life/: WW ill ■< '■ '■ I/V k -■ kRY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATION I MEDICINE NATION HVign IVNOIIVN 3NI3IQ3W JO A II V II a I 1 IVNOIIVN 3NI3I03W JO A II V II 8 II IVNOIIVN 3NI3IO t5* ^ «fcff'' i A/ i IY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATION \\ ITHII l»NOII»N 3N I 3 10 3W JO AllVHan 1 VNOIIV N 3N I 3 103 W JO AHV1I8 II TVNO II VN 3NI3I0 %FV \ i, i \ ARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATION 3NAL LIBRARY OF MEDICINE NATIONAL LIBRARY ( ;e given. Unquestionably the best method of treating an intermittent con- sists in giving an emetic during the intermission, (say gr. xxx. of ipecac,) and should this not have a cathartic effect, to administer some thorough opening medicine, which should be done in time to give the sulphate of quinine. Quinine should not be administered at random during the intermission, but in such a way and at such periods preceding the fit, as most effectually to counteract its impulse. Two grains every hour, should be given, beginning seven or eight hours, before the expected chill. The object of this is to set up in the system such an impulse as shall effectually resist the periodic depression. A grain or two of the extract of Colombo or Gentian combined with the quinine will be found an important, adjuvant. As the chill is wont to return about a week from the last paroxysm, 'the tonic pills should be repeated in the same manner, and at the same period of the day. And this should in some obstinate cases, be repeated, during two or three Aveeks, at the same interval of time. Should there exist a strong tendency in the patient to a repetition of the chills after they have been once broken up, it would be advisa- ble for him to change his place of abode, though the distance should be ever so short. As it regards blood-letting, it rarely if ever is ne- cessary or advisable in any stage of an intermittent. Emetics during ?2 170 INTERMITTENT, OR AGUE AND FEVER. the cold stage have been found serviceable. Six grains of tartar emetic to two quarts of warm water, divided into four parts, and one part given every ten minutes till it operates freely. It produces a free discharge of bile and when the hot stage comes on, it purges actively. Cases have occurred in which the paroxysm consisted of a succession of chills without being followed by a hot fit. The cold bath during the intervals and cordial tonics during the fit, succeeded in curing the patient. During the hot stage, the following medi- cines will be found beneficial: spirits of Mindererus half an ounce, every half hour, or at the same interval, ten grains of salt of tartar in a table spoonful of vinegar. Also ten grains of nitre with one- sixth of a grain of tartar emetic, or with one grain of ipecacuanha. The most suitable drinks will be, warm camomile or bone-set tea. Also lemonade. A drink made acid with a little elixir of vitriol. Barley-water with vinegar. A drachm of nitre in a pint of linseed tea. James' powder, four grains, with one-eighth of a grain of opium assisted by warm drink given every hour will prove of great service. We are aware that the propriety of blood-letting has had warm advocates both in the cold and hot stages of intermittents. But we repeat that rarely, if ever, will this measure be found neces- sary or beneficial. Its apparent advantage will be more than coun- teracted by the debility resulting from it. When great debility exists, and the disease is of a veiy obstinate character, the following combination will prove beneficial: Powdered cinchona two scruples, salt of tartar twelve grains, Vir- ginia snake-root twelve grains. This should be taken every hour for seven or eight hours. One tea spoonful and a half of the following may be taken every third hour—powdered bark and cream of tartar of each one ounce, with cloves pounded thirty in number. Five grains of camphor, with a drachm of bark in powder—Or three grains of carbonate of ammonia writh one drachm of bark in powder will be found very beneficial when the system requires support. When there is disease of the liver, one grain of calomel, night and morning, should be given to keep the bowels gently open and to affect the mouth. When the stomach is out of order, indicated by a sense of heavi- ness, tightness of the chest, and sickness of stomach, an emetic should first be administered, followed by a purgative, and then the bark in form of an enema. Salt of tartar fifteen grains, with ten drops of laudanum may be given in a table spoonful of vinegar, every two hours. When cough is combined with ague, blisters to the breast, linseed tea, decoction of mallows, mucilage of gum arabic will be beneficial. Regimen.—As to regimen in the cold fit, very little more is ne- cessary than warm camomile tea. In the hot fit, the drink may be barley water, mint or balm tea, lemonade, toast and water, or cold REMITTENT, OR BILIOUS FEVER. 171 spring water, taken often, but in small quantities at a time. When the sweating begins, the drinks just enumerated may be enlivened with wine, and if the patient be able to take it, he may be allowed a little nourishment. During the intermission, the diet should be as nutritious as the patient's appetite and digestion will allow. Every thing that tends to keep up a gentle perspiration, and to give tone to the vessels is useful; hence moderate exercise is singularly proper, since nothing is more conducive to these beneficial effects. The exercise should be of that kind to which the patient has been most accustomed; and taken in the open air, unless wet weather, or a damp situation forbid. But the utmost care should be taken, that exercise be not pushed to fatigue, which, by inducing debility, car- ries thousands, particularly foreigners, to untimely graves. REMITTENT, OR BILIOUS FEVER. Symptoms.—In this fever there is a remission or abatement of its violence, but not a total cessation. Like other fevers, it com- mences with a sense of coldness and shivering, accompanied by violent pains in the head and back, great dejection of spirits, sick- ness at the stomach, giddiness, loss of strength, and difficulty of breathing. The cold stage is succeeded by a considerable degree of heat, the pulse, which in the cold fit was small and quick, becomes full, but abates not of its quickness. The pain of the head and back increases, and the nausea is augmented, frequently terminating in copious vomitings of bile. These symptoms continuing, the skin, which had hitherto been hot and dry, becomes moist. Soon after this, the symptoms abate, and sometimes cease entirely. The pa- tient flatters himself with the hopes of health speedily returning; but, alas! these pleasing illusions, are soon dissipated by another attack, which comes on with increased violence. And if the fever be not opposed by means early employed and sufficiently powerful, a constant delirium and restlessness take place; the discharges be- come very offensive, succeeded by twitchings of the tendons, profuse clammy sweats, and convulsions which soon terminate in death. Causes.—Remittents are produced from the same causes which induce intermittents, but acting here in a more powerful manner. Like these, they are most prevalent in the months of August, Sep- tember, and October, when heat and moisture combine to hasten the corruption of animal and vegetable substances, by impregnating the air with noxious exhalations. 172 REMITTENT, OR BILIOUS FEVER. Treatment.—In the cure of this fever, all our efforts should be made to bring the remission to a complete intermission: and this is to be effected by bleeding, cathartics, emetics, and diluents, with such medicines as have a tendency to solicit the circulation of the fluids to the surface. At the commencement of the disease, where there exists much pain in the head, with a hard and quick pulse, bleeding will be necessary, and may be repeated if the symptoms do not yield to the first operation. But to evacuate the first passages of their impure contents is always necessary; and this is best done with calomel and jalap, or salts, senna and manna, and when cir- cumstances do not prohibit the use of emetics, they, also, may be employed. The extent to which these means are to be carried, can only be indicated by the symptoms present, the habit of body, and other considerations. It. will, in many cases, be proper to exhibit an emetic at the first attack, but this may sometimes be forbidden, by great irritability of the stomach, or the appearance of inflamma- tion. For frequently in diseases of the same origin, and in persons very nearly similar, with respect to age, sex, and temperament, one will frequently be accompanied with an inflammatory diathesis, whilst another will be more of the low, irritable species; and, con- sequently, the treatment must be varied, in proportion to the nature and violence of the disease. For among fevers, we see all the in- termediate degrees and varieties, from common agues to those of the most violent and infectious kinds. If the patient be of a strong plethoric constitution, with a hard and quick pulse, a deep-seated pain in the eyes, a burning heat at the stomach, and flushed countenance, indicative of strong inflam- matory disposition, bleeding is absolutely necessary, and should be repeated every ten or twelve hours, or oftener, until the inflammatory symptoms subside. The necessity of diligently evacuating the intestinal canal, must be obvious to every person. And it is not always by one or two brisk cathartics that this complaint is to be cured; but the operation must be continued until the whole of the bilious matter is evacuated, which may be known by the faeces changing their colour and put- ting on a natural appearance. When the irritating matter is thoroughly evacuated, mild laxatives, as the cathartic mixture, (see Dispensatory,) Seidlitz powders, or castor oil, answer very well in the course of the disease to keep the body gently open ; but in des- perate cases calomel is most to be depended on. And if a ptyalism, or a slight salivation be excited by the calomel, the patient has no cause of alarm, but rather of joy, as this is a certain indication of recovery. How desirable, then, must it be in high stages of bilious fever, to have this effect produced as early as possible, by giving calomel, and rubbing in mercurial ointment, and dressing the blisters with the same. Besides the aforesaid evacuants, clysters of warm soap-suds, or molasses and water, to which may be added a little vinegar, should REMITTENT, OR BILIOUS FEVER. 173 be employed; as they are not only useful in removing from the larger intestines any offending matter present, but also in producing the good effects of fomentations. Attention having been paid to the state of the bowels, which is always necessary because of the constant disposition to accumulate bile, such medicine as tend to determine the fluids to the surface, are next to be regarded. Of this class are the diaphoretic drops, sa- line mixture, Mindererus' spirit, febrifuge and Dover's powder. (See Dispensatory.) Either of these may be exhibited in their usual doses, every two or three hours; but in desperate cases the antimo- nial powders with calomel, or calomel alone, in small doses, are most to be relied on. The warm bath admirably promotes insensible perspiration, by relaxing the skin, and taking off the stricture of the vessels; it, con- sequently, should always, when practicable, be used, and if a bathing vessel cannot be procured, the extremities should be immersed in warm water at least once a day. The temperature of the bath, should be regulated by the feelings of the patient, and that which affects these most agreeably, should be preferred. The cold affusion, by throwing cold water over the patient, or sponging the body with vinegar and water, has been attended with the best effects in warm climates, particularly if the application be made during the height of the paroxysm, when the head is generally affected. After the inflammatory disposition has ceased, tonics will conside- rably hasten the cure; but, if incautiously used during the fever, as unfortunately is too often the case, they will render every symptom more violent, and will almost inevitably prolong the disease. How- ever, if the patient suddenly becomes giddy, feeble and languid, quinine, or bark and wine, must be had recourse to, and given freely on the remission; otherwise it will degenerate into a true nervous fever. But we must not mistake the debility which arises from oppression, requiring evacuants, for an exhausted state of the system; as, in that case, the use of tonics would be but little better than butchery. Another medicine of great importance in this disease is the Columbo root, which readily checks the vomiting, so frequently an attendant, and supports the patient's strength during the use of such medicines as are requisite to abate the febrile heat, and to carry off the bile. After unloading the stomach and intestines, by two or three brisk purges, and diminishing the arterial action by bleeding, if requisite, a wine glass full of the infusion of Columbo root, or ten or fifteen grains of the powder may be given in a cup of mint tea, every two or three hours, either conjointly or alternately, with some gentle opening medicine, as rhubarb, magnesia, cream of tartar, or salts, to remove the redundant bile by keeping the bowels open. Salts, though a nauseous medicine, may be rendered much less 174 REMITTENT, OR BILIOUS FEVER. so by adding a little sugar, acidulated with lemon juice or sharp vinegar, as in the form of the cathartic mixture; and this is an ex- cellent aperient, to be exhibited in small doses after the vitiated bile has been removed by calomel. A solution of salts in Seltzer water, is a form still more agreeable. During this general treatment, particular symptoms will require attention. The headache, for example, which so frequently accom- panies this fever, is to be treated by applying to the head, cloths wrung out of cold water, or vinegar and water often repeated, until the malady is removed; besides which, a blister should be applied between the shoulders. As to the vomiting, that depending on the peculiarities of habit, is to be variously treated. In some I have found the saline mixture, soda powders, or infusion of Columbo, answer very well; in others, a spoonful or two of new milk, or equal parts of milk and lime- water, given eveiy hour, have had the happiest effects. A spoonful of sweet oil and molasses has proved beneficial, when vomiting is accompanied with a burning sensation at the pit of the stomach. To others, porter has afforded immediate relief. Never was there a more welcome or wonderful illustration of this, than in the case of Mrs. Carroll, consort of Daniel Carroll, Esq., of Dudington. It was my good fortune to attend this very amiable lady under a most violent attack of the bilious fever, with incessant vomiting. All the usual remedies were employed, without any good effect, which excited considerable alarm. She being in a state of pregnan- cy, and recollecting that nature sometimes furnished a cure beyond the rules of our art, I asked her if there were any article of drink to which her appetite particularly led her. "Yes, sir," replied she; " I have been craving to drink some good London porter for two days past, but I would not mention it, being under the impression you would forbid my taking it." Learning that Dr. Thornton had some of that description, I immediately obtained a few bottles, and giving her a glass of it, diluted with a little water, it acted like a charm, and, in a few weeks, I had the very great satisfaction of seeing my fair patient perfectly restored to health. The warm bath, or local applications, such as flannels wrung out of a warm decoction of camomile flowers, or mint leaves stewed in spirits, or equal parts of sweet oil and laudanum rubbed on the stomach, have done much good; and when these fail, a large blister, or a cataplasm of mustard seed, ought instantly to be applied over the region of this organ. When the stomach is in a very irritable state, the patient may frequently moisten his mouth and throat with cold water, but should drink as little as possible of any liquid. Wakefulness, or inability to sleep, will often yield to the warm bath and blisters; and when they fail, a glass or two of porter, or the camphorated julep may be given; which also failing, a dose of laudanum is proper at bed-time, provided there exist no considerable inflammatory diathesis. REMITTENT, OR BILIOUS FEVER. 175 The pain in the bowels is mostly relieved by the warm bath, or a moderate bleeding and emollient injections; to which, occasion- ally, may be added twenty or thirty drops of laudanum. If these produce not the desired effect, and the fundament be scalled from the evacuations, give clysters of milk and lime-water, composed of half a pint of each. These failing, inject every hour with cold water, and apply cloths wrung out of it, to the belly. If delirium come on in the first stage of the disease, it is to be treated by bleeding, purging, and the means prescribed above for violent headache; but, should it occur at a later period, the pulse weak and irregular, with a great propensity to sleep, besides making cold applications to the head, the body should be frequently sponged with cold vinegar and water, or equal parts of vinegar and spirits. And, should not the recollection in a few hours become more im- proved, and the pulse fuller and more uniform from this mode of treatment, it will be proper to apply a blister to the head, and sinapisms or blisters to the extremities; besides which, wine or some cordial must be allowed; and if there be a cold sweat, or coldness of the extremities, flannels wrung out of hot spirits, or spirits of camphor, ought to be applied often around the arms, legs, and thighs. On the decline of this fever, patients are sometimes troubled with night sweats, to relieve which, gentle exercise in fresh air, and the tonic powder or pills, (see Dispensatory,) or bark and elixir vitriol will be proper. The usual fatility of this fever in Washington, as well as in many sections of our country, during the last summer and fall, was suffi- cient to create alarm, and to induce the benevolent to solicit, through the medium of public prints, information, relative to the most suc- cessful mode of treatment. Although the practice I pursued last autumn, did not materially differ from that above recommended, yet I am persuaded a brief sketch of the improvement, accompanied with a few remarks, will be gratifying to most of my readers, particularly as I can state, an incontrovertible fact, not a patient who was governed by my pre- scriptions died during the sickly season ; nor was there a case of the disease degenerating into the nervous, when early application was made. This extraordinary success was the more remarkable, as the number of my patients was very considerable ; in so much, that it was impracticable to visit all of them daily, and many were attended principally by my students. Some of the indigent sick would doubt- less have followed the fate of many of the paupers who died, had I not been sensible that exhibiting medicines, without paying due at- tention to regimen would not have the desired effect; and knowing this fact, I felt it my duty to those for whom I prescribed, to have 'hem supplied with nourishment suitable to the case. In most instances, the lancet was resorted to; and with some pa- tients of robust constitutions, and inflammatory dispositions, it wa3 used freely in the early stage of the disease. 176 REMITTENT, OR BILIOUS FEVER. Aperient medicines being of the greatest importance, were fre- quently administered, and I found their salutary effects evidently increased by conjoining such as determined to the surface. Twenty grains of calomel, united with a grain of tartar emetic, or six or eight grains of ipecacuanha, were administered to an adult in the morn- ing, and followed in a few hours by an ounce of Epsom salts, or an infusion of salts, senna and manna, in broken doses. When a pre- ference was given to medicine in the form of pills, I directed two of the aperient and diaphoretic pills, (see Dispensatory,) to be given every two hours, or two of them to be taken at bed time, and the dose repeated every hour in the morning, until several copious evac- uations were produced. With infants, calomel and ipecacuanha in large doses repeated occasionally, were often found sufficient. It should be observed, with respect to aperient medicines, that though active in their operation, they do not weaken the patient, as generally supposed; for they take away the cause of at least appa- rent weakness; and we have often found patients in fevers taking bark and stimulants to support them under this apparent debility, who, after the operation of some laxative medicine, required neither. In the employment of this remedy, however, it is necessary to attend to the discharges. The nurses will often report frequent evacua- tions, and if examined, these may be found mucous and insufficient, or a watery fluid scarcely coloured. It is necessary that the stools should be truly feculent, and be continued while the discharges are dark and offensive. We'ought, therefore, not to be governed by the number of evacuations; but by the effects and the patient's feelings. If he be relieved after each stool, and the pulse become softer, the hand more moist, and the head less loaded, he need not be appre- hensive, however violent the discharge. On the contrary, if the pulse become smaller and more frequent, the face sink, and faintness come on, however little the discharge, it has been too much. In some cases, emetics were employed with very good effects. They greatly contributed to relieve congestion in the liver, and were also useful in determining to the skin as well as carrying off the bile. When purgatives were not requisite, the febrifuge mixture, dia- phoretic drops, or antimonial powders were administered in their usual doses, every two hours, with the view of promoting a gentle diaphoresis, and to assist their effects, the patient being directed to take frequent small drinks of some tepid diluting liquor. Medicines of this class, by exciting perspiration, will be found to produce most beneficial effects, in those cases where the vital energy is not dimin- ished ; but when considerable debility is present, they frequently fail of having the desired effect, and act on the bowels, producing a dangerous diarrhoea. When the fever manifested a disposition to yield, the infusion of Columbo or camomile was given, particularly after the immediate operation of laxatives; which had the effect of correcting the bile, restoring the tone of the stomach, and supporting REMITTENT, OR BILIOUS FEVER. 177 the patient's strength. And so soon as there -was an intermission of fever, or symptoms of the disease assuming the typhoid state, the bark,* conjoined with Virginia snake-root, was given in such doses as the stomach would retain, which, together with the liberal use of porter and wine, and nourishing diet, speedily arrested the disease. In some instances the nitric acid, diluted, (see Dispensatory^) was employed as a tonic with considerable advantage, particularly in delicate habits; or when there were symptoms indicating the liver to be diseased. With others, again, the solution of arsenic in the usual doses was administered with the most happy effects. The warm bath, in every instance in which it was employed, pro- duced beneficial effects; and when the luxury could not be procured, sponging the body and extremities with vinegar and water, or equal parts of vinegar and spirits, afforded great relief. A few cases occurred of patients of robust constitutions, who not only neglected the proper remedies at the commencement, but ag- gravated the disease by taking stimulating drinks or active exercise, were at length attacked with great prostration of strength, accompa- nied with cold clammy sweats, coldness of the extremities and im- peded pulse. These symptoms indicated that considerable conges- tion had taken place, which would admit of no delay. I directed the wrarm bath, and when this could not be immediately obtained, friction and flannels wrung out of hot spirits, into which red pepper and mustard seed had been infused, were applied to the extremities, and renewed as often as they became the least cold. As soon as the natural warmth was restored, blood-letting with calomel and aperient medicines was resorted to; and also blisters over the region of the liver and extremities.—It will frequently occur, in such cases, that the action of the heart is so overpowered in the first instance, that the blood merely trickles, or rather oozes, from the punctured vessel for a considerable time, being much darker and thicker than natural. Vet, wrhen a few ounces have been drawn, it usually flows with freedom, and becomes, finally, of a brighter colour. The deficiency or irregularity of heat on the surface is among the first symptoms that indicate congestive disease ; and if the skin can be restored every where to its natural warmth, a cure may be ex- pected. It is evident the warm bath, frictions of the skin, blood- letting, calomel with purgatives, and blisters are the chief expe- dients to diminish congestion; but unless these be very early resorted to, they will not succeed, so rapidly does the stage of collapse super- vene. Recovery very generally succeeds, if natural warmth be speedily restored, and a universal perspiration excited. Upon this principle is to be explained the repeated success of the practice pur- sued by some practitioners in the plague; for immediately after per- sons were perceived to be affected, and, consequently, while there was yet no arterial excitement, they were subjected to frictions by * The sulphate of quinine had not at that time acquired its present celebrity. 23 178 REMITTENT, OR BILIOUS FEVER. warm oil, in a close room, and over a brazier of hot coals, until a free perspiration took place. Some patients, in the course of the disease, were afflicted with acid eructations and heart-burn, but were relieved by magnesia, the absorbent mixture, or mucilage of gum Arabic. These medicines were also useful in giving check to watery evacuations, which some- times occuned on the exhibition of diaphoretic medicines; others, again, on the decline of fever, were troubled with pain, arising from flatulency, which required occasionally a little, mint water, ginger tea, tincture of asafcetida, or spirits of lavender. This symptom, however, seldom came on when proper attention was paid to the discharge of the bowels. In a few cases, the hiccough became exceedingly troublesome, but was relieved by taking in turns the syrup of damsons, a lump of loaf sugar moistened with brandy, tincture of asafcetida, or the camphorated mixture. When these failed, a cataplasm of mustard seed and vinegar applied over the region of the stomach generally succeeded. Strangury was another spasmodic affection that required particular attention. Although the occurrence of this system was frequently the effect of blisters, (see Suppression of Urine,) yet, in some cases, it evidently was produced from a spasmodic irritation of the neck of the bladder. And when arising from this cause, the camphorated powders, the warm bath, or injections of warm camomile tea or infusion of hops, with laudanum, proved to be the best remedies. Hemorrhages sometimes occurred, and when preceded by head- ache, the pulse full and hard, indicating an inflammatory disposi- tion, recourse was immediately had to blood-letting, followed by aperient and diaphoretic medicines; but when the discharge was at- tended with faintness, or happened at the conclusion of fever, the bark, elixir vitriol, or nitric acid, with cold drinks, were prescribed. Nitre, in doses of ten grains every hour or two, in a glass of cold water, as well as cold applications near the parts affected, were em- ployed, in both cases, with evident advantage. Longings for improper food and drink, with some patients, were exceedingly troublesome. On the decline of fever, when this symp- tom did not arise from the caprice of the moment, and the patient anxiously craved any particular food or drink, it was allowed not only with impunity, but considerable advantage. Those cases in which I was consulted after the typhoid state of fever had come on, as manifested by a disturbed state of the brain and nervous system; showing itself in frequent sighings, wandering delirium, watchfulness or irregular and interrupted sleep; charac- terized, also, in the more advanced stage of fever, by a deranged state of the secretions and excretions, attended with a brown or black state of the tongue, and a cadaverous and offensive smell of the whole body, my attention was drawn to support the patient's strength by supplying him with nourishing diet, and giving stimulants, both REMITTENT, OR BILIOUS FEVER. 179 diffusable and permanent, as recommended under the head of Ner- vous Fever. Attention was also paid to the state of the bowels, and their offen- sive contents were evacuated daily, not by active purges, which, in this exhausted state of the system, would destroy the patient, but by injections, and the occasional use of small doses of calcined magnesia alone, or conjoined with a few grains of rhubarb. I was no less attentive in having the offensive materials which were constantly excreted by the skin, removed by wiping the body and extremities twice a day with a cloth wetted with equal parts of vinegar and spirits. Care was also taken to have the sheets and linen of the patient frequently changed. By perseverance in the means above stated, several persons, whom I was called to visit at the latter stage of the disease, recovered under the most unpromising circumstances. One case particularly deserves to be noticed, in order to show the impropriety of giving up a patient while there is life. Mrs. Lund Washington lingered under this disease, upwards of six weeks, before application was made to me, and learning she had been given up by her physicians as a hopeless case, I was unwilling to attend; but from the earnest solicitude of her son, Mr. Peter Washington, I consented, provided the medical gentlemen who at- tended her would meet me. From some cause or other, neither of the physicians appeared at the hour appointed, and as there was no time to be lost, I took the liberty of prescribing in their absence. I found her in a state of excessive debility, and on examining her mouth, the tongue was covered with small white blisters, and gums with a foul sordes, accompanied with a cadaverous breath. Her bowels were in a very irritable state, and from the acuteness of pain she occasionally felt in them, caused her to scream out in a most lamentable manner. The state of her mouth readily induced me to ascribe the affection of her bowels to the swallowing of some putrid matter, and notwithstanding her extremely debilitated state, I deemed it necessary to direct a table spoonful of castor oil to be given, and its operation encouraged by injections of soap-suds. At the same time, her strength was supported by arrow-root, made palatable by a plentiful addition of wine and nutmeg. I directed, also, fresh char- coal powder to be given in doses of a spoonful every two or three hours, which produced most beneficial effects, as the distressing symptoms soon yielded. On farther examination, I found one side of the hip and lower part of the back in a gangrenous state. To arrest this, poultices of charcoal and bark were frequently applied, and as soon as a bathing vessel could be procured, a strong decoc- tion of red oak bark prepared, she was taken up in a sheet and bathed daily, from thirty to sixty minutes at a time. The number of blisters which had bee^ applied, together with the large ulcers in her back, occasioned great pain in bathing, as well as in moving her from one sheet to another: but, notwithstanding this, as her stomach 180 REMITTENT, OR BILIOUS FEVER. would not retain a sufficient quantity of either bark or nitric acid, I had the bath continued about three weeks, which, together with the most nutritious diet and a plentiful use of wine, porter, and other stimulants, her general health was so far improved as to re- quire little or no attention except to the ulcers. These, after the mortified parts had sloughed off, were very deep and extensive, exposing the bone, and requiring more attention than I was able to give. I therefore requested the surgical aid of Dr. Bailey Washing- ton, and by the skill and attention of this gentleman, those ill- conditioned ulcers were healed in a few weeks. And I am happy to add, this most amiable lady is now restored to perfect health, to the exceedingly great joy of her affectionate family and numerous friends. Regimen.—With respect to regimen, the food and drink should be varied, and adapted to the taste of the patient. Nature, perhaps, generally takes care that no error shall be committed in that way, during the continuance of this disease. The patient is seldom per- suaded to swallow any thing but liquids, during the prevalence of the fever; and if by accident he should have an inclination for something more solid, arrow-root, sago, corn, or rice, gruel, mush, panado, custards, roasted apples, oranges, grapes, or other mild ripe fruits are all that should be allowed. To allay the thirst, barley or rice-water, apple-water, tamarind-water, molasses and water, toast and water, or cold spring water, lemonade, raspberry or currant jelly, dissolved in water, mint or balm tea, acidulated with lemon juice, or other pleasant acids, may be given with great benefit, in frequent, but small quantities. These cooling drinks not only quench thirst, but also tend to excite perspiration. Washing the face and hands of the patient, from time to time, with vinegar and water, is always refreshing. The room should be somewhat darkened, and kept moderately cool, by a constant suc- cession of fresh air; taking care, however, that the current of the wind be not immediately directed on the patient. The covering of the bed ought to be such as is found most comfortable, and the body kept, as nearly as possible, at rest. When the fever subsides, and the patient regains a desire for food, it will be best, in addition to the mild articles of diet already mentioned, to begin with puddings of various kinds, newly laid eggs, boiled soft, soups with vegetables, raw oysters, &c, resuming his diet gradually, as he finds his health return. To keep up the tone of the system, a moderate use of genuine wine, or porter diluted, or brandy, or rum and water made weak, will be proper; at the same time paying due attention to air, cleanliness, and exercise. Thus have I detailed, in the clearest manner, according to my experience, the best curative means of this, the most prevalent and dangerous of all our southern maladies. It is, however, much easier to prevent than cure diseases; and, in order to the first, I will point REMITTENT, OR BILIOUS FEVER. 181 out the general means which have been found conducive to this great end, and which constant experience has sanctioned. When the symptoms are malignant, attended with coma, stertor, syncope, stupor, convulsions, great debility, hippocratic countenance, or intermitting pulse, &c, and threaten sudden death, the bark is to be given in large quantities. Eight or ten grains of quinine every two or three hours, in desperate cases may be ventured. When there is pain in the breast or head, the bowels should be kept open with calomel and jalap. And if the pulse be full and frequent, with apoplectic, or comatose symptoms, bleeding may be cautiously at- tempted. Excessive diarrhoea should be restrained from the danger of debility. Where the paroxysms are protracted, violent, and run into each other, or are attended with coma, these symptoms are to be relieved by one ounce of Epsom salts and half an ounce of bark divided into four portions, and one taken every two hours. If there be present, syncope and excessive weakness, wine and bark should be given. In such cases large doses are necessary: half an ounce of bark or seven or eight grains of quinine every two or three hours. When the pulse is small and hard, or obscure, and a clammy moisture on the skin, blisters to the head and neck will be of service. There are certain states of the system forbidding the use of the bark. These are first, ah inflammatory disposition, evinced by a small, hard, and frequent pulse, flushed face, difficulty of breathing, pains in any part of the body, general fever, sizy blood, dry skin, yellow tongue. 2d. It is forbidden by a deranged state of the liver, evinced by a pale or yellowish cast of countenance, hard and tumid belly. This to be treated by purgatives, chiefly calomel and jalap. 3d. Dropsy. In this purgatives to be relied on. 4th. Pain in the head, during the intermission. 5th. In excessive sweats—tympanites or distension of large intes- tines with air. Hectic sometimes succeeds intermittents in children with a hard and swollen belly, cough and other consumptive symp- toms. To be treated by purgatives. An excessive flow of urine follows the ague in aged people and this is to be treated with bark, wine and abstinence from vegetables. When the disease is found incurable by the ordinary means, recourse is to be had to warm water alone, with no food for two or three days, taking six or eight pounds a day. At the end of three days, give barley water with burdock tea. After this gentle tonics. The substitutes for the bark, are the broad-leafed willow Primus Virginiana. Sassafras. Persimmon. Dogwood or cornus Florida, (from which the sulphate of cornine has been obtained.) The mag- nolia grandiflora. The poplar. The boneset. The calamus, united with equal parts of bistort and ginger. The rhatany, in the dose of twenty grains of the powder, or in form of extract, or decoction. Charcoal one scruple three or four times a day. Sulphate of copper 182 REMITTENT, OR BILIOUS FEVER. one-fourth to one-half a grain four times a day. Rust of iron and iron filings have been used in old cases. All these may be combined with bark. Arsenic has been given with great success in five drop doses gradually increased. Sulphate of zinc in two grain doses, three times a day, with a little opium one-eighth to one-fourth of a grain. With regard to diet, the best is the most nourishing, the least irri- tating, and most digestible. Rice, sago, panado, barley boiled with raisins or figs, apricots, peaches, prunes, apples, mutton, beef, fowls. Broiling is the best manner of preparing animal food. Drinks proper are beer, porter, port wine with water. Lamb and veal more indi- gestible than beef and mutton. Fish improper. Flesh of old animals more digestible than that of young. Vegetable substances more difficult than animal. Vegetables, smoked and baked meats, pastry, cucumbers, melons, soup, gravies, and butter, should be avoided. Prevention.—Bark, nourishing and stimulating drinks. Camo- mile, quassia or gentian tea—avoid morning, evening and night air, hot sun, intemperance in eating and drinking, improper food. The upper story of a house to sleep in preferable. Lime should be scat- tered abundantly around the premises. All putrid matter should be destroyed. Ventilation, and cleansing of houses, warehouses, ships, hospitals, and all places of filth, important. To obviate the attack of summer and autumnal fevers, we should intercept their causes, or guard the habit as much as possible against their influence. Therefore, on visiting a warm climate where any epidemic pre- vails, the first step is to prepare the system, as much as possible, for the unavoidable change it is about to undergo; and this preparation consists in living temperately, and taking every other night, or oftener, one or two grains of calomel, or chewing rhubarb, or drink- ing molasses and water, or using sulphur in such doses as to increase the discharge by the bowels, without debilitating the system. If there prevail a fulness of habit, the loss of ten or twelve ounces of blood will also be a useful precaution. In the meantime an imprudent exposure to the heat of the sun, or night air, should be strictly avoided. Hard drinking is another cause of disease, which should be care- fully guarded against in warm climates, particularly by seamen, who of all others are, perhaps, the most inattentive to health. The same admonition applies to their sleeping on deck during the night, and cold bathing when over-heated, or in a state of intoxication, which, by suddenly checking the copious perspiration, seldom fails to bring on disease. Cold, moist air is a frequent cause of disease in warm climates; hence, too much attention cannot be paid to comfortable fires, and suiting the dress to the changes of the weather. Flannel worn next to the skin is one of the chief preservatives of health. Many people, indeed, clamour against it as tending to de- bilitate, because it creates perspiration. But this is altogether a sill) REMITTENT, OR BILIOUS FEVER. 183 prejudice; as mild perspiration, or a soft skin, so far from being hurtful, is the very habit of health. It preserves a proper medium of temperature, by absorbing the excessive moisture from the body during the day, and by preventing the effects of the cold damp air at night. Cleanliness, both in our persons and apartments, is so essential to health, as to form a leading consideration in all our views to that first of blessings. The neglect of this not only renders a man loath- some and offensive to himself, but gives rise to many of our most inveterate and fatal diseases. Among the various means used for the prevention of diseases, and for the preservation of health in general, none, perhaps, is more beneficial in warm climates, than good wine, prudently used. It increases the circulation of the fluids, promotes both the secretions and excretions, and invigorates all the functions of the body. How much is it then to be lamented, that so valuable a cordial cannot al- ways be got pure; from the avarice of selfish men, who vend, at a lowr price, tart or half-spoiled wines; and, to render them saleable, adulterate them with the most poisonous ingredients, so that they become the most insidious foes to health. The common red wines are most generally adulterated, and arti- ficially coloured, as manifested by a red sediment in the glass, as well as in the bottle. But the most pernicious of all adulterations of wine, is that of sugar of lead, or lead itself, which gives it a sweet taste: and, therefore, it ought to be remembered, that every wine of a sweetish taste, accompanied with astringent qualities, may justly be suspected to be adulterated with that noxious mineral. (See Poison.) When genuine wine cannot be procured, good old spirits are of considerable service, especially when taken in small quantities, and much diluted. These pleasant preventives, wThether under the name of grog or toddy, must, in consequence of their gently stimu- lating qualities, be particularly beneficial to persons whose lot is cast in low situations and moist air. But they should never forget, that no where is the great virtue of self-government more necessary than in their use. For, if indulged to excess, they seldom fail, whenever a predisposition to any particular disease lurks in the system, to rouse it to action. In like manner, we must have regard to a proper regulation of diet, which consists in preserving the happy medium between long fasting on the one hand, and immoderate eating on the other. Ve- getables are particularly adapted to warm climates, and, consequently, should constitute the chief part of our diet. Sweet oil, when pure, is perfectly wholesome ; but rancid oil, butter, fat, or meat the least tainted, must be wholly rejected. To those of weak habit and bad digestion, much benefit will result from a glass of the infusion of Columbo, or camomile, or cold water, every morning, on an empty stomaoh. 184 NERVOUS FEVER. Such are the general means of preserving health, and preventing diseases in a southern climate. The chief point is to avoid the ex- citing causes, and keep the bowels always moderately lax. NERVOUS FEVER. The fevers already described, and, indeed, all diseases attended with a considerable degree of morbid heat, affect in some measure the nervous system; but in this particular species, the nervous sys- tem is more immediately and more violently affected, than in any other. When a fever is once produced, from whatever cause, it sel- dom fails, by long continuance, to occasion all the symptoms which appear in the nervous or malignant fever. This fever has been described by different authors under various names; the typhus or nervous fever, the slow fever, the jail fever, the hospital fever, the ship fever, the petechial fever, the putrid fever, and the malignant fever. The first appellation it receives from its attacking the brain, and from the effects it produces on the nervous system. The second, from the slow and gradual manner in which it sometimes comes on. The third, fourth, and fifth, from their being apt to arise in jails, hospitals, and ships, when numbers of men are crowded together, and when sufficient care is not taken to have such places well ven- tilated and cleansed. The sixth, from certain spots which some- times appear on the skin of the patient3 labouring under this disease. The seventh, from the putrid state, or tendency supposed to take place in the fluids ; and the last, from the dangerous nature and ma- lignity of the fever: but they are all one and the same disease, va- riously modified, according to the violence of the symptoms, and the different constitutions of the patients. Symptoms.—The symptoms are commonly more various in this, than in any other fever. It sometimes creeps on in such a slow, in- sidious manner, that the patient will have suffered the disease to make considerable progress, before he thinks it necessary to use any remedies. On other occasions it comes on with a great degree of rapidity, and with many of the symptoms common to all fevers. Thus, it commences with alternate sensations of heat and cold, a want of appetite, a nausea, and occasional vomiting. These are fol- lowed b)^ some confusion of the head, a sense of weakness, dejection of spirits, tremour of the hands, and frequent sighing, without know- ing the cause. At this stage the pulse is irregular, sometimes a little quicker; at other times, about the natural standard. In some, a dull and heavy pain, with a sense of coldness, possesses the back part of the head; in others, a pain in the orbit of one eye. NERVOUS FEVER. 185 These symptoms gradually increasing, the pulse becomes smaller, and at the same time quicker, while the arteries of the temples and neck beat with additional force. The patient is generally more restless towards night, the breathing is somewhat difficult, and very little refreshment is obtained, from his short and disturbed slumbers. This gradual increase of symptoms, with the peculiar, pale, sunk countenance attending fever, will give the alarm, even when other nervous diseases with which the earlier symptoms have been con- founded are present. In the progress of the disease, the system is equally affected; for sometimes headache, restlessness, and uneasiness, prevail in a high degree, whilst at the same time the tongue is clean and moist; and at other times, while there is no headache, or restlessness, the tongue will be dry and foul, and profuse sweats will break out. This fever, moreover, is not only thus irregular, in affecting various parts of the body differently, but it is also irregular in its exacerbations; and these instead of taking place in the evening, will arise often in the morning. Again, sometimes the fever is very violent for the first three or four days; it then diminishes for a time, and then perhaps increases again. After, or about the tenth day, the weakness increases considerably; the whole nervous system becomes affected with tremours and twitchings; the urine is commonly pale; the fin- gers are in constant motion; the tongue becomes dry, of a dark colour, and trembles when attempted to be put out; and sometimes gums and lips are covered with a dark viscid substance. To these succeed stupor, cold clammy sweats, with a fetid smell, hiccough, and twitching of the tendons, together with an involuntary discharge of the excrements. In every malignant case, this fever tends fatally on or before the seventh day: but more frequently those who die, are carried off about the middle or towards the end of the second week. When the patient survives the twentieth day he usually recovers. When the fever terminates favourably before, or at the end of the second week, the crisis is generally obvious; but when that happens at a later period, particularly if after the third week, the favourable turn is less evident; and sometimes several days pass, during which the disease goes off so gradually, that the most experienced are in doubts whether it abates or not. At length, however, it becomes evident by a warm moisture on the skin, by the dark-coloured gluey sub- stance which adheres to the gums and lips, growing less tenacious, and being more easily removed ; by the stools regaining a natural colour; by the urine being made in greater quantity, and depositing a sediment; by a return of appetite, and by the pulse becoming slower than it was at the commencement of the disease. Deafness ensuing, tumours appearing behind the ears, a red rash, and an inflamed scab below the nose, or about the lips, are also considered favourable. The symptoms which point out the near approach of death, are a change of voice, a wild stare, a constant inclination to 24 186 NERVOUS FEVER. uncover the breast, purple or livid spots on the skin, laborious respi- ration, profuse evacuations by sweating or purging, much watchful- ness, sinking of the pulse, great incoherency of ideas, muttering, picking at the bed-clothes, considerable dilatation of the pupil of the eyes, involuntary discharges by urine and stool, starting of the ten- dons, hiccoughs, and convulsions. If many of these symptoms occur, little expectation of recovery can be entertained. Dilated pupil, a glassy, staring eye, involuntary, cadaverous, smel- ling evacuations, hiccough, cold, clammy and partial sweats, with a small weak, creeping, and tremulous pulse, anxiety, restlessness, and greasy colour of the face, or a sad expression, low muttering, or high delirium, starting of the tendons, quick speech, voice altered, con- stant watchfulness, with incoherence, stern sullenness, or unmanage- able fury of mind, picking of the bed-clothes, blindness, inability to put out the tongue, difficult deglutition, sliding down in the bed, lying on the back, drawing up the knees, insensibility, with a dis- position to uncover the breast, or frequent attempts to get out of bed, denote the approach of death. Causes.—This fever is occasioned by impure air, putrid animal and vegetable effluvia, innutritious diet, and by living on damaged provisions. We are, therefore, not surprised to find it often originate in jails, ships, and dirty dwellings, where numbers are crowded together, and where it is not possible to have sufficient ventilation. Though human contagion, and the effluvia arising from putrid animal and vegetable substances, are the most frequent and active causes of this disease, yet they cannot be considered as the only ones; for we sometimes meet with instances in a country neigh- bourhood, of persons being seized with the disease in all its malig- nity, where it is not epidemic; nor can it be traced to any place where the human effluvia could be supposed to be confined in any uncommon degree. Hence nastiness, a moist atmosphere, much fatigue, cold, depress- ing passions, scanty diet, excessive study, too free use of mercury, immoderate venery, profuse hemorrhage, or whatever weakens the nervous system, may be enumerated among the causes. Treatment.—With regard to the cure, when the inflammatory symptoms appear to run very high, the early use of the lancet will be required. It should be observed, however, if blood-letting be employed in all the various forms of typhus, without due regard to the period of the disease, the quantity of the blood drawn, the age, habit, and constitution of the patient, it will often be followed by fatal consequences. On the contrary, if it be cautiously used in the beginning of the inflammatory typhus, it will be of the greatest utility, as it will render the other means more prompt and effectual, and thereby facilitate the cure. When the lancet is resorted to, the blood should be taken away in small quantity, and from a small orifice. And as the rising of the pulse, under bleeding, is a certain indication of its propriety, so NERVOUS FEVER. 187 its sinking is as certain an indication of its impropriety; hence we have a criterion to guide us in the operation. Towards the close of most acute fevers of severity, there is some tendency to a change in the constitution of the fluids; and this may occur as soon as the second or third day, in the most malignant cases of typhus. The blood, when drawn in this state, loses its florid colour, and as it flows from the arm, exhibits a dirty, dark appearance, sometimes of a muddy blue, and sometimes of a deep black. It does not coagu- late, but continues in a dissolved state in the vessel, which induced the ancients to call it putrid. It is unquestionably very unfavoura- ble, and indicates that depletion is improper. In general it will be the safest to resort to the evacuation of the alimentary canal; therefore, on the first appearance of the symptoms, twenty or thirty grains of ipecacuanha, or four or five grains of tartar emetic, may be dissolved in a pint or more of weak camomile tea; of which the patient may drink a gill every fifteen or twenty minutes, until it excites vomiting, which ought to be assisted by drinking freely of warm water: or should any costiveness prevail, give a dose of calomel alone, or conjoined with ipecacuanha, and in a few hours afterwards, some rhubarb, Epsom salts, or infusion of salts, senna and manna, in broken doses, to evacuate the bowels of their morbid contents. Through the whole course of the disease, the bowels must be kept in a soluble state, either by some of the above medicines or acid laxatives, as cream of tartar and tamarinds, by fruits, or by clysters. Two or three stools daily may be safely borne, though if so great an evacuation should appear to debilitate, even this number should be curtailed. However, the patient should, in no case, be more than two days without a stool, for a great deal of feculent matter is produced in fever, although little food is taken, and costiveness is apt to induce an increase of heat and affection of the head, as delirium, &c. In administering purgatives, care must be taken not to employ them in such doses as would operate very copiously, as great debility might thereby be produced. So long as the alvine evacuations continue of a dark colour or unnatural ap- pearance, calomel should be given not only as an aperient, but also with a view of producing ptyalism. The alterative operation of this medicine, in the early stage of the disease, is a circumstance highly to be desired, as it equalizes the circulation, and diminishes visceral congestions. In typhus proceeding from contagion and of a malig- nant nature, very few hours should be lost in these preparatory steps; for the disease often hastens with rapidity, and the worst symptoms sometimes occur, as early as the fifth day. In the early period of the simple typhus giving an emetic, followed the next day by some active purgative medicine, have frequently cut short the fever at once; and when this desirable effect has been produced, they have hardly ever failed to shorten its duration, and to lessen its danger. Although medicines, which might excite profuse sweating, would 188 NERVOUS FEVER. be highly improper in this fever, yet those possessed of a mild, dia- phoretic power, as Dover's powders, the camphorated powders or mixture, (see Dispensatory,) the spirits of nitre, or infusion of Virginia snake-root, may be occasionally employed with advantage. The saline mixture given in a state of effervescence, every two hours, readily abates thirst, and removes the increased irritability of the system. In like manner, a table-spoonful of yeast, given every three or four hours, affords much relief, and has, alone, often proved an effectual remedy. The Rev. Edward Cartwright, having read of the power of fixed air in preserving meat from putrefying, was induced to make trial of yeast on a boy of fourteen years of age, who had been ill several days of a putrid fever, for which bark and wine had been exhibited without any apparent advantage, and where there was but little hope of recovery. He directed two table-spoonfuls of yeast to be given every three hours, which having been complied with, the boy found almost immediate relief, and recovered very quickly. Mr. Cartwright reports, that he gave the same remedy to above fifty patients in this fever, without losing one. Whatever may be the mode of action of yeast in typhus, the fact appears to be indisputable, that fixed air takes off that extreme de- bility of the stomach so conspicuously marked in disorders of this nature; and in proportion as that subsides, the pulse rises, becomes slower and fuller, the burning heat on the skin disappears, and a truce is gained for the reception of nourishing supplies. The most agreeable mode of administering yeast, is to add two table-spoonfuls of it to a quart of beer or mild porter, of which a wine glassful may be taken eveiy hour or two. According to the practice of Drs. Thomas, Currie, and Jackson, as well as other eminent practitioners, the affusion of cold water is one of the most powerful and efficacious means which we can make use of in typhus fever. Its effects will be more salutary, in propor- tion as it is early adopted; that is, during the first stage of the disease. Such being an indisputable fact, established upon the firmest basis, we ought always to employ it, very soon after we have evacuated the contents of the alimentary canal. In the early stage of the disease, cold water may be poured in considerable quantity from a height, or dashed forcibly from a pail on the patient. But aspersion or ablution of the body, by means of a sponge, will be more eligible and safe in the advanced periods. The effects produced by both modes are grateful and refreshing to the patient, and they usually bring about an abatement of fever, followed by more or less of a diaphoresis, and this again by a refreshing sleep. Dr. Currie states, that the cold affusion may be used at any time of the day when there is no sense of chilliness present; when the heat is steadily above what is natural; and when there is no general or profuse perspiration. During the cold stage of the paroxysm of fever, while there is any considerable sense of chilliness present, or NERVOUS FEVER. 189 where the body is under profuse sensible perspiration, this remedy ought never to be employed, as by so doing we might extinguish life. In the advanced stage of fever, when the heat is reduced, and the debility great, some cordial, such as wine warmed, with an ad- dition of spice, or even brandy, should be given immediately after it. When recourse is had to this remedy, every arrangement should be made for the affusion before the patient is moved at all, and fatigue as well as disgust should be avoided as much as possible. In those cases where the delicacy of the system, or the apprehensions of the patient or of the by-standers, may prevent cold affusion from being employed, we may substitute tepid affusion for the more powerful remedy, or we may recommend either ablution or aspersion. The tepid affusion, the water being lukewarm, or from 87 to 97 degrees of Fahrenheit, produces a cooling effect equal to that of cold affusion; partly in consequence of a more speedy evaporation, and partly be- cause so great a glow or reaction does not succeed. The important object of diminishing heat, therefore, maybe obtained*with great certainty by the repeated employment of the tepid affusion, suffering the surface of the body to be exposed in the interval to the external air. A diminished frequency of the pulse, and respiration, and a tendency to repose and sleep immediately ensue, though its effects are not so permanent as those of the cold affusion. Doctor Currie reports, that a putrid fever having made its appear- ance in a regiment quartered in Liverpool, he had the men drawn up and examined, seventeen of whom were found with symptoms of it upon them—these he subjected to the cold affusion once, and sometimes twice a day. In fifteen of this number, the contagion was extinguished, and in the remaining two the fever went through its course. The healthy part of the regiment bathed in the sea, daily, and by these means, he effectually destroyed the contagion. He farther relates, that of thirty-two who went through the disease, by its being too confirmed to be removed at the time of his first seeing them, only two died; and with these, recourse was not had to the cold affusion. The same remedy has likewise been successfully employed by Dr. Currie, and many others in the more advanced stage of the fever, so as seldom to fail of procuring a safe termination. He relates the case of a soldier who was in the ninth day of the disease when he first saw him, his pulse was 100, and feeble, his heat was 104, his thirst very great, his tongue foul and black, his mind much confused, and at times he was delirious, and petechias were dispersed over his whole body. The mode of treatment was as follows: his strength was directed to be supported by administering a bottle of wine a day, with an equal quantity of gruel; every night he took an opiate draught, and his body was kept open by laxative clysters, and when these failed, by a few grains of calomel. A bucket-full of salt water was directed to be thrown over him immediately, which was to be repeated according to circumstances. 190 NERVOUS FEVER. The effect was, that in a few minutes after the affusion, the heat lessened to 98, the pulse moderated to 96, and his mind became more calm and collected. Two hours afterwards he had relapsed nearly into his former state, but the night was passed with greater tranquillity. The whole of this practice was continued with nearly the same result, until the twelfth day of the disease, the affusion having been performed in the evening, and occasionally at noon. The fever continued its usual period; but on the twelfth day, the heat having sunk to its natural standard, the cold affusion was thenceforth omitted, and instead of it the body was sponged all over once or twice a day with vinegar. A memorable instance of the good effects of cold affusion came under my immediate knowledge some years ago, says Dr. Thomas, whilst I practised in the West Indies. A professional gentleman of my acquaintance, residing in the Island of Nevis, was attacked with this fever; and it proceeded with such violence, that in a few days petechias appeared on different parts of his body, and a hemorrhage of blood issued from his nostrils, mouth, and other places. Under these unfavourable circumstances, he was freely exposed to the open air, and one or two buckets of cold water w7ere thrown over him; he was then wiped perfectly dry, and replaced in his bed; which plan of proceeding was repeated twice and sometimes thrice a day. By means of this application, the administration of an opiate at night, and a liberal allowance of wine, his life was preserved to the great, but pleasing astonishment of all his friends. The affusion of cold water on the surface of the body, is considered, by Dr. Jackson, as a power which makes a strong and general im- pression on the system, and which arrests the disease, or changes its condition in virtue of that impression; but not by subtracting in- creased heat, as supposed by Dr. Currie. Indeed, the good effects of the remedy in question, cannot, we think, be wholly owing to the mere subtraction of heat; for it has been used with great advantage in many cases of fever, where there has been no perceptible increase of temperature, and where, by affusion, ablution, or aspersion with cold water, the disease has been cut short abruptly, as well as in those where it had risen to a high point. Therefore, we may safely infer, that cold affusion, or the suddenly pouring cold water over the whole surface of the body, operates as a powerful stimulant, although its effects probably are of short duration, unless frequently repeated; they are produced by the suddenness of the application affecting the nervous energy, and by the shock rousing the dormant susceptibility, so as to induce a new action, as it were, of the nervous system, re- moving spasmodic contraction of the extreme vessels on the surface, carrying off a large portion of morbid heat by general evaporation, and the remainder by insensible perspiration; thence restoring the healthy action of the exhalents and capillaries. As the danger of this fever is in proportion to the debility, the great point is to support the patient's strength and spirits by a liberal NERVOUS FEVER. 191 use of tonics and cordials, which should be early employed. At the same time, a nourishing diet should be used, suited to the taste of the patient, and the most rigid attention paid to cleanliness and to a free circulation of pure air. In having recourse to these means, with a view of supporting the vital energy, we must take care to prevent the feculent matter from being confined, by occasionally administering laxatives or clysters. The sulphate of quinine excels all other tonics in this variety of fever. It should be given in the usual doses, either in pills or solu- tion, (see Dispensatory,) and repeated as often as the urgency of the case requires. Should the quinine not be at hand, the Peruvian bark may be given as freely as the stomach will bear, either in sub- stance, decoction, or infusion. The beneficial effects of the bark, may be increased by conjoining it with the snake-root, in proportion of one ounce of the former to two drachms of the latter, or by adding to each ounce of the bark, a scruple of camphor. Where the quinine is used the snake-root may be given in infusion. (See Dispensato- ry, under the head of Diaphoretics.) When the bark is rejected in its various forms, as it frequently is, we should not despair of finding a succedanium as long as our country abounds with the red and black oak. From my own observations in practice, frequent bathing in a strong decoction of the bark of either will produce the same salutary effects, as could possibly be expected from a free exhibition of the Peruvian bark internally. (Sec Materia Medica—and also Bilious Fever.) The other tonics of most efficacy in typhus are the mineral acids. I have myself employed the nitric acid diluted, (see Dispensatory,) in doses of a wine glassful every two or three hours, with very bene- ficial effects. Dr. Thomas speaks highly of the muriatic acid in all febrile diseases of malignant nature. In all such cases, he says, it will be found a powerful and efficacious medicine. His usual plan of administering it is nearly/is follows:—Having relieved the stomach by a gentle emetic, where nausea prevails, cleared the bowels of their feculent contents by a moderate dose of calomel and jalap or rhu- barb, and subjected the patient to cold affusion when the circum- stances already noticed have admitted of it, he gave to adults ten or twelve drops of the muriatic acid, guarded with five drops of lauda- num, in an infusion of Columbo, Virginia snake-root, or bark, and repeated the dose every four hours, gradually increasing the quantity to eighteen or twenty drops, or more. He says, from using it in this manner, his practice has been attended with the most decided suc- cess. Dr. Thatcher, also, bears testimony in favour of this remedy. He states a case of putrid fever, attended with extreme danger, in which he administered the muriatic acid in a strong decoction of thoroughwort, with a few drops of laudanum. When it had been taken freely for about twelve hours, a profuse sweat ensued, of a yel- lowish colour, and nauseous smell; a favourable change immediately appeared, and the recovery was rapid. 192 NERVOUS FEVER. Dr. Armstrong states, that he has employed the muriatic acid in typhus, with beneficial effects, when it did not excite griping pains or diarrhoea. He has prescribed as much as two drachms of it, largely diluted with water, in twenty-four hours, so as to make it a sort of common drink. Another tonic of considerable efficacy in fevers of a malignant nature, is the solution of arsenic. Dr. Ferrier found, in the last stage of typhus, when neither bark, wine, or brandy, cold bathing, or even occasional doses of Cayenne pepper, had the effect of rousing the powers of life, or of lessening the thick crust which covered the tongue, that most singular advantages were obtained by giving the arsenical solutions. As soon as the febrile paroxysms are stopped, he considers it best to suspend the use of the arsenical solutions, and to support the patient with bark and different cordials. Dr. Thomas corroborates the efficacy of this medicine, in stating a severe case of typhus which fell under his care; the patient having suffered two relapses of the fever, and her life despaired of, when he was induced to make use of this mineral solution. Its effects exceeded his ex- pectations, for the woman's life was apparently preserved by it. The solution of arsenic may be given in its usual doses every three or four hours. Of every other medicine, cordials only would supersede the bark; and with these putrid fever is sometimes successfully conducted, when the bark is disagreeable or rejected. The chief is wine, which it is often necessary to give in large quantities. It must be recol- lected, however, that wine is an indirect stimulant, followed by a narcotic effect; so that when we begin, we must continue its use until nature can exert herself. In this case, and in all instances of putrefaction, whether general or local, our remedies are intended to supply the powers of nature. When these are roused, our exertions may be safely remitted ; and we find that this effect is produced in general fever, when the pulse becomes fuller and softer, the eye more quick, the skin more clear, and the tongue more clean and moist; in partial gangrenes by a beginning suppuration of the mortified part. It is impossible to fix the precise quantity of wine that ought to be given, as it must be varied according to the nature of the existing symptoms, the age, constitution, and previous habits of the patient. Madeira is unquestionably preferable to every other wine, but, un- fortunately, it is seldom to be procured genuine from the retail stores; consequently, it is better to obtain the Sicily, dry Sherry, Lisbon, or Teneriffe wine. These should not only be given at first diluted, but in small portions at a time. A mixture of wine and milk, in proportion of one part of the former to three or four of the latter, constitutes an excellent drink, as well as diet, in the advanced stage of typhus. When the stronger wines excite too much, the weaker, such as claret, may be tried; and if these should not answer, small repeated draughts of brisk ale or porter, may be given, and in many NERVOUS FEVER. 193 cases with more salutary effects than wine; either being calculated, in the last stage of typhus, to give that degree of vigour to the sys- tem, requisite to remove those partial congestions which often exist at that period in combination with general debility. Good cider is another substitute for wine; and brandy, rum, or whiskey, may, though with less decided success, supply the place of either. Although stimulants are indispensably necessary, where there is a loss of tone in the vascular system, and real debility existing, yet to employ them inconsiderately, will often be attended with bad consequences. Dr. Armstrong observes, that it would be quite as rational to give a half intoxicated man a tolerably free allowance of ardent spirits, with a view to make him sober again, as to attempt to restore, while the stage of excitement continues, a typhus patient, by the adminis- tration of wine; for he may be said to be, in some degree, intoxicated by the stimulus of the fever, and he will, therefore, be more affected by every glass of cordial that is administered. Dr. Potter, also, ju- diciously remarks, that the prescribing of diffusable stimuli in every fever that has the name of typhus attached to it, is one of the greatest absurdities and strongest infatuations that infest the practice of physic. There is no fever that will bear, much less require, such agents to remove it in its first stage. It should be remembered, that when strong stimulants are incau- tiously administered, they have a powerful tendency to produce inflammation or congestion in the visceral organs, and thus to render the chance of recovery, at the best, very doubtful. Therefore, it is important in administering wine, or any other stimulant, to give it at first sparingly, and notice its effects carefully. If on trial the patient sleep well, breathe easily, and feel a universal glow, we may safely go on with it; but if, on the contrary, it produce restlessness, diffi- culty of breathing, the tongue becoming drier, and the pulse more tense and rapid, its farther use should be omitted until the inflam- matory diathesis be removed. In habitual drunkards, the stage of collapse sometimes rapidly supervenes, and they should always have an earlier and more liberal allowance of stimulus, than those who have lived in an abstemious manner, otherwise they will sink under the evacuations which may be indispensably necessary to remove the disordered condition of certain organs. By this general plan, a cure will, for the most part, be effected; but in the progress of the disease, particular morbid symptoms will 'require especial treatment. Thus, affections of the head, with stupor and delirium, will sometimes be relieved by frequently washing the temples with cold vinegar and water; and occasionally bathing the feet in warm water. But if these affections, notwithstanding, should continue, it will be necessary to shave the whole of the head, and apply cloths wrung out of cold vinegar and water, which should be frequently renewed; and if the delirium be accompanied with wild- ness of the eyes, a blister must be applied to the head. 25 194 NERVOUS FEVER. Where there prevails any unusual coldness in the lower extremi- ties, recourse must immediately be had to the warm bath, or to some warm stimulating applications externally, as well as the exhibition of stimulants internally, in order to restore the circulation to the surface. The efficacy of the bath will be greatly increased, in such cases, by having it strongly impregnated with salt, and the patient should remain in it, till his skin become warm; and on being re- moved to his bed, he should be well rubbed all over with hottlannels, and bottles of hot water, or heated bricks with vinegar poured upon them and enveloped in flannel applied to his feet, legs, and under the armpits. When a bathing vessel cannot be procured, use, as an embrocation, a strong solution of table salt, in heated spirits, which admirably recalls the languishing circulation to the surface. A depression of the animal heat will sometimes come on in the collapse of typhus without any apparent cause. The pulse becomes very small, and the extremities very cold; and if some warm cordial, as mulled wine, hot toddy, or ginger tea, sweetened, with the addi- tion of a little spirits, be not immediately administered internally, and warm stimulating applications applied externally, death will soon follow. Blisters, as well as sinapisms in such cases, have fre- quently been employed, and are serviceable by their stimulating effects; but they should not be continued on long at a time; and when a blister is raised in this disease, the sore should be frequently washed with an infusion of red oak bark; and nothing ought to be applied to the part which may tend to increase the discharge; for that, by debilitating the system, would prove injurious. If nausea or vomiting continue, apply flannels, wrung out of hot spirits, in which red pepper or mustard seed has been steeped, to the stomach and lower extremities. These failing, give the saline or camphorated mixture, and apply a poultice of mint leaves or cloths moistened with laudanum and camphorated spirits, to the stomach, and cataplasms of mustard seed and vinegar to the feet. A slight purging, attended with a gentle moisture of the skin, not unfrequently arises towards the close of this fever, and now and then assists in carrying it off: but where it does not seem to produce a critical effect, it ought to be stopped as speedily as possible by giving charcoal or the absorbent mixture, with a few drops of laudanum, or by clysters of starch, or the decoction of red oak bark, containing in each a tea-spoonful of laudanum. When the purging is not consid- erable, wine or brandy mulled up with spice, or a free use of arrow root, with plenty of nutmeg, or rice milk with cinnamon boiled in it, is often sufficient. If purging be produced from swallowing putrid matter, give a small dose of castor oil or rhubarb and magnesia, and afterwards charcoal. (See Bilious Fever.) In the stage of excitement, a diarrhoea accompanied with bloody stools sometimes occurs, indica- tive of either a preternatural fulness of the liver, or inflammation of die mucous membrane of the bowels. In this case we must resort NERVOUS FEVER. 195 to the warm bath, mucilaginous drinks, and evacuants, as calomel, and castor oil. *lt not unfrequently occurs, that patients, kept in very close apart- ments, have, on the approach of the last stage, black, bloody stools, without any offensive odour. About the same time petechial or purple spots begin to show themselves upon the extremities, which at first are only few in number, and appear as if drops of black ink had been allowed to dry here and there upon the skin: but becom- ing numerous, they soon spread over different parts of the body, and are generally accompanied by discharges of blood from the nostrils, mouth, bladder, or bowels. When these symptoms are accompanied with a weak, quick, thready pulse, we may be sure the stage of col- lapse is at hand. In such cases, recourse must be had to the most powerful antiseptics, such as vegetable and mineral acids, yeast, liquors in a state of fermentation, quinine, wine and bark, and aro- matics with very small doses of laudanum. At this momentous crisis, bathing the patient frequently in spirits, or in a bath composed of equal parts of whiskey and decoction of red oak bark, with a free admission of air, will not fail to produce good effects. In addition to this mode of treatment, when the hemorrhage proceeds from the nose, mouth, or ears, it is advisable to make use of local applications, as lints dippecf in a solution of alum, or blue vitriol, or some powerful styptic. Miliary eruptions sometimes appear as the crisis to this fever, and ought, therefore, on no account to be checked by any kind of evacu- ations ; nor should the patient, on the contrary, be kept too warm with a view of forcing them out. Profuse sweats are to be obviated by sponging the body and ex- tremities daily with equal parts of vinegar and spirits; by being lightly covered with bed clothes; by admitting fresh air freely into the chamber, and by giving whatever he drinks, cool, and agreeably acidulated with lemon juice or elixir vitriol. If hiccoughs or starting of the tendons supervene, it will be neces- sary to give camphor and volatile sal-ammoniac in large doses, with the warmest cordials. In cases of retention of urine, the treatment must be varied ac- cording to circumstances. In some instances the kidneys become inflamed, and in this state very little urine is secreted, until the healthy action of the vessels be restored by administering calomel and mild purgatives, swallowing freely of demulcent drinks, and, occasionally, using the warm bath. In the low typhus, the kidneys are rendered incapable of performing their functions from a loss of tone, and in such cases stimulants and tonics, with cold applications over the region of the bladder, as cloths wrung out of spirits, or equal parts of vinegar and spirits, are the best remedies. When the bladder is over distended, or inflamed, indicated by acute pain and some tumour, the catheter is indispensably necessary to draw off the water. In febrile complaints, it will be found that, where a small 196 NERVOUS FEVER. quantity of urine is secreted, the sediment is proportionably copious; and, on the contrary, where a large quantity is secreted, the sedi- ment is proportionably scanty. If attention be paid to keeping life bowels open from the commencement of fever, a suppression of urine will hardly ever take place. In an advanced stage of the disease, it sometimes happens, that in addition to a profuse secretion of viscid saliva, little white ulcers, or apthas, appear in the mouth. In such cases the detergent gargle, (see Dispensatory,) should be frequently employed, and the mouth occasionally washed with a solution of alum in water, an ounce of the former to a pint of the latter, and this will quickly take away the stench that arises from them. The viscid phlegm, which col- lects about the tongue and teeth, may be wiped away with flannel, dipped in vinegar, or salt and water, or after washing the mouth with sharp vinegar or some austere acid, it may be scraped off with a knife, or a piece of bent whalebone. From want of sleep, much rambling and low delirium sometimes occur, which will require an opiate at early bed-time. The most advisable way of giving it, to prevent any deleterious effects, is to conjoin laudanum, with the camphorated mixture, or the opium with a few grains of camphor, volatile sal-ammoniac, or some mild diaphoretic, as Dover's powder. Opiates are more admissible in this fever than in any other, and, as it is of the utmost consequence to procure rest, they should, with this view, be employed every evening, where there is no great delirium. In all fevers where we wish to procure sleep, and cannot have recourse to opium, on ac- count of delirium being present, a pillow of hops laid under the pa- tient's head, has been used with a singular advantage. In case of watchfulness, the camphorated julep, or porter and water will generally succeed. When, however, these means fail, and there is great prostration of strength, followed by stupor, and a train of the most distressing symptoms, wine should be exhibited in large quantities, and it will be found that the patient will show a relish for this valuable cordial, after refusing medicines and every kind of nourishment in a solid form. At first it is better relished mulled; but afterwards the patient will take it freely in its pure state, and in the quantity of one or twTo quarts a day, without intoxi- cation. The quantity of wine should be regulated by the degree of debility present, the age of the patient, and the effects produced by it. The proper rule to be observed in the use of wine, is to give it until the pulse fills, the delirium abates, and a greater degree of warmth returns to the extremities. And upon the smallest appear- ance of the stupor returning, the pulse quickening, and sinking, foi they usually go together, the wine must be resumed, and continued in that quantity which is found sufficient to keep up the pulse, and ward off the other bad symptoms. When wine cannot be had, rum or brandy diluted with milk or water sweetened^ will answer; and with some patients is better NERVOUS FEVER. 197 relished. The friends of the sick should never be disheartened too soon, for here, if any where, we may say," where there is life, there is hope." And I can truly aver, that I have often seen the patient raised, as it were, from the dead, by the determined use of generous wine alone, especially old Madeira. As soon as the patient is able to take nourishment, such as panado, arrow-root, &c, the quantity of wine must be gradually diminished. For although it be absolutely necessary to take it so liberally, during the continuance of this fever, yet, as soon as that shall have left the patient, much caution becomes necessary in the use of it; since the third part of what formerly had proved a salutary cordial and re- storative, would in this state of convalescence, occasion a dangerous intoxication. It sometimes happens, at the close of typhus, that the patient is affected with a slight degree of mania or temporary alienation of the mind. In such case it will be necessary to support the patient with a generous, nutritive diet; to keep him as quiet as possible; and to give him tonic medicines, as bark and elixir vitriol, nitric acid or tincture, or rust of steel, carefully avoiding evacuations. If the appetite does not readily return on the cessation of the fever, the mineral acids, or stomachic bitters, will be proper. Bathing daily in a strong decoction of red or black oak bark, will be found an excellent remedy in removing the irritability and weakness which are left behind; and when there is no visceral obstruction, the shower bath will be attended with beneficial effects. We repeat, it is of the utmost importance throughout the whole course of the disease, that the most rigid attention be paid to cleanli- ness, and the communication with the external air be kept up in dif- ferent degrees day and night, according to the state of the atmosphere. None but those whose business it is to attend to the sick, ought to be allowed to go near the patient, except when there is little or no affec- tion of the head. In such cases the presence of a friend may sooth the mind and help to dispel gloomy ideas; by comforting the patient with the hope of a speedy recovery, and diverting his thoughts from that anxiety and dread of danger which invariably attends this complaint. Regimen.—In addition to the mild articles of diet enumerated in the bilious fever, bread and milk, with a little water, sugar, and the pulp of a roasted apple, form a most grateful and nutritious food; and, for the sake of variety, cider, porter, or any other drink which the patient covets, should always be allowed. It has been observed, that this fever often originates from cor- rupted air, and, of course, must be aggravated by it; great care should therefore be taken to prevent the air from stagnating in the patient's chamber. When that is small, and cannot be well venti- lated, the patient should be carried into the open air, and allowed to sit there two or three hours every day in mild weather. When this cannot be conveniently done, every means in our power to ventilate 1 198 NERVOUS FEVER. the room should be employed. Strong-scented herbs ought every day to be strewed about the room, and vinegar frequently sprinkled about the bed-clothes, and some evaporated, by pouring it on hot iron. The bed-clothes ought to be in no greater quantity than is agreeable to his feelings, and when he can sit up, with his clothes loosely put on, it is often a refreshing change of posture and situa- tion. The patient should have his linen and bedding changed often, and the stools removed as early as possible; for nothing refreshes the sick more than cool air and cleanliness. In the early stage of this disease, when there is much preternatural heat, washing the face and hands often in cold vinegar and water, and wiping the body with wet cloths, will be highly refreshing; and in the more advanced stage of the disease, when there is less febrile heat, the vinegar should be united with an equal quantity of spirit. In all cases where the fever is unusually protracted, and leaves the patient in excessive weakness, the recovery is slow and precarious, and the greatest care is required to prevent any error in diet, during the convalescence, as a very small degree of excess at this time, will produce very troublesome consequences. Food of easy digestion, taken in small quantities, and often repeated; gentle exercise, when the weather is favourable; attention to prevent costiveness, by some mild laxative; and the use of bitters to assist digestion, or the rust of steel, when there is any prevailing acid on the stomach, are the most certain means of reinstating health. Contagion.—Having in the preceding chapter enumerated the different means for the prevention of diseases, I shall now point out such as are most suitable to arrest the progress of contagion when commenced. When a contagious fever makes its appearance, the first precaution is to separate the sick from the healthy, and thus to cut off, as much as possible, the intercourse between them. The next step should be, to purify both beds and clothes from every particle of filth. The chambers must be often fumigated, by burning good sharp vinegar or tar, and the floor washed daily with lye, or the solution of potashes, or strong soap-suds. A cloth wetted in lime-water and hung up in the room, and replaced as often as it becomes dry, is also a great mean of purifying infected air. When a contagious disease originates on ship-board, quick-lime should always be added to the water which is used for common drink, in the proportion of one pound of quick-lime to a hogshead of water; but if the water be impure, a larger quantity of lime will be necessary; and some of it should be put also into the ship's well, to prevent the putrid and foul air arising thence. When these means are ineffectual to stop the progress of any contagious disorder, fumigation with the nitrous vapour, will un- doubtedly succeed; and the method of preparing it, is to put half an ounce of vitriolic acid into a cup, warm it over a shovel of coals, adding to it, by little and little, about the same quantity of powdered NERVOUS FEVER. 199 saltpetre, and .stirring it occasionally with a slip of glass, as long as the vapour arises. The vessel is then to be carried about the room, the doors and windows being close shut, and put in every corner and place where it can be suspected there is any foul air; the fumigation to be continued for one or two hours every day, or oftener, until the contagion shall be destroyed. If the vapour should irritate the lungs, so as to excite much coughing, fresh air should be admitted, by opening the door or win- dows of the room. However, after a little familiarity with it, this vapour will not offend the lungs, but on the contrary will prove highly grateful and refreshing. The vapour of muriatic acid has also been successfully employed in purifying infected air, and destroying contagion. It is made use of in the following manner. Put one pound of common salt into an earthern vessel, and pour over it, from time to time, a small quantity of sulphuric acid, till the whole salt is moistened. If the air be foul and peculiarly offensive, apply a gentle heat under the vessel to extricate a larger quantity of vapour; but in general, the simple addition of the acid to the salt will be found sufficient, unless the apartment be very large. As a purifier, the chloride of lime stands pre-eminent. A table- spoonful or so, may be put in a saucer, and moved from place to place in the room, or it may be mixed with a little water, and sprinkled over the floor and walls. Care should be taken, that the atmosphere of the room be not too highly impregnated with the fumes from this, or either of the articles above mentioned, otherwise, a troublesome cough, with soreness of the throat and breast, will be experienced by the patient and attendants. On the first appearance of typhus, or any infectious disorder, in a jail, hospital, boarding-school, or any other place where many per- sons are crowded together, one of these gaseous fumigations should be employed in every room, in addition to a free ventilation and the greatest cleanliness. An eminent physician of the marine barracks of Brest, states, that previously to visiting the hospital, he was in the habit of introducing into his nostrils sponge cut into proper size and shape, and moistened with some essential oil. He also kept in his mouth a piece of orange-peel; and in this simple method he escaped several putrid and pestilential diseases, which in one year killed eleven physicians and one hundred and thirteen students. Where any one is apprehensive of having caught infection, which may be suspected by a bad taste of the mouth, and want of appetite, iin emetic should be given towards the evening, and on the patient going to bed he may be allowed a little mulled cider, or wine whey, with a small dose of the anodyne sudorific drops, (See Dispensatory.) The warm bath, if such a luxury can be commanded, would here be found exceedingly refreshing and beneficial.* *To this disease the philanthropic Dr. Benjamin Rush, of Philadelphia, fell a victim in the year 1813; a man distinguished throughout a long and brilliant 200 INFLAMMATORY fever. INFLAMMATORY FEVER. When fever is attended with an inflammatory diathesis, or when actual inflammation affects any part during the existence of fever, the patient is said to labour under one of an inflammatory kind'; but according to the different parts in which the inflammation is seated, different denominations are given to the disorder. This disease, however, exists when there is no topical inflammation, and is distinguished by more considerable heat than usual, indicating an increased action of the arterial system. The fever continues for several days with nearly the same violence, the morning remissions being scarcely ever observable. Symptoms.—A sense of lassitude and inactivity, succeeded by vertigo, chilliness, and pains over the whole body, but more particu- larly in the head and back; which symptoms are shortly followed by redness of the face, throbbing of the temples, great restlessness, in- tense heat, unquenchable thirst, oppression of breathing and nausea. The skin is dry and parched, the eyes inflamed, and incapable of bearing the light, the pulse hard and quick, beating from ninety to one hundred and thirty in a minute. The disease usually goes through its course in about fourteen days and terminates critically, either by a diaphoresis, diarrhoea, hemorr- hage from the nose, or a copious deposite of sediment in the urine— otherwise it changes to a typhus. Causes.—Sudden transitions from heat to cold, the application of cold to the body when warm, swallowing cold liquors when much heated by exercise; too free a use of spirituous liquors; violent passions of the mind; exposure to the rays of the sun ; topical in- flammations ; the suppression of habitual evacuations, and the sudden repulsion of eruptions. Treatment.—The symptoms which attend this fever indicate most strongly the necessity of having an early recourse to the lancet, which should be freely used. In repeating the operation, we must, however, be governed by the effect it produces on the pulse, and by the appearance the blood puts on after standing some time. If the former continue full, strong, and tense, and the latter exhibit a bufty, sizy coat on its surface, the bleeding should be repeated by all means. The pulse in this fever is apt to become fuller arid stronger after bleeding, which may be easily explained ; for the plethora may be so great as to distend the vessels beyond their proper tone. In such life, by his private and social virtues. He was efficiently engaged in promo- ting the independence of the United States in the war of the revolution; and contributed chiefly to the establishment of the Medical University of Pennsyl- vania, in which he filled successively the most important chairs. His memory is cherished with the greatest respect, not only by the members of the pro- fession of which he was the ornament, but also by the people of the United States. INFLAMMATORY FEVER. 201 cases, the vessels cannot act fully, and the pulse is contracted : but when the plethora is taken off by copious bleeding, and the vessels are allowed to contract properly, the pulse becomes fuller, which shows that the remedy is proper. When the fever has been of several days' standing, and the head is much affected, either with severe pain or delirium, topical bleed- ing, by the application of three or four leeches to each temple is advisable, should the pulse not justify the use of the lancet. Applying linen cloths, wetted in cold vinegar and water, to the forehead and temples, will often afford considerable relief. If nausea or sickness prevail at the commencement of the disease, it should be relieved by a gentle emetic. But when the determina- tion to the head is violent, and the vessels have not been sufficiently depleted by blood-letting, the aperient and diaphoretic pills, or a dose of calomel, or infusion of salts, senna and manna, will be most proper. Cathartic medicine will not only relieve the head; but pre- vent determinations to the lungs and liver; and medicines of this class should be repeated every day or two during the continuance of much febrile action. Diaphoretics are remedies also of great utility in continued fever. Therefore, with a view to determine the circulation to the surface of the body, give the febrifuge powders or mixture, the saline mixture, spirit of Mindererus, diaphoretic drops, Dover's, or antimonial pow- ders in their usual doses. (>See Dispensatory.) The warm bath will be found of considerable efficacy in encouraging the diaphoretic powers of these medicines. In many cases it will be sufficient to induce perspiration for the patient to bathe his feet in warm water, to lie in bed and drink plentifully of diluent liquors, as balm, ground ivy, or flax-seed tea, with the addition of a little nitre; but should these simple means not prove efficacious, it will then be necessary to resort to more powerful agents. It ought to be remembered, in the whole of the inflammatory cases, we should never have recourse to diaphoretics, till arterial ac- tion and general excitement are considerably reduced by blood- letting, and aperient medicines. And, it should also be laid down as a general rule, in every species of inflammatory fever, to solicit perspiration rather by simple means, than to force it by any violent measures. When the means employed have a tendency to allay heat, soften the skin, relieve delirium, and induce sleep, we may be assured of their propriety. But sweating, when excited in fevers by stimulant, heating and inflammatory medicines, is almost sure to prove hurtful. It likewise proves injurious when excited by much external heat, or a load of bed-clothes: as also where, instead of re- lieving, it rather increases the frequency and hardness of the pulse, the anxiety and difficulty of breathing, the headache and delirium. When sweating is partial, and confined to the superior parts of the body, it will be more likely to prove hurtful than salutary. 26 202 INFLAMMATORY FEVER. The torpid state of the vessels of the surface, renders it, sometimes necessary to have recourse to artificial heat, in order to equalize the circulation and produce perspiration. Therefore, when neither the warm or vapour bath can be procured, hot bricks, after being dipped in water, or vinegar poured upon them, and surrounded with flan- nels, should be applied to the feet, between the thighs, the sides, or armpits, while the patient is moderately covered, so as to confine the steam or vapours. These means will very generally and speedily cause a relaxation of the surface, and produce an abundant perspiration. In having recourse to the warm bath, it is worthy of remark, that the natural temperature of the human species is about ninety eight degrees, but owing to the cooling process constantly taking place on the surface, it is here considerably lower, and hence we feel the sen- sation of warmth, at several points below animal heat. It is this circumstance which renders it difficult to adjust a precise standard, though, perhaps, we may not err by fixing it from ninety to ninety- six degrees. However, it will be proper, from the different suscep- tibilities of persons, always to consult the feelings of the individual, and so to regulate the bath that it may impart a slight, but an agree- able sensation of warmth. But, though the application of heat to the surface, in the mode which we have described, will very gener- ally excite sweating, it does not do so uniformly. There are cases attended by great heat of the surface, particularly in the early stage of the nervous and scarlet fever, which is aggravated by all the means we have enumerated, as designed to create perspiration. And in diseases of this nature, the effusion of cold water will be found more effectual in removing the constitution of the cutaneous vessels, than warm applications. In the progress of this fever, it sometimes happens that particular parts of the body are much affected, and that there prevails either great oppression of breathing, or that violent pains in the head, stu- por or delirium ensue. In all such cases, the application of a blister near the part affected, will be proper, and relief will often be quickly procured by it. Where there is an unusual coldness of the extremi- ties, with a sinking pulse, blisters to the inside of the legs will, like- wise, prove highly serviceable. Their efficacy, in such cases, may be increased by the application of stimulating cataplasms, to the soles of the feet and palms of the hands. Blisters very powerfully restore the balance of the circulation, and diminish morbid conges- tions. In all cases of fever there is a fulness of the vessels; and we find the vessels of the eyes red, the face flushed, and the eye-ball itself apparently enlarged; but congestion produces, also, irritation. and often a less degree of phrensy. The usual wanderings of the mind are more rapid, the voice quick, the temper irritable, unrea- sonable, and occasionally violent. In each state, blisters are indi- cated, and often produce the happiest effects; sleep frequently coming on as soon as the plaster begins to stimulate. The milder INFLAMMATORY FEVER. 203 symptoms of congestion yield frequently to purgatives; and when these have been freely used, blisters are not often necessary. In this fever, as in most others, sleep is much interrupted; and from a want of this, delirium often arises. Opium, here, would be an uncertain medicine ; for should it fail to procure rest, the delirium would be greatly increased by it. In such cases, a pillow of hops laid under the patient's head, or a strong tea of this herb, will gen- erally have the desired effect of procuring refreshing sleep. The camphorated powders or julep, are of considerable utility in fevers, and, in many instances, have procured sleep. The calmness which camphor often seems to inspire; the serenity, and even the tempo- rary ease, which are among its first effects, render it peculiarly valuable. Hemorrhages sometimes occur in this fever, and at times are diffi- cult to be restrained. If the pulse be full and hard; if much headache have preceded, the bleeding must be continued. But if it happen at the conclusion of fever, or be attended with faintness, antiseptics constitute the proper remedies. (See Bilious and Nervous Fevers.) Palpitation of the heart, is frequently a troublesome symptom in fevers. It is often produced by a redundancy of blood, as indicated by a florid countenance, in which case the lancet must be resorted to. It sometimes proceeds from the state of the stomach and bowels, and may then be relieved by evacuants; but it arises also, in many cases, from a diminution, or an irregular distribution of the nervous power; and shows that the degree of debility is considerable when stimulants will be required. In some instances, the fever is continued and kept up solely by debility. In such cases, the bark may be employed, provided on using this medicine, the patient sleep well, breathe easily, and do not find any increased heat; but if, on the contrary, it produce dif- ficulty of breathing, and restlessness, its use should be omitted. If by a prudent and judicious use of the remedies pointed out, we can lessen the congestion in the head, preserve the strength by the due regulation of temperature, and support it after the first days by more nourishing diet, we shall find little occasion for administering bark ' or other tonics. Cordials are, however, often necessary; and of these, wine is the most efficacious. In this fever, partial evacuations, such as purging and sweating, which have no tendency to prove critical, often arise. When these happen, we must put a stop to them by resorting to the means re- commended in such case, under the head of Bilious and Nervous Fever. Critical evacuations may be distinguished from those which are not so, by attending to the appearance which take place in other parts of the system. For instance, if a purging should arise, and the tongue continue foul, and the skin dry, without any abatement of heat and thirst, then we may regard it as by no means critical; but if, on its taking place, the tongue become clean and moist, the 204 INFLAMMATORY FEVER. pulse moderate, the febrile symptoms abate, and a gentle sweat be universally diffused over the skin, then a crisis may be expected. When this fever does not yield to the remedies pointed out, but assumes the symptoms of typhus, it is then to be treated as advised under the head of Nervous Fever. Among the sequels of fever are cough, night sweats, an irritable and irregular state of mind, a capricious, and often an inordinate ap- petite. These are, in general, marks of debility only, and disappear with returning strength. Tonics are usually employed for a time with little effect. The constitutional powers are at last exerted, and the patient gains in hours the strength which, with most powerful tonics, he did not attain in days. The powers of digesrion, how- ever, do not return in the same proportion as the appetite, and re- lapses are not uncommon from unlimited indulgence. Regimen.—Throughout the whole course of the disease the pa- tient is to abstain from solid food and animal broths. The diet should be chiefly gruel, barley, or rice—water, arrow root, sub-acid fruits, water acidulated with lemon, the jelly of currants, or similar sharp fruits. It may be drunk warm or cold, as is most agreeable to the patient. His chamber is by no means to be kept warm, either by fires or by being closely shut up, as is too generally the case: on the contrary, it should be of a proper temperature, by allowing the admission of cool air into it from time to time. His bed ought to be lightly covered with clothes. The patient may sit up a little each day, according to his strength, for this will lessen the fever, headache, and delirium ; but when a salutary perspiration comes on, he should be indulged in bed. On his recovery, a strict attention should be paid to diet, scrupu- lously avoiding to over-load the stomach, and partaking of such things as are light, nutritive, and easy of digestion: all other causes likely to induce a relapse, are also to be carefully shunned. Fresh air, gentle exercise on horseback or in a carriage, agreeable company, and a moderate use of wine, will greatly contribute to the recovery of convalescents. Should the appetite not readily return, or the digestion prove weak, the tincture of" bark, stomachic bitters, or nitric acid will be proper. Having pointed out, in an intelligible manner, the most approved method of treating the intermittent, remittent, and continued fever, as well as the means of prevention, it seems advisable to give some useful hints with regard to the prognosis, by which the attentive reader may be instructed in the art of foretelling what may happen to the patient, with respect to the termination or change of a disease either by death or recovery. Prognosis of Fevers.—In treating the prognostics of fevers generally, we shall first present some useful admonitions which are given in the symptoms of impending disease. The prognostic of an impending disease may be drawn from the aspect of the countenance, the mode of living, the changes in habits INFLAMMATORY FEVER. 205 or situations, and the critical period of life. If a person from a healthy state, become sallow, weak, with the loss of appetite and spirits, or with disturbed sleep, we may reasonably suppose that some disease threatens. Should these indexes be gradually disclosed, with a countenance tinged lightly with yellow, obstructions in the liver have probably taken place; if more rapidly, with slight shiver- ings occasionally, a fever impends. A regular evening exacerbation, with cough, portends a hectic; a more violent shiver, with conside- rable heat, a continued fever, a deep redness in the face, with in- flammation in the eyes, plainly point out accumulations in the head, and chiefly venous ones; but as these often arise from diseases impeding a free circulation through the lungs; so that the state of these organs must be considered in forming the prognosis. They often exist together, and aggravate each other. Violent, fixed pains in the head, recurring at irregular intervals, and usually excited by every cause of increased circulation, generally show that some fixed obstruction prevents the free course of the blood through the organ; and this is followed by convulsions, sometimes by insanity, and fre- quently a sudden termination of life. A fulness in the stomach and abdomen are certain signs of accumulation, and it depends on the comparison of the other symptoms, whether it be obstructions of the viscera, accumulated contents, or merely flatulency: the prognostic must be regulated by comparing the symptoms of each disease. The mode of life will often lead us to form some prognostic of an impending disorder. Late hours cannot be borne with impunity, except by very few; and their principal effect is to induce obstruc- tions in the abdominal viscera. If connected with drinking spirituous liquors, the effect is usually felt in the liver. The sedentary student has reason to apprehend biliary accumulations, with costiveness, and a train of hypochondriac symptoms. Excess in eating or drinking will equally lead us to foretell diseases of the stomach, often of the head, connected with the stomach; but retributive justice is fre- quently seen to punish the former error with the greatest severity, in the feelings of the patient, by loss of appetite. Almost every situation is apparently consistent with health, if free air be admitted; but its deficiency leads to a variety of diseases from debility, which may be easily foreseen, and can only be avoided by a change. Changes of habits and situations are frequently the source of dif- ferent diseases, which we can often prognosticate, and sometimes guard against. Abstemiousness, suddenly adopted after free living, and the con- trary, are sources of disease, the former chiefly of complaints arising from insufficient stimulus, the latter from too great excitement. A sedentary, after an active life, is often attended with languor, low spirits, and visceral accumulations; the contrary, at first with languor and fatigue, soon followed by increased tone and vigour. The critical periods of life merit attention also in our prognostics of various diseases. If scrofulous affections do not yield in the early 206 INFLAMMATORY FEVER. period of life, there is little prospect of cure. The same may be said of epileptic fits and of Saint Vitus's dance, though to the latter there are many exceptions. The critical period of the female life is that of the cessation rather than appearance of the catamenia; for unless hectic symptoms come on, the discharge, though at a much later period than usual, becomes regular. The period of cessation, if not* preceded by free, often copious discharges of the menses, prognosticates a less healthy old age. Prognostics in diseases are usually drawn from the vital, animal, or natural actions. The vital actions, which give the best informa- tion, are the states of the circulation and the respiration. The first is chiefly known by the pulse. But before we proceed farther on this subject, it may be proper to describe its action. The pulse consists in the reciprocal contraction and dilatation of the heart and arteries, by the former of which the blood is propelled through every part of the body. Much attention is required in feeling the pulse, since it often misleads, unless the practitioner be accustomed to its examination. In estimating its strength or weakness, it is necessary to consider the sex, temperature, and age of the patient. The pulse in women is quicker than in men; in the sanguine than in the me- lancholic temperament; in youth than in age. During the first year of an infant, its pulse is from one hundred and eight to one hundred and twenty; during the second, from ninety to one hundred and eight; the third, from ninety to one hundred. It varies little till the seventh year, when it is about seventy-five; and in the following year scarcely exceeds seventy. These numbers are subject to great variety. The pulse is quickened after a full meal, or taking any stimulus; after exercise or any agitation; it is also quicker when standing than sitting, and in the latter posture than When lying down. In hysterical patients it is excited to an inconceivable rapidity by the slightest circumstances without portending danger. A fat person has naturally a weak pulse ; but it beats, also, to a disadvan- tage beneath a layer of fat. This circumstance should also be at- tended to in our estimate. The size of the artery we can often estimate, for we can feel in thin persons, two-thirds of its circum- ference, and errors can scarcely arise from this source. A natural pulse is from sixty to eighty, more strictly from sixty-five to seventy- five. On feeling the pulse, the artery should be first felt gently, and if any doubt arise whether the pulse is weak, it should be compressed strongly by three fingers, and the two uppermost slowly raised. If the pulse be strong, and seemingly weak only from compression, the blood, rapidly returning, will strike fully the finger below. If really weak, it gradually recovers its former force. A strong, firm pulse is consistent with high health; but if it strike the finger like a tense cord, it shows a tendency to disease, and if with this hardness, it be increased in frequency, inflammatory fever is present. A throbbing pulse, which strikes the finger with apparent but not real firmness, will sometimes be mistaken for what is styled INFLAMMATORY FEVER. 207 the hard pulse. But this has not the same firai resistance which we have described. It strikes sharply, but not strongly, and the relaxa- tion is as rapid as the pulse is transitory. When there is internal irritation, the throbbing pulse will continue often to the last, showing, in every succeeding moment, its peculiar character more strongly; but in the commencement of fevers it often so nearly resembles the strong pulse as to deceive. A small pulse will also be mistaken for a weak one,unless by a practitioner of experience; but the lightness of its strokes depends on the small size, sometimes the depth of the artery. If a pulse be at fifty-five or fifty, there is reason to apprehend some compression on the brain. A constant pulse of ninety in a minute, rising occasionally to one hundred and eight, shows a con- siderable irritation in the system, and is not without danger. If, in the early stages of fever, it rise to one hundred and twenty in a female, not peculiarly irritable, it portends considerable danger, either from debility or irritation. If at any stage it exceed one hun- dred and twenty or considerably exceed it, except for a short time, we have the greatest foundation for apprehension. An intermitting pulse is a mark of considerable debility, and prognosticates a dangerous disease. It is also a symptom of organic affections. This alarming view of the subject requires, however, some alleviation. An intermitting pulse is frequently owing to fulness of the stomach and bowels, and often arises from agitation of mind. It is also habitual; a circumstance not uncommon. In such constitutions, the usual intermission, on the access of fever, often disappears, and the first symptom of amendment is the return of the intermission, which, at the end of the long fever, may appear alarming, if not connected with other favourable symptoms. In general, the favourable signs are, pulses more soft, somewhat fuller, and in a slight degree more slow. The unfavourable signs are, more thready pulses, as if the artery were smaller, pulsations quick, weak, and irregular. The state of the circulation is also known by the complexion. A sallowness, and a want of transparency show that the blood is not carried to the extreme vessels; and even when the cheeks are flushed, if the skin round the lips and nose be of an opaque, sallow whiteness, the conclusion will be the same, and the strength of the constitution is considerably impaired. The appearance of the eyes is equally indicative of strength and weakness, and the character of the features is preserved in proportion to the remaining strength. Each appear- ance depends on the state of the circulation. Respiration is a vital action connected with the state of the circu- lation, and of the greatest importance as a prognostic. Respiration sloio, full, and deep, shows the strength and all the vital organs to be unimpaired, and in every situation is highly favourable. The weak, slight and insufficient respirations, is, in general, a mark of weakness; the suffocating of obstruction, the quick of considerable irritation, exciting rapid expiration. The stertorous shows insensi- 20S INFLAMMATORY FEVER. bility, from compression on the brain; the striduhus, inflammation of the trachea; the rattling, accumulations of phlegm often uncon- querable ; and the intermittent, attends the last efforts of expiring life. The animal actions, from which we may draw prognostics, are, the senses, muscular action, and sleep. Violent delirium is a symp- tom of active inflammation in the brain, and is dangerous only so far as it shows a violent acute disorder. The wandering delirium, in fevers of a low kind, is a symptom of no great danger, unless it come on early, and in a degree disproportioned to the state of the fever. In other complaints it will excite serious apprehensions, and shows that the inequality of excitement depends on debility. If it persist after the cessation of the fever, unless evidently in consequence of debility, there is reason to suspect an organic injury in the brain, and more so, if violent delirium have occurred in the early part of the complaint. Delirium, arising from want of sleep, is said not to be dangerous; but the want of sleep itself is generally owing to a languid inflammation of the brain. General restlessness is a symp- tom of the same kind. Of the external senses, and their organs, the eye affords the most particular symptoms by which the event may be foretold. The sensation of black spots, which induces the patient to pick the clothes, as if he could remove them, is a symptom of debility, and is attributed to a partial palsy in the retina. It is certainly a highly dangerous symptom, though by no means a desperate one, as it has been represented. A more dangerous symptom is double vision. It is, in general, an early symptom of hydrocephalus. When the eye- lids fall, and can scarcely be elevated by the exertion of the will, it shows considerable weakness, and when the patient sleeps without closing them, great insensibility. The latter symptom is, however, often owing to an irregular contraction of the muscles of the eyes; for in such cases the pupil is drawn up under the lid. The symptom is not, however, on this account, the less alarming. The clear natural appearance of the eye is a favourable symptom; but too great bril- liancy, or too quick motions of this organ, show approaching delirium. A severe fixed look, without an object, is a similar symptom. The appearance of the eyelids sometimes points out a weak state of the system, particularly when there is a blackness in the lower lid, to- wards the inner corner of the eye. A noise in the ears, in fevers, is said to be a sign of approaching delirium, though frequently a symptom of weakness only, and often occurs from this cause, in weak and old people. If this noise occur in the beginning of fevers, it is said to foretell a violent and a tedious disease. Hearing particularly acute is often a precursor of delirium; and without fever, it is the effect of strong excitement in the brain. Deafness in fevers is said to be a favourable symptom : we can, at least, observe that we have not found it unfavourable. Vitiated taste is very common, and offers no particular prognostic. Lassitude on the attack of fevers, in so great a degree as to pro- INFLAMMATORY FEVER. 209 duce fainting, is always a very dangerous occurrence. If attended with a considerable wandering, the danger is greater. It is a favourable sign if, in the beginning of a fever, the patient an sit erect with his head elevated. And, if the patient can sup- port himself in bed, and occasionally turn on his side, about the enth or twelfth day, the circumstances are favourable. Sleep, if calm and refreshing, is always a favourable symptom; but if interrupted, broken by terror, excited by dreadful images in dreams; if, instead of tranquil rest, the patient starts, catches, talks in a hurried manner, though not conscious of terror, it is unfavoura- ble. Deep sleep is itself a disease, and shows a considerable op- pression on the brain ; yet, at the period of a crisis, if attended with a soft pulse, moderately slow, and a soft, moist skin, it is salutary. After a crisis, the deepest long continued sleep is not dangerous, if not attended with stertor, (a sound like snoring,) or with a pulse pre- ternatural] y slow. The natural actions which furnish prognostics, are, digestion and its consequences, and the various excretions. In fever the appetite is at once destroyed ; nor is it a favourable sign, in an acute disease, that it should remain or return too soon. The appearance of the tongue is of considerable importance as a prognostic. Whiteness of its surface is a sign of fever; and if white and dry, it shows the fever to be more considerable. In the progress of a fever it becomes brown, a darker brown, and even black; and these colours are usually seen when the tongue is dry and hard. While the edges continue clean, and of their natural, speckled ap- pearance, there is little danger; and, indeed, fevers have terminated favourably, though the tongue has been for many days, dark, dry, and even black. The tongue, sometimes, in the course of fever, becomes suddenly clean, and of a shining red. This, in general, shows that the fever will be of long continuance. The tongue sometimes cleans slowly in elderly and debilitated constitutions. And, independently of fever, in such habits, the tongue is often black at the back part. A heavy load in the stomach is an unfavourable symptom, unless it arise from indigestible food; since it shows either an accumulation of viscid mucus, or a want of energy in the organ. When the irri- tability of the stomach is exhausted by excessive stimuli, the effect is a heavy load. Vomiting is the connecting symptom between the affections of 'the digestive organs, and those of the secretory ones. When violent and incessant, without previous accumulation of bile, it is an unfa- vourable symptom, as it generally arises from irritation of the brain : even when, from bile, it is distressing, for the act of vomiting emulges the biliary duct, and the inverted motion of the duodenum carries the bilious fluid back into the stomach, thus furnishing new fuel for the flame. A frequent diarr/ioea, independently of mucous inflammation, is 27 1 210 INFLAMMATORY FEVER. dangerous, as it shows considerable debility, and a difficulty of re- taining the food long as is necessary for its assimilation. The other excretions, which have attracted attention as prognos- tics, are the perspiration; the urinary and alvine evacuations. It is generally acknowledged, that the salutary perspiration is not at- tended with heat, is not clammy to the touch, is generally diffused without any load, uneasiness, or anxiety. The sweat of an opposite kind does not relieve, but debilitate. Cold clammy sweats arise from a total relaxation of the exhalents, and are, in general, the pre- ludes of death. The state of the urine has also afforded numerous prognostics, and the discrimination of its clouds, its sediment, &c, has been peculi- arly minute. The greater number of these appearances may be dis- regarded. Urine must be examined only after it has been made for some time. It should be poured into a glass while yet warm, and kept in air moderately cold. With such precaution, some useful lessons may, perhaps, be drawn from its appearance. The quantity of urine varies in different persons, and, in the same, at different periods. Hence, from this no conclusion can be drawn. In general, where it is remarkably deficient, it is at other times equally redundant; and this chiefly occurs in hysterical constitu- tions. The excess is also at no time dangerous, unless the quality of the urine is changed, since it only depends on irregular action of the renal vessels. When the urine is in small quantity, its colour is necessarily high; and at the conclusion of a gouty paroxysm, as well as of a paroxysm of an intermittent, it throws down a brick- coloured sediment. When highly red, without depositing any sedi- ment, it shows a violent, and probably a long fever. In general, a scum on the top, in the early period of fevers, seems to show consid- erable debility; and we have usually found such fevers slow and tedious. A cloud, suspended at first near the top, and afterwards falling lower till in succession it reaches the bottom of the glass, are favourable signs; and a suspended cloud, previously to the fourteenth day, shows that the disease will terminate at that period. If it ap- pear after the fourteenth day, the disease terminates at the twenty- first, gradually lessening on the intervening days. The progress of the cloud in the urine, in case of fever, is regular. It i3, at first, suspended at the top, gradually falls, though for a day or two, often stationary near the middle of the glass, and at last reaches the bottom. It falls to the bottom often some days before it is accompanied by any sediment; but when a white or reddish sediment also falls down, the crisis is nearly complete. The urine is sometimes turbid, if not at the moment of discharging it, very soon afterwards; and this, according to the authors of prognostics, is said to show an insidious disease. Frothy urine, or which long retains the air bubbles, is said to show a tedious disease, or a slow consuming fever. In bilious fevers, the urine is sometimes of a green or black colour, which shows a highly putrid state. The black is more dan INFLAMMATORY FEVER. 211 gerous, but unless highly fetid, we have frequently seen it without its being followed by a fatal event. In chronic diseases, red urine, depositing a copious, red, scaly, or branny sediment, is a mark of considerable debility. A mucous and viscid sediment is usually alarming from the apprehensions which it excites of abscess in the bladder. Mucus is, however, light and equable, wholly free from foetor, and arises from an inflammation of the mucous membrane. It arises also from any irritation of the neck of the bladder; and is a frequent symptom of gravel and calculus. The nature of the alvine discharge is of considerable importance, and these should be frequently examined with attention. In acute diseases the discharge is often estimated by the number of motions rather than their appearance, and we have been told there has been a free discharge from the bowels, when the stools had not the slight- est feculence. Liquid, frothy, watery motions, with little colour or smell, denote, in general, a tedious fever, for in every fever there seems to be an obstinate retention of the fasces, and motions of this kind show that the spasm is peculiarly violent. When the stools, in the beginning, are highly fetid and bilious, it has been accounted a dangerous symptom ; but if the discharge be free and copious, they are rather favourable. Calomel will, through the whole course of a fever, often bring off such motions by its superior power on the biliary secretion. Small, black, pitch-like motions, are always dangerous, and show equal weakness in the alimentary canal and the biliary system. On the contrary, hardened excrement, brought off with little straining or colic, is favourable. From the remarks which have been offered, it will appear that our prognostics of fever must be taken generally from the signs and degree of debility. This is obvious often to the sight. Every cir- cumstance which regards a patient in a fever, will, by attentive observation at the bed-side, throw some light on this subject. The situation of the patient is dangerous, if the character of the countenance is soon lost; if the eyes apparently glare on vacancy; if the answers are rambling and incoherent; if slight, partial involun- tary contractions occur in the features; if the tongue trembles, or is soon dry and dark; if he soon declines turning on his sides, lies on his back, and sinks down on his bed; if the extremities are cold and benumbed; if the tendons are particularly tense, and occasionally start; and if he appears to pick off or remove any dark spots on the bed clothes, or wishes some supposed dark object to be removed : each of these symptoms is a mark of debility; and the earlier they occur in fever, the greater is the danger. If, however, in a fever, the expression of the countenance is un- changed ; if the mind is steady and unruffled; the sleep, though short and interrupted, refreshing, and the patient is sensible of having slept; if the tongue is clean at the edges; the abdomen neither tense nor painful; if the patient lies on either side, and awakes without hurry or confusion, we may prognosticate a safe termination. 212 BRONCHITIS—COLD. In the more usual cases of fevers, if the disease has been properly managed in its earlier period, and the circumstances are on the whole favourable, there are few instances in which a salutary change does not take place on the tenth or fourteenth day. Where this is not observable, a gradual amendment takes place, which is clearly con- spicuous on the seventeenth, and the fever has disappeared before the twentieth. BRONCHITIS. Often the voice and the cough sound like those of croup, and with this disease it is sometimes confounded. Treatment.—In this complaint blood-letting and leeching have been recommended, but in the first stage, no remedy is more useful than puking. Counter-irritation by antimonial ointment, and blisters will prove serviceable. Great attention should be paid to the tem- perature of the extremities. A warm bath has been of signal use in promoting the comfort of the patient. Sometimes the patient is so weak and languid as to be unable to cough. In this case, a stimu- lant often repeated, will be found of great advantage. COLD, Or, in the language of the nosologists, Catarrh, is a disease of the inflammatory kind, which occurs more frequently on sudden changes of the weather, and attacks persons of all constitutions, but especially those of consumptive habits. It is also at times epidemic, when it is known by the name of influenza, and has been erroneously considered as depending upon a specific contagion for its cause. The influenza generally pays us a visit every six or seven years. The season of its visitation is the middle or latter end of autumn, after a long spell of dry weather. It would appear to be no respecter of persons, knocking equally at the door of the rich and the poor, and attacking the young no less than the aged. Symptoms.—Its first symptoms are a stoppage of the nose, dull pain, with a sense of weight in the forehead; stiffness in the motion of the eyes, and soon after cough, hoarseness, an increased secretion of mucus from the nose, and tears from the eyes, attended with more or less fever, and sometimes sore throat. COLD. 213 When this affection prevails extensively among a people, it is denominated influenza. The difference between catarrh and bron- chitis, is only in the location—the former is seated in the mucous membrane or lining of the nose, cells of the forehead, and upper part of the wind-pipe—the latter or bronchitis, is situated lower down in the tubes passing to the lungs. Cause.—This disease is generally the effect of cold, which, by obstructing the perspiration, throws the redundant humours upon the nose, fauces, and lungs; or to those great physical changes which give rise to epidemics. Treatment.—The treatment of this disease, as of all others of an inflammatory nature, consists of the antiphlogistic, or cooling reme- dies. Where it is slight, little else will be necessary than to pay attention to the state of the bowels; live abstemiously, avoid cold, and whatever may increase the feverish habit. Bathing the feet in lukewarm water, or bran and water, a little hotter than milk just taken from the cow, at the same time that something warm, as a glass of hot toddy, punch, or mulled wine, is taken internally, forms a remedy upon which many people place their sole reliance for the removal of their colds. But this, unques- tionably, is a hazardous practice; for it may be regarded as a general rule, in inflammatory diseases of whatever description, that all at- tempts to excite perspiration, by stimulating«and heating drinks, will be uniformly injurious. Foot-bathing is certainly a simple, and often found to be a power- ful assistant of the operation of other remedies, by equalizing the circulation and promoting perspiration. In this practice, however, much caution is necessary not to get fresh cold; the feet should be carefully and speedily wiped dry, and afterwards wrapped up in a warm dry flannel, or the patient should immediately go into a warm bed. When there exists any febrile action, the free use of cold water, in the early stage of the disease, forms a safer and a much more effica- cious remedy than the administration of warm or stimulating liquids. A glass or two of cold water, taken upon going to bed, is a very common, and sometimes a successful remedy for cold. The impression of cold drink upon the stomach, independently of its general refrigerant operation, seems to have the effect of promo- ting the action of all the secretory and excretory vessels. Taking a draught of cold water every hour or two, with ten or fifteen grains of nitre dissolved in it, will be found a remedy as effectual as it is simple, in almost every case of inflammatory catarrh. Should it be observed that the nitre has a tendency to increase the cough, nausea- ting doses of tartar emetic should be added to each draught of cold water; which promote expectoration as well as diaphoresis, without, at the same time, increasing arterial action. When recourse is had to this medicine, dissolve three grains of tartar emetic in a quart of pure cold water, of which solution a gill to a half pint may be given 214 COLD. to an adult every three or four hours, or at such intervals as will produce a very gentle nausea, without creating any considerable de- gree of uncomfortable sensation. The consent of the stomach with every part of the animal system is so generally acknowledged, that this organ is now admitted to be the medium through which almost all medicines, taken internally, produce their effects upon every part of the frame. Hence, cold applied to this viscus must be attended with more speedy and certain effects than to any other part whatever. Its operation in this case is simple: it produces its effects merely by the abstraction of the stimulus of heat. Although it will be admitted these two plans of cure, however contradictory, have both occasionally succeeded ; yet the cool mode of treatment, when employed with a due degree of circumspection, is unquestionably the most advisable, for the successful removal of the disease in its incipient state. Of all the improvements which have been made for many years, in the practice of medicine, the introduction of the use of external cold, in the treatment of acute disease may be regarded as one of the greatest importance. The theoiy upon which it is founded is rational, and the practice to which it has led, has been attended with the most happy effects. In fevers, inflammations, and eruptive disorders, it has restored thousands who would otherwise have perished; but its free and extensive use in catarrh, is inadmissible, as, by exposing the body afresh to a low temperature, the original mischief would be often spread wider, or the foundation would be laid for other diseases more formidable. However, upon the accession of the symptoms indicating the com- mencement of the disease, the air which immediately surrounds the body, and which is inhaled in respiration, should be as cold as is consistent with comfortable feeling. Perhaps a temperature from forty to fifty degrees, will be most salutary. An approximation to this may always be effected by the patient remaining, in cold weather, in a room warmed only by a small fire; and, in the milder months, by a free exposure to the open air; in all cases carefully avoiding causes which operate in rendering the cold air injurious. The covering of the body, both day and night, should be as light as the external temperature will allow, and every thing taken in the stomach should be perfectly cold. By pursuing the refrigerating plan, the activity of the whole arterial system is diminished, the inflamed ves- sels are relieved from that redundancy of blood, and increased action, in which the disease consists, and finally recover their wronted healthy tone without any morbid relaxation of their extremities. Whereas, the mode of treatment which admits of warm drinks, warm rooms, and warm air, when it operates in a manner the least dan- gerous, produces, by excessive excitement, such a relaxation of the exhalents of the bronchia, as to admit of a secretion of mucus, or pus, which, though it relieve the topical inflammation, by what is called expectoration, either lays the foundation for chronic catarrh, or terminates in consumption. COLD. 215 Full vomiting, at the commencement of the complaint, will seldom fail to prevent its farther progress. The operation of an emetic, be- sides its more immediate effect in evacuating the contents of the stomach, produces such a universal commotion in the system, as to excite every minute fibre into action; and in this way it is that emetics prove salutary in the majority of complaints in which they are ad- ministered. They excite a new and powerful action, which expels or overbalances the pre-existing weaker one. Thus they arrest the progress of fever, and thus, if administered at the accession of catarrh, they will prevent the occurrence of the symptoms which would otherwise infallibly ensue. In three cases out of four, perhaps, if upon feeling a stuffing of the nose, dull pain in the head, sneezing, and other symptoms which mark the commencement of the com- plaint, a person has resolution to try the experiment, he will find a brisk emetic have the effect of completely restoring him to his natural feeling. Emetics will also prove beneficial, not only at the com- mencement, but at other periods of the disease, particularly when the lungs are oppressed with phlegm. In the treatment of this complaint, the indications which arise to be fulfilled, may be reduced to the following heads:—To reduce in- flammatory action in the early stage—to palliate urgent symptoms— and to diminish irritation in the protracted stage. When the disease is violent, aperient medicines, in conjunction with blood-letting in a larger or smaller quantity, should be resorted to, and repeated as the symptoms may require. Although the occasional use of aperients is indispensable, and should be had recourse to early in the complaint, yet very active purging is often found more prejudicial than serviceable, by dimin- ishing expectoration. The saline aperients, as Epsom or Glauber salts, in the form of the cathartic, mixture, (see Dispensatory,) have the advantage over others in febrile diseases, being sedative and cooling. Those, however, who have an aversion to salts, may sub- stitute any other opening medicine, as castor oil, rhubarb, sulphur, and cream of tartar, or senna and manna. But the purgative which of all others is most powerfully febrifuge, is calomel, which may always be administered with perfect safety, provided the patient guard properly against imprudent exposures to wet and cold at the time he is under its operation, and there is no peculiarity of tem- perament that militates against its use. When recourse is had to calomel, give it in the form of the aperient and diaphoretic pills, (see Dispensatory,) or conjoin therewith a few grains of ipecacuanha, or a small portion of tartar emetic; and in a few hours after swallowing the medicine, or, if it be taken at bed-time, on the next morning, give a small dose of Epsom salts or castor oil. In catarrh, the means which nature occasionally takes for its re- moval, or, in other words, the symptoms which mark its critical or spontaneous termination, are, principally, a copious and equable flow of sweat, an increased secretion of mucus from the membrane of the 216 COLD. trachea and bronchia, the production of a diarrhoea; and hence, an indication for the use of diaphoretics, expectorants, and laxatives. Therefore, with the view of regulating and promoting the salutary efforts of nature, it is advisable, during the interval of purging, if the skin remain obstinately dry, and there exist a general feverish dispo- sition, to give the saline mixture in the state of effervescence, spirit of Mindererus, the febrifuge mixture or drops, Dover's, antimonial, or febrifuge powders, (see Dispensatory]) or infusion of seneca root, in their usual doses, with diluting liquors; as flax-seed, balm or ground ivy teas, weak wine whey, barley water, &c., in order to pro- duce a determination to the surface. When the cold chiefly occupies the head, it has been advised, to suffer the whole head to remain, for a considerable time, in contact with the steam of water, as hot as the patient can bear. And this is to be done in the following manner:—While the patient sits up in bed, a vessel containing two or three quarts of water, may be placed immediately under and before his face, letting it rest on his lap, and a piece of flannel or thin blanket being put over his head, and extending under and around the pan; this will keep the steam in contact with the face, neck, and head, and, at the same time, will admit sufficient air for respiration. In cases of great stuffing up of the nose, and difficulty of breathing through the nostrils, this prac- tice, has frequently had the effect of removing these symptoms in the course of a few hours; but it is seldom successful, where there are considerable pain and oppression at the fore-part of the head, in consequence of some inflammation occupying the cavities communi- cating with the nostrils. In such cases, a pinch of snuff, united with Cayenne pepper, has afforded some relief. But where the pain is extremely severe, the patient will experience most relief from a blister applied to the back of the neck, or to one or both temples. When the mucous membrane of the nose is much affected, it should be washed frequently with a thick mucilage of gum Arabic, or pith of sassafras, (see Materia Medica,) or smeared, from time to time, with a Utile tallow, thorn-apple, or simple ointment. (See Dispensatory.) An inflammation of the throat, producing soreness and difficulty of swallowing, is an occasional symptom of this complaint; and where it is slight, it will readily be removed by taking the nitre lozenges, (see Dispensatory,) or small portions of nitre in the mouth, and swallowing them as they slowly dissolve. Where it is of a more severe nature, the application of onions to the feet, (see Materia Medica,) or the remedies advised under the head of sore throat must be resorted to. In case of a pain or oppression at the breast, after the inflamma- tory action of the system is pretty well subdued, the application of a blister as near as possible to the affected part should not be omitted. The most prominent symptom of cold is cough, Avhich, being uni- formly present, and often very distressing, is usually that to which COLD. 217 the patient directs the chief part of his attention.—The medicines to be resorted to for the purpose of alleviating cough, and producing expectoration, are mucilaginous and sheathing drinks, as flax-seed tea, barley-water, &c, or taking now and then, a table-spoonful of the flax-seed syrup, or a tea-spoonful of equal parts of sweet oil and honey, or a mixture composed of one part oil, and two of honey and syrup, or some of the more simple pectoral mixtures. (See Dispen- satory.) After the inflammatory symptoms have abated, the pec- toral mixtures combined with laudanum or paregoric, (see Dispen- satory]) will afford the greatest relief; and where the patients rest is particularly disturbed in the night, an opiate at bed-time will be highly necessary, but it should be combined with some diaphoretic, as in the form of the anodyne sudorific bolus or draught, (see Dis- pensatory]) or by giving two parts of paregoric with one of antimo- nial wine in some warm tea. Barley, hoarhound, and sugar candies, liquorice, and various syrups of indigenous simples, are universally employed for the purpose of allaying the tickling which produces cough. The effect of all rem- edies of this kind, is to smear over the glottis or fauces, and, by thus sheathing them, rendering them less susceptible to the irritation. As they have the advantage of being innocent, and are usually found to afford a temporary relief, they may, in every case, be resorted to with advantage, as palliatives. Whenever a cold, either in consequence of its severity, or from its having been neglected in the first instance, runs out to a considera- ble length, it is usually kept up by a state of simple irritation of the part, which supervenes upon the disappearance of the inflammation, and becomes as it were habitual, exciting the vessels to an increased secretion of mucus, and producing cough by sympathy with the larynx. In this protracted stage of the complaint, when the cough and spitting alone remain, it is absolutely necessary that the patient should carefully guard against all unnecessary exposure to cold, and to defend particularly the breast and feet; and when obliged to go into an air of low temperature, to increase his clothing, and hold a thin pocket handkerchief before his mouth and nose. The vessels are in a state of relaxation or debility, when the cough is long pro- tracted, and the consequence of any unusual application of cold is very generally a suppression of their exertions, and a subsequent re- newal of the inflammatory affection. And it is in this way that colds are often kept up for months, until they degenerate into a per- manently morbid state of the lungs. In such cases, the nitric lac ammoniac, (see Dispensatory,) in doses of a table-spoonful in a cup of flax-seed tea, or sweetened water, every four hours, to adults, will be found a most valuable remedy. Benefit will also be derived from wearing a Burgundy pitch, or some wami adhesive plaster, upon the breast, or between the shoulders. Should these means prove ineffectual, one or two grains of calo- mel, with a double quantity of powdered squills, taken by an adult 28 218 COLD. at bed-time, and continued until a ptyalism be produced ; and after- wards the nitric lac ammoniac, administered as above directed, may be depended upon. Another remedy which has succeeded in this state of the disease, is the tincture of digitalis, in doses of ten drops, three times a day, to adults, and its efficacy will be increased, by using the vapour bath. Inhaling the vapour of hot water is a remedy which has long been in use, in all inflammatory complaints of the chest. However, upon the first commencement of catarrh, it has the effect of rendering the subsequent symptoms more severe; but at a more advanced period of the complaint, it tends powerfully to arrest its progress, by in- creasing the secretion from the glands and vessels of the part, and thereby diminishing their inflammatory action. The vapour has been found most efficacious when impregnated with vinegar or cam- phor, or infusions from emollient herbs. The inhaler, invented by Dr. Mudge, of England, is well adapted to render the process per- fectly convenient for children. But a common funnel will form a very good succedaneum for the inhaler, when this cannot be conve- niently procured, the broad part being inverted over a vessel con- taining the water, and the steam being received by the mouth ap- plied to the small end. Should a funnel not be at hand, a tea or coffee-pot, may be substituted, and the operation continued from a quarter to a half hour. In this manner, the vapour bath may be re- ceived twice or thrice a day, carefully avoiding sudden exposure to the external cold air. According to Dr. Mudge, a tea-spoonful of paregoric, taken at bed-time, in some warm liquid, and the use of the warm vapour arising from simple water, through this machine, will be sufficient to cure a catarrhous cough in a night's time. An unpleasant and not unfrequent sequel of this complaint, is a hoarseness, or diminution of voice, depending upon a state of the muscles, subservient to speech, approaching to palsy. This is gen- erally of a temporary nature, though it has been known to continue for several months. In such cases the infusion of seneca-root, with one fourth of honey, has been employed in doses of a table-spoonful every two or three hours, and, at the same time, some of it used as a gargle, with the most happy effects. It has also been readily cured by taking a tea-spoonful of the syrup of horse-radish every hour or two; or by retaining in the mouth a piece of this root, or by gargling the throat frequently with an infusion of red pepper, mus- tard-seed, or horse-radish. This symptom has been known to be instantly removed by means of electricity, and also by inspiring oxygen, or pure air. It is of importance, if the patient be in a de- bilitated state, to invigorate his constitution by nutritious diet, regular exercise, and removing to a more salubrious air. A popular writer of considerable celebrity, Dr. White, states a case in which not only a loss of voice, but a partial palsy of the muscles of deglutition, pro- ducing an imperfect, and, at times, a total incapacity of swallowing, COLD. 219 ensued upon the disappearance of a severe catarrh, attended with sore throat; and which did not go off for the space of a month. In this case, the patient was in the habit, previously to an attempt of deglutition, to suffer a tea-spoonful of brandy to pass over the affected parts; after which, she immediately became capable of swallowing with ease, but again lost the power of doing so, after the effect of the stimulus had worn off. Should hoarseness occur in the inflammatory or early stage of the disease inhaling watery vapours, bleeding, cold water, and demul- cents constitute the proper remedies. Although the attendant symptoms of cold, in its incipient stage, seldom amount to such a degree of urgency as to demand the anti- phlogistic mode of treatment in its more active forms; yet if it be aggravated or rendered frequent in its return, by neglect or impru- dence, it becomes a malady which not only combats, but often de- feats the skill of the most experienced physician. And it should be remembered whenever the cough is frequent, the fever considerable, and the breathing intercepted by transient pain, or tightness of the chest; unless the most powerful means, as bleeding, purging and blistering, with diluting drinks, be early employed, inflammation of the lungs will succeed, which, if not speedily removed, will inevita- bly terminate in consumption. I have now presented to my readers, in a manner familiar to every capacity, the most approved plan of cure of this destructive com- plaint. Should it be adopted in the domestic management of colds, I shall,not have wholly failed in my earnest endeavours to lessen some of the dreadful ills; for, of all the diseases incident to the hu- man species, there is none so frequent in its occurrence—none which excites so little attention—and none, perhaps, when neglected, is so often followed by fatal consequences, as that under the name of cold or cough. It is the rock upon which the health and lives of thou- sands have been wrecked. The frequency of this disease, from the sudden changes of weather to which our climate is subject, and the slight degree of alarm gen- erally excited by what is called " only catching a cold," too often occasions that neglect, which gives rise to the most distressing maladies, such as quinsy, pleurisy, inflammation of the lungs, rheumatism, 31 1 242 PERIPNEUMONY, OR INFLAMMATION OF THE LUNGS. the increase of the blood, and consequently of fever. Nothing but diluent drinks, as toast and water, barley-water, bran, or flax-seed tea, ought to be allowed, until the violence of the disease is subdued; and these liquids should be taken often, but in small quantities at a time, and never cold. When nourishment is required, the lighter kinds only should be used, as arrow-root, sago, panado, &c. After recovery, great care must be taken to prevent a relapse; the sparest diet should therefore be used; the inclemencies of the weather care- fully guarded against; moderate exercise employed, and the chest protected from the action of cold, by wearing flannel next to the skin. In this state of convalescence, a prudent use of wine with bark or Columbo, will assist digestion, and give tone to the system generally. PERIPNEUMONY, OR INFLAMMATION OF THE LUNGS. Symptoms.—Febrile affections, succeeded by difficulty of breath- ing, cough, and obtuse pain under the breast bone, or betwixt the shoulders, increased on inspiration. A sense of fulness and tightness across the chest; great anxiety about the heart, restlessness, loss of appetite and sleep; the pulse quick, sometimes hard, and seldom strong, or regularly full; the breath hot, the tongue covered with a yellowish mucus, and the urine turbid! From the obstruction to the free passage of blood through the lungs, the veins of the neck are distended, the face swollen, with dark red colour about the eyes and cheeks. The pain in the chest is generally aggravated by the patient lying on the side most affected, and very often he can lie only on his back. Causes.—Cold, obstructing perspiration, and thus producing a morbid determination to the lungs, or violent efforts, by over- distension. Treatment.—Such is the delicate structure of the lungs, that they will not sustain inflammatory attacks many hours before their important functions are destroyed, or so much mischief produced as to lay the foundation of consumption. The antiphlogistic plan, therefore, as advised in the pleurisy, for the resolution of the disease, should be put into immediate operation, and not by degrees, as is often the case, by which many lives are lost, but should be carried to the utmost extent, particularly the taking away of blood in considerable quantities from the arm. We would remark, however, although the evacuating plan is in- dispensably necessary in the early stage of the disease, yet it should F**l INFLAMMATION OF THE LIVER. 243 not be continued too long; for the truly salutary discharge is by expectoration; and if the strength be too far reduced, this will be prevented. INFLAMMATION OF THE LIVER, Is of two kinds, the acute and chronic; and, consequently, re- quires variations in the mode of treatment. Symptoms.—The acute is marked by a pungent pain of the right side, rising to the top of the shoulder, something like that of the pleurisy, attended with considerable fever, difficulty of breathing, dry cough, and often bilious vomiting. The chronic inflammation of the liver, is usually accompanied with a morbid complexion. The symptoms are sometimes very ob- scure, and confined rather to the common marks of stomach com- plaints, as flatulence and frequent eructations. The appetite, in consequence, fails, and occasional uneasiness or pain is felt in the region of the liver extending to the right shoulder, the characteristic of the disease. An obscure fever prevails, which is generally worse at night, inducing languor, want of sleep, and much oppression. The patient has generally clay-coloured stools, and high-coloured urine, depositing a red sediment, and ropy mucus. In the progress of the malady, the countenance seems livid and sunk, and the eyes of a dull white or yellowish hue. Under these symptoms, the body becomes gradually emaciated, while in the region of the liver, is felt a sense of fulness, with a slight swelling and difficult breathing, at- tended with a hoarse, dry cough, particularly aggravated when the patient lies on the left side. As the disease advances, dropsical symptoms, accompanied with jaundice, supervene; and under these complicated maladies, the suf- ferer sinks. Sometimes an abscess opens externally, which, if it do not effect a cure, at least prolongs the life of the patient. Causes.—Violent and repeated shocks from vomits; sudden changes in the weather, but especially cold nights after very hot days; sitting in a stream of air when Over-heated; drinking strong spirituous liquors, and using hot spicy aliment. In this complaint in its chronic form, the urine is highly tinged with bilious matter, and attended with a scalding sensation—tongue furred and dry—taste disagreeable—skin harsh and dry—short and dry cough—some difficulty in breathing—cannot rest with ease on the left side. As the disease advances, the patient becomes more and more thin and restless. When the round surface of the liver 244 INFLAMMATION OF THE LIVER. is the seat of the disease, it is referred to the chest—when the hollow surface is the seat the patient refers the pain to the stomach or bowels. In the chronic form, the following pills have been attended with good effect. Blue mass one drachm, extract of conium macu- latum half a drachm, ipecac one scruple make into thirty pills. Two morning, noon and night. Take calomel one scruple. Com- pound extract of colocynth two scruples. Tartar emetic one grain. Ipecac four grains. Castile soap ten grains. Oil of carui enough to make into eighteen pills. Two at bed time. To preserve the tone of the stomach and to regulate the action of the bowels, the following formula has been highly recommended by Dr. Johnson of London, Decoction of taraxacum four ounces, car- bonate of soda one drachm, extract of taraxacum two drachms. Tincture of gentian two drachms, mix and take two or three table spoonsful daily. The nitro-muriatic bath has been found servicea- ble in the following proportions. To eight ounces of wTater add four ounces of nitric and the same quantity of muriatic acid. One ounce of this mixture is to be used to a gallon of water. The feet and legs to be immersed in this mixture at the temperature of 96° twenty minutes on going to bed. If no pricking sensation is produced in the feet, more of the acid to be used. Treatment.—In this, as in all other cases of visceral inflamma- tion, the same means to take off inflammation, as advised in the pleurisy, should be carefully observed. And, as it is an object of the first importance to prevent the formation of matter, we should adopt these means as early as possible, to produce resolution, the only salutary termination.—Scarcely any complaint requires such prompt and copious blood-letting, as acute inflammation of the liver. After the acute stage is over, we may consider the affection of a chronic nature, and the mode of treatment must be regulated accordingly. In the chronic species of this disease, the cure depends principally upon mercury, which may be employed in the early stages of the complaint. The mercury may be introduced in the system, either by taking one or two of the mercurial pills, night and morning, or by rubbing as frequently on the part affected, the ointment about the size of a nutmeg, continuing the one or the other, until a ptyalism is produced or the disease is subdued. During this course, the use of the tonic powders, or pills, (see Dis- pensatory,) or bark and snake-root, when febrile symptoms have abated, will greatly hasten the cure. The nitric acid, with patients who are scorbutic, or much debili- tated, is far preferable to the calomel, on account of its antiscorbutic and tonic powers. It should be given to the extent of one or two drachms daily, diluted with water, in the proportion of one drachm of the acid to a quart of water. At first, it ought to be given in small doses, and frequently repeated, and the dose, gradually in- creased, as circumstances require. This medicine, like calomel, must be continued until the mouth becomes affected, the salivary INFLAMMATION OF THE STOMACH. 245 g ands enlarged, and their secretion increased; and when this takes place the disagreeable symptoms will be removed, and the patient, from being debilitated, becomes healthy, vigorous, and cheerful. My own experience of the efficacy of the nitric acid in chronic affections of the liver induces me to speak well of it; and I am hap- py to add it was a favourite remedy of that celebrated anatomist, and distinguished physician, Professor Wistar, in this distressing disease, particularly when there was an enlargement of the liver. Obstructions and indurations of the spleen, bear some resemblance to a diseased liver, and are veiy prevalent in low, marshy and aguish situations. Their treatment consists in the use of the same means recommended for the cure of this disease. Regimen.—The food should be easy of digestion, such as veal, lamb, fowls, or fresh beef. Water-cresses, garlic and other pungent vegetables are useful. A change of climate, and moderate exercise in the open air of the country, is both agreeable to the patient and very salutary.* INFLAMMATION OF THE STOMACH. Symptoms.—Acute pain in the stomach, always increased upon swallowing even the mildest drinks. Inexpressible anxiety, great internal heat, something like heart-burn, constant retching to vomit; and, as the disease advances, the pulse becomes quick and intermit- * Of this formidable disease, died, on the 29th October, 1823, Chakles Carroll, of Bellevue, Maryland. This inestimable friend was extensively known, and wherever known, was justly esteemed for his intelligence and moral excellence. Whatever of manly grace and virtue belongs to the human character, shone conspicuously in him. An affectionate husband and a kind Earent, a generous friend and a polished gentleman; he stood among his fel- >ws, a bright example of what a man should be. His phUanthropy prompted him to devote a considerable portion of his fortune, which was at one time ample, to the alleviation of the distresses of his fellow men. In more than one instance, as the author is able to testify, individuals owed much of their prosperity and happiness in life to his unsought bounty. Soon after the late war, Mr. C. removed from this city, where he had resided several years, to Genesee, New York. Early in the year 1822, he was induced to accept an office under the government of the United States, in Missouri. In that state, he contracted the disease, which, eighteen months afterwards, terminated fatally; and there, too, by a calamitous coincidence, his amiable and accom- plished son, Henry Carroll, (formerly private secretary to Mr. Clay, while minister at Ghent,) met with an untimely and violent death. The memory of Mr. Carroll's worth is deeply engraven on the hearts of all who knew him, and his name will, hereafter, stand high in the annals of virtue and benevolence. 246 INFLAMMATION OF THE STOMACH. ting: frequent hiccoughs, coldness of the extremities, and the patient is soon cut off. Causes.—Acrid or hard and indigestible substances, strong eme- tics, or corrosive poisons taken into the stomach, or drinking ex- tremely cold liquors, while the body is in a heated state. It may also be occasioned by external injury. Treatment.—Unless the inflammation can be resolved in the very beginning, it rapidly terminates in a mortification. Therefore, a violent pain in the region of the stomach, with sick- ness and fever, should always be very seriously attended to. Copious and repeated bleedings, not regarding the smallness of the pulse, are absolutely necessary, and is almost the only thing that can be de- pended on. In no inflammation is the immediate use of the warm bath so necessary as in this, which attacks at once the " throne " of life. If a better bathing vessel cannot be had, a barrel or half hogs- head, filled with warm water, about blood heat, will do. Let the patient be instantly put in it, covering the top with a blanket. Keep him in as long as he can bear it, and when taken out and wiped dry with warm cloths, he should immediately have a large blister or ca- taplasm over the stomach. The bowels must be kept open by the mildest clysters, as water gruel, or weak broth, with the addition of a little saltpetre, and sweet oil or sugar. These injections answer the purpose of internal fomentations, and also nourish the patient, who is often unable to retain any food, or even drink, upon his stomach. The erythematic inflammation of the stomach often arises in putrid diseases, and comes on insidiously. It is evident, by the inflamma- tion appearing on the internal surface of the mouth. When, there- fore, an inflammation of this kind affects the mouth and fauces in the bilious, typhus, or puerperal fevers, with a frequent vomiting, and an unusual sensibility in the stomach, we may suspect that the same affection extends downward. In such cases, or when the state of inflammation is approaching to gangrene, spirits of turpen- tine, in doses of a tea-spoonful, given alone or in a little water, upon the high authority of Professor Chapman, will arrest the disease.— This medicine is to be repeated, more or less frequently, according to the urgency of the symptoms. When the disease is a little alle- viated, the infusion of bark, with a few drops of any mineral acid, is borne with ease, and is highly beneficial. Regimen.—When the stomach will admit of nourishment, only that of the lightest kind should be allowed; barley-water, and mu- cilage of gum Arabic, moderately warm, are the most suitable drinks. Every thing of a heating and irritating nature, must be carefully avoided for some time after the attack. inflammation of the intestines. 247 INFLAMMATION OF THE INTESTINES. Symptoms.—Tension of the belly; obstinate costiveness ; great internal pain ; external soreness, especially about the navel, and so severe as scarcely to bear the slightest touch; great debility; hard small, and quick pulse. Causes.—The same, generally, that induce the preceding dis- ease. It may also be the sequel of other diseases, as rupture, colic dysentery, worms, &c. Treatment.—Whatever may be the cause, we must endeavour to bring about, as quick as possible, resolution, lest mortification be the consequence. The treatment of inflammation of the stomach will also be proper here, as copious bleedings, emollient clysters, fre- quently repeated, the warm bath, and immediately afterwards, a blister on the belly.—Cupping on the belly is also useful. Such is the nature of this complaint, that we cannot be too cau- tious in the administration of medicines or diluents by the mouth. But the frequent use of emollient injections will, in great measure, supersede their necessity, and at the same time, act as fomentations to the parts. Fresh olive oil, in the dose of a table-spoonful, is per- haps, the only medicine that can be admitted with safety. When the violence of the disease has considerably abated, we may venture to give some aperient medicine by the mouth, as castor oil, not rancid calomel, or cathartic mixture. In this stage of the disease, laudanum may be employed with great advantage, particularly by way of injection. When the disease is combined with spasmodic colic, the applica- tion of cold to the abdomen, either by means of pounded ice, cloths wetted with very cold water, or cold water dashed from a pail imme- diately over the belly, has sometimes succeeded, when all other means have failed, in removing the obstruction; producing an increased action of the intestines, from sympathy with the external parts. Regimen.—After the disease is subdued, the diet should be, for some time, of the lightest kind, and not flatulent.—The patient must be kept quiet, avoiding cold, severe exercise, and all irritating causes. ° 248 inflammation of the kidneys. INFLAMMATION OF THE KIDNEYS. Acute pain and heat in the small of the back; great numbness along the thigh, and not unfrequently, a retraction of one of the testicles; retching to vomit; voiding the urine in small quantities, sometimes very pale, and other times, of high red colour, attended with febrile affections. The patient generally feels great uneasiness when he endeavours to walk or sit upright, and lies with most ease on the affected side. Causes.—Excessive exertions, external injuries, violent strains, exposure to cold when heated, and calculous concretion in the kidneys. Treatment.—Bleed copiously, keep the bowels open with castor oil and emollient clysters, use the warm bath, or foment the part with a hot decoction of camomile or bitter herbs, or hot water alone; give mucilaginous and diluting liquors, as flax-seed tea, barley-water, and thin gruel, with the camphorated powders, (see Dispensatory]) or small portions of nitre. A decoction of peach leaves, (see Materia Medica]) is also beneficial in this complaint. Flannel wetted with spirits, and hartshorn, or tincture of Spanish flies, may be applied to the small of the back, for the purpose of exciting some degree of in- flammation of the external parts. After the inflammation has some- what abated, the exhibition of laudanum in its usual quantities, either by mouth or clysters, will add considerably to the cure. The disease is often removed by a moderate ptyalism. If the disease have been treated improperly, or neglected at the onset, and a suppuration take place, known by a discharge of matter with the urine, use uva ursi, (see Materia Medica]) or balsam co- paiva, twice or thrice a-day, for a week or two, and afterwards, take bark or steel. Regimen.—The diet should consist of the most mucilaginous substances, as arrow-root, sago, milk, buttermilk, custards, flax-seed tea, barley, or rice-water, &c. In the convalescent state, moderate exercise in the open air is of great service. / inflammation of the bladder—HEADACHE. 249 INFLAMMATION OF THE BLADDER. Symptoms.—Acute pain at the bottom of the belly, which is much increased by pressure ; a frequent desire for, and difficulty in making water, and frequent efforts to go to stool, attended with febrile affections. Causes.—Calculous concretions, suppression of urine from ob- struction in the urethra, Spanish flies taken internally, or applied to the skin, wounds, bruises, &c. Treatment.—It must be treated as the preceding disease, except- ing that, where there is an entire retention of urine, the patient should drink no more than absolutely necessary. Gum Arabic kept in the mouth will sheath the inflamed parts without adding to the quantity of urine. If necessary, the catheter must be introduced, though much care is required in the attempt, which often fails. After using the warm bath, a cataplasm of mustard and vinegar ap- plied to the perinaeum or some rubefacient, to excite external inflam- mation, will be attended with good effects. The lovers of wine and cider should remember that those beve- rages, however pleasant and exhilarating, have a tendency to aggra- vate all diseases of the kidneys and bladder, especially when they originate from an acrid state of the fluids. HEADACHE. If a foul stomach be the cause, give an emetic; after which, take Columbo three times a-day. If from a plethoric habit, which is known by a heaviness of the head, and flushed face, bleed and give opening medicines. If from rheumatism, apply a blister to the back part of the neck, or between the shoulders; and, at bed-time, bathe the feet in warm water, and take the anodyne sudorific draught. (See Dispensatory.) If from a weak habit, and where the pain returns at stated periods, as in cases of intermittents, and is confined to one side of the head, as over an eye, the cure will generally de- pend upon the free use of bark and snake-root, or the solution of arsenic, twice or thrice a-day; which seldom fails, especially if pre- ceded by a brisk purge. In this, as well as other periodical pains, laudanum exhibited in a pretty large dose an hour or two before the expected fit, will often prevent its coming on. Ether externally 32 250 HEADACHE. applied over the pain on a piece of linen, with a warm hand to con- fine it, will afford immediate relief in headaches attended with cold skin. Cayenne pepper mixed with snuff, by irritating the mem- branes of the nostrils, has also given much relief in cold or nervous headaches. It is not unfrequent that the partial or nervous headache, as it is termed, is produced from a decayed tooth, which, on discovery, should instantly be extracted. Symptomatic headache is a disease of so many organs, that it is difficult to ascertain the organ primarily affected. But when the real nature of the complaint is ascertained, the practice to be pur- sued, will, of course, be obvious. Where the causes are beyond our reach, the disease may be mitigated at least by some of the remedies we have pointed out, such as paying attention to the state of the bowels, blistering, and keeping up a determination to the surface. The sympathy between the head and the stomach has been al- ready noticed. It is the subject of such constant experience, that to enlarge on it would be superfluous. Headache attends fever of almost every kind. Every obstruction in the bowels; every accu- mulation of sordes, or indigestible matter in the stomach, produces the same disease; every obstruction to the regular evacuation of any gland, particularly those of the surface; every nervous affection, either from excessive excitability or exhaustion, has a similar con- sequence. Repelled fluids from the surface produce very constantly a symp- tomatic headache. A cause of this kind is the repulsion of acrid matter from the surface, by the application of astringent washes to cutaneous affections; by saturine or mercurial applications as cos- metics, from which the head generally suffers, though the mischief is often more extensive, and apoplexy or epileptic fits the frequent consequences. Repelled gout is a still more serious cause. We have not mentioned the mental causes, anxiety, fear, suspense, and grief; for these seldom produce the complaint until the body, or, in general, the stomach, is affected. The headache of students is often merely a nervous affection.—Whatever be the action of the nervous fibres in intellectual operations, its excess is often a cause of pain ; though, in many instances, the headache of students is con- nected with obstructions of the bowels, and very often with increased determination to the head. The hysteric headache partakes of this nervous cause, particularly when the pain feels as if a nail were fixed in the brain. Are we then to be surprised at its frequent oc- currence? Is it not wonderful that the head is ever free from pain? In the nervous headache, which occurs more frequently than is generally suspected, I have found no remedy so effectual as genuine wine. It may be given during the paroxysm, to persons unaccus- tomed to it, from a half pint to a quart, without producing any other than the pleasing effect of mitigating the pain. It is also the best EARACHE—DEAFNESS. 251 preventive of all nervous diseases, when used regularly and in mode- ration. (See Vine, Materia Medica.) When headache is accompanied with coldness of the extremities, bathing the feet in warm water, rubbing them with flour of mustard or tincture of Cayenne pepper, and keeping up a general circulation to the surface by flannel next the skin, will often afford immediate relief. And in cases of great determination to the forehead, as indi- cated by a flushed face and preternatural heat, the application of cloths wrung out of cold vinegar and water to the head and temples will be attended with good effects. Those subject to this complaint, should bathe their head every morning in cold water, avoid full meals, lie with their head high in bed; and always keep their feet warm, and the bowels in a regular state. EARACHE Is frequently produced by living insects getting into the ear. The most effectual way to destroy them, is to blow in the smoke of to- bacco, or pour in warm sweet oil. If occasioned by cold, inject warm milk and water in the ear, or drop in a little laudanum or vo- latile liniment. If this produce not the desired effect, foment the ear with steam of warm water, and apply a bag of camomile flowers, in- fused in boiling water, and laid on often, as warm as can be borne. When the inflammation cannot be removed, a poultice of bread and milk, or roasted onions may be applied to the ear, and frequently renewed till the abscess breaks; after which, it must be syringed twice or thrice a-day, with Castile soap and water. In this com- plaint, a blister behind the ear is highly useful. DEAFNESS Is occasioned by any thing injurious to the ear, as loud noise from the firing of cannons, violent colds, inflammation or ulceration of the membrane, hard wax, or by a debility or paralysis of the audi- tory nerves. It also frequently ensues in consequence of long pro- tracted fever. Treatment.—It is difficult to remove deafness, but when it is owing to a debility of some part of the organ, or arises in conse- 252 TOOTHACHE. quence of any nervous affection, stimulants dropped into the ear, often prove salutary. Ether dropped into the ear, seems to possess a twofold effect, one of dissolving the indurated wax, and the other of stimulating the torpid organ; but it is liable to excite some degree of pain, unless it be freed from the sulphuric acid. No prescription for deafness from indurated wax ever acted more surprisingly—none, I am sure, more agreeably, to my feelings, at least—than the following:— In consequence of a violent attack of bilious fever, which degen- erated into the nervous, my honourable friend, Colonel George M. Troup, of Georgia, was afflicted with a deafness for a year or two, so entire, that, in Congress, when the members were on the floor, he was obliged to place himself close to the orator, and even then, fre- quently failed of the pleasure and profit of hearing his reasonings. Suspecting indurated wax to be the cause of his deafness, I directed the cavities of both ears to be well syringed with warm and strong suds of Castile soap. This was done twice a-day, the ears con- stantly filled in the interim with pellets of wool dipped in strong camphorated liniment, and sometimes plugs of camphor. In a few weeks, the nerves of hearing recovered their sensibility, and, as the Colonel himself thought, more acutely, if possible, than before. Salt water is a better menstruum for the wax, and may be em- ployed, or some of the table salt finely powdered may be dropped in the ear. There is reason, however, for apprehending one bad effect from this remedy; namely: giving such a susceptibility to the organ, that it is more liable in future to be affected by cold, and, therefore, this remedy must be employed with caution. Deafness, in old people, is sometimes attended with noise in the ears, and is then generally owing to debility. Every evacuation increases it, and warm tonics, with a generous diet, are the best remedies. TOOTHACHE Is best removed by extracting the tooth; but if this cannot be effected, fill the cavity with a little cotton dipped in the toothache drops, Turlington's balsam, or any of the essential oils, or with pills of camphor and opium. The nerve may sometimes be destroyed by a hot iron or knitting needle. A carious tooth is sometimes pained by accidental colds, and in such cases, it would not be prudent to have it extracted. If the external aperture be smaller than the carious cavity, after clear- ing away the carious matter, the access of air may be impeded by stuffing of gold or silver leaf. When the nerve is accustomed to the TOOTHACHE. 253 external air, it will continue carious for many years without pain, and be truly useful. When toothache is connected with rheumatism or gout, which sometimes happens, the remedies of either should be employed. This unpitied, though often excrutiadng pain, is, in most cases, no more than the just punishment of our neglect of the teeth. Surely, then, we ought to take some care of them, though it were but for the pleasure of having them sound. But this care would be re- doubled, were we but daily to consider the advantage of good and clean teeth and sweet breath. Some women, indeed, are blessed with faces so nearly angelic, that not the blackest teeth can entirely defeat their charms, nor the vilest breath drive away their lovers, But how different would be the effect of both, if, through their ruby lips, opened with a smile, we were to see teeth of ivory, white as snow, pure as the fair owner's fame, and accompanied with breath as sweet as that of infancy. The following tooth powder and wash will be found valuable. Tooth powder. Of the powder of red bark and armenian bole, of each one ounce. Powdered cinnamon half an ounce. Bicarb of ^oda half an ounce. Oil of cinnamon three drops. • Tooth-wash.—Take of port wine one ounce. Carbonate of soda one drachm. Tincture of myrrh one drachm. Oil of horse- mint applied with a pellet of cotton or lint to the tooth has proved of the greatest benefit in putting an end to the pain of toothache. Prevention.—To prevent the toothache, and to preserve the teeth and breath perfectly sound and sweet, the tooth-brush dipped in warm water, and in the charcoal tooth-powder,, (see Dispensatory,) should be used constantly every morning. The charcoal powder, an invention of the celebrated Darwin, is good for whitening the teeth, and admirable in correcting bad breath. The tooth-pick and tumbler of pure water should never be forgotten after every meal. If the calcarious crust or tartar upon the teeth adhere firmly, a fine powder of pumice stone may be used occasionally. When the gums are spongy, they should be frequently pricked with a lancet, and gently rubbed with a powder composed of equal parts of Peru- vian bark and charcoal. Young persons who wish to carry their teeth with them through life, must take care never to sip their tea scalding hot, nor drink wa- ter freezing cold. Such extremes not only injure the tender coats of the stomach, but often ruin the teeth, and have caused many imprudent persons to pass a sleepless night, distracted with pains of the teeth and jaws. 254 RHEUMATISM. RHEUMATISM. Symptoms.—Wandering pains in the larger joints, and in the course of the muscles connected with them, increased on motion, and generally worse towards night. When with fever, it is called acute or inflammatory rheumatism ; and, without chronic. Causes.—Sudden changes of weather; application of cold to the body when over-heated; wearing of wet clothes. Treatment. In the inflammatory rheumatism, large and re- peated bleedings are necessary, as indicated by the fulness of the pulse, especially on the first days, and when there is much pain. With this should be combined a free use of diluent drinks, as flax- seed or balm tea, barley or rice-water, with a little nitre dissolved in each draught, or the antimonial powders, or mixture in small doses, to excite slight perspiration, which should be kept up with great care, as in this relaxed state of the skin, the disease is liable to recur upon the least application of cold. In this disease, a very essential discharge is the perspiration ; and if this be not produced, every medicine appears injurious. Of the diaphoretics, Dover's powder seems best adapted to this complaint; and it should be observed, when sweating is once begun, should not be intermitted, and when it has relieved, should be suffered very gradually to decline. The foxglove, exhibited in doses from ten to twenty drops every four hours, will be found a remedy of considerable efficacy, particu- larly when an objection is made to the free use of the lancet. The blood root, (see Materia Medica,) is also a useful auxiliary in this disease. Bleeding and blistering over the part affected, when the pain and inflammation continue violent, have likewise their good effects. After the inflammatory symptoms have in a great measure sub- sided, the anodyne sudorific draught or bolus, (see Dispensatory]) or laudanum alone, may be administered at bed-time, with great advantage. During this general treatment, attention must be paid to the state of the bowels, which should be kept open by emollient clysters or cooling medicines, as the cathartic mixture, or castor oil, exhibited in small and repeated doses. When the disease has fully attained its chronic state, it then forms a local affection, distinguished merely by stiffness, distension, and considerable immobility in the joint. In this species of the disease, a different plan of cure must be fol- lowed. Large evacuations are to be avoided, and external stimu- lants of the warmest kind should be applied, as the oil of sassafras, spirits of turpentine, opodeldoc, or the tincture of red pepper and mustard ; and, along with this, friction with a flesh brush or flannel rheumatism. 255 over the afflicted joint is not to be omitted. If these means prove ineffectual to rouse the energy of the part, add to an ounce or two of either of the above articles, one or two drachms of the tincture of Spanish flies. In addition to these remedies, the internal use of the rheumatic tincture, (see Dispensatory,) in doses of a table-spoonful, twice or thrice a-day in a cup of tea, is much to be depended upon. When these remedies prove ineffectual, we may suspect that some peculiar fault exists in the habit, which must be corrected before a cure can be expected. If the patient be much debilitated, or of a scorbutic habit, give him the nitric acid diluted, or bark freely. And if the disease be in consequence of venereal taint, or taking cold from the use of mercury, let him take calomel in small doses, or one of the mercurial pills night and morning until a ptyalism be produced. A strong decoction of sarsaparilla, (see Materia Medica,) is also a useful auxiliary, and sometimes a remedy of itself. In some cases of obstinate rheumatism, I have witnessed the hap- piest effects from taking, for some time, a tea-spoonful of flour of sulphur night and morning, in milk or spirits and water. In others, again, I found nothing equal to the pokeberry bounce, (see Materia Medica,) in doses of a wine glassful, morning, noon, and night. The cuckoo pint, or wake robin, (see Materia Medica,) in the form of a conserve, with an equal part of sugar, is often highly useful. The seneca root and mezereon in the form of decoction, has also been exhibited with most happy effects. Another valuable medicine in chronic rheumatism is the spirits of turpentine, in doses from twenty to sixty drops three times a-day, which may either be given on sugar, in a little water, or incorporated with double the quantity of honey, by melting them together over a gentle heat. But it should be observed that these active stimulants are never to be employed when there is the least febrile action prevailing in the system. The solution of arsenic has, in some instances, been exhibited with success in the chronic form of this complaint. Compressing the large arteries by means of a tourniquet or band- age, as mentioned under the head of intermittents, is another remedy which has been employed with advantage in severe rheumatic pains. In recent cases, when the pain wanders from one part to the other, or whenever the joints are stiffened and rigid, and the pain upon motion severe, or where the muscles have become contracted, by the length and violence of the disorder, immersing the whole body in a warm bath, strongly impregnated with salt, or applying it topically, by pouring warm water upon the limb from a kettle, or fomenting the part with a decoction of mullein two or three times a-day, will often sooth the pain, and prove a useful auxiliary to the other means we employ. Warm bathing, and warm pumping, are remedies of great utility in this disease; but as it requires painful muscular exertion to use the warm bath, it is not often resorted to. The vapour bath, from its superior temperature, is better adapted to its chronic form. 256 tic douloureux. Two other forms of rheumatism ought here to be mentioned; namely, the lumbago, and the sciatic. The first attacks the loins or lumbar region, with a most acute pain shooting to the joints of the thigh. This affection is nearly related to the inflammatory rheu- matism, and must be treated in the same manner; only, instead of applying blisters over the affected part, they should be applied on the inside of the thighs, and kept running for some time. The second, or sciatic, a violent, or fixed pain, attacking the hip joint, and partaking of the nature of the chronic rheumatism, is most successfully to be treated like that disease. Regimen.—In acute rheumatism, the patient must be kept on a cool spare diet; but no change whatever will be necessary in the patient's ordinary mode of living, in chronic rheumatism. In this species, mustard and horse-radish, (see Materia Medica]) used freely in their natural state, or united with food, will be found very bene- ficial. In all cases of both diseases, flannel, or fleecy hosiery, should be worn next to the skin, a flesh brush be used morning and night, and every precaution be taken to guard against exposure to cold and wet, and also to a moist or damp atmosphere. If the appetite be im- paired, stomachic bitters, elixir vitriol or some of the tonic medicines may be taken with advantage. Exercise, either of the whole body or of particular limbs, will be highly important. The want of exer- cise is apt to produce stiffness in the limbs. Prevention.—Cold bathing, and the use of flannel next to the skin, are the most effectual means of preventing the recurrence of both acute and chronic rheumatism. TIC DOULOUREUX, OR PAINFUL AFFECTION OF THE FACE. Symptoms.—A painful affection of the nerves, which mostly at- tacks the face. The most frequent seat of the affection is in the nerves over the cheek bone, just below the orbit of the eye, the nos- trils, upper lip, and gums. The pain is often excited by opening and moving the mouth, attended with ptyalism and convulsive agi- tation of the adjacent muscles. The only diseases likely to be con- founded with this are, rheumatism occupying the face and jaws, and the toothache. It may, however, readily be distinguished from the former of them, by an attack of pain being readily excited, by the slightest touch, by the shortness of its continuance, and by its ex- treme severity and violence; and from the latter, by the rapidity of its succession, and there being an entire freedom from pain at intervals. TIC DOULOUREUX. 257 Treatment.—A very great variety of medicines, given inter- nally, as well as remedies applied externally, have been tried for the alleviation and removal of this excruciating complaint, and even a division of the nerve has been resorted to; but although this ope- ration has answered the purpose in a few cases, still it has failed in many others. Electricity, blisters, topical bleeding, by means of leeches, stimulant and anodyne embrocations, and frictions with mercurial ointment, have all been employed in rotation as external applications; whilst the solution of arsenic, large doses of the extract, as also powder of Peruvian bark, preparations of iron, opium, and the extracts of hen- bane, hemlock, and nightshade, have been administered internally in considerable doses. It appears that the nightshade (bella donna) has, in many cases, proved a powerful and very efficacious medicine, and may, therefore, be given with confidence. From two to three grains of the extracts have been administered every five or six hours to adults during the great severity of the pain, or from twenty to forty drops of the tinc- ture, lessening the dose very considerably as soon as ease was pro- cured. It will always be most advisable to begin the use of this medicine in small doses, such as half a grain of the extract for an adult, repeated every four or six hours, increasing the quantity, by degrees, to about two grains; and we may, at the same time, make trial of it as an outward application to the cheek, by laying over it a piece of fine linen rag, moistened in a solution of the extract in water, in the proportion of six grains of the former, to two ounces of the latter, or it may be wetted in the tincture of nightshade. The use of this medicine internally, is, however, often attended with distress- ing symptoms, when given in such doses as to produce a certain effect, as impaired vision, giddiness in the head, numbness, tightness at the chest, and a sense of suffocation, with dryness in the throat; but these soon cease again, on greatly diminishing the dose, or wholly discontinuing the remedy. As persons unaccustomed to the use of so active a medicine, might be intimidated even by the probability of such unpleasant conse- quences, we would recommend them to make a previous trial of the carbonate of iron, in doses of one scruple, repeated three times a-day, gradually increasing each dose to the extent of one drachm, if no decided benefit be derived by taking it in smaller quantities. This remedy has been employed in several cases of the tic douloureux after a failure of very large doses of the extract of bark, the solution of arsenic, and most of the other means usually resorted to, with an exception of nightshade, in all of which the complaint soon ceased, and has not again returned in any of them. In the treatment of this very painful complaint, it has been advised to paralyze the nerve by the application of an ointment, consisting of two scruples of the superacetate of lead (sugar of lead) mixed with a little lard, every morning on the cheek affected about an 33 258 VACCINE DISEASE, OR COW-POX. hour before the paroxysm is expected. The experiment has been tried with success by Mr. Astley Cooper, in a case which had pre- viously resisted every other remedy, and even a division of the nerve by the knife. The following application has proved of signal benefit in this dis- tressing disorder. Laurel-water four ounces. Sulphuric ether one ounce. Extract of bella donna half a drachm to a drachm. To be applied to the part with cotton wadding wetted with it. A useful application will be found in the following ointment. Extract of bella donna half an ounce. Pulverized opium two scru- ples. Hog's lard half an ounce. Oil of thyme six drops. To be used with friction. Pills of bella donna and quinine have been very beneficial in a very distressing and protracted case in which many of the usual remedies had failed. Morphia has been applied by the skin to cure this complaint in the following manner. Two or three centigrammes of the sulphate of morphia were dissolved in a small quantity of water on a bit of glass. This solution was taken upon a vaccinating lancet, and forty punctures over the seat of pain were made. The operation was repeated several times and the patient completely cured. This disease has been successfully treated with tobacco. Take of the best shag tobacco four ounces. Distilled water two pints. Boil and let them simmer for two or three hours, and strain; then wash the tobacco in two pints more of boiling distilled water; strain and add it to the former liquor, and evaporate to an extract. One part of this extract to be mixed with seven parts of simple cerate to form an ointment. To make it more elegant, add a little neroly. Half a drachm night and morning to be rubbed in the part suffering. This has also cured toothache, used in the same manner by friction. It has been affirmed by some with great plausibility that this com- plaint arises from pressure produced by congestion of the blood ves- sels accompanying the nerve in its adit and exit from its bony canal. In this case, the application of cold would be of service, and such remedies as are likely to lessen such a state of aggravation. VACCINE DISEASE, OR COW-POX. The vaccine discovery may be justly considered as one of the most extraordinary blessings entailed on man; since it is incontesta- bly a certain security against the small-pox, a disease distressing in its symptoms, formidable in its appearance, doubtful in event, and to which mankind are generally exposed. VACCINE DISEASE, OR COW-POX. 259 The comparative advantages which the kine-pox has over the small-pox, are very great and striking. First, it is neither conta- gious nor communicable by effluvia; secondly, it excites no disposi- tion to other complaints; thirdly, it can be communicated, with safety, to children at the earliest age, and almost in every situation; and fourthly, it is never fatal. What more can be required to pro- duce a general conviction of its superior utility? The method of performing the inoculation is, to hold the lancet nearly at a right angle with the skin, in order that the infectious fluids may gravitate to the point of the instrument, which should be made to scratch the skin repeatedly, until it becomes slightly tinged with blood. The operator must be cautious not to make the wound deeper than ne- cessary, as the inoculated part will be more liable to inflammation, which may destroy the specific action of the virus. The most certain method of securing the infection is, to inoculate with fresh fluid from the pustule; but as this is often impracticable, it is advisable to hold the infected lancet over the steam of boiling water to soften the hardened matter. Where the virus has been procured upon thread, make a small longitudinal incision in the arm, and insert in it the affected thread, and detain it there by court- plaster, until the disease be communicated. Matter may also be procured from the scab. The mode of inoculating from it is the same as from the fluid, taking care, however, previously to moisten it with tepid water, and to use the matter of the inner side of the scab. The scab will frequently retain its virus for months, provided it be kept in a close box. The first indication of the success of the operation is a small in- flamed spot where the puncture has been made, which is very dis- tinguishable about the third, fourth, or fifth day. This continues to increase in size, becomes hard, and a small circular tumour is formed, rising a little above the level of the skin. About the sixth or seventh day, the centre of the tumour shows a discoloured speck, owing to the formation of a small quantity of fluid, which continues to increase, and the pustule to fill, until about the tenth day. At this time it shows in perfection the characteristic features which distinguish it from the variolous pustule. Its shape is circular, or somewhat oval, but the margin is always well defined, and never rough and jagged. The edges rise above the level of the skin, but the centre is depressed, and has not that plumpness which marks the small-pox pustule. As soon as the pustule contains any fluid, it may be opened for future inoculation. About two days before, and two after the eighth day, making a period of four days, is the season when the matter is found in its greatest activity. At the eighth day, Avhen the pustule is fully formed, the effects on the constitution begin to appear. The general indisposition is com- monly preceded by pain at the pustule and in the armpit, followed by headache, some shivering, loss of appetite, pain in the limbs, and a feverish increase of pulse. These continue with more or less vio- 260 VACCINE DISEASE, OR COW-POX. lence for one or two days, and always subside spontaneously without leaving any unpleasant consequences. During the general indispo- sition, the pustule in the arm, which had been advancing to matu- rity in a regular, uniform manner, becomes surrounded with a cir- cular inflamed margin, about an inch or an inch and a half broad, and this blush is an indication that the whole system is affected; for the general indisposition, if it occur at all, always appears on or before the time when the effforesence becomes visible. After this period, the fluid in the pustule gradually dries up, the surrounding blush becomes fainter, and in a day or two imperceptibly dies away, so that it is seldom to be distinguished after the thirteenth day from inoculation. The pustule now no longer increases in extent, but on its surface a hard thick scab, of a brown or mahogany colour is formed, which, if not removed, remains for nearly a fortnight, until it spontaneously falls, leaving the skin beneath perfectly sound and uninjured. The above is the progress of the vaccine inoculation in the greater number of cases, from the time of insertion to that of drying up of the pustule, with only the variation of a day or two in the periods of the different changes. The successive alterations, that take place in the local affection, appear to be more constant and more necessary to the success of the inoculation, than the general indisposition. With respect to the latter, the degree is very various: infants often pass through the disease without any perceptible illness; with children it is extremely moderate; and even with adults, its severity is but for a few hours, and then never dangerous. Very little medical care is necessary to conduct the patient through this disease with safety, especially when children are the patients. Adults may take a dose of salts on the eighth day, which will be particularly useful in plethoric habits. In general, no application to the inoculated part will be required, unless the inflammation in- crease, and the pustule become painful; then the part should be kept moist with cold vinegar and water, or lead-water, till the pustule be dried up. To conclude, much attention and discrimination are necessary in the vaccine inoculation, to ascertain whether the infection have fully taken, and whether or not the disorder be complete and genuine. The regularity, with which the local disease at the place of inocula- tion runs through its several stages, seems to be the principal point to be attended to; for the presence of fever is certainly not necessary to constitute the disease, since the greater number of infants have no apparent indisposition. Therefore, when the vaccine inoculation is followed by no local disorder, or only a slight redness at the punctured part, for a day or or two, we can have no doubt that the operation has failed. When the pustule advances in very hasty and irregular progress, when the inoculated puncture, on the second or third day after insertion, swells considerably, and is surrounded with an extensive redness, the pre- SMALL-POX. 261 mature inflammation very clearly indicates a failure in the operation, even when the inoculation has advanced for the first few days in a regular manner; but when, about the sixth day, instead of exhibit- ing a well formed pustule and vesicle of fluid, the part runs into an irregular festering sore, the purpose of inoculation is equally defeated, and these varieties require it to be watched with an attentive and experienced eye; since they might readily lead to a false, and per- haps fatal idea of security against any subsequent exposure to small- pox. The circumstance, however, which most strikingly distin- guishes the genuine from the spurious disease, is the appearance of the pustule. In the genuine, the pustule has a well-defined elevated margin, with an indentation in its centre, resembling a button mould. The spurious is either pointed like a small common abscess, or is rugged and irregularly formed, like an ordinary sore. Every other symptom, almost, occurs in each disease. SMA LL-POX. It would seem unnecessary to take any notice of the small-pox, after having treated so largely of its mild and merciful substitute, the cow-pox; but as that dreadful disease does sometimes find its way on board of ships and into country neighbourhoods, sweeping whole families in its progress, it may be very proper to subjoin the follow- ing history of its symptoms and treatment. Symptoms.—A few days prior to the attack, the patient complains of languor and weariness, succeeded by cold shiverings and transient glows of heat, immediately before the fever, which is accompanied by violent pain of the head and loins, and, frequently, with a se- vere, oppressive pain at the pit of the stomach. The patient is very drowsy, and sometimes delirious. About the third day, the eruption appears like flea-bites, first on the face and limbs, and after- wards on the body. From this perid, the pustules gradnally in- crease, and on the fifth or sixth day, will begin to turn white on the tops. The throat, at this period, often becomes painful and in- flamed ; and sometimes on the seventh day, the face is considerably swelled. In the confluent, the spots assume a crimson colour, and instead of rising, like the distinct kind, they remain flat and run into clus- ters ; and, during the first days of the eruption, much resemble the measles, but are of a purple colour. The flow of saliva is constant in this form of the disease, and becomes so viscid as to be discharged with the greatest difficulty. Treatment.—The cure of small-pox depends on the general principle of the antiphlogistic plan, especially in a free admission of 262 SMALL-POX. cold air, which maybe carried much farther in this than in any other disease. Bleeding in the first stage of this disease, or when the pulse is full, may be allowed ; but the use of cooling purgatives, with acid and diluent drinks, are indispensable. When the eruption makes its appearance in clusters of a dark red colour, the disease is more of a putrid nature; and, consequently, in- stead of bleeding, requires a liberal use of bark and wine to invigo- rate the constitution, as directed in the nervous fever. (See Oak, Materia Medica.) But, besides this general treatment, there are some symptoms which require particular attention. Thus, when convulsions or great restlessness prevails, exposure to cold air, and a dose of lauda- num are enjoined. Where perspiration is much impeded, or deglu- tition difficult, blisters may be applied to the breast and neck; and gargles, such as recommended for sore throats, frequently employed. If the perspiration be obstructed, the antimonial mixture may be used. When this" disease finds its way aboard of a vessel, or into a family, all those who have not had it, should immediately be inoculated with the variolous matter, if the vaccine fluid cannot be procured. The benefits which result from inoculation are great, as we have an opportunity to prepare the system by abstinence from animal food, and by taking one or two purges of calomel and jalap before the eruption takes place. But if the subject be of a weak delicate habit, a restorative diet alone will be more proper. In every stage of the small-pox, the bowels should be kept open, either by mild purgatives or clysters. The following remarks of a writer in Queen Mary's time respect- ing the conduct or management of this disease have so much truth in them, I cannot refrain from giving them a place here. " Take away the blood in which the vital potency resides, and you mani- festly weaken the sick more and more, and diminish the spirits which ought to oppose, or encounter the disease. For nature, through bleeding, being weakened (not only by being robbed of her defence, but by introducing an enemy, who universally defiles her economy and quenches the vital flame) there immediately an universal weak- ness spreads over the whole human frame, and the contest of nature with the disease ceases, by nature's being overcome. This truth is so evident, that we cannot but speak it with grief, when we do but think of that late precious life, which by that means, we faithfully believe, was lost. In a thousand that have this disease and are let blood, at least, nine hundred and fifty of them die, and of this mine own eyes are witnesses. Whenever any of the blood-sucker's pa- tients die, the pustules seem to fall in again, grow flat and dead, or to dent in the middle; and sometimes to turn purple, livid, or black; with many livid or purple spots in the interspaces. Then to excuse themselves, they say it was a dangerous and malign disease, and complicated with an erysipelas, purples, spotted fever, or the like; SMALL-POX. 263 by reason of which complication, 'twas impossible for the sick to escape death, what course soever had been taken." The best treatment consists in good nursing and a plenty of fresh air. HISTORY OF THE SMALL-POX. At what period of the world this scourge of mankind appeared, has never been determined. The ancient Greeks and Romans gave no evidence that they had a knowledge of it. The Arabian physi- cians were the first to give an account of it. Rhazes, an Arabian physician, described it about the beginning of the tenth century. It is supposed to have been conveyed about the middle of the sixth century by trading vessels from India to Arabia. And there is no question that the triumph of the Arabian or Saracenic arms, intro- duced it from Africa into the Levant, Spain and Italy. It spread its desolating ravages with great rapidity, during the 11th and 12th centuries, while Christian potentates arrayed their countless hosts in quest of the Holy Land. OF INOCULATION. This method of protection is derived from China, where it has been practised from time immemorial. From China it travelled into India and thence into Asia Minor—thence into Africa. They make (it is said) the incision when they inoculate, between the eye-brows. In 1721, Lady Mary Montague who had witnessed its triumphs in Turkey, and who had had a son inoculated there, submitted an in- fant daughter to the same process at this time, in London. The public and the profession viewed it with suspicion. An experiment was ordered to be made on six condemned criminals, all of whom were fortunate enough to recover, and who thus redeemed their lives. Yet such was the opposition to this innovation, that during a period of five years, not more than seven hundred and sixty four persons were inoculated all over England. OF VACCINATION. About fifty years ago it was known among those who kept dairies in Derbyshire and other counties in England, that cows are subject to a pustular disease, which, when communicated to milkers rendered them insusceptible of small-pox infection. Attempts were made to convey the small-pox to those who had been infected with the cow- pox, but all such attempts were fruitless. To Dr. Jenner is due the credit of taking up this subject and pursuing it with great ardour and judgment. He made many experiments, and ventured at length to publish his discovery in 1798, and to recommend inoculation with the virus of cow-pox as a substitute for small-pox. The result is well known, and vaccine inoculation has passed with rapid progress over every quarter of the world from the Arctic Circles to the ex- tremes of Asia and Africa. 264 MEASLES. Regimen.—The diet is to consist of vegetable substances; as arrow-root, panado, milk, rice, &c, and when the eruption is com- pleted, a more nourishing diet may be allowed. If the disease be of a putrid kind, wine, cider, perry, porter, or milk toddy, may be given freely. In this, as in all diseases connected with putrescency, the advan- tages arising from cleanliness, as well as from frequent ventilation of the chambers, are so obvious, that to insist on them is unnecessary. (See Nervous Fever.) MEASLES. This disease is the effect of a specific contagion, and attacks per- sons only once in life. Symptoms.—Alternate heat and chills, with the usual symptoms of cold. On the fourth day from the attack, eruptions like flea bites arise on the face and body, and in about four days more, these erup- tions disappear with the fever. Treatment.—When the disease is very slight, little more is necessary than to keep the patient's body open with the cathartic mixture. But, should the febrile symptoms run high, with difficulty of breathing, bleed, blister the breast, and give Dover's or antimonial powders, the febrifuge mixture, or diaphoretic drops. (See Dispen- satory.) The cough being usually troublesome, it will be proper to take freely of flax-seed syrup, or some of the pectoral mixtures. Breathing the steams of warm water will also be useful, in relieving the cough as well as the eyes. The water should be put in a basin, and the head covered with a flannel large enough to hang over its edges. After the eruption is completed, the anodyne sudorific draught, paregoric, or laudanum, will be serviceable at bed-time, to allay the cough. If the spots suddenly disappear, immerse in warm water, or bathe the legs and feet, and give freely of warm wine whey, until the eruptions return. The consequences attendant on the measles, are often more to be dreaded than the immediate disease; for although a person may get through it and appear for a time recovered, still pulmonary consump- tion frequently arises and destroys him. Another bad consequence of the measles is, that the bowels are often reduced to a very weak state, a diarrhoea remaining, which has sometimes proved fatal. An obstinate ophthalmia, or affection of the eyes, will also ensue, if pro- per attention be not paid in managing the disease. Most of these disagreeable symptoms may be prevented by blood-letting, and ad- ministering emetics, cathartics and diaphoretics, in the first stage of the disease. CHICKEN, OR SWINE-POX--MILIARY FEVER. 265 Should the symptoms manifest a malignant kind of the disease, and a putrid tendency prevail, we must then adopt a very different mode of treatment from what has been advised for the inflammatory. The cure must be conducted on the plan recommended for the ner- ous fever, and putrid sore throat. Regimen.—The diet should be low and proportioned to the degree of fever. Barley or rice-water, flax-seed tea, or other cooling mu- cilaginous drinks, with jellies, as arrow-root, gruel, sago, &c, will, in general, be all that is necessary, until the feverish symptoms be evidently on the decline. Much caution is necessary, that the patient be not suddenly exposed to cold air, which might repel the eruption, and produce fatal effects. CHICKEN, OR SWINE-POX. In this disease, an eruption much resembling that of a very fa- vourable small-pox, appears after a very slight fever. This eruption soon proceeds to suppuration, in which state it remains but a little time, before the disease terminates by the drying up of the pustules, which seldom leave scars behind. As to the treatment, medicine is very seldom necessary, it being generally sufficient that the patient be kept moderately cool, and supplied with the diluent drinks and light food.—Should there be fever, a cooling purge, and afterwards, the antimonial powders, or mixtures, may be employed. MILIARY FEVER Is now considered to be symptomatic, only, because it never ap- pears contagious or epidemic. It sometimes attends febrile affections, as well those of an inflammatory as of a putrid nature; but it sel- dom occurs in any, unless a hot regimen and sweat precede. The symptoms which attend, are restlessness, frequent sighing, fetid sweat, pricking of the skin, and an eruption of red small distinct spots, at first confined to the neck, breast, and arms, but soon spreads over the whole skin, except the face. When these eruptions make their appearance, they must be treated according to the rules laid down under their proper heads. 34 266 SCARLET fever. SCARLET FEVER. Symptoms.—Chilliness, followed by a burning dry heat; the pulse frequent, respiration irregular, a dejection of spirits, great pros- tration of strength, and often a stiffness of the neck. The face and neck are at first covered with red spots, which soon extend over the whole body. A sore throat generally comes on about the second or third day, but sometimes is wholly absent; however, a redness of the fauces in every case is conspicuous. This fever is distinguished from the»measles by the eruption being less distinct and more like a red-coloured effusion, and by not being accompanied by catarrhal symptoms. It is distinguished from Saint Anthony's fire by the fever being more considerable at night than the former, and the swelling being scarcely observable. It attacks more frequently young children; whereas, Saint Anthony's fire is mostly confined to adults, and is not attended with a scarlet hue on the throat. This fever is evidently infectious, generally epidemic, and appears most frequently at the end of summer. Treatment.—Give an emetic on its attack, and on the following day administer some gentle cathartic medicine. The bowels should be kept in a soluble state, and nitre given in the patient's drink. The heat should be repelled rather than encouraged. And this is to be effected by cold affusions, which should be steadily applied. It is not enough to sponge the body once or again, but the cold water must be dashed against the patient repeatedly till the heat is subdued, and the process must be repeated as fast as it returns. In this disease, cold water is peculiarly applicable; the heat being considerable, the determination to the head violent, and the debility alarming. We know no disorder which represses so powerfully the constitu- tional energy. Quinine and cordials would appear peculiarly useful in this complaint, from its tendency to putrefaction; but if these be early employed, they will be found to increase both fever and de- lirium, to check the perspiration, and to impede sleep. Where this disease is attended with malignant symptoms, its ten- dency is to the putrid kind of fever, and must be treated accordingly. (See Nervous Fever, and Putrid Sore Throat.) Regimen.—The diet should be light, the liquors cold, and acidu- lated with vegetable and mineral acids. The stools should be fre- quently removed, the linen frequently changed, and the room kept airy. The nurses should carefully wash themselves, and frequently . change their linen. With these precautions, there is little danger of infection. st. Anthony's fire—bleeding at the nose. 267 ST. ANTHONY'S FIRE. Symptoms.—An inflammation on some part of the skin, attended with pain and heat; and when extensive, there is considerable fever, accompanied with drowsiness. Causes.—Imprudent exposure to cold wdien the body is heated ; hard drinking, and sudden stoppage of any natural evacuations. Treatment.—When slight, it requires only that the bowels be kept gently open, by an infusion of peach leaves, (see Materia Medica]) small doses of cream of tartar and sulphur, or the cathartic mixture, with small portions of nitre in the patient's common drink ; but when the attack is violent, and the head affected, then, in addi- tion to the above, bleed, bathe the feet in warm water, apply a large blister between the shoulders, sinapisms to the extremities, and give the saline or antimonial mixture, (see Dispensatory,) with dilu- ent drinks. The best external applications are flour or starch, gently sprinkled by a puff on the part, or, in case of dryness and much heat, fresh leaves of the thorn apple, or cabbage leaves stripped of their stems and softened in boiling water, and renewed every two or three .hours. Cold applications, as cloths wetted with vinegar and water, with the addition of a small quantity of camphorated spirits, have also been employed with great benefit and relief to the feelings of the patient. If, in spite of these means, ulceration should take place, apply bark poultices, frequently renewed, or cloths dipped in the cam- phorated spirits, with the usual means of preventing mortification. Should the inflammation assume a purple colour, or the swelling suddenly subside, attended with internal oppression, anxiety, and pulse, apply blisters or sinapisms to the extremities, and give wine or warm toddy freely, to throw out the eruptions to the skin; and then it is to be treated as the nervous fever. Regimen.—The diet should be low, and the drink chiefly of rice and barley-water, acidulated with tamarinds or the juice of lemons. Prevention.—Avoid the extremes of heat or cold, abstain from spirituous liquors, and keep the bowels regularly open. BLEEDING AT THE NOSE. In febrile diseases, accompanied with pain in the head, flushed countenance, and redness of the eyes, bleeding from the nose in general is salutary, and ought not to be checked, unless the patient is likely to be too much exhausted by it.—However, when this dis- 268 SPITTING OF BLOOD. charge is too profuse, the patient should have his head raised and exposed to the cool air. Beside which, cold acidulated drinks should be used, and the patient should rather immerse his head in very cold water, or have cloths dipped in cold vinegar and water frequently applied to the nostrils, face and back of the neck. A piece of metal, as a key for example, applied cold to the naked back, is a familiar remedy, and often succeeds. If these should not prove sufficient, a pledget of lint dipt in strong alum-water, or a powder composed of flour and alum of equal quantity, should be introduced into the nostrils, with sufficient force to compress the orifice of the ruptured vessels. In addition to these means, give a dose of Epsom or Glau- ber salts, to evacuate the bowels, and from ten to twenty grains of nitre every hour or two, in a glass of cold water. Immersing the feet in warm water while the cold applications are continued to the head, will also be found beneficial. One of the most powerful styptics which we can use, says Dr. Thomas, is powder of charcoal. It may be applied by means of tents, first moistened with water, and then dipped in this powder; but in slight cases, it will answer by being taken like snuff. After the bleeding has ceased, the patient must be careful not to remove the tents of clotted blood, but should allow them to come away of themselves. SPITTING OF BLOOD. When there is a discharge from the mouth, of blood of a florid colour, brought up with more or less coughing, preceded by a sense of tightness, weight, and anxiety in the chest, and attended with a saltish taste of the spittle, it is in consequence of a ruptured vessel of the lungs. Causes.—Plethora; violent exercise of the lungs; and, frequently, mal-formation of the chest. Treatment.—The most important remedy in this alarming complaint, is blood-letting, which should be actively employed, paying, at the same time, attention to the state of the bowels. Spit- ting of blood, however, is sometimes owing to the contraction of the chest with debility; and in this case, the lancet must not be so freely used. Sedatives, particularly those which repress the activity of the circulation, are highly useful. Of these, the chief are nitre and foxglove. Nitre, in doses of ten grains, given every hour, in the coldest water, and swallowed while dissolving, is much to be de- pended on in the early stage of this disorder.—The tincture of fox- CONSUMPTION. 269 glove exhibited in small doses every hour or two, by retarding the action of the pulse, will also prove a most useful auxiliary in suppressing pulmonic hemorrhages, particularly in those cases where an inflammatory diathesis prevails. Whenever there is fixed pain in the chest, a blister applied to the breast or back will do much service. According to Dr. Rush, two tea-spoonsful of common salt, dis- solved in a small quantity of water, and exhibited every two hours, or oftener, will check this disease, as well as hemorrhages from the stomach and uterus. Astringents are frequently resorted to, as alum, kino, and sugar of lead; but they are of little utility, except in the passive hsemoptyses, and even in these, nitre is often found preferable. If the cough be troublesome, it will be necessary to have recourse to demulcents and pectorals, as advised under the head of cold. Sometimes a spitting of blood is produced in consequence of sup- pressed evacuation; in this case, it is not dangerous, and only requires remedies to restore the customary discharge. A spitting of blood may readily be distinguished from a discharge of it from the stomach, as, in the latter, the quantity is usually more considerable, of a darker colour, and is generally unattended by coughing. Regimen.—A low diet should be strictly observed, and the body kept as quiet as possible. Nothing should be taken warm; flax- seed tea, barley or rice-water, acidulated with the juice of lemons or elixir vitriol, ought to be used as common drinks, and taken as cold as possible. Prevention.—Carefully avoid all exertions which either detain or hurry the blood in its passage through the lungs, as singing, loud speaking, running, or lifting great weights. Obviate costiveness, by the occasional use of mild aperients, and use a spare diet. On ex- periencing any pain in the chest, blister, bleed, and constantly wear flannel next to the skin. Swinging, sailing, travelling in an easy carriage, and riding on horseback, will be the most appropriate exercise. CONSUMPTION. Symptoms.—Those which mark its first stage, are a slight fever, increased by the least exercise; a burning and dryness in the palms of the hands, more especially towards evening; rheumy eyes, upon waking from sleep; increase of urine; dryness of the skin, as also of the feet in the morning; occasional flushing in one and sometimes 270 CONSUMPTION. both cheeks; hoarseness; slight or acute pain in the breast; fixed pain in one side, or shooting pains in both sides; headache; occa- sional sick and fainty fits; a deficiency of appetite ; and a general indisposition to exercise, or motion of every kind. The first appearance of this disease will vary in different cases; but the most constant symptoms which characterize it, are a cough and phlegm resembling matter, of which, at length, it becomes en- tirely composed. This disease often attacks insidiously, and is chiefly confined to the young, the fair, with light skin and blue eyes, florid complexions, contracted chest, and high shoulders. In constitutions disposed to hectic, the fingers are often long, and the nails bent; they grow rapidly, but seldom expand in breadth and bulk. From the age of twelve or fourteen, to that of about thirty-five, is the hectic period ; more generally from sixteen to twenty-four; and the tendency seems to return about forty-five or fifty, especially in women at the period of the cessation of the catamenia. At the age of fourteen or sixteen in each sex, while the genital organs are evolving, there is often a considerable debility and irritability. The debility in females is often formidable, and a slight cough is no uncommon attendant. The cough is either quite dry, or accompanied with an expectoration of a small quantity of a thin frothy matter, which differs from that of true catarrh, in being easily diffusable in other fluids. Sooner or later, the general health becomes impaired, and at length, the fatal hectic makes its appearance with little suspicion; all the symptoms being referred to the great change that then takes place. No diagno- sis can arise from the existence of fever, since in the chlorotic state coldness, with occasional flushing, are not unfrequent. In general, however,the fever of phthisis attacks more pointedly in the evening; that of chlorosis in the morning. The appetite of hectic patients is best in the forenoon; of chlorotic at night; and the latter can eat meat suppers frequently with impunity. It sometimes occurs that persons who have been improperly treated in the venereal disease, have symptoms which assume the form of consumption ; but, in general, the chest is free, while pains are more violent at night, and more frequently in the middle of the bones of either extremity, or deep-seated in the head, than in the trunk. It has also seldom proceeded so far as to mislead, without showing its nature by eruptions, or by an affection of the throat. From the state of mind, we may draw some distinction; for cheerful hope illumines every hour of the hectic; despair darkens each moment of the syphilitic patient. Strange as it may appear, amidst all the horrors of this disease, the patient's hopes are seldom abandoned, and even increase, as the fatal termination advances. Causes.—Obstructions and inflammation of the lungs, depending most frequently on the existence of small tubercles in the substance, which, coming to suppuration, burst and discharge a purulent mat- CONSUMPTION. 271 ter. Sometimes, it is induced by a general affection of the system, and sometimes it is a consequence of other diseases, as cold, measles, small-pox, pleurisy, &c. &c. Treatment.—This must be varied and adapted to each stage and case of the disease. In the first or inflammatory stage, moderate bleedings, twice or thrice a-week, according to the force of the pulse and habit of the patient, are essential, aided by blisters to the breast and back, and employing, at the same time, a cooling regimen. In almost every species of the disease, blisters or issues are often a means of relieving the cough; for even when they have no ten- dency to remove the stimulating cause producing cough, as when it arises from a tubercle, yet they diminish the effect of the stimulus. They are particularly useful in that period of the disease, when a catarrhal has a disposition to degenerate into a phthisical affection; for in that modification of the disease, derivation from the lungs is of the utmost consequence. By this means, a change may often be effected in that state of suppuration which takes place from the in- ternal membranes of the lungs, and the purulent discharge may thus be converted into the natural mucus. Among other remedies in consumption, the use of emetics is strongly recommended. By the action of vomiting, the blood is propelled to the extreme vessels in every part of the body, particu- larly to the extreme vessels of the surface. Thus, there is produced a derivation from the lungs, and a consequent change in the state of suppuration at that part of the system; but they are chiefly useful in consumption, as obviating symptoms, particularly cough and diffi- culty of breathing, and by promoting expectoration. A considerable variety of medicines of the refrigerating kinds have been strongly recommended for combating consumption in its in- cipient state. They tend to diminish the impetus of circulation, and although they do not immediately remove a plethoric state, yet they, perhaps, tend to diminish the inflammatory diathesis even more effectually than the repeated blood-lettings. * The cooling neutrals, through the whole course of the disease, are useful; par- ticularly nitre, which may be advantageously taken in any period of the complaint. Demulcents are always indicated, and usually employed in the manner we have recommended under the head of cold, to sheath the fauces, and lessen the violence of cough. Gum Arabic held constantly in the mouth, will also be found extremely useful in relieving this distressing symptom. Of all the remedies which have of late been fashionable in con- sumption is the foxglove, (see Materia Medica]) but it does not seem to merit all the praises which have been given it. Under proper management, the foxglove produces a slowness of the pulse, not perhaps to be obtained from any other medicine yet discovered. xVnd it has been the opinion of some, that, by reducing it to the natural standard, from the employment of digitalis, consumption may be overcome. But it should be observed, that the quickness CONSUMPTION. of pulse in this disease is merely symptomatic, and that the reduction of it, even below the natural standard, can have no effect either in removing a tubercle, or in healing an ulcer in the lungs. Hence, on this ground, it is in vain to expect a radical cure from its use. However, as a diminution of the celerity of the pulse will somewhat alleviate the hectic fever, it may, in certain cases, be employed with advantage. The most eligible mode of using the foxglove is in a tincture, beginning with the dose of ten drops, and gradually in- creasing it to sixty to an adult, morning, noon, and night. In ex- hibiting this medicine, it should not, however, be given in such doses as to induce much sickness. Among other active medicines, recourse is frequently had to mer- cury, but unless consumption was excited by a venereal taint, we have never witnessed benefit from this medicine. On the contrary, when mercurial salivation is produced in the genuine consumption, it has uniformly hastened the death of the patient. The Iceland moss, or liverwort, has been, of late, highly extolled as a remedy in this complaint that readily allays cough, facilitates expectoration, abates hectic fever, and quiets the system without con- stipating the bowels. It is likewise said to strengthen the organs of digestion, without increasing the action of the heart and arteries. In- deed, the physicians of Europe have spoken so loudly in its praise, that every patient ought certainly to give it a trial. The most ap- proved method of using it, is in the form of decoction; an ounce of the herb to a quart of water, boiled for fifteen minutes over a slow fire, to which two drachms of sliced liquorice-root may be added about five minutes before it is taken off. A tea-cup full of this decoction should be taken four times a-day. Another form is by boiling two drachms of the herb in a pint of milk for ten minutes, and taking it for breakfast and supper. If choco- late be preferred, it may be blended with it, by making the choco- late with a decoction of the moss, without the liquorice, as above directed. Of all our indigenous plants, the Indian turnip, (see Materia Medica]) has the highest reputation as a remedy in consumption. It is evidently an active expectorant, and may be useful in the latter stage of the disease. In the treatment of this disease, balsamic medicines are frequently resorted to. They are totally unsuited to the inflammatory state of any one of the complaints of the lungs, whether acute or chronic. Action having been sufficiently subdued by depletory measures, they may be safely and advantageously administered in catarrhal con- sumptions and protracted coughs; and will be found particularly useful when expectoration is checked from debility, and a want of irritability of the glands. So opposite are the states of the lungs in catarrhal affections, that it requires essentially different substances to produce expectoration. It may be depressed or imperfectly per- formed, by a constriction of the lungs ; by the removal of which, an CONSUMPTION. 273 infinite degree of relief is often afforded. It is also apparent that the lungs, occasionally from extreme debility, pour out an excessive dis- charge; and that by direct stimulation of the exhalents, the effusion is abated and oppression removed. The advantages of the vegetable balsams, as they have been called, were supposed to consist in their power of promoting the healing of wounds and ulcers. At one time, many of them were highly extolled in pulmonary consumptions ; but each have had their day of fashion, and have each fallen into deserved neglect. According to the testimony of Drs. Duncan, Simmons, and other eminent physicians, gum-myrrh, exhibited in doses of twrenty or thirty grains thrice a-day, united with an equal quantity of nitre, has, in many instances, been employed with the best effects in this intractable disease. While, for resolving tubercles or healing ulcerations in the lungs, many medicines have been taken internally, some modes of cure have been recommended with the view of acting topically on the diseased parts. In this way, different articles have been directed to be inhaled into the lungs, under the form of vapour. In an inflam- matory state of the bronchial glands, warm water vapour may be useful, and vinegar has occasionally been added; but it seems often to irritate the cough, and the more stimulant vapours are evidently injurious, except where expectoration is difficult and deficient. In cases where the accumulations of the chest are owing to debility of the lungs, or are retained by the viscidity and tenacity of the matter, sulphuric ether is strongly recommended; and, we are told, upon the high authority of Dr. Pearson, that its powers are improved by several substances which are soluble in it. Hemlock is particularly praised, half a drachm of which is to be digested in an ounce of ether, for several days, so as to form a saturated tincture; of this, two or three tea-spoons full are to be put into a wine glass, to be held up to the mouth, and inspired till the whole is evaporated and repeated several times in the day. Similar in its effects to these inhalations, is the practice of smoking tobacco, the stramonium, and other substances. With the same views, tar fumigations, according to a distinguished Russian physician, Dr. C rich ton, of St. Petersburg, have been em- ployed, and, it is said, with triumphant success. The mode he re- commends for doing this, is, to put the tar in an earthen vessel over a. lamp, or heated iron, so as to cause a volatilization, till the air of the room is sufficiently impregnated, and this process is to be re- peated three or four times a-day. Having stated the remedies which have been most highly recom- mended in consumption, and from which, when properly adapted to (he circumstances of the case, there is the best chance of recovery, we will conclude with a few remarks on the means of obviating urgent symptoms. It is a fortunate circumstance, that even in thoic diseases where 35 / 274 CONSUMPTION. the prospect of recovery is the most faint, and where there is next to certainty of an approaching dissolution in no long time, we still have it in our power to protract the period of life, and to alleviate the distress of the patient. In many cases of this terrible disease, it is all that we can reasonably expect to accomplish. Although colloquative sweats are not productive of pain, yet they tend very much to debilitate the patient, and by the loss of strength, the chance of recovery is very much diminished. Hence the ne- cessity, in such cases, of giving some tonic, as the elixir vitriol or in- fusion of bark. In every instance of consumption, it is of importance to prevent costiveness, and it is always a desirable circumstance to keep the bowels in a soluble state, which should be obtained rather by diet than medicines. But when diarh&a occurs spontaneously, this should in like manner be restrained by shunning the use of those articles which are observed to increase it, and by employing what are found to moderate it. Of all the symptoms which require to be mitigated, there is none which more frequently demands attention, than the cough. For this purpose an almost infinite variety of articles, either of the demul- cent or sedative kind, (see Cold,) may be employed with advantage. But of these substances, after the inflammatory symptoms have been subdued, none is so useful or so powerful as opium. This article, however, valuable as it is, cannot be considered free from inconve- nience. There are some individuals with whom, from peculiarity of constitution, it always disagrees, producing confusion in the head, vertigo, sickness at the stomach, and various other distressing symp- toms. In these cases the solution of sulphate or acetate of morphine might be given with advantage, as it is free from most of the objec- tions just mentioned. (See Dispensatory.) Recourse has, however, been had to a variety of other sedatives, both with the view of allay- ing inordinate action, and of procuring sleep. Of all the substitutes for opium, none, according to the testimony of one of the most cele- brated and distinguished physicians in England, Dr. Duncan, equals the preparations formed from the common garden lettuce. (See Materia Medica.) It has been supposed, that by the continued use of opiates, we might allay irritation, and contribute to the great object, the healing of the ulcer. They have, however, failed in this view, though we cannot refuse their employment to lessen pain, and keep up the calm serenity, the pleasing delirium, in the midst of distress, and a state of hopeless of relief. From what has been said of the principal remedies recommended in consumption, the reader will find but little encouragement to in- dulge a hope of relief. He will probably exclaim, Is consumption, then, never cured ? Whence can arise the confident promises which every newspaper offers, and which the most respectable authorities confirm ? The deception arises from two sources. Catarrhal com- CONSUMPTION. 275 plaints are, in many instances, confounded with consumptive, and the most experienced eye is occasionally deceived. In some cases, also, vomicae are completely evacuated by expectoration, and the wound heals. So insidious is the attack of consumption, that it has often been taken for catarrh ; and, on the contrary, so violent is often a catarrh, that it has been pronounced to be truly phthisical, by practitioners of judgment and experience; nor has the delusion been destroyed but by expectoration. From such errors it is not to be wondered that so many medicines should have gained credit in the cure of consumption. To say, however, that this disease is never cured would certainly appear rash; for instances have occurred in which a recovery has been perfected by nature; but they are so few that they can scarcely inspire hope. Regimen.—Perhaps a greater number of cures in consumption have been effected by regimen than by medicine, especially if under this head be included, not merely diet, but air, exercise, and similar circumstances. It has been but too common to prescribe the same diet in every stage of the disease, which has been attended with the most perni- cious effects, and has often hastened the death of the patient. While the Brunonian fed his patients to avoid debility, the other practition- ers carried apparently their antiphlogistic system too far. In judging of that diet which is best suited to phthisical patients, due attention must always be paid to its effects upon the system. While a con- siderable discharge by blood-letting is requisite, it is certainly proper to avoid those articles which can furnish a large supply of rich chyle, even, although they should be, like milk, of the veiy miLdest nature. But after the suppuration takes place, and there is a free discharge of purulent matter, the antiphlogistic plan should be pursued no far- ther; on the contrary, a more nutritious diet is essentially necessary. The healing of tuberculous ulcers in the lungs, as well as of scrofu- lous sores at other parts, is only to be expected from recruiting and giving vigour to the system. In this state of the disease, therefore, a nutritious diet is naturally indicated; and, indeed, the evident marks of exhaustion point out the propriety of a due supply. Be- sides these particulars, a liberal and nutritious diet is often mani- fested in this stage of the disease by the feelings of the patient; for it is by no means uncommon to observe even a craving for animal food; and it may be remarked, that in very rare instances only are such calls of nature entirely to be neglected. The diet in the inflammatory stage of consumption should be light, and composed of articles that tend to correct acrimony, and diminish inflammation, as milk, butter-milk, rice-milk, arrow-root, sago, fruits of every kind, and vegetables. In the advanced stage of the disease, and when the pulse is weak, a more cordial and stimulating diet. and strengthening remedies are necessary. To prevent weakness, and other ill effects of an empty stomach, patients should partake frequently of meat, with wine, porter, or toddy; raw oysters are 276 INCONTINENCE OF URINE. thought to be peculiarly proper. With this cordial diet, tar pills, bark, and elixir vitriol, or an infusion of the inner bark of the wild cherry tree, or hoarhound, and bitters of all kinds, have been ex- ceedingly useful in this state of consumption. Air and situation are apparently objects of considerable impor- tance, in a disease where medicine must confess the utility of her resources. Change of air is among the remedies constantly recom- mended ; and to change is often professedly the only object. Exercise, when not carried to fatigue, in a dry country air, often does more good than medicine; and, consequently, should always be taken. Long journeys on horseback are the most effectual modes of exer- cise, carefully avoiding night air, and the extreme heat of the day in summer. That this exercise may not be carried to fatigue, pa- tients should, at first, travel only a few miles a-day, and gradually increase the distance as they increase their strength. When exercise on horseback cannot be supported, sailing and swinging- should be substituted, and no efforts to cheer the spirits, or innocently to amuse the mind, should be neglected. Great care should be taken to regulate the dress according to the changes of the weather. The chest, in particular, should be de- fended from the cold, and the feet from the damp. In the various stages of this disorder, the bowels ought to be kept moderately open by emollient clysters, or the mildest laxatives, if the diet should not have the desired effects. INCONTINENCE OF URINE. Symptoms.—An involuntary evacuation of urine. Causes.—A relaxation of the sphincter of the bladder; injuries received about the neck of the bladder; pressure of the womb in a state of pregnancy, &c. This sometimes proceeds from atony of the neck of the bladder: then a blister on the lower portion of the back with fifteen drops of the tincture of flies internally three times a-day will be of service with cold bathing. The sixteenth part of a grain of strychnine twice a-day has been attended with much benefit. When it arises from acrid urine diluent drinks should be used, together with the catheter. If there be a superabundance of lithic acid, alkalies should be em- ployed and tepid water injected into the bladder. When there is much irritation about the bladder and urethra, pills of camphor and hyoscyamus one grain each should be used. Fifteen drops of tur- pentine three times a-day have been given with decided benefit DIFFICULTY OF URINE. 277 " Incontinence of urine (says Mr. Charles Bell,) never takes place but when the boy is asleep upon his back; and the cure is a simple one. He is to accustom himself to sleep upon his face or side: the urine is not passed, nor is he excited to dream of making urine while he keeps this position. The circumstance is unaccountable, until we reflect on the position of this master-spring of the muscle of the bladder. When a person lies upon his belly, the urine gravitates to the fundus; but wrhen he lies upon his back, it presses upon this sensitive spot, and distends that part of the bladder which is towards the rectum." Treatment.—When the disease proceeds from a relaxation of the sphincter of the bladder, a large blister to the os sacrum, or lower- most part of the back-bone, will be found highly beneficial, and often effects a cure in one or two days. The cold bath, or dashing cold water upon the genitals, and tonic medicines, as the nitric acid, lime-water, bark, steel, and Columbo, are peculiarly proper in obstinate cases of this kind. The tincture of cantharides, in doses of ten or twelve drops, every three or four hours, is said, by Dr. Morton, to be a specific in this complaint. Others recommend alum whey, made as strong as the stomach will bear it, and direct half a pint to be taken night and morning. With others, the blue vitriol, in doses of half a grain, given twice a-day in any agreeable liquor, is most to be depended on. The occasional use of rhubarb, in small doses, to keep the bowels easy, tends greatly to alleviate the affection. When it is produced by an impregnated womb, little more can be done than observing a horizontal position as much as possible. DIFFICULTY OF URINE. When there are frequent uneasy urgings to void urine, and it is discharged with difficulty and pain, the disease is called a strangury; and when it is totally retained, is called a suppression of urine. Causes.—It arises from a variety of causes, as calculous concre- tions ; obstructions in the urethra; blisters; or the tincture of can- tharides, taken internally too freely; wounds, bruises, &c. Treatment.—The cure must greatly depend on the cause. If the pulse be full and feverish, bleed and procure stools by emollient, clysters and cooling laxatives, such as castor oil, or the cathartic mixture. (See Dispensatory.) Much dependence is to be placed in the free use of demulcent drinks, as barley-water, flax-seed tea, mucilage of gum Arabic, decoction of marsh-mallows, of parsley roots, or of watermelon seeds, especially if the affection be owing to 278 DIFFICULTY OF URINE. the cantharides, or any injury of the bladder. One of the cam- phorated powders, (see Dispensatory]) given every three or four hours, in the patient's common drink, often effects a cure.—Great relief will be obtained from the warm bath, used oftener or seldomer as the case may require, or sitting in a tub of warm water, or from the frequent applications to the belly, of cloths wrung out of hot water, or bladders half filled with it. Opiates are very serviceable, but should never be used in the height of fever. A starch clyster, with laudanum, has very frequently given im- mediate relief. Cooling laxatives and diuretics, which operate without any stimulus, particularly the Epsom or Glauber salts, as in the form of the cathartic mixture, often relieve. As a diuretic, the following mixture is considered most salutary. Take, of sweet spirits of nitre, one ounce, laudanum and antimonial wine, each, twq drachms, a table-spoonful of which may be given in some diluent drink, and half this quantity repeated every hour, if necessary. In the chronic strangury, after other means have failed, the use of calomel in small doses, or mercurial ointment rubbed into the thighs every night till a slight ptyalism ensues, has frequently ef- fected a permanent cure. In such cases an affection of the prostrate gland may be suspected to have been the cause. Walking on a cold wet floor, perhaps dashing water against the legs and thighs, would, in obstinate cases, succeed in procuring a discharge of urine, as it has done the faeces. When a suppression of urine arises from partial palsy, as frequently occurs in the old and debilitated consti- tutions, our best chance of success, in giving temporary relief, is to give the spirits of turpentine in pretty large doses, make use of general stimulants, and apply a large blister to the loins. When this complaint is in consequence of calculous concretions or gravel obstructing the urinary passages, which may be known by pains in the loins, sickness at the stomach, and sometimes a dis- charge of bloody urine, an infusion of wild carrot-seed, sweetened with honey, as also the infusion of peach leaves, (see Materia Me- dica,) have been found exceedingly beneficial. The infusion of hops, which is considered a solvent of the stone, administered in doses of a wine-glass full, and taken to the quantity of a pint daily, is said to be an excellent remedy in calculous affections. The uva ursi is likewise celebrated as a remedy in cases of gravel, in doses of five grains with half a grain of opium, thrice a-day. A more power- ful medicine, however, for gravel complaints, is the caustic alkali, or soap-lees, (see Dispensatory]) but, being of an acrid nature, it ought always to be given in mucilaginous drinks, and commenced with small doses, which should be gradually increased as far as the stomach can bear, and continued for a long time, particularly if there should be an abatement in the symptoms. When great pain attends a suppression of urine, and the bladder is full, which can be ascertained by feeling it above the os pubis, and on pressure creating pain in the neck of the bladder, or at the end HEMORRHOIDS, OR PILES. 279 of the penis, it will be necessary to have recourse to the catheter, or a hollow bougie for drawing off the water. The larger sizes of each are more easily introduced than the smaller, as they are not so liable to stop in the corrugations and foldings of the urethra, which occur in elderly men. It is easy to introduce the catheter into the female bladder, since the direction of the urethra is nearly straight; but in males there is greater difficulty. The celebrated Heister directs the man to lie on his back, and the operator to take the penis in his left hand as he stands on the patient's left side, reclining the penis to- wards the navel, then he is to introduce the catheter, thoroughly oiled, with its concave part to the belly, in the urethra, as far as the os pubis, and so thrusting it under the symphysis of those bones, and moving the hand gently outwards, forces it into the bladder. In the following cases, this instrument cannot be used:—When the neck of the bladder is greatly inflamed; when a scirrhosity or preternatural tumour of the prostrate gland or stone obstructs the passage; when the uterus is remarkably prominent and pendulous over the pubes; or when the uterus is retroverted; in which state it drags the bladder upwards and backwards. When the application of blisters causes a difficulty of urine, wash the blistered part frequently with warm milk and water, or apply sweet oil. In children, a suppression of urine is often relieved by a poultice of raw onions or radishes applied to the bottom of the belly. Regimen.—During the violence of this complaint, the lightest diet only should be used, and mucilaginous drinks taken freely. Those who are often afflicted with it, ought carefully to avoid aliment hard of digestion, flatulent, or of a heating nature. HEMORRHOIDS, OR PILES. When there is a discharge of blood from the hemorrhoidal veins, it is called the open or bleeding piles; and when, instead of this hemorrhage, there are painful tumours at the lower part of the rectum, it is called the blind piles. Causes.—Costiveness; strong aloetic purges; much riding; or sedentary habits. Treatment.—If the patient be of a full habit, bleed, keep the bowels gently open with Epsom salts, the cathartic mixture, cream ofs^artar and sulphur or molasses and water; and avoid violent ex- ercise, high-seasoned dishes, and every thing of a stimulating nature. Topical applications, as cloths wrung out of cold vinegar and water, or lead-water, are also useful, and should not be omitted in either case. When the piles are of the bleeding sort, and will not readily 280 HEMORRHOIDS, OR PILES. yield to the above means, apply cloths dipped in charcoal powder, or in a strong solution of white vitriol or alum, frequently to the fundament, or anoint the part with the hemorrhoidal ointment, (see Dispensatory]) and endeavour to restore the tone of the vessels by the use of bark, elixir vitriol, nitric acid, or tincture of rust or steel. When the disorder assumes a chronic form in the more advanced periods of life, or when the piles do not bleed, they are generally at- tended with considerable pain; in which case, dossils of lint dipped in olive oil may be applied, or olive oil with an equal portion of lau- danum, may be spread on soft rags and retained by the T bandage. In addition to this mode of treatment, when the tumours are very painful, it is necessary to sit over the steam of hot water, which sel- dom fails to produce immediate relief. The poke-weed (see Mate- ria Medica]) has, in some instances, been employed with good ef- fects. The balsam copaivi, in doses of a tea-spoonful night and morning is said to be useful in relieving the pain, and will sometimes effect a permanent cure. According to Dr. Thomas, the tincture of foxglove, given in pretty large and frequent doses, is a remedy both for the external and internal piles. When the tumours will not yield to the external applications above recommended, anoint them night and morning with the mercurial ointment, to which may be added one-fourth opium. If the blind piles encompass the anus so as to prevent the dis- charges by stool, and prove otherwise troublesome, the largest may be removed by a ligature. If the distend vein is high and inflamed, it may be opened with a lancet. When from long-continued piles a fistula is apprehended, Ward's paste is sometimes useful. It consists of a pound of elecampane root, with half as much black pepper, and a pound and a half of fennel seeds, made into a paste with honey. Perhaps the remedy of the honourable John Taliaferro, for whitlow, might be useful in this case. When the piles are apparently continued from relaxation, two drachms of the tincture of steel, with nearly the same quantity of laudanum, and four ounces of barley-water or thin starch may be injected as a clyster, morning and night. The following ointment has been found a valuable remedy. Sul- phate of zinc two scruples. Powdered opium one drachm. Pow- dered galls one drachm. Mercurial ointment, one ounce. In cases of blind piles, the following ointment has afforded instant relief. Oil of almonds an ounce. Extract of stramonium half an ounce. Sul- phate of morphia six grains. To be used as an ointment. The fol- lowing may also be employed. Opium one drachm. Galls two drachms. Simple cerate an ounce. In a very obstinate case of blind piles, the following powder has been of great service. Pow- dered oyster shells and burnt cork equal parts. Anoint the part with a little olive oil and dust the part with the powder. When every thing else has failed it must not be concealed that Hey's lini- ment has occasionally worked miracles. One tea-spoonful of Epsom DYSENTERY, OR BLOODY FLUX. 281 salts should be taken every morning to keep the bowels in a soluble state without operating enough to irritate. In all cases where debility attends, the sulphate of quinine should not be omitted. Prevention.—Those who are subject to this distressing com- plaint, may be assured of preventing its recurrence, by keeping the bowels in a soluble state, with the occasional use of sulphur at bed- time, by washing the fundament night and morning with the coldest water, and by making use of a sponge absorbed with cold water, af- ter obeying the calls of nature. DYSENTERY, OR BLOODY FLUX. Symptoms.—A discharge of mucus by stool, often bloody; vio- lent gripings; pain in the loins; a constant inclination to go to stool, without being able to void any thing; and sometimes fever. Causes.—Putrid air and aliment; green fruit; strong cathartics; obstructed perspiration, and whatever increases the natural irritability of the intestines. Treataiknt.—To conduct the patient safely through this disease, the bowels should be evacuated by calomel, castor oil, or the cathar- tic mixture, and if the patient be of an inflammatory disposition, or there be febrile symptoms, blood-letting will also be required. After the acrid contents of the stomach and intestines have been evacuated, the anodyne sudorific bolus or draught, (see Dispensatory,) may be given at bed-time; and on the following day, if there be no evacua- tion of a natural appearance, one or other of the above aperient medicines must be exhibited in small doses, until the desired effect be obtained. To produce the natural evacuation daily, is a circumstance of the greatest importance in this disease, and should, at all times, be kept in view. To neglect this, as my good old friend, Doctor Henry Stevenson, of Baltimore, used often to say, would be like " Locking the thief in the house, to do all the mischief he could." It is some- times proper, instead of bleeding, to give an emetic in the beginning of the disease, to persons of weak habits; but where there is a great degree of irritability of the stomach, or obstructions of the liver, vo- miting will do more harm than good. It is my usual practice, at the commencement of this complaint, to administer to adults about a scruple of calomel, conjoined with five or six grains of ipecacuanha, or a grain of tartar emetic, and a few hours afterwards, or if the medicine be taken at bed time, on the 36 282 DYSENTERY, OR BLOODY FLUX. next morning, to give a small dose of Epsom salts or castor oil. With children calomel, in large doses, united with a small portion of ipecacuanha, are the principal medicines I employ, as it is difficult to prevail on them to swallow either the salts or castor oil. This mode of practice, together with a plentiful exhibition of arrow-root, the occasional use of the warm bath, and after the inflammatory symptoms subside, an opiate at bed-time, has uniformly succeeded. When the febrile symptoms justified the use of the lancet, it was, of course, resorted to* in the early stage of the disease. By conjoining the ipecacuanha with calomel or opium, a determination to the skin is produced, which is very desirable in this complaint. It should be remarked, however, though diaphoretics are indispensable, yet the patient should not be suffered to sweat profusely. The object is rather to produce a general relaxation, than to weaken by the dis- charge. A soft pulse, and moist skin, are the chief signs of the good effects of the remedies employed, and of a certain amendment. When the disease is epidemic, after having premised the necessary evacuations, calomel is most to be depended on, in doses of four or five grains, combined with Dover's powder, the anodyne sudorific bolus, or with one or two grains of opium alone, exhibited every night. And when the calomel does not produce a natural evacua- tion, it is always proper to give a small dose of Epsom salts, castor oil, or one or two wine glasses of the cathartic mixture, every morn- ing, until the disease begins to yield. If acidity prevails in the stomach and intestines, as marked by oppression, heat, sour belching, and vomiting, and excoriations about the fundament, besides a liberal use of mucilaginous and sheathing drinks, a wine-glass full of the absorbent mixture, (see Dispensatory]) or a spoonful or two of new milk and lime-water, should be given every two or three hours. Frequent injections of cold water alone or flax-seed tea, or barley-water, with a table-spoonful of laudanum, are of infinite service when the pain in the bowels and tenesmus are distressing. In obstinate cases, or when there is the least apprehension of an inflammation of the bowels, the warm bath or local fomentation to the belly, and afterwards, a blister, are indispensable. At the close of the disease, or when it indicates symptoms of the putrid nature, the charcoal, Columbo, quinine, bark, and wine, are the appropriate remedies; and, as a purge, rhubarb may be employed. Children that have been very much emaciated by this disease, have been most wonderfully restored to health, by bathing them night and morning in a strong decoction of oak bark, (see Materia Medica]) impreg- nated with whiskey or common spirits, and by putting on them bark jackets, as advised in the ague and fever. Doctor Mosely, a physician of great celebrity, states, that in chronic dysentery, unattended with fever, there is not a more efficacious medicine than the vitriolic solution, (see Dispensatory]) in doses of a table-spoonful every morning, with an opiate at bed-time. DYSENTERY, OR BLOODY FLUX. 283 In preparing this solution, the proportion of either the vitriol or alum may be increased or diminished according to circumstances; that is, when evacuations are required, the quantity of alum may be diminished, or entirely omitted; and when great astringency is required, the quantity of alum is to be increased, and the vitriol diminished. A simple, though efficacious remedy in this disease, is a solution of common salt in vinegar or lemon juice, termed anti-dysenteric mixture. (See Dispensatory.) This medicine has also been strongly recommended in bilious fever, or putrid sore throat, when the bowels are in an irritable state. Dewberry is likewise a valua- ble medicine in this distressing disease. (See Materia Medica.) Regimen.—In the violence of this disease, the diet should consist only of arrow-root, sago, panado, or gruel, and the drinks of a cool- ing and sheathing nature, as barley or rice water, flax-seed tea, or mucilage of gum Arabic, or sassafras. (See Materia Medica.) But when the disease has existed some time, the diet should be more nourishing, particularly if the patient has been weakened by preced- ing disease, or is either of a tender or an advanced age. Oranges, and whatever ripe fruit the season affords, may be allowed. The room should be constantly fumigated with vinegar, and well ventilated. The clothing, as well as the bedding, ought to be often renewed, and all offensive odours, particularly the fasces, should be removed as speedily as possible. Prevention.—The same means of prevention are here to be used, as under the head of bilious; and, as this disease becomes infectious, by neglect of cleanliness, its farther progress, through the medium of bad air, may be checked by attending to the mode of purifying that element prescribed under the head of nervous fever.* * It was this disease, which carried from the honours of this, to the glories of a better world, the illustrious author of the Declaration of Independence, Thomas Jefferson. His disorder assumed a serious character on the 26th of June, 1826. The strength of his constitution and his freedom from pain, for a short time, encouraged the hope that his illness was merely temporary. He himself, however, felt the conviction, that his last hour was approaching. He had already lived beyond the limit ordinarily assigned to human existence, and, for some months past, he had looked forward to its termination, with a calmness and equanimity worthy of his past life, nunc dimittis domine, &c. "Lord, now lettest thou thy servant depart in peace," the beautiful ejacula- tion of the just and devout Hebrew, was his favourite quotation. On the 2d of July, the complaint left him; but his physician expressed fears that his strength might not prove sufficient to restore him from the debilitated state to which he was reduced. Conscious that he should not recover, and free from pain, he calmly gave directions relative to his coffin and interment, which he requested might be at Monticello, without pomp and parade. On Monday, the following day, he inquired with much solicitude, of those around him, what was the day of the month? On being told that it was the 3d day of July, he eagerly expressed his desire that he might be permitted to live yet a little while that he might breathe the air of the fiftieth anniversary. His de- sire was gratified. He was sustained up to the very moment when his wishes were complete, and was then borne to that world, where the pure in heart 284 APOPLECTIC FITS. APOPLECTIC FITS. Symptoms.—Sudden falling to the ground, with a deprivation of sense and motion, attended by deep sleep and noisy breathing, the circulation remaining unimpaired. Causes.—Plethora; hard drinking; too large doses of opium; blows; tight neck-cloths, or whatever interrupts the return of the blood from the head. Treatment.—In the cure of a disease threatening such sudden fatality, remedies must be speedily employed. The patient's head should instantly be raised and supported, and he be placed in a situation where he can respire a cool air. He is to be bled most co- piously, to the amout of a quart or more, and this must be repeated after a short time, if he is not relieved, especially if the disease occur in a person of robust and plethoric habit. Cup also on the temples. Brisk purges are next to be administered, and when these cannot be swallowed, the most stimulating injections should be thrown up. The Croton oil, (see Dispensatory]) will in these cases be valuable; for when the patient is unable to swallow, from one to two or three drops, dropped on the tongue, will soon find its way into the stomach, and produce the desired effect. Where the disease depends rather on a depletion of the blood vessels, than on too great fulness, which may be known by its at- tacking old people of debilitated habits, bleeding is sparingly to be resorted to, particularly if the countenance appear to be sunk and meet their God. Of Mr. Jefferson's public virtues and services, it were su- perfluous for the author to speak. History has taken charge of them. His excellent and amiable life, his warm and unvarying attachment to his friends, his liberal and unaffected hospitality, and his singular moderation and equa- nimity are also known to all, and by all, and are held in pleasing but mournful remembrance. None was ever more illustrious in life; none was ever more happy in death. On the same day died the venerable compatriot of Mr. Jefferson, the Ex- President, John Adams. Mr. Adams felt the gradual decay of age affecting his body rather by insensible degrees, than by any settled infirmity. He did not, till a few days before his death, show any indication of a more rapid de- cay of health than usual. The fourth of July found him unable to rise from his bed, on account of an unusual degree of debility. Roused by the sound of distant artillery, he said, "It is a glorious day." Being afterwards asked for a toast, to be drunk by his neighbours, he said, " I will give them Indepen- dence for ever." These were his last intelligible words; about four o'clock, in the afternoon, this ancient patriot joined the throng of "just men made perfect." Great and glorious was the consummation of these renowned founders of American liberty. They finished their course, when they reached the jubilee of that independence which they had, in so great a measure, con- tributed to establish. They departed, (to use the language of our present honoured Chief Magistrate, the distinguished son of John Adams,) cheered by the benedictions of their countrymen, to whom they left the inheritance of their fame, and the memory of their bright example. EPILEPTIC FITS. 285 pallid. In these cases, the patient ought to be laid on a bed, with his head elevated, and turned every hour. Clysters are then to be given, and as soon as liquids can be swallowed, the contents of the stomach and bowels should be evacuated by a brisk purge. Sinapisms and blisters to the extremities, should not be neglected. But scalding or searing the soles of the feet with a hot iron, will more certainly and suddenly rouse the torpid system. Regimen.—The diet should be of the lowest kind, consisting principally, for several days after the attack, of diluent drinks, such as rice or barley-water, tamarind-water, or flax-seed tea, &c. Prevention.—In full habits, let the diet be light and sparing, and the bowels kept open. In debilitated habits, the diet should be more nourishing, and the strengthening medicines, as bark, steel, &c, employed to give tone to the vessels. EPILEPTIC FITS. Symptoms.—The patient falls suddenly with a deprivation of souse, while the muscles of the face and every part of the body are violently convulsed. Causes.—Excessive drinking; sudden stoppage of the courses; severe fright; injuries of the head; teething, in children; and irri- tation from worms in the stomach and intestines. Treatment.—To prevent the patient from injuring himself by the violence of his struggles, he ought immediately to be placed on a bed. The clothing should be every where loosened, and the head moderately elevated. A slip of wood should be placed between the jaws to prevent their closing on the tongue, and nothing adminis- tered in a glass vessel. Should it appear that the patient has been drinking too freely of spirituous liquors, or has loaded his stomach with indigestible matter, a strong emetic should be immediately given; which, by cleansing the stomach, will often terminate the paroxysm. If suppressed evacuations be the cause, they must be re-excited by such means as are calculated to restore the course of nature. If the patient complain of pain in the head, a seton in the nape of the neck should not be omitted. If worms be the fault, which may be known by an offensive breath and irregular appetite, they must be removed before a radical cure can be effected. The suppression of cutaneous affections has occasioned the dis- ease ; the repulsion of the gout; and sometimes the deficiency of the constitutional strength, which prevents its formation, has had the 286 FAINTING FITS. same effect. In all these instances the knowdedge of the cause will suggest the means of relief. When causes of debility and irritability, produce epilepsy; in other words, when the irritability is so great that the slightest irritation will induce the fits, the remedy is equally obvious. Warm, generous diet, which may appear at first indicated, must be used with caution; since a fulness of the vessels is, alone, in tender habits, a cause of irritability. Tonic medicines, with some of the narcotic bitters, as hops, Iceland liverwort, and lettuce, are the best remedies in such cases, anxiously guarding, as usual, against any accumulations in the head ; but not by such medicines as will weaken. Sometimes an epileptic fit is preceded by an uneasy sensation in some of the limbs or trunk of the body, creeping upwards to the head. In this case, the fit will be prevented by applying a ligature above the part so affected. Many cases have occurred, in which this disease has been cured with the sugar of lead, particularly under the age of maturity. It should be commenced in small doses, beginning with one-fourth of a grain, for a half grown person, and gradually increased to two grains or more, thrice a-day, made into pills with the crumbs of bread. If from using this medicine the bowels be disordered, it should be laid aside until relief is obtained by the use of the bath, mild laxatives, and opium in more than usual doses. A small por- tion of opium, combined with the lead, (see Dispensatory]) will generally obviate or correct its unpleasant operation. The good effects of nitrate of silver, commonly called lunar caus- tic, have also been attested by eminent physicians, in doses from one fourth, very gradually increased to a grain, twice a-day, made into pills with bread. The flowers of zinc have likewise been highly spoken of, and are said to have performed permanent cures, in doses of six or eight grains, morning and night. As there is incontrovertible evidence, that these medicines have succeeded in certain cases, they are all deserving of a fair trial, par- ticularly in the treatment of a disease in which no plausible remedy should be left untried. FAINTING FITS. Symptoms.—The pulse and respiration suddenly become exceed- ingly feeble, insomuch, at times, as to create a fear of the total ex- tinction of life. Causes.—Fright; long fasting; large evacuations; debility, &c. hysteric fits. 287 Treatment.—The patient should be placed in a reclining pos- ture, and every part of the clothing, which by its tightness is likely to interrupt the free circulation of blood, must be immediately loos- ened. The doors and windows of the room, especially if the weather be warm, should be kept open, and no more persons admitted than are necessary to give assistance; and these should not prevent the free access of the air to the patient. Sprinkle the face with cold water or vinegar, and apply volatiles, burnt linen, or feathers, to the nostrils; and, that the stimulus may with more certainty be inhaled, the patient should be kept from breathing through the mouth, by holding a handkerchief forcibly against it, taking care however, to leave the nostrils perfectly free. HYSTERIC FITS. This disease more frequently occurs in unmarried or barren wo- men, and those who lead a sedentary life. It very seldom appears before the age of puberty, or after the age of thirty-five years. The time at which it most readily occurs, is that of the menstrual period. Symptoms.—Generally commences with universal languor and coldness of the extremities. The colour of the face is variable, being sometimes flushed and sometimes pale. The pulse becomes unequal and obscure. The stomach is sometimes affected with vomiting, the lungs with difficulty of breathing, and the heart with palpitations. A painful sensation is often felt, like that of a globe or a ball in the left side of the belly, advancing upwards, and producing the same uneasiness in the stomach, from which it rises to the throat, occa- sioning by its pressure, a sense of suffocation; when a degree of fainting comes on, certain convulsive motions take place, agitating the trunk of the body and limbs in various ways; after which, alter- nate fits of laughter and crying occur, and a remission then ensues. In some patients, a violent beating pain takes place «i some part of the head, as if a nail were driving into it. Sharp pains, likewise, attack the loins, back, and bladder, and the patient makes an unu- sual quantity of urine as limpid as water; which is one of the most characteristic signs of the disease. The appearances which take place in this affection, are consider- ably varied in different persons, and even in the same persons at dif- ferent times. It differs by having more or fewer of those circum- stances above mentioned; by those circumstances being more or less violent, and by the different duration of the whole fit. Causes.—Excessive evacuations, particularly of the menses, de- 238 PALSY. pressing passions, continued anxiety, violent excitement, sudden sur- prise, grief, indigestion, &c. Treatment.—If the patient be young and of a plethoric habit, blood-letting will be required during the fit; but in delicate consti- tutions, this operation is not advisable. Volatiles, singed feathers, and the like, should be applied to the nostrils : and if the patient can swallow, a tea-spoonful of ether, or tincture of assafoetida, or thirty or forty drops of laudanum, may be given, in a glass of cold water, and repeated in a couple of hours, or sooner, if necessary. Clysters of gruel, to which may be added a tea-spoonful or two of laudanum, will also have a good effect. The feet and legs should, as soon as possible, be put in warm water, and well rubbed with the hand. Cold water sprinkled on the face, and the admission of the cool air in the room, are likewise proper auxiliaries. During the intermission of the fit, the nervous system should be strengthened to prevent a recurrence, by the tonic powders, pills, or drops, (see Dispensatory]) in their usual doses, after having admin- istered some purgative medicine.—Upon the approach of any lan- # guor, the patient should instantly take a glass of wine, or a tea- spoonful of lavender, or ten or twelve drops of laudanum in a glass of cold water. When hysteric affections originate from a suppression or obstruc- tion of the menses, these must be promoted by adopting the means advised under those heads. Regimen.—An attention to diet is highly proper for the removal of this disease. A milk and vegetable diet duly persisted in, will have the most salutary effect, especially in sanguine constitutions; but, should vegetables create flatulency and acidity in the stomach and bowels, in such cases animal food will be the most appropriate diet. The best drink after dinner is water with a little good wine, or a smaller quantity of old spirits. Tea should be prohibited altogether, or used sparingly.—Moderate exercise, particularly riding on horseback, is of the greatest service, as are likewise amusements and cheerful company. PALSY. Is a disease consisting in a loss of the powrer of voluntary motion, but affecting certain parts of the body only, and by this it is distin- guished from apoplexy. In the most violent degrees of palsy, the patient loses both the power of motion, and sense of feeling, either of one side or the lower half of the body. The first is termed hemi- plegia the latter paraplegia. When it affects particular parts only, as the tongue, the lip, eyelid, &c, it is termed a local palsy. PALSY. 289 Symptoms. —If this disease be not the effect of apoplexy, it is often preceded by universal torpor, giddiness, a sense of weight or uneasiness in the head, dulness of comprehension, loss of memory, and a sense of coldness in the part about to be affected; there is also, sometimes tremour, creeping, and pain in the part. Causes.—Compression of the brain from any of the causes in- ducing apoplexy; certain poisons received into the body, as lead, arsenic, Planters. M. Dieson, Stephen Shelton, B. Chance, 374 MALIGNANT FEVER. A. Cartwright, M. D. of Natchez, Mississippi, and published in the Medical Recorder, Vol. IX., year 1826. From these essays he has made copious extracts, which he presents to his very polite corres- pondents of Feliciana, and to the public, in general, as the best treatise on the cause, symptoms, and cure of malignant fevers, that has ever been published, and indeed the best which could be gath- ered from the whole stock of information on the subject, now pos- sessed by the profession. The thanks of the medical profession, and of the public, are due to Dr. Cartwright for his zeal and industry in investigating this subject, and for the ability with which he has communicated the results of his labours. Symptoms.—The disease wras marked by three distinct stages, each of which had its peculiar symptoms. As it might, in its first and second stages, have been mistaken for some other malady, I will only describe the last stage, which presented features altogether pe- culiar, and could be confounded with no other disease whatever. In the last stage there was apparently no fever, and little or no pain. The patient often regained his strength so far as to be able, in the most of cases, to walk about his room. His eyes were of a yellowish red, sparkling appearance, and lent to a countenance, otherwise of apathy, a strange expression of wildness and horror. Black dissolved blood oozed from the mouth, the gums, and the nose; coffee ground vomit, or a dark brown flaky matter, with but little effort, was thrown from the stomach ; anxiety, restlessness, and great flatulency of the stomach, portended and accompanied its discharge, spasms seized the muscles; the breathing became heavy, slow, and irregular, at- tended often by a hoarse, deep, sullen sound. The speech became incoherent; yet, when the patient was spoken to, he appeared to be able to collect himself so far as to answer questions rationally, and although sensible of his situation, seemed resigned to his fate. These were the symptoms that characterized the third or last stage of the disease. Although all of them did not invariably occur in every patient, yet a sufficient number were generally present to point out the character of the disease to the medical attendant the moment he entered the sick room. The first stage consisted in a broken or irregular reaction; and the second, or milder stage, in a general excitement diffused throughout the system. The duration of the first stage was generally from one > to twenty-four hours; and that of the second stage, from one to forty- ■: eight hours. The first stage could readily be distinguished from the second period, by the partial evolution of heat in the one, and the uniformly hot surface of the other. The patient was found covered up with bed-clothes in the first stage, but in the second and third, he greatly preferred lying entirely naked. In a great many cases, the worst cases too, the state of the system which constitutes the second stage, never occurred ; but the disease passed immediately from the first to the last stage, without going MALIGNANT FEVER. 375 through the second stage of reaction.—These were called the cold cases of yellow fever, or yellow fever without reaction. The approach of the first stage of the disease was announced by an intoxicated appearance, and a remarkable exhilaration or depres- sion of spirits, and was soon ushered in by a contemporaneous sen- sation of heat and cold. The patient, although complaining of great internal heat, was often found under one or more blankets, which he would not permit to be removed. His skin, which to him felt excessively hot, was often actually cold to the touch. Yawning, stretching, soreness of the flesh, achings of the bones, and, at length, flatulency of the stomach, with great weight and oppression about the prsecordia, took place, followed by pain in the head, stomach, and back. The pain, in this stage, was never so severe as in that of general reaction. Indeed, it was sometimes entirely absent. It was re- marked by a very intelligent and accurate observer of the disease, Dr. Gustine, that the most fatal cases were those which were at- tended with the least pain. A want of thirst also attended the disease in its first stage. The tongue was then seldom much furred; its edges were often red ; sometimes, it presented no unusual appearance in the most malignant cases. The patient, in this and the second stage, was as anxious about living, as he was indifferent and careless of life in the last stage. Treatment.—Experience has long since proved that the same remedies produce very different effects in different diseases, and in different stages of the same disease. Stimulants, emetics, cathartics, &c, are the only relative terms; for, in many conditions of the sys- tem, stimulants impart no strength, tartar emetic will not puke, nor will calomel purge or salivate. I shall first point out the state of the system in which they were used, the effect they produced, and the manner in which they influenced the disease. In all important cases, I was in the habit of noting the state of the system when a remedy was given, and on my next visit, noting also the changes produced in the disease. When a remedy, in any particular state of the system, was found to be pernicious or useless, it was not con- cluded to be pernicious or useless in all states of the system, but only under those particular circumstances in which it had been proved to be so. When the disease terminated fatally, I looked back on the situation of the patient when the remedies had been used, their ef- fects on the disease, and immediately proceeded to make post mortem examinations, and to note down every morbid appearance. Having the charge of Natchez hospital, from the 6th of September, until the epidemic terminated in November, I had an excellent field for ob- servation. Patients of every description were admitted, and in every stage of the disease,—some who had been under the treatment of other physicians, and others who had taken no medicine. This hospital, with my private practice in the city, in which I resided during the epidemic, and the experience of the disease in my own 376 MALIGNANT FEVER. person, in the present, and also in a former epidemic, are the sources from which the following observations have been drawn. I have seen patients recover from yellow fever under very different, and apparently, opposite modes of treatment. The narrow views which are too often formed of the action of medicines, and of the laws which regulate the system, aided by the dogmas of the schools, have, until within a few years past, shackled the science of medicine, and hindered its progress. Facts are yet too often overlooked or disregarded, when they do not support some slender-built theory, or favourite hypothesis. In the first stage of yellow fever, or that in which consists of an ataxic or crippled reaction, when the blood is unequally determined, the heat unequally-diffused, sensation impaired, and a secretion sus- pended, I found no other remedy, or combination of remedies, which produced such decided effects, as tartar emetic, in full doses. It, however, seemed sometimes inadequate to make a sufficient impres-. sion on the torpid system. When given in this stage of the disease, its effects were not so soon apparent, as in the healthy state of the system, or in less violent diseases. Very often, it would be an hour or more, after a full dose had been taken, before the system appeared to feel it. At length the peculiar sensation of heat and cold, at the same time, would somewhat yield to a sensation of heat only; the temperature of the skin would become more uniform, and as the ex- citement was brought out, great distress would ensue, and the sys- tem appeared to arouse from its torpor, and to regain, in some mea- sure, its organic sensibility. Some one or more of the great organs of secretion now took on a secretory action. The nausea, the retch- ing and anxiety, soon gave way to full vomiting, first of phlegm, and then of bile. This, to a spectator, was an alarming period in the disease, and most distressing to the patient. The powers of life would sometimes appear as if they were about to give way under it, but happily it was only in appearance. The vomiting at length subsided, and the patient enjoyed a little respite from his sufferings, and, bathed in a perspiration, he would fall into a slumber of short duration, for these were only the first effects which tartar emetic pro- duced on the system. Soon reaction took place, and the disease passed into the second stage; but the reaction was general, and lost its ataxic or broken character; it was accompanied with a hot skin, violent pain, and a full, strong, tense pulse. The patient would now complain of excessive misery. I delighted to see the disease come out thus openly, and show itself by fever and pain; for, although the patient might fancy himself worse, yet he was far removed from the danger which attended on the ataxic fever from which his system had just emerged, and onhy required a bold use of the lancet, and other remedies hereafter to be mentioned, to restore him to health. But it was not always the tartar emetic, when given in the first stage, would produce vomiting. In those cases in the first stage, in which the skin was cold, and even when the reaction was ataxic MALIGNANT FEVER. 377 and scarcely perceptible, the organs as if palsied, secretion entirely suspended or strangely vitiated, the stomach irritable, and little or no pain complained of, tartar emetic, in full doses, might be given with- out producing vomiting. Strange as it may appear, tartar emetic, in such cases, was a most powerful stimulous; it brought out the ex- citement, heated the skin, raised the pulse, allayed the irritability of the stomach, restored sensibility to the organs, and finally awakened one or more of them, the kidneys, skin, &c, to active secretion. To have this effect, it should be given in doses of from three to ten grains every one, two, or three hours, dissolved in a small quantity of water, or what is better, as I have since learned, in similar states of the system, in pills. When secretion has been brought about by the remedy used in this way, and the excitement developed, it should not, at once, but gradually, be discontinued, by giving smaller por- tions at long intervals. Should a vomiting ensue before the skin has its heat and sensibility somewhat restored, bile will rarely be evacu- ated : in this event, another dose of the medicine should be imme- diately given, and repeated whenever great nausea ensues. I have rarely seen this practice fail, in such states of the system, to check the vomiting and heat the skin, when mustard and blisters had failed. It will be remembered, that those which are denominated cold cases, are the most hopeless. I have used the hot bath, fric- tions, sinapisms, blisters, besides various internal stimulants to bring on reaction ; but the combined influence of all these remedies has never had the same beneficial effect as tartar emetic alone. But in some cases of this kind, particularly in hard drinkers, it fails to pro- duce secretion, and to develop excitement. It may be imagined by men in their closets, that these are cases of congestion only, which congestion could readily be removed by small and repeated bleedings combined with internal and external stimulants. If the malignant nature of these cases depend entirely on congestion, it is a very dif- ferent congestion from that which takes place in many other diseases. In the latter, I have often succeeded in removing the congestion, by blood-letting, combined with internal and external stimulants; but in the cold cases of yellow fever, never. In such cases, if blood be taken away, even should the patient not immediately sink under it, so far from the reaction being produced, the blood vessels lose more and more of their contractile power; stimulants impart no strength; the warm bath and rubefacients produce no more effect on the skin than if applied to so much leather; the organs become more para- lyzed ; the sympathies more deranged; and the whole system soon appears as if it were divided into two different parts, one not depend- ing on another, and each having the principle of life diminished in it. Instead, then, of using blood-letting in such cases, to remove congestion, I used tartar emetic to produce secretion, and to develop the excitement. Although tartar emetic was sometimes inadequate to produce these desirable effects in the cold cases, it scarcely ever failed to be eminently serviceable in the first stage of cases of a less 48 378 MALIGNANT FEVER. malignant nature. The earlier it was given in the first stage of the disease, the better. When given freely, so as to produce secretion in the liver, kidneys, and skin, a general and equable reaction soon succeeded. It shortened the duration of the first stage, or that of ataxic reaction, and thereby converted a highly malignant into a mild case of yellow fever. For, in the mild cases, when left to na- ture, the first stage continues but a short time, and the disease soon passes into the second, or that of general reaction. These are the cases which bear bleeding and purging so well, and in which eme- tics are of no service, (unless given before the general reaction has taken place.) The good effects of emetics appear to depend on their ultimately producing a general and equable excitement throughout the system. In the more malignant forms of yellow fever, the stage of ataxic reaction, when left to nature, continues a longer time; and should the second stage, or stage of general excitement ever occur, its duration is so limited, that a sufficient time is not given to subdue the disease, before it passes into the third and last stage. Tartar emetic, then, given in the first stage, shortens its duration, and places the system in a similar state to what we find it in the milder forms of the disease. And, in proportion as the ataxic stage is shortened, so is the stage of general excitement prolonged, and the chances of the patient's recovery greatly increased. On looking over my notes, I perceived, that when it had been given in the first stage, such patients not only bore bleeding better, and could be purged more easily, than those to whom it had not been given; but whether they lived or died, the symptoms of the second stage, or that of reaction, continued longer than when tartar emetic had been omitted.—For in those cases in which it had not been given, should the stage of reaction ever occur, it continued but a short time, frequently not more than an hour; then external reac- tion, like the blaze of recently ignited coals, would subside, not from the fire having been extinguished, but from the heat which supported it having become greater. My notes, likewise, showed me that tar- tar emetic, however well adapted to some states of the system, was not so to every one in yellow fever. For when it had been given in the stage of general reaction, its effects were extremely equivocal, and, in some cases, injurious ; and in the third stage, it appeared to accelerate the fatal black vomiting. I thus found that I had pushed a favourite remedy too far, by using it improperly; and, at the same time, learned the particular states of the system to which it was peculiarly adapted; namely, during the first stage of the disease, antecedently to the development of a general reaction. Tartar eme- tic used in this stage, restored sensibility to the torpid organs, pro- duced secretion, and destroyed the ataxic character of the disease, by establishing a general and equable excitement; or, in other words, converted an irregular and intractable condition of the system, into an open, plain, and manageable case of fever. When I first treated yellow fever, in its first stage, by tartar emetic, and witnessed the MALIGNANT FEVER. 379 violent reaction that shortly succeeded its use, and heard the ago- nizing shrieks of my patients, from the pain that attended the increased sensibility and universal excitement that succeeded it, for a moment I thought I had done wrong, and would have ceased to use it, had I not found that this was the only state of the system in which the lancet could fearlessly and successfully be used. Even when the lancet was not used, the general reaction in- duced by tartar emetic, was nothing like so fatal, as when an ataxic state cloaked the violence of the disease. To illustrate this remark, Dr. McPheeters, lately from Missouri, was taken ill at the most peri- lous and alarming period of the epidemic. He found himself alone, and rendered helpless, by a violent disease that killed generally in three days. Being a man of great strength and energy of mind, he resolved to make use of efficient measures, and, accordingly, mixed up sixty grains of tartar emetic, and took a sixth part of it at once. It produced copious secretion, and was soon followed by a vehement excitement of the whole system. Having no means to subdue the reaction thus brought about, it ran its course. But every part being excited, the system was enabled to bear up against a power that oth- erwise would have caused it to succumb. Nine or ten days after- wards, I visited him. Reaction had nearly run itself down. He looked more like a patient in the advanced stage of a common syno- cha, than one in the yellow fever. Had not the ataxic reaction, with which the disease commenced, been removed, he would not, most probably, have survived. Blood-letting.—If blood-letting were resorted to before the development of general reaction, the reaction, which had yet only partially developed itself, abated ; the heat which had begun to spread itself over the surface, disappeared ; .and the pain would sub- side ; and this, too, before the quantity of blood taken away was, in any degree, considerable. Medicines did not operate, and the dis- ease at once passed into the last stage. During the ataxic reaction, in vain may we be told to bleed to the relief of the symptoms; foi they grow worse while the blood is flowing, and continue to become more alarming, and that in proportion to the quantity of blood taken away. When a feeble and broken reaction has taken place, to attack it by the lancet, is like attacking the first phalanx of an enemy, when he attempts to come out of his intrenchments, instead of waiting until the main body has appeared in the open field. But in the second stage, in which the heat of the whole surface is excessively increased, the pulse full and strong, the patient lying naked, and calling on the attendants to fan him, and to give him cold water, we may bleed fearlessly and successfully. The effects produced on the system by blood-letting in the reacting, so far from hastening the disease into the last stage, and bringing on fatal symptoms, prevented it from passing into that state, and robbed it of all its violence and danger. I will now give a case in which blood- letting was followed 380 MALIGNANT FEVER. by alarming consequences, from its being used a little too soon in the disease ; that is, before the second or reacting stage has fully deve- loped itself, yet so near the stage of general reaction, as to prevent blood-letting from proving fatal. Mr. McCauIey, a printer, was attacked with yellow fever, on the 20th of August. The disease appeared at once to overpower the system. It seemed as if the vis- cera had absorbed nearly the whole of the. circulating fluids, as the skin was cold and almost insensible; the pulse small, slow, and weak, and no secretion appeared to be taking place from any organ whatever. He complained of no pain, yet was restless and uneasy, and seemed to be oppressed in his breathing, as if a heavy body were lying across him. In this situation, early in the morning of the 21st, about twelve hours after his attack, a full dose of tartar emetic was given him. In two hours afterwards, he began to com- plain of pain in his head and back; his skin became somewhat warm, particularly about the head and breast; frequent efforts were now made to vomit, but nothing except the drinks was evacuated : a clammy sweat bedewed his forehead and breast, which soon dried up, and again appeared. He continued in this state until noon, when full vomiting took place. At two o'clock, the vomiting ceased, and the irritability of the stomach was so much allayed, that it re- tained several doses of calomel and castor oil, senna, tea, &c, which were given at regular intervals, until seven o'clock ; and, although assisted by injections, had not operated. He now complained of excruciating pain. His skin, except his extremities, was hot to the touch; his pulse at the wrist tense, but not full and strong. The ataxic reaction was verging on to general reaction ; but the latter had not, as yet, fully developed itself. Hoping that it would be the means of making the medicine operate, I opened a vein in the arm; as I never feared blood-letting in such states of the system, as, alone, it would either produce secretion, or cause medicines to do it. Being determined to bleed him until some sensible effect was produced, I took away upwards of sixty ounces of black dissolved blood, before the system seemed to feel its loss. The blood was stopped, in consequence of a slight sickness at the stomach. The patient answered several questions after I had tied up his arm. I went into an adjoining room, and, in about five minutes, was told the patient was dying. I took hold of his arm, but found no pulse. His face was sprinkled with water, washed with vinegar, and con- stant frictions applied to the skin during fifteen minutes, yet without effect.—Some laudanum was now procured, and one hundred and twenty drops poured down his throat. After waiting fifteen minutes longer, for a boy to return from the apothecaries, half an ounce of spirit of hartshorn was given, which he seemed not to feel. A stimu- lating injection was administered; his face was washed with the aqua ammonia, and the frictions were kept up. All of his atten- dants, excepting one, left him, and reported him dead. I thought, myself, that animation had been suspended too long, in his present MALIGNANT FEVER. 381 condition, to be restored. After remaining in this situation for nearly an hour, signs of life again appeared. After several sighs, respira- tion took place, and a tremulous pulse was felt. But from the slightest exertion on the part of the patient, synocope would again ensue, and continue for several minutes. I ordered the spirits of turpentine to be freely given, stimulating injections to be used, and sinapisms to be applied to the extremities. On the morning of the 22d, I found that no perceptible secretion had taken place : he had neither sweated, urinated, or had an eva- cuation from his bowels. Suspecting that there might be a want of power in the bladder to evacuate the urine, I examined, but found no urine in the bladder. I continued to give the turpentine, in drachm doses, every hour through the day. His bowels, on the evening of the 22d, acted ; and, shortly afterwards, he discharged a little very turbid urine. On the morning of the 23d, the great organs of secretion were all awakened, and the patient, though much ex- hausted, was, in a few days, restored to perfect health. Had the reaction in this case been general, and not of the ataxic kind, I judge from what I have seen in other cases, that no alarming effects would have followed the use of the lancet; but had not the ataxic ap- proached so nearly to general reaction, I am fully persuaded that the patient would not have borne half the quantity of blood to have been taken away, without producing death. I have dwelt the longer on this case, as the length of time which elapsed before the emetic operated, the changes that took place in the system in consequence of it, the great quantity of blood that was taken away before the system felt its loss, the alarming effects that followed it, and the length of time before the torpid organs assumed a secretory action, are well calculated to show the character of the most malignant form of yellow fever, and the manner in which they are influenced by remedial agents. I will now give one case, out of many, to show the effects of blood-letting after the excitement is fully evolved. Mr. Welch, a baker, was attacked with yellow fever on the 15th of September. On my visiting him, on the morning of the 16th, J found him wrapped in several blankets, and complaining both of heat and cold. I ordered five grains of tartar emetic every hour, till lie vomited copiously. In the evening, I found him lying naked on the floor, as the bed was too warm ; he was raving like a madman from the excruciating pain in his head and back; he begged the attendants to kill him at once, and put him out of his misery. His pulse was full and strong, and the whole surface of the body re- markably hot.—I took away, at one bleeding, six pints of blood, before the symptoms were relieved. He continued very sick at his stomach only for half an hour, but did not faint. Calomel and cas- tor oil, then given, operated freely on his bowels in six hours after- wards, and he speedily recovered. In my own case, I lost four pounds of blood at one time. It was taken away before general reaction had as fully developed itself as 382 MALIGNANT FEVER. I could have wished. A most distressing feeling of exhaustion en- sued, and continued for an hour or two. No healthy secretion took place for twenty-four hours afterwards; at the end of which time, by a judicious course of treatment pursued by my physician, and friend, Dr. Kenny, the skin, the liver, the kidneys, and salivary glands, all took on a secretory action ; and in less than a week from my attack, I was able to leave my room ; and in two or three days more, I resumed my practice. It was not until I had seen some of the most injurious effects from the loss of the smallest quantity of blood in the ataxic stage of the yellow fever, that I could be convinced of the propriety of waiting until the excitement had fully developed itself, before recourse should be had to the lancet. Purgatives.—If purgatives were given immediately on the ac- cession of the first stage, they sometimes produced secretion, which was followed by a reaction more or less general. But it was only in the milder forms of the disease, in which the organic sensibility was not greatly impaired by the first shock of the disease, that pur- gatives produced secretion. Drastic purgatives, in almost any state of the system, would, after so long a time, force away watery stools, which, like similar secretions in cholera morbus, soon exhausted the system, without producing any beneficial effects whatever, either immediately or remotely. When the system was placed in a proper state for the exhibition of purgatives, those of the milder class would be followed by bilious discharges, which were beneficial; but when it was not in this state, drastic purgatives would produce serous mucus, or sanguineo-serous discharges, which were extremely injurious. As the milder cathar- tics were found to have all the good of the drastic, and none of their evil effects, I preferred mild to drastic purgatives. Late in the epi- demic, I obtained some of the Croton oil. From the trials I gave it, I am induced to believe that it will be found to be a valuable remedy in many cases of yellow fever. Every time it was used, copious bilious dejections ensued. It was, however, only resorted to in those states of the system in which I would have used other purgatives. As this medicine is so pleasant to take, and can be retained on the stomach in cases in which almost any other purga- tive would be rejected, it promises to be of great utility in many forms of disease. Mercury.—Given in the first stage of the disease, mercurial pre- parations in, by far, the majority of cases, produced no evident effect on the system, and, consequently, none on the disease. Sometimes, however, even in this stage, they produced ptyalism, yet such ptyal- ism had little or no effect in arresting its progress. There is a state of the system which, however, occurs more often in bilious than in yellow fever, in Avhich I have found the specific effects of mercury to be particularly serviceable. After reaction has subsided, and the skin, kidneys, and liver have been excited into a secretory action—owing to some organ having, from some cause or MALIGNANT FEVER. 383 other, sustained a great shock, a torpor will again take place in one or more of these organs, that produces great irritation in the system, preventing sleep, destroying the appetite, producing fever, and there- by exhausting, more and more, the already too much exhausted patient. If the torpid organ be excited into action by any other remedy than mercury, as soon as it ceases to feel the impression of the remedy, it ceases to secrete : here, mercury, by keeping up an impression not transient, as the most of other medicines, but per- manent, will, by enabling the diseased organ to regain its powers, restore the patient to health. In the above state of the system, and in many others in which the specific effects of mercury are indicated, I had been taught to use calomel in small and frequently repeated doses ; but experience has convinced me, that there is scarcely any state of the system, requiring the specific action of mercuiy, in which calomel, in large doses, is not the best means to effect it. Scruple doses of this medicine will not only induce the specific effects of mercury sooner, but will be followed by fewer disappointments, and less inconvenience and danger, than when smaller doses of that medicine, or any other form of mercury, have been resorted to. Diuretics.—As a copious secretion of urine was a favourable symptom, and a suppression of it alarming, and often fatal, diuretics were remedies, in many cases, of great importance. When purga- tives would not produce a secretion of bile, instead of trying by re- iterated doses of these medicines, more especially of a drastic nature, to force awray alvine discharges, which, in such circumstances, would generally be of a serious kind, that tended only to weaken the pa- tient, I endeavoured to excite the kidneys to secretion by diuretics. I have often had the pleasure to find that the urinary secretion produced by them, was of equal advantage in arresting the progress of the disease, as the biliary, by purgatives. Soon after the secre- tion of urine was established, the skin and liver would both gene- rally begin to yield their peculiar secretions, and the disease would no longer be able to resist the efforts of these allied organs. Diaphoretics.—When neither the liver nor kidneys could be excited into action, diaphoretics were sometimes serviceable. But great irritability of the stomach, the distaste to all medicines, the want of nurses, and the rapid march of most cases, prevented me from encumbering my practice by such feeble medicines, in the treatment of a disease, which seemed to require only a few simple, efficient, and well timed medicines. Epispastics.—In every stage of the disease, I have used blisters, applied to the head, over the stomach and bowels, to the extremities and down the spine. The benefit, however, which I had reason to expect from my experience with them in bilious fevers and other diseases never followed their use. Sinapisms to the extremities, to assist tartar emetic, and the hot bath to produce reaction in the cold cases; or after reaction had been reduced, to stimulate the prostrated 384 MALIGNANT FEVER. patient, were far more serviceable than blisters. The former acted much more quietly, and produced greater pain than the latter. Stimulants.—How the bark and wine in large doses would have answered in the first stage of this disease, to change the ataxic reaction of that stage into a general reaction, I cannot from expe- rience determine. The Spanish practice in the Andalusian fever, consisted in large and repeated doses of bark, given immediately when the patient began to complain. This practice, we are told by Dr. Johnson, was attended with extraordinary success. I very much suspect that the good effect of bark, in that fever, principally depended on its transforming the broken excitement, with which the disease com- menced, to a general reaction, or open case of fever. I lost one patient who drank a draught of ardent spirits, with pepper in it, immediately after the attack. The fever became developed, but great gastric distress attended throughout its course. Autopsic appearances proved the existence of unusually high inflammation in the stomach. Of the Bath.—The cold bath, if used in that state of the sys- tem, which I have called ataxic reaction, was evidently injurious. I cannot better describe its effects, than by the following case:— Mrs. Rice, in the first stage, used ablutions of cold water and vinegar. The efforts made by the system, towards general reaction, became immediately subdued; and, to use her own language, "the cold water drove the fever in upon her heart and stomach." Great cold- ness and shivering, with internal heat and oppression, succeeded its use. Reaction never took place, and the disease passed, at once, into the last stage; and when I was called to see her, fatal symptoms had appeared. Had an emetic, instead of the cold ablutions, been tried, it is probable that reaction would have been general; would have borne blood-letting, and have been attended with a different result. The only condition of the system, in which cold ablutions or affusions were advantageous, was when the surface was uniformly and preternaturally hot. In this epidemic I never found any dif- ficulty in reducing the reaction by the lancet and other remedies, consequently, I seldom found it necessaiy to call in the aid of cold affusions. In the yellow fever under review, when reaction was reduced, or on the wrane, if secretion did not take place, the tepid bath, appa- rently by removing the remains of morbid heat, and by restoring the natural sensibility of the skin, enabled that important organ to take on a proper secretory action. But cold water, by carrying off too much heat, reduced the temperature of the skin below that degree which is compatible with natural sensibility; and, consequently, with healthy secretions. Pleased with the effect of the tepid bath, after the use of the lancet in the reacting stage of the disease, I re- sorted to the same remedy in the ataxic stage. The temperature of the bath wras 96 degrees. The patient, as soon as immersed, com- MALIGNANT FEVER. 385 plained of being disagreeably cold ; he was taken out in a shivering fit, and was shortly afterwards immersed in a bath so hot, as to be extremely painful to my own hands, yet he did not in the least com- plain of it. His skin soon became generally warm, and an emetic, which he had previously taken, began now to operate. He was removed from the bath, and in a few hours a fever so violent ensued, that copious blood-letting was employed to subdue it. The hot bath, whenever it could be procured, was employed in conjunction with emetics, in the cold cases of yellow fever, in order to bring about a general reaction. If emetics were not used in conjunction with the bath, the skin, it is true, would be heated: but its heat, like that of an inanimate substance would soon subside on being re- moved into a colder medium. Dr. Cartwright farther states, that he personally witnessed the yellow fever of 1825 in Natchez, "Under the Hill;" in Washing- ton, a village six miles from the river Mississippi; at Haughton's, a tavern in the country; and, lastly, in Natchez, " On the Hill;" and he proceeds to give the following additional facts relative to the causes, nature, and treatment, of the disease, which its occurrence and prevalence in the above mentioned places afforded him an op- portunity of observing. Natchez Landing, (or Under the Hill, as it is called,) consists of a few rows of buildings, situated immediately on the brink of the Mississippi river, at the foot of a bluff about two hundred feet high, which forms the site of the principal part of the city, called Natchez " On the Hill." Although during high water, the buildings under the hill are immediately on the brink of the river, yet when the river falls, as it always does^jn summer, a surface of ground several rods in width, becomes uncovered between the buildings and the river. The surface thus exposed by the falling of the river, consists of mud recently deposited, and of the debris of various vegetable and animal substances, which, during the season of trade, had been thrown out by the flat boats that landed at this place. On the margin of this uncovered surface, there is a warehouse, which, in the months of July and August, 1825, contained a large quantity of spoiled porter and sour pork. The owner of the warehouse was constantly en- gaged in repacking the pork; the brine from which, was permitted to run through the floor, into a kind of cellar, which had no outlet to it. Some of the porter barrels burst, and the spoiled porter, also, ran through the floor into the cellar, with the brine from the sour pork. Some few hundred yards above the warehouse, there was a boat containing a quantity of rotten corn, which had been sunk in the water, but became exposed in the summer by the falling of the river; and below the warehouse, but not so far from it, there were two or three houses that contained stagnant water, others, putrid sour krout, fish, oysters, &c, in their cellars. Leaving Natchez for the present, I proceed to Washington, to give 49 386 MALIGNANT FEVER. a brief sketch of its topography, and an account of the epidemic yellow fever, which prevailed there in the autumn of 1825. Washington, a small village, containing about four hundred in- habitants, is situated six miles east of Natchez, and not less than the same distance from the nearest point of the Mississippi river. The toWn occupies a high and healthy situation, remote from any swampy ground, or from any water-course whatever, except a small stream of running water, a branch of the St. Catherine's, about a quarter of a mile north-east of it. The citizens of Natchez, prior to 1825, always found Washington to be a place to which they could retreat with safety, from the ravages of the malignant fever. The in- habitants of that town had hitherto opened their doors to the sick and the dying, and received no harm, as not a case of yellow fever ever occurred among those who had not breathed the Natchez atmosphere. A grocer, who had been living " Under the Hill," removed his grocery store to Washington in the latter part of the summer. He rented an old wooden house on the north side of the main street, which, with the lot attached to it, is situated in the hollow space of ground described above. The earth had been thrown up around the palings of the lot, except at one place, to serve as a drain in rainy weather. This drain was choked up with weeds and trash when I examined it, during the progress of the epidemic about to be described, and served but imperfectly the purpose for which it was intended. The grocer who removed his store to the house on this lot, removed also a quantity of bacon and mackerel, a great part of which had begun to putrefy at the time of its removal, or putrefied soon afterwards. These provisions the grocer was in the habit of selling to negroes. Mr. Alfred Radcliff informed me, that a few days before the yellow fever originated in Washington, he called on the grocer, in order to purchase some bacon for a friend in the country; but on examining it carefully, the whole quantity which the grocer had on hand, was found to be in a putrescent state, and none of it fit to purchase. About two thousand pounds of bacon, he stated, was filled with large worms, and was in a putrid condition. The Rev. Mr. Burruss informed me, that in addition to the putri- dity within the house, the grocer was in the habit of receiving from the fishermen on the Mississippi river, supplies of fresh cat-fish, (a fish in this river weighing from ten to one hundred pounds,) the heads and entrails of which, besides what rotted on his hands, were thrown into the back yard of the lot above described. All I person- ally know with respect to the real situation of the grocery, is what every person knows, who either lived near, or came in its vicinity, that the stench from it was extremely disagreeable. The principal stores and boarding-houses in town, were situated a short distance from the grocery, both above and below it. Both of the town mar- kets were within twenty-five steps of it. Should it then be a matter of wonder, if a few persons living in the suburbs of Washington, in MALIGNANT FEVER. 387 the most healthy situations, should have been attacked with yellow fever, a little after the time it broke out around the grocery, when it is recollected that those who visited the stores, the taverns, and the markets, were exposed to the same atmosphere with those residing in the vicinity of the grocery? The yellow fever of Washington, like that of Natchez, in 1823, had three stages. The first stage was generally preceded by, and at- tended with, catarrhal symptoms. It was known by the patient's sensations being no true evidence of the actual coldness or heat of his surface ; by the heat of the surface being unequally diffused, the head and breast hot, the extremities often cold; by the patient pre- ferring to be wrapped up in blankets, although, at the time, his skin may have been pungently hot to the touch, by the chilly feeling being greatly increased, if the patient merely reached out his arm to have his pulse felt, or if any of the bed-clothes were removed, al- though he might have complained of these making him disagreeably hot, by a copious perspiration occasionally taking place, and drying up without relieving the disagreeable chilly feeling, abating the pun- gent heat of the skin, equalizing its evolution, or establishing the lost relation between the patient's feeling of heat, and the real heat of his body. So different were the sensibilities, both organic and animal, in this fever, from a healthy condition of the system, tha.t I have known patients to complain of their extremities being cold as ice, when they were actually burning hot. I was forcibly impressed with this fact, on seeing patients bear to their extremities, particularly their feet, applications sufficiently hot to corrode or blister the skin, and produce great pain, were not the organic and animal sensibility of the part very different from health. I recollect having affronted one person, from having him put in a tub of water, disagreeably hot to my hands, not because he found it too hot, but too cold. The second stage was known by the patient losing all his chilly feelings; by his throwing off the bed-clothes, calling for cold drinks, being tortured with the severest pain in his head and back, tossing himself from side to side in his bed, or going from one bed to another, by his uniformly hot surface, by a diminution in the secretory process, to wit: a paucity of bile and urine, great dryness and heat of the skin, and mucous membranes, and, lastly, by an increased energy of the whole arterial system. The third stage was pointed out, by the heat of the surface having diminished, but not the patient's sen- sation of heat having proportionally diminished, by a slow irregular respiration, or even when the number of respirations differed but little from the healthy state; by the yellow skin, accession of strength, the black vomit, and hemorrhages from the mouth and nose. The first stage, in some cases, quickly passed into the second; in others, it continued twenty four, or even forty-eight hours, before the reacting stage ensued. This stage, in some, never occurred, the dis- ease passing at once from the first to the last stage, while in others badly managed, it lost many of its characteristic features; namely: 388 MALIGNANT FEVER. there would be great heat, thirst, and pain, yet a quick irritable pulse, which would not bear the lancet; a comatose state of the brain, similar to typhus fever, accompanied with extreme irritability of the stomach, and a strong disposition in the bowels to take on a watery purging. Such cases were very fatal. The disease, not only in Washington, but in Natchez, the present season, differed from that of the latter place in 1823, in its very great liability, in many cases, to be attended with copious and vitiated secretions, not only in its first, but in all its stages. Treatment.—As in 1823, during the first stage, or that of ataxic reaction, tartar emetic was found to be the most useful remedy. I generally gave from six to ten grains at a dose, and repeated it in smaller doses, until it either produced bilious emesis, removed the chilly feeling, developed an excitement throughout the system, pro- duced secretion in the skin or kidneys, subdued the ataxic fever, or palsied the deranged organic actions. Vitiated secretions seemed to depend on the latter, as, in many cases, the first doses of tartar eme- tic put a stop to the vomiting of a vitiated fluid, which had taken place before its exhibition. Tartar emetic, however, used in small and repeated doses, often rendered the stomach more irritable, and even when used in effectual doses, it often did harm, unless properly managed. When the chilly sensation was very great, the warm or hot bath, if used a little before, or at the time, the emetic was given, enabled it to produce bilious reaction, much more readily, and with much less distress to the patient, than when the emetic had been trusted to alone. Case.—Mr. K., of Natchez, was violently attacked. He told me to give him any thing but tartar emetic; for it always cramped him, produced great coldness, and he had, every time he had taken it, come near losing his life. His life appeared to me to depend on a bold use of the remedy he so much dreaded, as 1 had no hope of subduing so violent an attack, unless some great change could be produced in his system by the remedy in question. As his kidneys were torpid, I gave him freely of gin sling, had him put into a hot bath, to remove the chilly sensation he complained of, and gave him, while in the bath, ten grains of tartar emetic in half a pint of strong seneca tea. He vomited bile copiously and easily; and so far from requiring hartshorn, laudanum, &c, to remove the coldness and cramp, as formerly, he soon lost near two pounds of blood, to subdue the consequent arterial reaction. He soon recovered. From Dr. McPheeters, I learned the efficacy of black mustard in vinegar, both as an emetic itself, and as a powerful coadjutor of tartar emetic, in cases wherein the latter alone, from torpor of the stomach or some other cause, failed to awaken the energies of the system. Warm brandy-toddy, in some cases, prevented the tartar emetic from pro- ducing vitiated secretions, and at the same time enabled it to produce those of a proper kind, or at least enable it to prepare the system for their production. As cold feet and hands had a great effect in MALIGNANT FEVER. 389 opposing the beneficial action of tartar emetic, warm pediluvia, si- napisms, frictions, &c, were found to be necessary to place the sys- tem in a proper condition for its reception. It was always necessary to subdue by the lancet, general arterial reaction or fever, whenever it came on, as it sometimes did, before bilious vomiting, had been produced. If it were a broken reaction or fever, however, tartai emetic was its best febrifuge. Great determination of blood to the head, in the ataxic stage, with a pulse at the wrist, which will not indicate blood-letting, while at the same time there is a very strong pulsation of the carotid arteries, so far from being a state of the sys- tem that contra-indicates tartar emetic, is the very state of the system in which 1 have witnessed more beneficial effects from the remedy in question, than any other whatever. I am not the only one who can bear testimony of the beneficial effects of tartar emetic in such states of the system. Dr. McPheeters has kept a record of a great number of cases of this kind, wherein emetics were found to be no less useful than the bark in intermittent fevers. If the pulse, at the wrist, and other circumstances, do not forbid blood-letting, this, of course, should be premised, previously to the exhibition of the emetic; but when this is not the case, the blood-letting should be deferred until after the remedy has produced a change on the de ranged organic sensibility of the system, broke up the irregular de- terminations of blood, and brought out a general reaction of the arte- rial system. The worst consequences sometimes occur from a timid use of tartar emetic, from giving it in too small doses, repeated at too long intervals, or from discontinuing its use on the first appearance of any unpleasant symptom, at a time when it may be most needed. Case.—Col. Marschalk, a very large, corpulent man, was attacked with the yellow fever of Washington : I gave him an emetic in the ataxic stage of his fever. In a few hours afterwards, I was called in great haste to see him. He was panting for breath, as if in a fit of asthma. No bilious vomiting had yet been produced. Great heat, pain, and inward distress, were complained of. I bled him about a pint, as his pulse would bear no more, and gave him three grains of tartar emetic every half hour in spirits seth. nitr. The second or third dose brought on effectual vomiting, attended with no distress; the skin became moist; the difficulty of breathing, internal heat, pain, and distress, were removed, and the patient recovered without farther difficulty. But it behooves me to state, that the worst effects are sometimes produced by tarter emetic rashly persisted in, without regard to the condition of the patient, in order to bring about some particular ef- fect on the system; as, for instance, bilious vomiting. But who has not witnessed the worst effects from cathartics, or from mercury, rashly persisted in, without regard to the condition of the patient, in order to bring about some particular effect on the system ; as, for instance, dark bilious stools, or a discharge of saliva ? 390 MALIGNANT FEVER. By an emetic properly managed, if given early in the disease, not only the fever of Washington, but that of Natchez, was often cut short at once, and the patient recovered without farther trouble: while the mildest attacks, if left to nature, ultimately seldom failed to prove fatal. If the disease did not yield at once to emetics, gene- ral arterial reaction ensued in the most of cases, requiring the lancet for its reduction, together with purgative medicines, which brought on bilious evacuations, that soon relieved the patient. Sometimes, however, when emetics had not been used at a period of the disease sufficiently early,or, if used, had not been properly managed; or, if properly managed, owing to some peculiarity of the case, had not produced their general beneficial effects on the system; but, most generally, when emetics had been entirely omitted, it was difficult to produce, by purgatives, the proper kind of evacuations from the bowels—I mean evacuations of a dark bilious matter of tolerable consistency. In such cases, it was very difficult to retain purgative medicines on the stomach, owing to its irritability; and, if retained, even calomel would often produce watery evacuations. In such cases, to continue the use of this or any other purgative remedy, without first altering that condition of the system on which the wa- tery evacuations depended, was to continue to use them to the de- struction of the patient. In as much as he became speedily exhaus- ted under such evacuations, I made it a rule to check them by an enema, of a tea-spoonful of laudanum in a little starch gruel, or by giving opium or its tincture. The next object was to alter that mor- bid condition of the system on which the watery or vitiated secretions depended. Tartar emetic, either with or without the addition of a little opium, in two or three grain doses, every one, two, or three hours, calomel with two or three grains of opium, or with ten or twenty grains of camphor, repeated according to circumstances, and assisted by the warm bath, blistering, &c, were often found useful in preparing the system to be properly acted on by purgatives. A remedy, however, which appeared to suit some cases the best, was the sulphate of quinine, or, where the stomach would bear it, the Peruvian bark with cream of tartar and cloves; either of which was given without regard to fever, if such fever would not admit of blood-letting. Even when the fever, (I mean heat of skin, &c.) was increased under this practice, the various organs of the system became more disposed to take on a proper secretory action, than be- fore such fever had been excited. I am confident that I used the sulphate of quinine in too small doses in our late epidemic. Dr. Perrine assured me, that in the bilious fever in the country, ten or fifteen miles from Natchez—to prevent a watery purging, which so often took place in that disease, he resorted, after having premised sufficient blood-letting, to the use of the sulphate of quinine in eight grain doses, every two hours through the day, notwithstanding the presence of fever, and at night gave aloes, scammony, and calomel in pills, still continuing the sulphate. He assured me that under MALIGNANT FEVER. 391 this free use of the sulphate, the fever would abate, and the cathartic would produce thick, copious evacuations of a dark colour, which would soon relieve the patient; whereas, to use the purgatives with- out the sulphate of quinine, if they operated at all, they only pro- duced watery stools, which soon robbed the patient of his strength, and aggravated his disease. Dr. McPheeters and myself have both used, with a similar intention, the sulphate of quinine, after the plan of that excellent physician, Dr. Perrine, and we have found it even to surpass our expectations. The purgatives which could be the most relied on, in the epidemic of 1825, to produce bilious secre- tions, were calomel, aloes, and scammony combined, the purified spirits of turpentine, and the Croton oil. When there was much pain in the bowels, accompanied with tenesmus, the charcoal was of great service. The best plan of giving medicines in cases of great irritability of the stomach, which neither sulphuric ether, opium, ef- fervescing mixtures, &c, will allay, has heretofore been with me a desideratum in practice. The fate of a patient frequently depends on minutiae, too often unattended to in practice. It is an easy mat- ter to prescribe aloes, scammony, jalap, &c., in order to purge a pa- tient, who is constantly sick at his stomach. But the object of the prescription is often entirely defeated, in consequence of the patient refusing to take these remedies; or, if he takes them, by the impos- sibility of his being able to retain them on his stomach. The best plan I ever tried, of giving these, and similar nauseous medicines, so as to obviate the inconvenience of their disagreeable taste, and to prevent them from being vomited, is to have the various purgative articles made into a soft mass with syrup. Any given quantity of this mass, is to be enclosed in a very thin wafer, made of flour, and softened by being soaked a few minutes in water or milk. The en- closed mass is then put into a spoon with a little water in it, out of which the patient is to swallow it. After this manner, a patient can take, at one dose, a mass sufficient to make a dozen pills, and he cannot, without the strongest efforts, throw it up from his stomach ; he tastes nothing but the flour wafer, and the nausea of his stomach is not increased, as it would be from his swallowing a quantity of bitter pills. In this way, a large quantity of Peruvian bark may be giving at a dose, without the patient's tasting it. One table-spoonful of flour, made into a batter with water, is sufficient to make sixty wafers. The plan of making them is, to have two smoothing irons heated, one of which is to be placed with its face upwards, on which a few drops of the batter is to be poured, and the other iron is then to be pressed upon it. The little cake or wafer, thus made, is, as I before observed, to be soaked in water, before using it, in order to make it sufficiently pliant to enclose the medicine. I venture to assert, that whoever tries this plan of giving nauseous drugs, as aloes, Sic, in cases of great irritability of the stomach, will seldom prescribe diem in pills, syrup, or solution: calomel, however, can be very conveniendy given, floating on a table-spoonful of common cold wa- 392 MALIGNANT FEVER. ter. A table-spoonful of water will float two scruples, if the calomel be not in lumps, and if it be sifted down lightly on the water. Spi- rits of turpentine should be purified by mixing it with alcohol, as di- rected by Dr. Nemmo. With these remarks on the manner of ad- ministering remedies in cases of great irritability of the stomach, re- marks, though seemingly of little importance eveiy where else, may not be entirely so at the bed-side of the sick, I close what I have to say on the Washington yellow fever, the history of which disease, if it does nothing else, will show that an epidemic yellow fever is not necessarily confined to water-courses. I now proceed to give an account of some cases of malignant fever which originated at Haughton's tavern, in the country, about a mile from Natchez. Nine or ten persons died in and about this place with yellow fever. The disease'commenced at Haughton's, in September, a little prior to its appearance in Natchez, " On the Hill." If medical topography throw light on the origin of yellow fever in other places, it does not withhold its light in the present in- stance. Haughton's tavern, and Shears's, (the two houses where all the cases referred to originated,) are situated without the chartered limits of the city, on a small peninsula formed by a junction of two very long, deep, and winding bayous. One of the bayous commences on the eastern, the other on the western, side of Natchez; and, with the exception of two or three squares, the whole of Natchez is drained by them. The western bayou, after draining the western part of Natchez, passes by the butcheries, receives their offal, and pur- sues a serpentine course, to meet its fellow, the eastern bayou, at Haughton's. Between the eastern bayou and the foot of the little hill, on which the houses alluded to stand, there is a flat surface of about an acre, surrounded on all sides by hills. A gully, leading through the isthmus formed by the two bayous, conducts the water of an adja- cent field on this flat surface, over which it spreads, before it falls into the bayou. Haughton's tavern is within ten steps of this flat ground, which, besides what the gully brings on it, and besides its own vegetable productions, is the receptacle of the kitchen offal, and of a privy which has no well. When the eastern and western bayous meet, a distance from the tavern of about thirty rods, there is also a flat surface surrounded by hills. The eastern and western bayous, in their whole course from Natchez, are seldom less than ten feet wide, and ten feet deep. In many places they are more than fifty yards wide, and as many feet deep. Their banks, which are steep and abrupt, are almost constantly falling in, which obstructs the current of water from a light rain, but affords no obstructions to the torrents which roll down them during heavy rains. In 1822, the yellow fever prevailed at this place. I then supposed that the pol- luted atmosphere of the city had extended thus far. I was inclined to this opinion, as several persons, whom I attended, assured me that they had not been in town. I did not, at that time, suspect the MALIGNANT FEVER. 393 bayous of having any agency in the production of yellow fever; but I have, since that time, in my practice through various parts of the adjacent country, which abounds with these bayous, found the re- mark verified, of an old practitioner of this place, the late Dr. Seip, that a " bayou was more sickly than a marsh." I again return to Natchez. The yellow fever " On the Hill," in 1825, differed but little from that of Washington. But " Under the Hill," it resembled more closely , in its symptoms and progress, that of 1823. Nearly all the physicians who got much practice, adopted the emetic plan of treating the disease of the present year, and these seldom lost more than one in ten of their patients; while, under the old plan of trusting to a few grains of calomel, frequently repeated, with inunction of mercurial ointment in order to bring on salivation, the disease was about as fatal as formerly. Dr. Hunt, who came to Natchez very much prejudiced, by education, against emetics in yellow fever, but who is too liberal to advocate the errors of theory, unsupported by facts, threw aside his prejudices, and not only pre- scribed emetics with great success to his patients, but when attacked with yellow fever himself, commenced the cure by an active emetic: so did Dr. Walker. Neither of these gentlemen ever had cause to repent of this first, yet all-important, step in the treatment of their disease. Prevention.—As respects the best method of preventing the disease, while usual health exists; and the best method of preventing the disease, when those who are exposed to its cause become indis- posed, Dr. Cartwright makes the following observations: Those persons in health, who, in order to avoid an attack of this epidemic, had recourse to medicines and ardent spirits to which they were un- accustomed, were among the first to be attacked. Fumigations and the smelling of volatile substances, were also found to be of no ser- vice. Those persons who escaped, regulated their diet and drinks, not by any fixed rule or standard, but by their former habits; and if they deviated from those habits, they approximated to simplicity and abstemiousness, not carried to the extent of debility ; for if the stomach were not sufficiently excited by food and drinks, the same effect was produced as if it had been too highly stimulated; namely, a derangement of action between it and the organs with which it is associated. Those who had been temperate and abstemious, con- tinued to be so. Two persons who had, for several years, kept up a strong excitement by ardent spirits, continued it during the preva- lence of the epidemic, and entirely escaped. But all who had not previously been habitual drunkards that imitated their example, be- came sick and died. Ardent spirits kept up the equilibrium of action in the systems of the former, but destroyed the equilibrium in the latter. Finally, those who escaped were such as preserved this equilibrium, by accommodating their diet, drinks,sleep,and exercise, to the existing slate of the system, and to their former habits, avoid- ing all exciting causes, as heat, cold, fatigue, &c. 50 394 MALIGNANT FEVER. As to those who are indisposed, it was found that the best means of warding off the attack, or rendering it milder, was to ascertain in what way the threat is made, and to apply the remedies accordingly. Persons of plethoric habit, whenever they felt a fulness and uneasi- ness about the head, or a disposition to fever, were relieved by bleed- ing, and escaped. Others, whose indisposition proceeded from a torpid state of the bowels to which they were subject, escaped by the occasional use of aperients. To those who complained of a bitter or mawkish taste in the mouth, sickness at the stomach, achings in the bones, soreness of the flesh, and sleeplessness, emetics were pre- scribed with success. A gentleman who complained of pain in his back, with resdessness and anxiety, and whose urine had, for several days, been small in quantity, was enabled, by a free use of diluent drinks and diuretics, entirely to avoid the attack of the epidemic. From these facts it is plain, that though the poisonous atmosphere of yellow fever may long be breathed with impunity, while a due balance of action among the various organs is preserved, yet not so when it is broken; that living in such an atmosphere tends to break this balance; the smallest disturbance of which is announced by symptoms that often point directly to the organ in which the distur- bance has commenced, and which, in many cases, may, by timely and appropriate measures, be restored to its healthy functions. ADMONITORY HINTS TO LADIES. Light were my task, if every gentle breast, Owned the just laws of native truth imprest; For not by hopes of vain applause misled, In reason's injured cause alone I plead. Tis you to judge; nor I that judgment fear If truth be sacred, and if virtue dear.—Roscoe. If we consider but for a moment the wonderful power which superior beauty in woman exerts over the human breast; how in- stantly, on the approach of its possessor, the hearts of the young are thrown into the most delightful palpitations, and the looks of the aged brightened with admiration and pleasure ; we can no longer wonder that it should be so highly prized by the sex. But it is to be lamented, that the most preposterous means should be employed to gain a property so desirable, and that real beauty should be so often abused. Thus, some girls fancy that beauty can only exist in forms slen- der and delicate. At the very thought of being corpulent, they are alarmed, and to obviate grossness, as they call it, they drink such quantities of vinegar, that it not only destroys the tone of the sto- mach, but introduces a withered ghastly paleness. We knew a lady whose practice was to devour many pickles every day for the pur- pose (as she thought) of preventing obesity. The consequence was that she lost the healthy tone of the stomach to such a degree that at last she could retain scarcely any article of food. She wasted away to a shadow, and life itself became a burden. For the same purpose they continue the absurd practice of wearing jackets, or cor- sets, so oppressive, as, by compressing the ribs, to prevent the expan- sion of the lungs. Another imprudence, and still more detrimental, is that of appear- ing at assemblies, in winter, in light dresses, exposed to the baneful effects of cold, with the aggravating addition of extraordinary wrarmth, 396 ADMONITORY HINTS TO LADIES. 1 by the fatigue of dancing; hence, consumptions, and a train of maladies, too long to be here particularly described, are produced. Motives of delicacy, as well as regard for health, have been re- peatedly urged in vain to enforce the necessity of relinquishing these destructive habits; the arguments of the moralist and of the physician, having alike failed to convey conviction ; and hundreds, who would now have been shining forth among the loveliest of their sex, are dressed in shrouds, because, " in an evil hour," they laid aside those articles of their apparel which health, as well as decency, forbade them to relinquish. There are others, wrho, reading of the fair-skinned belles of Europe, foolishly conclude that the rose and the lilly are the only colors of beauty. Catching at this female passion for fair and unfreckled faces, the quacks have prepared a number of nostrums, called cosmetics or beautifiers, which, they vauntingly profess, are to heal the chaps on the lips; to remove pimples and freckles ; and to give the counte- nance such a fair, smooth and charming appearance, as to render it impossible for any one to contemplate it without being enamoured. But, unfortunately, these boasted cosmetics, instead of heightening the polish and charm of beauty, too often contribute to tarnish and destroy them.* A fine lady of one of our large cities, one day after the use of one of these deleterious cosmetics had occasion to pass through one of the back streets on a damp, muggy day. On her return, she was amazed at the appearance of her skin, for since breakfast, she had turned quite black. A new compound had been formed by contact with a nauseous gas emanating from the portion of the city she had visited. Beauty ceases to be attractive when we know it to be artificial. Far from admiring, we turn away with disgust. We recently had occasion to admire the beautiful rose and lily of a handsome woman. It was of an evening. Calling the next morning on a professional visit to another branch of the family, and catching a glimpse of my fair lady, we shall never forget the sensation of disgust at the change in her complexion. A face naturally fair and of a sweet expression, had been awfully marred by the application of these poisonous cosmetics. The truth is, beauty is not the creature of a quack, but the gift of nature; and to bring it to perfection, nothing more is necessary than exercise, cleanliness, temperance, and cheerfulness. These are the handmaids of health ; and health, to persons of certain symmetry and expression, is beauty. * To such of my readers as are partial to the use of cosmetics, an infusion of horse-radish in milk is recommended as one of the best and safest. Another innocent preparation for clearing the skin of pimples, and recent eruptions, is the expressed juice of house-leek, mixed with an equal quantity of sweet milk or cream. When these fad, blistering the face all over the eruptions will often succeed in removing them. ADMONITORY HINTS TO YOUNG LADIES. 397 ---:-------------:------The rural wilds • Invite; the mountains call you, and the vales, The woods, the streams, and each ambrosial breeze That fans the ever undulating sky; A kindly sky! whose fostering power regales Man, beast, and all the vegetable reign.—Armstrong. How much, then, is it to be deplored, that so many of our young females should think so meanly of exercise, which, alone, brings the female frame to perfection, paints it in the liveliest colours, and, by giving richness to the blood, and vigour to the nerves, disposes to habitual cheerfulness, and alike qualifies the mind for thought, and the heart for love. On the contrary, how different is the female who leads an inac- tive and sedentary life, too generally looked on as proofs of a fine modern lady, which seldom fails to relax the system, retard the cir- culation, vitiate the blood, and obstruct the secretions. Hence that chalky paleness of the face—that faintness of the eyes, indigestion, flatulence, weak nerves, low spirits, irregularities of nature, and con- stant complainings. The grand discharge, th' effusion of the skin Slowly impaired, the languid maladies Creep on, and through the sinking functions steal. Armstrong. Yes, many a girl by constant muffling and housing herself; by dreading that the sun should ever kiss her cheeks, or the wind ruffle her tuckers; by much indulgence in bed, and other imprudences, renders herself so exceedingly pale, delicate, and puny, that her ap- pearance is better fitted to damp love than to excite it. "The vigour sinks, the habit melts away; The cheerful, pure, and animated bloom Dies from the face, with squalid atrophy Devoured." MANAGEMENT OF FEMALE COMPLAINTS. MENSTRUATION. One of the principal constitutional characteristics of the female, is menstruation, or the monthly evacuations peculiar to the sex. This important operation generally takes place about the age of twelve or thirteen ; but varies through the world, either in degree or frequency, both from constitution and climate. Women in the higher ranks of life, and those of a delicate nervous constitution, are subject to sickness, headache, and pains in the back and loins, during the periodical evacuation. Those of the lower rank, inured to exercise and labour, and strangers to those refine- ments which debilitate the system, and interrupt the functions essen- tial to the preservation of health, are seldom observed to suffer at these times, unless from general indisposition, or a diseased state of the womb. After the discharge has become established, it recurs periodically while in health ; and its recurrence is so regular that it can be cal- culated with great exactness. The usual period of its visitations is from twenty-seven to thirty days. As to the time of its continuance, this is various in different women; but it seldom continues longer than six days, or less than three, and does not cease suddenly, but in a gradual manner. Its approach is generally preceded by certain feelings of oppres- sion or deviation from the ordinary state of health, which warn the individual of what is to happen. There is, in particular, a sensation of fulness about the lower part of the belly, and a relaxation about the uterine system, which can scarcely be overlooked by the most heedless. It must at the same time be admitted, that in some few constitutions these feelings are so inconsiderable as to be little at- tended to; so that the woman mixes in society as usual, without any apparent inconvenience. * MANAGEMENT OF FEMALE COMPLAINTS. 399 It is of importance for women to know that occasional irregulari- ties are not always the consequence of disease. Constitutions vary as much in respect to the regular returns of this discharge, as they do with regard to its first appearance or its final cessation. Those in whom the change occurs very early from vigour of constitution, require little to be done for them; but, in weak and delicate habits, the non-appearance of this evacuation is too often considered as the cause, whereas, it ought to be viewed as the effect, of the state of the habit unpropitious to its taking place. And, according to family practice, under this false impression, warm teas and forcing medi- cines are employed at the approach of this disease, which have often done much harm. Nature is not so defective in her own judgment as to require such auxiliaries. Care should be taken to improve the general state of their health, by attention to diet, moderate exercise, change of air, and cheerfulness; which will be found to have the happiest influ- ence on the body and mind, and gives a salutary impulse to the circulation of the blood. With respect to the flow of the menses, women should remember, that what is to one woman a due propor- tion, would be to another, from the difference of constitution, and temperament, an immoderate flow; and before they attempt to re- strain it, let them carefully consider, what may have been the exci- ting or occasional cause. They are too frequently told that such a situation arises from mere debility; and under that belief will take cordials, and stimulating medicines. In general, this is not the case: and by such improper treatment, the flow is increased, and the habit rendered feverish. The quantity generally discharged in a healthy and regular woman, is from four to six ounces at each visitation. Those of a delicate constitution have, however, a more copious and longer con- tinued discharge than persons of a robust habit; thus, the full blooming country girl does not discharge half the quantity that the pale-faced lady of quality does. In some instances, the menstrual discharge does not make its appearance before the age of seventeen or eighteen, and, nevertheless, health is not in the least affected. The mere want of evacuation at the ordinary time, therefore, is not to be considered as morbid, unless the system be evidently deranged thereby. In many cases, however, symptoms of disease appear which are evidently connected with the defect of the menses, and go off upon its discharge. The treatment, in such cases, must be regulated by the particular circumstances and constitution of the in- dividual. There is no remedy adapted to every case of this kind; but an open state of the bowels, and a due regulation of the diet, to- gether with moderate exercise, are useful in every instance of this complaint. Warm clothing, too, particularly about the lower ex- tremities, is of most essential benefit. The occasional use of the warm bath is pleasant and beneficial, especially if the skin be dry and warm. As the health improves, the cold bath will prove an 400 MANAGEMENT OF FEMALE COMPLAINTS. auxiliary, if, after using it, the patient feels a glow of heat, and a greater degree of liveliness. When the means ordinarily employed have failed, marriage, or a change of climate, has produced the wished-for effect. In some instances the evacuation is impeded by a mechanical cause, that is, an obstruction of the passage to the womb. This oc- casionally is met with, and the chief obstacle to its speedy removal is the difficulty of ascertaining its existence. The operation by which it is completely remedied, is not more painful nor formidable than blood-letting. Fortunately, in most cases, the evacuation takes place in due time, and the constitution sustains no material or permanent injury. It is, however, in every instance, proper to pay particular attention to the system during the continuance of the evacuation. The stomach and bowels, at this period, are very easily disordered, and, therefore, every thing which is heavy or indigestible, ought to be avoided. Some are hurt by eating fruit or vegetables; others by taking fermented liquor. In this respect experience must enable each individual to judge for herself. Exposure to cold, particularly getting the feet wet, is hurtful, as it tends suddenly to obstruct the discharge. The same effect is likewise produced by violent passions of the mind, which are also, at this time, peculiarly apt to excite spasmodic affections, or hysterical fits. It is, in general, a very proper rule not to administer any very active medicines, at this time, unless some violent symptom abso- lutely requires them. Opiates, for instance, are, in many cases, necessary to allay spasmodic affections, or abate pain; and they are, in such circumstances, uniformly safe. They give speedy relief to hysterical feeling or suffocation, or to spasms of the stomach and bowrels. Blood-letting is also, in some instances, necessary, from particular circumstances, at this period, and in such cases it is safe, and does not obstruct the evacuation. Dancing, exposure to much heat, or making any great or fatiguing exertion, are improper. These causes may increase, to an improper degree, the quantity of the evacuation, and in certain circumstances may give a disposition to a falling down of the womb. To conclude, the period or time of life, when the monthly eva- cuation should disappear altogether, is considered as critical. It is really so in two cases. The first is, when the woman has suffered considerably at each period, from sickness, pain, and disorder of the bowels. Such women, not unfrequently, when the constitution is freed from the monthly change, enjoy better health than formerly. The second is, when there is a tendency to disease, in some particu- lar organ, especially in the womb itself, in some of the abdominal viscera, or in either of the breasts. In such cases, the time of life may prove the period, at which the disease begins to make its progress. The time at which this evacuation ceases, varies from the forty- MANAGEMENT OF FEMALE COMPLAINTS. 401 fourth to the fiftieth year. It is usual, for some time before it dis- appears, that it should become irregular. It not only is sometimes greatly less, and again much more in quantity than usual; but it is also occasionally obstructed for some months; and then, perhaps, comes oftener than it ought to do. The occasional obstruction, be- fore the final cessation of the discharge, is frequently accompanied with sickness and swelling of the belly, from the wind in the bowels. These circumstances, sometimes incline married women, for some weeks, to consider themselves with child. Others again, averse to be thought old, flatter themselves that the irregularity is occasioned by cold, or some accidental circumstances, and therefore very improperly employ their utmost endeavours to recall it. The complaints which, in many women, occur at this period of life, are to be ascribed rather to a general change in the habit, than merely to the absence or total cessation of the sexual evacuation. Women who have never had children, or good regular health, or diose who have been weakened by frequent miscarriage, are most apt to suffer at the decline of life. It frequently happens, that women who were formerly much pained when out of order, or who were troubled with nervous and hysteric complaints, begin at the cessation of the periodical discharge to enjoy a good state of health, to which they had formerly been strangers. When no particular complaint occurs in consequence of the de- cline of life, it would be exceedingly absurd to reduce the strength by an abstemious diet and low living. If, on the contrary, headache, flushings of the face, or an increased degree of heat, restlessness in the night, and violent pains in the belly and loins, swellings of the feet, or eruptions on different parts of the body, take place at this period, there is reason to believe that a general fulness exists, in consequence of the stoppage of the ac- customed discharge. Under such circumstances, spare living witli increased exercise, occasional blood-letting, and frequent gentle pur- gatives are enjoined. If ulcers break out in the legs, or in any other part of the body, on a total cessation of the menses, they ought to be regarded as criti- cal discharges, and should by no means be healed up without sub- stituting some other drains by an issue. PAINFUL MENSTRUATION. In some instances, menstruation is attended with great pain in the back, thighs, and lower part of the belly. This state is sometimes 51 ^ 402 MANAGEMENT OF FEMALE COMPLAINTS. accompanied with suppression of urine, or violent colic pain and spasms of the stomach. The discharge generally takes place slowly, and is deficient in quantity, and not unfrequently attended with the expulsion of a skinny looking substance. Causes.—This disease is supposed to be owing to a weak action of the vessels of the uterus, or spasm of the extreme vessels. Pain sometimes attends copious menstruation; but whenever it does, there is much reason to apprehend some local disorder of the womb. Treatment.—As soon as the symptoms that denote its approach are apparent, recourse should be had to the warm bath ; when this is not convenient, the patient should sit fifteen or twenty minutes in a tub of warm water, or cloths wrung out of warm water, or a bladder two-thirds filled with it, should be applied to the lower part of the belly. After this the back and abdomen should be well rubbed with the camphorated, or volatile anodyne liniment, and if the pain continue, the anodyne clysters should be administered. If, notwith- standing these means, the pain become violent, it will be proper to give a tea-spoonful of the diaphoretic drops, or four or five grains of Dover's powders, or one of the camphorated powders, (see Dispen- satory,) every hour or two until a gentle, but general perspiration be induced. This is also to be encouraged by drinking warm penny- royal or ginger tea. When this complaint arises from general ful- ness and irritation, it may require repeated bleeding and purging. If there be pain in the stomach without fever, give a tea-spoonful of laudanum, with twenty drops of essence of peppermint; or should costiveness prevail, give a dose of castor oil in conjunction with the anodyne. For the cure of this distressing complaint, Dr. Fothergill recom- mends a pill of opium, of one grain, to be taken the moment the pain comes on, and to be repeated every hour until it be suppressed; to keep the patient in bed ; and to let her dilute freely with herb teas, until the discharge be fully established, after which the pain seldom returns; and when the period has passed, chalybeate bitters until within a few days of the next period. Dr. Denman proposed small doses of calomel every night at bed-time, for several weeks to- gether, and twice in the course of the day, a dose of the volatile tincture of the Peruvian bark. Dr. Dewees, of Philadelphia, re- commends the volatile tincture of gum guaiacum, to be continued for a considerable length of time, and says it acts almost as a specific. And Dr. Robertson, of Edinburgh, is as sanguine in praise of the tincture of cantharides given in pretty large doses, thrice a day, until it excites some degree of pain in voiding the urine. Prevention.—In order to prevent this painful state, in those who are subject to it, the warm bath should be used, three or four nights preceding the menstrual period, and on going to bed, two tea-spoon- full of the diaphoretic drops, or ten grains of Dover's powder should be given in some warm tea. The bowels are to be kept uniformly MANAGEMENT OF FEMALE COMPLAINTS. 403 regular; and exposure to cold, especially near the time of the ap- pearance of the discharge, is to be carefully avoided. The constitution is to be improved, and strengthened by such means, as its particular condition requires; and in general, by the use of tonic medicines, and the shower bath, provided these do not disagree with the patient. OBSTRUCTED MENSES. Many women have the menstrual evacuation postponed for a week or two, beyond the usual time, or miss one or two periods without any very evident cause, and without inconvenience. But when it is suddenly suppressed very troublesome symptoms occur; and when it is retained for any considerable length of time, it is generally ac- companied by bad health. Symptoms.—When suddenly checked, it is usually attended with considerable pain in the back, bowels, or stomach, and sometimes in the chest. In persons of a full habit the face is generally flushed, the pulse hard and frequent, flying pains in the chest, perhaps, spit- ting of blood, cough, palpitation, difficulty of breathing, and a com- plication of nervous affection. Persons of a delicate frame and a melancholic temperament, and especially those who have suffered from some debilitating cause, have different symptoms, constituting what has been called chlorosis, or green sickness, a disease always connected with, and depending on, some derangement of the sexual organs. In chlorosis, every symptom of feebleness prevails, a pale skin, and even a greenish complexion, succeeds to the rosy hue of health; the skin under the eyes puffy and of a leaden colour; the whole body lax, oedematous and doughy ; the judgment, memory, and natural cheerfulness impaired; the pulse is generally slow and feeble, but easily excited; and it is then accompanied with shortness of breath, a palpitation of the heart, and an almost unconquerable disinclina- tion to motion; the appetite is destroyed, and the stomach so de- ranged, that the food, instead of being digested, undergoes the fo- mentation peculiar to its nature. Hence, the patient finds gratifica- tion in chalk, lime, pieces of old wall, and other improper sub- stances ; and the bowels are commonly costive. It not unfrequently happens that the blood which should have passed off by the uterus, being determined more copiously and for- cibly to odier parts, gives rise to hemorrhages; hence, it is fre- quently poured from the nose, stomach, lungs, and other parts, in such cases. When women (says Denman) are deprived of the common ute- rine discharge, they are sometimes liable to periodical emissions of 401 MANAGEMENT OF FEMALE COMPLAINTS. blood from the nose, lungs, ears, eyes, breasts, navel, and almost every other part of the body. To constitute the menses it is not necessary that the discharge should take place from the uterine or even genital organs, for some women have them by other passages, manifested by periodical vomit- ing, coughing of blood from the lungs, bleeding from the hemorr- hoidal veins, nose, and so on.—Edinburgh Medical and Surgical Journal. Causes.—A constriction of the extremities of the vessels of the womb, arising from accidental circumstances, such as exposure to cold, anxiety of the mind, fear, excessive evacuations, inactivity of the body, poor blood, the frequent use of acids, and other sedatives, &c. In some constitutions, particularly in those where pain attends the discharge, very slight occurrences suddenly interrupt the flow, and prevent its usual return, such as passions of the mind, fright, fa- tigue, irregularities of diet, putting on damp clothes, &c. This fact showrs the necessity for certain cautions and attention during the dis- charge. Obstructions, too, are sometimes the effect of disease of the general habit. Treatment.—When the evacuation has been suddenly checked, it is proper to have immediate recourse to the warm bath, or sitting up to the hips in warm water, or fomentations to the lower part of the abdomen, and bathing the feet in warm water. It is also advis- able to put the patient to bed and give a tea-spoonful of the diapho- retic drops, or five or six grains of Dover's powTders, in a cup of warm herb tea, such as sage, hyssop, penny-royal, every two hours, until a gentle perspiration is produced. Should there be fever, or pain in the head, or discharge of blood from other organs, bleed, give the cathartic mixture, or an infusion of salts, senna and manna, and afterwards endeavour to determine to the surface by the exhibi- tion of diaphoretic medicines. In every case where there are febrile symptoms, an amendment cannot take place until the antiphlogistic plan, such as bleeding, nitrous medicines, cooling cathartics, and a low diet, with rest, are adopted. After the febrile symptoms are removed, strengthening medicines, if necessary, may be employed, and in no instance suffer the bowels to remain in a constipated state. It is necessary to observe, in endeavouring to restore the monthly evacuation, we shall more likely succeed, if the usual remedies for, removing the constriction which affects the extremities of the vessels in the womb are directed at the time of its expected return, or when some natural efforts for that purpose are observable ; which may be known by a sense of fulness in the organs of generation, a weight in the back and loins, and slight spasmodic pains in the uterus. At this period, bladders two-thirds filled with warm water, applied to the lower part of the abdomen, or sitting over a vessel filled with hot water, will have a most happy effect. And, to increase the re- laxing powers of these topical applications, we may, at the same MANAGEMENT of female complaints. 405 time, give an opiate, particularly in the form of clyster, when there ' is pain. Sometimes an emetic administered about the time when the evacutioii should appear, and the patient during the operation to sit in a warm bath, has been of infinite service. In some instances an obstruction may continue in a young and healthy woman, for many months, without any inconvenience. This is chiefly the case in those who are very corpulent, or avIio have been in the pernicious practice of employing vinegar and strong purges to reduce their size. By the regular use of exercise, rising early in the morning, avoiding supper, keeping the bowels correct, and living, upon the whole, rather abstemiously, the health will be preserved, and, in course of time, the desired alteration will take place. Obstruction of the menses may also occur in young women with florid complexions, but, at the same time, of very delicate constitu- tions, and subject to a slight cough, with pain in the breast, and a predisposition to consumption. Such cases require the utmost cau- tion ; and in them, small bleedings, an antiphlogistic diet, mild laxa- tives, a temperate climate, warm dress, and moderate exercise, are essential: and when it can be procured, a sea-voyage, or change of air, will probably prove the most useful remedy. In the chlorotic species of obstruction, the treatment is much the same, as advised under the head of menstruation, for the manage- ment of those who are long having this evacuation. It will be found, almost in every instance, the complaint is occasioned by general de- bility, consequently, the cure must be regulated on the plan of in- creasing the tone of the system and exciting the action of the uterine vessels in particular. This is to be effected by a nourishing diet, moderate use of wine, change of air, gentle exercise, particularly riding on horseback, with strengthening medicines, as bark and elixir vitriol, the rust or tincture of steel, or the tonic powders or pills in their usual doses, together with the occasional use of calomel or the stimulating purgative pills, (see Dispensatory]) to keep the bowels . in a regular state. The nitric acid, diluted in doses of a wine glass full three or four times a-day, will be found a valuable medicine to improve the habit of body. And if the obstruction be attended with cough, it should be given in the form of the nitric lac-ammoniac. (See Dispensatory.) Previously to the use of tonic medicines, it is advisable to give an emetic, and afterwards a dose of calomel and rhubarb, or the aperient and diaphoretic pills, for the purpose of cleansing the stomach and freeing it from acidities and inactive fluids. Costiveness being a constant attendant on this disease, it is of the greatest importance, that purgatives be repeated, until all the sorties which have been collecting, most probably, for a considerable length of time, shall be removed. After this, and not before, the happiest effects may be ex- pected from the use of tonic medicines. Besides the above remedies, many others may be employed with 406 management of female complaints. the same view, as an infusion of camomile, wild cherry, or dog- wood bark, tansy, penny-royal, hyssop, rue, &c. A table-spoonful of mustard seed, morning and evening, or a tea cup full of a weak infusion of horse-radish, on some occasions have produced very good effects. Two ounces of the rust of steel, or filings of iron, steeped in a bottle of wine or cider for a week, and given in doses of a small wine- glassful, morning, noon, and night, has also been found beneficial. With the view of exciting into action the uterine vessels, the sur- face of the body should be kept warm by means of a flannel shift and drawers, by frequent friction of the lower part of the abdomen and limbs with a flesh brush or flannel, and by the exercise of walk- ing, dancing, and jumping. By marriage, or a change in the mode of life, the disorder has frequently been removed, after having resisted all the ordinary remedies. In those instances where the evacuation has become suppressed in consequence of previous bad health, it is evident that no attempt to restore it can either be effectual or useful till the cause be re- moved. Some have obstruction caused by very slight weakness, or very early in chronic diseases, others continue regular, till even the last stage of consumption. From the great variety of causes of sex- ual obstruction, it is certain that many medicines, which possess very opposite powers, may, in different cases, produce the same effects. For the same reason, a remedy which, in one case, may prove mild, inoffensive, and successful, will, in another apparently similar, occa- sion a most violent disorder. No remedy applicable to every case can possibly be discovered, therefore, medicines, with a view to re- store the periodical evacuation, ought to be employed with the greatest caution. IMMODERATE FLOW OF THE MENSES. This alarming complaint may occur under two different states of the constitution. In the one, the woman is of a full habit, and often of a ruddy countenance. In the other, she is pale, delicate, and easily fatigued. Symptoms.—In plethoric habits it is often preceded by headache, giddiness, or difficult breathing, and is afterwards attended with pain in the back and loins, universal heat, and a frequent, strong, and hard pulse. But, when it arises from general debility, or in conse- quence of a laxity of the organ, paleness of the face, chilliness, las- situde of the whole body, oppressed breathing on the slightest effort, pains in the back on remaining any length of time in an erect pos- management of female complaints. 407 ture, and coldness of the extremities, together with a long train of nervous complaints. Causes.—A variety of causes may produce this troublesome dis- ease. Some of these are general, such as a state of great weakness, or of too much blood ; others are local, such as debility of the ute- rus, occasioned by tedious labour or frequent miscarriages. It may also be produced by accidental circumstances determining the blood more copiously and forcibly into the uterine vessels, as violent exer- cise in dancing, much straining at stool from great costiveness, con- tusion on the belly, excess in venery, or strong passions of the mind, particularly at the menstrual period. Treatment.—In the management of this disease we have two objects: first, to moderate the discharge and procure present secu- rity; and, secondly, to prevent a return. The first thing to be done when the hemorrhage is sudden or pro- fuse, is instantly to remove the clothing which may occasion the least interruption to the free circulation of the blood, and to put the patient to bed, lightly covered with clothes. So long as the dis- charge continues, it is of importance to keep her in a recumbent posture, as cool as possible, and perfectly at rest, both in body and mind. Cloths, dipped in cold vinegar and water, and renewed as often as they become warm. These cold applications have a pow- erful effect in restraining uterine hemorrhage, and ought never to be omitted where the discharge of blood is profuse. If the patient be of a full habit, attended with severe pain in the head or back, and febrile symptoms, it will be proper to bleed, and to give the antimonial, or febrifuge powders or mixture. (See Dis- pensatory.) The state of the belly must also be attended to. It can be kept gently open by the cathartic mixture, sulphur, or any mild laxative medicine. Stimulating purgatives, or clysters, under such circum- stances, are improper, from their tendency to increase the discharge. When no symptoms indicating an increased action in the vessels of the womb are present, astringent medicines should be employed. And, in cases where the discharges have not continued long, and the strength not much impaired, it is often sufficient to arrest the disease by giving fifteen or twenty drops of elixir vitriol, or six or eight grains of alum dissolved in a glass of cold water every hour; or, what is preferable, alum whey, sweetened to the taste, in doses of a small cup full, as often as the stomach will receive it. But, if the dis- charge be obstinate, we should have recourse to pills of sugar of lead and opium. (See Dispensatory.) In no instance which has come under my knowledge, where the hemorrhage was in consequence of a laxity of the uterine vessels, have these pills failed in producing the desired effect. In those cases where the hemorrhage is profuse, or of long con- tinuance, and resists the means already pointed out, it will be proper to inject into the uterus from a gill to half a pint of a strong decoc- 408 management of female complaints. tion of oak bark, in which one or two drachms of alum have been dissolved, or as much of the saturated solution of alum in water, in order to constringe and strengthen the vessels of the womb. This may be repeated twice or thrice a-day, according to circumstances. When symptoms of an increased action in the vessels of the womb are observable, the tincture of foxglove, in doses of twenty drops every four hours, constitutes the best remedy. When there is reason to suppose the hemorrhage proceeds from a scirrhous or ulcerated state of the womb, all that can be done, is to afford temporary relief by giving opium in large doses. Indeed, opiates may be given with advantage in every case where there is considerable pain or anxiety, and the patient much exhausted. Under these circumstances, from one to two tea-spoons full of lauda- num, or from two to four grains of opium, according to the urgency of the case, will be useful not only in giving a check to the dis- charge, but also in preserving the strength, and abating nervous irri- tation. In most cases it is preferable to give opium in the form of injections to allay the spasmodic pains of the womb; and, when administered in this way, clysters of thin starch or gruel, in each of which two tea-spoons full of laudanum are added, should be given every two hours until relief be obtained. (See Abortion and Flood- ing.) In a female greatly reduced in strength and much emaciated, with an excessive menstrual flow, Dr. Dewees gave half a tea-spoon full of laudanum and the same quantity of Hoffman's anodyne liquor, and two grains of sugar of lead with one-third of a grain of opium, every hour till the discharge should be moderated. These remedies proved of great service, but early next morning, the flow was much increased. He now ordered twenty grains of sugar of lead, a tea- spoonful of laudanum and a gill of lukewarm water, as an injection. This quickly arrested the discharge, which did not return. Exer- cise and sea-bathing soon confirmed her health. Regimen.—The diet, at the time of excessive discharge, must be light and cool. The drink must always be cold, as ice-water, lemo- nade, or tamarind beverage. Port wine, in such cases, is too fre- quently resorted to, which uniformly does harm by increasing the circulation. Prevention.—To prevent a recurrence of the attack in those who are subject to it, the patient must necessarily avoid the causes by which it has been produced. When it is evident that the discharge is in consequence of a full habit, it will be proper to reduce the system by living sparingly, by keeping the bowels rather in a laxative state, and by rising early, and taking through the day regular but frequent exercise; and, after the plethora is removed, by strengthening the vessels, which have been over-distended, by the use of the cold bath. In a greater number of cases, however, we meet with a delicate constitution and spare habit, with pale countenance: this state re- management of female complaints. 409 quires the use of sea bathing or the shower bath, and the vessels of the womb are particularly strengthened by pouring cold water daily on the back and loins. It will be advisable to use a generous nutritive diet, with wine, and to have recourse to some of the tonic medicines, as advised un- der the head of obstructed menses, to strengthen the system gene- rally. At the same time the bowels must be attended to, and invi- gorating exercise taken daily; whilst, on the other hand, fatigue, and especially exposure to relaxing heat, must be carefully avoided. SEXUAL WEAKNESS. This complaint, commonly called fluor albus, or whites, to which women are peculiarly subject, must form an important object of attention, since it is always attended with disagreeable symptoms; and, when aggravated, soon spoils the beauty of a fine face, weak- ens the digestive powers, produces a general bad habit, and occasions sterility. Symptoms.—An irregular discharge from the passage leading to the wromb, of a fluid, which, in different women, varies much in colour, being of a white, green, yellow, or brown hue. In the be- ginning it is, however, most usually white and pellucid, and, in pro- gress of the complaint, acquires the various discolorations and diffe- rent degrees of acrimony, whence proceed a slight smarting in making water. Besides the discharge, the patient is frequently afflicted with severe and constant pains in the back and loins, indigestion, pale- ness of the face, chilliness, and languor. In process of time, every symptom becomes highly aggravated, the feet and ankles swell, pal- pitations, and a difficulty of respiration are experienced, the men- strual discharge is rendered irregular, the urine is turbid, the mind is dejected, and either consumption or dropsy supervenes and termi- nates a miserable existence. In some languid habits, the fluor albus returns periodically, instead of the proper menstrual evacuation, until the patient's constitution is duly invigorated. Causes.—It may be produced by any cause which either weak- ens or irritates the womb and its appendages. It may arise from general debility of the constitution, but it is especially caused by cir- cumstances impairing the power of the womb itself, as, for instance, a severe labour, a miscarriage, or profuse menstruation. In some instances it appears to depend on a full and irritable habit of body, and, in other cases, of local irritation, such as disorders of the womb, or of the urinary organs, or a collection in the gut, of the small thready worms called ascarides. 52 410 management of female complaints. Upon the high authority of Dr. Hamilton, this disease is most fre- quently first brought on by some imprudence in respect to diet and clothing, or exposure to cold or fatigue, or neglect of the bowels about the time when menstruation begins. Treatment.—In the treatment of this complaint regard must be had to the apparent cause, and to the state of the patient. The discharge is too often considered by the sex as the effects of general weakness in their habit, and, therefore, are led to the indiscriminate use of heating medicines, as port wine, balsam copaivi, &c, without paying attention to the habit of the body, or cause of the disease. A milk diet, change of air, and the partial cold bath, as sponging the loins and thighs with cold water every morning, with attention to cleanliness and proper exercise, are often sufficient to arrest the disease, if early adopted. In addition to this plan of treatment, if the patient be of a full habit, a disposition to fever from slight causes, attended with a sense of heat about the passage to the womb, it will be necessary to have recourse to the lancet, cooling cathartics, and febrifuge medicines, and to inject, several times a-day, flax-seed tea or milk and water, into the passage of the womb. In the great majority of cases, the complaint arises from general debility or laxity of the vessels of the parts, and in such cases the indications of cure are to increase the vital heat, promote the digestion, and restrain the preternatural dis- charge. In order to which, recourse must be had to such of the tonic medicines as will be found to agree best with the patient. Of these, the bark and elixir vitriol, the tonic powders or pills, the rust or tincture of steel, and lime-water have usually been employed, and often with good effects. In some instances,-however, I have known these medicines to fail, wdien the nitric acid, diluted, (see Dispensatory,) in doses of a wine-glassful, three or four times a-day, wonderfully succeeded. Previously to the exhibition of tonic medicines, it is advisable to give a dose of ipecacuanha or antimonial wine. Gentle emetics are supposed to be of singular utility in this complaint, not only by cleaning the stomach and bowels, and making a revulsion of the humours from the inferior part of the body, but likewise by their exciting all the powers of the constitution to a more vigorous action. The bowels must be kept in a regular state by conjoining a few grains of rhubarb with some of the tonic medicines, or by taking occasionally, at bed-time, one of the aloetic, or aperient or diaphoretic pills; or, in the morning, a tea-spoonful of Epsom salts dissolved in a tumbler of wrater. If there be a fulness of the stomach after eating, the tincture of rhubarb in small doses will excite digestion. In obstinate cases, it is often expedient to produce a change in the system, by giving a grain or two of calomel, or one of the mercurial pills at bed-time, until the gums become slightly affected, and then the cure may be completed by strengthening medicines, together with the shower bath. MANAGEMENT OF FEMALE COMPLAINTS. 411 Besides tonics, stimulating medicines, such as commonly deter- mine to the urinary passages, have very frequently been employed with great benefit. Of these, rosin in doses of ten grains in the yolk of an egg, or a spoonful of molasses, or balsam copaivi in doses of a tea-spoonful, or tincture of cantharides in doses of twenty or thirty drops in some mucilaginous drink, and taken three or four times a-day, will be found most salutary. These means strike at the cause of the complaint; but if it do not remove the effect very soon, we are not to trust to them alone. For once a morbid secretion being excited, it is very apt to continue, although the exciting cause cease to operate. On this account, we ought, without delay, to have recourse to astringent injections, such as a strong decoction of red oak bark, with the addition of a little alum or a solution of alum in water. Half an ounce of the former to be dissolved in a bottle of water; which should be thrown into the vagina by means of a female syringe, two or three times a-day. The celebrated Dr. Burns, says, after many trials, he satisfied himself, that although assistance may be derived from internal medicines and the cold bath, yet the chief dependence is to be placed on astringent applications to the seat of the discharge; and these, where there is no fulness of the general system, nor any affection of the womb itself, are perfectly safe, and seldom fail in producing a cure. It will be prudent, when this disease occurs as an early symptom of pregnancy, not to check the discharge suddenly, lest miscarriage be the consequence; but it may be moderated by injections of water, with the addition of a little vinegar, or an infusion of green tea. Neither should the discharge be suddenly suppressed when it has been of long standing, and acquired a considerable degree of acrimo- ny, with an offensive smell. For if it be unseasonably checked, the belly swells, and a train of the most disagreeable symptoms occurs. In such cases, soap-suds, or an infusion of camomile flowers or hops, should be frequently thrown up the vagina; and as soon as the blood is freed of its impurities, by suitable medicines, and has recovered, in some measure, its soft and balmy quality of which it has been deprived, the astringent injections may be employed with perfect safety. The application of a blister to the sacrum, has, in some obstinate cases, been attended with advantage. When the fluor albus proceeds from worms, purgatives and bitter clysters are the proper remedies. Pain in the back and loins is often mitigated by the application of a large adhesive or strengthening plaster, and by avoiding a standing posture of long continuance, much walking, dancing, or any other violent exertion. Women should carefully avoid all the remote causes of the disease: they should pay diligent attention to cleanliness, by washing the 412 MANAGEMENT OF FEMALE COMPLAINTS. parts frequently with cold water; add'when there are excoriations, milk and water, or lead-water, may be employed as a wash. Dr. Dewees on this subject is very high authority. His plan of treatment consists in washing the parts with warm water three or four times a-day—in gentle aperients—and a milk and vegetable diet, with tincture of cantharides till strangury is produced. And when the discharge has become thin and more abundant (and not till then) he uses injections of acetate of zinc six grains to the ounce of water— or of sulphate of copper, three grains to the ounce of water, three times a-day, always carefully washing out first the vagina with soap and water. Without strict attention to cleanliness, the best plan of treatment will be productive of but little benefit. Regimen.—The diet should be light, cordial, and nourishing, consisting of isinglass dissolved in milk by boiling it, jellies, custards, rice, milk, soft-boiled eggs, gelatinous broths, and light meats, together with a prudent use of genuine wine, particularly claret or port. Women, affected with this disease, should by no means indulge in the use of tea and other warm slops of a relaxing nature; but should lie on a mattress in preference to a feather bed ; and they should rise early, and take such daily exercise as their strength will admit, par- ticularly on horseback. When there is much languor, with chilli- ness, friction with the flesh brush, and wearing flannel next the skin must not be omitted. PREGNANCY. The great varieties of the female constitution occasion pregnancy to be, to some of the sex, of no trouble or distress, through the whole period of child-bearing; but it is to others often a continual disease, being, perhaps, from the very first week to the last of their pregnancy, more or less disturbed in their frame from the peculiar irritability of their habits. Some feel, very soon after conception, such an alteration in the state of the stomach, or in their sensations in general, as apprizes them of their situation. The woman is troubled with heart-burn, acidity, want of appetite, or disgust at her usual food, and sometimes has a craving for things she formerly did not desire. She is usually sick in the morning, and generally vomits after she gets up, though some have no sickness till the afternoon. Sudden qualms and feel- ing of faintness, with or without an inclination to reach, occur at different times in the day. The bowels also generally become bound. Some, instead of being sick, or in addition to the fits of sickness, are troubled with a constant desire to spit, with toothache, MANAGEMENT OF FEMALE COMPLAINTS. 413 water-brash, cough, nettle-rash, or other affections. But the time to which these extend, varies, as well as the period at which they take place. In the young and healthy constitution, one of the most early symptoms of the incipient stage of pregnancy, is an uneasiness in the breasts, somewhat differing from what she may have been ac- customed to on (he eve of menstruation, and soon attended with some sensible addition to the natural fulness and weight, as well as with a particular change in the appearance of the areola, or dark circle round each nipple. The nipples also soon become more pro- minent, the bulbous or glandular eminences around them enlarge, and a milky fluid will stain the linen, which had not been observed before. These occurrences may justly excite in the mind, the first appre- hension of pregnancy; after which, the interrupted course of the menstruation generally establishes the certainty of the situation. Obstruction, howTever, it must be recollected, may take place from other causes : hence, though we conclude, that she who is regular is not pregnant, we cannot infer, to a certainty, that she who is ob- structed has conceived. A woman in good health may accidently be obstructed for one or two periods; but, in this case, the other signs of conception are usually absent, and, at all events, prudence will dictate the necessity of patience till the fourth month. In bad health, the courses are often stopped; but, in such circumstances, the appearances of pregnancy are absent, whilst the symptoms of the accompanying disease point out the nature of the case. There is a situation in which there may, for a time, be some ambiguity, and that is where the woman has actually conceived, but the embryo has almost immediately perished, yet has not come away, but, together with some blood in the womb, is converted into a pretty firm, but shapeless mass, called a mole ox false conception. About the end of the fourth month, or a little sooner or later, in difficult cases the motion of the child is perceived, and this is the most satisfactory of all the signs; but those who are anxious to think themselves pregnant, when they really are not, are apt to mistake wind, passing along the bowels, for the motion of the child. The motion is at first gentle, it is felt pretty low, and resembles a gentle fluttering. The sensation is peculiar, and not unfrequently is, at first, accompanied with sickness, faintishness, or hysterical af- fections. It may be felt by night or day, and may either be repeated pretty regularly, or may not be again observed for two or three days. It is called quickening, not because the child at this time begins to live, for it is alive from the first, but because it can now move, or its motion is not till this time perceptible. Nature would seem, by these early notices, to put the mother im- mediately upon her guard, that she might i\ot disturb the tender embryo, by avoiding the occasions of either sudden alarm, fatigue, fever, or whatever might derange the equitable state of her health, 1 414 MANAGEMENT OF FEMALE COMPLAINTS. and by attending to those means for its preservation, which are best suited to her particular constitution. At the end of five months, the infant's size is nearly double what it was at the completion of four months, and the size is again nearly doubled by the commencement of the eighth month. At the full time, or nine calendar months after conception, the ordinary size of the child is twenty inches in length, and seven pounds avoirdupois weight. But there are deviations from this standard. Some do not exceed sixteen or seventeen inches in length, and five pounds in weight; while others weigh nearly fourteen pounds, and measure above twenty-four inches. This difference in size and weight ren- ders it extremely difficult, and it may be said impossible, to deter- mine, in many cases, whether the infant have attained to its matu- rity or not. The ordinary marks of hair on the head, nails on the fingers and toes, usually depended upon by those unaccustomed to consider this subject, are quite fallacious; and although there be cer- tainly marks by which it can be unequivocally determined when the infant has not exceeded the sixth month and a half, it would be an imposition on the credulity of mankind to allege, after the seventh month, the exact age of the infant could be ascertained by its general appearance, or its size and weight. To protect the child, while in the womb, from the numerous acci- dents to which it might be exposed from the exertions or imprudences of the mother, a most simple and effectual apparatus is provided. Not only is it enclosed in a bag, and surrounded by a quantity of water; but it is also nourished by means of a substance similar to a sponge, by which the blood of the mother does not run directly into its system. The infant lies generally with its head down-most, that is, to- wards the mouth of the womb, and with its limbs so bent and folded together, as to occupy wonderfully little room, like the chick in the egg just before it breaks the shell. When there are twins in the womb, each infant is included in a separate bag, and attached to its own after-birth. The head of the one infant lies towards the breach of the other. By means of the apparatus thus imperfectly described, it may be understood that the infant, while in the womb, is admirably defended from external injuries; but it may not be very obvious how it is nourished, and by what contrivance its increase of bulk is accom- plished. There is every reason to believe, that the after-birth serves the purpose; and, accordingly, the quantity of blood sent to it al- ways keep pace with the size of the child. Thus, in the early weeks, the vessels which run from the womb to the after-birth are not larger than the hairs of the head; while, in the latter months, many of them are as large as an ordinary writing quill, and the number of vessels always corresponds with the extent of its surface; for at every period of pregnancy, it is found, that a separation of the MANAGEMENT OF FEMALE COMPLAINTS. 415 slightest portion of the after-birth is productive of the bursting of nu- merous blood vessels. That the derangement of the general system during pregnancy is produced by the new actions which take place, for the purpose of supplying the infant with the principles of life, is rendered probable, by the fact, that the breeding symptoms cease from the moment the infant dies, and by the additional fact, that they most commonly are less and less severe the more children a woman has. Accordingly, the ordinary complaints during pregnancy seem to be the immediate effects either of a disturbed action of the stomach and bowels, or of the formation of too much blood. The most important circumstances to be attended to in the inci- pient months of pregnancy, is the costive habit of the bowels. Its prevention will subdue, if not wholly keep off, some of the trouble- some complaints of the stomach, and will often guard most securely against some of the exciting causes of early abortion. Blood-letting, cautiously used, either to reduce a too plethoric state of the general habit, or to alleviate some morbid affection, is a salu- tary agent; but it is, in general, more frequently had recourse to in pregnancy than it should be, upon very erroneous principles. Be- cause a pregnant woman, though by one of the established laws of nature, is now obstructed, they conceive it proper to draw blood, that the constitution may be freed of an imaginary redundancy, not re- collecting the process of pregnancy is going on, to employ the inter- rupted menstrual fluid, to the now essential purpose of affording growth and support to the increasing womb itself, as well as to its contents. All the temporary benefits to be derived from blood-letting may be most safely and permanently attained by a due attention to the diet, and to the state of the bowels. Nothing can be of greater importance to a pregnant woman, than cheerfulness. They should, therefore, not be depressed by the re- lation of any unpleasant intelligence. Some women are often greatly disturbed by the account of misfortunes which have happened to others in the same situation. The impression made on a timid mind, may remain during the whole state of pregnancy. The general health may be thus impaired, and the approach of labour too much dreaded, so that both body and mind are in a less favourable state than they would otherwise have been. It should be considered, that though difficult and dangerous cases now and then occur, they most commonly terminate well, if properly treated, and their number is exceedingly small, when compared with the multitude of women who are delivered; and it is probable it would be still smaller, if the cautions above laid down were properly observed. We would farther caution women against having recourse to cor- dials, to raise their spirits when low. Their good effects are, at best, but temporary, while they are ultimately baneful to their constitu- tion; and the use of a small quantity too frequently produces the necessity for a larger, until the mother and the unborn infant are in 416 MANAGEMENT OF FEMALE COMPLAINTS. jured by this pernicious practice. The best cordials for lowness of the spirits in pregnancy, are pure air, moderate exercise, and a light and cautious diet. There is another affection of the mind of a different character, from which lowness and hysterical indispositions often arise; namely, the force of a pregnant woman's imagination. This is often sup- posed to reach the infant in the womb, and to occasion marks and other deformities. But every mother may feel confident, that Pro- vidence has better guarded the unborn innocent, than to have ex- posed it to injury, from every variation in the feelings of a parent. Even admitting the possibility of such an influence, it could only take place at a very early period after conception, while the embryo is in its most tender state ; and even then it seems in a manner se- cured by nature against the above accidents, by the peculiar provi- sion made for its defence in the womb; but it soon attains a sufficient degree of firmness to overcome any sudden or irregular impulse of the blood, from which alone such deformities or other blemishes could happen. The mother should, as much as possible, avoid every occasion of terror, on her own account, wdien any thing alarming occurs; but let her not fear that her child will be marked from thence, or, still less, from some hidden operation of a disappointed longing, which most generally does not take place until the above-mentioned period is past. Numberless examples could be produced to convince women, that the notion which most of them have, that figures of animals, or other extraordinary marks, are stamped on the face or the body of the foetus in the womb, by the mere force of the woman's imagination, is a gross error. In every instance, it will be found, where a child is marked, the supposed cause of it has never been mentioned by the mother until after its birth; and when a woman has really been alarmed during her pregnancy, and ventured to foretell her child would be marked, she has as uniformly been delivered of her fears and her child together, for her prediction has never been verified.* * Dr. Moore, in his " Medical Sketches," relates a case so strongly in point, attended with such singular circumstances, that it is worth mentioning here. ■'A lady who had a great aversion to monkeys, happened, unfortunately, during the course of her pregnancy, to visit in a family where one of these animals was the chief favourite. On being showed into a room, she seated herself on a chair which stood before a table upon which this favourite was already placed. Not naturally of a reserved disposition, and rendered more petulant and wanton by long indulgence, he suddenly jumped on the lady's shoulders. She was terrified and screamed; but on perceiving who had treated her with such indecent familiarity, she actually fainted; and though the re- maining course of her pregnancy, she had the most painful conviction that her child would be deformed by some shocking feature, or perhaps the whole countenance of this odious monkey. "The pangs of labour did not overcome this impression, for in the midst ot her pains she often lamented the fate of her unfortunate child, who was doomed through life, to carry about a human soul in the body of an ape. MANAGEMENT OF FEMALE COMPLAINTS. 417 DISEASES OF PREGNANCY. When we reflect on the several changes in the system which are produced by pregnancy, we cannot be surprised that it should be the source of disagreeable sensations, and of the cause of many dis- eases. No part of the human body is possessed of greater irritability than the womb; nor any part the increased irritability of which is more readily communicated to the system in general. The breasts are so connected with the uterus by their office, that every affection of the womb is immediately accompanied by some change in the breasts.—Next to the breasts, the stomach most readily sympathizes with the womb; and through the stomach, the head and the heart are very soon brought to participate in its changes and complaints. Breeding Sickness—When it does not materially impair the general health, is to be regarded as a favourable symptom, because it certainly tends to prevent the formation of too much blood in the early months, which is one of the chief causes of abortion. It is generally sufficient to keep the bowels open. But when it becomes troublesome, it is necessary to interfere in time, otherwise alarming nervous complaints may be induced. The most effectual means of affording relief in those cases are blood-letting, and gentle laxatives regularly administered. The ap- plication of mint, (see Materia Medica,) or laudanum rubbed on the pit of the stomach, or administered in the form of an injection, has sometimes been of service. When sickness arises immediately upon first getting out of bed, a cup of tea or coffee often affords relief. Costiveness—Is a common attendant on pregnancy, and, if neglected, may produce serious consequences. Women in this situation should never allow more than one day to pass without having a motion. (See Dyspepsia.) Heartburn—Is commonly confined to the early months, but sometimes accompanies every stage of pregnancy. A table-spoonful of a fluid, prepared by mixing the white of an egg with a little sugar and water, so as to make it of the consistence of thin syrup, taken occasionally, has, in many cases, afforded relief. When the heart- burn is attended with a constant desire to hawk up phlegm, the sto mach should be emptied by a gentle emetic. (See this disease.) Longings.—Pregnant women have often unnatural cravings, or what are termed longings, which, however absurd they may appear When the child was born, she called to the midwife with lamentable voice, for a sight of her unfortunate offspring, and was equally pleased and surprised when she received a fine boy in her arms.—After having enjoyed, for a few minutes, all the rapture from this change from pain and misery, to ease and happiness, her pains returned, and the midwife informed her that there was still another child. " Another," exclaimed she, " then it is as I have dreaded, and this must be the monkey after all!" She was, however, once more hap- pdy undeceived, the second was as fine a boy as the first. 53 418 MANAGEMENT OF FEMALE COMPLAINTS. on some occasions, are frequently involuntary. They should be gratified, if possible, as women are apt to miscarry from the anxiety these occasion, when they are not indulged. It will be found, when the appetite is feeble, and the powers of digestion impaired, the sto- mach often rejects particular substances, and retains others, which, though seemingly whimsical, are found to agree with it. Fainting Fits.—Hysterical and fainting fits are apt to occur about the period of quickening, and, though sometimes attended with alarming appearances, are, in general, slight and of short dura- tion. A repetition is to be prevented, if the patient be of full habit, by keeping the bowels open, taking some blood occasionally, and putting her on a spare diet. But, if she be thin, and there be an appearance of nervous delicacy, strengthening means, as the cold bath, nourishing diet, cheerful society, regular exercise in the open air, with attention to the state of the bowels, are the best preventives. (See this disease.) Palpitations—Is another distressing affection to which some women are liable during the whole of pregnancy. The treatment of these nervous complaints must be varied accord- ing to the constitution and situation of the individual; but, in gene- ral, invigorating diet, moderate exercise in the open air, keeping the bowels regular, avoiding every thing that disagrees with the stomach, and whatever can agitate the mind, will render the attack less fre- quent. (See Palpitation of the Heart.) Looseness.—This may occur during pregnancy, and is to be treated just as at any other time. (See Diarrhoea.) However, it may be necessary to observe, that women of full habit, especially in the early stage of pregnancy, should be very cautious in checking it suddenly, as an immediate overflow of blood to the womb may be the consequence; and because such discharges are sometimes the effects of an effort of the constitution to throw off some oppressive load. Difficulty of Urine.—In some cases, during pregnancy, there is great pain or heat in making water. This is often accompanied by a most troublesome itching at the neck of the bladder, and neigh- bouring parts, with fever. In this case, it will be proper to bleed, to keep the bowels open with some cooling laxative, to drink freely of some diluent liquors, and to wash the parts three or four times a-day with lead water, or apply a sponge, wet with cold water, to be frequently renewed. Another more serious affection is a suppression of urine, at the same time that the stools are also obstructed. It chiefly takes place between the third and fourth month, and is attended with much pain in the lower part of the belly, owing to the distension of the bladder, and a feeling of bearing down, like the latter end of labour, with a desire of going to stool. This complaint consists in a change of the position of the womb, which is turned nearly upside down, and is sometimes brought on management of female complaints. 419 suddenly by a fall, sudden exertion, or straining at stool, but much oftener by retaining the water too long. Pregnant women, therefore, should, on no account, place them- selves in situations which may lay them under restraint in this re- spect, and carefully attending to every call is essential to their safety. When the womb has descended very low, the os tincse will be found to protrude the external orifice. In this case, the complaint may generally be removed by pushing the womb up into the pelvis, and and supporting it there while the woman discharges her water. The reduction may be effected by the patient placing herself on her hands and knees, and then passing two fingers of one hand into the vagina, and a finger of the other into the rectum, by which means it is pos- sible sometimes to succeed. But even this assistance may be ren- dered unnecessary, by trying the effect of different postures, by lying on her back, with her hips raised, or kneeling on the floor, with her elbows resting on a pillow; or by lying on either side, either of which attitudes may relieve the pressure on the urethra. In all cases of strangury, especially if the woman be of a full and plethoric habit, flushed and heated, she should lose blood according to the urgency of the symptoms. The bowels should be fully opened by copious injections, or mild laxatives. She should take mucilaginous drinks, and apply warm fomentations externally, or sit over warm water. These remedies, when the suppression is only partial, will generally afford relief; but whenever total suppression takes place, the patient should keep gum Arabic in her mouth, and avoid, as much as possible, drink of any kind, until she has been relieved ; and, if she do not soon succeed in her endeavours, recourse must be had to the catheter without delay. When the womb in- creases in size so large as to rise out of the pelvis, these distressing symptoms are relieved. Too much caution cannot be given to pregnant women on the subject of the retention of their urine. Every moment's delay in- creases the difficulty, and an hour's neglect may lay the foundation of the most painful and distressing complaint. Incontinence of Urine.—In the end of pregnancy there is sometimes an incontinence of urine, or the woman is obliged to void it frequently, but has no pain. This often proceeds from the pres- sure of the child's head on the bladder, and is considered as a favour- able sign of a natural labour. It can only be moderated by frequent horizontal posture, and its bad effects prevented by attention to cleanliness, and the use of a thick compress of linen or sponge. Swelling of the Feet.—It is usual, during pregnancy, espe- cially in the latter end of it, for the feet to swell. It is the effect of the enlarged womb preventing the ready return of the fluids from the lower extremities. But, when the swelling extends over the knees, and more especially when it appears on the upper parts of the body, and where it does not entirely subside after having been a few hours in bed, it is to be regarded as a very serious complaint. 420 MANAGEMENT OF FEMALE COMPLAINTS. In the slight degrees, which happen chiefly during a first preg- nancy, or when the womb seems much distended, or when the woman is rather relaxed, the occasional horizontal posture, when the swelling is troublesome, with spare diet and an open state of the bowels, are all that seems necessary. But, in the serious degrees of the complaint, it is generally found that blood-letting, to a pretty considerable extent, and repeated purgatives, can only prevent the dangers which might ensue either during labour or after delivery. A different kind of swelling of the legs proceeds from an enlarge- ment of the veins. The feet are not necessarily swelled; but along the inside of the legs, towards the knees, is a chain of knots of a blue color, disappearing by using friction after lying dowm. This is re- lieved by applying a roller, with a moderate degree of firmness, but not so tight as to give uneasiness, or affect the circulation. Inability to Sleep.—Inquietude and inability to sleep prove troublesome complaints towards the latter period of a pregnancy; the patient being obliged to rise frequently through the course of the night, in order to expose herself to the influence of cool air. Nothing affords so great relief, in cases of this nature, as bleeding in small quantities, with the occasional use of some cooling laxative medicine. Opiates are never attended with advantage in such con- ditions. Pains—Often occur about the back and tops of the thighs in the early part of pregnancy, and frequently are brought on by walking rather more than is proper. This requires a state of strict rest for some days, and the part to be rubbed with the anodyne liniment, (see Dispensatory]) or, if the pulse be full, and the patient strong, some blood should be taken away. Another kind of pain affects the back alone, and is of an aching nature, with a feeling of weakness. This is often relieved by the shower-bath, and the application of a strengthening plaster. Towards the latter end of pregnancy, colic pains are often so severe as to resemble the throes of labour. If they be not preceded by, nor attended with, costiveness, they may be easily remedied by opi- ates, and a proper regulation of the diet. In consequence of the stretching of the muscles, some of the fibres may separate, so as to allow part of the intestines to be pushed out beneath the skin; or this may take place at the time of delivery, and a pretty large swelling arise on some part of the belly. If the opening be large, the bowel is easily pressed back, but starts out and renews the swelling whenever the woman walks or even attempts to rise. This is called a rupture, and it may also take place at the navel, &c. The bowel is to be reduced, and kept in by a well adapted but easy bandage, and costiveness is to be prevented. When the woman is in labour, and has forcing pains, it is often necessary to apply the hand to the part, to keep the bowels from being strongly forced out, and after delivery, pressure must be immediately made otherwise faintishness may be produced. MANAGEMENT OF FEMALE COMPLAINTS. 421 When the integuments of the belly become cracked and sore from over-distention, nothing is so effectual as a frequent use of warm sweet oil, by friction. Cramps.—Women near the end of pregnancy are subject to cramps in the legs, the thighs, &c, which occur most frequently when lying in bed. They are occasioned by the pressure of the womb; and, therefore, like the other complaints depending on the same cause, they do not entirely cease till after delivery. In slight cases, change of posture affords almost immediate relief: when this fails, rubbing with a flesh brush or flannel, or the application of cold vinegar, opodeldoc, or anodyne liniment, to the affected parts, are the best modes of procuring relief. When the stomach is affected, the same remedies as advised in cramps of that organ are to be employed. False Pains.—Many women are afflicted, long before their con- finement, with pains so nearly resembling those of labour, that they often are mistaken for them. They are known by the name of false pains. They may affect the back, and come on with regular inter- missions, and are peculiarly apt to occur during the night. They may be distinguished by being rather more irregular and shifting than those of labour, or being more early attended with a pressing down. They are also usually accompanied with griping or wind in the bowels, or some difficulty in making water. In such cases, con- finement in a horizontal position; bleeding, if plethoric; laxative medicines, if costive; and administering small and frequent doses of some opiate, until the patient finds ease, will be necessary. They are sometimes produced by worms, which are removed by giving an injection of strong decoction of camomile flowers, with salt, and using laxatives. Occasionally they affect the side chiefly, and are accom- panied with a great motion of the child. Rubbing the part with anodyne liniment sometimes does good. Shivering not unfrequently occurs in the end of pregnancy, espe- cially in the night time; and as labour sometimes begins with this, it creates an unfounded belief that delivery is approaching. It is either unattended with pain, or the pain is irregular, affecting chiefly the bowels or sides. It goes off by taking twenty to forty drops of laudanum, in a glass of warm tea or thin gruel. Convulsions—Are usually preceded by some symptoms which indicate dieir approach, such as a sense of fulness or heaviness in the head, severe or even excruciating headache, dimness of sight, or the appearance of substances floating before the eyes, sometimes dark, sometimes of a fiery brightness. They may also be preceded by cramp in the stomach, attended with dreadful sickness. They are likewise to be apprehended, if the face and arms be swelled in the same way as feet are in ordinary pregnancy. At whatever period of pregnancy convulsions take place, we uni- formly find, that if they are repeated, and do not prove fatal, they bring on labour, or at least open the mouth of the womb. But there 422 management of female complaints. are many instances where, by proper measures, the repetition of the fits have been prevented, and the patient has safely gone to the full time. A knowledge of the causes of convulsions cannot be too widely diffused, as their occurrence may, in more than the majority of cases, be prevented. The formation of too large a quantity of blood, and an increased susceptibility of impression of the nervous system, occa- sion the tendency of this disease. When these exist in any conside- rable degree, circumstances suddenly bring on the fits, which in any other condition of the body have little influence, such as over fatigue, fright, distress of mind, irritations of the stomach or bowels, over- distention of the urinary bladder, or obstruction to the passage of the blood through the belly and lower extremities, in consequence of the pressure of the enlarged womb. The immediate cause of the fits is an overflow, or too great determination of blood to the vessels within the head. These facts explain the necessity for so regulating the diet and exercise during the latter months of pregnancy, as shall prevent both too great fulness of the habit, and also impaired energy of the ner- vous system. Under proper and active management, convulsions are found to be, in general, more alarming than really dangerous. The frightful appearances which attend such cases having paralyzed the exertions of practitioners, may perhaps account for the unfortunate event in many cases. The practice consists chiefly in evacuation. The patient must be instantly bled, and the bleeding must be repeated once and again, if it do not prove at first efficacious. A prodigious quantity of blood has been taken away with advantage, and has been the means of saving life. Two quarts of blood have been drawn off in the course of twenty- four hours under these circumstances, and with a happy effect. The bowels are also to be opened immediately by an injection of soft soap dissolved in warm water, and then giving a strong solution of Epsom salts, or an infusion of salts, senna and manna, every hour or two, until copious evacuations are produced. After the first bleed- ing the head should be immediately shaved, and a blister of conside- rable size should be applied to it. When convulsions are dependent on an irritable or excitable state of the nervous system, it is not necessary to use the lancet so freely. It will be best, after moderate bleeding, to apply leeches to the temples, at the same time not to neglect the bowels, which should be kept perfectly open. If by these means the disease be checked, the camphorated mixture in its usual doses may be given to allay the nervous irritation. For this purpose, opium in the form of a clyster has also been recommended. Dr. Denman proposed that a clyster, containing six or seven grains of opium, should be administered, un- der the supposition that, by putting a stop to the contractions of the management of female complaints. 423 uterus, the convulsive contractions in the other parts of the body may also cease. The warm bath is strongly recommended by Dr. Denman among the means of preventing convulsions in women previously to, or during their confinement. He also recommends the warm bath in labours rendered complex by convulsions, and this upon a long and extensive experience. He says, that when convulsions have con- tinued or increased, notwithstanding copious bleeding and the use of all other rational means, the patient may be put into the warm bath, in which she may remain a considerable time, if the convul- sions are suspended while she is in it. In instances where a warm bath could not be procured, or while it was preparing, he has directed flannels, wrung out of warm water, to be applied over the whole of the abdomen. Dr. D. also observes, that he has seen the patient relieved from that state of irritation immediately preceding the convulsion, by dip- ping feathers in cold water and dashing it with force on the woman's face, as this roused her, and interrupted the progress of the fit. Where the farther application of cold water is deemed necessary, and appears advisable, we may throw water over the patient's head, bringing this over the side of the bed, and holding an empty pail underneath to receive it. It should be done on the approach of the fit, which may be ascertained by attending to the vibrations of the intercostal muscles. Discharge of Water—May take place at different times during pregnancy, especially in the last two months. The quantity is va- riable, and sometimes the discharge is accompanied or succeeded by irregular pains. When this is the case, give a dose of laudanum, and afterwards some gentle laxative, to prevent costiveness. At the same time, the woman should remain quiet in bed. By these means, she may go to the full time. If the water continue several days but trifling in quantity, a solution of alum or decoction of oak bark, should be injected up the vagina two or three times a-day. Discharge of Blood—May proceed either from the passage to the womb, or from that organ itself. In the former case, no bad effects can be dreaded; but in the latter one, the most serious conse- quences may ensue. The immediate cause of a discharge of blood from the womb, during pregnancy, is the rupture of blood vessels, by the partial or total separation of those parts which connect the child with the mother. This circumstance explains the difference of danger in the early and latter months; for in the former, the blood vessels of the womb being small, are incapable of pouring out much blood; but in the latter, they are very large, and may discharge, in a short time, a great quantity. The management of these cases must be varied according to a number of circumstances. Tranquillity of mind, and confinement to bed in an airy room, lightly covered with clothes, are of great im- 424 MANAGEMENT OF FEMALE COMPLAINTS. portance. A bladder two-thirds filled with cold water, or cloths wrung out of cold vinegar and wrater, should be immediately applied to the lower part of the belly. If the discharge continue in small quantities, accompanied with irregular pains, a dose of laudanum, or the anodyne clyster, should be administered. When it has sud- denly been brought on by a fall, blow, or any great exertion, it is necessary to draw blood from the arm; but when the symptoms which threaten miscarriage have come on, it is improper either to bleed, or to give laudanum. The languor or faintness, usually induced by loss of blood, fre- quently lead officious attendants to exhibit spirits of wine, as neces- sary cordials. As these generally increase the action of the blood vessels, they serve to promote and increase the discharge, and should, therefore, be strictly prohibited. In the latter stage of pregnancy, if the attacks be severe or repeated, nothing can save the mother and the child but delivery, which must not be too long delayed in ex- pectation of pains coming on, or of their becoming brisk, if they have already taken place. ABORTION. By abortion or miscarriage is meant the expulsion of the child at a period of gestation so early that it cannot live. It is always accompanied with two circumstances, separation of the membranous bag, expulsive efforts, or contraction of the womb itself. The first is productive of discharge, the second of pains like those of labour. Sometimes the separation or detachment of part of the conception takes place before any pain is felt; on other occa- sions, the pain, or contraction of the womb, takes place first, and produces a separation. In the first of these cases, the symptoms of abortion take place suddenly, and are usually occasioned by fatigue, sudden exertion, or fright. In the second, the child is frequently dead a short time before the pains come on, and there are particular feelings, and changes, which indicate that a miscarriage is likely to take place; as, for instance, the cessation of the morning sickness, the subsidence of the breasts, absence of motion of the child, a feel- ing of weight, or heaviness in the lower part of the belly, &c. Causes.—Violent exertions of strength, severe exercise, sudden frights, violent fits of passion, over-fulness of blood, profuse evacua- tions, excessive venery, former miscarriages, a diseased state of the uterus, general debility of the system, external injuries, and strong acrid and stimulating medicines, which are often taken for the ex- press purpose of exciting abortion, and the death of the child. Such criminal intentions to destroy the foetus by artificial means MANAGEMENT OF FEMALE COMPLAINTS. 425 can never succeed, unless the most violent effects are produced on the organs contiguous to the womb, which seldom fail to produce inflammation of these delicate parts, and occasion the death of the mother. Whenever, therefore, women commit such unjustifiable crimes to conceal the indulgence of irregular passions, their life is exposed to the greatest danger. Treatment.—When a woman is threatened with a miscarriage, there are two objects to attend to : the first is, to prevent it if we can; the second is, to manage it so that as little blood as possible be lost; and both these are obtained by the same means. With this view, the patient should immediately, on the first alarm, undress and go to bed, lightly covered, with a firm determination not to rise till the pro- cess be either checked or completely over. There should be little fire in the room, though it be winter; and, in summer, the windows must be opened. Cloths, wet with cold water, should instantly be applied to the lower part of the belly and back: the drink must be cold, and every thing stimulating should carefully be avoided. In robust habits, or when the symptoms have been brought on suddenly by some such cause as a fall or exertion, it is proper to bleed, and, in cases of sickness or great feebleness, to give a dose of laudanum; or, what is better, to administer the anodyne clysters. (See Dispensatory.) Opiates are useful in every case where we hope to prevent abortion, and must be repeated more often or seldom, according to the effect they produce. They are, however, improper in those cases where miscarriages must decidedly take place. Their tendency to occasion costiveness, when employed, must be obviated by clysters, or some gentle laxative medicine, such as calcined mag- nesia, Epsom salts, or a little castor oil. If there be a continued but trifling discharge, great advantage may be derived from injecting, three or four times a-day, up the vagina, a solution of alum. In- deed, in all protracted cases, this is of much benefit. The solution ought to be thrown up pretty high, that it may reach the womb. When these means produce not the desired effect, and along with the discharge of blood large clots come off attended with bearing down or pains in the back and loins, especially if the symptoms which precede abortion have appeared, there must be every proba- bility that the threatening event cannot be avoided; and then we must endeavour to conduct the patient safely through the process. In all cases during the last stage of pregnancy, where our endea- vours to stop or repress the hemorrhage prove abortive, and the life of the woman becomes endangered by its severity, it will be advisa- ble to deliver her as soon as possible. If the ovum be still entire, and the pregnancy considerably advanced, the expulsive action is to be excited by rupturing the membranes. When the whole conception come away at once, the pain and dis charge usually go off; but, if only the child come away, all the symptoms either continue and increase till the after-birth come away, or, if diey be for a time suspended, they are sure to return. 54 1 426 management of female complaints. After the process is over, if the discharge be profuse, and do not stop on the application of cold water to the lower part of the belly, it will be proper to plug up the vagina, and this is best done by tak- ing a pretty large piece of soft cloth, dipping it in oil, and then wringing it gently. This is to be introduced with the finger, portion after portion, until the lower part of the vagina be well filled. The remainder is then to be firmly pressed on the orifice, and held there some time for the effused blood to coagulate. In obstinate cases, previously to the introduction of the plug, we may insert a little pounded ice, or snow tied up in a rag, if to be procured; but neither of these should be continued so long as to produce pain or much shivering. In addition to this mode of treatment, it will be advisable to have recourse to the astringent medicines, as advised under the head of Immoderate Flow of Menses. Regimen.—Arrow root, tapioca, sago, panado, or rice milk, con stitute a proper regimen. If the process be protracted, and the strength much impaired, the diet may be more liberal. In every case, ripe fruit is safe and useful. The bowels are to be kept regu- lar, and sleep, if necessary, is to be procured by an anodyne. Prevention.—It requires great attention to prevent abortion in subsequent pregnancies, whenever it has happened. In all such cases, it will be highly necessary to attend to the usual habitudes and constitution of the women, and to remove that condi- tion which is found to dispose to abortion. A woman that is subject to miscarriage, and who is of a full ple- thoric habit, ought to be bled just before the usual time of her mis- carriage, and she should take the tincture of foxglove, twice or thrice a-day for two or three weeks. In robust habits, blood-letting may be repeated every fortnight during the second, third, or fourth months; but the blood should be taken from a small opening, and not much at a time, lest fainting be produced. The quantity and the repetition must depend on the constitution of the patient, on the particular symptoms in the individual, and on the effect produced by the evacuation. She should likewise keep her body perfectly open with gentle ape- rient medicines, use a spare diet, and avoid all agitations of the mind. The sleep should be abridged in quantity, and taken on a mattress, instead of a feather bed. Regular and moderate exercise should be taken daily, being cautious, at the same time, not to carry it to the length of exciting fatigue. In women of a weak, lax habit, bleeding would be highly impro- per ; for such, a nutritive and generous diet, moderate exercise, and tonic medicines, will be required. And, along with nourishing diet, a moderate use of wine should be allowed, if it do not heat the pa- tient, or otherwise disagree. The cold bath is of signal service in every instance where it is not followed by chilliness. Until gestation be far advanced, it would be advisable for the wo- management of female complaints. 427 man to sleep alone, and strictly avoid every cause which is ascer- tained to be capable of producing abortion. Women more frequently miscarry in the second or third month than at any other time; but some have a certain period at which they usually go wrong, and do not vary a week from it. In such cases, the woman should confine herself to the house, avoid the least exercise, and frequently recline on the sofa or bed, till that period be past. When women miscarry repeatedly about the fifth or sixth month, and feel, previously to that accident, the symptom's of the child's death, and at the same time, the child, when expelled, is putrid, some latent poison, which will probably yield to a mercurial course of medicine, may be suspected. OF LABOUR. Labour generally happens in about nine calendar months, that is, from thirty-nine to forty weeks. In some cases, this time is consid- erably shortened, and, in others, is certainly protracted. There are two methods of reckoning; namely: from the time obstruction takes place, and from the sensation of quickening. If the former be de- pended on, the date of conception should be taken at a fortnight be- fore the obstruction; if the latter be preferred, five calandar months may be allowed from the time that the movement of the infant was distinctly perceived. There are three different steps in the delivery of a child: First, the mouth of the womb must be gradually opened; secondly, the child must be expelled; and, thirdly, the after-birth must be thrown off. The first of these effects must be accomplished by the repeated contractions of the womb, which produce sharp or grinding pains. The second is fulfilled by more forcible efforts, productive of bearing down pains, which at last, increase to great severity. The third takes place a short time after the child is born, and is attended with very slight pain. These pains proceed from the attempt made by nature to dilate the mouth of the womb, and they must continue until this be accom- plished. The complete dilatation is assisted and rendered both easier and frequently more speedy, by the protrusion, through the mouth of the womb, of part of the membranous bag, which contains the child and the water. The degree to which it is pushed out of the womb, during a pain, varies much in different cases. Sometimes it forms a very slight projection, at other times is very bulky, being little less than the child's head. When the membranes begin to be pushed, the water is said to " gather." 1 428 MANAGEMENT OF FEMALE COMPLAINTS. The mouth of the womb being considerably opened, efforts are next made to press down the child, or to empty the womb. These produce a change in the pains, which are attended with a little incli- nation to press down. This gradually increases, and at last, the sensation of bearing down becomes very strong and irresistible ; and it is observed, that, though the pains are strong and forcing, they are productive of less complaint than those which, in the beginning of labour, appeared to be less severe. There is a great variety in the duration of this part of the process. It is sometimes gradual and slow, in other cases sudden and rapid. The pains may be strong and forcing, and have very little interruption, or they may come on at very regular periods, with complete intervals of ease. During this period the membraneous bag, in which the child lies, usually bursts, and the water which it contained is discharged. This event is followed by an increase of the pain, which becomes more forcing, and the spirits of the woman rise in proportion. At length the head of the child comes to the birth, and, by repeated efforts, is at last expelled. This is followed by the gradual delivery of the body. After an interval of ease, one or two slight pains are felt, which serve to throw off and expel the after-birth. The duration of this process is various, but it is generally longer in a first child than afterwards. This is particularly the case with regard to the second stage. Some women are uniformly expeditious, others al- ways tedious. Some have the first stage slow and the second quick; some have the water discharged early, others not until the child is born. Some have much sickness, or retching, or shaking, others none at all. In short, there is great variety in these respects with different women, or even with the same woman in different labours. In a natural labour, the whole process is concluded within twenty- four hours after its commencement, often in a much shorter period. PROGRESS OF LABOUR. When a woman, after a preceding day of ease, an unusual acti- vity, about the period of her reckoning, begins to feel some restless- ness about her, with occasional pains in her loins and side; if she farther perceive that the bulk of her belly has fallen, that the motion of the child has not been for some time so sensibly or frequently felt, and that she has a nervous hurry of spirits upon her, with a feverish glow of heat, she may then conclude that nature feels an inclination to prepare her for the termination of her pregnancy. When labour has actually commenced, the bed on which the patient is to be delivered, should be properly prepared, that it may not remain wet and disagreeable after the delivery. It should be MANAGEMENT OF FEMALE COMPLAINTS. 429 placed in such a situation that the room may be ventilated, without the patient being exposed to a current of air. The mattress is to be put uppermost, as being more comfortable than a feather bed when it is not daily made up. A folded blanket, or dressed sheep-skin is put next to this, in order to prevent it from being wet and soiled. Over this the undermost bed sheet is thrown, and the bed made up as usual. Afterwards, a sheet, in five or six folds, is laid across the bed ; and these being removed when the child is delivered, and the woman is laid up, she finds herself clean and dry, without farther trouble. Every thing ought to be in readiness before it can possibly be needed, particularly the baby-linen, and such articles of dress as the mother may require. The dress of the woman, during labour, ought to be as light and as simple as possible, and so prepared, that it may not be necessary to disturb them soon after delivery by a change of apparel. When this is properly managed, they avoid an unreasona- ble fatigue, and the hazard arising from linen which may not have been cautiously aired. Little things are often of great importance, and are sometimes found so when it is too late. Premature labour is sometimes threatened by pains, which pro- duce, for awhile, some real change in the womb sufficient even to give the practitioner just reason to expect that they will terminate in the delivery. But things again recover their pristine state, the alarm of nature subsides, and the woman proceeds in her pregnancy, for several days longer, and sometimes for weeks. As the change in the womb above mentioned does certainly occur, even on a false alarm, it should put young and female practitioners on their guard, lest they promote labour too hastily, either by gene- ral treatment, or any manual operation; for these would only fruit- lessly tease the patient, when the judicious exhibition of an anodyne would do every thing that can be wished for. When, in consequence of irregular premature pains, the mem- branes containing the water with which the child is surrounded have been broken before labour has really commenced, it must be ex- pected soon to take place; though if the pains should have entirely ceased, on the discharge of the waters, it may be delayed for some days: but it most frequently happens within twenty-four hours. There is nothing in this circumstance alarming. It may occasion the first part of labour to be more slow, but not in any degree less safe in the end. It arises wholly from the fineness of the mem- branes, which contain the waters, and which must rupture in every labour, at some period or other, and hence the waters are unexpect- edly discharged, in a sudden manner, without the least preceding pain. In a slow labour, especially if it be the commencement, the time commonly spent in the lying-in apartment, might, with more pro- priety, be passed in the usual domestic habits. It wrould serve to lessen the too anxious expectation of a speedy delivery, as well as to 430 MANAGEMENT OF FEMALE COMPLAINTS. prevent the impatience of the attendants, both of which are often improperly indulged. A sensible woman should always consider that, in a slow labour, she may be afflicted with many distressing, or what have been called false or spurious pains, but there are very few by which nature does not mean some good in the end. She must, therefore, give her mind to patience, as all unnecessary interference would rather retard than assist the labour, and will only be employed by the designing or unskilful. In the first stage of labour, the bowels should, if necessary, be emptied by means of a clyster, or a dose of some gentle aperient medicine. This is attended with several advantages: it renders delivery easier, and sometimes promotes it sooner. All heating drinks and stimulants are carefully to be avoided, as they increase the natural tendency to fever which women have at that time, and the temporary vigour they induce is soon followed by a great degree of languor, that retards the delivery. Violent agitations of the body must be carefully guarded against, that the waters may not be discharged prematurely, which might be productive of the worst consequences. For these reasons, the fre- quent interference of the practitioner in the beginning of labour, except where there is some unusual resistance to the opening of the womb, or the water has drained off too early, might do much harm, and could be attended with no good effects. At that period, no medicine, or rather expedient for increasing the force of the pains, should be prescribed, as the more slowly the passages are enlarged the less injury will the patient suffer. In every instance she should be kept quiet and cool, though she ought not to be confined to one position. She may be allowed to stand, walk, or sit, or remain in bed, as may be most agreeable to her feelings; but she ought, by no means, to stand so long, or walk so much, by way of forwarding the labour, as is productive of fatigue, and, after the pains become very frequent and pressing, it will be, in general, most prudent not to come out of bed. Second Stage.—When the first stage is nearly completed, the woman should be placed on her left side in bed, with a folded pil- low between her knees. The bearing down pains, by which the child is forced through the passage, should be the effort of nature alone, and ought not to assisted by the exertions of the mother: for, in that event, either the delivery might be hurried on before the passages are sufficiently prepared, or the woman would be much worn out that she could not undergo the necessary fatigue that attends the complete expulsion of the infant. This important caution cannot be too strongly inculcated ; for in- attention to such conduct, and the impatience which women in such situations cannot perhaps avoid, often make a labour difficult and painful, that would otherwise have been natural and easy. r MANAGEMENT OF FEMALE COMPLAINTS. 431 Voluntary bearing down must be particularly guarded against at the time when the head of the child is only prevented from being born by the soft parts at the outlet of the basin; for, if the delivery then be hastened, these parts may be readily torn. The utmost at- tention of the practitioner is indispensably necessary to prevent so unfortunate an accident, in every case where, from the acute feel- ings of the patient, violent bearing down at that period cannot be resisted. When the child's head presses against the perineum, it should be supported by gently pressing with the hollow of the hand during the pain, to prevent its tearing. After the head of the child is excluded, the woman should be allowed to enjoy, for a little time, the temporary relief she feels, and therefore, the body ought not to be immediately taken out with force, as is often done ; for, besides the injuries which may be occa- sioned by not allowing the patient a little rest, the extraction of the afterbirth will be thereby rendered difficult. Two or three minutes may therefore be allowed to elapse before the body be drawn forward. If the patient have a rapid labour, and the midwife be at a dis- tance, she ought to keep constantly in bed, and refrain, as much as possible, from bearing down. If the child should be born before assistance be procured, the most experienced woman present should take the navel-string between the finger and thumb, and as soon as she finds the pulsation in the cord stopped, tie a string firmly near the navel, and apply another ligature about three inches from the first, and cut the cord between these; or, if she be afraid to do this, the child must lie beside the mother till the midwife come, taking care that the face be uncovered, to permit of breathing. We will now suppose the woman is just safely delivered of her child, and that a complete cessation of the regular pains has followed. She must now endeavour to calm that disturbance of the whole frame, which, added to her anxiety of mind before the delivery, had excited a great degree of heat and perspiration, especially if it should have been her first labour, or one attended with some unusual diffi- culty. In this state she must not let herself chill or cool too fast. It may, perhaps, have been necessary to throw off the bed-clothes, during the last hour or two; if so, they should immediately, on the birth of the child, be lightly placed over her again. She may now moisten her mouth with a cup of tea, grit gruel, or barley water, for either of which she will feel desirous, if she have not been fre- quently taking one or the other during the latter part of her labour; but they must be given to her without wine or brandy. If she feel herself disposed to sleep, she should indulge it: at all events, she should keep herself quiet, and not encourage conversation. For it may be observed, that, in general, the mind of a woman newly de- livered of her first child, is so occupied with the novelty, as well as the anxiety of her situation, that her attention is long kept alive, and, therefore, she can scarcely sleep, though exhausted by the fatigue of her labour. 432 MANAGEMENT OF FEMALE COMPLAINTS. In the third Stage—The midwife must carefully attend to the degree and force of contraction, which the womb is disposed to take on immediately, or soon after, the birth of the infant. The experi- enced practitioner will, indeed, have a presentiment, even while it is coming into the world, of what is likely to take place afterwards, from the manner in which the expulsion of the infant is completed. This should be effected slowly, as we have already observed, because such a practice favours that kind of action of the womb necessary to detach the placenta. Premature or active endeavours to loosen it, must, however, be avoided, if its separation should not readily take place, by the seasonable contraction of the womb. Let the opera- tions of nature be watched, and she will prove the surest guide, though in this part of the delivery, she ought never to be wholly depended on. We generally find, when there has not been any sudden or hurried delivery of the infant, the after-birth is soon expelled without any assistance. The vessels which passed from the womb to the after-birth would, when this was separated, pour an increased quantity of blood, did not the womb contract so much as to diminish their size and compress their orifices. This contraction both expels the after-birth and pre- vents flooding. When, therefore, the afterbirth is expelled, we have an evidence of the existence of that state of the womb which ensures the safety of the mother. A woman should, however, avoid expressing any impatience about this, as it might induce some practitioners to use that despatch which many have done, that the patient or her friends might not insinuate that they were a long while in bringing away the after burden. This kind of censure is too frequently passed upon the just conduct of the midwife, from the improper prejudice too often indulged in favour of a speedy delivery of the placenta. Women are apt to deem that practitioner most skilful who is the shortest time in finishing that part of her labour. Fatal, therefore, have sometimes been the con- sequences of this ill-judged management, particularly among the female practitioners. It is a mistaken idea, that, in general, some external mechanical force is necessary in order to expel the placenta. We cannot, there- fore, approve of the modes occasionally recommended, of coughing, sneezing, blowing on the back of the hand, or making general pres- sure over the belly, with a view of helping its descent, by any kind of tight bandage applied to the abdomen, immediately after the birth of the child. There is a general action of the hand on the abdomen, which the patient herself may perform, and by which the uterus is tenderly excited to contract, and the placenta of course detached in the most favourable manner, that will be found more useful than a bandage, or any extraordinary exertions of the patient, for this purpose. But as this may not be necessary in every case, it must be left to the MANAGEMENT OF FEMALE COMPLAINTS. 433 judgment of the practitioner to direct, with the proper caution to be observed in the applications. Wo would farther observe, that there can hardly ever be occasion for a woman to bear down during the delivery of the placenta. In- deed, on many occasions, it must be carefully avoided, lest it should produce, or increase, a disposition to the prolapsus uteri. The throes, which take place naturally, are caused by the contractions of the womb ; and with them alone the practitioner can, generally, in due season, safely bring it away. When the effects of nature do not tend to disengage the secundine within an hour after the birth of the infant, the interference of art ought to be submitted to. For if it be not thrown off within a short time after the infant is bom, it becomes putrid, and induces an alarm- ing fever, from which few women have recovered. In assisting the expulsion of the after-birth, unless the practitioner wait for the con- traction of the womb, that part may be turned inside out. This cir- cumstance should be properly understood by all those who happen to be out of reach of regular assistance; for the patient's life, after an easy labour, may be destroyed by the rashness of an ignorant practitioner. By explaining, however, the case of danger, those who are prevented from being under the care of persons of skill, may thereby escape those hazards to which they might otherwise be exposed.' The after-birth is generally fixed to the bottom of the womb, and as the greater portion of the womb, at the full period of pregnancy, is not attached to the adjoining parts, if the navel-string be violently pulled before the after-birth be separated, the womb must be turned inside out, the ordinary consequence of which is fatal. When the grinding pains are felt by which the contraction of the womb is distinguished, the practitioner should assist by pulling gently the navel-string during a pain, and by endeavouring to bring down the after-birth through the basin, in such a manner that its progress may not be interrupted by any of the neighbouring parts. Until the after-birth is expelled, the patient and midwife should be attentive lest there be a great discharge, and if this occur, no time is to be lost in checking it. This is done by exciting the con- traction of the womb, by the application of cloths wet with cold water, to the lower part of the belly and to the passage, or by pour- ing cold water out of a pitcher from a height on the abdomen ; and also by the introduction of the hand of the midwife to stimulate the womb. Some do this with the sole object of extracting the placenta or after-birth, considering the retention of this as the cause of the flooding. But this opinion is wrong, and the mere extraction of the placenta can only do good, so far as the introduction of the hand and the means used to effect this, serve to excite the action of the womb itself. We do not approve of a free and indiscriminate use of greasy ap- plication, in the progress of labour. They are wholly unnecessary 55 434 MANAGEMENT OF FEMALE COMPLAINTS. in the first stage of it, and in the latter part they interfere with the changes which then take place naturally, and produce that mucous secretion by which the parts are most favourably lubricated, for the easy termination of the labour. But after the complete removal of the placenta, it will be proper to apply a small quantity of pomatum or fresh lard, to defend the parts from the acrimony of the ensuing discharges. LABORIOUS LABOUR. When the delivery is not completed within twenty-four hours from its real commencement, though the head of the child be forced fore- most, it is styled laborious labour. It may occur under three different circumstances. First, the pains may be, from the commencement, few and weak, and the labour may, if left to itself, be long becoming brisk. Secondly, the pains during the first stage may be sharp and frequent, but not effective, in consequence of which, the power of the womb is worn out before the child has advanced far, or come into a situation permitting it to be expelled. Thirdly, the pains, during the whole process, may be strong and brisk, but for some obstacle the delivery may be either greatly protracted, or rendered altogether impossible, without assistance. Different causes may produce these states; such as general weak- ness of the constitution, particularly the action of the womb itself, premature discharge of the water, fear, impatience and strong passions of the mind. When the first stage of labour is protracted, and the pains do but little good, a clyster has often had the happiest effect in exciting more brisk and productive action. In like manner, a change of posture, or walking a little in the room, has sometimes rendered the pains brisker. But whenever sitting or walking produces fatigue, or is felt to be disagreeable, they certainly do harm. The most powerful means we can employ for remedying some of those conditions, which give rise to tedious and severe labour, are blood-letting and the use of laudanum, either in the form of a draught or clyster. The states requiring or admitting of these it is impossible to explain here; but it may be a service to do away a prejudice which may exist against their employment, when they are necessary. Opiates are serviceable sometimes, as cordials or general stimulants; at other times they are beneficial by suspending the use- less, but painful action, of the womb, and thus allowing time for the strength to recruit, and these effects they produce more safely and effectually than any other means could do. They are also of effi- cacy in checking that irregular spasmodic action of the uterus, which MANAGEMENT OF FEMALE COMPLAINTS. 435 gives much pain, and rather retards than forwards the expulsion of the infant. With regard to blood-letting, there is only one objection of any weight, namely, that it will weaken the patient; but, in reply to this, we observe, that if it have the effect of rendering the delivery more speedy and safe than it otherwise would be, it will rather save the strength by preventing unnecessary fatigue. It is also well known, that a much greater quantity of blood is often lost after delivery than would have been taken from the arm, and yet no bad effect what- ever follows from it. When convulsions occur during labour, or in the end of pregnancy, six times the quantity of blood that would be taken in any other situation, are often extracted with present relief and future advantage. Last of all, the experience of different ages and various countries proves the safety of the practice. It is not a remedy newly introduced, the effects of which we are ignorant of, for it is even the habit of some to bleed women in natural labour in order to render it still more easy and expeditious. Blood-letting is also a powerful means of preventing local inflammation, which may be excited by protracted labour. In difficult labour we must always pay due attention to the state of the bowels, and we should also be veiy attentive that the urine be voided regularly. There are some unfavourable positions of the head, which may be rectified by the finger without giving pain. If, notwithstanding all our care, the labour be protracted until the strength be impaired, and the pains are ceasing; or, if the obstacle be so great as, during the course of labour, to make the head be fixed within the bones of the pelvis, and produce suppression of urine, or a tender state of the soft parts, with a sense of tightness within the pelvis, restlessness, giddiness, or pain in the head, severe pain, or feeling of pinching, even in the absence of the labour pain, about the share bone, or other symptoms indicating that the powers of nature cannot any longer be safely trusted to, it will be necessary to have recourse to the use of instruments. These are never to be resorted to except in cases of absolute necessity; but it cannot be too strongly enforced on the mind of the patient who requires them, that, if she delay, after they have been advised by a practitioner of judgment and integrity, her own life, as well as that of her child. may be lost. PRETERNATURAL LABOUR. When any other part of the infant than the head is forced fore- most during labour, the case is styled preternatural, or, in common language, a cross-birth. Where neither the head nor lower parts ^ 436 MANAGEMENT OF FEMALE COMPLAINTS. are placed next the passage, nature cannot, in general, accomplish the delivery ; and, therefore, the life of the woman must depend on the position of the infant being changed. The operation by which this is performed, is called, in the language of midwifery, turning, and consists in bringing the feet into the passage. When the case is discovered before the water is drained off, the operation of turning may be had recourse to with perfect safety, pro- vided the woman be in good health, and without occasioning much pain to the patient or trouble to the practitioner. But when, either from the restlessness of the patient, or from the improper interference of the practitioner, the water has been evacuated at an early period of the labour, the life both of the woman and infant must be exposed to considerable hazard. In this case the turning is not to be at- tempted till, by the administration of sixty or eighty drops of lauda- num, the pains are suspended. A neglect of this rule may be fol- lowed by very serious consequences. Dr. Denman relates three cases of the upper extremities present- ing, and the delivery being partly effected by the spontaneous evo- lutions of the child. In the first case, the woman had been in labour during the whole night, and one of the child's arms was the pre- senting part; on attempting to turn the child, the pains were too violent to admit the introduction of the hand into the uterus. Ima- gining that the child was small, so that it might pass, doubled, through the pelvis, farther endeavours to turn were omitted, and, on waiting a little, the breech presented, and the head was the last part that was delivered. In the second case, the presentation was the same as in the first, and it was agreed on to turn the child; but the pains were strong and frequent, so that the action of the uterus was such as to forbid all endeavours that way. It was then agreed to wait for the effect which a continuance of the pains might produce, or till they were abated, when the child might be turned with less difficulty. The pains continued and propelled the child lower in the pelvis, and in little more than an hour it was born, the breech being expelled, as in the first case. In the third case, the arm pre- senting, and labour gone on for some time, after which attempts were made during several hours to turn the child, whose shoulder strongly pressed upon the perinaeum. At length, by the action of the uterus, the child was doubled and the breech expelled; after which the shoulders and head were extracted. In all these cases, the Doctor observes, that the women were at the full period of utero- gestation, and the children were of the usual size. More cases might be related, but these sufficiently prove the fact, that, in cases in which children present with the arm, women will not necessarily die undelivered, though they are not assisted by art. With respect to the benefit we can in practice derive from the knowledge of this fact, it may be observed, that the custom of turning and delivering by the feet in presentations of the arm, will remain necessary and proper in all cases in which the operation can be performed with MANAGEMENT OF FEMALE COMPLAINTS. 437 safety to the mother, or give a chance of preserving the life of the child. But, when the child is dead, and when we have no other view but merely to extract the child, to remove the danger thence arising to the mother, it is of great importance to know that the child may be turned spontaneously by the action of the uterus. If we avail ourselves of that knowledge, the pain and danger which some- times attend the operation of turning a child, may be avoided. Some propose bleeding ad deliquum for abating the too strong contraction of the uterus, and, at the moment of fainting, to attempt delivery. PLURALITY OF CHILDREN. It has been supposed when women have conceived twins, there are certain symptoms before delivery by which that circumstance can be ascertained; but there are no sure indications of the existence of a plurality of children till after the birth of one child, when this takes place, it is very easy to determine when any other remains. This may commonly be done without having recourse to the painful and indelicate means that have been proposed and practised : for, by feeling the state of the belly alone, a judicious practitioner can be very seldom mistaken on such occasions. When only one child has been originally contained in the womb, that organ, soon after delivery, diminishes very much in size, while the bowels, which are kept out of their natural situation, in the lat- ter months of pregnancy, immediately get forward to the fore part of the belly, and render it soft and yielding. But, when a second child remains, the womb does not apparently diminish in size. The intestines, therefore, remain behind and at the sides, and the fore part of the belly has the same hardness as before delivery. It some- times happens that the pains advance rapidly, and the second infant comes very soon after the birth of the first. In such cases, all that the practitioner has to do is to be assured that the second infant is in a proper position, and to take care so to conduct the extraction of the after-births that no alarming discharge may follow their expulsion. But, when the labour-throes cease, or become trifling on the birth of the first infant, the object of the practitioner should be neither to interfere before the woman has recruited sufficiently from her fatigue, nor to delay extracting the second child so long that the passages should become contracted, or the after-birth of the first-born be separated. Inattention to this important rule has been the cause of the loss of many lives. In more than the majority of cases, no more than an hour should be allowed to intervene between the birth of both children. 438 MANAGEMENT OF FEMALE COMPLAINTS. If the delivery be conducted on this simple and obvious principle, although in many instances it becomes necessary to alter the posi- tion of the second infant, and in that way the woman must be put to a little pain, yet all hazard, both to mother and child, may be almost certainly avoided. It requires, indeed, considerable attention after delivery, to guard against loss of blood, which is a very com- mon occurrence, where there had been a plurality of children in the womb. FALLING DOWN OF THE NAVEL-STRING. A portion of the umbilical cord may be forced down, either natu- rally or in consequence of mismanagement. In the former case, it will be felt through the membranes at the beginning of labour; in the latter, it does not come down till after the waters are drained off. When the cord is felt originally through the membranes, the pa- tient should be kept very quiet, and in one posture, till the circum- stances preparatory to delivery are completely accomplished; when the practitioner, by turning the infant, may probably be able to save its life. But when the early discharge of the water has occasioned the pro- trusion of the cord, it is not always in the power of a practitioner to obviate the threatening danger without exposing the life of the patient to much hazard, which is a risk that ought never to be incurred for the precarious chance of saving the infant. CONVULSIONS DURING LABOUR. The precautions by which convulsions, during labour, may, in many cases, be prevented, have already been mentioned under the head of pregnancy, and the dangers to which pregnant women are exposed, when attacked with this frightful disease, have also been pointed out. But when it does happen in time of labour, the safety of the woman commonly depends on expeditious delivery; and, therefore, the proper means for accomplishing so important an object must be employed without delay. If the mouth of the womb be in any way opened or distended, the midwife should introduce the hand in a gradual manner, finger by finger, assist the dilatation, and bring the infant into the world. Should the convulsions continue after the birth of the child, arid the MANAGEMENT OF FEMALE COMPLAINTS. 439 coming away of the after-burden, all that can be done is to keep the brain unloaded by topical bleeding, the bowels open by laxative medicines, and the irritability of the system counteracted by camphor and opium. A large blister may also be applied to the head, and small ones to the inside of each leg. FLOODING, DURING LABOUR, Arises in labour either from an accidental separation of the whole, or more commonly from a part of the after-birth, or from the unusual place of attachment of that substance. When the discharge is con- siderable, there cannot be a question that the patient must be deliv- ered either by turning the child or by the forceps, according to the stage of labour and situation of the child. After the birth of the child, if the natural powers do not separate the secundines within an hour, the practitioner should also perform that duty. When necessity obliges the practitioner to introduce a hand into the uterus, the back of the hand should be towards the uterus, and the hollow of the hand kept as close to the placenta or after-birth as possible in separating it, that the womb may not be injured. In some rare cases, the adhesion is so strong that it is impracticable to separate the whole of the cake without tearing the womb. The portion that is left generally becomes detached in three or four days, and its expulsion may be promoted by the use of a stimulating injec- tion. Such cases require the most serious attention, lest any putrid portion may be absorbed. After these stages of labour are safely completed, flooding some- times takes place. This is the effect of the womb not having become sufficiently contracted, and it requires different management in dif- ferent cases. If the discharge be profuse, cloths soaked in cold water and vinegar, applied to the naked belly, or even cold water poured on the part from a height, should be had recourse to. But some- times the flooding is not observable by the attendants, as the blood congeals as soon as discharged, and is collected within the womb and passages. This circumstance may be feared, if the woman be- come sick or faintish, or complain of ringing in her ears, or dimness of sight. In such cases, the womb must be forced into contraction by manual assistance. In all cases of considerable loss of blood, large doses of opium, frequently repeated, are found of the greatest service in supporting the living powers. (See Immoderate Flow of the Menses—Pro- gress of Labour, and Abortion.) 440 MANAGEMENT OF FEMALE COMPLAINTS. MANAGEMENT OF CHILD-BED. A child-bed woman, as soon as all the circumstances of her labour have been adjusted, may, with propriety, consider herself as still in a state of health, and as requiring little more than the common cautions, and good management, on all occasions necessary to pre- serve it. The first hours after the delivery, provided some light nourishment have been taken, should be dedicated to quiet and sleep, and no person should be allowed to enter the patient's chamber, except such as are absolutely necessary. The chamber door, and even the win- dows, if the weather be warm, should be opened; and the room, in every respect, kept as clean and as free from any disagreeable smell, as any other part of the house. The patient should often be supplied with clean linen, well aired; for cleanliness and free pure air, are essential in this situation; and upon the strictest examination, it appears that there never was miliary eruption produced without a sweat, nor puerperal fever without foul air. The heat of the room ought to be so tempered, that the pa- tient may neither be chilled with cold, nor yet suffer from sweat or burning. The strictest attention should be observed to have an evacuation daily by the use, if necessary, of mild laxatives, or by the exhibition of clysters composed of milk, oil, and sugar, or of soap-suds. It is a security against fever and inflammation, and even forms one princi- pal mode of relief when they occur. An equal regard should also be paid to get out of the bed, as soon as they can with propriety, and to sit up as long as possible without fatiguing themselves. If the lochia do not flow so plentifully as may be expected, or if they entirely stop, no regard need be paid to this circumstance, if the patient be otherwise as well as can be wished. We not only find this evacuation different in different women, but even in the same women in different lyings-in, from which she recovers equally well. Much mischief is often done by binding the belly too tightly. If there be any occasion for support, a thin napkin pinned very slightly round the waist, is all that is absolutely necessary, and the sooner this is disused the better. But little change takes place in the breasts, after the first months of pregnancy, until about the second day after delivery. Then it is usual to feel a great sensation of fulness in them, accompanied with a febrile irritation, which varies in different women, according to con- stitution and management; but in all is favoured by temperance, a cool regimen, and composure of mind. The child should always be put to the breast early, before the milk can have stagnated in them, or they can have acquired any MANAGEMENT OF FEMALE COMPLAINTS. 441 great degree of hardness. It will be beneficial, both to mother and child, if this be done a few hours after delivery; and this is most consistent with the operations of nature. If the patient have not nursed any former child, the infant will probably meet with difficulties in fastening on the nipples. In this case some older infant should be applied, or it will be proper to have them drawn by some other means without giving pain. Thick rings made of bees-wax, and fitted very exactly to the nip- ples, are often preventives of sores, by keeping the nipples elongated. They should be applied immediately after the child has finished its suction, and be put on so that the ends of the nipples may protrude themselves through them. These rings, however, ought not to be used when the milk runs out in too great quantities. If the woman do not suckle her child, no method should be used either to repel the, milk, or invite it into the breasts. Nature will be certain to do her part. She is soon made sensible, that the blood determined to them is not wanted, and there will, therefore, be little farther effort made on her part to continue it, and it will in the course of a short time cease of itself. A cooling cathartic, with a suitable regimen, will entirely supersede the necessity of any local treatment, and is all that can be required, even when a mother has suckled before. No degree of fever in child-bed should be passed over unattended to, or be thought lightly of. Even the most serious are often slight at their beginning. Neither should any local pain, or tenderness, or fulness of the bowels, be neglected, lest they should arise from the incipient stage of some inflammation; which, if not checked at first by proper medicines or suitable regimen, might, in a short time, put on some alarming appearance. Let it be remembered, that it is much easier to prevent diseases than to cure them. The diet of lying-in women should be particularly attended to. All gross meats which might overload the stomach, or, by heating the woman, prove a cause of fever, should be strictly prohibited. But every patient, after child-bearing, ought not to be half starved, as some recommend. Proper regard in this respect should be paid to her habit, former manner of living, and present state. Too great indulgence, it must be remembered, is more to be dreaded than too much abstinence, though both extremes should be equally avoided. The bad effects of confined or impure air are now most univer- sally known; consequently, the propriety and necessity of having the bed curtains always open, of preventing many visiters from crowding the room, of removing as speedily as possible every thing which can contaminate the air, and of admitting occasionally the fresh air, by opening the wdndows and doors, must be obvious. Women were formerly obliged to remain in bed for a certain num- ber of days after delivery, by which they were much weakened and fatigued. In modern times the practice has passed from one ex- treme to another. 56 442 MANAGEMENT OF FEMALE COMPLAINTS. This circumstance should surely be regulated according to the strength of the patient. When the woman feels that she can easily undergo the fatigue of rising, which, in ordinary cases, happens about the second, third, or fourth day, she ought to be taken out of bed that it may be properly adjusted. If she be made to sit upright, she will suffer considerable uneasiness; and, at the same time, by the bulky womb, (for that organ does not resume its natural state till two or three weeks after delivery,) pressing forcibly on the soft parts at the bottom of the basin, the foundation for a very troublesome and disagreeable complaint, namely, the falling down of the womb, must unavoidably be laid. She ought, therefore, to be placed in a po- sition half sitting and half lying, when out of bed, as long as the womb continues enlarged, by which means these inconveniences will be avoided. For the same reason, walking, even from one room to another, at least as long as the lochial discharge continues, and the womb is bulky, is highly improper. Many women boast that they have been able to go through the whole house within a few days after delivery; but they often find, at a subsequent period of life, by the complaints which they suffer, that they had little cause to be satisfied with their own prudence, or the attention of the practitioner who indulged them in such liberties. DISEASES OF CHILD-BED. As there are certain natural causes of disease during lying-in, so there are certain disorders to which women of every description are liable, for some time after delivery. The most usual complaints which occur in child-bed are as follow; namely:— Faintings.—The languid state in which many women are, im- mediately after delivery, is sometimes succeeded by faintings. This is not dangerous whilst the pulse and breathing continue good, and there is no unusual discharge. In this case the complaint may be attributed to the peculiar state of the body and mind of the patient at that time, and will be readily removed by the exhibition of a little wine, toddy, or any cordial. But when the faintings are attended with quick irregular pulse and cold extremities, the greatest danger is to be apprehended ; for it will generally be found that they are the consequences of some violent injury, or of great loss of blood. In this alarming case, if there be a considerable discharge from the womb, a soft cloth is to be pressed firmly on the external opening, and pressure should be made at the same time on the lower part of the belly with the hand, to prevent the womb from distending with management of female complaints. 443 blood, and to excite its action. A large dose of laudanum or opium is also to be administered without delay. And the heat is to be pre- served by the application of warm flannels to the stomach, hands and feet. SHIVERINGS Occur from similar causes to faintings, and sometimes in conse- quence of rash and sudden exposure to cold, after being heated with the exertion of labour. Nothing, in general, affords more speedy relief, than a tea-spoonful of spirits of hartshorn or laudanum in wa- ter. At the same time the ordinary means for restoring warmth, by the application of heated flannel, as recommended in case of fainting, ought to be had recourse to. If it should continue, the camphorated mixture, (see Dispensatory,) in doses of a table-spoonful every two hours, will be of service. This medicine, given as soon as the child is born, commonly prevents both shiverings and faintings in those who have been formerly liable to such symptoms. AFTER-PAINS. For some time after delivery, the contractions of the womb fre- quently continue, and occasion pain, which in some cases is so vio- lent as to resemble throes of labour. This complaint, termed after- pains, though productive of considerable uneasiness, is never to be considered dangerous. In general, they are most effectually relieved by a full dose of laudanum. When the pains continue after the exhibition of this medicine, warm flannels, or bladders, two-thirds filled with hot wa- ter, should be applied to the lower part of the belly. The campho- rated julep, in obstinate cases, will be beneficial, as well as clysters to open the bowels, and afterwards an opiate pill, or an injection of camomile tea, with two tea-spoons full of laudanum, should be administered. 1 444 MANAGEMENT OF FEMALE COMPLAINTS. LOCHIAL DISCHARGE. An increased and sometimes a continual discharge, after delivery, is often the consequence of getting up too soon, or making some early exertion. When this evacuation continues beyond the ordi- nary time, it occasions weakness, and requires the early employ- ment of means to prevent the train of nervous disorders, which com- monly succeeds a profuse discharge of the menses. With this view, tonic medicines, as bark and elixir vitriol, &c, must be employed along with nourishing diet, a liberal use of claret wine, and such other means as may support the strength. The importance of cleanliness, as long as the lochial discharge continues, does not require being pointed out: but when the evacu- ation has a bad smell, common attention in that respect is not alone sufficient; for unless the most scrupulous regard be paid to prevent its stagnation in the passage of the womb, excoriations or inflamma- tion, with all their formidable consequences, will ensue. The nurse should, therefore, on such occasions, be directed to wash that organ by means of a syringe, twice or thrice a-day, with warm milk and water, or with an infusion of camomile flowers, or decoction of oak bark. The lochial discharge is in some women very trifling, and may even stop very soon writhout any bad effect. But when it is sud- denly checked by exposure to cold, or other causes, most painful consequences may follow, such as swelling of the belly, great pain, sickness, and fever. In such cases the evacuation ought to be pro- moted by sitting in a tub of warm water, or by the application of warm fomentations to the parts, and the exhibition of some gentle evacuating medicine, and afterwards endeavour to determine to the surface by the use of Dover's powder, with warm diluent drinks. MILK-FEVER. The breasts are greatly distended for the first two or three days after delivery, and in some cases a considerable degree of pain and fever are occasioned. The best management in these cases consists in gently rubbing the breasts with a little sweet oil morning and evening, covering them with flannel, and keeping the bowels open with some gentle laxative medicine. When the mother's health will not admit of suckling the child, she should have her breasts occasionally drawn, and every circum- stance which can contribute to the secretion of the milk, should be MANAGEMENT OF FEMALE COMPLAINTS. 445 carefully avoided. Great abstinence should, therefore, be enjoined, her body should be kept perfectly open with laxative medicine, and as little milk as possible taken. Ripe acid fruits ought to be used, which will assuage thirst, and by proving laxative, will assist to carry off milk and prevent its secretion. LACERATION OF THE PARTS. The excessive dilatation sometimes required for the exit of the in- fant, and the contraction which follows delivery, occasion a degree of soreness and of uneasy feelings that not unfrequently lead the wo- man to suppose herself torn. These feelings are removed by bath- ing, at first with warm milk and water and afterwards with warm spirits. But where the swelling is considerable, attended with throbbing pain, emollient poultices ought to be applied, and renewed every four hours, until suppuration takes place, and then treated in the ordinary way. (See Abscess.) Women are sometimes really torn during the birth of the infant; which, in most instances, is the effect of mismanagement. Where the laceration is inconsiderable, little more than the ordinary manage- ment is required, as the process by which the passages are restored to their former state tends to reunite any slight separation of parts. INVERSION OF THE WOMB. There are two degrees of the inversion of the womb, namely, the partial and complete. The former, which is the more ordinary one, appears in the shape of a swelling as large as a child's head, pro- truded without the passages immediately after expulsion of the after- birth, accompanied with violent forcing and bearing-down pains, and followed by flooding, faintings, and urgent fruitless attempts to make water. This arises from a part, more or less, of that portion of the womb, which had extended, previously to delivery, above the bones of the basin, being turned inside out. The other degree is so complete an inversion of the womb, that it is torn away from its attachments to the sides of the basin, the im- mediate consequence of which is instant death. Such accidents can only arise from rash and ill-directed endea- vours to extract the after-birth, by drawing down the navel-string before it can be completely separated. But whatever be the cause, 446 MANAGEMENT OF FEMALE COMPLAINTS. the part must be immediately restored, or the consequence will soon prove fatal; for its orifice will contract in its unnatural state,and so prevent the needful relief. Therefore, without delay, place the pa- tient on her back, with her hips raised, and gently return the uterus into the vagina with three fingers, and then with the whole hand place it in its natural position; after which, clench the first, and re- tain it there until the uterus contract upon it; lastly, apply the ban- dages as advised in the case of falling down of the womb, and direct the patient to remain in bed some days. SEPARATION OF THE SHARE-BONES. Is the effect of severe labour or of some former accident, or inflam- mation within the joint which connects these bones. This affection is distinguished from every other, by the pain being uniformly in- creased or excited upon the slightest motion of the lower part of the body, and by feeling the share-bones rasp against each other when either leg is moved. The treatment must depend upon the cause. Where these bones have been separated by a blow or fall, at a former period of life, they only require being held together by means of a broad belt, till the patient have regained strength. The cold bath, whenever it can be used with propriety, should be had recourse to, morning and evening, as it tends greatly to the accomplishment of that object. SWELLED LEG. This disease takes place at different periods after delivery, from the fourth or fifth day to the seventh week. It is ushered in with pain in the back, smart fever, and painful stiffness in the groin. Soon after these symptoms, the thigh begins to swell at the upper part, and gradually the swelling is extended to the whole limb, so that in a short time it is double the size of the sound one. It is rather pale-coloured than red ; and is called by some the white leg. It is hot, shining, very painful on being touched or moved, and at first it does not pit when pressed upon by the finger, and may be distinguished by the above marks. By active treatment at the beginning of the complaint, its progress may be certainly stopped. MANAGEMENT OF FEMALE COMPLAINTS. 447 The bowels should be kept open by salts or cream of tartar, and a determination to the skin produced by Dover's powders or some of the diaphoretic medicines. (See Dispensatory.) Should these not have the desired effect in arresting the disease, a grain or two of calomel, given morning and night, until a slight affection of the salivary glands are excited, and afterwards the nitric acid, will gene- rally succeed. Topical applications are also to be employed, as flannels wrung out in hot vinegar, and renewed as often as they become cold. Good effects have also been derived from the application of a strong solution of crude sal-ammoniac and sugar of lead in vinegar. When these fail to produce any good effects, surrounding the limb with a portion of English bran and sweet oil, with the addition of half an ounce of laudanum, or soft-boiled turnips, and renewing it night and morning, will afford considerable relief. The best application, how- ever, in such cases, when they can be procured, are the leaves of the thorn apple, scalded in vinegar; with which the limb must be thickly covered, and then confined by a flannel bandage. Friction, with the anodyne or camphorated liniment, has pro- duced some good effects, but the mercurial ointment, united with camphor, has been externally employed with more permanent advantage. When the acute symptoms are over, and the limb remains weak, friction with the flesh brush is proper, and a roller should be applied with moderate firmness from the toe to the groin. The cold-bath is useful to re-establish the health. The diet, after the inflammatory symptoms have abated, ought to be nourishing; and sleep, when re- quired, should be procured by opiates INFLAMMATION OF THE BREASTS. This disease is easily known by the pain, hardness, and swelling which accompany it. In some cases, the whole breast appears to be affected, in others, only one side, and in some the affection is small and superficial. When the breast inflames, it is evident that the retention of the milk must, for a time at least, increase the pain. The first object then should be to have the breast drawn, either by the child or some other means; but, should the milk not come away readily, and the pain be increased thereby, farther attempts must not be made; otherwise both the disease and the sufferings of the woman may be aggravated. A cooling diet and an open state of the bowels are necessary while the swelling continues. And it 448 MANAGEMENT OF FEMALE COMPLAINTS. is better for the patient to remain in bed, as the weight of the breast, while in the erect posture, often increases the inflammation. The breast should be gently rubbed with a small quantity of swTeet oil or unsalted butter, and poultices of crumb of bread and lead water ap- plied. If the pain and hardness do not very soon go off by this ap- plication, warm emollient poultices, as milk and bread, with a little oil, or united with the leaves of the thorn apple, must be had re- course to. These poultices will not promote suppuration unless the inflammation has proceeded so far, that that process has already be- gun, and in this case the sooner it is produced the better. If the abscess do not point and break soon, no good can be gained by delay: an opening should therefore be made, so as to evacuate the matter freely. This not only gives immediate relief, but pre- vents a farther extension of the mischief. The milk and bread or flax-seed poultices must be continued for a few days, in order to re- move the hardness, and then the part must be dressed, as in ordinary cases. (See Abscess.) Indurations remaining after an abscess, may be frequently reme- died by the application of a mercurial plaster, or cloths wet with the camphorated spirit, or rubbing the part, night and morning, with mercurial ointment, united with a little camphor. Sometimes after the abscess heals, and the breast seems to be cured, it swells a little, especially towards night. This is from weak- ness, and is cured by strengthening the constitution. In the early stage of this complaint, the best application made by the most experienced physicians, is warm vinegar. When the breast seems likely to suppurate, the following applications have been made with the greatest advantage. Olive oil two ounces. Sugar of lead one drachm. Sulphuric ether two drachms. Laudanum one drachm. The following has been highly spoken of. Carbonate of lead one drachm. Vinegar two ounces. Add spirits of wine one ounce. Distilled water, five ounces. To be applied to the breast, cold, with a piece of linen. The patient to be restricted to the lightest diet. Bowels to be kept open with salts, magnesia, or senna and manna. The patient to be made to lie on her back and the breast to be lightly covered. Temperature of the air to be moderate and drinks cool. SORENESS OF THE NIPPLES. The nipples, from the delicacy of their structure, are very liable to be injured by the action of the child's mouth in sucking, along with the irritation which the stagnant milk occasions, unless they be MANAGEMENT OF FEMALE COMPLAINTS. 449 kept very dry. Women are subject to this complaint more frequently while nursing their first or second child than afterwards; for the nip- ples lose much of their sensibility by use. In the treatment of this disease, the great object to be attended to is, to remove, as much as possible, every circumstance which can tend to irritate these parts. It is important to keep the nipple dry and cool, for which purpose rings of lead are generally worn. The nipple ought to be washed frequently with some gentle stimulating liquor, as brandy and water, or port wine, or a solution of alum or white vitriol, in the proportion of fifteen or twenty grains to four ounces of water: these must be frequently varied, for the same lotion soon loses its effects. A saturated solution of borax, in vinegar or water, with the addition of a little honey, has been very beneficial to sore nipples. In obstinate cases, the sores should be touched by means of a fine hair pencil, with a solution of blue vitriol, or the following liniment, which is highly extolled by Dr. Hamilton. Take of litharge and vinegar, each, two drachms, olive oil, six drachms, to be made into a liniment by rubbing the whole together in a mortar until it be- comes of a flesh colour, and the consistence of cream. Washing the sore nipples with a decoction of the roots of wild indigo, (see Ma- teria Medica]) is also celebrated as a valuable remedy in these affections. As long as we are under the necessity of applying any medicines to the nipples of the mother, it will be prudent not to suffer the child to suck her. Where this cannot, however, be dispensed with, the part should be well washed with a little warm water, each time, pre- viously to giving the child the breast. To prevent the sore from being aggravated by sticking to the woman's clothes, a little cup made of wax may be laid over the nip- ple, which is the part most apt to suffer. If only one nipple be affected, the child may be confined to the other; but if both be af- fected, and the pain occasioned by its sucking is too great to be borne, the woman must then desist from the duties of a mother until the excoriations are somewhat healed, taking care, however, to have the breasts drawn regularly twice or thrice a-day. In many cases where the woman has never nursed before, the nipples at first are not sufficiently prominent to afford a proper hold for the child. In such cases the breasts should be fomented by flan- nels dipped in warm water, and then, by gentle pressure on the sides of the breasts with the hands, the milk is pushed forward. At the same time the pressure is made, the nipple should be drawn out by a breast-pipe, and the instant the glass is removed, the child being put to the breast, will keep it out by sucking until satis- fied. After the operation has been repeated two or three times, the child, except in extraordinary cases, will find no difficulty in sucking. Those who have been subject to sore nipples, should endeavour to diminish the sensibility of these parts, by applying to them for 57 450 MANAGEMENT OF FEMALE COMPLAINTS. several weeks previously to delivery, cloths dipped in alum water, in strong spirits, or in the pickle of salted meat boiled, which latter has been recommended as an infallible specific for that purpose. When little sores appear in the brown circle surrounding the nip- ple, and correspond with similar appearances in the child's mouth, or other parts of the body, there is just cause to suspect some latent poison lurks within the system, which, it is more than probable, it will require a mercurial course of medicine to subdue. INFLAMMATION OF THE WOMB Commonly occurs about the second or third day after delivery though in some instances later. The existence of it may be ascer- tained by pains in the lower part of the belly, which are greatly in- creased, by pressure, a constant fever, with a quick hard pulse, and a great prostration of strength. The lochial discharge is very early suppressed, and the secretion of milk very much diminished. It is commonly attended with sickness. It often happens that the woman can only lie on her back, and on turning to either side, she feels a painful heavy mass fall to that side, and at the same time an excessive pain in the loin, kidney, and groin, of the opposite side. Many causes tend to induce inflammation of the womb, such as abortion, difficult or tedious labour, the exhibition of heating and stimulating drinks, exposure to cold after delivery, &c. As this disease is very rapid in its progress, it calls for the earliest attention. Blood-letting is of great importance in the incipient stage, and may be repeated in ten or twelve hours if the effect produced and the constitution of the patient would justify it. Although strong active purges would be highly improper in this disease, yet it is necessary to preserve the regular motion of the bowels by giving, occasionally, the cathartic mixture or Epsom salts in small doses. Emollient and aperient clysters should be frequently administered, as they not only unload the intestines, but likewise act as fomenta- tions. Medicines which determine to the surface, as Dover's pow- der, or diaphoretic drops, with the same mixture, are also highly serviceable. To remove the tension, and alleviate the pain and soreness, flan- nel cloths wrung out -in a warm decoction of camomile flowers, or any bitter herbs, with the addition of one-fourth of spirits, to which a little laudanum may also be added, should be kept pretty con- stantly applied to the lower part of the belly, and at bed-time it may be rubbed with the camphorated or volatile anodyne liniment. (See Dispensatory,) In using fomentations, due care must, however, be MANAGEMENT OF FEMALE COMPLAINTS. 451 taken that they are not applied so wet as to run about the bed, and thereby occasion inconvenience to the patient. Opiates are necessary to procure rest, but they should not be em- ployed until the inflammation has been subdued by blood-letting, and aperient and diaphoretic medicines. Too much caution cannot be observed by women in guarding against any exposure to cold after delivery, as they are thereby apt to bring on diseases, which, if they do not prove quickly fatal, not unfrequently leave effects behind them, of which they will be sensi- ble the whole future period of their lives. PERITONEAL INFLAMMATION Frequently occurs in women after delivery, and is produced by the same causes which give rise to an inflammation of the womb. In some cases the inflammation attacks only a small portion of the membrane at first, and is afterwards communicated to the whole at once. The patient is usually seized with rigors and shiverings, thirst, fever and an accelerated pulse, and soon feels considerable pain, with soreness, either in a particular part of the abdomen, or over the whole of it. The uneasiness and pain increasing rapidly, the abdomen becomes puffed up and swelled to a size nearly equal to what it was before delivery. From the inflamed state of the parts, and the exquisite pain which prevails, the very weight of the bed- clothes becomes irksome and insufferable ; and, in order to support it, the patient is obliged to lie on her back with her knees bent in towards her belly. She is, moreover, incapable of bearing the least motion. In the cure of this disease, nearly the same mode of treatment which had been advised for an inflammation of the womb must be adopted. Bleeding from the system to about sixteen or twenty ounces should, therefore, be had recourse to at a very early period ; particularly where the patient is of a robust plethoric habit, and with such it may be necessary to repeat the operation within twelve hours. To employ the bowels freely, it will be necessary to employ active purgatives from time to time. Fifteen or twenty grains of calomel, with four of ipecacuanha, followed by an infusion of senna and manna, castor oil, or Epsom salts, will not fail to afford relief by pro- moting several evacuations of fetid and dark stools. Should there prevail great irritation at the stomach, with frequent vomiting, the patient should take, every two or three hours, the saline draught in the act of effervescence, with twelve or fifteen drops of laudanum, and drink freely of barley water, flax-seed tea, or some mucilaginous 452 MANAGEMENT OF FEMALE COMPLAINTS. drink. In order to determine to the surface, the diaphoretic medi- cines should be employed; and to procure sleep, after the inflam- matory symptoms have somewhat subsided, the anodyne sudorific bolus or draught may be given at bed-time. To alleviate the pain and soreness, fomentations, as advised in inflammation of the womb, must be resorted to very early. Emollient clysters should be admin- istered during the intervals of employing purgatives, as they will not only assist in keeping the bowels open, but will act, likewise, as internal fomentations. Throughout the whole period of the disorder, the patient is to be supported by food of a light, nutritive nature, administered in small quantities at a time, and repeated frequently, so as never to overload the stomach. DELIRIUM, Or wandering of the mind, seldom occurs sooner in lying-in women than eight or ten days after delivery, and sometimes not foi a much longer time. It makes its appearance veiy suddenly, the patient not unfrequently awakening terrified from a dream, or all at once she breaks out in some absurd or furious conduct. There is often very little increase of heat of the skin, or other ap- pearance of fever; though in some instances there is considerable heat, and the pulse is very quick, and this is especially the case where there has just been some strong exertion, or much speaking. But, as in all other cases of nervous constitutions, the state of the pulse is subject to considerable and sudden variations. The patient is usually extremely talkative, and sometimes speaks with wonderful volubility. In some cases one idea seems to possess the mind ; and in others the object of apprehension or consideration is rapidly varied. She can, however, for a short time be com- manded, and at times, at least, appears perfectly sensible of what is going on beside her. It is not easy to say what cause produces this disease, for it does not appear to be connected with a tendency to mental derangement in other circumstances. It is, however, a cu- rious and an important fact, that sometimes suckling the infant pro- duces melancholy, or other modifications of this complaint. When delirium accompanies the milk fever, or the weed, it is only a temporary symptom, and ceases upon the original disease being removed. When it is the effect of phrensy, the treatment consists in those means as advised under the head of inflammation of the brain. But, when it appears to be dependent on nervous irri- tation, the most successful mode of practice is, shaving and blister- ing the head, keeping the bowels open by cooling laxatives, deter- MANAGEMENT OF FEMALE COMPLAINTS. 453 mining to the surface by the diaphoretic powders or mixture, and afterwards allaying irritation by the camphorated mixture in their usual doses. If these remedies prove of no avail, the most soothing mild con- duct towards the patient ought to be invariably pursued, and the suitable means to promote general good health are to be adopted. The woman should be carefully watched, and never left alone. The recurrence of this disease, in cases where it has formerly taken place, may be prevented by pursuing steadily such measures as shall re- move the increased susceptibility of impression which follows delivery, and by guarding against all exciting causes. MILIARY ERUPTIONS. These certainly originate in a child-bed state from improper treat- ment ; for whenever a woman in such situation is confined within a heated room, oppressed with a great quantity of bed-clothes, and forced to drink stimulating liquors, with a view of promoting a sweat, according to the absurd and pernicious custom in the treat- ment of lying-in patients, she is generally seized with rash fever. (See Miliary Fever.) To conduct the patient with safety through the disease, we must have recourse to some opening medicines, and afterwards restore the strength by the use of Peruvian bark, elixir vitriol, and other tonics. Where the rash suddenly recedes, it will be necessary to have re- course to cordials and diaphoretics. Affections of this kind may, in general, be avoided by attention to diet, by keeping the patient's bowels in a good state, and by admit- ting a proper ventilation through the chamber. PUERPERAL FEVER. A fever happening from any disease in consequence of pregnancy, or delivery of a child, and happening during the time of lying-in, may be properly called a child-bed or puerperal fever. The symptoms which characterize the disease are, pain and ten- sion of the abdomen, short anxious breathing, uncommon quickness of the pulse, increased temperature of the body, tensive pain over the forehead, peculiar wildness of the eyes, prostration of the vital powers, suppression or diminution of the milk and lochia, a flaccid 454 MANAGEMENT OF FEMALE COMPLAINTS. state of the breast, and, upon drawing them, blood instead of milk, is frequently discharged. The progress of a puerperal fever is sometimes so very rapid, particularly in warm climates and hot seasons, as to destroy the patient in forty-eight hours. Even in cases seemingly the most fa- vourable, we should look on the event as doubtful, as the complaint is apt to be accompanied with delusive remissions, and indications arise in its progress, which are by no means equal to the danger. The causes are various, and sometimes the disorder is inflamma- tory, but it soon tends to the putrid kind, and sometimes from the beginning a putrid fever. During the first stage of puerperal fever, if there be marked in- flammatory symptoms, it is advisable to draw some blood from the arm, proportioning the quantity to the habit and constitution of the patient. The necessity of procuring stools by purgative medicines, as well as removing putrid feculent matter, must be obvious, and an equal regard should be paid to the state of the skin by administering such medicines as determine to the surface of the body, and thereby abate febrile heat. With the first intention, the aperient and dia- phoretic pills, given in broken doses, or ten or twenty grains of calo- mel, with a few grains of ipecacuanha, followed in a few hours after- wards by a table-spoonful of Epsom salts, will be found very beneficial at the commencement of the disease. And, in order to excite gentle perspiration, the spirit of Mindererus, Dover's powders, or diaphoretic drops, (see Dispensatory]) should be employed in their usual doses. After these means have produced some good effects, one or two grains of opium alone, or conjoined with a few grains of ipecacuanha, or the anodyne sudorific draught, may safely be given to relieve pain as well as to procure rest. It often happens that nausea and vomiting of bilious matter attend an attack of this fever. In such cases give a gentle emetic of ipeca- cuanha, and after its operation, if the sickness continue, apply to the stomach poultices of mint stewed in spirits. It has been observed that this fever, after continuing a day or two, very often acquires a malignant and putrid tendency. Under such circumstances it will be proper to have immediate recourse to the remedies advised under the head of nervous fever. To alleviate the soreness and distention of the abdomen, we should apply fomentations both inwardly and externally; inwardly, by in- jecting emollient clysters from time to time, and externally, by ap- plying flannel cloths, wrung out in a warm decoction of camomile flowers, or some bitter herbs, with the addition of one-fourth spirits and an ounce of laudanum, to one gallon of the decoction, over the whole region of the abdomen; and these ought to be renewed as often as they become cold, taking due care that they are not so wet as to run about the bed and incommode the patient. Where the abdominal cavity is highly painful to the touch, and is occupied by extensive inflammation, the application of cold to the MANAGEMENT OF FEMALE COMPLAINTS. 455 parts by cloths dipped in a mixture composed of two parts of vinegar or cold water, and one of spirits of camphor, has frequendy been at- tended with happy effects. If a gentle purging arise in the first stage, or commencement of the complaint, it ought not to be too hastily stopped, as the fever has, in some instances, been carried off by such spontaneous evacuation. PROTRUSION OF THE VAGINA. The vagina, or passage to the womb, is sometimes protruded, or pushed out of its natural situation. The disease appears in the form of a soft compressible tumour or swelling, protruding without the external passage, in some cases extending backwards, and in other cases situated on one side. It is not painful when pressed upon, and most commonly it subsides when the patient lies down, being only troublesome when she is in an erect posture. The disease is owing to local relaxation, and that is frequently the consequence of mismanagement after lying-in. If the prolapsed part be not inflamed, and there is little or no swelling, the tumour will be very little trouble. The part may be restored with the fingers, which, when done, the patient should rest in bed some days, and inject into the vagina, three or four times a-day, warm vinegar and water, or port wine and water, or lead water, or solution of alum in a decoction of red oak bark or water. If the patient be weak, strengthening remedies will be required, as the cold bath, bark, rust, or tincture of steel, or tonic powders, or pills. At the same time it will be prudent to wear the T bandage. When these means fail, it is recommended to make scarifications in the descending vagina. FALLING DOWN OF THE WOMB. This is a much more common complaint than the former, and takes place in women of every age, and every rank. As its name implies, it consists of change in the situation of the womb, by which that organ lies much lower than it ought to do. In some cases it absolutely protrudes entirely without the parts. The slightest degrees are styled bearing down; and the more violent ones descent or falling down of the womb. 456 MANAGEMENT OF FEMALE COMPLAINTS. In general, the first symptom of this complaint is an uneasy sen- sation in the lower part of the back while standing or walking, with now and then a kind of pressure and bearing down. If these feelings be disregarded, the complaint increases, and the patient becomes incapable of making water without first lying down, or pushing up a swelling which seems to stop the discharge of urine; and if the disease continue to increase, the womb is actually forced out of the parts, and takes on the form of a bulky substance hanging down between the thighs. This extreme degree of the complaint can seldom happen, excepting in women who have had a great many children, but the less degrees of it occur occasionally in very young unmarried women. The causes of descent of the womb ought to be known to every woman, as many of them may be avoided. Every disease which induces weakness of the habit in general, or of the passage leading to the womb, in particular, must lay the foundation for the complaint. Frequent miscarriages, improper treatment during labour, too early or violent exercise after delivery, are in married women, the most frequent circumstances by which falling down of the womb is pro- duced. In the unmarried, it is apt to take place in consequence of violent exercise, as in dancing, riding, &c., while out of order, a fact that ought to be impressed on the mind of every young woman. In the treatment of this complaint, the means must be adapted to the degree of its violence. When the descent is inconsiderable, and the case is of recent date, the daily use of the cold bath, invigorating diet, very moderate exercise, and the injection of any mild astringent liquor into the passage, evening and morning, will probably prove successful. But should the disease be in a great degree of long standing, a course of tonics, with the frequent use of astringent in- jections, as a strong solution of alum in water, or decoction of red oak bark, must be added to the above means. Dr. Leak advises, that after the parts are reduced, the intention of contracting the relaxed vagina so as to prevent its future descent, may be effected by the frequent use of the following astringent in- jection. Take of alum, and white vitriol, each, one drachm, boil- ing water one pound, mix and filter through paper. Inject it into the vagina, milk warm, with a womb syringe. At the same time endeavour to strengthen the whole bodily system by nourishing diet, and tonic medicines. When the complaint resists such remedies, or when, from its de- gree, it may appear unnecessary to employ them, the only relief which can be afforded, unless the womb become pregnant, is to be obtained by wearing an instrument called a pessary. It is made of wood or ivory, and if properly adapted to the passage, and of a pro- per construction, it can be worn without much inconvenience, and it never occasions pain. Certain attentions, are however necessary, whenever such an instrument is used. Thus, the pessary should never be allowed to remain in the passage above a few days at a MANAGEMENT OF FEMALE COMPLAINTS. 457 time, otherwise it becomes the source of great irritation. It should, therefore, be occasionally withdrawn on going to bed, well cleaned and re-introduced in the morning, before the patient rises. In some instances, after a pessary of a certain size has been worn for several months, one of a smaller size becomes better adapted to the passages, and in other cases one of a larger size is required. Sponges of such a size as, when expanded, fill up the cavity of the vagina, are very good pessaries. They support the uterus, and, by putting a string through them, the end of which is to be left hanging out of the os externum, the woman can take them away and apply them herself very conveniently. To answer this purpose, a fine sponge, wrung out in alum water, may be dried in a compressed state, and cut into any convenient form, so as to be introduced as high as possible: this will act by its astringency, and by its pressure, in a gentle and uniform manner. During the use of this application, an astringent injection may be used twice a-day; and the sponge tent should be made gradually smaller as the vagina contracts. The application of the bandage round the whole belly, with a moderate degree of firmness, often gives great relief to the uneasy feelings. The T bandage has also been worn in this case with con- siderable advantage. If a woman, liable to falling down of the womb, become preg- nant, there is no occasion for the pessary after the third month, and by proper treatment after delivery, the return of the complaint may be prevented. In the Edinburgh " Medical Commentaries " is the following ac- count. A woman of singular fortitude, about fifty years of age, was much afflicted with prolapsus uteri. After trying many remedies in vain, and being tired out with the continuance of the complaint, she at length cut into the substance of the womb with a common kitchen knife. A considerable hemorrhage ensued ; after which, the uterus gradually contracted, and she had neither a return of the prolapsus, nor was she afflicted with any other symptoms. Having boasted of her success, many women in the neighbourhood, afflicted with the same complaint, applied for her assistance, and by a similar opera- tion were effectually cured. It is supposed that scarifications may succeed instead of incisions of the prolapsed womb, and the same method of cure is still more strongly recommended in the protrusion of the vagina. We can recommend with great confidence, in cases of this sort, the "abdominal supporter" of Mr. Betts, which is so made as to lace up in front, behind, and at the sides. This admirable instrument takes off all pressure of the superincumbent organs in a debilitated and crippled state from long and tedious disease. A lady to whom we very recently had it applied, rose from her bed the same day, to which she had been long confined, and walked nearly one mile and back, a degree of exercise to which she had been a stranger more 58 458 MANAGEMENT OF FEMALE COMPLAINTS. than a twelvemonth. In another case, attended with a tedious hemorrhage, all the usual remedies failed till the application of this instrument proved of signal advantage. She was soon entirely restored. POLYPUS IN THE WOMB. The vagina and womb are subject to fleshy excrescences, called Polypus Tumours, in common with some other parts of the body. These, in many cases, are soft as clotted blood; in others they resemble flesh ; and sometimes they are found of a hard consistence. They are of different sizes and shapes. The mild polypus is connected to the womb generally by a nar- row neck. As it grows the womb enlarges; and presently its mouth dilates, so that the polypus can be felt with the finger. Then it gradually descends into the passage, or, in some instances, is forced down, with pains like those of labour. Excrescences of the womb differ from descent of that organ, in being attended with the frequent discharges of blood, and when felt, in being broad and bulky, and having no orifice like the protruded womb, and in being easily moved or twirled around, as it were by the finger. The cause of this complaint has not been ascertained. It is evi- dently unconnected with the married state, as it occurs in unmarried women; and it does not appear to attack, exclusively, any particular constitution. No medicines have any power over this tumour, but it may be safely and successfully removed, by the application of a ligature round its neck. This operation gives no pain, and is practicable, whenever the mouth of the womb has dilated completely. But, if the symptoms be not urgent, it will be better to delay, until the polypus have wholly, or in part, descended into the passage, as the ligature can then be still more easily and successfully applied. There is a tumour of a different kind, met with in the womb, which does not spring from the surface of its cavity, but is imbedded in its substance. It forms a knob or projection, which gradually in- creases ; and, in some instances, several of these form in succession, and the womb becomes considerably enlarged. This tumour is called a tubercle. It produces very nearly the same symptoms with polypus. The distinction between this disease and a polypus, can only be made by a skilful examination, which determines the point. The growth may very frequently be checked, and in several cases its size may be even greatly diminished, by taking, for a length MANAGEMENT OF FEMALE COMPLAINTS. 459 of time, two or three drachms of the vitriolated tartar, or cream of tartar, in a glass of water every morning before breakfast. Should this not be sufficient to keep the bowels in rather a laxative state, its operation may be assisted by taking, at bed-time, an aloetic pill. Much advantage is also derived by the use of the warm sea bath, which, if not attainable, a little salt added to the water may be sub- stituted. The patient must observe a light diet, and carefully avoid heating and stimulating drinks. Perhaps a mercurial course might be attended with good effects in this affection of the womb, and afterwards the nitric acid. The possibility of removing this complaint, or of keeping it in subjection by proper remedies, and the great probability of completely curing a polypus, by a simple operation, or of relieving by a me- chanical contrivance, a bearing down of the womb must be surely powerful inducements for women labouring under symptoms of these complaints, to submit early to skilful examination, which can alone determine the precise nature of their disease. CANCER OF THE WOMB. This disease most frequently appears about the time when the menstrual evacuation ceases, but no age is exempted from it. Its approach is, in general, gradual. At first the patient feels an uneasy weight in the lower part of the belly, with the sensation of heat or disagreeable itching. By degrees irregular shooting pains, darting across from the share bones, take place. The pain at last becomes fixed in the womb, and is described to occasion a constant gnawing, burning sensation. A discharge of ill-coloured, fetid, acrid matter from the vagina, attends this pain; and, notwithstanding every attention to cleanliness, excoriates the neighbouring parts. The nature of cancer is not yet properly understood by practi- tioners; but it is well known, that the first change in the part which afterwards becomes cancerous, is a thickening and hardening of its substance. This may be suspected to have taken place in the womb, if there be pains in the thighs and back, bearing down when using exercise, and occasional violent discharge of clotted blood. By early attention to such symptoms, many individuals have had the progress of the disease completely arrested. In the early stages of cancer of the womb, a continued perseverance in milk and vegetable diet, a total abstinence from animal food of all kinds, and every fermented liquor, and occasional blood-letting, and in some cases the establishment of one or two issues in the arms or above the knees, together with frequent doses of cooling laxative 1 460 MANAGEMENT OF FEMALE COMPLAINTS. salts, tends most materially to relieve the symptoms, and to retard the progress of the disease. Pain and irritation, which strongly tend to increase, are allayed by the use, every night, of the warm bath, impregnated with salt. This sooths the part, and indeed the whole system, and contributes materially to the relief of the patient. The injection of decoction of camomile flowers into the passage, morning and evening, is always proper. Discharges of blood are moderated by rest, keeping the patient cool, and pressing a cloth firmly on the passage. Should the size of the tumour render the passage of the stools or urine diffi- cult, it will be necessary to assist the evacuation of the former by laxatives, and to have the latter regularly drawn off. Care must be taken, however, to give no stronger laxative than is sufficient to produce the desired effect; for frequent stools, in such circumstances, give great fatigue and produce much injury. Should there be, in the last stage, much pain or restlessness, these must be overcome by opiates. The fetid discharge is to be carefully washed away, and every attention must be paid to the mitigation of those evils and distresses connected with protracted disease. A variety of medicines have been proposed for the cure of cancer in every part of the body. These are generally useless, and some- times hurtful. The pretensions of empirics, and the no less injurious interference of friends and acquaintances, who have all their own mode of cure, too often deceive the patient, and prevent her from using those simple but salutary means, which at first keep the disease in subjection; or from submitting to an operation when the complaint is seated in a part capable of being removed. The only tiirre when !-mefit can be derived is thus lost, and nothing afterwards remains but to diminish as much as possible, the misery of the patient. A MOLE, Is a fleshy or bloody substance contained in the womb, and its size varies from that of a nut to an orange, or it may even become larger. The symptoms are very much the same at first with those of pregnancy, so that this has been called a false conception. How- ever in pregnancy the belly often becomes flat and less, until the end of the second month; on the contrary, when there is a mole, the belly increases from the first, and so continues to the second or third month, at which time it generally comes away. If it continues lon- ger, it often proves troublesome by the flooding it occasions. After the period of four months, the mole excites no motion in the womb like those of a living child: it distends the belly equally, and changes MANAGEMENT OF FEMALE COMPLAINTS. 461 its situation according to the posture of the mother, which is never known to happen whilst the foetus is alive. It is produced by the retention of a clot of blood in the womb after a miscarriage, a profuse menstruation, or it may follow a delivery at the full time, or may be occasioned by the retention of a blighted conception. When a mole occasions no ill symptoms in the mother, no violence should be used to bring it away, but it may continue many years without creating any remarkable inconvenience. If it comes away by the end of the third month, it rarely happens that any assistance is necessary. Let the finger be gradually introduced into the womb, and if that suffice not, introduce another, and thus the mole will generally be excluded by the pain which attends on these occasions. The mole is expelled with the same symptoms as in a miscarriage, and requires similar management. A substance of a different nature is occasionally met with; namely, a mass consisting of small bladders, called hydatids. These blad- ders, which contain water, may be very numerous, and somewhat resemble a thick cluster of grapes. Some of them are not larger than the head of a pin, others larger than a nut, or one or two may even acquire a greater size. Generally speaking, they are produced by the same causes which occasion a mole; but they usually proceed from the retention of a blighted conception, which comes to be con- verted into hydatids. In this last case, the time when the embryo or foetus perishes, is marked by the breast becoming flaccid, and the morning thickness going off. The belly does not increase in size, or if it do, it is slowly. The patient does not become regular, as she would have done, had the womb been emptied; but she maybe subject to irregular discharges of blood. At length, after an uncer- tain period, pains like those of labour come on, and the mass is ex- pelled, often with a very considerable flooding. The management is the same as in an abortion. After the expulsion, milk sometimes appears in the breasts. DROPSY OF THE OVARIUM. The appendages of the womb called Ovaries, are frequently the seat of dropsy. This disease occurs at every period of life. It is a most extraordinary fact, that a small body, not larger than a nutmeg, and having naturally no cavity, should by disease become so enlarged as to contain, in many instances, above ten gallons of watery fluid. At first, dropsy of the ovarium is very considerable, and attended with no disagreeable symptoms. It increases gradually in bulk, 462 MANAGEMENT OF FEMALE COMPLAINTS. and is originally confined to one side only, more frequently the left one. The patient enjoys usual good health, in most cases, till the tumour has acquired a considerable size; it then induces pain and numbness in the thigh corresponding with the side in which the swelling is situated, and by degrees the body becomes wasted, the appetite bad, and the strength impaired. Nothing can be more uncertain than the progress or termination of this complaint. Experience has proved, that, under the most apparently desperate circumstances, the health has been in a man- ner restored, or life for a considerable time protracted; while, on the other hand, where no urgent symptoms have appeared, a sudden aggravation of complaints has occurred, and a rapid advance to the fatal termination has takan place. With respect to the cause of this disease, nothing satisfactory can be offered. Women of every age and condition are found afflicted with it. Human prudence, there is reason to fear, can neither fore- see nor prevent its occurrence. This disease can be very rarely cured. Our chief and most rational object is to keep it from increasing quickly. For this pur- pose diuretics have been tried, but they have no effect. The best practice seems to be, to make gentle pressure externally with a ban- dage, so as to support the parts, at the same time, that we may keep the bowels open, and use means for invigorating the constitution. Troublesome symptoms must be palliated by appropriate remedies. When the tumour has acquired a great size, and produces breath- lessness and other urgent symptoms, the water may be taken off by the operation of tapping. A temporary relief, however, will only be obtained by these means, for the fluid is commonly soon again accu- mulated in increased quantity. In some rare cases, where the general health of the patient re- mains unimpaired, by the use of strengthening remedies, the disease has been prevented from returning after tapping; and hence patients, under such circumstances, should not altogether despair. Dr. Cutbush gives an instance of a dropsy of the Fallopian tubes, being effectually cured by the application of tobacco. (See Materia Medica.) WORMS- Women after childbirth, are very frequently much troubled with worms, particularly the small white worms called ascarides. These produce a very troublesome itching about the fundament or lower part of the intestine. They also occasion want of appetite, or de- praved appetite, itching in the nose, pale face, irregular pains in the MANAGEMENT OF FEMALE COMPLAINTS. 463 belly or sides, and sometimes a difficulty in making water. If the stools are examined, they may often be found mixed with slime, and worms can be discovered like small pieces of white thread. The most effectual means of destroying these animals, is, to use morning and night, as long as the symptoms continue, a clyster, composed of two drachms of aloes rubbed up with a pint of muci- lage of gum Arabic, slippery elm, or flax-seed, or thin gruel. If this should not answer, injections of half an ounce or more of the oil or spirits of turpentine, mixed well with the mucilage, or gruel, should be repeated twice or thrice a-week. A different kind of worm is found higher up, having, to a super- ficial observer, much the appearance of the common earth worm, whilst another species, namely, the tape worm, is flat and jointed. These produce, generally, more pain in the belly than ascarides, and seldom any itching about the extremity of the bowels. The treatment is twofold, first to give calomel at bed-time, fol- lowed by brisk purgatives the next morning, which not only forces the worms away, but by removing much of the slime of the bowels, destroys their favourite and necessary habitation. The second part of the treatment consists in giving such medicines as are supposed to kill the worms, such as the filings of tin or iron, or Carolina pink root, or pride of China. (See Materia Medica.) For the destruction of the tape worm, the oil of turpentine is con- sidered very efficacious, as also the male-fern root. The dose of the former, is from a half to an ounce given in milk, mucilage, or thin gruel. The dose of the latter, is from one to two drachms, which may be taken in the morning on an empty stomach, for two or three successive days, and the following morning after the last dose, take a dose of calomel and rhubarb, jalap or castor oil. As an auxiliary remedy in cure of worms, considerable benefit is sometimes derived by applying, externally, over the region of the belly and stomach, a cataplasm made of the leaves of tobacco pounded and wetted in vinegar, or one of ox gall formed of a due consistence with corn or oat meal. These remedies have been known to succeed after powerful ver- mifuge medicines, internally administered, have failed to produce any good effect. An hereditary predisposition to have worms formed in the bowels and stomach, seems to exist in some persons, as all the children of one family have been known to be troubled with them. 464 MANAGEMENT OF FEMALE COMPLAINTS. BARRENNESS. Sterility is a misfortune few women become altogether reconciled to. In various countries and in different ages of the world, charms and spells, and powerful elixirs, have been resorted to; rich offer- ings have been presented at the shrine of a favourite saint; pil- grimages have been undertaken to holy wells; and, in addition to all, the virtues of potent herbs and drugs have been made trial of, for the removal of this infirmity. When we consult the writings of the old physicians on this subject, we find numerous recipes, con- taining medicines sometimes of opposite qualities, and sometimes no quality at all. The practice of the moderns is, at least, more simple, if not more efficacious. Sterility proceeds from either a temporary or permanent incapability of conceiving or retaining the embryo, till it acquires a form. The causes producing this incapability, may consist in some malformation or deficiency of the womb, or its ap- pendages, which cannot always be discovered during life, or in merely a weakness in the action of the womb. This last is by far the most frequent cause, and it is occasioned by local weakness of the womb, or general affections of the whole system ; and is marked usually by an obstruction, deficiency, or redundancy of the men- strual evacuation, or by the complaint termed female weakness. It is very rare, indeed, for a woman to be barren, who is, in all respects, regular. We do not, in the present age, pretend to the knowledge of any elixir or medicine, which has the specific power of curing sterility. We proceed on the principle of rectifying the constitution, where it is injured or weak, and of restoring the menstrual evacuation, to its due and healthy state. The means for effecting these purposes, must depend on the situation of the individual, and may be learned from some of the preceding chapters of this work. There are chiefly two states of the constitution productive of those deviations in the action of the womb, which cause barrenness. The first is a state of fulness, and a disposition to obesity. The person gradually becomes fat and inactive, the menstrual evacuation continues regular for some time ; but at last diminishes, and becomes obstructed, or goes to the opposite extreme, and be- comes frequent or profuse. The patient is either barren or subject to false conceptions and abortion. This state is to be rectified by spare or vegetable diet, total abstinence from malt liquor, regular and constant exercise, especially early in the mornings and on horseback, the prudent use of laxatives, and after some time the cold bath. These means will, if persisted in prudently, effect the desired changes; but if pushed to an undue degree, and especially if re- peated purgatives, and much vinegar, or great abstinence be resorted to, the health may be completely ruined. MANAGEMENT OF FEMALE COMPLAINTS. 465 The second state is that of relaxation, the habit is spare, instead of corpulent; the mind is lively, and, perhaps, even irritable; the menstrual evacuation either profuse, or it recurs too frequently, and at times clots and shreds are discharged. This requires a different treatment; the diet, if not unusually nutritive, is at least not to be sparing, the exercise must not be car- ried the length of fatigue, the cold bath is useful, and strengthening medicines are required. Such remedies as have been pointed out for the removal of irre- gularities of the menstrual evacuations, or of fluor albus, must be employed when necessary. By persisting carefully in a proper plan, sterility may at length be frequently removed. There are many instances of women bearing children, after having been several years barren. This doubtless often—indeed very generally arises from defective menstruation. We can point to several instances of ladies in whom, great im- provement in this respect took place and impregnation was the con- sequence. Perhaps nothing would prove of more service than that renovation of the constitution which usually follows the sickness produced by a sea-voyage, and a short residence in a different cli- mate. At any rate we can point to several cases where this seemed to have been attended with the desired effect. Sterility may arise from leucorrhcea, and here those remedies should be resorted to which yield the most success in these chronic discharges, such as cutaneous revulsions—baths—douches—dry fric- tions over the body, added to the use of woollen or flannel shirts. Blisters and issues about the lumbar region have been beneficial. Amenorrhoea and menorrhagia are also causes of sterility. The treatment must be varied according to the numerous causes which produce them. 59 MANAGEMENT AND DISEASES OE CHILDREN. After the child is born, the first thing to be done, if it be lively, is to separate it from the mother. But, if it do not cry or manifest signs of life, this is to be done with greater hesitation. Children do not breathe in the womb, but have that function compensated for, by the circulation of the blood, through the after-birth, by means of the navel-string. Now, if after being born, the child do not breathe, gasp, or ciy, then, after ascertaining that the face and mouth are not covered with the membranes, and that the naval-string is not in- circled round the throat so as to prevent breathing, the next thing for consideration is, whether it is still deriving any assistance from the after-birth; for if so, removing the child would be a fatal step. This we know, by taking the navel-string between the fingers and thumbs; if a beating or pulsation be felt, the circulation is going on, and, as long as that continues, the cord ought not to be tied. There may be exceptions to this general rule; but of these exceptions, nurses and attendants cannot judge, and, therefore, to them, the rule is ab- solute. The child is to be kept warm below the clothes, except the face, and is to be rubbed with the hand, particularly over the breast. If it begin to breathe soon, and give* one or two convulsive struggles, there is seldom any risk; it will speedily cry aloud, and may then be separated. But, if it do not breathe, and the pulsations in the cord stop, then, after this, no good can accrue from letting the child remain in that situation; the cord is to be tied and cut; or, if the pulsation stop immediately after the birth of the child, it is not to be continued connected to the mother. In either case, whether there never was pulsation discernible, or whether there was at first pulsa- tion, but that have now ceased, the child is to be immediately re- moved, and measures used for restoring animation, unless there be evidence from the putrid appearance of the child, or cord, that it has been long dead. MANAGEMENT OF CHILDREN. 467 Still-Born.—Children may be still-born, in consequence of va- rious causes, such as pressure on the navel-string, during labour, so as to obstruct the circulation; long continued labour after the waters are drained off; or from remaining long with the head pressed in the bones of the mother; besides other causes connected with the state of the child itself, inducing actual death before delivery, or unfitting it for breathing after birth. The occasional recovery of still-born children under circumstances where experience alone could have encouraged such hopes, ought to teach practitioners of midwifery the importance of employing, with patience and attention, the means conducive to this purpose. These means consist chiefly in preserving the heat, and endea- vouring to produce respirations. The first is done by immersing the child up to the neck in lukewarm water, or covering it with warm flannel until that can be procured. The second is effected by such means as tend to rouse the system in general, such as friction with spirits over the body, the application of some stimulant to the face, such as touching the temples, nostrils, and lips, with a feather dipped in vitriolic ether, or spirits of hartshorn, slapping the buttock and soles of the feet, with the palm of the hand, and giving an in- jection consisting of a tea-spoonful of spirits with two or three table- spoonsful of warm water, or a little salt and water, but chiefly by endeavouring directly to excite the functions of respiration, by infla- ting the lungs with air. This is done by means of a bag of elastic gum, or a common syringe, the pipe of which is to be inserted into one nostril, while the other and the mouth are carefully closed; and are then, by gentle pressure on the breast, to be emptied. In this way the lungs are to be alternately distended and compressed for some time. Should the process of breathing commence after these means have been used for a few minutes, nothing else is to be done than keeping the infant warm, with its face freely exposed to the air. Fortunately the above means for recovering still-born infants are seldom required, and the child, in a few seconds after birth, cries and breathes freely. Navel Cord.—In general there is more impatience shown by the attendants than is prudent, in respect to tying the navel-string. In order to tie the cord as it ought to be, two ligatures will be neces- sary, which should be formed of such a number of threads, knotted together at each end, that in tying firmly with them, there may be no danger of dividing the navel-string. And as soon as the circula- tion in the umbilical cord is stopped, one of them is to be applied about three or four fingers' breadth from the navel, and the other about two inches from the first, on that side next the placenta, and then divide the cord between them. On separating the child from the parent, the first thing to be done, is cautiously to wash off the white crust which covers the skin by means of a little soap and lukewarm water. The child being 1 468 management of children. cleansed, a small bit of soft rag is next wrapt round the navel-string, and a band is wound lightly round the belly. After this the child is to be dressed suitably to the season. The portion of cord which is left next the belly, drops off within five or six days after birth, and leaves a tenderness that is generally entirely removed in two or three weeks, by the ordinary means which nurses employ. A split raisin applied every morning under- neath the singed rag, accelerates greatly this process.—When a complete separation of the cord does not take place in a week, it is usually found to hang only by a very small filament or thread, which should be divided. Clothing.—Midwifery was first practised by women. Hence the dressing of children became an art which few could attain. Each midwife strove to outdo all others in this pretended knowledge. These attempts were seconded by the vanity of parents, who, too often desirous of making a show of the infant as soon as it was born, were ambitious to have as much finery heaped upon it as possible. Thus it came to be thought as necessary for a midwife to excel in bracing and dressing an infant, as for a surgeon to be expert in ap- plying bandages to a broken limb ; and the poor child, as soon as it came into the world, had as many rollers and wrappers applied to the throat and body, as if every bone had been fractured in the birth; and these often so tight, as not only to gall and wound its tender frame, but even to obstruct the motion of the organs necssary for life. The clothing of infants should be light and simple, and made to tie with tape, as pins are dangerous. Almost every child cries on being dressed, and, therefore, it is desirable to have the dress constructed in such a manner, that it may be easily and readily applied. If it be wished to have them strong upon their limbs, and active, early in life, as by nature they are intended to be, they should have the perfect freedom of their limbs, and their bodies easy, from the first day of their birth.—Their clothes should, therefore, be reasonably loose upon them, and not too great in quantity, although properly proportioned to the nature and variableness of the weather. The quantity of an infant's bed covering should also be appropri- ate to the season of the year. The night-clothes must not be equal in quantity to those which are worn during the day; otherwise a great tendency to be affected with colds, &c, may be induced. For the same reason, when the infant sleeps in his day-clothes, he should be very slightly covered. Infants sleep much at first, and ought not to be disturbed; in this respect, they may be left to their own propensity, and as they grow older, they sleep less. The only point to be attended to, when they become so old as to have the sleep regulated, is to prevent their sleeping so much through the day, as would make them restless at night. MANAGEMENT OF CHILDREN. 469 Purging.—The practice of giving infants, as soon as born, butter and sugar, mixed, salt and water, or purging medicines, has often proved detrimental by promoting acidity in the bowels. If the in- fant, after being completely dressed, be apparently quite easy, it should be laid down to sleep, without taking any thing; and after a few hours it may be applied to the mother's breast, whose milk, at that period being laxative, answers the purpose of cleansing better than all the drugs in the apothecary's shop; and by putting the child early to the breast, especially the first time of suckling, the nipple will be formed, and the milk gradually brought on. Hence much pain, and its consequences, will be prevented. To teach the child how to suck, a little milk and water, sweetened with white sugar, may be given at the end of a tea-spoon, which the innocent will clasp in its mouth ; or a finger wetted with it may be frequently put between the gums. In cases where the infant appears to be loaded with phlegm, a little well made plain grit gruel should be given immediately, and when this or its natural food, the milk, is not found sufficient to ex- pel the meconium, or first black stools, a solution of manna, or a tea-spoonful of good castor oil, may with propriety be given. Nutriton.—It is too much the practice to give children food or drink before putting them to the breast, on the principle of support- ing them until the milk come.—Infants do not suffer so much from want of nourishment immediately after birth, as they do when de- prived of the breast for the same number of hours, after they have once sucked. The young of no other animal requires to be fed be- fore sucking the mother; and if infants be applied early to the breast, they will not require it either. No food is so proper for the child, as the mother's milk; and where she has plenty, and the milk agrees with the infant, it ought to constitute the sole support for several weeks. " Doubt ye the laws by nature's God ordained 1 Or that the callow young should be sustained Upon the parent breast? Be those your schools Where nature triumphs and where instinct rules." After the second or third month, it may then be proper to give the child once or twice a-day, a little of some other food. This will ease the mother, will accustom the child by degrees to take food, and will render weaning both less difficult, and less dangerous. Nature abhors all sudden transitions. For this purpose the food of children ought not only to be simple, but to resemble, nearly as possible, the properties of milk. Indeed, milk should make a principal part of dieir food, not only before they are weaned, but for a long time after. Infants generally suck greedily, and, if allowed, would gorge themselves, and injure their stomach. The mother, therefore, ought not to become the slave of the child, and, especially, ought not to allow it to sleep at the breast.—Children may early be taught to suck ^ 470 MANAGEMENT OF CHILDREN. at regular intervals, and never should be indulged as often through the night as through the day; which breaks the mother's rest, is apt to hurt her health, and generally injures her as a nurse. One suck late at night, and another early in the morning, will be quite sufficient. It has been improperly imagined, that all mothers ought to be nurses. By this opinion many children have been destroyed, and a greater number have only lived to regret their existence; the weak- ness of their frames having made them strangers to the comforts of good health. Whenever the parent is injured by giving suck, or the child is stinted in nourishment, or hurt by the quality of the milk, it becomes a positive duty to procure a healthy nurse. " Think not that I would bid your softness share Undue fatigue, and every grosser care; Another's toils may here supply your own, But be the task of nurture yours alone." When the infant cannot obtain the milk of the mother, or that of a healthy woman who laid in about the same time, the best food, for several weeks, at least, is new milk alone, or mixed with an equal quantity of arrow root, or well boiled grit or barley gruel, with the addition of a little sugar. As the child advances in age, and its strength increases, weak broths, with a little barley, rice, or hard biscuit, boiled in them, may be allowed. It is soon enough to allow children anim,al food, when they have got teeth to tear it. Bread may be given to a child as soon as it shows an inclination to chew. The very chewing of bread will promote the cutting of the teeth, and the discharge of saliva. Children discover an early inclination to chew whatever is put into their hands. Parents ob- serve the inclination, but know not how to apply the remedy. In- stead of giving to the child something which may at once exercise its gums and afford it nourishment, they commonly put into its hands a piece of hard metal, or impenetrable coral. A crust of bread, or a hard biscuit not only answers the purpose better than any thing else, but has the additional properties of nourishing the child, and carrying the saliva down the stomach, which is a great promoter of digestion. In feeding children considerable judgment is necessary to propor- tion the quantity of food to their age and strength. Weakly chil- dren will always require less food than those who are stronger, for they are less able to digest it. They are frequently attacked with alarming and even fatal convulsions, from their bowels being over- loaded. Under all circumstances, if the food is too thick, or given in too great a quantity, the perfect digestion of it is prevented. It is not necessary to feed a child oftener than five or six times in twenty-four hours, and the less it is fed in the night the better. It is almost ridiculous error to suppose that whenever a child cries it MANAGEMENT OF CHILDREN. 471 wants victuals, and thus be constantly feeding it both day and night. If the child's wants and motions be judiciously attended to, it will be found that it seldom cries, but from pain; and if it be properly nursed, and quite easy in its dress, it will rarely ciy at all. Nurses should be particularly cautioned not to lay a child on its back when fed. In the posture of sitting, it swallows its food more easily, and more readily feels when it has enough. Cleanliness.—The most scrupulous attention to cleanliness, during the whole period of childhood, cannot be too strongly incul- cated. For the first week or two the infant should be bathed, morn- ing and evening, in tepid water, and afterwards in cold water. The whole body ought to be washed in the morning, and the lower half at night. In washing with cold water it is proper to begin with the head, and to finish as expeditiously as possible. The infant should be afterwards well dried, particularly at the bendings of all the extremities, and the whole body and limbs should be gently rubbed with dry soft linen or flannel, until a glow of warmth appears upon the skin. It is the manner of washing a child that secures it from suffering from the application of cold water. The more delicate and weakly an infant is born, the more will cold water strengthen it, if well applied; and, besides its bracing quali- ties, it will, by cleanliness, prevent excoriations, and keep off that troublesome complaint termed the scald head. When the application of cold water has been omitted for some days, it will be better to begin with the addition of a little salt or some brandy to the water; lessening the quantity of it gradually, so as to leave it off entirely in a few days. When children are a few months old, cold bathing may be sub- stituted in the room of washing with cold water; and it may be pro- per to add some directions, respecting the mode of dipping a child in cold water. Of these, the principal is, carefully to watch for that moment when it has taken in a full breath, and then to plunge it into the water, and take it out instantly, so that no part of the ac- tion of respiration may be necessary during the time of submersion. The child will then breathe freely on being taken out of the water, and suffer little or none of that agitation which often defeats the intention of the practice, and produces a terror when it is to be repeated. Children should have their linen and clothes frequently shifted. How often do we meet with little infants, merely from sloth or igno- rance, wearing the same dress for days, and rendered disgusting both to sight and smell. Scarcely any other care or advantage can pre- vent the child from suffering when cleanliness is neglected. Attention should be paid to keep the child dry, and the clothes ought to be immediately removed when soiled or wet; the child should also be wiped with a soft sponge, dipped in water. It is won- 472 MANAGEMENT OF CHILDREN. derful how early an infant may be taught to void the urine and stools at proper intervals into a pot. Air, Exercise, and Sleep.—If grown persons, who have been many years accustomed to impure air, often feel themselves sick in a crowded room, it must be very evident, that a much less degree of bad air will affect infants, whose lungs are weak and irritable. The temperature in which children are kept should be so regula- ted as never to be below that which is agreeable to an adult. By sudden exposure to cold air, the infant is apt to have cough, or stuffing of the nostrils produced; on the other hand, warm apart- ments, and especially a neglect of a circulation of air, hurts the health, and makes him liable to fits. On the proper exercise of infants, more depends than the superfi- cial observers could imagine; for, by inattention to this circumstance, a foundation is often laid for diseases, which, though their first ap- proaches be slow and gradual, terminate suddenly in a fatal manner. It is, therefore, of great importance, both to the population of the country, as well as the health of the inhabitants, that parents should attentively consider, that the more children are exposed to the open air, within prudent bounds, the less they are subject to take cold. By exercise in the fresh air, wTeakly and delicate infants will, Acquire a vigour and elastic spring To which they were not born.—Armstrong. For a week or two the mere washing and dressing of children, and the motion which they from time to time make with their arms and legs, is productive of sufficient exertion. By degrees, they may be tossed or dandled a little, and ought to be occasionally placed on a bed to allow them to kick, and move their arms freely. When they are able for it, they should be encouraged to creep on the car- pet, and even when two or three months old, the feeble and unavail- ing attempts they make to move or to raise themselves are useful. The age at which infants may be taken out, depends much on the season. In warm weather they may be carried out when a fortnight or three weeks old, but in winter they must be older. At first they ought only to be kept without doors for a very short time; and the person who has charge of them should walk slowly and gently, and avoid standing, especially in a current of air. By degrees they may be sent abroad twice a-day, when the weather is favourable, and may be kept out gradually for a longer space of time. Infants sleep much at first, and ought not to be disturbed. In this respect, they may be left to their own propensity, and as they grow older they sleep less. The only point to be attended to, when they become so old as to have the sleep regulated, is to prevent their sleeping so much through the day, as would make them restless at night. MANAGEMENT OF CHILDREN. 473 A crib is the proper bed for a child. Cradles are hurtful, as the rocking is often carried to a dangerous degree, and, besides, they are so confined, and generally so closely covered, that the child breathes an impure air. Nature never intended that infants should have exercise during sleep after they have breathed; therefore, the idea, that rocking in a cradle resembles the motion to which infants have been accus- tomed when in the womb, is an erroneous one. The young of other animated beings sleep quietly and profoundly for a great part of their time without any rocking, although they also were habituated to a gentle waving motion before birth. Every restriction to one particular position, in whatever situation the infant may be, ought to be constantly guarded against; for as the softness of the bones renders them easily moulded into an im- proper shape, deformities, which may destroy the health, or prove the source of much future distress, will, if this caution be not ob- served, be readily induced. An infant should not, therefore, be laid always on the same side, nor carried constantly on the same arm. Weaning—Forms an important era in the life of an infant, as on the proper regulation of this great revolution in his mode of living, his future health often depends. The time at which a child should be weaned, depends much on his health, and on circumstances connected with the nurse. A deli- cate child requires to be nursed longer than one who is stout: and where there is reason to suspect a tendency to particular complaints, connected with weakness of constitution, or where children suffer from teething, or former children have suffered from weaning, it will be right to continue the nursing for near a twelvemonth. But when the child is vigorous, he may be weaned at nine months, or even earlier, if any particular circumstance require it. Since there's no help, come let us kiss and part, Nay, I have done, you get no more from me, And I am glad, yea, glad with all my heart, That thus so clearly I myself can free.—Drayton. This is, perhaps, one of the severest trials a mother is called to endure, when compelled to relinquish the sweet office of nurse to her babe. What sensation can equal the rapture of the moment! When the fond mother, bending o'er his charms, Clasps the fair nursling in delighted arms; Throws the thin kerchief from her neck of snow, And half unveils the pearly orbs below ; With sparkling eyes the blameless plunderer owns Her soft endearments and endearing tones, Seeks the salubrious fount with opening lips, Spreads his inquiring hands, and smiles and sips.—Darwin. 59 474 MANAGEMENT OF CHILDREN. Many errors are daily committed in the method of weaning. Some women deprive the infant of the breast at once ; and others, by the application of mustard or any nauseous substance, to the nip- ples, endeavour to make him desert the breast of his own accord. Both practices are equally cruel and improper. In all cases, the change ought to be made gradually, the child receiving more food, such as arrow root, biscuit, jellies, beef-tea, &c, and less milk for some time previously to weaning. It will also be of advantage to accustom him for a few weeks to have no suck early in the morning; nothing from bed-time till an early breakfast. Many give drink through the night, which is merely a bad practice. By giving food three, or even four times daily, and lessening the quantity of milk gradually, as the other diet is increased, children very seldom suffer from weaning. The great cause of injury is the change of diet, which produces disorders of the stomach and bowels, and this, it is evident, cannot be so effectually prevented by any method as making the change gradually. The practice of giving a child toddy, or laudanum, &c, to make it sleep, when it is weaned, is very hurtful, as these injure the sto- mach and bowels. The infant should be accustomed, when weaned, to receive food or drink at stated periods, and not according to the caprice of nurses. Although this task will at first be somewhat difficult, it can always be accomplished by perseverance : and the benefits which the infant itself, and its attendants derive from this circumstance, will more than compensate for the trouble attending the attempt. As little drink or food ought to be given during the night as possible ; for a bad habit may be induced, which may lay the foundation for many future complaints. Nursing.—Much of the present comfort and future health of a child depends upon the nursery maid. ' What careless dread a mother's breast alarms, Whilst her loved offspring fills another's arms, Fearful of ill, she starts at every noise, And hears, or thinks she hears, her children's cries." Among the qualifications required in a nurse, the following may be enumerated :—Cleanliness in her person, with a cheerful obliging temper ; patience, and a method in all her arrangements ; attention to regulate the temperature of the nursery, so as to avoid either cold or excessive heat, and to have the clothes always dry and clean; prudence in the diet of the child, and perfect obedience to rules and orders. As children can be early educated to evil and mischief, it will not be denied, that, with equal attention, they may be trained to good. And since they are, in some measure, under the control of the nur- sery maid, it behooves parents to be watchful, and not to trust their offspring in the hands of one not endowed with good qualities. MANAGEMENT OF CHILDREN. 475 " Once exiled from your breast, and doomed to bring His daily nurture from a stranger spring; Ah ! who can tell the dangers that await Your infant, thus abandoned to its fate V Indeed, there is no doubt much of the misery, and many of the crimes of human life, have their foundation laid in the nursery; and could some of those who have suffered most for their misconduct know all the steps which led to it, they would regret that the seeds of ungovernable passion, of selfishness, and other vices, had been planted before they could discern their right hand from their left. It is greatly in the power of a nurse to regulate the disposition of a child, as well as to promote its health, by carefully avoiding those causes which may have the least tendency to render it fretful and peevish, and by removing, as far as possible, every distress on its first appearance. A child does not cry unless uneasy from hunger, want of sleep, pain, or some inconvenience. Bodily uneasiness will, with any child, affect the mind, rendering it peevish and irritable, and pre- sently, causes which may be called mental, will do the same. For a child is not merely an animal machine, it has also a mind capable, very early, of feeling various passions. As soon as children begin to notice, and to be attracted by sounds and objects, the nurse ought to sing in a cheerful and lively strain. And we should present, and take away, in a cheerful and amusing manner, objects which attract the eye, by which the child is early taught to receive, and readily part with, what it desires. Now, when his little hands from bondage free, Restless expand in new-born liberty, You teach the child, with reprehension light, In preference to the left to use the right. The practice of servants scolding children in jest, and teaching them to scold in return, encouraging them to scratch, and revenge real or pretended injuries, and to take vengeance on chairs and stones, is productive of incalculable mischief. And we not unfrequently find great pains are taken by the nurse to inspire the child with terror at the doctor, and at medicine, the effects of which are best seen when the child becomes sick. We will farther observe, it is through a most criminal inattention to children in the nursery, a foundation is sometimes laid in their tender minds for those superstitious terrors, from which not all their efforts in subsequent life can entirely relieve them. I allude to those dismal stories about witches, spirits, hobgoblins, raw head and bloody bones, wherewith silly nurses, especially poor blacks, are so fond of frightening infants. Considering the importance of deep impressions made during those tender years, parents cannot too strictly forbid every thing of this sort; neither can they ever exceed, in their generous labours, to illuminate the minds of their children 476 MANAGEMENT OF CHILDREN. with lofty ideas of their Creator, and that mighty power which he will never fail to exert in their favour, if they will but be good. Caution to Parents.—Independently of the means we have pointed out to ensure the health of children, and preserve the human species, we must have an equal regard to the dispositions of children. We consider the health of the mind of even greater importance than the health of the body, and indeed they are very intimately con- nected ; for wrhat mother can vouch for the health of her babe a single day, if she have not command enough over herself and it to control its appetites, wants, and desires; on the due regulation of which not only its happiness, but its health, must depend. It is to be recollected, that a child has a mind endowed with gra- dually unfolding powers and passions ; that when it begins to notice and desire, it becomes an object of education and training; and this is the time to acquire that ascendency over your children's minds which, if properly employed, will ensure you a due degree of influ- ence over them through life. Every discreet mother, deeply im- pressed with the importance of the trust committed to her, will begin by gentle admonition, softened by maternal endearments, to check the first indications of obstinacy and ill temper in her child; for, like small weeds springing up in a luxuriant soil, they may, with care, be easily eradicated ; but if permitted, by neglect, to take root, they will soon overshadow the choicest virtues, or choke them while yet in embryo. And, should life's olive branches rise To bless your fond parental eyes ; She who, with all a mother's care, The nursling plants can fondly rear; Th' excrescent shoots with firmness prune, Each noxious weed with care consume, Till nurtur'd by her fostering hand, The rising plants grow and expand, Bud, blossom, bear—While each survives The ripened fruits of virtuous lives.—Polyanthus. As soon as children can comprehend language, they may be taught obedience, and their inordinate desires should be regulated in such a manner as to prevent their becoming so totally unmanageable, as is too often the case. For instance, should an infant of eight months take a fancy to its mother's watch, as it would be a very improper plaything, it should receive a gentle, but firm, denial. It would, probably, grieve. Something else should be offered it; and if it take it, and be pleased, all will be well. Often as it reverts to the watch, the denial must be repeated, and it will soon relinquish (he expectation, and be perfectly happy with other toys, and so in every thing else. On the other hand, should it show resentment when the watch is denied, and refuse all other playthings that may be offered, instead of weakly yielding to the storm, and, with mistaken tender- ness, giving up the watch, or with anxious care concealing it from MANAGEMENT OF CHILDREN. 477 its sight, still greater resolution must be observed, tempered with ten- derness and moderation, as the object must be to correct the disposi- tion. On no account permit it to have the watch, and as often as it inclines to dispute the point, let it perceive you are determined. After a few lessons of this kind, your word will no longer be disputed , while your children, thus early taught submission, will never require any severity whatever. But then our government must be uniform, to produce this happy effect. It will not do, because we chance to feel out of humour, or it should militate against our own gratifica- tions, to deny an infant an indulgence to-day, which, in a paroxysm of maternal fondness, we may grant it to-morrow. Be assured, children will very soon learn to take advantage of such capricious conduct; and when once they discover that we are irresolute in our commands, or may be overcome by resolution and importunity on their part, they will not fail to profit by the discovery; and that by such imperceptible degrees, that many a fond mother finds her au- thority gone, and her jurisdiction contemned, before she is aware that she has, by her imbecility, forfeited the one, or alienated the other. Nor is this evil confined to infancy. She will feel the me- lancholy effects of failing to substantiate her claim to obedience from her children during the docile period of childhood, to the latest evening of her life. " How sharper than a serpent's tooth it is To have a thankless child." It is absurd to pretend that a child is inferior to a puppy, and yet a puppy may be early rendered docile and gentle, or sulky and ill- natured, according as it is educated. To tease and contradict infants and children is not the way to improve the disposition, or to teach patience; but it is not imprac- ticable to treat them in such a way as to prevent their crying, if they do not immediately obtain, or should be deprived of, what they desire, whether that be the breast or a shining toy. This is to be accomplished, not by stubborn harshness, always hurtful to a child, and indicating a savage disposition in those who use it, but by prudence. Does any child, at least any one not under the guidance of an absolute fool, ever make a practice of crying, because it is prevented from grasping the flame of a candle? No, surely; and why?— because the mother or nurse will never yield to this; and very soon the child beholds the candle without a wish to do more than look at it—yet, the very same child will cry itself asleep, or almost into fits, if prevented from scattering the sugar out of the sugar basin. Some children, we know, are cheerful, good-humoured, lively, and little disposed to be petted or fretful, when denied what they wish. Others, equally healthy, are perpetually crying, passionate, and cross, if they do not instantly obtain what they desire. Peevish- ness and crying cannot, when the child is sickly and uneasy, at all 1 478 DISEASES OF CHILDREN. times be prevented; but when these propensities exist in health, there is no question that the fault lies with the parents. It ought, therefore, to be remembered, that on the treatment the child receives from its parents during this stage, will, perhaps, depend much of its misery or happiness, not only in its passage through this, but through the other stages of existence. If, on the one hand, every little sally of passion and impatience be immediately controlled ; if that which is admissible be regularly permitted, and that which is improper as regularly withheld, the little creature will soon learn to distinguish that which is allowed from that which is prohibited. It will, indeed, urge its claim for that which it has been taught it has a right to; but will not harass itself and its attendants with ceaseless whinings, or raving to obtain that which uniform prohibition has placed beyond expectance. But a melancholy reverse appears, if, on the one hand, no consis- tency be observed in its management; if at one time the slightest indulgence be refused, and at another the most extravagant, and even injurious cravings be gratified; the child becomes more and more fretful, till at length it manifests such ill-nature, as to render it odious to all around, and sooner or later the poor little sufferer pays with its life the purchase of its early indulgences. DISEASES OF CHILDREN, REQUIRING EXTERNAL TREATMENT. In considering the disease of children, we shall begin with those to which the new-born infant is liable from circumstances incidental to its birth, or mismanagement soon after it, which require, princi- pally, external treatment; and then shall take notice of original imperfections. Sickness, the minister of death, doth lay So strong a siege against our brittle clay, As while it doth our weak forts singly win, It hopes at length to take all mankind in: First, it begins upon the womb to wait, And doth the unborn child there uncreate, Then rocks the cradle where the infant lies, Where, ere it fully be alive, it dies.—Carkw. INJURIES IN CONSEQUENCE OF BIRTH. When the infant has been detained a long time in the passage, the several parts subjected to pressure are liable to be injured. DISEASES OF CHILDREN. 479 Swelling of the Head.—The most common of these injuries are swellings on the head, or alteration of the shape of that part. First born children are generally affected with some degree of swell- ing on the crown of the head. The edges of this swelling are hard, and the middle soft, so that an experienced person would suppose that the bones of the head were deficient at that part. It will com- monly subside in a short time. But when a tumour remains on any part of the head, a cloth dipped in equal parts of spirits and vinegar, and applied two or three times a-day, will soon disperse it. The practice among nurses, therefore, of endeavouring to give the head a proper shape by squeezing and pressing it with the hands, &c, is unnecessary, and ought never to be allowed, on account of the dangers which may be the consequence. Scratches or Marks on the head require no particular atten- tion, as they soon disappear. Injuries of the Face.—In some cases, where the infant has come down in an unusual direction, the face is much affected: the eyes being inflamed, the nose flattened, the lips swelled, the features distorted, and the colour of the countenance livid. These frightful appearances usually go off in a few days, when no violence has been done by improper interference during the delivery. Swelling of the Breasts.—The breasts of children sometimes swell and inflame, especially if attempts be made to press out forci- bly a milky fluid, which they often contain. If the pressure of the clothes be avoided by their being put on loosely, it will generally go off without any application. However, it is sometimes necessary to rub the part gently with warm olive oil; and in cases of such in- flammation, equal parts of spirits and vinegar must be applied cold, by means of soft linen, or poultices of the crumbs of bread, and lead water or milk, should be employed for its resolution. If, from mis- management, they should, suppurate, a warm milk and bread poul- tice, is to be frequently applied, and when the tumour bursts, the part is to be dressed with simple ointment. Swelling of the Scrotum.—The Scrotum will also be re- markably tumid, and even discoloured, particularly when a child has been born by the breech presentation. In this case it will be proper to suspend it by a cloth, after first covering it with a piece of linen, wetted with brandy, which should be frequently renewed. Injuries of the Limbs.—The limbs are in some cases fractured or dislocated, by the rashness and awkwardness of the practitioner. These accidents, on some rare occasions, unavoidably happen from the situation of the infant; but are most frequently to be attributed to ill-directed attempts to accomplish the delivery. From whatever cause these disagreeable occurrences originate, they should never be concealed from the attendants; but, on the contrary, the proper means to remedy them should be immediately adopted. Management of the Navel.—From neglect, or from a bad 480 diseases of children. constitution of the child, the navel sometimes, after the cord drops off, becomes very tender and excoriated, giving a good deal of trou- ble. Great attention is to be paid to cleanliness. It is to be bathed twice or thrice a-day with infusion of camomile flowers, and after- wards with a solution of ten grains of white vitriol in six ounces of rose water. A bit of singed rag is usually employed as the dressing, but when this sticks firmly, a little simple ointment may be used. If there should be more than usual tenderness, it may be proper also to sprinkle it with a little prepared chalk or starch. In some instances there is a discharge, and the part continues raw: then it will be proper to apply three or four pieces of soft cabbage leaf, laid one over another, that they may be preserved moist and cool, and continued as long as the discharge may continue considerable. The bleeding, which sometimes happens at the navel, is of such little consequence, that a light compress, with some gentle styptic, and secured by a sticking plaster or bandage, soon removes it. The sore- ness, when considerable, may require a milk and bread poultice, and the exhibition of some mild laxative medicine. Sore Eyes.—Children, within a few days after birth, in conse- quence of exposure to much light or a strong fire, or from other causes, some of them operating during delivery, have sometimes in- flammation of the eyes. The eyelids swell, and the inside, as well as the white of the eye, become red, and covered with a quantity of yellow purulent matter, which comes out at the corner of the eye, which hardening, tends to glue the lids together. In some cases the eyelids are a little swelled: in others their insides are turned out, es- pecially when the infant cries. If this be neglected, specks may form on the eye, or the disease may be communicated to the eyeball, and suppuration take place within, destroying vision for ever. The cure consists in guarding against exposure to large fires, much light, or cold; and in bathing the eyes, morning and evening, with a little warm milk and water, and twice or thrice through the day with a very weak solution of sugar of lead, or of white vitriol. When the inflammation is considerable, a blister to the nape of the neck, and the occasional use of a grain of calomel at bed-time, or the cathartic mixture (see Dispensatory]) in doses of a tea- spoonful every hour or two, to keep the bowels in a laxative state, are proper. Should the eyelids stick together, the edges should occasionally be anointed with simple cerate, or a little mercurial ointment, and a drop of the vinous tincture of opium, or equal parts of laudanum and water, applied with a camel's hair pencil into the eye four or five times a-day. Excoriations.—From the delicate texture of the skin of infants, excoriations readily take place whenever one part of it is in constant contact with another, unless the most careful attention be paid to keep every part dry. The inflammation termed galling, which so frequently occurs in DISEASES OF CHILDREN. 4S1 the groin, between the legs, and on the neck of an infant, evidently arises from inattention to cleanliness, and from the use of coarse or new pilches.* The cure will be easily effected by washing the parts often in cold water, and, after being wiped dry, dusting them with prepared chalk or starch. But if they have been neglected, and become fretted, they require to be washed frequently, with a solution of ten grains of white vitriol, in five ounces of rose-water. If the excoria- tions are situated about the genitals, it may also be proper to apply a thick mucilage of gum Arabic, or to cover the part with a little fresh saturnine or simple cerate, to defend it from the action of the urine. Slight ulcerations, behind the ears of infants, are also very com- mon, and only require to be washed daily with cold water, and co- vered with a single rag to keep the cap from sticking to them. They are sometimes beneficial, especially during bowel complaints, or teething, and will get well and break out again into very foul sores, several times, without any cause for alarm. However, when these sores become extensive and painful, it will be proper to apply a blister to the nape of the neck, to draw off the heated serum, and to give now and then a few grains of magnesia, and rhubarb, or the absorbent and aperient mixture. (See Dispen- satory.) The sores should also be well washed with Castile soap * and water, and dressed with an ointment composed of one drachm of calomel and one ounce of simple cerate, mixed well together, and spread on each side of a double linen cloth, which must be applied twice a-day. ORIGINAL IMPERFECTIONS. Infants are not always born in a state of perfection with respect to the structure of their bodies; for, sometimes they have deficient, su- perfluous, or misplaced parts. Many of these imperfections admit of no remedy, while others may be easily rectified. Flesh Mark.—The most frequent of these imperfections is the flesh mark, or redness on the skin, resembling a stain with a bram- ble. This may occur on any part—the face, the body, or the fin- gers. It has been attributed to the effect of the mother's imagina- tion, or to a fright, but without any sufficient cause. It is met with * If children were attentively held over a pan for a month or two, it would be found that they are more cleanly than people suppose, and would super- cede altogether the use of cloths, either by night or day. 60 482 DISEASES OF CHILDREN. when no such circumstance has occurred, and, on the other hand, it is wanting in those cases where, if this had the supposed effect, we would chiefly expect it. The mark may be more or less extensive, and of different shades of colour. It proceeds from the collection of a great many blood vessels, by which the structure of the part is altered. By pressure, the redness disappears, for the blood is forced out, but it immediately returns. When it becomes elevated and en- larged, then there is an evident pulsation in the part. It grows with more or less rapidity, and at last bursts, and discharges sometimes an alarming quantity of blood. Pressure applied early, when the mark is on such a part as to bear it, is frequently an effectual means of removing it, or at least of preventing all tendency to enlarge. The application of some stimu- lant or astringent to the part, if it be small, the cuticle being previ- ously removed by a mild blister, and also, occasionally employing pressure, will be found useful. IIare-Lip—Is so well known as to need no description. The treatment of the hare-lip must be varied according to many circum- stances, which can only be determined by an experienced surgeon. If the child can suck, the operation by which alone the blemish can be removed, should be deferred till he be several months old at least, as the parts will then be better adapted for retaining the pins •by which the cure is accomplished. But when sucking is prevented, the operation may be tried, though it affords only a forlorn hope. Tongue-Tied.—Infants are born with a thin membrane under their tongue, called the froenum, which is sometimes so broad as to require dividing, in order to give freedom to the tip, and to allow the child to take proper hold of the nipple in sucking. If the tongue is not bound down, and if the child suck the finger when put into the mouth, there is no reason for saying he is tongue- tied. The operation, where it is really necessary, is very trifling; but if incautiously performed, the artery below the tongue may be opened, and much blood lost. It is easily divided by a pair of sharp scissors, and the operation can never be attended with any inconvenience, or hemorrhage, if it be done with proper caution. Club-Foot.—The gristly state of the bones of the foot renders a cure in most cases practicable, when the proper means are begun immediately after the birth; but if the deformity be not attended to till the infant be some months old, it will be difficult and precarious. The method by which this disease can be removed is very simple. It is merely the application of proper means to reduce the foot, in the most gradual manner, to its natural situation. These should not be continued only till this is effected, but ought to be kept applied constantly for several weeks after, in order that the deformity may be completely removed. In the most favourable cases, the cure cannot be completed within less than several months and it often requires even a much longer time. DISEASES OF CHILDREN. 483 Natural Passages.—Sometimes the natural passages, particu- larly the bowels, may be shut up, the nostrils or eyelids may be closed, or the fingers may adhere, or have fleshy attachments, like additional fingers. These cases admit of cure only by a surgical operation by which the natural passage is opened, and afterwards secured from closing again by the introduction of a bougie. The vagina of the female is so sometimes imperforated. Parents should, therefore, carefully examine the infant, that it may not grow up with a defect, which, at a certain period of life, must inevitably prove troublesome, and which, at last, will require an operation to relieve. Infants have sometimes a discharge from the vagina, a few days after birth; resembling matter; but it is of no consequence, as it goes off of itself in a short time. When a child does not make water, the use of a silver probe will ascertain whether there be any obstruction, and if there be not it promotes the discharge. Sometimes an infant will be very long, perhaps, a day or two, be- fore it voids the urine, where no defect or obstruction is to be seen. It will then be proper to rub the belly with some warm brandy mixed with a little oil. Some have recommended it to be rubbed with an onion. Which ever be used, it is advisable immediately af- terwards to apply to the belly a bladder half filled with scalded bran, or camomile flowers, or hot water; and lest by some accident it should burst, it would be proper to enclose it in a second bladder. A clyster of thin gruel, with a little oil, should be given ; and if ne- cessary, a tea-spoonful of castor oil may be swallowed. If the child is in considerable pain, a few drops of laudanum may with propriety be added to the clyster. Ruptures—Are very common complaints among infants ; but are fortunately not attended with so much danger as similar disorders in grown people. The kind, which is in general most immediately dangerous, is that which takes place at the navel, where a great part of the bowels may be forced out, covered only with a very thin and almost transparent skin. If this be so large, that the intestines can- not be pressed back, the child generally dies, in consequence of the tumour inflaming or going into mortification. But if the bowels can be pressed back, and, especially if the skin of the tumour be not very delicate, there is no risk. The application of a compress, and a suitable bandage round the belly, keeps the intestine in its place, and in the course of some time the aperture closes so far as to pre- vent the protrusion. A broad piece of flannel, in the form of a roller, together with a piece of adhesive plaster applied over the part, by affording a safe and firm support, prove extremely useful. When they happen in the groin, all that can be done, is to bathe the part occasionally with equal parts of brandy and vinegar, keep 484 DISEASES OF CHILDREN. the body open, use the cold-bath, and prevent the child from crying, as much as possible. A bandage cannot easily be applied with effect. to so young a patient, though it is still worth a careful trial. In proportion as the infant acquires strength, these troublesome com plaints disappear. And nothing is more conducive to this than the continued use of the cold-bath, and paying attention to the state of the belly, as costiveness always aggravates the disease. There will often appear in the scrotum of infants, at birth, a tur- gesence, which has been called the watery rupture. Of this it is proper that parents and nurses should be aware, that it may not be mistaken for the true rupture. From this it will be readily distin- guished by its being elastic,'as it cannot be made to disappear by- pressure, and by its not becoming larger when the infant cries. If it be placed between the eye and a lighted candle, at night, it will be seen to be transparent. It will generally be cured by compresses moistened with vinegar and water, with the addition of as much brandy as the skin is able to bear, or by the repeated application of cloths dipped in a solution of two drachms of sal ammoniac in eight ounces of water. But the best method is to puncture the bottom of the tumour with the point of a lancet, which is attended with very little pain, and soon effects a cure. Another little complaint like the watery rupture, is tumefaction of the prepuce, which also arises from extravasated water, and is a partial dropsy of the skin. The complaint will be removed in a few days, by washing the parts frequently with lead-water, or by apply- ing a poultice made with it and the crumbs of bread, and by keep- ing the bowels open. DISEASES OF CHILDREN, REQUIRING MEDICAL TREATMENT. Before we proceed to the consideration of those disorders requiring medical treatment, it may be proper to give a hint in regard to the doses of medicine. In prescribing for children, the chief difficulty lies in fixing the appropriate dose; and hence medicines more fre- quently fail with them, or are over-dosed, than with the adult. As a direction, therefore, it is proper to examine, in a general manner, the proportions fit for this early period of life. DISEASES OF CHILDREN. 485 Thus, seven years require half the dose of an adult. Three years . . .the fourth. One year ... the sixth. One month . . . the tenth. With these proportions in view, where no peculiarity of constitu- tion exists, the doses stated will generally succeed. SNUFFLES. This term is given to a disease, which generally affects children within the month, and most commonly in the first or second week, on account of the noise made in respiration. The discharge is much more abundant than that which attends common cold. It is from the first purulent and thick, and afterwards turns thin. Children afflicted with this malady are always of a weakly, un- healthy habit; and though having apparently no particular com- plaint, they seem incommoded from a stoppage of the head, which is particularly perceptible in sleep when their breathing is difficult. A purple streak is observable on the verge of the eyelids, as an at- tendant on this disorder, with a general fulness externally, about the throat and neck. Its duration extends to several weeks; and when it departs, it is usually succeeded by a disorder of the bowels and other complaints. This disease appears with various degrees of violence. The chief symptom that gives uneasiness here is the difficulty of breathing through the nose, which arises from an inflammation of the mem- brane that lines the posterior nostrils and throat. By this inflamma- tion extending, every part comes to be affected, even to the stomach and bowels; and hence the great and increasing debility it quickly occasions. The stools are thick and pasty, and of a peculiar green or blue colour. From this account of the disorder, the state? of the bowels is a cir- cumstance which must be more attended to, than in almost any other disease. To this end, one or two tea-spoons full of castor oil should be given every day, so as to procure four or five evacuations daily. The bark should be given in a decoction or clyster, joined with cor- dials, to support the strength of the child. The same remedies should be exhibited to the wet nurse. The acrimony of the discharge on the adjacent surfaces of the nose and throat, should be prevented by washing the parts frequently with warm camomile, or elder-flower tea, and afterwards applying a little sweet oil. Where convulsions are threatened, or occur, lauda- num is very proper, after the operation of laxative medicines; and 486 DISEASES OF CHILDREN. in many cases, the anodyne should be given two or three times a-day. In this disease, blisters are improper, as tending to produce gangrene of the part. CUTANEOUS AFFECTIONS. Infants are much subject to an eruption called the gum, which assumes a considerable variety in its appearance in different cases, and even in the same individual. Red Gum—Is the most common, and usually appears a short time after birth, and occasionally recurs till all the milk teeth are cut. The red gum of infancy, consists of a number of small, red, elevated spots. The top is clear, and the base is of a vivid red. This eruption is scattered over the trunk of the body, and sometimes on the cheek and forehead. On the feet the spots are still larger, more distinct, and sometimes a clear fluid is found at the top. When the redness round the base is considerable, the rash has at first sight an appearance of measles; but there is no fever, nor sneezing, nor watery eye, nor cough: on the contrary, the infant is in perfect health. In general, it is necessary only to keep the bowels open with the absorbent and aperient mixture, or magnesia, and to keep the child moderately warm; otherwise, the rash striking in, may fall upon the bowels and produce fever. Yellow Gum—Is merely a species of jaundice, but is, in gene ral, of very short duration. It affects most children in a greater or less degree, and usually appears within a week, or much earlier after birth. It proceeds from the absorption of bile, and is known by a yellow colour of the skin, or even of the eyes, and is preceded, and attended by sleepiness and carelessness about sucking. It is readily removed by the exhibition of three or four grains of ipecacuanha, or a few drops of antimonial wine, to excite vomiting, and by keeping the bowels open by the occasional use of calomel, the absorbent and aperient mixture (see Dispensatory]) or a watery infusion of rhubarb. Should the symptoms continue, the emetic ought to be repeated after two or three days, and one or other of the above aperients given every other day. White Gum—Appears after the period at which infants are sub- ject to the former variety; consisting of a number of white, hard, elevated spots, the base of which is sometimes, but not always, sur- rounded with a little redness. It resembles the itch, and is some- times mistaken for it: but it is not infectious, nor is it itchy, unless the child be kept dry, and the parts are irritated. It requires no particular treatment; merely cleanliness and attention to the bowels. In speaking of this eruption it may be proper to mention, that there DISEASES OF CHILDREN. 487 is also another, which still more resembles itch, though it generally is rather later appearing than the white gum. It consists of soft, smooth, shining elevations of the skin, forming small papulae, or eminences, differing little in colour from the neighbouring skin. They are itchy, and if the top be scratched off, a clear water oozes out; and if the scratching be frequently repeated, they become red and bloody, or covered with a dark little scab. By washing with soap and water, and rubbing the parts three times a-day with lemon juice, or a solution of borax and vinegar, the complaint may be re- moved ; but if this be neglected, it may become similar to the itch, and require the same remedies. Tooth Rash—Consists of very small red spots, or papulae, set so closely together, as to form patches from the size of a six cent piece to that of a dollar, especially on the extremities: whilst on the body the papulae are larger, more inflamed, and, at a distance, look like measles. This requires only a gentle laxative occasionally. Milk-Blotch—Is another cutaneous disease, which appears on lusty children, especially about the time of teething. It is a scabby eruption, which generally appears first on the cheeks, or forehead, and then spf%ads over the face. The pustules are red, and the top soon becomes covered with a scab, consisting of different layers. This often puts on a very unpleasant appearance, but it is neverthe- less of an innocent nature; and it has been observed that those children who have been much loaded with it, have usually been healthy, and have cut their teeth easily. A remarkable circumstance attending this eruption is, that however thick and long continued the scabs may be, the crusta lactea never excoriates, nor leaves any scar on the parts, unless improperly treated. The milk-blotch is itchy rather than painful. It generally pro- ceeds from too full diet, or a plethoric habit, and, therefore, requires not only to have the diet lowered, if the child be weaned, or the nurse fed upon less animal food, if on the breast, but also, to have occasionally a laxative. Local applications should be used with caution; but if the eruption be very itchy and troublesome, and do not yield to a change of diet and laxatives, it may be washed with lime-water, or the saturated solution of borax in vinegar three times a-day, or with a scruple of sal-ammoniac, dissolved in six ounces of rose or spring water. The anxiety parents and nurses often express to have those ugly appearances removed, has induced many practitioners to interfere unnecessarily and improperly. It should always be remembered, that such eruptions are critical and salutary; and, therefore, when from excessive itching it becomes necessary to apply to them any of the above washes, or a weak solution of sugar of lead, or, what is preferable, a weak solution of white vitriol, gentle laxatives are to be given. An eruption very similar to the above, frequently takes place during teething, and is a most obstinate and troublesome complaint, 488 DISEASES OF CHILDREN. rendering the infant extremely restless, from the heat, itching, and irritation which attend it. Besides the period of attack, there are other circumstances which distinguish this eruption from the former; namely: there being a redness of the skin round the edge of the incrustations; an ichorous or clear-coloured exudation, which con- cretes, issuing from the surface of the scabs; and the disease having a tendency to spread over every part of the face which is touched with that exudation. The ordinary unctuous applications generally aggravate this affec- tion. The best remedies, therefore, are brisk laxatives, as an infusion of senna and manna, rhubarb or salts, and cream of tartar, sometimes sulphur and a wash composed of linseed oil and lime-water, or of one part of the acetate of ammonia in four parts of spring water, or half an ounce of borax in a gill of sharp vinegar. With either of these, the scabs may be washed evening and morning. Copper-coloured Blotches.—Eruptions of this kind on the buttocks or soles of the feet, occurring from within a week to a fort- night after birth, indicate a diseased state of the infant's habit, which requires the most serious attention. If they be neglected, ulcerations of the palate, throat, and nostrils follow. Should the child be nursed by another than the mother, the nurse's nipples, armpits, and throat become affected. The only cure for this affection is mercury, which ought to be exhibited both to the nurse in such doses as will affect her milk, and also to the infant in doses adapted to its strength.—(See Venereal Disease.) Erysipelas or Rose—Is a very formidable disease with infants. It appears generally at an early period, commonly within a few days after birth. It most commonly first appears on the toes or fingers, which look swelled and bluish, as if from cold; but sometimes it begins at the belly, or about the shoulder or neck, or at the inside of one or both thighs, accompanied with fever. The part is of a purple or livid colour, and is to be distinguished from other affec- tions by the hardness and uniform increased thickening of the inflamed skin. The best practice at the outset, is to dust the part very frequently with fine flour or hair powder, and keep the bowels open with gentle doses of calomel and Epsom salts. If suppuration take place, the abscess ought to be early opened. (See St. Anthony's Fire.) Both infants and children are subject to other eruptions of the skin, than those we have enumerated, of which it is impossible to convey an accurate idea by mere description. But we will observe, as a general rule, that all eruptions, however different in forms and appearance, may be divided into two classes; namely : those of a temporary, and those of an indefinite duration. The former are commonly ushered in with symptoms of general indisposition; the latter break out gradually, without any derangement of the ordinary health. The former are owing to some disorder of the stomach or DISEASES of children. 489 bowels, or some interruption of the usual excretions or secretions. The latter are, probably, in most instances, the effects of some dis- eased condition or action of the lymphatic system, though sometimes they may be occasioned by a local affection of the skin itself. In all cases where symptoms of indisposition, such as heat, restlessness, sickness, or oppression, a few grains of ipecacuanha, or, what is pre- ferable, a dose of calomel that shall both vomit and purge, together with the warm bath, should the first prescribed, and afterwards occa- sional purgatives with absorbents, and a suitable regulation of the diet, are to be advised. But where the eruption is accompanied by fever, or marks of indisposition, some of the medicines termed altera- tives, as calomel in very small doses, antimonial wine, salts, sulphur, &c, are the remedies chiefly to be depended upon. In some cases, other topical applications, besides the warm bath, are required to allay the irritation, arising from the excessive heat, and itching of the skin. The most efficacious are, milk and water, decoction of bran, the saturated solution of borax in vinegar, weak solution of white vitriol or potash, the acetate of ammonia, much diluted, and equal parts of lime-water and oil. When the body is much covered with eruptions, and they remain long out, attention should be paid to their not being repelled sudden- ly by any exposure to cold, or by any other improper treatment; but should they happen to strike in, we may then have recourse to the tepid bath and light cordials, as wine whey, in order to solicit their return to the surface, which will be of the greatest consequence, should the child suffer from the repulsion. These cutaneous affections will be found owing either to some ill quality in the breast milk, a heating regimen, or errors in diet. It is only necessary to avoid the occasional causes, and the infant will not be troubled with them. THRUSH, OR SORE MOUTH, Is an eruption of white spots, resembling little pieces of coagulated milk, generally appearing within the mouth, on the lips and inside of the mouth, and sometimes affecting the whole alimentary canal. This disease is apt to affect the nipple, producing excoriation; whilst on the other hand, a sore nipple may produce thrush. In general, it proceeds from a disturbed state of the stomach and bowels, occasioned by giving too much spoon-meat. It may also be pro- duced by exposure to cold, damp weather, and some peculiar states of the atmosphere. In three or four days these spots grow yellow, and soon after drop 61 490 diseases of children. off, and gradually disappear, leaving the skin on which they have been seated of a bright red colour. It is usual for nurses to have im- mediate recourse to borax; but although this may clean the mouth, it does not remove the cause, and, if early employed, the spots will quickly reappear. In the treatment of this complaint, the most approved practice is to give a dose of rhubarb and magnesia first, which generally corrects the disordered state of the bowels; and for two days, or until the spots begin to change their colour, a tea-spoonful of cold water, or a liquor prepared by mixing with the white of one egg, three table- spoonsful of cold water, and a little white sugar, should he frequent- ly put into the mouth. When the spots become yellow, borax and honey, in the proportion of one drachm of the former, finely pow- dered, to an ounce of the latter, and well mixed together, will have an excellent effect in cleansing the mouth, and healing the ulcers, especially when the milk adheres much to its surface. A little of this paste may be put on the child's tongue, as often as may be ne- cessary to keep the parts clean ; which will be licked to every part of the mouth, and will effectually do, without putting the infant to pain, by forcibly rubbing it on. But the cure is not permanent, un- less the occasional causes be avoided, and the absorbent and aperient mixture, (see Dispensatory]) or magnesia, be given to subdue the feverish state of the system. SICKNESS AND VOMITING. Infants, sometimes, are very suddenly seized with a sickness, and an inclination to vomit, which they resist as long as possible. This adds greatly to their distress, and prolongs it. The breath is sour or ill-smelled, the eyes inanimate, the lips slightly livid, the counte- nance ghastly, and the child loathes the breast. These appearances are highly alarming to an observer, and, if the child have been previously complaining, will indeed indicate great danger. But when they come on suddenly, especially if the stomach have been loaded, or some improper food given, the death-like aspect presently passes off. The child is speedily relieved, first by vomiting, and afterwards by sleeping. If there be no appearance of spontaneous vomiting taking place, four or five grains of ipecacuanha should be given. Vomiting is a frequent occurrence with infants, and is not to be considered as morbid, unless it be attended with sickness, ill-smelled breath, and discharge of cheesy or sour stuff. Thriving children puke often after sucking; but then they generally throw up only a mouthful at a time, without straining, or being ill. This requires diseases of children. 491, no medicine. But vomiting, accompanied with sickness or paleness, and dull appearance, demands attention. It either proceeds from disorder of the stomach, and, in that case, is relieved by a gentle emetic, and if necessary, rubbing the pit of the stomach with a little laudanum ; or it is a symptom of some serious indisposition, or affec- tion of the head, which must be determined by the presence, or con- comitant appearance, of other symptoms, such as fever, screaming drowsiness, spasms, &c. Vomiting depending on teething is distin- guished by the state of the mouth. COSTIVENESS Is natural to some children, and acquired by others. When con- stitutional, it is better to do but little, particularly if the child be healthy in other respects. But, if the child, after having been some weeks open, become costive, and do not thrive, or if from the first it have been costive, is pale and delicate, and is subject to fits of crying, there is no doubt of the propriety of interfering. It is better to interfere too soon than too late. Calomel is generally a safe and useful laxative, and may be given at first every day, for three or four days, in such a dose as to make the bowels rather open; half a grain, a grain, or even more, accord- ing to the effects, may be employed. This practice often prevents the continuation of costiveness, or, if it do not, some other laxative is to be given daily, or once in two days, to procure an easy stool. We may employ the syrup of senna, (see Dispensatory,) calcined magnesia, manna, or sulphur, and occasionally, in place of these, a suppository or dry clyster. Temporary costiveness may be at any time removed by a supposi- tory made of a small piece of yellow soap, shaped like a large writ- ing quill. This may be rendered more powerful, if necessary, by being dipped, previously to use, into some powdered salt. Another excellent suppository is prepared by scraping a candle until it be ren- dered sufficiently small and tapering to introduce it into the anus about an inch, or two inches at most. It will be better to dip it in oil before used. A strip of paper or linen cloth twisted up, and well moistened with oil, is easily introduced, and forms also a good sup- pository or dry clyster. 492 diseases of children. COLIC PAINS. The delicacy of the bowels of infants renders them affected by the most apparently trifling causes; and hence many circumstances in- duce colic pains, wdiich are known to exist by the drawing up of the infant's limbs, and by its agonizing manner of ciying. Colic may be induced by costiveness, by cold, by damp clothes, by the liberal use of spoon-meat, particularly if the bread have been a little sour, by some fault in the milk, or it may accompany thin and slimy purg- ing, which is sometimes produced by the injudicious use of magnesia or other laxatives. In slight degrees of colic, applying warmth to the belly, and giv- ing the child a little fennel tea, generally afford relief. But in the more violent and dangerous kind of colic, the treatment must be va- ried according to the circumstances of the individual case. If it seem to arise from accumulated slime, or from some fault in the milk, suitable doses of cold-pressed castor oil, or magnesia and rhu- barb, together with the warm bath, or fomentations of the belly are to be advised. But if the bowels be quite open, and the complaint have been excited by exposure to cold, or some external circum- stance, along with the warm bath it will be proper to rub the belly with some laudanum. When constipation attends colic, the most active means of opening the bowels are to be had recourse to. For this purpose large closes of calomel, followed by castor oil, together with laxative clysters, are required. It is a common practice to give carminative medicines to infants, in order to-remove flatulence, such as gin and water, grated ginger, and spices of different kinds. These ought never to be employed when the infant is the least feverish, or when the bowels are in a costive state. If any flatulence remain after costiveness has been re- moved, and there be no febrile symptoms, a drop or two of lauda- num, or double the quantity of paregoric, in fennel tea, may be given with advantage. Dr. Burns recommends the following mix- ture in doses from ten to twenty drops in a little water, as being al- ways safe, and generally effectual, in ordinary cases of colic. Take two drachms of tincture of assafoetida, twenty drops of oil of anise or fennel seed, and an ounce of mucilage of gum Arabic, rubbed up together with a lump of sugar. CONVULSIONS. The convulsions of children are generally preceded by slight symptoms of distortion of the face, as involuntary laughter when DISEASES OF CHILDREN. 493 asleep or awake, squinting of the eyes towards the nose, or turning them upwards, the child, at the same time, changing to a bluish co- lour. The tit itself is distinguished by distortions, more or less gene- ral, according to the violence of the attack. Convulsions may be produced by wind, or irritation in the bowels, dependent on worms, costiveness, indigestible food, acrid stools, &c, or by teething, by breathing confined air, by the striking in of some eruption, or by the affection of the brain itself. When convulsions occur suddenly in a state of previous health, they are frequently at- tended with little hazard; but when they occur in the course of some other disease, which the child has been labouring under for some time, they are highly dangerous. When a child is seized with convulsions, a great consternation im- mediately prevails, and without some determinate rules, either noth- ing will be done, or very contradictory plans may be adopted. The first general rule, in such cases, is to order the tepid bath, which is proper in every instance. When the motion is strong, it allays it; when it is slight, it brings on a state of quiet repose. The water should be agreeably warm to the hand, and the child should be kept in it up to the neck for some minutes, if he do not get relief sooner. If he be very pale or languid, the addition of a table-spoon- ful of mustard or hartshorn to the bath is useful. Secondly, Whilst the child is in the bath, a common injection is to be prepared, and administered immediately after he comes out; and afterwards a dose of calomel, proportioned to his age, is to be given. Thirdly, If the child seem to be sick, or oppressed in breathing, or about the stomach, or have been known to have had something which has disordered the stomach, vomiting should be excited by tickling the throat with a feather during the fit, or giving ipecacu- anha as soon as the child can swallow. Fourthly, After the child is taken out of the bath, it will be use- ful to rub him, particularly over the spine and the stomach, with oil of amber, or with spirits, having about a sixth part of hartshorn ad- ded. If any rash have struck in, rubbing the surface with campho- rated oil of turpentine, or applying a small warm plaster over the stomach will be useful. Fifthly, If the gums be swelled, or there be any appearance of teething, the part should be instantly scarified. And when they proceed from worms, the remedies detailed in that disease are to be employed. The convulsions, or inward fits, of infants a day or two old, require chiefly gentle laxatives, such as magnesia and rhubarb, or calomel, and sedulous attention to nourishment, with gentle friction over the surface, especially of the belly, with camphorated spirit of wine. 494 DISEASES OF CHILDREN. TEETHING. The symptoms that mark dentition are, heat and swelling of the gums, and a tendency to drivel or slaver much, with starting and thrusting of the fingers into the mouth. There are only twenty teeth evolved in infancy, ten in each jaw, and these are not permanent. They, generally, begin to appear be- tween the sixth and eighth months, and the two middle incisors, or front teeth of the lower jaw, usually come through first, and, in about a month, the corresponding teeth above appear. Then the two lateral incisors below, and next those above come out. About ihe twelfth or fourteenth month, the first, or anterior double teeth, appear on each side below, and then above. Between the sixteenth and twentieth months, the space between'the first teeth and grinders, is filled up with those which are called the eye-teeth, and from this time till the thirtieth month, the other back teeth appear; so that when the child is two years and a half old, he, generally, has all his milk teeth. These continue till it is six or seven years of age, and then are succeeded by others, which are stronger, and more perma- nent. Many children cut their teeth with great ease, but others suffer considerably. On inspecting the gums of a child, that is not teething, they are found to be sharp, and the skin which covers them, seems even to form an edge or seam along the gum. But when a tooth is growing up, the gum, and the skin which covers it, are put on the stretch, and the appearance of seam at that part is lost In the treatment of the effects of teething, wre have chiefly three objects; First, to allay irritation: Secondly, to alleviate urgent symptoms: and, lastly, to support the strength. First, It is customary to give the child a gum stick, to rub on the itchy gum; but if this be made of any hard substance, it is apt to injure the gum, or the child may knock it into his eye.—A crust of bread is often employed, but if a piece of it break off in the mouth, the child may be choked. The fingers are instinctively used, nor is there any risk of the child, by being indulged in this respect, acquir- ing afterwards a bad habit. The most effectual means of allaying irritation, is to cut the gum when it is distended or swelled. This is often indispensably necessary for the removal of urgent symptoms; it generally gives much relief, and is.always safe and innocent. It does not, even if the incision should heal, render the future progress in any degree more tedious. It is not painful, but gives, on the contrary, immediate ease. Experience teaches us that a costive state of the bowels adds greatly to irritability of the system ; and, therefore, if there be no looseness, it is always proper to give gentle laxatives, such as rhu- barb and magnesia, during dentition. Cool air is highly useful, but the child is not to be imprudently exposed to a great degree of cold. DISEASES OF CHILDREN. 495 It should be frequently out, and ought to have the cold bath in the morning, and be washed with cold water at night. When there is considerable irritation, rubbing the spine and sur- face of the belly with a little laudanum, is useful. Secondly, In the treatment of urgent symptoms, wre must, besides cutting the gum, which is a general rule, have recourse to such remedies as the particular nature of the affections requires. When the fever is high, that is, when the skin is very hot and the pulse quick, it is proper to give laxatives, and use the warm bath, morning and evening, in the place of cold water. If the child be lusty and drowsy, indicating a tendency to affection of the head, it will be necessary to give a pretty smart dose of physic, and apply either one or two leeches to the forehead, according to the age. If these means do not speedily relieve the child, the head should be shaved and a small plaster put on. We never have cause to regret having used prompt and decided means of preventing danger, but have much oftener to reproach ourselves with not having used early, those reme- dies which the result of the case shows to have been proper. Purging, if severe, or attended with weakness or emaciation, is to »e restrained by giving clysters with laudanum; and, occasionally, imall doses of calomel, magnesia, and rhubarb, or the absorbent and aperient mixture, when the stools are unnatural. Sickness, loathing of food, and ill-smelled breath, are relieved by a gentle dose of ipecacuanha. A short cough, as well as tenderness of the eyes, will be removed by a Burgundy pitch plaster, applied to the back. Ulceration of the gum requires gentle laxatives ; and the strength is to be supported, and the parts bathed, with port wine and water. Thirdly, The strength is to be carefully supported under the irri- tation, by the breast milk, or if the child be weaned, by beef-tea, arrow-root, tapioca, sago, rice-milk, milk and water, &c. In some cases, where the child is recently weaned, it will be of advantage to give it the breast again. If it do not take sufficient food by the mouth, nutritive clysters must be resorted to. In every instance nourishment is essential; but in some, particularly when the weak- ness is increasing, cordials, such as wine whey, must be added. LOOSENESS, OR CHOLERA INFANTUM. A purging is one of the most frequent complaints of infancy; however, it should be remembered that it is not always a disease ; but on die contrary, it often proves a remedy. By it, nature com- monly throws off an offending cause. Its causes, therefore, and treatment, require very particular attention. 496 DISEASES OF CHILDREN. Both vomiting and purging very often arise from unwholesome milk or other food; from teething, from a moist cold air, as well as from the sudden disappearance of some eruption on the skin. The purging is not then hastily to be stopped; until the offending cause be removed. The treatment, therefore, of this complaint, must consist first in removing, as far as possible, the irritating matter, and then checking the particular symptoms. If the offending cause appear lodged in the stomach, the cure should begin by giving an emetic, or a dose of calomel, that will both vomit and purge; and afterwards small doses of rhubarb, or the absorbent and aperient mixture. (See Dis- pensatory.) The nature of this disease is to be often drawn from the appear- ance of the stools; and the treatment ought, in a great measure, to be regulated from that circumstance. Thus, when the stools are sour and curdled, after the necessary evacuations have been pre- mised, the absorbent mixture, or prepared chalk, or magnesia, in suitable doses, combined with grated nutmeg, or some aromatic, is strongly pointed out, in addition to opening machines.—When again the stools are slimy, and of a clayey colour, in addition to the former plan, injections of soap-suds are not to be omitted, and Castile soap dissolved in milk will be found a useful drink. When the stools are watery and bloody, or fetid, castor oil and calomel are the best pur- gatives ; and if attended with much griping, clysters of milk and soap-suds should be often repeated. The extent and continuance of this plan, must depend on the obstinacy of the complaint. To these medicines, opiates, according to the age of the child, may be given with the greatest advantage at bed-time, provided there exist no febrile symptoms. When the child is cold and languid, the purgative medicines ought to be joined with some aromatics, as grated ginger, and grven less frequently: and during the intermediate days, as well as the even- ing after the physic has operated, a cordial diet, such as the addition of wine or gruel, or arrow root, with plenty of nutmeg, should be allowed. The occasional exhibition of injections of thin starch and laudanum, in the proportion of ten drops of the latter to two table- spoons full of the former, must be had recourse to, in order to mode- rate the discharge when the strength is much reduced. Beside this internal treatment, the warm bath, or bathing the child, night and morning, in a strong decoction of oak bark, will be found exceedingly beneficial. External applications are also of the greatest service, as cloths moistened with the camphorated spirits, or wrung out of brandy stewed with spices, and applied warm to the belly and extremities. Blisters to the legs and arms, have also their good effects, and ought to be repeated in obstinate cases. Wearing flannel next the skin, or a bark jacket, will also prove an auxiliary. A soft flannel bandage, passed frequently and with some degree DISEASES OF CHILDREN. 497 of tightness, round the body, immediately over the stomach and bowels, is found to be a very useful remedy in this complaint. In the treatment of all abdominal complaints, much attention is necessary to the nature and kind of food or nourishment taken. The food of children, with this view, should be deprived of acid as much as possible; hence, instead of milk, animal food, in the form of beef tea, or mutton broth, is preferable. When there is an habi- tual disposition to purging, there is no diet superior to arrow root; and when this is not at hand, flour baked in an oven till it breaks into a powder, and afterwards made up with boiled milk, is a good substitute. Tapioca and sago are also very nutritious. Indeed, it is proper to alternate the food occasionally, from one kind to another, and frequently to exhibit the animal food in a solid form, when the stomach rejects fluid nourishment. The change of the wet nurse sometimes makes a necessary part of the treatment; and when a child has been weaned, resuming the breast has often had the hap- piest effect. Although powerful astringent medicines are commonly inadmissi- ble in cases of purging during infancy, great benefit has sometimes seemed to accrue from the use of a mixture composed of twenty grains of toasted rhubarb, two drachms of prepared chalk, a table- spoonful of brandy, previously set fire to and allowed to burn as long as any spirit remains, and three table-spoons full of water.— The dose is from one to two tea-spoons full every hour or two while awake. The dewberry root boiled in milk (see Materia Medica,) will also be found a valuable astringent medicine in this troublesome complaint. In several hopeless cases burned cork (see Page 314,) has wonderfully succeeded. In many instances, a change of air, alone, has proved an effectual remedy, after every other means had failed. DISCHARGE FROM THE VAGINA. Infants have sometimes a discharge from the vagina, a few days after birth, resembling matter; but it is of no consequence, as it goes off itself in a short time. Children of five or six years old are subject to a mucous discharge resembling the genuine whites of adults, which will, in some in- stances, be in an excessive quantity, so as to run through all their clothes. The disease readily yields to a little cooling physic, as the cathartic or absorbent and aperient mixture, and keeping the parts perfectly clean with soap-suds or lead-water. When it is obstinate, balsam copaivi maybe given thrice a-day; and, if the child be puny. the tincture of steel is a suitable remedy. 63 498 DISEASES OF CHILDREN. WORMS. The symptoms enumerated as most commonly distinguishing worms, are pain and eructation of the stomach, variable appetite, foul tongue, fetid breath; the belly full, hard and tense, with occasional gripings or pains in different parts of it, particularly about the navel; irregular state of the belly, heat and itchiness of the fundament, urine white and limpid, and often discharged with difficulty. With these symptoms are joined a dull appearance of the eyes, often dila- tation of the pupil, itchiness of the nostrils, short dry cough, slow fever, with evening exacerbations and irregular pulse, grinding of the teeth in sleep, &c. However, many of the above symptoms occur in other diseases; and I believe, as was suggested to me by the learned Dr. Caldwell of Philadelphia, that worms are much oftener suspected to be the cause of children's complaints, than what they really are. For the cure of worms, two indications arise; first, to expel them, and secondly, to prevent their generation.—The first may be effected by giving a dose of calomel at bed-time, and rhubarb the next morn- ing, to work it off.—The pink-root (see Materia Medica,) has long been held in high estimation as a vermifuge. It may be given in the form of tea, with milk, sweetened, for breakfast, observing not to continue the use of it, if it be found to affect the child's eyes. The bark of the pride of China (see Materia Medica,) is much extolled of late as a remedy for worms. My friend Dr. Grimes, of Savannah, said, that he considered it one of the best vermifuges we are acquainted with. He directs a tea to be made of the bark of this tree, and as much of it taken during the day, as the child can bear without producing vomiting, purging, or considerable weakness <*f the limbs. External applications have also been found useful for the removal ■of this complaint. These consist of a liniment made of equal parts *)f beef's gall, aloes, and sweet oil, or fresh butter, rubbed on the belly every night; or a plaster made of dry rue and aloes, or gall mixed up with a little turpentine and lard, and applied over the region of the belly, taking care to cover the navel with a piece ef cotton. The future generation of worms will be prevented by avoiding greasy food, and by taking the rust or tincture of steel thrice a-day, joined with bitters to give tone to the bowels. DISEASES OF CHILDREN. 499 WATERY HEAD. This disease is distinguished by pain of the head, accompanied with nausea, sickness, and other disorders of the animal functions, without any evident cause, and sudden in their attack; variable state of the pulse ; constant slow fever; and in the advanced stage of the disease, dilatation of the pupil of the eye, with a tendency to a comatose state. It most frequently takes place between the age of two and ten years, and with children of a scrofulous habit. It may, however, arise from falls and blows on the head. The first stage of the disease is marked by loss of appetite, and a degree of melancholy and uneasiness without the child being able to fix on any particular cause. Pain in the head is next felt, espe- cially above the eyes, and in a direction betwixt the temples. In very young subjects, pain in the head is indicated by the child put- ting his hand often to his head, and waving it about. This pain gradually extends, and is at last felt more particularly in the arm and leg of one side. The affections of the stomach next commence, and alternate with pain and uneasiness of the head. The febrile symptoms, though pretty constant, are milder in the morning, but suffer also an evening exacerbation. Vomiting occasionally' occurs' but costiveness is a leading symptom. The tongue is little affected, except towards the end, when it assumes a scarlet colour, and some- times becomes apthous. As the disease advances, all the symptoms of hectic are conspicuous, and during the whole disease the child shows a strong propensity to the bed, or a desire to avoid being moved. This disease is truly inflammatory in its commencement, and can only be treated with success by the early employment of those means which are best calculated to subdue inflammation; such as copious and repeated bleedings, the application of leeches or cups, blisters to the head and temples, and an issue behind the neck. Besides these external remedies, active purges, as calomel and jalap, must be frequently administered, and, if possible, a ptyalism should be produced by the use of mercury, either in the form of calomel in small doses, or by rubbing in the unction. If acid prevails, the absorbent mixture (see Dispensatory]) must occasionally be given, and during the continuance of fever, the tincture of digitalis or foxglove (see Dispensatory,) will be found an auxiliary. After subduing the inflammatory action of the system, opium or laudanum may be employed with advantage, to relieve the spasm, or pain of the head, when it is considerable. In the last stage of the disease, cold bathing, and the use of tonic medicines, may be required to invigorate the system. 50G DISEASES OF CHILDREN. CROUP, OR HIVES. This disease, peculiar to children, is a species of asthma, with violent catarrhal symptoms. It is most common in low marshy countries, or on the sea coast, and in wet and cold seasons. Indeed, it is readily occasioned by any thing wet or damp, or which obstructs the perspiration. There are two species of croup, the acute, or inflammatory, and the chronical, or lingering. The former is attended with a very quick pulse, cough, hoarse- ness, and difficulty of breathing, soon after, and sometimes even before the occurrence of the croaking noise, which is the characteris- tic of this disorder. As the disease increases, the pulse quickens, the heat augments, and an excessive restlessness takes place. The breathing becomes more and more difficult, and laborious, and the peculiar wheezing sound which accompanies it, so increases, as to be heard at a considerable distance. The symptoms continue to increase in violence, until a spasm of the muscles of the parts taking place, the patient is suffocated, the disease often completing its course in the space of three or four days and nights. The extreme degree of danger which always accompanies this disease, and the rapidity with which its symptoms proceed, show that immediate remedies are requisite to arrest its progress. Therefore, on the first appearance, blood-letting,both general and topical,should be employed, and repeated two or three times a-day, according to the violence of the symptoms, and the habit of the patient. Imme- diately after bleeding, an emetic should be administered, and the sickness kept up for several hours, or even days, by small doses of the antimonial solution. (See Dispensatory.) Inhaling the steams of hot vinegar and water, and embrocating the throat with the volatile liniment, have also their good effects. Besides which, the application of a cataplasm of mustard, or blister to the throat, are not to be neglected, if the symptoms are the least alarming. The decoction of seneca or rattle-snake root, (see Materia Medi- ca]) is a valuable medicine in this dreadful complaint. It should be given at first in such doses as to excite vomiting, and afterwards in smaller doses, to keep up a nausea at the stomach, and to produce perspiration. Onions (see Materia Medica]) are also celebrated as a sovereign remedy. The tincture of digitalis, or foxglove is considered by some a good remedy, if employed in the early stage of the disease. Attention should always be paid to keep the bowels open by castor oil, or some aperient medicine. The most speedy and efficacious of all remedies, in this alarming DISEASES OF CHILDREN. 501 disease, which has come under my notice, is calomel in very large doses. For this valuable remedy, I candidly acknowledge myself indebted to my excellent and very learned friend, Professor Davidge, of Baltimore. From him I have been imboldened to use it, in desperate cases, in doses of from thirty to sixty grains, to children. On my own daughter, only four years old, and apparently in the very act of suf- focation, I used it in the dose of at least sixty grains. The cure was almost instantaneous. Among other instances of cure as surprising, was one in the infant of my amiable friend, Mrs. Chalmers, lady of the Rev. Mr. Chalmers, of Washington, with the dose of forty grains. The cure was so immediate, that the overjoyed parent in- sisted I would instruct her in the remedy, for fear, on the next at- tack, I might not be in the way to prescribe. On learning I had given her infant, not. more than three or four years old, forty grains of calomel, she was excessively frightened, and exclaimed, " You have killed my child!" and indeed she could hardly be persuaded for some time, though her eyes told her the contrary, that I had not killed her child. So powerful is the effect of this medicine, that it suddenly removes the disease without having recourse to other means. It acts on the stomach, bowels, and skin. In cases not very alarming, I have given calomel in smaller doses, conjoined with ipecacuanha, with good effects. The flax-seed syrup is peculiarly beneficial in all diseases attended with cough, and, therefore, should not be omitted in this. To pre- vent a relapse, and to restore the strength of the patient, it will be proper, at the close of this complaint, to use the cold bath and to give bark in any form which is most agreeable and convenient. The latter, or chronical croup, is produced by spasm and unac- companied with fever. A most important remedy in this species, if early used, is the warm bath, immediately followed by a clyster, to which some of the juice of raw onions may be added. A tea-spoon- ful or two of the juice may also be given by the mouth, and some applied externally. (See Materia Medica.) If the symptoms do not yield to this treatment, an emetic should be administered, and after its operation, a dose of laudanum will be proper. Some children are troubled with this complaint for several years, and then seem to outgrow it. A flannel shirt, light diet, cold bath, change of air, gentle exercise, and, whatever strengthens the body, are the best preventives. This disease is almost peculiar to infancy and childhood, while inflammation of the larynx and bronchial tubes occurs at all ages. It is a rare thing to see this disease in one above twelve years of age.* Many who were supposed to have died of croup, proved upon post-mortem examination to be bronchitis. * General Washington and Josephine, consort of Napoleon, died of this disease. 502 DISEASES OF CHILDREN. Symptoms.—This disease usually begins like a catarrh, the symp- toms more or less severe with some degree of fever preceded by silliness. The voice soon becomes hoarse. The fever symptoms increase. And in a day or two, the breathing becomes more and more impeded, particularly during inspiration. At last the breath- ing becomes stridulous and the voice shrill. Sometimes masses of lymph are discharged, resembling portions of false membrane. As the disease advances, the expression of countenance becomes more anxious. The lips and cheeks have a swollen, livid appearance, alternating with a deadly paleness. Pulse is frequent and small. The little patient is feeble and restless. The body is hot, yet the extremities are cold. At last the body is covered with a cold, clammy sweat, and the child dies of suffoca- tion. This disease not unfrequently begins in the throat, and thence spreads into the air-passages. Treatment.—This disease of all others, demands promptitude and decision. If the false membrane mentioned above be allowed to form, not one of a hundred will be saved. Regarding the treat- ment of croup, great diversity of sentiment exists. According to some, bleeding and blisters are mainly to be depended on, while others think them injurious. When the disease has just commenced, and before the membrane has begun to form, bleeding, if ever, is then of essential service; whereas after five or six days have elapsed, bleeding must prove the death of the patient. This statement is in accordance with the experience of the most able practitioners. The same remark applies to the use of leeches; if employed at an early stage, they are of service—if not, they prove injurious. Emetics are to be employed, especially at the commencement of the disease. The most efficacious is the tartar emetic, two grains in two ounces of water, a tea-spoon full every five minutes, till vomiting is pro- duced. Its counterstimulant effect is serviceable even if it is diffi- cult to produce its effect. We are told by good authority that cold affusion has been of signal advantage, when every other remedy has been tried in vain. Respecting the use of calomel, the medical world is divided in opinion, some thinking highly of it, while others condemn it altogether. If used at all, it should be employed in very minute doses. Bron- chotomy or making an incision into the wind-pipe has been recom- mended and occasionally practised with success. Spasmodic croup is an affection, consisting entirely of spasm. It is supposed to be produced by cerebral irritation, causing some morbid action in the nerves that supply the muscles of the throat, and which, by pro- ducing a convulsive spasm, occasions the contractions of the larynx. In the treatment of croup two things are to be kept in view. First, to subdue the local inflammatory action. Second, to promote the discharge of the viscid secretions collected in the throat. To this end let emetics and the warm bath be employed as soon and promptly as possible. In the onset of the complaint, purgatives should be DISEASES OF CHILDREN. 503 employed. After the inflammation has been in a great measure sub- dued, the polygata senega has been of sovereign use. It is best given in decoction. An ounce of the root, to a pint of boiling water suffered to simmer fifteen or twenty minutes, and then sweetened with honey. Dose, an ounce every hour or two, according to the urgency of the symptoms. It is affirmed the false membrane is formed by a whitish fluid which begins on the surface of the tonsils, thence spreads over the surface of the pharynx and oesophagus, and also the larynx and trachea. This matter is said to be effectually removed by one scruple of the nitrate of silver to an ounce of dis- tilled water. It must be applied to the tonsils and adjacent parts. Insufflation of finely powdered alum has had the same effect. WHOOPING COUGH Is a contagious disease, attacking in paroxysms of a convulsive suffocating cough, with a loud noise or whoop at each respiration, and generally terminating by vomiting. It is clearly the effect of a specific contagion of a peculiar nature, and highly active, affecting, like the small pox and measles, but once in life. The treatment of this disease must be regulated by the degree of fever and spasm. When the fever is considerable, bleeding becomes clearly indicated, as well as blisters over the breast, and the use of laxative medicines, together with such as may determine to the sur face; of which class, the decoction of rattle-snake root, (see Materia Medica]) or the antimonial solution is to be preferred. When the spasmodic state is most predominant, and the symptoms of fever mild, emetics will be highly useful, followed by a dose of the anodyne sudorific drops (see Dispensatory]) at bed-time. If a free use of the flax-seed syrup be insufficient to allay the cough, laudanum, or paragoric, when fever does not forbid, may be given with the greatest advantage. In this tiresome disease, I have found no remedy, when there is little or no fever, superior to the following mixture, in doses of from thirty to sixty drops or more, given m syrup or tea, three or four times a-day, until a slight strangury be excited. Take of tincture of bark, one ounce and a half; paragoric, half an ounce; tincture of cantharides, one drachm.—Mix. The strangury usually comes on about the third day, and the whooping-cough seldom continues longer than a few days afterwards. A grain of assafoetida, administered four or five times a-day, proves oftentimes a very useful remedy in cases of whooping-cough. When the disease is recurrent, and returns some time after its ap- parent departure, as it frequently does on taking cold, an emetic, a 504 DISEASES OF CHILDREN. dose or two of castor oil, and the anodyne sudorific drops, laudanum. or paregoric, at bed-time, as the symptoms may indicate, will quickly remove it. A milk and vegetable diet is peculiarly proper in this complaint; and, when the patient is debilitated, a change of air and tonic medicines, as the bark or Columbo, will be found necessary. RICKETS Consist in an enlargement of the head, belly, and joints, flattened ribs, and general emaciation, with a bloated or florid countenance. This disorder generally takes place from six months to two years of age, and arises either from unhealthy parents, or from the children being improperly nursed, kept wet, dirty, in a close damp air, with- out due exercise. Weakness and relaxation being the cause of this complaint, its remedy must of course be to promote digestion, and to brace and strengthen the solids. Hence a nutritious and cordial diet, with exercise in the country air, is indispensable. Along with this, the cold bath and tonic medicines, as bark, Columbo, and steel, to warm and invigorate the constitution, are peculiarly proper; but they could not be entered upon, without previously purging with calomel and jalap. The tincture of rhubarb (see Dispensatory,) should also be occasionally employed, to keep the bowels in a regular state. How- ever, nothing will be found more effectual in recovering the patient, than a generous diet and cold bathing, particularly in salt water. Sea bathing constitutes, perhaps, the most promising remedy in this disease. ST. VITUS'S DANCE. The diseases called chorea, or St. Vitus's dance, occurs, most fre- quently from the age of eight years to the period of puberty. It ap- proaches with languor, and indifference with regard to the usual amusements; a variable, and sometimes a keen appetite, continued costiveness, occasionally combined with a flabby, lank state of the belly, but much oftener with a hardness and swelling, particularly at the lower part. The stools are not of natural appearance. Pre- sently convulsive affections of the face take place, and are succeeded with twitches and starting of the extremities. The patient often cannot walk easily, in consequence of one leg twisting in before the HYDROPATHY, OR WATER-CURE. 505 other. He is perpetually changing his position, and fidgetting when sitting. This disease generally proceeds from, or is connected with, a cos- tive state of the bowels; and nothing gives so essential relief, as re- gular and continued purging. When the patient is old enough to swallow aloetic pills, two, or sometimes more, of these, may be taken twice or three times a-day; or where these cannot be used, infusion of senna, Epsom salts, or other purgatives, must be employed; and it will be found that usually, though not always, the stools are fetid, or unnatural in their appearance. This, so far from weakening the patient, has a contrary effect; for although he may, perhaps, have five or six stools in a day, the pulse becomes stronger, the counte- nance brighter, the step firmer, and the gesticulations or twitches abate, and, at last, after a period, varying from a fortnight to several weeks, or some months, the cure is completed. The cold bath and tonics may sometimes be useful; which have been introduced into general practice, and with success, by Dr. Hamilton, sen. ^ Scald Head, and other diseases peculiar to children, which have not been noticed here, will be found in the preceding part of this work. 64 HYDROPATHY, OR WATER-CURE. Vincent Priessnietz is the founder of this method. He is a native of the mountains of Austrian Silesia in Germany. Having crushed his finger and finding the usual applications of little benefit, he plunged his finger in cold water, and was surprised at the relief he obtained. It soon healed. He met with an individual suffering from fractured ribs, and recollecting his finger he wrapped the pa- tient's body in sheets dipped in cold water. He was equally suc- cessful in this case. Priessnietz now began to make some stir in the neighbourhood. He cured several others applying to him. An in- dividual with cold hands and feet, he relieved by sweating the body and then sponging it with cold water. When the patient was much debilitated by the perspiration, he threw open the windows. The burning sensation on the skin and the oppression were relieved by drinking cold water. Far from checking,it increases the perspiration. Patients who could not be made to sweat were wrapped in sheets dipped in cold water and wrung out. This succeeded in a remark- able manner. Such was his success with the use of cold water that he soon began to resort to seat-baths—foot-baths—head-baths—eye- baths—the douche, &c. &c* Priessnietz use of cold water restoring many to health, whom the faculty had failed to relieve, there were not wanting those who at- tempted to put an end to what they were pleased to style " the mis- chief." The laws against all sorts of quackery were severe. Some alledged that the sponge he used, contained some sort of remedial property. As the use of any thing medicinal was against the law, except by a physician, a commission of doctors was instituted to ex- amine into the matter. They could detect nothing. The search was in favor of Priessnietz. One doctor prosecuted him for quackery, swearing it was he that cured a certain man of the gout, and not Priessneitz. The man was examined and duly questioned. He affirmed the doctor relieved him of his money—but Priessnietz of his gout. In Graefenberg in 1841, Priessnietz had five hundred patients of all ranks and conditions. And of the three thousand patients in two years whom he had treated, it is affirmed he only lost two. *This compendium of Priessnietz mode is taken from Shew's excellent work on the Water-Cure. HALF HATH HEAD BATH COIXi: TdTHE BATH .U1TR SWIATI.Yl HYDROPATHY, OR WATER-CURE. 507 SWEATING. In order to produce perspiration, the patient is laid upon a woollen coverlet. It is wrapped around him, carefully brinp-in"- it in close contact with the body in order to retain the heat. The excess of caloric thus confined produces a free exhalation from the skin. As soon as a perspiration ensues, the windows are opened, and cold wa- ter given to drink to promote it. From four to five o'clock in the morning is considered the best time for this process. It may occupy from a half to three hours. The patient afterwards undergoes the cold bath. Thence he passes into the fresh air. Those who are found unable to walk are rubbed with wet cloths, then with dry ones. WET SHEET. The patient is laid upon it—his body is enveloped in it, being made to come into close contact with it. He is then enveloped in a blanket and bed-covering. In acute fevers this is changed every quarter of an hour, till the skin becomes soft and disposed to sweat. He remains in this several hours. He is then taken to undergo a tepid ablution. COOLING BANDAGES. These have the same effect upon any part of the body that the wet sheet has upon the whole body. They are folded from four to eight times and renewed as often as from five to ten minutes. WARMING OR STIMULATING BANDAGES. A piece of linen is folded two or three times, and being dipped in cold water, is wrung out and applied. This is not to be changed till dry. It is secured from the action of the air by a dry bandage, so that the part may be raised in temperature. This combined ac- tion of heat and moisture is serviceable in indurations, tumours, swellings, &c. &c. RUBBING WET SHEET. This is a linen sheet of coarse quality and is allowed to hold con- siderable water. It is not to be wrung out. It is thrown over the 508 HYDROPATHY, OR WATER-CURE. head and around the neck, so as to give a slight shock. With one end of the sheet, a smart friction is used for five or six minutes, till the skin becomes red and warm. This is followed by coarse, dry cloths. ABLUTIONS. This is performed with a sponge dipped in cold water, and fol- lowed with a warm, dry towel. The best time for using this is in the morning. PLUNGING BATHS. The patient remains in this from six to eight minutes, often only from two to three minutes, the water being from 40 to 50 degrees. Exercise to be taken after. HALF BATH. This is employed in cases where the invalid is unable to bear a whole bath. The water is about 60°. Priessnietz also used sitting baths. Head baths. Eye baths. Finger baths. Leg baths. Tooth baths. Drop baths. Shower baths. THE DOUCHE. This is so contrived that a stream of water is made to fall upon the body with more or less force. The water is simply conducted into a channel, giving it a fall of from twelve to twenty feet and to the stream, a calibre of half an inch to five inches. It should not be used either when the body is quite cold, or in a state of perspiration. The stream is not all at once to be received upon the body, but one or more portions of the body to receive it first. The Douche is the most powerful stimulant known in Hydropathy, and is applicable where excitement is necessary. DRINKING. The quantity of water directed by Priessnietz was from eight to twelve tumblers daily. The greatest quantity to be taken before breakfast, less before dinner, and the least before supper. None to be drank while the body is very cold. The less the quantity taken at meals, the better. The purity of the water is of the utmost importance. HYDROPATHY, OR WATER-CURE. 509 Our limits forbid going into detail. We subjoin a single example illustrative of the treatment by the water-cure. INFLAMMATION OF THE STOMACH. The patient is placed in a half-bath at a temperature of 75 degrees, the water of which reaches above the stomach. During the bath, he drinks water in small quantities, but often. While in the bath his body is washed, and rubbed by two attendants; the stomach not exempted if the pressure can be borne. After the lapse of a quarter of an hour, if the pain be somewhat abated, the bath is made some- what cooler. At the expiration of half an hour the patient is con- veyed into bed, wrapped in a wet sheet, and a bandage over the stomach wrung out in cold water. When the patient has passed some time in this state, and his position becomes irksome, he is washed in water of a moderate temperature, a well-wrung bandage applied to his body, and is returned to bed where his covering is so regulated as to keep hiin warm. If he incline to eat, water-gruel is given. This process is undergone several days. CROUP. " It is known by a dry, hollow, barking, whistling, or stridulous cough. As soon as we see symptoms indicative of this disease, we must wrap the patient without delay in a well-wrung wet sheet, and apply a well-wrung bandage around his throat, and thus endeavour to promote perspiration. With the appearance of the exhalation from the skin, the dangerous symptoms will generally be relieved, the cough becomes loose, the voice alters, and respiration more free. While the patient is in the wet envelopment (sheet and blanket) water-drinking is not essential; but if he have thirst, it may be al- layed with chilled water. If, with the appearance of perspiration, amendment ensue, it will not be necessary to change the applications to the throat, nor the sheets; we should rather allow the patient to remain eight or ten hours in moderate perspiration which we may regulate by loosening or tightening the envelopment. The tempera- ture of the apartment should be moderate. An oblution of cold water should follow this proceeding, when the patient is to be re- turned to bed and lightly covered, to keep up a slight action of the skin. Exacerbations are apt to occur at midnight, when our utmost care will be needed. The use of the wet sheet in this case must not be neglected. The same applications to the throat are to be repeated when an amendment does not ensue." HOMOEOPATHY. The author of this system of medicine, is Samuel Christian Fre- derick Hahnemann of Meissen in Saxony. He was born in 1755, He studied at Leipzic and Vienna, and received his degree from the University of Erlangen.* The author of the Homoeopathic system seeing the futility of all human reasoning upon the principle of life, and observing the ex- travagances into which physiologists have been led, has regarded such knowledge as belonging to the Deity alone. And shrouded in like obscurity, he has considered the intrinsic nature and essence of diseases. Here he confesses himself in ignorance. Disease accord- ing to him is an aberration of the vital principle in the organism de- termined by different morbific causes, acting upon the nervous sys- tem, which show themselves by various painful sensations, by various functional derangements and by the changes of the tissues and other phenomena. Hahnemann was educated by his father in the observance of the strictest truth, and to account for every thing he did. With such sentiments he entered upon the practice of medicine. He soon found himself beset with many conflicting statements. It was not long before he quit a profession so little congenial to his exalted intellect and directed his attention to natural science and general literature. It was in 1790 while occupied with the transla- tion of Cullen's Materia Medica, that he was struck with that author's praises of the effects of cinchona in numerous diseases which seemed to conflict with the prevailing notions on the subject. It occurred to him as the only sure method of ascertaining the true action of this article in disease, to try its effects upon an indi- vidual in a state of health. To this end he took several consecutive doses of cinchona in the morning and found that a fever was the consequence in the evening. He observed that this affection returned during several days at the same hour. To the mind of Hahnemann this was, what the observation^ of the apple was to the genius of New- ton. Such was the origin of Homoeopathy. He thought he saw the reason why cinchona cured fever—that it did so by producing a disease * For this brief outline of Homoeopathic medicine we are indebted to the Organan, the works of M. Croserio, Dunsford and Everest—and in many places we have copied the words verbatim. H0M030PATHY. 511 similar to the one for which it was prescribed. To confirm his belief, he repeated these experiments with different medicinal substances. He found that mercury produced affections resembling syphilis, which it cures. It produced ulcerations, inflammatory swellings, discharges from the genital organs, swelling of the inguinal glands, ulcers of the throat, &c. &c. Sulphur, he found, produced affections of the skin analogous to those of the itch. Those who have fre- quented sulphur baths, have experienced an eruption with itching which continues long after the baths have been relinquished. From his experiments he deduced this proposition: that the more nearly the effects of a remedy on a healthy individual resemble the symp- toms of disease, the more rapid and complete the recovery of the patient. During the lapse of twenty years he made his experiments with perseverance which laid the foundation of his system, called Homoeopathic, from the Greek words " homoios," similar, and "pa- thos," affection—that is a " system of medicine which cures diseases by such agents as produce similar symptoms, when taken by an in- dividual in health." This method has been at all times unconsciously used.* Vomit- ing has been removed by emetics—diarrhoea by purgatives—the effects of the sun, the heat of a fire, by generous wine—the fatigue of dancing by tea—burns by a strong heat, instead of cold water— frost-bitten limbs by friction with snow.f Hippocrates had said that emetics cure vomiting, but it was re- served for the German philosopher to pursue this thought to any considerable extent. In 1790, he published his work called "Orga- non of the Healing Art," in which he dwells at large upon this new doctrine. One year after, he sent forth his "Materia Medica pura." This is a record of the various symptoms produced by the action of medicines on persons in health. Such is a brief account of the ori- gin of Homoeopathia, a system which encountering the violent op- position of apothecaries and doctors, has at length found its way into all quarters of the globe. Diseases have hitherto been divided according to their nature, ori- gin and duration. Thus they were sthenic or asthenic (excess or deficiency of tone,) inflammatory, bilious, mucous, nervous,—they were local or general, according as a part or whole of the body was assailed—they were acute or chronic according to their continuance. Homoeopathia divides diseases into acute and chronic, not so much in reference to their duration as to the cause of their continuance, which changes their nature, and requires a special consideration in the treatment. Hahnemann calls those diseases acute which are cured by the powers of nature alone—and those chronic which if left to them- selves have a constant tendency to aggravation. He regards them * We regard ourselves merely as a compiler of other men's views, and are not to be supposed as an advocate of these views.—Editor. t Napoleon, it is said, saved his soldiers thus amid the snows of Moscow. 512 HOMOEOPATHY. as produced by an internal virus, and as capable of being cured only by specifics. The virus producing chronic diseases according to him is of three kinds : the syphilitic—the sycotic—and the psoric. The first, if not destroyed by a specific, remains perpetually in the organ- ism. The second, or sycotic virus, manifests itself by excrescences on the surface of the body, or interior of the organs. From this virus spring warts, on different parts of the body—polypi of different or- gans, nsevi materni. Thuja occidentalis, a vegetable substance, has a specific action on this virus. The third virus is the psoric, or that of the itch. This last is the most diffused of all the rest. From this spring the malformations of the body, the congenital neevi, crus- tae lactese, worms, glandular swellings, rickets, preternatural defor- mities of the bones, chronic diarrhoeas, catarrhs, chronic ophthalmia, phthisis, herpetic eruptions, biles, schirrus, cancers, dropsies, aneu- risms, hemorrhoids, chlorosis, nervous disorders, obstructions of the breasts, ulcers of the uterus, of the legs, &c, varicose veins, leucorr- hoeas, chronic gonorrhoeas, &c. &c. CAUSES OF DISEASE. These are three, the predisposing, the remote, and the proximate. The predisposing is that state of the system by which the individual is disposed to contract a, disease by some cause or other, which will have no effect upon a person not subject to such a state. The re- mote causes are those, the action of which on the living system de- termines the development of the malady. Homoeopathists keep in view the remote cause—it often impresses some different characteris- tics on the internal nature of the disease, and exacts particular con- siderations in the choice of the remedy designed to combat it. A diarrhoea for example, caused by cold ought not to be treated by the same remedy as one produced by a fit of colic, or unwholsome food. Inflammation of the brain is produced by various causes, and is treated by Homoeopathy by different remedies. The proximate cause is the change which takes place in the body by the action of the remote cause, and constitutes the disease itself. Homoeopathy confesses it is as impossible to know the proximate cause of disease, as to find out the cause of life in health. Thus the redness, the afflux of blood, the swelling of the tissue in the pleura and lungs, in pleurisy and pneumonia, the redness of the tunics, in gastritis, the swelling of the liver in hepatitis, &c, are only the ma- terial productions of the malady. They are no more the proximate cause than the different organic changes, which we observe in post- mortem examinations. HOMCEOPATHIC MEDICINE. Hahnemann believed that in order to appreciate fully the action of a medicine, it was necessary to make a trial of it on a healthy HOMOEOPATHY. 513 person. In this manner, with the necessary precautions, it is easy to determine what changes were wrought by its action. In order to make a trial with medicines, a healthy person was chosen, and a small dose of the substances with which the experiment was to be made, was taken, and it was repeated daily, until some sensible ef- fect was produced. Care was taken to mark the sensations, and to observe in what order and under what circumstances, they were produced. The dose of the medicine was renewed as often as the effects en- tirely ceased. During these experiments, all impressions were avoid- ed, having a tendency to disturb its action, that is, highly seasoned dishes, violent emotions, &c. &c. The same medicine was tried on persons of different ages, sexes and temperaments. It was only after these direct investigations, undertaken for the purpose of ascertaining its virtues, that a medicine was employed by Homoeopathia in dis- ease, and took its place in the Materia Medica. The medicines composing the Materia Medica Homoeopathia are about two hundred in number. PREPARATION OF HOMfEOPATHIC MEDICINES. One grain of a medicinal substance is triturated with the third part of one hundred grains of pure and dry sugar of milk for a quarter of an hour; to this mass, the remaining two-thirds of sugar of milk are then added, half at a time, and each part triturated for a quarter of an hour. Again, one grain of this mixture containing the hundredth part of a grain of the medicine is triturated with ninety- nine grains of fresh sugar of milk in the same manner as before, with the grain of the pure medicine. Every grain of this second tritura- tion will contain Tv.fanr of a grain of the medicine. Another grain of this preparation is taken, and the trituration repeated with ninety- nine grains of a new portion of the sugar of milk. Every grain of this third preparation will contain 7,7^^7 of a grain of the medi- cine. Now a grain of this last trituration is added to ninety-nine drops of alcohol, or distilled water, and strongly shaken twice. Every drop of this mixture contains T^,i>ta,tf*i>- 65 CHEONO-THEHMAL SYSTEM. The author of this system is Dr. Dickson of London. Our limits forbid giving any thing more than merely an outline. Its principal feature is the intermittency of all diseased action— that all diseases have their intermissions, or periods of immunity from suffering, more or less complete. And the remedies most suc- cessful in their cure are the identical agents employed in the treat- ment of intennittent fever—that ague is the type of all disease. Not that every disease is an ague and nothing more. A canoe (says Dickson) is the model of all sea-vessels—the type of every brig, barque, frigate, sloop, nautically termed ship. But a ship is a canoe and something more—a canoe enlarged and variously modified. There is unity of type, with variety of development—simplicity of principle with various modifications of form. The actions of life in health are all periodic—the actions of disease are periodic also. The remedies most influential in preventing the return of an ague fit are: quinine, arsenic, opium, prussic acid, iron, silver, copper, &c. &c. These are most effective when taken during the intermission. From the relation which their influence bears to time and temperature (cold and heat) they have been termed chrono-thermal—yj»nt time— £«ftM<* heat or temperature. The principle upon which the above mentioned articles cure and cause disease is one and the same, namely, their power of electrically altering the motive state of cer- tain parts of the body, and of changing at the same time their ther- mal conditions. These remedies are all of great efficacy; but some of thern more so than others, less with reference to the disorder, and its cause, than to the constitution, or peculiarity of system of indi- vidual patients. How conflicting (says the author of this system) are the views expressed by practitioners in reference to the effects of various medicines. By some, a particular remedy is extolled—by others it is denounced. These conflicting opinions are easily ex- plained. The difference of action of the same remedy at different times, depends upon certain electrical conditions of the brain. Remedies are valuable or not in proportion as they are capable of electrically or galvanically affecting temperature or motion—change in one never taking place without the other. The causes of disease can only affect the body through the nervous system. No disease CHRONO-THERMAL SYSTEM. 515 can arise independent of this—no disease can be cured without it. Let the nerves of a part be paralysed and the most potent agents cease to exert their wonted influence over the parts supplied by such nerves. Divide the pneumo-gastric nerves of a living dog, and arsenic loses its accustomed effect on the lungs and stomach. Is not this one of many proofs that an external agent can only influence internal parts, by means of its electric power over the nerves con- nected with, or leading to those parts? Through the same medium and in the same manner, do the greater number of the chrono-thermal remedies exert their salutary influence on the human frame. All these forces act by attraction or repulsion. The brain and spinal column are the nervous centres through which, every medicine tells, and many are the avenues through which, these centres may be approached. Assimilation, secretion, absorption, the change of the matter of one organ into another, of the fluids and solids, and of solids into fluids, are (says Dickson) operatives of vital chemistry, and the brain and nervous system are electric apparatus by which these operations are effected. Let a bone or tendon be fractured, and they are reunited by the result of secretion under the influence of this electricity through the nerves supplying those parts. If, during childhood, the great nerve of a limb be paralysed, the growth of that limb is arrested in breadth and length. Nerves are the moving powers, destroy them, and all vital action ceases. The following is a summary of all the chrono-thermal doctrines: 1st. The phenomena of perfect health consists in a regular series of alternate motions, or events, each embracing a special period of time. 2d. Disease under all its modifications is in the first place, a sim- ple exaggeration or diminution of the amount of the same motions and being universally alternative with a period of comparative health, strictly speaking resolves itself into fever—remittent, or intermittent, chronic or acute—every kind of structural disorganization, from tooth decay to pulmonary consumption. 3d. The tendency to disorganization usually denominated acute or inflammatory, differs from the chronic or scrophulous in the mere amount of motion and temperature; acute diseases being more re- markably distinguished by excess of both, exhibit a more rapid pro- gress to decomposition or cure; while chronic diseases approach their terminations by less obvious alternations of the same action and temperature. The principles of the chrono-thermal system are few and simple: First. Fever remittent or intermittent comprehends every shade which disorder can assume. Secondly. That the treatment of eveiy disease is to be conformed to that of intermittent fever. Thirdly. That attention to temperature is the end to all medicine. 516 CHRONO-THERMAL SYSTEM. Fourthly. That blood-letting may be dispensed with in nearly all diseases, even in apoplexy. The sum of this system appears to be this: that the movements of all animal bodies—the greater and the less—the atomic, the func- tional, and the organic—whether in health or disease—disease how- ever caused, like all the movements of all the systems, minor and major of the universe at large—are equally intermittent and periodic ; and that there can no more be a continuous disease (that is a disease without an intermission) than there can be an eternal earthquake, or an eternal tempest. It was Samuel Dickson who first established the periodicity of all animal movement—that look when you will— above—below—beneath—around—in the tempest and whirlwind— on sea or land—in heaven above or on earth beneath—in animals and in man—in health and in disease—the face of all things bears the impression of this same great, uniform, universal characteristic of periodicity—that life in health is really a " fitful fever "—a thing of alternate motion and rest—alternate chill and heat, depression and excitement—and that intermittent fever is the model or type of all the movements of life, called disease—that all medicinal agents in nature cause, and cure by their electric influence solely—in one case electrically producing—in another electrically reversing every mor- bid, motive condition of the body—that whether opium produce sleep or wakefulness—whether copaivi relieve or aggravate discharges— that whether prussic acid or strychnine cause or relieve paralysis and spasms depends upon the positive or negative electrical state of the brain of the individual patient. Samuel Dickson was the man who waived his magic wand over the chaotic mass, and brought harmony and beauty out of disorder and confusion! 'Twas he that first breathed upon the irregular and jumbled materials, and part came to his part—portion to kindred portion, till a beautiful array of facts is presented in all the symmetry and proportions of truth! He it was who first touched and retouched the shapeless marble, till forth appeared one by one, the glowing features of the perfect statue !• * In giving the above brief summary we have as much as possible confined ourselves to Dickson's own language. MATEMA MEDICA. Life's lowest, but far greatest, sphere I sing, Of all things that adorn the gaudy spring; Such as in deserts live, whom, unconfined, None but the simple laws of nature bind; And those who, growing tame by human care, The well-bred citizens of gardens are ; Those that aspire to Sol, their sire's bright face, Or stoop into their mother Earth's embrace; Such as drink streams, or wells, or those dry fed Who have Jove only for their Ganymede; And all that Solomon's lost work of old (Ah! fatal loss!) so wisely did unfold. Though I the oak's vivacious age should live, I ne'er to all their names in verse could give.—Cowley. " How wonderful are thy works, O Lord! in wisdom hast thou made them all: the earth is full of thy riches." In all parts of these his Glorious Works, in their admirable fitness to one another, and their constant subserviency to the good of all, we behold the Wisdom and Goodness of the Great Creator. But in no department of his works do mingled wisdom and good- ness shine with greater lustre than in the vegetable kingdom. There is scarcely a plant that greens the fields, a flower that gems the pas- ture, a shrub that tufts the garden, or a tree that shades the earth, which does not contain certain medicinal virtues, to remove our pains and to heal our diseases. The American continent, though the last found, is not the least favoured of God in this respect. Embracing almost every clime and soil of the globe, it richly abounds with drugs of every healing quality. The common saying, that every country contains the best cures for its own diseases, seems fully verified in America. Here, above all countries, is the ague, and here, exclusively, is the grand cure, the Peruvian bark tree, or dogwood. And here too, exclusively, is found the Spanish fly, the tobacco, the Jamestown weed, the pink and snake roots, besides those other valuable plants, equal to the ipecacuanha, rhubarb, jalap, &c. &c, which have hitherto been im- 518 materia medica. ported at a great expense, though not always genuine; but which may now be obtained in our own fields and woods, both unadulte- rated and cheap. Worthy of the high character of Americans, many gentlemen of the finest genius among us have explored the medical treasures of our country, and have shown an eagerness to make known the pre- cious means to preserve the health and lives of our citizens. First on the list of this noble band of philanthropists stood that bright lite- rary and professional genius, the late Professor Barton, from whose " Collections towards a Materia Medica of the United States," much valuable matter has been selected. If by the laws of Rome, " a civic crown was adjudged to the man who saved the life of a citizen," what eulogy is sufficiently great to be attached to the memory of him who, besides illuminating several other walks of ornamental and useful knowledge, has by investigating the virtues of our native vegetables, laid the foundation whereby millions of our worthy citizens may be rescued from an untimely death. Professor Chapman, succeeding the lamented Barton as teacher of Materia Medica, gave additional interest to the studies connected with his department, and by the application of his powerful talents to the acquisition of appropriate learning and discovery, has made a handsome accession to the stock of knowledge before extant. In the chair of Materia Medica, this accomplished teacher displayed advantageously those happy qualities which have since secured to him the post he now enjoys, professor of the theory and practice of physic, &c. Professor Bigelow of Harvard University, and Elliott of South Carolina, have since communicated to the world the results of their valuable scientific labours in a series of interesting lectures and ela- borate publications. Much is due also to Professors Dexter, Mitchell, Hosack, Cox, Baker, Caldwell, and to Doctors Mease, Cutler, Thatcher, &c. From the valuable discoveries, and communications of these gen- tlemen, I have, with great industry and care, compiled an Ameri- can Materia Medica, exhibiting, in alphabetical order, the names, characters, and qualities of our best medicinal plants hitherto dis- covered, together with the diseases they suit, and their proper doses, and forms of administration; the whole stripped of technical terms, and making, as I humbly hope, one of the most complete systems for family use now extant. AGARIC. See Touchwood. AGRIMONY, Agrimonia—Grows two or three feet high, in hedges and the margins of fields—blossoms in July on long spikes, materia medica. 519 yellow. It is known by the vulgar name of cuckold, from the seeds sticking to the clothes in the fall of the year. In whey or tea it forms a good drink in fevers. The juice of this plant, or a strong infusion of the roots, two hands full to a quart of boiling water, and sweetened with honey, is an excellent medicine in the jaundice, scurvy, and habitual diarrhoea or looseness. Dose of the infusion half a pint; of the juice a wine-glass full three times a-day. The herb has been applied externally to fresh wounds. ALDER, BLACK, Alnus Nigra—Sometimes called Virginia winterberry, grows in most places, generally sending up several slen- der stalks to the height of ten feet, and bears a red berry. The bark is tonic, and accordingly is used in substance, or in strong decoction, like the Peruvian bark, in intermittents, and other cases of debility, as dropsy, gangrene, &c. The inner bark in the shape of poultice externally, with the decoction internally, a handful or two boiled slowly in three pints of water to a quart, is celebrated both by Professor Barton and Dr. Mease, as of admirable use in arresting the progress of mortification. A strong decoction of the berries formed into a syrup with molasses in doses of a wine-glass full, or two tea-spoons full of the powder of the inner bark, is said to be a good purge. Dr. Thatcher recommends a decoction or infusion of the bark taken internally in doses of a tea-cupful, and employed also as a wash, for the cure of cutaneous eruptions, particularly of the her- petic kind. ALEXANDER.- See Parsley, Wild. ALUM ROOT, Heuchera Americana—Called also American Sanicle. The root is a very intense astringent. It is the basis of a powder which has lately acquired some reputation in the cure of cancer. Professor Barton observes that he does not believe that the alum root has cured genuine cancer; but that it has proved very beneficial in obstinate ulcers which have been mistaken for cancers. He says it is one of the articles in the Materia Medica of our In- dians, the powdered root of which they apply to wounds, ulcers, and cancers. ANGELICA, Angelica—Grows in marshy woods and hedges, flowering in June and July. It is frequently cultivated in our gardens. Every part of this useful vegetable partakes of its aromatic virtues, but especially the root, which, in the form of powder, tincture or tea, is useful in flatulent colics. Conjoined with dogwood bark, or any other tonic, it may, like the Peruvian bark, be employed with advantage in intermittents and low stages of fever. The dose, one tea-spoonful, in substance, of the former to two of the latter. It 520 materia medica. may also be employed in the form of strong decoction, in doses of a gill, or in cold phlegmatic habits, in tincture, either alone, or with dogwood berries, centaury, lemon peel, or any other articles of the bitter and tonic class. A strong decoction of the root, combined with red oak bark, a large handful of each to a pint of boiling water, makes an admirable gargle for relaxed and spongy gums, and ulce- rated sore throat. APPLE, PERU. See Thorn Apple. ARBUTUS. See Bearberry. ARROW ROOT, Maranta Arundinacea—Is cultivated in the southern states. A table-spoonful makes a pint of the finest jelly in nature, which affords the most nutritious food in acute diseases for children. To persons labouring under bowel complaints, as diarrhoea and dysentery, it is of itself a remedy. The jelly is made in the following manner:—To a table-spoonful of the powdered root, add as much cold water as will make it into a thin paste, and then pour on boiling water through the spout of a kettle, stirring it at the same time briskly, till it becomes a clear jelly; after which, season it with sugar and nutmeg, and, to render it still more palatable, a little wine or lemon juice may be added. But, to children, blending it with new milk is best. ASARABACCA SWAMP, Asarum—Grows in low lands. It has but two leaves, which rise immediately from the root, and divide from one stem. The flowers are purple and bell-shaped, and pro- ceed from between the leaves. The whole of this plant has a nauseous bitter taste.—The root, from a half to a table-spoonful in powder, operates both upwards and downwards. In the form of infusion, a half-handful to a quart of boiling water, is said to be serviceable in the whooping-cough, in doses of a table-spoonful to children every half hour, or oftener, un- til it vomits; and in doses of a tea-cupful three times a-day, it has been used with success to promote the menses, or courses. AVENS COMMON, Geum Urbanum— Grows a foot high by fences and borders of fields. The blossoms are white or yellowish in July. Its smell resembles that of cloves. A strong tincture of the root, two hands full, steeped in a quart of spirits, given to the quantity of a half wine-glassful or the powder, in doses of a tea-spoonful, several times a-day, has afforded an ex- cellent remedy in intermittents and other disorders where strength- ening medicines are requisite. It is said to be equal to the Peruvian bark. There is another variety of this plant, called water avens, throat root, cure all, "which is to be found in boggy meadows. The bios- MATERIA MEDICA. 521 soms are purplish, and appear in May. Its properties are the same as the preceding. A decoction of it has been found beneficial as a gargle in ulcerated sore throats, which probably gave rise to the name of throat root, or throat wort. BACK-ACHE BRAKE. See Fern Female. BALM, Melissa Officinilas—Makes an excellent tea in fevers, and when sweetened, and acidulated with the juice of lemons or cream of tartar, forms a most grateful beverage. BARBERRY, Berberis Vulgaris—Grows along the sides of roads in hedges;—leaves oblong, tender, and subject to the rust; the flowers are in clusters: the fruit oblong, and acid, the stem is de- fended by three thorns. A double handful of the berries boiled in three quarts of water to two, and given in doses of a tea-cupful four or five times a-day, sweetened with white sugar, is extolled as a remedy in diarrhoea, dysentery, and jaundice. BASTARD IPECACUANHA. See Ipecacuanha American. BAYBERRY, Myrica Cerifera Humilis—Called also Dwarf- Candleberry Myrtle, grows in swamps to the height of two or three feet, and bears numerous green berries, of which tallow is made. The bark of the root has been considered a good remedy for the jaundice. The powder of it, in doses of twenty or thirty grains, has been employed as a mild emetic. The inner bark, in poultice, ap- plied morning and evening to scrofulous swellings, and drinking a tea-cupful of a strong infusion of the leaves, is said to have wrought surprising cures in a few weeks. BEARBERRY, Arbutas Uva Ursi—BeaYs whortleberry—wild cranberry. Is a low evergreen shrub, somewhat resembling the myrtle. The leaves have a bitter astringent taste, and,unquestionably pos- sess great medical virtues, especially in relieving the irritation of the stone, gravel, and old cases of gonorrhoea, menstrual discharges, also catarrhs and consumptions. The dose—half a pint, twice or thrice a-day, of a decoction made of the leaves, a handful to a pint, or a tea-spoonful in substance, two or three times a-day. BEECH DROPS. See Broomrape Virginia. BENNE, Se Samum Orientate—Is now cultivated in South Carolina and Georgia. The leaves by infusion afford an excellent 66 522 MATERIA MEDICA. mucilaginous drink, which is used with manifest advantage in dys- entery, diarrhoea, and cholera infantum. The seeds yield a pure and pleasant oil, which in doses from one to two wine-glasses full, acts well on the bowels. It is now gene- rally used at the tables of the wealthy, and from the specimen I had of it at the table of my honourable friend Governor Milledge, near Augusta, I consider it equal to the best Florence or salad oil. BETH ROOT, Trillium Rhumboydum—Grows in meadows, about a foot high—the leaves oval, three at the top of each stalk, one flowrer of a purple colour, bell-shaped, producing a small berry, that contains the seed—the root of a brown colour externally, bul- bous and full of small fibres. The powder of the root, in doses, of one tea-spoonful three or four times a-day, is said to be exceedingly useful in spitting of blood, im- moderate discbarge of the menses, or in cases of discharging bloody urine. It is also said to be a good application, in the form of poul- tice, to putrid ulcers, and to obviate gangrene or mortification. BIND WEED. See Potato, Wild. BITTER-SWEET. See Nightshade, Woody. BLACKBERRY, or DEWBERRY.—These, though different in name, are nearly, if not entirely, the same in nature. They both bear the same kind of berry, which, when ripe, is pleasant and wholesome. The roots of these vines, but especially of the dewberry, are fa- mous as astringents. From my own observation in practice, two hands full of the clear root in three pints of milk or water boiled to a quart, and given in doses of a tea-cupful every two or three hours, has often cured obstinate diarrhoea and dysentery, when the best medicines of the shop have failed. BLACK SNAKE ROOT. See Virginia Snake Root. BLAZING STAR. See Devil's Bit. BLOOD ROOT, Sanguinaria Canadensis—Has a variety of names, as Red Root, Puccoon, Indian Paint, Turmeric. It grows about a foot high in rich woodlands, and flowers in April. The leaves are roundish and deep indented; somewhat like the white oak leaves—stems naked, supporting single flowers; blossoms white. When the fresh root, which is about the size of the little finger, and blood red, is broken, a juice issues in large drops resembling blood. According to Dr. Downie, the root in powder, from twenty to thirty grains, is strongly emetic. Professor Barton considers it nearly MATERIA MEDICA. 523 equal to the Seneca or rattle-snake root in cases of ulcerous sore throat, croup and hives, and other similar affections. Professor Dexter celebrates it in doses of one grain of the powdered root, or ten drops of the tincture, every two or three hours, as an excellent diaphoretic in colds, or pleurisies, rheumatism, and other inflamma- tory complaints. A tincture may be prepared by steeping a handful of the root sliced in half a pint of spirits. It may also be exhibited in the form of decoction, a handful to a quart of boiling water, and a table-spoon- ful for a dose every two or three hours. The blood root is considered the chief ingredient of the quack medicine known by the name of Rawson's bitters; recommended as a remedy for the jaundice. The juice of the root is said to be good for destroying warts. To Professor Smith, of Hanover, N H., the world is indebted for the discovery that this plant, used as a powder and snuffed up the nose, is a certain cure for the polypus. Professor Smith also found it of great use in the incipient stages of pulmonary consumption, given in large and repeated doses, and in cases of great irritation it was combined with opium. Professor Ives, of New Haven, considers the Blood Root as a remedy in many diseases of the lungs and liver. He observes, that in typhoid pneumonia, " in plethoric constitutions, when respiration is very difficult, and the cheeks and hands become livid, the pulse full, soft, vibrating and easily compressed, the Blood Root has done more to obviate the symptoms and remove the disease," than any remedy which has been used. He infuses from a scruple to half a drachm of the powdered root in half a gill of hot water, and gives one or two tea-spoonsful every half hour, in urgent cases. This treatment has often removed the symptoms in a few hours. Dr. Ives thinks highly of its use in influenza, in consumption, and particularly in whooping-cough. He also states that, given in large doses, sufficient to produce vomiting, it often removes the croup, if administered in the first stages. "It has been given," he remarks, " for many years, in the country; some physicians relying wholly on this remedy for the cure of the croup." Dr. Macbride of Charleston, S. C, has found the Blood Root use- ful in Hydrothorax, given in doses of sixty djrops, thrice a-day, and increased till nausea followed each dose. He also used it with ad- vantage, in torpor of the liver, attended with colic and yellowness of the skin, a disease common in southern climates. BLOODWORT STRIPED, Lapathum Sanguineum Ru- brum—Grows six or seven inches high, on the sides of banks and in upland woods. Out of the top of the stalk, which is small and bare of leaves, grow small purple flowers, which turn into husks that contain the seed. The leaves, three or four in number, lie flat upon the ground, are hairy, and full of red winding veins; the root small, tough, and fibrous. 524 MATERIA MEDICA. An infusion of this plant, a handful to a quart of boiling water, in doses of a tea-cupful every three hours, is said to be useful in re- straining immoderate flowing of the menses, and all other hemorr- hages. A strong decoction of the roots with half the quantity of sugar or honey, and formed into a syrup in doses of a table spoonful every hour or two, is beneficial in consumptions or violent coughs. The expressed juice, in doses of a wine glassful, and the leaves bruised, and frequently applied to the wound from a snake, or any venomous insect, is said to eradicate the poison. BLUE CARDINAL FLOWERS. See Lobelia. BONE-SET. See Thoroughwort. BOWMAN'S ROOT. See Indian Physic. BOXWOOD. See Dogwood. BROOMRAPE VIRGINIA, Orobanche Virginiana—Grows from Canada to Georgia, and rises six or eight inches- high, of a brown colour, brittle sprigs, but no leaves; the root is bulbous. It is generally found under the shade of the American beech tree, hence it is sometimes called beech drops, but more generally cancer root. Every part of this plant is considerably astringent, and along with the astringency, especially in the recent plant, there is combined a peculiar and extremely nauseous bitterness. It has been celebrated as a remedy in dysentery, but its principal reputation is in cancerous affections. It is supposed this formed part of the celebrated cancer powder of Dr. Hugh Martin, whose success in the management of many cases of this dreadful disease, has been acknowledged by the regular practitioners of Philadelphia. It is certain, says Professor Barton, that the powder of cancer root has been of great service, externally applied to obstinate ulcers, some of which had resisted all the ordinary applications. The fresh-bruised root has also been applied with good effects to cancerous sores. In the form of decoction it has been found useful as a wash to gallings in warm weather, or excoriation of the skin. It is also esteemed a good application in cases of St. Anthony's Fire. BUCK THORN, Spina Cervina—Grows in hedges. It is a prickly bush; which flowers in June,and produces in the fall a round black berry containing four seeds. Equal parts of the expressed juice of the berries and molasses, 01 half the quantity of sugar, with a little calamus or ginger, formed into a syrup by a gentle fire, is said to be a good purgative medicine in doses of a large wine glassful, and is much used in the cure of dropsies. MATERIA MEDICA. 525 BURDOCK, Arctium Lappa—Grows on the road-side, on rub- bish and ditch banks, bearing purplish blossoms in July and August. The juice of the fresh leaves, or an infusion or decoction of the roots, operates gently on the bowels, sweetens the blood, promotes sweat and urine, and is esteemed serviceable in scorbutic, rheumatic, and venereal disorders. The juice is given in doses of a wine glass- ful, and the decoction half a pint three times a day. BURNET SAXIFRAGE, Pimpinella—Grows about a foot high. The leaves are variously shaped, flowers in September; the seeds are furred and egg-shaped. The root, in the form of decoction, a handful to a quart of water, is esteemed by some a useful medicine in asthma, coughs, and ob- structions of the menses, in doses of a wine glassful twice or thrice a-day, sweetened. BUTTERFLY WEED. See Pleurisy Root. BUTTER-NUT. See Walnut, White. BUTTON SNAKE ROOT.—" The button snake root grows in South Carolina and Georgia, in poor pine land, the root bulbous, with numerous fibres, of a pungent nitrous taste; the leaves or blades long, narrow, pointed, and saw-edged. A stalk shoots up in autumn, to the height of three feet, bearing globular prickly flowers, of an ash colour, which, from a fancied resemblance to buttons of an old fashion, gives it its name. " This root is a. powerful sudorific ; but, in cases of gangrene and foul ulcers, is, perhaps, superior to any thing yet discovered. The mode of applying it, is in the form of poultice, by boiling it soft."* * For the above I am indebted to my honest, but unfortunately too credulous friend, Paul Hamilton, Esq., formerly Secretary of the Navy, whose zeal and success in exploring the virtues of our indigenous plants can never be suffi- ciently applauded. For these and many other patriotic virtues, a kind Provi- dence was pleased to raise him up a son as disinterested and public spirited as himself; I mean that extraordinary youth, Lieutenant Archibald Hamilton, who, in defence of his country, went forth in the early period of fife to meet the veteran tars of Great Britain. He was a midshipman on board the United States • frigate, when after a short action she captured the British frigate, Macedonian. His activity and valour in that brilliant affair were so conspicuous, that the gallant Decatur assigned to him the honourable and pleasing duty of bearing the British co- lours to the seat of government. With uncommonly good fortune he had ar- rived at Washington on the very evening that the President and his lady, with die heads of departments, at a splendid ball, were celebrating this glorious victorv. I had the pleasure to be one of the party, and never shall I forget the looks of his venerable father, his most amiable mother, and charming sisters, when this blooming young warrior was ushered into the crowded ball room, with the trophies of American valour. The joy manifested on this occasion was not confined to his relations alone; for it was to be seen in the counte- nance of every one present, but more especially in the young females, who. 526 MATERIA MEDICA. CALICO TREE,Kalmia Latifolia—Broad-leafed laurel; called also winter green; grows seven or eight feet high in swamps and moist rocky pastures; blossoms are white, tinged With red in June or July. There is another species, Kalmia Augustifolia, narrow- leafed or dwarf laurel, called also ivy, lambkill; blossoms reddish, variegated. A decoction of the plant externally applied has often cured the itch; but, like all other poisons, it should be used with great caution. An ointment, made by simmering the leaves in hog's lard, is good for the scald head and obstinate sores. According to Dr. George G. Thomas, an obstinate diarrhoea has been cured, by the decoction made from an ounce of the leaves in half a pint of water, boiled to half, and thirty drops three or four times a-day. In this form it has also been used internally with great success in the scald head. CALAMUS, OR SWEET FLAG, Acorus Calamus—Grows in marshy situations, and in shallow water, and may be known by the long sword-shaped leaves, resembling those of the blue and yellow flags, but narrower, and of a brighter green. The root is like that of the blue flag in appearance, but has a strong aromatic smell, and a warm pungent taste. The flavour is greatly improved by drying. The root possesses stomach virtues, and is frequently grated into water, and given to children for flatulent colics, free of fever. It is sometimes used as an ingredient with dogwood, cherry bark, cen- taury, &c, in morning bitters, as a preventive of the ague in low marshy situations. CAMOMILE, Chamosmelum—Grows well in our gardens. An infusion, or tea, made of the flowers, is excellent to warm and strengthen the stomach in cases of indigestion, loss of appetite, and other complaints arising from debility. It is also of great use in doses of a tea-cupful three times a-day, as a preventive to ague and fever, and bilious fever in sickly situations. In the form of fomen- tation and poultice it is serviceable in discussing hard tumours. as was very natural to suppose, from his unassuming and graceful deportment, could not conceal the tender emotions of their hearts. To the honour of the President, this modest and amiable youth was soon after promoted to a lieutenancy. He followed the fortunes of Commodore Decatur, when he shifted his flag from the United States to the President; and was with this intrepid officer when in that single frigate he endeavoured to fight his way through a British squadron. In this most unequal conflict the President was overpowered, but not until she had completely silenced one of the hostile frigates. By the last shot that was fired from the enemy, the gal- lant young Hamilton was killed. To say he was brave to the height of that heroism which has raised the in- fant navy of his country to be the admiration of the world, is to say but half his praise. The far nobler praise was his, of having rendered himself the idol of his brother officers, and his numerous relations and friends—to all of whom he has bequeathed the inexpressible pleasure of attaching to his memory every thing that was amiable and good. MATERIA MEDICA. 527 CAMOMILE, WILD. See Mayweed. CANCER ROOT. See Broomrape Virginia. CANDLE-BERRY MYRTLE. See Bayberry. CARAWAY, Carum, Carui—A choice aromatic; grows kindly in our gardens. The seeds assist digestion, strengthen the stomach, and are serviceable in flatulent colics. The dose of the seeds in powder, from one to two tea-spoons full to adults. CARROT, WILD, Daucus Carato.—The wild carrot grows two or three feet high in meadows and swamps, and flowers in July. The seeds have an agreeable aromatic smell, and in a slight degree, a warm pungent taste. An ounce or half a handful of the seeds infused in a pint of water, and taken in doses of a tea-cupful every hour or two, is said to give immediate relief in suppression of urine, and is also serviceable in promoting the menses. The roots of the carrot cultivated in our gardens, beaten to a pulp, form an excellent application to cancerous and other ill-conditioned ulcers, allaying the pain, checking the suppuration and fetid smell," and softening the callous edges. A marmalade of carrots, on ac- count of their strong and antiseptic qualities, has been successfully used for preventing and curing the sea scurvy. An infusion of these roots has also been found useful in gravel complaints. CASTOR OIL, Ricinus Communis—Flourishes well among us. The kernels yield almost a fourth part of their weight in oil, which is obtained from them either by expression or decoction. Expression is the best method of preparing; but the common mode is to shell the seeds and boil them in water, and as the oil rises, to skim it off. Castor oil is a gentle and useful purgative, and is a most efficacious remedy for the colic or dry belly-ache, and also dysenteries, in doses of a wine-glassful every two or three hours until it operates. In doses of a tea-spoonful, it is the most suitable purge, when not ran- cid, to expel the meconium from new-born infants. CAT-GUT, or GOAT'S RUE, Galega Virginiana.—\t is vul- garly called cat-gut, from the resemblance of some of its roots to the article of that name. A decoction of the roots is reputed to be an excellent medicine for destroying worms. CELANDINE, THE GREATER, Chelidonium Major— Grows about two feet high, in meadows and by running brooks, has many stalks, with larger joints than is common in other plants, very easily broken ; the leaves large and sawT-edged; the fhnvers, consist- 528 MATERIA MEDICA. ing of four leaves, are yellow; after which come long pods enclosing black seeds ; the roots long, reddish externally, and yellow within and full of yellow juice. Twenty or thirty drops of the juice, or half a tea-spoonful of the dried root in powder, in a cup of new milk, morning and night, is said to be beneficial in dropsy, green sickness, and cutaneous erup- tions. The juice rubbed on warts, ring and tetter worms, effectually cures them. A poultice made of this plant boiled in milk, or the roots roasted, and mashed in vinegar, is extolled by some as an ex- cellent application to disperse scrofulous tumours on the neck. CENTAURY, Centaurium, minor—Is a fine stomach bitter, and either in a simple infusion, or united with calamus or angelica root, is excellent in relaxations of the stomach and general debility. CHERRY TREE, WILD, Prunus Cerasus Virginiana.—The bark of this tree is an excellent substitute for the Peruvian bark. I have myself frequently employed it in the cure of ague and fever, bilious fever, and other diseases where tonic medicines were proper. In intermittents of long standing, I have found it more efficacious when united with the Virginia snake root, in the proportion of one part of the latter to four of the former. It may be employed, either in powder, or decoction in the same doses as the Peruvian bark. A strong infusion of it in sound cider, is said to be useful in the jaun- dice. A decoction of the bark will be found a good wash to ill-con- ditioned ulcers. The cherry of the tree, when ripe in autumn, is much used in the southern states, for making bounce and cordial.— The gum of the common cherry tree is a good substitute for the gum Arabic. CHICK-WEED, RED, Annagallis Phenicea—Cslled also red pimpernel, guach-hul—is cultivated in many gardens, and grows spontaneously near Baltimore and Havre de Grace. According to the deposition of Valentine Kettiring to the Legisla- ture of Pennsylvania, and report made by their committee, the red chick-weed is a specific in that most dreadful of all diseases the hydrophobia, or bite of a mad dog. The dose for an adult is a small table-spoonful of the dried leaves in powder. For beasts the dose is much larger. CINQJJEFOIL, Potentilla Reptans—Grows on pasture grounds, and is something similar to strawberry. The stalks trail along the ground, and have but five leaves on each stalk, placed together, of an equal size, and bear a yellow flower. The whole of the plant, particularly the root, in the fonn of de- coction, a handful to a quart of water, or milk, boiled slowly, and sweetened with loaf sugar, is recommended as a remedy for the dysentery and bowel complaints. The dose for adults is a tea cup- MATERIA MEDICA. 529 ful three or four times a-day, and one third or half the quantity for children. CLEAVERS. See Goose Grass. COCUM. See Pokeweed. COCK-UP-HAT, OR YAU WEED, Stillingia—Grows on the high dry lands of the southern states, and is much used there as a cathartic medicine. It is employed in the cure of that hideous disease, the yaws, and is said to be a specific in the venereal disease. COHUSH, OR PAPOOSE ROOT, Caulophyllum Thalictro- ides—Grows about two feet high, in low, moist, rich grounds, near running streams, and on islands that have been overflowed. The leaves grow on small stalks near the top of the stem, which resem- bles the hand and fingers. The flowers are of a pale blue colour, which yield a berry something like grapes. The root is composed of many fibres, and is crooked, resembling the rattle snake root. An infusion of the root, a handful to a quart of boiling water, in doses of a tea-cupful three or four times a-day, or the same quantity steeped in a quart of spirits, in doses of a wine glassful twice or thrice a-day is highly extolled by the country people as a remedy for the rheumatism, and serviceable in cases of obstruction of the menses and dropsical complaints. COLT'S FOOT, Tussilago Farfara—Grows about eight inches high, in moist .situations, producing yellow flowers, early in the spring, which appear before the leaves. These are soon succeeded by large roundish leaves, which have a bitter mucilaginous taste. It is said a decoction of the leaves and flowers, two hands full to a quart of water, with or without milk, taken freely, is serviceable in coughs, consumptions, diarrhoea, and dropsical complaints. The leaves, finely powdered, and used as snuff removes giddiness and obstructions of the head. COLUMBO AMERICAN, Columba Americana—Crows plenti- fully in die western country, in the vicinity of the Ohio river; and. from abundant experiments, is found fully equal to the imported. It has long been esteemed a powerful antiseptic and tonic; and as such, has been employed with manifest advantage in gangrene. cholera morbus, bilious vomiting, or purging, bilious fever, indiges- tion, want of appetite, &c It may be given in powder, in doses of a small tea-spoonful every three or four hours, or in decoction, in doses of a tea-cupful. Two or three ounces or the root, steeped in a quart of spirit, forms an excellent bitter; which, when taken in mint water, or infusion of orange peel, in doses of a table-spoonful, is excellent for moderating the retching in pregnant woman. 67 530 MATERIA MEDICA. COMFREY, Consolida—Grows about two feet high in moist situations near springs, but is cultivated in our gardens. The leaves are large, similar to water dock, flowers of a pale blue colour; the roots long, rather thicker than a man's finger, mucilaginous, and black externally, but white within. A handful of the roots boiled in milk, and given in doses of a tea- cupful three or four times a-day, is a popular remedy in dysentery, bowel complaints, and the fluor albus, or whites. It is also bene- ficial as a diet drink in the clap, or in other cases attended with a burning heat in making water. CORIANDER, Coriandrum—Is cultivated in our gardens. The seeds are warm, and of a pleasant flavour, and in doses of a tea to a table-spoonful, have been found useful in cases of indiges- tion and flatulence. When mixed with senna, they more effectually correct the odour and taste of the infusion, than any other aromatic. They also form an excellent addition to ingredients for bitters. COW PARSNIP, Heracleum Spondylium—Is found in hedges, meadows, and pastures ; but should be carefully distinguished from the hemlock or wild parsnip that grows in hedges, and is poisonous. According to Dr. Orne of Salem, it has been often used with success in epilepsy, especially in cases of indigestion with flatulence. The dose is three drachms of the powdered root, taken daily, and a strong infusion of the leaves and tops drank at bed-time. CRANE'S BILL, Geranium Maculatum—Improperly called by some crow foot. It grows five or six inches high in meadows and woods; has long slender stalks, with seven long narrow leaves at a joint. The root is generally crooked and knotted, blackish on the outside, and reddish, has a rough taste, with an aromatic flavour. When applied externally, it is highly extolled for its styptic power, in stopping hemorrhages of wounded vessels. The powdered root, in doses of a tea-spoonful thrice or four times a-day, or a decoction in milk, used as a common drink, is said to be excellent in checking immoderate menstrual discharges, also the whites and gleets, and ob- stinate diarrhoea. The following account of the efficacy of crane's bill, as stated by Dr. Mease, in the Medical Museum, deserves the attention of the reader. The son of Mr. David Cooper, near Woodbury, partially divided the artery at the wrist with the point of a hatchet in trimming a tree; the wound bled profusely, and an aneurismatic tumour of the size of a pullet's eg'g was quickly formed. Dr. Hendry, wdio was imme- diately called, applied a tourniquet, and also a piece of flat lead to the tumour; and apprehending that, the usual operation would be necessary, requested the assistance of Dr. William Shippen from Philadelphia. On th« anival of that gentleman, the operation was MATERIA MEDICA. 531 resolved on; when the father of the young man insisted upon the trial of a vegetable remedy, which he said he had learned the use of from one of the aborigines of our country. He immediately repaired to the woods, and returned with some of the specific, which was pounded in a mortar with a little cold water, and applied to the part, and in a short time, to the great satisfaction of the sufferer and his friends, checked the bleeding. The tourniquet was left on as a pre- cautionary measure, but fortunately no occasion offered for using it. In the course of a few days the wound healed, and the young man had no farther trouble. A man in pruning a tree, divided the stout muscles of the forearm in an oblique direction; the wound was full four inches in length, and bled profusely from a large artery, and numerous smaller ves- sels. His shirt sleeves was filled with blood; for being made tight round his wrist and forearm, it prevented the blood from escaping, and forming a coagulum round the bleeding orifice, checked for a short time farther effusion. The powerful effects produced by the geranium in the former case, induced Dr. Hendry to apply it in the present; accordingly, he pro- cured some of the roots, and after washing and pounding them, filled the wound therewith : the effect upon the smaller vessels, was almost instantaneous in checking the profusion of their contents, and the bleeding in a short time entirely ceased; and although, as in the former case, the tourniquet was very properly suffered to remain, yet no occasion offered for using it. Another case occurred of a wound in the ankle from a scythe, which had bled so profusely as to cause the man to faint; but on the application of the geranium by Dr. Hendry, as above, it ceased in a short time. In the instance of a violent vomiting of blood, which had resisted a variety of remedies, an infusion of the plant in water, produced the desired effect in a few minutes. Another instance mentioned to me by Dr. H., of the astringent effect of the geranium, was that of a young man who had a most obstinate hemorrhage from the socket of a jaw-tooth, which had been extracted. An attempt was made by a physician from Philadelphia to close the bleeding orifice by burning it with a red hot needle, but without effect; on the application, however, of the geranium, the bleeding soon ceased. In consequence of the virtues of the gera- nium having been so often experienced about Woodbury in cases of hemorrhage, the inhabitants have been induced to cultivate the plant in their gardens; and it would be well if their example wrere followed by every one in the country; for though Providence has diffused the valuable plant over every part of our country, yet as it grows princi- pally in the woods, and the accident it is intended to relieve may admit of no delay, and often happens in winter, when the plant can- not be found, it should be transferred to every garden, that it may be at hand when wanted. 532 MATERIA MEDICA. CROSSWORT. See Thoroughwort. CROW FOOT, Ranunculus Bulbosus—A very acrid plant, growing in meadows and fields. The leaves or roots bruised and applied to any part of the body, will soon raise a blister, and ought to be used when the Spanish flies cannot be obtained. The roots, collected in the fall, may be very well preserved through the winter by burying them in some fine dry sand. CUCKOLD. See Agrimony. CUCKOW BREAD. See the following. CUCKOW PINT, Arum Maculatam—Also called lords and ladies, wake robin, dragon root. The leaves are generally bespan- gled with black and white spots, striped in gaudy style; whence the country people have given it the name of lords and ladies. The root is bulbous, resembling a small turnip. Both this and the leaves, in a fresh state, are extremely acrid, and have been used with advantage externally for blistering, and inter- nally in cachexies, rheumatisms, and all other complaints of cold phlegmatic habits. Of the fresh root, from ten to thirty grains may be taken thrice a-day, in the form of emulsion, which gum Arabic, or cherry tree gum. The root, which should be used fresh, may be kept so for a year, by burying it in a cellar in sand. CUCUMBER ROOT, Medeola Virginica—According to Pro- fessor Barton, is a very common plant. The root is white, and tastes a good deal like the cucumber. It possesses diuretic proper- ties, and has cured dropsies. CURE-ALL. See Avens. CURRANTS, Ribes—The white, red, and black currants, all grow luxuriantly in our gardens; and when perfectly ripe,and made with sugar and water, into the form of lemonade, serve as a most grateful and cooling drink in fevers. An infusion of the bark, sweetened with currant jelly, or honey, is an excellent gargle in sore throat, and an infusion of the young shoots is said to be beneficial in eruptive fevers. Currants afford an excellent wine; for making which, the following is an admirable recipe:— Of red or white currants, ripe, take fourteen pounds, broken into three gallons of water, and let it stand for two days, when the stalks, &c, will be at the top. Press off all the stalks, and, while straining the mixture, add twelve pounds of sugar; turn it into a cask, and keep it full enough to let the feculent matter work out—repeatedly removing it, and filling it up, until no more rise, which will be in MATERIA MEDICA. 533 about fourteen days; add to it one quart of spirits nearly tasteless, or else brandy, and bung up close, keeping it at least six months before it is bottled. Let the currants be gathered free from dew or rain; and if they be spread a day or two before they are used, they will be none the worse. Fourteen pounds will make one gallon of juice, twelve pounds of sugar another gallon; therefore, the above ingredients should be equal to five gallons, and enough to fill up with. CUSTARD APPLE, Annona Triloba—It is said to be a good purgative medicine. DANDELION, Leontodon Teraxacum—Vulgarly called piss-a- beds, grows in meadows, pastures, and road-sides and ditch-banks, with yellow flowers; which blow from April to September, and pos- sess the remarkable quality of expanding early in the morning, and closing in the evening. The root, leaves, and stalk, contain a large proportion of bittei milky juice, which, in doses of a wine-glass full twice or thrice a-day, is good in chronic inflammations of the liver, dropsies, diffi- culty of making water, and other complaints arising from obstruc- tions of the viscera. It may also be taken in the form of a strong decoction, from a gill to a half-pint, twice or thrice a-day. DEADLY NIGHTSHADE. See Nightshade, deadly. DEERBERRY. See Mountain Tea. DEVIL'S BIT, Veratrum Luteum—The root of this plant is a very pungent bitter, and is employed as a tonic, either in the form of tincture or infusion. In this last form it has been employed as a vermifuge. DEWBERRY. See Blackberry. DILL, Anetheum Graveolens—Flourishes in our gardens, pro- ducing seed delightfully aromatic, which, in doses of one or two tea-spoons full, is excellent to remove flatulent colics, and assist digestion. DOCK WATER, OR WATER DOCK, Rumex Aquaticus— Grows in wet ditches, mill-ponds, sides of rivers, and in shallow water, flowering in July and August. Half a pint of a decoction of the leaves or roots, two hands full to a quart of boiling water, or two or three tea-spoons full of the dried roots in powder, taken two or three times a-day, is an admirable medicine to sweeten and purify the blood in scurvy, scald head, tetter-worm, and other cutaneous diseases. The fresh roots bruised, and mixed with vinegar, or in strong decoction, are a good cure of 534 - MATERIA MEDICA. the ring-worm, and have often subdued that filthy complaint the itch, when quack medicines, and even sulphur, had failed. They are also worth trying in the form of a poultice to tumours, and cancerous ulcers. The curled dock, narrow and broad-leafed dock, which grow in yards and cultivated fields, are all varieties of this useful plant, and possess similar virtues. It is said the narrow-leafed dock, applied in the form of fomentation and poultice, to a cancerous sore, and from a pint to a quart of the decoction taken daily, makes a perfect cure. DOGWOOD, Cornus Florida.—The bark of this famous tree, which may well be termed the chinchona or Peruvian bark of North America, possesses, like that, all those tonic powers, which give it such admirable control over intermittents, gangrene, and all diseases proceeding from debility. From my own observation in practice I am abundantly warranted in pronouncing it generally preferable to the imported bark, which is often injured by adulteration. Like the Peruvian bark, but in somewhat larger doses, it may be used in substance or decoction, in- fusion or tincture, either alone or conjoined with snake-root, or some of the aromatics. But the shape in which it will be found most agreeable, is that of an extract; which is easily prepared by boiling the bark, straining it, and then evaporating it very slowly to the consistence of honey. To prevent the fatal effects of burning it, the vessel in which it is evaporated should be of the wide-mouth sort, placed in a large pot of boiling water, and often stirred towards the close of the operation. The dose is from a half to a whole tea-spoonful, three or four times a-day. The beautiful red berries of dogwood, combined with lemon-peel, snake-root, calamus, or any other warm aromatic seeds, form a fine bitter against the common fall complaints. DRAGON'S CLAW. See Fever Root. DRAGON ROOT. See Cuckoo Pint. ELDER COMMON, OR BLACK, Sambucus Niger—Grows to the height of a small tree, iri hedges, and along the border of meadows: the young shoots are full of pith; and the old stalks empty; flowers in July, and the berry of a blackish purple colour when ripe. The expressed juice of elder berries put into a plate, or wide- mouth vessel, and evaporated in the sun to the state of an extract, in doses from a tea to a table-spoonful, acts as a good aperient medi- cine. A tea made of the leaves, a large handful to a quart of boiling water, and taken freely, removes a costive habit, promotes perspira- tion, and thus proves useful in eruptions of the skin, St. Anthony's MATERIA MEDICA. 535 fire, colds, dropsies, and all obstructions of the viscera. The inner green bark, steeped in wine, a large handful to a pint, or made into a strong decoction, purges gently, in doses of a gill. The flowers stewed with lard, form a good ointment for burns. Elder berries also make an excellent wine, according to the fol- lowing recipe: Elder wine is made by mixing twelve gallons and a half of ripe elder berry juice, and forty-two pounds of sugar, with thirty-seven gallons and a half of water, that previously has had boiling in it six ounces of ginger, and nine ounces of pimento, bruised and strained off; and when it has nearly cooled, rather less than milk warm, add a pint of thin brewer's yeast, and let it foment for fourteen days, in the barrel, then bung up close, and bottle in six months. ELECAMPANE, Inula Helineum—Grows three or four feet high, in stony pastures, and by the road-side: flowers large and yellow, in July and August; and the root, when dry, has an agree- ble aromatic smell, and in a decoction sweetened with honey, or in the form of syrup, or a tea-spoonful of the powdered root in mo- lasses, is recommended for promoting expectoration in asthma and coughs. The fresh root in ointment or strong decoction, is said to cure the itch. ELM, AMERICAN, OR SLIPPERY, Ulmus Americana— My very learned friend, Professor Mitchell, has witnessed its good effects internally in catarrhs, pleurisies, and quinsies, and externally as a poultice for gun-shot wounds, tumours, and all ulcers and sores accompanied with irritation. A tea-spoonful of the inner bark in powder, to a quart of boiling water, or a simple infusion of the bark- in boiling water, forms an astonishingly rich jelly, which I have often tried with the happiest effects in diarrhoea and dysentery. With the addition of a little sugar, lemon juice, citron, or nutmeg, it might be made an excellent substitute for sago, or arrow root. I am indebted for this improvement to the reverend and very amiable Dr. Gant, many years chaplain to Congress, and physician to Mr. Jefferson. This learned gentleman, universally celebrated for his successful treatment of dysentery, declared to me with great candour, that he ascribed much of his reputation in that dangerous disease to this fine jelly. EMETIC WEED, OR INDIAN TOBACCO, Lobelia Infla- ta—Grows in dry fields, and rises to the height of one or two feet, with branched stems, flowering in July and August, with blown cups, filled with numerous small seeds. The blossoms are solitary, in a kind of spike, of a pale blue colour. The leaves are oblong. and have a very acrid and pungent taste, similar to that of tobacco. The leaves collected in August, while the plant is in blossom, and carefully dried and preserved, act as a speedy and excellent emetic, 536 MATERIA MEDICA. in doses from ten to twenty grains; or it may be exhibited in the form of a saturated tincture, in doses from a tea to a .table-spoonful. As it is a medicine of considerable activity, it should be given in small quantities; and the dose repeated every ten or fifteen minutes, until it excites vomiting. From its speedy operation as an emetic, there is no doubt it would be an effectual remedy for the croup and whooping-cough. In small doses it must be of great utility in con- sumptive and other coughs, by exciting expectoration. It is, how- ever, valued on account of its approaching nearer to a specific in that most distressing disease, the asthma, than any other that has been yet discovered. The following highly interesting observations from the Rev. Dr. M. Cutler, an eminent botanist, who first noticed the virtues of this plant, is related in Dr. Thatcher's American New Dispensatory. " By chewing a small portion of it, commonly not more than one of the capsules, it proves a gentle emetic. If the quantity be a little increased, it operates as ,an emetic, and then as cathartic, its effects being much the same as those of the common emetics and cathartics. " It has been my misfortune to be an asthmatic for about ten years. I have made trial of a great variety of the usual remedies, with very little benefit. In several paroxysms, I had found relief more fre- quently than from any thing else, from the skunk cabbage. The last summer I had the severest attack I ever experienced. It com- menced early in August, and continued about eight weeks. Dr. Drury, of Marblehead, also an asthmatic, had made use of a tincture of the Indian tobacco, by the advice of a friend, in a severe paroxysm early in the spring. It gave him immediate relief, and he has been entirely free from the complaint from that time. I had the tincture made of the fresh plant, and took care to have the spirit fully satu- rated, which, I think, is important. In a paroxysm, which was, perhaps, as severe as I ever experienced, the difficulty of breathing was extreme, and after it had continued a considerable time, I took a table-spoonful. In three or four minutes my breathing was as free as it ever was, but I felt no nausea at the stomach. In ten minutes I took another spoonful, which occasioned sickness. After ten minutes I took a third, which produced sensible effects upon the coats of the stomach, with moderate puking, and a kind of prickly sensation through the whole system, even to the extremities of the fingers and toes. The urinary passage was perceptibly affected with a smarting sensation in passing urine, which was probably provoked by stimulus on the bladder. But all these sensations very soon sub- sided, and a vigour seemed to be restored to the constitution; which I had not experienced for years. I have not since had a paroxysm, and only a few times some small symptoms of asthma. Besides the violent attacks, I had scarcely passed a night without more or less of it, and often so as not to be able to lie in bed. Since that time I have enjoyed as good health as perhaps before the first attack. Dr. MATERIA MEDICA. 537 Cutler states a particular case has been related to him, of an effectual cure of the hydrophobia, or bite of a mad dog in the last stage of the disease, by this plant. In a disease so formidable as this, it is cer- tainly worthy of trial." Dr. Bradstreet, of Newburyport, has given the saturated tincture in cases of dyspepsia, also in some cases of a rheumatic nature, with beneficial consequences. He considers its sensible effects to be very like those of common tobacco, but its medicinal action more speedy and diffusible, and of shorter duration. He thinks that it affects those accustomed to the use of tobacco as readily as others. The active properties of the Lobelia are readily extracted both by water and alcohol. The tinc- ture, however, is most easily kept, and is the most convenient form for exhibition. The tincture is prepared by digesting two ounces of the dried plant in a pint of diluted alcohol. A tea-spoonful given to an adult will generally produce nausea and sometimes vomiting. In certain instances, however, much larger doses have been given, without producing any other effect than a flow of saliva. ERGOT, OR SPURRED RYE, Secale Cornutum.—Rye is subject to a disease, in low wet situations, or when a hot summer succeeds a rainy spring. The spurious substance called ergot, is found projecting from among the leaves of the spike or ear; it is a long crooked excrescence resembling the spur of a cock, pointed at the extremity, of a dark brown colour externally, and white within. Some spikes are occupied wholly by spurs, while others have two or three only, interspersed with genuine seeds of rye. This extraordinary substance possesses considerable medicinal pro- perties. In lingering and laborious cases in child-bed, it acts as an invaluable medicine, speedily inducing forcible pains, and expediting delivery. It is given in the form of powder, in doses of from five to fifteen grains; but it has sometimes been found more active in the form of decoction, prepared by gently boiling thirty grains of the powder in half a pint of water, of which one-third may be taken every twenty minutes, until proper pains shall have commenced. It is proper, however, to caution the domestic practitioner against employing this powerful medicine in cases of preternatural presenta- tion, or even in every case of natural presentation. The powerful and continued efforts of the uterus, from the effects of the ergot, pre- vent the retreat of the child's head after being advanced, and the unceasing pressure, in some instances, occasioned the death of the child. Let this circumstance, therefore, have its due effect, and induce, the utmost precaution in the administration of this powerful article. This medicine has also been successfully employed in cases of obstructed menses, or monthly evacuations. (See Thatcher's Dis- pensatory.) 68 538 MATERIA MEDICA. EVERGREEN CASSINE. See South Sea Tea. FEATHERFEW, OR FEVERFEW, Matricaria Vulgaris.— It is frequently cultivated in gardens. A handful of the leaves and tops infused in a quart of water, and given in doses of a tea-cupful three or four times a-day, is used by country people to promote the menses, to strengthen the stomach, to raise the spirits, and promote perspiration in colds and fevers. FENNEL, SWEET, Fceniculum Dulce—Grows kindly in our gardens. A tea-spoonful of the seeds, with a little sugar and spirits, is a common remedy among the country people in flatulent colic. To children afflicted with the above complaint, an infusion of the seeds, sweetened, is highly serviceable. The seeds yield an aro- matic oil, which, in doses from two to twelve drops, removes flatu- lence, promotes expectoration, and is serviceable in coughs. FERN FEMALE, OR BACKACHE BRAKE—Grows near ponds, and in moist pastures, about twelve inches high. The leaves are single, winged, and about a hand's length; the root is about the size of a goose-quill, of a brown colour, very sweet, and of a muci- laginous taste. A quart of a strong decoction of the roots, and a pint of honey, formed into a syrup, by gentle simmering, and given in doses of a table-spoonful every hour or two, is esteemed highly beneficial, in all violent coughs. It is said that three parts of the roots of this plant, and one part of sumach root, boiled slowly in any kind of spirits, until it becomes slimy, and then applied warm to the spine, has frequently relieved the backache ; hence the vulgar name back- ache brake. It has also been employed as a remedy for the rickets in children. FERN MALE, Polypodium—Called also sweet fern, male poly- pody. It grows in woods and stony places, flowering from June to October. The root, when chewed, is somewhat mucilaginous and sweet, and afterwards astringent and bitter. Sweet fern in powder, in doses from one to two tea-spoons full, or a decoction, a pint a-day, followed on the fifth day with a dose of castor oil, or some purgative medicine, is esteemed a powerful medicine against worms, and particularly the tape worm. FEVER BUSH, OR WILD ALLSPICE, Demus Febris- Grows in meadows and swamps, and generally rises five or six feet high, leaves numerous and somewhat spear-shaped ; the blossoms rather of a reddish colour; the berries are blood red, and of a plea- sant smell. A handful of the twigs of this bush, infused in a quart of boiling MATERIA MEDICA. 539 water, and given in doses of a tea-cupful every hour or two, is said to be extremely cooling and beneficial in fevers. A handful or two of the berries infused in a quart of spirits, forms a pleasant bitter. FEVER ROOT, OR DRAGON'S CLAW—Grows upon moun- tains and the sides of hills; about six or seven inches high ; the leaves grow in a cluster from the top of the root; spear-shaped; blossoms yellow; the root black, about the size of cloves, very ten- der, resembling the claws of the animal whose name it bears. When it is pulverised and exposed to the air, it will liquify. The root in the form of powder in doses of a tea-spoonful or in the form of decoction, a handful to a quart of water, in doses of a tea-cupful every hour, is esteemed an excellent medicine in bilious fever, pleurisy, colds, St. Anthony's Fire, and other febrile diseases. FIG TREE, Ficus.—This tree ought more generally to be cul- tivated in our gardens, as it affords a fruit both grateful to the sto- mach, and easy of digestion, possessing also medicinal properties. A decoction of figs makes an excellent gargle for cleansing the throat and mouth ; and the fruit, externally applied to tumours, or gum biles, is good to promote suppuration. When unripe, figs, as well as the whole tree, yield an acrid milky juice, which, if taken, proves both emetic and purgative, but externally is a mild caustic: hence it is frequently used to remove warts, ring and tetter worms. FLAG, BLUE, OR WATER FLAG, Iris Pseudacoris—Grows by the brink of rivers, in swramps and meadows, blossoming in July ; flowers blue, variegated with white, yellow, and purple. The juice, in doses of a tea-spoonful, diluted with water, is said to be an active cathartic medicine, and to produce copious evacua- tions from the bowels, and to be useful in dropsy and dysentery. It produces similar effects in powder, from thirty to sixty grains, and has been employed as a vermifuge. In the form of decoction, used as a diet drink, it is greatly extolled in venereal cases. The root of the yellow flag, mixed with the food of hogs that have been bitten by a mad dog, has been known to save, when without it others have run mad. FLAG, SWEET. See Calamus. FLAX-SEED, Linum—Possesses great medicinal virtues. An infusion, or tea, is the most suitable drink for patients labouring un- der violent colds, coughs, difficulty or burning in making water. The (lax-seed syrup, which is prepared by adding a pint of honey to a quart of strong tea, and simmering it away slowly by a gentle fire for an hour, observing to take off the scum as it rises, I have found to be a most valuable medicine in diseases of the breast and lungs, 540 MATERIA MEDICA. in doses from a tea to a table-spoonful every hour or two, or oftener, when the cough is troublesome. The flax-seed bruised, also forms one of the best emollient poultices with which we are acquainted. FLEA-BANE, PHILADELPHIA, Erigeron Philadelphicum —Called, by some, skerish. It is said, by Professor Barton, to be a very common plant in many parts of the United States, and that in the form of infusion or decoction, it operates powerfully as a diuretic, and also as a sudorific. It is likewise reputed to be a good remedy for promoting the menstrual discharge. In Virginia there is a plant called pisswort, which is esteemed a powerful medicine in cases of strangury, or difficulty of urine. FLOWER DE LUCE. See Flag, Blue. FLUX ROOT. See Pleurisy Root. FOXGLOVE, Digitalis Purpurea—Has lately been cultivated in our gardens. It rises to the height of two or more feet, and its leaves are large, egg-shaped, notched like a saw, and covered with hairs. Blossoms of a beautiful purple colour, hanging downwards in a row along one side, which are compared to the fingers of a glove, and in the inside are elegantly mottled with spots like little eyes. The foxglove has been employed with advantage in those disor- ders where the frequency of the pulse requires to be abated. In the incipient stage of consumption, it has, by diminishing the circulation through the lungs, frequently succeeded in arresting the progress of the disease. It has also been advantageously employed in the second stage, but here it should be exhibited with the greatest pre- caution. The treatment of consumption with foxglove, cannot be more satisfactorily shown, than in the following practical remarks of my learned friend, Dr. John Spence, of Dumfries, Virginia, commu- nicated in that useful work, the New York Medical Repository :— " In the incipient stage of consumption, where there is considera- ble vigour of constitution, particularly if attended with active hemor- rhage from the lungs, I push the use of the digitalis cautiously, but freely ; that is, I try to reduce the pulse under sixty strokes in a minute, and maintain this depression for two or three weeks, not- withstanding there be occasionally considerable and distressing nau- sea. At the same time, I advise a milk and vegetable diet, with gentle exercise on horseback, or in a carriage, when the weather will admit, and the use of the swing-chair for an hour at a time, or twice or thrice a-day. When the pains about the chest are wandering, I also advise the repeated application of a blister, and other stimulating plasters, to the breast, and between the shoulders; but if the pain be fixed, I prefer the introduction of a seton, as near the part affected as possible. My patient is also directed to drink moderately of emol- MATERIA MEDICA. 541 lient teas, or tar-water, to be warmly clothed, to avoid cold and wet feet, and setting up late at night. All great exertions of the body, but particularly of the lungs, as singing, or speaking loudly, must also be carefully avoided. In the second or more advanced stage of this disease, accompanied with a quick pulse and great general debility, the treatment is very different, The foxglove must be so managed, as to lower the pulse, and moderate the fever, but never pushed to such an extent, as to excite nausea or sickness at the stomach. A little experience will soon enable a judicious and attentive practitioner to ascertain the dose adapted to his patient's constitution ; and as soon as he has attained this knowledge, he must be persevering in the use of the medicine. At this period of the disease, the patient's strength must never be suffered to languish. He must be supported by nutritious diet. Agreeably to the present manners of society, two or three meals are taken in the course of the day; but this mode of eating is very improper with delicate constitutions, more food being generally eaten at such stated periods, than is necessary; thereby causing great beat, accelerating the pulse, and throwing the whole system into commotion. The diet should be nourishing, and of easy digestion, such as jellies, broths, eggs boiled soft, oysters, raw or moderately roasted ; indeed, a bit of fowl, beef, mutton, or venison, dressed rare, may be taken in small quantities every two or three hours through- out the day. This deviation from the present fashion of eating is indispensable, ample nourishment being thereby thrown into the system without exciting irritation. At the same time I recommend solid food in this way, I forbid the use of spices, wine, or spirits. The same directions respecting topical applications and exercise, are equally applicable to this as the incipient stage, and particularly the exercise of swinging ; and care must be taken that the swing-chair be so constructed, that the patient may be perfectly at ease without being afflicted with fatigue or bodily exertion." Many other respectable physicians bear testimony in favour of this medicine in consumptive cases. Dr. Beddoes of London, considers the foxglove almost as infallible a remedy in consumption, as the Peruvian bark in intermittents. From its power of reducing the force of the circulation, it is esteemed likewise a valuable remedy in bleeding of the nose, spitting of blood, and excessive discharge of the menses, and also palpitation in the heart, from the passions of the mind, or intemperance. Dr. Rand, of Boston, has experienced the most decidedly good effects of this medicine in most of the preceding complaints. In one instance, heemoptoe, or spitting of blood, in a very athletic young man, where the discharge eluded the force of every other medicine, it reduced the pulse in eight hours, from one hundred to fifty pulsa- tions in a minute, and ^topped the hemorrhage. He has also given the medicine with complete success in cases of mental derangement. Foxglove possesses also diuretic power; and has long been em- 1 M2 MATERIA MEDICA. ployed in dropsy. It unquestionably acts powerfully as a diuretic, or in evacuating the water in dropsy, and will be found of the great- est utility in every species of this disease, but more especially the dropsy of the breast, where there exists an increased action in the system. However, from the respectable authority of Dr. Withering, and the celebrated Dr. Darwin, wre are assured it had been exhibited with the most happy effects, in cases of extreme debility, where the pulse was feeble, intermitting, and the countenance pale. It should not be given in such doses as to excite much sickness or purge, otherwise it will not produce its diuretic effect. The best rule for its administration, is to commence with the smaller doses, twice or thrice a-day, and gradually increase the quantity daily, until the medicine either act on the kidneys, the stomach or the bowels; and on the first appearance of any of these effects, it is to be suspended. After evacuating the water, tonic or strengthening medicines should be employed. Dr. Currie, another physician of great emi- nence in England, has employed this medicine with signal advan- tage in inflammation of the brain, heart, and lungs, and found it also an excellent remedy in the inflammatory rheumatism. The leaves of this plant are the part in use, of which from one to three grains in powder, may be given to an adult twice or thrice a-day, alone, or united with some aromatic, or the powder may be formed into pills with soap, or the crumbs of bread, or it may be given in the form of infusion, by infusing a drachm of the dried leaves in half a pint of boiling water, for four hours, adding to the strained liquor one ounce of any spiritous water; from one to two table- spoons full to be given twice or thrice a-day, as a medium dose for an adult. Another more convenient way of ascertaining the dose of foxglove, is by making a saturated tincture of it in proof spirits, which has the twofold advantage of being invariable in its original strength, and of keeping a long time without losing any of its virtues. Put two of the leaves nicely dried, and coarsely powdered, into a half pint of spirits; let it stand by the fire-side twenty-four hours or longer, frequently shaking the bottle, and thus making a saturated tincture of foxglove, which must be poured from the sediment, or passed through filtering paper. From twenty to sixty drops of the tincture may be taken in a little mint-water, or tea, two or three times a-day. This medicine has also been externally applied with good effects. An infusion of it is recommended as a good w7ash for painful cutaneous eruptions, or ulcerations. An ointment prepared by simmering the leaves in lard or fresh butter, has been found suc- cessful in scrofulous ulcers and scald head. FRENCH APPLE. See Thorn Apple. FROST WORT, Systis Canadensis—Grows in woods, about two feet high, leaves small and numerous, of a whitish colour, like frost; MATERIA MEDICA. 543 the stalk purple; flowers of a pale colour, producing a small pod with very small seed. It is said, in cases of scrofula, or king's evil, an infusion of the leaves, a handful to a quart of boiling water, in doses of a tea-cupful three times a-day, and the leaves in the form of a poultice, applied to the swelling twice a-day, has performed cures. FUMITORY, Fumaria Officinalis—Grows in corn-fields, and by fences, and rises a foot high; leaves'pale green, and the flowers of a reddish purple. The leaves, in the form of infusion, a handful to a quart of boiling water, and taken in doses of a tea-cupful thrice a-day, are esteemed a good medicine in scabby eruptions, and all cutaneous diseases, particularly if the eruptions be washed with the infusion. GARGET. See Poke Weed. GARLIC, COMMON, Allium Sativum—Is highly stimulating, and, therefore, useful to persons of cold, phlegmatic constitutions. It provokes the apnetite, assists digestion, removes flatulence, pro- motes expectoration and urine; and hence has long been used in scurvy, asthma, and dropsy. Where it cannot be taken in substance, the best form is either in syrup or pills. Externally applied, it blisters the skin. A poultice or cataplasm of equal parts of bruised garlic and crumbs of bread, mixed with sharp vinegar, applied to the soles of the feet, in the low stage of acute disorders, or nervous fever, is good to raise the pulse, and relieve the head. Sydenham says it exceeds all other applica- tions for occasioning a revulsion from the head, and that the efficacy of garlic, thus applied every night, until slight inflammation be pro- duced, is superior to Spanish flies. It is an excellent remedy in cases of croup, or violent sore throat. (See Onions.) It will also be found a good application to the pubes in producing a discharge of urine, when its retention has arisen from want of due action of the bladder. When made into an ointment, it is said to disperse cold and indolent tumours, and has been esteemed for its efficacy in cutaneous eruptions. In deafness, a small clove of the root, wrapped in gauze, cotton, or wool, moistened with the juice, and introduced into the ear, has frequently proved an efficacious re- medy, if repeated twice or thrice a-day. GENTIAN, Gentiana—Grows on the sides of roads, and in waste pastures, two or three feet high. The stem is strong, smooth, and erect; the leaves, which rise from the lower part of the stern, are spear-shaped, large, ribbed, and rough : flowers yellow, in whorls, terminating in yellow bitter berries. Its virtues are equal to the imported. It has long occupied the first place in all recipes for bitters, whether used to provoke the ap- 544 MATERIA MEDICA. petite, or give tone to the system. It may also be taken in the form of infusion, a small handful of the root to a quart of boiling water, in doses of a tea-cupful three or four times a-day. In the form of a decoction, it is used with decided advantage in pneumonia cases, where the fever is nervous, and it acts as a tonic and sudorific; a tincture of it is esteemed as a remedy in dyspepsia, given in doses of one-fourth or half an ounce. It is said to increase the appetite, prevent the acidification of the food, and to enable the stomach to bear and digest articles of diet, which before produced oppression and dejection of spirits. GILLENIA, COMMON, Gillenia Trifoliata—-Grows in woods, in lighj soil; flowers in June and July; and has commonly a num- ber of stems from the same root which are a foot or two in height, erect, slender, smooth, of a reddish tinge, and considerably branched. The leaves are alternate, and slightly toothed; the flowers few in number and scattered; and the root branched and knotty. The root, when boiled in water, imparts to it a beautiful, deep red colour and an intensely bitter taste. This plant has long been known to practitioners as an emetic. Professor Bigelow adds his testimony of its possessing properties in a certain degree analogous to those of ipe- cacuanha. Dr. de la Motta, of Charleston, S. C, testifies to its effi- cacy, as an emetic both upon an empty stomach and a full one. Twenty or twenty-five grains, divided into four equal parts, each taken every fifteen minutes, are the proper dose. GINSENG, Panax Quinquefolium—Is thinly scattered through- out the mountainous regions of the northern, middle, and western states, between the 38th and 47th degrees of north latitude. It in- habits rich, shady wgj^ds, the declivities of mountains, and the banks of torrents. The stem is smooth, round, and green, regularly divided at the top into three branches, with a flower stalk in the centre. It flowers in July, and has red berries. The root consists of one or more fleshy, oblong portions, of a whitish colour transversely wrinkled. This plant is precisely the same with the Asiatic, the roots of which are so highly valued in China. The Chinese consider the ginseng as possessing unequalled medicinal powers, and their phy- sicians have written many volumes upon the qualities of the plant. It is made an ingredient in almost all remedies which they give to the nobility, its price being too expensive for the common people. The sick take it to recover health, and the healthy to make them- selves stronger and more vigorous. They affirm that it removes all • fatigue, either of body or mind, dissolves humours, cures pulmonary diseases, strengthens the stomach, increases the vital spirits, and pro- longs life to old age. Its price at Pekin, according to travellers, has been eight or nine times its weight in silver, and even more. The report of the high value of the ginseng in China led to an MATERIA MEDICA. 545 inquiry among Europeans, whether the plant was not to he found in parallel latitudes in the forests of America. Father Lafiteau, a Jesuit, after much search in Canada, found the plant in the year 1717. The French and the Anglo-Americans commenced the col- lection of the root, and large quantities were exported. The first shipments to China proved extremely profitable. In a short time, however, the supply overstocked the market, the Chinese began to think the American ginseng inferior to the Tartarian, and its value depreciated, so that it ceased to be an object of profitable commerce. Its demand has not materially risen at any subsequent period, though it is still occasionally exported. The Chinese most readily purchase the forked or branching root; and those exporters have been most successful who have prepared their ginseng by clarifying it after the Chinese manner. They dip it in scalding water, and scour it with a brush. The roots are then prepared with the fumes of a species of millet, to give them a yellow colour. The millet is put in a ves- sel with a little water, and boiled over a gentle fire. The roots are placed over the vessel upon transverse pieces of wood, being first co- vered with a linen cloth or another vessel. When treated in this way, they assume, iipon drying, a horny or semi-transparent ap- pearance. The roots may also be dried in the sun, or by the fire, and retain their qualities perfectly. In this case, however, they have not that yellow colour which the Chinese so much admire. As far as ginseng has been tried in this country, and in Europe. its virtues do not appear, by any means, to justify the high estimate of it by the Chinese. That it is not a very active substance, is proved by the fact, that a whole root may be eaten without incon- venience. Its place in the Materia Medica is among demulcents. It has an agreeable taste, consisting of a mixture of sweet and bitter, with some aromatic pungency. Dr. Fothergill tells us that "in tedious chronic coughs, incident to people in years, a decoction of it has been of service. It consists of a lubricating mucilage, com- bined with some degree cf aromatic warmth." Ginseng is princi- cipally used as a cordial; many persons chewing it or taking it steeped in wine or spirits, in doses of a wine glassful twice a-day. As a masticatory, ginseng is innocent and refreshing. It forms an excellent substitute for tobacco. I have repeatedly prescribed it to those whose constitutions have been injured by the immoderate use of tobacco, and, in every case, have witnessed the most beneficial consequences from its use. It is necessary, however, that the saliva should be swallowed. GOLDEN ROD, OR THREAD. See Mouth Roof. GOOSE GRASS, Galium Aparine—Called by some Poor Ro- bin's plaintain, from its efficacy in curing the gravel. Grows in hedges, low grounds, and near brooks, to the height of 69 546 MATERIA MEDICA. five or six feet, climbing on the bushes near it. The upper side of the leaves is white, with sharp prickles; the flowers small, and di- vided into four segments: these change into a fruit rather large, composed of two berries slightly adhering together and covered with hooked prickles, containing two seeds. The leaves in the form of decoction, a handful to a quart of water, are highly celebrated as a remedy in gravel complaints, and suppres- sion of urine, in doses of a tea cup full every hour or two, until relieved. It has also been recommended in the cure of scurvy, spit- ting of blood, and epilepsy or fits. GROUND HOLLY, Pyrola Umbellata—It is sometimes called Pipsissewa, which is its Indian appellation. It possesses, in an eminent degree, the same properties as Bear's Whortleberry, which see. GROUND PINE, Arthetica—Grows plentifully in stony lands, about six inches high, sending forth many small branches, with small narrow grayish leaves, somewhat hairy; flowers of a pale colour, growing from the joint of the stalk, among the leaves, after which come small round husks. A large handful of the leaves and flowers steeped in a pint of wine, and taken in doses of a wine glassful twice or thrice a-day, is said to be beneficial in rheumatism and uterine obstructions. GROUND PINK, Silene Virginica—Called also catch-fly. A decoction of the roots is said to have been found a very efficacious remedy for worms. GUINEA PEPPER. See Pepper, Red. HART'S TONGUE—Grows among rocks and shady places, the leaves being of a shining black colour, long, pointed, and tongue- shaped. This herb, in the form of infusion, a handful to a quart of boiling water, in doses of a tea cupful two or three times a-day, is said to be a good remedy in diarrhcea and dysentery; and in the form of oint- ment, prepared by simmering a handful of the leaves in half a pint or more of lard, is a good application to scalds and burns. HEART'S EASE, OR HERB TRINITY, Viola Tricolor- Grows generally in corn-fields, producing white and yellow blossoms, intermixed with purple, which flower from May to September. A decoction of a handful of the fresh leaves, or half the quantity of the dried, in a pint of milk, used daily for some weeks, is said to be a certain remedy for that disorder in children, called milk scab, or that species of scald head which affects the faces of children. MATERIA MEDICA. 547 HEART SNAKE ROOT—Flourishes in Carolina and Georgia, in rich and high lands, never exceeding the height of six inches. The root is of a very aromatic taste, and the smell somewhat resem- bling the sassafras. The leaf shaped like a heart, dark green, and very glossy on the upper surface. The juice of the root and leaf pounded together, in doses of a table-spoonful for an adult, is an active and safe emetic; and a decoction in as large quantities, and as frequent as the stomach will bear, is of excellent service in the jail, camp, and nervous fever. HELEBORE, WHITE, Veratrum Album—Grows in wet mea- dows and swampy places. The stalk is thick, strong, hairy, upright, and usually rises from two to four feet. The leaves are large, oval, ribbed, plated, of a yellowish colour, and surround the stem at its base. The flowers are of a greenish colour, and appear from June to August, followed each by three flat pods, containing whitish tri- angular seed. The root is short, commonly near an inch thick, with numerous fibres hanging from it, of a brown colour externally: it has, when fresh, a nauseous bitter taste burning the mouth and fauces; and, snuffed up the nostrils in very small quanties, excites most violent sneezing. Every part of this plant is extremely acrid and poisonous. By the hand of skill, it has been employed internally, with beneficial effects, in several obstinate diseases, as those of the melancholic and maniacal kind, and epilepsy, king's evil, herpetic, and other cutane- ous affections. In these complaints, the bark of the root, collected in the spring, has been given in the form of powder, beginning with half a grain at a dose, and gradually increasing the quantity daily, according to its effects. The American species, says Dr. Thatcher, very probably possesses all the properties of the foreign officinal root. It is undoubtedly a plant of highly active powers, meriting a particular investigation as an article of our Materia Medica. In fact, a new interest has lately been excited both in Europe and the United States, relative to the properties of white helebore. It is even supposed to be the basis of the French specific remedy, called Eau Medicinale d'Husson, so highly famed for its almost infallible powers in the cure of the gout, as to command the enormous price of from one to two crowns a dose. This remedy wras discovered about forty years ago by M. Husson, a French officer, who affirms it to be prepared from a plant whose vir- tues were before unknown in medicine; and it has long been cele- brated in Fiance, and other parts of the European continent. The importance and popularity of the subject were incitements to various attempts for that purpose, and to the ingenuity of Mr. I. Moore, member of the royal college of surgeons, London, the public are indebted for a composition, which if not identically the same bears a strong resemblance to the Eau Medicinale, in smell, taste, and dose; and also in all its effects, as far as it has been tried in the 548 MATERIA MEDICA. cure of gout. The composition of Mr. Moore consists of wine of opium Sydenham, one part, wine of white helebore, three parts, made by infusing for ten days, eight ounces of the sliced root of that plant, in two and a half pints of white wine, and strained through paper. This compound, when exhibited in doses from one to two drachms, has, in a variety of instances, effected a speedy cure of gouty paroxysms. There are, indeed, well attested facts, where the most painful gouty affections have yielded to a single dose of about one drachm; and the instances of its failure have hitherto, it is be- lieved, been more rare than can be said of any other remedy. The employment of the composition of Mr. Moore, has also, in the hands of respectable physicians, been extended to acute rheumatism, and to some comatose affections, with the most decided advantage; and a perseverance in similar trials is strongly recommended. Its opera- tion may be promoted by some aromatic, or peppermint, pennyroyal, or ginger tea. It in general occasions some nausea and vomiting, followed by bilious stools. Externally applied in the form of oint- ment or decoction, it cures the itch, and other cutaneous affections. An ointment is prepared by simmering the root slowly in hog's lard. The decoction is made by boiling two ounces or a handful of the root bruised, in a quart of water, to a pint and a half, and then strained. The addition of a few ounces of lavender, rose, or lemon water, may be made, if convenient. With this the parts affected should be washed twice or thrice a-day. HEMLOCK, Conium Maculatum—Grows to the height of six or seven feet in rich land, near ditches, and in moist shady places. It is an umbelliferous plant, with large leaves, of a dark green colour on the upper side, and a whitish green underneath; much resem- bling parsley, especially the leaves of the smaller sorts, whose poison- ous quality is the most violent. The stalk is round, smooth, hollow, and marked with brown or red spots; the flowers are white; the seeds greenish; flat on one side, very convex, and marked with five furrows on the other. The root is long, yellowish without, white and fungous within, and somewhat resembling a carrot. It changes its form according to the season; and the leaves have a rank smell resembling the urine of a cat, but do not much affect the taste. This poisonous plant possesses great medicinal virtue when judi- ciously employed. It has been used with considerable advantage in painful cancerous ulcers, venereal ulcerations, cutaneous affections, gleets, painful discharges from the vagina, and in a variety of cases of scrofulous affections. It has also been of great efficacy in epi- lepsy, chronic rheumatism, and jaundice. Externally applied, it has been useful in discussing scirrhous tumours, particularly those of a scrofulous nature. The proper method of administering hemlock, inwardly, is to begin with a grain or two of the powder of the leaves, or the inspissated juice, and gradually to increase the dose until the head is affected MATERIA MEDICA. 549 with slight giddiness, as it occasions some sickness, and trembling agitations of the body, or produces one or two evacuations the morn- ing after the dose. One or more of these symptoms are the evidences of a full dose, and here continue until none of these effects are ob- served ; and then, after a few days, increase the dose; for little advantage can be expected, but by a continuance of full doses. The dried leaves are less liable to injury from keeping than the inspissated juice. The leaves should be collected in June, when the plant is in flower, and its peculiar smell strong. The drying of the leaves should be performed quickly before a fire, on tin plates. The proof of the drying having been well performed, is the pow- der's retaining the odour of the leaves, and the deepness and fresh- ness of the colour. It should be kept in close vials, and secluded from the light. HENBANE, BLACK, Hyosciamus Niger—Grows at the sides offences, about old ruins, and on dung-hills, and with the dung is sometimes carried into gardens, where, from its similitude to parsnips, it is mistaken for them ; and wben eaten produces stupor and apo- plectic symptoms terminating in death. It rises from one to two feet in height; the stalks are thick, woody, irregularly branched, and co- vered with a hairy down, the leaves surrounding the stalk at their base, stand irregularly; they are large, soft, and downy, pointed at the ends, and very deeply indented at the edges; their colour is a grayish green, and they have a disagreeable smell; the flowers are large, egg-shaped, and of a dirty yellowish colour, with purple streaks. The root is long, tough, white, and when recently cut through, smells like liquorice. According to Dr. Stork, the juice of this poisonous plant inspis- sated, and exhibited in doses of from one grain to twenty, every twenty-four hours, has relieved many from palpitation of the heart, a tendency to melancholy, coughs, and other spasmodic disorders and convulsions, and this after other means had failed. HERB BENNET. See Avens. HERB TRINITY. See Heart's Ease. HOGBED, OR HOG WEED, Ambrosia—Grows near farm yards, and on stony soils, like moss, about three inches high. The leaves are of a deep green colour, small and curly. The hogs de- light to make their bed on it, from whence it derives its name. A handful of this plant infused in a quart of water, and given in doses of a tea-cupful three or four times a-day, is a popular remedy among women to promote the menses or courses. HOLY THISTLE. See Thistle, Holy. HOODED WIDOW HERB, Scutellaria Lateraflora—Is found 550 MATERIA MEDICA. in abundance on the banks of rivers, and the borders of ponds, flow- ering in July and August. The stem is square, branched, and at- tains the height of from one to three feet. The leaves opposite, nar- row pointed, on long foot stalks; the blossoms small, of a violet colour, intermixed with small leaves. Dr. Thatcher has introduced this plant in his American Dispensa- tory on account of its recently reputed efficacy as an antidote to ca- nine madness. It is directed to be given in the form of a strong in- fusion of the leaves every morning fasting, and to be continued for several weeks. For cattle, it may be mixed with their food or drink. HOPS, Humuli—Are an agreeable strong bitter, principally used in making malt liquors. They also induce sleep; hence the popu- lar remedy of a pillow of hops to procure sleep in the delirium of fever and insanity, which not unfrequendy succeeds. They give out their virtues to spirits or water. In the form of fomentation and poultice, hops serve as a most valuable application to ill-conditioned ulcers, or painful cancerous sores. Mr. Stephen Hammock, assistant surgeon to the royal hospital at Plymouth, gives the following account of the benefit obtained from the external use of hops. I have seen (says Mr. H.) very good ef- fects from hops in poultices and fomentations applied to ulcers of the worst kind, in more than sixty patients received into the hospital from ships of war. Some of the ulcers proceeded from scurvy, and some from other causes. But though all of them have been sordid, fetid, and extensive, yet the foetor has soon been corrected by these applications, and the ulcers have ceased to spread. A large handful of hops is to be well boiled with a quart of water, to which should be added meal or bran, forming a poultice, applied to the ulcer, without any intervening lint. But, previously to this application of the poultice, the ulcers are directed to be well fomen- ted with the decoction. The pain proceeding from the ulcers is soon alleviated, and the ulcers soon cease to spread. They become clean, and in a state to be dressed with lint, or any soft ointment. (See Duncan's Annals of Medicine, also Medical Repository.) Hops form the bases of beer and yeast, of which the following are the most simple, and among the most approved. Beer.—Take fifteen gallons of water, and boil one half of it, or as much as can conveniently be managed ; put the part of the water thus boiled, while it is yet of its full heat, to the cold part, contained in a barrel or cask, and then add one gallon of molasses, commonly called treacle, stirring them well together; add a little yeast, if the vessel be new, but if it has been used for the same purpose, the yeast is unnecessary. Keep the bung-hole open, till the fermentation ap- pears to be abated, and then close it up. The beer will in a day 01 MATERIA MEDICA. 551 two afterwards be fit to drink. A few hands full of hops, boiled in the water, either with a little orange peel, or without, give a whole- some and pleasant bitter to this beer, and assist in keeping it from turning sour. If tops of the spruce-fir be added to the water which is boiled for making this beer, it is then called spruce beer. Extemporaneous Small Beer.—To two quarts of common por- ter, add of molasses half a pint, of ginger two drachms, water just warm, four quarts: let the whole ferment in a warm place, then rack off. Another.—Lemon peel one ounce, cream of tartar, four ounces, hops one ounce, molasses one quart, ginger one drachm, bruised cloves four in number, boiling water four gallons, ferment with yeast. To make Yeast.—Boil a pint bowl full of hops in two quarts of water to one quart; put eight table-spoons full of flour into a pan, and strain the hop water boiling on it; when mixed, it should be thick batter, and when milk warm, stir in it a breakfast cup of good yeast; put it in three porter bottles, stopping them with paper; put them into a milk-pan near the fire, and as soon as the mixture rises to the top of the bottle, remove them to the cellar until it subsides, then cork the bottles, and set them on a cool cellar floor, or in an ice-house. In very warm weather, the corks ought to be taken out every day, to let out the carbonic acid air, and the bottles again stopped. Another valuable recipe.—Boil twelve clean-washed, middle sized potatoes, and at the same time, boil in another vessel, a handful of hops in a quart of water; peel and mash the potatoes in a mortar or bowl; pour part of the hop water, while hot, upon the potatoes, mix them well, and pass them through a sieve, then add the remainder of the hop water, and half a tea-cupful of honey, beat all well, and add a small portion of leaven to bring on the fermentation. Put the whole in a stone jug, and set by the fire, in the winter; all the utensils must be scalded every time they are used, and washed per- fectly clean. One tea-cupful of the above potato yeast, will answer for two quarts of flour. In summer the yeast ought to be made every second day. HOREHOUND, Marrubeum Vulgare—Grows among rubbish, flowering from July to September. The leaves have a very bitter taste. An infusion or tea of the leaves sweetened, is a very common remedy for colds. A syrup prepared by simmering slowly for an hour, a pint of honey in a quart of a strong decoction of the plant, is, from my own experience, an excellent medicine in coughs, or any breast complaint, in doses of a small table-spoonful every two or 552 MATERIA MEDICA. three hours, or oftener, when the cough is very troublesome. In like manner a candy prepared by simmering slowly half a pint of the juice with a pound of sugar, will be found equally serviceable. In the southern states there is a plant, called wild horehound, growing to the height of one or two feet, of which a tea, prepared by adding one or two hands full of the fresh leaves, or half the quantity of the dried, to a quart of water, in doses of a gill or more, every two or three hours, acts gently on the skin and bowels, and is used like the Peruvian bark, as a tonic in the cure of ague, and bilious fever. HORSE-RADISH, Cochlearia Armoracia—Grows on the sides of ditches and damp places, but is cultivated in our gardens for culi- nary and medicinal purposes. It has long been known as a most powerful antiscorbutic, and when taken freely, it stimulates the ner- vous system, promotes urine and perspiration, and is, therefore, use- fully employed in palsy, dropsy, scurvy, and chronic rheumatism. The root should be cut into small pieces, without bruising, and swal- lowed in the dose of a table-spoonful, without chewing, once or twice a-day, or it may be steeped in wine, and taken in doses of a small wine-glassful. Upon the authority of the celebrated Dr. Cullen, it is, in the form of syrup, excellent in hoarseness, or in the decline of violent colds and pleurisies. Whether externally or internally employed, horse- radish proves a stimulant; hence it has been found serviceable by chewing it in palsy of the tongue, and applied in paralytic com- plaints to the affected parts. The root, scraped, and applied in the form of poultice, to the feet, until some inflammation is produced, in low stages of fever, attended with delirium, has also produced good effects. It is said, the root steeped in vinegar, will remove freckles of the face ; if so, it deserves to be tried in cases of ring or tetter worm. HOUSELEEK, Sempervivum—Grows on the roofs of houses and old walls, flowering in July. The juice of this plant, mixed with honey, is said to be of con- siderable service in the thrush of children. Stewed with cream, it is a great favourite with the country people for the cure of corns, fresh burns, stings of wasps, bees, and other external inflammations. An infusion of the leaves is also said to be cooling and laxative. HYSSOP, Hyssopus—Is cultivated in our gardens. An infusion of the leaves, sweetened with honey, or in the form of syrup, is use- ful in humoral asthma, coughs, and other disorders of the breast and lungs, accompanied with inflammatory symptoms. ICE-PLANT, Mesembryanthemum—Grows in woods to the MATERIA MEDICA. 553 height of six inches, and becomes white in September; the stalks and leaves are like frozen jelly, and when handled, dissolves as ice. The root pulverised, in doses of a half or tea-spoonful, in the morning, is said to be a good remedy for children troubled with fits; hence it is called by the country people, Fit root. Adults may take it in much larger doses. INDIAN HEMP—Grows in woods, and on the borders of mea- dows, three feet high; the stalk is bare for a root, then spring many branches, leaves numerous, flowers whitish, similar to buckwheat, which terminate in seed pods resembling a cucumber. The bark of the root, in the form of powder, in doses of from twen- ty to thirty grains, or half a tea-spoonful, will generally operate as an emetic and cathartic. In doses of five or six grains, or a wine- glassful of the infusion, every two hours, it promotes perspiration. It has been found beneficial in rheumatism, dropsies, and asthmatic complaints. A table-spoonful of the infusion, half a handful of the bark to a pint of boiling water, given occasionally to children in the whooping-cough, throws off the phlegm, and prevents straining. INDIAN PHYSIC, OR AMERICAN IPECACUANHA, Spircea Trifoleata—Grows about twTo or three feet high, in low woods and meadows. Professor Barton says, the root, which is the part made use of, is a safe and efficacious emetic. The celebrated Colonel Bird, of Virginia, was so enamoured of diis plant, that he wrote a pamphlet on its virtues, which he found, from great and successful practice in his own very numerous family, to be at least equal if not superior to those of the imported ipecacu- anha. In the dose of thirty to forty grains in powder, for an adult, it is one of the most safe and certain emetics. In broken doses of five or six grains, every two hours, it is equally valuable as a sudo- rific. It may also be given in infusion, a handful to a pint of boil- ing water, of which a small tea-cupful may be taken every fifteen or twenty minutes until it promotes vomiting. INDIAN TOBACCO. See Emetic Weed. INDIAN TURNIP, Arum Triphyllum—Grows in meadows and swamps, six or eight inches high, purple stalks, leaves three in number, roundish, and berries of a bright scarlet colour. It is a very acrid plant. As ointment prepared by simmering the fresh root in hog's lard, and one eighth part of wax, is said to be a good application in the scald head. From the authority of Professor Barton, we learn that the recent root, boiled in milk, has been ad- vantageously employed in cases of consumption. He even cites a very striking instance. It is also recommended in the asthma, and whooping-cough, in the form of conserve, made of a pound of the 70 1 554 MATERIA MEDICA. peeled root pounded finely in a mortar, with three pounds of loaf sugar; dose, a tea-spoonful twice or thrice a-day. INDIGO WEED, OR WILD INDIGO Sophora Tinctoria— Grows in great abundance on the road-sides, and in the woods, and is used by travellers in the middle states to drive away the flies. A decoction of this plant in large doses, is said to operate power- fully on the stomach and bowels, but in smaller doses of a wine- glass full, proves a mild laxative. An infusion, or tea, is said to be cooling and good in fevers; and, in the form of fomentation and poultice, to arrest the progress of mortification, especially if a little of the infusion be taken internally at the same time. An ointment prepared by simmering the bark of the root in cream, fresh butter, or lard, has been recommended as a good application to sore nipples or ulcers of the breast. IPE CAC UANHA, AMERICAN. See Indian Physic. IVY. See Calico Tree. JAMESTOWN, OR JIMSON WEED. See Thorn Apple. JERUSALEM OAK, OR WORM SEED, Chenopodium An- thelmenticum—Has long been employed to expel worms. One or two tea-spoons full of the seed with molasses or honey, are generally given to a child two or three years old, in the morning, on an empty stomach, and the dose is sometimes repeated at bed-time. It ought to be continued for several days. When there is an aversion to using it in this form, the seed may be boiled in milk, and taken in doses of one or two wine-glasses full, or the expressed juice of the plant sweetened, may be exhibited in doses of a table-spoonful. The oil, which is prepared from the seed, possesses the same virtue, and is found a more convenient form of giving the medicine. JUNIPER, COMMON, Juniperus Communis—An evergreen shrub, growing on dry barren commons, and hilly ground. A strong decoction, made of a handful of the tops and berries to a quart of boiling water, in doses of a tea-cupful three or four times a-day, has long been employed in dropsy, scurvy, and gravel, or dif- ficulty of urine. The oil of juniper possesses the same properties in a high degree, and imparts them to ardent spirits. The peculiar flavour, and well known diuretic effect of Holland gin, are owing to this oil. Hoffman found it of great use in debility of the stomach and in- testines, particularly in old people. The stronger preparations have been found useful in uterine obstructions, and in paralytic affections of the bladder. MATERIA MEDICA. 555 LAMBKILL. See Calico Tree. LAUREL. See Calico Tree. LAVENDER THRIFT, Statice Limonium—Grows on the sea-shore, on salt marshes, flowering from July to September. The stem is naked, branched, and about a foot high ; the leaves long and pointed ; the flowers blue, and growing on long spikes on the tops of the branches. According to Dr. Hughes of Providence, and Dr. Baylies of Dighton, a decoction of the root has been tried with success in ap- thous state of fever, and ulcerous sore throat, as a most powerful an- tiseptic. In large doses it operates as an active emetic, and in smal- ler, as a strong expectorant. LEMON TREE, Citrus Medica—Is now cultivated in the southern states, and holds the first place among the cooling and an- tiseptic vegetables, to correct the putrid tendency of animal food in summer. The acid of lemons, from its antiseptic properties, has long been employed as a remedy in the scurvy. Dr. Cutbush says, from the commencement of our navy, it has been used on board the ships of war with very great success, in preventing, as well as curing, this disease. The fresh fruit is preferred. Lemon, or lime juice, diluted with water, and the addition of a little sugar, forming lemonade, serve as one of the most grateful be- verages in bilious and nervous fevers. When saturated with com- mon table salt, it proves a valuable medicine in dysentery, putrid sore throat, and remittent fever. In diarrhoea and diabetes, where the aliments are apt to run off in their crude state, this mixture is said to be a most efficacious remedy. A table-spoonful of lemon juice, fifteen or twenty grains of salt of tartar, or salt of wormwood, with the addition of a little water, swallowed in a state of efferves- ence, is excellent to stop nausea, and allay febrile heat. The acid of lemons is a common remedy against narcotic vegetable poisons, such as opium. Either of the following methods is recommended for preserving the juice of lemon or limes. Boil the juice after straining, and bot- tle it, or squeeze the fruit, put the juree»and pulp into a bottle, cover the top with an inch of oil, cork and rosin the bottle. The juice is supposed to feed on the pulp. Before using the juice, the pulp and oil must be carefully taken out. The dried peel of lemons is a grate- ful aromatic, and as a stomachic generally constitutes one of the in- gredients of bitters. LETTUCE, Latuca Stativa—From the fortunate discovery and perseverance of the celebrated Dr. Duncan, the inspissated juice of the common garden lettuce is found to be but little inferior in sopo- 556 MATERIA MEDICA. rifle power to opium. In those constitutions in which opium cannot be employed without producing very disagreeable consequences, we may with safety employ, as a sedative, the lettuce opium or tincture. Many eminent physicians bear testimony of the good effects of this medicine in procuring sleep, in alleviating pain, and in allaying inordinate action, particularly a troublesome cough. And in no in- stance has it been found to produce nausea, costiveness, or irritation of the skin, which generally follows the use of opium or laudanum. The best method of obtaining the inspissated juice of lettuce in abundance is as follows: Let the ice-lettuce, which is considered best for this purpose, be planted in rows; and when the top of the stem is about a foot above the ground, cut off about an inch from the top of each plant. The milky juice immediately rises above the wounded surface. But it is better to cut off the tops of all the plants before you begin to collect. After having done this, begin to collect the milky juice by means of a wet sponge where the incision was first made, and as you go along cut off a thin cross slice from the stem of each plant, leaving fresh wounds. After going round the plants about five or six times in the way mentioned, they will cease to yield any more milky juice at that time. But this process may be repeated two or three times in a day. The milky juice collected in this way is to be expressed into a tea-cup, or any similar vessel. It soon acquires a dark brown colour, like opium obtained from the poppy; has all its other sensible qualities; and hence it may justly be distinguished by the title of lettuce opium. It may be administered in the form of pills, in doses from one to two grains. The tincture is prepared by adding one ounce of the extract to a pint of spirits, which may be given in doses of a tea- spoonful. Another mode of preparing the tincture is by steeping two or three ounces of the dried leaves and stalks in a pint of spirits, for eight or ten days, in a warm place, frequently shaking the vessel, ind then let it be strained through paper. LETTUCE, WILD, Lactuca Virosa—Grows abc A four feet high, about hedges and the borders of meadows. It 1 us three dif- ferent kinds of leaves: those proceeding from the roo are slightly toothed; and those attached to the flower stalks are arrow-shaped, pointed, and minute; the flowers are yellow, and small; the leaves are milky, and smell like opium. An extract prepared from the expressed juice of the leaves, ga- thered when in flower, and given in doses of from five to ten grains, twice or thrice a-day, is said to be a powerful diuretic, and of great efficacy in the cure of dropsy. LICHEN, OR LUNGWORT, Lichen—Is a thin shell, or skin, which grows on the bark of the white oak tree, resembling the lungs, from whence it is called lungwort. MATERIA MEDICA. 557 It is said to possess the same qualities as the Iceland moss, or lichen, so celebrated in the cure of consumption. An infusion, a handful to a quart of boiling water, used as a com- mon drink, or a strong decoction formed into syrup, with honey or sugar, may be taken in doses of a wine glassful three or four times a-day. It is also said to be a useful medicine in the whooping- cough. LIFE ROOT—Grows on the borders of meadows; about two feet high; leaves large and saw-edged ; flowers yellow, and the roots small and fibrous. An infusion of this plant, a handful to a quart of boiling water, taken in doses of a tea cupful five or six times a-day, is said to be an excellent remedy for the gravel. LOBELIA, OR BLUE CARDINAL FLOWERS, Lobelia Syphilitica—Grows abundantly in the middle and southern states in moist grounds, and near springs; has an erect stalk three or four feet high ; blue flowers; a milky juice and a rank smell. Professor Barton says this piant was purchased from the northern Indians by the late Sir Wm. Johnson, as a remedy in the venereal disease: hence, its specific name syphilitica. He doubts, however, its power to cure the pox; though, from its diuretic quality, it cer- tainly has been found useful in gonorrhoea or clap. He states that many persons in the western country, from their ignorance of botany, have made use of a plant which they call obelia, in the venereal complaint. But from the specimen he has received, he believes the plant to be the seratula spicata or spiked sawwort. It is a powerful diuretic, and there is good reason to believe that it has been found useful, not only in venereal complaints, but also in cases of gravel. Thus, ignorance sometimes leads to knowledge. The lobelia is generally administered in the form of a decoction, a handful of the root and leaves boiled slowly in three pints of water to a quart, of which a gill or more may be taken three times a-day. MADDER, WILD, Rubia Tinctorum—Is cultivated in Penn- sylvania and South Carolina for dyeing a fine red colour, but also possesses great medical powers. It has been highly recommended in visceral obstructions, particu- larly of the uterus, in coagulations of the blood induced either by falls or bruises, in dropsical complaints, and especially in the rickets. It may be given in powder from five to fifteen grains to children, and from half to a whole drachm three or four times a-day to adults. When taken internally, it possesses the remarkable quality of tinging the urine of a red colour, and produces similar effects on the bones of animals, when eaten with their food. MAGNOLIA—Goes by several names, as beaver tree, swamp sas- 558 MATERIA MEDICA. safras, elk bark, Indian bark. It is an agreeable aromatic tonic bit- ter medicine. An infusion or decoction of the bark has been used in the ague and fever, and is much celebrated among the western Indians as a remedy in rheumatism. I am informed, from a respectable source, that John Dickinson, Esq., author of the celebrated Pennsylvania Farmer's Letters, was completely cured of a violent attack of the chronic rheumatism by a strong decoction of the twrigs of the magnolia. The species Magnolia Grandiflora, evergreen laurel, sometimes called tulip tree, grows to the height of eighty feet near Savannah. The bark of the root of this tree is also used as a substitute for the Peruvian bark in intermittent fevers. The cones or seed-vessels of the magnolia, which is commonly called cucumber tree, has been advantageously used in Virginia in the form of tincture, in rheuma- tic complaints. MAIDEN HAIR, Asplenium Trichomanes—Called also milk waste, spleenwort—Grows on old walls, rocks, and shady stony places, generally to the height of seven or eight inches; leaves very fine and soft, and spotted underneath; stalks of a dark purple colour; flowers from May to October. Its leaves have a mucilaginous sweetish taste, without any peculiar odour. An infusion, by pouring a quart of boiling water on a handful of the dry herb, sweetened with honey, and taken in the quantity of a tea cupful every hour or two, or a spoonful in the form of syrup, is said to be good in tickling coughs, hoarseness, and disorders of the breast, proceeding from acrid humours in irregularities of the menses, and obstructions of the viscera. MALE FERN. See Fern, Male. MALLOW, COMMON, Malva Sylvestris—Grows in hedges, footpaths, and among rubbish; flowering from June to August. The leaves possess a mucilaginous sourish taste. A decoction of this plant is said to be useful in dysenteries and gravel complaints, though it is chiefly employed as an emollient poultice to produce suppuration. MANDRAKE, OR MAY APPLE, Podophyllum Peltatum— Grows on lows grounds, two or three feet high, leaves generally three, broad at the base, and terminating in a sharp point; flowers yellow; the fruit resembling a lime, or small yellow apple, which is much admired by some. The root, is an excellent purgative, and may be taken in doses from ten to thirty grains in substance, or double the quantity infused in a gill of water. Dr. Little, of Pennsylvania, esteems it preferable to jalap. The honourable Paul Hamilton, who often used it, directs MATERIA MEDICA. 559 equal parts of the juice and molasses to be mixed, and a table spoon- ful taken every hour or two until it operates. The best time of gathering the mandrake, for medicinal purposes, is in autumn, when the leaves have turned yellow, and are about falling off. The Indians dry it in the shade, and powder it for use. MARSH TREFOIL, OR BUCK BEAN, Menyanthes Trifo- liata—Is a native of Europe and of America. Spongy and boggy soils which are inundated at certain seasons of the year, and =are never wholly destitute of water, are the favourite situations of this plant. The root penetrates horizontally into the bog earth to a great distance, and is regularly intersected with joints at the distance of about half an inch from each other. The stalks are long, and from each of them proceed three leaves. Flowers white, tinged with red. The root is intensely bitter, and has long held a place in the Euro- pean Materia Medica, as a powerful tonic. When given in small doses, of about ten grains, it imparts vigour to the stomach, and strengthens digestion. We are told by authors that it has been em- ployed with advantage in intermittent and remittent fevers. Boer- baave, in his own case of gout, was relieved by drinking the juice of the plant mixed with whey. Other physicians have found it useful in keeping off the paroxysms of that complaint. Taken by infusion, it also has good effects in some cutaneous diseases of the herpatic or seemingly cancerous kind. We may regard this plant as one of our numerous vegetable bit- ters, which are fully equal in strength to imported articles of their class. MARSH MALLOW, Althaea Officinalis—Grows in marshes and wet places. The leaves have a soft woolly surface, feeling like velvet. The flowers are of a white pale flesh colour, and appear in August. Every part of the marsh mallow, and especially the root, when boiled, yields a copious mucilage, on account of which it is employed in emollient cataplasms or poultices, for softening and maturing hard tumours. It is likewise of eminent service, in the form of infusion, in asthma, hoarseness, dysentery, and gravel. MARSH ROSEMARY. See Lavender Thrift. MASTERWORT, Imperatoria—Grows in meadows and rich soils, two feet high; leaves, three together, saw-edged, and spear- shaped ; flowers in June. The root of this plant is a warm and grateful medicine in flatu- lency, weakness of the stomach and bowels, and dropsical affections. It may be taken in the form of powder, decoction, or tincture. One drachm, or a tea-spoonful of the powder, in a glass of wine or spirits, and taken an hour before the fit, has frequently prevented the ague. 560 MATERIA MEDICA. The decoction or infusion is made of one handful in a quart of boil- ing water, and the dose is a tea cupful three times a-day. MAY APPLE. See Mandrake. MAY WEED, OR WILD CAMOMILE, Cotula Foetida— Grows about two feet high, in pastures near fences; the flowers are yellow, resembling camomile flowers, and are frequently used as a substitute for them. MEZEREON, Daphne Mezereum—Called also spurge laurel, dwarf bay. Grows plentifully in woods and shady places near the Ohio, and flowers in the month of February or March. The fruit is a berry, in which is found a single seed. The leaves are spear- shaped, and the flowers grow of a beautiful red or rose colour. The bark of the root of this plant is the part used in medicine, and has an extremely acrid burning taste in the mouth and fauces. Dr. Withering asserts that a patient who lived under extreme diffi- culty of swallowing for three years, was effectually cured in two months, by chewing the root as often as she could support its irrita- ting effects. The fresh root scraped, and applied to the surface of the skin, affords an efficacious blister—when taken internally, it determines to the surface, and has been found greatly serviceable in rheumatism and obstinate cutaneous diseases. Its principal use, however, is in the venereal disease, in the last stage, or when mer- cury has failed. It is particularly efficacious in relieving noctural pains, and removing venereal nodes. One gill to a half pint of the decoction, made of two drachms, or a handful of the bark, with an equal quantity of liquorice root, boiled in three pints of water to a quart may be taken three or four times a-day. MILK, OR SILK WEED, Vincetoxicum—Grows by the road- sides, and on sandy ground, about three feet high; the stalk square; leaves oval and milky; flowers yellow, which terminate in a pod resembling a cucumber, filled with down, which, when ripe, is blown away. A handful of the root, boiled slowly in a quart of water for half an hour, and given in doses of a gill or more three or four times' a-day, is reputed to be an effectual remedy in the cure of dropsy, and serviceable in catarrhs, scrofulous and rheumatic disorders, and gravel complaints. MILKWORT, COMMON, Polygala Vulgaris— Thrives in dry pastures, and flowers in June and July. Its roots possess an ex- tremely bitter taste, together with all the virtues of the American rattlesnake root. A table-spoonful of a strong decoction of the root, two hands full boiled slowly in three pints of water, to a quart, and taken every MATERIA MEDICA. 561 nour or two, promotes perspiration as well as expectoration, and has, therefore, been used with advantage in colds, pleurisies, and other disorders of the breast. MILTWASTE. See Maiden Hair. MINT. See Peppermint. MISLETOE OF THE OAK, Viscum— Is to be found on several kinds of trees. That which grows upon the oak is said to have cured epilepsy or fits. It is directed that the misletoe be sepa- rated from the oak, about the last of November, gradually dried, and when pulverised, confined in a bottle well corked; to be given in doses of a tea-spoonful three or four times a-day, gradually increasing the dose according to its effects. MOORWORT, BROAD-LEAFED, Andromeda Mariana— Called wicke at the southward. A strong decoction of this plant is extremely useful as a wash in that disagreeable ulceration of the feet, which is called toe-itch, and ground itch, a very common complaint among the negroes and lower class of people in South Carolina and Georgia. MOTHERWORT, Leonurus Cardiaca—Grows in waste places, and flowers in July and August. The flowers are in thorny whorls, purplish within, and white on the outside; the leaves are opposite, two to each whorl; they have a strong disagreeable odour, and bitter taste.. An infusion of this plant is a common domestic medicine in faint- ing, and disorders of the stomach. It is said to be peculiarly adapted to some constitutions affected with nervous and hysterical agitations; and that, if taken at bed-time, procures refreshing sleep, when opium and laudanum had failed. MOUNTAIN TEA, OR DEERBERRY, Gaultheria Procum- bens.—It spreads very extensively over the more barren mountainous parts of the United States. A strong infusion of this plant, a large handful to a quart of boil- ing water, in doses of a tea-cupful three or four times a-day, is es- teemed useful in asthma, and for promoting the menstrual discharge. MOUTH ROOT, OR GOLDEN THREAD, Nigelia— Is found in swamps; the stems erect and naked; the leaves grow by threes at the termination of the stems; the white solitary blossoms appear in May; the roots are thread-shaped, and of a bright yellow colour. This plant has been supposed to be efficacious, as a local applica- tion, in ulcerations of the mouth. Its reputation in this case is, 71 562 MATERIA MEDICA. however, wholly unmerited, since it possesses no astringent or stim- ulating quality, by which it can act on the ulcerated spots. As a pure tonic bitter, capable of strengthening the viscerse and promoting digestion, it is entitled to rank with most articles of that kind now in use. MUGWORT, OR COMMON WORMWOOD, Artemisia Ab- sinthium,—Grows two or three feet high, on road sides and among rubbish; leaves deeply divided, pointed ; on the upper side of a deep green, and on the under, soft or downy; flowers small and purplish. An infusion, a handful of the tops to a quart of boiling water, in doses of a tea-cupful, or a tea-spoonful of the powdered leaves three or four times a day, is an admirable stomachic in weakness of the stomach, lowness of spirits, and hysterical affections. It is also said to be a useful medicine in difficult menstruation, in intermittents, jaundice, and dropsical affections. Externally it is applied in the form of fomentation and poultice to resist putrefaction and relieve the pains of bruises, as well as prevent the swelling and discoloration of the part. MULBERRY TREE, Morus, Nigra et Alba.—Its fruit has the common quality of all other sweet fruits, quenching thirst, abating heat, and proving laxative in its effects. A syrup made of the juice of the fruit, serves as an excellent gar- gle for mitigating inflammations of the throat and ulcers of the mouth. The bark of the root of the black mulberry tree, in doses of thirty grains, or half a tea-spoonful of the powder, or double the quantity infused in a gill or half a pint of boiling water, or equal parts of a strong decoction and molasses, formed into a syrup, in doses of a wine glassful, is an excellent purgative, and has been used with suc- cess as a vermifuge, particularly for the tapeworm. The fruit of the common mulberry tree, when properly fermented and prepared, yields a pleasant vinous liquor, known under the name of mulberry wine. Considerable quantities of these berries are likewise consumed in the cider countries, where they are mixed with the apples, in making a delicious beverage called mulberry ci- der. For this purpose, the ripest and blackest mulberries are select- ed, and the expressed juice is added to the cider, in such a propor- tion as to impart a perceptible flavour. The liquor thus acquires a very pleasant taste, as well as a deep red colour similar to that of the finest port wine, both of which continue undiminished by age. MULLEIN, Verbascum—The leaves, a handful to the quart of milk, is a common remedy in bowel complaints. In the form of fomentation or poultice, it is employed to relieve the piles, and other painful swellings; and in a dry and pulverised state, to destroy fungous or proud flesh. MATERIA MEDICA. 563 MUSTARD, BLACK AND WHITE, Sinapis, Nigra et Alba —Mustard used with our food, provokes the appetite, assists diges- tion, and promotes the fluid secretions, and is especially adapted to persons of weak stomachs, or where much acid prevails, as it acts upon the system generally without producing much heat. A table-spoonful of prepared mustard in a pint of warm water, on an empty stomach, operates as an emetic in nervous disorders. A table-spoonful of the unbruised, seed, taken twice or thrice a-day, proves a gentle laxative, increases the urinary discharges, and is useful in chronic rheumatism, asthma, palsy, and dropsy. In obsti- nate intermittents, or ague and fever, or with persons who find the Peruvian bark oppressive at the stomach, a tea-spoonful of the whole seeds, or the flower of mustard, united with the bark or any of its substitutes, will very frequently succeed in the cure, when a pound of bark alone would not produce the desired effect. In languid con- stitutions, or low stages of fevers, a gill of the seeds mixed with a small handful of horse-radish, and infused in a quart of wine, in doses of a wine glassful, occasionally, is a most cordial stimulant. Another excellent form in which mustard may be taken, is that of whey. It is prepared by boiling two or three table-spoons full of the seeds bruised, in half a pint, of milk, and as much water, till the curd be perfectly separated, to which a little sugar may be added, and of this drink, a tea-cupful may be taken three or four times a-day, in nervous fevers. The powder of the seeds, mixed with the crumbs of bread or flour, and formed into a poultice with sharp vinegar, is an excellent appli- cation to the parts affected with rheumatism, and to the soles of the feet, and palms of the hands, in fevers, where there is a languid cir- culation, or cold extremities, or in cases of delirium. NETTLE, STINGING, TJrtica—The expressed juice of a wine glassful, or a decoction, one handful to a quart of boiling water, in doses of a tea-cupful three or four times a-day, is said to be useful in jaundice, asthma, consumption, and gravel complaints. It is also said that the flower and seeds, in doses of a drachm thrice a-day, may be substituted for the Peruvian bark in ague and fever. Externally, it has been employed in restoring excitement to paralytic limbs, and other cases of torpor and lethargy. It may be applied by stinging the part with the nettles; or the fresh leaves may be applied to the arms or legs. NIGHTSHADE, AMERICAN. See Pokeweed. NIGHTSHADE, DEADLY, Atropa Belladonna—Grows two or three feet high in hedges, among rubbish, and uncultivated places; flowers dusky brown on the outside, and a dull purple writhin, ap- pearing single among the leaves in June or July; the berries round, green, changing to red, and, when ripe, of a shining black. The 564 MATERIA MEDICA. wdiole of this plant is poisonous, and children allured by its beautiful berries, have too often experienced their fatal effects. Like all other strong poisons, in the hands of skill it performs won- derful cures in palsy, epilepsy, melancholy, jaundice, dropsy, and cancer. " I have," says the great Professor Cullen, " had a cancer of the lip entirely cured by it." A scirrhosity in a woman's breast, of such a kind as frequently proceed to cancer, I have found entirely discussed by the use of it. In the employment of this dangerous medicine, it is necessary to begin with very small doses. Half a grain of the powdered leaves or root, or two table-spoonsful of the infusion, prepared by infusing twenty grains in half a pint of boiling water, and strained after cooling, is a sufficient dose for adults to commence with. The dose is to be gradually increased, and repeat- ed daily: but as soon as any dangerous symptoms occur, its use ought to be suspended for some days, and afterwards resumed in smaller doses. Externally, the powdered leaves are applied to miti- gate the pain in cancerous and other ill-conditioned ulcers, and the leaves, in the form of poultice, to discuss scirrhous and cancerous tumours. The garden nightshade, growing also on dung-hills, with white flowers, odour of musk, and the berries, when ripe, of a shining black, possesses virtues similar to those of the deadly nightshade. From one to three grains of dried leaves infused in boiling water, and taken at bed-time, will generally induce a copious perspiration, increase the discharge of urine, and operate as a mild laxative on the following day. If after increasing the dose some visible effect be not produced, its farther use will not avail much. The dose is to be repeated every night, or every other night. In the form of poultice. it has abated the inflammation of the eyes, painful swellings, and inflammation of the venereal kind, and scrofulous and cancerous tumours. The woody nightshade, called also bitter sweet, because it is first sweet, and then bitter, grows on the sides of ditches, and in moist hedges, climbing upon the bushes with winding, woody, but brittle stalks. The flowers are in clusters of a blue purple colour, appear- ing in June or July, and always turning against the sun. The ber- ries are red. This species is not so deleterous as the above two, and it acts more uniformly. Its sensible operation as a medicine, is also by sweat, urine, and stool, and in the form of infusion, is said to be eminently serviceable in acute rheumatism. It has also been found efficacious in jaundice, scurvy, obstruction of the menses, and in obstinate cu- taneous disorders. An infusion, prepared by adding a pint of boiling water to an ounce or half a handful of the twigs or stalks, either in a fresh or dried state, of which a tea-cupful or more may be taken morning and evening. Another form is made by steeping four ounces of the twigs in a pint of wine. The dose a wine glassful. In the form of poultice or cataplasm, it is also said to be a powerful dis- MATERIA MEDICA. 565 cutient of hard tumours. For this purpose boil two or three hands full of the leaves in wine or vinegar, to which may be added a little flax-seed, and this to be applied warm to indurated or hard tumours. The application of the juice and leaves to cancerous sores, in some instances, has performed a cure. OAK, Quercus.—The bark of the oak possesses, in a considerable degree, astringent, tonic, and antiseptic properties. Hence, we can never be at a loss for a remedy in those diseases in which the Peru- vian bark has been recommended. In intermittents and low stages of fever, in the advanced stage of dysentery, diarrhoea, indigestion, and other diseases of weakness, or loss of tone in the system, I have myself employed internally the black and red oak bark with equal effects, though in rather larger doses than the Peruvian bark. Many cases have come under my knowledge in practice, of persons, espe- cially children, reduced to mere skeletons, by protracted disease, of bilious, nervous fever, and bowel complaints, whose stomachs would not retain medicine, being most wonderfully restored to the blessing of health by bathing in a strong decoction of oak bark not more than milk warm, twice a-day. In the year 1809, I was requested by my brother, Dr. Thomas Ewell, who had the superintendence of the Marine Hospital in Washington, to visit some of his patients in the confluent small-pox, which had proved fatal in several instances. The first case presented to my view was that of a poor sailor, in the last stage of this dreadful disease, and so far gone, that it was thought utterly useless to prescribe for him, his coffin being actually ordered. Reflecting, however, on the virtues of the oak bark, I did not myself entirely despair of his case; and instead of passing him by, I ordered a bath of a strong decoction of oak bark to be prepared with all possible despatch, setting, at the same time, some of the soldiers to boil the water, while others hastened to the woods for the bark. When we came to immerse him in it, we found his whole body such a mass of corruption, from the top of his head to the soles of his feet, so filled with vermin, that there was no other way to bathe him but in a sheet. I directed him to be supplied liberally with milk toddy, and to repeat the bath every two or three hours. By persevering in this treatment for two or three weeks, gradually diminishing the toddy and oak bath, as his strength increased, to the astonishment of all the spectators, he was miraculously snatched from the jaws of death. When his sight was restored, he was much surprised to see that the astringent waters of the bath, had made him look, as he said, " as black as a negro." I am happy to add, that of several others in the hospital, who were treated in a similar mode, not one died. In farther proof of the tonic and antiseptic virtues of the oak bark, I beg leave to cite the following case from Professor Barton. u In a case of gangrene of the foot," says this learned professor, 566 MATERIA MEDICA. " from the puncture of a nail, which came under my notice in the course of last summer, I gave to the patient very large quantities of the decoction of oak bark, at the same time that the affected part was constantly kept wet with the same decoction, or with a poultice made of bread and milk and the bark. I cannot but ascribe the recovery of my patient to the use of these means, and I am irnbold- ened to recommend the use of this cheap remedy, as one highly worth attention in similar cases." OAK POISON. See Poison, Oak. ONIONS, Allium Ccpa—Possess similar virtues with the garlic, only in a less degree. The disagreeable smell which they impart to the breath, may be effectually obviated by eating a few leaves of parsley immediately after the onions. Onions are justly reputed an efficacious remedy in suppression of urine, in dropsies, and in abscess of the liver. The following ex- emplification of the virtue of onions in liver complaints, deserves the attention of the reader. Captain B. Burch, of the District of Columbia, was afflicted with an abscess of the liver, deemed incurable by his physicians, and see- ing some onions in the room, expressed a wish to eat one. Thinking his case desperate and no longer a. matter of any consequence what he ate, his wife immediately gratified his appetite. After eating one or two onions he found himself much better, which induced him farther to indulge his appetite. He subsisted for several weeks en- tirely on onions, with only the addition of a little salt and bread; and from using this diet he was restored to perfect health, and is now a very hearty man in his fifty-third year. This, with innumerable instances of a similar sort, ought to convince the young practitioner, that in the cure of this disease nature ought always to be consulted, as she seldom or never errs. Upon the high authority of our virtuous and able statesman, the honourable William H. Crawford, onions externally applied is an invaluable remedy in violent sore throat. This worthy patriot in- formed me, that one of his children being violently attacked with the croup, at his mansion in Georgia, a physician was sent for; but before he arrived, the disease became so alarming as to threaten the child with immediate death, if something for its relief were not speedily done. Having heard that an ointment of garlic had been employed with beneficial effects in sore throats, he instantly had some onions beaten, not having any garlic at hand, to which was added a small portion of hog's lard; and with this mixture, the neck, breast, and back of the child were well rubbed, which, in the short space of one hour, relieved all the distressing symptoms. Another case of croup, cured by this application, came under the notice of Mr. Crawford last fall, as he was travelling from Georgia to the seat of government. A little girl, daughter of the gentleman at whose MATERIA MEDICA. 567 house he tarried one night, was seized with this alarming malady; and on his recommending the above remedy, it was employed with the same happy effects. He also stated to me, that, while in Paris, he was afflicted with a very sore throat, which did not yield to the usual remedies; he di- rected some onions to be beaten, and had them applied to the soles of his feet and legs, over which his stockings were drawn. The happy result was, that he had a good night's rest, and in the morn- ing found his throat entirely cured. He communicated the cure wrought on himself to a French lady who was greatly distressed with a sore throat, which induced her to make the experiment, and the fortunate result was very remarkable. ORANGE TREE, Citrus Aurantium—Is now cultivated in the southern states, and deservedly esteemed for its grateful acid juice, which, by quenching thirst, and diminishing heat, is of considerable use in febrile disorders. From its virtues to resist putrescency, it has always, and most deservedly, held the first place on the list of antiscorbutics. The following is a recipe for making orange wine:—Take the ex pressed juice of forty sour oranges, five gallons of water, and fifteen pounds of sugar; boil the water and sugar for twenty minutes, skim constantly, and when cooled to a proper heat for fermentation, add the juice and outer rinds of the fruit, rasped or sheered off, putting all in a proper keg; leave it open for two or three days and then bung it close for six months. PAPAW. See Custard Apple. PAPOOSE ROOT. See Cohush. PARSLEY-LEAFED YELLOW ROOT, Zanthoriza Apii- folia—Is a native of the southern states. The stems reach the height of three feet, and are somewhat thicker than the barrel of a goose-quill. The root is from three to twelve inches long, and about the diameter of a man's little finger, sending off numerous scions, sometimes two feet in length, by which means it spreads considera- bly. The flowers appear before the leaves, very early in the spring. Both the stem and the root are of a bright yellow colour, and possess a strong and bitter taste. In medicinal virtues, it is nearly allied to the celebrated Columbo root. The powdered stem and root, in the dose of two scruples, are highly recommended in all cases requiring bitter and tonic medicines.* * The above is the character of this plant, as given by my excellent friend, the late Professor Woodhouse. Friendship is often partial; but eulogy, to be just, must employ bright colours to paint the character of such a man as Dr. Woodhouse. With that rare benevolence which imparts its noblest ardour to friendship, he combined a genius which threw a solar radiance over the 568 MATERIA MEDICA. According to Professor Barton, we have a very common plant in various parts of the United States, particularly in the rich soil adja- cent to the Ohio and its branches, in the western parts of Virginia, Pennsylvania, and Kentucky, which is commonly called Yellow Root. He describes the root of this plant as being a very powerful bitter, perhaps not less so than the preceding, and very popular as a tonic medicine. The usual forms of administering it are powder, tincture, and infusion. This latter has been employed as a wash in inflammation of the eyes. It is supposed this is the plant which some of the Indians make use of to cure cancers. PARSLEY, WILD, Petrosellinum—Grows in meadows, and among rocks near the sea; stems firm, near six feet high; long, thick root, strong smell, acrid taste; flowers in July, and kidney-shaped seed, which alone are used in medicine, as a powerful diuretic. A small handful of the seed, boiled in a quart of water and sweet- ened with honey, in doses of a tea-cupful every hour or two, is cele- brated as a remedy in suppression of urine, or gravel complaints. PEACH TREE, Amygdalus Persica—Both the flowers and leaves are excellent cathartics, and ought to be preserved by every family. A tea-spoonful of a strong infusion, sweetened, and taken every hour or two, will operate mildly on the bowels, without griping as senna does. Of the syrup, prepared by boiling slowly the juice of the leaves, with nearly an equal quantity of molasses, honey, or sugar, a table-spoonful to children, and a wine glassful to adults, will also prove a mild laxative medicine. I have myself witnessed its good effects in St. Anthony's Fire and measles, and have no doubt of its utility in other diseases requiring gentle laxatives. Two of my most intimate friends, on a visit to one of their cotton plantations just settled in the interior part of Georgia, and where there was neither medicine nor physician, were taken dangerously ill of the bilious fever. A good neighbour hearing they were ill, went to see them, and prescribed what he called "an excellent phy- sic," which was simply a strong infusion of peach leaves, to be taken in doses from a gill to a half pint every two or three hours. It ope- rated on the stomach, bowels, and skin; and by persevering in the use of it for a few days, they were happily restored to health. A decoction, prepared by boiling a handful of the dried leaves in a quart of water to a pint and a half, and taken in doses of a tea- dark abyss of chemical science, besides illuminating other walks of useful knowledge. To darken the gloom of so awful a dispensation, it pleased the great FA- THER of LIGHTS to take into his presence another star of equal lustre with Dr. Woodhouse. I mean that refulgent genius, Dr. Shaw, late Professor ot Chemistry in the University of Maryland. The friends of an art so impor- tant as Chemistry, will have cause to mourn the early extinction of those bright luminaries. / MATERIA MEDICA. 569 cupful every two or three hours, is reputed, upon respectable au- thority, to have proved an effectual remedy in many cases of affec- tions of the kidneys or gravel complaints, as also in cases of voiding blood by urine, which had resisted the usual remedies. PENNYROYAL, Mentha Pulegium—An infusion, a handful to a quart of boiling water, the dose a tea-cupful three times a-day, has long been esteemed in hysteric complaints and obstructions of the menses. Dr. Withering says, that the expressed juice of penny- royal, with a little sugar or honey, a tea-cupful every two or three hours, is a useful medicine in the whooping-cough. PEPPERMINT, Mentha Piperita—Is an excellent stomachic in flatulent colics, languors, hysteric cases, and vomiting. The usual modes of administering it, are infusion, the distilled water, and the essential oil. The last, united with rectified spirits of wine, forms the essence of peppermint, so highly esteemed. In nausea, cholera morbus, obstinate vomiting, and griping, pep- permint, infused in spirits, and applied, as hot as can be endured, to the stomach and bowels, will be a most valuable remedy. A lady of Alexandria was seized with a violent fit of the colic, bringing on a weakness and irritability of the stomach, with nausea and vomiting incessantly. Two eminent physicians sent for could prescribe nothing that did any service. Dr. Craik being called in, immediately ordered a large cataplasm of stewed mint in spirits, to be applied as warm as it could be borne, to the pit of the stomach and abdomen. It operated like a charm. The distressing nausea and vomiting left her, the aperient medicines were then retained, and the obstinate constipated state of the bowels was speedily removed. * PEPPER, RED OR CAYENNE, Capsicum Annum—Is culti- vated in our gardens; it is a powerful stimulant, and has been found beneficial in chronic rheumatism. Those who are subject to flatu- * To heighten my satisfaction in this cure, it was wrought by a man, of whom I can never think without feeling the most tender sentiments of grati- tude ; I mean my uncle, Dr. James Craik, with whom I was then a student in Alexandria. From the double motive of pleasure to myself and profit to others, I beg to sketch a short outline of Dr. Craik. Habits of temperance, early adopted and steadily adhered to, imparted to his constitution, though naturally delicate, a degree of vigour and vivacity that carried him through life very pleasurably, till his eightieth year. After he retired from practice, he continued daily to take considerable exercise; and such was his activity, that, but a short time before his death, he walked from his country-seat to Alexandria, a distance of eight miles! The virtues which adorn the husband, the parent, the friend, and the mas- ter, have seldom been seen to shine with more durable lustre than in Dr. Craik. In reward of his virtues, Heaven was pleased to distinguish him with un- common favours. For upwards of forty years he was honoured in an extra- 72 570 MATERIA MEDICA. lence will find benefit in using it with vegetables and soup. In cases of violent pain or cramp in the stomach, no medicine is supe- rior to a strong infusion of red pepper, one or two pods to a half pint of spirits, in dose of from a half to a wine glassful. It is also useful, both as a medicine and gargle, in putrid sore throat, when infused in water. Steeped in spirits and applied warm to the extremities in chronic rheumatism, or low stages of nervous fever, when the circu- lation is languid, it has produced the most happy effects. PINK ROOT, CAROLINA, Spigelia Maralandica—Grows abundantly in the southern states, and is deservedly esteemed a ver- mifuge, or destroyer of worms. An infusion, a handful to a quart of boiling water, and one or two tea-cupsful night and morning, is the usual form and dose. With the addition of milk and sugar, children will take it almost as readily as their tea. It sometimes oc- casions disagreeable affections of the eyes; when this occurs, suspend the use of the medicine until these symptoms disappear, and then select from another parcel, or make tea of the tops only, as it is sup- posed the deleterious effects are in consequence of some other root being attached to it. Pink root is also considered a valuable medicine in fevers, as is verified daily, when given to children in a febrile state for a vermi- fuge, when no other effect has been produced than a removal of the fever. PISS WORT. See Flea Bane. PLANTAIN, Plantago—Has long been employed as an anti- dote against the bites of snakes, spiders, and other venomous insects. The juice, extracted from the whole of the plant, is generally given in doses of two table-spoonsful every hour, or oftener, until the pa- tient be relieved. It is sometimes given in conjunction with hore- hound or rue. The leaves, bruised, are considered, by some, a good application to fresh wounds. ordinary degree, with the friendship of the great Washington, being all that time his companion and physician. This, however, was nothing compared to the happiness he enjoyed in marriage with a lady, who, for all the charms " of a mind-illumined face, and all the graces of truth, goodness, and harmony of love," never had her superior among the fairest daughters of Eve. " So like an angel did she spend her days, So like a blessed saint's,- were all her ways; So bland, so gentle, all her actions were, One would have thought her an immortal here." After more than fifty years of the happiest life, Dr. Craik was removed to those scenes where bliss immortal reigns. But their separation was short. He first deceased, she for a few months tried To live without him—liked it not, and died.—Heath. MATERIA MEDICA. 571 PLEURISY ROOT, Asclepias Decumbens—Has a variety of names, as butterfly weed, flux root, decumbent swallow wort. It is a beautiful plant, growing two or three feet high, under fences and upland pastures. The flowers are of a bright orange colour, and ap- pear in July and August. These are succeeded by long slender pods containing the seed, which have a delicate kind of silk attached to them. The root is spindle or carrot-shaped, of a light brownish colour on the outside, white within. This plant possesses great medicinal virtues, and ought, therefore, to be cultivated in our gardens. It has long been employed as a remedy in the treatment of violent cold and pleurisies. No medi- cine is better calculated than this to produce general and plentiful perspiration without heating the body, and hence its well merited fame in curing the disease, which name it bears. Mr. Thompson Mason of Virginia, was among the first who noticed the virtues of this plant, and from his long experience of its utility in pleurisy, re- commended it as a specific. He states, that after the use of an eme- tic, and the loss of some blood, in the incipient stage, he adminis- tered, of the pleurisy root, finely powdered, as much as would lie upon the point of a case-knife, in a cup of warm water, and repeated the dose every two hours until the patient recovered, which happened frequently in a very few days. By these simple means Mr. M. cured great numbers. We have, also, many of the most respectable physicians celebra- ting its virtues in pleurisy, and other recent affections of the breast. A tea-cupful of a strong infusion, a handful to a quart of boiling wa- ter, is given every two or three hours. Professor Barton says the root of this plant in powder possesses a purgative quality, and that he has used it with advantage in dysentery. In Virginia also it has been used with great effect in this complaint. This root is fre- quently resorted to by country people for the relief of pains of the stomach from flatulence and indigestion ; hence it is called, by some, wind-root. The late Paul Hamilton, Esq., ascribed the same virtues of curing pleurisies and dysentery to a plant that grows in South Carolina, and which is also called Pleurisy Root, Asclepias Erectus. He thus describes it:— It grows in rich high lands. The root has the appearance and taste of a small, long, sweet potato ; the stalk erect; the leaves re- sembling the persimmon leaf, is situated transversely, and when bro- ken, it throws out a viscid milk; blossoms in May and June. The blossoms are a cream colour, with purple centres. Twenty grains of this root in powder, he says, given in warm water or tea, is excel- lent in flatulent colic; and the same quantity repeated every two hours, in pleurisy, will seldom fail to bring on a perspiration, while the pectoral effects are admirable. POISON OAK, Rhus Toxicodendron—Embraces several spe- 572 MATERIA MEDICA. cies, the most dangerous of which is the swamp sumac. The poi- son may be communicated, not only by the touch, but also by the smoke, smell, or steam producing an eruption on the skin, with pain and itching, and sometimes attended with swollen head and fever. One of the best remedies which has come under my notice, is a wash of crude sal ammoniac and corrosive sublimate, two drachms of the former to one of the latter, in a quart of water; used exter- nally twice or thrice a-day; with a dose or, two of salts, or an infu- sion of senna and salts.—I have lately been informed, from a source which can be relied on, that lime-water excels any other applica- tion as a wash in this distressing affection of the skin. The species called sometimes poison wood, has a low shrubby stalk, the leaves somewhat heart-shaped, the flowers small, the berries round, and of a yellow gray colour when ripe. Dr. Anderson, of Hull, has em- ployed the leaves of this species in doses from half a grain to four grains, three times a-day, with success in paralytic cases. Poison vine, called also poison creeper, has a slender stem, and frequently climbs to the top of our tallest trees. The flowers, which appear in June, are small, of a light yellow colour, and have a de- lightful odour. An extract of the leaves, two grains to a dose, and increased, has been successfully employed in paralytic affections, as well as an infusion in tetter-worm and scald head. Professor Barton says, that a decoction has been used with seem- ing advantage in cases of consumption; and others say, that a decoc- tion of the root is serviceable in asthma. POKE WEED, Phytolacca Decandra—Is known by a variety of names, as American nightshade, coacum, garget, skoke. The berries, steeped in spirits, have long been employed in the chronic rheumatism. It has, however, sometimes failed, which may have been owing to the peculiarity of constitution, or to the inertness of the bounce or tincture from age, an effect often observed by Professor Barton, as also by myself. From the authority of this learned pro- fessor, the juice of the ripe berries, inspissated to the state of an extract, and spread upon a rag, or upon the leaf of the plant, is an excellent application to scrofulous or indolent tumours. The juice of the leaves has been applied in the same manner with equal ad- vantage. An ointment of the leaves with lard is good, in various kinds of ulcers. The roots, bruised, are sometimes applied to the hands and feet of the patients in ardent fevers. To make an extract, expose to moderate and continued heat, the juice of the berries or leaves, until by evaporation, it thickens to the consistence of honey. It may also be made from the root, which is equally efficacious. Boil the roots for some time, strain the decoction, and then reboil it to a thick consistence. Other virtues have been recently ascribed to this plant by respectable physicians. An infusion of the leaves is recommended externally as an admi- rable remedy for the piles. One ounce of the root steeped in a pint MATERIA MEDICA. 573 of wine, and given to the quantity of two table spoonsful, is said to operate mildly as an emetic.—It is also said that this plant may be relied on as an efficacious remedy for the venereal disease, in its various stages, even without the aid of mercury. From my own experience of the virtues of poke-weed, I can re- commend it as a most valuable medicine in rheumatic and gouty affections, as also in nocturnal pains, and obstinate ulcerations in the venereal disease, brought on by the excessive use of mercury. The usual form of exhibition is the bounce, a wine glassful three times a-day. The bounce is prepared by filling a jug with the whole beriies when ripe, and then pouring as much spirits to them as the vessel will contain. An ointment, prepared by simmering slowly the leaves or a hand- ful of the root scraped in a pint of hog's lard, with a small portion of bees-wax, has been used with great success in cancers, and various kinds of ulcers. POLYGONUM—An infusion of it, as a diet drink, is a powerful promoter of urine, and very useful in gravel complaints. POLYPODY, COMMON, Polypodium—Grows on old walls, shady places, and at the roots of trees, flowering from June to Octo- ber. The root has a sweetish taste, but by long boiling becomes bitter. An infusion of half an ounce of the fresh root in half a pint of boiling water, in doses of a wine glassful every hour or two, operates as a mild laxative. POMEGRANATE, Punica—Is cultivated in the southern gar- dens. The fruit is agreeable to the palate, and possesses the proper- ties of subacid fruits.—Its rind, boiled in milk, and drunk freely, or in powder, a tea-spoonful for a dose three times a-day, has been used with success, in diarrhoeas, dysenteries, and other diseases requiring astringent medicines. The flowrers possess the virtues of the rind, - only in a less degree. POPLAR TREE, OR WHITE WOOD, Liriodendrum Tu- lipifera—The bark of this noble tree, as well as the root, is a very strong bitter, and considerably aromatic. In intermittents, in the last stage of dysentery, and other disorders requiring tonic medicines, it is considered but little inferior to the Peruvian bark, and is generally employed in similar doses and forms. Professor Bigelow states that the bark is acceptable and apparently useful to patients who have derived occasional benefit from " Hux- ham's tincture," " Stoughton's elixir," and similar compositions of bitter and aromatic drugs. There is another species of poplar, the aspen tree, popidus tremula, the bark of which, according to Professor Barton, is also an excellent tonic and stomachic. 574 MATERIA MEDICA. POPPY, WHITE, Papaver Somniferum—Grows in our gar- dens, and yields a juice, which, when inspissated, to a proper consis- tence, is called opium. According to the experiments of Dr. S. Ricketson, of Dutchess county, New York, the opium obtained from our poppies, is equal, if not superior to the imported. With respect to the method of cultivating the plant, and preserving the opium, we shall insert the directions given by Dr. Ricketson. " The poppy seeds should be planted about the middle of May, in rich moist ground, an inch deep, and ten or twelve inches apart, and kept clean. When the plants are arrived to the state of flower- ing, on a sun-shining day, cut off the stalks, at about an inch dis- tance from the flowers, and as soon as the juice appears, which it does at first equally well on the part of the stalks cut off with the flowers, as on the standing part, collect it with a small scoop, or pen- knife. After the juice ceases to appear on the standing stalk, it should be cut off about an inch lower, when it will be found to yield almost as freely as before, and repeated as long as any juice appears. The juice, when collected, should be put into an evaporating pan, placed in the sun's heat, and frequently stirred, till it becomes of a consistence to be formed into pills, or to be made into rolls for keep- ing and exportation. The quantity of opium that may be preserved. depends very much on the largeness of our plants, and the care used in collecting it. From one poppy plant, I have obtained seven grains of opium. If any would choose to have the opium freed from its impurities, it may be easily done, by pressing the juice, before it is inspissated, through a linen strainer; but if pains be taken,accord- ing to the foregoing directions, I believe there will be little or no occasion for it." A strong decoction of the dried heads mixed with half the quantity of sugar, or honey, and formed into a syrup, by simmering slowly by a gentle fire for an hour, is occasionally used in doses of a table- ,. spoonful in coughs and breast complaints, on account of its anodyne effects.—Poppy heads are also used externally in fomentations and poultices, either alone or conjoined with the leaves of southern wood, camomile flowers, or other ingredients. POTATO, SWEET, Convolvulus Batata—From this root Bowen's patent sago is prepared, which forms a very nutritious jelly, like arrow root, and is prepared in the same manner; to which the reader is referred. The process generally used for procuring the powder of the sweet potato, is to grate the clean roots, wash the mass through brass sieves of different sizes, and collect the flour at the bottom of the vessel which receives the fluid; finally, dry it in pans either by the fire or in the sun. The vine of the sweet potato, supports the famous insect called the potato fly, which, from repeated experiments, is found fully equal MATERIA MEDICA. 575 in all respects to the best Spanish flies. The potato flies generally make their appearance about the last of July or first of August, and may be collected in great abundance morning and evening, by shaking them from the leaves in a vessel of hot water, and after- wards drying them in the sun. These insects will also feed upon the vine of the Irish potato. As they can be procured in immense quantities annually, with but little trouble, every family should care- fully collect them. POTATO, WILD, Convolvulus Panduratus—Grows in low grounds and sandy soils, near running water.—It trails along the ground several feet, much like a grape vine, the root very large, hard, and white, running very deep in the earth; the leaves triangular, the flowers are whitish, with a purple tinge, and bell-shaped. It is called wild rhubarb, and from the article whose name it bears, is employed as a purgative in doses from a tea to a table-spoonful of the powdered root. Professor Barton says, the root in powder or decoction has been much recommended in Virginia, and other parts of the United States, in cases of gravel. The decoction is prepared by boiling slowly a handful of the root sliced or bruised in three pints of water to a quart, of which, in gravel complaints, a tea cupful may be taken four or five times a-day. PRICKLY ASH, AND PRICKLY YELLOW WOOD, Zan- thoxylum—Possess the same virtues. Both species are covered with numerous prickles, whence the name.—Both the bark and berry are of a hot acrid taste, and when chewed, powerfully promote spittle. It is used in this way to cure the toothache, as well as putting some within the hollow, also to cure the palsy of the tongue. The prickly ash has a great deal of reputation in the United States as a remedy in chronic rheumatism. In that disease its operation seems analogous to that of Mezereon and Guaiacum, which it nearly resembles in its sensible properties. It is not only a popular remedy in the country, but many physicians place great reliance on its pow- ers in rheumatic complaints, so that apothecaries generally give it a place in their shops. It is most frequently given in decoction; an ounce being boiled in about a quart of water. Dr. G. Hay ward, of Boston, states that he took this decoction in his own case of chronic rheumatism, with evident relief. It was prepared as above stated, and about a pint taken in the course of the day, diluted with water sufficient to render it palatable by lessening the pungency. It was warm and grateful to the stomach, produced no nausea nor effect upon the bowels, and excited little, if any, perspiration. There is no medicine which I have found so effectual in relieving nocturnal pains, and disposing venereal ulcers to heal, as the prickly ash in the above form and doses. A tincture prepared by steeping half a pint of the berries, or a handful of the bark, in a bottle of spirits, is much esteemed as a re- ^1 °'D MATERIA MEDICA. medy in doses of a wine-glassful, in flatulent colics. It is sometimes employed in this form, in cold phlegmatic habits, afflicted with the rheumatism. PRICKLY PEAR—Grows on sandy lands and rocky places. A large handful of the pear cut in slices, boiled in a quart of milk, and taken in doses of a gill every morning, is reputed to be of great ben- efit in scurvy, dropsy, cancers,and cutaneous eruptions; and that the inner soft mucilage of the pear, while green, on a rag, to ulcers, morning and night, is very efficacious. It is also said that a fresh piece of the inner side of the pear, applied twice a-day to corns, af- ter soaking the feet in warm water, and paring off the horny part, will, in a few days, perform a cure. PRIDE OF INDIA, OR CHINA, Melia Azedarach—ls now completely naturalized to the southern states. Thepublic walk and streets of Savannah and Augusta, are ornamented by rows of this tree, a mile long, which furnish a most delighful shade against the scorching sun, and add not less to the healthiness than to the beauty of these cities. Independently of its luxuriant verdure, and cooling shade, it is highly valuable for its medicinal properties, being now ascertained to be one of the best vermifuges in nature. Many physicians in the southern states have witnessed its re- markable effects in destroying and dislodging worms. It has been even found a remedy against the tape-worm. I have not myself made use of this medicine, possibly because of the deleterious effects of the berries on some pigs and a parrot. In the fall of the year 1795, at a country seat which I then owned, in Lancaster county, Virginia, a sow with eight or ten pigs came into the yard where I had several trees of the Pride of China, and ob- serving the pigs to eat with avidity of the berries, which were drop- ped on the ground, I had many of them thrown from the tree, and in a few hours all the pigs were seized with the common symptoms of inebriation, and died. The sow did not appear to be the least affected, although she also ate of them. The death of the pigs would not have operated so strongly on my mind had it not been for a parrot, which not long after fell a victim to these berries. This enchanting bird, which spoke many words as plainly as a human person, and which for several years had been a pet in the family of Dr. Andrew Robertson, the father of Mrs. E****, had not long ar- rived at its new home, before it was tempted to eat of the fruit of this tree. A gentleman who was not apprized of the deleterious properties of this berry, presented the much admired Poll with one of them, which she soon ate, and relished it so well, as loudly to call out, "give me some more! give me some more!" After consum- ing several, she, in a short time, fell into a state of stupefaction, fol- lowed by a violent purging, which soon terminated her existence. The common modes of using this medicine, are the infusion or tea, MATERIA MEDICA. 577 and saturated decoction. Of the former, a handful of the bark to a quart of boiling water, is given in doses of a small tea-cupful morn- ing and night. The decoction is made by boiling a large handful of the fresh bark of the root in three pints of water, to a quart, which is given to children in doses from a half to a whole wine-glassful. Dr. Kollock, of Savannah, observes, when exhibited in the latter form, every three hours, until it operates, he has found it beneficial as a febrifuge in those affections usually denominated worm fevers, but where no worms are voided. The pulp which invests the stone of the fruit, pounded with tallow, has been successfully employed in cases of scald head. Would not an ointment prepared by slowly simmering the root in hog's lard, be found also an excellent applica- tion to that loathsome disease; also the tetter worms and ulcers'? PUCCOON. See Blood Root. QJJEEN OF THE MEADOWS—Grows in hedges, and on the sides of meadows, about four feet high ; the stalk reddish, leaves long, spear-shaped, and opposite each other, flowers purple. A large handful of the roots boiled in three pints of water to a quart, and given in doses of a tea cupful every two hours, is said to be an excellent remedy in suppression of urine, and for carrying off the water in dropsy. QUINCE TREE, Pyrus Cydonia—-The liquor expressed from the ripe quince, also the syrup, has frequently been given with great success in nausea, vomiting, and fluxes. The juice of the quince with sugar, a gallon of one to two pounds of the other is said to make a most delightful wine. The ripe fruit, sliced and steeped in French brandy or spirits, with a little sugar, or equal parts of the juice and spirits sweetened, forms an admirable cordial and stomachic. The quince makes also a nice preserve, and the seeds a fine mucilage, which, with sugar and nutmeg, is an ex- cellent drink in dysentery. RADISH, Raphanus— Is esteemed as an antiscorbutic, particu- larly if eaten with the skin. When old, or after having been kept some time, they ought to be avoided, especially by persons of weak stomachs, as apt to create indigestion and colic, and to render the breath disagreeable. RASPBERRY, Idaus—Like the rest of the rich subacid fruit, when ripe, are wholesome and nourishing. Raspberries, as well as strawberries, held in the mouth, will dissolve tartarous concretions formed on the teeth. R VTTLE OR SENECA SNAKE ROOT, Polygola Senega —Grows nearly a foot high, the leaves pointed, and somewhat oval; 73 578 MATERIA MEDICA. the stalks upright and branched, the flowers white, the root variously bent and jointed, whence it is supposed to resemble the tail of the animal whose name it bears. The first reputation of the Seneca root was one which it divides with a multitude of other plants, that of curing the bite of the rattle snake. A reward was given by the legislature of Pennsylvania, to Dr. Tenant, for the promulgation of this supposed property. When, however, we consider the number of cases of recovery from the bite of this serpent, under every variety of treatment, we cannot avoid the conclusion, that these injuries are not necessarily dangerous, and that spontaneous recoveries are, perhaps, as frequent as those which are promoted by medicine. In violent colds, croup, pleurisy, acute rheumatism, and all in- flammatory complaints, I can recommend it as an admirable medi- cine to promote perspiration. The best form of using it is in decoc- tion, a handful to a quart of boiling water, a wine glassful to adults, every two or three hours, increasing or lessening the quantity to avoid vomiting and purging. Professor Chapman recommends it very highly in obstructions of the menses ; four ounces of the decoction to be taken in the course of the day, increasing the quantity when the menstrual effort is ex- pected, as far as the stomach will allow. If this excite nausea, aro- matics are to be added, as cinnamon, calamus and angelica. Dr. Archer, of Harford county, Maryland, was among the first who noticed the efficacy of this medicine in cases of croup or hives. He directs a tea-spoonful of the strong decoction to be given to a child every hour or half hour, as the urgency of the symptoms may demand, and, during the intervals, a few drops occasionally, until it acts as an emetic or cathartic; then repeated in small quantities, to keep up a constant stimulus in the mouth and throat. Patients who use this medicine, should not be permitted to drink any thing what- ever for some time after each dose. He employed it in the form of a powder in doses of four or five grains, mixed with a little water. Professor Barton, with his usual candour and liberality, observes, " I am persuaded that the Seneca is a very important medicine in the treatment of this common, and too frequently unmanageable dis- ease; and praise is, in my opinion, due to Dr. Archer for his impor- tant discovery, for such I cannot but deem it. That the Seneca is a specific or certain remedy for the cure of croup, I do not believe; but from my own experience I am led to repose more confidence in the use of this medicine than in any other. I have made use of a very strong decoction of the root. I have always given it in large quantities. It appears to be chiefly beneficial when it occasions an expectoration of mucus, and when it proves emetic. It is also very useful by virtue of its purgative quality. But I have known it oc- casion very plentiful stools, without benefiting the patient. Indeed, in the exhibition of Seneca, I would rather wish to guard against large purgings. I have sometimes treated my patients almost entirely MATERIA MEDICA. 579 with Seneca. Even in such cases I have perceived most unequi- vocal good effects from it: but, have more generally given along with the Seneca, calomel, and sometimes calomel combined with ipecacuanha. I have not omitted the employment of the lancet, though this in many cases of croup is not absolutely necessary, and the use of blisters or sinapisms applied near the seat of the disease. I am happy to close this short notice by observing, that several re- spectable physicians in Philadelphia inform me that they have used the Seneca with much advantage in the disease in question. In various forms of dropsy, the Seneca root has been resorted to with advantage, and has received the commendations of Percival, Millman, and some others. Its cathartic and diuretic effects are very considerable, when persevered in, in large quantities; and have, in many instances, effected the dissipation of dropsical swelling.-. In the prevailing epidemic I have found a decoction of this vegeta- ble, taken freely at the commencement of the disease, a medicine of great utility. RATTLESNAKE VIOLET. See Violet. RED CEDAR, Juniperus Virginiana-—Is found from Lake Champlain to the Cape of Florida. The leaves have a strong disa- greeable taste, with some pungency and bitterness. Its most fre- quent use is in the composition of the cerate employed for keeping up the irritation and discharge of blisters. This preparation is the same with the Savin cerate, used in Europe, the leaves of the red cedar being substituted for the Savin. When properly prepared by boiling the fresh leaves for a short time in about twice their weight of lard, with the addition of a little wax, a cerate is formed, of pecu- liar efficacy as a perpetual epispastic. When applied as a dressing to a newly vesicated surface, and afterwards repeated twice a-day, it rarely fails to keep up the discharge for an indefinite length of dine. Under its operation, the discharge usually changes from a serous to a puriform appearance, and concretes upon the surface; so that it re- quires to be removed from time to time, to admit the full action of the cerate. Internally, the leaves have been found to exert effects very similar to those of the Savin. They have proved useful as an emenagogue, and as a general stimulant and diaphoretic in rheumatism. They have also had some reputation as a diuretic in dropsy. RHUBARB, WILD. See Potato, Wild. ROSE, Rosa.—The hundred-leafed, or damask rose, is justly termed the queen of flowers. Otto, or essence of roses, is obtained from these by distillation, and is doubtless the most elagant perfume in vegetable nature. Independently of their use in this manner, a decoction of its leaves will be found a mild laxative, and, when 580 MATERIA MEDICA. formed into a syrup, may be given with advantage to children. The conserve of roses is also prepared from them for medicinal purposes. ROSE WILLOW, Salix—Grows near brooks, along the banks of rivers, and on the borders of meadows. It is about the size of an apple tree, and covered with a grayish-coloured bark, and very red within, with a bunch in the top resembling a bunch of roses. Four ounces, or a large handful of the bark, boiled in three pints of water to a quart, and taken in doses of a tea-cupful three or four times a-day, is said to be an excellent remedy in cases of gleet, the whites, immoderate flowing of the menses, and in cutaneous eruptions. RUE, Ruta—Has an ungrateful smell, and a pungent bitter taste. The leaves are acrid, and wdien applied to the skin are apt to produce blisters. Employed in the form of tea, they are reputed to be of great service to persons of cold phlegmatic habits. According to Boerhaave, an infusion of the leaves powerfully promotes perspi- ration, quickens the circulation, removes obstructions, and is particu- larly adapted to weak and hysterical constitutions, suffering from re- tarded, or obstructed secretions. SAGE, Salvia—An infusion of the leaves or tea, is considered serviceable to persons of cold phlegmatic habits, labouring under nervous debility. Sweetened with the addition of a little lemon juice, it forms an exceedingly grateful and useful drink, in febrile disorders. Sage was supposed by the ancients to possess the virtue of pro- longing human life; hence the following verse: "Cur moriatur homo, cui salvia crescit in horto?" How can a man die, in whose garden there grows sage? in allusion to its many virtues. What a shameful abuse of this pretended property was made by the late Sir John Hill, in his patent tincture of sage, for the prolonging of human life, and warding off old age, is known to every one. This conduct could not fail to draw upon him the pen of the wits of the age; and Garrick, with Thomson, conjointly, published the following epigram :— "Thou essence of dock, valerian, and sage, At once the disgrace and pest of the age, The worst that we wish thee, for all thy bad crimes, Is to take thy own physic, and read thy own rhymes." Dr. Hill made the following reply:— "Ye desperate junto, ye great or ye small, Who combat dukes, doctors, the deuce, and them all, Whether gentlemen, scribblers, or poets in jail, Your impertinent curses shall never prevail: I'll take neither sage, dock, nor balsam of honey; Do you take the physic, and I'll take the money." MATERIA MEDICA. 581 Such shameless imposition on common sense, deserves something worse than ridicule ; for deceiving the sick and helpless, they merit the execrations of every man who has one spark of humanity. SAMSON SNAKE ROOT—Grows from six to twelve inches on dry land, and bears on the top two or three pale blue flowers; leaves opposite, sword-shaped; the root matted, variously bent, and has an agreeable bitter taste Upon the respectable authority of the honourable William May- rant, of South Carolina, the root of this plant possesses in a very great degree tonic powers. He stated to me, that being himself re- duced to a mere skeleton by dyspepsia, or indigestion, and having tried the usual remedies employed in such cases, writhout receiving any benefit, he was at length induced, as his last hope, to try the virtue of this plant, which had been recommended to him by a negro man. He was directed to steep a handful of the root in a bottle of spirits, of which he was to take half a wine glassful diluted with wa- ter three times a-day; and such was the astonishing effect wrought by this medicine, that in a few weeks his health was perfectly rein- stated. He discovered the plant to grow near Fredericksburg, Vir- ginia, and collected some of it to exhibit in Washington. Several persons in delicate health, and troubled with dyspepsia, were readily persuaded, from the recommendations of Col. Mayrant, to make use of his favourite remedy, and not without receiving considerable benefit. It may be taken in the form of powder, tincture, or de- coction. SANICLE, AMERICAN. See Alum Root. SARSAPARILLA, Smilax Sarsaparilla—Grows in several parts of the United States. It is a small vine resembling a bramble. A decoction of sarsaparilla, prepared by boiling a large handful of the root in a quart of wTater, till the third part be evaporated, has long been employed as an auxiliary to mercury, in the treatment of venereal complaints. It promotes perspiration, attenuates viscid humours, relieves venereal headache, nocturnal pains, and disposes venereal ulcers to heal. In rheumatic affections, cutaneous disor- ders, and scrofula, it is a very useful medicine. It may also be ex- hibited in the form of powder in doses of two drachms, or extract in doses of one drachm, three or four times a-day. SASSAFRAS, Laurus Sassafras.—An infusion or tea of the flowers, or bark of the root, has often been successfully given as a sweetener or purifier of the blood, in scorbutic, venereal, and cuta- neous disorders, or where an acrimony of the fluids prevails. Con- joined with bark of dogwood, cherry tree or oak, it is very useful in obstinate intermittents. The oil, externally applied, in the chronic rheumatism, and also in wens, has oftentimes proved salutary. The 582 MATERIA MEDICA. pith of the small twigs, in water, forms a mucilage of excellent use for sore eyes, and as an injection in the incipient stage of gonorrhoea. It also affords, when sweetened, with the addition of nutmeg, a palatable jelly, useful in dysentery and febrile diseases. SCULL CAP, BLUE. See Hooded Widow Herb. SCURVY GRASS, Cochleara Officinalis—Is a pungent stimu- lating plant, and in the simple state of a salad, or, in the form of ex- pressed juice, a wine-glassful three times a-day, has long been es- teemed one of the best of all the antiscorbutic plants. SENNA, AMERICAN, Cassia Marilandica—Is easily cultiva- ted from the seeds, and ought to be more generally introduced in our gardens. It has long been employed as a purgative. To increase its effects on the bowels, manna, salts, or tamarinds, are generally added. To correct its ill flavour, and prevent griping, it should be joined with some aromatics, as coriander or fennel seed, ginger, &c. In the form of decoction, a handful to a pint of boiling water, the dose is a tea-cupful every hour or two until it operates. It may also be ex- hibited in the form of tincture, to relieve flatulent colics, four ounces of senna to a quart of spirits, with an ounce of coriander seed, or ginger, and a wine-glassful the dose. SKOKE. See Thorn Apple. m SKUNK CABBAGE, DraconituFcetidum—Abounds in swamps and meadows, and emits a disagreeable smell, nearly resembling that of a skunk or polecat, and from this, and its leaves resembling those of a cabbage, it has acquired its name. The roots dried and powdered, have proved of excellent use in asthmatic cases, and often afforded relief in this distressing disease, when other means were ineffectual. It should be exhibited during the paroxysm, and repeated as circumstances may require, in doses of thirty or forty grains. It will be proper to persevere in the use of it for some time after the paroxysm has gone off, until the patient has perfectly recovered. Dr. Cutler has celebrated its efficacy in his own case of asthma, after other medicines had failed. In one of the most violent asth- matic cases, two tea-spoonsful of the powdered root, in spirits, pro- cured immediate relief; and, on repeating the trials with the same patient, it afforded more lasting benefit than any other medicine. In childbed it produces the desired effect, in doses of a tea-spoonful re- peated occasionally. In numerous other instances of spasm, and also in chronic and acute rheumatism and dropsy, in powder or decoc- tion, it has performed important cures. The seeds possess the same virtues as the root. i MATERIA MEDICA. 583 Dr. Cutler vehemently cautions, that, in collecting the roots, the white hellebore, or poke root, which some people call skunk weed, be not mistaken for this plant, as the consequence might be fatal. There is an obvious difference ; the hellebore has a stalk, but the skunk cabbage has none; and the roots of the latter are much larger than those of the former. SNAKE ROOT. See Virginia Snake Root. SOAPWORT, Saponaria Officinalis—Grows in moist swamps and meadows, particularly on the Ohio river, where it is used as a substitute for soap. It rises about a foot high, the leaves are pointed, and furnished with three ribs, the flowers numerous, large, and of a pale pink colour. A handful of this plant boiled in three pints of water to a quart, in doses of half a pint, three or four times a-day, has been found useful in the jaundice, obstructions of the liver, and the venereal disease. SORREL, Oxalis Acetosella—Called also sour trefoil, or cuckow bread, yields, on expression, a grateful acid juice, which has been beneficially used in the scurvy and scorbutic eruptions. An infusion of the leaves makes a palatable diet drink in fevers, and on being boiled in milk, forms an agreeable whey. A conserve made of the leaves, with double their weight of loaf sugar, forms an excellent substitute for lemons, and may be given with advantage, in all pu- trid and other fevers, where antiseptics are indicated. The leaves bruised, and externally applied to scrofulous ulcers, have produced excellent effects, by promoting suppuration and granulation. SOUTHERN WOOD. See Mugwort. SOUTH-TEA, OR YAUPON, Alex Vomotoria—Grows abun- dantly in the southern states. It rises about twelve feet high, shoot- ing into many upright, slender, stiff branches, covered with whitish smooth bark; the leaves small, evergreen, and saw-edged; the flow- ers small and white, and grow promiscuously among the leaves, succeeded by small berries, which become red in October, and re- main so all the winter. It is held in great esteem among the southern Indians. They toast the leaves, and make a decoction of them, which is called black drink. An infusion, or tea of the leaves, is considered as palatable as Bo- hea tea, and when used freely, is a powerful diuretic, and hence of service in the cure of dropsy and suppression of urine. SPIKENARD, Aralia Racemosa—Grows in low rich grounds and among rocks, to the height of three or four feet; the leaves are 584 MATERIA MEDICA. many, on long branches, from a thick purplish stalk, flowers very small, of a bluish colour, producing berries much resembling those of the elder, of a sweetish pleasant aromatic taste. The roots are very long, and about the thickness of a finger. A pint of berries steeped in a quart of spirits, in doses of a wine- glassful, is said to be a speedy cure for the gout in the stomach. The roots in the form of infusion, a handful to a quart of water, and given in doses of a tea cupful three or four times a-day, have been found efficacious in gouty complaints. The fresh root applied in the form of poultice, is said to be excellent for wounds and ulcers. SPLEEN WORT. See Maiden Hair. SPRUCE LAUREL. See Mezereon. SQUIRREL EAR, OR EDGE LEAF—According to the late Paul Hamilton, Esq., is produced on barren pine land, in Carolina and Georgia. It is a species of sage, and very efficacious as an anti- dote to the poison of the snake bite. It is known by the remarkable characteristic which forms its name; the leaf, instead of the surface, presents its edge to the sun, and is in colour and shape, very much like the ear of the squirrel, although larger. The stalk never rises beyond three feet, and its leaves are alternate and transverse. A wine-glassful of the juice of this plant has been known to rescue from death persons bitten by the rattlesnake, who were so far gone, as to be incapable of speaking. The flower of this plant is white and fuzzy, and appears in every warm month in the year; the smell that of mellilot, with a slight tincture of the aromatic. STAR GRASS, Aletris Farinosa—Grows in fields and about the edges of woods, and flowers in June and July. The leaves are grass-like, but smooth and stiff, of a willow-green colour, and spread like a star upon the ground. " No plant," says Dr. Bigelow, "sur- passes this in genuine, intense, and permanent bitterness." Hitherto, it has been chiefly used as a tonic, exhibited in small doses. STINK WEED. See Thorn Apple. STRAWBERRY, Fragaria—The fruit of this plant is delicious, and being of a cooling and laxative nature, may be considered as medicinal. If freely eaten, they impart their peculiar fragrance to the urine, and when retained in the mouth for some time, dissolve tartareous concretions on teeth. They are of great service in cases of scurvy, and, according to Linnaeus, a copious use of them has proved a certain preventive of the stone in the kidneys. An infusion of strawberry leaves, while young and tender, makes excellent tea; but for such purpose they ought to be dried in the shade, being slightly bitter and styptic. They have been used with advantage in MATERIA MEDICA. 5S5 laxity and debility of the intestines, as likewise in hemorrhages and other fluxes. Lastly, they are of considerable service as aperients in suppression of urine, visceral obstructions, and jaundice. SUMACH, COMMON, Rhus Copallinum.—The berries or seeds, when ripe, are red and very acid. An infusion of them, sweetened with honey, is a good gargle for the sore throat, and for cleansing the mouth in putrid fevers. Mr. Jesse Torrey considers the bark of the root of sumach to be one of the best antiseptics produced by vegetation. Corroding ul- cers, defying every common application, immediately began to heal by washing them with a strong decoction, and applying the boiled bark as a poultice. He says it is a very important material in decoc- tions for hectic and scrofulous diseases. Sumach constitutes one of the ingredients of the following recipe, which was handed to me by a gentleman of the first respectability and veracity, as a remedy for the venereal disease. Of the inner bark of pine and swamp elm, and the bark of the root of sumach, take each one pound; boil them in a gallon of water to three quarts, drink half a pint three times a-day: if costiveness be produced, a dose of salts may be used. If there be ulcers, they are to be washed with a decoction made warm. The detergent effects will appear in a very short time. Abstinence from too much stimulants will accelerate the cure. This remedy is one of Heaven's best mercies to offending man; and instances can be produced of the effects of it, which would stagger credulity. Mercury, and nitric acid have failed, but this has never been known to fail when properly applied. It is, moreover, a fine application in dysenteric affections. SUNDEW, Ros Solis—Called also red root, or youthwort. Grows in mossy bogs, flowering in July and August. The whole of this singular plant is acrid, and its juice sufficiently caustic to corrode corns and warts. It is said, the juice, properly mixed with milk, and applied to the skin, will remove freckles and sun-burns SWALLOWWORT. See Pleurisy Root. TANSY, Tanacetum Vulgare.—This plant possesses a warm taste, and may be used as a substitute for hops. An infusion of the leaves is recommended for a weak stomach, hysteric complaints, and obstructed menses. According to Dr. Withering, its seeds are an excellent vermifuge, in doses from a scruple to a drachm, and that if animal substance be rubbed with the herb, it will be effectually preserved from the attack of the flesh fly. 74 586 MATERIA MEDICA. THORN APPLE, Datura Stramonium—Has a variety of names, as James-town, or jimson weed, French apple, stink weed, Sec. Its common name, James-town weed, is said to have arisen from the circumstance of a number of sailors being violently diseased by ignorantly eating the boiled plant at Jamestown, in Virginia, at its first settlement. It grows among rubbish, and on dunghills, to the height of two or three feet, flowers in July and August. The corolla is funnel-shaped and plated white with a tinge of purple. The capsule is large, egg-shaped, and covered with thorns, which have four divisions, and contain numerous kidney-shaped seeds. The leaves are large, egg-shaped, and deeply indented, of a disa- greeable smell, and nauseous taste. Every part of this plant is a strong narcotic poison; nevertheless, when judiciously administered, it is unquestionably one of the most valuable medicines in our possession. Professor Barton considers it a medicine of great and invaluable powers, especially in cases of mania, attended with little or no fever, or with a cold skin and lan- guid circulation. The form in which he exhibited it, was that of an extract prepared from the fresh* leaves, beginning with a few grains, and gradually increasing the dose to fifteen or twenty grains. In one case of mania, in a woman, he increased it to sixty grains. In a few weeks it brought on an eruption in various parts of the body, " and she was dismissed," he observes, " from the hospital, per- fectly cured." Dr. Fisher recommends it highly in those cases of mania in young persons, where fits occur daily, or monthly, at regu- lar periods, especially if assisted by chalybeates, or such other medi- cines as particular symptoms require ; but advises the free and regu- lar use of it, one or two doses every day. The most convenient form, especially for children, he thinks, is the saturated tincture: the requisite dose may be known by the dilatation of the pupils. Dr. Alexander King, of Connecticut, has employed this medicine, in the form of decoction, one drachm of the seed bruised, boiled in half a pint of water to a gill, in several cases of inflammation of the brain, attended with delirium. The following is one of the cases re- cited by the doctor. A man of robust constitution, and sanguine habit, about twenty- six years of age, after drinking pretty freely, was seized with a slight paroxysm of the apoplexy, which was followed by a cold fit of fever, attended with a violent pain of the head, and delirium. On the second day, I found him delirious, with an inflammation of the brain, or rather the meninges. I bled him largely, so that he even fainted in a recumbent posture, which was succeeded by another partial paroxysm, similar to the first. I put him on a course of medicine, nearly the same as prescribed in a former case. The next day I found no abatement of the symptoms; he had slept none for two nights past, and was quite outrageous. I then prescribed for him a decoction of the seeds of the datura stramonium, and directed the nurse to give him a tea-spoonful every quarter of an hour. I MATERIA MEDICA. 587 found, on visiting him the next morning, that soon after taking the decoction, he became calm and composed, and went to sleep. I continued the same medicine through the course of the fever, which lasted about seven days, except one day in which I purposely omit- ted the use of it, in order fully to satisfy myself as to the operation of the medicine. On that day the delirium returned, and he slept none the night following. The next morning I had recourse to the decoction as usual, and it produced the same salutary effects as before. In this case, I had a fair opportunity to observe the action of the medicine, in an early stage of the disease, which was cooling, ano- dyne, and sedative. As a remedy in epilepsy, Professor Barton thinks it may be relied on even in the most deplorable cases. A lady, aged fifty-five, having for some months been afflicted with alarming attacks of epilepsy, by which her powers of intellect and of articulation were impaired, hap- pily experienced a restoration, by taking one grain of the extract once in twenty-four hours. Although she did not suffer another at- tack, after commencing the course, she found it necessary to continue it for several months, to remove all apprehensions of a recurrence. A single grain seldom failed to excite unpleasant vertiginous sensa- tions, accompanied with efflorescence of her face, and some degree of sleepiness. In asthma and spasmodic cough, stramonium is said to have proved essentially beneficial. It is also said to have pro- duced salutary effects in cases of chronic rheumatism, and difficult menstruation. As this medicine is indued with most active powers, it ought to be administered in very small doses at first, and the quantity gradually increased daily, until it produce, in a slight degree, vertigo or dilata-- tion of the pupil. In the course of my practice, I witnessed the deleterious effects of this plant in a child, who was attacked with convulsions similar to those which attend persons afflicted with the disease termed St. Vi- tus's dance, accompanied with delirium, tremour, thirst, glaring eyes, dilated pupil, and considerable efflorescence of the skin. The parents were perfectly ignorant of the cause of the child's sudden indisposition; but from the symptoms, I was convinced it had taken some of the stramonium, and on making the necessary inquiries, learned that it had been playing with some of the seeds a few hours before. Immediately on visiting the child, I directed the warm bath, and gave it six or eight grains of blue vitriol, which was re- peated at the interval of fifteen minutes, before it excited vomiting, when some of the seeds were thrown up. After the operation of the emetic, I administered a large dose of castor oil, which, assisted by stimulating injections, produced in a few hours some evacuations, and the child was entirely relieved from all those distressing symp- toms. Domestic practitioners will recollect, that two or three grains of blue vitriol is a full dose for adults; and the large dose given in 58S MATERIA MEDICA. this case, was from persuasion that the child's stomach had been de- prived of its sensibility, through the narcotic effects of the poisonous seeds. The extract may be made by exposing the juice of the plant to the heat of the sun, or by boiling the bruised seed or leaves in water for the space of four hours; then strain off the liquor, evaporate over a gentle fire, without taking off the scum, until it has acquired the thickness of syrup: then place it in a wrarm oven, in an earthen ves- sel, until it becomes of a proper consistence for use. The dose is from one to two grains, or more, for an adult. The saturated tinc- ture is prepared by steeping one or two hands full of the leaves in a half pint of spirits for a few days. The stramonium has also been employed externally with the most happy effects. In recent wounds, inflammations, or bruises, the leaves, either alone, or united with bread and milk poultice, have been applied to the part with manifest advantage. In the form of ointment, which is prepared by simmering slowly the fresh leaves bruised in hog's lard, with about one-eighth part of bees-wax, for an hour, and then strained through a coarse cloth, it will be found ex- cellent for the piles, scalds, and burns. From my own observation it far excels all other applications I have made to obstinate cutaneous sores, ill-conditioned ulcers, and painful cancerous affections. THOROUGHWORT, Eupatorium Porfoliatum—ls known also by the following names : thoroughstem, crosswort, boneset, and Indian sage. The first of these names, thoroughstem, has been im- posed upon it from the peculiar structure of the leaves, which are opposite, and appear as though the stem were thrust through them. It has received the second name, of crosswort, by which it is known in many parts of Virginia, from the position of the leaves, each pair of which take their origin from opposite sides of the stem, so that they cross each other nearly at right angles. I am at a loss, says Professor Barton, to refer the word boneset to its real origin ; but I presume the plant received this name from the great relief which on many occasions, it has been found to afford to persons labouring under violent remitting and other fevers, in which the bones are greatly pained. The resemblance of the leaves of this plant to those of the common sage, was long ago remarked by the botanists. Hence the name Indian sage, by which the eupatorium is known in some parts of Pennsylvania. This plant flourishes in wet meadows, and other moist places. The stalk is hairy, and rises from two to four feet. The flowers are white, and appear in July and August. The leaves at each joint are horizontal, saw-edged, and rough, from three to four inches long, and about one inch broad at the base, gradually lessening to a very acute point, of a dark green, and covered with short hairs. This plant possesses very active powers, and has been exhibited with uncommon advantage in intermittents, remittents, and other MATERIA MEDICA. 589 diseases of debility. When exhibited in the form of a warm decoc- tion, a handful of the herb boiled in a quart of water, a wine-glassful every two hours, has proved peculiarly beneficial, says Professor Barton, in fevers* by exciting a copious perspiration. In larger doses it proves emetic ; with which view it is used in some parts of the United States, as an excellent remedy in intermittents. The dried leaves in powder, in doses of twelve or fifteen grains, are said to operate gently on the bowels. Every part of this plant may be ad- vantageously employed in practice. The flowers, as a tonic bitter, are deemed equal to the flowers of camomile, for which they micht be substituted on many occasions. This medicine has also been found very efficacious in cutaneous diseases. In a peculiar and distressing affection of the herpetic kind, which was formerly very common in Virginia, and there known by the name of James River ring worm,* Professor Barton states, from the respectable authority of Dr. Thomas Knox, of Cul- pepper county, Va., that a decoction of this plant drunk daily, for a considerable time, made a perfect cure. A wine-glassful of the ex- pressed juice of the green herb drunk every hour, is celebrated as a certain cure for the bite of a rattlesnake. The bruised leaves should be applied to the part. THROAT ROOT. See Avens. THYME, GARDEN, Thymus Vulgaris—Is one of the most powerful aromatic plants, and, as such, is frequently employed in die form of tea, in those complaints where medicines of this class are indicated. TOBACCO, Nicotiana Tabacum—This " obnoxious luxury," is a medicine of the most uncommon powers; being emetic, cathartic, sudorific, diuretic, expectorant, narcotic, and anti-spasmodic ; hence its utility in a variety of diseases. A table spoonful of an infusion, one ounce in a pint of boiling water, will excite vomiting; however, as it has no peculiar property as an emetic, and its operation is attended with severe sickness, it is not often employed with this view. As a purgative, it is employed in the form of clysters, in all cases of obstinate costiveness. Ex- hibited in this form, in the quantity of two or three table-spoonsful of the infusion, mixed to half a pint of milk or thin gruel, it has fre- quently afforded almost instantaneous relief in violent colics, after other medicines had proved ineffectual. If this quantity produce no relief, nor excite giddiness nor nausea, the injection may be repeated every half hour, with the gradual increase of the infusion, till one * This disgusting disease prevailed mostly among the inhabitants on James River. It attacked the thighs, the scrotum, and especially the parts immedi- ately adjacent to the arms. It extended its ravages into the rectum and per- haps much farther. 590 MATERIA MEDICA. or other of the effects take place. By this mode of proceeding, the violent effects of tobacco may always be avoided. As a diuretic, it has on many occasions proved an invaluable remedy, as in ascites and other dropsical affections, also in gravel, or difficulty of making water. In those cases, according to Dr. Fowler, the dose for adults should be from sixty to one hundred drops of the infusion in a tea- cupful of water twice a-day, about two hours before dinner, and at bed-time ; it being observed to disagree most with the stomach in the morning fasting. And, such is the difference between the morning and night, that almost every patient will require to take one-fourth, and some one-third more in the forenoon than in the evening, in order to enable them to bear the dose with equal convenience. The common dose just mentioned, relates only to adults of an ordinary constitution; for it deserves particular notice, that between constitu- tions which are nervous and irritable, and those which are very ro- bust or torpid, or long accustomed to the use of tobacco, the dose will admit of very great and surprising alterations. As an expectorant, in asthmatic cases, unattended with inflamma- tory symptoms, this medicine has frequently afforded relief. In cases of tetanus, or lock-jaw, injections of tobacco infusion, says Dr. Mease, have been used with success. They not only produce evacuations from the bowels, which are generally obstinately constipated, but tend to a relaxation of the violent spasms so peculiar to this disease. On this account he suggests the propriety of giving it in the dreadful disease produced by the bite of a mad dog. Besides the internal use of tobacco in the above diseases, it is like- wise commended for its virtues externally employed. In the tooth- ache, a piece of lint moistened with the expressed juice of tobacco, .has often acted as a charm in mitigating the pain. In obstinate ulcers, an ointment, or the dried leaves of tobacco, steeped in water, and applied to the part affected, have been attended with beneficial effects, after the usual remedies had failed. In the itch, and obstinate cases of cutaneous eruptions, the tobacco infusion, as a wash, applied two or three times a-day, seldom fails of effecting a radical cure. In that detestable distemper, called lousy evil, to which many children are subject, though, from neglect of cleanli- ness, adults are sometimes afflicted with it, the infusion has effected a radical cure, in several instances, after preparations of mercury, and other applications, had failed. It will be found equally destruc- tive to crab-lice, if applied two or three times a-day to the parts which they infest. In cases of worms, tobacco, externally applied, is deserving the highest estimation. Professor Barton states, that the leaves pounded with vinegar, and applied in the shape of poultice to the region of the stomach and abdomen, have often discharged worms, after powerful anthelmintics had been exhibited internally in vain. " We ought not to be surprised," says he, " at this effect of the tobacco, since we know that the same vegetable, applied externally, is often MATERIA MEDICA. 591 efficacious in inducing vomiting. Accordingly," says he, " I have for some years been in the habit of applying tobacco leaves to the region of the stomach of persons who have swallowed large quanti- ties of opium, and other similar articles, with a view of destroying themselves." It is well known, that in these cases the stomach is often extremely irritable, insomuch that the most powerful emetics have little effect in rousing that organ into action. Here, as an auxiliary at least, the tobacco, in the manner I have mentioned, is certainly very useful, and in many instances ought not to be neglected. In farther testimony of the efficacy of tobacco, externally applied, in the most formidable diseases, I cannot forbear inserting at length, a letter addressed to the editors of the Medical Museum, by a gentle- man of distinguished medical attainments and surgical knowledge. Preceding this letter, is a minute detail of the case, related by an Italian physician, of a young woman, long afflicted with an ab- dominal swelling, producing violent convulsions, which, after having baffled the most efficacious means, was radically cured by Dr. Cut- bush, senior physician of the American Marine Hospital; at Syracuse, in the year 1S05. " Sir—In consequence of the earnest solicitations of the parents of the young woman, whose case is above stated by one of her phy- sicians, she was brought to my house in Syracuse to be examined. 1 received from herself and parents a history of her case, which cor- responded very nearly with the above statement. Her parents in- formed me they had consulted thirty-three physicians and surgeons of Naples, and different parts of Sicily, without receiving any ad- vantage. Some were of opinion that the swelling was owing to a collection of water in the uterus; others in the ovaria; others, that it was an enlarged liver; finally, two or three were strongly im- pressed with the idea, that it was an extra-uterine foetus, which pro- duced all the distressing symptoms above stated. On examination, I found a very large swelling, extending from the epigastrium in a diagonal direction to the anterior spinous process of the right ilium. The tumour had a number of inequalities on its surface; no fluctua- tions could be felt; she could not bear it pressed without suffering great pain. I must confess I did not give any decisive opinion in the case, it being perfectly new to me, and especially after the nu- merous contradictory opinions and practice of the first physicians of Naples and Sicily had failed in giving relief. She had been twice under the liberal use of mercury in Naples and Syracuse; in the latter place, by the direction of a surgeon belonging to Lord Nelson's squadron, when his lordship was there in 1798, without beneficial effect. From this history and examination, I entertained no hope of relieving her, but the solemn entreaties of her parents determined me to make trial of a remedy, which I had found useful in discuss- ing obstinate tumours, and which finally terminated a disease that had been the source of great distress to the unfortunate female, and 592 MATERIA MEDICA. which, doubtless, proved the disease to have been an hydropic affec- tion of the uterus, or right Fallopian tube, though no undulation could be discovered. I directed the leaves of the nicotiana, recently collected, to be stewed in vinegar, and applied to the abdominal swelling. The first application produced nausea, vomiting, vertigo, great depression of muscular strength, copious perspiration, and a loose state of the bowels. Her pulse became very sIoav. In conse- quence of the violence of the above symptoms, it was not long con- tinued ; but on the succeeding day, it was repeated morning and evening, and produced all the above symptoms, but in a less degree, attended with an immoderate flow of water from the vagina. The application was continued twice a-day for one week, when its effects on the system were less powerful; but I was informed, with the most rapturous expressions, that the tumour had diminished very much. The day following, a priest was despatched to inform me, that the water was continually running from her as she walked her room. The remedy was continued about twenty days, but the swelling disappeared entirely before the fourteenth. No medicine was given, excepting a small quantity of opium or wine during the day. When the application of the tobacco was omitted, her abdomen was perfectly soft, and she could bear it pressed without pain. She was occasionally attacked with syncope, and complained of a want of appetite : I advised a bandage to be applied around her body, a course of tonic medicines, a generous diet to be gradually increased, equitation, (riding) and cheerful company. I saw'her in October, 1805; she informed me that all the functions of the body were natural; her countenance was florid and cheerful.—April 1st, 1806, I was informed she remained in good health. " It is difficult to account for the modus operandi of tobacco in this case, unless the violent commotion, which it excited in the sys- tem, ruptured the cyst which probably contained the water. I con- \ ceive the external application of tobacco, as a remedy in many diseases, demands more attention from physicians, than it has gene- rally received. In obstinate constipation of the bowels, I have applied tobacco stewed in vinegar or water, with the greatest suc- cess; even after powerful cathartics, enemata of different kinds, injections of tobacco smoke, or the infusion of the plant have failed; and conceive it preferable, in many cases of ascites, to the common mode of administering it internally in the form of tincture or infusion. "I am, sir, with esteem, yours, EDWARD CUTBUSH." Happy if this plant " of many virtues" could always be exerted to beneficent purposes, and for which, no doubt, it was intended by the all-wise and benevolent Creator: but, alas! we are constrained to deplore not only the idle and expensive, but too often fatal abuse of it, by snuffing, chewing, and smoking practices, which cannot be / MATERIA MEDICA. 593 too severely censured, especially in young persons, and those of weak digestion, consumptive or delicate habits. When used in either of these forms, by persons unaccustomed to it3 use, it will in small quantities produce stupor, giddiness, and vomiting: but, like spirits, opium, and other narcotics, the use of it may be introduced by de- grees, so that its peculiar effects, even from large quantities employed, seldom appear. TOE ITCH. See Moorwort, Broad-leafed. TOOTHACHE TREE. See Prickly Ash. TOUCHWOOD, Boletus Igniarius—Called also spunk. It is a spongy substance, growing on the white oak, pine, and hickory trees, generally used for catching fire with flint and steel. The heart of that which grows on the oak reduced to powder, and ap- plied to violent hemorrhages from wounds, is said to be an excellent application to stop the bleeding. TREFOIL, WATER, Menianthes—Grows about twelve inches high, in marshes, swamps, and wet meadows. It bears many ele- gant flowers, in a spike, which are sometimes white, but are com- monly rose-coloured on the outside, and in the inside finely fringed ; the leaves are three together, resembling our garden beans. A drachm of the powdered leaves is said to operate up and down. An infusion of the leaves, two hands full to a quart of boiling wa- ter, in doses of a tea-cupful two or three times a-day, is esteemed a useful medicine in chronic rheumatism, in scorbutic complaints, and in all impurities of the blood. TULIP-BEARING POPLAR. See Poplar, White. TURMERIC. See Blood Root. UNICORN ROOT, Aletris Farinasa—Grows in meadows, and on the sides of mountains, about six or seven inches high ; leaves spear-shaped, lying on the ground, and are green all the winter. The flowers grow on the stalk from the ground, which hang down at the top when fully blown; the root is whitish,full of small fibres, about the thickness of the end of the little finger, and crooked at the end. The powdered root, in doses from half to a tea-spoonful, is said to » afford relief in hysteric and flatulent or wind colic. A large handful of the root steeped in a quart of spirits, in doses of a wine-glassful three times a-day, is highly esteemed by some as a valuable remedy in chronic rheumatism. VALERIAN, WILD, Valeriana Officinalis—Grows abundantly in the vicinity of the Ohio river. It rises two or three feet high ; the r.) 594 MATERIA MEDICA. leaves in pairs, large, hairy, and of a dusky green colour; flowers stand in large tufts on the top of the branches, of a pale whitish-red colour. The root, which is the part used in medicine, consists of a num- ber of slender fibres, matted together, and attafched to one head, of a brown colour, having a strong and unpleasant smell. Valerian has long been recommended by the most learned physicians as a medi- cine of great use in nervous disorders; and is particularly serviceable in hysteric cases, as well as in epilepsy, proceeding from a debility of the nervous system. According to Dr. Withering, it is an excel- lent medicine in cases of habitual costiveness. It should be given in doses from one to two tea-cupsful or more, in powder, three times a-day. It seems most useful when given in substance, and in large doses. VINE, GRAPE, Vitis Vinifera.—Several species of this valuable shrub grow in the United States. The success which has attended the attempts to cultivate foreign and native grapes, sufficiently proves that our climate is perfectly congenial to the cultivation of the vine, and that, with very little attention, we might supply ourselves abun- dantly with cheap and wholesome wines. Wine certainly is most excellent to prevent, as well as to cure, diseases. A prudent use of it, when genuine, I can say, from my own experience and observation, admirably conduces to health. It will be found particularly beneficial to the weak and aged, and to those who are exposed to a warm and moist air, or to a corrupted one. It exhilarates the spirits, quickens the circulation, promotes di gestion, invigorates both the body and mental faculties, and thereby renders persons less susceptible to disease. As a medicine, wine is a most grateful and valuable cordial in languors and debility, in which it is found to raise the pulse, support the strength, promote perspiration, and resist putrefaction. Hence, we cannot appreciate too highly this reviving liquor, which justly merits the title of " donum Dei," gift of God. Were we to have less recourse to ardent spirits, and instead of continuing in those abomi- nable practices of drinking before dinner, to take a few glasses of wine after dinner, we should find "our account" in it. During my long residence in Savannah, and exposed as I was alternately by my professional pursuits, to the scorching sun and chilling night air, [ was never attacked with the prevailing fever incident to that cli- mate, which I ascribe almost entirely to the daily use of the purest and best wine. In farther corroboration of this fact, I will with can- dour state, that, when from unforeseen reverses of fortune, I was in- duced to remove to the more healthy situation, as I thought, of Washington, not a season has elapsed, but some one or other of my family has suffered severely with the bilious or nervous fever, which I cannot but ascribe, in a great measure, to our not drinking such good wine as we were accustomed to at the southward. MATERIA MEDICA. 595 There are many persons in good circumstances, who object to the daily use of wine, as being too expensive. To such I would recom- mend it as economy. Besides the very great satisfaction which would naturally flow from having a healthy family, money is often saved by a prudent use of it. To illustrate this, it is only necessary to state, that several families at the southward, who were in the habit of paying annually large accounts for medical attendance, inquired of me how it was, that myself and family enjoyed such perfect health, while they were sickly. I remarked, that it was principally owing to drinking good wine, and assured them, though against my interest, if they would but pursue my plan, they also would enjoy good health. Some of them adopted my plan, which carried con- viction with it; for on the following year, and afterwards, they enjoyed much better health, were enabled to attend to their busi- ness, and found the expense of the wine saved in their physcian's bill. Others again, object to the habitual use of wine, as not congenial to their constitution, observing that whenever they entertained, or dined with, their friends, they were induced, either from politeness or persuasion, to drink as the rest of the company,* from which their heads were uniformly affected, and they always felt disagreeable on the following day. This objection is at once refuted, by simply stating, it is my wish to impress on my readers the use but not the abuse of wine, which no man more heartily than myself abhors, es- pecially in young persons, whose readiness to take glass for glass with their elders, is to me one of the most lamentable spectacles in nature. The excessive use of this stimulant, as well as every other, is most certainly injurious to the system, and ought, therefore, to be carefully guarded against by every rational person. It deserves also to be noticed, that the same quantity of wine which would produce intoxication in one person, would have little or no effect on another; and there is also a wide difference between taking it on an empty stomach and a full one. One glass, taken an hour or two before dinner, will affect the head, in most cases, more than a pint after dinner. In like manner, a half pint of adul- terated or impure wine, will produce unpleasant sensations, when a pint of genuine Madeira will have no other than the pleasing effect of invigorating the constitution. The apprehension which some per- sons entertain, that children, early accustomed to wine, will be apt to become drunkards, is without the smallest foundation whatever. * The following anecdote will at once show the absurdity of pressing our friends to drink more wine than their appetites crave. A foreigner was invi- ted to a party, consisting, as he was told, of English philosophers, of whom he conceived a great deal. After a very plenteous dinner, the cloth was cleared, and the bottles were placed on the table. He was pressed after five glasses to drink on, but the the stranger persisted in assuring the company, he felt no drought. These philosophers began to be angry, and the foreigner rang the bell, and insisted on another course, r they ought as much to eat, as he to drink, against inclination. 596 MATERIA MEDICA. On the contrary, it is a lamentable truth, that we daily see per- sons, who were restrained in the early period of their lives, from drinking wine, toddy, or table drink, in the presence of their parents, become perfect sots after they arrive at the age of manhood. It is one of the greatest commendations of wine, that we never see those who daily indulge the use of it become drunkards. This is verified not only in France, but in many parts of our Union. In Charles- ton, Savannah, and Augusta, the inhabitants generally make use of wine; the consequence of which is, they are sober, discreet, and not- withstanding the climate, are healthy. It is a rare thing indeed to see a drunkard of any description in the streets of those cities. Whether it be owing to drinking less of ardent spirits, or a better po- lice, I will not pretend to say; but it is the fact, and would that I could, with equal propriety, make the same remarks of the metro- polis of the United States, where drunkenness, among the lower class and negroes, reigns triumphantly, throwing open, as it were, the gates of every species of vice. Vice is a monster of so frightful mien, < As, to be hated, needs but to be seen; Yet seen too oft, familiar with her face, We first endure, then pity, then embrace.—Pope. It is also worthy of remark, that among the genteel circles in Charleston, Savannah, and Augusta, you will hardly meet with an instance of a gentleman drinking any thing before dinner, or press- ing his friends to take more wine after dinner than they feel an in- clination for; however, this is only what might be expected of those not excelled by any society on earth, either for polished manners or true hospitality. " Experientia docet," experience teaches, is my motto, and as I speak from this alone, I feel conscious of the recti- tude of my heart, in earnestly recommending to my fellow-citizens, both old and young, the daily and prudent use of genuine wine, at least during the sickly season, and in unhealthy situations, without any fear whatever of becoming sots. That the tenderest infant may be benefitted by it, I am convinced from my own practical observa- tions ; but if higher authority be required, I will conclude with the following sentiment of the late Professor Rush :— " It is remarkable," says he, " that the children of persons in easy circumstances, who sip occasionally with their parents, the remains of a glass of wine after dinner, are much less subject to disease, than the children of poor people, who are without the benefit of that arti- cle of diet." Having said so much in praise of the generous juice of the grape, and considering it, as I sincerely do, one of the choicest medicines in the Materia Medica, I cannot do otherwise than present my readers with the following most approved method for making Ameri- can wines, taken from the Domestic Encyclopedia, as well as the mode of detecting adulterated wines. t MATERIA MEDICA. 597 Grapes must be fully ripe before they are gathered; gather them in a fair day, when they are perfectly dry ; and take away all the rotten and unripe grapes, for they spoil the wine. If your vintage be large, and you gather more grapes than you can mash and press out in one day, let them be gathered without bruising, for bruised grapes soon attract an unsavoury taste, and hurt the wine ; however, if they be mashed the same day they are gathered, the bruising will do no hurt. Chaptal advises to cut of the tails of grapes very short with a pair of scissors, and to choose none but sound grapes, and those clusters which are best exposed, rejecting those which have been sheltered, and near the ground, and to prefer those which ripen at the bottom of the vines. They are then to be put into small baskets to prevent the loss of juice, by the superincumbent weight; and when full they ought to be put in carts, or on the backs of men or horses. I would advise the gathering of them to be directed by some grave discreet person; for as this work is done generally by servants and children, it is made matter of pastime and frolic, and many grapes are torn off, and either bruised or scattered on the ground, to the no small damage of the owner, both in the loss of fruit and in hurting the wine. These things should be impressed on the minds of the gatherers before they begin, that every thing may be done regularly and in order, by which means more work will be done, and to much better purpose. If white frosts happen before some of your grapes are fully ripe, let them still hang on the vines, and they will grow ripe, rich, and high-flavoured ; but they must be gathered before the weather be so hard as to freeze the grapes, for that will spoil them : the light frosts that only kill the leaves do not hurt the fruit, unless it be such as are late ripe; these should be carefully covered from all frosts, they should grow against walls or board fences fronting the south or south-east, and at night be covered with mats or frames thatched with straw, which should be so contrived as to be set up to cover the fruit or let down at pleasure. As the wine made from black grapes has a different management from that made of white grapes, I shall begin with the white; these then must be gathered, as I mentioned before, in a fair day, when the grapes are perfectly dry; and both the rotten and the unripe grapes carefully plucked off from every bunch ; the clusters are then thrown into the mash vat, and two or three men, according to the quantity, having washed their feet and legs very clean in bran and water, get into the vat and trample and mash the grapes thoroughly, so that none escape. Chaptal says, as a general rule, that the grapes must be equally pressed, to ensure a uniform fermentation: and the vat filled in twenty-four hours, to avoid the inconvenience and imperfections arising from a successive series of fermentations, and when unex- 598 MATERIA MEDICA. pected rain suspends the collection of the grapes, the juice of those already collected and placed in the vat, must ferment separately. The first and second pressing being mixed together, is put into hogsheads, and filled within four inches of the bung, that it may have room to work and ferment, the casks placed in some warm room or dry cellar. Then having a small spile fixed in the middle of the head of the cask, the third or fourth day, draw a little of the wine in a glass, and if it be pretty fine, draw it off immediately into a clean, dry, well-scented cask, the larger the better, so you have wine enough to fill it, which you must do within two inches of the bung, and stop it closely, leaving only the vent hole open for a se- cond fermentation; after a few days it will work a second time, but not so much as at the first; if your wine be strong and good, which you may know by the age of your vineyard, and by the goodness of the seasons, it will be best to leave the bung-hole open for this se- cond working; the wine will be the better, for strong wines require a greater fermentation than weak wines; and the stopping of the bung-hole checks the working, and prevents weak wines from spend- ing themselves too much ; on the contrary, if strong wines have not a thorough working, they are apt to grow thick and ropy; by this you may form a proper judgment what degree of fermentation is proper for the wine that is under working, and govern yourself ac- cordingly. Three or four days after the second fermentation begins, carefully watch your wines every day, again try them in a glass, and if they be pretty fine, prepare a cask sweet and good, burn a good large brimstone match in it, and as soon as the match is burnt out, whilst the cask is full of smoke draw off the wine into it; now fill up your cask to the brim, and bung it up tightly, and stop the vent-hole; the smoke of the brimstone will hinder any farther fer- mentation ; and this is called stunning or sulphuring; then make a mortar of clay, and horse dung, mixed up with strong flax-seed jelly, covering the bung and vent-hole close with it, let it stand till it is fit for use. When you first rack off, if you have any old wine that is rich and good, of the same kind or colour, put four or six gallons of it and two gallons of good brandy, into your cask; this quantity is sufficient for an English hogshead, and then rack off your wine into it for the first time ; this will greatly strengthen and preserve it. When wine is in fermentation, all the gross parts are thrown up to the top of the cask or vessel that it ferments in, and there meet- ing the air they contract a harshness. If then they be suffered to pass down through the body of the wine, which they certainly will do as soon as the fermentation is over, they will communicate those evil qualities to the wine. For this reason, draw off your wine both times before the fermentation be quite over.—These general rules are of great consequence. I now pass on to the making of red wine from the black grapes. Red wines have a different management from the white; the whole MATERIA MEDICA. 599 of one or even two days' treading or mashing, where the vintage is great, is thrown into a large vat, the must, stalks, skins and all, and stands in some warm dry place or cellar. The vat is covered close with sheets or blankets, or both, and thus it remains according to custom, from four to seven or even ten days, according to the cold- ness or heat of the weather. This is done to obtain a strono- fermen- tation, in order to give a deeper colour to the wine; and this is the only end proposed by it; the manager of this work visits the vat twice a-day, and in a glass views the colour of the wine, and tastes it; if the tincture be not deep enough to his mind, he knows by the taste of the wine, whether it will stand a longer fermentation ; if it will not, he contents himself with the colour it has, and draws and presses it off, and fills it into casks leaving about two inches from the bung, for a second fermentation. When the second fermentation is over, which generally happens in four or five days, he draws it off into clean well-scented casks, and adds to it six gallons of good old wine and two gallons of brandy to an English hogshead, which con- tains from sixty to sixty-three gallons. Where the same kind of wine is not to be had, he makes use of port wine. He then fills the cask quite full, and bungs it up tightly, leaving only the vent hole open to let out the generated air. Note: when I say, where the same kind of wine is not to be had, he makes use of Portugal wines, it is mentioned for our practice, not that the French make use of such wines, for they always have wines enough of their own of the same kind. Besides the main pulp or core of the grape, which is white in black grapes as well as others, there sticks to the inside of the skin, a considerable body of rich pulp, of a deeper dye in some than in others. This pulp gives the colour to the grape: this same pulp also gives the colour to the wine, for the same grape is capable of making white wine as well as red wine ; if the main core which is first trod out, be only used, the wine will be white; but if the red pulp be mixed with it, it makes it of a rich purple colour: as this is a clear case, the great point of improvement is, to dissolve or extract this rich pulp without injuring the wine.—That the present method is the best and most effectual to that purpose, I can by no means think ; the violent fermentation through which the wine is made to pass, in order to procure the tincture, must exhaust the spirits in a very great degree, and leave the body in a weak and languid state, and subject it to harshness, to turn meagre or vapid in a short time ; I think I have reason to conclude, that if the husks or skins, after four days lying in the murk, were taken out, and thrown into the mash vat, and trod over again, and especially if some of the must, or rather wine, be now and then thrown over the husks, in order to wash away the pulp, that a full tincture may be obtained, without torturing the wine, as the present manner is, and without running so great a risk of spoiling it. 600 MATERIA MEDICA. Another method, by Joseph Cooper, Esq. of Gloucester county, New Jersey.—I put a quantity of the comb from which the honey had been drained, into a tub, and added a barrel of cider, immedi- ately from the press: this mixture was well stirred, and left for one night. It was then strained before a fermentation took place; and honey was added till the strength of the liquor was sufficient to bear an egg. It was then put into a barrel; and after the fermentation commenced, the cask was filled every day, for three or four days, that the filth might work out at the bung hole. When the fermen- tation moderated, I put the bung in loosely, lest stopping it tightly might cause the cask to burst. At the end of five or six weeks, the liquor was drawn off into a tub, and the whites of eight eggs, well beaten up, with a pint of clean sand, were put into it: I then added a gallon of cider spirit; and after mixing the whole well together, I returned it into the cask, which was well cleansed, bunged it tightly, and placed it in a proper situation for racking off, when fine. In the month of April following, I drew it off into kegs, for use, and found it equal, in my opinion, to almost any foreign wine: in the opinion of many judges, it was superior. This success has induced me to repeat the experiment for three years; and I am persuaded, that by using clean honey instead of the comb, as above described, such an improvement might be made, as would enable the citizens of the United States to supply them- selves with a truly federal and wholesome wine, which would not cost a quarter of a dollar per gallon, were all the ingredients pro- cured at the market price; and would have this peculiar advantage over every other wine, hitherto attempted in this country, that it contains no foreign mixture, but is made from ingredients produced on our own farms. Adulterated Wines.—Wines may be adulterated by a variety of substances. The object proposed to be accomplished by this fraud, is to mask some of their defects, and to give them colour, odour, or strength. Among the substances employed, there are some, the use of which is attended with no danger; others on the contrary are more or less poisonous, and cannot be swallowed without giving rise to serious accidents, which may often be followed by death. This consideration has induced us to state the method whereby it may be determined, whether the wine has been adulterated. Sugar of lead, cerusse, and still more frequently litharge, are mixed with acid or sharp-tasted wines, in order to render them less so, and these substances do, in fact, give them a sweet taste. Of all frauds this is the most dangerous. White wines, adulterated by preparations of lead, offer, indepen- dently of their saccharine astringent taste, many properties by which we may detect them. They redden but slightly the tincture of litmus, because the acid they naturally contain is saturated by the oxide of lead. Sulphuric acid (oil of vitriol) and the sulphates, (or salts formed by the union of sulphuric acid,) such as the sulphate of MATERIA MEDICA. 601 soda, (Glauber's salts,) sulphate of magnesia, (Epsom salts,) dis- solved in pure water, and mixed with these wines, render them thick and muddy; in a short time a white precipitate is found at the bottom of the vessel in which the experiment is made. The de- posite does not disappear upon the addition of water. Muriatic acid and the muriates, as the muriate of soda, (common salt,) when dissolved in pure water, and added to adulterated wine, also occasion a heavy white precipitate, which may be dissolved in twenty-five or thirty times its weight of water. The sub-carbonates of soda, potash and ammonia, act in the same manner. The white pre- cipitate they throw down is insoluble in water, but is dissolved in a very singular manner by pure nitric acid. The chronic acid, and the cromate of potash, occasion a precipitate of a very fine Canary yellow colour. Sulphuretted hydrogen, and the hydro- sulphates, as liver of sulphur, turn white wines sophisticated with lead of a black colour, and at the end of a few minutes throw down a black deposite.—If we collect upon a filter, and dry the precipi- tates obtained by the means just indicated; and if, after having mixed them with powdered charcoal and caustic potash, we expose them in a crucible to a red heat, during half an hour, we obtain a metallic button easy to be known; first, by its deep blue colour; secondly, by the facility of marking it with the nail; thirdly, by the quickness with which it is dissolved in aqua-fords, forming thereby a liquid salt of a sweetish taste, and having the property of being precipitated of a white colour by the sulphates, the hydro-chlorates, and the carbonates. Pure potash, soda, and the volatile alkali mixed with these wines, cause a white precipitate. Evaporated in a cap- sule at a boiling heat, they leave a deposite, which, being heated to redness with powdered charcoal, furnishes, at the end of thirty or forty minutes, metallic lead. This property is sufficient to prove the presence of lead in wines. Red wines, when adulterated with the preparations of lead, are never of so deep a colour as before the adulteration; they are of a pale red. We may prove the existence of lead in red wines, by the aid of the substances directed to be used for white wines. It is, however, necessary to observe, that ammonia causes a dirty green- coloured precipitate, when mixed with red wines which contain lead; on the contrary, in white-wines the precipitate is white. That the hydro-sulphates may lead us into error, if we confine ourselves to the superficial examination of their action. That these substances detect the presence of lead in red wines, by throwing down a black precipitate, is true, but the same substances, when mixed with the greater parts of red wines, produce the same effect; they become dark, and finish, by depositing flakes of a deep violet colour. It is necessary then, when we wish to decide upon the test furnished by the hydro-sulphates, to add that, the black precipitate they form, when mixed with red wines, indicates the presence of lead, if, after 76 602 MATERIA MEDICA. having been dried upon a filter, and calcined with potash and char- coal, it leave a button of metallic lead. Wines adulterated by Alum.—The object of this adulteration is to render the wines redder and less changeable; and to give them an astringent taste. The danger of this fraud is generally known, digestion becomes painful, vomiting from time to time, obstruction of the bowels, and piles, are the result of drinking wines thus adul- terated. Of all the methods proposed to discover the presence of alum in wine, the following appears to merit the preference. By evaporating several pints of wine we observe a reddish mass, com- posed of alum, and the colouring matter and tartar, which make a part of the wine. This mass being dissolved in a large quantity of water, and made to boil with some charcoal of the linden tree*, a liquid almost without colour is obtained. If the liquid be filtered, and then evaporated by a gentle heat, until a thin crust be formed upon the surface, and set in a cool place, the tartar will crystallize and the supernatant fluid will hold the alum in solution. This fluid ought to have a sweetish astringent taste, and throw down a white precipitate, upon the addition of ammonia, or caustic potash; that formed by this last body ought to be soluble by an excess of potash. A solution of barytes, its acetate or muriate, ought to render it thick and occasion a white precipitate, insoluble in water and nitric acid. Wines adulterated by Chalk.—Some persons are in the habit of adding chalk or lime to red or white wine, having a disagreeable acidity, with a view of saturating the acetic, or tartaric acid, and thus by the combination of the chalk or lime with the acid, destroy their sharp taste. Wines treated in this manner are really much safer, but they may give rise to disagreeable symptoms if they con- lain too great a quantity of the acetate of lime. This fraud may be discovered by the following means:—Evaporate a quantity of the wine in an open vessel, or if the spirit be desired, let it be distilled : when the fluid is reduced to the consistence of a syrup, add a few ounces of distilled water, agitate the mixture for ten or twelve min- utes and filter the liquid, which will be found to contain acetate of lime, formed by the acetic acid of the wine, and the lime or chalk which has been added. The tartar which the wine contained will not be dissolved, but will remain upon the filter. VIOLET, RATTLESNAKE—Grows about four inches high, on the banks of rivers, and in pine woods ; leaves grow in a cluster from a stalk, oval-shaped, fleshy, and full of small veins; flowers of a pale blue colour. An infusion of this plant, a handful to a quart of boiling water, taken in doses of a tea-cupful three or four times a-day, and some of" * Or any fresh-made charcoal. MATERIA MEDICA. 603 the green leaves bruised, and applied twice or thrice a-day to scrofu- lous tumours, or king's evil, is said to be an infallible remedy. VIOLET, SWEET, Viola Odorata—Is cultivated in our gar- dens ; leaves heart-shaped, notched, flowers deep purple, odoriferous. A tea-spoonful of the powdered herb is celebrated as a mild laxa- tive. To children, a strong infusion or decoction formed into syrup with molasses, honey, or sugar, in doses of a wine glassful, will be more acceptable. VIRGIN'S BOWER—Grows about two feet high, near ponds and low pastures; leaves opposite in pairs,and terminated by an odd one; the flowers somewhat resemble the appearance of feather tails. A small handful of the leaves infused in a quart of boiling water, and given in doses of a gill three times a-day, is said to be very bene- ficial in venereal sores, or cutaneous eruptions of long standing, particularly if the sores be washed with the same. The bruised green leaves have been applied to ulcers, as an escharotic, to destroy fungous or proud flesh. VIRGINIA, OR BLACK SNAKE ROOT, Serpentaria Vir- giniana—Grows in rich woodlands, from seven to nine inches high, leaves heart-shaped, flowers of a purplish brown colour. The root is composed of a number of strings, or fibres, issuing from one head, and matted together, of a brownish colour on the outside, and pale or yellowish within. It has an aromatic smell, and a warm, bitterish, pungent taste. It promotes perspiration, raises the pulse, and resists putrefaction. Hence it is especially adapted to the low and advanced stage of typhus or nervous fever. It may be given in the form of infusion or tea, a handful to a quart of boiling water, in doses of a tea-cupful, or in powder, from ten to thirty grains every two or three hours. Conjoined with the Peruvian bark, or any of its substitutes, it is an admirable remedy in obstinate cases of the ague and fever, and other disorders of general weakness. In cold phlegmatic habits, it has also been exhibited in the form of tincture, and when united with double the quantity of dogwood bark, or berries, it affords a good bitter. Professor Barton observes, that a strong decoction of the root was used with great benefit as a gargle in a putrid sore throat, which prevailed in New Jersey. In that species of pleurisy, which is properly enough designated by the epithet bilious, Professor Chapman states, he has repeatedly had occasion to recur to the serpentaria, and always with more or less utility. This bilious pleurisy he considers as having all the characteristics of pneumonic inflammation, with the addition of some of the symptoms incident to autumnal fever, such as headache, great gastric distress, and almost always violent vomitings of bile. It dif- fers, also, from ordinary pleurisy, in having less activity of inflam- 604 MATERIA MEDICA. mation, and consequently in not bearing the same extent of deple- tion. The system, indeed, will often be very evidently depressed by one or two bleedings. In this case, the practice which has been commonly pursued is, after the removal of a comparatively small portion of blood, and the thorough evacuation of the alimentary ca- nal, to administer very freely draughts of the infusion of the serpen- taria, in order to excite perspiration. Externally applied, the decoction has been found to cure the itch. WAKE ROBIN. See Cuckow Pint. WALNUT, WHITE, Juglans Alba—Affords one of the finest cathartic medicines in the whole American Materia Medica. The inner bark, boiled for several hours, then strained and reboiled to the consistence of thick honey, forms the best preparation of this invalu- able medicine. A common-sized pill or two, at going to bed, is ad- mirable to remove those costive habits, which occasion headaches, loaded stomachs, colics, &c. And, in increased doses, say double quantities, it will be found a sovereign medicine in dysentery, bilious fever, and all other complaints requiring aperient medicines, more especially if combined with equal quantities of calomel. I cannot quit this extract without most heartily recommending it to every American family to keep it constantly by them. The bark of the root is excellent to raise a blister, therefore, may be substituted for Spanish flies. WATER CRESSES.—Grow in running brooks and wet ditches. The green herb, eaten as a vegetable, and the expressed juice in doses of a table-spoonful two or three times a-day, is an effectual re- medy for the scurvy. WATER TREFOIL. See Trefoil, Water. WHITE BRYONY—Grows in low meadows and swamps; the stems twist about bushes, and shoot out to a great extent; the leaves pointed, irregularly toothed, very large, diminishing gradually to the top; flowers of a yellow green, which produce a red berry; the root is white and large. A very strong decoction of the root strained, and then simmered slowly by the fire, until it become of the consistence of honey, is said to be a good purgative medicine in doses from one to three tea- spoonsful. WHITE WOOD. See Poplar. { WILLOW, Salix—Professor Barton thinks that our willows pos- sess nearly the same virtues that have been ascribed to those of Eu- rope, and that they might be substituted for the Peruvian bark. The MATERIA MEDICA. 605 bark of the white willow, smooth willow, and crack willow, so called from the remarkable britdeness of its branches, collected when it abounds with sap, has been successfully employed in intermittent or ague and fever, in doses of one or two drachms. The broad-leafed willow is said to possess greater virtues than either of the above. This species may be distinguished by the shape of its leaves from all others, except the bay-leafed willow. The leaves of the latter are smooth and shining, of a deeper green, and have not the downy ap- pearance on the under surface, which is so remarkable in this. It is found in woods and hedges, on hilly situations, and delights in cold clayey moist grounds. A strong'decoction of this bark resembles port wine in colour. It is astringent to the taste, and somewhat bitter. According to Dr. Wilkinson, it is a remedy of great efficacy in most cases where the Peruvian bark is indicated. He directs one ounce and a half (a handful) of the bark to be infused in one quart of water for six hours, then boil it over a gentle fire for a quarter of an hour, and strain for use. Of this the ordinary dose is a wine-glassful three or four times a-day. But in ague and fever, the dose may be repeated every third hour in the interval of the fit. WINTERBERRY. See Alder, Black. WINTERGREEN. See Calico Tree. WOOD BETONY—Grows about a foot high in upland woods, and old pastures; the stem square and hairy; the leaves opposite, and hairy, the flowers in spikes, of a purple colour. An infusion of the herb, a handful to a quart of boiling water, in doses of a tea-cupful every two hours, is said to be serviceable in rheumatic or gouty affections. WORMSEED. See Jerusalem Oak. WORMWOOD. See Mugwort. YARROW—Grows in dry pastures and along the sides of fences, about a foot high; leaves pointed; flowers white, tinged with a little purple beneath. A handful of the tops of yarrow, infused in a quart of boiling wa- ter, in doses of a tea-cupful three or four times a-da)r, is reputed to be a valuable medicine in the dysentery, bleeding piles, and re- straining immoderate flow of the menses. A table-spoonful of the Expressed juice taken twice a-day, and the herb bruised, or in the form of a poultice, is said to have cured a cancer of the breast. The green leaves pounded, and applied over a bruise, dissipates it in a few days. 606 MATERIA MEDICA. DIRECTIONS RESPECTING THE COLLECTION AND PRESERVATION OF VEGETABLE SUBSTANCES. Herbs and leaves are to be gathered in dry weather, after the dew is off them, and are to be freed from decayed, withered, or for- eign leaves. They are usually tied in bundles, and hung up in a shady, warm, and airy place, or spread upon the floor, and frequently turned. If very juicy, they are laid upon a sieve and dried by a gentle degree of artificial warmth. They should be dried in such quantities at a time that the process may be finished as quickly as possible; for by these means their powers are best preserved; the test of which is, the perfect preservation of their natural colour. Flowers ought also to be collected in clear dry weather, after the dew is off, inhnediately after they have opened. They should also be dried nearly as leaves, but more quickly, and with more atten lion. As they must not be exposed to the sun, it is best done by a slight degree of artificial warmth. Barks and woods should be collected when the most active part of the vegetables are concentrated in them, which happens in spring and in autumn. Spring is preferred for resinous barks, and autumn for those that are gummy. Barks should be taken from young trees, and freed from decayed parts, and all impurities. Seeds and fruits are to be gathered when ripe, but before they fall spontaneously. Roots which are annual, should be collected before they shoot out their stalks or flowers. Those which are worm-eaten or decayed are to be rejected. The others are immediately to be cleaned with a brush and cold water, letting them lie in it as short a time as possi- ble; and the fibres and little roots, wdien not essential, are to be cut away. Roots which consist principally of fibres, and have but a small top, may be immediately dried. If they be juicy and not aro- matic, this may be done by a moderate heat; but if aromatic, by simply exposing them, and frequently turning them in a current of cold dry air. If very thick and strong, they are to be split or cut into • slices, and strung upon threads; if covered with a tough bark, they may be peeled fresh, and then dried. Such as lose their virtues by drying, or are directed to be preserved in a fresh state, are to be kept buried in dry sand. MATERIA MEDICA. 607 The proper drying of vegetable substances is of the greatest im- portance. It is often directed to be done in the shade, and slowly, that the volatile and active particles may not be dissipated by too great heat; but this is an error, for they always lose infinitely more by slow than by quick drying. When, on account of the colour, they cannot be exposed to the sun, and the warmth of the atmos- phere is insufficient, they should be dried by an artificial warmth less than 100 degrees of Fahrenheit, and well exposed to a current of air. When perfectly dry and friable, they have little smell; but af- ter being kept some time, they attract moisture from the air, and re- gain their proper odour. THE NURSE'S GUIDE. No radiant pearl, which crested fortune wears, No gem, that twinkling hangs from beauty's ears, Not the bright stars, which night's blue arch adorn, Nor rising sun, that gilds the vernal morn, Shine with such lustre as the tear that breaks For other's wo, down virtue's manly cheeks.—Darwin. Indigent Sick.—Having in my professional duties so often witnessed the most grievous sufferings of the sick for want of suitable nourishment, and this occurring too, not unfrequently in re- spectable families who have been reduced in circumstances, I feel it my duty, since it is not foreign to the subject, to call the attention of those in affluence, throughout our numerous cities and extensive country, to extend the arm of charity to the indigent sick, in theii respective neighbourhoods. While feasting in their own houses, let them listen to the voice of humanity, and not forget the " house of mourning," where the lone widow and her orphans pine in sick and starving solitude. It is not easy to estimate the good which may be done to suffering humanity by beneficent acts of this kind. What a treat to the sick, instead of coarse food, to have a com- fortable bowl of soup, arrow root, sago, panado, or custard!—And what a cordial, to a person labouring under protracted disease, in- stead of simple water to have a glass of good porter, ale, cider, or wine, which nature craves in this exhausted state. It is a well known fact, that a rarity sent -unexpectedly has often been the means of recalling long lost appetite, and thereby rescuing from an untimely grave a valuable life. Indeed, there cannot be a greater object of charitable commiseration than a person confined to the bed of sickness, without the means of obtaining suitable nourishment. Nor are the indigent alone the grateful receivers; for in the houses of the wealthy a real good sick cook is rarely met with ; and many who possess all the goods of fortune have attributed the first return of health to an appetite excited by what is called good kitchen physic. How important an advantage in overcoming disease is a nutritious diet! Nor is this the only good to be derived from acts of charity the nurse's guide. 609 for we have frequently seen a fond mother denying herself the ne- cessary quantity of food that she might the better provide for her sick children, reduce that strength upon which the welfare of her family essentially depends. In faith and hope the world will disagree, But all mankind's concern is charity ; All must be false that thwart this one great end, And all of God, that bless mankind, or mend.—Milton. In the preliminary observations of this work (Seepages 32 and 33) we stated facts illustrative of the important advantages resulting from good nursing and dieting. The frequent occurrence of fatal effects when this is neglected, imperiously demands that I should present to my readers the most approved rules which ought to be understood by eveiy nurse, as well as to exhibit the mode of preparing such aliments as are most proper for the sick; in order that the tram- mels of ignorance in nurses, if possible, may be broken, and sim- plicity of diet and general management become an increased object of our attention. But trust me, when you have done all this, Much will be missing still, and much will " Be amiss."—Milton. 0 Duty of a Nurse.—Before we proceed farther on this subject, it may be necessary to observe, that none should be nurses unless they possess honesty, sobriety, and fidelity. The more .equal and cheerful they are in their disposition, the better, provided they keep at their proper distance, and never incommode the patient with idle chit chat, or any thing that can occasion sudden alarm. They ought to be expert in the execution of their office, yet without bustle or noise; the track being easily kept when once got into, and the objects to be attended to but few. " To watch the " afflicted" with anxious care, The lurking symptoms of disease detect, And with the aid of sweet nutritious food, Or potent herb, or kindly drug, to aid Oppressed nature in her arduous task Be thine! and thine the grateful rich reward Of conscious duty done—a meed more fair Than all the laurels which bedeck the brow Of modern Caesar." The office of a nurse, however trifling it may appear, if well known and rightly performed, is unquestionably of great benefit to mankind. To prove this fact it is only necessary to appeal to every skilful physician, whether, when the plan prescribed by him has been punctually observed, he has not commonly seen the disease either yielding readily to the remedies, or terminating in its usual period, without any mysterious or difficult symptoms arising through t i 610 the nurse's guide. the course of it. Whereas, on the contrary, when his plan has been altered, as for instance, when the medicine has not been taken at the appointed time; when improper diet has been given instead of that directed, when the air in the rooms and many other circum- stances have been improperly attended to, whether he has not then known the disease to be either aggravated, or diverted from its course, often terminating fatally; when, if no such errors had been commit- ted, there was the highest probability of the patient's recovery. Air and Temperature.—It being a well known fact that the life of every animal depends as much on air as on diet; and its health also as much on the goodness of the former, as on that of the latter, care should be taken what sort of rooms we sleep in, but more espe- cially so when confined by sickness. It is a misfortune that the poor as well as the slaves are constrained from necessity to sleep in low dwellings, and many of them in the same room, by which due attention is not'generally paid to cleanli- ness ; hence the air becomes impure and extremely offensive. Others again accustom themselves, sick or well, to the curtains drawn. This is equally detrimental to health, for the air being thus confined, be- comes contaminated, and so offensive as to be disagreeable to any one entering the room from the fresh air. How much more so then must this be the case in sickness, which tends g^atly to destroy its purity. In warm weather it is necessary to keep a window open day and night, during the whole course of the disease; but in this case the nurse must take care that the patient is not exposed to either a damp or violent current of air. Whenever a fire is required, it should be kept up, and regulated according to the nature of the disease, and state of the weather. The room being brought to a due heat, should never be suffered to cool suddenly; for the air ought to be kept as temperate as possible. When the general exhaustion is great, the temperature of the apartment should not by any means be permitted to be so low as to endanger an attack of chilliness; as in this case a rapid reduction of the animal heat may speedily be fatal, by sinking the heart's action. In some instances an exposure to the cold air, in getting up to the night-chair, has been the cause of a shivering fit, under which the patient died in a few hours; but death will rarely happen, if some warm stimulant be immediately administered internally, and suffi- cient warmth applied to the extreme parts of the body. Chills and Fevers.—It is too prevailing a custom in the cold fit of an ague, or when the patient complains of chilliness, for the attendants to heap great loads of bed clothes, which never fail to produce difficult or oppressed perspiration. In such cases, wrarmth should be restored by applying warm flannels to the stomach and abdomen, and the same or warm bricks to the feet. Recourse t THE NURSE'S GUIDE. 611 should also be had to friction with a flesh brush or flannel on the extremities. It is vulgarly imagined that it is absolutely necessary to promote perspiration, and under this absurd idea, heating and stimulating drinks are given by way of cordials which readily induce delirium or a more obstinate fever. The fact is this, when the pulse is quick and the body hot, sweat can only be induced by lessening the action of the pulse, and heat of the body. And this can only be accom- plished by strict observation of a cooling regimen. In some cases, it is necessary, that the sick person should be kept out of bed as much as possible; and placed so, as to face the current of air; the body being defended sufficiently by the clothing, to pre- vent any inconvenience being experienced. It should be recollected, however, as we have already noticed, that in the stage of collapse, or when the exhaustion is great, this practice is not admissible. But there is much less reason to fear this practice will be too frequently adopted, than it will be neglected, in those cases in which it is re- commended. For, too often, in this point, are the wishes of the physician opposed, and his directions disobeyed ; the languor of the patient, and the unwillingness to be removed, with the prejudices against a practice so novel, forming, very often, almost insuperable obstacles. Indeed, it is very difficult to persuade those, who have not witnessed the effects resulting from this mode of practice, that it is not necessary, for every person in a fever to be kept closely con- fined to his bed under a load of bed-clothes and supplied with heat- ing drinks. It frequently happens, therefore, that no sooner has a physician left the room, than the patient is supplied with warm li- quors, the windows and curtains are closed, and the bed-clothes, which had been removed, are replaced. Such opposition to the di- rections of a physician, viewed in the most favourable light, is highly censurable; being, in a great measure, the effect of ignorance, it is all that prevents it from being really criminal. Nurses should, therefore, be on their guard, and neither deviate themselves from the rules laid down, nor permit any person at the expense of the patient's life to interfere with what might be consi- dered their duty, otherwise their conscience will upbraid them as murderers. It is to be hoped, b)r means of this treatise, ignorance will no lon- ger be a cloak for omissions, and that one uniform method will he attained in the management of the sick, which will unquestionably be of vast importance to mankind. Cleanliness.—It is certainly of great moment to the sick to have their bed and bedding kept clean as possible, and their linen frequently changed that it may not become foul or offensive.—Such of the bed-clothes, as are not changed, should, in diseases of a putrid nature, be exposed to a current of air, since, by their known capacity for retaining effluvia, they may become so loaded with contagious 612 THE NURSE'S GUIDE. and putrid matter, as to prove infectious to the attendants, and, per- haps, to impede the recovery of the patient. In summer it is much more healthy to sleep on mattresses than feather beds, which are apt to make persons become faint and lan- guid. The best materials for making mattresses are, clean horse- hair, Carolina moss properly cured, corn husks split, or straw. When a bed is unsettled, or a patient's head uncomfortably low, or when his feet are pushed from under the bed-clothes, he should be raised in bed, and the bed, bolster, and covering shook up and smoothed. The patient's face and hands are to be washed every morning. And when he is no longer able to assist himself, his face, breast, hands, and arms, must be frequently sponged with vinegar and wa- ter. The floor should be kept clean and occasionally sprinkled with vinegar, particularly before it is swept, and on no account should any thing the least offensive be suffered to remain in the room. It is also the duty of the nurse to pay great attention to the state of the patient's mouth. When his tongue and gums are covered with a brown or dark crust, she must wipe them with a bit of flannel moistened with salt and water, two or three times a-day; or, if this cannot be accomplished, she must put a thin slice of lemon, without the rind, in his mouth. The patient is often unable to swallow, from the dry and shrivelled state of his tongue; in such cases, the nurse, before offering him drink, should put a tea-spoonful of lemon juice and water, or vinegar sweetened, into his mouth; after which, the scum upon his tongue will become softened in a minute or two, and then he will drink with ease. Delirium.—When, during great derangement of mind, a patient insists upon leaving his bed, the nurse must endeavour to calm him; or, if that should fail, she may speak with authority, but she is not on any account to use forcible restraint. The nurse must wrap his legs in a blanket, put on his bed gown or cover his shoulders, and permit him to sit on his bed, or even to go to the fire, till the vio- lence of his derangement shall abate. When indulged in this way, he will, in general, soon return to the bed of his own accord. In the putrid fever, delirium is one of the most constant and alarming symptoms, and the removal of it depends much upon the nurse or attendants. We have seen a temporary stop put to the patient's raving, by making him drink, or upon his discharging his urine or faeces: for being then unconscious of thirst arid other natural wants, he is, therefore, ignorant of the means of satisfying them : and when he does so, he fancies he is about something else, which is the sub- ject of his delirious thoughts. This observation leads to a material practical purpose; for it follows from it, that unremitting attention should be given to the patient's feelings, and all his possible wants, as those natural notices, and instinctive cravings, which occur in f the nurse's guide. 613 health, are now wanting, in consequence of the depraved state of sensation. The following excellent passage will be found in Levant's Chap- ter on the Synochus Putris (Nervous Fever.) As soon as the deli- rium comes on, the pain subsides, or at least the patient does not complain of pain, nor seem to feel any; but replies in a hurried manner, when asked how he does, that he is very well; according to the observation of a French physician " Quand le malade repond, je me porte bien, ce seul mot suffit, il n'est pas plus a' lui." " When the patient answers that he is very well, this alone convinces me," says Dr. Cheyne of Dublin, " that he is no longer himself. In all these cases, the patient endeavours to get out of bed, to sit up, or even to walk about from one room to another; but, unhappily, the attendants are solicitous to confine him to bed, and to load him with bed-clothes; nay, he is frequently kept struggling for two or three days together, with two strong people lying upon him continually. Now, to prevent all this misery, I know no method equal to what is here recommended; namely, let the patient have his clothes put on, and be placed in an easy chair; let his head be shaven, washed with vinegar, and covered with a linen cap. When he is tired of the erect posture, let him lie along on a couch, or upon the bed, with his head high. Let his diet be cooling, and his body be kept open by clysters, repeated occasionally. Let this method be persisted in till his delirium goes off; or till the pulse subsides, and he seems ex- hausted ; then, perhaps, he will begin to doze, or slumber on his chair, which will do him no harm, and when he is inclined to go into bed, let him lie down. By this method," adds Dr. C, " I have recovered great numbers of persons, when I was suffered to conduct them in the hospital; and I do believe some have perished by an op- posite treatment, who might have been saved." Medicine.—Although it be admitted, the cure of diseases de- pends very much upon the right choice of medicines; yet, it cannot reasonably be expected that these will produce the desired effect un- less they be punctually taken, agreeably to the directions given. It has oftentimes occurred, that when aperient powders containing calomel have been prescribed, and directions given that they should be administered in syrup or molasses, the physician, on making the necessary inquiry on the following day, has been told by the nurse that they had no effect upon the bowels. " How was the medicine given ?" " In tea, sir." " Why was it not administered agreeably to instructions?" " Because the patient preferred taking it in a liquid, and I thought it would answer as well." By thus changing the vehicle, the calomel being heavier than the tea, was left at the bottom of the spoon, and, as it was not swallowed, could not, of course, have any purgative effect. In like manner, the patient or nurse frequently thwarts the intention of the physician by making use of the medicines prescribed, irregularly; so that if there be any 614 the nurse's guide. particular action to be kept up on the system, it is rendered abortive, and blame cast where it should not rest. It is not unusual for medi- cines, though ever so well adapted to the case, to excite nausea and retchings immediately after each dose has been taken. Hence, a prejudice arises directly against the medicine, which being taken for the cause, it is condemned and set aside. The consequence is, the disease becomes more aggravated. Cases may happen, wherein if but one medicine be neglected, it can never be administered again properly; and, consequently, the patient may either be lost, or greatly injured. It is, therefore, the duty of the nurse, when a physician prescribes in whom confidence can be placed, strictly to adhere to the curative process he selects, as without such attention iEsculapius himself might fail. It commonly occurs, through the course of many diseases, particu- larly fevers, that the patient has little or no inclination to eat, till na- ture has gained the victory. But this not being rightly understood by either him or his attendants, an outcry is made that he will never have an appetite whilst he takes medicine. Hence the remedies are discontinued; yet the appetite does not recover, nor does the case grow better, but rather worse. The reason is obvious, if they would but only observe, that as the disease is cured, the appetite in conse- quence will revive. Again, it not unfrequently happens in diseases which are obsti- nate, requiring a long course of medicines, that the patient becomes impatient and discontinues the use of the remedies. And in such cases, it is too common, that the patient becomes prejudiced against his physician and mistrusts his ability wholly, though perhaps he has been conducted by him through the most difficult stages of his illness, and not uncommonly sends for another, who, if not so honest as to undeceive him, enjoys the honour that wras due to the former. By these observations we do not mean to screen any unskilful or improper use that maybe made of medicine, or to raise it into higher esteem than what it deserves; on the contrary, it will ever be found that he who knows his business best, will make his constant care to heal with fewest medicines; and will always be most ready to re- sign his patient to diet alone, as soon as he knows it can be done with safety. During a long spell of sickness it not unfrequently occurs, that good-natured friends are in the habit of recommending nostrums, each on the supposition that his own is infallible. When the pa- tients are credulous, as is too often the case in lingering diseases, they readily grasp at any relief, however monstrous the proposition may appear: the consequence is, that in nineteen cases out of twTenty, the medicaments of wdiich they are composed are utterly unfit for the disease, and, consequently, prove deleterious in their effects. It too frequently occurs that insuperable difficulties of another kind arise. For, there are some persons bred up with strong preju- the nurse's guide. 615 dices, and an excessive like or dislike of certain things, and cannot easily be persuaded to comply with what is thought the most proper method of cure; namely, a particular regimen, bleeding, vomiting, &c. And thus their lives are often lost, or if they survive, the fu- ture period of their existence is rendered very miserable by some consequent disease remaining fixed in the constitution. Again, we often find, with respect to children who have been much indulged, when the physician ascertains the nature of the disease, and pre- scribes suitably to the case, he will very likely be told by the parents, if he expect any medicine to be gotten down, it must either be nicely flavoured, or absolutely without taste. Or, should he advise topical bleeding by leeches, he will more than probably be told, however necessary their application may be, it is a remedy which must be de- clined, for the very sight of them would throw the child into convul- sions.—And, as to a blister, the infliction of this torture on such deli- cate skin could not be endured; for as soon as any pain from its ac- tion was produced, it would be directly torn off. Placed under such limitations, it cannot be expected, however capable and anxious the physician may be to procure relief to his patient, that much advan- tage can be obtained from his prescriptions. He, therefore, either declines his attendance, or acting within the bounds to which he is limited, he does little more than alleviate some of the more distress- ing symptoms, whilst he has the mortification to witness the almost uninterrupted progress of the disease. Leeches.—As these little animals are depended on for the remo- val of very dangerous diseases, and as they often seem capriciously determined to resist the endeavours made to cause them to adhere, it will be proper to give a few duections, by which their assistance may, with more certainty, be obtained. This useful ally to the physician, it may be remarked, is as little fond of the taste of physic as the physician can be himself. The introducing of a hand, to which any ill-flavoured medicine adheres, into the water they are kept, will be often sufficient to deprive them of life; the application of a small quantity of any saline matter to their skin, immediately occasions the expulsion of the contents of their stomach ; and, what is most to our present purpose, the least medicament that has been applied, remaining on the skin, or even the accumulation of the matter of perspiration, will prevent them from fastening. The skin should, therefore, previously to their ap- plication, be very carefully cleansed from any foulness, and mois- tened with a little milk. The best mode of applying them is by retaining them to the skin in a small wine-glass, or the bottom of a large pill box, when they will, in general, in a little time, fasten themselves to the skin. On their removal, the rejection of the blood they have drawn may be obtained by the application of salt externally; but here, for the sake of those to whom we are so much indebted, it may be necessary to 616 the nurse's guide. remark, that a few grains of salt are sufficient for this purpose; and that covering them with it, as is sometimes done by nurses, generally destroys them. It sometimes happens, that the blood will continue to flow from the orifice made by a leech longer than is desirable; and, sometimes, children have been nearly lost from the inability of the attendants to suppress the discharge. In such cases, the blood should be washed off clean, and the point of the finger pressed moderately hard on the orifice, when the blood will cease to flow. A small compress may then be applied to the wound, which may be retained by the point of the finger as long as the blood appears upon withdrawing the pressure; remembering that no more blood need be suffered to flow, than is thought necessary; since all that is required to prevent it, is patiently to persevere in the necessary pressure. It sometimes occurs, on the application of leeches to the funda- ment, in order to relieve the piles, that they get into the rectum. If that accident should happen, an injection of a solution of common salt is the proper remedy; but the animal is soon gorged, and then may be destroyed. Clysters.—As the use of clysters is also of great importance in the cure of many diseases, and as nurses are not always conversant, even in this part of their office, it may be proper to give some direc- tions relative to the administration of them, which may be done in the following manner: The bed being prepared with a sufficiency of clothing to keep it diy, the patient must be placed on the side across it, with the knees forward, and then covered decently; the clyster being likewise prepared, and brought to that moderate heat called milk warm, must be poured into the bladder and secured by tying the opening; which being done and the pipe anointed, the whole must be placed in the bed near to the patient. The nurse must now pass the point of her left forefinger, the nail being cut short, close to the anus, or a little within it, and then slide the pipe along this finger, till the greatest part of it be entirely introduced. In doing this, the pipe must be directed a little backwards, taking care not to push it against any part so as to cause pain. When thus introduced, its outer end must be held fast with one hand, whilst with the other she takes hold of the string, and pulls out the cork; which done, the bladder must be grasped with both hands, and the contents forced up, keeping the pipe in its place at the same time. When the clyster has been pressed out of the bladder, the pipe must be instantly withdrawn. A large pewter syringe is more convenient to administer an injec- tion ; and some of them are so constructed that the patient may use it himself. Diet.—In the cure of diseases, experience proves how much de- pends upon the choice and administration of diet. We see one the nurse's guide. 617 series of disorders, wherein the appetite, either from a bad habit or some morbid effect, craves such things chiefly as have a tendency to heighten the disease. Another series, in which the whole fabric being fully engaged and struggling with the disease in order to con- quer it, the stomach, till in that conflict nature gets the better, loathes every kind of aliment, except such as is fluid. And we see in the third class, the stomach not affected, but dispensing with all kinds of food. Yet these being taken indiscriminately, the disease is not only nursed, but the medicines usually the most efficacious in curing it, are rendered entirely ineffectual. The nurse should, therefore, be extremely cautious how she devi- ates from the diet which has been prescribed, as fatal consequences may arise from what may seem to have been but a trifling variation. The stomach must never be oppressed with much at a time, about half a pint being enough, and that should be repeated only as nature indicates. This will, generally, be known by the patient's desire or dislike of it. We say generally, for in some cases where there is great weakness, insensibility, or both, the patient may not be able to give such indication. And there are cases, especially fever that ter- minates badly, where the patient's thirst is insatiable. In either of these exigencies, the nurse must proceed with discretion; that is, in the former she must rouse the patient every hour or two, and give a cupful or half a pint of such drink as directed ; and, in the latter, she must give drink more frequently, but small quantities at a time. But it should be observed that, whenever patients fall into tranquil slumber, they should hardly ever be disturbed to give them drink or food until five or six hours shall have elapsed. Such a repose is most desirable, and will, sometimes, renovate nature, when her fa- culties had before seemed prostrate, beyond the power of recovery. It is a vulgar error, and a very common one too, that a sick person is to be supported by rich broths, by pastry, or by solids. The out- cry is, that the doctor will starve him. Hence a variety of dishes is prepared to tempt the stomach to take food, and, in order to provoke the appetite, pickles are frequently given. The patient, from the extreme kindness of friends or offi- ciousness of the nurse, is teazed with repeated urging, to try to take a little more, until the stomach has received so much as to produce effects directly opposite to those intended. Even after the disease is conquered, and the appetite begins to crave, it is always advisable to feed the patient sparingly for several days. Unlimited indulgence in the article of food, is a source from which a multitude of diseases arises in health; then how much more deleterious in its effects, must this be the case in a state of convalescence. At this crisis, it is, indeed, a nice point to avoid giving the patient too much or too little nutriment; but even here, perhaps, excess is the most dangerous extreme. Great anxiety to prevent the sick frorn sinking, often induces their attendants and friends to give much more food than can possibly be digested, and it often lies as an offensive 78 618 THE NURSE'S GUIDE. load upon the stomach, or induces an exhausting vomiting or diarr- hoea. When the weakened condition of the digestion or assimilative organs are considered, it cannot but appear, even from that reason, that small portions of plain, simple food, given at stated intervals, will best support the remaining strength of the system, and this is really confirmed by experience. In preparing all kinds of aliment, it is essentially necessary to be very cleanly, but more especially in that for sick people, the stomach being often so greatly weakened and disordered by the disease, as to render it difficult to find out by way of diet, what is agreeable to the natural powers, and suitable to the case. The nurse, who ought to be the cook, with respect to this part of diet, may select, from the articles enumerated for the sick, such ali- ments as are suitable to the case. It is advisable that a choice be made of the things most likely to agree with the patient, that a change be provided, as invalids require variety; and that they should succeed each other in different forms. Conclusion.—I believe I have now completed the task that was allotted me, and sincerely hope, notwithstanding its imperfections, the improvements I have made to the seventh edition of the "Medi- cal Companion," will greatly enhance its value, and be productive of much comfort and good. So long as sickness is a concomitant of humanity, so long will a work of this kind retain its estimation. By persons in health, the possession of such a book may not be suf- ficiently prized; but when sickness finds access to a beloved wife or child, it will doubtless be read with pleasure, and considered in reality a valuable and acceptable companion for the sick chamber. It is not to one description of persons alone that the "Medical Companion," will prove useful, but to every class of society.—Many families are ignorant even of the mode to prepare the various articles of diet suitable for the sick, and, with such, this part of the work, as a Family Assistant, must be of incalculable value. To the in- quisitive mind, the attentive perusal of this book, from the begin- ning to the end, will be found to contain so many interesting facts, as will not fail to prove a source of rational and instructive enter- tainment. To diffuse medical knowledge, is the most effectual mode of checking the career of empiricism ; and, indeed, so obvious is this, that it is surprising to find heads of families pay so little attention to the perusal of books of this kind, wherein they might obtain such in- formation as would enable them to detect ignorant pretenders in the healing art, as well as afford them the very great satisfaction of ren- dering that assistance in the management of the sick, for which hu- manity often loudly calls.—Such knowledge is also highly useful, on the one hand, in preventing unnecessary apprehension respecting symptoms by no means dangerous ; and, on the other, in giving the alarm, where delay might be injurious or fatal. And, again, there DIET FOR THE SICK. 619 are situations in which a little medical knowledge may be of essen- tial consequence to the comfort, or even the life of the patient, before regular assistance could be procured. DIET FOR THE SICK. Sage Tea.—Take of the leaves of green sage, plucked from the stalks and washed clean, half an ounce, (a handful,) loaf sugar an ounce, outer rind of lemon peel, undried, a quarter of an ounce, or a little lemon or lime juice, boiling water, two pints. Infuse them in a mug or pitcher, covered, for half an hour, and then pour off the tea. When the sage is dried, it must be used in a less proportion than that above. In the same manner teas may be made of balm, ground ivy, cat- mint, rosemary, southern wood, &c. The lemon peel, or lemon juice, being omitted or not, and the sugar lessened or increased, as occasion requires. Lemons, or apples cut in slices, tamarinds, currants, fresh or in jelly, cranberries, dried whortleberries infused in boiling water, sweetened with sugar Or syrup : these may be so prepared and varied in form, as to suit every taste, and to answrer the purpose of pleasant, cooling, and salutary drinks, in all febrile complaints. Such drinks should always be kept in a covered vessel. Bran Tea.—Take of bran, fresh ground, two hands full; mo- lasses or honey one spoonful; boiling water, six pints. Mix them well, and when they have stood covered about three or four hours, strain off the tea. Flax-seed Tea.—Take of flax-seed, one ounce ; white sugar, one ounce and a half; lemon juice, two table-spoons full; boiling water, two pints. Infuse them in a pitcher some hours, and then strain off the liquor. An ounce of liquorice shaved, may sometimes be used instead of sugar. Camomile Tea.—Take of camomile flowers, one handful; boil- ing water, one gallon. When they have stood covered about half an hour, strain off the tea. If the drinking this tea be to strengthen the stomach, it must be made stronger, as for instance, about a quar- ter of an ounce to a pint. Lemonade.—Take of the outer rind of fresh lemon peel, about one drachm; lemon juice, one ounce; double refined sugar, two 620 DIET FOR THE SICK. ounces; boiling water, a pint and a half. When they have stood in a vessel about ten minutes, strain off the liquor. Orangeade.—Take of the fresh outer rind of Seville orange, one drachm ; orange juice, two or three table-spoons full; white sugar, one or two ounces, or enough to make it of an agreeable sweetness; boiling water, one quart. When they have stood in a pitcher about ten minutes, strain off the liquor. Imperial Drink.—Take of cream of tartar, one drachm; the outer rind of fresh lemon or orange peel, half a drachm; loaf sugar, one ounce; boiling water, two pints. When they have stood in a pitcher about ten minutes, strain off the liquor. Barley Water.—Take a handful of either pearl barley, or the common sort, wash it clean, first in cold, and afterwards in boiling water, then simmer it in a quart of water for an hour ; when half done, put into it a bit of fresh lemon peel and a little sugar.—Rice water may be prepared as above. Toast Water.—Toast slowly a thin piece of white bread till extremeby brown and hard, but not the least black, then plunge it into a jug of cold water, and cover it over an hour before used. Pectoral Drink.—Take of common barley and raisins stoned, each two ounces ; liquorice root, half an ounce; water, two quarts. Boil the water first with the barley, then add the raisins, and after- wards, near the latter end of the boiling, the liquorice. The decoc- tion then will be fully completed, when one quart only of the liquor will be left after straining. Arrow-root Jelly.—Mix a large spoonful of the powder with a tea-cupful of cold water, by degrees, then pour this into a pint of boiling water, stirring it well, and when it boils it is finished. A little sugar and nutmeg may be added. Or prepare it as directed under the head of Arrow-root.—(See Materia Medica.) Sago Jelly.—Take of sago, washed well, one large spoonful; water, nearly a pint. Boil them gently, stirring often, till the mix ture is smooth and thick; then add two spoons full of wine, a little nutmeg, and sweeten it to the taste. A bit of lemon peel added to it when boiling, gives it a pleasant taste and flavour, and with some patients it agrees better when boiled in milk. Tapioca Jelly.—Choose the largest sort, pour cold water on to wash it two or three times, then soak it in fresh water five or six hours, and simmer it in the same until it becomes quite clear, then ^mr DIET FOR THE SICK. 621 put lemon juice, wine, and sugar. The peel should be boiled in it. It thickens very much. Calves' Feet Jelly.—Boil two calves' feet in one gallon of water till it comes to a quart, then strain it, and when it is cold,skim the fat entirely off, and take the jelly up clean; if there be any set- tling at the bottom, leave it. Put the jelly into a saucepan, with a pint of mountain wine, half a pound of loaf sugar, the juice of four large lemons, and the white of six or eight eggs, beat up the whisk; mix all well together, set the saucepan upon a clear fire, and stir the jelly till it boils. When it has boiled a few minutes, pour it through a flannel bag till it runs clear.—Have now ready a large china basin, with some lemon peel in it, cut as thin as possible, let the clear jelly run upon them while warm, and from these it will acquire both an amber colour, and an agreeable flavour. Afterwards it may be poured into glasses. Boiled Flour.—Take a pound or two of fine flour, tie it up as tight as possible in a linen rag, dip it repeatedly in cold water, and dredge the outside with flour till a crust is formed around it, which will prevent the water soaking into it while boiling. It is then to be boiled till it becomes a hard dry mass. Two or three table- spoons full of this may be grated down and boiled in milk and water to a proper thickness, and sweetened to the patient's taste, and a little nutmeg or other spice may be added. This forms an excellent food in dysentery, and in bowel complaints in children. Water Gruel.—Take of the coarse part of corn meal or grist, two hands full; water, three quarts; boil it till only two quarts re- main, then strain off the liquor, and season it to the palate with salt, sugar and nutmeg, to which may be added a spoonful or two of wine. Or, take of oatmeal, two large spoons full; water, one quart; mix them well, and boil them about ten or fifteen minutes,stirring often; then strain the gruel through a sieve, and add sugar and salt enough to make it agreeable to the taste. When it is designed as a meal, dissolve it in a little butter, and then add bread and nutmeg, as oc- casion requires. Rice Milk.—Take a large tea-cupful of rice, washed nicely ; water, one pint; boil it for about half an hour, then add a quart of new milk; let it simmer over a slow fire till it is sufficiently done, and then add to it a little sugar and nutmeg. Treacle Posset.—Take of milk one pint, put it on (he coals till it just begins to boil, then add two or three table-spoons full of treacle or molasses, stirring the milk as it is poured in. When mixed it is lit for use. 622 DIET FOR THE SICK. Panado.—Take of bread one ounce; mace, one blade ; water, one pint—Boil them without stirring, till they mix and turn smooth, then add a little grated nutmeg; a small piece of butter, and sugar enough to make the mixture agreeable. When butter is not ap- proved of, two spoons full of wine may be used in its stead. Or, set a little water on the fire, with a glass of white wine, some sugar, and a scrape of nutmeg and lemon peel; mean while, grate some crumbs of bread. The moment the mixture boils up, keeping it still on the fire, put the crumbs in, and let it boil as fast as it can. When of a proper thickness just to drink, take it off. White Caudle.—Take of oatmeal two table-spoonsful; water, one quart ; mace, two or three blades; three or four cloves. Mix them well together, boil them about fifteen minutes, stirring often, then add a few slices of the outer rind of a lemon; when the mix- ture has boiled about fifteen minutes, strain it through a sieve. As it is used, add to it white wine, grated nutmeg, white sugar enough to make it agreeable to the patient. Toasted bread is to be added likewise, as the appetite may require. Or, put into a pint of fine gruel, made of coarse corn meal, or grits, while it is boiling hot, the yolk of an egg beaten with sugar, and mixed with a large spoonful of cold water, a glass of wine, and nutmeg. Mix by degrees. Some like gruel, wtith a glass of table beer, sugar, &c, with or without a tea-spoonful of brandy. Flour Caudle.—Into five large spoonsful of the purest water, rub smooth one dessert spoonful of fine flour. Set over the fire five spoonsful of new milk, and put two bits of sugar into it; the moment it boils, pour into it the flour and water, and stir it under a slow fire twenty minutes. It is a nourishing and gently astringent food. Rice Caudle.—When the water boils, pour into it some grated rice, mixed with a little cold water; when of a proper consistence, add sugar, lemon peel, and cinnamon, and a glass of brandy to a quart. Boil all smooth. Bread Soup.—Take the upper crust of a roll, the drier the bet- ter ; or two or three crackers, cut or break them into pieces, and put it into a saucepan, with a pint of water, and a piece of butter about half as big as a walnut; boil them well, every now and then stirring and beating them, till the bread is mixed; then season the soup with a very little salt, and pour it into a basin. Egg Soup.—Take of water one pint; the yolk of an egg; butter the bigness of a small walnut; sugar enough to make it agreeably sweet. Beat up the yolk with the water, and then add the butter and sugar. Stir it all the time it is upon the fire; when it begins to diet for the sick. 623 boil, pour it to and fro between the saucepan and mug till it be smooth and well frothed, and then it will be fit to drink. Beef Tea.—Cut one pound of lean beef into thin slices or shreds, and boil it in a quart of water for twenty minutes, taking off the scum as it rises. After it grows cold, the liquor should be strained, in which state it resembles a light infusion of green tea, has a very grateful flavour, and is more strengthening than other broths. Chicken Broth.—Take a middling-sized chicken, divide it into two parts, put one half into a saucepan, with a quart of water, sea- soned with a little salt; as the scum rises take it off; then may be added a small bundle of parsley, and a crust of bread; when they have boiled about three-quarters of an hour, the parsley may be ta- ken out, and the broth will be fit for use, or it may be used seasoned only with salt. Mutton Broth.—Take of mutton one pound ; water three pints. Put them into a saucepan, and set it upon a clear fire, throw in a little salt, and as the scum rises take it carefully off with a spoon; then add a small onion, if there be no objection to it, and a little parsley. Boil till the meat is very tender, then take it out, pour the broth into a basin, and when cold, skim the fat part which is con- gealed on the surface, entirely off; after which, a part of the broth may be warmed and given to the patient as often as needful. A little boiled rice or barley may be added here occasionally. Calves' Feet Broth.—Boil two feet in three quarts of water, to half, strain and set it by; when to be used, take off the fat, put a large tea-cupful of the jelly into a saucepan, with half a glass of sweet wine, a little sugar and nutmeg, and beat it up till it be ready to boil, then take a little of it, and beat by degrees to the yolk of an egg, adding a bit of butter, the size of a nutmeg, stir all together, but do not let it boil. Grate a bit of fresh lemon peel into it. Boiled Pigeon.—Take one pigeon, drawn and washed very clean; boil it in a sufficient quantity of milk and water; that is, about half a pint of each, for fifteen minutes. When thus prepared, it may be taken out and eaten with the following sauce:—Take the liver parboiled, bruise it fine, with a little parsley boiled, and finely chop- ped ; melt some butter, and mix a little of it first with the liver and parsley, and then add the rest, and pour the whole upon the pigeon. To broil Pigeons.—After cleaning, split the backs, pepper and salt them, and broil them very nicely; baste with butter, and serve as hot as possible. 624 diet for the sick. Roasted Pigeons—Should be stuffed with parsley, either cut or whole, and seasoned within. Serve with paisley and butter. Partridges and other birds may be dressed as above. Bread Pudding.—Take of crumbs of bread about half a pound; new milk, about three-quarters of a pint. Pour the milk boiling hot upon the bread, and let it stand about an hour covered close up; then add the yolks of two eggs, well beaten; a little grated nutmeg; about a spoonful of rose water; a little salt, and sugar also if agree- able ; beat the bread well, and mix the whole together with a spoon. Tie it then close up in a clean linen cloth, and when the water boils, put it in; boil about three-quarters of an hour, then take it out, lay it upon a plate, pour over it some melted butter mixed with a little mountain wine, if there be no objection, and sprinkle a little sugar over all. Batter Pudding.—Rub three spoonsful of fine flour extremely smooth, by degrees, into a pint of milk; simmer till it thickens, stir into it two ounces of butter, set it to cool, then add the yolks of three eggs; flour a cloth that has been wet, or butter a basin, and put the batter into it; tie it tight, and plunge it into boiling water, the bottom upwards. Boil it an hour and a half, and serve with sweet sauce. If approved, a little ginger, nutmeg, and lemon peel, may be added. Rice Pudding.—Wash and pick some rice, throw among it some pimento finely pounded, but not much ; tie the rice in a cloth, and leave room for it to swell. Boil it in a quantity of water for an hour or two. When done, eat it with butter and sugar, or milk. Put lemon peel if you please. It is very good without spice, and eaten with salt and butter. Or, swell the rice with a very little milk over the fire, then add some more milk, an egg, sugar, allspice, and lemon peel. Bake in a deep dish. Potato Pudding.—Take eight ounces of boiled potatoes, two ounces of butter, the yolks and whites of two eggs, a half pint of new milk, one spoonful of white wine, a morsel of salt, the juice and rind of a lemon beat all to froth; sugar to taste.—A crust or not. as you like. Bake it. Custard Pudding.—Mix by degrees a pint of good milk with a large spoonful of flour, the yolks of four eggs, and a little pounded cinnamon. Butter a basin that will exactly hold it, pour the batter in, and tie a floured cloth over. Put in boiling water over the fire, and turn it about a few minutes, to prevent the egg going to one side, Half an hour will boil it. r > DIET for the sick. 625 Wine Whey.—Take of new milk two pints; water one pint; white wine one gill. Put the milk and water into a saucepan, well tinned, and set them upon a clear fire, and when they begin to boil, throw in the wine. Boil them about fifteen minutes, during which time, as the curd, or cheesy part collects, take it off with a spoon, and if the whey be not clarified enough with this quantity of wine, add a spoonful or two more; then boil it a little longer and skim it, by which means it will become sufficiently fine, and then it may be poured into a basin for use. Or, put half a pint of new milk on the fire ; the moment it boils up, pour in as much sound raisin wine as will completely turn it, and it looks clear; let it boil up, then set the saucepan aside till the curd subsides, and do not stir it. Pour the whey off, and add to it half a pint of boiling water, and a bit of white sugar. Thus you will have whey perfectly cleared of milky particles, and as weak as you choose to make it. Mustard Whey.—Boil one ounce and a half of mustard in powder, in a pint of milk, and an equal portion of water, till the curd be entirely separated, after which the liquid is strained through a cloth. This preparation is one of the most pleasant and effica- cious forms in which mustard can be given. A tea-cupful sweetened with sugar, taken three or four times in a day, is exceedingly bene- ficial in low fevers as a diaphoretic cordial. Vinegar and lemon whey may be formed in the same manner as wine whey. Alum Whey.—Boil two drachms of powdered alum in a pint of milk till it be curdled; then strain out the whey. This astringent preparation is often employed with advantage in uterine hemorrhage, and in diabetes. The dose is two or three ounces, or as much as the stomach will bear, several times in the day. To mull Port Wine.—Boil some spice in a little water till the flavour be gained, then add an equal quantity of wine, some sugar and nutmeg; boil it together, and serve with toast. Another way. Boil some allspice, or a bit of cinnamon, and some grated nutmeg a few minutes, in half a pint of water; then pour to it a pint of wine, add sugar to your taste, beat it up, and it will be ready. To mull White Wine.—Boil a pint of good wine with a table- spoonful of allspice ; beat up the yolk of an egg with a little sugar, and add it to the wine while boiling. Refreshing Drinks in Fevers.—Boil two quarts of water with two ounces of tamarinds, an equal quantity of currants and raisins, till near a fourth be consumed. Strain it on a piece of 79 626 diet for the sick. lemon peel, which remove in an hour, as it gives a bitter taste if left long. Tamarinds, currants, fresh or in jelly, or scalded currants, or cran- berries, with cold water, make excellent drinks; a little sugar may be added, if agreeable. Lemon Water.—Put two slices of lemon, thinly pared, into a tea-pot, a small piece of the peel and some white sugar, pour in a pint of boiling water, and stop it close two hours. Apple Water.—Cut two large apples in slices, and pour a quart of boiling water on them, or on roasted apples, strain in two or three hours, and sweeten lightly. DISPENSATORY. Having finished, as far as the limits of this work will permit, a general detail of the practice of domestic medicine, adapted to the climate of our country, it now only remains to notice the medicines requisite for family use, and to point out the best forms of prescribing them, in the treatment of the different diseases, described in the pre- ceding parts of this work. The following tables of medicines will be found sufficient to answer eveiy purpose of practice, and the expense will be found nothing, compared to the great advantages which must result from being constantly supplied with them. To render the work still more complete, I have, in these tables, annexed to the medicines, their doses, according to the age of the patient; observing, however, that whatever general rule may be given, it can only be applied with reference to the habit and state of the patient. The judgment of the person who administers the medicine must, therefore, be exercised in this respect. It will be found that the constitution is often at- tended with certain peculiarities, both in relation to medicine in general, and also to certain substances, particularly, which knowledge is only to be obtained by experience. EXPLANATION OF WEIGHTS AND MEASURES. 20 grains make.........1 scruple, 3 scruples ..........1 drachm, 8 drachms........• . I ounce, 12 ounces...........1 pound. A tea-spoonful is equal to 60 drops, or . . 1 drachm. A table-spoonful is the measure of . . . \ an ounce. A large wine-glassful is equal to ... 2 ounces. A TABLE OF MEDICINES FOE FAMILY USE, WITH THEIR DOSES AND QUALITIES ANNEXED. $p= These doses must be increased, or diminished, according to the strength and habit of the patient. Medicines. Mult. From 15 to 10. From 10 to 6. From 6 to 4. From 4 to 2. From 2tol. Under one. Qualities. Arsenic, solution of, Antimonial wine ----as a diaphoretic Alum Aloes 5 to 12 drops 3 to 4 drachms. 26 to 60 drops 5 to 15 grains 5 to 20 grains 20 to 80 drops do. do. 2 to 4 dims. 30 grs. 2 drms. 4 to 8 drops. 2i to 3 drms. 15 to 40 drops 3 to 10 grains 3| to 15 grs. 15 to 40 drops do. do. 1 to 2 drms. 25 to li drms. 3 to 6 drops 2 to 2\ drms. 12 to 30 drops 2 to 7 grains 3 to 12 grains 12 to 30 drops do. do. 20 to 1 drm. 2 to 5 drops \ to 2| drms. 10 to 20 drops \\ to 5 grains 2 to 10 grains 1 to 4 drops 1 to 2 drms. 8 to 15 drops 1 to 3 grains 1| to 8 grains \ to 3 drops 1 to 1| drm. 6 to 10 drops i to 2 drops | to 1 drachm 4 to 8 drops Tonic. Emetic. Diaphoretic. Astringent-Cathartic. Nutritious fbod. Balsam copaivi Balsam, Turlington, Barley Bitters Borax Bark, Peruvian 10 to 20 drops do. do. 15 to 40 grs. 8 to 15 drops do. do. 12 to 30 grs. 5 to 10 drops do. do. 10 to 25 grs. do. do. 6 to 16 grains Corroborant. Corroborant. Nutritive. Stomachic. Deterg. externally. Tonic & antiseptic. Medicines. Adult. From 15 to 10. From 10 to 6. From 6 to 4. From 4 to 2. From 2 to 1. Under one. Qualities. Calomel 10 to 30 grains 8 to 20 grains 6 to 15 grains 5 to 12 grains 4 to 10 grs. 3 to 8 grains 1 to 5 grains Active purgative. Camphor 4 to 20 grains 2 to 10 grains 2 to 6 grains 2 to 4 grains 1 to 3 grains 1 to 2 grains * to 1 grain Stimulant. Cream of tartar 4 to 12 drms. 3 to 8 drms 2 to 5 drachms 2 to 4 drms. 1 to 3 drms. | to 2 drms. | to 1 drm. Cooling aperient. Caustic vol. alk. liq. ' to 2 drachms | to 1 drachm 25 to 50 drops 20 to 40 drps. 15 to 30 drops 10 to 20 drops Stimulant. Corrosive sublimate .... Anti-venereal Columbo 10 to 60 grains 8 to 40 grains 7 to 35 grains 6 to 25 grains 5 to 20 grains 4 to 15 grains 2 to 10 grains Stomachic and tonic. Chalk, prepared, 25 to 50 grains 16 to 40 grains 15 to 35 grains 12 to 30 grs. 10 to 25 grs. 7 to 20 grains 5 to 12 grains Absorbent. Camomile flowers .... Stomachic &. antisep. Castile soap 20 to 80 grains 20 to 50 grains 15 to 40 grains 12 to 30 grs. 10 to 25 grs. 8 to 20 grains 5 to 10 grains Attenuant and deter. Croton oil 1 to 4 drops. | to 2 drops \ to 1 drop | to | drop 1-6 to | drop | to J drop i to i drop Cathartic. Castor oil 4 to 12 drms. 3 to 8 drachms 2ls to 6 drms. 2 to 5 drms. 1| to 4 drms. 1 to 3 drms. 1 to 2 drms. Purgative. Essence peppermint 10 to 50 drops 8 to 30 drops 6 to 20 drops 4 to 15 drops 3 to 12 drops 2 to 10 drops 1 to 6 drops Carminative. Elixir vitriol 15 to 40 drops 10 to 30 drops 8 to 20 drops 6 to 15 drops 4 to 10 drops 2 to 6 drops 1 to 4 drops Tonic. iEther vitriolic | to 2 drachms 30 dps. to 1 drm 18 dps. to 1 drm. 15 to 50 drops 12 to 40 drops 8 to 30 drops 5 to 10 drops Stimulant. Flax-seed .... Pectoral and obtund. Ginger 5 to 25 grains 4 to 18 grains 3 to 15 grains 3 to 12 grains 2 to 10 grains 2 to 8 grains 1 to 6 grains Aromatic. 05 to Medicines. Adult. From 15 /old. Gamboge Gum Arabic Hartshorn, spirit, Honey Ipecacuanha Jalap Lunar caustic Laudanum Morphine.solution of Magnesia Manna Nitre Nitric acid Oil of olives Opium Paragoric elixir 6 to 12 grains i to 1| drachms 15 to 30 grains 15 to 40 grains 1-6 to 3 grains 20 to 60 drops 6 to 24 drops | to 2 drachms 1 to 2 ounces 10 to 30 grains * to 3 grains 1 to 4 drachms 4 to 8 grains 20 to 50 drops 10 to 20 grains 8 to 25 grains i to 2 grains 12 to 40 drops 5 to 20 drops 20 grs. to 1 drm \ to 1| ounces 8 to 20 grains i to 1 grain 1 to 2 drachms From 10 to 6. From 6 to 4. 3 to 6 grains 15 to 30 drops 8 to 15 grains 6 to 20 grains 1-10 to li grains 10 to 25 drops 4 to 16 drops - 15 to 50 grains i to 1 ounce 5 to 12 grains 50 dps. to l|dm, 10 to 15 drops From 4 to 2. From 2 to I, 5 to 10 drops 6 to 12 grains 5 to 15 grains 1-10 to 1 grain 8 to 20 drops 3 to 12 drops 10 to 40 grains 3 to 6 drms. 2 to 10 grains 5 to 10 grains 4 to 12 grains 1-12 to i gr. 5 to 15 drops 2 to 8 drops 8 to 30 grains 2 to 4 drms. 2 to 8 grains 3 to 8 drops 4 to 8 grains 3 to 8 grains 3 to 8 drops Under one. 2 to 6 drops Qualities. I to 5 grains 2 to 5 grains 2 to 6 drops 1 to 4 drops 1 to 3 drops 30 dps. to ldr. 20 to 60 drops 6 to 20 grains 1 to 3 drms. 1 to 6 grains 1 to 3 drms. 15 to 30 dps. 4 to 10 grains i to 2 drms. 1 to 4 grains 1 to 2 drms. 3 to 20 drops Purgative. "* Obtunding. Stimulant. Pectoral. Emetic. Purgative. Stimulant. Anodyne. Anodyne. Absorbent. Mild aperient. Diuretic and febrile. Tonic and anti-scor. Obtunding and open. Anodyne & antisep. Anodyne & pectoral o CO o Medicines. Adult. From 15 to 10. From 10 to 6. From 6 to 4. From 4 to 2. From 2 to 1. Under one. Qualities. Pink root, Carolina, .... Vermifuge. Rhubarb, powdered, 15 to 50 grains 10 to 40 grains 8 to 30 grains 6 to 25 grains 5 to 20 grains 4 to 12 grains 2 to 10 grains Mild cathartic. Diaphoretic. Tonic. Rust of steel 5 to 25 grains 3 to 15 grains 2| to 3 grains 2 to 10 grains 1 to 6 grains i to 2 grains . . . . Red precipitate .... .... Escharotic. Sugar of lead 1 to 6 grains i to 4 grains i to 3 grains { to 3 grains 1-6 to 2 grs. i to 1 grain Astringentand tonic. Spanish flies .... Blistering. Salts 4 to 16 drms. 3 to 12 drachms 2 to 8 drachms 2 to 6 drms. 1| to 4 drms. 1 to 3 drms. | to 2 drms. Cathartic. Salt of tartar 10 to 30 grains 8 to 20 grains 6 to 12 grains 4 to 8 grains 3 to 6 grains 2 to 4 grains 1 to 3 grains Absorbent & febrile. Spirits of turpentine .... Stimulant. Sal ammon. volatile 5 to 20 grains 4 to 12 grains 4 to 10 grains 3 to 8 grains 2 to 6 grains 11 to 4 grains 1 to 3 grains Stimulant. .... Discutient. Senna Purgative. Spirits of lavender 30dps.to2dms. 20 dps. to 1 drm 15 to 50 drops 12 to 40 drops 10 to 30 drps. 6 to 20 drops 2 to 10 drops Cordial. Sulphur, flour of, 2 to 8 drachms 1 to 4 drachms 1 to 3 drachms | to 2 drms. 20 gr. to 1 dr. 10 to 40 grs. 5 to 20 grs. Aperient. Tamarinds . . . . . . . . . . . . . . . . .... Cooling, laxative. CO Medicines. Adult. From 15 to 10. From 10 to 6. From 6 to 4. From 4 to 2. From 2 to 1. Under one. Qualities. Tartar emetic 2 to 6 grains 2 to 4 grains li to 3 grains 1 to 2 grains i to 1 grain i to 1 grain i to 1 grain Emetic. Turner's cerate Healing. Tincture of steel 8 to 18 drops 5 to 12 drops. 4 to 10 drops 3 to 8 drops 2 to 6 drops 1 to 5 drops 2 to 3 drops Tonic. i to 1 ounce 2 to 4 drachms 1 to 3 drachms i to 2 drms. 20 to 60 drps. Anti-rheumatic. 2 to 6 drachms. li to 4 drachms 1 to 31 drachms 1 to 3 drms. 1 to 2 drms. i to lg drms. 20 to 40 drops Tonic. 4 drms. to 2 ozs. 3 to 8 drachms 2 to 6 drachms 2 to 5 drms. li to 3 drms. 1 to 2 drms. 20 to 40 drops Mild cathar. & stom. 10 to 60 drops 8 to 40 drops 6 to 30 drops 5 to 20 drops 4 to 15 drops 2 to 12 drops 1 to 8 drops Diuretic. 10 to 50 drops 10 to 40 drops 8 to 30 drops 6 to 20 drops 4 to 15 drops 2 to 5 drops 1 to 5 drops Stimulant. 1 to 4 drachms 1 to 3 drachms 40 dps.to 2i dm. 30dp.to2drs. 20 dp. to li dr 15 dps. to 1 dr 10 to 40 drops Tonic. .... .... .... .... Detergent. Vitriol, white, 20 to 60 grains 14 to 30 grains 6 to 15 grains 4 to 10 grains 2 to 5 grains 1 to 3 grains Emetic. 2 to 5 grains 1 to 3| grains | to 2 grains i to 1 grain .... .... Tonic. .... Escharotic. Virginia snake root 10 to 20 grains 8 to 15 grains 6 to 10 grains 3 to 6 grains 1 to 4 grains 1 to 3 grains Stimulant & stomac. CO 10 A TABLE OF MEDICINAL COMPOSITIONS, WITH THEIR DOSES AND PROPERTIES. Composition. Antimonial powders Anti. solu. or mix. Anodyne sudor, dps. Absorbent mixture Absor. & aperi. mix. Anti-dysenteric mix. Astringent mixture Cathartic mixture Camphor powders Camp, julep or mix. Decoc. or infus. bark Decoction of seneca Diaphoretic drops Adult. 8 to 15 grains 3 to 6 drachms 60 to 100 drops 4 to 8 drachms ... i 6 to 12 drachms 5 to 8 drachms 6 to 12 drachms 10 to 15 grains 6 to 8 drachms 2 to 6 ounces 6 to 12 drachms 1 to 3 drachms From 15 to 10. 7 to 12 grains 2 to 4 drachms 50 to 80 drops 3 to 5 drachms 5 to 8 drachms 3 to 6 drachms 5 to 8 drachms 8 to 12 grains 4 to 6 drachms 1| to 4 ounces 5 to 8 drachms 1 to li drachms From 10 to 6. 6 to 8 grains 1 i to 3 drachms 40 to 70 drops 3 to 4 drachms 4 to 6 drachms 2i to 4 drachms 4 to 6 drachms 6 to 10 grains 3 to 4 drachms 1| to 3i ounces 4 to 6 drachms 1 to 1 drachm From 6 to 4. 4 to 6 grains 1 to 2 drms. 30 to 60 drops 2 to 3 drms. 3 to 4 drms. 3 to 5 drms. 2 to 3 drms. 3 to 5 drms. 5 to 8 grains 2 to 4 drms. 1 to 3 ounces 3 to 5 drms. 20 to 40 drops From 4 to 2. 3 to 5 grains 1 to 2 drms. 20 to 50 drops li to 2i drms. 2 to 4 drms. 2i to 4 drms. li to 2 drms. 2i to 4 drms. 4 to 6 grains 1 to 3 drms. 1 to 2 ounces 2| to 41 drms 15 to 30 drops From 2 to 1. 2 to 4 grains 1 to 1 drm. 10 to 30 dps. 1 to 2 drms. 1 to 3 drms. 2 to 3 drms. 1 to 2 drms. 2 to 3 drms. 3 to 5 grains 1 to 2 drms. 6 to 12 drms. 2 to 4 drms. 10 to 20 drops Under one. 1 to 3 grains 1 to 1 drm. 5 to 20 drops 1 to 1 drm. 1 to 2 drms. 1 to 2 drms. \ to 1 drm. 1 to 2 drms. 2 to 4 grains | to 1 drm. 4 to 8 drms. 1 to 3 drms. 5 to 10 drops Properties. Diaphoretic. Diaphoretic. Anodyne & sudorific Absorbent. Absorb. & aperient. Anti-dysenteric. Astringent. Cooling, cathartic. Stim. & diaphoretic. Stimulant. Tonic. Diaphoretic. Diaphoretic. o CO CO Composition. Adult. From 15 to 10. From 10 to 6. From 6 to 4. From 4 to 2. From 2 to I. Under one. Properties. Diuretic mixture 2 to 4 ounces 2 to 3 ounces 1| to 3 ounces 1 to 2 ounces 1 to li ounce i to 1 ounce 1 to 4 drms. Diuretic. Dover's powder 10 to 20 grains 6 to 12 grains 5 to 10 grains 4 to 8 grains 3 to 6 grains 2 to 4 grains \ to 1 grain Diaphoretic. Febrifuge powders 8 to 15 grains 7 to 10 grains 6 to 8 grains 4 to 6 grains 3 to 5 grains 2 to 4 grains 1 to 3 grains Febrifuge. Febrifuge mixture 6 to 12 drachms 5 to 8 drachms 4 to 8 drachms 4 to 6 drms. 3 to 5 drms. 2 to 4 drms. 1 to 4 drms. Febrifuge. Infusion of columbo 1 to 3 ounces 1 to 2 ounces 1 to 2 ounces £ to 2 ounces | to 1 ounce 2 to 6 drms. 1 to 4 drms. Tonic. Lime water 1 to 4 ounces 1 to 3 ounces 1 to 2 ounces | to 2 ounces | to 1 ounce 2 to 6 drms. 1 to 2 drms. Absorb, and tonic. Pectoral mixture 4 to 8 drachms 3 to 6 drachms 2| to 5 drachms 2 to 4 drms. U to 3 drms. 1 to 2 drms. | to 1 drm. Obtunding. Purgative electuary 2 to 4 drachms 1\ to 3 drachms 1 to 2 drachms 1 to 1| drms. | to 1 drachm 1 to 1 drm. .... Purgative. Saline mixture 6 to 8 drachms 4 to 7 drachms 4 to 6 drachms 3 to 5 drms. 3 to 4 drms. 2 to 3 drms. 1 to 2 drms. Diaphoretic. Spirit of mindererus 6 to 8 drachms 4 to 7 drachms 4 to 6 drachms 3 to 5 drms. 3 to 4 drms. 2 to 3 drms. 1 to 2 drms. Diaphoretic. Syrup of flaxseed 6 to 8 drachms 4 to 7 drachms 4 to 6 drachms 3 to 5 drms. 3 to 4 drms. 2 to 3 drms. 1 to 2 drms. Pectoral and obtund. Solu. sul. quinine 1 to 2 drachms | to 2 drachms | to 1 drachm 20 to 40 drops 15 to 30 drops 10 to 30 drops 5 to 10 drops Tonic. Tonic powders 15 to 50 grains 10 to 30 grains 8 to 25 grains 6 to 20 grains 4 to 12 grains 1 to 6 grains 1 to 3 grains Tonic. Vitriolic solution 4 to 6 drachms 2 to 4 drachms 2 to 3 drachms H to 2\ drms. 1 to 2 drms. 1 to 2 drms. \ to 1 drm. Astringent. CO 1 s DISPENSATORY. 635 EMETICS, Are medicines which excite vomiting, and are usually employed in fevers of almost every species, especially when accompanied in the commencement with nausea, vomiting, and other symptoms indi- cating/a disordered state of the stomach. They cleanse the stomach of its noxious contents, and prepare the way for the reception of other remedies. As a general rule, emetics should always be given on an empty stomach, and in the morning. They act with greater certainty, and with less distress to the patient. They will, however, answer very well in the evening. In ordinary cases, administer the medicine in divided quantities, so as to guard against too violent an effect, and encourage its operation by drinking freely of warm water. To check inordinary vomiting from too large a dose of emetic medicince, give laudanum, combined with some cordial, apply fo- mentations to the pit of the stomach, and sinapisms to the extremi- ties. Chicken water, copiously drunk, is sometimes useful by turning the action downwards. When these fail, anodyne injections may be resorted to, and a large blister should be put on over the region of the stomach. Of the emetics, the mildest are ipecacuanha, the antimonial solu- tion, and antimonial wine, in broken doses. The most active and expeditious, are the white and blue vitriol. Where poisons have been swallowed, one or other of these should be given in very large doses, and repeated every fifteen minutes until the desired effect be obtained.—(See Thorn Apple, and Poisons.) Antimonial Solution.—Take of tartar emetic, six grains, water half a pint; spirits of lavender thirty drops; sugar, one lump.—Mix. Dose for adults a wine-glassful every fifteen minutes, which should be encouraged by drinking freely of warm water, and afterwards turned downwards by taking a bowl of thin gruel made very salt. CATHARTICS, Are medicines which, by quickening the peristaltic motion, in- crease the evacuations of the intestines, or as may happen, induce purging. Cathartics differ very materially in their degree of activity; some operating mildly, while others are more violent in their effects. The former is usually distinguished by the title of laxatives, and the latter by that of purgatives, the harshest of which, are called drastic purgatives. The primary and most obvious effect of cathartics, is the evacua- tion of the bowels. These are liable to various accumulations of a 636 DISPENSATORY. morbid nature, which, remaining, disturb health, and frequently ex- cite or confirm disease. Cathartics, in relieving the bowels, under such circumstances, extend also their operation upwards, and bring down, in many instances, the contents of the stomach. To this may be added, that the strong impression which they impart to the liver and pancreas, excites these glands to invigorated efforts, and the result is a vast increase of their respective secretions. It is in this way, that congestions are removed, biliary calculi dislodged, and jaundice and other affections, from organic obstruction, cured. They also subdue the pulse, equalize excitement, and render important service in the management of the febrile and inflammatory cases. Exhibited in the commencement of almost any febrile affection, they will often arrest its progress, and, during the subsequent or more ad- vanced periods, they are sometimes daily repeated, and, so far from weakening, add to the strength of the patient. As in the case of emetics, give the medicine on an empty stomach, and either in the morning or at bed-time. By doing this, we prevent its being rejected, and secure a much more easy and effectual opera- tion. And it should be recollected, as cathartics are of very different properties and modes of operation, they should carefully be selected according to the circumstances of the case. Ijaxatives.—Of this description are castor oil, sweet oil, magnesia, calomel, neutral salts, sulphur, cream of tartar; as also the cathartic mixture, and the aperient and diaphoretic pills, in broken doses. Cathartic Mixture.—Take of Glauber salts, one ounce and a half; lemon juice or sharp vinegar, one ounce; water, half a pint; sugar, a sufficient quantity to sweeten it.—Mix. Or, take of cream of tartar finely powdered, and manna, each one ounce; water, half a pint; sugar, a sufficient quantity to sweeten it. -Mix. Dose for adults, a wine-glassful every hour till it operates. Antibilious, or Aperient and Diaphoretic Pills.—Take of calo- mel, jalap, each twenty grains; tartar emetic, two grains; syrup or mucilage of gum Arabic, sufficient to form a mass; make eight pills. Dose for adults, two at bed-time, and the dose repeated every hour in the morning until it operates sufficiently.—Or take four in the morning, and one every hour until the desired effect be obtained. Purgatives.—The drastics are the Croton oil, gamboge, aloes, calomel, jalap, rhubarb, and senna, the purgative infusion, purgative powder, stimulant purgative pills, and purgative electuary. The distinction, however, between laxatives and purgatives, is by no means easy, since by diminishing or increasing the dose of the former, they may, with some propriety, be considered as belonging to the first or second class. DISPENSATORY. 637 Croton Oil— This oil is obtained from the seeds of the Croton Tiglium ; a native of the East Indies. It is one of the greatest and most powerful cathartics, with which we are acquainted. Like all other active cathartics, it sometimes gripes the bowels. This effect may be relieved by drinking freely of chicken water, gruel, or flax- seed tea; or, if necessary, by a little laudanum. The usual dose, ' for an adult, is one drop, but four or five drops are sometimes given. It may be given in syrup, or made into the form of pill with crumbs of bread—the latter form is preferable. Purgative Infusion.—Take of senna and manna, each, half an ounce; salts, one ounce; ginger, one drachm; boiling water, one pint. Dose for adults, one gill every hour or two, until it operates. Purgative Powder.—Take of calomel and jalap, each, twenty grains, to be taken in the morning in syrup or molasses, by adults. Or, take of rhubarb and vitriolated tartar in fine powder, each one drachm; mix well together, and divide into four powders.—One taken going to bed, and another in the morning, will be found an efficacious remedy, whenever it is required to cleanse the stomach and bowels of bilious and other offensive matter. Stimulant Purgative Pills.—Take of calomel and gamboge each one drachm; syrup sufficient to form a mass. Beat them together, and then make twenty-four pills. Dose for adults, from three to six. Or, take of calomel, aloes, rhubarb, and soap, each, one drachm, syrup or mucilage of gum Arabic, sufficient to form a mass.—Beat them well together, and make forty-eight pills. Dose for adults from four to eight. Or, take of calomel and jalap, each, one drachm ; powdered gin- ger and soap, each, half a drachm; mucilage or syrup sufficient to form a mass—divide into thirty pills. Dose for adults from four to eight. Aloetic Pills.—Take of Socotorine aloes, in the finest powder, one drachm and a half; Castile soap, one drachm; ginger, half a drachm. Beat them well together, and then add mucilage or syrup sufficient to form a mass—which is to be made into forty-eight pills. Dose for adults, two at bed-time, or a sufficient number to keep the bowels in a regular state. Purgative Electuary.—Take of jalap, one drachm ; cream of tartar, one ounce; syrup or molasses as much as will give the whole a proper consistence. Dose for adults, from one to two tea-spoons full in the morning, to keep the bowels in a soluble state. 638 DISPENSATORY. DIAPHORETICS. In the common language of the schools, the term diaphoretic, is restricted to those articles only which promote the insensible perspi- ration ; and such as occasion sweating, are distinguished by the ap- pellation of sudorifics. But, as in the medicines arranged under these titles we can discern no difference, except in the degree of force, or what arises from the manner of administration, we shall comprehend the whole under the head of diaphoretics. To promote perspiration it is essentially necessary that the patient should be confined to his bed. Let his pulse, and the temperature of the body, be carefully watched. It is a principle settled and fully recognised, never to resort to diaphoretics in fevers of an inflamma- tory species, till arterial action and general excitement are consider- ably reduced by previous venesection and evacuations by puking or purging. After this direct depletion, diaphoretics then come in with great advantage, and will commonly either mitigate or completely arrest the progress of the disease. In the exhibition of diaphoretics give diluent drinks, unless the stomach be irritable. This remark particularly applies to the anti- monial preparations, and some of the combinations of ipecacuanha. The temperature of the drinks must be regulated by that of the skin. The latter not being high, they should be warm, or even hot; but if the contrary prevail, they must be given cold. In the low stages of disease, while pursuing the diaphoretic plan, studiously avoid purging, unless circumstances imperiously require this remedy. It is very apt, in this state of the system, to check sweating, and to bring on an aggravation of the complaint. It does this by diverting action from the surface of the intestines, and by ex- posing the patient to cold. Diaphoretic Drops.—Take of sweet spirits of nitre and antimonial wine, each, one ounce.—Mix. Dose for adults,a tea-spoonful every two hours. If the stomach is in an irritable state, add only half the quantity of antimonial wine. Antimonial Wine.—Dose for adults, twenty drops every hour or two, till the proper effect be produced. Saline Julep or Mixture.—Take of lemon juice, one ounce ; vol- atile sal ammoniac, one drachm, or salt of tartar four scruples. After the effervescence, add syrup, two tea-spoons full; simple cin- namon water, or tea, half an ounce, or spirits of lavender, thirty drops; spring water, six ounces.—Mix. Dose for adults, two table- spoons full every three hours. Effervescing Draught.—Take fifteen grains of salt of wormwood, DISPENSATORY. 639 or volatile sal ammoniac, dissolved in a table-spoonful of water, in one cup; in another, two large tea-spoons full of lime juice, lemon, juice, or one table-spoonful of very good vinegar, with one or two* table-spoons full of water sweetened; pour one to the other, and let the patient drink immediately while they effervesce. When made with fresh lime or lemon juice, this is an elegant, pleasant, and use- ful medicine in all fevers, and peculiarly effectual in removing nau- sea and vomiting; it may be repeated every two or three hours. Spirit of Mindererus.—Take of volatile sal ammoniac, two drachms ; lemon juice or vinegar, half a pint, or as much as may be sufficient to saturate the volatile alkali.—Mix. A dose to be taken every two hours. Antimonial Solution.—Dose for adults, a table-spoonful eveiy two hours as a diaphoretic. (See Emetics.) Antimonial Powders.—Take of tartar emetic, three grains; nitre, two drachms.—Mix, and divide into twelve doses. One dose to be taken every two or three hours by adults. In obstinate cases, the addition of ten or twelve grains of calomel to the above recipe, will render the medicine more salutary. Febrifuge Powders.—Take of ipecacuanha, two scruples; nitre two drachms.—Mix, and divide into twelve doses. One dose to be taken every two or three hours by adults. Febrifuge Mixture.—Take of nitre, two drachms; lemon juice or vinegar, one ounce; water, half a pint; sugar, a sufficient quan- tity to sweeten it.—Mix. A wine-glassful to be taken by adults every two hours. It will be rendered more active by the addition of two drachms of antimonial wine. Dover's Powders.—Ipecacuanha, powdered, and opium, each, one drachm ; vitriolated tartar, in powder, one ounce.—^The greatest possible pains should be taken to grind the mass to a completely fine powder. Nitre may be substituted for the vitriolated tartar, when that is not at hand. This powder is the most efficacious sudorific we possess. It is an admirable remedy for quieting the bowels, when affected by the exhibition of mercury, or any other cause. Dose for adults from ten to twenty grains every three or four hours. Camphorated Powders.—Take of camphor, two scruples; nitre, powdered, two drachms. Moisten the camphor with spirits, and after reducing it to a fine powder, add the nitre. Divide it into twelve doses. One to be taken every two or three hours by adults. Infusion of Virginia Snake Root.—Snake root, half an ounce; 640 DISPENSATORY. boiling water, half a pint; infuse for two hours in a covered vessel and strain.—Dose. A table-spoonful occasionally, taken warm. It is used to aid other diaphoretics, and in its effects, resembles camphor. Anodyne Sudoi'ific Drops.—Take of laudanum half an ounce; antimonial wine, one ounce.—Mix. Dose for adults,two tea-spoons full at bed-time. Anodyne Sudorific Bolus.—Take of opium, one grain and a half; ipecacuanha, ten grains: syrup or mucilage, sufficient to form a bolus. Or, take of opium, one grain and a half; tartar emetic one grain; or golden sulphur of antimony, two grains; mucilage sufficient to form a pill. To be taken by adults at bed-time. For children, the best means of procuring a perspiration is the tepid bath, succeeded by the use of a table-spoonful of saline julep, or the diaphoretic drops, every two or three hours. Besides the warm bath, the external stimulating diaphoretics are, friction, rubefacients, and blisters, which excite copious partial per- spiration, previously to their vesicat on. There are many vegetable substances which belong to this class of medicines, particularly the Virginia and seneca snake roots, sarsa- parilla, thoroughwort, &c. (See Materia Medica.) DEMULCENTS. Demulcent Drinks—Are those which sheath the acrimony of the humours, and render them mild, such as flax-seed tea, marsh-mallow tea; mucilage of quince seeds, pith of sassafras, slippery elm, (see Materia Medica,) and gum Arabic. A solution of gum Arabic is made by boiling an ounce of picked gum Arabic, in a little more than a quart of water, until it be dissolved. All these are useful to sheath and defend very sensible parts from the irritation of acrid humours, as is the case in tickling cough, and common lax, or bloody flux, heat of urine, &c, in all which, the natural mucus of the parts is defective. ABSORBENTS. Absorbent Medicines—Are such as correct acidity in the stomach, Calcined Magnesia—One or two tea-spoons full to be taken oc- casionally mixed in milk or mucilage of gum Arabic, by adults. Prepared Chalk.—A tea-spoonful to be given in the same maimer as mngnesia. f DISPENSATORY. 641 Lime Water.—A wine-glassful, with an equal quantity of new milk, to be taken occasionally by adults. Absorbent Mixture.—Take of chalk prepared, half an ounce; gum Arabic, powdered, and white sugar, each, two drachms; water, four ounces. Dose for adults, a table-spoonful every two or three hours. Absorbent and Aperient Mixture—Is made by adding one drachm of rhubarb in powder, or half an ounce of the tincture of rhubarb, to the above recipe. Or, take of prepared chalk and magnesia, each, half an ounce; sugar, two drachms; rub them well together, then add mucilage of gum Arabic, two ounces; weak cinnamon tea, four ounces.—Mix. Dose for children, from one to two tea-spoonsful. DIURETICS, Are remedies to promote the urinary discharge, which may take place, either by stimulating the kidneys, or by an invigoration of the powers of absorption, and especially in cases of dropsical effusion. It hence appears, that diuretics are of two species, though in which- ever mode they operate, it is by an action primarily on the stomach, extended to the absorbents or kidneys, according to the affinity of the article to the one or other of these parts. Mild Diuretics.—Of this class of medicines, nitre, by reducing the force of circulation, will be found eminently useful in febrile cases. Dose, ten or fifteen grains, for adults, every two or three hours. Conjoined with camphor, as in the camphorated powders, its diuretic effects, in some cases, is increased. Dulcified Spirits of Nitre.—Dose for adults, half an ounce every three or four hours. Unless this medicine be given in large doses, it will excite perspiration, rather than act as a diuretic. It is chiefly valuable in the cases of children. There is, indeed, scarcely any medicine which, in their complaints, we can substitute in its place, and it may be given to them, in the same proportion even in the earliest periods of life. Cream, of Tartar.—Dose for adults, half an ounce, dissolved in a pint and a half of water, to be taken throughout the course of the day. It must be gradually increased, as the stomach becomes ac- customed to it. Of all the diuretic medicines, this is perhaps most fitted to those cases of dropsy which are accompanied with increased or febrile ac- tion of the pulse, though it here sometimes operates more effectually 81 1 642 DISPENSATORY. when combined with jalap, as in the form of laxative electuary. (See Cathartics.) Dose for adults two tea-spoonsful every three or four hours, where we wish to evacuate large accumulations of fluid, and here an abstinence from drink must be enjoined. Salt of Tartar—Is considered, by some practitioners, a valuable diuretic, in closes of half a drachm, dissolved in water, three or four times a-day. By combining it with the infusion of Columbo, or some of the bitter tonics, its efficacy is very much improved. Thus exhibited, it is said to increase the diuretic effect, while at the same time it invigorates the system generally. Parsley.—The common parsley of our gardens is another valuable diuretic. A strong infusion of the roots in doses of a tea-cupful every two or three hours, is well adapted to relieve the ordinary sup- pression of urine. It is customary to unite with the parsley the seeds of the water melon. Diuretic Infusion.—Pound a handful of the kernels of pumpkin seeds or melon seeds, with a small quantity of hard white sugar, to a smooth paste; then add a quart of boiling water, and a quarter of an ounce of saltpetre, or half an ounce of sweet spirits of nitre, and rub them well together. This is a pleasant and mild diuretic, particularly useful where the discharge of urine is attended with heat and pain. A tea-cupful may be taken every hour or two by adults. Diuretic Pills.—Take dried squills in fine powder and calomel, each, half a drachm ; mucilage of gum Arabic, sufficient to form a mass, and then make twenty pills, two of which are to be taken at bed time. The pills powerfully promote urine, and are very effi- cacious in carrying off cold, phlegmatic humours, in all dropsical swellings. When the squill alone is given, it may be taken in doses of two or three grains, three or four times a-day, in the form of pills, by adults. Oil of Juniper.—Dose for adults, ten drops in gruel.—(See Ma- teria Medica. See also, under this head, wild parsley, wild carrot, foxglove, and tobacco.) Stimulating Diuretics.—The Spanish fly promotes, as well as restrains, the urinary discharge. Exhibited in a state of excitement, or at any time in small doses, it most commonly occasions strangury. But taken in a reverse state of the system, or in large doses, it as constantly proves diuretic. Thus, in the weaker forms of dropsy, two, three, or four drachms of the tincture, given in divided doses during the twenty-four hours, will produce the most copious evacu- ations of urine. DISPENSATORY. 643 EXPECTORANTS. Expectorants have been defined those medicines which facilitate or promote the excretion of mucus or other fluids, from the pulmo- nary system or lungs. Expectorants are employed when the mucus is too thin and acrid, when too viscid, or when the excretories are not sufficiently irritable to propel their contents. Where the mucus is thin and acrid, inflammation generally exists, and in such cases mucilaginous drinks, as flax-seed tea, mucilage of gum Arabic, or slippery elm, Iceland moss, or syrup, liquorice, antimonials, and nauseating medi- cines are employed. Oils differently prepared, and jellies, are also useful. Independently of inflammation, the mucus is sometimes too thin and acrid, from too great irritability of the vessels of the bron- chial glands, and we then employ opiates and stimulating medicine?, as mustard, horse-radish, seneca, squills, garlic, Indian turnip, mea- dow saffron, and tobacco. (See Materia Medica.) When the ex- pectoration is too viscid, or the vessels not sufficiently irritable to assist the excretion, expectorants, strictly so called, are useful. These are the more stimulating medicines just mentioned; to which may be added all the variety of fetid gums, and the turpentines, including the balsams. Steams of warm water, impregnated with vinegar, aromatic herbs, and ether, are adapted to the same purpose. Nitric Lac Ammoniac.—Pour very gradually two drachms of ni- tric acid, diluted in eight ounces of water, on two drachms of ammo- niac, and triturate them in a glass mortar till the gum is dissolved, forming a milky fluid. Of this a table-spoonful may be taken every two or three hours in sweetened water. Laudanum, in some cases may be usefully added. Pectoral Mixture.—Gum ammoniac, two drachms; syrup of squills, half an ounce; laudanum, fifty drops; spring water, six ounces. Reduce the gum to powder in a marble mortar, and gra- dually add the water, and triturate till the gum is dissolved, then strain from the impurities and add the other articles. Dose, a table- spoonful every two or three hours, for adults. Or, take of sweet oil, one ounce; rain or soft water, half a pint; salt of tartar, five grains; white sugar, half an ounce. Dissolve the salt of tartar and the sugar in the water, and afterwards add the oil, when, by agitating the phial, a mixture will be formed of cream-like appearance. To this add paregoric elixir, half an ounce. Dose, a table-spoonful every hour or two. Pectoral Emulsion.—Take of oil of almonds, or pure sweet oil, one ounce; barley-water, six ounces; best white sugar and gum 644 DISPENSATORY. 1 Arabic, powdered,of each half an ounce; laudanum, forty drops. Incorporate the sugar and gum Arabic together in a mortar with a small quantity of the barley-water, then gradually mix the oil, and afterwards add, by little at a time, the remainder of the water with the laudanum. One or two table-spoonsful of this emulsion may be taken frequently. Or, take of the best purified honey and pute sweet oil, each, two ounces; fresh lemon juice, one ounce; syrup and paregoric, each, half an ounce. Mix, to form an emulsion. Dose, a tea-spoonful whenever the cough is most troublesome. Cough Mixture.—Take of paregoric elixir, one ounce; powdered gum Arabic, one ounce; simple water, two ounces; sweet spirit of nitre, two drachms; antimonial wine, one drachm. Mix and dis- solve. Dose, one tablespoonful to be taken whenever the cough is troublesome. But, in the first stage of catarrh, when inflammatory symptoms are present, this and all opiates, are improper. Or, take of elixir paregoric, one ounce and a half; antimonial wine and syrup of squills, each one ounce; lac ammoniac, four ounces; syrup bal. tolu, one ounce. Dose, half a table-spoonful every two or three hours for adults. Or, take of tincture of opium, one drachm; wine of ipecacuanha, half a drachm; oxymel of squills half an ounce.—Mix. Dose, for adults, a tea-spoonful every two hours while the cough is severe. Domestic Remedies for Whooping-Cough.—Dissolve thirty grains of salt of tartar in a gill of water, add to it ten grains of co- chineal finely powdered, sweeten this with fine sugar, and give an infant a tea-spoonful four times a-day. To a child of two or three years old, two tea-spoonsful; from four years and upwards, a table- spoonful or more may be taken. The relief is said to be immediate, and in general within five or six days. Or, take equal portions of new milk, and the lie strained from hickory ashes, of which one table-spoonful may be given every hour through the day to a child of seven or eight years old —This reme- dy is also strongly recommended. Pectoral Lozenges.—Take of purified opium, two scruples; tinc- ture of balsam of tolu, two drachms; syrup, composed of one part of water, and two parts of white sugar, four ounces; refined Spanish liquorice, previously moistened with a little warm water, so as to make it soft; gum Arabic, in fine powder, each, two ounces and a half; emetic tartar, eight grains. Rub the opium and the emetic tartar with the tincture and syrup until the former is perfectly dis- solved, then add the liquorice, softened with warm water, and whilst beating them together, gradually sprinkle in the gum Arabic. Di- vide the mass into lozenges or troches; each weighing ten grains, and exsiccate them gradually in the air. One may be put in the DISPENSATORY. 645 mouth and gradually dissolved, every hour or two when the cough is troublesome. ° Nitrous Lozenges.—Take of purified nitre, two drachms; re- hned sugar, reduced to a fine powder, six drachms; pulverized gum ragacanth, three drachms.—Beat these together with a small por- tion of water, until they are intimately mixed, and form a coherent mass, which may be divided into moderated sized troches or lozenges, to be dried by means of a gentle heat. In cases of quinsy or sore throat one of these lozenges frequently put in the mouth and suffer- ed gradually to dissolve, will be found very beneficial. ANODYNES. Anodynes are medicines which ease pain and procure sleep. Opium.—Of all the articles of the Materia Medica, this is, per- haps, the most extensively useful; there being scarcely one morbid affection, or disordered condition of the system, in which, under certain circumstances, it is not exhibited either alone or in combina- tion. Opium, the product of the poppy, with some persons, leaves unpleasant effects, and with such, the lettuce opium, (See Materia Medica,) should be employed. Opiate Pills.—Take of pure opium, and powder of cinnamon, or ginger, each, twelve grains; mucilage.or ..syrup sufficient to make them into twelve pills. Dose, for adults, one or two at bed-time. Anodyne Draught.—Take of laudanum, a tea-spoonful; syrup, two tea-spoons full; cinnamon, or herb tea, one ounce.—Mix. This to be taken at bed-time by an adult. When laudanum disagrees in the ordinary quantity, it may often be given with much advantage in doses of five or six drops every hour till the proper effect be pro- duced ; or it may be given in vinegar, whey, or conjoined with the antimonial wine, as in the form of the anodyne sudorific draught (See Diaphoretics.) As laudanum is extremely prejudicial to children, it ought not to be administered to them, except under peculiar circumstances. In- stead of its internal use, a little of it should be rubbed on the back- bone ; or the same effects may be produced by rubbing on that part a tea-spoonful of anodyne balsam. When laudanum is prescribed by way of injection, the proportion must be more than double what can be given by the mouth. Paregoric.—Dose, for adults, one or two tea-spoons full, in a cup of tea or gruel. 646 DISPENSATORY. Morphine.—For this article, as well as for the quinine and most of the other improvements, in pharmacy and chemistry, we are in- debted to the skill and industry of the French chemists. It is an alkali obtained from opium, and is that principle in opium which quiets irritability and disposes to sleep, without producing those dis- agreeable effects, which sometimes arise, from any other preparation of that valuable medicine. Hence it is particularly valuable to those with whom opium generally disagrees. Morphine is used in medi- cine in combination with sulphuric, or acetic acid, forming the sul- phate, or the acetate of morphine, of which the sulphate is to be pre- pared. They are used in solution; which, may be obtained from any apothecary, and is thus prepared :—Take of sulphate, or acetate of morphine, sixteen grains, water one ounce, acetic acid, or strong vinegar five to six drops, alcohol one drachm.—Mix. The dose for an adult is from six to twenty-four drops of the so- lution, or one-fourth to one-half grain of the morphine itself, in pills or syrup. ANTISPASMODICS As the causes of spasms differ essentially, the remedies must equally differ. Bleeding, mercury, warm bathing, blister, opiates, camphor, volatile alkali, musk, castor, assafoetida, garlic, ether, wine, and spirits, bark, steel, and other tonics, are the remedies usually re- sorted to. In the choice of these, we employ the sedatives and fcetids to shorten the fit; and the stimulants and tonics to prevent returns. Gum Pills.—Take assafoetida, three parts; gum ammonia, two parts; camphor, one part; beat them well together, and with as much syrup as is necessary, make into pills of the size of a common pea, from three to five may be taken at a dose, and repeated as often as shall be found necessary; not, however, exceeding three or four doses in a day. This is a powerful antispasmodic, and very useful in all nervous and hysterical complaints. When it is wished to render the mass purgative, which is generally proper, add as much socotrine aloes as of camphor. CORDIALS. A glass of wine or a little brandy toddy. Compound Spirits of Lavender.—Dose, for adults, a tea-spoonful on a lump of sugar, to be dissolved in the mouth, and gradually swallowed. DISPENSATORY. 647 Cordial Mixture.—Take of aromatic spirit of hartshorn, two water, two ounces; spring water, three ounces.—Mix. The dose, for adults, a table-spoonful now and then. Cordial Draught.—Take of volatile tincture of valerian, one drachm; simple syrup, water, of each four tea-spoons full.—Mix them together. To be taken at once by adults. Cordial Drops.—Take of paregoric elixir, volatile tincture of va- lerian, of each equal parts. Mix them well together. Dose, one tea-spoonful in a glass of water, for adults. For children the best cordial is white wine whey. STIMULANTS. In relation to general stimulants, there is a distinction too impor- tant to be overlooked. We have a set distinguished by great diffu- sibility, and which, nearly as soon as exhibited, occasion universal excitement over the body; and there is a second section, by which tone is imparted, though very slowly, and by a long administration. The diffusible are very transient in their effects, while such as are more gradual in their operation, produce permanent or enduring im- pressions, and are called tonics. As in the administration of stimulants, we hope to overcome an existing action, by exciting a new and stronger one, it is obvious that they can only be resorted to with any hope of advantage, in the feeble shapes of disease, or in more violent forms, reduced by pre- vious evacuations. But, in determining the exact point at which to commence the use of stimulants, we may also be aided by watching their operation. Being ill-timed, they commonly produce pain in the head, or delirious wanderings, or morbid vigilance, or stricture of the breast, restlessness and anxiety, with a hot dry skin, parched tongue, and a quick, small, and corded pulse. In the administration of stimuli, we should endeavour to graduate the article to the state of excitability. This is a point of infinitely greater importance than is commonly imagined. It is not always the most active article produces the greatest effects. In the low states of disease, we have witnessed, in some instances, more effects from wine whey, than strong toddy. This proceeds from the article being in unison with the condition of the system. Narcotics.—That the purer narcotics are endowed with a stimu- lant power, is very satisfactorily proved by the operation of opium. Exhibited in a moderate dose, the purer narcotics excite activity both of body and of mind. But to command their stimulant power, they ought to be given in small doses, frequently repeated, and 64S DISPENSATORY. drachms; compound spirit of lavender, three drachms; cinnamon gradually increased, and the excitement which they enkindle is thus sustained. But when the design is to mitigate pain, or to procure sleep, or to relieve irritation, or deaden sensibility, they should be exhibited in a full dose, and at more distant intervals. It should be remembered that the indications, chiefly, which narcotics are capa- ble of fulfilling, are to excite and support the actions of the system, to assuage pain, and allay irritation, to relieve spasmodic affections and to induce sleep, and to check the morbidly increased secretions and excretions. Volatile Sal Ammoniac.—In a great variety of febrile affections this medicine has been prescribed, though it is in the low, or typhus fevers, that it is chiefly employed. In one respect the volatile alkali differs from every article of the class to which it is attached, and, it would seem, from all other me- dicines. The peculiarity to which we allude is this, that the excite- ment it raises approaches more nearly to that of healthy action, and hence it may be recurred to earlier than stimulants generally, in the inflammatory affections, and with greater safety in mixed cases so equivocal or obscure, as to render uncertain the propriety of stimu- lation. It may be given in the shape of a pill or julep, in the dose of five or ten grains, every hour or two, according to circumstances. The best form, however, is the latter, which may be made agreeably to the annexed prescription. Take of volatile sal ammoniac, two scruples; gum Arabic, white sugar, each one drachm ; oil of cinnamon, five drops; spring water, five ounces.—Mix. Dose, for adults, a table-spoonful every two hours. Camphor.—No medicine, perhaps, has been prescribed for a greater variety of purposes than camphor. In every modification of febrile action, when approaching to the typhoid state, camphor has been resorted to, and not without success. It excites perspira- tion, quiets nervous irritation, removes delirium, and abates the force of the disease. Camphor is best exhibited in the form of julep or mixture. Camphorated Julep, or Mixture.—Take of camphor, one drachm; gum Arabic, two drachms; white sugar, half an ounce; water, half a pint. Moisten the camphor with spirits, and after reducing it to a powder, add the gum Arabic and sugar, and then, by degrees, pour on the water, while triturating them together in a mortar. Dose, for adults, a table-spoonful every two or three hours. Or, take camphor, one drachm; myrrh, half a drachm; white sugar, two drachms; spring water, six ounces.—Dose, for adults, a table-spoonful. The mixture, thus made, is perfectly transparent and very palatable. Of late, however, the solution, or rather sus- DISPENSATORY. 649 pension of camphor in milk, has nearly superseded all other prepara- tions of the medicine in practice. It is made by simple trituration. The dose of camphor is from five to ten grains, to be repeated once in two or four hours, according to circumstances. Pills of Camphor and Assafoetida.—Take of camphor, assafoetida, each one drachm; moisten the camphor with a few drops of alcohol, unite them together, and make thirty-six pills. It is sometimes ad- visable to add half a drachm of calomel to the above. This is an admirable combination, as well as camphor united with opium, for that species of mania, excited by frequent intoxication. Dose, for adults, two pills every three or four hours. Spirit of Turpentine.—This is one of the most active and diffu- sible of stimulants. In the typhus or low fevers, when other diffusible stimuli are given, much may be expected from turpentine. It promptly relieves gout in the stomach, and is particularly suited to periodical colics, arising from flatulence. The dose of the spirit of turpentine, in those cases, is about a drachm, to be repeated, more or less frequently, according to the nature of the disease, and the best mode of giving it is alone, or with a small portion of water. By at- tempting to blend it with mucilage, or any such vehicle, it seems in some degree to be volatilized, and is thereby rendered more pungent to the fauces, and difficult to swallow. Aromatics.—Ginger, cinnamon, cloves, nutmegs, allspice, and all the aromatics are more or less stimulant. Wines.—As a cordial and tonic, wine is often directed in various chronic cases, attended with debility, and also in the convalescence from acute diseases. Compared with ardent spirits, the action of wine is infinitely less injurious in a state of health, and as a remedy in disease, it evinces the same superiority. The effect it produces is slower, and more permanent, combining also qualities which, while they blunt the ardency of the stimulus, afford no inconsiderable por- tion of nutriment; by which the system is sustained and invigorated. In exhibiting wine we are cautiously to regulate its administration by the effects it manifests, since, urged too far, it might induce indi- rect debility, and thus cause irreparable mischief. Wine may always be considered as doing good, when it renders the pulse fuller, slower, and stronger, when it removes or lessens delirium, calms irritation, and composes to sleep. But if, on the contraiy, it accelerate the pulse, flush the countenance, increase the temperature of the skin, excite thirst, aggravate delirium, or restlessness, and thus occasion an exacerbation of the disease, the evidence of its injurious tendency is no less decisive,*and we should at once withdraw it altogether, or reduce the quantity. 82 650 DISPENSATORY. ASTRINGENTS. Astringent Medicines are employed for checking hemorrhages, and immoderate evacuations of every kind. Infusion of Roses.—Upon a large handful of dried red rose-leaves, pour a pint of boiling water; let them infuse half an hour. Infusion of Oak Bark.—Upon a handful of white oak bark, shred fine, pour a quart of boiling water; let it stand one hour, then boil a few minutes. Infusion of Galls.—Upon a quarter of an ounce of galls, pour a quart of boiling water; let them infuse one hour, then boil for a few minutes. A small quantity of cinnamon adds greatly to the flavour of this and the oak bark; and acidulating any of them with the acid of vitriol, lenders it more efficacious: they should be taken cold, to the quantity of half a gill, or a wine-glassful, every hour or two. Astringent Decoction.—Take of cinnamon, three drachms ; Pe- ruvian bark, one ounce; spring water, three pints. Boil these together till only one half remains; then strain off the liquor after it has cooled, and add elixir vitriol, one drachm. Dose, for adults, two ounces thrice a-day. Astringent Mixture.—Take of the infusion of galls, four ounces; • prepared chalk, two drachms; laudanum,forty drops.—Mix. Dose, for adults, a table-spoonful every three or four hours. Or, take of tincture of kino and prepared chalk, each, half an ounce; laudanum, forty drops; boiling water, four ounces.—Mix. Dose, for adults, a table-spoonful every two or three hours. Vitriolic Solution.—Take of white vitriol, three drachms; alum, two drachms; spirit of lavender, half an ounce; boiling water, one pint.—Mix. Dose, for adults, a large table-spoonful every morning, on an empty stomach, without diluting it, and in some cases to be repeated every six hours. When evacuations are required, the quantity of alum may be diminished, or even entirely omitted; and when great astringency is required, the quantity of alum is to be increased, and the vitriol to be diminished. Pills of Sugar of Lead, 6>"c.—Take of sugar of lead and ipecacu- anha, each, six grains; opium, one grain; syrup sufficient to form a mass. Divide in four parts; one pill to be taken every three hours, until the hemorrhage cease. DISPENSATORY. 651 Anti-dysenteric Mixture.—Take of lemon juice or best vinegar, two ounces; common salt, as much as the acid will dissolve; strong mint tea, half a pint; white sugar, sufficient to sweeten it.—Mix. Dose, for adults, a wine-glassful every two or four hours. TONICS. Tonic Medicines are those which increase the tone or strength of the body. In the widest acceptation of the term, this class of remedies is extremely extensive, since it includes every means which invigorates the powers of life. Among the means to over- come debility, or to invigorate the system, is properly regulated diet. The diet should always be accommodated to the state of the system; and whatever may be the nature of the case, the patient should eat much more frequently than the common meals. The stomach has been pronounced, by a very sagacious observer, to be in one respect like a school-boy, who is always doing mischief when not employed. After recovery from acute diseases, it should at first consist of the lightest vegetable matter, and especially the farinaceous articles, such as rice, tapioca, arrow root, and sago. To these may succeed eggs, oysters, game, and the white poultry, and finally, ham, beef, and mutton. As a general rule, solid food is preferable to fluids. It is usually more comfortable to the stomach, and restores strength with greater rapidity. In selecting the articles of diet, the palate of the person himself should be consulted, since the pleasure which is received in eating, is of itself no ordinary stimulus, and particularly to a very debilitated system. Next to diet, in point of efficacy as a tonic, are the warm and cold baths. Though different in temperature, they produce effects not very dissimilar. Each, when judiciously managed, will very rapidly, in many instances, invigorate the body.—(Seepages 32 and 33.) As a tonic, exercise is undoubtedly among the most decisively useful, and has been divided into two parts, active and passive.—It is proper, in extreme debility, or in the first stage of convalescence from an acute disease, to begin with the second species.—This con- sists chiefly of frictions, which may be made with the naked hand, or with a brush, either alone, or with the addition of some stimulating matter. To rub at least once a-day for half an hour or more, the whole body with fine dry salt, creates a universal glow, renders the skin smooth and florid, imparts vigour to the muscles, improves ap- petite and the powers of digestion, and in all its tendencies is highly salutary. When the patient is able to take exercise, let the mode be adapted as much as possible to the seats of debility or disease; but'be careful of fatigue. .Medicinal Tonics.—Of this class, nature has been lavish in her 652 DISPENSATORY. supplies. Two of her kingdoms, at least, are exuberant in articles possessed of such powers; namely: the vegetable and mineral. Peruvian Bark-^As one of the best strengthening remedies; it may be taken in powder alone, or conjoined with one-fourth of the Virginia snake root, in doses of a tea-spoonful, five or six times a-day. When the doses are to be frequently repeated, as soon as one is taken, put another, with a small quantity of wine or water, into a glass, by which means it will become equally and universally moist, and may be mixed more easily and more smoothly. As many per- sons cannot take the bark in substance, it should be exhibited in infusion, or decoction. Cold Infusion of Bark.—Mix one ounce and a half of bark in powder in a quart of water; let it stand twenty-four hours, occasion- ally shaking the bottle, and then strain off the liquor. Dose, for adults, a wine-glassful every two hours. Decoction of Bark.—Put two ounces of coarsely powdered bark into a quart bottle of water, which, after being corked, is to be placed in a pot of water, and boiled for two or more hours. This is a very elegant preparation, and one of considerable efficacy. The dose of the decoction, for adults, is a wine-glassful every two or three hours. To correct some inconveniences occasionally produced by the bark, it is frequently combined with other remedies. When it excites vomiting, or oppresses the stomach, cinnamon, or some aro- matic, must be added; when it purges, opium; when it induces constipation, rhubarb; and where there is much acidity of the stomach, magnesia, or small portions of the mineral or vegetable alkali. As children cannot be induced to take the bark in sufficient quantities, it should be administered in the form of clysters, united with a little milk or flax-seed tea, to which may be added a little laudanum. Applied externally by means of a bark jacket, (See page 166,) it will be found to have as salutary an effect as when exhibited internally. Quinine.—For this article we are indebted to the French chemists. It is an alkali, obtained from the Peruvian bark, and is used in medicine in combination with sulphuric acid, forming the sulphate of quinine. It is the most powerful tonic with which we are acquainted, and so superior is it considered to the bark, that it has almost entirely driven that article out of use. Its dose being ex- tremely small, and its taste that of a simple bitter, it will not disagree with the stomach when any tonic would be proper, and it may be given to children of any age. Like every other tonic, it should not be given during active fever, nor until the bowels are thoroughly cleansed. Dose, one grain every hour or two, according to circum- DISPENSATORY. 653 stances. It may be taken mixed in syrup, or made into pills with crumbs of bread, or in solution. The solution is prepared as follows. Solution of Sulphate of Quinine.—-Take of sulphate of quinine, eight grains; water, one ounce; mix, and then add sulphuric acid, or elixir vitriol, from twenty to thirty drops. Dose, for adults, a tea- spoonful every hour or two. Pills of Sulphate of Quinine.—Take of sulphate of quinine, twelve grains; crumbs of corn bread, or mucilage of gum Arabic, a sufficient quantity to make twelve pills. Dose, for adults, one every hour or two. It would sometimes be advantageous to add a little rhubarb to these pills, to prevent costiveness. Columbo.—Dose, for adults, in powder, a tea-spoonful; to be given in mint tea or water. Infusion of Columbo.—Take of Columbo, bruised, one ounce; boiling water, one pint. Dose, for adults, a large wine-glassful every two hours. This bitter is peculiarly serviceable in cases of weak stomachs and bowels, attended with lax, and abounding in bilious crudities. Infusion cf Gentian.—Put half an ounce of gentian, bruised, and two drachms of orange peel, in a pint of cold water for twelve hours, then strain; when used in hot weather, add half a gill of brandy. Dose, for adults, a wine-glassful three times a-day. Bitters are pro- perly considered strengthening remedies, when not continued too long; they improve the appetite, and strengthen the stomach and bowels, but a constant and long-continued use of them, or any one tonic, is generally prejudicial. The black oak bark, the dogwood bark, the wild cherry tree, and thoroughwort, (see Materia Medica?) claim our attention as tonics. Mineral Tonics.—Iron, in its operation on the system, evinces all the effects of a powerful and permanent tonic: no medicine,perhaps, leaving behind it such lasting impressions. The indications, there- fore, that it is calculated to fulfil, are numerous and important, most of which, however, are embraced within the sphere of chronic debility. Iron Filings—If made with a fine file, will require no other pre- parations ; the dose, for adults, is six or eight grains, or about as much as a common pinch of snuff, with an equal quantity of pow- dered ginger, to be mixed in syrup or molasses, and taken two or three times in a day. In this simple form, iron acts as well as in any more laborious preparation. It is a most useful tonic in all pale and relaxed habits, subject to watery swellings ; particularly for chil- 654 DISPENSATORY. dren of this description, with pale faces and distended bellies, whose complaints are frequently accompanied by worms. The doses for young and old, provided the filings be made with a fine file, may be much the same, as no more acts than what is dissolved. The rust and tincture of steel are employed with the same view. Tonic Powders.—Take of Columbo, in powder, and rust of steel, each, one ounce; unite them well together in a mortar, and then di- vide into forty-eight doses—one to be taken by adults, thrice a-day. Tonic Pills.—Add to half an ounce of the tonic powder, a suffi- cient quantity of mucilage to form a mass, and make pills of an ordinary size. Three or four of them, or the number constituting a dose, to be taken thrice a-day. In cases of debilitated stomach, an equal quantity of powdered ginger may be added to the above. Chalybeate Wine.—Put rust of steel, one ounce and a half; orange peel and gentian root, each half an ounce, into a bottle of wine. The vessel containing these ingredients is to be exposed to the sun, or near the fire, for three days, and to be repeatedly shaken during this time. This preparation is an excellent stomachic, and agreeable tonic. Dose, for adults, two or three tea-spoonsful thrice a-day. Blue Vitriol, or Sulphate of Copper.—The fourth of a grain, united to a small portion of opium, given three or four times a-day, gradually increasing the dose, is celebrated as a valuable remedy for obstinate intermittents. White vitriol, in doses from three to five grains, for adults, in the form of pills, is also considered highly useful as a tonic. Solution of Arsenic.—This is a valuable tonic, and may be given with perfect safety, cautiously administered, to persons of every age. Pills of Sulphate of Quinine.—Take of sulphate of quinine, twelve grains; mucilage of gum Arabic, a sufficient quantity to make twelve pills. Dose for adults, one every hour. Solution of Sulphate of Quinine.—Take of sulphate of quinine, eight grains; powdered gum Arabic, thirty grains; cinnamon or ginger tea, one ounce.—Mix gradually. Dose, for adults, a tea- spoonful every hour, observing to shake the mixture just before using it, This is an excellent anti-febrifuge and tonic. Nitric Acid, as well as Elixir Vitriol, given in doses from ten to twenty drops, in a glass of sweetened water, thrice a-day, will be found very pleasant and useful tonics. They speedily quicken the appetite, and restore tone to the digestive organs. DISPENSATORY. 655 ALTERATIVES. Alteratives—Are those medicines supposed to correct the acrimony which appears on eruptions of the skin, and in removing venereal complaints. These are almost exclusively mercurials, assisted by the warm bath, sarsaparilla, mezereon, slippery elm, lobelia, (See Materia Medica,) nitric acid, tar water, &c. Mercurial Pills.—Take of calomel, one drachm; opium and tartar emetic, each, ten grains; crumbs of bread, a small quantity; syrup, or mucilage of gum Arabic, sufficient to form a mass. Divide into forty parts; one pill to be taken night and morning by adults. Mercurial Solution.—Take of corrosive sublimate, twenty-four grains; laudanum, half an ounce; spirits, one pint and a half.—Mix. Dose, for adults, one table-spoonful morning and night. Calomel—In doses of one or two grains, given every night, or every other night, drinking with it the following diet drink. These, together, make a powerful alterative for blotches on the skin, foul eruptions, and all other cases, in which the object is to remove ob- structions, and sweeten the humours. An occasional warm bath greatly promotes their good effects, whilst, at the same time, it con- tributes to prevent the mercury attacking the mouth, and bringing on salivation, which, during the use of mercury, must be carefully watched and guarded against, by avoiding cold, and suspending the medicine, from time to time, for a few days. Alterative Diet Drink.—Boil one ounce of the borings of lig- numvitae, and two ounces of split sarsaparilla, in three pints of water until it comes to a quart; then strain it through linen, to be drunk in one or two days, by divided doses. The sarsaparilla, which is the least efficacious, is by far the most expensive article in this diet drink; it may, therefore, be omitted, adding in its place half an ounce more of lignumvitse, or two ounces of parsley roots. In either case, a small handful of stoned raisins, or two or three sliced figs, or half an ounce of liquorice root, will render it more agreeable. Nitric Acid, diluted.—Take of nitric acid, two drachms; water, one quart.—Mix. As this acid is not always to be got of equal strength, it would be best to make a quart of water as sour with it as can be drunk; which quantity sweetened, may be taken daily by adults, in doses of a wine-glassful every hour or two. To prevent its injuring the teeth, it should be sucked through a quill, or its sharp- ness may be obtunded by washing the mouth with milk, or muci- lage of gum Arabic. Nitric acid is diffusible in its operations, pervading every part of 656 DISPENSATORY. the system, and imparting more or less vigour to all the functions. It is, hence, an exceedingly useful remedy in a great variety of af- fections. Of these, perhaps, the most striking are certain forms of inflammation of the liver; to most glandular diseases, it is, indeed, well adapted. Where there is too much debility to justify the use of mercury, or when it has already been used ineffectually, it is un- questionably the best medicine that can be administered, and, there- fore, should be uniformly employed in such cases. TINCTURES, ELIXIRS, &c. Laudanum.—Take of purified opium, two ounces; brandy, two pints. Digest for eight or ten days, frequently shaking the bottle, then strain off the tincture. Tincture of Rhubarb.—Take of Rhubarb, three ounces; lesser cardamom seeds, or ginger, bruised, half an ounce; brandy or rum, two pints. Digest for eight or ten days, and then strain. Tincture of Bark.—Take of Peruvian bark, powdered, two ounces; orange peel and Virginia snake-root, each half an ounce; brandy or rum, two pints. Digest for eight or ten days, and then strain. Tincture of Columbo.—Take of Columbo root, bruised, three ounces; brandy, two pints. Digest for several days, and strain. Tincture of Foxglove.—Take of dried leaves of foxglove, one ounce; brandy half a pint. Digest for a week, and filter through paper. Tincture of Cantharides.—Take of cantharides, bruised, two drachms, brandy, one pint. Digest for seven or eight days, and strain. Tincture of Myrrh.—Take of myrrh in powder, one ounce and a half; spirits, one pint. Digest for seven days, and strain. Paregoric Elixir.—Take of purified opium, flowers of Benzoin. camphor, and essential oil of annis-seed, each, two drachms; brandy. two pints. Digest for eight or ten days, frequently shaking the bot- tle, and then strain the elixir. Turlington's Balsam.—Take of Benzoin, three ounces; balsam of tolu, one ounce ; aloes, half an ounce; brandy, two pints.—Digest for seven days, and strain. Rheumatic Tincture.—Take of gum guaiacum, and vitriolated DISPENSATORY. 657 tartar, in powder, each, three ounces; spirits, two pints. Digest for eight or ten days, and strain. A dose to be taken twice or thrice a-day. Bitters.—Take of gentian root, two ounces; orange peel, and co- riander seeds, each, one ounce; brandy, two pints. Digest for se- veral days, and then strain. Camphorated Spirits.—Take of camphor, two ounces; brandy one pint. Mix them together, that the camphor may be dissolved.' Antimonial Wine.—Take of tartar emetic, one drachm ; boiling water, two ounces; wine, one pint. Dissolve the tartar emetic in the water, and when cold, add the wine. Dose, for adults, two tea- spoonsful every fifteen minutes, until it excites vomiting. To has- ten its operation, the patient should drink freely of warm water. As a diaphoretic, it may be given in doses, from twenty to thirty drops every two or three hours. ' Domestic Remedies for Rheumatism.—Take of sarsaparilla and walnut shells, each, half a pound; antimony, half an ounce sus- pended in a bag; water, three quarts. Simmer slowly by the fire down to two quarts. Strain and use a pint in broken doses daily. Or, take a large handful of rattle-snake root, bruised; spirit, one quart; let it steep by the fire for several days, frequently shaking the bottle. Of this a wine-glassful is to be taken night and morning. Saturated Solution of Arsenic.—Take of arsenic, in powder about one drachm ; water, half a pint. Boil it for half an hour in a Florence flask, or in a tin saucepan, let it stand to subside, and when cold, filter it through paper. To two ounces of this solution, add half an ounce of spirit of lavender. A dose to be taken twice or thrice a-day. Lime-Water.—Pour two gallons of water, gradually, upon a pound of fresh burnt quick-lime, and when the ebullition ceases, stir them well together; then suffer the whole to stand at rest till the lime has settled ; after which strain off the clear liquor, and keep it in vessels closely stopt. Calcined oyster-shells may be used instead of quick-lime. Tar- Water.—Pour a gallon of water on two pounds of tar, and stir them strongly together with a wooden rod. When they have stood to settle two days, pour off the water for use. Caustic Alkali, or Soap Lees.—Mix two parts of quick-lime, with one of pot ashes; and suffer them to stand till the lixivium be formed, which must be carefully filtrated through paper before it be 83 658 DISPENSATORY. used. If the solution does not happen readily, a small quantity of water may be added to the mixture. Itch Lotion.—Take of corrosive sublimate, one drachm; crude sal ammoniac, two drachms; water, one pint and a half.—Mix. Solution of Crude Sal Ammoniac.—Dissolve half an ounce of crude sal ammoniac in one pint and a half of cold water, and then add half a pint of vinegar. Saturnine, or Lead - Water.—Take of sugar of lead,two drachms; vinegar, one ounce; water, one pint and half.—Mix. WARM AND DISCUTIENT LINIMENTS. Opodeldoc.—Take of Castile soap, powdered, three ounces, cam- phor, one ounce; brandy, one pint. Digest the soap, in the spirit by the fire until it be dissolved, and then add the camphor. Volatile Liniment.—Is made by mixing one part of spirit of harts- horn with two of sweet oil, good hog's lard, or fresh butter from the churn: they should unite into a uniform, white, soapy mixture; and if they do not, it is owing to the spirit of hartshorn not being suffi- ciently caustic. When lard or butter is made use of, they should be first melted; they may then, like the oil, be mixed with the spirit of hartshorn, by shaking them together in a phial. Camphorated Oil.—Take of camphor, half an ounce; olive oil, two ounces. Moisten the camphor with a little spirit, and then rub it in a mortar with the oil until dissolved. Anodyne Liniment—Is prepared by adding half an ounce of lau- danum to two ounces of either of the above liniments. Mindererus' Spirit—Applied warm, by means of a soft flannel, very powerfully tends to discuss an incipient tumour, or other in- flammatory swellings. Ether—Pour about a tea-spoonful into the hollow of the hand, and'immediately apply it over the part affected, keeping the hand on the part until the ether be evaporated, or as long as the patient can bear the heat it excites. No remedy so suddenly and effectually re- moves cramps and all spasmodic pains. Warm Plaster.—Take of the gum plaster and Burgundy pitch, each an ounce; of blistering plaster, one quarter of an ounce; melt and mix them together. This is a most useful application whenever DISPENSATORY. 659 it is required to keep up a constant perspiration, and gentle irritation of the skin, over any particular part affected with rheumatism, or any internal pain, unattended with external inflammation. Charcoal Powder.—Put lumps of charcoal a second time into the fire until they are red hot; then take them out, and as soon as they become cool, blow off the external ashes, and immediately reduce them to a fine powder, which must be kept in a corked bottle. This powder is admirable for correcting bad breath, as well as arrest- ing the progress of mortification. EYE WATER Take of vinegar, one ounce; spirits or brandy, half an ounce; rose or spring water, half a pint. The strength may be diminished or increased, according to circumstances. This is a useful application to weak, watery eyes, or to remove the pain and sense of pricking, experienced in the globes of the eyes, after they have been fatigued by close attention to some one object. Another.—Take of sugar of lead and white vitriol, each, twenty grains; spring water, half a pint.—Mix. After the sediment is formed, pour off the clear liquor, with which wash the eyes repeat- edly during the day, and at bed-time apply a thick fold of linen or cotton rag moistened with it, over the eyes. Another.—Take of corrosive sublimate, from two to four grains ; water, half a pint.—Mix. This solution may be used in general with great advantage in syphilitic or scrofulous cases, where the eye- lids have been long affected with chronic inflammation. ASTRINGENT WASHES. Take of lime-water, half a pint; brandy, four ounces.—Mix. Or, lime-water, half a pint; corrosive sublimate, fifteen grains.— Mix. Or, lime-water half a pint: tincture of myrrh, one ounce.—Mix. Or, make a solution, either of lunar caustic, or blue vitriol in water, of sufficient strength to produce a little smarting. To be ap- plied on lint to the sore. Solution of Kali.—Dissolve from one to two drachms of salt of tartar in half a pint of water. To be applied as above. 660 DISPENSATORY. GARGLES. Common Gargle.—Take of barley water, or flax-seed tea, half a pint; crude sal ammoniac, one drachm.—Mix. Or, sage tea, half a pint; vinegar, half an ounce; nitre, one drachm; honey, one ounce.—Mix. Or, take of decoction of barley, one pint; nitre, six drachms, honey, three ounces.—Mix. These are mild, cooling applications, and very serviceable at the commencement of inflammatory affec- tions of the tonsils and fauces. Gargle of Borax.—Take of borax, two drachms; flax-seed tea, or mucilage of quince-seed, six ounces; honey, one ounce. The borax gargle is very much in use as a mild detergent in apthous af- fections in children, and for removing superficial inflammatory ul- cerations of the gums; especially if attended with a copious secre- tion of saliva. Linseed Gargle.—Take of flax-seed tea, twelve ounces; honey, two ounces ; elixir vitriol, half a drachm. Where mild astringents are indicated, this gargle will be found to answer very well. Astringent Gargles.—Take of sage tea, or infusion of roses, half a pint; vinegar and honey, each, two ounces; alum, half a drachm. —Mix. Or, infusion of oak bark, half a pint; honey, one ounce ; alum, half a drachm.—Mix. Detergent Gargle.—Take of astringent gargle, half a pint; tinc- ture of myrrh, from half an ounce to an ounce.—Mix. Or, take of corrosive sublimate, three grains ; dissolved in spirit of wine, half an ounce; and then add decoction of bark, six ounces; tincture of myrrh, half an ounce ; honey, one ounce.—Mix. In ve- nereal cases, of long standing, the tonsils and uvula, or part of the fauces, are found in a state of ulceration; in which cases, besides the internal administration of mercury, the parts should be frequendy washed with the above gargle. INJECTIONS FOR GONORRHCEA. Take of white vitriol and sugar of lead, each, one scruple ; muci- lage of gum Arabic, or common water, half a pint.—Mix, and after standing ten or fifteen minutes, strain off the clear liquor. An ordi- nary syringe full, to be thrown up the urethra six or eight times a- day, after making water. DISPENSATORY. 661 Or, dissolve fifteen or twenty grains of white vitriol in half a pint of mucilage of gum Arabic or water. To be used as the preceding. Or, dissolve one grain and a half of corrosive sublimate in half a pint of water. To be used as above. Or, take of mercurial ointment, one drachm; sweet oil,one ounce —Mix. This injection should be warmed previously to using. These injections may be made weaker or stronger, according to circumstances. The first and second injection are decidedly the best in recent cases. When the scalding of the urine is troublesome, four drops of mu- riatic acid to two ounces of water, or one part of acetated ammonia, to eight or ten of water, are often useful as injections. In obstinate cases of gonorrhoea the mercurial injections, as above, will be found most beneficial: and in obstinate gleets, the following have been employed with very happy effects. Injection of Tea.—Take of green tea, one drachm ; boiling water, six ounces; macerate in a close vessel till cold, and strain. Or, take of kino in powder, two drachms; alum, one drachm; mucilage of gum Arabic, one ounce; spring water, one pound.—Mix and strain. Injection of Copaivi.—Take of balsam copaivi, one drachm; mu- cilage of gum Arabic, half an ounce; rose or spring water, six ounces. Rub the copaivi and mucilage well together, and add the water. This, as well as the preceding injection, is, perhaps, better fitted for females, when a discharge is kept up from a relaxed state of the folds of the vagina, whether arising from gonorrhoea, from too fre- quent coition, or from the fluor albus, or whites. At the commencement of gonorrhoea, the irritation is often so great as to occasion the greatest possible distress; the urethra then being so exquisitely sensible that the slightest distension of its orifice or canal, even by fluids of the blandest nature, gives the most ex- quisite pain. The urine, in such cases, is scanty and high-coloured ; and whenever it is passed, aggravates all the symptoms, leaving an increased desire to pass more urine, attended with a burning smart- ing pain. The intention of cure, then, would be to lessen the in- flammation of the parts, by removing the distention, and of diminish- ing the stimulating properties of the urine. With this view, besides evacuating medicines and diaphoretics, particularly the camphorated powders and leeches, should be applied to the under part of the ure- thra along its whole course, and cold saturnine applications to the penis. 662 DISPENSATORY. ♦ CLYSTERS. Simple and Emollient Clysters.—Milk and water in equal parts. Flax-seed tea. Mallow tea. Infusion of quince-seed. Barley water. Mucilage of gum Arabic, or slippery elm. Thin starch. From half a pint to a pint of either of these should be administered a little more than milk warm. They are useful and efficacious where mere relaxing and emollient effects are required ; the addition of the mucilaginous substance will occasion them to be longer re- tained than simple water would be, and are particularly proper when any irritation or remarkable tenderness of the intestines exists: with the same intention, a table-spoonful of good sweet oil, fresh hog's lard, or fresh butter from the churn, may be added ; but, unless per- fectly fresh, should be omitted, as the least rancidity will irritate and injure. Common Clyster.—Take of barley water, or flax-seed tea, from one to two pints; sweet oil, two or three ounces; Glauber or Epsom salts, one or two ounces.—Mix. Or, take of warm water, one pint or more ; molasses, one gill, or brown sugar two table-spoons full; hog's lard, one spoonful, or sweet oil, two ounces.—Mix. This quantity is intended for adults. Stimulating Clyster.—Common salt and brown sugar, each two large table-spoons full; hog's lard, two table-spoons full; or olive or castor oil, four ounces; water, one pint.—Mix. Or, take of senna, one ounce; spring water, two pints. Boil them till a pint only remains; and, to the strained liquor, add common salt and hog's lard, each two table-spoons full.—Mix. Turpentine Clyster.—Take of turpentine, half an ounce; the yolk of an egg, flax-seed tea, or solution of gum Arabic, ten ounces. Rub the turpentine with the egg till they are perfectly incorporated, and add the linseed infusion. The turpentine injection has fre- quently been of service in suppression of urine, arising from a stone in the bladder. Anodyne Clyster.—A gill of new milk, or thin starch, or the same quantity of any of the mucilaginous substances enumerated under the head of Simple and Emollient Clysters, with the addition of one or two tea-spoonsful of laudanum, for adults. In general, a patient will bear three times the quantity of laudanum administered in this way, than would be a proper dose when taken into the sto- mach: so that, to procure rest, twenty-five drops would be given in a draught, seventy-five may be administered in a clyster,°and the sickness, and other ill consequences, which some persons complain of after laudanum has been taken into the stomach, seldom follow when administered by clysters. DISPENSATORY. 663 Nourishing Clysters.—May be formed by adding to a gill or half pint of beef tea, arrow-root, or gruel, twenty or thirty drops of lau- danum. The addition of laudanum is made to prevent the clyster from being rejected OINTMENTS. Simple Ointment.—Take of olive oil, five parts; white wax, two parts. Mix them together, by a slow fire, and stir until it be cold. Saturnine Ointment.—Take of sugar of lead, two drachms; white wax, two ounces; olive oil, half a pint. Rub the sugar of lead, previously powdered, with some part of the olive oil; then add it to the wax melted with the remaining oil, and stir the mixture until it be cold. Basilicon Ointment.—Take of rosin and bees-wax, each, one pound; hog's lard, one pound and a half. Melt them together by a slow fire, and strain the mixture while hot. Turner's Cerate.—Take of calamine, prepared, yellow wax, each half a pound ; hog's lark, one pound. Melt the wax with the lard, and as soon as the mixture, exposed to the air, begins to thicken, mix with it the calamine, and stir the cerate until it be cold. Mercurial Ointment.—Take of quicksilver, half a pound; mut- ton suet, the more rancid the better, or old mercurial ointment, one ounce ; hog's lard, one pound. Triturate the mercury with the pre- pared suet and a small portion of the lard, till the globules perfectly disappear; after which add the remainder of the lard, and let the whole be intimately mixed. It is requisite that the trituration be constant and uniform, and continued in the first instance, till the globules be perfectly extinguished, and afterwards till the ointment be intimately mixed. If a small quantity of old mercurial ointment, or rancid lard, be employed, the extinction of the quicksilver is much more rapid and effectual. This ointment is principally employed, with the intention of introducing mercury in an active state into the circulating system, which may be affected on the sound skin of any part by gentle friction, particularly on the inside of the legs and thighs. Camphor, in the proportion of a drachm to an ounce of the ointment, is sometimes added, in order to render this application more stimulating and to promote the absorption of mercury. Hemorrhoidal Ointment.—Take of galls levigated, two parts; hog's lard, eight parts.—Mix. Tar Ointment.—Take of tar and mutton suet, each one pound. Melt them together, and strain through coarse linen. This is much extolled for removing tettery eruptions, and for curing scald-heads. 664 DISPENSATORY. Itch Ointment.—Take of hog's lard, two ounces; sulphuric acid, two drachms. This ointment should be formed in a Wedgewood's or glass morter. It is said to be an affectual cure for the itch. Blistering Plaster.—Take of wax, rosin, tallow, and cantharides, each equal parts. Having melted the three first ingredients together, sprinkle and mix in the flies powdered a little before they become firm. When the blistering plaster is not at hand, its place may be supplied by sprinkling the flies over any ointment or paste, spread thin, on leather or cloth. CATAPLASMS AND POULTICES. Cataplasm of Alum, commonly called Alum Curd—Is made by briskly agitating the whites of two eggs with a lump of alum till a coagulum is formed. It is useful in some cases of ophthalmia, when attended with a watery excretion, if applied to the eye between two pieces of thin linen rag. The alum curd has been found an effica- cious remedy applied to chilblains, previous to the skin cracking and becoming sore. Cataplasm of Mustard.—Take of good mustard and flour, or crumbs of bread, each, equal parts; sharp vinegar, sufficient to form a poultice. It may be rendered more stimulating, if necessary, by the addition of a little garlic or horse-radish. Cataplasm of Common Salt.—Take of linseed, or Indian meal, and crumbs of bread, each, equal parts; saturated solution of com- mon salt, sufficient to make a poultice. This form of poultice has lately been brought into considerable repute for the reduction of in- dolent strumous swellings and enlargement of the glands. After being some time used, it generally occasions very considerable redness upon the surface, and excites, not unfrequently, so much inflamma- tion upon the part to which it is applied, that it becomes necessary to abstain from its use, and substitute the common white bread and milk poultice in its stead; as soon, however, as the inflammation subsides, the saline poultice should again be employed; and by alter- nating this mode of practice, strumous swellings, and scrofulous en- largements, of a chronic, obstinate nature, have verj' frequently been totally dispersed. Saturnine Poultice.—Crumbs or slices of bread are to be soaked in lead water, which are afterwards to be simmered in an earthen vessel, over a gentle fire, to a due consistence. To superficial in- flammations, this form of cataplasm, or making a dough of corn meal and lead water frequently repeated, are very beneficial. DISPENSATORY. 665 Milk and Bread Poultice.—This poultice, which is generally in use, is commonly made by soaking crumbs or slices of bread in milk, and simmering them together over a gentle fire till they are reduced to the proper consistence of a poultice. The whole is then to be beat smooth with a spoon, and applied as warm as the patient's feel- ings will readily admit, which should be repeated every four hours. Flax-seed Poultice.—Take of flax-seed bruised, half a pound ; boiling water, half a pint, to be formed into a poultice. Or, This poultice may be made by stirring linseed powder into boiling water, in quantity sufficient to form it of a proper consistency. Carrot Poultice.—Boil any quantity of fresh carrots till they are sufficiently soft to be beat into a smooth, even pulp, which is to be applied as a poultice. This has been found very effectual for sweetening cancerous sores and foul ulcers, thereby rendering the condition of the patient much more comfortable. Turnips used in the same way have been found to produce the same effects, and ap- parently in a greater degree than carrots. Charcoal Poultice.—To a sufficient quantity of the bread and milk, or linseed poultice, stir in as much charcoal in fine powder as it will bear, and let the whole be well mixed. This cataplasm is often used to sweeten foul offensive ulcers and venereal sores, and for this purpose it is of great service; it will, likewise, often dispose them to assume a more favourable and healthy aspect. 84 glossary; OR, EXPLANATION OF TECHNICAL TERMS. ABDOMEN, the belly. Abortion, miscarriage. Abscess, a tumour containing matter. Absorbents, medicines to correct acidity and absorb or dry up superfluous mois- ture. Abstemious, low living. Accelerate, to quicken. Acescent, having a tendency to acidity. Acidulated, impregnated with acids. Acme, full height. Acrid, sharp and corrosive. Acute, this term is applied to a disease which is violent and tends to a speedy termination. Mult, of full age, beyond puberty. Affinity, likeness, resemblance. Affusion, pouring one thing on another. After-birth, or placenta-cake, is the sub- stance by which the child is connected with the mother in the womb. After pains, see grinding pains. Ague-cuke, enlargement of the spleen. Alcohol, rectified spirits of wine. Aliment, nourishment. Alimentary canal, or lube, the stomach and intestines. Alkali, any substance which mingled with acid, produces fermentation. Alternate, branches or leaves, or flowers, springing out regularly one above an- other. Alternate, changed by turns. Analogous, one like another. Annual, living only one year. Anodyne, composing medicines, and such as mitigate pains. Antidote, a medicine to destroy poisons. Antifogmatics, drams. Antipathy, an aversion to particular things. Antiphlogistic, counteracting inflammation. Antiscorbutic, good against the scurvy. Antiseptics, medicines to correct putridity or rottenness. Antispasmodic, whatever tends to prevent or to remove spasm. Antispasmodics, medicines for curing spasms, as laudanum and ether. Anus, the fundament. Aperient, opening. Apthous, resembling the thrush. Areola, the circle which surrounds the nipple on the breast. Aromatic, spicy, pungent. Artery, a conic canal, conveying the blood from the heart to all parts of the body. Astringents, medicines to correct looseness and debility. Atmosphere, surrounding air. Aitenuants, medicines tor reducing the body. Ataxic, irregularity of the symptoms, or of the animal functions. BIENNIAL, continuing alive for two years. Bile, or gall, a fluid secreted by the liver into the gall-bladder, and thence dis- charged into the intestines for the pur- pose of promoting digestion. Bougie, a taper body, introduced into a passage or sinus, to keep it open or to enlarge it. Bolus, a form of medicine in a mass, larger than pills. Bulbous root, as garlic and onion; it is either, Solid as in the tulip and turnip, Scaly as in the lily, Coated as in the onion. 668 GLOSSARY. CALCULOUS, stony or gravelly. Callous, hard or firm. Cantharides, the Spanish flies, used in blisters. Capillary, fine, hair like. Capsule, a dry hollow vessel containing the seed or fruit. Carious, rotten, applied principally to the bones and teeth. Carminatives, medicines for dispelling wind. Cataplasm, a poultice or soft plaster. Catarrh, a discharge from the head or throat. Cathartic, a purge. Catheter, a pipe to draw off urine. Catkin, a composition of flowers and chuff on a long slender thread shaped recepta- cle, the figure of the whole resembling a cat's tail. Caustics, burning applications. Cautery, the act of burning with a hot iron or caustic. Cutaneous, of or belonging to the skin. Characteristic, a mark, sign, or token. Charcoal, a coal made by burning wood under turf. Chronic, lingering disease, in opposition to acute. Chyle, a milky fluid separated from the aliment in the intestines, mixing with and forming the blood. Circulation, the motion of the blood, which is propelled by the heart through the arteries, and returned by the veins. Clammy sweats, cold glutinous. Cleansing, see lochial discharge. Coagulum, a curd. Comatose, inclined to sleep. Compress, several folds of linen rags, a bandage. Concave, hollowed out like a bowl, as the petals of the cherry or the hawthorn; and the broad-leafed plantain. Cone, or strobile, a species of seed vessel formed by a catkin with hardened scale; containing a seed within the base of each scale ; as in the pine or fir. Confluent, running together. Constipation, obstruction, costiveness. Contagion, infectious matter. Contusion, a bruise. Convalescence, recovery from sickness. Convex, opposed to concave: rising like the surface of a globe. Convulsions, violent motions, fits. Corolla, blossoms, petals, or flower-leaves, is that beautiful part of a flower which first draws the attention, as the flower itself. Corroborants, tonics, or strengthening me- dicines. Corrosive, substances that consume or eat away. Cortex, bark, or covering. Cosmetic, beautifying. Crisis, a certain period in a disease at which there happens a decisive altera- tion, either for the better or worse. Critical, decisive or important. Crudity, rawness, indigestion. DEBILITY, weakness. Decoction, a preparation by boiling. Decumbent, lying down or declining. Deglutition, the act of swallowing. Deleterious, poisonous, deadly. Delirium, light-headedness. Demoniacal, baneful, hurtful. Demulcent, softening, sheathing. Dentition, teething. Detergent, cleansing. Diaphoretic, promoting perspiration. Diarrhcea, a looseness. Diathesis, disposition or habit of body. Dietetic, relating to diet, or regimen. Diluents, substances to dilute or make thin. Discutient, a medicine that has the power to repel. Dislocation, a joint put out of place. Disposition, tendency. Diuretic, whatever promotes the secretion of urine. Drastics, active or strong purges. Dyspeptic, belonging to bad digestion. ECCHYMOS1S, a tumour, the effect of blood-letting. Efflorescence, eruption, or the redness round it. Effluvia, exhalation. Egg-shaped, signifies a shape resembling the solid substance of an egg; or, in re- spect to leaves, it implies only the form of an egg, divided lengthwise. Emaciation, wasting of flesh. Empiric, a quack. Enamel, the outside covering of the teeth. Endemic, a disease peculiar to a certain district. Enervate, to weaken. Epidemic, contagious. Equilibrium, equal in weight. Eructation, a belch. Eruption, breaking out in pustules. Exacerbation, the increase of a disease. Excoriation, the loss of the skin. Excretion, discharge of animal fluids, or matter. Exhibit, to administer. Expectoration, a discharge from the breast. Extremities, arms and legs. FAECES, excrements. Farinaceous, mealy. Febrifuge, removing fever. Febrile, feverish. Fetid, of an offensive smell. Fibrous, composed of small threads or fibres. GLOSSARY. 669 First passages, stomach and bowels. Flatulent, producing wind. Flooding, an overflow of the menses. Foztus, the child in the womb. Fomentation, partial bathing, by the appli- cation of flannels dipped in liquids. Fracture, a broken bone. Friction, the act of rubbing. Fungus, proud flesh. Fumigation, a vapour raised by burning. GANGRENE, a feeble circulation, fol- lowed by mortification. Gargle, a wash for the mouth and throat. Germen, or seed-bud, the lower part of a pistil, is destined to contain the embryo seed. Genus, the second subdivision of plants; it comprehends an assemblage of species under the same class and order. Gland, a secretory organ. Glutinous, gluey, sticky. Grinding, or after-pains : pains that occur after labour. Grog-blossoms, pimples on the face pro- duced by diinking. HEART-SHAPED, a term used to ex- press the form of a petal or leaf which resembles a heart divided lengthwise. Hectic fever, a slow consuming fever gene- rally attending the absorption of puru- lent, or other acrid matter into the blood. Hemorrhage, a discharge of blood. Hemorrhoidal, relating to the piles. Hepatic, relating to the liver. Hypochondriacal, melancholy, very deject- ed, low in spirits. ICHOR, a thin watery humour. Imbecility, debility, weakness. Immersion, plunging under water. Imposthume, a collection of purulent matter. Inanition, emptiness. Incarnating, healing. Incrussate, to thicken. Indented, the edges of an indented leaf are hollowed, or deeply scolloped, the lobes standing asunder, as if part of the leaf had been cut out. The leaves of the oak and turnip are familiar examples. Indigenous, native to a country. Indigestible, difficult of digestion. Induration, hardening. Indisposition, a disorder of health. Inebriety, drunkenness. Infection, contagion. Inflammation, an increased action in a part Inflated, distended, as if inflated like a blown up bladder. Infusion, steeping any thing in liquor with out boiling, as tea is made. Inliale, to draw in by breath. Inspissate, to thicken. Intestinal, belonging to the intestines, or guts. Intestines, the internal parts of the body, Irrespirable, unfit to be breathed. Irritability, a disposition to contract from a stimulus. Juleps, mixtures, of simple and compound mixtures. LACTEALS, vessels containing chyle Languor, want of strength or spirits. Lateral, growing from the sides of the stems or stalks. Laxatives, relieving costiveness. Levigated, reduced to a fine powder. Ligature, a bandage; any thing tied round another. Ligneous, woody. Liniment, a composition of the consistence of oil. Lobed, divided, or lip-shaped. Lotion, a wash. Lochial discharge, or cleansings, a discharge from the womb. MAGNUM DEI DONUM, the great gift of God. Mastication, act of chewing. Maturity, of full years. Meconium, the infant's first or black stools. Membrane, a web of fibres, interwoven, for covering certain parts. Menses, ) .. .,, MenUruation,lthemouthlycoarses Mephitic, suffocating, noxious. Meum et tuum, mine and thine. jJUSJ*"' \ morbid exhalation,or vapours. Miliary eruption, an eruption of pustules resembling the seeds of millet. Modus operandi, mode of operation. Morbid, diseased, corrupt. Mucilage, a glutinous, slimy substance. Mucus, resembling the matter discharged from the nose, lungs, &.c. NARCOTICS, medicines producing tor- por and sleep. Nausea, an inclination to vomit. Nervous, irritable. Nostrum, a patent or other medicine, the composition of which is kept secret by the proprietor. OBLONG, considerably longer than broad, and narrowed, though rounded at the ends ; as the leaves of the daisy. Obtund, to blunt. OZdematous, swelled, as in a dropsical state of the skin. Opiates, medicines which promote sleep, as opium. Ophthalmia, a disease of the eyes. Ovate, or oval, egg-shaped. 5SARY. C70 GLOS PANCREAS, the sweet bread. Paralytic, relating to palsy. Paroxysms, a periodical fit or attack. Pectoral, medicines adapted to cure dis- eases of the breast. Pedical, a short foot stalk, or partial foot- stalk, being that part of a compound or branched fruit-stalk, which is the imme- diate support of a single flower, or floret. Pelvis, the bones at the lower part of the trunk of the body. Perennial, continuing for several years; at least more than two, and regerminating several years successively. Pestilential, infectious. Petals, the leaves which constitute the blossoms or flowers are so called to dis- tinguish them from the other leaves of the plant. Phlegmatic, relaxed and abounding with phlegm. Phlogistic, inflammatory. Phthisical, consumptive. Pilch, napkin, clout. Placenta-cake. See after-birth. Plethoric, of a full habit. Plenitude, fulness of blood. Precarious, doubtful, uncertain. Predisposition, susceptibility of disease. Premature, too hasty, too early. Preternatural, unusual, not natural. Primary, original. Prolapsus, the falling down or out. Proximate cause, the immediate cause of disease. Ptyalism, a copious flow of spittle. Puerperal, of, or belonging to, child-bed. Pulmonary, belonging to the lungs. Purulent, matter of good quality. Pus, matter. Pustule, a purple or small swelling. Putrescence, rottenness. QUARTAN, returning every fourth day. Quickening, the motion of the child felt by the mother in the womb. RECTUM, the strait gut in which the faeces are contained. Red gum, an eruption so called. Refrigeration, a chill, coldness. Regimen, regulation of food, air, exercise, &c. Remote cause, the inducing cause of disease. Repletion, the act of filling the body with food. Resolution, a termination without suppu- ration. Resolvents, dissolving medicines. Respiration, the act of breathing. Resuscitation, reviving, bringing to life. Retention, the retaining of some natural discharge. Rheumy, an acrid discharge. SALINE, consisting of salt. Saliva, spittle. Sanative, healing. Sanguiferous, carrying blood. Saponaceous, soapy. Saturnine lotion, lead water. Scorbutic, of, or belonging to, scurvy Scrofulous, of, or belonging to, the king's evil. Secondary, not primary; a secondary fever is that which occurs after crisis. Secretion, the separation of fluids from the body. Secundines, the placenta, and membranes. Sedatives, composing medicines. Segments, the small part of a leaf, cup, or petal, included between the incision. Semen, the seed. Serous, thin, watery. Serrated, notched like a saw. Sinapism, a poultice made of flour, mus- tard, and vinegar. Slough, the parts that separate from a sore. Solitary, only one in a place; as but one flower on a fruit stalk, or only one fruit- stalk proceeding from the same part of a plant. Soluble, loose, laxative. Spasm, cramp, convulsion. Specific, an infallible remedy. Spear-shaped, applied to a leaf, signifies that it is shaped like a spear or lance. Spherical, globular. Spike, a head or ear, as in rye, barley, wheat, 8tc. Spine, the back-bone. Stamina, the constitution or habit of the body. Stimulants, imtative medicines. Stomachics, medicines for the stomach. Strangury, a difficulty of making water. Striated, channelled, furrowed. Stupor, a suspension of sensibility. Styptic, a medicine stopping the discharge of blood. Sudorifics, medicines to promote sweating. Suppository, a candle, or any other sub- stance or composition, introduced into the rectum to produce a stool. Swooning, fainting. Symptomatic, a disease not primary, but arising from another in contradistinction to idiophatic. Syncope, a fainting or swooning. Synocha, inflammatory fever. TECHNICAL, belonging to arts. Temperament, a peculiar habit of body. Temperature, state of the air. Tertian, returning every third day. Tetany, the lock-jaw. Tonic, bracing, strengthening. Topical, local, confined to the diseased part. Tumour, a swelling. GLOSSARY. 671 Turgescence, an over fulness. Type, a mark. Typhus, a genus of fever comprehending those called nervous, yellow, and putrid! ULCER, a sore, generally ill-conditioned. Umbel, a composition of flowers, in which a number of slender fruit-stalks proceeds from the same centre, and rise nearly to the same height, so as to form a regular surface at the top. Hemlock, carrot. and low parsnip, are examples. These are said to be umbelliferous plants. Umbilical cord, the navel string. Urethra, the canal which conveys the urine. Uterine, belonging to the womb. Uterus, the womb. Uvula, the palate. VACCINE, vaccinous, belonging to, or matter of the cow-pox. Vagina, the passage to the womb. Valetudinarian, a weak, sickly person. Variolus, small-pox matter. Vascular, belonging to the vessels. Vehicle, a liquor to make medicines in. Venous, belonging to the veins. Ventilation, a free admission or motion of air. Venomous, > Virulent, Jpowonous. Vermifuge, worm-dispelling medicines. Vertigo, giddiness. Vesicating, blistering. Villous, shaggy, rough, hairy. Virous, poisonous matter. Viscera, the entrails. Viscid, glutinous, tenacious. Vital, the seat of life. WHITES, the discharge from the womb. Whorls, this term is applied either to branches, leaves or flowers, when they grow all round their respective stems, resembling, in some measure, the spokes round the nave of a wheel. INDEX. A. Page ABDOMEN, description of 52 Abdominal Supporter of Mr. Betts, highly useful in cases of prolapsus uteri and pro- trusion of the vagina, . 457 Abortion, observations on 424, 425 --------prevention of . 426 Abscess, common . . . 350 Absorbents, class of . . 640 ----------mixture, doses of 633 ----------how prepared 640 Abstemious living, good effects of.......79,80 Acid, nitric, tonic, . . 654, 655 ----muriatic, useful in nerv- ous fever,..... 191 ----vegetable antiscorbutic 331 Acute rheumatism, . . . 254 Acidity, or heartburn, . 299, 417 Adams, John, his death and character noticed . . 284 Admonitory hints to ladies, 395 Advice to masters, ... 33 ------to parents, . . . 476 Adulterated wines, to de- tect ......600,601 After pains...... 443 After birth, caution respecting 433 ______.---mode of extracting, 439 Agaric, stops bleeding, . 518 Agrimony, useful in jaundice, 518 Ague and fever, .... 164 Air, its influence on the blood, 65 ----on the body, ... 66 85 Page Air, necessity for its renew- al, .......68, 72 ----confined, bad effects of 69 ----warm, relaxes the body, 74 ----damp, checks perspiration, 74 ----the most wholesome, 74 ----impure, how restored, .......75, 198, 199 Air and temperature, how to be regulated in sickness, 610 Alder, black, antiseptic, . 519 Aloetic pills, how prepared 637 Alteratives, class of . . 655 Alterative diet drink . . 655 Alum, doses of ... . 62S -----curd, how prepared 664 -----whey, how prepared, 625 -----root, useful in cancers, 519 Alvine discharge, nature of 211 Americans, patriotism of . 149 Anatomical description of the human body, concise and * interesting, .... 36 Anasarcous swellings, . . 317 Ankle, dislocation of . . 364 Angelica, good aromatic, 519 Anger, its ill effects on mind and body 116; melancholy, instances of 118; advantages of repressing 118; wonder- ful effects of music in sub- duing .....118, 119 Animation suspended, how re- stored, ..... 340, 467 Animal heat depends on the circulation of the blood, 51 674 INDEX. Page Animal heat, depression of, how to be restored, 177, 194 Anodynes, class of, . . 645 Anodyne liniment, to prepare, 658 -------sudorific drops, doses of,....... 633 -------how prepared, 640 Anti-bilious pills, how prepar- ed, ....... 636 Anti-dysenteric mixture, 633, 650 Antimonial wine, doses of 628 ------how prepared, . 657 ------powders and solution, 639 Antiphon promised to do upon souls what Hippocrates did on bodies..... Ill Antipathy to certain remedies, consequences of . . . 29, 615 Anus, imperforated . . 483 -----falling down of . . 349 Aperient medicines, import- ance of in fevers, . 176, 635 Aperient and diaphoretic pills, 635 Apoplexy, or apopletic fits 284 Appetites, three kinds of 77, 617 Apparent death, to resuscitate 339 Apparel, observations on 143 Apple, Peru, a valuable plant 520 Apple water,..... 626 Apthae, or thrush . . . 489 Arbutus, useful in gravel . 520 Ardent spirits, utility of . 82 -------------abuse of de- structive to body and soul .......128, 129 Aristides, his goodness . 125 ILrms, description of . . 37 -----dislocation of . . 363 -----fracture of . . . 367 Armstrong, Dr., remarks on use of stimulants in fevers, 193 Arria, her invincible love 97 Arrow root, very nutritious 520 Arsenic solution, doses of 628 ------how prepared . . 657 Art of preserving health . 64 Arteries, their use explained 39 Asarabacca, useful in whoop- ing-cough ..... 520 Ascarides, worm . . . 462 Ascites, or dropsy of belly 316 Page Askew, his singular recovery 108 Asthma, treatment of . . 298 Astorgas dines on the heart of his mistress .... 103 Astringents, class of . . 650 Astringent mixture . . . 650 ----------gargles and washes 660 Atheist, conversion of. . 34 ------ punishment of . 158 Athenians, religious instruc- tions of the .... 160 Atmosphere, component parts of....... 67 Avarice, injurious to health 125 -------fatal instances of 126 -------Hippocrates' advice 126 Avens, antiseptic . . . 520 Azote, or corrupted air . 67 B. BACK-BONE, use of . 36 Backache-brake, for cough 521 Baker, Professor, praise due 518 Balm, useful in fevers . 521 Balsamic medicines in consump- tions, when useful, . . 272 Balsam, copaiva, doses . 628 -----— remedy for gonorrhoea 322 ------Turlington's, how pre- pared ...... 656 Barberry, useful in dysentery 521 Bark, Peruvian, caution in the use of...... 166 ----jacket, how prepared 166 Peruvian, substitutes for in bilious fever . . . 181 ----cold infusion of . 652 ----decoction of . . 652 ----tincture of 656 Barley-water, how prepared 620 Barrenness, observations on 464 Barton, Professor, his noble ef- forts to serve his fellow citi- zens ...... 518 ------his unbounded liberal- ity ....... 19 asserts the efficacy of oak bark in gangrene, 565; of poke weed in rheumatism, 572; of thorn apple in epi- INDEX. 675 Page lepsy, &c, 586; of tobacco to dislodge worms . . 590 Bastard ipecacuanha . . 521 Bashfulness, evidence of virtue 140 Bath, cold, when proper . 32 ----warm, efficacy of . 32, 43 ----regulation of . . . 202 Bayous, agency of in producing malignant fever . . . 392 Bayberry, useful in jaundice 521 Bearberry, useful in gravel 521 Beaufort, his dread of death 114 Beauty, wonderful effects of 395 Beaumont Dr., his experiments on digestion made in the case of St. Martin, who was woun- ded in the side ... 83 Bearing down of the womb 455 Bed-room, observations on 75 Beech drops, useful in cancers 521 Beef tea, how prepared . 623 Beer, recipes for ... 550 Beggar, anecdote of . . 88 Benne, useful in dysentery, and yields a good salad oil . 521 Bethroot, useful in hemorrhages 522 Bigelow, Professor, honourable mention of .... 518 ---------testifies to the virtues ofgillenia..... 544 Bile, the manner in which it is secreted, and use of . 56 Bilious fever, treatment of 172 -----------its fatality in Wash- ington ...... 175 -----------prevention of 182 Bind weed, purgative . . 522 Byrd, Colonel, celebrates the bastard ipecacuanha . 553 Bites of moschetoes . . 342 ----of venomous animals 343 ----of mad dogs . . 344 Bitters, how prepared, . 657 -------dangerous effects of 31 Bitter sweet, good for cutaneous disorders, &c. . . . 522 Blackberry, remedy indysente- ry....... 522 Black snake-root, useful in fe- vers ....... 603 Bladder, description of . 57 Bladder, distended, cause retroverted womb nflammation of Bleeding at the nose Bleeding piles . . . -------- from wounds topical Page of 418 249 267 279 356 370, 615 Blistering plaster, how prepared 664 Blistering plaster, substitutes for (See crowfoot, cuckoo-pint, mezereon, garlic, horse-radish.) Blood, circulation of . . 50 -----, how it is recruited 55 -----, spitting of . . 268 Blood-letting, how performed 369 Blood-letting, rules to be ob- served . . . 186, 200, 451 Blood root, cure for polypus 522 Blood wort, checks bleeding 523 Bloody flux..... 281 Blossoms, grog, cure of . 332 Blotches, or eruptions . 332-487 Boerhaave, Dr., verifies that re- ligion conduces to health 157 -----------his singular mode of treating epilepsy . 115 Boils or tumours . . . 350 Bolea, captain, his singular mode of taking revenge . . 122 Bonaventure, his admiration of a beautiful woman . . Bones of the human machine description of . . . Boneset, remedy in agues Bowman's-root, good emetic Box-wood, excellent tonic Brain, seat of .... -----inflammation of Breasts, anatomy of . . ------swelling of, infants -------cancer of . . . 103 37 524 524 524 44 228 48 479 352 622 Bread soup, how prepared -----pudding, how pre- pared .....623, 624 Breath, how to preserve its sweetness..... 253 Breeding sickness . . . 417 Bronchitis..... 212 ---------and croup sometimes confounded .... 212 Broomrape, useful in cancers 524 676 INDEX. Brown, Professor, his remedy for tetanus .... 295 Buboes, management of . 328 Buckthorn, good purgative 524 Burch, captain, cured of abscess of liver by onions . . 566 Burdock, purifies blood . 525 Burleigh, Lord, his just remark on religion .... 160 Burnet saxifrage, useful in asth- ma ....... 525 Burns or scalds . . . 346 Butterfly weed, remedy, in cold and pleurisy .... 525 Butternut, excellent cathartic 525 Button snake-root, useful in gangrene..... 525 C. Caldwell, Professor, the manner he preserved the health of his son....... 75 ------remarks on worms 498 ------deserves high esteem 578 Calico tree, remedy for itch 526 Calimus, good aromatic . 526 Calomel, doses of . . . 629 Calves' feet jelly, how made 621 --------- broth, how made 623 Camomile, stomachic . . 526 Camphorated powders, doses 633 -----------how prepared 639 -----------mixture. . 648 -----------liniment. . 658 -----------spirits . . 657 Cancer, treatment of . . 352 ------ of the womb . . 459 Cancer root, astringent . 527 Candleberry myrtle, emetic 527 Caraway, excellent aromatic 527 Carrol, Mrs., cured of bilious fever by porter . . . 174 Carrol, Charles, his death and character..... 245 Carbonic acid, or fixed air 68 Carrot, wild, diuretic . . 527 ------poultices how prepared 665 ------corrects fetid ulcers 527 Cartwright, Dr., thanks due to Page him for his essays on malig- nant fever..... 373 Cartwright, Dr. his manner of administering doses of medi- cine to his patients . . 393 Cartilages, description of 38 Castor oil, doses of . . 629 ---------how made . . 527 Cataplasm, of mustard . 664 --------- of common salt 664 --------- of alum . . 664 Catarrh, or cold . . . 212 Cat gut, or goat's rue, remedy for worms..... 527 Cathartics, class of . . . 635 Cathartic mixture, doses of 633 how prepared . 636 Catheter, manner of introdu- cing....... 279 Caustic alkali, doses of . 629 ------how prepared . 657 Caution to parents . . 476 ------ to masters . . 33 Celandine, useful in cutaneous affections..... 527 Cellular membrane, use of 43 Centaury, good stomachic 528 Chalk, prepared, doses of 629 Chapman, Professor, his great zeal in diffusing knowledge 518 --------treatment of epidemic 238 attests the efficacy of seneca in obstructions of the menses 603, and of balsam co- paivi, in gonorrhoea . . 323 Chancres...... 328 Chalybeate wine, how prep. 654 Charcoal powder, how prep. 659 ------- poultice, how made 665 Charity, godlike act . . 608 Charlemagne, nobleness of 97 Cheerfulness consistent with re- ligion ...... 154 Cherry tree, wild, substitute for Peruvian bark . . . 528 Cheselden, Dr., on anatomy 37 Cheyne, Dr., his mode of treat- ing delirium .... 613 Chesterfield, Lord, on dress 143 Chicken pox .... 265 Chicken water, how made 623 INDEX. 677 Page Chickweed, red, remedy for hy- drophobia ..... 528 Chilblains..... 346 Child, position of in the womb 414 Child-bed, diseases of . 466 -------— management of 440 Children, management of 442 Chills, how a return may be counteracted .... 170 Chills and fevers, vulgar mode of treating .... 610 Chin, or whooping cough 503 Chlorosis, or green sickness 403 Chocolate, properties of . 83 Cholera infantum, . . . 495 ------morbus .... 304 ------epidemic or malignant 305 Chordee...... 322 Chorea, or St. Vitus's dance 504 Chremes, story of, a lesson to the intemperate ... 78 Christian, his consolation 111 Chronothermal system, account of....... 514 Chyle, how conveyed . . 55 Cider, when wholesome . 82 Cinquefoil, used in bowel com- plaints ...... 528 Circulation of the blood, how performed..... 49 Clap, or gonorrhoea . . 321 Cleanliness promotes health and preserves beauty . • 145 ---------, its importance in sickness ... 33, 471, 611 Cleavers, good for the gravel 529 Clinias, calmed by music 118 Clothing of infants . . • 468 Cloruret of lime used with suc- cess in the cure of sore eyes in infants..... 239 Club-foot, management of 482 Clysters, or glysters, . . 662 Cocum, used in rheumatism 529 Cock-up-hat, useful in yaws 529 Coffee, properties of . . 83 Cohush, for rheumatism . 529 Cold, or catarrh ... 212 ____remarks on the popular remedies..... ____of foot bathing . . 213 Cold, of cold drinks ... 213 ----of full vomiting . . 215 ----of steaming the head 216 ----inhaling vapour of hot wa- ter ....'.. . 218 ---«- prevention of . . 220 ----importance of avoiding the exciting causes . . . 229 ----exposure to intense 89, 221 Coldness of the extremities in fevers . . . 177, 194, 202 Cold water, its operation upon the stomach .... 213 the impression it makes when externally ap- plied ...... 213 Cold bath when beneficial 32 Cold washing of infants . 471 Cold plague, its fatality, letter respecting .... 372 Colliquative sweats . . 274 Colic, treatment of . . . 302 Colic pains, in children . 492 Collection and preservation of vegetable substances 606 Colts-foot, useful in coughs 529 Columbo, American,good tonic 529 Comfrey, astringent . . 530 Common ulcers . . . 353 Conception, signs of . . 412 Conscience, the effects of, &c. 113 Congestion, signs of . , 176 Conclusion and general re- marks ...... 618 Contagion how to be arrested 198 Consumption .... 269 -----------use of refrigera- ting medicines in . . 271 ---------— of balsamic do. 272 -----------of inhalation and fumigation .... 273 -----------of sedatives 274 ---.--------of exercise 276 Convulsions in children . 492 ----------in pregnancy 421 -------—— in labour . . 438 ----------hysterical . 288 Corday, Charlotte, interesting history of..... 138 Cordial mixture .... 647 Coriander, good aromatic 530 678 INDEX. Cornaro, by temperance re- stores a constitution im- paired by dissipation Corns, treatment of . . Cosmetics, observations on Costiveness, remarks on -----------dangerous effects of, in pregnancy . . of infants Cough, management of . ------symptomatic . . ------danger of using patent medicines in ... . ------remedies recommend- ed ......225, mixture, how prepared Countenance, prognostic of disease...... Cow parsnip, useful in epilepsy Cow pox, or vaccine disease Cox, Professor, praise due to Craik, Dr. and Mrs., their death and character Crane's bill powerful styptic Cramp, or tetances . . ------in pregnancy . . ------of the stomach ------of the legs . . . ------colic..... Crawford, Wm. H. Hon., tes- tifies to the efficacy of on- ions in croup .... Crawford, Dr., his treatment of a hypochondriac . . Cream of tartar, doses of Cross-wort, useful in fevers Croup and Bronchetis some- times taken for the same Croup or hives .... Crow-foot, excites blisters Cruelty, instances of . . Cuckold, useful in jaundice Cuckow pint, used externally for blistering .... Cucumber-root, useful in drop- sies ....... Cullen, Dr., celebrates horse- radish in hoarseness Cupping, how performed . Cure-all, excellent tonic . Currant wine, how to make Page 79 349 396 301 415 491 223 223 225 226 644 205 530 258 518 569 530 293 421 293 294 302 566 293 629 532 212 500 532 117 532 532 532 552 370 532 532 Currie, Dr., his improvement in the treatment of nervous fever....... Custard apple, a good purga- tive ....... pudding how made Cutaneous eruptions Cutbush, Dr., his successful practice in the epidemic, bears testimony of the effi- cacy of acids in scurvey, 555; of tobacco in dropsy Cutler, Rev. Dr., deserving high commendations . . . ------------testifies to the Page 189 533 624 331 591 518 efficacy of emetic weed and skunk cabbage in asthma, 536, 582 D. Dandelion, useful in visceral obstructions .... Darwin, Dr., gives an account of a parsimonious surgeon killing himself . . Darwin, Dr., cites a case in which pride was effectually cured...... his remedy tocor- 533 113 136 253 rect bad breath, Davidge, Professor, his remedy for croup..... 501 Daviess, Colonel, his dying words...... 150 Deadly night-shade, useful in rheumatism, .... 563 Deafness, treatment of . 251 Death overmuch feared by some 112 Deerberry, useful in asthma 533 Delirium treatment of . 452, 612 Delivery, or child-birth . 438 Denman, Dr., his mode of pre- venting convulsions. . 423 -----------his remarks on 436 494 660 533 preternatural labour . Dentition, or teething Detergent gargles . Devil's bit, vermifuge, &c. Dewberry, useful in dysentery 533 INDEX. 679 Page Dewees treatment in immode- rate flow of the menses 406 -------------in sexual weak- ness ...... 412 Dexter, Prof, entitled to praise 518 Diabetes, or incontinence of urine,...... 276 Diaphragm, use of, . . 52 Digestion...... 83 ---------extraordinary case of St. Martin .... 83 --------- an opportunity of seeing what was going on in the stomach of St. Martin 84 Diaphoretics, class of, . . 638 ____________drops, . 628, 638 Diarrhoea, or looseness, . 313 Diet, for a healthy state, . 83 ----recommended in bilious fever....... 182 ----for the sick, . . 619 ----mode of preparing, . 619 Difficulty of urine, . . 276,418 Digestion, how performed, 52, 54 Dill, good aromatic, . . 533 Directions for preserving vege- table substances . . . 606 Diseases of pregnancy . 417 --------of childbed . . 442 -------prognostics of . 204 Dislocations, observations on 362 Dislocation of the jaw . 363 -----------of the shoulder, 363 -----------of the elbow, 364 ___________of the wrist or finger364 ___________of the thigh 364 Page Dorsey, Professor, his remedy for sore eyes .... 237 ------notice of his death and character..... 230 Doses of medicines, table of 6'2S Dover's powders, how. prepared 639 ---------------doses of 634 Dragon's claw, useful in fevers 534 Dragon's root, used for blisters 534 Drastic purges .... 636 Dressing of infants . . . 468 Dress, love of, natural . . 141 -----neglect of, improper 143 -----advantages of wearing flannel...... 144 Dropsy of the belly . . • 316 ------of the cellular mem- brane, or anarsarcae . . 317 ------of the head . . 490 ------of the ovarium . 461 of the fallopian tubes 462 Dislocation of the knees and ankles...... 364 Dispensatory .... 627 Dispositions of children, how to be managed . . • 474 Diuretics, class of . . , 641 Diuretic infusion and pills 642 Dock water, purifies the blood 533 Dog-wood, best substitute for the Peruvian bark . . 534 Domestic remedies for whoop- ing cough..... "14 _________________for rheu- matism ...... "57 Drowned persons how to be treated...... 340 Drunkards, reclaimed, in- stances of . , • • • 131 ------- ludicrous descrip- tion of ..... • 339 Drunkenness, its horrid conse- quences ..... Dysentery, treatment of 281 E. Ear, description of . • • noise in, prognostic of disease Ear-ache .... Esaymosis . • Effervescing draught Egg soup, how made Eginardus, anecdote of Elder, common, aperient -----wine, how made Elecampane, expectorant Elegy on the death of Col Jesse Ewell .... on a deluded girl Elixir paragoric, doses of how prepared Elixir vitriol, doses of . 45 208 251 370 638 622 9b' 534 535 535 315 327 630 656 (529 680 INDEX Page Elm, American, remedy in dysentery..... 535 Emetic weed, excellent emetic and remedy for asthma 535 Emetics, rules for their exhibi- tion ....... 635 Emissions, involuntary . 325 Empirics, cause of increase 28 ---------cures on which their fame is built .... 29 Enthusiasm, source of delusion 152 Envy, nature of ... . 123 -----baneful effects of . 124 -----antidote against . 125 Epicurus, his dread of death 113 Epidemic, or typhoid pneu- monia ...... 226 Epilepsy, or epileptic fits 285 Epispastics..... 383 Ergot, hastens delivery . 539 Eructations..... 300 Eruptions of the skin 331,453, 486 Erysipelas, or St. Anthonv's fire......267, 524 Ether, vitriolic, doses of . 629 Essence of peppermint, doses of......• 629 Evacuations, importance of 94 ----------- alvine, prognos- tic of diseases . . . 211 Evergreen, diuretic . . 538 Ewell, James, Dr. memoir of xv Excretory vessels, use of . 40 Excoriations, or galling . 480 Exercise, promotes health 87 ---------absolute necessity of 88 ---------mode of prescrib- ing, in sickness . . . 651 Expectorants, rules for their exhibition..... 643 Eye, description of 44 ----inflammation of . . 237 Eye-water, how prepared 659 F. Face, painful affection of 256 Faintingfits..... 286 --------in pregnant and ly- ing-in women . . 418, 439 Page Falling of the fundament 349 -------of the palate . . 235 -------of the navel strings 438 ------of the womb . . 455 Fallopian tubes, their use 58 False conception . . . 460 ----r lins..... 420 Fanaticism, dangerous conse- quences of ... . 151 Fashion, its excess disgusting 141 Fear, its origin .... 112 ----turns the hair gray . 113 ----produces insanity . 113 Fear, superstitious foundation of......115, 475 Feather beds, necessity of airing 93 Febrifuge mixture and pow- ders .....634, 639 Feeding of children . . 470 Feeling, one of the senses 46 Feet, description of . . 38 Fennel, sweet, aromatic . 538 Fern, male and female, useful in coughs, and remedy for tapeworm, .... 538 Fever, in general . . . 162 ----- bilious, or remittent 171 ----- hectic, or consumption 269 ----- inflammatory . . 200 ----- intermittent, or ague 164 ----- malignant, or yellow 372 -----miliary .... 265 ----- milk, in lying-in women 440 ----- nervous, or typhus 184 ----- puerperal . . . 453 ----- scarlet .... 266 Fibres, description of . . 40 Fig-tree, a mild caustic . 539 Finger, dislocation and frac- ture of...... 364 Flag, blue, active cathartic 539 ----------sweet, aromatic 539 Flannel, wearing of, promotes health...... 144 Flatulence, in infants . . 492 ----------in adults . 300, 302 Flaxseed...... 539 --------, infusion of, good remedy in cough . . 226 --------syrup, how made 539 INDEX. 681 Page Flea-bane, promotes urine 540 Flies, potato, equal to Spanish 574 how collected 575 540 409 622 74 281 540 Flower-de-luce, cathartic Fluor albus, or whites . . Flour, caudle, how prepared Flowers, pernicious effects of Flux, or dysentery . . . Flux-root, remedy in colds Food, how received into the stomach and digested . 54 ----rules to be observed in taking .... 78, 80, 616 Foxglove, a most valuable me- dicine in inflammatory com- plaints ...... 540 Fractures of the limbs . 362 --------of the small bones 364 --------of the ribs . . 368 French apple, cures epilepsy 542 Frost-wort, useful in king's evil 542 Frozen limbs, management of 221 Fumitory, useful in eruptions 543 G. Galen, how he became con- verted .... Galling, of infants . Gall bladder, use of Gamboge, doses of . Gaming, a horrid practice - melancholy occur- rence of good advice on Gangrene, or mortification Garget, useful in rheumatism Gargles, how prepared Garlic, excites blisters . Gentian, stomachic Gillenia, common, emetic Ginseng, demulcent and sub- stitute for tobacco . . -------manner of preparing for exportation . . Glands, their use . . • Gleet, treatment of . . • Glossary ...... Glyster, or clyster, simple and emollient..... ------common 86 34 480 57 630 133 134 134 360 543 660 543 543 544 544 545 40 324 667 662 662 Page Glyster, stimulating . . 662 ------ anodyne . . . 662 ------turpentine . . • 662 ------nourishing . . . 663 ------mode of administering 654 Golden rod, a tonic bitter 545 Gonorrhoea..... 320 Gonorrhoeal inflammation of the testicle cured by purga- tives ....... 324 Goose grass, useful in gravel complaints .... 545 Gout....... 319 ----doctor, anecdote of . 319 Gratitude, the most exalted virtue...... 153 Gravel ....... 277 Greene, General, his death and character..... 229 Green sickness .... 403 Grief, injurious to health . 109 ---- deep, cause of insanity and death..... 110 ---- its best remedy . . 110 Gripes, in infants . . . 492 Grog blossoms .... 332 Ground holly, useful in gravel 546 Ground pine, useful in rheu- matism, &c..... 546 Ground pink, remedy for worms 546 Guinea pepper .... 546 ------worm .... 344 Gun-shot wounds . . . 358 Gum pills...... 646 H. Hamilton, Honourable Paul, his description of button snake root..... -------- of the pleurisy root --------of the squirrel ear --------his mode of admin- istering the May apple . Archibald, Lieut., his death and character Harriet, her unhappy fate Hartshorn, spirits, doses of Hare lip, management of . Hart's tongue, remedy in di- arrhoea ...... 525 571 584 558 525 101 630 482 546 682 INDEX. Page Harvey, his sublime sentiments 37 Hatred, destructive to mind and body..... 120 Head, description of . . 44 -----injuries of . . . 365 -----water in the . . . 499 Headache...... 249 Hearing, difficulty of . . 251 Heart, description and use of 49 -----grand organ of circula- tion ....... 50 Heart-burn..... 299 Heart's ease, useful in cuta- neous affections . . . 546 Heart snake-root, an emetic and diaphoretic . . . 547 Hectic fever..... 270 Hellebore, remedy in cuta- neous diseases . . 547, 548 Hemlock, useful in many ob- stinate cases .... Hemorrhoids or piles . . Hemorrhoidal ointment . Henbane, useful in convulsions Herb bennet, good for ague trinity, for eruptions 548 279 663 549 549 549 347 296 580 Hernia, or ruptures Hiccough ...... Hill, Dr., his effrontery Hippocrates, his desire to cure covetousness .... 126 Hip joint, rheumatic affection of 256 Hives or croup .... 500 Horehound, good for coughs 551 Hoarseness..... 218 Hog-bed, promotes the menses 549 Holwell, Col., his account of the black hole in Calcutta 69 Homoeopathy, account of 510 Homoeopathic medicine . 512 medicines, pre paration of Hooded widow herb, antidote to canine madness . . Hope, the source of human happiness ..... ----- its great influence on the state and disorders of the body...... -----, ill-grounded Hop beer, how made 513 549 105 106 107 550 Page Hops, anodyne and antiseptic 550 Horse-radish, stimulant . 552 Hosack, Dr., a distinguished botanist..... 518 Hospital, a cheap plan recom- mended to planters . . 34 --------ought to be establish- ed in our sea port towns 34 Hotfseleek, useful in burns and stings of insects . . . 552 Hunger, painful sensation of, explained..... 55 Hunter, Dr., slept comfortably under snow .... 91 Husbands, affection of some 99 ---------cruelty of some 131 Hydropathy, or water cure 506 Hydrophobia..... 344 Hydrocephalus, or water in the head...... 499 Hygieine, or the art of preserv- ing health..... 64 Hypochondriac disease . 290 Hypochondriacs, ludicrous ca- ses of.....291,292 Hypocrisy..... 151 Hyssop, useful in asthma, &c. 552 Hysteric fits..... 287 I. Idleness, the bane of virtue Iceland moss, decoction of, good for cough . . Ice-plant, useful in fits Imagination, force of . 105, Imperforated anus . . vagina 226 552 416 483 483 620 158 140 277 297 553 553 tobacco, good for colic 553 ------turnip, good for coughs 553 Indigent sick, often neglected 608 Indigestion or dyspepsia . 300 Imperial drink Impiety, consequences of Impudence, disgusting Incontinence of urine, how treated by Dr. Bell Incubus, or nightmare Indian hemp good for rheuma tism....... ------ physic, safe emetic INDEX. 683 T 1- Pag6 Indigo weed, emetic and ca- thartic ...... 554 Indolence, source of disease 87 Infants, management of . 466 ■, diseases of . . 478 Infection, how to arrest . 198 Inflammation of the brain 228 -----------of the lungs 242 -----------of the liver . 243 -----------of the stomach 245 -----------of the intestines 247 -----------of the kidneys 248 -----------of the bladder 249 -----------of the breasts 447 1-----of the womb 450 -----------of the eyes . 237 -----------of the pleura 242 -----------of the throat 230 Inflammable air, how to correct 71 Inflammatory fever . . . 200 Influenza...... 212 Infusion of roses . . . 650 -------of oak bark . . 650 -------of galls ... 650 -------of Peruvian bark 652 -------of Columbo . . 653 -------of gentian . . 653 Ingenhouz, Dr., his remarks on the properties of plants 73 Inhalations .... 218, 273 Injections for gonorrhoea . 660 Injuries of the head, &c. . 365 Inoculation for small-pox, from whence derived . . . 263 Intemperance, vice of . . 127 -----------a miserable re- fuge from misfortune . 128 —---------reclaimation from 131 Intermittent, or ague and fever 164 Intermittent fever, best method of treating..... 169 --------------remedies re- commended as highly bene- ficial .....169, 170 Intestines, use of . . . 53 Intoxication, symptoms of 339 ----------how to treat 339 Inversion of the womb . 445 Ipecacuanha, American, emetic 554 -----------doses of. . 630 Page Iron, carbonate of, useful in tic douloureaux .... 257 Iron filings, how exhibited 653 Issues....... 371 !tch....... 333 ---lotion, how prepared 658 Ives, Professor, attests the vir- ' tues of blood-root, in certain cases...... 523 1^........ 554 Jalap, doses of ... . 630 Jamestown, or jimson weed, useful in many complaints 554 Jaundice, or yellow gum . 336 --------infantile . . . 486 Jealousy, horrid effects of 103 Jefferson, President, his death and character . . . 283 Jerusalem oak, vermifuge 554 Joan, queen of Naples, mur- ders her husband . . 104 Johnson, Dr. formula to pre- serve the stomach and regu- late the action of the bowels in inflammation of the liver 244 Jones, Hon. Dr., asserts the ef- ficacy of cotton in scalds 346 Joy, excessive, often fatal 109 Judkins' ointment, good for buboes...... 239 Juniper, an excellent diuretic 554 K. Kidneys, use of . . . , —-----inflammation of 57 248 Kingston, Sir Wm., his cruel mode of taking revenge 121 King's evil..... 335 Knee, dislocation of . . 364 L. Labour...... 427 Laborious labour ... 434 Lacedemonians, politeness of 140 Laceration of the parts . 445 684 INDEX. Page Lafiteau, Father, first discover- er of ginseng in America 545 Lambkill, for itch . . . 555 Lassitude, prognostic in fevers 208 Lavater's remarks on females 98 Laudanum, doses of . . 630 ----------how prepared 656 Lavender thrift, for sore throat 555 Laurel, for diarrhoea . . 555 Laxative medicines . . 635 Leeches, mode of applying and preserving, and checking the discharge of blood . . 615 Legs, description of . . 38 -----fractures of . . . 365 Lemonade, how prepared 619 Lemon tree, antiseptic . 555 ------how to preserve the juice...... 555 Lettuce, garden, an excellent anodyne •..... 555 -------wild, a powerful diu- retic ...... 556 Lichen, useful in coughs . 556 Life-root, remedy for gravel 557 Ligaments, description and use of...... 38 Lightning, to recover persons apparently killed by . • 340 Lime water, how prepared 657 -----------doses of . . 634 Limekiln, dangerous effects of 72 Lind, Dr., on the influence of the mind over the body 106 Liver, description and use of 56 -----inflammation of . 243 -----enlargement of . . 245 Lobelia, useful in venereal 557 Lochial discharge . . . 444 Lock jaw...... 294 Longings.....178, 417 Looseness, or cholera infantum 495 Looseness, in pregnancy . 418 Love defined .... 96 ----influence of . • . 96, 97 ----propitious, conducive to health...... 100 ----disappointed . . 100, 101 Lover, false, a detestable cha- racter ...... 104 Page Louisa, affecting history of 100,101 Low spirits..... 290 Lumbago...... 256 Lues venera, or confirmed pox 326 Lungs, description and use of 48 .------inflammation of . 241 Lying-in women, diseases of 442 M. Madder, useful in visceral ob- structions ..... 557 Mcintosh's, Dr., treatment of syphilis ..... 329 Mac Pheeters, Dr., celebrates black mustard, as emetic, in malignant fever . . . 388 Macbride, Dr., finds blood root useful in hydrothorax . 523 Magnesia, doses of . . 630 Magnolia, good in rheumatism 557 Maiden hair, useful in coughs 558 Malignant fever .... 372 --------- letter from Louisiana to the author respecting 372, 373 ---------Cartwright's essays on, noticed .... 374 --------- symptoms of . 374 --------- three distinct stages of....... 374 --------- treatment of 375, 388 --------- animal and vegeta- ble putrefaction, agency of in producing . . . 385, 386 --------- bayous do. . 392, 393 --------- prevention of . 393 ------■— cholera. See cho- lera, epidemic or malignant 305 Malignant or putrid sore throat 232 Mallow, useful in dysentery and gravel .... 558 Mandrake, an excellent purga- tive ....... 558 Manna, doses of . . 630 Marsh, trefoil, tonic bitter 559 Marsh-mallow, good emollient 559 Marsh rosemary, for sore throat 559 Master-wort, tonic . 559 Materia Medica . . . 517 May apple, purgative . . 560 INDEX. 685 Mayrant, Col., celebrates Sam- son snake root as a remedy for dyspepsia .... 581 May weed, stomachic . 560 Mease, Dr., deserving of high praise...... 518 Measures and weights, table of 627 Measles...... 264 Meconium, observation on 469 Medicines, table and doses of 628 ■ approved manner of administering ... 390 Medicine, the importance of possessing some knowledge of....... 28 ■■ necessary caution in the use of..... 30 ■ subject to abuse 28 --------the necessity of tak- ing agreeably to directions 613 Membranes, description of 40, 43 Menstruation .... 398 -----------cessation of 400 —————— painful . . 401 -----------suppression of 403 -----------profuse . . 406 Mercurial pills, how prepared 655 ——— solution . . . 655 ■— ointment . . 663 Mezereon, useful in venereal and cutaneous affections 560 Midriff, description and use of 52 Miliary fever .... 265 ——— eruptions . . . 453 Milk fever..... 444 ----blotch..... 487 Milk, or silk weed, useful in gravel, &c..... 560 Milkwort, useful in coughs and colds...... 560 Mind or soul, observations on 47 Mindererus spirits, how pre- pared ...... 639 Mint, allays vomiting . . 561 Mineral tonics .... 651 Miscarriage..... 424 Misletoe, useful in fits . 561 Mitchell, Professor, deserving high commendation 518 Modesty, its great influence 137 Mole, or false conception 460 Page Moore, Dr., cites a case rela- tive to imagination . . 416 Moorwort, remedy for toe itch 561 Mortification, or gangrene 360 Moschetoes, bite of . . 342 Motherwort, useful in nervous affections..... 561 Mountain tea, promotes men- strual discharge . . . 561 Mouthroot, tonic bitter . 561 Mugwort, good stomachic 562 Mulberry tree, an excellent purgative..... 562 -------wine, how made 562 Mulled wine, to prepare . 625 Mullein, good for piles . 562 Mumps, treatment of . . 236 Muscles, description of . 39 Mustard, excellant stimulant 563 ------- whey, how made 625 Music, powerful effects of 118 Mutton broth, how made 623 N. Narcotics, observations on 647 Navel cord, or string, manner of tying .... 431, 467 ---------presentation of 438 Neopolitan, manifests unboun- ded love for his wife . 99 Nervous fever .... 184 ------- headache . . . 250 Nerves, description and use of 39 Nettle-rash, treatment of . 332 Nettle, stinging, an excellent stimulant : . . . . 563 Night-shade, usefel in rheuma- tism and in tic douloureaux 564 ---------- deadly, used in palsy, epilepsy, &c. . 563 Night-mare, or incubus . 297 Nipples, sore . , . . 448 ----------- mode of pre- venting ..... 449 Nitre, doses of ... . 630 Nitric acid, diluted . . . 655 ----lac ammoniac, how pre- pared ...... 643 Nitrous lozenges, how pre- pared ...... 645 686 INDEX. Page Nose, bleeding from . . 267 Nostrils, description and use of....... 46 Nostrums, dangerous conse- quences of .... 28, 225 Nurses' Guide .... 608 Nurse, duty of ... . 609 -----, caution to 611, 613, 617 Nursing infants .... 474 Nutrition, proper for children 469 O. Oak, astringent, tonic, and antiseptic . . . 565, 566 Oak, poison, good for palsy 566 Obstructed menses . . . 403 Ointment for piles . . . 280 --------for scald head . 335 --------simple . . . 663 --------saturnine . . 663 --------basilicon . . 663 --------mercurial . . 663 --------hemorrhoidal . 663 --------tar .... 663 --------itch .... 664 --------thorn-apple . . 586 Omentum or caul, description of 56 Onions, remedy in liver com- plaint and croup . . 566 Opiates, caution in the use of 242 Opium, doses of . . . 630 Opodeldoc, how prepared 658 Opthalmia or sore eyes . 239 -------- strumus or sore eyes 239 Orange-tree, antiscorbutic 567 ------wine, how made . 567 Original imperfections . 481 Ovaria, ovaries, situation and use....... 58 Oxygen, or pure air . . 67 Pagan religion, account of 111 Painful affection of the face, or tic douloureaux . . 256 Pain of the ear .... 251 ---------stomach 293 Page Pain of the head ... 249 Pains, after, of lying-in women 443 -----false in pregnancy 421 of the back, thighs, and abdomen, in pregnancy 420, 421 Painful menstruation . . 401 Palate, elongation of . . 235 Palmer, Mr., anecdote of 321 Palpitation of the heart 203, 296 ---------in pregnancy 418 Palsy, treatment of . . 289 Pancreas, or sweet bread, its use....... 57 Panado, how made . . 622 Papaw, purgative . . . 567 Papoose root, useful in ob- structed menses and dropsy 567 Paraphymosis .... 324 Parents, caution to . . . 476 Paragoric elixir, doses of. 630 --------how prepared . 656 Parrot, killed, by eating the berries of pride of China 576 Parsley, leaved, yellow root, a good stomachic ... 567 wild, useful in gravel 568 Passions, the active forces of the soul..... 95 Patent medicines, why dan- gerous .... 28, 29, 225 Patriotism, definition of . 147 ---------Themistocles . 148 ---------of French soldier 148 ---------of English sailor 149 ---------of Americans 149 Peach-tree, a mild cathartic 568 Pectoral drink, how made 620 mixture or emulsion, doses of..... 634 Penny-royal, promotes the menses...... 569 Peppermint, allays vomiting 569 Pepper, red, stimulant . 569 Peripneumony, or inflamma- tion of the lungs . . 242 Peritoneal inflammation . 451 Perspiration produced by ex- ternal applications . 177, 201 Petechial fever .... 184 Philemon, died laughing . 109 INDEX. 687 Page Phrensy, or inflammation of the brain..... 228 Philopoemon, the great, taken for a servant .... 143 Phymosis...... 323 Physic, Dr., his excellent ad- vice in hemorrhage of the extremities .... 356 Piles ....... 279 Pills, mercurial .... 655 ----for inflammation of the liver ...... 244 ----purgative .... 637 ----of sugar of lead, and ipe- cacuanha ..... 650 ----camphor and assafoetida 649 Pink root, excellent vermifuge 570 Pins, swallowing of . . 345 Piss-wort, promotes urine and menses...... 570 Placenta, or after birth, mode of extracting . . . 433, 439 Plantain, antidote against the bite of venomous insects 570 Plaster, blistering, how made 664 -------, warm and stimulating 658 Pleurisy, treatment of . . 240 --------root, remedy in cold and pleurisy .... 571 Plurality of children . . 437 Plutarch's observations on bashfulness .... 140 Poison, swallowed . . . 342 -------oak, useful in paralytics 571 ------antidote for . . 572 Poke weed, useful in rheuma- tism ...... 572 Polygonum, promotes urine 573 Polypody, mild laxative . 573 Polypus, in the womb . . 458 Pomegranate, mild astringent 573 Poplar tree, good tonic, &c. 573 Poppy, white, anodyne . 574 ------- syrup of . . . 574 -------mode of cultivating and collecting the juice . 574 Potato fly, mode of collecting 574 Potato, sweet, nutritious 574 -------wild, purgative . 575 -------pudding, how made 6'24 Potter, Professor, his remarks on stimulants, as used in fevers...... Pox, treatment of . . . Prejudices, ill consequences of...... 29, Pregnancy, signs of . 412, ----------force of imagina- tion in diseases of Preliminary observations . Preternatural labour . . Prickly ash, remedy in rheu- matism, &c. ------- pear, remedy for corns Pride of China, remedy for worms, scald head, &c. Progress of labour . Prognosis of fever . . Prometheus, his history of in- temperance .... Prostrate glands, situation and use of ...... Ptolemeus, cries for joy . Puccoon, good for jaundice Puerperal fever . . . Pulse, its action described Purgative infusion, how pre- pared ...... ---------powder . ---------electuary, doses, and how prepared . . 634, pills Purging, or diarrhaea -------- of infants Putrid fevers . . -----sore throat Page 193 326 614 413 416 417 27 435 575 576 576 428 204 128 58 108 577 453 206 637 637 637 637 304 469 184 232 Q. Quacks, cause of their increase 28 Quaker girl's attraction . 146 Queen of the meadows, diuretic 577 Quince tree, mucilaginous 577 Quinine, preparation of . 652 not to be administer ed at random in intermit- tent fever..... ------solution of . . sulphate, pills of Quinsy, or inflammatory sore throat ...... 169 654 654 230 688 INDEX. R. Radish, antiscorbutic . . 577 Raleigh, Sir Walter, forbear- ance of..... 118 Ramsay, Dr., his melancholy death...... 358 Rash, nettle . ... 332 Raspberry dissolves tartar on the teeth..... 577 Rattlesnake root, remedy for croup and cold . . . 577 -----------violet . . . 579 -----------bite of . . 343 Rayschachius, sudden death of, from grief .... 110 Red cedar, substitute for savin 579 Red gum...... 486 Regimen, importance of in sickness ... 33, 609, 616 Religion, promotes health 150, 157 -------- extremes in, to be avoided..... 152 -------- purifies and en- hances our enjoyments 154 Remittent, or bilious fever 171 ----------or bilious fever, prevention of . . . . 182 Respiration, prognostic of dis- ease ...... 207 Resuscitation of persons appa- rently dead .... 340 Revenge, horrid instance of 121 ------- advice to the Ro- mans respecting . . . 121 ------- Bolea's way of taking 122 Rheumatism..... 254 Rheumatic tincture, how pre- pared ...... 656 Rhubarb, wild, purgative 579 Ribs, description and use of 37 Rice milk, how made . . 621 ---- caudle, do. ... 622 ----pudding, do. . . . 624 Rickets...... 504 Ring worm..... 333 Rose or erysipelas . . . 488 Rose, damask, mild laxative 579 ---- willow, remedy in gleet, &c...... . 580 Page Routs, dangerous tendency of 68 Rue, produces blisters, &c. 580 Ruptures .... 347, 483 Rush, Professor, esteems wine a preventive of disease 596 ----his death and character 199 Rust of steel, doses of 631 S. Sage, was supposed by the an- cients to prolong life . 580 Sago jelly, how prepared 620 Sailor, American, patriotism of 150 Sailors, deserve kind treatment 35 ------too inattentive to health 182 Saliva, use of ... . 46 Sal ammoniac, volatile, dose of 631 -------------crude, solution of ....... . 658 Salt of tartar, doses of . 631, 642 Saline julep, or mixture, dose of 634 Saline, how prepared . . 638 Samson snake-root, remedy in dyspepsia..... 581 Sanicle, American, for cancers 581 Sarsaparilla, good for rheuma- tism ..-..-. 581 Sassafras, purifies the blood 587 Saturnine, or lead water, how prepared..... 658 Scald head . • . . . 334 Scalds and burns . . . 346 Scarlet fever..... 266 Scirrhus or cancer . . . 352 Sciatic ...... 256 Scrofula, or king's evil . 335 Scull cap, for hydrophobia 582 Scurvy ...... 330 Scurvy-grass, antiscorbutic 582 Sea-sickness..... 338 Secretory vessels, their use 40, 55 Seminal weakness . . . 325 Senna, American . . . 582 Senses, inlets of pleasure 44 Setons and issues . . . 371 Sexual weakness . . . 409 Shippen, Dr. Wm., father of the Pennsylvania Univeisity 230 Ship fever . . • . . 184 Shaw, Professor, his death 568 INDEX. 689 Paga Shiverings, in childbed . 443 Sight one of the senses . 46 Sickness and vomiting of in- fants ...... 490 Sinapisms, how prepared . 664 Skin, the functions of ex- plained ......40,41 ----diseases of . . . 331 Skoke for ulcers and wounds 582 Skunk cabbage, useful in asth- ma ....... 582 Slaves, brutally murdered 116 -----proper manner of treat- ing ....... 34 Slave trade abominable . 71 Sleep, most reviving cordial 91 -----how to be regulated with infants...... 472 -----effects of too much or too little..... 93 ----- after dinner, whether advisable..... 93 '. talking or walking in 93 -----signs of, in fever . 209 Sleeplessness . . . 196, 420 Slow fever..... 184 Small-pox . . . . • 261 --------how managed in Queen Mary's time . . 262 --------history of . . 263 Smell, one of the senses . 46 Smith, Professor, discovers the utility of blood-root in poly- pus ....... 523 Snakes or serpents, bite of 343 Snuffles of infants . . . 485 Soapwort, valuable in jaundice, &c........ 583 Socrates, maxim of . . 78 Solander, Dr., his advice to travellers in cold weather 89 Solution of arsenic, doses of 628 ----------------how pre- pared ...... 657 Solution of crude sal ammoniac 658 -------of kali .... 659 Somnambulism and somnilo- quism...... 93 Sore eyes.....237, 480 ----nipples..... 448 ____throat .... 230, 232 87 Page 47 583 583 583 Soul, immortal .... Sorrel, antiscorbutic . . Southern wood, stomachic South sea tea, diuretic Spaniards, their cruelty to the Indians ..... Spanish woman, her extraordi- nary hope ..... Speech, blessing of . . Spence, Dr., attests the efficacy of foxglove in consumption 540 Spikenard, good in gout . 583 Spirit of mindererus, how pre- pared....... of turpentine, mode of 117 107 47 639 administering . . . 649 -----of lavender, doses of 631 Spitting of blood ... 268 Spleen, description of . 57 Spleenwort useful in coughs, &c........ Spotted fever .... Sprains and bruises . . Spruce laurel, useful in venereal 584 Squirrel ear, antidote for the bites of serpents . . . Star grass, an intense bitter Stevenson, Dr., his remarks on bowel complaints . . ——— his mode of treat- 584 184 361 584 584 281 291 ing a hypochondriac Still-born infants, mode of re- covering ..... 467 Stimulant purgative pills . 637 Stimulants, how to exhibit 647,648 Stings of insects . . . 343 Stink weed, for cutaneous eruptions, &c . . . 584 Stomach, description and use of 52 aperture in St. Mar- tin's, described by Dr. Beau mont...... 83 Stools, prognostics in diseases 206 St. Anthony's fire . . . 267 St. Martin the young Canadian, experiments on digestion made in his case by Dr. Beau- mont ...... Strangury .... 277, Strawberry, cooling and laxa- tive ....... 83 419 584 690 INDEX. P«ge Stroke of the sun . . . 228 Structure of human machine 36 Strumous opthalmia or sore eyes.....; 239 Sumach, common, anti-vene- real ....... 585 Sulphur, doses of . . . 631 Sudorific drops, or bolus . 640 Sun dew removes freckles 585 Superstition source of delusion 151 Suppression of urine . 276, 418 Sutures, mode of applying 357 St. Vitus's dance . . . 504 Swallowwort, good for cold 585 Swallowing of pins . . 345 Sweating, immoderate . 166 Swelled leg..... 446 Swelling of feet in pregnancy 419 -------of head in infants 479 -------of breasts in do. 479 -------of scrotum in do. 479 Swine pox..... 265 Tetter or ring-worm . . Thatcher, Dr., deserves praise Theodosius, emperor, his anger subdued by music . . Thighs, description of ------ dislocation of ------ fracture of . . . Thomas, Dr., attests the effi- cacy of Cayenne pepper in putrid sore throat . . ------- of charcoal to stop P«ge 333 518 119 38 364 364 bleeding of the nose Thorax or breast, description of........ Thorn apple, remedy in mania, epilepsy, &c..... ---------- case of a child- 234 268 48 586 587 442 56 181 Swooning or fainting Sympathy .....52 System, the, certain states of in remittent fever in which the use of bark is forbidden T. Table of medicines for family use....... 628 Table of weights and measures 627 Taliaferro, Hon. John, his re- medy for whitlow Tansy, vermifuge . . Tape worm .... Tapioca jelly, how made Tartar emetic, doses of Tartar on the teeth, how to re- move and prevent . . Tar water, how prepared Taste, one of the senses Tea, properties of . . . Teeth, management of Teething...... Temperance promotes health 78, 129, Tendons, description and use of....... Tetany or lock jaw , . Throat root, for sore throat swallowing the seed Thoroughwort, useful in fevers 588 589 232 589 489 256 Thyme, good aromatic Thrush, or sore mouth Tic douloureaux . . -------------remedies for 258 -------------symptoms of 256 -----------■— treatment of 257 Tincture of steel, doses of 632 350 585 463 620 632 253 657 46 82 253 494 132 39 ofmyrrh . . . 632 of rhubarb 632, 656 of bark . . . 656 of Columbo . 656 of foxglove 656 of cantharides 656 rheumatic 656 of laudanum 656 r scald head . 334 iter, how made 620 Tobacco, for colic, dropsy, &c. 589 ------- used for tic doulou- ...... 257 used for toothache 257 reaux Toe itch, good for toe or ground itch....... 593 Tongue, description and use of 47 ------appearance of, an im- 209 482 651 60t 294'Toothache ...'.. 252 portant prognostic Tongue-tied, how remedied Tonics, class of ... Tonic powders, and pills . INDEX. 691 Toothache-tree, for rheuma- matism and venereal . 593 Toot rash - . . . . 487 Topical blood-letting . . 369 Touchwood, excellent styptic 593 Tourniquet, how to apply, 325, 356 Travellers in winter, caution to 90 Treacle posset, how made 621 Trefoil water, emetic, and ca- thartic ...... 593 Troup, Hon. G. M., his deaf- ness cured .... 252 Tulip bearing poplar, tonic 593 Turmeric, diaphoretic . 593 Turlington's balsam, how pre- pared ...... 656 Turner's cerate .... 663 Twins, or plurality of children 437 Typhus fever, treatment of 184 Typhoid pneumonia, or epi- demic ...... 226 U. Ulceration of the navel . 479 Ulcers common . . . 353 ----- ill-conditioned . 550 Ureter, description and use of 57 Urethra, description of . 58 Urine, prognostic in fever 210 -----difficulty in voiding 276, 418 -----incontinence of . 276 -----suppression of . . 278 Unicorn root, useful in colic 593 Uterus, description of . 57 Vaccine disease . . . 258 Vaccination discovered by Dr. Jenner in 1798, as a preven- tive against small-pox 263 Vagina, or neck of the womb 58 ------ protrusion of . . 455 Valerian, wild, useful in nerv- ous disorders .... 593 Vanity, effects of . . . 134 ------ cure of ... • 137 Vapours* or low spirits . 290 Vegetable substances, how col- lected and preserved . 606 Page Vegetation of plants, corrects impure air..... 73 Veins, their use .... 40 Venereal disease . . . 321 ---------------prevention of 330 Venesection, or bleeding, how performed..... Vine, grape, cultivation of Violet rattlesnake root, reme- dy for scrofulous tumours -----, sweet, mild laxative 369 594 602 603 Virgins' bower, useful in cuta- neous affections . . . 603 Virginia, or black snake-root, promotes perspiration . 603 Volatile sal ammoniac, mode of administering . . 648 ------ liniment, how prep. 658 Vitriol, white, doses of . 632 Vitriolic solution, doses of 634,651 how prep. 650 ... 67 159 Vital air . Voltaire, his conversion Vomiting and purging, cholera morbus . Vomiting in infants . . W. Wakefulness, or inability to sleep...... Wake robin, for blistering Walnut, white, cathartic . Warm bath, virtues of 32, 43, • how to be regula- ted Warm and discutient liniments plaster Warts and corns Washing of infants . . Washington, Genl., his death and character Mrs. L., her mi- 304 490 174 604 604 202 202 658 658 349 471 raculous recovery Water cresses, antiscorbutic Water trefoil, antiscorbutic Water, impure, how to correct Water gruel, how made . Watery head .... Watery rupture .... Wayne, General, his death 179 604 604 82 621 499 483 320 692 INDEX. Page Weakness of the stomach 300 Weaning ..... 473 Weems, Dr., his prescription 303 ---------- his death . 303 Wells, dry, danger of , . 72 Whitlow...... 350 White swelling .... 337 Whites, or sexual weakness 409 White gum..... 486 White caudle, how made 622 White bryony, purgative . 604 White wood, tonic . . . 604 Whooping-cough . . . 503 Willow, astringent and tonic 604 Wistar, Dr., attests the effica- cy of nitric acid in liver complaints .... 245 --------his death and cha- racter ...... 230 Wine, excellent preventive and remedy of diseases 594 -----use of, is economy 595 -----abuse of, injurious 595 -----receipts for making 597 -----adulteration of, how to detect ..... 600 -----cautions in administer- ing in fevers .... 192 -----whey, how prepared 625 Winterberry, tonic . . . 605 Wintergreen, for itch . . 605 Womb, or uterus, description of 57 Page falling down of 455 inversion of 445 cancer of . . 459 polypus in the 458 inflammation of 450 hemorrhage from 439 betony, good in rheu- 605 Woodhouse, Prof., his death 567 Worms.....462, 498 Worm-seed, vermifuge . 605 Worm-wood, stomachic . 605 Wounds...... 356 Wrists, dislocation of. . 364 Y. Yarrow, astringent, remedy for bruises ar>d cancers . 605 Yeast, utility of, in nervous fevers...... 188 ----- corrects fetid ulcers 550 ----- receipt for making 551 Yellow fever .... 372 ----------prevention of 393 Yellow gum .... 486 Z Zimmerman, Dr., his judicious mode of treating religious melancholy .... 152 (D* Any of the Books in the following Cata- logue may be had of the Agents for the Geneiai View of the World. VALUABI^SCHOOirBOOKS, PUBLISHED BY THOMAS, COWPERTHWAIT & CO. PHILADELPHIA, AND FOR SALE BY THE BOOKSELLERS GENERALLY THROUGHOUT THE UNITED STATES. Mitchell's American System of Standard School Geography, In a Series; adapted to the progressively developing ca- pacities of youth. MITCHELL'S PRIMARY GEOGRAPHY, Containing 120 Engravings, and 14 Coloured Maps, designed as a first book of Geography for children. MITCHELL'S SECONDARY GEOGRAPHY, In quarto form, and elaborately Illustrated with Maps and Cuts (preparing). MITCHELL'S SCHOOL GEOGRAPHY, Accompanied with an Atlas, containing 18 Maps, engraved from original drawings, and executed in a clear and distinct manner. MITCHELL'S ANCIENT GEOGRAPHY, Comprising Classical Geography, Sacred Geography, and a copious Index, giving both the Ancient and Modern names of all places of importance. O) 2 VALUABLE BOOKS, PUBLISHED BY MITCHELL'S KEY To the study of the Maps, comprising his Atlas, in a series of lessons for beginners in Geography. MITCHELL'S HIGH SCHOOL GEOGRAPHY, With an Atlas, (in press,) will contain about 800 pages, and comprise a complete system of Mathematical, Physical, Political, Statistical and Descriptive Modern Geography, toge- ther with a Compendium of Ancient Geography, illustrated by Engravings executed by the first Artists of the country The Atlas to accompany the above will contain not less than 30 Maps, constructed particularly for the work, and designed to correspond with and illustrate it in the most precise manner. MITCHELL'S NEW AND IMPROVED POCKET MAPS Of every State and Territory in the Union, including a NEW MAP OF TEXAS, and one of OREGON AND CALIFORNIA; also, The Complete Traveller's Guide through the United States. RECOMMENDATIONS. MITCHELL'S PRIMARY GEOGRAPHY. I have examined with much interest, this little book, and am free to say, that it is decidedly the best introduction to the study of Geogra- phy that I have seen: the maps are superior, and the matter better selected and better adapted to the capacities of children and youth.— Every parent should present to each of his young children, a copy of this neat little volume. Nothing I am sure would be more acceptable to them ; and no book of the kind with which I am acquainted, will con- vey to their young minds so much instruction as this. I am free to believe, that the young student who studies its lessons intelligibly, will have a better knowledge of Geography, Astronomy and the history of our country, than the majority of pupils who study through our larger Geographies. I cheerfully recommend it to Parents, Teachers and Directors of Public Schools, and shall introduce it without delay intc the schools under my charge. S. DAY, Supt. Public ScJioots. THOMAS, COWrERTHWAIT AND CO. 3 CITY OF BOSTON- In School Committee, May 6, 1846. Ordered, That immediately after the next August election, the studies of Geography and Natural Philosophy be transferred from the Gram- mar to the Writing Department. Ordered, That Mitchell's Primary Geography be introduced at the same time as the text-book in Geography for the Fourth Class in the Writing Schools. Attest, S. F. McCLEARY, Secretary. This work has been introduced into numerous Public as well as Private Schools in all parts of the United States. The publishers have received a great many recommendations in its favour, but are obliged to omit them for want of space. MITCHELL'S SCHOOL GEOGRAPHY. From the Teachers of Public Schools in the City of New York. New York City, 7th August, 1839. We have examined "Mitchell's School Geography," and the Atlas that accompanies it, with considerable care, and must give it the prefer- ence to any work of the kind with which we are acquainted. Its merits are numerous,—the definitions are remarkably plain and concise,—the exercises are copious and important, and the descriptive department is luminous and correct. The divisions of the American Continent are represented and described as they really exist at the present time, and the gross mis-statements generally found in School Geographies are cor- rected. The typographical execution is uncommonly neat and distinct Indeed, the Atlas is a model of the kind, and actually teems with in- formation. The Geography is embellished with some hundreds of neat and well-e«?cuted engravings, which illustrate and greatly enhance the value of the work. DAVID PATTERSON, M. D., Principal of Pub. Sch. No. 3, N. Y. WILLIAM BELDEN, A. M., Principal of Pub. Sch. No. 2. JNO. W. KETCHUM, Principal of Pub. Sch. No. 7. LEONARD HAZELTINE, Principal Pub. Sch. No. 14. JOHN PATTERSON, Public School No. 4. !• 4 THOMAS, COWPERTHWAIT AND CO. at the work before us, without being struck with the care with which all the parts are arranged ; the beauty and distinctness of the typography. and the colouring of the maps; the accuracy of the statistical tables, containing a great variety of new and important information ; and the excellent adaptation of the questions to the text. In these respects I think the Geography surpassed by none. J. A. BURNS, Charleston, S. C. I certify that at a meeting of the Board of Examiners and Visiters of the City Schools of Louisville, " Mitchell's School Geography and Atlas" was adopted as the class-book in geography in all the schools. JOHN FREEMAN CLARK, Agent of City Schools. MITCHELL'S ANCIENT GEOGRAPHY AND ATLAS. This is the title of a work just issued from the press of Thomas, Cowperthwait & Co., Philadelphia. The Geography, with the Atlas to correspond, is divided into two parts — the classical, which describes the countries mentioned in ancient history generally—and the sacred, describing countries, cities, &c, mentioned in the Old and New Testa- ment, and adapted to interweaving, with a knowledge of Bible History, a knowledge of Biblical Geography—which cannot fail to render the study of the Bible far more interesting to both old and young. The mechanical part of the work is excellent. Students of Ancient History, both sacred and general, have long felt and lamented the want of a work, uniting cheapness with clearness and comprehensiveness, to aid them in their studies, by giving definiteness to historical events, in showing their whereabouts; and we are glad to find these essential qualities in the work now before us. We believe the work not more adapted to the use of families and pub- lic schools in general, than to meet the wants of clergymen, Bible Classes, and Sunday Schools.—Boston Atlas. Most cordially do we recommend this work for the use of schools and families, and much of it as highly appropriate to the Bible Class.— Boston Recorder. This work should be in every Sabbath School as well as every family where the Bible and History are studied. We believe it very well planned and faithful.—New York Tribune. The study of Ancient Geography, in connection with History, is far too much neglected in education. We should rejoice if this valuable work should tend to promote its study in all our schools.—Missionary of the Cross. THOMAS, COWPERTHWAIT AND CO. O OUTLINE SERIES. OUTLINES OF THE HISTORY OF ENGLAND, by G. Hogarth, with numerous Cuts and Questions for the use of Schools. OUTLINES OF GRECIAN HISTORY, by the Rev. B. Bouchier, M.A., with Maps, Views and Questions. OUTLINES OF ROMAN HISTORY, by G. Hooarth, with numerous Cuts and Questions for Scholars. OUTLINES OF AMERICAN HISTORY, with'numerous Engravings and Questions for Examination of Pupils. This work is the production of an eminent American his- torian, and is added to render the series more complete.— The author has adopted the able Outlines of England, Greece and Rome by way of model, using the best authorities attainable for his facts. RECOMMENDATIONS. It is very injudicious to give a child a large volume for the commence- ment of any study. A cloud of confusion is frequently thus thrown over the mind which years of after study cannot entirely dissipate. As in astronomy we teach the pupil first to fix in his mind the appearances and relative positions of the brightest stars, so in history we should first present to him the most prominent occurrences and their relations ; the filling up of the ground-plan is afterwards a natural and easy process. For such an introduction these little volumes are precisely suited. They are clear and satisfactory, and yet so brief as neither to tax the memory nor patience of the learner. They are handsomely printed and bound, and made attractive by numerous illustrations. The History of Rome, of Greece, and that of England are part of a series published in London by the Society for promoting Christian Knowledge; and are spoken of in the highest terms by English critics. We have no doubt they will become extensively useful here, and recommend them to the attention of those who have the care of public as well as private instruction.— NeaFs Saturday Gazette, Philadelphia. These are certainly some of the best School Histories that have ever been prepared. The volume on Rome, and that on England, with one on Greece, which we understand is to appear shortly, form part of a series of works published in London, by the Society for promoting Christian Knowledge; and that on the United States was adapted to them.—They are intended for general circulation and are most judiciously suited to their purpose. They aro so brief that a pupil may easily be taken through them in one season at school, and yet they give a clear, connected and pleasing account of every historical event in their province; thus fur- nishing a basis on which all that is learned in the same department afterwards will be methodically arranged.—Phila. Saturday Courier. 2 6 VALUABLE BOOKS, PUBLISHED BY No series of books has appeared for a long time adapted to so great a number of classes in our schools generally. Those on Jlome and England, and that on Greece which is to follow in a few weeks, were published under the direction of the Society for promoting Christian Knowledge, and they are spoken of in the highest terms in England. The Rev. James Pycroft, in his course of English Reading, a work which alone would prove him one of the profoundest men of the age, speaks of them repeatedly as the books which should, by all means, be put into every learner's hands as the first histories; and we fully con- cur in this opinion.— United Stales Gazette. They present a combination of brevity, completeness, and clearness of statement, which is seldom attained in a history. They are hand- somely got up, and liberally embellished with appropriate illustrations. They are highly recommended in England, particularly by Pycroft whose judgment on such a subject is probably equal to that of any man living. As the price, (31 cents each) is no obstacle, every one who has not studied history should have these outlines put into his hands ; and many who have studied other works would be much bene- fited by these.—Philadelphia Inquirer. These little volumes will prove quite a treasure to the youthful students of history. They have all the requisites for becoming extensively useful. They are written with a full knowledge of the subjects of which they treat, and the wants of the learner. While they clearly set forth the facts, they appeal and satisfy the judgment. They comprehend all that introductory works should contain, are well printed and bound, and em- bellished with a great number of well executed and appropriate illustra- tions.—North American. [*■- These are handsome little works, and seem remarkably well adapted to serve as text-books for the younger classes in schools.—The ori- ginal series is published in England by the Society for promoting Christian Knowledge. This society has issued some of the best ele- mentary books that are now used in England, and among the ablest and most attractive of them all are these histories. We wish them success, and believe that from their excellence and cheapness, they can- not fail to obtain it.—Sentinel. They are brief enough for all to study them, and yet will give the student a clearer knowledge of the history of the countries to which they relate than some larger volumes. They are handsomely printed and bound, and embellished with numerous cuts. Teachers and pa- rents should examine them.—Lynchburg Virginian. They furnish a condensed, and yet sufficiently clear and pleasing sketch of all the important events which have transpired within their respective provinces. Originally published in London by the Society for promoting Christian Knowledge, they have been adapted to our own country by the present publishers who have issued them in a neatly printed and handsomely embellished series.—Gettysburg Star. THOMAS, COWPERTHWAIT AND CO. 7 SCIENTIFIC PORTION OF THE OUTLINES. The following works are not yet all published, but will be brought out as speedily as possible. They will be hand- somely illustrated, and, it is believed form a very valuable addi- tion to the libraries and text books of the young who are in pursuit of knowledge. , OUTLINES OF ASTRONOMY, by the Rev. Professor Hall, Edited by C. List, Esq. OUTLINES OF NATURAL PHILOSOPHY, by C. List. Esq. OUTLINES OF BOTANY. OUTLINES OF CHEMISTRY. OUTLINES OF MINERALOGY. OUTLINES OF GEOLOGY. OUTLINES OF PHYSIOLOGY. PINNOCK'S ENGLAND. Pinnock's improved edition of Dr. Goldsmith's History of England, from the invasion of Julius Caesar to the death of George the II., with a continuation to the year 1845: with questions for examination at the end of each section ; besides a variety of valuable information added throughout the work, consisting of Tables of Contemporary Sovereigns and Emi- nent Persons, copious Explanatory Notes, Remarks on the Politics, Manners and Literature of the Age, and an Outline of the Constitution. Illustrated with numerous Engravings. Fifteenth American, corrected and revised from the Thirty- fifth English edition. • RECOMMENDATIONS. Philadelphia. Gentlemen,—Be pleased to accept my thanks for the favour you have done me in sending a copy of your neat and attractive edition of Pin- nock's Goldsmith's England. It appears to me to have been sedulously prepared for the purpose which it professes to subserve—that of a con- venient manual for schools and academies. By the questions and tabular views at the end of the chapters, the scholar will be able to test his own acquisitions, and to embrace at a glance an important collection of facts, in regard to the history and biography of the period of which he has been-reading. These landmarks for the memory serve to raise a host of reminiscences, all interesting to the diligent and inquiring stu- dent. With my wishes for the success of the work, accept the assurances of the high respect with which I subscribe myself, Your obedient servant, WALTER R. JOHNSON, Professor of Mechanics and Natural Philosophy in the Franklin Institute. s THOMAS, COWPERTHWAIT AND CO. Recommendations to the same general effect have been received from the following gentlemen :— SIMEON HART, Jr., Farmington, Conn. Rev. D. R. AUSTIN, Principal of Monmouth Academy, Monson, Mass. T. L. WRIGHT, A.M., Principal of East Hartford Classical and En- glish School. Rev. N. W. FISKE, A.M., Professor Amherst College, Mass. E. S. SNELL, A.M., Professor Amherst College, Mass. Rev. S. NORTH, Prof. Languages, Hamilton College, N. Y. W. H. SCRAM, A.M., Principal of Classical and English Academy, Troy, New York. JAMES F. GOULD, Principal of Classical School, Baltimore. A. B. MYERS, Principal of Whitehall Academy, New York. HORACE WEBSTER, Professor Geneva College, N. Y. W. C. FOWLER, Professor Middlebury College, Vermont. B. S. NOBLE, Bridgeport, Conn. Rev. S. B. HOWE, late President of Dickinson College. B. F. JOSLIN, Professor Union College, New York. PINNOCK'S GREECE. Pinnock's improved edition of Dr. Goldsmith's History of Greece. Revised, corrected, and very considerably en- larged, by the addition of several new chapters and numerous useful notes; with questions for examination, at the end of each section. Twenty-fifth American from the nineteenth London edition, improved by W. C. Taylor, L L.D., with numerous Engravings, by Atherton and others. RECOMMENDATIONS. From Mr. N. Dodge, Teacher, South Eighth Street, Philadelphia. The edition of " Pinnock's History of Greece" on the basis of Gold- smith's is, in my estimation, a work of superior merit. The introduc- tory chapters are especially valuable. The body of the work is greatly improved; and the continuation, though brief, supplies a want greatly felt by every reader at the conclusion of the original work of Dr. Gold- smith. I shall introduce it into ray seminary as the best text-book on the subject. N. DODGE. We fully concur in the opinions above expressed. THOS. H. AVILSON, Rev. S. W. CRAWFORD, A. W. ALEXANDER, A. M. M., Principal of the Acad'l. JOHN SIMMONS, Dep. of the University of WILLIAM M'NAIR, Pennsylvania. E. H. HUBBARD, THOMAS M'ADAM, EZEKIEL FOUSE, THOMAS T. AZPELL, Rev. W. MANN, A. M. A. MITCHELL, J. MADEIRA, H. MORROW, J. E. SLACK, D. R. ASHTON, L. W. BURNET, BENJAMIN C. TUCKER, 2* VALUABLE BOOKS, PUBLISHED BY 9 JOHN HASLAM, THOMAS EUSTACE, JOHN EUSTACE, WM. MARRIOTT, RIAL LAKE, THOMAS COLLINS, MATTHIAS NUGENT, SAM. CLENDENIN, JAMES CROWELL, WILLIAM B. ROSE, A. LUDINGTON, ES. LEVY, WILLIAM ROBERTS, SAMUEL J. WILLEY, THOMAS BALDWIN, U. KITCHEN, M. L. HURLBERT, SHEPHERD A. REEVES, EDMUND NEVILLE, NICHOLAS DONNELLY, WM. A. GARRIGUES. PINNOCK'S ROME. Pinnock's improved edition of Dr. Goldsmith's History of Rome. To which is prefixed an Introduction to the Study of Roman History, and a great variety of information through- out the work on the Manners, Institutions, and Antiquities of the Romans; with questions for examination at the end of each section. Twenty-fifth American from the twenty-third London edition, improved by W. C. Taylor, L L.D., with numerous engravings by Atherton and others. RECOMMENDATIONS. Having examined Pinnock's improved edition of Dr. Goldsmith's History of Rome, I unhesitatingly say, that the style and elegance of the language, the arrangement of the chapters, and the questions for ex- amination, render it, in my estimation, a most valuable school book:— I therefore most cheerfully recommend it to teachers, and do confidently trust that it will find an extensive introduction into the schools of our country. JAMES F. GOULD. Baltimore. We fully concur in the above recommendation. S. P. SKINNER, C. H. ROBINSON, ROBERT WALKER, WILLIAM HAMILTON, DAVID RING, JAMES E. SEARLEY, SAMUEL ROSZEL, E. YEATES REESE, N. SPELMAN, B. WALSH, PARDON DAVIS, SAMUEL HUBBELL, O- W. TREADWELL, A. DINSMORE, JAMES WILKESON, JOSEPH H. CLARKE, S. A. CLARKE, JOSEPH WALKER, JAMES SHANLEE, E. RHODES HARNEY, ROBERT O'NEILL, MICHAEL POWER, JOHN PRENTISS, EDWARD S. EBBS, MICHAEL TONER, 10 VALUABLE BOOKS, PUBLISHED BY FROST'S UNITED STATES. History of the United States, for the use of Schools and Academies, by John Frost, Illustrated with Forty Engravings. RECOMMENDATIONS. I am glad to see that the " History of the United States," which you announced some time since, has made its appearance. The ex- tensive research which has of late years been carried on upon the subject of American History, and the careful investigation of original sources of intelligence, by individuals eminently qualified for the task, have furnished valuable materials from which to enlarge and correct the historical records of our country. It was time to have these advantages transferred to works designed for the purpose of education. I was happy, therefore, to observe, by your announcement, that a book on this plan was to be prepared. I have since been gratified with the perusal of the volume; and I take pleasure in saying that it appears to me in every respect well executed. It avoids the fault with which most compilations are chargeable — that of merely sketching a general outline of events, too brief and abstract to gain the attention of the student. It is free at the same time, from injudicious prolixity and detail. The style is clear, concise and spirited; free on the one hand from the ambitious and rhetorical character, and on the other, from the negli- gence and inaccuracy into which most of our popular compends have fallen. As a history of the United States, it is, in my opinion, more full and more exact than any of the same size, and in all other respects prefera- ble, as a book intended to aid the business of instruction. WILLIAM RUSSELL, Editor of the American Journal of Education, 1st series. We fully concur in the sentiments above expressed. G. .T. HOPPER, RUFUS LOCK WOOD, ROYAL MANN, JOHN OAKLY. HENRY SWORDS. GEORGE INGRAM, J. C. TREADWELL, JOS. M'KEEN, F. S. WORTH. WM. FORREST, F. A. STREETER, JAMES LAWSON, DAVID SCHOYER. SOLOMON JENNER. JOS CHAMBERLAIN, JOSEPH MOONY. O. W. NICHOLS, M. BEARDSLEY. WM H. WYCKOFF, THEO. W. PORTER, O. C. JENNINGS. ROBERT J. FURNEY, JYew York. AARON RAND. EDMUND D. BARRY.D.D.. Principal of a Classical Aca- oVmy. SAMUEL GARDNER. I). STENENS. SAMUEL BROWN, JOSEPH M ELY. P. PERR1NE. SAMUEL RICHARDS. Columbia Academy, Philadelphia. I am so well pleased with " Frost's History of the United States," and its merits as a school book, that I have organized a class who are now engaged in studying it. Respectfully, yours, &.c. J. H. BROWN. / THOMAS, COWPERTHWAIT AND CO. 11 We fully concur in the opinions expressed in the foregoing recommendation. JOHN COLLINS, JOHN ALLEN, WILLIAM MANN, S. H. REEVKS, JAMES CROWELL THOMAS COLLlNs\ R. M'CUNNEY. THOS. H WILSON, DAVID SMITH, KARTRAM KAIGHN, M. SEMPLE, B. W. BLACKWOOD, WM. M'NAIR, E. W. HUBBARD. WILLIAM LEWIS, E. NEVILLE, JAMES E. SLACK. RICH. O'R. LOVETT. MATTHIAS NUGENT, 41 L. W. BURNETT, CHARLES MEAD, THOMAS M'ADAM, D. R. ASHTON, JOSEPH RAPP, No. Sansnm street. JOHN PURLZ, A. LUOINGTON, S. CLENDENIN, A. MITCHELL, T. T. AZPELL. J. B. WALKER, H. LONGSTRETH, A. M., Classical Teacher, Friends' Academy. WM. MARRIOTT, Princi- pal of Philadelphia Select Academy, corn, of 5th and Arch streets. W. ALEXANDER, A.M. T. G. POl'TS. RIAL LAKE, E. FOUSE, N. E. corner of Rice and Sixih sts. WM. A.GARRIGUE3, Ma- thematical Teacher, I. I. HITCHCOCK, THOMAS BALDWIN, T. SEVERN, JOHN SIMMONS, JOHN EVANS. JOHN STOCKDALE, Rev. S. W CRAWFORD, A. M., Principal of the Aca- demical Department of the University of Pennsylvania. I have long felt the want of a good History of the United States, and was pleased to have the opportunity of perusing Frost's. 1 am so much pleased with its elegance of Lan- guage, neat arrangement, copious questions, and style of getting up, that I shall at once introduce it into my school, and use my influence to give it a wide circulation. E. B. HARNEY. Baltimore. We fully concur in the above. EDWARD S. EBBS, MICHAEL POWER, A. DINSMORE, JAS WILKINSON, N. M. KNAPP, DAVID KING, JOHN R. GARBOE, JOSEPH WALKER, JAMES E. SEARLY, T. RANDOLPH. C. H. ROBERTSON, C. F. BANSEMOS, ROBERT O'NEAL, JOHN HARVIE. E YEATES REESE, PHILIP WALSH, JOHN KIRBY, A. M. BENJAMIN G. FRY, S M. ROZEL, JOSEI'H H. CLARKE, JOHN KEELEY. PARDON DAVIS. Philadelphia, March 24, 1838. This is to certify that " Frost's History of the United States" has been adopted as a class-book by the Controllers of the Public Schools of the First School District of Pennsyl- vania, and is in general use in the public schools of the city and county of Philadelphia. R. PENN SMITH, Secretary of the Board of Controllers' FROST'S HISTORY OF THE UNITED STATES, For the use of Common Schools, condensed from the author's larger History of the United States. RECOMMENDATIONS. The following are selected from a larpe number of recommendations of the above work, which have been received by the publishers. It has been adopted by the Controllers of the Public Schools of the city and county of Philadelphia, and by other committees of pub- schools in various parts of the country. From, the Rev. C. H. Alden, Principal of the Philadelphia High School for Oirls- " Frost's History of the United States" is a Text book in my school, and is justly a favourite. I have often regretted that an edition, in a smaller volume, with numerous illustrative engravings, was not furnished for the use of our junior classes and common schools. I am glad, therefore, to see what I thought a desideratum, and in a style, and at a price so well adapted to the purposes intended. This volume, I find, is abridged from the larger volume very judiciously, and can be recommended very confidently to general use. There is no history of our country, in my opinion, at ail comparable with it as a common school book. CHARLES HENRY ALDEN 12 VALUABLE BOOKS, PUBLISHED BY I judge " Frost's History of the United Statos" to be a most excellent epitome of Ame- rican History. Many interesting and important facts relative to American affairs, in other works of the kind omitted, are therein judiciously introduced. The simplicity and elegance of the style, cannot fail to please every attentive reader. The appendix, containing the constitution of our beloved land, as also a useful chronological table, will render the work doubly valuable. WM. ALEXANDER, Teacher of Languages, Philadelphia. FROST'S AMERICAN SPEAKER. The American Speaker; comprising a comprehensive Trea- tise on Elocution, and an extensive Selection of Specimens of American and Foreign Eloquence. Embellished with en- graved Portraits of distinguished American Orators, on steel. By J. Frost, author of History of the United States. The design of this work is to furnish a correct and satisfac- tory Treatise on the Principles of Elocution in a small space ; and a very rich and copious collection of specimens of Deli- berative, Forensic, Academic, and Popular Eloquence, filling up the greater portion of the volume. It has met with a very rapid sale, six thousand copies having been called for within a few weeks after its first appearance. The estimation in which it is held by intelligent teachers has been attested by recom- mendations from every quarter. We have no room for the numerous recommendations which we have at hand. FROST'S PRACTICAL GRAMMAR. " A practical system of English Grammar, with progres- sive exercises" in Othography, Analysis and Grammatical Composition, adapted to the use of schools and private students, by John Frost, A.M.,&c. &c. The distinguishing features of this work are of an entirely novel character, and calculated, by simplifying the study of the science, to faci- litate the progress of the student, and at the same time abridge the labours of the teacher. The publishers would, therefore, especially re- commend its examination to the attention of all who are interested in the cause of Education. RECOMMENDATIONS. Philadelphia, April 15th, 1842. Prof. Fhost :—Permit me, sir, to acknowledge the receipt of your new Grammar which I put immediately to the only true test of a school book, viz., use in school. The pupils seem delighted with the VALUABLE BOOKS, PUBLISHED BY 13 THE CHILD'S HISTORY OF THE UNITED STATES. Designed as a First Book of History for Schools; Illus- trated by numerous anecdotes," by Charles A. Goodrich, improved from the thirty-first edition. Philadelphia, 1845. This is a delightful little book, and it would not be easy to find a more suitable one to put in the hands of children. THE CONSTITUTION AND REVISED STATUTES OF THE UNITED STATES, And Additional Laws to 1844, reduced to Questions and Answers for the use of Schools and Families, by William B. Wedgwood, A.M., Member of the New York bar; Author of the Revised Statutes of New York, New Hampshire, Maine, Connecticut, Massachusetts, Vermont, Pennsylvania, Ohio, &c. RECOMMENDATIONS. From the Hon. Benjamin F. Butler, L L. D., late Attorney General of the U. S. New York, July 0,1th, 1844. Dear Sir: — I think you entitled to the thanks of the public, and I trust you will receive their substantial patronage, for the plan you have adopted, and thus far so successfully executed, of placing before the youth of the country in the Common School, and at the domestic fireside, the elementary principles of our Federal and State Constitutions, and the more important statutes, and provisions of their respective States. In a country like ours, where every citizen is required not only to exer- cise the right of suffrage, but to take his part in the execution of the laws, and where so much depends on the general intelligence of the masses, it is of the first importance that the leading rules of our Con- stitutional and Legislative codes should be known and understood by all classes; and the method you have adopted is so well adapted to promote this end, that I cordially unite with the other friends of popu- lar instruction to whom you have submitted your works, in commend- ing them to the favour of our countrymen. I am, dear sir, your friend and ob't. serv'L B. F. BUTLER. William B. Wedgwood, Esquire, New York. Cincinnati College, July 10th, 1845. Gentlemen.__The books you were pleased to submit for my inspection, viz., " The Constitution and Revised Statutes of the U. S. and Ad- ditional Laws to 1844," and "The Revised Statutes of Ohio, and Additional Laws to 1844," each "reduced to questions and answers for the use of schools and families, by William Wedgwood, Esq., Member of the New York bar," I have examined with care, and with- out hesitation I give them my entire approbation. They are exartly 14 THOMAS, COWPERTHWAIT AND CO. suited to the exigencies of the times which plainly show that " univer- sal instruction should be the companion of universal suffrage." There is, in the arrangement, style, and form of these books an attractiveness combined with adaptedness, that will secure, as I think, an extensive circulation. Mr. Wedgwood deserves the thanks of his countrymen for his successful efforts in the production of these volumes. I hope they may find their way into all our Public Schools, Academies, and Colleges. Very respectfully yours, TH. J. BIGG8, President of the Cincinnati College. "The Constitution and Revised Statutes of the United States," " The Revised Statutes of the State of Pennsylvania," by William B. Wedgwood, of the New York bar. Philadelphia, Thomas, Cow- perthwait & Co. These are two distinct volumes. They are composed in the form of questions and answers, designed for the use of Schools. Happy would our country and state be, secure in their policy and their honour, if no man could exercise the privilege of a voter without the ability to answer the leading questions in these books. We consider the study of them in schools of primary importance. As every boy in the country is destined to share the sovereign authority which belongs to the people, it is a duty which the elder generation owes to the re- publican cause, to instil into the young mind not only the general princi- ples upon which the government rests, but to teach the special laws which constitute its policy. Without this teaching, there can be no really honest or intelligent voting.—North American. Constitution and Statutes of United States to 1844. Constitution and Statutes of Ohio, to 1844, by Wm. B. Wedgwood.—These works are designed for families and schools, and what works can be more valuable in a utilitarian point of view, than those which give to our un- fledged and half-fledged democrats, a knowledge of the laws and govern- ment under which they live 7 Call yourselves by what name you please, Whigs, Liberty men, or Socialists, you are still democrats in fact, and to what do you more need to attend than to the Constitution and Laws 1 For the higher classes in schools, male or female, for all apprentices and clerks, for all who wish in few words and with little labour to know the substance of the Constitution and Laws of Ohio and the United States, we can recommend these works; indeed we would advise merchants, doctors, mechanics, and farmers, to buy these works, in which the substance of the municipal law is embodied. They are at Desilver & Burr's. Constitution and Revised Statutes of the U. States. A work un- der this title has just been published, prepared by W. B. Wedgwood, Esq., on the plan we mentioned a few clays since, of adapting it by questions and answers, to the use of Schools. It is a matter of the highest importance that the children of the country should grow up with a knowledge of the laws under which they live ; and Mr. Wedg- wood's series of works is better adapted to secure this universal acquaint- ance than any other ever published. It is very highly recommended by VALUABLE BOOKS, PUBLISHED BY 15 eminent jurists and others, and doubtless merits the most decided confi- dence and support.—N. Y. Courier and Enquirer. THE REVISED STATUTES OF THE STATE OF PENNSYLVANIA, And Additional Laws to 1844. Reduced to Questions and Answers, for the use of Families and Schools, by William B. Wedgwood, A.M. THE REVISED STATUTES OF THE STATE OF OHIO, And Additional Laws to 1844. Reduced to Questions and Answers, for the use of Schools and Families, by Wm. B. Wedgwood, A.M. Of the importance of these books, it is unnecessary to speak : of the excellence of their form, the recommendations which have been received, give the highest testimony. NEW BOOK.—We some time since noticed in a brief manner the appearance of a new book, intended for families, and especially schools and the young, which contains a fund of information very im- portant and yet very little attended to in education. The Declaration of Independence is given, and the causes that led to its adoption ; the Constitution of the United States, and the nature of its provisions and powers; the more important provisions of our Peace Treaties with foreign nations; what are crimes against the General Government and the rights of the criminal; government of the Navy; Copy-right; Patent- right and Naturalization Laws, &c, &c, all put in the shape of questions and answers, and suited to the comprehension of every reader—The author is W. B. Wedgwood, Esq., of the New York bar—Cincinnati Daily Inquirer and Message. THE AMERICAN STATISTICAL ARITHMETIC, Bv Francis H. Smith, Superintendent of the Virginia Military Institute, and formerly Professor of Mathematics at West Point; assisted by Professor R. T. W. Duke. recommendations. The undersigned members of the Board of Visitors of the V. M. Institute, having examined the American Statistical Arithmetic, by Col F H Smith Supt. of the Institute, take great pleasure in recom- mending it as a work of decided merit, admirably suited for the wants of the Schools and Academies. P C JOHNSTON, GEORGE H. LEE, rSrON J. W. BROCKENBROUGH, C. PDORMAN, W. H. RICHARDSON. CHARLES DIMMOCK. 16 VALUABLE BOOKS, PUBLISHED BY It is a novel, and, we think, a very useful treatise. The design of the work is to illustrate the various rules of Arithmetic by examples, selected, as far as practicable, from the most prominent facts connected with the history, geography, and statistics of our country. The design is a good one. By this mode, Arithmetic becomes a medium for com- municating much important information, which will be readily appre- ciated by the youthful mind, and impressed upon it through life. We cordially commend the work to the attention of Teachers, School Committees, etc.—Philadelphia Saturday Courier. The term statistical is used in this work, because many of the exam- ples are taken from the statistics of the nation and the States, so that while the pupil is improving his intimacy with figures, he is acquiring valuable knowledge of facts concerning his own country—facts that lose none of their value by the change of times, since a taste for such truths being obtained, leads the mind to a constant inquiry to correct its knowledge by the latest exhibition of facts. The authors have been very careful to use all simplicity in their ex- planations and illustrations, and in some of the rules have, in our opinion, been more fortunate than most of their predecessors in pre- senting the rationale of any axiom laid down.—United States Gazette. SMITH'S BIOT'S ANALYTICAL GEOMETRY. AN ELEMENTARY TREATISE ON ANALYTICAL GEOMETRY: Translated from the French of J. B. Biot. Adapted to the state of Mathematical instruction in the Col- leges of the United States, by F. H. Smith, A.M., Principal Professor of Mathematics at the Virginia Military Institute, late Professor of Mathematics in the Hampden Sidney Col- lege, and formerly Assistant Professor in the U. S. M. Acade- my at West Point. A new and greatly improved edition of this work is now in press. KEY TO THE AMERICAN STATISTICAL ARITH- METIC, by Prof. F. H. Smith, A.M. SMITH'S INTRODUCTORY ARITHMETIC. SMITH'S ELEMENTS OF ALGEBRA. The three last mentioned works will soon appear, and will be follow- ed by such others as will be requisite to form a complete Mathematical Series. THOMAS, COWPERTHWAIT AND CO. 17 BRIDGE'S ALGEBRA. A TREATISE ON THE ELEMENTS OF ALGEBRA, by Rev. B. Bridge, D.D., F.R.S., Fellow of St. Peter's College, Cambridge, and late Professor of Mathematics in the East India College, Herts. Revised and corrected from the eighth London edition. In this work, the hitherto abstract and difficult science of Algebra is simplified and illustrated so as to be attainable by the younger class of learners, and by those who have not the aid of a teacher. It is already introduced into the University of Pennsylvania at Philadelphia; and the Western University at Pittsburg. It is also the text-book of Gummere's School at Burlington, and Friends' College at Haverford, and of a great number of the best schools throughout the United States. It is equally adapted to Common Schools and Colleges. BONNYCASTLE'S ALgEBRA. AN INTRODUCTION TO MENSURATION AND PRACTICAL GEOMETRY, by John Bonnycastle, of the Royal Military Academy, Woolwich. To which is added a Treatise on Gauging; and also the most important Problems in Mechanics, by James Ryan, author of a Treatise on Alge- bra, the New American Grammar of Astronomy, the Diffe- rential and Integral Calculus, &c. This work is well known, as holding an eminent rank among Mathematical Treatises. GUMMERE'S SURVEYING. A TREATISE ON SURVEYING, containing the Theory and Practice. To which is prefixed a perspicuous system of Plane Trigonometry. The whole clearly demonstrated and illustrated by a large number of appropriate examples, particu- larly adapted to the use of Schools, by John Gummere, A. M., Fellow of the American Philosophical Society, and cor- responding Member of the Academy of Natural Sciences, Philadelphia. Fourteenth edition, carefully revised and en- larged by the addition of articles on the Theodolite, on Level- ing and Topography, 1845. The favourable reception, and extensive circulation of this Treatise make recommendations unnecessary. 3* |* VALUABLE BOOKS, PUBLISHED BY GUY AND KEITH. GUY ON ASTRONOMY, AND KEITH ON THE GLOBES ; Guy's Elements of Astronomy, and an Abridge- ment of Keith's New Treatise on the Globes. Thirtieth American edition, with additions and improvements, and an explanation of the astronomical part of the American Almanac. Illustrated with eighteen plates, drawn and engraved on steel, in the best manner. RECOMMENDATIONS. A volume containing Guy's popular Treatise of Astronomy, and Keith on the Globes, having been submitted to us for examination, and carefully examined, we can without any hesitation recommend it to the notice and patronage of parents and teachers. The work on Astro- nomy is clear, intelligible, and suited to the comprehension of young persons. It comp#es a great amount of information and is well illustrated with steel engravings. Keith on the Globes has long been recognized as a standard school book. The present edition, comprised in the same volume with the Astronomy, is improved by the omission of much extraneous matter, and the reduction of size and price. On the whole, we know of no school book which comprises so much in so little space as the new edition of Guy and Keith. THOMAS EUSTACE, JOHN HASLAM, W. CURRAN, SAMUEL CLENDENIN, SHEPHERD A. REEVES, JOHN STOCK DALE, J. B. WALKER, J. E. SLACK, JOS. R. EASTBURN, WILLIAM M'NAIR, H. O. WATTS, J. O'CONNER, Sec'y. to the Phila. Assoc'n of Teachers. B. N. LEWIS, Rev. CHAS. H. ALDEN, BENJAMIN C. TUCKER, J. H. BROWN, JOHN ORD, SETH SMITH, WM. ROBERTS, T. H. WILSON, JOSEPH WARREN, W. B. ROSE, CHARLES MEAD, BENJAMIN MAYO, HUGH MORROW, J. H. BLACK, S. C. WALKER, THOMAS COLLINS, WILLIAM MANN, R. LAKE, WM. MARRIOTT, C. B. TREGO, JOHN ERHARDT, R. W. CUSHMAN, THOMAS M'ADAM, Rev. SAMUEL W. CRAW- FORD, A.M., Principal of Academical Dept. of Uni- versity of Pa. OLIVER A. SHAW, A. LUDINGTON, M. SOULE, WM. A. GARRIGUKS, M. L. HURLBERT, S. JONES. VALUABLE BOOKS, PUBLISHED BY 19 WM. C. FOWLER, Professor of Chemistry in Middlebury College, Vermont. B. S. NOBLE, Bridgeport, Conn. Rev. C. H. ALDEN, A.M., Principal of Philadelphia High School for Young Ladies. Rev. S. B. HOWE, late President of Dickinson College. Rev. Dr. WESTBROOK, Principal of Female Seminary and Rector of Rutgers' College Grammar School. Dr. B. F. JOSLIN, Professor Union College, New York. GEO. B. GLENDINING, Principal of Young Ladies' Academy, Troy, N. Y. M. CATLIN, A.M., Professor of Mathematics in Hamilton College, New York. SWAN'S SERIES OF READERS PRIMARY SCHOOL READER, Part First. PRIMARY SCHOOL READER, Part Second. PRIMARY SCHOOL READER, Part Third. GRAMMAR SCHOOL READER. DISTRICT SCHOOL READER. • RECOMMENDATIONS. From the Teachers of the Public Schools in Salem. Mb. Wm. D. Swan, — Dear Sir: We have examined, with some care and much satisfaction, the several Parts of your Primary School Reader. We have long felt that more attention should be given to the wants of our Primary Schools. It is of the utmost importance, we think, that children in these Schools should receive more instruction and exercise in the elementary sounds of the letters, and conse- quently in clear and distinct enunciation. Your books are, in our opinion, admirably adapted to meet the wants of our Primary Schools, in the particular named, and we most earnestly and heartily commend them to the notice of the friends of education. C. C. FELTON, D. P. GALLOUP, CHARLES NORTHEND, J. B. FAIRFIELD, EDWIN JOSELYN, A. LACKEY. From Mr. Thomas Sherwin, Principal of the English High School, Boston. Boston, Dec. 1, 1845. Mb. Wm. D. Swan,—Dear Sir : Accept my thanks for a copy of your Series of Readers, which you have kindly sent me, as they were issued from the press. I have carefully examined these Volumes myself, and have heard in private the uniformly favorable opinions of many gentlemen well qualified to judge of their merits. 20 THOMAS, COWPERTHWAIT AND CO. Allow me to say, that I think they are admirably adapted to the ob- jects for which they were designed, and that I heartily recommend them to the favour of all interested in the cause of English education. Very respectfully, yours, THOMAS SHERWIN. Extract from the Records of the School Committee of the City of Boston. Ordered, That the Primary School Reader, Part Third, by William D. Swan, be introduced into the Grammar Schools, as the Reading Book for the Fourth Class, in the room of the Gradual Reader. Attest, S. F. M'CLEARY, Secretary. From the Cincinnati Gazette. A prominent object with the author, is to teach distinct and clear articulation ,■ and this end, which is as important as any other that the teacher has, or ought to have in view, we think Mr. Swan's books are admirably calculated to attain. Another good thing in them, is the real- ly interesting character of their lessons in reading. These lessons are in the main such as will lay right hold of the mind of a child, and im- part instruction whilathey may seem to be affording only entertainment. The Series is, at least, worth examining. Want of space prevents our saying anything more of these important works. , JOHNSTON'S TURNER'S CHEMISTRY. (New Edition.) "A Manual of Chemistry, on the basis of Dr. Turner's Elements of Chemistry, containing, in a condensed form, all the most important facts and principles of the science; designed for a Text-book in Colleges and other Seminaries of Learning." From Professor Booth of the High School. Philadelphia, Nov. 30,1842. I find upon a careful examination of Johnston's Manual of Chemis- try, that it is extremely weH adapted to the object for which it is de- signed. As a text-book, I regard it superior to Turner's Chemistry, on which it is based, being more condensed and practical, and yet sufficiently and equally presenting the late rapid advancement of the science. From John F. Fbaseb, Professor of General Chemistry in the Franklin Institute, Philadelphia. I find it to be a carefully-compiled and well-digested Treatise, and, as I believe, well adapted to serve the purpose of a text-book, for which it is intended. This work has been introduced into many Academies and several Colleges, and is held in the highest estimation. VALUABLE BOOKS, PUBLISHED BY 21 JOHNSTON'S PHILOSOPHY. A manual of Natural Philosophy, Designed as a Text-book for the use of High Schools and Academies, by J. John- ston, A.M., Professor of Natural Science in the Wesleyan University. This is considered the most complete Treatise on the various branches of Natural Philosophy now extant. WILMSEN'S READER, OR CHILDREN'S FRIEND. This is one of the best books that has been offered to the young people of this country. It is well adapted to the progressive condition of the present system of education, because it is somowhat in advance of it. It is eminently practical. Every page of it contains maxims of wisdom and morality, or lucid delineations of facts, which are applica- ble to the occurrences of every day. It is universally known, that the schools of Prussia afford models to the rest of the world, and as this is one of the readers used in them, it is no unimportant fact in relation to it, that this translation is made from the 150th German edition. Mr. Wm. Wells, the translator, is well known to a large circle in this city, who need no assurance of his competence to the task, both from natu- ral abilities and attainments. We hope the circulation of the work will be equal to its high degree of merit—Daily Chronicle. Wilmsen's Reader from the German, translated and adapted to the use of Schools, by William Wells, Teacher of Modern Languages. The work, of which this is a translation, has long been the first work in the schools of Prussia, where popular instruction has been brought to great perfection. It is called the Children's Friend, and its easy and instruc- tive lessons render it eminently deserving of that title.—Public Ledger. This work will, if properly used, enable any child of ordinary capa- city to learn how to think, and also supply the mind with thousands of useful facts upon which to exercise its faculties. Its employment will not cause other works to be dispensed with, but on the contrary, will rather act as a stimulus to a more ardent pursuit of knowledge. It is confidently recommended as one of the most valuable works for the in- struction of youth ever published in this country.—Phila. Inquirer. The instructor, while his class is reading in it, can make inatten- tion almost impossible without tasking himself, or perplexing the scholar. Philadelphia, Nov. 28, 1845. I had an opportunity of hearing a large portion of Wilmsen's Reader read in manuscript by the translator, and for some time past have had a copy of the work in my possession. I was highly pleased with the 22 THOMAS, COWPERTHWAIT AND CO. work before it was printed, and am still more so now; and think it ought as soon as practicable to'be introduced into our Public Schools. JOHN M. COLEMAN, Principal of the New Market Street School. PARLEY'S CABINET LIBRARY. THE MOST POPULAR FAMILY AND SCHOOL LIBRARY EVER PUBLISHED. This work consists of Twenty Volumes, and contains five hundred different subjects, and is illustrated by five hundred Engravings. It is an entirely original series, recently written and completed by S. G. Goodbich, the author of Peter Parley's Tales. This is the only Library that has been expressly written for a School and Family Library. It is adopted into many of the Libraries of the leading Schools and Seminaries in New England and New York, and has been introduced, in the space of a few months, into more than two thousand families, in Boston, New York, and Philadelphia. The following is a list of the Volumes :— BIOGRAPHICAL DEPARTMENT. Vol. 1.—Lives of Famous Men of Modern Times. " 2.—Lives of Famous Men of Ancient Times. « 3.—Cubiosities of Human Natube ; ob, The Lives of Ec- centric AND WONDERFUL PeBSONS. « 4__Lives of Benefactors ; including Patriots, Invent- OBS, DlSCOVEREBS, &C. " 5.—Lites of Famous American Indians. » 6.—Lives of Celebrated Women. HISTORICAL DEPARTMENT. " 7.—Lights and Shadows of Amebican History. " 8.—Lights and Shadows of European History. « 9.—Lights and Shadows of Asiatic Histoby. « 10.—Lights and Shadows of Afbican Histoby. « 11.—History of the American Indians. « 12__Manners, Customs, and Antiquities of the Ameri- can Indians. MISCELLANEOUS. " 13.—A Glance at the Sciences, Astronomy, Natural Phi- losophy, &c. " 14.—Wonders of Geology. " 15.—Anecdotes of the Animal Kingdom. " 16.—A Glance at Philosophy, Mental, Moral, and Social. " 17.—Book of Literature, Ancient and Modern, with Specimens. " 18.—Enterprize, Industry, and Art of Man. « 19.—Manners and Customs of all Nations. u 20.—The World and its Inhabitants. THOMAS, COWPERTHWAIT AND CO. 23 with suitable books for Libraries, we heartily commend this Series to the notice of all who are desirous of obtaining books for this object They are unquestionably among the best tha» have been prepared for School Libraries, being every way attractive and instructive. From the Boston Atlas, May 3. It is a compact family and School Library of substantial reading, which is delightful in point of style, and wholesome in its moral, social, and religious tendency. From the Boston Post, July 8. We hardly know when we have been better pleased with a publica- tion than this. From the Albany Advertiser. It ought to be, and no doubt will be, extensively introduced into Schools. Board of Education, } City of Rochester, Sept. 2,1844. $ Whereas, the Board of Education have examined a series of books called " Parley's Cabinet Library," now in course of publication by Sam- uel G. Goodrich, Esq., (the celebrated Peter Parley,) embracing, in the course of Twenty Volumes on the various subjects of History, Biogra- phy, Geography, the Manners and Customs of different Nations, the condition of the Arts, Sciences, &c.; and whereas, this Board are satis- fied that the same are highly useful to the young: therefore, Resolved, that we recommend that the same be procured by Trustees for the several School Libraries, at the earliest practicable period.—A true copy of the minutes. I. F. MACK, Sup't. Want of space obliges us to omit many other recommendations of this work, which have been received from the friends of Education in various parts of the country. PARLEY'S SERIES. PARLEY'S AMERICA, new and revised edition. PARLEY'S EUROPE, do. do. PARLEY'S ASIA, do. do. PARLEY'S AFRICA, do. do. PARLEY'S ISLANDS, do. do. PARLEY'S TALES OF THE SEA, do. PARLEY'S ROME, do. do. PARLEY'S GREECE, do. do. PARLEY'S WINTER EVENING TALES. PARLEY'S JUVENILE TALES, do. PARLEY'S BIBLE STORIES, do. 4 24 VALUABLE BOOKS, PUBLISHED BY PARLEY'S ANECDOTES, new and revised edition. PARLEY'S SUN, MOON and STARS, do. PARLEY'S WASHINGTON, a new and valuable School Biography. PARLEY'S FRANKLIN, do. do. PARLEY'S COLUMBUS, do. do. GOLDSMITH'S NATURAL HISTORY, Illustrated, 12mo. JAUDON'S EXPOSITOR. COMLY'S GRAMMAR. HISTORIC SACR^E, new edition. VIRI ROM^E, do. do. CLARK'S CESAR. SMART'S CICERO, new edition, 12mo. RUDDIMAN'S RUDIMENTS OF THE LATIN TONGUE, new and improved ed., with Notes, by Wm. Mann, A.M. CLEVELAND'S FIRST LESSONS IN LATIN. CLEVELAND'S ADAMS' NEW LATIN GRAMMAR. CLEVELAND'S NEW LATIN READER, with an enlarged and improved Vocabulary, and Notes adapted to his Grammar. CLEVELAND'S NEW LATIN READER, Part Second, with Notes. CLEVELAND'S LATIN EXERCISES, adapted to the Grammar, with a key. GRiECA MAJORA. THE REV. J. PYCROFT'S LATIN AND GREEK GRAMMAR PRACTICE. These works have the approbation of some of the first scholars and instructors. The Rev. J. S. Riddle, author of the Latin Dictionary, has testified to their value to junior classes, to those who would teach themselves, and all who would make progress in a sound acquaintance with Greek and Latin Grammar. With these books any well educated person might teach Latin and Greek with more ease than French or Italian in the common way. Words and phrases are taught at the same time as rules and inflections. They are practical in their aim and character, and will be found useful companions to any Grammar. Opinion of the Rev. S. W. Crawford, of the Academical Department of the University of Philadelphia. I have examined with considerable care the two works of Pycroft, of which you were pleased to ask my opinion. The plan is excellent THOMAS, COWPERTHWAIT AND CO. 25 and admirably calculated to accomplish the end intended. They ought to be used in every classical seminary. I would be glad to have it in my power to introduce them into the Academical Department of the University. BROOKS' ROSS' LATIN GRAMMAR. With Latin Idioms, and a New Prosody, and other import- ant Additions and Emendations, by N. C. Brooks, A.M., Professor of the Latin and Greek Languages, and Principal of the Latin High School Baltimore. This favourite work, familiar to so many as a guide and compan- ion in the study of the Latin language, makes its appearance from the careful hands of Mr. Brooks, in an highly improved form. The new emendations relate both to arrangement and matter___A more definite order is introduced into the various parts, with more clear illustrations. In Syntax the number of rules is lessened without the omission of any- thing essential, and this advantage is gained by a masterly analysis of the principles of the language, as applied to the syntactical construction. A new system of Prosody is introduced in place of the Prosody of Ross, which was for the most part in Latin. The work altogether is much improved, and in its present form it cannot but come into general use; for the intrinsic merits of this grammar are confessedly great, and they are now enhanced by the careful supervision of an accomplished scholar. We observe that several£experienced teachers in the city have adopted it jn their schools in consequence of the valuable improvements made upon the original by Mr. Brooks.—Baltimore American. The publishers have issued a work well worthy the attention of the country : and have done no little credit to their good judgment, by inviting the assistance of so profound and indefatigable a scholar as our esteemed and excellent neighbour and friend, Professor Brooks : who instead of having edited a new edition of Ross, as is modestly set forth in the title page, may be said, rather, to have furnished the public with a Latin Grammar, in the preparation of which he has availed himself, by way of assistance, mainly of the Grammar of Mr. Ross. We have no hesitation in commending this book highly. We have not seen its superior.—It ought to have a rapid sale; and, as we have no doubt, many future editions will attest its deserved popularity. Pro- fessor Brooks is passionately fond of literature, is a ripe and elegant scholar, quite enthusiastic in his profession, and well merits the high reputation to which he has attained—Methodist Protestant. Our limited space will admit no more notices of this excellent work. GRAETER'S GERMAN PHRASES, New Edition, 12mo. 26 VALUABLE BOOKS, PUBLISHED BY PORNEY'S FRENCH SPELLING BOOK, New and Improved Edition. PICOT'S SERIES OF FRENCH SCHOOL BOOKS. No. 1. FIRST LESSONS IN FRENCH. No. 2. FRENCH STUDENT'S ASSISTANT. No. 3. INTERESTING NARRATIONS IN FRENCH. No. 4. HISTORICAL NARRATIONS IN FRENCH. No. 5. SCIENTIFIC, LITERARY, AND OTHER NAR- RATIONS. No. 6. FLEURS DU PARNASSE FRANCAIS, or Elegant Extracts from the best French Poets. From Peter S. Du Ponceau, LL.D., President of the American Phi- losophical Society, Philadelphia. Philadelphia. Dear Sir,—I beg you will receive my thanks for the copy of the new edition of your First Lessons in French, which you have done me the honour to present to me. I have read it with pleasure. The high reputation which you have acquired by the successful exercise of your profession in this city, during five and twenty years, renders any recom- mendation of that work entirely unnecessary: nevertheless, I cannot help expressing my satisfaction at the publication of a work so well cal- culated for the instruction of our youth in the French language. I am dear Sir, Your most ob't humble serv't, PETER S. DUPONCEAU. From the Consul General of France for the United States. Consulat General de France aux Etats-Unis, New-York, Sep. 26, 1844. My dear Sir, You wish to know what I think on the subject of the School Books which you published lately, viz : No. 1.—First Lessons in French, &c. No. 2.—The French Student's Assistant, &c. No. 3.—Interesting Narrations in French. No. 4.—Historical Narrations in French. No. 6.—Fleurs du Parnasse Francais. My candid opinion is that they are excellent; and as they are con- sidered by many professors and other persons able to judge, as admirably calculated to facilitate the object for which they are intended ; I hope they will be extensively used, and that your incessant efforts to make the American public profit by your long and valuable experience will be duly appreciated. Receive, my dear Sir, the new assurance of my highest consideration and sincere friendship. Yours, L. DE LA FOREST. Charles Picot, Esq,., Philadelphia. THOMAS, COWPERTHWAIT AND CO. 27 From the Courrier des Etats-Unis. Le plan, concu par M. Picot, est une cle merveilleuse de la science qu'il professe; elle doit, a coup sur, aplanir a ses eleves bien des diffi- cultes, en traduisant aux yeux la theorie et la parole du maitre. From Dr. Togno, Principal of an Academy for Young Ladies, at Winchester, Va. My dear Sir,—I have carefully and minutely examined your Series of School Books, so well calculated to facilitate the acquisition of the French language. I feel convinced that your complete course of instruc- tion, if closely followed by an intelligent French teacher,, will, with the aid of your method of pronunciation, double translation, &c, &c., pro- duce the most rapid and solid progress in the pupil with respect to the complete attainment of the spoken and written French language, as well as the expansion of the pupil's mind. From J. L. H. Ver Mehr, Esq., Professor of the French Language, St. Mary's Hall. Burlington, N. J., Le 29 Nov., 1844. Monsieur,—C'est avec un bien grand plaisir que j'ai recu les cinq volumes que vous avez eu la bonte de me faire remettre. Les publications de ce genre se succedent si rapidement dans ce pays, qu'il faut un talent particulier pour attirer l'attention. Je crois, Monsieur, que votre methode d'enseigner la prononciation est admirable. J'en fais I'epreuve sur quelques eleves, et elles me semblent s'y interesser et surmonter des difficultes, que je croyais insurmontables. Vous avez eu le talent d'etre court et clair. Vos «premieres lecons francaises" ainsi que votre " Recueil de Narrations historiques" seront dorenavant les livres de l'Institution oii j'enseigne. Veuillez me croire avec des sentimens distingues, Monsieur, votre tres-humble, J. L. H. VER MEHR. HENTZ'S FRENCH READER. A CLASSICAL FRENCH READER, Selected from the best writers of that language, in Prose and Poetry ; preceded by an Introduction, designed to facilitate the study of the Rudiments of the French. RECOMMENDATION OF SWAN'S READERS, AND WILM- SEN'S READER. Philadelphia, Dec. 9, 1845. Gentlemen,—I am indebted to the politeness of your agent for copies of Swan's Readers. An earlier acknowledgment of their receipt has been prevented by a wish to speak experimentally of their merits. I have used them in my Seminary for more than three months with great 4* 28 VALUABLE BOOKS, PUBLISHED BY satisfaction, and am convinced that the exercises, faithfully pursued, can- not fail to prevent, and even to eradicate the habit of reading in a different key and tone from those of conversation ; which, acquired in the school room, obtains so extensively in our pulpits and legislative halls, to the great annoyance of both speakers and hearers. Wilmsen's Reader is a successful attempt to communicate by means of the reading lessons, an unusual amount of instructive and interesting information. The lessons are progressive, happily chosen, and afford gratifying evidence of what may be done, in teaching, indirectly, other subjects, while correcting and improving the articulation. Accept my thanks for the volumes and believe me, Your ob't serv't ALFRED L. KENNEDY, Principal Central Institute for Young Gentlemen, No. 52, North 6th street. Messes. Thomas, Cowpehthwait & Co. Philad. Philadelphia, Jan. 6, 1846. I have examined with considerable attention " Wilmsen's Reader, or Children's Friend. I have never met a work better adapted in all respects to the wants of youth. It instructs them in their duties to society and to themselves, furnishing them with sound principles for their govern- ment, and illustrating these principles by applications to their ordinary pursuits. While it imparts knowledge, it elicits inquiry, and developes the intellectual faculties of the juvenile reader. The author of this work has contrived to introduce into the small compass of 274 pages, a sur- prising amount of information, on general and scientific subjects, which is communicated in a style not puerile, although well adapted to the in- struction of children. The merits of this little work are such as must secure its general introduction into families and schools. WILLIAM J. LEWIS, Mathematical Teacher, South Fourth street. We concur in the above opinion: A. S. W. WRIGHT, Prin. Model School. P. A. CREGAR, Prin. S. E. P. G. School. Philadelphia, Jan. 8, 1846. The vocation in which I am engaged has made me acquainted with a goodly portion of the school books in use ; and so far as regards many of the class-books used in reading, a predominant defect is obvious. This defect consists in their want of adaptation to the feelings and habits of thought of the learner, both in matter and style. The authors or compilers seem to have forgotten that a subject, no less than a lan- guage, can be foreign to the learner's mind. A book has recently, however, been brought to my notice, entitled " Wilmsen's Reader, or Children's Friend," in which this error appears to have been entirely corrected. Its design evidently is to convey know- ledge on subjects and objects which immediately concern and surround THOMAS, COWPERTHWAIT AND CO. 29 the learner, and that in a style and language simple and familiar, yet not puerile in the exceptionable sense of that term. This is a desideratum ; and in this trait " Wilmsen's Reader" appears unrivalled. Such a fea- ture cannot be too highly appreciated. L. W. BURNET, Principal of the Academy at the corner of 4th and Vine sts. Published under the Sanction of the Musical Fund Society of Phila- delphia. CANTUS ECCLESIjE, OH, THE SACRED CHORISTER: Being a collection of Psalm and Hymn Tunes, Chants, Sentences, and Anthems: comprising a selection of the best standard compositions, and a large number from the works of Haydn, Handel, Mozart, Beethoven, Sarti, Sabbatini, Nau- mann, Graun, Rossini, Donizetti, &c.; together with many Original Compositions, by American authors, and a System of Instruction in Vocal Music, by L. Meignen, Esq., written expressly for this work, harmonized for Four Voices, and pro- vided with an Accompaniment for the Organ or Piano Forte. By W. H. W. Darley & J. C. B. Standbridge. The publishers have received the most flattering recom- mendations of this work, which are so numerous that they have only space for the following extracts. RECOMMENDATIONS. 15th of October, 1844. Bishop Kemper's best respects to the publishers of the •< Cantus Ec- Ciesiffi," and is much obliged to them for their valuable present. He will take it with him to Wisconsin, and introduce it into the Mission School at Narhotah Lakes : from whence he hopes it will become gene- rally known. Philadelphia, February 11th, 1845. Mb. W. H. W. Darlet. Dear Sir:—After a careful perusal of your « Sacred Chorister," I have no hesitation in declaring my highest regard of this whole work. It contains a large number of new and excellent pieces, which are not sur- passed for harmony or melody by any that I have seen ; and I feel satis- fied that it is a most able production and admirably adapted for general use. Yours, very respectfully, H. WEATHERLY, Chorister of the 3d Presbyterian Church, Philadelphia. 30 VALUABLE BOOKS, PUBLISHED BY Raleigh, North Carolina. To Messrs. Darley & Standbridbe. Gentlemen.• — I have critically examined the collection of church music recently published by you, under the title of " Cantus Ecclesiae," and it gives me great pleasure to say that I look upon it as one of the best works of the kind published in the United States. I believe it to be highly calculated to promote and diffuse a correct taste in church music, and shall use every exertion to forward its introduction in this state. I have the honour to remain, &c, G. BLESSNER, Professor of Music, Raleigh, North Carolina. THE SOUTHERN HARMONY, AND MUSICAL COMPANION: Containing a choice collection of Tunes, Hymns, Psalms, Odes, and Anthems ; selected from the most eminent Authors in the United States: together with nearly one hundred New Tunes, which have never before been published; suited to most of the Metres contained in Watts's Hymns and Psalms, Mercer's Cluster, Dossey's Choice, Dover Selection, Metho- dist Hymn Book, and Baptist Harmony; and well adapted to Christian Churches of every denomination, Singing Schools, and Private Societies: also, an easy Introduction to the Grounds of Music, the Rudiments of Music, and Plain Rules for begin- ners. By William Walker. Stereotype edition, corrected and improved ; with an Appendix. Thomas, Cowperthwait & Co., Philadelphia; William Walker, Spartanburg, S. C. This work is so well known throughout the Southern and Western States, and its peculiar adaptation to the purposes for which it was designed so generally admitted, that recommend- ations are considered unnecessary. THE SOUTHERN AND WESTERN POCKET HARMONIST, Intended as an Appendix to the Southern Harmony; em- bracing the principal Hymns, Songs, Choruses, and Revival Tunes, usually sung at Protracted and Camp Meetings of the different denominations of Christians throughout the Southern and Western States: also, a number of Choice Pieces for the Church and Social Singing Societies ; to which is prefixed a Concise Introductory to the Grounds of Music. By William Walker, author of the Southern Harmony. Thomas, Cowperthwait & Co., respectfully invite the attention of purchasers to the Southern and Western Pocket Harmonist, a new work, by William Walker, author of the Southern Harmony. The author has been induced to comply with the wishes of manY THOMAS, COWPERTHWAIT AND CO. 31 Ministers of the Gospel, Teachers of Music, and other friends, to prepare this work, in order that the people might be furnished with a selection of good Music, suited to the various Revival occasions, Protracted and Camp Meetings, Associations and Social SMging Societies, among the different denominations of Christians, together with the Hymns, Songs, and Choruses, printed entire under the tunes. A work of this kind has long been desired, and often asked for. As it is intended as an Appendix to the Southern Harmony, it is hoped that it may be found a valuable auxiliary to that work, and prove a blessing to all those into whose hands it may come. Thomas, Coavperthwait & Co., also publish the following Hymn Books, which may be had of booksellers generally throughout the United States: BAPTIST HARMONY, VIRGINIA SELECTION, DOSSEY'S CHOICE, DUPUY'S HYMNS, MERCER'S CLUSTER, MILLER'S HYMNS. The following additional recommendations having been received since the arrangement of the foregoing, are here in- serted. SMITH AND DUKE'S STATISTICAL ARITHMETIC. Virginia Military Institute, July 9, 1845. The undersigned, members of the Board of Visiters of the Yirginia Military Institute, take pleasure in recommending to the Principals of Schools and Academies, " The American Statistical Arithmetic," by Col. Francis H. Smith, Superintendent of the Virginia Military Insti- tute, as a work of peculiar merit, and well adapted to the wants of Ame- rican youth in that branch of learning. P. C. JOHNSTON, CORBIN BRAXTON, Signed I. W. BROCKENBROUGH, WM. H. RICHARDSON, GEO. H. LEE, C. DIMMOCK, C. P. DORMAN. From Professor Pike Powers, (late of the University of Va.) Staunton, April 19, 1845. To Col. F. H. Smith. Dear Sir : — I received from your agent, a few days ago, a copy of your Arithmetic, and I feel impelled to tender you my thanks for it, and to express my high sense of its value. I consider it decidedly the best Arithmetic I have seen, not only as regards the valuable statistical in- formation it contains, but also in its arrangement, and the very clear and simple explanation of the rules which it gives; and I heartily wish it may receive the favour which in my estimation it so well deserves." From John D. Keily, Principal of the Anderson Seminary, Petersburg, Va. Sir:—I am instructed by the trustees of this institution, to inquire of 32 BOOKS PUBLISHED BY THOMAS, COWPERTHWAIT & CO. you directly, at what rate you would let them have your Arithmetic 1 After a long and careful examination, and comparison with several new and old Arithmetics, I unhesitatingly assured the trustees that yours was the best. This school,designed by its founder for the education of the destitute, has to supply all its pupils (160) with books, &c, thereby making a heavy annual draft upon its limited funds: hence the difficulty of changing books, when the new are decidedly superior. May I hope to hear from you soon 1 Vacation is near at hand, at which we usually purchase our annual stock of stationery, &c. Your book pleases me so much, that I design recommending n to my friends, teachers in the north, &c. Yours, &c, JNO. D. KEILY, Principal Anderson Seminary. MITCHELL'S ANCIENT GEOGRAPHY. Philadelphia, Jan. 7, 1846. Gentlemen.- — The fact that I have for some time past earnestly de- sired to introduce Mitchell's Ancient Geography into my Seminary, and that I shall do so at the earliest convenience of my pupils, is evidence of the esteem in which I hold the work. The beauty of the illustrations and maps I have not seen equalled by any other school book in the country. The Sacred Geography is a most interesting and invaluable auxiliary to the study of the best of books, and I hope will be extensively employed. With many thanks for your repeated politeness, I am, Your obedient servant, ALFRED L. KENNEDY", Principal Central Institute for Young Gentlemen, 52 N. 6th st. Messrs. Thomas, Cowperthwait & Co. Philad. ., MITCHELL'S INTERMEDIATE OR SECONDARY GEOGRAPHY. Repeated inquiries from many of the most respectable Teachers in various parts of the Union, for a Geographical School Book, intermedi- ate between MitcheWs Primary and School Geography, induce the Publishers of these works to believe, that a book of that description will be a desideratum in completing their Series. We, therefore, desire to inform the numerous patrons of Mr. Mitchell's works, and all who feel an interest in the cause of education, that we will publish, at as early a period as a due attention to accuracy and elegance of execution will permit, an Intermediate or Second Book of Geography, containing rather more than one-half the amount of mat- ter that is contained in Mitchell's School Geography. The text, the maps, and the exercises on the maps, will be printed together, and will form one volume, 4to. The proposed work will correspond in style of embellishment, colour- ing, arrangement of lessons, and general scope of composition, to the other Geographical works of Mr. Mitchell, so as to form a connecting link in the Series in progress; and of which the Primary Geography, the School Geography and Atlas, and the Ancient Geography and Atlas, already published, form a part. * 34 71 I1VN 9NDI01W JO ADVHBI1 TVNOIIVN 3NIDIQ3W JO ABVBail IVNOIIVN 3NI3IQ3W JO A II V II 8 I L^n^aCy. \j^c\ CINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY O nfrs II1VN INIDIQiW JO AUVDail IVNOIIVN 1NI3I03W JO ABVBail IVNOIIVN !NI3IQiW JO AIVIIII f ' ■» N * " *• ^ * 1XS -L-^z-*c . « IY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL t^7- * S. i 5. raail TVNOIiVN 3NI3IQ3W JO A B V II a I 1 TVNOIIVN 3NI3I03W JO ABVBBIT TVNOIiVN 3NI3IQ3W M RY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL aw® I ON Al A f B 9 I 1 TVNOIiVN 3NI3I0 3W JO ilYHII TVNOIIVN 3NI3IQ3W JO ABVBBI1 TVNOIIVN 3NI3IQ3W raaii ivnoiivn 3n i 3 10 3 w jo ABVBan tvnouvn 3 n i 3 10 iw jo lavmn tvnouvn in i 3 \a 3 w >. s / RY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL t\%& nan tvnouvn in i 3 \a 1 w jo a b v b a i t tvnouvn 3 n i 3ia jw jo abvbbit tvnouvn 3 n i 3ia 3w RY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAL f A mhm Y OF MEDICINE NATIONAL LIBRARY OF MEDICINE NATIONAI NATIONAL LIBRARY OF MEDICINE i\ILI1 011AED3D B ■i-y- •."r .-Pj.jjf. *' ''!■!■ h Sjll! i i 13©ii Will lllifii wmm NLM011820308