet or bistoury, and the use of a mild mucilaginous wash freely indulged in. During the existence of inflammation of the tongue in its early or acute stage, cold mucilaginous drinks should alone be allowed. ITCH. This disease, highly contagious, and asserted to be caused by a small insect, is characterized by an eruption of small vesicles, accompanied by intense itching. The hands and arms, particularly about and in the joints, are principally affected. Treatment.—Sulphur is a certain cure, and must be used internally and externally. The ointment is to be thoroughly rubbed in, two or three times a day, for several days, the parts then well washed with Castile soap and water, and if not perfectly well, the frictions must be repeated. From one to three teaspoonfuls of the flowers of sulphur, mixed in molasses, should be given two or three times a day. A strong wash of the sulphuret of potash, in water, or lime- water, is also an excellent remedy. During the continuance of this disease, the diet should be of a vegetable character. ITCHING, PRURITUS. A very distressing and troublesome cutaneous affection, aggravated by heat, and at times, by exposure to the air. It almost always attacks the neighborhood of the privates, the upper and inner parts of the thighs, and around the anus, producing an almost irresistible desire to rub or scratch, and, in some cases, those parts are kept raw or inflamed, attended at times with febrile excitement. Treatment.—Occasional small doses of calomel, or blue mass, and ipecac, at bedtime, followed in the morning by a dose of sah)s and magnesia ; minute doses, one-twelfth of a grain, of tartar emetic dissolved in water, four or five times a day, continued for weeks; or the same quantity of corrosive sublimate dissolved in water, three or four times JAUNDICE. 235 a day for eight or ten days, a few drops of Fowler's solution of arsenic, three or four times a day, for several weeks; iodine and iodide of potash mixed with the extract of sar- saparilla, and continued for weeks ; injections of cold water every morning: all of these have at times proved service- able, and it will often be found necessary to use them all in succession. Local applications are much used, and occa- sionally prove serviceable; the following are considered among the most certain :— Lime-water by itself, or combined with calomel, forming the black wash, or with corrosive sublimate, forming the yellow wash ; a weak solution of creasote ; chloride of soda diluted with four or five times as much water; a solution of sulphuret of potash in water or lime-water ; a solution of borax in rose-water, to which may be added morphia; a strong solution of nitrate of silver in rose-water, five to twenty grains to the ounce : this is perhaps the best of all. Tar ointment, an ointment of white precipitate, and corro- sive sublimate. Constant bathing with cold salt and water, should be rigidly enforced, after which, any of the above may be used. The diet should be plain and nutritious, avoiding all heating, stimulating food and drink. JAUNDICE, ICTERUS. This disease is caused most frequently by a functional derangement of the liver and. digestive organs, and is fre- quently observed in the course of severe attacks of some fevers. The symptoms are, languor, decrease, or loss of appetite, nausea, or vomiting, a bitter taste in the mouth, a furred tongue, depression of spirits, the eyes and skin more or less yellow, the urine of a deep saffron or brown color, which is imparted to the linen; the discharges from the bowels are generally of a clay color, though constipation is not of un- frequent occurrence. A dull pain is commonly felt in the right side, the pulse is hard and full, and fever is often pre- sent. The brain sometimes becomes affected, coma super- vening, and adding much to the danger of the case. Treatment.—The principal indication in the treatment of jaundice, is to restore the hepatic secretion to its natural 236 DOMESTIC MEDICINE. state, which, in the majority of cases, will be all that is re- quired. Should there be considerable fever, with a hard, full pulse, pain in the side, bleeding from the arm, and locally from the side, by cups, must be resorted to. When the pain is of a spasmodic character, it may possibly depend upon the passage of a gall-stone, and will require, after the bleeding, a warm bath, and opium, both internally and by injections, in large doses. If the tongue is much furred, with considerable nausea, an emetic must be given, after which, in four or five hours, from twelve to twenty grains, of calomel, with one of ipecac, is proper, and should be followed, in a few hours, by repeated doses of oil, senna and salts, or salts and magnesia, to open the bowels freely. The application of a mustard poultice, flannel soaked in turpen- tine, or large emollient poultices of hops, flaxseed meal, or bread and milk, and bathing the feet in hot mustard-water, will, when much pain is present, afford great relief. The free use of mucilaginous drinks, containing a small quantity of supercarbonate of soda, is beneficial, and often contributes materially to alleviate the pain. Should coma supervene, cupping or leeching the temples, or back of the neck, must be resorted to, with the applica- tion of cold water to the head, and, as far as the strength of the patient will allow, keeping the bowels freely acted upon by the use of injections, or some.mild aperient. To relieve the great nervous restlessness frequently existing, the use of small doses of Dover's powder, or of the tincture of hyoscyamus, or cicuta, will prove useful. Excessive itch- ing of the whole body sometimes occurs, for which, rubbing with rye meal will be found of service. It is important, as long as the disease continues, to keep the bowels gently open every day by moderate doses of rhu- barb and magnesia, senna tea, or salts and magnesia, and an occasional dose, at bedtime, of plue pill or calomel, com- bined with ipecac. The patient should be confined in the first instance to diluent drinks, followed by gruel, sago, arrow-root, and, when convalescence is established, beef, mutton, or chicken broth, with the use of a mild tonic, as chamomile tea, bark and snake-root tea, or a solution of quinine, will hasten recovery. MEASLES. 237 MEASLES. This disease, as a general rule, occurring but once in the same person, and almost uniformly in infancy or childhood, commences with alternate chills, and flushes of heat, lan- guor, restlessness, pain in the loins and limbs; the eyes are inflamed, with a watery discharge from them and the nostrils; the eyelids are heavy, turgid and red; thirst, nausea, or vomiting succeed, with headache. There is generally inflammation of the mucous membrane of the air- passages, soreness of the throat, hoarseness, and a short dry cough. The pulse is frequent and strong, and the respira- tion hurried and uneasy. The eruption generally appears on the third day, seldom earlier, frequently later. It shows itself in distinct spots, on the face, neck, and arms, afterwards spreading over the body, and lower extremities, often running into each other, and having more or less a crescentic shape, the interme- diate skin being of a healthy color. It is occasionally seen in the mouth and throat. At times, about the fifth or sixth day, it assumes a dark or livid color, with a tendency to re- cede, or be thrown inwards. When the disease goes natu- rally through its course, the eruption changes on the fifth or sixth day, from a red to a brown hue, and begins to peel off. The fever now generally ceases, although the cough may continue some time longer, requiring care, to prevent a not unfrequent and protracted complaint of the lungs, or bronchial mucous membrane. In some cases, near the close of the disease, diarrhoea supervenes, and demands attention. The worst cases of measles are generally those where the eruption is partial, or appears late, imperfectly, or irregularly. The eruption is the distinguishing feature of the disease, but the catarrhal, or bronchial affection, is by far the most important, and is generally, if not always, the cause of death, when that occurs. The thoracic symptoms being mild, we argue favorably of the termination, and unfavor- ably, whenever the eruption does not come out well, or is of a livid color, with a typhoid, or low condition of the sys- tem. 238 DOMESTIC MEDICINE. Treatment.—In ordinary cases of measles, little else is required than mild mucilaginous drinks, gently opening the bowels by oil, or other mild laxative. In consequence of the pectoral symptoms, and the possible results which may be apprehended, it is proper in all cases to keep the patient in bed, with no more clothes on than he is accustomed to, or the season demands. The temperature ofithe room should be uniform, to a cer- tain extent governed by the feelings of the patient. The antiphlogistic regimen should be enforced. When the fever is high, the pulse full, hard, and fre- quent, with pain, and difficulty in breathing, or coughing, increased upon taking a full breath, it is necessary to bleed from the arm, and apply leeches or cups to the throat or breast. When general bleeding is considered inadmissible, owing to the debilitated condition of the patient, the appli- cation of leeches or cups to the breast may be beneficially resorted to, after which a warm bath will often prove ser- viceable. A small dose of calomel, or blue mass, three to five grains, with one grain of ipecacuanha, followed in three or four hours by a dose of oil, may be given when the tongue is much furred. If the cough and soreness of the throat be troublesome, a few drops of hive syrup may be given every one or two hours, until vomiting be produced, after which it may be continued in small doses, to keep up its effects upon the system. At the same time flaxseed tea, gum-water, or other mucilaginous drink, should be occa- sionally given. The skin being hot and dry, we may use the following advantageously: Hive syrup, $iv; sp. aether nitros. 3vi; liq. amnion, acetat. gii. Dose, one or two teaspoonfuls every one or two hours. For the difficulty of swallowing, and soreness of the throat, the frequent use of a mild liniment, and a gargle of borax, sage tea, and honey of roses, will be found service- able. Notwithstanding the general and local loss of blood and other appropriate treatment, from inattention, or injudicious and too early exposure, the cough attendant upon measles will often assume a serious character, and terminate in irri- MEASLES. 239 tation or inflammation of the bronchial mucous membrane. In such cases, the following mixture will prove useful:— R.—Powdered gum Arabic, 5yj; tartar emetic, grs. ii; hive syrup, gi; spirits of nitre, %i; syrup of gum Arabic, ^ij. Dose, from one half to two teaspoonfuls every hour, according to the age of the patient. In cases where much difficulty of breathing, a dry cough, and more or less pain exist, with a tendency to a recession of the eruption, sometimes observed in the latter stages of the disease, cupping or leeching the breast, followed by a blister, will frequently be required to effect a cure, and prevent serious consequences. The blister may remain on for four or six hours, or until considerable pain and irritation are produced, when it should be removed, and a flaxseed-meal or bread-and-milk poultice applied. When the poultice is removed, the blistered sur- face may be dressed with basilicon ointment, or simple cerate. A warm bath, repeated two or three times a day, is useful in those cases where the eruption does not come out fairly, or is disposed to recede, and after the bath, garlic or mustard poultices should be kept constantly applied to the soles of the feet, or calves of the legs, the wrists, and, in bad cases, to the stomach and breast, to excite and keep up a constant, though not severe irritation. During the entire course of an ordinary attack of this disease, the patient should only be allowed mucilaginous drinks, and sago, arrow-root, or rice-gruel, but when typhoid symptoms, or a low, weak, and exhausted state of the system exist at any stage of the disease, with the appearance of purple or livid spots, a more generous and nourishing diet, as beef tea, or chicken broth, with wine or brandy, quinine, or bark tea, to which elixir of vitriol may be added, become necessary, and should be given every hour or two. After the disappearance of the symptoms of measles, it is important that the patient dress warmly, and avoid ex- posure to raw, damp air, and by no means should be allowed to go out too soon, for so great is the predisposition after this disease, to pulmonary and other diseases of a dangerous character, that we frequently find the consequences intrac- 240 DOMESTIC MEDICINE. table, from a want of proper attention to prudential and precautionary measures. MUMPS. This disease, contagious, or susceptible of communicating itself to others not previously affected, consists in an inflam- mation and swelling of the parotid gland, of one or both sides, attended with pain, increased by the movements of the lower jaw, or by pressure, and at times considerable fever. Frequently, it attacks the gland of one side at first, and when nearly well, that of the other side becomes affected. The swelling, at first distinct, soon extends to the maxillary glands, and over a great part of the throat. The disease commonly reaches its height in four or five days, and then begins to decline, when it not unfrequently happens, that the testicles in males, and the breasts in females, increase in size, become hard and painful, disap- pearing, however, in a few days. Treatment.—As a general rule, little is required than guarding against exposure to cold, bathing'the parts several times a day, with a mild anodyne, oleaginous liniment, applying a strip of flannel around the neck and jaws, and an occasional small dose of salts or spirits of nitre, and antimonial wine. Should there be much headache, with febrile action, the bowels must be acted upon, with a few grains of calomel, followed by a dose of salts and magnesia, and the nitre and antimonial wine every hour or two. At times, the inflammation and fever are so great as to require general bleeding, and the application of leeches to the parte. The swelling and pain of the testicles, or breasts, will gene- rally be removed by frequent bathing with a mild, warm liniment, or the application of a bread-and-milk poultice; occasionally, however, so severe are they, as to require the application of leeches, followed by a warm poultice. The solution of acetate of ammonia (spirits of Mindererus), ap- plied hot, with a piece of flannel soaked in it, has been strongly recommended as a local application. When mumps assume a chronic form, sometimes observed when attacking old persons, leeches, blisters, and an oint- ment of iodine, ten grains, hydriodate of potash, one drachm, NEURALGIA. 241 with one ounce of simple cerate, or lard, will be found re- quisite. At times, in these cases, a few small doses of calomel, or blue mass, are required to produce a slight impression upon the system. NETTLE RASH. An eruption of small, hard eminences, generally round, or oblong, red and white in color, accompanied by heat, burning, and tingling. It is generally caused by derange- ment of the stomach, from improper or indigestible food. It is, in some, very apt to follow the use of certain articles of food or medicine, as mushrooms, raw cucumbers, shell- fish, almonds, copaiva, cubebs, valerian. Vomiting and purging sometimes occur after the appear- ance of this rash, and, by removing the cause, prove an effectual cure. Antacids, combined with the milder ca- thartics, are generally found sufficient; occasionally, how- ever, it will be proper, from the severity of the case, and the greater derangement of the alimentary canal, to give a mild emetic, or a dose of calomel and .ipecac, followed, in a few hours, by a dose of oil, salts and magnesia, or senna tea. A warm bath will generally prove serviceable. A lotion of vinegar and water, salt and water, or the following mixture, may be applied to allay the heat and itching. Carb. ammonia 5i; acet. plumbi 5i; rose-water ^viij. NEURALGIA. Under this name is included that class of diseases in which there is pain, at times spasmodic and intense, gene- rally unattended by inflammation, fever, tenderness, or any change of structure in the affected part, no matter how • long and painful the attacks may have been. These pains may occur in all parts of the body, though they generally attack the face and head, and when there, it is known by the name of tic douloureux. As a general rule, these severe pains come on, and disappear suddenly, often assum- ing a regular intermittent character, without any well- marked apparent cause. In those predisposed to neuralgia, a sudden change of 21 242 DOMESTIC MEDICINE. weather, exposure to draughts, derangement of the digestive organs, or other slight causes, will produce an attack. Treatment.—Tonics and antispasmodics are generally more curative than the antiphlogistic or depleting remedies, which, although occasionally useful, if pushed too far, prove positively injurious. The division of the trunk of the affected nerve has, at times, though rarely, effected a cure. Mr. Jeffries relates a case of violent facial neuralgia, cured by the removal of a piece of china which had been there for fourteen years. Many cases are recorded of violent and long-continued facial neuralgia being effectually cured by the extraction of one or more carious teeth. I had under my charge a lady of excellent general health, who had suffered upwards of ten years from repeated violent attacks of facial and frontal neuralgia, for which every known remedy had been unsuc- cessfully tried, who was immediately benefited, and per- manently cured by the extraction of six old roots. From this, and similar cases on record, may properly be deduced the necessity of examining carefully the condition of the teeth, and gums, in all cases of this disease about the face or head, and of immediately removing those stumps, or decayed teeth that do not admit of plugging. This last operation will not, however, always succeed, for an irritation originating apparently in a decayed tooth, may have ex- tended to the lining membrane of the root, causing inflam- mation and suppuration, that nothing but extraction will remove. In some cases, where neither stumps nor decayed teeth exist, to account for the disease in the face, freely scarifying the gums, even to the bone, has effected a cure. Great caution is to be observed in extracting teeth for this disease, lest sound ones be sacrificed, for nearly all the teeth have, in some cases, been removed under the impres- sion of their causing the disease, without any benefit re- sulting. Numerous, indeed, are the remedies which have been applied locally in this painful disease, sometimes with bene- fit, at others without effect. Among the many, the follow- ing are deserving of notice and trial: Veratriae 9j ; pulv. opii 3ss; pulv. capsici 3j ; axungitc 3j ; to be well mixed. NEURALGIA. 243 A small portion to be rubbed on the part, for ten or fifteen minutes, three or four times a day. Or, cyanuret potassii 3j ; ext. belladonnse 3UJ ext. opii 3j j pulv. capsici 9j; tinct. belladonna 3X > acl- ammoniae 3*v.—M. A small quantity to be well rubbed on the part several times a day. Croton oil, pure, or mixed with lard, simple cerate, soap liniment, or sweet oil, in the proportion of two drachms to an ounce of either, or the ointment of tartar emetic, rubbed on the affected part, will often prove successful. A Bur- gundy pitch plaster, sprinkled with tartar emetic, is an excellent mode of using it. The following liniment of Rauque, has enjoyed a high reputation as a local application in neuralgia :— Ext. belladonna 3J j ether sulphuric ^j; laurel water The subcarbonate of iron has been successfully given in- ternally in long-standing cases of neuralgia. Beginning with a moderate dose, a teaspoonful, it should be rapidly increased, until two or three tablespoonfuls are taken in the course of the day, mixed with molasses, syrup, or sugar and water. The alcoholic extract of nux vomica, from one-fourth to one grain, or, the active principle, strychnia, one-twelfth of a grain, three or four times a-day, will sometimes succeed. The arsenious acid, in pill, one-twelfth of a grain, or as Fowler's solution, ten or fifteen drops, three or four times a day, continued for some time, is deservedly celebrated as a remedy of great power in the various forms of neuralgia. In some cases of facial neuralgia, a snuff, composed of quinine,.morphia, and powdered cicuta, has been used ad- vantageously. Chloroform, applied by soaking a piece of linen in it, or mingled with sweet-oil, will at times allay the pain. A lotion of cyanuret of potash, ten or twenty grains, in an ounce of water, applied to the affected part by means of a ball of cotton, or piece of sponge tied on a stick, will afford, at times, great and immediate relief. The following pills of Meglin, have acquired no little celebrity in chronic cases of this disease: Ext. hyoscyami 3ss; oxid. zinc ess; ext. valerian 3ss; to be made into thirty pills. Dose, one every night and morning, gradually 244 DOMESTIC MEDICINE. increasing the number, until vertigo, or uneasiness in the head be produced. Very strong coffee, taken freely, has sometimes effected a cure, and at times a large quantity taken at the commence- ment of a paroxysm will arrest its future progress. PROLAPSUS ANI. This is a descent of a portion of the rectum, or lower in- testine, or its lining membrane, below the sphincter, form- ing a tumor at the anus ; in general, however, it is confined to the membrane alone. The ordinary causes of this dis- ease, are habitual straining at stool in those subject to cos- tiveness ; the long-continued use of drastic or other cathartics, chronic dysentery, or diarrhoea and relaxation, or debility of the general system. The extent of protrusion may be small, and slow in pro- gress, or sudden, and large. Treatment.—The first thing to be done, is to return the protruded part, by gentle pressure with the finger, previously oiled. Washing in cold water for a few minutes will often cause a return of the part. Where considerable resistance is met with, the warm hip-bath, emollient poultices, injec- tions of laudanum, and if much pain and swelling exist, the application of a few leeches near the part, and cold water become necessary. To prevent a recurrence of prolapsus in those once affected, care must be taken to avoid irritating the rectum by drastic cathartics or constipation, which produce straining at stool. The bowels must be kept daily open by means of a laxative diet, or the mildest laxatives, as sulphur and magnesia. Dr. Physick strongly recommended rye mush and molasses for this purpose, as also the having the bowels open in an erect position. The use of cold water, freely applied after each evacuation, as well as morning and night mild astringent injections, or ointments of catechu, rhatany, galls, oak-bark, or alum, are generally required to obviate or remove the relaxation of the parte. Small doses of cubebs, copaiba, or oil of turpentine, are often successful in chronic cases. Me- chanical contrivances are sometimes necessary to prevent the constant protrusions. RHEUMATISM. 215 RHEUMATISM. This is a constitutional complaint, attended with a pecu- liar irritation or inflammation, to which all parts of the body are liable, and may be acute or chronic. The first sensible or appreciable symptoms are generally of a local character, though close observation would frequently detect premoni- tory symptoms of derangement of the digestive organs. The local symptoms are generally first felt in the back, extremi- ties, or shoulder-joints. An attack of rheumatism is most frequently caused by exposure to raw, damp, cold air, or to a draught, after having been heated by undue exercise. Acute rheumatism attacks principally the young and vigor- ous, though no age is exempt. It commences with chilli- ness and shivering, soon followed by a hot skin, restlessness, thirst, pain, increased by motion or pressure, and more or less severe, in one or several of the joints, generally the large ones, with redness and swelling, frequently shifting from one to the other, or to some internal organ, especially the heart. These symptoms vary in intensity, in proportion to the number and size of the joints affected. The pulse is commonly full, hard, and frequent, and the tongue moist, and more or less furred. Costiveness is usual. The urine is generally high-colored and small in quantity, depositing frequently a copious brickdust sediment. The pain of rheu- matism is more generally present than the swelling, and this more so than the redness. The pain is generally aggra- vated towards night, and frequently when warmly covered in bed. Treatment.—If much pain, a hot skin, and hard pulse exist, with or without swelling and redness, bleeding, both general and local, must be resorted to, and repeated if necessary. ... , The blood drawn in acute rheumatism is almost always cupped and buffy, after each bleeding, however frequently repeated, but these general signs of inflammation should not be regarded, in themselves, as indications of the pro- priety or necessity of its repetition. Free, purging is by many considered not less efficacious than bleeding and for this purpose the bowels are to be freely n' 21* 246 DOMESTIC MEDICINE. acted upon by giving ten or fifteen grains of calomel, one or two of ipecacuanha, and one of opium at night, followed the next morning by one large, or frequently-repeated smaller doses, of senna tea, or salts and magnesia. Mode- rate purging continued for some time, is strongly recom- mended in this disease. Dover's powder, in doses of six to ten grains every two hours, for three or four doses, confining the patient to bed, and causing him to drink freely of hot sage, or boneset tea, will at times succeed in effecting a cure, more especially if the bowels have been previously acted upon by a dose of calomel and rhubarb, or oil. The violence of the disease having been subdued, soreness and stiffness alone remaining, the use of a stimulating anodyne liniment, three or four times a day, will be found of advantage. In cases of acute rheumatism, with fever and inflammation, the diet should consist of vegetable or farinaceous articles, but in other cases a more liberal one may be allowed. Gently bathing a painful rheumatic joint with warm sweet-oil and laudanum, and then enveloping it in a gum- elastic sheet, or oiled silk, will often afford relief. Nitre or saltpetre, in large doses, one, to one and a half ounces dissolved in a quart of water, and drank during the day, has been strongly recommended in acute rheumatism, but the general belief in the greater safety of smaller doses induces the recommendation of from forty to eighty grains, in a pint of water or flaxseed tea, to be taken in wineglass- ful doses, every one or two hours during the day. In those cases of rheumatism, attended by. debility and much perspiration during sleep, the use of sulphate of quinine in two to five-grain doses, will frequently prove ser- viceable. In chronic rheumatism, an occasional pill of five grains of blue mass, one grain of ipecacuanha, and half to one grain of opium at bedtime, acting upon the bowels the fol- lowing morning with a dose of rhubarb and magnesia, or some mild but efficient pills, twenty or thirty drops of the tincture of colchicum, three or four times a day, fre- quently repeated stimulating liniments to the parts affected, regular morning and evening friction with the flesh-brush RHEUMATISM. 247 or horse-hair glove or strap, will frequently effect a cure, and rarely fail to afford relief. In chronic rheumatism, as well as in neuralgia, which by • many physicians is regarded solely as a modification of rheu- matism, it is important to examine carefully the spine, as upon pressing upon each prominence in the centre of the back, there is frequently observed in one point a manifest tenderness, at times amounting to severe pain, not previously noticed, which extends, or shoots from that part to almost every portion of the body, and cases, which had previously resisted all plans of treatment, have been cured by the ap- plication of leeches or cups, followed by blisters to the affected part of the spine. The iodide of potash is deservedly celebrated for the cure of rheumatism, especially of a chronic character, and the results effected by it are sometimes astonishing. It is given dissolved in water, or in the extract of sarsaparilla, in which last it appears to be preferable. Dissolve from three to six drachms of iodide of potash in eight or ten ounces of the extract of sarsaparilla, and give from one to three teaspoon- fuls four or five times a day. The volatile tincture of guaiacum in doses of one or two teaspoonfuls, two or three times a day, has long been held in high esteem for the cure of chronic rheumatism. Obstinate rheumatic pains have been completely cured, by giving every night, for some time, one or two teaspoon- fuls of the flowers of sulphur in a little milk. The Chelsea pensioner, a well-known remedy for chronic rheumatism, is made as follows : Flor. sulphur, 3ij; sup. tart, potass. 3i; pulv. guaiac 3i; pul. rhei 3ij ; sp. niyris- ticse 3ij; honey, a sufficient quantity to make an electuary. Dose, one or two teaspoonfuls every night and morning. With a slight alteration in the quantities, and omitting the spirit of nutmeg, this mixture is strongly recommended by Dr. Graves, of Dublin. Acupuncturation, which consists in the introduction of a fine needle of gold, silver, or steel, into the skin and muscles of the part affected, has been found of great value in many cases of chronic rheumatism. 248 DOMESTIC MEDICINE. The needle is introduced with a slight rotary motion, and gentle pressure. Little pain is caused by their intro- duction ; and frequently, after the failure of other remedies, the introduction of four or five needles in the vicinity of the disease will remove the pain. The needles may remain in from ten minutes to one hour, or longer, care being observed to avoid any sudden motion of the body, for fear of breaking them. SCURVY. This is a disease in which the blood is vitiated, and the system debilitated, with a tendency to hemorrhage, petechia, local congestion, and inflammation in different parts of the body, especially the gums. Scurvy generally occurs at sea, especially on long voyages. It appears clearly established that a prolonged abstinence from succulent vegetables, fruits, or their preserved juice, as articles of food, is the most general cause of scurvy. Although scurvy arises from deficiency of proper food, the disposition to the disease is greatly increased by neglect of cleanliness, imperfect ventilation, want of proper exer- cise, and a cold, damp atmosphere. Lemon-juice was formerly supposed to be a certain cure for, as well as a preservative against, this disease; but later and more extensive observations prove its incorrectness, however valuable it may prove when conjoined with fresh animal food, vegetables, and good biscuit. Scurvy approaches gradually, the first symptoms being lassitude, indisposition to move about, unusual fatigue after moderate exercise, the gums swell and bleed upon the least friction, and have a soft, spongy, and livid appearance; there is great despondency of mind, the tongue is furred, or clean and moist, the "appetite and digestion at times unimpaired. The breath is offensive, the pulse small, feeble, and slow, the urine is small in quantity, and high- colored. The skin is dry and rough, or sometimes smooth and shining, generally covered with livid spots, coalescing into large blotches, particularly about the legs and thighs. The legs swell, and the whole body ultimately becomes oedematous. If there are sores on the body, they discharge SCURVY. 249 a fetid or bloody sanies. In the more aggravated form of the disease, the patient loses the use of his limbs; the tendons in the hams are contracted, with pain and swelling of the knees and other joints. Hemorrhages break forth from the nose, ears, and bladder. Diarrhoea occurs, with bloody and offensive discharges. The teeth become loose, and frequently fall out. Palpitation of the heart, panting, vertigo, dizziness, and a feeling of faintness, are generally present. Treatment.—The most natural and effectual cure of this disease is a return to a diet of fresh meat and vegetables; but where, as at sea, this cannot be obtained, the use of preserved fruits, sugar, spruce-beer, vinegar, tartaric acid, lime or lemon-juice, and an infusion of malt, should be resorted to. Irish potatoes, eaten raw, alone, sliced in vinegar, or boiled, have been recommended as a cure, and preventive of scurvy. The water, if fresh, in which they have been boiled, should also be drank. Sauerkraut has long been celebrated as an antiscorbutic. The disease having made its appearance on board ship, when the above articles cannot be procured, the following medicines may be given advantageously: Peruvian bark, in powder, or infusion, chamomile or Virginia snake-root tea, or any other bitter that may be on board. Elixir of vitriol may be given, either with the above medicines, or added to sugar- and-water, as a common drink. Nitre or saltpetre, in vinegar, or lemon-juice, has been used successfully in scurvy. The sores in the mouth may be washed with a mixture of powdered charcoal, two or three teaspoonfuls in a tumblerful of water, acidulated with vinegar. To the sores on the body, which are often large and painful, dis- charging an offensive matter, the charcoal or yeast poultice will prove very beneficial. As prophylactics, to prevent the occurrence of this dis- ease, attention to cleanliness and ventilation of the ship, to the general comfort of the men, and a full supply of suitable provisions, including lime or lemon-juice, tartaric or citric acid, good water, potatoes, cabbages, and fresh meat, when procurable, are of the utmost importance. 250 DOMESTIC MEDICINE SMALL-POX. This is a fever commencing with sickness of stomach, headache, pain in the back, and general lassitude, followed on the third day, by an eruption on the skin, more or less abundant, which in the course of a week, inflame and sup- purate. In some cases a similar eruption is observed on the mucous membrane lining the nose and mouth, with swell- ing and inflammation of the adjoining parts. Small-pox is called distinct, when the pustules can be counted, are not very numerous, and do not run into each other. It is called confluent, when the pimples are so close as to run into each other, on the third or fourth day of the inflammation. There are generally considered to be four stages through which it passes. 1st. That of incubation, from the reception of the matter or germ of the disease, to the commencement of fever, generally from seven to fourteen days, and often from the commencement, there are languor, lassitude, restlessness at night, with impairment of digestion. 2d. The irritatory or eruptive fever, occupying three or four days. 3d. The stage of maturation, extending from the develop- ment to the full maturation of the pustules, and varying from five to nine days. 4th. The stage of decline, drying up, and secondary fever. In a great proportion of cases, the eruption of small-pox develops itself as follows:—Minute pimples, sensibly elevated above the surface of the skin, first on the face and forehead. The sides of the nose, chin, and. upper lip generally display the earliest pimples, then some appear on the neck and wrists, the trunk and thighs are then attacked, and finally the feet. In all cases of distinct small-pox, the constitutional symp- toms are materially lessened after the full development of the eruption, the pain of the back, the vomiting, and the headache abate, or disappear, and other symptoms are sensi- bly diminished. The ordinary symptoms of small-pox, are, about the ele- SMALL-I'OX. 251 venth day from the reception of the small-pox germ, rigors or chilliness, or one severe shivering fit, pains in the head, back, and limbs, a quickened pulse, a hot skin, with dry- ness, or at times a disposition to sweating. The pain in the back is at times sudden and excessive. There is gene- rally great pain in the head, and frequently the stomach experiences the force of the first symptoms, as acute pain, accompanied by incessant vomiting. This irritable con- dition of the stomach frequently continues until the erup- tion has extended over every part of the body. There is great prostration of strength. The greater or less pain in the back, and loss of muscular power, are almost diagnostic of the severe or mild character of the disease. The pulse is generally full and strong, and the skin hot and dry, although occasionally there may be considerable depression of pulse, with moisture. In many cases there is excessive itching, the patient being scarcely able to refrain from tearing the skin and pustules. The face is much swollen, and the eyes closed, or nearly so, for several days before the bursting of the pustules. In some cases the lining mem- brane of the nose, mouth, and neighboring parts, is more or less covered with pustules, adding greatly to the suffering and danger of the case. Treatment.—It is an acknowledged fact, that the erup- tion, when abundant, cannot be checked or diminished by any remedial means in our possession, and when moderate,. little interference is required with medicine. Our efforts should be confined to moderating arterial excitement, when too great, to supporting the system when required, and re- lieving such urgent symptoms as may arise during either of the stages. Heroic remedies, instead of being beneficial, prove rather prejudicial in this disease. The cooling, or antiphlogistic plan of treatment, should alone be pursued, although in some cases of a violent character, or at the close of one of an ordinary kind, nutri- tious, and even stimulating food, with tonics, may be je- quired to support the general strength, and enable the force of the disease to be resisted. Bleeding from the arm, or by cups or leeches from other parts, as may be judged more appropriate to the symptoms 252 DOMESTIC MEDICINE. of each case, is often required. The bowels should be freely acted on by one or more doses of calomel, or blue mass, followed by repeated doses of saline aperients, as Seid- litz powders, or salts and magnesia, and cooling injections of salt and water, or cold flaxseed tea and oil. To moderate the fever in aid of the above, repeated doses of spirits of nitre, or Mindererus, alone or combined, to which may be added a small portion of tartar emetic, or antimonial wine, will prove useful. Cooling, acidulous drinks should be given as freely as the patient may desire. The room should be kept cool, with no more covering than the feelings of the sick call for, and the linen of bed and body may be changed daily. When the pustules come out slowly, with continued sick- ness of stomach, or vomiting of bilious matter, or a constant desire so to do, an emetic of ipecacuanha, and a mustard poultice or blister applied to the abdomen, with hot stupes to the feet and ankles, become necessary. If the head is much affected from the beginning, bleeding from the arm, and cups or leeches to the head, one or more doses of calomel or blue mass, and frequent injections to act freely on the bowels, are indispensable. If, at the commencement of the disease, or after a few days, there is reason to apprehend a severe attack, the hair should be cut close, or shaved, to keep the head cool by cold applications, thus endeavoring to prevent delirium. In all cases, let the room be kept dark and cool, allowing a free current of air, obviating a draught by curtains though not around the bed, and allow nothing but mild mucila- ginous cooling drinks. To allay the irritation or itching, often excessive, cool mucilaginous washes may be used, and if much matter be discharged, some dry powder, as rye flour, or rice flour, with lapis calaminaris, may be dusted over the pustules. To prevent pitting, many local applications have been tried, generally with little success, and even the utter ex- clusion of light, though always to be enforced, will often fail of success. Among the ordinary, and to a certain extent, useful local applications may be noticed, cold cream, spermaceti cerate TETANUS, LOCKED JAW. 253 with powdered calamine, rubbed with it. Collodion has been tried without much success, during the different stages, as well to limit the extent of pustulation, as to prevent pit- ting. For the purpose of preventing pitting, Dr. Crawford, of Montreal, after much experience, speaks in the highest terms of a saturated tincture of iodine, locally applied daily, or more frequently to the eruption. The earlier commenced, the more efficacious. Besides relieving the excessive itch- ing, it is thought by Dr. C. to diminish the inflammation and ulceration, and moderate the fever. In conclusion, it may be said, that for ordinary cases of small-pox, keeping the bowels open by a dose of calomel or blue mass, followed by saline laxatives and injections, de- termining to the surface, and keeping down fever, by re- peated doses of spirits of nitre or Mindererus, and antimo- nial wine or tartar emetic, the free use of cold mucilaginous lemonade, not interfering with nature, but aiming to second her in all stages, will prove most successful. SUN STROKE. The effects produced by the long-continued action of the direct rays of the sun, are so closely allied to those of in- flammation of the brain, and apoplexy (which see), of which it is a frequent cause, and the treatment required being that laid down for those diseases, it is unnecessary to do more than refer to them. Let it be distinctly understood, that it is of importance to commence the treatment as soon as possible. TETANUS, LOCKED JAW. This is a disease in which certain muscles of different parts of the body are in a state of rigid contraction, with paroxysms of more or less severe painful spasms, alternating with irregular intervals of more or less complete relaxa- tions, without coma, or any essential disturbance of the mind. Tetanus is caused generally by punctured wounds, the most trifling injury from nails, splinters, paring corns, or extracting teeth, being capable of producing it, while from those of the most severe character, not the slightest 22 254 DOMESTIC MEDICINE. tetanic symptom will appear. Tetanus generally deve- lops itself from four to fourteen days after the injury. In some cases, the disease commences suddenly, while in others, by far the most common, the person feels some time after a wound, generally in the hands or feet, a stiff- ness in the back of the neck, with dryness and soreness of the throat, and at times violent pain under the sternum, or breast-bone. The closure of the jaws is next observed, which may occur suddenly, or be preceded by pain, weak- ness, and stiffness in the muscles of the jaws. Frequently, the jaws are so powerfully closed that it is impossible to open them. There is often a powerful spasmodic action of the muscles of the throat, which prevents swallowing. A violent paroxysmal stabbing pain frequently occurs, when the disease is fully formed, in the region of the diaphragm. The face becomes distorted, and the spasm about the mus- cles of the thorax is so violent, that respiration is difficult and painful. The eyes are generally fixed, and suffused with tears. The mind generally unimpaired. The pulse is full and hard at the commencement, becoming more frequent and feeble towards the close of the disease. There is commonly a profuse perspiration through all the stages of the disease. The bowels are almost invariably so torpid, as to resist the action of the most powerful cathartics. The ordinary duration of the disease, when terminating fatally, varies from two to six or eight days. Treatment.—Upon the first appearance of the least symptom of tetanus, the wound should be enlarged, the part soaked in hot lye for an hour or more, and stimulating applications, as oil of turpentine, or the decoction of can- tharides, repeatedly applied to the part, after which an ointment of Spanish flies, basilicon, and oil of turpentine, should be inserted into the wound, and covered with a warm emollient poultice, renewed every hour, to hasten and encourage suppuration. Where much febrile excite- ment exists, large and frequent bleedings from the arm are necessary, and should be followed by the repeated applica- tion of cups to the breast and spine, as well to draw blood locally, as to act as revulsives. The amount of blood to be lost, and the frequency of application of the cups, must TETANUS, LOCKED JAW. 255 necessarily depend upon the violence of the symptoms, and the condition of the patient. The use of warm and cold baths, as well as affusions of cold water, have been tried in this disease, occasionally with advantage. A large dose of calomel, combined with opium and ipecac, should be given early in the disease, and followed by large and repeated doses of the strongest senna tea, until the bowels are thoroughly evacuated; copious cathartic injections should be used at the same time, to assist the operation of the cathartic. Throughout the course of this disease, it is necessary to give opium by the mouth, and by injections, in the largest doses, and laudanum, or a solution of mor- phia, are to be preferred, as in many cases, where solid opium had been given, it has been found after death in the stomach, unacted upon. The enormous quantity of one quart of laudanum has been given in the course of two days to a lady laboring under this disease, who recovered. The use of wine, in large quantities, has been strongly recommended in the latter stages, but to be of any service there should be scarcely any limit as to quantity. By many physicians, the greatest reliance is placed upon the most powerful applications to the spine, after frequent cuppings to that part, and for this purpose cotton, steeped in spirits of turpentine, or spirits of wine, laid along the spine and set on fire, the actual cautery, or the strongest blisters, painful remedies as they may appear, should alone be depended upon. Nauseating doses of tobacco infusion have been recommended, and may, in certain cases, prove useful by the extreme prostration and relaxation caused by it. The carbonate of iron, in as large doses as can be swallowed, has been recommended by Dr. Elliottson. Should the disease be overcome, and convalescence com- mence, a nourishing diet may be allowed. During the continuance of the disease, in consequence of the difficulty of swallowing, fluids alone can be taken, and they may be, whatever will prove most agreeable to the sufferer. At certain stages of the disease, there is much to be hoped for from the internal and external use of chloroform or pure ether, and several cases of its successful adminis- tration have been recorded. 256 DOMESTIC MEDICINE. Dr. T. F. Bctton has lately published in the Medical Examiner, of Philadelphia, a well-marked case of Tetanus, perfectly cured by the inhalation of a mixture of three parts of sulphuric ether, with one of chloroform. In conclusion, it may be said, that in the treatment of this severe malady, the main reliance should be placed in general bleeding, the frequent application of cups to the breast and spine, large and frequent doses of powerful cathartics, with blisters to the spine, large and frequently repeated doses of laudanum, an unlimited use of the best wine, and the administration of chloroform by inhalation, and by the mouth. TOOTHACHE. This, though frequently dependent upon constitutional derangement, which should be attended to, is generally a purely local affection, and will be removed by the following local applications:— Equal parts of alum and common salt in fine powder, sprinkled on moistened cotton, and inserted in the cavity, or laid upon the decayed tooth. Common salt dissolved in vinegar, and held in the mouth for a few minutes. A few drops of oil of cloves, or cinnamon, creasote, pure or diluted with alcohol, on cotton, inserted in the cavity. A grain of camphor, and a grain of opium, made into a mass, and inserted in the cavity. Tincture of benzoin, a few drops. Camphor dissolved in oil of turpentine. Powdered alum and spirits of nitre. The mouth rinsed with hot brandy and water. A ginger or mustard poultice applied to the cheek often cures. URINE, INCONTINENCE OF. This frequent complaint of childhood, generally one of habit, occasionally proceeds from disease of or a stone in the bladder, in which cases the removal of the cause can alone effect a cure. Among the causes may be named debility of the sphincter muscles of the bladder, the pre- URINE, RETENTION OF. 257 sence of worms in the lower bowels, or, at times, a general derangement of the digestive organs. Treatment —In ordinary cases the following will gene- rally succeed. Do not allow much or any drink for several hours before going to bed, have the urine passed before retiring, and after having been in bed a few hours, wake him to have the bladder emptied. Daily bathing in cold water, a cold shower bath, and rubbing the back morning and evening with a moderately stimulating liniment, will prove serviceable. A mustard poultice, dry cupping, or an occasional blister to the lower part of the back, will be at times required. The tincture of cantharides, in doses of five to ten drops, three or four times a day, gradually increasing the quantity, until some heat or pain is per- ceived in making water, will often succeed. It should be stopped as soon as these effects are produced, and should strangury occur, mucilaginous drinks, with spirits of nitre, two or three grains of camphor, and a few drops of lauda- num, may be given. An injection of laudanum is one of the best remedies for strangury, as well as for the disease itself. The extract of nux vomica, in doses of one-half to two grains, two or three times a day, is strongly recom- mended. In debilitated habits, the use of tonics, those of iron preferred, and other means calculated to improve the general health, will offer the greatest chance of effecting a cure. URINE, RETENTION OF. An inability to discharge the contents of the bladder, or retention of urine, is attended with excessive pain, and a sensation of weight or fulness in the region of the bladder, and the lower part of the back, accompanied by a frequent desire to pass urine. The retention is seldom complete, as at each effort a few drops will be passed with much strain- ing. Above the pubis, when the retention has continued some time, there will be felt a roundish tumor, and upon pressure the pain is produced. If not relieved, fever is excited, the bladder becomes excessively distended, and in some cases has been ruptured. Treatment.—Thirty or forty drops of spirits of nitre and 22* 258 DOMESTIC MEDICINE. ten to twenty of antimonial wine every hour or two, with copious draughts of flaxseed tea, or gum-water, and the application of a large poultice of bread and milk, flaxseed meal, hops, or chamomile flowers, over the lower part of the abdomen, will in most cases cause a flow of urine. An injection of fifteen to thirty drops of laudanum, in a wine- glassful of any bland fluid, will prove successful in cases where spasm appears to be the cause, and is always to be used if great pain is present. Cupping the back will often be required, followed by a mustard poultice or blister. A few drops of the muriated tincture of iron, oil of turpen- tine, or tincture of cantharides, and the free use of an infusion of uva ursi, buchu, or water-melon seeds, have been used successfully. If much inflammation exists, bleeding from the arm, or locally, by cups or leeches, must be resorted to. The introduction of a catheter to draw off. the water, is some- times required, and in cases of fever, it is not only neces- sary, but should be repeated more or less frequently. URINE, SUPPRESSION OF. This is, generally speaking, a symptom of other diseases, as fever, inflammation, local injuries, and certain forms of dropsy. It is always to be regarded with great anxiety, and where, after a continuance of several days, coma super- venes, a fatal termination of the case may be anticipated. In such cases the perspiration has frequently a urinous odor. Treatment.—If the state of the pulse and general condi- tion warrant it, bleeding from the arm is necessary, other- wise cupping over the region of the kidneys is to be resorted to, and repeated according to the urgency of the symptoms. Put the patient in a warm bath, or the feet in hot mustard-water, and apply a large warm poultice over the region of the kidneys, a cathartic of cream of tartar and jalap, or senna and salts, followed by injections of warm water, soap-suds, or flaxseed tea, are>to be given, and repeated according to circumstances. A mustard poultice to the loins is often serviceable, and a fly blister to the same part is frequently necessary. Repeated doses of VOICE, LOSS OF. 259 spirits of nitre and antimonial wine, with mucilaginous drinks, are to be used. An infusion of juniper berries, parsley, water-melon seeds, or wild carrot, with spirits of nitre, often act powerfully on the kidneys. Small doses of oil of turpentine with the use of diluent drinks are often successful. Proceeding, as suppression of urine does most generally, from other diseases, the various indications must necessarily depend upon the condition of the system, and the nature of the disease. VOICE, LOSS OF. This proceeds from a variety of causes, and may prove temporary or permanent. It may result from derangement of the digestive organs, be an attendant upon ordinary catarrhal affections, or the effect of various diseases and organic affections of the larynx. Treatment.—In„the majority of cases, resulting from a cold or its causes, the following will generally prove suffi- cient. Frequent doses of any of the expectorant or cough medicines, as hive syrup, syrup of squills, syrup of ipeca- cacuanha, onion or garlic syrup, in conjunction with a mus- tard or ginger plaster, or frictions with a stimulating lini- ment to the throat. In some cases an emetic of ipecacu- anha wili be required; while in those which prove intractable to the above, the application of leeches or cups to the front or back of the neck, followed by a fly blister, must be resorted to. In chronic cases, twenty or thirty drops of balsam of copaiva several times a day have been found successful. In recent or mild attacks, medical inhalation may be tried in conjunction with the above; and in those of a chronic character, especially if depending upon laryngeal disease, the employment of various remedies by medical inhalation will alone effect a cure. In two severe cases, of weeks' duration, after the failure of other means, a perfect cure was effected by using the following by inhalation : Ext. conii5ii; balsam copaiva 3vi; tinct. assafoetida §i; sulphuric ether 3ii; oil turpentine 3iv; tinct. camphor 3iv; camphor water | ii. See art. Inhalation. When loss of voice occurs in those of debilitated constitutions, the use of tonics internally, regular exercise in the fresh air, cold salt 260 DOMESTIC MEDICINE. and water, and linimente, morning and night, to the throat and breast, with friction with a coarse towel, or hair glove, will be found indispensable. WHITLOW, FELON. This is an inflammation at the end of one of the fingers, exceedingly painful, and much disposed to end in an abscess or suppuration. The pain is intense, often extending up the hand and arm, and frequently causing an enlargement of the glands of the arm-pit. Every effort should be made to arrest the progress of this apparently trifling ailment, which may result from the most trifling causes, or no evident one. The following local applications are sometimes used with success: common brown soap, warmed and spread upon a rag. Immersing the finger in warm water, gradually in- creasing its heat to the extent that can be borne by the addition of boiling water. Rubbing the part frequently with mercurial ointment, keeping it constantly applied. The constant application of sulphuric ether to produce intense cold by its evapora- tion. Enveloping the end of the finger with a strip of blister plaster. When the pain is excessive, leeches applied to'the part, and the bleeding encouraged by immersing the finger in warm water, followed by a blister, will prove successful. As soon as fluctuation can be perceived, indeed often before, the part should be lanced, carrying the incision down to the bone. Should it be evident that matter has formed under the nail, this should be scraped thin with a piece of glass, and the incision made through it. During the pro- gress of this acutely painful disease, large and repeated doses of laudanum, as well by the mouth as by injection, are required, to procure ease and sleep. Where the disease evinces a tendency to extend up the arm, and the inflam- mation is necessarily great, the loss of blood and active purging will be found indispensable. WORMS. There are five species of intestinal worms. 1. Ascaris Lumbricoides, a round worm, resembling the WORMS. 261 common earthworm, inhabiting the small intestines, though frequently passing upwards into the stomach, or downwards into the large intestines, often discharged by vomiting and purging. This species is generally found in the earlier periods of life, and at times exists in great numbers. 2. Ascaris Vermicularis. Threadworm. As its name imports, a small and slender worm, from one quarter of an inch to one inch in length, more frequently found in children, occupying principally the rectum or lower*bowels. The number occasionally found is immense. 3. Tricocephalus Dispar. Long Threadworm. From one and a half to two inches long, inhabiting the large intestines, principally the caecum. 4. Taenia Solium. Common Tapeworm. More frequent in adults than in children. The movements of this worm are sometimes felt in the bowels. 5. Taenia Lata. . Broad Tapeworm. Generally shorter than the other species of tapeworm. Worms are most frequently found in children of a debili- tated and unhealthy constitution, though the most robust and healthy are not exempt. The only positive symptom of their presence, is their expulsion from the bowels, though the following may generally be considered to indicate their presence. Frequent and irregular colicky pains, with, or without diarrhoea, a swelling and hardness of the abdomen, constant picking of the nose, itching of the fundament, nausea, a foul or sour breath, giddiness, grinding of the teeth, frequent starting during sleep, a variable and capri- cious appetite, at times voracious and insatiable, at others entirely wanting; vomiting often occurs, and the discharges from the bowels are irregular. There is often an uneasy feeling at the pit of the stomach, frequently abated by eat- ing. The eyes have a heavy look, and there is frequently a dark-colored ring around the lids. Treatment.—Active purging is one of the most certain means of expelling worms, though there are many sub- stances which exercise a destructive influence upon them, and are beneficially resorted to, either before the use of, or combined with, cathartics. A dose of calomel at bedtime, followed the next morning by one of oil, senna tea, or rhu- 262 DOMESTIC MEDICINE. barb and magnesia, repeating this every third or fourth day, employing in the intervals pink-root tea, wormseed oil, or some other anthelmintic, will generally succeed. This plan of proceeding having been continued sufficiently long, or until no more worms are expelled, there may be given a combination of tonic and anthelmintic remedies, with the view of preventing their reappearance, and for this purpose I have never found any remedy to succeed more uniformly than a proper combination of common salt, rust of iron, supercarbonate of soda, and ginger. For the threadworm, injections are peculiarly appropriate, and an infusion of any bitter herb, lime-water, soap-suds, assafoetida rubbed down with warm water, or the tincture of aloes, may be employed. A suppository, made of powdered aloes and rhubarb, mixed with lard or butter, introduced into the rectum at night, followed the next morning by an injection of salt and water, Or senna tea, is often successful. The oil of turpentine is one of the best anthelmintics for all species of worms, and may be given in doses varying from one teaspoonful to one or two tablespoonfuls, alone, or combined with mucilage or castor oil. It is frequently given by itself in the morning, not allowing any drink, until it begins to operate, when a dose of castor oil should be given, and followed by an abundance of mucilaginous drinks. The unpleasant symptoms, strangury, and nausea, are not more apt to follow a large than a small dose. A strong decoction of the bark of the pomegranate root has proved successful in all species of worms. It is made by boiling one or two ounces, in a quart of water, down to a pint. Dose, one or two tablespoonfuls every half hour, or hour, for four or five doses. Sickness, faintness, giddi- ness, and trembling, sometimes follow the use of this medi- cine, if given too strong, or for too long a time, in which case, it will be proper to suspend its use for a day, and com- mence again with smaller doses. Professor H. S. Patterson speaks in high terms of the efficacy of the oil of pumpkin seeds for the expulsion of the tapeworm. The seed may be made into an emulsion with warm water or milk, or the expressed oil may be used. A tablespoonful may be given several times a day. PART IV. SURGERY. There are few diseases, if any, properly called Surgical, which do not, at some stage, require medical treatment; though it has been customary to arrange under the head of "Surgery" the many sudden cases, or accidents, which require prompt and preliminary mechanical assistance, fol- lowed immediately, or at a later period, by such remedial measures as may be indicated by the recurring symptoms, whether local or general, or combined, which may be said to be uniformly the case. BRUISES, SPRAINS. The inflammation having been reduced, bathing in cold salt-and-water, or pouring it upon the part, from a pitcher, will be found serviceable. In conjunction with this, the use of liniments more or less stimulating, as opodeldoc, soap liniment, volatile liniment, to all of which laudanum and tincture of arnica may be added, should be resorted to, three or four times a day, for fifteen or twenty minutes each time. Should the joint remain weak, the application of cold water, friction with a stimulating liniment, and a bandage, to overcome or prevent the swelling, so apt to occur after these injuries, and give an artificial support to the part, enabling nature to perform her part in restoring its natural strength, must be duly persisted in. If severe, and attended with great pain, bleeding from the arm is sometimes required, and the application of leeches will generally prove serviceable. Keeping the 264 DOMESTIC MEDICINE. bruised part, or sprained joint, for some time in warm water and wood-ashes, will frequently afford great relief;— more so, generally, than when cold water is used; but here the feelings of the individual should not be neglected. BURNS, SCALDS. Some of the applications to burns and scalds do good by protecting the part from the action of the atmosphere, while others are intrinsically beneficial. Among the more common and useful local applications are the following: Immersing the part in very cold water, or pouring it upon the* burnt surface for some time; equal parts of lime-water and sweet oil, scraped potatoes, carded cotton, lead-water; soap made into a lather, and applied with a shaving-brush over the surface, renewing it as soon as it begins to dry; a solution of gum Arabic in water; dredging the surface with flour, and covering it with a piece of linen. One of the best applications to a burn, the skin being broken, is an oint- ment of spirits of turpentine and basilicon, in equal parts, called Kentish's Ointment, applying it, spread on linen rags, on the burnt surface alone. In some eases, violent febrile action occurs after a considerable burn, requiring bleeding and other antiphlogistic remedies; while in others, so depressed are the powers of the system, that the free exhibition of stimulants becomes necessary. The following have been strongly recommended as excel- lent applications to burns: Six ounces of olive oil, and the whites of four eggs, beat well together, and spread over the burn, with a feather, or pledget of soft linen. It should be applied frequently, in order that there be formed a complete covering, which will not fall off for six or eight days, when, almost always, the burn will be found healed, and a new skin perfectly formed. Or, sweet oil, three tablespoonfuls, yellow wax, one ounce, and the yolks of two eggs, hardened under hot ashes. Dissolve the oil and wax with a gentle heat, then add the yolks of the eggs, and stir until the whole acquires the consistence of an ointment. It should be spread upon linen, and applied twice a day. A thin paste of wheat flour and water, spread or poured over a burn, has been recommended as a quick mode of relieving the pain. DISLOCATION OF THE LOWER JAW. 265 DISLOCATIONS, LUXATIONS. A dislocation is the removal, by muscular or other force, of the head of a bone from its articulating cavity. This is rendered evident by the sudden deformity or unnatural appearance of the joint, the pain and inability to move the limb, and the almost uniform shortening of the limb. In all dislocations, there is necessarily more or less tear- ing and stretching of the ligaments, and muscular and nervous fibres, around the joint, followed by more or less inflammation, and effusion into the parts. To reduce a dislocation, make extension and counter- extension by gentle, steady, and continued pulling of the limb, endeavoring all the time to replace the head of the bone in its natural position. At times, so powerful is the contraction of the muscles, that, before reduction can be accomplished, it is necessary to bleed largely, to use the warm bath, and keep up nausea for some time, with repeated doses of a solution of tartar emetic The bone being replaced, a bandage must be applied, and kept on for one or more weeks, and perfect rest of the limb enjoined. After the reduction of" a dislocation, it will generally be proper to apply cloths wet with cold water, or weak lead- water, should heat or pain in the joint be complained of; and in that case, a bandage should not be applied until those symptoms of inflammation have disappeared. DISLOCATION OF THE LOWER JAW. This may happen on both sides, though much more fre- quent on one alone. It is most frequently caused by violent gaping; and a blow will produce it. One or both heads slip from their sockets, the jaw becomes fixed, the mouth wide open, and the power of speaking lost. The replacing is performed by surrounding the thumbs with one or more thicknesses of leather or muslin : the patient being seated, and the operator in front, each thumb is to be placed on the last tooth. Forcible downward pressure being made, at the same time drawing the jaw forward, the bone will resume its natural position with a sudden and loud snap. Pieces of wood, or the handles of forks, may be used instead of the fingers. At times, the 266 DOMESTIC MEDICINE. most favorable position for the patient will be on the floor. The operator, standing behind, supports the head, being enabled to exert greater power. DISLOCATION OF THE COLLAR-BONE. This, though of rare occurrence, does sometimes result from blows or falls. The reduction is effected by drawing the arms and shoulders backward and outward, the operator simultaneously replacing the end of the bone. A bandage should then be applied over the shoulder, and under each arm, the elbow kept close to the side, and the arm sup- ported in a sling for two or three weeks. DISLOCATION OF THE ARM. This is generally produced by falling, and jerking up the elbow, though it may occur from other causes. When it has once occurred, a slight cause is apt to reproduce it. When present, the arm cannot be brought close to the side, nor raised to a level with the shoulder. The dislocated arm is shorter than- the sound one. In reducing this luxation, extension is to be made by the arm above the elbow, the forearm being flexed, and counter-extension against the acromion process of the sca- pula, the upper part of the shoulder. By a forcible exten- sion, the head of the bone will slip into its place. Sir Astley Cooper commended the following course as generally successful in recent cases. The patient should be placed in a recumbent posture upon a table or a sofa, near the edge. A wet roller is bound round* the arm, immediately above the elbow, upon which is tied a hand- kerchief. Then, with one foot resting on the floor, the elbow is separated from the side, and the heel of the other foot is placed in the armpit. The arm is then steadily drawn for three or four minutes, when the head of the bone will be easily replaced. DISLOCATION OF THE FOREARM. This most generally occurs backwards, when the forearm is half-flexed. Every effort to extend it causes great pain, the olecranon, or point of the elbow, projecting, and being DISLOCATION OF THE ANKLE-JOINT. 267 higher than usual. It is-reduced by setting the patient in a chair, the operator placing his knee on the inner side of the joint, in the bend of the arm, takes hold of the wrist, bends the arm slowly and forcibly, pressing at the same time on the forearm with his knee. DISLOCATION OF THE WRIST. This is of rare occurrence, and must be reduced by for- cible, steady, and continued extension of the hand, with gradual pressure, to push the end of the bone into its place. DISLOCATION OF THE THIGH. This may occur in four different places, the most frequent being upward and outward, and downwards and inwards. This luxation is very difficult to reduce, from the powerful action of the muscles, and the construction of the joint. To reduce that most common, or upward and outward, place the patient on his back, on a table covered with a mattress. Pass a strong band between the pudendum and the luxated thigh, and secure it to a post, or staple, to make counter- extension. Make extension by securing a folded sheet, or band, above the knee, with a roller, which is given to the assis- tants. Extension being made, the operator endeavors to replace the head of the bone. After the reduction, the diet should be low, and patient kept perfectly quiet for some time. DISLOCATION OF THE KNEE-PAN. This accident, though of rare occurrence, may take place outward or inward, the former being the most frequent, The bone will readily be observed out of its natural posi- tion, and there is pain, stiffness of the joint, and an inabi- lity to walk, or attended with great pain when attempted. The reduction is to be effected "by bending the leg for- ward, straightening the knee as much as possible, and with the hand the bone should be forced back into its natural position. Cooling applications, and perfect rest are re- quired, and no effort to walk made for several weeks. DISLOCATION OF THE ANKLE-JOINT. This may occur inward, outward, forward, and backward, 268 DOMESTIC MEDICINE. that outward much the most frequent. When this acci- dent does occur, the small or outer bone of the leg is gene- rally found fractured, a few inches above the ankle-joint. It is to be reduced by forcibly and steadily drawing down- wards on the heel and front of the foot, and forcing it into the natural position. DROWNING. In reference to the course to be pursued to resuscitate those who have been drowned, the following successful case, originally published in the Boston Medical Journal, will sufficiently indicate what should be done in such cases:— " Most frequently cases of drowning occur where it is difficult, and often impossible, to procure medical aid; and in such, where time is of primary importance, it cannot be questioned that the narrative of the course pursued in suc- cessful cases, may prove more valuable than the ordinary description of treatment. " In the month of August, 1818, being on a visit to a relative, Mr. J. S., on the North River, I was aroused by the cries of the domestics that a black child, two years old, was missing; and fears were entertained that he had fallen into a cistern, extending under ground, near the house. I endeavored to find and haul up the child by means of a long pole, having a hook attached, used for drawing buckets of water. Not heing able to discover the body, I had to grope about the bottom of the cistern, hoping to entangle the dress in the hook. After several minutes thus em- ployed, I was fortunate in finding the hook attached to something, and drawing it up, was gratified to see the child suspended by its frock. On examination, I found respira- tion and circulation extinct, the surface livid, and death present, as far as the functions of the vital organs were con- cerned. Now, what was to be done to endeavor to restore the action of the lungs and heart? I was entirely un- acquainted with any mode of proceeding, not having com- menced the study of medicine. Mr. S. was absent, no physician within several miles, and only two colored females present to render such services as I might order. Fortu- nately there was a copy of the Edinburgh Encyclopaedia in DROWNING. 269 the library, and after ordering the clothes to be removed, the body exposed to the sun, and constant friction with the hand, I referred to the article Drowning, to find what ought to be done. A hurried glance over the pages induced me to go to work with hot friction, hot water, and breathing into the nostrils. Hot water as a bath, hot ashes to rub with, were freely and unceasingly used, at the same time I continued the inflation of the lungs, through the nostrils, alternated with gentle pressure on the breast, to imitate, as much as possible, natural respiration. Without being able to specify the precise time the child had remained under water, it was thought, taking all the preliminaries into con- sideration, that about fifteen minutes had elapsed prior to the employment of any means for resuscitation. One thing is certain, by the watch, between two and three hours elapsed that were unceasingly employed in rubbing, bath- ing, and breathing into the nostrils, before the least sign of returning animation was manifest, when to my great joy there was one gasp, a strong inducement to continue my efforts. Several minutes passed before a second occurred; after which, the respiration and circulation were fully re- established, and the life saved. Some idea may be formed of the amount and force of the heat and frictions, when it is stated that a considerable portion of the skin of the limbs and body was found to have been abraded, requiring for some time mild unctuous applications to restore the parts to a healthy condition. After hours of hard labor in the hot sun, I had the satisfaction of seeing my efforts crowned with success; but little did I imagine I was in- flicting so extensive an injury to the skin. It is most pro- bable had I known what might have resulted, I should not have been enabled to report the successful issue of the case. Under similar circumstances, I would have no hesitation in pushing the same means to a similar extent, if necessary. " In conclusion, I think I may fairly recommend, in cases of drowning, the following course to be pursued. " 1st. Remove the wet clothes, and see that the mouth and nostrils be free from foreign substances. " 2d. Place the body in a warm room, allowing a free cir- culation of air. 23* 270 DOMESTIC MEDICINE. " 3d. Continue uninterruptedly, for many hours, if neces- sary, friction with hot ashes, salt, or sand, and give a hot bath, if practicable, using friction all the time. " 4th. Simultaneously with the above, continue unceas- ingly the forcing of air into the lungs, by blowing into the nostrils a full volume of fresh air with the mouth. In doing this, the lips should be closed with the fingers, to prevent the escape of air by the mouth. Immediately after each full insufflation, the breast should be gently pressed with the hand to imitate natural respiration. "The respiration and circulation being re-established, place the person in bed, give small quantities of mild nour- ishment, and, if necessary, a little wine or brandy." FOREIGN BODIES IN THE GULLET, PHARYNX, AND (ESOPHAGUS. The arrest of a piece of meat, or other substance, in the upper part of the throat, will prevent respiration, causing suffocation and death, in a few minutes, unless relief be afforded. The first thing to be done is to examine the throat, and remove with the fingers, forceps, or hook, the impacted body. A few slaps on the back often afford relief. Dr. M. Hall directs pressure to be made on the abdomen, and a forcible blow to be given with the flat of the hand on the thorax, to induce an effort similar to expiration. (Esopha- geal vomiting takes place, and the foreign substance is dis- lodged. If the body is lower down, a probang, which is a piece of whalebone, with sponge firmly attached to one end, may be passed down, to force the substance into the stomach. If the substance cannot be removed quickly, and the re- spiration is difficult or arrested, our only resource will be to open the trachea, or larynx, to allow air to enter into the lungs, when, generally, the foreign substance will be ejected forcibly upwards. Twenty-five years since, called in haste to a laborer sut- focated by the stoppage of a piece of beef in the throat, unable to extract it, and respiration suspended, I at once opened the trachea, and instantaneously the beef was for- cibly driven into the mouth. Two hours continuous efforts FOREIGN BODIES, ETC. 271 to re-establish respiration, with opposition, instead of aid from bystanders, proved unsuccessful. A few moments earlier, his life might have been saved. Fish, and other bones, pins, coins, &c, may be swallowed, and sticking in the passage, or scratching in their descent, will cause pain and uneasiness, which may continue some time after their removal without creating alarm. A few swallows of sweet oil, vinegar and water, mush, or water, may assist their pas- sage into the stomach, when soft food, as mush, gruel, with a few doses of castor, or sweet oil, will facilitate their dis- charge from the bowels. FOREIGN BODIES IN THE RESPIRATORY ORGANS. The passage of a foreign substance, as food, buttons, coins, stones, or other articles, into the air-passages, may cause death in a few moments by the arrest of respiration ; or, by remaining in the parts, may lay the foundation of a serious disease, which, sooner or later, will terminate fatally. When small bodies enter the windpipe, great difficulty often attends their removal, and success is by no means certain. Nausea and vomiting often occur, causing the body to be ejected, and a mild emetic is at times advisable, and may prove successful. Suspending the individual, head downwards, will sometimes allow the body to escape. Opening the trachea, and reversing the natural position of the body, will often be required. Mr. Brunnel, of Thames Tunnel celebrity, while amusing some children, had a half sovereign to slip into the larynx, and lodge in the right bronchus. At the expiration of three weeks, the trachea was opened, but it was not until the end of six weeks that the coin was forced out of the mouth by a fortunate move- ment of the coin, which enabled it to be forced or slide out by a sudden effort. Until that moment every effort had been tried to effect the dislodgement of the coin, by change of position and other means, without avail. In many cases, all that can be done, will be to combat such symptoms as may arise. The plan of making pressure on the abdomen, and a forcible blow on the thorax with the flat of the hand, may be tried in the first instance, aided, if not immediately 272 DOMESTIC MEDICINE. successful, by putting a finger or a quill down the throat to induce efforts to vomit, thus causing the foreign sub- stance to be ejected. BROKEN BONES, FRACTURES. Fractures are simple or compound. A simple fracture is when a bone is broken in one place, without an external wound. When broken in more than one place, it is called comminuted. A compound fracture is when, with a broken bone, there is a corresponding wound of the soft parts ad- joining, the ends of the bone protruding or not. The dan- ger of the case in this last is greater than in the former, and is necessarily increased according to the amount of bruises of the soft parts, or the comminution, or shattering of the bone. In the treatment of broken bones, the essential objects are the placing or restoring the fractured ends to their natural position, and the keeping them so by such means as may be appropriate to each case, to endeavor to avert unfavorable symptoms, and to adopt proper measures to remove such symptoms as they arise. The healing, or uniting of a broken bone, is entirely a work of nature; man's business is so to adjust the parts, that nature will be able to accomplish her object. The means to be employed in cases of fracture, are, ex- tension, counter-extension, and setting or adjusting. Ex- tension is the pulling the broken part in a direction from the trunk, to place the ends of the bone in their natural position. Counter-extension is the pulling of the broken bone in the opposite direction from extension, or retaining the limb, or body, firm, so as to prevent either from being drawn by the extending force. Extension and counter-extension being properly attended to, setting is the placing the ends of the bone accurately together by the operator, using all suitable means to keep them so. An important principle to be attended to in the reduc- tion of fractures, will be the placing the limb in a position to relax the most powerful muscles connected with the broken bone, as their action principally hinders the replace- FRACTURE OF NOSE. 273 ment, and constantly tends to displace the ends of the frac- ture once adjusted. After the fractured ends have been placed in apposition, it is necessary to retain them there by bandages, splints, and a proper position of the limb. The above having been duly attended to, suitable means are to be employed to prevent or remove unfavorable symp- toms. For this object, the diet should be strictly antiphlo- gistic. Costiveness is to be overcome by injections, which are generally preferable to medicine given internally; and the use of a bed-pan is indispensable. The bandages for the first few days should be frequently wet with cold water, as tending to lessen the disposition to inflammation and swelling. The ordinary signs of a fractured bone, are, a severe and sudden pain, an alteration, though not uniformly the case, of the form or natural appearance of the part, with most generally a shortening of the limb. If the fracture be in an extremity, we find an inability to move the limb without severe pain at the injured part, an inequality of the skin covering the bone, with crepitation, or a grating noise, produced by rubbing the ends of the fractured bone together. Having succeeded in properly adjusting the ends of the bone, and brought the limb into its natural position by means of gentle though steady pulling upon the lower end, while the upper part is held in a fixed position by assistants, or by being made fast to a fixed point, a bandage, from two and a half to three inches wide, must be accurately, but not too tightly applied; after which, splints of wood or pasteboard are to be laid along the sides of the limb, filling up the inequalities with a sheet folded smoothly, or com- presses of muslin, which should be rather longer and broader than the splints. The splints are to be retained in their position by a bandage, or, as in fracture of the thigh, with five or six pieces of tape passed around and tied. FRACTURE OF NOSE. In this fracture, generally produced by a severe blow, there is frequently much bruising and crushing of the soft parts. The proper course of proceeding is to introduce a round 274 DOMESTIC MEDICINE. body into one or both nostrils, as a lever, and endeavor to replace the fragments by placing a finger on the ring of the nose to prevent their being pushed too far out. A piece of adhesive plaster should be applied on the outeide, which will be all that is required in ordinary cases, though occa- sionally it will be necessary to apply a roller around the head, with pledgets of soft linen on each side of the nose. FRACTURE OF LOWER JAW. The symptoms are, a severe pain at the time of the acci- dent, an inequality perceived on passing the finger along the base of the jaw, and an unevenness of the teeth. Should much swelling occur before being seen, greater difficulty is experienced in determining the nature of the accident. To reduce a fracture of the jaw, it is necessary to shut the mouth, and forcibly push upwards the lower fragment, until the teeth come in contact with those in the upper jaw, and keep them so by passing a roller around the head, securing that by a few turns of the roller around the back part of the neck and front of the chin. The patient should be nourished for fifteen or twenty days on spoon victuals, sucked between the teeth. FRACTURE OF RIBS. This generally occurs from falls or violent blows. It is ascertained by acute pain in breathing, and by a careful ex- amination, a grating noise upon pressure. When difficult to decide, as in fat subjects, it is proper to apply the ban- dage, as though perfectly manifest. In simple fracture, it is only necessary to keep the parte at rest by passing a ban- dage six inches wide, several times around the chest, as tightly as can be borne, the bandage being kept in its place by a shoulder-brace. When the lungs have been wounded by a fragment of bone, there is generally spitting of blood and violent coughing. Inflammation is excited, fever occurs, accompanied by difficult respiration and other symp- toms of inflammation of the lungs. Copious venesection with the usual remedies for inflammation are to be used. FRACTURE OF CLAVICLE, COLLAR BONH. This bone, from its position, is frequently broken, the FRACTURE OF THE ARM. 275 fracture commonly occurring near the middle. The frag- ments are generally displaced; the external, or that nearest the shoulder, is drawn downward by the weight of the arm, and the inner portion is found riding over the humeral. The arm of the affected side falls over upon the breast, and cannot be rotated nor raised to the head. He leans to the affected side, which has been considered an almost distinguishing feature of the fracture. To reduce this frac- ture, fold a sheet smoothly, to form a pad eight inches long, five broad, and three thick; place it along the side, the upper end well in the armpit. Retain it firmly in its posi- tion, with a bandage passed around the body. Bring the arm down over the pad (this movement brings the ends of the fractured bone in contact), and the forearm across the body. Pass a bandage around the arm and body, beginning at the elbow and carrying it to within four inches of the shoulder. Lay a small pad or compress of linen, three inches square, and one-third of an inch thick, over the fractured part, and pass a strip of bandage over it (like a suspender), pinning the ends to different parts of the ban- dage around the body. Support the hand and forearm in a sling, and keep the whole on for five or six weeks. FRACTURE OF THE ARM. This occurs most frequently near the middle of the arm. When transverse, and near the middle, little derangement is seen in the length or form. When oblique, the limb is shortened by the action of the muscles, and there is con- siderable alteration in the shape of the arm. To reduce this fracture, seat the patient on a chair, make counter-extension by drawing on the hand of the sound side, and extension on the forearm of that broken. Adjust the ends of the bone, and keep them so by a bandage beginning at the hand, continuing it to the shoulder and around the body, under the sound arm to the top of the shoulder, when three or four pasteboard splints placed along the limb, and the bandage carried over them, will complete the adjustment. Place the forearm across the breast, and support it with a sling. 276 DOMESTIC MEDICINE. FRACTURE OF THE FOREARM. One or both bones may be broken. The symptoms are, pain, augmented by every motion of the hand, inability to turn the arm, mobility at the place of fracture, and deformity of the part. When occurring near the wrist, it has been mistaken for a dislocation. To reduce this fracture, restore the natural appearance of the part by extension, counter-extension, and compressing the muscles situated between the bones, to force the frag- ments in a lateral direction ; place a thick compress on the outer and inner side, extending the length of the hand and forearm; over these apply two splints, equal in length and breadth to the compresses, and finish by passing a ban- dage over the splints, to maintain the compresses and splints in position. FRACTURE OF FINGER. In this, which sometimes occurs, pass a narrow bandage around, and apply a small splint before and behind, which are to be kept on by the bandage. At times it is necessary to apply a splint to the entire hand, to prevent the motion of the fingers. FRACTURE OF THIGH. This is attended by mobility at the fractured part, an inability to stand on the limb, or move it without extreme pain. In treating this fracture, the bed must be prepared, and the fixtures laid down, before the patient is placed on them. The bandage for this fracture must be cut into pieces long enough to pass around the limb, one end overlapping the other four or five inches. In laying these pieces down on the mattress, the one to be applied last (that nearest the hip), must be put down first, the upper edge of the lower strip to cover about an inch of the upper one. There must be four splints, one of wood, to extend from the armpit to six or eight inches below the foot, another, of wood, to reach from the crotch along the inside, to the end of the first, and two of binder's board, two inches wide and nine long, for the under and upper part of the thigh. Six or FRACTURE OF LEG. 277 eight pieces of tape, a yard long, are to be laid on the mat- tress, over them a splint cloth, a piece of muslin one yard and a half long, and a yard wide; over the middle of this, longitudinally, is placed one of the small splints, and across this, is to be laid the bandage of strips. Two bags, filled with chaff, or finely cut straw, to extend from the hip to the foot, four inches wide, are also required. If these can- not be obtained, flannel or tow may be used in lieu of them. The patient is now carefully laid on the mattress, the fractured thigh placed accurately upon the bandage of strips. Extension and counter-extension being now made, and the ends of the bones brought into their natural posi- tion, the strips of bandage are brought over the front of the thigh and crossed, beginning with that next the knee. The two long splints are now rolled in the splint-cloth, and brought alongside the limb, when the bags are placed between them and the thigh and legs, to prevent irritation, and fill up the inequalities. The fourth splint is now laid on the top of the thigh, the tapes drawn around the splints, and tied. FRACTURE OF LEG. One or both bones of the leg may be broken at any part between the knee and the ankle, that of both bones being most frequent. In a transverse fracture, the bone is easily reduced and kept in its natural position with two splints and a bandage well applied. In general, the following will prove most suita- ble to continue permanent extension and counter-extension, when the fracture is of an oblique character. Two splints, to extend from the knee, six or eight inches below the sole of the foot. A hole is cut near the lower end of both splints, and four small holes in the upper end. A piece of wood, eight inches long, to fit in the holes at the bottom of the splints, is to be prepared. In applying this apparatus, lay the patient on his back, extension and counter-extension made as usual. A pillow, upon which is arranged a ban- da o-e of strips, is placed under the leg, two pieces of tape are then secured by several turns of a roller, on each side of the leg below the knee. These tapes are to be passed 278 DOMESTIC MEDICINE. through the four holes in the upper end of the splints, and tied. A silk handkerchief is next to be passed around the ankle, crossed on the top of the foot, and tied. The frac- ture being reduced, the bandage of strips is applied neatly to the leg, and the silk handkerchief next tied over the cross-piece connecting the two splints, by which any degree of extension may be permanently applied. FRACTURE OF PATELLA, KNEE-PAN. This generally occurs transversely, from falls or blows, or by the powerful action of the muscles of the leg. Occa- sionally, the tendon above or below the bone is fractured, and not the bone. In either case, the treatment is the same. The great object to be attended to in this fracture, is to maintain the fragments in apposition, that the sub- stance connecting them may be rendered as short as possi- ble, to preserve the perfect motion of the joint. To accom- plish a cure in this case, Dr. Dorsey always found the fol- lowing simple plan to succeed : A piece of wood, half an inch thick, two or three inches wide, and long enough to extend from the buttock to the heel. Near the middle of this splint, two bands of strong doubled muslin, a yard long, are nailed at a distance of six inches from each other. Upon this splint, covered with compresses of flannel or linen, to fill up the inequalities of the limb, place the patient's leg and thigh. The heel now being raised, apply a bandage two inches wide, and eight or ten long, commencing at the ankle, and extending to the knee. The upper fragment of the bone is now drawn down as near as possible to the lower one, and a compress of linen is placed above it, over which, several turns of the bandage are passed obliquely under the knee, so as to resemble the figure 8, when the bandage is carried to the top of the thigh, and brought down over the splint, the band attached to the splint being left free. These bands are now to be used, more completely to fix the fragments, the lower one, round the thigh, above the upper fragment, and the upper strap below the lower frag- ment, and secured by pins. No motion should be attempted before the fourth or fifth week, and even then it should be done very gently. Dr. Neill, of Philadelphia, strongly TOE-NAIL INVERTED. 279 recommends the use of strips of adhesive plaster, three quarters of an inch wide, to extend from above the upper fragment obliquely under the knee, and similar ones from below upwards, confining the action of the muscles of the thigh by rather broad strips of plaster circularly around the thigh. A short hollow splint of binder's board, applied to the ham, and retained by a bandage, completed the arrange- ment. HANGING, RESUSCITATION FROM. The immediate cause of death in those hanged, is the want of air in the lungs, which is necessary to carry on respiration, and effect those changes in the blood indispen- sable to the continuance of life. As soon as an individual, hanged, has been cut down, he should be kept in an erect position, and bled from the arm, jugular vein, or carotid artery, to relieve the congestion of the brain, which always necessarily occurs. Every means should be used to encou- rage the flow of blood, by placing the arm in, or rubbing it with warm water, at the same time using every exertion to bring about natural respiration, by blowing a full volume of air gently into one nostril, closing the other and the mouth, immediately afterwards making pressure upon the sides, or breast, to imitate the natural respiration. This should be repeated every few seconds, for some time, or until all hope has fled. Cold water must be kept constantly applied to the head, the feet and legs should be kept in hot water, and stimulating liniments should be applied to the legs and arms, and a large warm poultice to the abdomen. TOE-NAIL INVERTED. This painful complaint generally depends upon an in- flammation of the soft parts around the side of the nail, most frequently of the great toe, attended by suppuration and fungous granulations, causing excessive pain and lameness. The most frequent cause is cutting the nail too short, or trimming too much that portion of indurated flesh, so often found on either side of the great toe-nail. By this, the soft parte, already irritated or inflamed, are forced by the pres, 280 DOMESTIC MEDICINE. sure of the boot or shoe, in walking, against the edge of the nail, thus increasing the inflammation, and causing the disease. Treatment.—Introduce gently under the edge of the nail a small piece of lint, dry, or spread with any simple oint- ment, to prevent friction, and morning and evening bathe the feet in a solution of carbonate of soda in cold water, or diluted chloride of soda. If this does not succeed, drop into and upon the sore, a few drops of a solution of lunar caustic, ten grains to an ounce of water, for three or four evenings, continuing the lint, and a strip of linen around the toe, will rarely fail to effect a perfect cure. In some cases, until a cure is effected, it is necessary to cut a hole in the shoe, corresponding to the part, and after- wards to avoid tight boots or shoes. ULCERS. They are of various kinds, and may occur on any part of the body, though most frequently found on the legs. In persons of a morbid habit of body, from whatever cause pro- ceeding, the accidental abrasion of the skin will often ter- minate in an ulcer, which will remain a long time and prove difficult to cure. The mildest dressings, as cold water, a cold poultice, simple cerate, with perfect rest, will generally prove sufficient in simple ulcers. When of long standing, more stimulating applications are necessary, as basilicon, citrine, or red precipitate ointment, a solution of lunar caustic, or bluestone, chloride of soda, diluted or pure, ap- plied once or twice a day; a cold poultice of bread and milk, powdered elm bark, or flaxseed meal, kept on for a few days, will frequently dispose the ulcer to heal, when simple dress- ings may again be tried. The exuberant granulations, proud flesh, require to be touched occasionally with lunar caustic, by rubbing a piece over them, or using a strong solution in water, or by the application of finely powdered burnt alum. The application of strips of adhesive plaster, around the limb and across the ulcer, with a bandage properly applied, will often succeed in curing those of long standing. It ia important in the treatment of ulcers, of whatever character, WOUNDS, CONTUSED. 281 to pay attention to the general system, and as they are most frequently found in persons of irregular habits, with a de- ranged condition of the digestive organs, mild cathartics, a regular healthy diet, and a continued use of the extract of sarsaparilla, to which may be added iodine and iodide of potash, or, at times, minute portions of corrosive sublimate, with some gentle tonic, will be found requisite to effect a cure. In some ulcers, the application of leeches in the neighborhood, repeated every few days, will be found to materially assist the operation of the other remedies. WOUNDS. They are of different kinds, as incised, punctured, con- tused, lacerated, poisoned, or gunshot, and are more or less dangerous, according to their extent, the age and constitu- tion of the patient, as well as the season of the year. Occa- sionally, the most trifling wound will terminate fatally, while others of the most serious and extensive character, will be perfectly and rapidly recovered from. In all wounds of whatever character, the first and impor- tant step is to arrest the hemorrhage, which is often profuse, and then to remove any foreign body that may have been introduced. WOUNDS, CONTUSED. In these wounds, more or less injury is done to the deep- seated parts, even when the skin has not been broken. The smaller vessels are generally ruptured, and blood is effused into the surrounding parte, and under the skin. Treatment.—A simple bruise or contusion will frequently require nothing more than cold lotions, or a cold poultice and perfect rest; if more severe, and attended by inflamma- tion, local bleeding by leeches, or general bleeding from the arm, with coolinglaxatives, will be necessary. When the inflammation has subsided, repeated friction with some stimulating liniment will prove serviceable, and pressure, by means of a well-applied bandage, will tend to support the parts, cause the absorption of the effused blood, and prevent the subsequent swelling, so apt to occur Pourino- cold water from a height upon the parts, is found 282 DOMESTIC MEDICINE. of great benefit after the disappearance of the more promi- nent symptoms. WOUNDS, INCISED. Remove any foreign substance that may have been forced into the wound, bring the edges into contact, and retain them there, by one or more adhesive strips, a few stitches, and, if required, by a bandage, or roller, passed around the part. The wound being large, upon, or near a joint, it is necessary, either before or after the dressing, to apply a splint to keep the lips of the wound from being torn asun- der by any sudden motion. In most cases this will prove sufficient, but should the wound require dressing, the most simple ointment, spread on linen, should be applied two or three times a day. At times, fever and inflammation may supervene, in which case, general or local bleeding, cooling laxatives, cold poultices, or lotions, and a low diet, are ne- cessary. WOUNDS, LACERATED. They are those in which great injury is done to the parts, by being torn or mangled, whether by machinery, or other powerful force, applied suddenly, or by the body falling from a height upon stones, or other hard bodies. These wounds bleed very little, no matter how large the surface torn. Gangrene and secondary hemorrhage are apt to follow lacerated wounds. Treatment.—The removal of extraneous bodies, and the suppression of hemorrhage, should any exist, are the first things to be attended to. The edges of the wound are then to be approximated closely, and retained by adhesive straps, for, although in most cases, adhesion will but partially oc- cur, it is important to keep the parts in their natural posi- tion, and allow nature a fair opportunity of displaying her powers, which are great, and of a restorative character. A soft emollient poultice should then be applied, and renewed several times a day, until suppuration has been established, when simple dressings will be proper. WOUNDS, POISONED. They are produced, by the introduction into the system, PUNCTURED WOUNDS. 283 through the external surface of the body, of certain vege- table substances, the healthy, or morbid secretions of ani- mals, or by opening, and examining dead bodies. The sting or bite of bees, wasps, mosquitoes, and other insects, is of the nature of poisoned wounds; cold lotions, touching with spirit of hartshorn, or the strong aqua am- monia, and avoiding rubbing, or scratching, are generally sufficient. The bite of the rattle-snake, and that of some other spe- cies, will, unless immediately attended to, quickly prove fatal. A ligature must be drawn tightly around the limb, between the wound and the body, then cut out the wound, wash freely, and suck the wound, or apply a cupping-glass, for some time, after which, a strong solution of lunar caus- tic, or the nitric acid, is to be thoroughly applied, and the wound covered with a warm poultice. The spirit of harts- horn may, in these cases, be given internally, freely, and frequently. That poisoning of the system resulting from a wound received in examining a dead body, is of a dangerous character, generally terminating fatally. As soon as dis- covered, enlarge and wash the wound freely, suck it for some time with the mouth, touch freely with a strong solu- tion of lunar caustic, or the pure nitric acid, and apply a warm poultice, to produce and keep up suppuration. PUNCTURED WOUNDS. These are made by sharp-pointed instruments, frequently causing intense pain, and proving very dangerous. The danger from these wounds is not always proportioned to the size of the instrument, or depth of the wound, for that generally fatal disease, tetanus, often results from the slightest wounds. Treatment.—In a common punctured wound, it is seldom necessary to do more than apply a soft, warm, or cool poul- tice to the part for a few days, when the wound will gene- rally be found to have healed, but should the part swell, with an evident formation of matter, it will be proper to open it with a lancet. In other cases of a more severe character, it is proper, in the first place, to arrest the 284 DOMESTIC MEDICINE. hemorrhage, which, however, is not often great, then to remove any foreign substance which may have been intro- duced, and if this cannot be effected without enlarging the wound, it is proper to do so; after this, wash the parts with tepid water, bring the edges of the wound together, and retain them there by strips of adhesive plaster, and apply a cold poultice, or pledgets of linen, soaked in cold water. When the wound has been caused by a rusty nail, or jagged instrument, giving rise to an apprehension of tetanus, it will be safer, besides enlarging the wound, and soaking it well in warm lye, to pour oil of turpentine, or a strong solution of lunar caustic into the wound, or to touch all parts of it with a stick of lunar caustic, and then apply a compress saturated with the oil of turpentine over the wound, and repeat the application of the turpentine several times a day. Should much pain, heat, throbbing, and swelling occur in the wound, with febrile symptoms, a warm emollient poultice should be applied, and renewed every few hours. General and local bleeding, with fre- quently repeated cathartics, are often required. In wounds of this character, perfect rest and an unstimulating diet should be enforced. Upon the first appearance of symp- toms indicating the approach of tetanus, the most energetic plan of treatment should be immediately commenced. WOUNDS OF THE EAR. Wash the parts, draw the edges of the wound together, retaining them in place by as many stitches as may appear necessary. Apply a piece of linen, spread with simple cerate, over the ear, and a bandage around the head. If a part of the ear has been removed, and can be found, it, after being well washed in warm water, should be accurately applied in its proper place, and retained by stitches and a bandage, as in some cases such proceeding has been fol- lowed by perfect reunion. WOUNDS OF THE FACE. The greatest efforts should be made to heal these wounds by the first intention, so as to prevent the fonuation of scars. The edges of the wound must be brought together, POISONS TAKEN INTO THE STOMACH. 285 and retained in apposition by one or more strips of adhe- sive plaster. It is, at times, indispensable to employ one or more stitches to keep the parts in contact, and then to apply the plaster over them. WOUNDS OF THE SCALP. Shave the hair from around the wound as closely as pos- sible, wash off any foreign substance, bring the edges together, retain them there with strips of adhesive plaster, or stitches, if necessary, lay a compress over it, and apply a bandage around the head. Should fever result, bleeding, both general and local, free purging with salts and magnesia, are necessary, and nothing should be allowed but cold gum- water, flaxseed tea, or pieces of ice. POISONS TAKEN INTO THE STOMACH. Whatever may be the poison, accidentally or designedly introduced into the stomach, the first and most important step is to produce copious vomiting, by the exhibition of one of the following articles. Tartar emetic dissolved in water, antimonial wine, sulphate of zinc, sulphate of cop- per, a tablespoonful of flour of mustard, alone, or with an equal quantity of common salt, in a pint of warm water, an infusion of tobacco, " half a drachm in a pint of hot water." Dose, a wineglassful every five, ten, or fifteen minutes, or a pinch of snuff in a tumblerful of warm water. Whichever be selected, and that soonest obtained is always the best, large and frequently repeated draughts of water, warm or cold, or any mucilaginous drink should be given; for, as has been correctly remarked, whatever poison has been swallowed, the first and best antidote is an abundance of water, which, by diluting and producing free vomiting, is most apt to throw it off. Putting a feather, or one of the fingers down the throat, will often cause vomiting, and may always be resorted to in order to hasten the operation of any of the above emetics. In some cases, particularly from opium, or other narcotic poisons, the use of the sto- mach pump must be resorted to, and in these cases the frequent affusion of cold water over the whole body, and keeping the patient awake by compelling him to keep 286 DOMESTIC MEDICINE. moving, or even flagellation, have succeeded as auxili- aries. A very interesting case is related by Dr. Buck, who injected into the stomach of an individual, poisoned by a large dose of laudanum, after other means had failed, a pint of common vinegar, and immediately afterwards, four heaping teaspoonfuls of saleratus, previously dissolved in half a pint of warm water. The effect was immediate; profuse vomiting took place, and life was saved. In many cases it is probable that this would prove the quickest and most certain manner of removing poisons from the stomach. In cases of poisoning where the substance used cannot be discovered, a Pharmaceutist of Montpellier has judiciously advised the employment of the following powder, made by mixing equal parte of calcined magnesia, charcoal, and sesquioxide of iron, the precipitated carbonate, remarking that it is perfectly innocuous, and that the ingredients are antidotes to the most active and common poisons. It should be given freely, after copious vomiting by the ordinary means, and in any quantity that may be required. ARSENIC. One of the most violent and fatal poisons. Symptoms.—A sharp metallic taste in the mouth, con- stant ptyalism, or spitting, nausea, and faintness, followed by a burning pain in the stomach, with continued vomiting. The matter discharged is, after some time, of a yellowish green, or bilious color, frequently tinged with blood. There is also a distressing sensation of heat, dryness, and tight- ness in the throat, with an inextinguishable thirst. The voice is hoarse, and the articulation of words difficult. Diar- rhoea often supervenes, with great anal irritation and tenes- mus. The abdomen becomes painful and hard, the irritation frequently extending to the urinary organs, producing a deep-seated pain in the region of the bladder, with, at times, gangrene of the genital organs. The pulse is small, quick, and weak, the skin cold and clammy, the countenance col- lapsed. The tongue and mouth are furred, white spote are seen on the palate and fauces, delirium and convulsions supervene, and death soon closes the scene, In some cases. POISONS TAKEN INTO THE STOMACH. 287 the symptoms of irritation are mild; but faintness, syncope, coma, or stupor and convulsions usher in death with no less certainty. Treatment.—Demulcent drinks, as milk, white of eggs and water, flour and water, should be freely given, together with whatever emetic is at hand, "white vitriol, blue vitriol, ipecacuanha, salt and mustard, or warm water," to produce and encourage vomiting; if the patient cannot swallow, the same must be given by the stomach-pump. The hydrated oxide of iron, fully proved to be a perfect antidote, should now be given freely, one or two tablespoonfuls every five or ten minutes, mixed with water, until the urgent symptoms are relieved. As this preparation of iron cannot always be procured, and valuable time would be lost in preparing it, the precipitated carbonate, or sesquioxide of iron, has been shown by the Royal Academy of Medicine of Paris to be equally an antidote, and should be given in larger doses than above specified, mixed with water. The common rust of iron, although not equal to either of the above, has been given with success, and should be freely administered, when the other preparations cannot be readily procured. Tobacco has been said to be an antidote to arsenic; two cases are related by Dr. R. Emerson, which he received from Dr. Eastman, of poisoning by arsenic, cured by a strong decoction of tobacco. Neither nausea, vomiting, nor purging were produced, although the individuals, when in health, were extremely susceptible to the action of tobacco. COPPER. Poisoning from the preparations of this mineral, parti- cularly the acetate, verdigris, generally occurs from acci- dents, caused by want of cleanliness in cooking in copper utensils. Symptoms.—A coppery taste in the mouth, headache, pain in the bowels, vomiting and purging, cramps in the legs, and at times severe pains in the thighs, as also jaun- dice, which last is never produced by arsenic, or mercury. The pulse is small, quick, and weak, and coma, paralysis, and tetanic convulsions usher in death. Antidotes.—The whites of eggs and iron filings should 288 DOMESTIC MEDICINE. be given freely after the stomach has been thoroughly emptied by powerful vomiting with any active emetic, or what will answer still better, the antidotes and emetic may be mixed with some mucilaginous fluid or water, and given at the same time. CORROSIVE SUBLIMATE. A powerful corrosive poison. Symptoms.—A burning heat in the throat, vomiting, purging, violent pain in the stomach and bowels, excessive thirst, a cold clammy sweat, violent cramps, a weak and frequent pulse, great prostration of strength, and sometimes salivation, with inflammation of the mouth, and offensive breath. Diarrhoea, with at times a discharge of blood, fre- quently attends. The antidote to corrosive sublimate is the white of eggs, which, beat up with water, should be freely given, and vomiting produced, and maintained for some time, by the exhibition of mucilaginous drinks, or warm water, to a por- tion of which, some emetic, as ipecacuanha, white or blue vitriol, mustard, and salt, has been added. If the whites of eggs cannot be procured, milk, or wheat flour, mixed with water, should be used instead. Peruvian bark in powder, has been recommended as an antidote, and should be given in water. If vomiting cannot be speedily and effectually produced, the stomach pump must be resorted to. OXALIC ACID, SALT OF SORREL. The resemblance in appearance of this violent poison to the much-used Epsom salts, has frequently caused it to be taken in mistake, and from ite rapidity and certainty of action, death has often resulted. The taste of oxalic acid is very acid, while that of salts is extremely bitter, which should prevent such mistakes. Symptoms.—Violent pain in the fauces, throat, and stomach soon appears, generally followed by vomiting; the skin becomes clammy, and the pulse weak or imperceptible. Languor and great debility, with drowsiness, or torpor, shortly appear, and death is not far distant. When taken POISONS TAKEN INTO THE STOMACH. 289 very much diluted, it is not so irritating, but little less poi- sonous. The antidotes to oxalic acid are, common chalk, or the carbonate of magnesia, and when these are not at hand, it has been recommended to use plaster scraped from a wall. So rapid is the action of this acid, that the proper mode of proceeding, is to mix, as soon as possible, either of the above antidotes, if vomiting has not commenced, with one or two tablespoonfuls of ipecacuanha, or any other emetic, with a large quantity of water, and cause the patient to drink freely till vomiting occurs, which should be encouraged by giving large draughts of warm water, with the antidotes for some time, or until a certainty exists of all the poison having been ejected. TARTAR EMETIC. When given in a large dose, or, at times, in a small one, owing to idiosyncrasy, a case of which I have seen, poison- ous symptoms may supervene, as violent and continued vomiting, severe pain in the stomach and bowels, with pro- fuse purging. The strength is suddenly and greatly pros- trated, the pulse very weak and slow, and cold clammy sweats break out over the body. Antidotes.—After having given freely of mucilaginous drinks, to wash out the stomach, recourse should be had to Peruvian bark, in powder, infusion, or tincture, or the in- fusion or tincture of galls, given in water, until there is a certainty of no more poison remaining in the stomach. A mustard or spice plaster, or flannel steeped in spirits of turpentine, should be applied to the stomach, calves of the legs, or soles of the feet. A pill of one grain of opium, or thirty or forty drops of laudanum, may be given by the mouth, or in a small quantity of mucilage, or warm water, as an injection. One or two teaspoonfuls of hot brandy, with cinnamon, cloves, and ginger infused into it, may be given occasionally with great advantage. NARCOTIC POISONS. These produce symptoms indicating derangement of the nervous system, as pain of the head, vertigo, partial, or 290 DOMESTIC MEDICINE. total blindness, stupor or insensibility, paralysis, or convul- sions, profound coma, and death. OPIUM. In consequence of the effects of opium, or its prepara- tions, depending upon the age, habit, idiosyncrasy, and present condition of the individual, it is impossible to state with certainty what quantity is necessary to occasion death, some cases having been reported, where small or moderate doses had destroyed life, while in others large quantities had been taken with impunity, or but little effect. Symptoms.—Taken in a moderate quantity, the first effect of opium is of a stimulating character, exciting the mind, and adding strength to the muscular system, suc- ceeded, sooner or later, by a drowsy or lethargic state, which, if the quantity has been too large, or an idiosyn- crasy exists, may prove poisonous, and terminate fatally. The quantity having been great, the stage of excitement has been considered wanting, or of so short duration as to escape notice, and stupor or insensibility soon appears. The breathing is slow, sometimes stertorous, the pulse generally weak and irregular, the muscles are relaxed, the face pale and tranquil, and the body usually bathed in a copious perspiration. The pupil is generally contracted. The operation of solid opium is generally thought to dis- play itself within an hour, and that of laudanum or other liquid preparation sooner. Death may occur in from four to ten or eighteen hours. Treatment.—There being no antidote to opium, upon which perfect reliance can be placed, the first step is to expel it from the stomach, and, as one of the effects of this narcotic is to render the stomach insensible to the action of remedies, it is necessary to administer unusually large doses of emetics, as thirty or forty grains of white or blue vitriol, tablespoonful doses of ipecacuanha, or mustard and salt, or indeed of any article which is at hand calculated to effect the object. It is frequently necessary to administer still larger doses of these emetics as injections where swallowing cannot be performed, or when vomiting does not soon occur. It is often for the same reasons necessary to resort to the use of the stomach-pump. GONORRHEA. 291 The stomach having been thoroughly emptied of ite contents by powerful vomiting, we must guard against and remove the subsequent effects proceeding from a quantity of opium having remained in the stomach some time, as drowsiness, torpor, or insensibility, by keeping the patient awake by the application of mustard and cayenne pepper, or other irritants, to different parts of the body, keeping him in motion, and in some cases switching with a number of twigs. It is probable, in this stage, the moderate appli- cation of cowhage to different parts of the body would, by its intense action, answer perfectly. Throwing bucketfuls of cold water repeatedly over the body, is a valuable remedy. Moderate quantities of a powerful stimulant and excitant may be given occasionally, and eight or ten drops of ammonia, with thirty or forty of the tincture of cayenne, or a few grains of the powder mixed with the ammonia and water, will answer. It is well to remember, that after the unpleasant symptoms, as well as all apparent danger, have been removed, the individual doing well, he should be watched closely, instances having occurred under similar circumstances where a renewal or relapse of the comatose symptoms has taken place, and terminated in death. In cases of poisoning from narcotics, as opium, after the respi- ration has been suspended, the action of the heart will be found to continue, though exceedingly weak, for some time, hence the necessity, in such cases, of continuing our endeavors to keep up artificial respiration, as the experi- ments of Sir B. Brodie fully prove that the restoration of the action of the lungs can be effected by such a course. The fact of a recovery having been effected by Mr. Whatcley, of a man poisoned by a large dose of solid opium, by long-continued artificial respiration, adds double value to the above opinions of Sir B. Brodie. GONORRHOEA. This disease commences with an itching or tingling sen- sation at the orifice of the urethra, which becomes slightly red and swollen, in consequence of the inflammation; this is succeeded by a constant desire to pass water, attended with scalding or burning, frequently severe. There is often considerable soreness along the under part of the 292 DOMESTIC MEDICINE. penis, extending its whole length. Generally, within two or three days, there is observed a discharge proceeding from two or three inches of the membrane lining the ure- thra from the external orifice, at first whitish, subsequently of a deeper-colored matter, becoming, when the disease is violent, yellowish or greenish, and, at times, slightly tinged with blood. The glans, or head of the penis, and the pre- puce, or foreskin, sometimes swell considerably, and painful erections, termed chordee, occur during the night. In severe cases of gonorrhoea, a painful swelling of the tes- ticles, and considerable tenderness in one or both groins, will occasionally occur. Treatment.—At the commencement of gonorrhoea, it is of importance to operate freely upon the bowels, and for this purpose, the different saline laxatives are recommended. There is no one superior to Epsom or Rochelle salts—one or two tablespoonfuls in a tumbler half full of water,—and great benefit results from a repetition, every one or two days, of a small portion of the same, or one or more Seidlitz powders, to keep up a cooling effect upon the system. The use of some mild diluent drink has always been considered necessary in the treatment of gonorrhoea; Sir Astley Cooper, and other eminent medical authorities, are of opinion that too much cannot be drank. For this pur- pose, flaxseed tea, or elm bark, or pith of sassafras, infused in hot or cold water, answers well. The following I have found the most serviceable : Juniper berries, five ounces; cream of tartar, two ounces; supercarbonate of soda, one ounce; to be well bruised and mixed. Upon two table- spoonfuls of this mixture pour one pint and a half of boil- ino- water: allow it to stand a few hours, when it will be ready for use. All of the clear liquid should be taken during the day, and sweetened, if preferred. Ricord, and others, allude in strong terms to the advantage resulting from perfect rest, -particularly during the inflammatory The diet should be plain, diminishing the usual amount of animal food, avoiding greasy, rich, or spicy food, as well as stimulating drink of every description. To allay the irritability of the bladder and urethra, as well as to remove the scalding in making water, a small GONORRHEA. 293 quantity of supercarbonate of soda, half a teaspoonful, dis- solved in a half-tumblerful of water, to which should be added one teaspoonful of sweet spirits of nitre, and re- peated three or four times a day, will generally prove suc- cessful. There are cases in which the chordee occurs so frequently and so violently during the night, as to resist almost every remedial agent; should such occur, the following pills will generally succeed : Powdered camphor, twenty-five grains; powdered opiumr five grains; ipecacuanha, six grains; to be mixed, and made into ten pills. Two to be taken on going to bed. Cleanliness in this complaint cannot be too strongly insisted upon. The penis should be bathed two or three times a day in cold water, to which a tablespoonful of common salt may be added, this tends to lessen and remove the inflammation of the urethra, and prevent the painful nocturnal erections. It is important to remember, that after each bathing of the penis, or whenever it may be handled, it is necessary to wash the hands before wiping them on a towel, as many serious cases of inflammation of the eyes, and loss of sight, have resulted from a neglect of this pre- caution. • Gleet is a discharge from the urethra, caused by a dis- eased condition of the mucous membrane, after the subsi- dence of the inflammatory symptoms "of gonorrhoea. It is generally unattended by pain or scalding in making water, although, even in this chronic stage, any great irregularity, or excess in eating or drinking, or sexual intercourse, will often produce a frequent desire to pass water, with a slight scalding and increase of discharge. For the cure of gleet, no remedy has succeeded so uni- formly and speedily as the Extract of Copaiva, Sarsapa- rilla, and Cubebs, with the daily use of one or two Scidlitz powders. For obstinate cases of gleet, the following has been ad- vantageously used in connection with the extract:— R._Iodine gr. x ; iod. potass. 3iii; dissolved in a bottle of the tonic extract of sarsaparilla. Dose, one or two tea- spoonfuls four times a day. r 25* 294 DOMESTIC MEDICINE. A cold bath of salt and water applied to the penis twice a day, exerts a beneficial influence. In the latter stage of gonorrhoea, or, after the subsidence of the acute symptoms, and especially in gleet, the use of mild injections has been strongly recommended, and there can be no doubt of their contributing to remove that chronic inflammation, upon the existence of which depends entirely this local discharge. The following are the most serviceable injections :— Sulphate of zinc, twenty grains; wine of opium, two drachms; rose-water, eight ounces. Alum, sixteen grains; wine of opium, two drachms; rose-water, eight ounces. "Nitrate of silver, two to four grains; rose-water, eight ounces. Sugar of lead, fifteen to twenty grains; rose-water, eight ounces. Ioduret of iron, three grains; distilled water; six ounces. Injections should be used from three to five times a day. Great benefit results from the use of injections of flaxseed tea, or the infusion of elm bark, or pith of sassafras, adding fifty or sixty drops of wine of opium to the half pint, at the commencement of the disease. The occasional introduction into the urethra of a metallic bougie, smeared with mercurial ointment, has frequently proved serviceable. Ricord says, " During the continuance of a gonorrhoea, the patient must never be allowed to expose himself to the least fatigue, without wearing a suspensory bandage." SWELLED TESTICLE. A painful swelling of one or both testicles, attended with inflammation, frequently sudden in its attack. There is commonly severe pain in the loins. Although generally resulting from an excessive irrigation nTthe urethra, from gonorrhoea, or the use of too powerful injections for the cure of that disease, it may be produced by blows, or by a cold attacking those parts. Treatment.—When severe, with considerable febrile ac- tion, bleeding from the arm will be proper. In ordinary cases a few leeches applied to the part, followed by warm SYPHILIS, VENEREAL DISEASE. 295 emollient poultices, repeated doses of salts and magnesia, to which has been added a few grains of tartar emetic to pro- duce nausea and -relaxation of the system, will generally effect a cure in a few days. If possible, the person should be confined to bed, and under no circumstances should he get up, without wearing a suspensory bandage. In the commencement of an attack, a powerful emetic has fre- quently arrested its further progress. Nothing but mucila- ginous drinks should be allowed during the painful period of a swelled testicle. The inflammation and pain having been subdued, the frequent use of mild anodyne and stimu- lating linimente is serviceable to remove the hardness of the testicle which generally follows. One of the best is a mixture of soap liniment and laudanum, or sweet oil, spirits of camphor, and laudanum. SYPHILIS, VENEREAL DISEASE. This commences with one or more chancres, small sores with a hard base, and rather prominent margin, on the inner side of the prepuce or foreskin. There is frequently considerable swelling of the foreskin, which renders it dif- ficult to draw it back and expose the sores. If not arrested in its progress, there occurs an inflammation, with enlarge- ment of the glands in the groin, bubo, apt to proceed rapidiy to suppuration. In neglected cases of long standing, or when not thoroughly cured, the throat becomes affected, and the lining membrane of the bones, as well as the bones themselves, become diseased. Treatment.—Upon the first appearance of a chancre, it should be touched with a stick of lunar caustic, or a strong solution, to destroy the specific poison, and reduce it to a common sore, after which, the black or yellow wash may be poured upon the sore, two or three times a day, and then covered with simple cerate, or Turner's cerate, spread upon old linen. The black wash is made by putting two to four drachms of calomel, in eight ounces of lime water, and the yellow wash, from five to twenty grains of corrosive subli- mate in the same quantity of lime water. When the fore- skin cannot be drawn back, it is proper to inject under it Castile soapsuds, and then the yellow, or black wash, several 296 DOMESTIC MEDICINE. times a day. If the chancres do not speedily heal, three to five grains of blue pill, combined with half a grain of ipcac, and a quarter of a grain of opium, must be given two or three times a day, until the gums become tender, or the chancre heals, when the mercury should be disconti- nued. The bowels should be acted upon pretty freely, for a week or two, by moderate doses of rhubarb and magnesia, salts and magnesia, or sulphur and magnesia, and at the same time the patient must take a tablespoonful of the fol- lowing mixture, three times a day, for several weeks. Iodin. 9i; iod. potass. Jiv; syr. ipecac, giss; syr. rhei giss; extract sarsaparil. gxiij. Upon the first appearance of a bubo, besides continuing the above remedies, twenty or thirty leeches should be ap- plied to the part, after which, a blister is to be put on, and renewed every few days, or dressed with a stimulating oint- ment, as the savin, or a mixture of basilicon, and Spanish fly ointment. If suppuration occurs, the matter must be let out by a free puncture with a lancet, as soon as dis- tinctly felt, and the part dressed with a warm bread-and- milk, or flaxseed-meal poultice, for several days, after which, simple cerate, or Turner's cerate, spread on linen, may be used. The sore not healing, a weak solution of bluestone should be applied to it, once or twice a day, and dressed with either of the above ointments. A moderate diet, and keeping the bowels open, are important during the course of this disease. After the symptoms of this disease have disappeared, the use of the iodine and sarsaparilla prepa- ration above given, should be continued for weeks, to pre- vent the possibility of a reappearance of any of the secon- dary symptoms, which are of frequent occurrence. Should this companion and friend prove the means of alleviating the suffering incident to sickness, and conduce to the restoration of health, acknowledged to have been effected by the former editions, the time and labor ex- pended in its preparation will be considered well employed. EDWARD JENNER COXE, M.D. INDEX. Abscess, 123. Abstinence, 120. Almond milk, 25. Aloes, 25. Alum, 26. burnt, 26. gargle, 26. poultice, 26. Ammonia water, 27. Antacids, 27. Anthelmintics, 96. Antidotes, 27. Antiphlogistic regimen, 112. Antispasmodics, 28. , Aphtha, 124. Apoplexy, 125. Arrow-root, 28. Arsenic, 28. Assafoetida, 29. Astringents, 29. Asthma, 126. Balsam copaiva, 30. Turlington's, 30. Bark, Peruvian, 30. and snake-root tea, 31. Huxharn's tincture, 31. Basilicon, 31. Bathing, 129. J3eef essence, 31. tea, 32. Bismuth oxide, 32. Blackberry root, 32. Black wash, 32. Blisters, 32. Bleeding, directions for, 117, Blue pill, 34. vitriol, 34. Boils, 131. Boneset, 34. Brain, compression of, 132. concussion of, 133. Brandy mixture, 34. Broth, oyster, 34. Brown mixture, 34. Bruises, 263. Burgundy pitch, 35. Butter, oil of, 35. Burns, 264. Calomel, 35. Camphor, 35. spirit of, 35. Carrot, 36. Castor oil, 36. Catarrh, influenza, 133. Catechu, 36. Cathartics, 37. Cayenne pepper, 37. gargle, 38. Cerate, Goulard's, 38. simple, 38. Turner's, 38. Chalk, prepared, 38. mixture, 39. ChamomHe, 39. Chia seed, 39. Chicken pox, 136. Chilblain, 136. Chloroform, 40. Cholera morbus, 137. Asiatica, 139. Clysters, 40. Cod-liver oil, 42. Colic, 155. painters', 158. 298 " INDEX. Columbo, 42. Constipation, 160. Consumption, 163. Convulsions, 167. Cooling mixture, 45. Corns, 168. soft, 169. Corrosive sublimate, 45. Cough mixture, 45. Cowhage, 46. Cramp in stomach, 169. Cream of tartar, 46. lemonade, 46. Croup, or hives, 170. Cubebs, 46. Dandelion, 46. Demulcents, 47. Diaphoretics, 47. Diarrhoea, 178. Dietetics, 48. Disinfectants, 49. Dislocations, 265. Diuretics, 49. Dover's powder, 50. Drinks, 50. Drowning, 268. Dysentery, 179. Earache, 183. Ecchymoses, 184. Effervescing mixture, 51. Egg flip, 51.. Elixir of vitriol, 51. Elm bark, 51. Emetics, 52. Emmenagogues, 53. Errhines, 53. Erysipelas, 185. Escharotics, or caustics, 53. Ether, sulphuric, 54. Exercise, 113. Expectorants, 54. Fainting, 187. Felon, 260. Fever, 188. intermittent, 188. remittent, 190. scarlet, 192. yellow, 195. Fever powders, 54. Flaxseed, 54. tea, 55. Food, heallhfulness of, 108. Foreign bodies in gullet, 270. respiratory organs, 271 Fractures, 272. Fruit, 55. Galls, 56. ointment, 56. Gamboge, 56. Garlic, 56. syrup, 57. Gentian, 57. tincture, 57. Gonorrhoea, 291. Gray powder, 57. Gruel, corn, 57. oatmeal, 57. rice, 58. sago, 58. Guaiacum tincture, 5S. Dewees', 58. volatile, 58. Gum ammoniac, 59. Arabic, 59. water, 59. Hanging, resuscitation from, 2TC». Hartshorn, spirits of, 59. Hemorrhage, 199. leech-bites, 200. lungs, 200. nose, 203. stomach, 205. urinary organs, 206. Headache, 197. Hemorrhoids, 207. Heartburn, 198. Hiccough, 108. Hiera picra, 60. Hive syrup, 60. Hydrophobia, 209. Hygienic maxims, 103. Inflammation, bladder, 215. brain, 216. eye, 217. kidneys, 219. larynx, 219. liver, 222. lungs, 224. peritoneum, 226. pleura, 227. stomach, 229. throat, 230. INDEX. Inflammation, tongue, 232. Inhalation, medical, 60. Ipecacuanha, 72. syrup, 73. wine, 73. Iron, 73. carb. precipitated, 73. Issues, 73. Itch, 234. Itching, pruritus, 234. Jalap, 74. Jaundice, 235. Jellies, 75. Kino, 75. Laudanum, 75. Lavender, spirit of, 75. Lead, sugar of, 76. Goulard, extract of, 76. water, 76. Liniment, soap, 76. volatile, 76. Liquorice, 77. Logwood, 77. Lunar caustic, 77. Magnesia, 77. Measles, 237. Medicine, practice of, 123. Mindererus spirit, 78. Moss, Iceland, 78. Irish; Carrageen, 78. Mumps, 240. Mustard, 79. seed, 79. poultice, 79. Myrrh, tincture of, 79. Narcotics, 80. Nettle rash, 241. Neuralgia, 241. Nitre, sweet spirits of, 80. Oak bark, 80. Ointment, citrine, 81. mercurial, 81. red precipitate, 81. sulphur, 81. Onion syrup, 81. Opium, 82. Ophthalmia, 217. Opodeldoc, 82. Orangeade, 82. Oxalic acid, 83. Panada, 83. Paregoric, elixir, 83. Parsley, 84. Pectoral drink, 84. Pennyroyal, 84. Pink root, 84. Plaster, adhesive, 84. lead; diachylon, 85. mercurial, 85. strengthening, 85. spice, 85. Pleurisy, 85. Poisons taken into the a 285. Poultice, emollient, 85. charcoal, 86. yeast, 86. Pride of China, 86. Prolapsus ani, 244. Pulse, 117. Quassia, 87. Quinine, sulphate of, 87. Quinsy, 230. Rennet, 87. Rheumatism, 245. Rhubarb, 87. syrup of, 87. parched, 88. spiced, 88. tea, 88. tincture, 88. Rubefacients, 89. Rules, specific, 110. Salivation, 91. Salt, common, 89. Saltpetre, 90. Salts, Epsom, 90. and magnesia, 90. Glauber, 90. Savin, 90. Scurvy, 248. Senna, 91. tea, 91. and prunes, 91. Setons, 73. Sialagogues, 91. Small-pox, 250. 300 INDEX. Snakeroot, senega, 92, Virginia, 93. Soda, supercarbonate, 93. Splints, 93. Squills, 93. Sudorifics, 93. Sun-stroke, 253. Surgery, 263. Syphilis, 295. Tapioca, 93. Tartar emetic, 94. Testicle, swelled, 294. Tetanus, 253. Tobacco, 94. Toe-nail, inverted, 279. Tonics, 94. Toothache, 256. Turpentine, oil of, 95. Ulcers, 280. Urine, incontinence of, 256. retention of, 256. suppression of, 258. Vaccination, 121. Valerian, 96. Venereal, 295. Vermifuges, 96. Voice, loss of, 259. Warner's cordial, 97. Wash, black, 32. Wash, yellow, 102. Water, 97. apple, 98. barley, 98. compound, 98. chicken, 98. lime, 98. rice, 99. sea, 99. sedative, Raspail, 99. tamarind, 100. tar, 100 toast, 100. Watermelon seeds, 100. Whey, 100. White vitriol, 100. Whitlow, 260. Wine, 101. antimonial, 101. whey, 101. Wormseed, 102. oil, 102. Worms, 260. Wounds, 281. contused, 281. incised, 282. lacerated, 282. poisoned, 282. punctured, 283. of ear, 284. face, 284. scalp, 285. Yellow wash, 102. us... • '» ■.-r.'ii